Portable digital X-ray for TB pre-diagnosis screening in rural communities in Nigeria

SETTING:This pilot project was conducted in hard-to-reach communities of two Niger Delta States in the South-South Region of Nigeria.OBJECTIVE:To assess the usefulness of portable digital X-ray, the Delft-Light Backpack (DLB) for TB active case-finding (ACF) in hard-to-reach Niger Delta communities using the WHO 3B TB screening/diagnosis algorithm.DESIGN:DLB X-ray was used to screen all consenting eligible participants during community TB screening out-reaches in all hard-to-reach communities of Akwa Ibom and Cross River States in the Niger Delta, Nigeria. Participants with a CAD4TB (computer-aided detection for TB score) ⩾60 had Xpert (sputum) and/or clinical (radiograph) assessment for TB diagnosis. Data from the project were analysed for this study.RESULTS:A total of 8,230 participants (males: 47.2%, females: 52.8%) underwent TB screening and 1,140 (13.9%) presumptive TB cases were identified. The TB prevalence among all participants and among those with presumptive TB were respectively 1.2% and 8.6%. The number needed to screen was 84. Among people with presumptive TB, the proportion of males and females with confirmed TB was respectively 12.0% and 5.6% (P < 0.001).CONCLUSION:TB screening using DLB X-ray during community-based ACF in hard-to-reach Niger Delta communities of Nigeria showed a high TB prevalence among participants. Nationwide deployment of the instrument in hard-to-reach areas is recommended.     

Application of machine learning algorithms for localized syringe services program policy implementation – Florida, 2017

BackgroundPeople who inject drugs (PWID) are at an amplified vulnerability for experiencing a multitude of harms related to their substance use, including viral (e.g. HIV, Hepatitis C) and bacterial infections (e.g. endocarditis). Implementation of evidence-based interventions, such as syringe services programs (SSPs), remains imperative, particularly in locations at an increased risk of HIV outbreaks. This study aims to identify communities in Florida that are high-priority locations for SSP implementation by examining state-level data related to the substance use and overdose crises.MethodsState-level surveillance data were aggregated at the ZIP Code Tabulation Area (ZCTA) (n = 983) for 2017. We used confirmed cases of acute HCV infection as a proxy of injection drug use. Least Absolute Selection and Shrinkage Operator (LASSO) regression was used to develop a machine learning model to identify significant indicators of acute HCV infection and high-priority areas for SSP implementation due to their increased vulnerability to an HIV outbreak.ResultsThe final model retained three variables of importance: (1) the number of drug-associated skin and soft tissue infection hospitalizations, (2) the number of chronic HCV infections in people aged 18–39, and 3) the number of drug-associated endocarditis hospitalizations. High-priority SSP implementation locations were identified in both urban and rural communities outside of current Ending the HIV Epidemic counties.ConclusionSSPs are long researched, safe, and effective evidence-based programs that offer a variety of services that reduce disease transmission and assist with combating the overdose crisis. Opportunities to increase services in needed regions across the state now exist in Florida as supported by the expansion of the Infectious Disease Elimination Act of 2019. This study provides details where potential areas of concern may be and highlights regions where future evidence-based harm reduction programs, such as SSPs, would be useful to reduce opioid overdoses and disease transmission among PWID.

Key messages

• The rate of acute HCV in Florida in 2017 was 1.9 per 100,000, nearly twice the national average.
• Serious injection related infections among PWID are significant indicators of acute HCV infection.
• High-priority SSP implementation locations in Florida were identified in both urban and rural communities, including those outside of current Ending the HIV Epidemic counties.

     

The prevention of fetal asphyxia

The double responsibility of obstetric practice demands that the physician give due regard to safeguarding the life of the child during labor as well as during pregnancy. Death of the child during labor is practically always due to asphyxia, brought about by various maternal and fetal causes, some of which act slowly and are preventable, while others are so rapid in their action that little opportunity is given for treatment.A lack of oxygen and an increase in carbon dioxide in the fetal blood causes a stimulation, first, of the cardio-inhibitory center in the medulla, which results in a decrease of the fetal heart rate. Later on, the respiratory center is stimulated, and with ineffectual efforts to breathe, asphyxia results. A fetal heart rate temporarily slowed, not lower than 100, during pains, but increasing to normal rate between pains, is a sufficient indication to follow the heart rate more frequently, discover the cause if possible, and make preparations for interference, if required. A fetal heart rate persistently below 100, both during and between pains, demands prompt delivery of the baby if this can be done without great risk to the mother. A rapid heart rate does not indicate either a threatened, or an advanced state of asphyxia.The diagnosis of threatened fetal asphyxia is facilitated by use of the De Lee head stethoscope. The adjustable model made by Pilling & Co., is better adapted to all positions. It should be used at frequent intervals during the second stage of labor, when compression of the cord, coiled about the neck or partially prolapsed, against the pubic bone, occasionally produces asphyxia. Prompt delivery of the baby, under such circumstances, may prevent death from asphyxia.