scholarly journals Case finding of tuberculosis among mining communities in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248718
Author(s):  
Sally-Ann Ohene ◽  
Frank Bonsu ◽  
Yaw Adusi-Poku ◽  
Francisca Dzata ◽  
Mirjam Bakker
Keyword(s):  
Secondary Data ◽  
Diagnostic Value ◽  
Case Finding ◽  
Screening Methods ◽  
X Rays ◽  
Mining Communities ◽  
X Ray ◽  
Factors Associated ◽  
Number Needed To Screen ◽  
Symptom Screening

Background Data on active TB case finding activities among artisanal gold mining communities (AMC) is limited. The study assessed the yield of TB cases from the TB screening activities among AMC in Ghana, the factors associated with TB in these communities and the correlation between the screening methods and a diagnosis of TB. Methods We conducted secondary data analyses of NTP program data collected from TB case finding activities using symptom screening and mobile X-ray implemented in hard to reach AMC. Yield of TB cases, number needed to screen (NNS) and the number needed to test (NNT) to detect a TB case were assessed and logistic regression were conducted to assess factors associated with TB. The performance of screening methods chest X-ray and symptoms in the detection of TB cases was also evaluated. Results In total 10,441 people from 78 communities in 24 districts were screened, 55% were female and 60% (6,296) were in the aged 25 to 54 years. Ninety-five TB cases were identified, 910 TB cases per 100,000 population screened; 5.6% of the TB cases were rifampicin resistant. Being male (aOR 5.96, 95% CI 3.25–10.92, P < 0.001), a miner (aOR 2.70, 95% CI 1.47–4.96, P = 0.001) and age group 35 to 54 years (aOR 2.27, 95% CI 1.35–3.84, P = 0.002) were risk factors for TB. NNS and NNT were 110 and 24 respectively.; Cough of any duration had the strongest association with X-ray suggestive of TB with a correlation coefficient of 0.48. Cough was most sensitive for a diagnosis of TB; sensitivity of 86.3% (95% CI 79.4–93.2) followed by X-ray, sensitivity 81.1% (95% CI 71.7–88.4). The specificities of the symptoms and X-rays ranged from 80.2% (cough) to 97.3% (sputum). Conclusion The high risk of TB in the artisanal mining communities and in miners in this study reinforces the need to target these populations with outreach programs particularly in hard to reach areas. The diagnostic value of cough highlights the usefulness of symptom screening in this population that may be harnessed even in the absence of X-ray to identify those suspected to have TB for further evaluation.

scholarly journals Diagnostic value of chest ultrasound in children with cystic fibrosis

2019 ◽  
Author(s):  
Lidia Strzelczuk-Judka ◽  
Irena Wojsyk-Banaszak ◽  
Aleksandra Zakrzewska ◽  
Katarzyna Jonczyk-Potoczna
Keyword(s):  
Cystic Fibrosis ◽  
Life Expectancy ◽  
Disease Progression ◽  
Genetic Disorders ◽  
Life Quality ◽  
Diagnostic Procedures ◽  
Diagnostic Value ◽  
Radiographic Examination ◽  
X Rays ◽  
X Ray

AbstractCystic fibrosis (CF) is one of the most common genetic disorders in the Caucasian population. The disease has a progressive course and leads to reduced life quality and life expectancy. Standard diagnostic procedures used in the monitoring of CF patients, include methods exposing patients to the ionizing radiation. With increasing life expectancy in CF the cumulative dose of ionising radiation increases, prompting clinicians’ search for safer imaging studies. Despite its safety and availability lung ultrasound (LUS) is not routinely used in the diagnostic evaluation of CF patients.The aim of the study was to evaluate the diagnostic value of LUS in children with CF compared to chest X-ray, and to assess the diagnostic value of the recently developed LUS score - CF-USS (Cystic Fibrosis Ultrasound Score).LUS was performed in 48 CF children aged from 5 to 18 years (24 girls and 24 boys). LUS consisted in the assessment of the pleura, lung sliding, A-line and B-line artifacts, “lung rockets”, alveolar consolidations, air bronchogram and pleural effusion. Chest radiography was performed in all patients and analyzed according to the modified Chrispin-Norman score. LUS was analyzed according to CF-USS.Correlation between the CF-USS and the modified Chrispin-Norman scores were moderate (R=0.52, p=0.0002) and strong in control studies. In 75% of patients undergoing LUS, small areas of subpleural consolidations were observed, not visible on X-rays. At the same time, LUS was not sensitive enough to visualize bronchial pathology, which plays an important role in assessing the disease progression.ConclusionsLUS constitutes an invaluable tool for the diagnosis of subpleural consolidations. CF-USS results correlate with conventional x-ray modified Chrispin–Norman score. LUS should be considered an accessory radiographic examination in the monitoring of CF patients, and CF-USS may provide clinicians with valuable information concerning the disease progression.

X-ray checks of NG tube position: a case for guided tube placement

2021 ◽  
pp. 20210432
Author(s):  
Stephen Taylor ◽  
Alex R Manara
Keyword(s):  
Time Delay ◽  
Drug Treatment ◽  
Tube Placement ◽  
X Rays ◽  
X Ray ◽  
Factors Associated ◽  
Radiology Reports ◽  
Tube Position ◽  
Clinically Significant ◽  
Combined Methods

Objectives: Checking nasogastric (NG) tube position by X-ray is too late to prevent 1.5% of blind tube placements entering the lung and results in delays to feeding and drugs. We audit the safety of the tube position and delay incurred by X-ray. Methods: From Radiology reports, we determined whether tube position was safe for feeding, factors associated with an X-ray request and the time delay from X-ray request to that report. For tubes misplaced into the lung, the distance from the carina to tube tip was measured and compared with that from published records of guided tube placement. Results: From 1 July 2019 to 30 June 2020, 1934 X-rays were done to check NG tube position in 891 patients. Gastric placement was confirmed in 85% but, because of tube proximity to the oesophagus, only 73% were deemed safe to feed. The 2.2% of tubes reported to be in the lung were a median of 18 cm beyond the carina compared to 12 cm and 0 cm for electromagnetic and direct vision methods of guided placement. X-ray checks delayed feed and drug treatment by >2 h in 51% of placements and 33% of patients required >3 X-rays during their enteral episode. Conclusion: X-ray checks are common and detect a high percentage of unsafe tube placements, leading to repeated X-ray and delayed delivery of drugs and nutrition. Interpretation can be difficult even when following standard national criteria and post-placement X-ray cannot prevent deep lung placement. Guided or combined methods of confirming tube placement should be investigated. Advances in knowledge: Reports included 27.5% of placements as unsafe, 2.2% in the lung at a median depth of 18 cm beyond the carina and too late to prevent 7 pneumothoraces. X-rays were repeated >3 times in 33% of patients over their enteral course and we are associated with clinically significant delays to drug treatment (and nutrition) in 51%; combined methods of tube confirmation or guided placement may be safer and more efficient.

scholarly journals Subclinical tuberculosis disease - a review and analysis of prevalence surveys to inform definitions, burden, associations and screening methodology

2020 ◽  
Author(s):  
Beatrice Frascella ◽  
Alexandra S Richards ◽  
Bianca Sossen ◽  
Jon C Emery ◽  
Anna Odone ◽  
...  
Keyword(s):  
Case Finding ◽  
Population Surveys ◽  
P Values ◽  
X Ray ◽  
Country Level ◽  
Symptom Screening ◽  
Screening Strategies ◽  
Chest X Ray ◽  
And Performance ◽  
Tuberculosis Disease

Abstract While it is known that a substantial proportion of individuals with tuberculosis disease (TB) present subclinically, usually defined as bacteriologically-confirmed but negative on symptom screening, considerable knowledge gaps remain. Our aim was to review data from TB prevalence population surveys and generate a consistent definition and framework for subclinical TB, thus enabling an estimate of the proportion of TB that is subclinical, explore associations with overall burden and programme indicators, and performance of screening strategies. We extracted data from all publicly available prevalence surveys conducted since 1990. Between 36.1–79.7% (median 50.4%) of prevalent bacteriologically-confirmed TB was subclinical. No association was found between prevalence of subclinical and all bacteriologically confirmed TB, patient diagnostic rate or country-level HIV prevalence (p-values, 0.32, 0.4, 0.34, respectively). Chest X-ray detected 89% (range 73–98%) of bacteriologically-confirmed TB disease, highlighting the potential of optimizing current TB case-finding policies.

scholarly journals Strategies for active detection of tuberculosis in Ukraine: Comparative effectiveness amongst key populations (2014-2018)

2019 ◽  
Vol 13 (07.1) ◽  
pp. 89S-94S
Author(s):  
Natalia Kamenska ◽  
Dilyara Nabirova ◽  
Karapet Davtyan ◽  
Hayk Davtyan ◽  
Rony Zachariah ◽  
...  
Keyword(s):  
Sex Workers ◽  
Case Finding ◽  
Key Populations ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Treatment ◽  
Number Needed To Screen ◽  
Symptom Screening ◽  
Specimen Collection ◽  
Sex With Men

Introduction: Ukraine has gaps in Tuberculosis (TB) service coverage, especially in key populations (KPs). We compared effectiveness of three different strategies for active TB detection among KPs and their linkage to TB treatment during three time periods. Methodology: The KPs included people who inject drugs (PWID), sex workers (SW), men who have sex with men (MSM) and groups at-risk of TB (ex-prisoners, Roma and homeless). The active case finding included decentralized symptom screening and specimen collection (2014, strategy-1), decentralized screening with patient referred for specimen collection (2015-2017, strategy-2) and strategy-2 plus GeneXpert (2018, strategy-3). Results: In total 680,760 KPs were screened, of whom 68% were PWID. TB case detection per 100,000 populations was 1,191 in strategy-1, 302 in strategy-2, and 235 in strategy-3. The number needed to screen (NNS) to identify one case was respectively 84, 332, and 425. TB detection was highest among homeless (range: 1,839-2,297 per 100,000 population). The lowest detection was among the MSM and SW. Between 2014 and 2018, 82-94% of all diagnosed TB patients in KPs started TB treatment. Conclusions: The active case finding in KPs increased detection of TB cases in Ukraine, and the majority of diagnosed KPs initiated TB treatment. Centralization of diagnosis reduced the effectiveness of TB screening. Each region in Ukraine should assess the composition and the needs of KPs which will allow for adoption of specific strategies to detect TB among KPs with high TB prevalence.

Fish bone as a foreign body

2003 ◽  
Vol 117 (7) ◽  
pp. 568-569 ◽  
Author(s):  
Manoj Kumar ◽  
George Joseph ◽  
Seena Kumar ◽  
Malcolm Clayton
Keyword(s):  
Foreign Body ◽  
Digestive Tract ◽  
Foreign Bodies ◽  
Diagnostic Value ◽  
Fish Bone ◽  
Plain Radiography ◽  
X Rays ◽  
X Ray ◽  
Fish Bones ◽  
The Uk

Fish bones are one of the most common foreign bodies in the upper aero-digestive tract. The use of plain X-ray in identifying fish bones has questionable value. We believe that the knowledge of the type of the fish ingested improves the diagnostic value of the neck X-rays. This study was designed to evaluate the relative radio-densities of the bones of commonly eaten fish in the UK. Twenty-three species of fish were studied and their bones were grouped into three depending upon their ratio-densities. This information is expected to be useful in identifying fish bones while reading plain radiography.

scholarly journals Anterior Shoulder Instability: Outcome of Initial Non-operative Treatment in 739 patients with a mean follow up of 15 years

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0038
Author(s):  
Christopher Bernard ◽  
Devin Leland ◽  
Lucas Keyt ◽  
Aaron Krych ◽  
Diane Dahm ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
X Rays ◽  
Anterior Instability ◽  
Long Term Outcomes ◽  
X Ray ◽  
Factors Associated

Objectives: There remains a paucity of data describing the efficacy of non-operative treatment following an index anterior instability event. The purpose of this study was to describe the long-term outcomes of non-operative treatment following index anterior instability event, define the success rate of initial non-operative treatment for anterior shoulder instability, and describe factors that predict conversion to surgery after initial non-operative management to help guide surgical decision making in these patients. Methods: An established geographic database was utilized to identify patients under the age of 40 treated for anterior shoulder instability between 1994 and 2016. Patient demographics, comorbidities, injury characteristics, instability history, activity level, x-rays, advanced imaging, treatment course, and outcomes were evaluated. Patients treated non-operatively for the first 6 months following index instability event were analyzed to determine long-term outcomes, success rate of continued non-operative treatment, and factors associated with conversion to surgery. Results: 739 patients met criteria with an average follow-up of 190 months (range 0.13 to 490 months). Average age was 23.8, mean BMI was 25.6, 9.1% had a history of hyperlaxity, and 83.9% of instability events were due to trauma. 29.7% of patients had a Hill-Sachs lesion on index x-ray, and 6.3% had a bony Bankart. 198 shoulders went on to operative treatment (26.8%) with a mean time to surgery of 62.7 months following initial instability event. At final follow-up, 24.0% reported mild pain, 6.2% as moderate, 0.2% as severe. 13.8% of patients had evidence of glenohumeral arthritis on final follow-up x-rays compared to 1.6% on initial radiographs. Factors associated with conversion to surgery included 2 or more dislocations prior to first clinical evaluation (OR=1.75, p<0.001), labor intense occupation (OR=1.49, p=0.031), Hill Sachs lesion on index x-ray (OR=1.31, p=0.034), and MRI findings including: anteroinferior labral tear (OR=2.15, p<0.001), posteroinferior labral tear (OR=1.38, p=0.049), SLAP tear (OR=1.29, p=0.054), Hill-Sachs lesion (OR=1.85, p<0.001), and glenohumeral cartilage injury (OR=1.26, p=0.041). Conclusion: The majority of patients less than 40 can be definitively treated non-operatively after an initial 6 month episode of non-operative treatment. A small proportion will report pain over the long-term and/or develop glenohumeral arthritis. Multiple factors upon initial evaluation were associated with future conversion to surgery including: increasing number of prior instability events, occupation, and degree of soft tissue injury on MRI.

scholarly journals Optimizing Active Tuberculosis Case Finding: Evaluating the Impact of Community Referral for Chest X-ray Screening and Xpert Testing on Case Notifications in Two Cities in Viet Nam

2020 ◽  
Vol 5 (4) ◽  
pp. 181
Author(s):  
Tuan Huy Mac ◽  
Thuc Huy Phan ◽  
Van Van Nguyen ◽  
Thuy Thu Thi Dong ◽  
Hoi Van Le ◽  
...  
Keyword(s):  
Health Workers ◽  
Case Finding ◽  
Local Context ◽  
Smear Microscopy ◽  
Viet Nam ◽  
X Ray ◽  
Active Case ◽  
Number Needed To Screen ◽  
Chest X Ray ◽  
The Impact

To accelerate the reduction in tuberculosis (TB) incidence, it is necessary to optimize the use of innovative tools and approaches available within a local context. This study evaluated the use of an existing network of community health workers (CHW) for active case finding, in combination with mobile chest X-ray (CXR) screening events and the expansion of Xpert MTB/RIF testing eligibility, in order to reach people with TB who had been missed by the current system. A controlled intervention study was conducted from January 2018 to March 2019 in five intervention and four control districts of two low to medium TB burden cities in Viet Nam. CHWs screened and referred eligible persons for CXR to TB care facilities or mobile screening events in the community. The initial diagnostic test was Xpert MTB/RIF for persons with parenchymal abnormalities suggestive of TB on CXR or otherwise on smear microscopy. We analyzed the TB care cascade by calculating the yield and number needed to screen (NNS), estimated the impact on TB notifications and conducted a pre-/postintervention comparison of TB notification rates using controlled, interrupted time series (ITS) analyses. We screened 30,336 individuals in both cities to detect and treat 243 individuals with TB, 88.9% of whom completed treatment successfully. All forms of TB notifications rose by +18.3% (95% CI: +15.8%, +20.8%). The ITS detected a significant postintervention step-increase in the intervention area for all-form TB notification rates (IRR(β6) = 1.221 (95% CI: 1.011, 1.475); p = 0.038). The combined use of CHWs for active case findings and mobile CXR screening expanded the access to and uptake of Xpert MTB/RIF testing and resulted in a significant increase in TB notifications. This model could serve as a blueprint for expansion throughout Vietnam. Moreover, the results demonstrate the need to optimize the use of the best available tools and approaches in order to end TB.

scholarly journals Active Case Finding for Tuberculosis in India: A Syntheses of Activities and Outcomes Reported by the National Tuberculosis Elimination Programme

2021 ◽  
Vol 6 (4) ◽  
pp. 206
Author(s):  
Sharath Burugina Nagaraja ◽  
Pruthu Thekkur ◽  
Srinath Satyanarayana ◽  
Prathap Tharyan ◽  
Karuna D. Sagili ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Case Finding ◽  
Sputum Smear ◽  
X Rays ◽  
National Data ◽  
Community Based ◽  
Implementation Challenges ◽  
Number Needed To Screen ◽  
National Tuberculosis ◽  
Elimination Programme

India launched a national community-based active TB case finding (ACF) campaign in 2017 as part of the strategic plan of the National Tuberculosis Elimination Programme (NTEP). This review evaluated the outcomes for the components of the ACF campaign against the NTEP’s minimum indicators and elicited the challenges faced in implementation. We supplemented data from completed pretested data proformas returned by ACF programme managers from nine states and two union territories (for 2017–2019) and five implementing partner agencies (2013–2020), with summary national data on the state-wise ACF outcomes for 2018–2020 published in annual reports by the NTEP. The data revealed variations in the strategies used to map and screen vulnerable populations and the diagnostic algorithms used across the states and union territories. National data were unavailable to assess whether the NTEP indicators for the minimum proportions identified with presumptive TB among those screened (5%), those with presumptive TB undergoing diagnostic tests (>95%), the minimum sputum smear positivity rate (2% to 3%), those with negative sputum smears tested with chest X-rays or CBNAAT (>95%) and those diagnosed through ACF initiated on anti-TB treatment (>95%) were fulfilled. Only 30% (10/33) of the states in 2018, 23% (7/31) in 2019 and 21% (7/34) in 2020 met the NTEP expectation that 5% of those tested through ACF would be diagnosed with TB (all forms). The number needed to screen to diagnose one person with TB (NNS) was not included among the NTEP’s programme indicators. This rough indicator of the efficiency of ACF varied considerably across the states and union territories. The median NNS in 2018 was 2080 (interquartile range or IQR 517–4068). In 2019, the NNS was 2468 (IQR 1050–7924), and in 2020, the NNS was 906 (IQR 108–6550). The data consistently revealed that the states that tested a greater proportion of those screened during ACF and used chest X-rays or CBNAAT (or both) to diagnose TB had a higher diagnostic yield with a lower NNS. Many implementation challenges, related to health systems, healthcare provision and difficulties experienced by patients, were elicited. We suggest a series of strategic interventions addressing the implementation challenges and the six gaps identified in ACF outcomes and the expected indicators that could potentially improve the efficacy and effectiveness of community-based ACF in India.

scholarly journals THE ASSESSMENT OF THE FORENSIC EXAMINATION OF X-RAY SIGNS OF THE DAMAGE TO BONES AND JOINTS IN THE CASE OF ITEMS OF MEDICAL CRITERIA FOR DETERMINING HEALTH HAZARDS

2017 ◽  
Vol 20 (4) ◽  
pp. 208-213
Author(s):  
Vladimir A. Klevno ◽  
N. V Tarasova
Keyword(s):  
Computed Tomography ◽  
Bone Fractures ◽  
Conventional Radiography ◽  
Diagnostic Value ◽  
Medical Examination ◽  
X Rays ◽  
X Ray ◽  
Medical Examinations ◽  
The Brain

The main evidence-based method of bone fractures and injuries of the surrounding tissues is the results of radiological diagnosis (conventional radiography and computed tomography), provided for forensic medical examinations on a variety of media, which is a prerequisite for faultless judgments by the expert on the nature and severity of the harm done to human health. The aim of the study was to estimate the diagnostic value of different methods of radiation diagnosis to establish the harm to health in accordance with medical criteria in the execution of forensic medical examination of living persons with injuries of bones and major joints. Research materials: data from statistical reporting of the the Bureau of forensic medical examination for the Moscow region over 2011-2016. Results: lack of clear visualization of injuries on radiographs of bones and joints, defects in X-rays images can lead to expert errors in the application of medical criteria in the determination of the severity of the injury. So, according to our data, the number of expert’s errors amounted to 18.2%. Conclusion: computed tomography allows visualize not only bone fractures, but also the condition of surrounding tissues, including bleeding in the meninges and the substance of the brain, which is a prerequisite in the detection the characteristics corresponding to medical criteria.

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