The challenges of tuberculosis control in protracted conflict: the case of Syria

Objectives Syria’s protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria. Results Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and has destroyed key infrastructures leading to an increased risk of both sensitive and drug resistant TB while restricting the ability to diagnose, contact trace, treat and follow up. Pre-conflict, TB in Syria was officially reported at 22 per 100,000 population; the official figure for 2017 of 19 per 100,000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affects the diagnosis of multidrug and rifampicin resistant TB which is reported at 8.8% of new diagnoses in 2017. Conclusion Control of TB in Syria requires a multipronged, tailored and pragmatic approach to improve timely diagnosis, increase detection, stop transmission and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction

Predicting emergency interventions in patients with acute ureteral colic using acute renal colic scoring system in a Pakistani cohort

Objective: To evaluate the acute renal colic score (ARC) in predicting the need of emergency intervention (EI) in patients with ureteric colic secondary to a ureteral stone.Patient and methods: In an emergency room (ER) of a university hospital, we conducted a prospective cohort study over a period of 6 months. ARC score was calculated using four parameters, i.e., serum creatinine, total white cell count (TLC), stone length and level. Primary outcome measure was EI, which was defined as the need of endourological intervention within 48 h of presentation. ARC was calculated for each patient against the two possible outcomes, i.e., EI vs. no EI. The need of intervention was based on patient-related clinical factors and the decision of the attending urologist.Results: The study included 132 patients. EI was performed in 85 patients (64.4%). URS was the most common intervention performed in 81 (95.3%) patients, followed by the a insertion of a double J stent in two (2.4%) patients for forniceal rupture and high TLC count and percutaneous nephrostomy in two (2.4%) patients for raised creatinine and TLC. All four variables in ARC score including serum creatinine (p \u3c 0.001), TLC (p \u3c 0.001), stone size (p \u3c 0.001) and stone level (p \u3c 0.001) were found to be significantly associated with need for EI. Using ROC the sensitivity and specificity of the score was 92.9% and 87.5%, respectively, with AUC of 0.93.Conclusions: ARC score is highly sensitive and specific in determining the need of EI in patients with uncomplicated ureteric colic within 48 h of initial presentation