Causes of non-malarial febrile illness in outpatients in Tanzania.

OBJECTIVE: In sub-Saharan Africa, the use of malaria rapid diagnostic tests (mRDT) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of mRDT-negative fever aetiologies among children and adults in Tanzania. METHODS: A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative mRDT were enrolled from a Tanzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx/throat and urine. Patients were followed on Days 7 and 14 and children meeting WHO criteria for pneumonia were followed on Day 2 with chest radiology. RESULTS: Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339/530) of children. Of 38 X-rayed children meeting WHO pneumonia criteria, 47.4% had a normal X-ray. Overall, only 1.3% of 1028 blood cultures were positive. Salmonella typhi was the most prevalent pathogen isolated (7/13, 53.8%) and S. typhi patients reported fever for a median of 7 days (range 2-14). Children with bacteraemia did not present with WHO symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24/428 and 29/498, respectively). CONCLUSION: Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying African children in need of antibiotics among the majority who do not

Assessment of left ventricular volumes using simplified 3-D echocardiography and computed tomography – a phantom and clinical study

<p>Abstract</p> <p>Objectives</p> <p>To compare the accuracy of simplified 3-dimensional (3-D) echocardiography vs. multi-slice computed tomography (MSCT) software for the quantification of left ventricular (LV) volumes.</p> <p>Design</p> <p>Three-D echocardiography (3-planes approach) and MSCT-CardIQ software were calibrated by measuring known volumes of 10 phantoms designed to closely mimic blood-endocardium interface. Subsequently, LV volumes were measured with both the methods in 9 patients referred routinely for coronary angiography and the agreement between the measurements was evaluated.</p> <p>Results</p> <p>Simplified 3D-echocardiography provided higher degree of agreement between the measured and true phantom volumes (mean difference 0 ± 1 ml, variation range +4 to -4 ml) than MSCT software (mean difference 6 ± 5 ml; variation range +22 to -10 ml). The agreement between LV measurements in the patients was considerably poorer, with significantly larger volumes produced by MSCT (mean difference -23 ± 40 ml, variation between +93 and -138 ml).</p> <p>Conclusion</p> <p>Simplified 3-D echocardiography provides more accurate assessment of phantom volumes than MSCT-CardIQ software. The discrepancy between the results of LV measurements with the two methods is even greater and does not warrant their interchangeable diagnostic use.</p

Universities in international networks

This chapter examines the international networks of some universities in Europe. Contacts between universities and researchers are often made easier by formal organisational links, associations and agreements. The ways of organizing research and higher education vary from country to country. Sweden differs from many of the others in that a greater proportion of the research in progress is conducted at state universities and university colleges instead of at independent private institutions. In earlier times higher education and research were the preserve of an exclusive elite. It was at the courts of princes, under the auspices of the Church, and at those universities founded in Europe during the Middle Ages that these select few accumulated knowledge and developed educational ideals. The European Union’s determined concentration on research and higher education during the 1980s and 1990s has few if any international parallels

Radiological imaging of pulmonary emphysema : Preoperative evaluation of candidates for lung volume reduction surgery

Lung volume reduction surgery (LVRS) for pulmonary emphysema, first described by Brantigan in 1957, was re-introduced by Cooper et al in 1995. From a surgical point of view, information on the extent and distribution of emphysema is mandatory and also partly determines the outcome. No consensus exists on the best method for describing emphysema severity and heterogeneity in candidates for LVRS. The aims of this thesis were to define a suitable CT-technique for visual evaluation of severe emphysema, to design an objective model for classification of emphysema heterogeneity and to evaluate the additional information gained by lung perfusion scintigraphy in classification of emphysema. Study I investigated whether radiologists in evaluating severe emphysema subjectively preferred high resolution computed tomography (HRCT) or spiral computed tomography (CT). HRCT was preferred in 56%, spiral CT in 19% and in 25%, the techniques were considered equal. Study II investigated which of three types of images yielded the best results in estimating the degree of emphysema. In the grading of emphysema, the radiologists performed similarly with both HRCT and spiral CT, while "density-masked" images (an image of a quantitative measurement) gave significantly better results. Study III investigated whether spiral CT was superior to HRCT in evaluating the heterogeneity of emphysema and whether the combination of both CT-techniques improved the evaluation. Spiral CT was significantly better compared to HRCT, while the combination of the techniques did not improve the evaluation. Study IV presented a method for classification of emphysema heterogeneity that was calculated objectively, surgically oriented and classifies each lung separately. Study V investigated whether lung perfusion scintigraphy (LPS) contributes to the preoperative classification of emphysema heterogeneity compared to classification based only on CT. The answer was yes, and hence both CT and LPS should be included when assessing emphysema heterogeneity prior to LVRS. To conclude, in contrast to subjective preferences, visual evaluation of emphysema should be based on spiral CT (10 mm slice thickness and reconstruction with a high spatial algorithm) instead of HRCT in potential candidates for LVRS. The presentation of images as "densitymasked" images improves the visual evaluation of degree of emphysema. This type of imaging can easily be performed on all CT scanners and can thus be recommended as part of a complete CT examination. The addition of lung perfusion scintigraphy to spiral CT of the lungs improves the classification of emphysema heterogeneity in candidates for LVRS. A method for objective classification of emphysema heterogeneity has been developed

The effect of arm positioning on timing and enhancement of intravenous contrast media at coronary computed tomography angiography.

Adequate intravenous contrast media (CM) enhancement is crucial for evaluation of the coronary arteries

Automatic individualized contrast medium dosage during hepatic computed tomography by using computed tomography dose index volume (CTDIvol)

To compare hepatic parenchymal contrast media (CM) enhancement during multi-detector row computed tomography (MDCT) and its correlation with volume pitch-corrected computed tomography dose index CTDIvol) and body weight (BW). One hundred patients referred for standard three-phase thoraco-abdominal MDCT examination were enrolled. BW was measured in the CT suite. Forty grams of iodine was administered intravenously (iodixanol 320 mg I/ml at 5 ml/s or iomeprol 400 mg I/ml at 4 ml/s) followed by a 50-ml saline flush. CTDIvol presented by the CT equipment during the parenchymal examination was recorded. The CM enhancement of the liver was defined as the attenuation HU of the liver parenchyma during the hepatic parenchymal phase minus the attenuation in the native phase. Liver parenchymal enhancement was negatively correlated to both CTDIvol (r = -0.60) and BW (r = -0.64), but the difference in correlation between those two was not significant. CTDIvol may replace BW when adjusting CM doses to body size. This makes it potentially feasible to automatically individualize CM dosage by CT. aEuro cent CTDI (vol) is related to liver CM enhancement in the parenchymal phase. aEuro cent CTDI (vol) provides comparable information to body weight (BW). aEuro cent CTDI (vol) may be used when automatically adjusting CM dose for patient size

sj-vid-2-arr-10.1177 2058460118778068 -Supplemental material for Variable size of aortic subvalvular pseudoaneurysm

<p>Supplemental material, sj-vid-2-arr-10.1177 2058460118778068 for Variable size of aortic subvalvular pseudoaneurysm by Anders Svensson, Kerstin Cederlund, Torkel B Brismar and Raquel Themudo in Acta Radiologica Open</p

Visualization of dialysis fistula by computed tomography using time-resolved 3D volume rendering

BACKGROUND To evaluate the function of arteriovenous (AV) dialysis fistula using dynamic computed tomography (CT) and time-resolved 3-dimensional (3D) volume rendering (VR). METHODS Seven patients referred for angiographic CT examination of the AV dialysis fistula were enrolled. Twenty-four grams of iodine were administered intravenously (iomeprol 400 mg I/mL at 6 mL/sec) followed by a 50-mL saline flush. Dynamic scanning was performed for 15-24 sec. CT images were then postprocessed on a dedicated workstation creating time-resolved 3D VR images and movies. RESULTS All studies showed good image quality showing pathology in 6 of 7 patients. Unexpected findings were observed in 1 patient, aneurysm (n = 1). Radiation dose was 5 mSv. CONCLUSIONS The function of AV dialysis fistula can be visualized using dynamic CT and time-resolved 3D VR