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BACKGROUND: European and North-American guidelines on management of H. pylori infection in children provide the option not to treat even if the infection is endoscopically confirmed. We used data from the EuroPedHp Registry to identify factors associated with therapy decisions. METHODS: We included treatment-naïve patients reported between 2017 and 2020 from 30 centers in 17 European countries. Multivariable logistic regression identified factors including comorbidities within and outside the gastrointestinal (GI) tract influencing the decision for or against therapy. RESULTS: Of 1165 patients (52% females, median age 12.8), 28% (321/1165) reported any alarm symptom, 26% (307/1165) comorbidities, and 16% (192/1165) did not receive eradication treatment. Therapy was initiated less often in children having any GI comorbidity (57%, n = 181), particularly in those with eosinophilic esophagitis (60%, n = 35), inflammatory bowel disease (54%, n = 28), and celiac disease (43%, n = 58), compared to those with non-GI (86%, n = 126) or no comorbidity (89%, n = 858), despite similar frequencies of alarm and non-alarm symptoms, ulcers, erosions, and nodular gastritis. Patients with GI and without comorbidities remained more likely untreated in high versus low H. pylori prevalence countries (p < 0.0001). In children without comorbidities, factors favoring therapy included older age, being overweight, having symptoms, erosions, antral nodularity, and available antibiotic susceptibility results. CONCLUSION: In this cohort, H. pylori-infected children with GI comorbidities compared to no comorbidity showed 75% reduced chance of receiving eradication therapy. We found no evidence supporting different management strategies in infected patients with GI comorbidities compared to all pediatric patients with endoscopically proven H. pylori infection.

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Mycobacterium tuberculosis has evolved a highly specialized system to snatch essential nutrients from its host, among which host-derived cholesterol has been established as one main carbon source for M. tuberculosis to survive within granulomas. The uptake, catabolism, and utilization of cholesterol are important for M. tuberculosis to sustain within the host largely via remodeling of the bacterial cell walls. However, the regulatory mechanism of cholesterol uptake and its impact on bacterium fate within infected hosts remain elusive. Here, we found that M. tuberculosis LacI-type transcription regulator Rv3575c negatively regulates its mce4 family gene transcription. Overexpression of Rv3575c impaired the utilization of cholesterol as the sole carbon source by Mycobacterium smegmatis, activating the host's innate immune response and triggering cell pyroptosis. The M. smegmatis homologue of Rv3575c MSMEG6044 knockout showed enhanced hydrophobicity and permeability of the cell wall and resistance to ethambutol, suppressed the host innate immune response to M. smegmatis, and promoted the survival of M. smegmatis in macrophages and infected mouse lungs, leading to reduced transcriptional levels of TNFα and IL-6. In summary, these data indicate a role of Rv3575c in the pathogenesis of mycobacteria and reveal the key function of Rv3575c in cholesterol transport in mycobacteria.

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OBJECTIVE: This study aimed to measure the quality of life (QOL) of lung cancer patients and evaluate the relationship between QOL and suicidal ideation (SI) in a tertiary hospital in Vietnam. METHODS: A cross-sectional study was conducted at Bach Mai Hospital in Hanoi, Vietnam. A total of 256 patients with lung cancer were recruited. The QOL of cancer patients was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) version 3. Multivariate Tobit regression was employed to identify associations between SI and QOL. RESULT: Overall, the mean global health status score was 58.3 ± 15.8, and those with SI had significantly higher scores than those without SI. Regarding functional scales, patients with SI had significantly lower physical functioning (82.22 ± 11.42) compared to those without SI (90.58 ± 11.90) (p<0.05). Meanwhile, regarding symptom scales, scores for fatigue, nausea and vomiting, pain, insomnia, appetite loss, constipation, diarrhea, and financial difficulties among patients with SI were significantly higher than those without SI (p<0.05). In the multivariate analysis, having SI increased the role functioning score (Coef. = 9.41, 95% CI = 0.38-18.45) and diarrhea score (Coef. = 22.33, 95% CI = 2.05-42.60). CONCLUSION: This study indicated moderate QOL and perceived the lowest social functioning in lung cancer patients. SI was associated with role functioning scores and diarrhea scores. SI should be monitored and controlled regularly in this population during treatment to improve their QOL.

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Background: White-rot fungi and bacteria communities are unique ecosystems with different types of symbiotic interactions occurring during wood decomposition, such as cooperation, mutualism, nutritional competition, and antagonism. The role of chitin-active lytic polysaccharide monooxygenases (LPMOs) in these symbiotic interactions is the subject of this study. Method: In this study, bioinformatics tools were used to analyze the sequence and structure of putative LPMOs mined by hidden Markov model (HMM) profiles from the bacterial metagenomic DNA database of collected humus samples around white-rot fungi in Cuc Phuong primary forest, Vietnam. Two genes encoding putative LPMOs were expressed in E. coli and purified for enzyme activity assay. Result: Thirty-one full-length proteins annotated as putative LPMOs according to HMM profiles were confirmed by amino acid sequence comparison. The comparison results showed that although the amino acid sequences of the proteins were very different, they shared nine conserved amino acids, including two histidine and one phenylalanine that characterize the H1-Hx-Yz motif of the active site of bacterial LPMOs. Structural analysis of these proteins revealed that they are multidomain proteins with different functions. Prediction of the catalytic domain 3-D structure of these putative LPMOs using Alphafold2 showed that their spatial structures were very similar in shape, although their protein sequences were very different. The results of testing the activity of proteins GL0247266 and GL0183513 show that they are chitin-active LPMOs. Prediction of the 3-D structures of these two LPMOs using Alphafold2 showed that GL0247266 had five functional domains, while GL0183513 had four functional domains, two of which that were similar to the GbpA_2 and GbpA_3 domains of protein GbpA of Vibrio cholerae bacteria. The GbpA_2 - GbpA_3 complex was also detected in 11 other proteins. Based on the structural characteristics of functional domains, it is possible to hypothesize the role of chitin-active GbpA-like LPMOs in the relationship between fungal and bacterial communities coexisting on decomposing trees in primary forests.

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Mixed solid solutions have played an important role in improving the kinetics and performance of hydrogen storage materials, as reported for the Li-Mg-N-H, K-Mg-N-H, and Rb-Mg-N-H systems. Besides, the formation of a homogeneous solid solution, mostly due to partial ionic substitution, is known to be an effective approach to improve the ionic conductivity of a material, which is an important property in electrochemical applications. We have reported a series of solid solutions based on mixed amide-hydride materials of the Group 1 elements, e.g., K(NH2)xH1-x, Rb(NH2)xH1-x, and Cs(NH2)xH1-x, via the exchange of NH2-/H- anions with the change of the lattice cell of the solid solution. Extending the research in this direction, we study the M-N-H solid solution in the MNH2-MH systems (M = K, Rb, Cs, and their combinations), i.e., KNH2-RbH, RbNH2-KH, RbNH2-CsH, and CsNH2-RbH via ex situ/in situ XRD, IR, and 1H 2D solid-state NMR. The results obtained confirm the formation of mixed metal amide-hydride solid solutions associated with an exchange between both anionic (NH2- and H-) and cationic species (K+, Rb+, and Cs+). With this study, we aim to create an accessible library of M-N-H solid solutions for further studies as additives for hydrogen storage materials or ionic conductors.

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BACKGROUND: Surgical site infection (SSI) rates are higher in low-resource countries (LRC) than in high-income counterparts. METHODS: Prospective cohort study using the INICC Surveillance Online System, from 116 hospitals in 75 cities across 25 Latin-American, Asian, Eastern-European, and Middle-Eastern countries: Argentina, Bahrain, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Egypt, Honduras, India, Kosovo, Kuwait, Lebanon, Mexico, Mongolia, Pakistan, Papua New Guinea, Philippines, Poland, Romania, Saudi Arabia, Thailand, Turkey, Venezuela, Vietnam. CDC/NHSN definitions were applied. Surgical procedures (SPs) were categorized according to the International Classification of Diseases criteria. RESULTS: From 2014 to 2023, we collected data on 1,251 SSIs associated with 56,617 SPs. SSI rates were significantly higher in SPs of INICC compared to CDC/NHSN data: hip prosthesis (3.68% vs 0.67%, relative risk [RR]=5.46, 95% confidence interval [CI]=3.71-8.03, P<.001), knee prosthesis (2.02% vs 0.58%, RR=3.49, 95% CI=1.87-6.49, P<.001), coronary artery bypass (4.16% vs 1.37%, RR=3.03, 95% CI=2.35-3.91, P<.001), peripheral vascular bypass (15.69% vs 2.93%, RR=5.35, 95% CI=2.30-12.48, P<.001), abdominal aortic aneurysm repair (8.51% vs 2.12%, RR=4.02, 95% CI=2.11-7.65, P<.001), spinal fusion (6.47% vs 0.70%, RR=9.27, 95% CI=6.21-13.84, P<.001), laminectomy (2.68% vs 0.72%, RR=3.75, 95% CI=2.36-5.95, P<.001), among others. CONCLUSIONS: Elevated SSI rates in LRCs emphasize the need for effective interventions.

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Flexible bronchoscopy has revolutionized respiratory disease diagnosis. It offers direct visualization and detection of airway abnormalities, including lung cancer lesions. Accurate identification of airway lesions during flexible bronchoscopy plays an important role in the lung cancer diagnosis. The application of artificial intelligence (AI) aims to support physicians in recognizing anatomical landmarks and lung cancer lesions within bronchoscopic imagery. This work described the development of BM-BronchoLC, a rich bronchoscopy dataset encompassing 106 lung cancer and 102 non-lung cancer patients. The dataset incorporates detailed localization and categorical annotations for both anatomical landmarks and lesions, meticulously conducted by senior doctors at Bach Mai Hospital, Vietnam. To assess the dataset's quality, we evaluate two prevalent AI backbone models, namely UNet++ and ESFPNet, on the image segmentation and classification tasks with single-task and multi-task learning paradigms. We present BM-BronchoLC as a reference dataset in developing AI models to assist diagnostic accuracy for anatomical landmarks and lung cancer lesions in bronchoscopy data.

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Porcine epidemic diarrhea (PED) is one of the diseases that causes great losses for livestock farmers. Because vaccines against the disease are not very effective, there is a great demand for biological products with effective resistance to PED virus (PEDV). One of the most important trends today is the use of active ingredients from nature in animal husbandry. This study aimed to create an effective agent against PEDV from the extract of Stixis scandens, which has been shown to inhibit PEDV. The aqueous (denoted as TCN) and ethanolic extracts (denoted as TCC) of Stixis scandens leaves were first prepared and then qualitatively analyzed for their chemical compositions. The TCN was used to synthesize ZnO nanoparticles (NPs) at various sizes from 20 to 120 nm. Subsequently, TCC was loaded on ZnO NPs to form ZnO-extract nanoformulations with an extract loading content of 5.8-7.6%. Total polyphenols (TP) and total alkaloids (TA) in TCC were 38.51 ± 0.25 µg GAE per mg and 22.37 ± 0.41 µg AtrE per mg, respectively. TP was less loaded but more released from the nanoformulations than TA. The A1T nanoformulation, containing only 7.6% extract, had a minimum PEDV inhibitory concentration of 3.9 µg mL-1, which was comparable to that of TCC. The experiments confirmed that the nanoformulations are promising for PEDV inhibition applications.

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Antimicrobials are a core aspect of most livestock production systems, especially in low-and middle-income countries. They underpin the efficient use of scarce feed resources and stabilize returns on capital and labor inputs. Antimicrobial use (AMU) contributes to the production of healthy animals, yet AMU in livestock is linked to antimicrobial resistance (AMR) in animals, humans and the environment. The Vietnamese Platform for Antimicrobial Reduction in Chicken Production was implemented during 2016-2019 and was one of Southeast Asia's first interventions focused on AMU reductions in livestock production. The project targeted small-scale commercial poultry farms in the Mekong Delta region of Vietnam using a "randomized before-and-after controlled" study design. It provided farmers with a locally adapted support service (farmer training plan, advisory visits, biosecurity, and antimicrobial replacement products) to help them reduce their reliance on antimicrobials. A partial budget analysis was performed comparing the control group (status-quo) and intervention group (alternative). The median net farm-level benefit of the intervention strategies with the project's support was VND 6.78 million (interquartile range (IR) VND -71.9-89 million) per farm. Without project support the benefit was reduced to VND 5.1 million (IR VND -69.1-87.2 million) to VND 5.3 million (IR -VND 68.9-87.5 million) depending on the antimicrobial alternative product used. At the project level with a focus on AMU and its reduction, subsequently influence on the resistance reduction, our results showed that achieving resistance reduction benefits with the current knowledge and technologies required investment of at least VND 9.1 million (US$ 395.10) per farm during the project's lifetime. The results highlight the positive net profit for the majority of enrolled farms and a reasonable investments from the project. The recommendation focuses on the implementation of policies on financial support, legislation, and information as potential solutions to facilitate the application of intervention strategies to reduce AMU in poultry production.

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PURPOSE: To explore occupational and non-occupational risk and protective factors for the coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). METHODS: Serum specimens and questionnaire data were obtained between October 7 and December 16, 2021 from COVID-19-vaccinated HCWs at a quaternary care hospital in Munich, Germany, and were analyzed in the RisCoin Study. RESULTS: Of 3,696 participants evaluated, 6.6% have had COVID-19 at least once. Multivariate logistic regression analysis identified working in patient care occupations (7.3% had COVID-19, 95% CI 6.4-8.3, Pr = 0.0002), especially as nurses, to be a potential occupation-related COVID-19 risk factor. Non-occupational factors significantly associated with high rates of the disease were contacts to COVID-19 cases in the community (12.8% had COVID-19, 95% CI 10.3-15.8, Pr < 0.0001), being obese (9.9% had COVID-19, 95% CI 7.1-13.5, Pr = 0.0014), and frequent traveling abroad (9.4% had COVID-19, 95% CI 7.1-12.3, Pr = 0.0088). On the contrary, receiving the basic COVID-19 immunization early during the pandemic (5.9% had COVID-19, 95% CI 5.1-6.8, Pr < 0.0001), regular smoking (3.6% had COVID-19, 95% CI 2.1-6.0, Pr = 0.0088), living with the elderly (3.0% had COVID-19, 95% CI 1.0-8.0, Pr = 0.0475), and frequent consumption of ready-to-eat meals (2.6% had COVID-19, 95% CI 1.1-5.4, Pr = 0.0045) were non-occupational factors potentially protecting study participants against COVID-19. CONCLUSION: The newly discovered associations between the living situation, traveling as well as dietary habits and altered COVID-19 risk can potentially help refine containment measures and, furthermore, contribute to new mechanistic insights that may aid the protection of risk groups and vulnerable individuals.

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Four isolates of the opportunistic pathogen Elizabethkingia anophelis were identified for the first time in a Vietnamese hospital and underwent antimicrobial susceptibility testing and genomic characterization by whole-genome sequencing. Complete, fully circularized genome sequences were obtained for all four isolates. Average Nucleotide Identity analysis and single nucleotide polymorphism phylogenetic analysis on the core genome showed that three of the four isolates were genetically distinct, ruling out the hypothesis of a single strain emergence. Antibiotic susceptibility testing highlighted multi-resistant phenotypes against most antimicrobial families, including beta-lactams, carbapenems, aminoglycosides, quinolones, macrolides, amphenicols, rifamycins and glycopeptides. Additionally, in silico genomic analysis was used to correlate the phenotypic susceptibility to putative resistance determinants, including resistance genes, point mutations and multidrug efflux pumps. Nine different resistance genes were located inside a single resistance pocket predicted to be a putative Integrative and Conjugative Element (ICE). This novel ICE was shared by three isolates from two different lineages and displayed similarity with ICEs previously reported in various Elizabethkingia and Chryseobacterium species. The role of such ICEs in pathogenicity, genome plasticity and antimicrobial resistance gene spread within the Flavobacteriaceae family needs to be further elucidated.

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OBJECTIVES: To identify infants with biliary atresia (BA), European Society of Paediatric Gastroenteroloy and Nutrition (ESPGHAN)/North American Society of Pediatric Gastroenteroloy and Nutrition (NASPGHAN) guidelines recommend measurement of conjugated/direct bilirubin in infants with prolonged jaundice and using a stool colour card (SCC). The 'Quality of Care' Task Force of ESPGHAN performed two surveys to assess current case finding for BA and age at Kasai portoenterostomy (KPE). METHODS: The first survey approached 26 European hepatology centres to report age at referral and age at KPE of all infants diagnosed with BA from 2015 to 2019. The second survey targeted paediatricians in France to assess awareness and compliance with the recently introduced SCC. RESULTS: Data from 785 patients with BA from 18 centres in 15 countries revealed a mean age at referral to tertiary centre of 55 days (median 53, IQR 48-60) (n = 636). The mean age at KPE was 61 days (median 60; IQR 54-67) (n = 772). For 6% of patients, cirrhosis was too advanced for surgery. Of 392 paediatricians answering the second survey, 53% felt familiar with the target diseases, 80% correctly identified cholestasis and 59% always inquired about the infant's stool colour. If abnormal, 93% would order blood tests and 85% call for advice. The SCC screening was considered helpful for case finding and improving knowledge of cholestatic diseases by 62% and 45% paediatricians, respectively. CONCLUSIONS: Referral of infants for KPE remains late, indicating low adherence to search for cholestasis in icteric infants by age 2-3 weeks. Knowledge and structures need improvement to allow earlier guideline conform case finding, diagnosis and therapy.

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This study aimed to determine the influence of psychiatric training and hands-on learning with individuals with mental illness on increasing medical students' benevolent attitudes towards psychiatry and psychiatric patients. The cross-sectional study compares medical students' attitudes before and after a compulsory psychiatry curriculum and psychiatric bedside training at Hanoi Medical University with those of non-medical students who have yet to undergo similar training. Two validated scales regarding the attitudes toward psychiatry and psychiatric patients were evaluated. Analysis of the Medical Conditions Regard Scale[1] revealed a significant difference, indicating that medical students displayed more accepting and benevolent attitudes towards psychiatry and psychiatric patients after completing the curriculum and bedside training than medical students before participation. Most stigmatising and rejecting attitudes were found among non-medical students. This study is the first to examine medical students' attitudes toward psychiatry and psychiatric patients compared to non-medical students in Vietnam. It can guide the development of the medical curriculum to increase benevolence towards psychiatric patients and interest in the psychiatric field of work in Vietnam and Southeast Asia, aiming to improve the mental health care sector.

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The recently uncovered two-dimensional materials serve as versatile building blocks for electronic devices. In this study, we methodically investigate the impact of substrate-induced strain and exchange field effects on the electronic density of states (EDOS) and electronic heat capacity (EHC) of single-layer ß12-borophene. Utilizing the Green's function approach, we compute these functions. The van Hove singularities in EDOS are observed to shift with strain, and depending on the direction and strength of the exchange field, the number of singularities increases. All these responses can be attributed to the renormalization of the velocity of electronic bands. Additionally, the inherent Schottky anomaly (an unusual peak at low temperatures) in the EHC undergoes a notable shift to higher and lower temperatures and variations in the intensity of the EHC due to substrate effects.

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OBJECTIVES: Burkholderia dolosa is a clinically important opportunistic pathogen in inpatients. Here we characterised an extensively drug-resistant and hypervirulent B. dolosa isolate from a patient hospitalised for stroke. METHODS: Resistance to 41 antibiotics was tested with the agar disc diffusion, minimum inhibitory concentration, or broth microdilution method. The complete genome was assembled using short-reads and long-reads and the hybrid de novo assembly method. Allelic profiles obtained by multilocus sequence typing were analysed using the PubMLST database. Antibiotic-resistance and virulence genes were predicted in silico using public databases and the 'baargin' workflow. B. dolosa N149 phylogenetic relationships with all available B. dolosa strains and Burkholderia cepacia complex strains were analysed using the pangenome obtained with Roary. RESULTS: B. dolosa N149 displayed extensive resistance to 31 antibiotics and intermediate resistance to 4 antibiotics. The complete genome included three circular chromosomes (6 338 630 bp in total) and one plasmid (167 591 bp). Genotypic analysis revealed various gene clusters (acr, amr, amp, emr, ade, bla and tet) associated with resistance to 35 antibiotic classes. The major intrinsic resistance mechanisms were multidrug efflux pump alterations, inactivation and reduced permeability of targeted antibiotics. Moreover, 91 virulence genes (encoding proteins involved in adherence, formation of capsule, biofilm and colony, motility, phagocytosis inhibition, secretion systems, protease secretion, transmission and quorum sensing) were identified. B. dolosa N149 was assigned to a novel sequence type (ST2237) and formed a mono-phylogenetic clade separated from other B. dolosa strains. CONCLUSIONS: This study provided insights into the antimicrobial resistance and virulence mechanisms of B. dolosa.

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Rice holds a significant position in the global food supply chain, particularly in Asian, African, and Latin American countries. However, rice pests and diseases cause significant damage to the supply and growth of the rice cultivation industry. Therefore, this article provides a high-quality dataset that has been reviewed by agricultural experts. The dataset is well-suited to support the development of automation systems and smart farming practices. It plays a vital role in facilitating the automatic construction, detection, and classification of rice diseases. However, challenges arise due to the diversity of the dataset collected from various sources, varying in terms of disease types and sizes. This necessitates support for upgrading and enhancing the dataset through various operations in data processing, preprocessing, and statistical analysis. The dataset is provided completely free of charge and has been rigorously evaluated by agricultural experts, making it a reliable resource for system development, research, and communication needs.

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OBJECTIVES: Assessment of anthropometric data is essential for paediatric healthcare. We surveyed the implementation of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) evidence-based guidelines and practical recommendations on nutritional care, particularly regarding anthropometric measurements. METHODS: Paediatric hospitals from 28 European countries provided pseudonymized data through online questionnaires on hospital characteristics and their standards of nutritional care. Practical tasks assessed an unbiased collection and reporting of anthropometric measurements in random patients' files and discharge letters. RESULTS: Of 114 hospitals (67% academic), 9% have no nutritionist/dietitian available, 18% do not provide standard policy to assess weight and height and 15% lack training for nursing staff for accurate performance. A wall-mounted stadiometer to measure standing height and equipment for sitting weight is unavailable in 9% and 32%, respectively. Infant length is measured by one instead of two healthcare professionals and with a tape instead of a rigid length measuring board in 58% and 15% of hospitals, respectively. The practical tasks reviewed 1414 random patients, thereof 446 younger than 2 years of age. Missing documentation occurred significantly more often for height versus weight and their percentiles in infants ≤2 years versus older children, and in general paediatric versus gastrointestinal patients, with no difference between academic and nonacademic hospitals. Review of documented anthropometric data in discharge letters disclosed that consultants significantly underestimated the deficits in their units compared to documented data. CONCLUSIONS: The survey revealed significant gaps in performance and documentation of anthropometry in the participating hospitals. A resurvey will assess changes in quality of care over time.

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Nitrite contamination and the spread of pathogens can seriously degrade water quality. To simultaneously control these factors, an innovative approach of fabricating a remediation agent that contained denitrifying bacteria and TiO2-AgNPs co-immobilized on floating expanded clay (EC) was proposed in this study. The EC was fabricated from a mixture of clay and rice husk through pyrolysis at a high temperature of 1200 °C, followed by a rapid cooling step to create a porous structure for the material. TiO2NPs were modified with Ag to shift the absorbance threshold of TiO2-AgNPs into the visible region of 700-800 nm. The experimental results showed that the stirring speed of 250 rpm was suitable for immobilizing TiO2-AgNPs on EC and achieved the highest Ti and Ag content of 639.38 ± 3.04 and 200.51 ± 3.71 ppm, respectively. Coating TiO2-Ag/EC with chitosan (0.5%) significantly reduced the detachment level of immobilized TiO2-AgNPs compared to that of the material with no coating. In particular, this functionalized material inhibited 99.93 ± 0.1% of Vibrio parahaemolyticus pathogen but did not adversely affect the denitrifying bacteria after 2 h of visible light irradiation. Based on the electrostatic bond between oppositely charged polymers, the denitrifying bacteria, Bacillus sp., in alginate solution was successfully immobilized on the chitosan-coated TiO2-Ag/EC with a bacteria density of (76.67 ± 9.43) × 107 CFU g-1, retaining its nitrite removal efficiency at 99.0 ± 0.27% through six treatment cycles. These findings provide solid evidence for further investigating the combination of biodegradation and photodegradation in wastewater treatment.

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In Vietnam, chest radiography (CXR) is used to refer people for GeneXpert (Xpert) testing to diagnose tuberculosis (TB), demonstrating high yield for TB but a wide range of CXR abnormality rates. In a multi-center implementation study, computer-aided detection (CAD) was integrated into facility-based TB case finding to standardize CXR interpretation. CAD integration was guided by a programmatic framework developed for routine implementation. From April through December 2022, 24,945 CXRs from TB-vulnerable populations presenting to district health facilities were evaluated. Physicians interpreted all CXRs in parallel with CAD (qXR 3.0) software, for which the selected TB threshold score was ≥0.60. At three months, there was 47.3% concordance between physician and CAD TB-presumptive CXR results, 7.8% of individuals who received CXRs were referred for Xpert testing, and 858 people diagnosed with Xpert-confirmed TB per 100,000 CXRs. This increased at nine months to 76.1% concordant physician and CAD TB-presumptive CXRs, 9.6% referred for Xpert testing, and 2112 people with Xpert-confirmed TB per 100,000 CXRs. Our programmatic CAD-CXR framework effectively supported physicians in district facilities to improve the quality of referral for diagnostic testing and increase TB detection yield. Concordance between physician and CAD CXR results improved with training and was important to optimize Xpert testing.

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BACKGROUND: Limited approval of second-line treatments in pediatric inflammatory bowel disease (pIBD) necessitates optimized use of infliximab (IFX) with proactive therapeutic drug monitoring (TDM). We investigated whether early combo-therapy with an immunomodulator (IMM) provides additional benefit. METHODS: In the retrospectively reviewed medical records of all children treated with IFX and proactive TDM between 2013 and 2022, IMMearly (IMM ≤3 months since IFX start) was evaluated against IMMother/no (late/short or no IMM) over follow-up of 3 to 60 months. Kaplan-Meier analysis was used to analyze time to loss of response (LOR) with IFX discontinuation or time to antibodies-to-IFX (ATI) development. RESULTS: Three hundred fifteen patients with pIBD were reviewed; of those, 127 with 2855 visits were included (77 CD, 50 UC/IBD-unclassified). Sixty patients received IMMearly, 20 patients IMMother, and 47 had IFX monotherapy. Median follow-up time was 30 and 26 months for IMMearly and IMMother/no, respectively, with comparable proactive TDM. Infliximab treatment persistence was 68% after 60 months. Loss of response was observed in 7 IMMearly and 15 IMMother/no patients (P = .16). Early combo-therapy significantly delayed LOR with IFX discontinuation (median LOR free interval IMMearly 30 months vs IMMother/no 9 months, P = .01). Patients with IMMother/no were 10-, 3- and 2-times more likely to experience LOR with IFX discontinuation after 1, 3, and 5 years, respectively. There were no significant group differences regarding the presence of any positive (>10 arbitrary units per milliliter [AU/mL]) or high (>100 AU/mL) ATI, median ATI concentrations, and ATI-free interval. CONCLUSIONS: Early IMM combo-therapy in proactively monitored patients with pIBD significantly prolonged the median LOR free interval compared with late/short or no IMM treatment.