Published also as a thesis, Univ. de Paris, with title: Indications et résultats de la chirurgie d'exérèse dans le traitement de la tuberculose pulmonaire.

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine in the branch of Diagnostic Radiology Johannesburg 2018. / INTRODUCTION: Tuberculosis (TB) is an important public health issue, but diagnosis in children can be challenging. The radiological hallmark of pulmonary TB (PTB) in children is mediastinal lymphadenopathy, however there is inter-observer variability in detecting this. The value of the lateral CXR in addition to the frontal view to detect lymphadenopathy has not been well studied. OBJECTIVES: To investigate the prevalence of lymphadenopathy in children with confirmed PTB detected on frontal compared to frontal-lateral CXRs. METHODS: This was a secondary analysis of a study from Red Cross Children’s Hospital in Cape Town. Children with definite TB and a control group (Lower respiratory tract infection other than TB) who had frontal and lateral CXRs were included in this study. Three radiologists independently read the CXRs in 2 separate sittings (frontal CXR and ‘combination frontallateral’ CXR). A 3 reader consensus reading was used during data analysis. Odds ratios and 95% confidence intervals were calculated to determine the presence of lymphadenopathy. Kappa statistics were calculated to determine inter reader agreement. RESULTS: Of 172 children (88 confirmed TB and 84 control children), with a median age of 29 months, lymphadenopathy was reported in 86 (50%) patients on the frontal CXR alone and in 143 (83%) on the frontal-lateral CXR combination, p= 0.00. Amongst confirmed PTB cases, 52 (60%) had lymphadenopathy on the frontal CXR alone while 72 (82%) had lymphadenopathy on the frontal-lateral CXR combination, p= 0.00. Amongst the control group, 34 (40%) had lymphadenopathy on the frontal CXR alone while 71 (85%) had lymphadenopathy on the frontal-lateral CXR combination, p= 0.00. The consensus reading using a frontal-lateral CXR combination resulted in a 5 fold increase (OR 4,9; 95% CI 2,9-8,4) in diagnosis of lymphadenopathy compared to a frontal CXR only. Overall inter reader agreement for all 3 readers was fair on both the frontal CXR (Kappa= 0,21) and the frontal-lateral CXR (Kappa= 0,23) combination. CONCLUSION: The addition of a lateral view to the frontal CXR increased detection of lymphadenopathy, however, the prevalence of lymphadenopathy was similar in children with PTB and those in the control group, with fair inter reader agreement. / LG2018

Pang, Tak Ting Phoebe. / "September 2010." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 153-161). / Abstracts in English and Chinese. / Acknowledgement --- p.I / Abstract --- p.II / 摘要 --- p.IV / List of Figures --- p.V / List of Tables --- p.VII / Abbreviations --- p.VIII / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Chapter 1.1 --- Historical perspective of tuberculosis --- p.1 / Chapter 1.1.1 --- Sanatorium care --- p.2 / Chapter 1.1.2 --- Vaccination --- p.2 / Chapter 1.1.3 --- Drug treatment --- p.3 / Chapter 1.1.4 --- Transmission dynamics of tuberculosis --- p.3 / Chapter 1.1.5 --- Resurgence of tuberculosis --- p.4 / Chapter 1.2 --- Current global and local tuberculosis epidemiology --- p.6 / Chapter 1.2.1 --- "Tuberculosis and HIV/AIDS, drug resistance in the world" --- p.6 / Chapter 1.2.2 --- Global epidemiology of tuberculosis --- p.9 / Chapter 1.2.3 --- Local epidemiology of tuberculosis --- p.9 / Chapter 1.2.4 --- "Tuberculosis, HIV/AIDS and drug resistance in Hong Kong" --- p.14 / Chapter 1.2.5 --- Approaches in studying tuberculosis epidemiology --- p.15 / Chapter 1.3 --- Determinants of tuberculosis epidemiology --- p.17 / Chapter 1.3.1 --- TB determinants in the triad of epidemiology --- p.17 / Chapter 1.3.2 --- Rise of spatial epidemiology --- p.18 / Chapter 1.4 --- Recent developments of spatial epidemiology --- p.21 / Chapter 1.4.1 --- Spatial epidemiology and infectious disease --- p.21 / Chapter 1.4.2 --- Disease mapping --- p.22 / Chapter 1.4.3 --- Geographic information system --- p.22 / Chapter 1.4.4 --- Statistics in spatial epidemiology --- p.23 / Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.24 / Chapter 2.1 --- Objective of literature review --- p.24 / Chapter 2.2 --- Literature search --- p.25 / Chapter 2.2.1 --- Strategy for literature search --- p.25 / Chapter 2.2.2 --- Results for literature search --- p.25 / Chapter 2.3 --- Spatial perspective in tuberculosis epidemiology --- p.31 / Chapter 2.3.1 --- Mapping the spatial pattern --- p.32 / Chapter 2.3.2 --- Understanding the spatial pattern --- p.32 / Chapter 2.3.3 --- Modelling the spatial pattern --- p.33 / Chapter 2.4 --- Neighbourhood determinants of tuberculosis --- p.34 / Chapter 2.4.1 --- TB and demographics --- p.35 / Chapter 2.4.2 --- TB and socioeconomic status --- p.36 / Chapter 2.4.3 --- TB and the environment --- p.38 / Chapter 2.4.4 --- TB and care factors --- p.40 / Chapter 2.5 --- Techniques applied in studying tuberculosis epidemiology --- p.41 / Chapter 2.5.1 --- Constructing spatial data --- p.41 / Chapter 2.5.2 --- Disease maps used --- p.45 / Chapter 2.5.3 --- "Integrated approach using spatial statistics, conventional statistics and molecular analysis" --- p.52 / Chapter 2.6 --- Research gap and thesis objectives --- p.55 / Chapter 2.6.1 --- Research gap --- p.55 / Chapter 2.6.2 --- Thesis objective --- p.56 / Chapter CHAPTER THREE --- METHODOLOGY --- p.57 / Chapter 3.1 --- Rationale and approach --- p.57 / Chapter 3.1.1 --- Logical flow of the study --- p.57 / Chapter 3.1.2 --- Methodological flow of the study --- p.60 / Chapter 3.2 --- Choosing spatial units --- p.63 / Chapter 3.3 --- Data collection --- p.69 / Chapter 3.3.1 --- Tuberculosis data --- p.70 / Chapter 3.3.2 --- Spatial data --- p.70 / Chapter 3.3.3 --- Neighbourhood data --- p.70 / Chapter 3.4 --- Data manipulation --- p.73 / Chapter 3.4.1 --- Tuberculosis data --- p.73 / Chapter 3.4.2 --- Spatial data --- p.74 / Chapter 3.4.3 --- Neighbourhood data --- p.74 / Chapter 3.5 --- Centrographic analysis --- p.76 / Chapter 3.5.1 --- Types of centrographic statistics --- p.76 / Chapter 3.6 --- Exploratory spatial data analysis --- p.78 / Chapter 3.6.1 --- Spatial proximity matrix --- p.78 / Chapter 3.6.2 --- Moran's Index --- p.79 / Chapter 3.6.3 --- Local Indicator of Spatial Association --- p.79 / Chapter 3.7 --- Explanatory analysis --- p.81 / Chapter 3.7.1 --- Selecting variables for modelling --- p.82 / Chapter 3.7.2 --- Ordinary linear regression --- p.82 / Chapter 3.7.3 --- Geographically weighted regression --- p.83 / Chapter CHAPTER FOUR --- RESULTS --- p.85 / Chapter 4.1 --- Overview --- p.85 / Chapter 4.1.1 --- Individual level --- p.85 / Chapter 4.1.2 --- Aggregated level --- p.89 / Chapter 4.2 --- Results for centrographic analysis --- p.97 / Chapter 4.3 --- Results for exploratory spatial data analysis --- p.101 / Chapter 4.3.1 --- Results for Moran's Index --- p.101 / Chapter 4.3.2 --- Results for Local Indicator of Spatial Association --- p.103 / Chapter 4.4 --- Results for explanatory analysis --- p.110 / Chapter 4.4.1 --- Correlation analysis and variables selection --- p.110 / Chapter 4.4.2 --- Results for ordinary linear regression --- p.114 / Chapter 4.4.3 --- Results for geographically weighted regression --- p.116 / Chapter CHAPTER FIVE --- DISCUSSION --- p.131 / Chapter 5.1 --- Preamble --- p.131 / Chapter 5.1.1 --- Methods overview --- p.132 / Chapter 5.1.2 --- Results overview --- p.132 / Chapter 5.1.3 --- Layout of this chapter --- p.134 / Chapter 5.2 --- Neighbourhood determinants in relation to TB --- p.135 / Chapter 5.2.1 --- Crowding and tuberculosis --- p.135 / Chapter 5.2.2 --- Poverty and tuberculosis --- p.137 / Chapter 5.2.3 --- Immigrants and tuberculosis --- p.138 / Chapter 5.2.4 --- Marital status and tuberculosis --- p.139 / Chapter 5.2.5 --- Implication of local parameter estimates of association --- p.140 / Chapter 5.3 --- Study design for spatial epidemiology --- p.142 / Chapter 5.3.1 --- Application of spatial dependence in spatial epidemiology --- p.142 / Chapter 5.3.2 --- Choosing spatial units --- p.144 / Chapter 5.4 --- Methodological concern in this study --- p.146 / Chapter 5.4.1 --- Concern over disease mapping --- p.146 / Chapter 5.4.2 --- Application of geographically weighted regression --- p.148 / Chapter 5.5 --- Limitation of the study --- p.150 / Chapter 5.6 --- Conclusion --- p.152 / REFERENCE --- p.153 / APPENDIX --- p.162 / Appendix 1 How to calculate TB SNR? --- p.162 / Appendix 2 How GWR works? --- p.164 / Appendix 3 What is AIC? --- p.165 / Appendix 4 How Monte Carlo test works? --- p.166 / Appendix 5 List of GWR output --- p.167

A dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine (Internal Medicine) Johannesburg 2001 / Introduction and Aim: The waxy outer cell wall of mycobacteria consists mainly of mycolic acids (MA). The unique immuno-stimulatory properties of MA via the CD 1-restricted antigen presentation pathway have been demonstrated in humans. Purification and isolation of M.tuberculosis (MTB) MA has allowed them to be applied as an antigen in an ELISA-based sero-diagnostic assay to detect specific antibodies in the sera of humans. The aim of the study was to measure the levels of antibody to MA in the sera of patients with culture proven pulmonary tuberculosis (PTB), and in control subjects without evidence of tuberculosis. / IT2018

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2009.

The majority of today's elderly people were primarily infected with Mycobacterium tuberculosis at a time when no effective chemotherapeutic treatment was available. With the progressive decline in cell mediated immunity that accompanies aging, the potential to reactivate a dormant lesion, or to be re-infected increases. The latter particularly applies in areas of high density living e.g. homes for the elderly. The incidence of pulmonary tuberculosis in whites in South Africa is very similar to that in industrialized countries (approximately 16/100 000). In a survey of old age homes in East London (South Africa) involving 809 white subjects the prevalence rate was found to be 1403/100 000; clusters were found in individual homes where up to 10% of residents had tuberculosis. The age specific incidence in the community for whites was 86/100 000, and in homes for the aged the incidence in 648 elderly subjects followed for 2 years was 1080/100 000. It is concluded that the elderly living in high density accommodation constitute a high-risk group for the development of the disease. The diagnosis of pulmonary tuberculosis in the elderly may be complicated by the high prevalence of atypical radiographic changes, difficulty in obtaining sputum, and the high false-negative rate of the tuberculin skin test. Thus, the value of haematological and biochemical abnormalities in 93 elderly tuberculotics, 113 elderly non-tuberculotics and 264 young tuberculotics were investigated. The results in the elderly tuberculotic patients were: Normochromic normocytic anaemia (70%), leucocytosis (55%), thrombocytosis (33%), rapid ESR in 90%, lymphopenia (22%) and monocytopenia (37%); hyponatraemia (60%), hypokalaemia (42%) and hypoalbuminaemia (83%), serum bilirubin (20%) and alkaline phosphatase, aspartic transaminase and lactic dehydrogenase are elevated in approximately 2/3 of patients. In comparison with the younger group (mean age 48 years) with cavitating tuberculosis, the prevalence of elderly patients (with generally mild and non-cavitating disease) with elevated bilirubin, alkaline phosphatase and liver enzymes was approximately 50% higher. When the results of liver enzyme elevations in the elderly tuberculotics were compared retrospectively with elderly patients with non-tuberculotic destructive lung disease, the former group had significantly higher values. The sensitivity (76%), specificity (48%) and positive predictive value (60%) suggest that liver enzyme abnormalities may provide useful contributory data in the non-invasive diagnosis of pulmonary tuberculosis in the elderly. The chest radiographs in 93 consecutive cases of bacteriologically proven pulmonary tuberculosis showed infrequent apical involvement (7%), with the most frequent abnormality being opacification of the middle and lower zones of the lungs; half the cases had a pleural reaction. cavitation occurs in only 1/3 of patients, and was sited equally in the apical zones and in the mid and lower zones. These findings contrast with the pattern of cavitating apico-posterior disease commonly seen in reactivated tuberculosis in younger adults. A series of 21 patients was studied to compare the yield of sputum smear examination with sputum culture for M. tuberculosis. Sputum production in non-cavitating disease was found to be infrequent and unpredictable and the number of bacilli is usually scanty. Repeated Culture of sputum for M. tuberculosis is required to improve the likelihood of obtaining a positive bacteriological diagnosis. On the basis of this study at least 4 negative sputum cultures are required to exclude the disease. In a study of 10 patients the impact of 4-drug therapy on the viability of M. tubercle in their sputum was assessed. Viable tubercle bacilli continue to be excreted in patients with cavitating pulmonary disease on treatment for up to 9 weeks. It is suggested that patients with cavitating disease should probably not be allowed to return to high density accommodation for the elderly until their sputum is clear of acid fast bacilli on sputum smear examinations. The usefulness of using annual tuberculin skin reaction (Mantoux) tests as a screening procedure was evaluated in 648 residents in old age homes. The criteria for further investigation for pulmonary tuberculosis was either recent conversion to positive (reaction equal to 10 mm or more) or a year-on-year increase of greater than 12 mm, or any reaction> 20 mm. 206 subjects were identified as "possibly having the disease" and of these the diagnosis of pulmonary tuberculosis confirmed in 13 cases. 10/13 patients had Mantoux reactions of greater than 20 mm and 3/13 between 10 mm and 19 mm. As a result of this study the recommendation is made that a yearly Mantoux test is a useful screening procedure, and will help identify a population who should be further investigated with chest radiographs and sputum cultures.

Lic.-avh. Stockholm : Karolinska institutet, 2006.

Thesis (M.C.T.M. (Clinical Tropial Medicine))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services. LIRV has E-Thesis 0012 ; please contact circulation services.