EPIDEMIOLOGY OF TUBERCULOSIS IN INTERNATIONALLY DISPLACED CHILDREN RESETTLING IN HARRIS COUNTY

Background More than 300,000 refugees arrived in the United States (U.S.) from 2010-2015, and Texas accepts the 2nd highest number of refugees. Texas also accepts large numbers of asylees, parolees, and special immigrant visa holders. Additionally, a large proportion of trafficked persons in the U.S. live in or pass through Texas. Foreign-born children are disproportionately affected by tuberculosis (TB) and account for two-thirds of U.S. childhood TB cases. Children are at greater risk for progression from TB infection to disease and experience greater morbidity and mortality from TB disease. This makes screening for and treatment of TB infection in children from high-prevalence areas an important public health intervention. Since 2007, children 2-14 years old emigrating from high-prevalence countries (TB incidence \u3e20 cases /100,000 persons) have been tested for TB infection. Children ≥15 years old are additionally screened with a chest radiograph. The Centers for Disease Control and Prevention (CDC) recommends treatment of children with TB infection, as treatment reduces the risk of life threatening disease and prevents future transmission. There are few studies describing the epidemiology of TB in internationally displaced children relocating to the U.S.; there have been no studies centered on Texas. We describe the secular trends and comparative epidemiology of positive TSTs and IGRAs in children of different immigration statuses cared for through the Houston-area public health program. Methods This was a retrospective cross-sectional study of children \u3c18 years-old evaluated by the Harris County Public Health Refugee Health Screening Program between January 1st, 2010 and December 31st, 2015 with the following immigration statuses: refugee, asylee, parolee, special immigrant visa holder, or victim of human trafficking. We analyzed factors associated with TB test positivity, infection and disease for children with these immigration statuses. Data are from the U.S. Committee for Refugees and Immigrants (USCRI), the Harris County Public Health Refugee Health Screening Program, and the Texas Children\u27s Hospital TB clinic. Chi-square test or Fisher’s exact test were used for dichotomous variables, one-way ANOVAs for univariate analyses, and Wilcoxon rank sum or Kruskal-Wallis for continuous variables. Multivariate logistic regression was performed to further analyze factors associated with TB test positivity. To assess secular trends in usage and positivity, monthly totals were analyzed using linear regression and the Wilcoxon Sign Rank test. A p-value \u3c0.05 was considered significant. Children \u3c 5 years were typically tested using tuberculin skin test (TSTs) and older children typically using interferon-gamma release assays (IGRAs). The primary outcome was a positive test of TB infection (TST and/or IGRA). Children who were TST+/IGRA- with no known contacts, a normal chest radiograph and no signs or symptoms consistent with TB disease were typically considered uninfected. However, there were some children who met these criteria who were considered to have TB infection and were treated as such –this typically occurred earlier in the study period, and was most commonly due to young age (\u3c 2 years old) or some variability in provider practice. Results The program evaluated 5,990 children, of whom 5870 (98%) were tested, predominantly (64%) with an IGRA alone. During the study period, IGRA use increased (p\u3c0.001), though percentages of positive test results (IGRA or TST) did not decline significantly (p=0.10). Overall, 364 (6.2%) children had at least one positive test of infection: 143/1,842 (7.8%) tested with TST alone, 129/3,730 (63.6%) tested with IGRA alone, and 92/298 (30.9%) had at least one positive test result for those tested with both TST and IGRA. Among the 364 children with any positive test of infection, 4 (1.1%) were diagnosed with TB disease, 325 (89.3%) were diagnosed with TB infection, and 35 (9.6%) were considered uninfected. Three factors were significantly associated with a positive TST or IGRA result: region of origin, younger age group, and HIV infection. All children were more likely to have a positive TST compared to IGRA (OR 2.92, 95% CI: 2.37-3.59). Discordant test results were common (20%) and most often were TST+/IGRA- (95.0%). 35/57 (61.4%) of children who were TST+/IGRA- were considered uninfected and did not receive therapy for TB infection; none developed TB disease. The 22/57 (38.6%) TST+/IGRA- children who were treated for TB infection, were treated as such typically due to young age (\u3c 2 years old) or variability in provider practice. Conclusions Positive TST results were twice as common as positive IGRA results and discordant TST/IGRA results were common. Positive TST results in BCG-immunized children frequently represent cross-reactivity and false positivity. Use of IGRAs as opposed to TSTs in BCG-immunized children would reduce false positive tests and allow for TB infection therapy to be targeted to those who would most benefit. These findings support 2018 changes in U.S. immigration guidelines that mandate IGRA use for recently immigrated children above 2 years of age

Synsedimentary deformation and thrusting on the eatern margin of the Barberton Greenstone belt, Swaziland

Mapping on the eastern margin of the 3.6 to 3.3 Ga Barberton Greenstone Belt NW Swaziland has revealed a tectonic complex which is more than 5 km thick. The area consists of fault bound units made up of three lithological associations. Some of these were affected by four phases of deformation. Fold structures, foliations, and lineations are associated with the deformation. Sedimentation, geological structures, and evolutionary history of the area are explained

Simulated acoustic emissions from coupled strings

We consider traveling transverse waves on two identical uniform taut strings that are elastically coupled through springs that gradually decrease their stiffness over a region of finite length. The wave system can be decomposed into two modes: an in-phase mode ( + ) that is transparent to the coupling springs, and an out-of-phase mode ( − ) that engages the coupling springs and can resonate at a particular location depending on the excitation frequency. The system exhibits linear mode conversion whereby an incoming ( + ) wave is reflected back from the resonance location both as a propagating ( + ) wave and an evanescent ( − ) wave, while both types emerge as propagating forward through the resonance location. We match a local transition layer expansion to the WKB expansion to obtain estimates of the reflection and transmission coefficients. The reflected waves may be an analog for stimulated emissions from the ear

Imaging diagnosis-computed tomography of traction bronchiectasis secondary to pulmonary fibrosis in a Patterdale Terrier

An 8-year-old, Patterdale terrier was referred for evaluation of tachypnoea, exercise intolerance, and weight loss. Computed tomographic images showed pneumomediastinum, diffuse pulmonary ground glass opacity, and marked dilatation of peripheral bronchi, but no evidence of thickened bronchial walls. The histopathologic diagnosis was diffuse pulmonary interstitial fibrosis, type II pneumocyte hyperplasia, and bronchiectasis. The lack of evidence of primary bronchitis supported a diagnosis of traction bronchiectasis. Traction bronchiectasis can occur as a sequela to pulmonary fibrosis in dogs. (C) 2016 American College of Veterinary Radiology

Ultrasonography in the diagnosis and management of cats with ureteral obstruction

This was a retrospective cross-sectional study of cats with azotaemia (serum creatinine >180 μmol/l) that had ultrasonography of the urinary tract, ultrasound images available for review and received treatment for azotaemia. Cats with pre-renal azotaemia or urethral obstruction were excluded. Associations between clinical and ultrasonographic results and the dependent variables ‘tentative diagnosis of ureteral obstruction’, ‘pyelography positive for ureteral obstruction’ and ‘death in hospital’ were tested using binary logistic regression