Gender-based differences in community-wide screening for pulmonary tuberculosis in Karachi, Pakistan: an observational study of 311 732 individuals undergoing screening

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216409
Author(s):  
Shifa Salman Habib ◽  
Syed Mohammad Asad Zaidi ◽  
Wafa Zehra Jamal ◽  
Kiran Sohail Azeemi ◽  
Salman Khan ◽  
...  
Keyword(s):  
Observational Study ◽  
Pulmonary Tuberculosis ◽  
Screening Programme ◽  
Prevalence Ratio ◽  
X Ray ◽  
Tb Treatment ◽  
Digital Chest ◽  
Chest X Ray ◽  
Gender Based

We describe gender-based differences in a community-wide TB screening programme in Karachi, Pakistan, in which 311 732 individuals were screened in mobile camps using symptom questionnaires and van-mounted digital chest X-ray, between 1 January 2018 and 31 December 2019. Only 22.4% (69 869) of camp attendees were women. Female attendees were less likely to have sputum collected and tested (31.5% (95% CI 30.4% to 32.7%) vs 38.5% (95% CI 37.6% to 39.1%)) or to initiate TB treatment (75.9% (95% CI 68.1% to 82.6%) vs 82.8% (95% CI 78.9% to 86.2%)), when indicated. Among the participants, the age-standardised prevalence of active TB was higher among women (prevalence ratio 1.4, 95% CI 1.1 to 1.7). These findings underscore the importance of integrating gender into the design and monitoring of TB screening programmes to ensure that women and men benefit equally from this important intervention.

scholarly journals Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?

2019 ◽  
Vol 9 (3) ◽  
pp. 96-101
Author(s):  
C. Timire ◽  
C. Sandy ◽  
M. Ngwenya ◽  
N. Woznitza ◽  
A. M. V. Kumar ◽  
...  
Keyword(s):  
Risk Groups ◽  
Cross Sectional Study ◽  
Percentage Agreement ◽  
Cross Sectional ◽  
Active Screening ◽  
X Ray ◽  
Tb Treatment ◽  
Previous Contact ◽  
Digital Chest ◽  
Chest X Ray

Setting: Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation.Objectives: To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB.Design: This was a cross-sectional study using programme data.Results: A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64–78). Around 29% (95%CI 23–36) of the patients were potentially over-treated during Tas4TB.Conclusion: Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.

scholarly journals A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis

Thorax ◽  
2010 ◽  
Vol 65 (10) ◽  
pp. 863-869 ◽  
Author(s):  
A. P. Ralph ◽  
M. Ardian ◽  
A. Wiguna ◽  
G. P. Maguire ◽  
N. G. Becker ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
X Ray ◽  
Smear Positive Pulmonary Tuberculosis ◽  
Chest X Ray

HIV-TUBERCULOSIS: A STUDY OF CHEST X-RAY PATTERNS IN RELATION TO CD4 COUNT

2021 ◽  
pp. 10-12
Author(s):  
Abdhesh Kumar ◽  
Naveen Kumar ◽  
Kumar Sourav
Keyword(s):  
Pulmonary Tuberculosis ◽  
Tertiary Hospital ◽  
Hiv Positive ◽  
Who Guidelines ◽  
X Ray ◽  
Ciency Virus ◽  
Chest X Ray ◽  
Radiological Patterns ◽  
High Index Of Suspicion ◽  
Ray Patterns

Background: Fight against human immunodeciency virus (HIV) is incomplete without addressing problems associated with difcult diagnosis of tuberculosis in HIV-Tuberculosis coinfected patients. Chest X-ray is a primary tool to evaluate tuberculosis in HIV. Aim: To assess and compare various radiological patterns of pulmonary tuberculosis in HIV patients and compare these patterns in relation to CD4 counts. Materials and Methods: Prospective cohort study was conducted in a tertiary hospital in J.L.N.M.C.H Bhagalpur from april 2019 to january 2021 with 200 HIV positive patients. WHO guidelines were used for diagnosis of HIV and tuberculosis. Results: 27% of the patients had sputum positive pulmonary tuberculosis, with higher incidence (33%) among CD4 less than 200 as compared to CD4 more than 200 (14%). Inltration (39%) followed by consolidation (30%), cavity (11%), and lymphadenopathy (9%) seen with CD4 less than 200. Inltration (37.5%) followed by cavity (25%) and miliary (25%) with CD4 above 200. Bilateral (68.5%) and mid and lower zones or all zone involvement more commonly seen. Conclusion: In patients with CD4 lower than 200 noncavitory inltration and consolidation predominated. Involvement of lungs was atypical; diffuse or mid and lower zone involvement was higher than classical upper lobe involvement. A high index of suspicion is necessary for the accurate and timely diagnosis of tuberculosis in HIVpositive patients.

scholarly journals S77 Pre-treatment Chest X-ray Severity And Its Relation To Bacterial Burden In Pulmonary Tuberculosis

Thorax ◽  
2014 ◽  
Vol 69 (Suppl 2) ◽  
pp. A43-A43
Author(s):  
S. Murthy ◽  
F. Chatterjee ◽  
P. Phillips ◽  
S. Murray ◽  
T. McHugh ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Bacterial Burden ◽  
X Ray ◽  
Chest X Ray ◽  
Pre Treatment

scholarly journals Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217190
Author(s):  
Rebecca Nightingale ◽  
Beatrice Chinoko ◽  
Maia Lesosky ◽  
Sarah J Rylance ◽  
Bright Mnesa ◽  
...  
Keyword(s):  
Lung Function ◽  
Pulmonary Tuberculosis ◽  
Respiratory Symptoms ◽  
Treatment Completion ◽  
First Year ◽  
Tb Treatment ◽  
Effective Interventions ◽  
Hiv Coinfection ◽  
History Of ◽  
Chest X Ray

RationalePulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited.ObjectivesTo describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period.MethodsAdults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling.Measurement and main resultsWe recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion.ConclusionSpirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.

scholarly journals Associations between general practice characteristics and chest x-ray rate: an observational study

2021 ◽  
pp. BJGP.2021.0232
Author(s):  
Stephen H Bradley ◽  
Matthew Barclay ◽  
Benjamin Cornwell ◽  
Gary A Abel ◽  
Matthew Callister ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Patient Satisfaction ◽  
Observational Study ◽  
Population Characteristics ◽  
Substantial Variation ◽  
X Ray ◽  
Patient Satisfaction Scores ◽  
Improved Outcomes ◽  
Chest X Ray ◽  
General Practices

Background: Chest x-ray (CXR) is the first-line test for lung cancer in many settings. Previous research has suggested that higher utilisation of CXR is associated with improved outcomes. Aim: To explore the associations between characteristics of general practices and frequency of investigation with CXR. Design & Setting: Retrospective observational study of English general practices. Method: We constructed a database of English general practices containing number of CXRs requested and data on practices for 2018, including patient & staff demographics, smoking prevalence, deprivation and patient satisfaction indicators. Mixed effects Poisson modelling was used to account for variation due to chance and to estimate the amount of remaining variation that could be attributed to practice and population characteristics. Results: There was substantial variation in GP CXR rates (median 34 per 1000 patients, IQR 26-43). Only 18% of between-practice variance in CXR rate was accounted for by recorded characteristics. Higher practice scores for continuity and communication skills and higher proportions of smokers, Asian and mixed ethnic groups, and patients aged >65 were associated with increased CXR rates. Higher patient satisfaction scores for access and with greater proportions of male and patients of black ethnicity were associated with lower CXR rates. Conclusion: Substantial variation was found in CXR rates beyond that expected by chance, which could not be accounted for by practices’ recorded characteristics. Since other research has indicated that increasing CXR rates can lead to earlier detection, supporting practices which currently investigate infrequently could be an effective strategy to improve lung cancer outcomes.

Molluscum-Like Papules as a Presentation of Early Papulonecrotic Tuberculid in Association with Nodular Tuberculid in a Male with Asymptomatic Active Pulmonary Tuberculosis

2015 ◽  
Vol 19 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Rachel Asiniwasis ◽  
Maha T. Dutil ◽  
Scott Walsh
Keyword(s):  
Pulmonary Tuberculosis ◽  
Early Stage ◽  
Induced Sputum ◽  
Simultaneous Occurrence ◽  
Antituberculous Therapy ◽  
X Ray ◽  
Active Pulmonary Tuberculosis ◽  
History Of ◽  
Chest X Ray ◽  
Histopathologic Findings

Background/Objectives The clinical and histopathologic findings of a rare simultaneous occurrence of papulonecrotic tuberculid and nodular tuberclid in a patient with active but asymptomatic pulmonary tuberculosis are presented. Papulonecrotic tuberculid was observed at a very early stage, presenting as molluscum-like lesions. This has been described once in the literature. This was observed in conjunction with lesions compatible with the rare clinicopathologic variant of nodular tuberculid. Critical to the diagnosis of active pulmonary tuberculosis was the use of induced sputum testing, which confirmed the diagnosis despite the lack of a cough and a chest x-ray negative for active tuberculosis. Methods/Results A 40-year-old male presented with a 2-week history of fever and a skin eruption consisting of molluscum-like papules on the ears, arms, and abdomen and nodules on his legs. Biopsies from both lesions were consistent with papulonecrotic and nodular tuberculid, respectively. Despite the lack of any respiratory symptoms, induced sputum grew Mycobacterium tuberculosis, and the lesions resolved on antituberculous therapy. Conclusions and Relevance Tuberculids are rare in Western countries but must be considered in the differential diagnosis of eruptions in patients from endemic countries. An active tuberculous focus must be sought out.

scholarly journals Sensitivity of lung ultrasound for the detection of pneumothorax one day after pulmonary resection—a prospective observational study

2020 ◽  
Author(s):  
Thomas Galetin ◽  
Mark Schieren ◽  
Benjamin Marks ◽  
Jerome Defosse ◽  
Erich Stoelben
Keyword(s):  
Observational Study ◽  
Thoracic Surgery ◽  
Test Performance ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Lung Resection ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray ◽  
Diagnostic Test Performance

Summary Background Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions. Methods We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated. Results A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%. Conclusions Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.

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