Management practices of tuberculosis in children among pediatric practitioners in Mangalore, South India

Magnetic Resonance Imaging Images under Deep Learning in the Identification of Tuberculosis and Pneumonia

This work aimed to explore the application value of deep learning-based magnetic resonance imaging (MRI) images in the identification of tuberculosis and pneumonia, in order to provide a certain reference basis for clinical identification. In this study, 30 pulmonary tuberculosis patients and 27 pneumonia patients who were hospitalized were selected as the research objects, and they were divided into a pulmonary tuberculosis group and a pneumonia group. MRI examination based on noise reduction algorithms was used to observe and compare the signal-to-noise ratio (SNR) and carrier-to-noise ratio (CNR) of the images. In addition, the apparent diffusion coefficient (ADC) value for the diagnosis efficiency of lung parenchymal lesions was analyzed, and the best b value was selected. The results showed that the MRI image after denoising by the deep convolutional neural network (DCNN) algorithm was clearer, the edges of the lung tissue were regular, the inflammation signal was higher, and the SNR and CNR were better than before, which were 119.79 versus 83.43 and 12.59 versus 7.21, respectively. The accuracy of MRI based on a deep learning algorithm in the diagnosis of pulmonary tuberculosis and pneumonia was significantly improved (96.67% vs. 70%, 100% vs. 62.96%) (P < 0.05). With the increase in b value, the CNR and SNR of MRI images all showed a downward trend (P < 0.05). Therefore, it was found that the shadow of tuberculosis lesions under a specific sequence was higher than that of pneumonia in the process of identifying tuberculosis and pneumonia, which reflected the importance of deep learning MRI images in the differential diagnosis of tuberculosis and pneumonia, thereby providing reference basis for clinical follow-up diagnosis and treatment.

'We are not aware of notification of tuberculosis': A mixed-methods study among private practitioners from western India

BACKGROUND

Implementing the Standards for tuberculosis care in India (STCI) guidelines in the private sector is vital. This study attempted to estimate the knowledge and practices regarding STCI guidelines among private practitioners and to explore the reasons and solutions for low tuberculosis (TB) notification rates.

METHODS

We conducted a cross-sectional study for assessing the knowledge and practices of the STCI guidelines among 100 full-time allopathic private practitioners in Bhavnagar (in western part of India) from September 2018 to January 2019. Knowledge and practice were categorised as good or poor by assigning scores to the responses to a questionnaire based on the STCI guidelines. It was followed by two focus group discussions to explore the reasons and solutions for low notification rates of TB as perceived by private practitioners.

RESULTS

Among the 100 private practitioners, 55% had good knowledge, and 41% had good practice regarding the STCI guidelines; 69% knew about the gazette notification of mandatory notification of TB, and 58% were notifying TB cases to the government. Lack of awareness about the process as well as incentives for notification, time constraints and infrequent visits by health workers were the main reasons perceived by private practitioners for not notifying TB cases to the government. The critical solutions suggested by them were creating awareness regarding the notification process as well as incentives, increasing health worker visits and use of social media for notification.

CONCLUSION

Only about half of private practitioners follow the STCI guidelines for TB care, and the notification rates are low in our setting. Regular sensitisation programs need to be arranged for private practitioners to create awareness on TB notification.

Significance of Mantoux Test and Its Correlation with Erythrocyte Sedimentation Rate in Pediatric Cleft Lip and Palate Patients: An Institutional Perspective

Aims and Objective

This retrospective study evaluates the importance of Mantoux test and Erythrocyte Sedimentation Rate (ESR) levels in pediatric tuberculosis and also signifies the impact of this test in treatment planning and implementation in pediatric cleft lip and palate patients.

Methodology

Retrospective analyses of the records of 2010 pediatric cleft lip and palate patients below 5 years age were performed, and patients with elevated ESR subjected to Mantoux test were identified. The parameters included were age, sex, ESR levels, type of cleft, history of contact with TB & BCG vaccination, Mantoux conversion, chest X-ray findings, number of smear-positive pulmonary tuberculosis.

Results

Out of 2010 patients with cleft lip and palate, 180 patients were subjected to Mantoux test due to high ESR levels. Among these, 54 (30%) patients found as Mantoux positive, in which 45 patients were identified as smear-positive pulmonary tuberculosis patients; as a result, surgery was deferred and they underwent antituberculous therapy. Most of the Mantoux-positive cases were found in patients with ESR range of 20-30 mm, i.e., 38 patients (71%), and common age group was 6 months-1 year. The most commonly involved cleft type was: unilateral cleft lip and palate having 36 patients (66.7%). The overall incidence of tuberculosis was 2%.

Conclusion

Although the correlation of Mantoux test with elevated ESR was not significant in our study, it could be of value as a screening tool along with the Mantoux test, which is sensitive but nonspecific in the diagnosis of active tuberculosis. Together, they could be a valuable screening tool in any community or hospital for diagnosis of the disease.