Undetected Cases Research Articles

Prevalence of masked hypertension in children with chronic kidney disease: a cross-sectional study.

Hypertension poses a significant risk as a complication of chronic kidney disease (CKD), contributing to its hastened advancement. Implementing ambulatory blood pressure monitoring (ABPM), a straightforward and non-invasive method proves beneficial in identifying masked hypertension. A cross-sectional study was carried out involving children aged 5-15years diagnosed with CKD to estimate the difference in masked HTN prevalence between the 2014 and 2022 AHA ABPM guidelines. The study encompassed a comprehensive assessment, including 24-h blood pressure monitoring and was performed using ABPM. Left ventricular mass (LVM) was computed based on measurements obtained from M-mode echocardiography. PWV was determined by calculating the ratio of distance (D) to time (t). We examined a cohort of 138 children diagnosed with CKD. Our findings reveal that, in accordance with the 2022 American Heart Association (AHA) ABPM guidelines, prevalence of masked hypertension stands at 29.7% marking a notable increase of 17.4% compared to the 2014 ABPM guidelines signifying a substantial proportion of undetected hypertensive cases. Furthermore, the prevalence of hypertension is 48.5% as detected by ABPM, marking a notable increase of 22.5%. A substantial occurrence of masked hypertension was identified in pediatric CKD patients through the application of ABPM. ABPM proves to be an effective tool for uncovering masked hypertension in children with CKD.

An evaluation of the first ten years of Newborn Screening for cystic fibrosis in Ireland

Abstract Ireland has the world’s highest incidence of cystic fibrosis (CF). Newborn screening for CF (NBSCF) improves outcomes but identifies carriers and may yield false positive/inconclusive results. This study aimed to evaluate the performance of the first 10 years of the Irish NBSCF programme. Data collected by the programme between 01st July 2011 and 30th June 2021 were analysed, including cases of CF, CF carriers and Cystic Fibrosis Screen Positive Inconclusive Diagnosis (CFSPID). Microsoft Excel was used to calculate sensitivity, specificity and positive predictive value (PPV). Results were compared to European Cystic Fibrosis Society (ECFS) standards. Overall 650,809 neonates were screened, with 290 cases of CF, 533 CF carriers and 21 CFSPIDs reported. NBSCF identified 284 (98%) of the children with CF, sensitivity was 97.93% (95% CI 96.29-99.57), specificity was 99.91% (95% CI 99.91-99.92%), PPV was 0.34 (95% CI 0.31-0.37). The observed incidence of CF was 1 in 2,203, still Europe’s highest. Of the six undetected cases, most were of Asian ethnicity, suggesting panel limitations for diverse ethnicities.The Irish NBSCF programme exceeded ECFS standards. Most false negatives were caused by CFTR mutations undetected by the genetic panel. Increasing the size of the genetic panel increases detection of CFSPID and carriers and is not currently recommended. Ongoing validity monitoring is vital as the Irish population diversifies. Key messages • The Irish Newborn Screening Programme for Cystic Fibrosis is effective. • Ongoing validity monitoring is vital as the Irish population diversifies.

Epidemiology of Dementia in the Campania Region (Italy): A 2015-2020 population-based study

Abstract As the global population ages, dementia poses a significant health challenge, ranking seventh among leading causes of death worldwide. Considering the high societal and financial burden of dementia, our study aims to provide estimates of prevalence and incidence for any dementia and Alzheimer’s dementia (AD) in the Campania Region (South Italy). It is Population-based study, using routinely collected healthcare data of individuals living in the Campania Region (South Italy) from 2015 to 2020. We included individuals aged ≥65 years who had at least one administrative record for dementia and/or AD. Prevalence rates adjusted for age and sex used 2020 European population as reference. To estimate incidence, we tested three possible algorithms, which differed for the duration of the time interval between study baseline (Jan 1, 2015) and index date (first record for dementia and/or AD in administrative databases). We employed a clinical database for the validation of our algorithms towards neuropsychological test results. Among individuals, 80,392 had dementia, of which 35,748 had AD. The age- and sex-standardized prevalence rates per 1,000 individuals for any dementia and AD were 77.64 (95%CI=77.57; 77.68) and 34.05 (95%CI=34.01; 34.09), respectively. There were 82.10 incident cases of any dementia per 100,000 per year (0.79 sensitivity and 0.62 specificity), and 59.89 incident cases of AD per 100,000 per year (0.80 sensitivity and 0.59 specificity). The capture-recapture method showed low number of undetected cases (1.7% for any dementia and 3.0% for AD). Our algorithms showed acceptable performance with AUC ranging from 0.59 to 0.72, and double likelihood ratio of correctly identifying individuals above and below MMSE standard cut-offs (24 and 26). Our algorithm, integrating administrative and clinical data, holds potential for assessing dementia’s epidemiological burden, identifying risk factors, planning healthcare access, and developing prevention strategies. Key messages • Providing comprehensive estimates of dementia burden aids public health planning and resource allocation. • Integrated administrative and clinical data provide robust tools for epidemiological analysis and preventive strategies.

Status and analysis of undetected plague cases in Yunnan Province, China.

The virulence of Yersinia pestis strains in the Rattus flavipectus plague focus is relatively low. The purpose of this study was to investigate the undetected, sporadic plague cases in plague foci and provide the basis for plague prevention and control. A 3-year-old plague-confirmed case was investigated in the R. flavipectus plague focus of Yunnan Province in 2020 due to the intensive screening for fever symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Epidemiological investigation, laboratory testing, and clinical treatment were conducted for the case. The expanded survey was carried out around the case within a 7-km radius, including the resident population, domesticated dogs, and rats. PCR and indirect hemagglutination tests were performed on the collected samples. The isolation rates of Y. pestis were 100.0% (7 out of 7) in dead rats and 4.00% (3 out of 75) in live rats in the survey area of the foci. A total of 5.00% (6 out of 120) of the domesticated dogs were F1 antibody positive. Nine local people were determined for plague infection recently (0.92%, 9 out of 978). The locations of human cases coincided with the Y. pestis epidemic area among the animals. This study discovered the existence of plague cases that had not been detected by routine surveillance in the R. flavipectus plague focus, and the actual epidemic of human infection may be underestimated.

Assessment of the epidemiological risk factors of diabetic and hypertensive patients amongst the adult population

Background: 93 lakh people in India are undergoing diabetes and hypertension medication. It is true that the most important modifiable risk factors for type 2 diabetes and hypertension today are poor diet, cigarette smoking, and insufficient exercise. NCD-related deaths worldwide will increase by 17% by 2025, costing $47 trillion in lost productivity between 2011 and 2030. Methods: 300 diabetics, hypertensive and diabetic with hypertensive patients were selected from 8 urban wards and 8 rural panchayats of Bhopal by multi-stage random sampling. A semi-structured, pretested and validated questionnaire derived from WHO-STEPS survey was used to collect data in terms of socio-demographic variables, behavioural risk factors measurement and physical measurements. Mean and standard deviations were calculated for quantitative data, frequency and proportions were calculated for qualitative data. Chi-square value was calculated and p value less than 0.05 was considered statistically significant. Results: The mean age was 46.55±2.17 years. DBP found to be 3% more than 39% of males have systolic BP ≥140 mm of Hg. 33.6% fall under obese-I category. Current tobacco smokers, current alcohol consumption, heavy alcohol use, salt intake >5 gm/day, BMI ≥30 (obese-II) was significantly associated with hypertension. Conclusions: The study’s findings indicate that the alarmingly high occurrence of risk factors for diabetes and hypertension among adults need immediate attention. This indicates the need for an extensive screening and awareness campaign to identify undetected cases in the community and to offer early treatment and continuous follow-up to prevent consequences.

Postzygotic mosaicism of SMARCB1 variants in patients with rhabdoid tumors: A not-so-rare condition exposing to successive tumors.

Rhabdoid tumors (RT) are aggressive, rare tumors predominantly affecting young children, characterized by biallelic SMARCB1 gene inactivation. While most SMARCB1 alterations are acquired de novo, a third of cases exhibit germline alterations, defining Rhabdoid Tumors Predisposition Syndrome. With the increased sensitivity of next-generation sequencing (NGS), mosaicisms in genes linked to genetic diseases are more detectable. This study focuses on exploring SMARCB1 germline alterations, notably mosaicism in blood samples of children with RT and in parents, using a custom NGS panel. A cohort of 280 children and 140 parents with germline analysis was studied. Germline DNA from 111 children with RT and 32 parents were reanalyzed with a custom NGS panel with 1500X average depth targeting the SMARCB1 gene to identify intragenic variants not detected with conventional low-sensitivity methods. Follow-up data was obtained for 77 patients. Nine previously undetected mosaicism cases were identified, totaling 17/280 patients with a mosaic variant (6.1%) in the cohort, with variant allele frequencies between 0.9% and 33%, thus highlighting the prior underestimation of its prevalence. Follow-up data showed that 4 out of 7 survivors with mosaic variants developed distinct novel tumors, 2 sharing SMARCB1 alterations with the initial tumor, emphasizing the potential clinical impact of SMARCB1 mosaicism. The hitherto underestimated rate of SMARCB1 mosaicism in RT underscores the need for optimized genetic counseling and oncological monitoring. The findings have significant medical implications, considering the dire prognosis of RT.

Epidemiological inference at the threshold of data availability: an influenza A(H1N2)v spillover event in the United Kingdom.

Viruses that infect animals regularly spill over into the human population, but individual events may lead to anything from a single case to a novel pandemic. Rapidly gaining an understanding of a spillover event is critical to calibrating a public health response. We here propose a novel method, using likelihood-free rejection sampling, to evaluate the properties of an outbreak of swine-origin influenza A(H1N2)v in the United Kingdom, detected in November 2023. From the limited data available, we generate historical estimates of the probability that the outbreak had died out in the days following the detection of the first case. Our method suggests that the outbreak could have been said to be over with 95% certainty between 19 and 29 days after the first case was detected, depending upon the probability of a case being detected. We further estimate the number of undetected cases conditional upon the outbreak still being live, the epidemiological parameter R 0, and the date on which the spillover event itself occurred. Our method requires minimal data to be effective. While our calculations were performed after the event, the real-time application of our method has potential value for public health responses to cases of emerging viral infection.

Histopathological and medico-legal aspects in a case of death related to an undiagnosed cerebral large B-cell lymphoma.

We report an unusual and undetected case of primary central nervous system lymphoma presenting as multiple lesions in the periventricular occipital lobe in an immunocompetent host, which had manifested as a stroke. The neoplastic diagnosis was made only after death following a thorough autopsy and histopathological examinations which enabled the diagnosis of a rare cancer (primary cerebral lymphoma) which remained undetected and undiagnosed during life.

Derivation of the Quebec Brain Injury Categories for complicated mild traumatic brain injuries.

Approximately 10% of patients with mild traumatic brain injury (TBI) present with intracranial bleeding, and only 3.5% eventually require neurosurgical intervention, which often necessitates interhospital transfer. Better guidelines and recommendations are needed to manage complicated mild TBI in the emergency department (ED). The main objective of this study was to derive a clinical decision rule, the Quebec Brain Injury Categories (QueBIC), to predict the risk of adverse outcomes for complicated mild TBI in the ED. The secondary objective was to compare the QueBIC's performance with those of other existing guidelines. The authors conducted a retrospective multicenter cohort study in 3 level I trauma centers. Consecutive patients with complicated mild TBI (Glasgow Coma Scale [GCS] score 13-15) who were aged ≥ 16 years were included. The primary outcome was a combination of neurosurgical intervention, mild TBI-related death, and clinical deterioration. Statistical analyses included set covering machine analyses. In total, 477 patients were included in the study. The mean age was 62.9 years, and 68.1% were male. The algorithm classified patients into three risk categories (low, moderate, and high risk). The high-risk group (128 patients) (subdural hemorrhage [SDH] width > 7 mm or any midline shift) presented a sensitivity of 84% (95% CI 71%-93%) and a specificity of 80% (95% CI 76%-84%) to detect neurosurgical intervention and mild TBI-related death, leaving 8 undetected cases. Patients in the moderate-risk group (169 patients) had at least 1 variable: SDH width > 4 mm, initial GCS score ≤ 14, > 1 intraparenchymal hemorrhage, or intraparenchymal hemorrhage width > 4 mm. The combined QueBIC high- and moderate-risk category had a sensitivity of 100% (95% CI 63%-100%) and a specificity of 53% (95% CI 47%-58%) to detect mild TBI-related death or neurosurgical intervention. The sensitivity and specificity values for clinical deterioration when no death or neurosurgical intervention occurred were 81% (95% CI 64%-93%) and 44% (95% CI 39%-49%), respectively. The remaining 180 patients (37.7%) did not meet any high-risk or moderate-risk criteria and were considered low risk. None had neurosurgical intervention or mild TBI-related death. Only 6 (3.3%) low-risk patients showed clinical deterioration. QueBIC is a safe and effective tool to guide the management of patients presenting to the ED with complicated mild TBI. It accurately identifies patients at low risk for specialized neurotrauma or neurosurgical care. Further validation is required before its use in EDs.

Whole Genome Sequencing to Identify Multiple Clusters of Carbapenemase-Producing Enterobacterales Cases – Colorado, 2022-2023

Background: The Colorado Department of Public Health and Environment (CDPHE) detected an increase in Klebsiella pneumoniae carbapenemase-producing carbapenem-resistant Enterobacterales (KPC-CRE) infections in October 2022. We investigated patient epidemiological links and isolate relatedness to characterize interfacility transmission of KPC-CRE in the Denver metro area and inform regional prevention strategies. Methods: We defined a case as polymerase chain reaction detection of KPC from clinical or screening specimens collected during January 2022 – January 2023. Cases were identified through statewide CRE surveillance and carbapenemase testing at the CDPHE laboratory and counted once within a 30-day period. Medical records were reviewed to identify healthcare facility admissions and patient facility overlap in the 12 months prior to sample collection. Whole genome sequencing (WGS) was performed for 34 patients with available KPC-CRE isolates using short- and long-read sequencing techniques. We performed multi-locus sequence typing, generated genome phylogenetic trees, and compared plasmid contig sequences to identify relatedness between KPC-CRE isolates. Clusters were defined as ≥2 genetically related isolates of the same organism or carbapenemase plasmid, from different patients. Results: We identified 48 cases (34 clinical and 14 screening) among 39 patients (figure). Patients had a mean age of 52 years (range 16-86) and median of three healthcare facility admissions (range 1-14). Twenty-eight patients (72%) were male. We identified 16 (41%) patients with epidemiological links to one acute care hospital (ACH), 11 (28.2%) patients to one long-term acute care hospital (LTACH), and four (10.2%) patients to each of two ventilator-capable skilled nursing facilities (vSNF). Five distinct clusters of KPC-CRE were identified by WGS among 23 patients (E. hormaechei, two distinct E. cloacae clusters, K. pneumoniae, and K. oxytoca) with linkages to ten healthcare facilities, including two vSNFs, two LTACHs, and six ACHs. Three distinct KPC genes were identified among the clusters: KPC-2, KPC-3, and KPC-4. Genomes assembled from long reads identified identical or similar KPC-gene-containing plasmids across different species or sequence types, suggesting horizontal gene transfer of KPC. Conclusions: Multiple KPC-CRE strains co-circulated and were associated with patient movement between acute and post-acute care settings. WGS allowed us to identify multi-facility clusters. Time and location of carbapenemase acquisition were challenging to determine for genetically related isolates when epidemiologic links could not be determined from medical records. This could be due to undetected cases. We notified healthcare facilities of their shared transmission risk and advocated for improved attention to infection control, carbapenemase screening, and communication upon patient transfer.

Management of traumatic recurrent arteriovenous fistula of the lower extremity: Open versus endoscopic repair

Background: Traumatic Arteriovenous Fistula (TAVF) and traumatic artery aneurysms are the late complications of vascular injuries. Complications arise from neglected or undetected cases of TAVF, hence the need to promptly diagnose and manage them. Aims/Objective: this is to highlight the principles and challenges of managing traumatic recurrent AVF of the lower extremities in a low-income setting like ours. We present a 43- year man with traumatic recurrent AVF of the lower extremity, associated with chronic venous disease and ankle ulcer dating 17 years, who underwent successful treatment via open repair, in our facility, through the combined efforts of a multidisciplinary team involving vascular and plastic surgeons as well as a physiotherapist.

Active Community-Based Case Finding of Endemic Leishmaniasis in West Bengal, India

IntroductionThe ongoing visceral leishmaniasis (VL) elimination programme in India is targeting the elimination of the disease VL but not the pathogen. The persistence of hidden parasite pool may initiate a resurgence in suitable conditions. This study dealt with a novel approach to unearth such pathogen pool and their proper management to prevent the resurgence of VL.Materials and MethodsWe deployed a new approach for detection of pathogen pool by following up the VL and post kala-azar dermal leishmaniasis patients treated during the last 10 years along with mass sero-surveillance within a radius of 500 m of recently treated individuals.ResultsWe followed up 72.6% (3026/4168) previously treated VL and post kala-azar dermal leishmaniasis patients and diagnosed 42 (1.4%) new and 38 (1.3%) recurrent post kala-azar dermal leishmaniasis. We detected 93 asymptomatic leishmanial infection, 8 VL and 1 post kala-azar dermal leishmaniasis by mass sero-surveillance.ConclusionOur three-step process including mapping and follow-up of previously treated cases, mass surveillance within 500 m of radius of known cases, and 6 monthly follow-on clinical and serological screening of asymptomatic cases, enabled detection of previously undetected cases of post kala-azar dermal leishmaniasis and VL. Recurrent post kala-azar dermal leishmaniasis deserves special attention regarding their treatment guideline. Early diagnosis and effective treatment of all leishmaniasis cases will hasten pathogen elimination and prevent resurgence of VL. This may help the policymakers to develop appropriate strategy for elimination of pathogen to prevent resurgence of VL.

Deep Transfer Learning-Based Automated Diabetic Retinopathy Detection Using Retinal Fundus Images in Remote Areas

Diabetic retinopathy (DR) significantly burdens ophthalmic healthcare due to its wide prevalence and high diagnostic costs. Especially in remote areas with limited medical access, undetected DR cases are on the rise. Our study introduces an advanced deep transfer learning-based system for real-time DR detection using fundus cameras to address this. This research aims to develop an efficient and timely assistance system for DR patients, empowering them to manage their health better. The proposed system leverages fundus imaging to collect retinal images, which are then transmitted to the processing unit for effective disease severity detection and classification. Comprehensive reports guide subsequent medical actions based on the identified stage. The proposed system achieves real-time DR detection by utilizing deep transfer learning algorithms, specifically VGGNet. The system’s performance is rigorously evaluated, comparing its classification accuracy to previous research outcomes. The experimental results demonstrate the robustness of the proposed system, achieving an impressive 97.6% classification accuracy during the detection phase, surpassing the performance of existing approaches. Implementing the automated system in remote areas has transformed healthcare dynamics, enabling early, cost-effective DR diagnosis for millions. The system also streamlines patient prioritization, facilitating timely interventions for early-stage DR cases.

Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study

IntroductionNon-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades....

Reverse triggering ? a novel or previously missed phenomenon?

Reverse triggering (RT) was described in 2013 as a form of patient-ventilator asynchrony, where patient's respiratory effort follows mechanical insufflation. Diagnosis requires esophageal pressure (Pes) or diaphragmatic electrical activity (EAdi), but RT can also be diagnosed using standard ventilator waveforms. We wondered (1) how frequently RT would be present but undetected in the figures from literature, especially before 2013; (2) whether it would be more prevalent in the era of small tidal volumes after 2000. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from 1950 to 2017, with key words related to asynchrony to identify papers with figures including ventilator waveforms expected to display RT if present. Experts labelled waveforms. 'Definite' RT was identified when Pes or EAdi were in the tracing, and 'possible' RT when only flow and pressure waveforms were present. Expert assessment was compared to the author's descriptions of waveforms. We found 65 appropriate papers published from 1977 to now, containing 181 ventilator waveforms. 21 cases of 'possible' RT and 25 cases of 'definite' RT were identified by the experts. 18.8% of waveforms prior to 2013 had evidence of RT. Most cases were published after 2000 (1 before vs. 45 after, p = 0.03). 54% of RT cases were attributed to different phenomena. A few cases of identified RT were already described prior to 2013 using different terminology (earliest in 1997). While RT cases attributed to different phenomena decreased after 2013, 60% of 'possible' RT remained missed. RT has been present in the literature as early as 1997, but most cases were found after the introduction of low tidal volume ventilation in 2000. Following 2013, the number of undetected cases decreased, but RT are still commonly missed. Reverse Triggering, A Missed Phenomenon in the Literature. Critical Care Canada Forum 2019 Abstracts. Can J Anesth/J Can Anesth67 (Suppl 1), 1-162 (2020). https://doi-org.myaccess.library.utoronto.ca/ https://doi.org/10.1007/s12630-019-01552-z .

Optimizing resource allocation: Cost-effectiveness of specified D-dimer cut-offs in cancer patients with suspected venous thromboembolism

An accurate diagnosis of venous thromboembolism (VTE) is crucial, given the potential for high mortality in undetected cases. Strategic D-dimer testing may aid in identifying low-risk patients, preventing overdiagnosis and reducing imaging costs. We conducted a retrospective, comparative analysis to assess the potential cost savings that could be achieved by adopting different approaches to determine the most effective D-dimer cut-off value in cancer patients with suspected VTE, compared to the commonly used rule-out cut-off level of 0.5 mg/L. The study included 526 patients (median age 65, IQR 55–75) with a confirmed cancer diagnosis who underwent D-dimer testing. Among these patients, the VTE prevalence was 29% (n = 152). Each diagnostic strategy's sensitivity, specificity, negative likelihood ratio (NLR), as well as positive likelihood ratio (PLR), and the proportion of patients exhibiting a negative D-dimer test result, were calculated. The diagnostic strategy that demonstrated the best balance between specificity, sensitivity, NLR, and PLR, utilized an inverse age-specific cut-off level for D-dimer [0.5 + (66-age) × 0.01 mg/L]. This method yielded a PLR of 2.9 at a very low NLR for the exclusion of VTE. We observed a significant cost reduction of 4.6% and 1.0% for PE and DVT, respectively. The utilization of an age-adjusted cut-off [patient’s age × 0.01 mg/L] resulted in the highest cost savings, reaching 8.1% for PE and 3.4% for DVT. Using specified D-dimer cut-offs in the diagnosis of VTE could improve economics, considering the limited occurrence of confirmed cases among patients with suspected VTE.Graphical In the context of accurate diagnosis of VTE, strategic D-dimer testing helps identify low-risk patients, preventing overdiagnosis and reducing imaging costs. In our retrospective study, the diagnostic strategy that demonstrated the best balance between specificity, sensitivity, and best PLR, utilized an inverse age-specific cut-off level for D-dimer. We observed a significant cost reduction of 4.6% for PE and 1% for DVT. Abbreviations: CTPA, computed tomography pulmonary angiography; CUS, compression ultrasound; DVT, deep vein thrombosis; PE, pulmonary embolism; VTE, venous thromboembolism.

Prediction and control of cholera outbreak: Study case of Cameroon

This paper deals with the problem of the prediction and control of cholera outbreak using real data of Cameroon. We first develop and analyze a deterministic model with seasonality for the cholera, the novelty of which lies in the incorporation of undetected cases. We present the basic properties of the model and compute two explicit threshold parameters R¯0 and R̲0 that bound the effective reproduction number R0, from below and above, that is R̲0≤R0≤R¯0. We prove that cholera tends to disappear when R¯0≤1, while when R̲0>1, cholera persists uniformly within the population. After, assuming that the cholera transmission rates and the proportions of newly symptomatic are unknown, we develop the EnKf approach to estimate unmeasurable state variables and these unknown parameters using real data of cholera from 2014 to 2022 in Cameroon. We use this result to estimate the upper and lower bound of the effective reproduction number and reconstructed active asymptomatic and symptomatic cholera cases in Cameroon, and give a short-term forecasts of cholera in Cameroon until 2024. Numerical simulations show that (i) the transmission rate from free Vibrio cholerae in the environment is more important than the human transmission and begin to be high few week after May and in October, (ii) 90% of newly cholera infected cases that present the symptoms of cholera are not diagnosed and (iii) 60.36% of asymptomatic are detected at 14% and 86% of them recover naturally. The future trends reveals that an outbreak appeared from July to November 2023 with the number of cases reported monthly peaked in October 2023. An impulsive control strategy is incorporated in the model with the aim to avoid or prevent the cholera outbreak. In the first year of monitoring, we observed a reduction of more than 75% of incidences and the disappearance of the peaks when no control are available in Cameroon. A second monitoring of control led to a further reduction of around 60% of incidences the following year, showing how impulse control could be an effective means of eradicating cholera.

COVID-19 and Tuberculosis: Mathematical Modeling of Infection Spread Taking into Account Reduced Screening.

The COVID-19 pandemic resulted in the cessation of many tuberculosis (TB) support programs and reduced screening coverage for TB worldwide. We propose a model that demonstrates, among other things, how undetected cases of TB affect the number of future M. tuberculosis (M. tb) infections. The analysis of official statistics on the incidence of TB, preventive examination coverage of the population, and the number of patients with bacterial excretion of M. tb in the Russian Federation from 2008 to 2021 is carried out. The desired model can be obtained due to the fluctuation of these indicators in 2020, when the COVID-19 pandemic caused a dramatic reduction in TB interventions. Statistical analysis is carried out using R v.4.2.1. The resulting model describes the dependence of the detected incidence and prevalence of TB with bacterial excretion in the current year on the prevalence of TB with bacterial excretion in the previous year and on the coverage of preventive examinations in the current and previous years. The adjusted coefficient of model determination (adjusted R-squared) is 0.9969, indicating that the model contains almost no random component. It clearly shows that TB cases missed due to low screening coverage and left uncontrolled will lead to a significant increase in the number of new infections in the future. We may conclude that the obtained results clearly demonstrate the need for mass screening of the population in the context of the spread of TB infection, which makes it possible to timely identify patients with TB with bacterial excretion.

Adaption and validation of the Rwandese version of the Mood Disorder Questionnaire for the screening of bipolar disorder

BackgroundBipolar disorder is challenging to diagnose. In Rwanda, a sub-Saharan country with a limited number of psychiatrists, the number of people with an undetected diagnosis of bipolar disorder could be high. Still, no screening tool for the disorder is available in the country. This study aimed to adapt and validate the Mood Disorder Questionnaire in the Rwandan population. MethodsThe Mood Disorder Questionnaire was translated into Kinyarwanda. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, and final adjustments. A total of 331 patients with either bipolar disorder or unipolar major depression from two psychiatric outpatient hospitals were included. The statistical analysis included reliability and validity analyses and receiver operating characteristic curve (ROC) analysis. The optimal cut-off was chosen by maximizing Younden's index. ResultsThe Rwandese version of The Mood Disorder Questionnaire had adequate internal consistency (Cronbach's alpha =0.91). The optimal threshold value was at least six positive items, which yielded excellent sensitivity (94.7%), and specificity (97.3%). The ROC area under the curve (AUC) was 0.99. ConclusionThe adapted tool showed good psychometric properties in terms of reliability and validity for the screening of bipolar disorder, with a recommended cutoff value of six items on the symptom checklist for a positive score and an exclusion of items 14 and 15. The tool has the potential to be a crucial instrument to identify otherwise undetected cases of bipolar disorder in Rwanda, improving access to mental health treatment, thus enhancing the living conditions of people with bipolar disorder.

Evaluating the Demand for Nucleic Acid Testing in Different Scenarios of COVID-19 Transmission: A Simulation Study.

The 2019 novel coronavirus (COVID-19) has been recognized as the most severe human infectious disease pandemic in the past century. To enhance our ability to control potential infectious diseases in the future, this study simulated the influence of nucleic acid testing on the transmission of COVID-19 across varied scenarios. Additionally, it assessed the demand for nucleic acid testing under different circumstances, aiming to furnish a decision-making foundation for the implementation of nucleic acid screening measures, the provision of emergency materials, and the allocation of human resources. Considering the transmission dynamics of COVID-19 and the preventive measures implemented by countries, we explored three distinct levels of epidemic intensity: community transmission, outbreak, and sporadic cases. Integrating the theory of scenario analysis, we formulated six hypothetical epidemic scenarios, each corresponding to possible occurrences during different phases of the pandemic. We developed an improved SEIR model, validated its accuracy using real-world data, and conducted a comprehensive analysis and prediction of COVID-19 infections under these six scenarios. Simultaneously, we assessed the testing resource requirements associated with each scenario. We compared the predicted number of infections simulated by the modified SEIR model with the actual reported cases in Israel to validate the model. The root mean square error (RMSE) was 350.09, and the R-squared (R2) was 0.99, indicating a well-fitted model. Scenario4 demonstrated the most effective prevention and control outcomes. Strengthening non-pharmaceutical interventions and increasing nucleic acid testing frequency, even under low testing capacity, resulted in a delayed epidemic peak by 78days. The proportion of undetected cases decreased from 77.83% to 31.21%, and the overall testing demand significantly decreased, meeting maximum demand even with low testing capacity. The initiation of testing influenced case detection probability. Under high testing capacity, increasing testing frequency elevated the detection rate from 36.40% to 77.83%. Nucleic acid screening proved effective in reducing the demand for testing resources under diverse epidemic prevention and control strategies. While effective interventions and nucleic acid screening measures substantially diminished the demand for testing-related resources, varying degrees of insufficient testing capacity may still persist. The nucleic acid detection strategy proves effective in promptly identifying and isolating infected individuals, thereby mitigating the infection peak and extending the time to peak. In situations with constrained testing capacity, implementing more stringent measures can notably decrease the number of infections and alleviate resource demands. The improved SEIR model demonstrates proficiency in predicting both reported and unreported cases, offering valuable insights for future infection risk assessments. Rapid evaluations of testing requirements across diverse scenarios can aptly address resource limitations in specific regions, offering substantial evidence for the formulation of future infectious disease testing strategies.