Case Detection Rate Research Articles

ASPECTOS CLÍNICO-EPIDEMIOLÓGICOS ASSOCIADOS À INCAPACIDADE FÍSICA POR HANSENÍASE NA VI REGIÃO DE SAÚDE DE PERNAMBUCO

Clinical and epidemiological monitoring of leprosy is crucial for assessing the quality of services and programs for patient care. This study aimed to analyze the clinical and epidemiological aspects associated with physical disability caused by leprosy among residents of the Arcoverde Health Region, Pernambuco. This is an analytical, cross-sectional, retrospective epidemiological study using leprosy notification data from the study area, recorded in the Information System for Notifiable Diseases from January 2022 to June 2023. Descriptive statistics were used. The research was approved by the Ethics Committee of São Leopoldo Mandic College (Opinion: 5.704.506). Seventy cases of leprosy were recorded. The detection rate of new cases in the general population was 13.30 cases per 100,000 inhabitants, classified as high. However, the detection rate in the population under 15 years old and in patients with grade II physical disability was classified as low. There was a predominance of cases in males, mixed race individuals, age group from 15 to 29 years, tuberculoid clinical form, and grade zero disability. However, discrepancies were found between the evaluation of this disability and the recording of affected numbers. It is believed that this could be related to flaws in information recording on the notification form or failures in conducting neurological assessments of patients. It is concluded that leprosy is distributed across the territory of the Arcoverde-PE regional health management, with some localities experiencing active transmission and delayed early detection of cases. It is suggested that local health managers plan actions to update the health team regarding the diagnosis and treatment of the disease.

Culprit allergen prevalence in polyreactive individuals reflects prescription trends: A tool for estimating comparative anaphylaxis risk using the example of neuromuscular blocking agents.

Prescription-event monitoring (PEM) is the current gold standard for determining the risk of rare drug side-effects and comparing the risk between agents; however, spontaneous or prompted reporting schemes have low case-detection rates and exposure may be difficult to estimate. A novel method is described that allows a comparative adverse event rate between two drugs to be estimated-based on patterns of cross-reactivity-requiring only a sample of cases and no direct knowledge of drug exposure rates. Agreement was compared between the novel method and historical estimates of risk using PEM for comparative risk of rocuronium versus vecuronium anaphylaxis. The novel method was applied to a sample of patients investigated by the Western Australian Anaesthetic Drug Reaction Clinic over a 21-year period. Relative population exposure was estimated from the number of patients with either rocuronium or vecuronium anaphylaxis subsequently shown to be reactive on skin testing to both agents. This was used to correct the total number of cases of hypersensitivity triggered by each agent. Measures of spread were by bootstrap sampling. Historical estimates were gathered by literature review. Additional comparisons of agreement between estimates made by the novel method and PEM were made using cross-reactivity data and PEM rates reported in the literature. There was agreement between estimates of comparative anaphylaxis risk between the novel method and PEM. Two-hundred and twenty-eight cases of anaphylaxis were observed, 89% caused by rocuronium. Patients reactive to both agents were more likely to be female, and had a higher acute mast cell tryptase level. Patients with a history of rocuronium anaphylaxis were more likely to be reactive to one agent only (69% vs. 33%, P < 0.01). It was estimated that rocuronium was prescribed 3.9 times more frequently than vecuronium. When the observed proportion of cases was corrected for exposure rate, the risk of rocuronium anaphylaxis was 2.2 times that of vecuronium (95% confidence interval 1.7 to 2.8). The median risk from historical estimates was 4.7 times, while the previous PEM estimate in Western Australian was 3.0 times. Using a subgroup of patients susceptible to the same side-effect of two drugs, the relative exposure rate and corrected comparative risk of an adverse effect can be estimated for a population. Using this technique, which requires assessment only of cases to estimate relative exposure rates, we have estimated that the risk of anaphylaxis from rocuronium to be 2.2 times that of vecuronium in Western Australia.

Inequalities in tuberculosis control in Ethiopia: A district-level distributional modelling analysis.

Implementation studies indicate that the addition of tuberculosis diagnosis and treatment services into the community health extension workers' tasks-that is 'task-shifting'-improved case detection and treatment outcomes in Ethiopia. Given resource and operational constraints, only a limited number of areas can be targeted by an expanded task-shifting program. Therefore, we mapped the distributional disparities in tuberculosis services across regions and districts and modelled the equity pathways towards optimising national scale-up of this task-shifting intervention in Ethiopia. We used data from various sources including District Health Information Software 2; demographic, geospatial and topographic data; and previously published implementation study findings. We developed methods to integrate these datasets and to calculate the proportion of health facilities with tuberculosis services, the district population to health centre ratio, and the proportion of district population living within 2h walking distance from a health centre. Equity and disparities were then measured in terms of: tuberculosis services coverage; health centre adequacy, that is the district population served by health centres; and spatial access adequacy, that is the district population with health centre access within a two-hour walking distance. Subsequently, districts were ranked according to these measures to allow prioritisation of the health extension worker task-shifting intervention. Tuberculosis services coverage varied from 54% in Afar region to 100% in Harari region, and health centre inadequacy ranged from 10% of districts in Benishangul-Gumuz to 87% in Sidama. After spatial access adjustment, health centre inadequacy ranged from 7% of districts in Sidama to 91% in Somali; and tuberculosis services inadequacy from 7% of districts in Sidama to 97% in Afar. Task-shifting implemented in inadequate districts (55% of all districts) could raise national case detection rate from 66% (currently) to 88% and treatment success rate from 93% to 99%; Benishangul-Gumuz achieving the largest increase of all regions. Access to effective tuberculosis services presents substantial disparities across districts in Ethiopia, due to both health system and tuberculosis-specific factors. Jointly considering both types of factors would enable prioritisation of districts where health extension workers would be most impactful.

Determinants of non-testing for HIV among women during antenatal care follow up in sub-saharan Africa: a hierarchical analysis of recent Demographic and Health Survey datasets

IntroductionHIV/AIDS is a global public health concern that is closely related to other sociocultural problems. The prevention of mother to child transmission cascade often begins with and is integrated into antenatal care in order to ensure a high rate of case detection and optimal treatment coverage. Although guidelines suggest that all pregnant women should have HIV testing as part of their regular screening checks during antenatal care, a significant proportion of pregnant women were not tested for HIV during antenatal care follow-up in sub-Saharan Africa. Hence, this study was aimed at assessing the determinants of women not tested for HIV during antenatal care follow-up in sub-Saharan Africa.MethodA cross-sectional study was conducted to assess the determinants of non-testing for HIV among women as part of antenatal care in sub-Saharan Africa, utilizing secondary data from the 2015–2022 Demographic and Health Surveys. The study included a weighted sample of 788,421 women who had antenatal care follow-up during their most recent pregnancy within five years preceding the survey. A multilevel mixed effect logistic regression analysis was employed to identify the determinants of non-testing for HIV among these women. The adjusted odds ratios with 95% confidence intervals were calculated to determine the associations between the outcome and explanatory variables. Statistical significance was determined using a p-value of less than 0.05.ResultThe hierarchical analysis of this study identified several significant factors associated with women not being tested for HIV during antenatal care in sub-Saharan Africa. These factors include young age, low or no education, not being in a union, unemployment, and low household wealth index. Additionally, limited media exposure, stigmatizing attitudes towards people living with HIV, male-headed households, and rural residence were significant at the individual and household levels. At the community level, low media exposure and high illiteracy rates were significant, while at the country level, high fertility rates and low literacy rates were also associated with lower rates of HIV testing during antenatal care.ConclusionThis study identified significant individual, community, and country-level factors associated with women not testing for HIV during antenatal care in sub-Saharan Africa. Key factors include young age, low education, unemployment, not being in a union, low household wealth, limited media exposure, stigmatizing attitudes towards people living with HIV, male household head, rural residence, low community media exposure, high community illiteracy, high fertility rates, and low literacy rates. These findings highlight the need for targeted, context-specific interventions to improve HIV testing rates and enhance maternal and child health outcomes in the region.

Assessment of the acceptability and detection rate of HIV self-testing in Nigeria: a systematic review and meta-analysis

BackgroundHIV remains a major public health challenge in Nigeria, with significant gaps in testing coverage caused by stigma, limited healthcare access, and logistical issues, highlighting the need for enhanced HIV control efforts. HIV self-testing presents a promising solution to overcome these barriers; however, there is a lack of systematic review and meta-analysis on its effectiveness within Nigeria for evidence-based medicine decision.ObjectivesTo systematically assess the acceptability and detection rate of HIV self-testing in Nigeria.MethodsStudies conducted in Nigeria on HIV self-testing with or without comparison to other HIV tests were included. The primary outcomes were the detection rate of new HIV cases and acceptability (uptake) rate for HIV self-testing. Electronic databases (PubMed/Medline, Web of Science, Scopus, CINAHL, and Cochrane Library) and Google Scholar were searched. Pooled estimates were calculated using a random-effects model. Heterogeneity was analyzed using the I2 test, and risk of bias was assessed with the Hoy and colleagues’ scale. The PROSPERO registration number: CRD42023479752).ResultsEight studies, encompassing 7556 participants, met the inclusion criteria. The overall risk of bias was low. The detection rate of HIV self-testing for new HIV cases was 25.78% (95% CI 0.90–50.66, I2:100.0), acceptability (uptake) rate was 56.92% (95% CI: 26.54–87.30, I2:100.0), and repeat testing rate was 20.10% (95% CI − 11.44–51.65, I2:100.0).ConclusionsThe use of HIV self-testing test kits in Nigeria showed a high detection rate of new HIV cases, moderate acceptability, but low repeat testing rates. Larger, higher-quality studies are essential to explore the broader impact of HIV self-testing on reducing HIV incidence in Nigeria.

Using environmental DNA to assess the response of steelhead/Rainbow Trout and Coastrange Sculpin populations to postfire debris flows in coastal streams of Big Sur, California

Abstract Objective Debris flows are among the most extreme disturbances to streams and are predicted to become more frequent under climate change. We assessed the response of steelhead/Rainbow Trout Oncorhynchus mykiss (hereafter, collectively referred to as O. mykiss) and Coastrange Sculpin Cottus aleuticus populations to major postfire debris flows in two small coastal basins of California using noninvasive environmental DNA (eDNA) sampling. Methods We analyzed water samples from disturbed reaches for eDNA in the first two summers after debris flows. In Big Creek, all Coastrange Sculpin habitat was disturbed by debris flows, but a major tributary occupied by O. mykiss was not affected. In Mill Creek, all available habitat for both species was disturbed. We also sampled two unburned basins as undisturbed reference streams. Result In Big Creek, O. mykiss eDNA was detected in all water samples during both years, and concentrations in some samples approached the lowest concentrations in the reference streams. Coastrange Sculpin eDNA was detected only in a single water sample in the first year and was not detected in the second year. In Mill Creek, neither species was detected in the first year, but during the second year, O. mykiss eDNA was detected at very low concentrations in 40% of samples and Coastrange Sculpin eDNA was detected in a single sample. Conclusion Our results indicate that O. mykiss and Coastrange Sculpin either survived in or quickly reoccupied the disturbed reaches from within the basins. However, the detection rates for cases in which all habitat for a species in a basin was affected by debris flows indicate that abundances were very low, suggesting that persistence may be uncertain unless there is successful reproduction or immigration. Finally, eDNA appears to be effective for monitoring sensitive fish populations after a major disturbance; however, detection rates in individual samples may be low and require appropriate sampling designs to achieve the desired detection probability. Abstract Impact statement Monitoring of fish populations after disturbances is critical, yet traditional methods could have negative effects. Analysis of environmental DNA in water samples was able to detect the presence of Coastrange Sculpin and threatened steelhead/Rainbow Trout within 2 years after major debris flows in two small basins of California.

Revisiting the Wood Criteria for Frontotemporal Degeneration Pedigree Classification: 10 Years Later

AbstractBackgroundPreviously, the Penn Frontotemporal Degeneration (FTD) Center developed and validated criteria to stratify pedigrees of patients with FTD by likelihood of identifying a genetic etiology (Wood, JAMA Neurol., 2013). Pedigrees were classified as high‐risk, medium‐risk, low‐risk, apparent sporadic, or unknown significance. Genetic testing for the three most common genes that cause FTD (C9orf72, MAPT, GRN) was completed to assess the detection rate of genetic cases per category. Given advances in FTD genetics, the current study aims to cross‐validate this pedigree classification criteria in an independent cohort and determine the extent to which consideration of newly identified disease‐associated genes increases the detection rate.MethodFirst, pedigrees in the initial cohort (n = 306) were reclassified when appropriate based on updated family history information. Next, we evaluated whether more comprehensive genetic analysis altered detection rates in the initial cohort. Then, we applied the Wood criteria to an independent cohort of pedigrees of probands with FTD‐spectrum disorders (n = 400) and assessed detection rate with testing for exclusively C9orf72, MAPT, and GRN, and then with broader sequencing.ResultIn the initial cohort, genetic analysis beyond C9orf72, MAPT, and GRN identified genetic etiologies in six additional pedigrees, five of which were in the high‐risk group, raising the overall cohort detection rate from 15% to 17%. In the independent cohort, when only C9orf72, MAPT, and GRN were analyzed detection rates were approximately 18% (72/400) overall, 67% (38/57) in the high‐risk group, 29% (15/51) in medium‐risk, 9% (6/70) in low‐risk, 3% (4/135) in apparent sporadic, and 10% (9/87) in unknown significance. Broader sequencing identified two additional genetic cases in the high‐risk group and one in the apparent sporadic group, increasing the overall cohort detection rate from 18% to 19%.ConclusionThese results reiterate the importance of gathering a detailed neurologic family history in genetic risk assessment for FTD. Given the emergence of gene‐specific clinical trials, we suggest that using this cross‐validated pedigree classification criteria provides an accurate first step in determining the likelihood of a genetic diagnosis. Genetic counseling and comprehensive testing should be routinely offered in clinical care for all patients with FTD, regardless of risk stratification.

Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial

IntroductionPaediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children...

Estimating the health and macroeconomic burdens of tuberculosis in India, 2021-2040: A fully integrated modelling study.

Tuberculosis (TB) imposes a substantial health and economic burden on many populations and countries, but lack of funding has significantly contributed to several countries falling short of global TB reduction targets. Furthermore, existing assessments of the economic impact of TB do not capture the impacts on productivity and economic growth or the pathways by which epidemiology, demography, and the economy interact. Evidence is needed to answer how investment in treatment and control measures may help to mitigate the twin Indian health and macroeconomic burdens of TB over the coming decades. We develop a fully integrated dynamic macroeconomic-health-demographic simulation model for India, the country with the largest national TB burden, and use it to estimate the macroeconomic return to investment in TB treatment. Our estimated results indicate that, over 2021 to 2040, the health and macroeconomic burdens of TB in India will include over 62.4m incident cases, 8.1m TB-related deaths and a cumulative gross domestic product (GDP) loss of US$146.4bn. Low-income households will bear larger health and relative economic burdens while larger absolute economic burdens will fall on high-income households. Achieving the World Health Organisation's End TB target of 90% case detection could reduce clinical and demographic disease burdens by 75% to 89% and reduce the macroeconomic burden by US$120.2bn. Developing a 95% effective pan-TB treatment regimen would reduce the same burdens by 25% to 31% and US$35.3bn, respectively, while less effective but immediately achievable scaling-up of existing treatment regimens would reduce burdens by 20% to 25% and US$28.4bn, respectively. If an increase in case detection to 90% could be combined with 95% effective pan-TB treatment, it could reduce clinical and demographic disease burdens by 78% to 91% and reduce the macroeconomic burden by US$124.2bn. In order to develop this complex integrated model framework, some aspects of the epidemiological model were simplified such that the model does not capture, for example, separate modelling of drug susceptible and multidrug-resistant (MDR) cases or separate public/private healthcare provision. However, future iterations of the model could address these limitations. In this study, we find that even our least effective, but most accessible, revised TB treatment regimen has the potential to generate US$28bn in GDP gains. Clearly, the economic gains of increasing case detection rates and implementing improved TB treatment regimens hinges on both the feasibility and timeframe over which they can be achieved in practice. Nevertheless, the revised TB treatment regimen is readily accessible, and our results therefore demonstrate that there is room for undertaking substantial additional investment in control and treatment of TB in India, in order to reduce the suffering of TB patients while maintaining acceptable provision of resourcing elsewhere in the Indian economy.

ENHANCING TUBERCULOSIS CASE FINDING THROUGH SULI SIMULATOR APP: A CASE STUDY IN LUBUKLINGGAU CITY, SOUTH SUMATERA PROVINCE, INDONESIA

Introduction: Tuberculosis (TB) remains a significant public health challenge and is included as one of the targets in the Sustainable Development Goals (SDGs). TB case finding in Lubuklinggau City decreased from 967 in 2019 to 273 (24,37%) in 2020. Aims: This study aims to analyze the TB disease management program strategy implementation in contact investigation activities by utilizing the SULI SIMULATOR application. Method: A qualitative design with a participatory action research (PAR) approach was employed, involving focus group discussions, in-depth interviews with 36 informants, and document review. Data were validated using triangulation methods and sources, followed by thematic analysis. Result: The findings revealed that, in terms of input, some PHC lacked analysts in their human resources. In terms of process, the successful implementation of the TB disease prevention program, with the application of SULI SIMULATOR for TB contact investigation, led to an increase in the case detection rate (CDR) to 255 cases (22.76%) in 2021 compared to the previous year's 237 patients (21.16%). Conclusion: The active involvement of the community and family is crucial in promoting early detection of TB cases through contact investigation activities, as well as providing support for treatment in family and community-based health efforts

Implementing SARS-CoV-2 Testing during a Large-Scale Sporting Event in Africa: Lessons Learned from the Africa Football Cup of Nations Tournament in Cameroon.

During the 33rd Africa Cup of Nations (AFCON) football tournament in Cameroon, organizers and health authorities required a negative SARS-CoV-2 test result <48 hours before entry and provided free SARS-CoV-2 testing and vaccination at stadium and fan zone entrances. We describe the outcomes and implementation of mandatory SARS-CoV-2 testing at fan zones during AFCON. All consenting fan zones attendees were administered an electronic questionnaire capturing exposure factors, COVID-19-like symptoms, and COVID-19 vaccination status, before being tested for SARS-CoV-2 using an antigen rapid diagnostic test (Ag-RDT). Participants testing positive were sampled for confirmatory real-time SARS-CoV-2 polymerase chain reaction (PCR) and sequencing for variant surveillance. The case detection rate was estimated using PCR-confirmed cases, and the challenges were summarized from staff discussions and project/study documentation. In total, 4,820 fan zone attendees (median [interquartile range] age 30 [24-38], 27.7% females) were tested for SARS-CoV-2, including 1,228 (25.5%) fully vaccinated. Of 4,820 participants, 148 (3.1%) had a positive Ag-RDT result, of whom 67 consented to PCR testing and 19 of 64 (29.7%) were confirmed PCR-positive. The case detection rate was 40.1 (95% CI: 24.2-62.7) per 10,000 attendees. The Omicron variant (B.1.1.529) was found in all 11 samples successfully sequenced. The implementation of mandatory SARS-CoV-2 Ag-RDT at fan zone entrances was challenged by high attendance volume just prior to matches, lobbying of economic stakeholders, and inconsistent quality assurance when using test kits. Despite the challenges encountered, implementing mandatory SARS-CoV-2 Ag-RDT at fan zones, was a unique opportunity for SARS-CoV-2 case identification and genomic surveillance.

A Cross-Sectional Study of the Use of Antigen Rapid Diagnostic Tests for Community Identification of Severe Acute Respiratory Syndrome Coronavirus-2 in Kenya.

Mass testing with antigen-detecting rapid diagnostic tests (Ag-RDT), including testing of asymptomatic individuals, is expected to improve the identification of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections. Mass testing was offered at large gatherings to determine the SARS-CoV-2 case detection rate and the acceptance and cost of implementing this community testing strategy. In 49 high-attendance venues in Kiambu County, Kenya, from June to September 2022, individuals 2 years and older were offered coronavirus disease 2019 (COVID-19) testing, vaccination, and participation in a survey. Polymerase chain reaction (PCR) testing and genome sequencing were conducted for those testing positive by Ag-RDT and those testing negative but with COVID-19 symptoms. Costs were collected from financial records, budgets, and invoices and estimated from a health systems perspective using a micro-costing method. A total of 4,062 individuals were offered testing. The testing acceptance was 3,174/4,062 (78.1%). The case detection rate was 34/3,174 (1.07%; 95% CI: 0.7-1.4%), and 11/34 (32%) of the positives were asymptomatic. The PCR results were available for 27 Ag-RDT‒positive participants and 14 Ag-RDT‒negative participants with SARS-CoV-2 symptoms and were positive in 24/27 (88.9%) and 4/14 (28.6%), respectively. Circulating variants were identified in 11 participants. Community mobilization was the major cost driver (26%) followed by purchase of SARS-CoV-2 Ag-RDTs (20.5%). The cost per individual tested was USD $15.89, and the cost per individual tested positive for SARS-CoV-2 was USD $1,484. The study demonstrates that SARS-CoV-2 Ag-RDTs could be used for identification of SARS-CoV-2 infections in both symptomatic and asymptomatic individuals at mass gatherings.

Impact of the COVID-19 Pandemic on the Detection of Leprosy in Micro-Regions with a High Risk of Illness in Minas Gerais, Brazil.

Leprosy control remains challenging in Brazil and has been aggravated by the COVID-19 pandemic. To analyze the impact of the COVID-19 pandemic on the epidemiological scenario of leprosy through the detection rate of new cases, the risk of illness, and the hidden prevalence of leprosy according to high-risk micro-region in Minas Gerais, Brazil. An ecological study conducted in the health micro-regions of Minas Gerais, using data on new leprosy cases diagnosed between 2015 and 2023. The annual detection rate of new cases, the risk of illness index and the hidden prevalence of leprosy were evaluated. The time trend was evaluated by calculating the annual percentage change (APC) of the detection rate, based on segmented linear regression, considered significant when it showed p < 0.05. The state of Minas Gerais showed a significant negative annual increase between 2015 and 2020 (APC = -7.91; 95%CI -21.76--1.72), and in 2020 it showed an inflection point, with an annual increase of 9.91 in the period from 2020 to 2023. When evaluating the hidden prevalence of leprosy in Minas Gerais, we observed a reduction in the estimates' average from 2015-2019 (2.78) to 2020-2023 (2.00). The state as a whole showed an upward trend in the risk of illness, with the average index varying from 0.28 (medium risk) to 0.55 (high risk). The pandemic has had a considerable and heterogeneous impact on the detection of new cases, as well as on the risk of becoming ill and the hidden prevalence of leprosy, with repercussions for the control of the endemic in populations. There is a need to implement public health policies that prioritize the early identification of cases and ensure that vulnerable populations are monitored.

Five-year tuberculosis trends analysis in eight districts of Mwanza region, Tanzania; (2017-2021).

In Tanzania like other developing countries, TB detection is hindered by totally missed, late notification, and delayed diagnosis of active cases. Apart from having TB control strategies and interventions to detect patients and put them on treatment to cut down the chain of transmission, TB remains a health concern. Limited data exist on the burden and trends of tuberculosis in Mwanza, which includes fishing communities and living conditions that are associated with high TB transmission like overcrowding. This study aimed to determine tuberculosis trends in the Mwanza region of Tanzania for five years, from 2017 to 2021. We extracted routine TB diagnostic data from 2017 to 2021 from eight districts of the Mwanza region of Tanzania from the electronic TB database. Data were captured in Microsoft Office Excel 2007 with district TB and leprosy coordinators and then imported into STATA 13 (Stata Corp LLC, College Station, TX, USA) for analysis. We estimated the TB case detection rate per 100,000 population. A total of 6,414 laboratory-confirmed tuberculosis cases were detected in eight districts of the Mwanza region in Tanzania from 2017 to 2021. The average tuberculosis detection rate in five years was 34.7 per 100,000 population. Overall, the TB detection rate was two times higher in people without HIV (30.5) compared to those infected with HIV; 13.4 per 100,000 population. Of the 15 rifampicin-resistant TB cases detected in the year 2018, 66.7% (10/15) were HIV-negative compared to 33.3% (5/15) infected with HIV. The TB case detection rate decreased in Mwanza region from 43.9 in 2017 to 21.4 per 100,000 population in 2021. Other parameters were missing in the database, which indicates remarkable gaps in the established database to monitor TB management in the region. The program may consider investigating and improving the documentation of information necessary to attain its goals.

INCIDÊNCIA E CARACTERÍSTICAS CLÍNICO-EPIDEMIOLÓGICAS DA TUBERCULOSE EM IMPERATRIZ – MA

INTRODUCTION: Tuberculosis (TB) is an infectious disease transmitted by Mycobacterium tuberculosis, which spreads through the airways when infected individuals cough, sneeze or speak, releasing aerosols containing active bacilli. OBJECTIVE: To analyze the incidence and clinical-epidemiological characteristics of tuberculosis in Imperatriz - Ma, between 2019 and 2023. MATERIALS AND METHODS: Descriptive epidemiological study, with a quantitative approach, carried out from compulsory notifications of new cases of the disease available via DATASUS. The incidence coefficients were calculated for each year of the disease. The epidemiological variables were treated using descriptive statistics. RESULTS: During the period under investigation, 447 new cases of tuberculosis were reported in the city of Imperatriz. The detection rate of new cases was higher in 2022 and lower in 2021. Regarding the epidemiological characteristics, most cases were male, brown race/color, pulmonary clinical form, first positive sputum culture, negative TB/HIV coinfection, DOT not performed, non-smoker, non-alcoholic and with evolution to cure. In addition, the age group of 20 to 29 years, incomplete 5th to 8th grade of PE and 6th month bacilloscopy not performed stood out. FINAL CONSIDERATIONS: It is essential to invest in strategies that expand access and adherence to treatment, promote a more humanized approach in patient monitoring, and develop intersectoral actions to address socioeconomic and educational barriers.

The effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis: A qualitative study

Background: Tuberculosis (TB) is an infectious disease, the high incidence of tuberculosis and its impact have caused the world to pay special attention, one of which is through the target of the third issue of the sustainable development goals (SDGs), namely tackling the TB epidemic in 2030. Efforts to prevent and reduce TB incidence in Indonesia through to find, treat, and cure TB program. Approaches to finding, diagnosing, treating, and curing TB patients and stopping transmission in the community. The treatment is being carried out actively, massively, and intensively, but the problem-solving has not yet been completed, innovation is needed through the collaboration of integrated health professional organizations, to anticipate the treatment of TB independently, in the service units of private hospitals, clinics and doctors' independent practice places. This innovation is to increase the new case detection rate, and the tracking of initial lost to follow up patients. Purpose: To analyze the effectiveness of integrated health professional organization collaboration in the treatment of pulmonary tuberculosis Method: Qualitative research with descriptive and exploratory design. The source of data and information is informants from the health profession determined by purposive sampling. In-depth interview and focus group discussion interview methods. Informants are representative members of each health profession organization appointed by the organization's leadership. Results: Health professional organizations are committed to and contribute to the well-organized treatment of TB. Integrated activity programs, increasing the discovery of new case detection rates, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and active monitoring of patients initially lost to follow-up, as well as preventing independent case handling. Conclusion: The collaboration of health professional organizations is very effective in helping the government handle Tuberculosis, has a commitment to increase the new case detection rate, identification of drug-resistant pulmonary tuberculosis (DR-PTB) and drug-sensitive pulmonary tuberculosis (DS-PTB), and actively monitor patients who are initially Lost to follow up, which is carried out in an integrated manner.

Detection of Bovine Respiratory Syncytial Virus in Cattle: A Systematic Review and Meta-Analysis

Bovine respiratory syncytial virus (BRSV) is an economically important pathogen of cattle and contributes to the bovine respiratory disease complex (BRDC). Despite individual studies investigating BRSV prevalence, risk factors, and detection methodologies, a systematic review and meta-analysis have been lacking. The aim of the current study was to conduct a systematic review and meta-analysis to determine the prevalence and detection rate of BRSV and identify associated risk factors. Additionally, the study aimed to explore the variability in BRSV prevalence based on different detection methods and associated risk factors. Adhering to PRISMA guidelines, data from three databases—Web of Science, PubMed, and Scopus—were systematically retrieved, screened and extracted. Out of 2790 initial studies, 110 met the inclusion criteria. The study found that prevalence and detection rates varied based on the detection methods used (antibody, antigen, and nucleic acid), study populations, production systems, and geographic locations. Findings were reported as a pooled proportion. The pooled proportion, hereafter referred to as prevalence or detection rate, was determined by calculating the ratio of cattle that tested positive for BRSV to the total number of cattle tested. Key findings include a pooled prevalence of 0.62 for antibody-based methods, 0.05 for antigen-based methods, and 0.09 (adjusted to 0.03) for nucleic acid-based methods. Detection rates in BRDC cases also varied, with antibody methods showing a rate of 0.34, antigen methods 0.16, and nucleic acid methods 0.13. The certainty of evidence of the meta-analysis results, assessed using GRADE, was moderate for antibody detection methods and low for antigen and nucleic acid methods. The study identified significant risk factors and trends affecting BRSV prevalence, such as geographical location, herd size, age, and co-infections. The results of the current study showed the complexity of understanding BRSV prevalence in different settings. The variability in BRSV prevalence based on detection methods and associated risk factors, such as geographic location and herd size, highlights the need for tailored approaches to detect and manage BRSV accurately.

Masks of Pulmonary Thromboembolism on Chest Radiographs

Aim. Assessment of detectability of pulmonary thromboembolism on radiographs. Identification of masks of pulmonary thromboembolism manifestations mimicking other diseases on radiographs.Materials and Methods. The retrospective analysis included 23 patients with pulmonary embolism proven by computed tomography, who were treated at the SBHI City Hospital No. 26. All patients underwent digital chest radiography in two projections on admission using a Samsung XGEO GC80 digital X-ray machine. Computed tomography was performed on a 128-slice General Electric Revolution EVO tomograph using intravenous bolus contrast with Omnipaque at a concentration of 300 mg iodine/ml. The findings of radiologists were compared with the data of computed tomography; detectability of pulmonary embolism on radiographs, correlation between the embolism massiveness and its manifestations on radiographs were evaluated.Results. Among the 23 digital radiographs interpreted, pulmonary thromboembolism was suspected in 1 case (detection rate of 4 %). In 8 cases (35 %) no abnormalities were found on radiographs. In three patients (13 %) findings were interpreted as manifestations of peripheral lung cancer, that turned out to be areas of pulmonary infarction on CT. The detection rate of indirect signs of pulmonary thromboembolism (discoid atelectasis, small hydrothorax, infarctions, pulmonary hypertension) was at least twice as high in the CT examination. No correlation between the massiveness of thromboembolism and its manifestations on radiographs has been revealed. The most frequent manifestations of pulmonary thromboembolism on radiographs were discoid atelectasis (35 %), lung infarction (35 %), small hydrothorax (26 %) and high position of the diaphragm on the affected side (22 %). Rare sign was dilatation of the pulmonary artery trunk (9 %).Conclusion. The detectability of pulmonary thromboembolism on digital radiographs is extremely low. Most often this diagnosis is hidden under the mask of a normal X-ray, tumour lesions or manifestations of cardiac insufficiency (hydrothorax). The lack of direct correlation between thromboembolism massiveness and lesions seen on radiographs requires the radiologist to be more attentive to clinical symptoms (sudden dyspnoea, chest pain, dry cough, etc.) when interpreting radiographs.

Comparative benefits of Ki and SUV images in lesion detection during PET/CT imaging

BackgroundClinical application of the tracer net influx rate (Ki) imaging in PET/CT remains limited, due to a lack of evidence demonstrating the superiority of Ki images in lesion detection, and guidelines on when to utilize Ki images. This study aims to compare the benefits of Ki and standardized uptake value (SUV) images in lesion detection during PET/CT imaging. By analyzing the performance of both techniques in identifying tumor lesions, the study seeks to provide guidance for the clinical application of Ki images.ResultsThis retrospective study included 134 patients with 244 pathologically confirmed lesions (200 malignant and 44 benign). Patients with a histopathological diagnosis received a weight-based 18F-FDG injection and underwent 60-min total-body PET/CT dynamic imaging. SUV images were reconstructed using data collected from the last 10 min of the scans. Ki images were generated using the Patlak methods with data from minutes 12–60. The background SUVmax, SUVmean, SUVSD, Kimax, Kimean, and KiSD values were recorded. The signal-to-noise ratios of the SUV (SUVSNR) and Ki (KiSNR) images were calculated. The lesion detection rate and sensitivity of the SUV and Ki images were evaluated. The lesion-detection rates were 97.7% (214/219) and 99.5% (218/219) for the SUV and Ki images, respectively (p = .22). Five false-negative lesions on the SUV images were true-positive on the Ki images (3 hepatic malignancies and 2 metastatic lymph nodes). The sensitivity (94.0% vs. 96.0%, p = .22), specificity (41.9% vs. 41.9%, p > .99), accuracy (84.4% vs. 86.1%, p = .61), positive predictive value (87.9% vs. 88.1%, p = .94), negative predictive value (60.0% vs. 69.2%, p = .47), and the area under the curve [0.68 (95% confidence interval, 0.61–0.73) vs. 0.69 (95% confidence interval, 0.62–0.74)] were similar in the SUV and Ki images (all p ≥ .10).ConclusionKi images exhibit benefits in lesion detection compared to SUV images, particularly in organs with high background such as liver. The enhanced contrast provided by Ki imaging is recommended to clinically improve detection rates in such cases.

Analysis of Tuberculosis Control (Case Study in The City of Mojokerto) Year 2024

This study aims to analyze the tuberculosis (TB) situation in Mojokerto City, focusing on the increase in cases among children and identifying effective countermeasures. TB, a preventable and curable infectious disease caused by Mycobacterium tuberculosis, is particularly problematic in developing countries like Indonesia due to high incidence and mortality rates, necessitating a comprehensive control strategy. Employing qualitative methods, this research delves into the practices, perceptions, and social dynamics affecting TB control efforts in Mojokerto, illuminated by the latest data showing a significant increase in pediatric TB cases and the public health situation. Findings reveal a TB incidence rate of 385 per 100,000 inhabitants, a case detection rate of 75%, and a notably high pediatric TB case proportion of 32%. The effectiveness of case tracking by health centers varies, with an average of only 54% receiving Tuberculosis Preventive Therapy (TPT). Major obstacles include limited access to radiology services, social stigma, and the need for adequate health facilities. Innovations such as the "Mbak Desi Fights TB" program and enhanced cross-sector cooperation are deemed crucial to strengthen control strategies. The study concludes that a multifaceted strategy is essential for combating TB in Mojokerto, which should include enhanced case detection, health system strengthening, and community integration in control efforts. Increased collaboration across sectors and advancements in research and development are expected to accelerate TB elimination. This research offers efficient recommendations to improve TB control strategies, based on an in-depth analysis of the current conditions and social dynamics in Mojokerto.