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1.
BMC Infect Dis ; 20(1): 720, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004004

RESUMO

BACKGROUND: Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. METHOD: Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6-14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. RESULTS: At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). CONCLUSION: About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.


Assuntos
Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Características da Família , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Escarro/microbiologia , Teste Tuberculínico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
2.
Rev Soc Bras Med Trop ; 53: e20200104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027414

RESUMO

INTRODUCTION: Gene-Xpert MTB RIF (Xpert) is based on nucleic acid amplification by real-time polymerase chain reaction, which allows for the identification of Mycobacterium tuberculosis and rifampin resistance. We describe the use of Xpert for extrapulmonary tuberculosis (EPTB) in children and adolescents. METHODS: A case series of two reference centers in Rio de Janeiro from 2014-2019. RESULTS: The final diagnosis of EPTB was established in 11/36 (31%) patients, with five cases detectable by Xpert. For lymph node evaluation (9/11), diagnosis by Xpert occurred in 5/9 patients, all with caseous aspects. CONCLUSIONS: Xpert can facilitate the rapid diagnosis of lymph node tuberculosis.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Técnicas de Amplificação de Ácido Nucleico , Rifampina
3.
Rev Assoc Med Bras (1992) ; 66(9): 1196-1202, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027445

RESUMO

OBJECTIVE: To describe the temporal trend, clinical profile, and the prevalence of risk factors and associated comorbidities in new cases of tuberculosis in the Northeast (2001-2016). METHODS: A prevalence study involving all tuberculosis cases registered in Northeast Brasil, 2001-2016. Data were obtained from the National System of Notification of Disorders. For statistical analysis, the inflection point regression model and descriptive statistics were used. RESULTS: 331,245 cases of tuberculosis were reported. The overall incidence rate decreased from 44.84/100,000 inhabitants (2001) to 30.92/100,000 inhabitants (2016), with a decreasing trend (AAPC: -2.3; p<0.001). The profile was characterized by men (73.53%), age 20-59 years (73.56%), pulmonary tuberculosis (86.37%), positive smear microscopy (54.78%). The main risk factors and comorbidities were: AIDS (4.64%), HIV (12.10%), Diabetes mellitus (5.46%), alcohol (11.63%), institutionalized, (4.31%) and deprived of liberty (2.30%). The cure rate was 70.66% and the abandonment rate was 9.11%. CONCLUSIONS: Even with a reduced incidence, tuberculosis represents a real public health problem in the Northeast region. The profile was characterized by a male population, in economically-active age, lung smear-positive pulmonary presentation, and the risk factors and comorbidities of Aids, TB/HIV co-infection, diabetes mellitus, alcohol consumption, institutionalized and deprived of freedom reflect the complexity of the challenges in facing the disease.


Assuntos
Tuberculose , Adulto , Brasil , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tuberculose/epidemiologia , Adulto Jovem
4.
BMC Infect Dis ; 20(1): 738, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028260

RESUMO

BACKGROUND: In accordance with international guidance for tuberculosis (TB) prevention, the Tanzanian Ministry of Health recommends isoniazid preventive therapy (IPT) for children aged 12 months and older who are living with HIV. Concerns about tolerability, adherence, and potential mistreatment of undiagnosed TB with monotherapy have limited uptake of IPT globally, especially among children, in whom diagnostic confirmation is challenging. We assessed IPT implementation and adherence at a pediatric HIV clinic in Tanzania. METHODS: In this prospective cohort study, eligible children living with HIV aged 1-15 years receiving care at the DarDar Pediatric Program in Dar es Salaam who screened negative for TB disease were offered a 6-month regimen of daily isoniazid. Patients could choose to receive IPT via facility- or community-based care. Parents/caregivers and children provided informed consent and verbal assent respectively. Isoniazid was dispensed with the child's antiretroviral therapy every 1-3 months. IPT adherence and treatment completion was determined by pill counts, appointment attendance, and self-report. Patients underwent TB symptom screening at every visit. RESULTS: We enrolled 66 children between July and December 2017. No patients/caregivers declined IPT. Most participants were female (n = 43, 65.1%) and the median age was 11 years (interquartile range [IQR] 8, 13). 63 (95.5%) participants chose the facility-based model; due to the small number of participants who chose the community-based model, valid comparisons between the two groups could not be made. Forty-nine participants (74.2%) completed IPT within 10 months. Among the remaining 17, 11 had IPT discontinued by their provider due to adverse drug reactions, 5 lacked documentation of completion, and 1 had unknown outcomes due to missing paperwork. Of those who completed IPT, the average monthly adherence was 98.0%. None of the participants were diagnosed with TB while taking IPT or during a median of 4 months of follow-up. CONCLUSIONS: High adherence and treatment completion rates can be achieved when IPT is integrated into routine, self-selected facility-based pediatric HIV care. Improved record-keeping may yield even higher completion rates. IPT was well tolerated and no cases of TB were detected. IPT for children living with HIV is feasible and should be implemented throughout Tanzania.


Assuntos
Antituberculosos/uso terapêutico , Infecções por HIV/patologia , Isoniazida/uso terapêutico , Tuberculose/prevenção & controle , Adolescente , Instituições de Assistência Ambulatorial , Antirretrovirais/uso terapêutico , Cuidadores/psicologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Adesão à Medicação , Cooperação do Paciente , Estudos Prospectivos , Tanzânia , Resultado do Tratamento
5.
Mem Inst Oswaldo Cruz ; 115: e200229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33053077

RESUMO

Malaria and tuberculosis are no longer considered to be neglected diseases by the World Health Organization. However, both are huge challenges and public health problems in the world, which affect poor people, today referred to as neglected populations. In addition, malaria and tuberculosis present the same difficulties regarding the treatment, such as toxicity and the microbial resistance. The increase of Plasmodium resistance to the available drugs along with the insurgence of multidrug- and particularly tuberculosis drug-resistant strains are enough to justify efforts towards the development of novel medicines for both diseases. This literature review provides an overview of the state of the art of antimalarial and antituberculosis chemotherapies, emphasising novel drugs introduced in the pharmaceutical market and the advances in research of new candidates for these diseases, and including some aspects of their mechanism/sites of action.


Assuntos
Antimaláricos/uso terapêutico , Antituberculosos/uso terapêutico , Malária/tratamento farmacológico , Tuberculose/tratamento farmacológico , Humanos , Malária/diagnóstico , Doenças Negligenciadas , Tuberculose/diagnóstico
7.
BMC Public Health ; 20(1): 1557, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066742

RESUMO

BACKGROUND: Tuberculosis (TB) is one of the major infectious diseases that seriously endanger people's health. In Shandong province, the relationship between the level of economic development and TB incidence has not been studied. This study aims to provide more research basis for the government to prevent and control TB by exploring the impact of different economic factors on TB incidence. METHODS: By constructing threshold regression model (TRM), we described the extent to which different economic factors contribute to TB registered incidence and differences in TB registered incidence among seventeen cities with different levels of economic development in Shandong province, China, during 2006-2017. Data were retrieved from the China Information System for Disease Control and Prevention. RESULTS: Per capita medical expenditure (regression coefficient, -0.0314462; SD, 0.0079305; P > |t|, 0.000) and per capita savings (regression coefficient, 0.0001924; SD, 0.0000566; P > |t|, 0.001) passed the significance test at the level of 1%.They are the two economic indicators that have the greatest impact on TB registered incidence. Through the threshold test, we selected the per capita savings as the threshold variable. In the three stages of per capita savings (<9772.8086 China Yuan(CNY); 9772.8086-33,835.5391 CNY; >33,835.5391 CNY), rural per capita income always has a significant negative impact on the TB registered incidence (The regression coefficients are - 0.0015682, - 0.0028132 and - 0.0022253 respectively. P is 0.007,0.000 and 0.000 respectively.).In cities with good economies, TB registered incidence was 38.30% in 2006 and dropped to 25.10% by 2017. In cities with moderate economies, TB registered incidence peaked in 2008 at 43.10% and dropped to 27.1% by 2017.In poorer cities, TB registered incidence peaked in 2008 at 56.30% and dropped to 28.9% in 2017. CONCLUSION: We found that per capita savings and per capita medical expenditure are most closely related to the TB incidence. Therefore, relevant departments should formulate a more complete medical system and medical insurance policy to effectively solve the problem of "difficult and expensive medical treatment". In order to further reduce the TB incidence, in addition to timely and accurate diagnosis and treatment, it is more important for governments to increase investment in medicine and health care.


Assuntos
Desenvolvimento Econômico/estatística & dados numéricos , Tuberculose/epidemiologia , China/epidemiologia , Cidades/epidemiologia , Humanos , Incidência , Sistema de Registros
8.
J Cardiothorac Surg ; 15(1): 290, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008483

RESUMO

BACKGROUND: Pulmonary arteriovenous malformations are uncommon conditions of abnormal communications between pulmonary arteries and veins, which are most commonly congenital in nature. Although such condition is not extremely rare, it is a challenge to the differential diagnosis of pulmonary problems such as hypoxemia and pulmonary lesions. CASE PRESENTATION: We report a meaningful case of a 23-year-old male presented with elevated hemoglobin (23.0 g/dl) on admission. Physical examination revealed cyanosis, digital clubbing and low oxygen saturation on room air. The patient was initially diagnosed as polycythemia vera while the subsequent result of bone marrow aspiration was negative. During further assessment, pulmonary arteriovenous malformations were detected by CT pulmonary angiography. Lobectomy was successfully performed with significant increase in oxygen saturation from 86 to 98%. The hemoglobin decreased to almost normal level of 14.9 g/dl 3 months after surgery and the patient had been followed up for nearly 5 years. CONCLUSIONS: Pulmonary arteriovenous malformations should be suspected in patients with central cyanosis, digital clubbing, polycythemia, pulmonary lesion and without cardiac malformations. Embolization or surgery is strongly recommended to reduce the risks caused by pulmonary arteriovenous malformations.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/anormalidades , Tuberculose/complicações , Fístula Arteriovenosa/complicações , Angiografia por Tomografia Computadorizada , Progressão da Doença , Humanos , Masculino , Pneumonectomia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Adulto Jovem
9.
BMC Infect Dis ; 20(1): 744, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036570

RESUMO

BACKGROUND: The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the twenty-first century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field. However, several gaps remain in the knowledge of the burden of COVID-19 on patients with TB and HIV. This study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB, to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. METHODS: We conducted an electronic search of potentially eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and July, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB in adults. We screened titles, abstracts and full articles for eligibility. Descriptive and meta-analysis were done and results have been presented in graphs and tables. RESULTS: After removing 95 duplicates, 58 out of 437 articles were assessed for eligibility, of which 14 studies were included for descriptive analysis and seven studies were included in the meta-analysis. Compared to the descriptive analysis, the meta-analysis showed strong evidence that current TB exposure was high-risk COVID-19 group (OR 1.67, 95% CI 1.06-2.65, P = 0.03). The pooled of COVID-19/TB severity rate increased from OR 4.50 (95% CI 1.12-18.10, P = 0.03), the recovery rate was high among COVID-19 compared to COVID-19/TB irrespective of HIV status (OR 2.23, 95% CI 1.83-2.74, P < 0.001) and the mortality was reduced among non-TB group (P < 0.001). CONCLUSION: In summary, TB was a risk factor for COVID-19 both in terms of severity and mortality irrespective of HIV status. Structured diagnostic algorithms and clinical management are suggested to improve COVID-19/HIV/TB or COVID-19/TB co-infections outcomes.


Assuntos
Coinfecção/epidemiologia , Infecções por Coronavirus/epidemiologia , Saúde Global/estatística & dados numéricos , Infecções por HIV/epidemiologia , Pneumonia Viral/epidemiologia , Tuberculose/epidemiologia , Betacoronavirus , Infecções por Coronavirus/mortalidade , Humanos , Pandemias , Pneumonia Viral/mortalidade , Prevalência , Sistema de Registros , Fatores de Risco
11.
Global Health ; 16(1): 101, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081805

RESUMO

Corruption is recognized by the global community as a threat to development generally and to achieving health goals, such as the United Nations Sustainable Development Goal # 3: ensuring healthy lives and promoting well-being for all. As such, international organizations such as the World Health Organizations and the United Nations Development Program are creating an evidence base on how best to address corruption in health systems. At present, the risk of corruption is even more apparent, given the need for quick and nimble responses to the COVID-19 pandemic, which may include a relaxation of standards and the rapid mobilization of large funds. As international organizations and governments attempt to respond to the ever-changing demands of this pandemic, there is a need to acknowledge and address the increased opportunity for corruption.In order to explore how such risks of corruption are addressed in international organizations, this paper focuses on the question: How are international organizations implementing measures to promote accountability and transparency, and anti-corruption, in their own operations? The following international organizations were selected as the focus of this paper given their current involvement in anti-corruption, transparency, and accountability in the health sector: the World Health Organization, the United Nations Development Program, the World Bank Group, and the Global Fund to Fight Aids, Tuberculosis and Malaria. Our findings demonstrate that there has been a clear increase in the volume and scope of anti-corruption, accountability, and transparency measures implemented by these international organizations in recent years. However, the efficacy of these measures remains unclear. Further research is needed to determine how these measures are achieving their transparency, accountability, and anti-corruption goals.


Assuntos
Revelação , Fraude/prevenção & controle , Saúde Global/economia , Responsabilidade Social , Nações Unidas , Organização Mundial da Saúde , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Humanos , Malária/prevenção & controle , Tuberculose/prevenção & controle
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1552-1555, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018288

RESUMO

The introduction of deep learning techniques for the computer-aided detection scheme has shed a light for real incorporation into the clinical workflow. In this work, we focus on the effect of attention in deep neural networks on the classification of tuberculosis x-ray images. We propose a Convolutional Block Attention Module (CBAM), a simple but effective attention module for feed-forward convolutional neural networks. Given an intermediate feature map, our module infers attention maps and multiplied it to the input feature map for adaptive feature refinement. It achieves high precision and recalls while localizing objects with its attention. We validate the performance of our approach on a standard-compliant data set, including a dataset of 4990 x-ray chest radiographs from three hospitals and show that our performance is better than the models used in previous work.


Assuntos
Redes Neurais de Computação , Radiografia Torácica , Tuberculose , Humanos , Tuberculose/diagnóstico por imagem
13.
BMC Infect Dis ; 20(1): 734, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028245

RESUMO

BACKGROUND: HIV continues to be the main determinant morbidity with high mortality rates in Sub-Saharan Africa, with a high number of patients being late presenters with advanced HIV. Clinical management of advanced HIV patients is thus complex and requires strict adherence to updated, empirical and simplified guidelines. The current study investigated the impact of the implementation of a new clinical guideline on the management of advanced HIV in Kinshasa, Democratic Republic of Congo (DRC). METHODS: A retrospective analysis of routine clinical data of advanced HIV patients was conducted for the periods; February 2016 to March 2017, before implementation of new guidelines, and November 2017 to July 2018, after the implementation of new guidelines. Eligible patients were patients with CD4 < 200 cell/µl and presenting with at least 1 of 4 opportunistic infections. Patient files were reviewed by a medical doctor and a committee of 3 other doctors for congruence. Statistical significance was set at 0.05%. RESULTS: Two hundred four and Two hundred thirty-one patients were eligible for inclusion before and after the implementation of new guidelines respectively. Sex and age distributions were similar for both periods, and median CD4 were 36 & 52 cell/µl, before and after the new guidelines implementation, respectively. 40.7% of patients had at least 1 missed/incorrect diagnosis before the new guidelines compared to 30% after new guidelines, p < 0.05. Clinical diagnosis for TB and toxoplasmosis were also much improved after the implementation of new guidelines. In addition, only 63% of patients had CD4 count test results before the new guidelines compared to 99% of patients after new guidelines. Death odds after the implementation of new guidelines were significantly lower than before new guidelines in a multivariate regression model that included patients CD4 count and 10 other covariates, p < 0.05. CONCLUSIONS: Simplification and implementation of a new and improved HIV clinical guideline coupled with the installation of laboratory equipment and point of care tests potentially helped reduce incorrect diagnosis and improve clinical outcomes of patients with advanced HIV. Regulating authorities should consider developing simplified versions of guidelines followed by the provision of basic diagnostic equipment to health centers.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , República Democrática do Congo , Feminino , Guias como Assunto , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toxoplasmose/complicações , Toxoplasmose/diagnóstico , Tuberculose/complicações , Tuberculose/diagnóstico , Adulto Jovem
14.
Washington, D.C.; OPS; 2020-10-08.
Não convencional em Espanhol | PAHO-IRIS | ID: phr-52815

RESUMO

La tuberculosis es una de las diez causas principales de muerte en el mundo y representa todavía un importante problema de salud pública en la Región de las Américas. La Región ha avanzado en la prevención y el control de la enfermedad; sin embargo, al ritmo actual de descenso del número de muertes y de la incidencia no se alcanzarán las metas ni los hitos propuestos para poner fin a la epidemia. Por ello, es necesario acelerar los esfuerzos de los países para cumplirlas. Este informe sobre la Tuberculosis en las Américas presenta la situación de la tuberculosis en la Región, así como los avances logrados por los países en la prevención, el diagnóstico, el tratamiento y hacia la eliminación de la enfermedad en el marco de la Estrategia Fin de la TB, de los Objetivos de Desarrollo Sostenible y de los compromisos asumidos en la reunión de alto nivel sobre la tuberculosis celebrada por las Naciones Unidas en el 2018. El documento muestra y analiza datos epidemiológicos y programáticos de la situación de la tuberculosis en la Región, y en él se destacan la detección de casos, el tratamiento preventivo, los resultados del tratamiento, la tuberculosis farmacorresistente, la coinfección por la TB y el VIH, y los grupos en situación de vulnerabilidad, entre otros aspectos. Además, incluye un análisis sobre el financiamiento de la tuberculosis en la Región. Los autores esperan que este informe facilite la comprensión de la situación de la tuberculosis en la Región y sirva de ejemplo para realizar análisis similares en cada uno de los países, con miras a impulsar una mejor toma de decisiones hacia el fin de la tuberculosis.


Assuntos
Tuberculose , América , Saúde Pública , HIV , Objetivos de Desenvolvimento do Milênio , Desenvolvimento Sustentável , Mortalidade
15.
Washington, D.C.; OPS; 2020-10-01. (OPS-W/CDE/HT/20-0036).
em Espanhol | PAHO-IRIS | ID: phr-52783

RESUMO

[Extracto]. La carga de morbilidad y mortalidad asociada con la infección por el VIH ha disminuido a lo largo de los últimos diez años a medida que ha aumentado el acceso al tratamiento antirretroviral. A pesar de este progreso, casi la mitad de las personas con infección por el VIH inician su atención con un cuadro avanzado y muchas siguen muriendo por infecciones oportunistas relacionadas con el VIH. La meningitis criptocócica es una infección oportunista grave que constituye una causa primordial de morbilidad y mortalidad en las personas con infección avanzada por el VIH, y representa cerca del 15% de todas las muertes relacionadas con el sida a nivel mundial. Se estima que, cada año, unos 223.100 casos de meningitis criptocócica causan 181.000 defunciones de personas con infección por el VIH. La criptococosis es poco común en los niños con infección por el VIH, incluso en zonas geográficas con una elevada morbilidad en adultos. [...]


Assuntos
HIV , Tuberculose , Doenças Sexualmente Transmissíveis , Doenças Transmissíveis , Criptococose
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1229-1233, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018209

RESUMO

AIChest4All is the name of the model used to label and screening diseases in our area of focus, Thailand, including heart disease, lung cancer, and tuberculosis. This is aimed to aid radiologist in Thailand especially in rural areas, where there is immense staff shortages. Deep learning is used in our methodology to classify the chest X-ray images from datasets namely, NIH set, which is separated into 14 observations, and the Montgomery and Shenzhen set, which contains chest X-ray images of patients with tuberculosis, further supplemented by the dataset from Udonthani Cancer hospital and the National Chest Institute of Thailand. The images are classified into six categories: no finding, suspected active tuberculosis, suspected lung malignancy, abnormal heart and great vessels, Intrathoracic abnormal findings, and Extrathroacic abnormal findings. A total of 201,527 images were used. Results from testing showed that the accuracy values of the categories heart disease, lung cancer, and tuberculosis were 94.11%, 93.28%, and 92.32%, respectively with sensitivity values of 90.07%, 81.02%, and 82.33%, respectively and the specificity values were 94.65%, 94.04%, and 93.54%, respectively. In conclusion, the results acquired have sufficient accuracy, sensitivity, and specificity values to be used. Currently, AIChest4All is being used to help several of Thailand's government funded hospitals, free of charge.Clinical relevance- AIChest4All is aimed to aid radiologist in Thailand especially in rural areas, where there is immense staff shortages. It is being used to help several of Thailand's goverment funded hospitals, free of charege to screening heart disease, lung cancer, and tubeculosis with 94.11%, 93.28%, and 92.32% accuracy.


Assuntos
Neoplasias Pulmonares , Tuberculose , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento , Sensibilidade e Especificidade , Tailândia
17.
Artigo em Inglês | MEDLINE | ID: mdl-33027392

RESUMO

Tuberculosis of the skull or calvarial tuberculosis (CTB) is rare. The literature until 2019 reported less than 60 cases of CTB in childhood. The authors describe two patients with CTB associated with other manifestations of TB, such as: spine and rib injuries, peripheral adenopathy, hepatic and splenic involvement who improved with chemotherapy. The patients were a four-year-old and an eight-year-old child, whose diagnoses were confirmed by histopathological, bacteriological or molecular investigation. Both were not infected with the human immunodeficiency virus (HIV) and did not need orthopedic treatment.


Assuntos
Crânio/diagnóstico por imagem , Teste Tuberculínico/métodos , Tuberculose/diagnóstico , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Humanos , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose/tratamento farmacológico
18.
BMJ Open ; 10(8): e039455, 2020 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-32868368

RESUMO

INTRODUCTION: The outbreak of the SARS-CoV-2 virus causing COVID-19, declared a global pandemic by the WHO, is a novel infection with a high rate of morbidity and mortality. In South Africa, 55 421 cases have been confirmed as of 10 June 2020, with most cases in the Western Cape Province. Coronavirus leaves us in a position of uncertainty regarding the best clinical approach to successfully manage the expected high number of severely ill patients with COVID-19. This presents a unique opportunity to gather data to inform best practices in clinical approach and public health interventions to control COVID-19 locally. Furthermore, this pandemic challenges our resolve due to the high burden of HIV and tuberculosis (TB) in our country as data are scarce. This study endeavours to determine the clinical presentation, severity and prognosis of patients with COVID-19 admitted to our hospital. METHODS AND ANALYSIS: The study will use multiple approaches taking into account the evolving nature of the COVID-19 pandemic. Prospective observational design to describe specific patterns of risk predictors of poor outcomes among patients with severe COVID-19 admitted to Tygerberg Hospital. Data will be collected from medical records of patients with severe COVID-19 admitted at Tygerberg Hospital. Using the Cox proportional hazards model, we will investigate the association between the survival time of patients with COVID-19 in relation to one or more of the predictor variables including HIV and TB. ETHICS AND DISSEMINATION: The research team obtained ethical approval from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and Research Committee of the Tygerberg Hospital. All procedures for the ethical conduct of scientific investigation will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting clinical care providers and policy-makers.


Assuntos
Infecções por Coronavirus , Hospitalização , Hospitais , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Surtos de Doenças , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Registros Médicos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Saúde Pública , Projetos de Pesquisa , África do Sul/epidemiologia , Sobreviventes , Tuberculose/complicações
19.
S Afr Med J ; 110(7): 621-624, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32880335

RESUMO

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB.


Assuntos
Infecções por Coronavirus , Infecções por HIV/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral , Triagem/organização & administração , Tuberculose/epidemiologia , Betacoronavirus/isolamento & purificação , Coinfecção , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Pandemias/economia , Seleção de Pacientes , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Prognóstico , Medição de Risco , África do Sul/epidemiologia
20.
S Afr Med J ; 110(7): 625-628, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32880336

RESUMO

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.


Assuntos
Infecções por Coronavirus , Infecções por HIV/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva , Pandemias , Seleção de Pacientes/ética , Pneumonia Viral , Alocação de Recursos , Triagem , Tuberculose/epidemiologia , Betacoronavirus/isolamento & purificação , Coinfecção , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/legislação & jurisprudência , África do Sul/epidemiologia , Triagem/economia , Triagem/ética , Triagem/legislação & jurisprudência
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