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We provide an overview of the latest evidence on computer-aided detection (CAD) software for automated interpretation of chest radiographs (CXRs) for TB detection. CAD is a useful tool that can assist in rapid and consistent CXR interpretation for TB. CAD can achieve high sensitivity TB detection among people seeking care with symptoms of TB and in population-based screening, has accuracy on-par with human readers. However, implementation challenges remain. Due to diagnostic heterogeneity between settings and sub-populations, users need to select threshold scores rather than use pre-specified ones, but some sites may lack the resources and data to do so. Efficient standardisation is further complicated by frequent updates and new CAD versions, which also challenges implementation and comparison. CAD has not been validated for TB diagnosis in children and its accuracy for identifying non-TB abnormalities remains to be evaluated. A number of economic and political issues also remain to be addressed through regulation for CAD to avoid furthering health inequities. Although CAD-based CXR analysis has proven remarkably accurate for TB detection in adults, the above issues need to be addressed to ensure that the technology meets the needs of high-burden settings and vulnerable sub-populations.

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Estudio descriptivo y retrospectivo realizado durante el período 2010-2011. Se incluyeron en el estudio los pacientes que se internaron en el CIM 62 del hospital Garrahan con traqueostomía realizada durante dicha internación. Se registraron 88 pacientes. La mayoría de ellos (85%) presentaban alguna Enfermedad de Base previa a la realización de la traqueostomía, siendo la enfermedad neurológica la más frecuente. El principal motivo de realización de traqueostomía fue el fracaso en la extubación/ARM prolongada. Los pacientes presentaron una estancia media de internación de 35 días posteriores a la realización de la traqueostomía. Actualmente se está desarrollando un Programa de Entrenamiento en el manejo de la traqueostomía con el objetivo de agilizar su egreso (AU)

A retrospective descriptive study was conducted over the period 2010-2011. Patients admitted to CIM 62 of hospital Garrahan who required a tracheostomy during their hospital stay were included in the study. Overall, 88 patients were included. The majority (85%) presented with some underlying disease, most frequently a neurological disorder, previous to the tracheostomy, The main reason for tracheostomy was extubation failure/prolonged MV. Mean hospital stay before tracheostomy was 35 days. Currently a training program for tracheostomy placement is being developed to streamline discharge (AU)

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OBJECTIVE: To assess the 2012 served available market for tuberculosis (TB) diagnostics in China in the sector served by the China Centre for Disease Control and Prevention (CDC) and the hospital sector in China, including both designated TB hospitals and general hospitals. DESIGN: Test volumes and unit costs were assessed for tuberculin skin tests, interferon-gamma release assays (IGRAs), smear microscopy, serology, cultures, speciation tests, nucleic-acid amplification tests (NAATs), drug susceptibility tests and adenosine-deaminase tests (ADA). Data were obtained from electronic databases (CDC sector) and through surveys (hospital sector), and were estimated for the two sectors and for the country as a whole. Test costs were estimated by staff at China CDC, and using published literature. RESULTS: In 2012, the China CDC and hospital sectors performed a total of 44 million TB diagnostic tests at an overall value of US$294 million. Tests used by the CDC sector were smear microscopy, solid and liquid culture and DST, while the hospital sector also used IGRAs, NAATs, ADA and serology. The hospital sector accounted for 76% of the overall test volume and 94% of the market value. CONCLUSION: China has a very large TB diagnostic market that encompasses a wide range of diagnostic tests, with the majority being performed in Chinese hospitals.

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BACKGROUND: India represents a significant potential market for new tests. We assessed India's market for tuberculosis (TB) diagnostics in 2013. METHODS: Test volumes and unit costs were assessed for tuberculin tests, interferon-gamma release assays, sputum smear microscopy, serology, culture, speciation testing, nucleic-acid amplification tests (i.e., in-house polymerase chain reaction, Xpert(®) MTB/RIF, line-probe assays) and drug susceptibility testing. Data from the public sector were collected from the Revised National TB Control Programme reports. Private sector data were collected through a survey of private laboratories and practitioners. Data were also collected from manufacturers. RESULTS: In 2013, India's public sector performed 19.2 million tests, with a market value of US$22.9 million. The private sector performed 13.6 million tests, with a market value of US$60.4 million when prices charged to the patient were applied. The overall market was US$70.8 million when unit costs from the ingredient approach were used for the 32.8 million TB tests performed in the entire country. Smear microscopy was the most common test performed, accounting for 25% of the overall market value. CONCLUSION: India's estimated market value for TB diagnostics in 2013 was US$70.8 million. These data should be of relevance to test developers, donors and implementers.

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SETTING: Two thirds of tuberculosis (TB) patients in the Netherlands are foreign-born. OBJECTIVE: To determine if travelling to the country of origin is a risk factor for TB among two different immigrant groups that have lived in the Netherlands for at least 2 years. DESIGN: In this unmatched case-control study, the frequency and duration of travel to the country of origin in the preceding 12 months were compared between adult Moroccan and Turkish TB patients and community controls. RESULTS: Moroccan patients had travelled more often (26/32 = 81%) in the preceding year than Moroccan controls (472/816 = 58%). The travel-associated odds ratio (OR) for TB among Moroccans was 3.2 (95%CI 1.3-7.7), and increased to 17.2 (95%CI 3.7-79) when the cumulative duration of travel exceeded 3 months. The corresponding population fraction of Moroccan TB cases attributable to recent travel was 56% (95%CI 19-71). Among Turkish immigrants TB was not associated with travel (OR 0.9, 95%CI 0.3-2.4). CONCLUSION: Travel to the country of origin was a risk factor for TB among Moroccans, but not among Turkish people living in the Netherlands. The difference in travel-associated OR between these two immigrant groups is probably related to differences in TB incidence in these countries.

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The authors determined the positive predictive value (PPV) for progression to tuberculosis (TB) of two interferon-gamma release assays (IGRAs), QuantiFERON-TB Gold In-tube (QFT-GIT) and T-SPOT.TB, and the tuberculin skin test (TST) in immigrants contacts. Immigrant close contacts of sputum smear-positive TB patients were included when aged > or =16 yrs and their TST result was > or =5 mm 0 or 3 months after diagnosis of the index patient. Contacts were followed for the next 2 yrs for development of TB disease. Of 339 immigrant contacts with TST > or =5 mm, 324 and 299 had valid results of QFT-GIT and T-SPOT.TB, respectively. Nine contacts developed active TB. One patient had not been tested with TST, while another patient had not been tested with QFT-GIT and T-SPOT.TB. The PPV for progression to TB during this period was 9/288 = 3.1% (95% CI 1.3-5.0%) for TST > or =10 mm, 7/184 = 3.8% (95% CI 1.7-5.9%) for TST > or =15 mm, 5/178 = 2.8% (95% CI 1.0-4.6%) for QFT-GIT and 6/181 = 3.3% (95% CI 1.3-5.3%) for T-SPOT.TB. Sensitivity was 100%, 88%, 63% and 75%, respectively. The predictive values of QFT-GIT, T-SPOT.TB and TST for progression to TB disease among immigrant close contacts were comparable.

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OBJECTIVE: To assess the association between remote exposure to tuberculosis (TB) and results of the tuberculin skin test (TST), and two interferon-gamma release assays (IGRAs)-QuantiFERON-TB Gold In-Tube (QFT-GIT) and T-SPOT.TB-in immigrant contacts of sputum smear-positive TB patients. METHODS: Immigrants aged >or=16 years in close contact with smear-positive TB patients were included. QFT-GIT and T-SPOT.TB were performed if the TST induration size was >or=5 mm. Associations between test results and origin from an endemic country were assessed. RESULTS: Of 433 close contacts, 322 (74%) had TST >or=5 mm, of whom, 282 (88%) had valid test results for all assays. Positive QFT-GIT results were obtained for 152/282 (54%) and positive T-SPOT.TB for 168/282 (60%). After adjustment for age, sex and recent contact, positive IGRA results and TST results >/=10 mm were found to be more frequent among immigrants who originated from Africa, in particular sub-Saharan Africa. CONCLUSION: When IGRAs are used to determine latent TB infection in foreign-born individuals, positive findings not only relate to recent TB infection, but also reflect prior TB exposure in the country of origin. This late reactivity will limit their usefulness in contact investigations among immigrants originating from endemic areas.

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OBJECTIVES: Fertility problems are an increasing public health issue in industrialised countries. Exposure to exogenous agents with endocrine disrupting properties, such as some pesticides, are potential risk factors for subfertility. The aim of this study was to determine whether time-to-pregnancy (TTP) is prolonged in male greenhouse workers exposed to pesticides in comparison with a non-exposed reference group. METHODS: Data were collected through self-administrated questionnaires with detailed questions on TTP, as well as on lifestyle (for example, smoking habits, coffee and alcohol consumption), work tasks, and occupational exposures of the men and their partners in the six months before conception of the most recent pregnancy. TTP was compared between male greenhouse workers (n = 694) and a non-exposed reference group (n = 613) by means of discrete proportional hazards regression analysis. RESULTS: The crude analyses did not show a decreased overall fecundability among greenhouse workers compared to the non-exposed reference group. However, when fecundability was assessed for primigravidous couples, duogravidous couples, and multigravidous couples separately, greenhouse workers were found to be less fecund when trying to conceive their first pregnancy (FR = 0.65; 95% CI 0.46 to 0.92), which is also the most valid analysis in which pregnancy planning issues were avoided. Among couples who already experienced one or more pregnancies, no association was seen between pesticide exposure and TTP after adjustment for confounders. CONCLUSION: A prolonged time-to-pregnancy was observed in male greenhouse workers exposed to pesticides before conception of their first pregnancy.

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Se analizaron la evolución y la respuesta al tratamiento de 73 pacientes con migraña (criterios diagnósticos de Prensky) con más de seis meses de evolución de su enfermedad y tres meses de seguimiento en el hospital. Se clarificó al paciente y su familia el diagnóstico de migraña y se sugirieron pautas de manejo reconociendo factores desencadenantes y aliviantes así coo medidas higiénicas generales. Se indicó tratamiento de los episodios con análgesicos comunes y/o ergotamina. Se registró la evaluación subjetiva del paciente y/o sus padres respecto a su evolución y los datos de frecuencia, duración e intensidad de sus cefaleas en un calendario, realizado por ellos. Se confeccionaron 2 índices: de dolor (horas mensuales de cefalea x intensidad promedio). Se indició profilaxis medicamentosa a los pacientes que reunían criterios de frecuencia e intensidad. Se utilizó ciproheptadina como droga de primera elección flunarizina como alternativa. Sesenta y siete pacientes fueron evaluables según su evaluación subjetiva y 21 completaron 2 meses de registro calendario. Hubo concordancia entre ambas evaluaciones. Dieciseis de 17 pacientes que no recibieron profilaxis evolucionaron favorablemente (asintomáticos o mejorados), al igual que el 84 por ciento de los que si recibieron drogas profilácticas. Veinte pacientes que recibieron ciproheptadina evaluables por sus registros calendarios pre intraprofilaxis tuvieron una mejoría del 57 por ciento para el índice de dolor y del 72 por ciento para el índice de cefalea (p<0.05) resulados que se consideran favorables.

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Objetivo: analizar los diagnòsticos màs frecuentes como causa de dolor abdominal en niños menores de 4 años de edad y evaluar los signos sintomas que puedan orientar al médico hacia un màs temprano diagnòstico que permita la iniciaciòn de un ràpido tratamiento, en el intento de disminuir los índices de morbi mortalidad debidos a errores diagnosticos iniciales. Material y Métodos: se analizan en forma retrospectiva las historias clínicas de 86 pacientes que ingresaron a observaciòn en el Area de Emergencia entre junio de 1995 y mayo de 1996. Fueron varones el 66 por ciento, con edades comprendidas entre 1 mes y 4 años. Se implementó una planilla de registro donde se consignaron, además de los datos filiatorios, los signos síntomas iniciales y su evolución, los diagnósticos iniciales, el examen clínico al ingreso, los exámenes complementarios realizados, el tiempo entre el comienzo del dolor y el diagnóstico final y el tratamiento implementado. Resultados: La apendicitis fue la causa más común (52 por ciento), seguida de la invaginación intestinal (21 por ciento) y la oclusión intestinal debida a constipación o ascaridiasis. Hubo error en el diagnóstico inicial en el 30.23 por ciento. El tiempo medio de evolución previo al ingreso fue de 48 horas y las complicaciones tuvieron relación con la demora diagnòtica. El tratamiento fue quirúrgico en el 74 por ciento de los pacientes. Conclusiones: el dolor abdominal es relativamente frecuente en niños menores de 4 años de edad. Las dificultades diagnòsticas son una característica de esta población. Un alto porcentaje de estos pacientes requiere tratamiento quirúrgico, por lo que los pediatras debemos acentuar el esfuerzo para evitar demora diagnóstica y así disminuir los índices de morbi mortalidad. El examen clínico es fundamental para este objetivo. La consulta con un cirujano con experiencia debe realizarse ante la sospecha de apendicitis.

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