The electronic nose as a rule-out test for tuberculosis in an indigenous population.

INTRODUCTION: To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS: A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS: 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION: The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.

The Practice of Paediatric Radiation Oncology in Low- and Middle-income Countries: Outcomes of an International Atomic Energy Agency Study.

AIMS: Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' MATERIALS AND METHODS: A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. RESULTS: Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. CONCLUSIONS: Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. In many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. In some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients.

The design and methodology of a usability protocol for the management of medications by families for aging older adults.

BACKGROUND: Health research apps often do not focus on usability as a design priority. This is problematic when the population of interest is disproportionately underrepresented as users of mobile apps, especially observed with aging older adults (> = 75). Challenges with the adoption of health information technology (HIT) among this group are exacerbated by poor design and user interface/experience (UI/UX) choices. This protocol describes the testing and evaluation process of one HIT app for the family-based collaboration platform InfoSAGE. METHODS: We aim to recruit twenty subjects from both informal family-caregivers and aging older adults to examine the usability of the InfoSAGE mobile medication manager. Participants will be audio and visually recorded, in addition to the use of screen capture recordings, while 'thinking aloud' as they complete eight common use-case scenarios. Multiple independent reviewers will code video and audio recordings for thematic analysis and use problems will be evaluated. Success and failure of each scenario will be determined by completion of sub-events. Time-to-complete analysis will be used to ascertain the learning curve associated with the app. DISCUSSION: Frequently observed problem areas will be used as the basis of further evolution of the app, and will further inform generalized recommendations for the design of HIT apps for research and public use. This study aims to improve the model of development for dual user populations with dissimilar technological literacy to improve retention and use. Results of this study will form the foundation of a design framework for mobile health apps.

Early parathyroid MIBI SPECT imaging in the diagnosis of persistent hyperparathyroidism.

We present a case that demonstrates the utility of early SPECT images associated with fusion images with MRI for presurgical localization in a case of persistent hyperparathyroidism after a first surgery. Three years after that surgery, severe hypercalcemia (14.7 mg/dL) and elevated parathormone (PTH) (944 pg/mL) were detected. MRI and SPECT parathyroid scintigraphy showed an abnormal parathyroid lesion localized behind the inferior pole of the thyroid right lobe. At surgical reexploration a right inferior parathyroid adenoma was removed (258 mg). However, intraoperative PTH remained high and a total thyroidectomy was performed looking for an intrathyroid lesion. After that, the elevated PTH persisted and an ectopic parathyroid gland was identified in the tracheoesophageal groove (958 mg), corresponding with the lesion seen on the fusion image of MRI and SPECT. After removal of this lesion, the PTH dropped to 85%.

Respuesta a la TEC en un caso de trastorno explosivo intermitente refractario / Effect of ECT on a case of intermitent explosive disorder, refractory of pharmacological treatments

Introducción: El trastorno explosivo intermitente se manifiesta como una historia de episodios de pérdida de control de impulsos agresivos, con violencia o destrucción de la propiedad. El caso que presentamos tuvo una evolución atípica, por su gravedad clínica, la asociación con clínica obsesivo-compulsiva y su refractariedad a los tratamientos convencionales. Caso clínico: Se trata de un paciente varón de 35 años, que presentaba desde los 18 años crisis de agitación muy importantes, con destrucción de objetos, ante mínimas contrariedades. Presentaba, además, sintomatología obsesivo-compulsiva, con rituales de limpieza y perfeccionismo. El tratamiento farmacológico con potenciadores de la vía serotoninérgica, clozapina y diversos eutimizantes, resultó inefectivo. Finalmente, la asociación de la terapia electro-convulsiva logró controlar los episodios de agitación. Conclusiones: La literatura acerca del tratamiento con TEC de este síndrome se limita a series de casos. La gravedad clínica del caso motivó que se pautara dicha técnica, con buen resultado

Introduction: IED (intermittent explosive disorder) is a condition which makes people lash out violently for no reason; the person loses control suddenly and brakes or smashes something. The reported case showed atypical evolution due to its clinical condition such as an obsessive compulsive behavior and its resistance to common treatment. Clinical case: Since age eighteen, a thirty five-year old man had disproportionate reactions to any provocation, also showing obsessive compulsive symptoms characterized by repeated patterns of cleaning and perfectionism. He was treated pharmacologically with serotonin reuptake inhibitors (SRI), clozapine (antipsychotic) and other mood-stabilizers, thus resulting ineffective. Electro-convulsive therapy (ECT) finally controlled the violent outbursts. Conclusion: Information including ECT on this type of disorder limits to certain cases. The seriousness of the case encouraged specialists to employ this technique resulting in successful outcome (AU)

Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador.

In developing countries, continuing education for healthcare staff may be limited by staff shortages and lack of sophisticated means of delivery. These limitations have implications for compliance with an important infection control practice, namely good hand hygiene. A comparison was made between the efficacy of two educational tools commonly used in healthcare and practical sanitation settings in developing countries, i.e. videotapes and flipcharts, in delivering hand hygiene education to 67 nurses in a paediatric hospital in El Salvador. Efficacy was measured on the basis of scores obtained in pre- and post-training tests consisting of 10 multiple-choice questions. Half of the nurses received video-based instruction and half received instruction via flipcharts. Both methods of instruction increased participants' knowledge of good hand hygiene, and the extent of knowledge acquisition by the two methods was similar. Feedback obtained from flipchart users six months after training indicated that most of the respondents used the flipchart to teach hand hygiene to patients' families (62.5%), patients (50%) and healthcare workers (43.8%). Flipchart users ranked flipcharts as their favourite educational tool. Flipcharts offer an economical, easy-to-use, non-technological yet effective alternative to videotapes for delivering education in developing countries. Although the use of flipcharts requires a skilled and well-trained instructor, flipcharts could be used more widely to deliver education in resource-poor settings.

Monogeneans on native and introduced freshwater fishes from Cuba with the description of a new species of Salsuginus Beverley-Burton, 1984 from Limia vittata (Poeciliidae).

During a parasitological survey carried out between March and September 2003 in Cuba, the following monogeneans were found on the gills of freshwater fishes: Salsuginus cubensis n. sp. on the Cuban molly Limia vittata Guichenot (Poeciliidae); Cichlidogyrus sclerosus Paperna & Thurston, 1969 and C. tilapiae Paperna, 1960 on the African cichlid Tilapia rendalli Boulenger (Cichlidae); Haplocleidus dispar Mueller, 1936 and Pterocleidus acer Mueller, 1936 (all Dactylogyridae) on the sunfish Lepomis macrochirus Rafinesque (Centrarchidae) (new geographical records); and Gyrodactylus sp. (Gyrodactylidae) on the biajaca Nandopsis tetracanthus Valenciennes (Cichlidae) (new host and geographical record). Salsuginus cubensis differs from all other species of the genus in the size and morphology of the copulatory complex. The occurrence of C. sclerosus, C. tilapiae, H. dispar and P. acer in their respective hosts is due to the introduction of these hosts to Cuba. A review of the species composition of the Monogenea in native and introduced freshwater fish from Cuba is presented and the zoogeographical distribution of the species found is briefly discussed.

Preventive health information on the Internet. Qualitative study of consumers' perspectives.

OBJECTIVE: To explore how best to make high-quality preventive health information available to consumers on the Internet. DESIGN: Focus groups. SETTING: Three urban workplaces and one local hospital with patients from a rural family medical practice. PARTICIPANTS: Twenty-two men and 17 women patients. METHOD: Qualitative survey of four focus groups, analysis of transcripts and researchers' notes. MAIN FINDINGS: Five themes characterized participants' perceptions of a consumer website of evidence-based preventive guidelines: content expectations, website design, trustworthiness of content, marketing, and the implications of consumer health information on the Internet. CONCLUSION: Consumers want preventive health information both for taking care of themselves and for participating in a more informed way in their health care when they see a physician. Findings of this study reveal some ways in which consumers' use of Internet health information can affect physicians' and other health professionals' work.

Evidence-based preventive practice guidelines. Qualitative study of useful resources on the Internet.

OBJECTIVE: To explore family physicians' perspectives on how best to provide evidence-based preventive clinical practice guidelines (CPGs) to physicians on the Internet. DESIGN: Focus groups. SETTING: A large, urban centre and a rural community hospital. PARTICIPANTS: Thirty-four of more than 150 family physicians who subscribed to an e-mail discussion group. METHOD: Qualitative survey of four focus groups, analysis of transcripts and researchers' notes. MAIN FINDINGS: Four themes characterized participants' preferences for disseminating preventive CPGs on the Internet: content expectations; quick, easy access to information; trustworthiness of information; and implications for clinical practice. CONCLUSION: Physicians want quick, easy access to trustworthy information. A website for preventive CPGs with these characteristics would be a useful resource.

Intelligent medical information filtering.

This paper describes an intelligent information filtering system to assist users to be notified of updates to new and relevant medical information. Among the major problems users face is the large volume of medical information that is generated each day, and the need to filter and retrieve relevant information. The Internet has dramatically increased the amount of electronically accessible medical information and reduced the cost and time needed to publish. The opportunity of the Internet for the medical profession and consumers is to have more information to make decisions and this could potentially lead to better medical decisions and outcomes. However, without the assistance from professional medical librarians, retrieving new and relevant information from databases and the Internet remains a challenge. Many physicians do not have access to the services of a medical librarian. Most physicians indicate on surveys that they do not prefer to retrieve the literature themselves, or visit libraries because of the lack of recent materials, poor organisation and indexing of materials, lack of appropriate and available material, and lack of time. The information filtering system described in this paper records the online web browsing behaviour of each user and creates a user profile of the index terms found on the web pages visited by the user. A relevance-ranking algorithm then matches the user profiles to the index terms of new health care web pages that are added each day. The system creates customised summaries of new information for each user. A user can then connect to the web site to read the new information. Relevance feedback buttons on each page ask the user to rate the usefulness of the page to their immediate information needs. Errors in relevance ranking are reduced in this system by having both the user profile and medical information represented in the same representation language using a controlled vocabulary. This system also updates the user profiles, automatically relieving this burden from the user, but also allowing the user to explicitly state preferences. An initial evaluation of this system was done with health consumers using a web site on consumer health. It was found that users often modified their criteria for what they considered relevant not only between browsing sessions but also during a session. A user's criteria for what is relevant is constantly changing as they interact with the information. New revised metrics of recall and precision are needed to account for the partially relevant judgements and the dynamically changing criteria of users. Future research, development, and evaluation of interactive information retrieval systems will need to take into account the users' dynamically changing criteria of relevance.

Early childhood caries and risk factors in rural Puerto Rican children.

A sample of 167 Puerto Rican children whose ages ranged from six months to forty-seven months (mean = 23 months) were studied. Children were examined for Early Childhood Caries with light and mirror and a structured interview was administered to parents and caretakers to identify risk factors. Results indicated that only 37.4 percent of the children were free of decalcification lesions or frank decay. While 53.9 percent of the children had lesions on maxillary incisors, 40.0 percent had molars affected by decalcification lesions and caries. Analysis of risk factors indicate that giving the baby a bottle when crying at night, number of adults and children in the family, use of fluoridated dentifrice, and age of the child were associated with the caries process in these children. Bottle and breast feeding, per se, were not risk factors. Disease patterns suggest other dietary risk factors, such as frequent snacking on food/drinks with sugar.