scholarly journals 1373. Clinical Presentation, Demographics, and Outcomes of Cases of Tuberculosis (TB) at Princess Margaret Hospital, Nassau, The Bahamas 2014–2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S498-S498
Author(s):  
Javardo McIntosh ◽  
Nikkiah Forbes ◽  
Kevin Moss ◽  
M Anthony C Frankson
Keyword(s):  
Risk Factors ◽  
Retrospective Chart Review ◽  
Risk Groups ◽  
World Health ◽  
Contact Tracing ◽  
Hiv Positive ◽  
The Bahamas ◽  
Princess Margaret Hospital ◽  
Migrant Populations ◽  
Night Sweats

Abstract Background Tuberculosis (TB) is one of the oldest diseases known to man, yet the world health organization reports that Tuberculosis is one of the top 10 causes of death worldwide. There are various factors that have made the eradication of tuberculosis in the Bahamas difficult such as high rates of HIV infection and immigrants migrating from countries with high TB prevalence. In understanding the epidemiology and risk factors of TB cases in the Bahamas, the development of protocols can improve screening procedures and decrease disease burden. Methods A retrospective chart review of cases of Tuberculosis diagnosed at the Princess Margaret Hospital, Nassau, Bahamas. 189 cases of active tuberculosis diagnosed between 2014–2016 and all cases were evaluated for demographics, risk factors, clinical manifestation, method of diagnosis, symptoms, and treatment outcomes. Results Of the 189 cases of notified tuberculosis between 2014 and 2016, 46 cases were reported in 2014, 60 cases in 2015 and 83 cases in 2016. The mean age was 37.96 (±18.20) years old. 164 (86.8%) presented with symptoms, 19 (10.1%) of cases were diagnosed by routine screening and 6 (3.2%) of cases were diagnosed by contact tracing. 109 (59.9%) were HIV negative and 73 (40.1%) were HIV positive. 144 (76.2%) presented with cough, 84 (44.7%) weight-loss, 80 (42.3%) fever, 44 (23.3%) night sweats, 43 (22.8%) chills, 32 (16.9%) fatigue, and 25 (13.2%) hemoptysis. 126(66.7%) completed the full course of antibiotic therapy, 29(15.3%) patients expired before completing treatment and 18(9.5%) of patients defaulted. Conclusion HIV is a major risk factor for Tuberculosis in the Bahamas and it is advised that all patients diagnosed with TB be tested for HIV. We also advise screening HIV-positive patients for TB. Screening other high-risk groups such as migrant populations would also benefit to reduce the amount of latent TB cases which may progress to active TB. Disclosures All authors: No reported disclosures.

scholarly journals 1371. Tuberculosis and HIV Coinfection in the Bahamas: A Retrospective Review of Cases Diagnosed Between 2014 and 2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S496-S497
Author(s):  
Javardo McIntosh ◽  
Kevin Moss ◽  
Nikkiah Forbes ◽  
M Anthony C Frankson
Keyword(s):  
Risk Factor ◽  
Antiretroviral Therapy ◽  
Cd4 Count ◽  
World Health ◽  
Public Health Issue ◽  
Hiv Positive ◽  
Hiv Status ◽  
The Bahamas ◽  
Radiologic Findings ◽  
Hiv Coinfection

Abstract Background Tuberculosis (TB) is one of the oldest diseases known to man, yet the world health organization reports that TB is one of the top 10 causes of death worldwide. HIV infection is the most potent biologic risk factor for developing tuberculosis. The HIV epidemic has been responsible for increasing the burden of TB worldwide and The Bahamas has been no exception. The aim of this study was to determine the HIV testing rate as well as prevalence of TB-HIV coinfection for The Bahamas and compare cases of TB based on HIV status for clinical presentation, radiologic findings, TST results and Smear and Culture results. We also evaluated cases of TB-HIV for degree of immunosuppression and compliance to antiretroviral therapy. Methods A retrospective chart review of cases of Tuberculosis diagnosed at the Princess Margaret Hospital, Nassau, Bahamas. 189 cases of active tuberculosis diagnosed between 2014 and 2016 and all cases were evaluated for demographics, risk factors, HIV status, clinical manifestation, radiologic findings, and smear and culture results. Results Of the 189 cases of notified tuberculosis between 2014 and 2016, 109 (59.9%) were HIV negative and 73 (40.1%) were HIV positive. For patients who were HIV positive, 54(74%) were previously diagnosed with HIV and 19(26%) were newly diagnosed. Of the patients who were previously diagnosed with HIV, 14(25.9%) were on antiretroviral (ARV) medications and compliant, 34(63.0%) were on ARVs and noncompliant and 6(11.1%) were not on ARVs. 4(8.2%) patient had a CD4 count ≥500, 8(16.3%) patients had a CD4 count between 499–200 and 37(75.5%) had a CD4 counts 1000. Conclusion HIV is a major risk factor for Tuberculosis in the Bahamas and it is advised that all patients diagnosed with TB be tested for HIV. Routine screening of HIV patients for TB is recommended. Noncompliance with antiretroviral therapy remains a public health issue as it increases susceptibility to TB infection. Disclosures All authors: No reported disclosures.

scholarly journals Negative latent tuberculosis at time of incarceration: identifying a very high-risk group for infection

2017 ◽  
Vol 145 (12) ◽  
pp. 2491-2499 ◽  
Author(s):  
L. ARROYAVE ◽  
Y. KEYNAN ◽  
L. LÓPEZ ◽  
D. MARIN ◽  
M. P. ARBELÁEZ ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Latent Tuberculosis ◽  
Risk Groups ◽  
High Risk Group ◽  
World Health ◽  
Formerly Incarcerated ◽  
Adjusted Risk ◽  
Number Needed To Screen ◽  
Health Organization

SUMMARYThe main aim was to measure the incidence of latent tuberculosis infection (LTBI) and identify risk factors associated with infection. In addition, we determined the number needed to screen (NNS) to identify LTBI and active tuberculosis. We followed 129 prisoners for 2 years following a negative two-step tuberculin skin test (TST). The cumulative incidence of TST conversion over 2 years was 29·5% (38/129), among the new TST converters, nine developed active TB. Among persons with no evidence of LTBI, the NNS to identify a LTBI case was 3·4 and an active TB case was 14·3. The adjusted risk factors for LTBI conversion were incarceration in prison number 1, being formerly incarcerated, and overweight. In conclusion, prisoners have higher risk of LTBI acquisition compared with high-risk groups, such as HIV-infected individuals and children for whom LTBI testing should be performed according to World Health Organization guidance. The high conversion rate is associated with high incidence of active TB disease, and therefore we recommend mandatory LTBI screening at the time of prison entry. Individuals with a negative TST at the time of entry to prison are at high risk of acquiring infection, and should therefore be followed in order to detect convertors and offer LTBI treatment. This approach has a very low NNS for each identified case, and it can be utilized to decrease development of active TB disease and transmission.

scholarly journals SECOND WAVE OF COVID 19 RISING CASES IN INDIA: SHORT COMMUNICATION SITUATION

2021 ◽  
Vol 9 (04) ◽  
pp. 261-263
Author(s):  
Ajoke Akinola ◽  
Keyword(s):  
Risk Groups ◽  
The United States ◽  
Warning Signs ◽  
World Health ◽  
Contact Tracing ◽  
Time Record ◽  
The Government ◽  
Health Organization ◽  
First Time ◽  
Second Wave

Statistics currently indicated that the second wave of COVID 19 pandemic has killed over 2.94 million, and active cases 136.13 million globally as on April 12, 2021 reported by John Hopkins University and world health organization (WHO). India reported a first time record high ever of 13,689,453 COVID-19 infections, and 171,058 deaths from the ministry of health and WHO revealed on April 12, 2021. As India (13,873,825 confirmed cases and 172,085 deaths) (April, 14 2021) over takes Brazil, in the rising cases of Infection of COVID-19 as the second worst hit country in the world. It becomes the second-most affected country globally by the coronavirus after the United States (30, 888,765). Whereas the second wave is deadlier than the first wave according to the DG council of scientific and industrial research, Dr. Shekhar Mande.Preventable solutions are all but not limited to identify reasons for the spike and implement measures immediately. Some of which are uncontrolled gathering, floating of electoral commission (EC) guidelines on COVID-19 prevention during the election campaign political rallies. Some religious gatherings not adhering to the government protocol on COVID 19 prevention practices during this period (April 2021). Initially testing was limited to the high risk groups but has been expanded to cover several populations with the governments intervention. Further is to improve contact tracing, instead of negligence across the states. Drive for testing measures and rapid vaccination drive should continue as identified that authorities concerned are not testing enough. Lastly never ignore any warning signs or strange body feelings you might encounter. Act immediately, implement all preventive measures and seek medical help at once.

Development of a blended learning approach to delivering HIV assisted contact tracing in Malawi: applied theory and formative research (Preprint)

2021 ◽  
Author(s):  
Nora Ellen Rosenberg ◽  
Tapiwa A Tembo ◽  
Katherine R Simon ◽  
Katie Mollan ◽  
Sarah E Rutstein ◽  
...  
Keyword(s):  
Low Income ◽  
Cognitive Theory ◽  
Health Workers ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
World Health ◽  
Contact Tracing ◽  
Hiv Positive ◽  
Applied Theory ◽  
Implementation Package

UNSTRUCTURED Despite progress towards the UNAIDS “95-95-95” targets (95% of HIV-positive persons tested, 95% of tested persons on treatment, and 95% of treated persons virally suppressed), a gap remains in achieving the first 95% target. Assisted contact tracing (ACT), in which health workers support HIV-positive indexes to recruit their contacts (sexual partners and children) for HIV testing, efficiently identify HIV-positive persons in need of treatment. ACT is recommended in the World Health Organization’s 2016 guidance, and although many countries, including Malawi, began implementing ACT, testing outcomes in routine settings have been worse than those in trial settings. To bridge the gap between research and practice and support scale-up in Malawi, a set of implementation strategies (“implementation package”) was developed using frameworks and theories. First, the Consolidated Framework for Implementation Research (CFIR) guided qualitative research to identify key barriers and facilitators to intervention delivery. Limited clinic coordination and health worker capacity to address the complexities of ACT were identified as key barriers; ongoing individual training and group problem-solving were identified as facilitators. Next, the theory of expertise, social cognitive theory and principles of continuous quality improvement informed the development of the implementation package to address these barriers and facilitators. Finally, human-centered design principles guided the translation of the implementation package from in-person to digital delivery. This trajectory highlights the key roles behavioral theories, implementation frameworks, and technology can play in bringing an evidence-based intervention, such as ACT, to scale in a low-income setting like Malawi.

Venous thrombosis risk factors in pregnant women

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Victoria Bitsadze ◽  
Jamilya Khizroeva ◽  
Ismail Elalamy ◽  
Makatsariya Alexander
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Clinical Medicine ◽  
Scoring Systems ◽  
Risk Groups ◽  
World Health ◽  
Circulating Blood Volume ◽  
Endogenous Factors ◽  
In Pregnancy

AbstractObjectivesAssess all risk factors of venous thromboembolism (VTE) in pregnancy and puerperium.MethodsDifferent guidelines for VTE prevention have been analyzed.ResultsVarious recommendations have appeared for practitioners during the last 10–15 years on the basis of the risk factors analysis in order to prevent VTE in pregnant women more effectively. Nevertheless, none of these recommendations can yet take into account all risk factors, although convenient scoring systems have emerged for risk assessment and clear recommendations on anti-thrombotic prophylaxis regimens in risk groups in recent years.ConclusionsVTE is the third most common cause of death on Earth after myocardial infarctions and strokes, according to the World Health Organization. Pregnancy is a unique condition of woman, when enormous changes occur in functioning of the most important systems of homeostasis in a relatively short time. These are physiological hypercoagulation, slowing of blood flow, increase in circulating blood volume, etc. However, while being physiological, these changes increase the risks of venous thromboembolism by almost six times. In some cases, there appears an imbalance or dissociation between the functioning of natural antithrombotic systems and the activation of coagulation as a consequence of genetically or acquired determined causes (genetic thrombophilia, antiphospholipid syndrome, comorbidities, obstetric complications and other exogenous and endogenous factors). Accordingly, identification of risk factors, their systematization, and determination of VTE risks in pregnancy and puerperium is one of the most important tasks of clinical medicine. This article will review historical understanding of thrombosis in pregnant women, progress in understanding VTE risk factors in pregnant women, and available reserves in identifying new risk factors during pregnancy and puerperium in order to stratify risks more efficiently.

Endemic versus Non-Endemic Gonorrhoea in Stockholm: Results of Contact Tracing

1993 ◽  
Vol 4 (5) ◽  
pp. 284-292 ◽  
Author(s):  
A-K Rudén ◽  
A Jonsson ◽  
P Lidbrink ◽  
P Allebeck ◽  
S M Bygdeman
Keyword(s):  
Risk Factors ◽  
Medical Care ◽  
Social Workers ◽  
Partner Notification ◽  
Risk Groups ◽  
Contact Tracing ◽  
Study Group ◽  
Steady Partner ◽  
Period 2 ◽  
Increased Risk

The aim of the present study was to characterize endemic versus non-endemic gonorrhoea to identify risk groups for transmission and to evaluate the effects of intensified contact tracing performed by specially trained social workers at venereal clinics. A total of 671 gonorrhoea patients (283 women and 388 men) comprised the study group. Seventy percent of the women and 48% of the men had an endemic infection ( P<0.001). Men without a steady partner had an increased risk of non-endemic infection. A decrease from 75% to 40% was noted in the proportion of endemic infection in Stockholm from the first quarter of the study period (2 years) to the last. Contact tracing resulted in 1.2 identified partners per patient. A total of 736 partners were examined either as a result of contact tracing efforts or because they had sought medical care on their own prior to intervention. Forty-seven percent of these partners were infected, 44% were not infected and 9% were examined outside the study with results unknown to us. The partner notification efforts yielded 161 new untreated cases. Contact tracing of women generated one new case per 4.0 interviewed women and contact tracing of men one new case per 4.3 interviewed men. Interviewing index patients with endemic infection yielded the highest number of new cases. Forty-three percent of the patients were infected outside Stockholm but only a smaller part of these patients spread their infection further into the community. The experiences of the contact tracing and analysis of risk factors for transmission of gonorrhoea provide valuable knowledge that can be used to discourage spread of gonorrhoea.

scholarly journals Tuberculosis among Health Care Workers

2019 ◽  
Vol 4 (9) ◽  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Close Contact ◽  
Risk Groups ◽  
Hiv Positive ◽  
Bacterial Disease ◽  
Infected People ◽  
Care Workers ◽  
Night Sweats ◽  
Latent Tb

Tuberculosis (TB) is a bacterial disease caused by Mycobacterium Tuberculosis. It spreads form one person to another through air. When infected people with TB cough, sneeze or spit, they propel the TB germs in the air. A person needs to inhale only a few of these germs to be infected. Evidence of TB has been reported in human remains dated thousands of years. About one quarter of the world’s population has latent TB, which means TB bacteria have infected people but are not (yet) ill with the disease and therefore cannot transmit the disease. Tb occurs in specific risk groups such as immigrants, HIV-positive patients, homeless patients, prisoners, and alcoholics. Health care workers, who face frequent occupational exposure, are at particularly high risk. When a person develops active TB, the symptoms (such as cough, fever, night sweats or weight loss) may be latent for many months. This can lead to delays in seeking care and transmission of the bacteria to others. People with active TB can infect 10-15 other people through close contact over the course of the course of a year. Without treatment, 45% of HIV- negative people with TB on average and nearly all HIV- positive people with TB will die. Transmission of tuberculosis (TB) in health care settings to both patients and health care workers has been reported from virtually every country of the world, regardless of local TB incidence. We are presenting the case of an asymptomatic 28- year-old Caucasian male from Europe who initially was being screened for TB for pre-employment purposes.

Serum Retinol and β-carotene Levels and Risk Factors for Cardiovascular Disease in Morbid Obesity

2010 ◽  
Vol 80 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Gabriela Villaça Chaves ◽  
Gisele Gonçalves de Souza ◽  
Andréa Cardoso de Matos ◽  
Dra. Wilza Abrantes Peres ◽  
Silvia Elaine Pereira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Morbid Obesity ◽  
Serum Levels ◽  
World Health ◽  
Morbidly Obese ◽  
Serum Retinol ◽  
Significant Difference ◽  
Β Carotene

Objective: To evaluate retinol and β-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro. Methodology: Blood serum concentrations of retinol and β-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and β-carotene serum levels were evaluated. Results: Metabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of β-carotene were significantly lower when body mass index increased. Serum retinol didn't show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, β-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average β-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome. Conclusion: Considering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.

Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

2015 ◽  
Vol 18 (4) ◽  
pp. 140 ◽  
Author(s):  
Mehmet Taşar ◽  
Mehmet Kalender ◽  
Okay Güven Karaca ◽  
Ata Niyazi Ecevit ◽  
Salih Salihi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Carotid Artery Disease ◽  
Risk Groups ◽  
Cardiac Risk ◽  
Cervical Plexus ◽  
Cardiac Risk Factors ◽  
Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. <br />Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared.<br />Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection.<br />Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed. <br /><br />

A(H1N1)v cases of the 2009/2010 and 2010/2011 influenza seasons in the Medical and Health Sciences Centre of Debrecen University

2012 ◽  
Vol 153 (17) ◽  
pp. 649-654
Author(s):  
Piroska Orosi ◽  
Judit Szidor ◽  
Tünde Tóthné Tóth ◽  
József Kónya
Keyword(s):  
High Risk ◽  
Influenza Season ◽  
National Level ◽  
Organ Transplant ◽  
High Risk Patient ◽  
Risk Groups ◽  
Health Sciences ◽  
World Health ◽  
Transplant Patients ◽  
Health Organization

The swine-origin new influenza variant A(H1N1) emerged in 2009 and changed the epidemiology of the 2009/2010 influenza season globally and at national level. Aims: The aim of the authors was to analyse the cases of two influenza seasons. Methods: The Medical and Health Sciences Centre of Debrecen University has 1690 beds with 85 000 patients admitted per year. The diagnosis of influenza was conducted using real-time polymerase chain reaction in the microbiological laboratories of the University and the National Epidemiological Centre, according to the recommendation of the World Health Organization. Results: The incidence of influenza was not higher than that observed in the previous season, but two high-risk patient groups were identified: pregnant women and patients with immunodeficiency (oncohematological and organ transplant patients). The influenza vaccine, which is free for high-risk groups and health care workers in Hungary, appeared to be effective for prevention, because in the 2010/2011 influenza season none of the 58 patients who were administered the vaccination developed influenza. Conclusion: It is an important task to protect oncohematological and organ transplant patients. Orv. Hetil., 2012, 153, 649–654.

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