Implementation of an integrated care strategy for child contacts of tuberculosis patients: a quasi-experimental study protocol.

BACKGROUND: Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE: To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS: A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS: gov identifier NCT04331262. DISCUSSION: This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.

Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis.

BACKGROUND: The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. METHODS: Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. RESULTS: From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). CONCLUSIONS: Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation.

Atypical hepatic haemangiomas.

Hepatic haemangioma is the most common benign liver lesion in the general population. It often exhibits a uniform pattern of characteristics, thus being called "typical." However, a certain number of hepatic haemangiomas have special or uncommon characteristics and are termed "atypical." The majority of patients are asymptomatic. Its differential diagnosis is critical, and its differentiation from other aetiological possibilities can be challenging, especially in cases of atypical haemangiomas, which may lead to confusion or even misleading diagnoses. We report on a 55-year-old patient with atypical multiple hepatic haemangiomas mimicking metastasis or echinococcus infection.

Papilomatosis biliar: presentación de un caso con trasplante hepático / Biliary Papillomatosis: A Case Report

Las neoplasias papilares intraductales de los ductos biliares (NPIB), tradicionalmente llamadas "papilomatosis biliar", son raras y se caracterizan por una apariencia macroscópica papilar y, en muchos casos, secreción visible de mucina. Ocurren con mayor frecuencia en pacientes con antecedente de litiasis biliar. Presentamos el caso de una paciente de 47 años de edad, a quien se le realizó un trasplante hepático por cirrosis biliar secundaria a litiasis intra y extrahepática, quien presentó durante muchos años episodios de colangitis recurrente, los cuales fueron manejados entre otros, con una anastomosis bilioentérica. En los estudios de imagen previos al trasplante, además de los cambios por cirrosis, se encontró una importante dilatación de la vía biliar intra y extrahepática, con cálculos de la vía biliar. La patología del explante mostró papilomatosis de la vía biliar. La paciente desarrolló recurrencia temprana en la vía biliar extrahepática nativa. Ha recibido manejo conservador hasta este momento.

Intraductal papillary neoplasias of the bile ducts (IPNB), traditionally called "biliary papillomatosis", is a rare entity characterized by macroscopic papillary appearance and in many cases visible secretion of mucin. It occurs more frequently in patients with history of biliary lithiasis. We present the case of a 47 years old patient who underwent liver transplantation due to biliary cirrhosis secondary to intra- and extrahepatic lithiasis, which suffered for many years episodes of recurrent cholangitis managed among others, with a bilioenteric anastomosis. At pre-transplant imaging studies, in addition to changes due to cirrhosis, a significant intra- and extra- hepatic biliary tract dilation was found with multiple calculi within. Pathology results reported the presence of bile duct papillomatosis. The patient developed early recurrence into the native extrahepatic bile duct. She has so far received conservative management.

Extrahepatic portal vein aneurysm after liver transplantation in a child: case report.

Portal vein aneurysms are very rare and represent <3% of all venous aneurysms. They can be congenital or acquired. Most patients do not have liver disease at diagnosis. Although uncommon, portal vein aneurysm has been described after liver transplant. We report the case of a six-yr-old girl who presented with an aneurysm of the extrahepatic portal vein after segmental liver transplantation. Because the patient was asymptomatic and owing to its extrahepatic location, this aneurysm has been successfully followed by clinical exam and imaging for four yr.

Colonic angiolipoma - a rare finding in the gastrointestinal tract. Case report and review of literature.

Angiolipomas are benign lesions that are frequently found in subcutaneous cellular tissue, but are rarely located in the gastrointestinal tract. Here we discuss a case of colonic angiolipoma that presented as a mass near the hepatic flexure, occupying approximately 90% of the colonic lumen. The diagnosis was made by endoscopy and computed tomography. The mass was resected successfully and diagnosis was confirmed by histological studies and immunohistochemical tests.

Miositis osificante progresiva / Fibrodysplasia ossificans progressive

El artículo presenta el caso de una niña de diez años de edad con diagnóstico de miosistis osificante progresiva (MOP), punto de partida para analizar los hallazgos radiológicos que sugirieron el diagnóstico. Se revisan,además, los principales conceptos de esta entidad, entre éstos su incidencia en la población pediátrica, los factores de riesgo, la presentación clínica, las características radiológicas, los diagnósticos diferenciales, el tratamiento y el pronóstico