Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS)-pilot evaluation of a simple point-of-care ultrasound protocol and short training program for detecting urinary tract morbidity in highly endemic settings.

BACKGROUND: Urogenital schistosomiasis (UGS) causes inflammation and fibrosis of the urinary tract. In resource-limited settings, affordable tools for morbidity assessment in clinical care are needed. Point-of-care ultrasound has not yet been validated for UGS-related pathology. METHODS: We developed a protocol for Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS), assessing pathology of the bladder wall, ureters and kidneys. Following standardized training, two clinicians performed FASUS on children and adults with hematuria in Lambaréné, Gabon. Recorded ultrasound clips were remotely reviewed by two ultrasound experts as a diagnostic reference. RESULTS: In 2015 and 2016, scans were performed in 118 patients. The image quality was sufficient in 90% of bladder views and more than 97% of kidney views. UGS-compatible pathology was detected in 51/118 (43%) by the operator and in 46/107 (43%) by the experts among baseline scans of sufficient quality. Inter-rater agreement between operators and experts was very good (κ > 0.8) for hydronephrosis and good (κ > 0.6) for bladder wall thickening. CONCLUSIONS: FASUS is a promising clinical, point-of-care tool for detecting UGS-related urinary tract morbidity in symptomatic patients. Based on larger validation studies, appropriate diagnostic and therapeutic algorithms for the use of FASUS should be established.

Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort.

AIM: To assess the impact of introducing a chest radiograph reading and recording system (CRRS) with a short training session, on the accuracy and inter-reader variability of tuberculosis (TB) interpretation of chest radiographs (CXRs) by a group of non-expert readers in a human immunodeficiency virus (HIV)-positive cohort. MATERIALS AND METHODS: A set of 139 CXRs was reviewed by a group of eight physicians pre- and post-intervention at two clinics in Shan State, Myanmar, providing HIV/TB diagnosis and treatment services. The results were compared against the consensus of expert radiologists for accuracy. RESULTS: Overall accuracy was similar pre- and post-intervention for most physicians with an average area under the receiver operating characteristic curve difference of 0.02 (95% confidence interval: -0.03, 0.07). The overall agreement among physicians was poor pre- and post-intervention (Fleiss κ=0.35 and κ=0.29 respectively). The assessment of agreement for specific disease patterns associated with active TB in HIV-infected patients showed that for intrinsically subtle findings, the agreement was generally poor but better for the more intrinsically obvious disease patterns: pleural effusion (Cohen's kappa range = 0.37-0.67) and milliary nodular pattern (Cohen's kappa range = 0.25-0.52). CONCLUSION: This study demonstrated limited impact of the introduction of a CRRS on CXR accuracy and agreement amongst non-expert readers. The role in which CXRs are used for TB diagnosis in a HIV-positive cohort in similar clinical contexts should be reviewed.

Ultrasound surveillance for hepatocellular carcinoma: service evaluation of a radiology-led recall system in a tertiary-referral centre for liver diseases in the UK.

AIM: To review the radiology-led ultrasound (US) surveillance programme for the detection of hepatocellular carcinoma (HCC) in cirrhotic patients in a UK tertiary-referral centre. MATERIALS AND METHODS: The radiology information system was searched for patients who had undergone US for surveillance of cirrhosis from September 2009 to May 2013. Patient demographics and cirrhosis aetiology were documented. Data including numbers of surveillance scans, abnormal findings suspicious for HCC, subsequent radiological investigations, numbers of HCC and survival for HCC patients were recorded. Service performance data, such as rates of attendance and rebooking, were also recorded. RESULTS: Eight hundred and four patients entered surveillance and 2,366 surveillance US examinations were performed; 368 (46%) underwent follow-up (6-monthly US). Abnormalities leading to further radiological investigations were found in 81 patients. Reasons for incomplete surveillance included non-attendance and radiology failure to re-book appointments. HCC was diagnosed in 22 patients. Fourteen had HCC diagnosed on a surveillance scan, eight had HCC diagnosed on a scan performed for other reasons. Patients diagnosed with HCC on a surveillance scan were more likely to be treated with curative intent and had longer survival. CONCLUSION: Even with a radiology-led recall service for HCC surveillance, the proportion of patients receiving scans 6-monthly was low, due in part to the lack of organisational support that is available for other screening programmes. This study gives a realistic representation of the implementation of surveillance in a UK hospital at the current time and of the rates of HCC proceeding to treatment.

Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza.

BACKGROUND: : Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions. AIM: : Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making. DESIGN: : We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-11 influenza pandemic. METHODS: Inclusion criteria: patients ≥18 years, with PCR confirmed H1N1 influenza. Exclusion criteria: died in the emergency department or case notes unavailable. Successful discharge was defined as discharge within 24 h of presentation and no readmission within 7 days. RESULTS: Eighty-six patients were included and 16 were successfully discharged. Estimated P/F ratio and C-reactive protein predicted safe discharge in a multivariable logistic regression model (AUC 0.883). A composite univariate predictor (estimated P/F minus C-reactive protein, AUC 0.877) was created to calculate specific cut off points for sensitivity and specificity. A pragmatic decision tool was created to incorporate these thresholds and relevant guidelines. Discharge: SpO 2 (in air) ≥ 94% and CRP <50. Observe: SpO 2 ≥ 94% and CRP >50 or SpO 2 ≤ 93% and CRP <50. Admit: SpO 2 ≤ 93% and CRP >50. CONCLUSIONS: We identified that oxygen exchange and CRP, a marker of acute inflammation, were the most important predictors of safe discharge. Our proposed simple triage model requires validation but has the potential to aid clinical decisions in the event of a future pandemic, and potentially for seasonal influenza.

Optimal threshold for birth weight discordance: Does knowledge of chorionicity matter?

OBJECTIVE: To establish the optimal threshold of birth weight discordance (BWD) for prediction of stillbirth, perinatal mortality and morbidity in twins born in British Columbia with or without chorionicity information. STUDY DESIGN: This is a retrospective population-based cohort study of twins born in British Columbia from 2000 to 2010. Data from one hospital was used to adjust for chorionicity. Multivariate generalized estimating equation and receiver operating characteristic curve analyses were performed to evaluate the predictability of BWD in comparison with other fetal anthropometric measurements. Positive likelihood ratio is used to estimate test accuracy. Survival analysis was conducted to take gestational age and other confounders into account. RESULTS: We analyzed two cohorts, with (pairs=1493) and without (pairs=6328) chorionicity information, of which 1.5% experienced stillbirth, 2.9% suffered perinatal mortality and 22.6% identified with perinatal morbidities. BWD was a significant predictor of stillbirth. Standard receiver operating characteristic curve analysis and survival analysis suggested that BWD of ⩾30% is the optimal thresholds for stillbirth and perinatal mortality irrespective of chorionicity. However, the P-value for predictive accuracy of BWD was nonsignificant for perinatal morbidity, after adjusting for confounding variables engaging multivariate analysis. Sex discordance can be used as a proxy for chorionicity. CONCLUSION: BWD is a good predictor for stillbirth. A BWD cutoff limit of 30% and higher has optimal accuracy for detecting perinatal mortality.

[Spanish adaptation and diagnostic validity of the Yale Global Tics Severity Scale]. / Adaptación al español y validez diagnósticade la Yale Global Tics Severity Scale.

AIM: The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global Tics Severity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument for quantifying the clinical evolution of patients with Tourette syndrome. PATIENTS AND METHODS: Analysis of the properties of the adapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis), internal consistency (Cronbach's alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change (Wilcoxon rank sum test). RESULTS: The factor analysis confirmed the existence of two dimensions on the scale, which account for 76.3% of the variability. The internal consistency, measured by Cronbach's alpha, was 0.997 for the motor tic dimension and 0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to or greater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the global scores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for the first interview (incorporation into the study group) and the second one (after 15 days' treatment). CONCLUSIONS: The Spanish version of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity and reliability is greater in the motor and phonic tic dimensions than in that of disability.

Adaptación al español y validez diagnóstica de la Yale Global Tics Severity Scale / Spanish adaptation and diagnostic validity of the yale global tics severity scale

El instrumento de medida habitualmente utilizado para valorar la gravedad clínica del síndrome deTourette es la Yale Global Tics Severity Scale (YGTSS), originariamente escrita en inglés, y no existe una versión validada enespañol que permita su aplicación directa a los pacientes hispanohablantes. Objetivo. Analizar las propiedades psicométricasde la versión de la YGTSS, traducida al español, y su sensibilidad para medir cambios, como instrumento para cuantificar laevolución en pacientes con síndrome de Tourette. Pacientes y métodos. El análisis versa sobre la validez del concepto (análisisfactorial de componentes principales), consistencia interna (alfa de Cronbach), fiabilidad intraobservadores (coeficientede correlación intraclase) y sensibilidad al cambio (test de rangos de Wilcoxon). Resultados. El análisis factorial confirmó laexistencia de dos dimensiones en la escala, que explican el 76,3% de la variabilidad. La consistencia interna fue de 0,997 parala dimensión tics motores, y de 0,996 para la dimensión tics fónicos. La fiabilidad intraobservadores fue igual o superior a0,95, tanto en los 10 ítems referidos a los tics (motores y fónicos) como en el ítem de discapacidad. En las puntuaciones globalesde tics motores, tics fónicos y discapacidad, hubo diferencias estadísticamente significativas entre la media de puntuaciónentre la primera entrevista (entrada en el estudio) y la segunda entrevista (a los 15 días de tratamiento). Conclusiones.La adaptación efectuada al español de la YGTSS cumple adecuadamente las tres propiedades psicométricas en nuestra poblaciónde estudio. La validez y fiabilidad es mayor en las dimensiones de tics motores y fónicos que en la discapacidad

The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global TicsSeverity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument forquantifying the clinical evolution of patients with Tourette syndrome. Patients and methods. Analysis of the properties of theadapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis),internal consistency (Cronbach’s alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change(Wilcoxon rank sum test). Results. The factor analysis confirmed the existence of two dimensions on the scale, which account for76.3% of the variability. The internal consistency, measured by Cronbach’s alpha, was 0.997 for the motor tic dimension and0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to orgreater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the globalscores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for thefirst interview (incorporation into the study group) and the second one (after 15 days’ treatment). Conclusions. The Spanishversion of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity andreliability is greater in the motor and phonic tic dimensions than in that of disability

Infección de HIV, hepatitis C y tuberculosis auto referida en una cárcel de Andalucía, 1999 / HIV, Hepatitis C and tuberculosis self reported infectionin an Andalusian prison, 1999

Objetivos: Conocer la incidencia de afectados por el virus de inmunodeficiencia humana, hepatitis C y tuberculosis enuna prisión andaluza, según autoinformes, analizar los posibles factores asociados y determinar el conocimiento de sus formasde transmisión.Métodos: Estudio transversal, llevado a cabo en una cárcel de Andalucía durante el año 1999. Se escogieron al azar del listadogeneral de internos 450 participantes, siendo que ninguno rechazó participar en el estudio. Los datos se recogieron apartir de un cuestionario sobre situación penitenciaria, salud, consumo de drogas y conocimiento sobre riesgo de infecciónde HIV, VHC y TBC.Resultados: La muestra se compone de 450 personas, en su mayoría hombres (90,4%), con una edad media de 32,19 años. El19,1% de los reclusos dijeron que eran seropositivos para HIV, el 2,7% que tenían tuberculosis y el 18,2% que tenían hepatitis C.Existe un mayor conocimiento sobre las forma de transmisión del HIV y menor sobre la tuberculosis. Los modelos de regresiónindican que quienes cumplen una condena mayor a cinco años y han estado más de una vez en prisión, consumían heroína en lacalle y han estado en tratamiento con metadona tienen una mayor probabilidad de declararse HIV o VHC positivos.Conclusiones: La prevalencia declarada de hepatitis C en los reclusos es muy inferior a la esperada. Las altas puntuacionesobtenidas en las escalas de conocimiento de transmisión de las afecciones por parte de quienes las padecen apoyan la utilizaciónde la estrategia de iguales para promoción de la salud en las prisiones (AU)

Objectives: To investigate the prevalence of HIV, hepatitis C and tuberculosis, by means of self reports amongst prisonersin an Andalusian prison, analyse possible associated factors, and to evaluate current knowledge about the transmissionof these diseases.Methods: Cross-sectional study, carried out in an Andalusian prison in 1999. Four hundred and fifty participants werechosen at random from the general inmate list. None of them refused to participate in the study. Data was collected using aquestionnaire about the prison situation, health, drug consumption, and risk behaviour awareness.Results: The sample consisted of 450 inmates, 90,4% male, with a mean age of 32.19 years old. In this sample, 19.1% ofthe inmates stated that they were HIV positive, 2.7% that they had tuberculosis and 18.2% hepatitis C. Participants showedmore awareness of HIV and less of tuberculosis risk behaviours. Participants undergoing a sentence of more than five years,with more than one entry in prison, with a history of heroin consumption in the street, and who had received methadonemaintenance treatment presented the highest probabilities of stating that they had hepatitis C and HIV respectively.Conclusions: Declared prevalence of hepatitis C in prisoners was lower than expected. The high scores obtained in thescales of awareness of HIV, hepatitis C and tuberculosis transmission risk behaviours by those who report these diseases supportthe use of peer intervention for health promotion in prisons (AU)

Los programas de tratamiento con metadona: situación real e ideal, definida por profesionales de Andalucía / The methadone maintenance programs: real and ideal situation, definition by Andalucia´s professionals

Objetivos. Se explora la situación actual de los programas de tratamiento con metadona (PTM) en Andalucía, definida por los profesionales implicados y cómo ellos valoran que dicho programa debiera ser en términos de excelencia. Para ello se ofrecen propuestas y medidas de mejora con las que acercar las situaciones descritas. Material y métodos. Reunión de expertos articulada con una variante del grupo nominal. Participaron 9 profesionales. Resultados. La situación ideal y en términos de excelencia de los PTM no concuerda en buena parte de sus cláusulas con la realidad actual de estas intervenciones. Los aspectos más destacados sobre cómo debieran ser los PTM son la dispensación, la agilidad y rapidez de los programas, junto a la existencia de una buena coordinación entre los recursos. La descripción y valoración de la situación actual de los PTM es menos favorable con rela ción a la situación ideal definida por los asistentes. Se recogen y puntúan propuestas y medidas de mejora con las que acercar ambas situaciones. Conclusiones. Aunque los PTM sean intervenciones de eficacia comprobada por la evidencia científica, son susceptibles de mejora. Para ello recoger la voz de los protagonistas directos en estas prácticas es importante para asegurar su continuidad y dotarlos de mayor calidad

Objectives. This study explores the methadone maintenance programs (MMPs) currently offered in Andalucia based on the opinions of providers involved, as well as their views on how these programs should be organised to achieve excelence. In order to advance towards this goal, proposals and measures for improvement are also provided. Material and methods. Experts' consensus meeting (9 providers) based on an adaptation of the nominal group technique. Results. there is a lack of concordance between the ideal situation of the MMPs in terms of excelence and the real situation of current service provision. The most relevant components of an ideal MMP were dispensing procedures, steadiness and rapidity in program provision, and good coordination across available resources. Description and assessment of the actual situation was less favourable when compared with the ideal situation as defined by participants. Proposals and measures for program improvement to approach both situations were also gathered. Conclusions. Although available scientific evidence has proved the efficiency of MMT programs, there is still room for improvement. Therefore, it is important to gather the views of the main actors in order to ensure the continuity of existing programs and to improve their quality

Infección de HIV, hepatitis C y tuberculosis auto referida en una cárcel de Andalucía, 1999 / HIV, Hepatitis C and tuberculosis self reported infection in an Andalusian prison, 1999

Objetivos: Conocer la incidencia de afectados por el virus de inmunodeficiencia humana, hepatitis C y tuberculosis en una prisión andaluza, según autoinformes, analizar los posibles factores asociados y determinar el conocimiento de sus formas de transmisión.Métodos: Estudio transversal, llevado a cabo en una cárcel de Andalucía durante el año 1999. Se escogieron al azar del listado general de internos 450 participantes, siendo que ninguno rechazó participar en el estudio. Los datos se recogieron a partir de un cuestionario sobre situación penitenciaria, salud, consumo de drogas y conocimiento sobre riesgo de infección de HIV, VHC y TBC.Resultados: La muestra se compone de 450 personas, en su mayoría hombres (90,4%), con una edad media de 32,19 años. El 19,1% de los reclusos dijeron que eran seropositivos para HIV, el 2,7% que tenían tuberculosis y el 18,2% que tenían hepatitis C. Existe un mayor conocimiento sobre las forma de transmisión del HIV y menor sobre la tuberculosis. Los modelos de regresiónindican que quienes cumplen una condena mayor a cinco años y han estado más de una vez en prisión, consumían heroína en la calle y han estado en tratamiento con metadona tienen una mayor probabilidad de declararse HIV o VHC positivos.Conclusiones: La prevalencia declarada de hepatitis C en los reclusos es muy inferior a la esperada. Las altas puntuaciones obtenidas en las escalas de conocimiento de transmisión de las afecciones por parte de quienes las padecen apoyan la utilización de la estrategia de iguales para promoción de la salud en las prisiones

Objectives: To investigate the prevalence of HIV, hepatitis C and tuberculosis, by means of self reports amongst prisoners in an Andalusian prison, analyse possible associated factors, and to evaluate current knowledge about the transmission of these diseases.Methods: Cross-sectional study, carried out in an Andalusian prison in 1999. Four hundred and fifty participants were chosen at random from the general inmate list. None of them refused to participate in the study. Data was collected using a questionnaire about the prison situation, health, drug consumption, and risk behaviour awareness.Results: The sample consisted of 450 inmates, 90,4% male, with a mean age of 32.19 years old. In this sample, 19.1% of the inmates stated that they were HIV positive, 2.7% that they had tuberculosis and 18.2% hepatitis C. Participants showed more awareness of HIV and less of tuberculosis risk behaviours. Participants undergoing a sentence of more than five years,with more than one entry in prison, with a history of heroin consumption in the street, and who had received methadone maintenance treatment presented the highest probabilities of stating that they had hepatitis C and HIV respectively.Conclusions: Declared prevalence of hepatitis C in prisoners was lower than expected. The high scores obtained in the scales of awareness of HIV, hepatitis C and tuberculosis transmission risk behaviours by those who report these diseases support the use of peer intervention for health promotion in prisons

Complications following endovascular abdominal aortic aneurysm repair.

There is a growing population of patients who have undergone endovascular abdominal aortic aneurysm repair (EVAR) and thus there is an increasing likelihood that radiologists who are unfamiliar with this technique and its complications will have to report radiological investigations on one of these patients. The purpose of this review is to describe and illustrate the normal and abnormal radiological appearances after EVAR on plain radiography, ultrasound and CT.

Aortic side branch embolization before endovascular aneurysm repair: incidence of type II endoleak.

PURPOSE: To assess the feasibility of embolization of aortic side branches and its impact on the incidence of type II endoleak after endovascular aneurysm repair. MATERIALS AND METHODS: Endovascular aneurysm repair was performed in 74 patients. Aortic side branch vessels were evaluated on the preoperative angiogram and computed tomography (CT) and, where embolization of lumbar and inferior mesenteric vessels was considered technically possible, this was attempted prior to endovascular repair. Follow-up CT was used to assess the presence of type II endoleak. RESULTS: Seventy-two patients were followed up for longer than 1 month. Embolization was attempted in 25 cases, successfully in 10, with partial success in 11, and failure in four. Twenty patients with successful or partly successful preoperative embolization were discharged and followed-up. Four (20%) had demonstrable type II endoleak during follow-up, with two of these persisting at latest follow-up. Of 43 patients without previous embolization, there were 10 (23.3%) type II endoleaks during the follow-up period, four of these persisting. In cases with type II endoleak, mean sac diameter change was -0.5 mm in the cases with previous embolization and +3.1 mm without. The mean period to onset of type II endoleak was 6.9 months without, and 15.3 months with, previous embolization. CONCLUSION: Although the cohort size is below a level that would confer significance, the trend of these findings is such as to suggest a lack of influence of aortic side branch embolization on the incidence of type II endoleak during the follow-up period.

Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation.

This case presents the imaging features of a posterior shoulder dislocation complicated by a rare but surgically relevant lesion of the posterior labrum. Due to the attachment of the posterior capsule to the posterior portion of the labrum, which in itself is attached to the posterior scapular periosteum, stripping of the labrum by the posterior capsule resulted in a posterior labrocapsular periosteal sleeve avulsion.

Protection against immune haemolytic disease of newborn infants by maternal monocyte-reactive IgG alloantibodies (anti-HLA-DR).

The extent to which maternal anti-Rh(D) antibodies support lysis of erythrocytes by monocytes in the antibody-dependent cell-mediated cytotoxicity (ADCC) assay is closely correlated with the severity of Rh(D) haemolytic disease of the newborn infant (HDN). However, in some cases HDN is much milder than would be predicted from the ADCC value. We postulated that maternal ADCC-blocking alloantibodies against paternal antigens on monocytes can protect these infants against severe haemolysis. We studied 13 severely Rh(D)-alloimmunised mothers whose infants showed unexpectedly mild HDN (group I) and 14 women with similar ADCC values but whose infants had severe HDN (group II). 7 group-I women had monocyte-reactive IgG alloantibodies that inhibited lysis by paternal monocytes in the ADCC. No such antibodies were found in group II (p less than 0.01). In 6 of the 7 serum samples with monocyte-reactive antibodies, the antibodies had HLA-DR specificity. Our findings suggest that Rh(D)-positive children of some severely Rh(D)-alloimmunised women may be protected from severe HDN by maternal non-HLA-class-I, IgG alloantibodies against paternal monocyte blood-group antigens. These antibodies may inhibit the mononuclear phagocyte system of the fetus.