Undetected Cases Research Articles

Retrospective evaluation of the results of immunodiagnostics for tuberculosis in children

Introduction. For early immunodiagnostics of tuberculosis (TB) in Russia, the Mantoux test (MT) has been used for decades; since 2013, the recombinant tuberculosis antigen (RTA) test has seen widespread use.
 The objective of this retrospective analytic observational cohort study was to evaluate the results of immunodiagnostics for TB in children with newly diagnosed active TB.
 Materials and methods. We studied data from Russian TB institutions on the results of MT and RTA assay in children with active and inactive TB first detected in 2013–2018, as well as children with active TB first detected in Moscow in 2017–2022.
 Results and discussion. In 2013–2018, out of 12,902 examined children with active TB, 11,673 (90.5%) had positive results of both skin tests and 198 (1.5%) had negative results. A negative RTA assay result with positive MT was found in 861 (6.7%) patients, and a positive RTA assay result with negative MT in 170 (1.3%). The sensitivity of the RTA assay in detecting active TB was 91.3%, while the sensitivity of MT was 97.2% (p 0.01). Similar data were obtained in the same regions in 14,127 children with inactive TB: the sensitivity of MT was higher than that of the RTA assay — 97.2% versus 95.2% (p 0.01). In Moscow, due to the small number of observations in 2022, it was not possible to show statistical reliability of the difference between the sensitivity of MT and RTA assay in detecting active TB in 2017–2022 (95.8% and 92.1% respectively; p 0.5). For the results obtained in 2017–2021, the difference was significant (p 0.05).
 Conclusion. The sensitivity of MT is higher than that of the RTA assay in screening children for TB. It is recommended to use the more sensitive MT test for screening children; screening with the RTA assay will increase the number of undetected and undiagnosed cases of active TB in children. Currently, MT cannot be excluded from the algorithm of early TB diagnosis in children.

Avulsions in adolescent soccer players: preliminary results of radiographic, ultrasonographic and magnetic resonance findings

Objectives: The main objective of this study was to characterize soccer related avulsions radiologically. The secondary objectives were to describe the athletes' clinical profile and other musculoskeletal changes associated with avulsions. Materials and methods: Cross-sectional study with adolescent athletes from a Brazilian team soccer academy. Inclusion criteria were age between 11 and 16 years and clinical and magnetic resonance imaging (MRI) diagnosis of avulsion. Exclusion criteria were exams with an unacceptable technical standard and absence of clinical data. Four radiologists revised the exams consensually (two for each method). The equipment used was a General Electric (GE) US scanner, model Logic 10, and a 1.5 T MRI GE scanner, Optima MR 360 model, and a Shimadzu RX scanner, Radspeed MC model. Results and discussion: Nine showed signs of avulsion from a sample of 37 athletes. The mean age was 13.1 years, and all were male. Four athletes were injured during the matches (44.4%), and another five were in training (55.6%). Clinically, one injury was considered mild (11.1%), two moderate (22.2%), and six severe (66.7%). The anatomical locations and frequencies of avulsions were: five in the anterior inferior iliac spine (AIIS) (55.6%), two in the ischiatic tuberosity (IT) (22.2%), and two in the iliac crest (22.2%). Ultrasonography (US) was performed in 10 cases and detected seven avulsions (77.8%). All lesions not detected by US occurred at the IT. A pelvic radiograph was performed in seven cases and was positive in five athletes (77.8%). Undetected cases occurred at the AIIS. Avulsions occurred in isolation in eight cases (88.9%), simultaneously with indirect trauma in three (33.3%) and direct trauma in two (22.2%). Conclusion: In adolescent soccer players, a quarter of traumatic injuries are avulsions, which are more common at the AIIS. US proved ineffective in identifying some IT lesions and radiography, some others at the AIIS.

COVID-19 reinfection in Afghanistan: A descriptive analysis of data from DHIS2, 2022

Background: Despite millions of COVID-19 infections worldwide since the beginning of the pandemic, relatively few confirmed cases of COVID-19 reinfection have been reported. In Afghanistan, COVID-19 undetected cases are more than detected cases. This study aims to describe the burden of COVID-19 reinfection cases in Afghanistan, along with the epidemiological and demographical patterns. Methods: A descriptive study of national-wide secondary data on COVID-19 reinfection cases was carried out from January to June 2022. Data were extracted from the District Health Information Software 2 (DHIS2) and managed and analyzed using Microsoft Excel and Epi Info V.7.2.1. Results: In 2022, 79 reinfection cases of COVID-19 were reported, with males being more affected than females. The mean age of re-infected patients was 39, with most from Wardak province. Most cases occurred within six months after the primary infection. Cough was more prevalent among reinfected cases. Only 26 patients had taken two doses of the vaccine, while 44 (55.70%) had not received it. Out of all cases, 44 (55.70%) were recovered and 5 (6.85%) died. Conclusion: The COVID-19 reinfection rate is very low in Afghanistan, which was common in males since other cases might be unreported. Coughing was more common among reinfection patients. Relying on the results, vaccination and awareness-raising may play a protective role in reinfection; hence, enhancement of vaccination and taking preventive measures are recommended to prevent further reinfection.

Correlation of Cyclic Threshold Values Generated by GeneXpert Ultra MTB/RIF and Fluorescence Microscopy to Predict Mycobacterial Burden in Suspected Cases of Pulmonary Tuberculosis.

Smear microscopy for acid-fast bacilli visualization is important to assess the infectivity rate in patients with pulmonary tuberculosis (PTB), but it has limited sensitivity; hence, it is important to find an alternative strategy. The aim of our study was to compare the fluorescence microscopy grading by Auramine O phenol staining technique of respiratory samples with the cyclic threshold (Ct) values of GeneXpert Ultra (Mycobacterium tuberculosis/rifampicin [MTB/RIF]) and assess the diagnostic efficacy of GeneXpert Ultra (MTB/RIF) compared to microscopy in suspected cases of PTB. The study was conducted in the Mycobacteriology Laboratory, Department of Microbiology, in Kasturba Hospital, Manipal. The study was a prospective, single-centered, cross-sectional study. Four hundred and fifty-two respiratory samples were included in the study. An optimal Ct cutoff value for ruling smear-positivity and smear-negativity and the mean Ct cutoff value were calculated. Clinical and radiological data from the requisition forms were assessed. IBM SPSS statistics software version 22 was used. The correlation between GeneXpert Ultra (MTB/RIF) Ct values and smear status was calculated by polychoric correlation. The extended McNemar's test was used to find the association between the variables. GeneXpert Ultra (MTB/RIF) yielded a higher positivity rate of 22.2% compared to smear microscopy 17.2%. Ct value and smear grading yielded a positive correlation (P = 0.8681; P < 0.05). GeneXpert Ultra (MTB/RIF) yielded nontuberculous mycobacteria in five undetected cases and speciated as Mycobacterium abscessus complex. Our study confirms the GeneXpert Ultra (MTB/RIF) Ct value levels as a predictor of smear positivity.

Mathematical modeling and optimal control of tuberculosis spread among smokers with case detection

&lt;p&gt;Tuberculosis (TB) remains one of deadly infectious diseases worldwide. Smoking habits are a significant factor that can increase TB transmission rates, as smokers are more susceptible to contracting TB than nonsmokers. Therefore, a control strategy that focused on minimizing TB transmission among smokers was essential. The control of TB transmission was evaluated based on the case detection rate. Undetected TB cases often resulted from economic challenges, low awareness, negative stigma toward TB patients, and health system delay (HSD). In this study, we developed a mathematical model that captured the dynamics of TB transmission specifically among smokers, incorporating the effects of case detection. Our innovative approach lied in the integration of smoking behavior as a key factor in TB transmission dynamics, which has been underexplored in previous models. We analyzed the existence and stability of the TB model equilibrium based on the basic reproduction number. Additionally, parameter sensitivity analysis was conducted to identify the most influential factors in the spread of the disease. Furthermore, this study investigated the effectiveness of various control strategies, including social distancing for smokers, TB screening in high-risk populations, and TB treatment in low-income communities. By employing the Pontryagin maximum principle, we solved optimal control problems to determine the most effective combination of interventions. Simulation results demonstrated that a targeted combination of control measures can effectively reduce the number of TB-infected individuals.&lt;/p&gt;

Seroprevalence of brucellosis in communal and smallholder cattle farming in North West Province, South Africa.

Brucellosis is an important bacterial zoonosis responsible for considerable economic losses in livestock and health-related burden worldwide. The objective of this study was to determine the seroprevalence of brucellosis in communal and smallholder cattle farming in four districts of the North West province of South Africa (Dr Ruth Segomotsi Mompati, Ngaka Modiri Molema, Bojanala platinum and Dr Kenneth Kaunda districts). Seven hundred and seventy blood samples from farmed animals (n= 378) and abattoir-slaughtered animals (n= 392) were collected. In addition, milk samples (n= 22) were collected from lactating farmed cows. Rose Bengal test (RBT), complement fixation test (CFT) and milk ring test (MRT) were used to detect antibodies againstBrucellaspecies. The RBT showed a seroprevalence of 2% at 95% confidence interval (CI: 1.35-3.35), CFT confirmed an overall seroprevalence of 1.95% (95% CI: 1.14-3.12) for all four districts sampled. Although the seroprevalence of brucellosis was found to be low, the possibility of undetected cases of the disease could not be ruled out. Overall, the findings of this study confirmed that brucellosis is endemic in the surveyed areas of the North West province of South Africa.Contribution:The outcome of this study will contribute to the National Brucellosis Project organised by the Department of Agriculture, Land Reform and Rural Development (2016-2026) to assist in the effective implementation of the disease control measures with a view to prevent further outbreaks in the country's cattle population.

Evaluating pooled testing for asymptomatic screening of healthcare workers in hospitals

BackgroundThere is evidence that during the COVID pandemic, a number of patient and HCW infections were nosocomial. Various measures were put in place to try to reduce these infections including developing asymptomatic PCR (polymerase chain reaction) testing schemes for healthcare workers. Regularly testing all healthcare workers requires many tests while reducing this number by only testing some healthcare workers can result in undetected cases. An efficient way to test as many individuals as possible with a limited testing capacity is to consider pooling multiple samples to be analysed with a single test (known as pooled testing).MethodsTwo different pooled testing schemes for the asymptomatic testing are evaluated using an individual-based model representing the transmission of SARS-CoV-2 in a ‘typical’ English hospital. We adapt the modelling to reflect two scenarios: a) a retrospective look at earlier SARS-CoV-2 variants under lockdown or social restrictions, and b) transitioning back to ‘normal life’ without lockdown and with the omicron variant. The two pooled testing schemes analysed differ in the population that is eligible for testing. In the ‘ward’ testing scheme only healthcare workers who work on a single ward are eligible and in the ‘full’ testing scheme all healthcare workers are eligible including those that move across wards. Both pooled schemes are compared against the baseline scheme which tests only symptomatic healthcare workers.ResultsIncluding a pooled asymptomatic testing scheme is found to have a modest (albeit statistically significant) effect, reducing the total number of nosocomial healthcare worker infections by about 2%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\%$$\\end{document} in both the lockdown and non-lockdown setting. However, this reduction must be balanced with the increase in cost and healthcare worker isolations. Both ward and full testing reduce HCW infections similarly but the cost for ward testing is much less. We also consider the use of lateral flow devices (LFDs) for follow-up testing. Considering LFDs reduces cost and time but LFDs have a different error profile to PCR tests.ConclusionsWhether a PCR-only or PCR and LFD ward testing scheme is chosen depends on the metrics of most interest to policy makers, the virus prevalence and whether there is a lockdown.

Gaining further insights into the COVID-19 pandemic in Australia: Evidence using capture-recapture methods

ObjectiveWe re-examined the reported number of COVID-19 cases in Australia and across its states during the first wave of the pandemic. We provided estimates of the total number of cases, adjusted for under-reporting. MethodsPublicly available data sourced from Australian governments at federal, state and territory levels included records on cumulative confirmed COVID-19 cases and cumulative deaths occurring in Australia and across its states on a daily basis. Lower bound and upper bound estimates of the total number of COVID-19 cases in Australia and across its states, that included the undetected cases that have not been recorded, were estimated. ResultsOn January 25, 2020, Australia recorded its first 4 cases of COVID-19 and the first death occurred on March 3, 2020. On April 1, 2020, 4864 cases had been reported with 21 deaths. Our estimation showed that on April 1, 2020, the minimum and maximum number of COVID-19 cases in Australia were in fact 10,160 (95 % CI: 9781–10,538) and 21,748 (95 % CI: 21,607–22,014) respectively. We estimated that the total number of cases were at least twice and at most four times the observed cases recorded. These differences were also found at the state level where in New South Wales there was a minimum and maximum of 207 and 447 cases in total for every 100 reported cases, while in Victoria these figures were much lower at 157 and 265 respectively for every 100 reported cases. ConclusionCase ascertainment during the pandemic is known to have been underestimated due to difficulties in testing and contact tracing, amongst others. Capture-recapture methods provided a measure of the gap between the official number of cases recorded and the actual number during the first wave of the pandemic.

Risk Factors Associated with Suspected Clostridium difficile Infection (CDI) in Elderly Diarrhea Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital

Clostridium difficile infection (CDI) is a typical healthcare-associated infection that contributes to a significant proportion of morbidity and mortality among hospitalized patients. Anaerobe microbiological laboratory examinations cannot be performed at Prof. Dr. I.G.N.G. Ngoerah Hospital, leading to many undetected cases; therefore, it is crucial to determine the risk factors. Identification of cases may help to prevent, recognize, and appropriately treat CDI, reducing morbidity and mortality. This study aimed to determine the risk factors associated with suspected CDI in elderly patients with diarrhea due to their vulnerability to immunosenescence. This research used medical records as secondary data to determine the risk factors associated with suspected CDI in elderly diarrhea patients at Prof. Dr. I.G.N.G. Ngoerah Hospital during the year period of 2017 to 2021 with total of 70 samples who met inclusion criteria by purposive sampling technique. One hundred percent of all samples had a history of hospitalization for ³ 48 h. There were 53 patients (77.1%) had a history of antibiotic use, 26 (37.1%) proton pump inhibitors (PPIs), 66 (94.3%) chemotherapy, 66 (94.3%) urinary tract infections, 6 (8.6%) kidney disease, and 7 (10%) myocardial infarction. Seven (10%) patients had vascular disease, and 11 (15.7%) had diabetes mellitus. Risk factors associated with suspected CDI in elderly patients with diarrhea at Prof. Dr. I.G.N.G. Ngoerah Hospital include hospitalization ³ for 48 hours, use of antibiotics in the last few months, proton pump inhibitors, decreased immune system, urinary tract infection, kidney disease, myocardial infarction, vascular disease, and diabetes mellitus.

Application of multiple binding sites for LAMP primers across P. falciparum genome improves detection of the parasite from whole blood samples

IntroductionMalaria remains a significant health concern, particularly in regions with widespread prevalence. As the transmission rates decrease, there is a rise in low-density infections with the causative parasite, P. falciparum, that often escape detection through standard point-of-care diagnostic tools. In-low transmission areas, even few undetected cases can trigger outbreaks, necessitating rapid and sensitive diagnostics. Loop-mediated isothermal Amplification (LAMP) stands out as a nucleic acid technique that can easily utilizes un-processed samples such of saliva, urine, and lysed whole blood templates for a sensitive detection. However, most nucleic acid tests detect genes with few copies per parasite making it difficult to detect low-density parasitaemia.MethodsWe selected Pfr364 multi-copy repeats of the P. falciparum genome as a target for amplification due to their higher copy number, ideal for rapid amplification, addressing amplification drawbacks of limited parasites DNA. We used a sequence clustering approach to design a novel set of LAMP primers, capable of binding to multiple sites. Subsequently, we developed a hydroxynaphthol blue (HNB) colorimetric LAMP assay, using genomic DNA obtained from the 3D7 strain cultivated in vitro. This assay’s performance was validated using archived clinical samples of both whole blood and matched saliva, ensuring accuracy through comparative analysis against gold standard, nested PCR, targeting the 18S RNA gene.ResultsThe HNB-LAMP assay achieved rapid amplification within 15 minutes and exhibited high sensitivity with a limit of detection of 1 parasite. Further, the LAMP assay was robust in whole blood lysed with Triton X-100 and heat-treated saliva clinical samples. Against nested PCR, the assay showed sensitivity of 100% for whole blood and 40% for saliva samples. Moreover, co-analysis with the nested PCR showed a perfect agreement between the two techniques. (K = 0.99 for whole blood, and 0.66 for saliva).ConclusionOur study presents a method for detecting P. falciparum using LAMP, which results in increased sensitivity, shorter assay times, and a simpler workflow than nucleic acid tests relying on conventional DNA extraction and additional equipment for result interpretation. These findings hold great promise for improved malaria diagnosis, especially in settings where low-density parasitaemia is prevalent and rapid and accurate malaria detection is crucial.

Iliac endofibrosis in high-performance sports: an interdisciplinary diagnostic challenge

Iliac endofibrosis (IE) is a rare arterial disease in endurance athletes, especially cyclists and triathletes. The diagnosis is considered challenging and the latency from the onset of initial symptoms to diagnosis is often several years. Diagnostic options include determination of the ankle brachial index (ABI) after maximal exercise as a non-invasive procedure, as well as duplex sonography, CT or MRI angiography, and invasive angiography. The aim of this paper is to analyse in more detail this time lag to correct diagnosis from the first description in 1985 to the year 2021, as well as to identify the most important diagnostic tools for practice. Literature research according to PRISMA criteria in PubMed, Web of Science, Cochrane databases, supplemented by a search in Google Scholar up to 10/18/2021. We identified a total of 133 publications that dealt thematically with IE in endurance athletes. In 42 publications (40 case reports and 2 clinical trials), the diagnosis was confirmed intraoperatively, and in 32 (32/42; 74.4%), statements were made about the duration from the onset of the first symptoms to the final diagnosis (mean 45, median 36 months). This latency was constant over the entire observation period from 1985 to 2021, with no trend toward shortening. Twenty-four papers (24/42; 56%) reported detailed results of ABI determination as well as further diagnostic testing. In all cases, the ABI value decreased to less than 0.66 (in 5 case reports, this decrease was measured at rest; in 19 case reports, it occurred after stress), whereas further diagnostic testing by duplex sonography, DSA, MRA, or CTA revealed no abnormal findings in 3 cases (3/24; 12.5%) and showed no more than minor stenosis in 14 cases (14/24; 58.3%). A drop in ABI after exercise is the most reliable method to diagnose iliac endofibrosis. This non-invasive and easy-to-perform examination should be integrated into the performance diagnostics of highly ambitious endurance athletes at risk. This may ideally prevent irreversible vessel wall damage by early diagnosis as well as a reduction of the presumed high number of undetected cases.

Detection of hidden cases of familial hypercholesterolemia in the Netherlands: a central laboratory data-driven strategy

Abstract Introduction Familial hypercholesterolemia (FH) is a common genetic disorder in which patients are at high risk for premature coronary artery disease (CAD) due to lifelong exposure to low-density lipoprotein cholesterol (LDL-C). Although early diagnosis and lipid lowering therapy (LLT) are essential to prevent adverse cardiovascular outcomes, FH patients remain globally underdiagnosed and undertreated, warranting novel screening methods to identify these patients. In the present study we aimed to evaluate whether existing central laboratory data can be utilized as a new method to detect undiagnosed FH patients. Additionally, we investigated the extent of underdiagnosis and undertreatment among patients with severe hypercholesterolemia in the Netherlands. Methods In this single-center, cross-sectional study, we selected individuals with at least one previously measured LDL-C plasma level ≥99.5th percentile for age and sex, from a central laboratory database containing lipid profiles of approximately 600.000 primary care patients. First, a blood sample was obtained to get more recent lipid values. Participating patients were subsequently asked to fill out a detailed questionnaire on medical and family history. Using these data, we calculated the Dutch Lipid Clinic Network (DLCN) criteria for each patient for the clinical diagnosis of FH. Results We identified a total of 5,100 patients with severe hypercholesterolemia (at least one LDL-C ≥99.5th percentile for age and sex) from the central laboratory database. Out of these, 1,206 patients (24%) participated in this study. Mean ± SD LDL-C corrected for LLT was 5.72 ± 1.83 mmol/L, 785 patients (65.1%) used LLT, and 150 patients (12.4%) had CVD in their medical history. In total, 131 patients (11%) had a persistent LDL-C ≥99.5th percentile for age and sex. DLCN criteria for phenotypic FH (DLCN score ≥6) were met by 302 patients (25%) of whom 39 patients (12.9%) had undergone prior genetic testing according to clinical guidelines. Of the 302 clinically diagnosed FH patients only 1 (0.3%) met the European Society of Cardiology (ESC) guideline recommending LDL-C targets &amp;lt;1.8 mmol/L in FH patients. Conclusion These data highlight the significant underdiagnosis and undertreatment of FH in the Netherlands, despite the fact that this country has a relatively high FH identification rate. We demonstrate that the use of central laboratory data is an effective strategy for identifying previously undetected cases of FH and eagerly await the genetic confirmation of the newly identified FH patients in this study, which will provide valuable insights into the genetic basis of this disorder and help further improve patient care.

Neonatal jaundice detection in low-income Mexican settings: is there scope for mHealth innovation?

Abstract Introduction Neonatal jaundice (NNJ) is a common and usually harmless condition, but undetected severe cases can cause brain damage and disabilities in thousands of babies each year. Low- and middle-income countries often lack accurate methods for detection and rely primarily on visual assessment (VA), resulting in a higher incidence of consequences. Norwegian researchers developed an easy-to-use and affordable smartphone app (Picterus) to detect NNJ that has shown higher accuracy than VA in Norwegian and Mexican neonates. We evaluated the feasibility of implementing Picterus in low-income settings in Mexico to improve outcomes for affected newborns. Methods Qualitative methods, including 1 focus group, 15 semi structured interviews, and 4 observations, were used in urban and rural health facilities in Oaxaca, Mexico, with medical doctors, nurses, and health authorities as participants. Results Four themes were identified through thematic analysis guided by the Consolidated Framework for Implementation Research: (1) the current process to detect NNJ, (2) participants’ needs to improve it, (3) feasibility of implementing Picterus in the health system, and (4) users’ expectations from the app. The findings indicate deficiencies in the current process of NNJ detection and a desire among participants for a more accurate tool. Picterus was perceived as an easy-to-use and useful tool compatible with the work routine; however, barriers to adoption were identified, primarily related to internet deficiencies and costs. Conclusions Picterus has the potential to improve NNJ detection but contextual barriers must be addressed for a successful implementation in the setting. Additionally, there is scope to optimize VA to strengthen NNJ detection. Key messages • Prevalence of severe consequences of NNJ is higher in LMIC compared to high-income ones reflecting an unjust but preventable health inequity with significant health, social and economic costs. • Picterus offers a reliable and accessible tool to bridge the gap in NNJ detection, potentially improving outcomes for affected newborns in all settings.

Leveraging Behavioral Correlation in Distribution System State Estimation for the Recognition of Critical System States

State estimation for distribution systems faces the challenge of dealing with limited real-time measurements and historical data. This work describes a Bayesian state estimation approach tailored for practical implementation in different data availability scenarios, especially when both real-time and historical data are scarce. The approach leverages statistical correlations of the state variables from a twofold origin: (1) from the physical coupling through the grid and (2) from similar behavioral patterns of customers. We show how these correlations can be parameterized, especially when no historical time series data are available, and that accounting for these correlations yields substantial accuracy gains for state estimation and for the recognition of critical system states, i.e., states with voltage or current limit violations. In a case study, the approach is tested in a realistic European-type, medium-voltage grid. The method accurately recognizes critical system states with an aggregated true positive rate of 98%. Compared to widely used approaches that do not consider these correlations, the number of undetected true critical cases can be reduced by a factor of up to 9. Particularly in the case where no historical smart meter time series data is available, the recognition accuracy of critical system states is nearly as high as with full smart meter coverage.

Evaluating Diagnostic Utility of geneXpert Ultra (Mycobacterium tuberculosis/Rifampicin), Microscopy and Liquid Culture to Isolate Mycobacterium tuberculosis and Nontuberculous Mycobacteria among Pulmonary Tuberculosis Suspects

CONTEXT: Nontuberculous mycobacteria (NTM) are posing major public health problems and have recently gained importance as they are being isolated from patients with pulmonary disorders. Most of the time, NTM are misinterpreted as tuberculosis (TB) and this misdiagnosis leads to treatment failure. Hence, this study aimed to identify NTMs isolated from suspected cases of pulmonary TB cases and was aimed to distinguish Mycobacterium TB (MTB) from NTM infections. AIMS: Our study aimed to compare microscopy grading of respiratory samples with the Ct values of GeneXpert Ultra (MTB/rifampicin [RIF]), to assess the diagnostic accuracy of microscopy, GeneXpert ultra (MTB/RIF), liquid culture, to compare GeneXpert ultra (MTB/RIF) results with microscopy with culture and clinical implications, importance of performing a rapid test for pulmonary TB and pulmonary NTM infections in suspected cases of adults. SETTINGS AND DESIGN: The study was conducted in the Mycobacteriology laboratory, Department of Microbiology, in Kasturba Hospital, Manipal. The study was a prospective, cross-sectional study, single center. SUBJECTS AND METHODS: A total of 452 respiratory samples obtained from April to July 2023 were included in the study. Smearpositive pulmonary TB cases were identified and subjected to amplification by GeneXpert ultra (MTB/RIF) and 84 samples were GeneXpert ultra (MTB/RIF) positive and RIF sensitive. Liquid culture by mycobacteria growth indicator tube (MGIT) 960 was performed and for positive tubes, TB Ag MPT64 was performed. The results were compared and analyzed with patients’ demographic information. Clinical and radiological data from the requisition forms were assessed. STATISTICAL ANALYSIS USED: IBM SPSS statistics software version 22 was used. Correlations between GeneXpert ultra (MTB/RIF) Ct values and smear status were calculated by polychoric correlation. Extended McNemar’s test was used to find the association between the variables. RESULTS: GeneXpert ultra (MTB/RIF) yielded a positivity rate of 22.2% compared to smear microscopy 17.2%. Liquid culture yielded a positivity rate of 20.3%. Ct value and smear grading yielded a positive correlation (ρ = 0.8681; P &lt; 0.05). Undetected cases of TB by GeneXpert ultra (MTB/RIF) were identified as positive under liquid culture by MGIT 960. TB Ag MPT64 was performed and yielded NTM and speciated as Mycobacterium abscessus complex by line probe assay. CONCLUSIONS: Our study states the need for identification and differentiation of MTB from NTM.

Outcomes of a Diagnostic Pathway for Prostate Cancer Based on Biparametric MRI and MRI-Targeted Biopsy Only in a Large Teaching Hospital.

Diagnostic pathways for prostate cancer (PCa) balance detection rates and burden. MRI impacts biopsy indication and strategy. A prospectively collected cohort database (N = 496) of men referred for elevated PSA and/or abnormal DRE was analyzed. All underwent biparametric MRI (3 Tesla scanner) and ERSPC prostate risk-calculator. Indication for biopsy was PIRADS ≥ 3 or risk-calculator ≥ 20%. Both targeted (cognitive-fusion) and systematic cores were combined. A hypothetical full-MRI-based pathway was retrospectively studied, omitting systematic biopsies in: (1) PIRADS 1-2 but risk-calculator ≥ 20%, (2) PIRADS ≥ 3, receiving targeted biopsy-cores only. Significant PCa (GG ≥ 2) was detected in 120 (24%) men. Omission of systematic cores in cases with PIRADS 1-2 but risk-calculator ≥ 20%, would result in 34% less biopsy indication, not-detecting 7% significant tumors. Omission of systematic cores in PIRADS ≥ 3, only performing targeted biopsies, would result in a decrease of 75% cores per procedure, not detecting 9% significant tumors. Diagnosis of insignificant PCa dropped by 52%. PCa undetected by targeted cores only, were ipsilateral to MRI-index lesions in 67%. A biparametric MRI-guided PCa diagnostic pathway would have missed one out of six cases with significant PCa, but would have considerably reduced the number of biopsy procedures, cores, and insignificant PCa. Further refinement or follow-up may identify initially undetected cases. Center-specific data on the performance of the diagnostic pathway is required.

Loss of control of the pandemic during vaccination in Uruguay

In countries where lockdown was not strictly enforced during vaccination and the vaccination rate was near 1% of the population per day, a loss of control or a multiplying effect in virus spread was observed when the vaccination program was implemented. Particularly, in Uruguay between March and June 2021, there was a clear link between the vaccination rate and the number of positive cases of SARS-CoV-2 observed each day. The peaks in the vaccination rate by day were followed by peaks in positive cases with an 8-day lag. Typically, 10% to 20% non-detected positive cases are considered superspreaders due to their high viral load despite experiencing mild or no symptoms. These superspreaders or undetected positive cases were responsible for 80% of the virus's spread. The data we got access to allow us to define a cohort study for whole individuals being vaccinated during 5 consecutive days during March 2021 when vaccination starts. In this cohort there was a 75% reduction in tested positive cases in vaccinated individuals compared to what was expected. We have some extra data that suggest these number were maintained during the 4 months with high vaccination rate. We propose that this reduction is due to individuals they thought they were experiencing side effects from the vaccine and were not tested, but in fact they had COVID. These non-tested positives individuals, representing nearly 5% of positive cases per day, may have unknowingly become superspreaders, increasing the odds ratio to be infected during vaccination by 1.20x to 1.4x compared to a non-vaccination situation with same control measures applied. Previously, Uruguay had been considered one of the first countries in the world in pandemic management for a year without vaccination, with a particular health politic: “responsible freedom”. However, during a period of four months with high vaccination rate in 2021, the country exhibited the worst levels of disease Worldwide, applying the same politic.

Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial

BackgroundTuberculosis (TB) remains a major cause of morbidity and mortality in the world, despite being a preventable and curable disease. The World Health Organization (WHO) End-TB Strategy, aligned with the Sustainable Development Goals (SDGs), sets a target of reducing the TB mortality rate by 95%, TB incidence rate by 90%, and catastrophic costs due to TB by 2035, compared with a 2015 level. To achieve these ambitious targets, several interventions have been implemented in the last few years, resulting in major progress toward reducing the burden of TB. However, over one-third of the global TB cases remained undetected and never received treatment. Most of those undetected cases were found in low- and middle-income countries such as Ethiopia. Though several interventions were implemented to increase TB case detection and mitigate catastrophic costs associated with TB, sustaining these interventions in resource-constrained settings remains challenging. Consequently, an alternative method is needed to increase TB case detection while decreasing diagnosis delays and catastrophic costs. Therefore, this study aimed to integrate traditional TB care into modern TB care to improve TB control programs, including early TB case detection, and reduce catastrophic costs in high TB burden settings such as Ethiopia.MethodsA cluster randomized controlled trial will be conducted in northwest Ethiopia to determine the effectiveness of integrating traditional care with modern TB care. The intervention will be conducted in randomly selected districts in the South Gondar Zone. The control group will be an equal number of districts with usual care. The intervention comprised three key components, which include referral linkage from traditional to modern health care; training of health professionals and traditional care providers in three different rounds to increase their knowledge, attitude, and skills toward the referral systems; and TB screening at traditional health care sites. The primary outcomes of interest will be an increase in case detection rate, and the secondary outcomes of interest will be decreased diagnosis delays and catastrophic costs for TB patients. Data will be collected in both the intervention and control groups on the main outcome of interest and a wide range of independent variables. Generalized linear mixed models will be used to compare the outcome of interest between the trial arms, with adjustment for baseline differences.DiscussionThis cluster-randomized controlled trial study will assess the effectiveness of a strategy that integrates traditional healthcare into the modern healthcare system for the control and prevention of TB in northwest Ethiopia, where nearly 90% of the population seeks care from traditional care systems. This trial will provide information on the effectiveness of traditional and modern healthcare integration to improve TB case detection, early diagnosis, and treatment, as well as reduce the catastrophic costs of TB.Trial registrationClinicalTrials.gov NCT05236452. Registered on July 22, 2022.

Castleman's disease in the rheumatological practice

The term Castleman's disease encompasses agroup of rare lymphoproliferative diseases that show histopathological similarities in lymph node biopsy. Diagnostic criteria and aspecific ICD-10 code have been available for afew years. Case studies listed at the beginning illustrate that close cooperation between clinicians and pathologists is required to enable areliable diagnosis. For an optimal histopathological assessment, the pathologist is also dependent on the removal of acomplete lymph node. Before distinguishing apotentially fatal multicentric idiopathic Castleman's disease from the resectable unicentric form, which is important in terms of prognosis and treatment, early diagnosis presupposes that Castleman's disease is considered in the differential diagnosis. Various immune phenomena and overlaps with autoimmune diseases can increase the probability of misdiagnosis or undetected cases in the clinical routine of rheumatologists. The intention of the present overview is therefore to point out the similarities with autoimmune diseases that are relevant for differential diagnoses and to point out situations that justify areview of the previous diagnosis.

Quality of life of MS patients in Trinidad and Tobago: Anomaly or adaptation?

There has been growing interest in quality of life associated with multiple sclerosis but the research has been overwhelmingly carried out in developed countries. This study aimed to assess quality of life of multiple sclerosis patients in Trinidad and Tobago. All multiple sclerosis patients were asked to complete demographic, EQ-5D-5L and MSQOL-54 questionnaires. EQ-5D data were compared with population norms for Trinidad and Tobago. MSQOL-54 data were compared with results from a matching cohort of non-MS respondents. Regression analyses were used to explore the association between MSQOL-54 scales and EQ-5D utility. The 97 patients were mainly urban, highly educated and 75% female. EQ-5D-5L data showed more frequent and more severe problems and lower index values than the population and patients of other chronic illness clinics in Trinidad and Tobago. MSQOL-54 results showed that patients were more affected by physical items, but had high scores on mental and emotional items when compared with the matching cohort and patients in other countries. The low prevalence and demographics of patients suggest the possibility of undetected cases in rural areas and/or among less educated groups. Further investigation into the high levels of mental and emotional health among patients may lead to the design of interventions to help patients of multiple sclerosis and other illnesses.