Checklist Of Signs Research Articles

An Updated Overview of Low Back Pain Management in Primary Care.

Currently, guidelines for lower back pain (LBP) treatment are needed. We reviewed the current guidelines and high-quality articles to confirm the LBP guidelines for the Korean Society of Spine Surgery. We searched available databases for high-quality articles in English on LBP published from 2000 to the present year. Literature searches using these guidelines included studies from MEDLINE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Embase. We analyzed a total of 132 randomized clinical trials, 116 systematic reviews, 9 meta-analyses, and 4 clinical guideline reviews. We adopted the SIGN checklist for the assessment of article quality. Data were subsequently abstracted by a reviewer and verified. Many treatment options exist for LBP, with a variety of recommendation grades. We assessed the recommendation grade for general behavior, pharmacological therapy, psychological therapy, and specific exercises. This information should be helpful to physicians in the treatment of LBP patients.

Anti-bullying interventions in schools: a systematic literature review.

This paper presents a systematic literature review addressing rigorously planned and assessed interventions intended to reduce school bullying. The search for papers was performed in four databases (Lilacs, Psycinfo, Scielo and Web of Science) and guided by the question: What are the interventions used to reduce bullying in schools? Only case-control studies specifically focusing on school bullying without a time frame were included. The methodological quality of investigations was assessed using the SIGN checklist. A total of 18 papers composed the corpus of analysis and all were considered to have high methodological quality. The interventions conducted in the revised studies were divided into four categories: multi-component or whole-school, social skills training, curricular, and computerized. The review synthesizes knowledge that can be used to contemplate practices and intervention programs in the education and health fields with a multidisciplinary nature.

The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients

BackgroundClinical decision support systems (DSS) aimed at supporting diagnosis are not widely used. This is mainly due to usability issues and lack of integration into clinical work and the electronic health record (EHR). In this study we examined the usability and acceptability of a diagnostic DSS prototype integrated with the EHR and in comparison with the EHR alone.MethodsThirty-four General Practitioners (GPs) consulted with 6 standardised patients (SPs) using only their EHR system (baseline session); on another day, they consulted with 6 different but matched for difficulty SPs, using the EHR with the integrated DSS prototype (DSS session). GPs were interviewed twice (at the end of each session), and completed the Post-Study System Usability Questionnaire at the end of the DSS session. The SPs completed the Consultation Satisfaction Questionnaire after each consultation.ResultsThe majority of GPs (74%) found the DSS useful: it helped them consider more diagnoses and ask more targeted questions. They considered three user interface features to be the most useful: (1) integration with the EHR; (2) suggested diagnoses to consider at the start of the consultation and; (3) the checklist of symptoms and signs in relation to each suggested diagnosis. There were also criticisms: half of the GPs felt that the DSS changed their consultation style, by requiring them to code symptoms and signs while interacting with the patient. SPs sometimes commented that GPs were looking at their computer more than at them; this comment was made more often in the DSS session (15%) than in the baseline session (3%). Nevertheless, SP ratings on the satisfaction questionnaire did not differ between the two sessions.ConclusionsTo use the DSS effectively, GPs would need to adapt their consultation style, so that they code more information during rather than at the end of the consultation. This presents a potential barrier to adoption. Training GPs to use the system in a patient-centred way, as well as improvement of the DSS interface itself, could facilitate coding. To enhance patient acceptability, patients should be informed about the potential of the DSS to improve diagnostic accuracy.

Reliability and validity of warning signs checklist for screening psychological, behavioral and developmental problems of children

Objective: To evaluate the reliability and validity of warning signs checklist developed by the National Health and Family Planning Commission of the People's Republic of China (NHFPC), so as to determine the screening effectiveness of warning signs on developmental problems of early childhood. Method: Stratified random sampling method was used to assess the reliability and validity of checklist of warning sign and 2 110 children 0 to 6 years of age(1 513 low-risk subjects and 597 high-risk subjects) were recruited from 11 provinces of China. The reliability evaluation for the warning signs included the test-retest reliability and interrater reliability. With the use of Age and Stage Questionnaire (ASQ) and Gesell Development Diagnosis Scale (GESELL) as the criterion scales, criterion validity was assessed by determining the correlation and consistency between the screening results of warning signs and the criterion scales. Result: In terms of the warning signs, the screening positive rates at different ages ranged from 10.8%(21/141) to 26.2%(51/137). The median (interquartile) testing time for each subject was 1(0.6) minute. Both the test-retest reliability and interrater reliability of warning signs reached 0.7 or above, indicating that the stability was good. In terms of validity assessment, there was remarkable consistency between ASQ and warning signs, with the Kappa value of 0.63. With the use of GESELL as criterion, it was determined that the sensitivity of warning signs in children with suspected developmental delay was 82.2%, and the specificity was 77.7%. The overall Youden index was 0.6. Conclusion: The reliability and validity of warning signs checklist for screening early childhood developmental problems have met the basic requirements of psychological screening scales, with the characteristics of short testing time and easy operation. Thus, this warning signs checklist can be used for screening psychological and behavioral problems of early childhood, especially in community settings.

ANALISIS KESESUAIAN PENERAPAN SAFETY SIGN DI PT. TERMINAL PETIKEMAS SURABAYA

Safety sign is the equipment contained in the work environment in order to protect and enhance the awereness of workers against potential dangers which are occur in the work environment. This research was conducted to find out the suitability of applying the safety sign on work environment based on ANSI Z535 standard. This Research is observational with cross sectional design. Data collection was done by direct observation using ANSI Z535 safety sign checklist within a certain time. There are 5 types of safety sign based on the ANSI Z535standard researched. They are danger sign, warning sign, sign, sign the notice caution and safety condition sign. Field observation was retrieved results suitability against ANSI Z535 standard with highest suitability figures on danger sign fulfill 8 of 16 items (50%), warning sign fulfill 6 out of 16 items (37.5%), caution sign fulfill 9 out of 16 items (56.25%), notice the sign fulfill 9 dari14 items (68.28%), and safety condition sign fulfill the entire item (100%). Conclusions on the research was application of a danger sign, warning sign, sign, and caution notice sign have not been suit with ANSI standard Z535. While the safety condition sign has been suit. HSSE management should have been did a monitoring, evaluation and improvement against the safety sign that damaged and did not suitable with the standards in International and Domestic Docks PT. Terminal Petikemas Surabaya.Keywords: suitability, safety sign, ANSI Z535

Evaluation of suspicious Hirschsprung disease in children using radiologic investigation method: a prospective observational study

Background: Hirschsprung disease (HD) is a developmental disorder characterized by absence of ganglia in the distal colon, resulting in a functional obstruction. It is a common cause of pediatric intestinal obstruction. Objective of present study was to evaluate a checklist of radiologic and clinical signs to determine the probability of HD in suspicious patients.Methods: In a diagnostic accuracy study, 19 children with clinical manifestations of HD attended pediatric OPD in a tertiary care teaching hospital, Haldia from January 2014 to December 2016 were assessed. A checklist was used to evaluate the items proposed by contrast enema (CE), based on six subscales, including transitional zone, rectosigmoid index (RSI), irregular contractions in aganglionic region, cobblestone appearance, filling defect due to fecaloid materials and lack of meconium defecation during the first 48 hours after birth. The patients were classified as high score and low score. Sensitivity and specificity were calculated for identifying HD, in comparison with pathologically proved or ruled out HD.Results: Of the 19 patients, 11 (57.89%) cases had HD and 08 (42.11%) cases were without HD. The mean age was 2.793 ± 4.21 months. Abdominal distension, lack of meconium defecation, and constipation were the most common clinical symptoms with frequencies of 15 (78.9%), 11 (57.8%), and 14 (73.68%), respectively. In summary, the mean sensitivity of detecting the radiological signs of transition zone, spastic colon, reversed recto-sigmoid index and the overall impression in histological confirmed HD patients are 59.09%, 49.99%, 59.09% and 56.06% respectively.Conclusions: The mean specificity of detecting the absence of the radiological signs of transition zone, spastic colon, reversed recto-sigmoid index and the overall impression in histological confirmed non-HD patients are 68.75%, 81.25%, 87.5% and 79.17% respectively. This would in turn give an overall mean specificity rate of 79.17% in successfully excluding HD with the above mentioned radiological signs from the contrast enema.

Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy: A Rapid Review.

In this rapid review, studies were identified through the Medline database. The main outcomes of interest were severe hyperbilirubinemia and encephalopathy. A subset of articles was double screened and all articles were critically appraised using the SIGN and AMSTAR checklists. This review investigated if systems approach is likely to reduce the occurrence of severe hyperbilirubinemia. Fifty-two studies met the inclusion criteria. Included studies assessed the association between bilirubin measurement early in neonatal life and the subsequent development of severe hyperbilirubinemia and chronic bilirubin encephalopathy/kernicterus. It was observed that, highest priority should be given to (i) universal bilirubin screening programs; (ii) implementation of community and midwife practice; (iii) outreach to communities for education of prospective parents; and (iv) development of clinical pathways to monitor, evaluate and track infants with severe hyperbilirubinemia. We found substantial observational evidence that severe hyperbilirubinemia can be accurately predicted and prevented through universal bilirubin screening. So far, there is no evidence of any harm.

Economic case for intraoperative interventions to prevent surgical-site infection.

Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting. The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists. Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable; three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality. With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.

Evaluating the understanding of nurses regarding pain management in neonatal units and special neonatal units of Qamar Monir Bani Haeshem Hospital in Khoy, Iran, in 2016

Introduction: Pain is a mental and multi-dimension phenomena, which its measurement and definition are difficult. Inability in expressing the pain clearly is the fundamental reason for the difficulty in pain measuring. Since newborns are unable to express their pains, to evaluate their pain quantitatively, valid, and standard tools should be used. The present study aimed to investigate the understanding of nurses about babies' pain in neonatal and special neonatal units of hospitals in Khoy. Materials and Methods: This is a descriptive and analytical cross-sectional study which was performed on 66 people by census method on nurses working in neonatal units and special neonatal units of Qamar Monir Bani Haeshem Hospital. Tool for collecting data includes 5 parts questionnaires containing demographic information, 7 questions related to understanding the pain of babies, 10 questions related to the effects of pain, 9 questions related to the tools of measuring the pain with criterion (true, false, I do not know), and the final part with 28 questions related to the attitude of measuring the pain in infants (I agree, I disagree). To determine the validity of the tool content validity was used and to determine the reliability Cronbach's alpha correlation test and preliminary study were performed (α = 0.82, α = 0.86). After coding, the data were described in frequency, mean, and standard deviation table using SPSS Version 16 software. To analyze the data statistical tests such as Pearson's correlation, t-test, and ANOVA were used (P < 0.05). Results: The majority of the participants were married (97%) with Bachelor education degree (95%) working in neonatal unit (45.5%) with a mean age of 33 years and servicing year of 8 years. The awareness rate of the physiology of pain, with the highest prevalence of 42.2%, complications and pain intensity by 45.5% were at good levels, and tools for measuring pain with 54.6% were poor. Nurses' attitude toward assessing and measuring the pain of babies with 54.5% was positive. Investigating the statistical relationships between the attitudes of nurses and awareness of severity and complications of pain (P ≤ 0.001), between the age and awareness of severity and complications of pain (P ≤ 0.002), and between the servicing year and awareness of pain physiology, severity, and complications of pain (P ≤ 0.003), significant statistical difference was found. Discussion and Conclusion: Based the results, focusing on pain of the babies and the infants in nursing education programs, holding the continuing education courses regarding the pain and pain assessment, and attaching pain assessment checklist for monitoring vital signs checklist and reporting it in each shift are recommended.

Children's Family Drawings as Expressions of Attachment Representations Across Cultures: Possibilities and Limitations.

The present study explored the cross-cultural appropriateness of children's family drawings as a measure for attachment quality. The sample consisted of 63 children aged 6years from two diverse ecosocial contexts: middle-class families from Berlin, Germany (n=32) and rural farming families from small villages around Kumbo, Cameroon (n=31). The analysis of drawings with two classical attachment procedures, the Checklist of Drawing Signs (Kaplan & Main, 1986) and the Global Rating Scales (Fury, 1996), revealed substantial cultural differences. The results thus substantiated children's drawings as important cultural documents. Implications of the findings, however, are discussed in consideration of culture-specific conceptions of attachment relationships as indicated by cultural variations in mother's socialization goals.

Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study

The objective of this cross-sectional study was to compare the prevalence of selected clinical signs in laminitis cases and non-laminitic but lame controls to evaluate their capability to discriminate laminitis...

The vasomotor symptoms and skin changes in natural menopause among Iranian women

Introduction: Menopause is the most important event in middle-age. Women, in this period, face several changes. Vasomotor symptoms and skin changes are prevalent in the middle-age. This study, mainly, was performed identifying the vasomotor symptoms and skin changes in menopausal women. Materials and methods: Study sample was consisted of 150 women who have visited the healthcare centers, experienced natural menopause as discontinuity of menstrual at least for 12-monthes. They have been selected randomly. Survey instruments were structured questionnaire, informational records, symptoms and signs checklist, centi-meter and balance and the data collecting method was through interview, observation, and examination. The data were analyzed using logistic regression. Results: According to study results, skin warming and hotness (55.3%), hands and legs nipping (63.3%), hirsutism of pinion lip (27.3%), reduction of armpit hair (38%), acne (12%), Skin extenuation and wrinkling (51.3%) were reported. The most important point of the study is the significant relationship between amount of tea consumption and flushing severity (P=0.008, OR=3.18). Also, there was a significant relation between education and menopause duration, sleep disorders and severity of flushing, menopause duration and skin collagen reduction (P<0.05). Conclusion: Skin and vasomotor changes is prevalent in these women. Flushing severity influenced by tea consumption, such that drinking more tea will decrease the flushing, is the start point of more researches in this field.

Sport-Related Concussion Knowledge and Occurrence: A Survey of High School and College Athletes in South Korea

Few studies have been conducted on individuals’ knowledge of sport-related concussions (SRCs) in South Korea. The purpose of this study was to examine South Korean athletes’ knowledge and recognition of SRC. A cross-sectional survey assessing (a) the recognition of specific signs and symptoms associated with SRC; (b) history of SRC; and (c) knowledge of the return-to-play decision (RTP) process after SRC was distributed to 410 high school and collegiate student-athletes from a variety of sports. No participants correctly identified all 9 items on the checklist of SRC signs and symptoms. While 8.9% reported a history of SRC, approximately 50% of those never reported their postconcussion signs and symptoms. Furthermore, 63.9% of the athletes who reported SRC made RTP decisions on their own. These results reflect the lack of knowledge in South Korean athletics of common signs, symptoms, and appropriate RTP decisions following concussion.

Economic Evaluation of Interventions for Prevention of Hospital Acquired Infections: A Systematic Review.

ObjectiveThis systematic review sought to assess the costs and benefits of interventions preventing hospital-acquired infections and to evaluate methodological and reporting quality.MethodsWe systematically searched Medline via PubMed and the National Health Service Economic Evaluation Database from 2009 to 2014. We included quasi-experimental and randomized trails published in English or German evaluating the economic impact of interventions preventing the four most frequent hospital-acquired infections (urinary tract infections, surgical wound infections, pneumonia, and primary bloodstream infections). Characteristics and results of the included articles were extracted using a standardized data collection form. Study and reporting quality were evaluated using SIGN and CHEERS checklists. All costs were adjusted to 2013 US$. Savings-to-cost ratios and difference values with interquartile ranges (IQRs) per month were calculated, and the effects of study characteristics on the cost-benefit results were analyzed.ResultsOur search returned 2067 articles, of which 27 met the inclusion criteria. The median savings-to-cost ratio across all studies reporting both costs and savings values was US $7.0 (IQR 4.2–30.9), and the median net global saving was US $13,179 (IQR 5,106–65,850) per month. The studies’ reporting quality was low. Only 14 articles reported more than half of CHEERS items appropriately. Similarly, an assessment of methodological quality found that only four studies (14.8%) were considered high quality.ConclusionsPrevention programs for hospital acquired infections have very positive cost-benefit ratios. Improved reporting quality in health economics publications is required.

The Diagnostic Value of Skin Disease Diagnosis Expert System.

Background:Evaluation is a necessary measure to ensure the effectiveness and efficiency of all systems, including expert systems. The aim of this study was to determine the diagnostic value of expert system for diagnosis of complex skin diseases.Methods:A case-control study was conducted in 2015 to determine the diagnostic value of an expert system. The study population included patients who were referred to Razi Specialized Hospital, affiliated to Tehran University of Medical Sciences. The control group was selected from patients without the selected skin diseases. Data collection tool was a checklist of clinical signs of diseases including pemphigus vulgaris, lichen planus, basal cell carcinoma, melanoma, and scabies. The sample size formula estimated 400 patients with skin diseases selected by experts and 200 patients without the selected skin diseases. Patient selection was undertaken with randomized stratified sampling and their sign and symptoms were logged into the system. Physician’s diagnosis was determined as the gold standard and was compared with the diagnosis of expert system by SPSS software version 16 and STATA. Kappa statistics, indicators of sensitivity, specificity, accuracy and confidence intervals were calculated for each disease. An accuracy of 90% was considered appropriate.Results:Comparing the results of expert system and physician’s diagnosis at the evaluation stage showed an accuracy of 97.1%, sensitivity of 97.5% and specificity of 96.5% The Kappa test indicated a high agreement of 93.6%.Conclusion:The expert system can diagnose complex skin diseases. Development of such systems is recommended to identify all skin diseases.

Tinnitus in individuals without hearing loss and its relationship with temporomandibular dysfunction

Research has shown that dysfunction of the temporomandibular joint is often associated with tinnitus. Aimto characterize tinnitus in individuals with normal hearing and search for a possible relationship with Temporomandibular Disorders (TMD). Study design: prospective and cross-sectional. Materials and Methodsthe participants included 20 adults of both genders with tinnitus and normal hearing thresholds on audiometry. We studied tinnitus psychoacoustic characteristics and employed the checklist of TMD signs and symptoms from the Tinnitus Handicap Inventory (THI). Resultsthe high pitch, continuous and bilateral tinnitus was the most frequent. Upon acuphenometry, the average tinnitus pitch reported by the subjects was 8.6 kHz and the average loudness was 14.1 dBSL. The degree of discomfort caused by tinnitus was mild. We observed that the higher the pitch, the lower was the loudness and the higher was the THI score. We found that 90% of the patients had at least one TMD sign or symptom. Conclusionsthe most common was the high pitch, continuous and bilateral tinnitus; 90% of patients had at least one sign or symptom of TMD and there was no correlation between the tinnitus and acuphenometry, THI and the TMD checklist.

Diagnostic accuracy of radiologic scoring system for evaluation of suspicious hirschsprung disease in children.

Background:In 1996, Donovan and colleagues represented a scoring system for better prediction of Hirschsprung disease (HD).Objectives:Our objective was to devise another scoring system that uses a checklist of radiologic and clinical signs to determine the probability of HD in suspicious patients.Patients and Methods:In a diagnostic accuracy study, 55 children with clinical manifestations of HD that referred to a training hospital from 1998 to 2011 were assessed. A checklist was used to evaluate the items proposed by contrast enema (CE), based on six subscales, including transitional zone, rectosigmoid index (RSI), irregular contractions in aganglionic region, cobblestone appearance, filling defect due to fecaloid materials and lack of meconium defecation during the first 48 hours after birth. The patients were classified as high score and low score. Sensitivity, specificity, positive predictive value and negative predictive value of our scoring system were calculated for identifying HD, in comparison with pathologically proved or ruled out HD.Results:Of the 55 patients, 36 (65.4%) cases had HD and 19 (34.6%) cases were without HD. In the HD group, 32 patients showed high scores and four patients had low scores. The sensitivity and specificity of our diagnostic scoring system were 88.9% (95% CI: 78.6% - 99.1%) and 84.2% (95% CI: 68.7% - 100%), respectively. Moreover, positive predictive value (PPV) and negative predictive value (NPV) were 91.4% (95% CI: 82.1% - 100%) and 80% (95% CI: 62.5% - 97.5%), respectively.Conclusions:Our new scoring system of CE is a useful diagnostic method in HD. If a patient’s score is high, that patient is highly suspicious to HD and reversely, when one’s score is low, the patient presents a reduced probability to be diagnosed with HD.

G245 Advocating for quality low-cost management of children with diarrhoea in rural bangladesh:

Aims Globally, an estimated 0.8 million children under five die of diarrhoea annually. Clear, evidence-based clinical management protocols exist, but their successful implementation in resource-limited clinical settings remains challenging. This clinical audit aimed to evaluate the impact of a simple, novel integrated care pathway (ICP) on standards of assessment and management of children with acute diarrhoea in a rural hospial in Bangladesh, and to assess any cost implication for the family. The ICP includes a simple checklist of clinical symptoms and signs which allow the severity of dehydration to be accurately assessed, and integrates this with the relevant treatment algorithm. The impact of the new ICP was measured against the 4 endpoints listed in the results section. Methods Retrospective case notes study of admitted children (1 month to 12 years) with acute diarrhoea in 2012. Patient management was evaluated against hospital guidelines. As the ICP was implemented at the end of May 2012, the patients were split into two cohorts: A (pre-ICP) and B (post-ICP). 183 patients were included in total. Results Accuracy of Dehydration Assessment: Children diagnosed with degree of dehydration inconsistent with their documented clinical signs were 34 (29%) in cohort A and 3 (4%) in cohort B. WHO rehydration plan: Children rehydrated with recognised rehydration plan (A, B or C) were 38 (33%) in cohort A and 55 (81%) in cohort B. Use of inappropriate IV fluids: Children given IV fluids without severe dehydration were 56 (49%) in cohort A and 13 (16%) in cohort B Cost implications: Average cost for rehydration fluids (oral and IV) was £3.26 for patients in cohort A and £0.92 for patients in cohort B. Conclusion The implementation of the ICP in this clinical setting improved the quality of acute diarrhoea management. Rates of incorrect dehydration assessment fell by 25%, rates of evidence-based rehydration increased by 48% and rates of unnecessary IV fluid administration decreased by 33%. In addition, there was a 72% reduction in cost of fluids for the family.

Clinical characteristics of abnormal savda syndrome type in human immunodeficiency virus infection and acquired immune deficiency syndrome patients: A cross-sectional investigation in Xinjiang, China.

To investigate the distribution of abnormal hilit syndromes in traditional Uighur medicine (TUM) among human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) patients, and to find out the clinical characteristics of abnormal savda syndrome type HIV/AIDS patients. Between June and July in 2012, 307 eligible HIV/AIDS patients from in-patient department and out-patient clinics of Xinjiang Uighur Autonomous Region the Sixth People's Hospital in Urumqi were investigated. TUM syndrome differentiation was performed by a senior TUM physician. Each participant completed a Sign and Symptom Check-List for Persons Living with HIV/AIDS (SSC-HIV) questionnaire. Depression was evaluated by using Hamilton Rating Scale for Depression Questionnaire. Blood specimen was collected from each participant to test the levels of blood chemicals. Of 307 HIV/AIDS patients, 189 (61.6%) were abnormal savda syndrome type, 118 (38.4%) were non-abnormal-savda syndrome type. Mean CD4 counts of abnormal savda syndrome type patients was (227.61±192.93) cells/µL, and the prevalence of anemia, thrombocytopenia, and elevated cystatin C were 49.7%, 28.6%, and 44.7%, which were significantly higher than those in the non-abnormal-savda syndrome type patients (26.3%, 16.0% and 25.0%,P<0.05). In addition, depression (79.9%) and HIV/AIDS-related symptoms such as fatigue (42.3%), back aches (40.7%), lack of appetite (33.9%), night sweats (31.7%) were more common among abnormal savda syndrome patients (P<0.05). Abnormal savda syndrome is the dominant syndrome among HIV/AIDS patients, and they present a more sever clinical manifestation.

A Systematic Review on TST and IGRA Tests Used for Diagnosis of LTBI in Immigrants

High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.