Evaluation of Xpert® MTB/RIF and ustar easyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania : a prospective descriptive study

Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania.; Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising "culture and/or cytology" was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis.; Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %.; Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Pulmonary cryptosporidiosis in HIV negative, immunocompromised host

Cryptosporidia are intestinal spore forming protozoa, which cause intracellular infections, predominantly in the epithelial cells of the intestine. Extra-intestinal infections with Cryptosporidium parvum have been rarely reported. However, a few reports of pulmonary cryptosporidiosis in HIV/AIDS cases have been mentioned in literature. In immunocompromised individuals who do not have HIV-related disease, Cryptosporidiosis has been rarely reported. We present a case of respiratory infection caused by C. parvum . The patient was a 10-year-old child with nephrotic syndrome and was receiving corticosteroids for 6 months. The child had history of low-grade fever, breathlessness and cough with expectoration of 3 months duration. The patient was nonreactive for HIV, and there was no evidence of primary immunodeficiency. Major serum immunoglobulins (IgG, IgA, and IgM) were in normal range. Simultaneous gastrointestinal involvement with C. parvum was observed

REACT: REal-time Adaptive Collision Testing An Interactive Vision approach

As the demand for high levels of interaction in computer systems increases, so too does the need for real-time, interactive animation. Detecting collisions between geometrically modelled objects remains a major bottleneck in areas such as Virtual Reality (VR). In order to maintain a constant frame-rate, a trade-off between speed and accuracy is necessary. This is possible if, at each frame, potential collisions are graded by their importance to the viewer’s perception. An appropriate Level Of Detail (LOD) at which to test each object may then be chosen, based on the importance of the collision in which it is involved. We adopt some ideas from an emerging area of research, Interactive Vision, and propose a scheme which uses an eye-tracking device to locate the position of the user’s gaze. This, along with other perceptual criteria, may be used to choose an appropriate LOD for each colliding object at each frame, allowing the application to degrade detection accuracy where it is least likely to affect the user’s perception of the collision