Xpert Ultra in diagnosing extrapulmonary TB: accuracy and trace calls.

INTRODUCTION: Xpert Ultra (Ultra) was developed to improve the detection of TB; however, data on Ultra´s diagnostic accuracy in extrapulmonary TB (EPTB) are limited.METHODS: In this prospective diagnostic accuracy study, 242 EPTB samples were subjected to Ultra and Xpert MTB/Rif (Xpert) testing, and these were compared with both culture and a composite gold standard.RESULTS: Compared to culture, Ultra sensitivity and specificity using bone, cerebrospinal fluid (CSF), lymph node and tissue samples, and overall were respectively 100% and 77.3%, 75% and 100%, 87.5% and 87.5%, 100% and 87%, and 89.7% and 87.4%; in comparison to the composite gold standard, Ultra´s sensitivity and specificity were respectively 66.7% and 100%, 17.6% and 100%, 46.9% and 95.7%, 38.5% and 94.1%, and 46.2% and 96.9%. Using latent class analysis, sensitivity and specificity were respectively 94.5% and 96.3% for Ultra, 65.5% and 99.8% for Xpert, and 58.6% and 99.2% for culture. There were 22/242 (9%) trace calls on Ultra.CONCLUSION: We found improved sensitivity for Ultra compared to Xpert, although Ultra specificity was lower, with a large number of trace results (9%).

A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod.

AIM: A stoma rod or bridge has been traditionally placed under the bowel loop while constructing a loop colostomy. This is believed to prevent stomal retraction and provide better faecal diversion. However, the rod can cause complications such as mucosal congestion, oedema and necrosis. This single-centre prospective randomized controlled trial compared outcomes after creation of loop colostomy with and without a supporting stoma rod. The primary outcome studied was stoma retraction rate; other stoma-related complications were studied as secondary outcomes. METHOD: One hundred and fifty-one patients were randomly allotted to one of two arms, colostomy with or without a supporting rod. Postoperative complications such as retraction, mucocutaneous separation, congestion and re-exploration for stoma-related complications were recorded. RESULTS: There was no difference in the stoma retraction rate between the two arms (8.1% in the rod arm and 6.6% in the no-rod arm; P = 0.719). Stomal necrosis (10.7% vs 1.3%; P = 0.018), oedema (23% vs 3.9%; P = 0.001), congestion (20.3% vs 2.6%; P = 0.001) and re-admission rates (8.5% vs 0%; P = 0.027) were significantly increased in the arm randomized to the rod. CONCLUSION: The stoma rod does not prevent stomal retraction. However, complication rates are significantly higher when a stoma rod is used. Routine use of a stoma rod for construction of loop colostomy can be avoided.

A tale behind the rectum.

Tailgut cysts, also called benign retrorectal hamartomas, are uncommon developmental cysts found behind the rectum. Here, we present a rare case of a tailgut cyst associated with uterine anomaly, sacral and vertebral anomalies and vascular duplication, in a young lady who presented with constipation and infertility.