The utility of abdominal ultrasound in the diagnosis of paediatric abdominal tuberculosis: a single centre review

Background: Childhood tuberculosis (TB) is a common disease worldwide, with an increased propensity for severe, disseminated disease in settings with a high burden of concomitant HIV infection. Ultrasound is commonly used in diagnosing abdominal TB, however the indications for its use are unclear and often vary amongst clinicians. Objective: In this study, we describe the findings of ultrasound examinations performed for suspected abdominal TB at a tertiary children's hospital and examine the variability in reporting patterns amongst radiologists performing these imaging investigations. Materials and methods: Ultrasound studies performed for “suspected abdominal TB” between 01 January 2013 – 31 December 2018 were reviewed. In studies reported as suggestive of abdominal TB, evidence of microbiologically confirmed disease was sought. Subsequently, a selection of images from these studies were independently reviewed by three paediatric radiologists to determine their level of agreement when interpreting imaging findings. Results: During the study period 1093 studies were performed for suspected abdominal TB, of which 166 (15%) had abnormal features suggestive of TB. Forty-seven percent of these patients (78/166) had microbiologically confirmed disease. The commonest reported features were lymphadenopathy, 77% (128/166) and splenic microabscesses, 55% (92/166) for which substantial inter-reader agreement was documented, Fleiss' kappa = 0.64 and 0.66 respectively. There was moderate inter-reader agreement in the diagnosis of abdominal TB among radiologists (Fleiss' kappa=0.47). Conclusion: Caution is advised when basing clinical decisions on ultrasound studies performed for suspected abdominal TB, as imaging features are non-specific and there is considerable variability in interpretation of studies among reporting radiologists

Coexistence of urinary incontinence and osteoporosis in females - a systematic review

To assess the available research and find links between coexistence of decreased bone health and urinary incontinence in female

Juvenile xanthogranuloma: Awakening of the other histiocytosis?

No abstract available

Role of cranial computed tomography in human immunodeficiency virus-positive patients with generalised seizures

Background: Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination. Method: We conducted a prospective descriptive observational study. Consecutive HIVpositive patients of 18 years and older, who presented to the Kimberley Hospital Complex’s Emergency Department within 24 hours of their first generalised seizures and who had undergone normal post-ictal neurological examinations, were included. Emergency CT results as well as CD4-count levels were evaluated. Results: A total of 25 HIV-positive patients were included in the study. The results of cranial CT brought about a change in emergency care management in 12% of patients, all of them with CD4 counts below 200 cells/mm3 . Conclusion: We suggest that emergency cranial CT be performed on all HIV-positive patients presenting with generalised NOS and a normal post-ictal neurological examination, particularly if the CD4 count is below 200 cells/mm3. Keywords: HIV; Seizures; CT Brai

Review of cardiovascular magnetic resonance in human immunodeficiency virus-associated cardiovascular disease

Despite ongoing advances in the treatment of patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), they remain a major global public health concern conferring an increased risk of morbidity and mortality in affected individuals. This is, in part, because of the widespread dysfunction imposed by HIV and its treatment on the cardiovascular system, including the myocardium, valvular apparatus, pericardium and coronary, pulmonary and peripheral vasculature. In recent times, cardiovascular magnetic resonance (CMR) imaging has emerged as the gold standard tool for assessment of a variety of indications, allowing comprehensive characterisation of functional, morphological, metabolic and haemodynamic sequelae of several cardiovascular pathologies. Furthermore, continued advancement in imaging techniques has yielded novel insights into the underlying pathophysiology and guides future therapeutic strategies. In this article, we review the various clinical phenotypes of HIV-associated cardiovascular disease and highlight the utility of CMR in their assessment

Rabies Outbreak in the Urban Area of Delhi: An Investigation Report and One Health Perspective for Outbreak Management

Rabies is a global problem and is endemic in India. Rabies cases occur throughout the year, and the majority of cases are associated with dog bites. We report a rabies outbreak investigation in an urban area of Delhi conducted by our multidisciplinary team, and its role in proactively controlling a rabies outbreak by concerted efforts and timely advice to various stakeholders using a “One Health Approach.” A veterinary care NGO from Delhi picked up a suspected rabid stray dog and submitted a brain sample for diagnosis of rabies, as they had received information from a resident of the locality about an unprovoked animal bite incident involving a girl (category III bite) and close contact of two more stray dogs living in the vicinity of the suspected rabid dog. The laboratory diagnosis of rabies in the suspected dog brain sample was confirmed by using Fluorescence Antibody Test (FAT). A multi-expert investigation team with expertise in medicine, microbiology, veterinary sciences, laboratory diagnosis, and public health was constituted to investigate the outbreak. The timely, adequate, and appropriate anti-rabies management initiated for the animal bite victims in this incident could prevent rabies. Proactive involvement of multiple stakeholders and knowledge attributes and practice of local residents could prevent human rabies. As there were no further reports of dog bites from the area, the chain of rabies transmission in that area could be controlled. The presented work is a classical case scenario where concerted efforts of all stakeholders achieved effective control and prevention of rabies by adopting the “One Health approach”

Intravitam Diagnosis of Rabies in Patients with Acute Encephalitis: A Study of Two Cases

Rabies is one of the oldest known zoonotic diseases. Rhabdovirus, an RNA virus belonging to the genus Lyssavirus and family Rhabdoviridae, causes rabies. Rabies diagnosis is challenging as the rabies virus remains confined to neurons after the initial animal bite. It largely remains immune-evasive until the infection reaches the central nervous system. The bottleneck in rabies diagnosis remains the non-availability of technical expertise and failure to collect an appropriate sample. The laboratory confirmation of rabies in both antemortem and postmortem samples is important. The samples were tested for anti-rabies antibodies using quantitative ELISA. In this report, two case studies are presented to demonstrate the suitability of ELISA for the intra vitam diagnosis of rabies using cerebrospinal fluid (CSF) as a diagnostic sample. The interpretation of serology results for both vaccinated and unvaccinated individuals has been discussed in detail, which has helped to confirm the antemortem diagnosis of rabies. In this report, we observed that ELISA can be a viable alternative for anti-rabies antibody detection in CSF and can be used as a viable alternative to more technically challenging tests, such as Rapid Fluorescent Focus Inhibition Test (RFFFIT) and Immunofluorescence Assays (IFA)