Evaluation of Diagnostic Performance of Immunochromatographic Rapid Card Test for Malarial Antigen against Peripheral Smear Microscopy: A Cross-sectional Study

Author(s):  
Abhishek Mehta ◽  
Vijay Prakash Singh ◽  
Amod Borle
PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0242205
Author(s):  
Abebe Sorsa ◽  
Muhammedawel Kaso

Background GeneXpert is a new introduction in the diagnostic modality to fight tuberculosis (TB) among people living with HIV (PLHIV) under the program of intensified TB case finding. This study aimed to evaluate the diagnostic performance of GeneXpert under the program of intensified TB cases finding among PLHIV. Methods Cross-sectional study was conducted by recruiting individuals attending an HIV clinic from February 2018 to January 2019. Data on clinical parameters were collected using a standardized tool. Two-morning sputum samples were collected and processed for smear microscopy and GeneXpert. SPSS 21 used for data analysis. Proportion, percentage, and mean with SD were used to describe variables. Univariate and multivariable logistic regressions were used to assess factors associated with the GeneXpert. Values for which the 95% CI interval not includes 1 and for which P<0.05 were considered significant. Result A total of 384 presumptive TB-HIV co-infection cases were included, of which 166 (43%) were diagnosed to have TB. Fifty-four (32.5%) TB cases were smear AFB positive while 79 (47.7%) TB cases were GeneXpert positive. The GeneXpert detection rate was almost two-fold of that of smear microscopy and all smear positive TB cases were detected by GeneXpert. Moreover, GeneXpert was able to detect an additional third of TB confirmed cases among smear AFB negative cases. Advanced stage of the disease, high viral load and presence of anemia were significantly associated with TB. The WHO TB screening tool remained least sensitive with the lowest positive predictive value. Conclusion GeneXpert demonstrated two-fold case detection rate compared to the sputum smear microscopy and additional third TB case detection rate among smear AFB negative cases. Clinical screening tool for evaluation of TB-HIV co-infection showed poor performance in TB case notification.


Author(s):  
Tade Bagbi ◽  
Ningthoukhongjam Reema ◽  
S. Bhagyabati Devi ◽  
Thangjam Gautam Singh ◽  
Mohammad Jaleel ◽  
...  

Abstract Introduction Tuberculosis (TB) in people living with human immunodeficiency virus (PLHIV) is difficult to diagnose due to fewer organisms in sputum and extrapulmonary samples. Sputum culture takes 4 to 8 weeks for growth of the mycobacteria. Delayed treatment for TB in PLHIV leads to increased mortality. This study evaluated cartridge-based nucleic acid amplification test (CBNAAT) as a diagnostic tool for diagnosis of pulmonary TB (PTB) and extrapulmonary TB (EPTB) in PLHIV in the second most HIV prevalent state in India and for comparing its efficacy between Ziehl–Neelsen (ZN) staining sputum smear–positive and sputum smear–negative TB. Methods This cross-sectional study was conducted in RIMS, Imphal, with 167 PLHIV patients, age 15 years or older, having signs and symptoms of TB. Appropriate samples for sputum microscopy and CBNAAT were sent. Conclusion The overall sensitivity of sputum smear for acid-fast bacillus (AFB) was found to be 30.71% and that of CBNAAT was 38.57%. Sensitivity of CBNAAT for sputum smear–positive and sputum smear–negative TB was 100 and 11.3%, respectively. Sensitivity of ZN smear for AFB of EPTB sample was 48.1% and that of CBNAAT was 59.25%. In both PTB and EPTB, CBNAAT showed an increase in diagnosis of microbiologically confirmed PTB cases by 7.8 and 11.1%, respectively, over and above the cases diagnosed by ZN smear microscopy. Rifampicin resistance was detected in five patients. We conclude that CBNAAT is a rapid test with better sensitivity in diagnosis of PTB and EPTB in PLHIV, compared with ZN smear microscopy. It detects rifampicin resistance for multidrug-resistant TB and helps in early treatment intervention.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Priyatam Khadka ◽  
Januka Thapaliya ◽  
Ramesh Bahadur Basnet ◽  
Gokarna Raj Ghimire ◽  
Jyoti Amatya ◽  
...  

Abstract Background In most developing countries, smear-negative pulmonary TB (SNPT) often gets missed from the diagnosis of consideration, though it accounts 30–65% of total PTB cases, due to deficient or inaccessible molecular diagnostic modalities. Methods The cross-sectional study enrolled 360 patients with clinical-radiological suspicion of SNPT in Tribhuvan University Teaching Hospital (TUTH). The patient selection was done as per the algorithm of Nepal’s National Tuberculosis Program (NTP) for Xpert MTB/RIF testing. Participants’ demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer’s protocol. The same samples were stained using the Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with a Line Probe Assay. Result Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3(0.8%) of them were rifampicin resistance. The infection was higher in males, i.e. 60(25.3%) compared to female 25(20.3%). The age group, > 45(nearly 33%) with median age 42 ± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH. Consequently, with Xpert MTB/RIF assay, the additional case 16.5% (n = 85/515) from smear-negative presumptive TB cases were detected. Among the most occurring clinical presentations, cough and chest pain were positively associated with SNPT. While upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were the most peculiar radiological impression noted in PTB patient. 94 multi-drug resistant(MDR) suspected cases were enrolled; of total suspects, 29(30.8%) samples were rifampicin sensitive, 1(1.06%) indeterminate, 3(3.19%) rifampicin-resistant while remaining of them were negative. 2(2.2%) MDR cases were recovered from the patient with a previous history of ATT, of total 89 previously treated cases enrolled However, a single rifampicin-resistant from the new suspects. Conclusion With an application of the assay, the additional cases, missed with smear microscopy, could be sought and exact incidence of the diseases could be revealed.


BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031322
Author(s):  
Agnès Esiéné ◽  
Paul Owono Etoundi ◽  
Joel Noutakdie Tochie ◽  
Junette Arlette Mbengono Metogo ◽  
Jacqueline Ze Minkande

IntroductionPulmonary embolism poses one of the most challenging diagnoses in medicine. Resolving these diagnostic difficulties is more crucial in emergency departments where fast and accurate decisions are needed for a life-saving purpose. Here, clinical pretest evaluation is an important step in the diagnostic algorithm of pulmonary embolism. Although clinical probability scores are widely used in emergency departments of sub-Saharan Africa, no study has cited their diagnostic performance in this resource-constrained environment. This study will seek to assess the performance of four routinely used clinical prediction models in Cameroonians presenting with suspicion of pulmonary embolism at the emergency department.Methods and analysisIt will be a cross-sectional study comparing the sensitivity, specificity, positive and negative predictive values and accuracy of the Wells, Simplified Wells, Revised Geneva and the Simplified Revised Geneva Scores to CT pulmonary angiography as gold standard in all consecutive consenting patients aged above 15 years admitted for clinical suspicion of pulmonary embolism to the emergency departments of seven major referral hospitals of Cameroon between 1 July 2019 and 31 December 2020. The area under the receiver operating curve, calibration plots, Hosmer and Lemeshow statistics, observed/expected event rates, net benefit and decision curve will be measured of each the clinical prediction test to ascertain the clinical score with the best diagnostic performance.Ethics and disseminationClearance has been obtained from the Institutional Review Board of the Faculty of medicine and biomedical sciences of the University of Yaounde I, Cameroon and the directorates of all participating hospitals to conduct this study. Also, informed consent will be sought from each patient or their legal next of kin and parents for minors, before enrolment into this study. The final study will be published in a peer-review journal and the findings presented to health authorities and healthcare providers.


BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035757
Author(s):  
Chenyang Zhao ◽  
Mengsu Xiao ◽  
He Liu ◽  
Ming Wang ◽  
Hongyan Wang ◽  
...  

ObjectiveThe aim of the study is to explore the potential value of S-Detect for residents-in-training, a computer-assisted diagnosis system based on deep learning (DL) algorithm.MethodsThe study was designed as a cross-sectional study. Routine breast ultrasound examinations were conducted by an experienced radiologist. The ultrasonic images of the lesions were retrospectively assessed by five residents-in-training according to the Breast Imaging Report and Data System (BI-RADS) lexicon, and a dichotomic classification of the lesions was provided by S-Detect. The diagnostic performances of S-Detect and the five residents were measured and compared using the pathological results as the gold standard. The category 4a lesions assessed by the residents were downgraded to possibly benign as classified by S-Detect. The diagnostic performance of the integrated results was compared with the original results of the residents.ParticipantsA total of 195 focal breast lesions were consecutively enrolled, including 82 malignant lesions and 113 benign lesions.ResultsS-Detect presented higher specificity (77.88%) and area under the curve (AUC) (0.82) than the residents (specificity: 19.47%–48.67%, AUC: 0.62–0.74). A total of 24, 31, 38, 32 and 42 identified as BI-RADS 4a lesions by residents 1, 2, 3, 4 and 5 were downgraded to possibly benign lesions by S-Detect, respectively. Among these downgraded lesions, 24, 28, 35, 30 and 40 lesions were proven to be pathologically benign, respectively. After combining the residents' results with the results of the software in category 4a lesions, the specificity and AUC of the five residents significantly improved (specificity: 46.02%–76.11%, AUC: 0.71–0.85, p<0.001). The intraclass correlation coefficient of the five residents also increased after integration (from 0.480 to 0.643).ConclusionsWith the help of the DL software, the specificity, overall diagnostic performance and interobserver agreement of the residents greatly improved. The software can be used as adjunctive tool for residents-in-training, downgrading 4a lesions to possibly benign and reducing unnecessary biopsies.


PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0239342
Author(s):  
Letebrhan Weldemhret ◽  
Ataklti Hailu ◽  
Goyitom Gebremedhn ◽  
Hadish Bekuretsion ◽  
Gebreselassie Alemseged ◽  
...  

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Agnès Esiéné ◽  
Joel Noutakdie Tochie ◽  
Junette Arlette Mbengono Metogo ◽  
Paul Owono Etoundi ◽  
Jacqueline Ze Minkande

Abstract Background The diagnosis of acute pulmonary embolism (PE) is one of the most challenging in emergency settings where prompt and accurate decisions need to be taken for life-saving purposes. Here, the assessment of the clinical probability of PE is a paramount step in its diagnosis. Although clinical probability models (CPM) for PE are routinely used in emergency departments (EDs) of low-resource settings, few studies have cited their diagnostic performances in sub-Saharan Africa (SSA). We aimed to comparatively assess the accuracy of four CPM in the diagnosis of acute PE in sub-Saharan Africans. Methods We carried out a cross-sectional study to compare the sensitivity, specificity, positive and negative predictive values and accuracy of four CPM namely; the Wells, simplified Wells, revised Geneva and the simplified revised Geneva (SRG) Scores to computed tomography pulmonary angiography (CTPA) in all adults patients with suspected PE admitted to the EDs of the Gynaeco-obstetric and Paediatric Hospital of Yaoundé and the Yaoundé Central Hospital in Cameroon between January 1, 2017 and April 30, 2018. Results In total, we enrolled 30 patients with clinical suspicion of acute PE. PE was confirmed on CTPA in 16 (53.3%) cases. Their mean age was 53.7 ± 15.5 years and 36.7% were males. All four scores had a diagnostic performance superior to 50% in all criteria assessed. The simplified Wells score had the highest sensitivity (62.5%) followed by the Wells score (56.3%). The SRG score had the highest specificity (71.4%). The score with highest PPV was the SRG score (66.7%) and that with the highest NPV was the Wells score (56.3%). Overall the models with the highest accuracies were the Wells and SRG scores (60% for each). Conclusion All CPM had a suboptimal diagnostic performance, perhaps highlighting the need of a more optimal CPM for acute PE in SSA. However, the Wells and the SRG scores appeared to be most accurate than the other two scores in the ED. Hence, both or either of them may be used in first intention to predict PE and guide which ED patients should undergo further investigations in an emergency SSA setting.


2020 ◽  
Vol 8 (1) ◽  
pp. 77
Author(s):  
K. K. Rakesh Raju ◽  
V. T. Ajithkumar ◽  
T. P. Ashraf ◽  
A. Riyaz ◽  
N. C. Cherian ◽  
...  

Background: Malnutrition and anaemia form major public health problems among the school age children, particularly in the developing countries.Methods: A cross sectional study was conducted among children between 6 months and 18 years, in randomly selected 25 Anganwadis of Attappadi area. Objective of the study was to estimate the prevalence of anaemia and malnutrition among the children of Attappadi. Children were divided in to tribal and nontribal. Anthropometric measurements, haemoglobin estimation by cyanmethemoglobin method and peripheral smear examination were done.Results: 65.5% tribal and 54.1% non-tribal were anaemic. Among males 65.9% tribal and 56.4% non-tribal were anaemic. Among females 65.1% tribal and 52.6% nontribal were anaemic. In the age group less than 6 years, 9% tribal females, 8.9% nontribal females, 12% tribal males and 5.8% nontribal males were severely stunted. Above 6yrs it was 3.3% tribal females, 2.7% nontribal females, 2.4% tribal males and 7.4% nontribal males. In the age group less than 6 years, 12.5% tribal females, 3.9% nontribal females, 15.9% tribal males and 4.3% nontribal males had severe underweight. Above 6 years it was 8.3% tribal females, 0% non-tribal females, 19% tribal males and 3% non-tribal males.Conclusions: Anaemia and malnutrition are common among children of Attappadi. Tribal children are more affected than non-tribal children. Anaemia is more common among two age groups, less than 5 years and more than 11 years. Among females’ adolescent girls are more affected. Periodic assessment of growth parameters and early detection and treatment of anaemia are needed.


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