Tuberculosis (TB) has re-emerged as a major worldwide public health hazard with increasing incidence among adults and children. Although cases among children represent a small percentage of all TB cases, they are a reservoir from which many adult cases will arise. Estimates indicate that 9 million people develop TB annually, out of which 1 million (11 percent) occur in children less than 15 years old. Childhood tuberculosis is on the increase worldwide because of persisting inability to conform the diagnosis, leading to a large number of children dying of undiagnosed tuberculosis. Diagnosis of pulmonary tuberculosis has depended on bacteriological examination of sputum. In most of the developing countries sputum smear microscopy has been used as it has been found to be cheap and relative efficient. As a result of the high TB burden, there is an urgent need for improved methods of laboratory diagnosis of TB. This is especially needed in children were diagnosis is more challenging as mycobacteria is being detected in fewer than 50 percent of the cases. Children cannot produce adequate sputum samples for examination. Their sputum samples, if produced, has a low bacterial yield and making detection of mycobacteria by using the smear microscopy difficult. Therefore, gastric lavages from children are being recommended as the best specimen for culture. In this study, gastric lavages from 408 children suspected of having tuberculosis were examined for the recovery of mycobacteria. Recovery was optimized by the use of the relatively new non-radiometric fully automated BACTEC MGIT 960. BACTEC MGIT 960 produced a positivity rate of 27.2 percent against 17.2 percent that of Lowenstein-Jensen (L-J) media, which is a conventional culture method used widely. The direct microscopy which is the cheapest traditional method used in diagnosis of tuberculosis (TB) yielded a 5.6 percent positive rate. The BACTEC MGIT 960 had also a very high isolate detection rate of 98.2 percent compared to that of L-J media of 61.9 percent, and only 20.4 percent were detected with the direct microscopy. On time taken to detection or mean time to detection (TTD) of v isolates, the BACTEC MGIT 960 technique had a shorter mean time to detection, 12.5 days as compared to 34.3 days shown by the L-J media technique. The study showed that children normally get tuberculosis from adult members of the household. A positive TB case was found in the households of 55.4 percent of the suspects. The study has found that 46.4 percent of the children below the age of 4 years developed the disease, compared to 10.5 percent the older children in the age group 10 to 14 years. The study found that tuberculosis in children is mainly caused by Mycobacterium tuberculosis. Out of the 113 isolates detected, 110 (97.3 percent) were M. tuberculosis. The remaining 2.7 percent were the non-tuberculous M. avium complex and M. kansasii. It was inconclusive whether the 2.7 percent of other species were causing tuberculosis and this need to be studied further.

Hypoactive sexual desire is one of the most prevalent psychosexual problems seen by clinicians, yet there is little consensus as to its etiology, maintenance, appropriate therapeutic intervention or prognosis. Sexual disinterest is considered to be difficult to treat due to severe intrapsychic and/or interpersonal conflict. Few empirical studies exist, however, regarding intrapsychic or interpersonal dynamics in couples where one spouse is assigned the diagnosis of hypoactive sexual desire (HSD). The purpose of this study was to develop a clearer understanding of the intrapsychic and interpersonal dynamics of the clinical group diagnosed with hypoactive sexual desire. Individual and interactional data was collected from both diagnosed individuals and spouses. The sample consisted of three groups of subjects and their partners. Twenty-two subjects assigned a DSM-III-R diagnosis of lifelong or acquired, generalized Hypoactive Sexual Desire (HSD) and their spouses were compared on intrapsychic and interpersonal variables with two groups consisting of twenty-one sexually dysfunctional subjects displaying a DSM-III-R arousal or orgasm disorder (SDys) and their spouses, and 19 couples with no reported sexual dysfunction (NSD). Only subjects free from other Axis I disorders, medical illness, or substance abuse were selected. Control subjects met similar criteria but had no reported sexual dysfunction. All partners were sexually functional. Subjects were administered: the Derogatis Sexual Functioning Inventory (DSFI), the Sexual History Form (SHF), the Medical History Questionnaire (MHQ), the Minnesota Multiphasic Personality Inventory (MMPI), the Affect Balance Scale (ABS), the State-Trait Anxiety Inventory (STAI), the Dyadic Adjustment Scale (DAS) and the Structural Analysis of Social Behavior (SASB) over a three week period. Statistical procedures used to analyse the data included Canonical Correlation, ANOVA, Profile Analysis, Hotelling's test (T²) and Student-Newman-Keuls test procedure. The test results measuring intrapsychic phenomena revealed that although all groups had normal MMPI profiles, the affect/anxiety variate was significantly elevated in the HSD and SDys groups. In addition, self concept as measured by the SASB introject was significantly more negative in the HSD and SDys groups as compared to the control group. No significant intrapsychic differences were found between partners in the three groups. The interpersonal measures indicated that HSD subjects and SDys subjects perceived their relationships as less nurturing and affirming than did control subjects. Additionally, HSD subjects and their spouses perceived their relationships as measured by the SASB to be more hostile. The study provides some evidence to support the view that HSD subjects have lower self concepts and higher relationship conflicts than do subjects with arousal or orgasm problems or control subjects. Similar to much of the previous research conducted on nonmedical aspects of human sexuality, the study design was exploratory and descriptive in nature thus removing any possibility of drawing cause and effect conclusions. / Graduate and Postdoctoral Studies / Graduate

The aim of the present study was to determine the convergent validity of three instruments thought to assess attention deficits and hyperactivity in children. The Freedom from Distractibility factor from the Wechsler Intelligence Scale for Children-Revised, The Conners Parent Symptom Questionnaire and the Gordon Diagnostic System were the instruments chosen for the investigation as they are thought to measure attention deficits across a variety of settings and by different means. To examine the relationship, responses were collected for 36 children (26 males, 10 females) in Grades 1 to 7 attending schools in the Lower Mainland of British Columbia and who according to parent reports exhibited behavior patterns similar to the descriptions needed for the diagnosis of Attention Deficit-Hyperactivity Disorder. Results of the analyses are inclusive and need to be followed up in subsequent research. The WISC-R provides a valid and reliable measure of general cognitive ability. Two subtests from the WISC-R, Coding and Digit Span appeared to measure attention, however the Freedom from Distractibility Quotient should not be utilized as a measure of attention. Learning Problems and the Hyperactivity Index on the Conners Parent Symptom Questionnaire also serve as measures of attention. In a more general sense the Conners Parent Symptom Questionnaire might be a useful contribution to an assessment battery as a description of a child's behavior from a parent's point of view and as such provides an ecological assessment of behavior. It also allows one to measure behavior over time. The Vigilance and Distractibility total correct and errors of commission would appear to be measures of attention while the Delay task failed to classify the children according to the behavior objectives set out by the study. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

No description available.

Includes bibliographical references / Background: Health care workers are at increased risk of acquiring latent tuberculosis infection (LTBI). The emergence of interferon - gamma release assays (IGRAs) for the diagnosis of LTBI, presents an opportunity for improved estimation of TB infection prevalence and incidence. Their utility in settings with high background prevalence TB and HIV infection is unknown. Major aims of the study were to: * Evaluate the prevalence and factors associated with TB infection using both tuberculin skin test (TST) and IGRA assays in a sample of health care workers. * Evaluate change in interval test response over one year to determine annual risk of infection and determinants associated with test conversion. Methods: Participants completed a questionnaire on occupational and environmental characteristics including a TB symptom screen and underwent chest radiograph and rapid HIV test. Three tests for latent TB infection were administered: TST, QuantiFERON - TB Gold In - Tube (QFT - GIT) and a T - SPOT.TB test. All tests were repeated one year later. Results: The prevalence of TB infection at baseline was 84%, 65% and 60% as measured by TST, QFT - GIT and T - SPOT.TB. There was only fair agreement between TST and IGRAs. HIV positive status was significantly associated with having a TST negative / T - SPOT.TB positive discordant test response (OR=4.72). TST had superior sensitivity than IGRAs for the diagnosis of LTBI. In primary level staff a positive TST outcome, was negatively associated with HIV positive status (OR=0.41). Long employment duration was positively associated with TST (OR=4.17) and QFT - GIT (OR= 2.42) positivity. Involvement in sputum collection (OR=3.25) and home - based care of TB patients (OR= 4.14) was associated with a positive IGRA test. The conversion rate for TST and IGRAs was 38% and 22%, respectively. Reversion rates ranged from 1 % - 16 % and was lowest for TST. Factors associated with conversion (for IGRAs) included employment sector, counselling of TB patients and a baseline positive TST. Conclusion: The annual rate of TB infection was very high pointing to occupational exposure as a contributory factor. TST had superior sensitivity than IGRAs for LTBI diagnosis but poor uptake on serial testing. IGRAs had excellent uptake but its clinical utility was negatively influenced by high rates of reversion.

No description available.

Background: Determination of intra-abdominal injury following blunt abdominal trauma (BAT) continues to be a diagnostic challenge. Ultrasound (US) bas been described as a potentially useful diagnostic tool in this setting and is being used with increasing frequency in trauma centers. We determined the diagnostic capability of US in the evaluation of BAT. Methods: A retrospective analysis of our trauma US database was performed over a 30-month period. Computed tomographic scan, diagnostic peritoneal lavage, or exploratory laparotomy confirmed the presence of intra-abdominal injury. Results: During the study period, 8,197 patients were evaluated at the Ryder Trauma Center. Of this group, 2,576 (31%) had US in the evaluation of BAT. Three hundred eleven (12%) US exams were considered positive. Forty-three patients (1.7%) had a false-negative US; of this group, 10 (33%) required exploratory laparotomy. US had a sensitivity of 86%, a specificity of 98%, and an accuracy of 97% for detection of intra-abdominal injuries. Positive predictive value was 87% and negative predictive value was 98%. Conclusion: Emergency US is highly reliable and may replace computed tomographic scan and diagnostic peritoneal lavage as the initial diagnostic modality in the evaluation of most patients with BAT.

Introduction World Health Organization approved the use of Xpert MTB/RIF Ultra (Ultra) in children due to quick turn-around time, improved yield over smear microscopy, and ability to detect rifampicin resistance despite culture being the “gold standard”. This study reviewed published literature on current childhood tuberculosis diagnostic modalities. It also retrospectively compared demographic, clinical, and radiological features of children with confirmed and unconfirmed PTB, reviewed criteria for microbiologically unconfirmed PTB, and assessed incremental microbiological yield on second and third Ultra and/or mycobacterial culture results in routine clinical care at a tertiary paediatric hospital. Method For the review on childhood TB diagnostic modalities, PubMed was searched using Boolean terms OR/AND between childhood tuberculosis and words such as diagnosis, polymerase chain reaction, molecular, histology, imaging, and cultures. All abstracts were read after which selected articles that met the objectives of the thesis were fully reviewed and referenced appropriately. The retrospective study was conducted in children (0 to 13 years) treated for Pulmonary TB (PTB) between 1 February 2018 and 31 January 2019 and who had at least one respiratory specimen investigated by Ultra and/or mycobacterial culture before TB treatment was commenced. Relevant demographic, clinical information, tuberculin skin test results and laboratory results were abstracted from paper-based medical records and electronic database. Baseline chest radiographic findings were obtained from the radiology digital imaging database. All data was entered anonymously into a Microsoft Excel spreadsheet and exported to R-statistical software for statistical analysis. Descriptive and inferential statistics were used in the analysis. Incremental yield of Ultra and/or mycobacterial cultures on sequential respiratory specimens was determined. Results Ultra is an important diagnostic method for confirming TB in children even though mycobacterial culture, molecular, and histology tests are also available. Other modalities such as imaging and immunologic tests support the diagnosis of microbiologically unconfirmed TB. 174 children with PTB ± EPTB were included in the retrospective study. The median age was 2.5 years. Tuberculosis was microbiologically confirmed in 93 (53.4%). Yield on Ultra in first respiratory specimens was 39.1%. When the results of Ultra and mycobacterial culture on first respiratory specimens were combined, 47.1% (82/174) had microbiologically confirmed TB. Microcytic anaemia and pulmonary pathology were more common in confirmed TB. Of 81 children with microbiologically unconfirmed TB, 31 (38.3%) met a consensus definition of unconfirmed intrathoracic TB formulated by an international expert committee. In the subset of children (n=70) who were screened by Ultra on two sequential respiratory specimens, the incremental yield was 30.3%. When the results of Ultra and mycobacterial culture were combined the incremental yield in children who had 2 sequential respiratory specimens tested was 24.4% and 3.1% on Ultra and mycobacterial culture, respectively. Conclusion Ultra and/or mycobacterial culture on single respiratory specimens resulted in high microbiological yield. Ultra on second sequential respiratory specimens increased microbiological confirmation. The value of additional Ultra and/or mycobacterial culture testing in routine clinical practice requires further study.

Several hundred inherited disorders of the skeleton have been delineated. Individually these conditions are rare, but as a group they cause much crippling and hardship. Several factors, including the rarity and complexity of the manifestations of these conditions, as well as semantic overlap, impede the accurate diagnosis which is essential for effective treatment. In this regard, the adoption of microcomputers warrants evaluation as a high technology aid. Microcomputers have developed tremendous capabilities during recent years. The state of the art has become such that a diagnostic aid facility on such a device has been demonstrated in various disciplines of medicine and may also be feasible in the area of inherited skeletal disorders. The study which forms the basis of this thesis, concerns the investigation of this feasibility and has led to the development of an effective working model which sets the basis for microcomputer-aided diagnosis. The design features followed in this project are similar to those conventionally employed for "Expert systems" on mainframe computers. A comprehensive knowledge base consisting of over 200 skeletal disorders and 700 radiographic and clinical manifestations, has resulted. Furthermore, the application is capable of "learning", although inference as employed by the inference engines of real expert systems, is not employed. In this context learning implies that the knowledge base, with the passage of time, improves considerably when used by experts. Serendipitous findings in this regard are: • 1) Considerable improvement of existing profile descriptions can occur without any increased demands on computer memory and storage space; • 2) Growth of the knowledge base in the form of additional disease profiles can be effected with very modest inroads on memory and storage resources. The computerized diagnostic aid which resulted from this thesis, has been demonstrated to be successful in both the Department of Human Genetics of the University of Cape Town and the Department of Paediatrics of the Johannes Gutenberg University in Mainz. Evaluated both in terms of efficiency and utility, the system provides an enhancement to the specialist genetic diagnostician. These achievements have been effected by means of a unique newly developed application of compressed bit-mapping, attained by writing the applicable programs in Turbo Pascal and 8086- assembler languages. Calculations indicate that much larger data bases may possibly be implemented on present-day microcomputers by means of the methods developed in this project.

Indiana University-Purdue University Indianapolis (IUPUI) / Secondary caries and the replacement of existing restorations account for 50 to 70 percent of operative dentistry today. Quantitative Light Fluorescence (QLF) has been shown to be effective at diagnosing very early tooth demineralization on smooth surfaces (less than 50 μ in depth); however, QLF has never been utilized to evaluate secondary caries in dentin. The objective of this study was to validate the accuracy of QLF in diagnosing early secondary caries and then verify the results using confocal microscopy and polarized light microscopy. Seventy-five mandibular molar teeth were prepared with Class V amalgam preparations on the mesial surface. A fluoridated varnish and 1.23- percent acidulated phosphate fluoride (APF) were introduced to this evaluation system, two agents known to effectively inhibit tooth demineralization. The artificial caries system utilized was adjusted to ensure that secondary caries would occur at restoration/tooth surface interfaces. The teeth were exposed to this artificial caries challenge for five days and following lesion formation, QLF was used to determine if incipient demineralization could be detected. The results of the QLF analysis were then compared with the data gathered using confocal microscopy and polarized light microscopy. Our results demonstrate that QLF detected 100 percent of the lesions seen with confocal microscopy and polarized light microscopy; however, no sound specimens were analyzed with any of the three techniques. There were no consistent significant differences between the fluoridated varnish and APF (p < 0.05) with any of the three methods utilized. We conclude that QLF can be used in early caries diagnosis and that emphasis should now be focused on treatment of the early lesion.