Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinic.

OBJECTIVES: To describe initial registration characteristics of adult and paediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 and December 2010. METHODS: Routine data on patient with TB category and TB type, stratified by HIV and ART status, were used to explore differences in proportions among TB only, TB/HIV co-infected patients not on ART and TB/HIV co-infected patients on ART using chi-square tests. Trends over time illustrate strengths and weaknesses of integrated service provision. RESULTS: Among 10 143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smear-positive pulmonary TB (PTB) was highest among HIV-negative patients with TB (34.9%); extra-pulmonary TB (EPTB) was lowest among TB only (16.2%). Among 338 children <15 years, EPTB and smear-positive PTB were more common among TB-only patients. Time trends showed significant increases in the proportion of adults with smear-positive PTB and the proportion of adults already on ART before starting TB treatment. However, some co-infected patients still delay ART initiation. CONCLUSIONS: HIV ascertainment and ART uptake among co-infected patients are successful and improving over time. However, delays in ART initiation indicate some weakness linking TB/HIV patients into ART during TB follow-up care. Improved TB diagnostics and screening efforts, especially for paediatric patients, may help improve quality care for co-infected patients. These results may aid efforts to prioritise TB and HIV prevention, education and treatment campaigns for specific populations.

[Imaging of traumatic injuries of the knee]. / Imagerie des traumatismes du genou.

Traumatic injuries to the knee are frequent (road or sports related accidents, falls in elderly people). The Ottawa knee rules are applied and dictate the need for additional evaluation. Some fractures are adequately assessed on plain radiographs alone whereas other fractures (tibial plateau fracture) require additional evaluation with CT. Some fractures may be occult: the significance of lipohemarthrosis (indirect sign of intra-articular fracture on the lateral radiograph with horizontal beam) must be known. Benign appearing avulsion fractures suggest the presence of underlying capsuloligamentous injuries requiring further evaluation with MRI. The imaging work-up of sprains is usually negative. MRI may show areas of bone contusion that further the understanding of the mechanism of injury, predict and confirm the presence of capsuloligamentous injuries. Angiography is performed to detect popliteal artery injuries after knee dislocation which is associated with a risk of ischemia.

[Imaging of the diabetic foot]. / Imagerie ostéo-articulaire du pied diabétique.

Destruction in diabetic feet is secondary to neuropathy (peripheral and autonomic nervous system) in association with microangiopathy. The loss of sensation to pain and the static trouble lead to increase the pressure in some areas and predispose to pedal skin ulceration, the precursor of osteomyelitis. Plain radiography should be the first step in the evaluation for diagnosis and follow-up. The initial patterns are nonspecific but very rapid evolution associating osteolysis, osteosclerosis and fragmentation lead to the Charcot foot. When osteomyelitis is suspected, scintigraphy with labelled white blood cells and MRI are necessary to differentiate infection from neuropathy.