BACKGROUND: After decades of praziquantel mass drug administration (MDA), several countries approach schistosomiasis elimination. Continuing MDA in largely uninfected populations no longer seems justified. Alternative interventions to maintain the gains or accelerate interruption of transmission are needed. We report results, strengths, and shortcomings of novel test-treat-track-test-treat (5T) interventions in low Schistosoma haematobium prevalence areas on Pemba, Tanzania.
METHODS: School- and household-based surveys were conducted in 2021 and 2022 to monitor the S. haematobium and microhematuria prevalence and assess the impact of interventions. In 2021, 5T interventions were implemented in 15 low-prevalence areas and included: (i) testing schoolchildren in primary and Islamic schools for microhematuria as a proxy for S. haematobium, (ii) treating positive children, (iii) tracking them to their households and to water bodies they frequented, (iv) testing individuals at households and water bodies, and (v) treating positive individuals. Additionally, test-and-treat interventions were implemented in the 22 health facilities of the study area.
RESULTS: The S. haematobium prevalence in the school-based survey in 15 low-prevalence implementation units was 0.5% (7/1560) in 2021 and 0.4% (6/1645) in 2022. In the household-based survey, 0.5% (14/2975) and 0.7% (19/2920) of participants were infected with S. haematobium in 2021 and 2022, respectively. The microhematuria prevalence, excluding trace results, in the school-based survey was 1.4% (21/1560) in 2021 and 1.5% (24/1645) in 2022. In the household-based survey, it was 3.3% (98/2975) in 2021 and 5.4% (159/2920) in 2022. During the 5T interventions, the microhaematuria prevalence was 3.8% (140/3700) and 5.8% (34/594) in children in primary and Islamic schools, respectively, 17.1% (44/258) in household members, and 16.7% (10/60) in people at water bodies. In health facilities, 19.8% (70/354) of patients tested microhematuria-positive.
CONCLUSIONS: The targeted 5T interventions maintained the very low S. haematobium prevalence and proved straightforward and feasible to identify and treat many of the few S. haematobium-infected individuals. Future research will show whether 5T interventions can maintain gains in the longer-term and expedite elimination.
BACKGROUND: ISRCTN, ISCRCTN91431493. Registered 11 February 2020, https://www.isrctn.com/ISRCTN91431493 .

We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously.

UNASSIGNED: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Understanding its epidemiology and burden is critical for targeted interventions.
UNASSIGNED: To highlight the prevalence, incidence and treatment outcomes of TB in Egypt during the last 2 decades.
UNASSIGNED: For this systematic review and meta-analysis, we searched Medline/PubMed, ResearchGate, Google Scholar, and Scopus databases. We searched the local databases for unpublished studies, and the reports of international agencies, applying clear inclusion and exclusion criteria. The search covered prevalence; incidence; treatment outcomes; age, gender and residence of patients; and type of TB. Data were analyzed using STATA version 16.0. Pooled estimates with 95% confidence interval (CI) were calculated using a random effects model. Odds ratio (OR) with 95% CI was used as effect measures for related variables. Heterogeneity across studies was assessed using the I² statistic with sub-group analysis.
UNASSIGNED: A total of 23 studies from 22 governorates, out of 27 governorates, involving a 139 597 study population met the eligibility requirements with no publication bias. The pooled prevalence was 8.70 (95% CI: 5.80-12.41, I² = 92.7%) and the pooled incidence was 9.10 (95% CI: 6.65-14.86, I² = 95.5%) per 100 000 population. About 82.6% of cases showed cured/completed treatment, 4.4% failure of treatment, and 3.9% died. In the subgroup analyses, the odds of TB prevalence were higher among males than females (2.05; 95% CI: 1.44-3.28), among those living in rural than in urban areas (1.29; 95% CI: 0.61-1.97), in Upper Egypt and Greater Cairo than in Lower Egypt and Delta Region (1.85; 95% CI: 0.97-4.15). The odds of pulmonary TB prevalence were higher than the extrapulmonary TB (2.43; 95% CI: 1.63-5.71). The odds of the treatment cases who were cured/completed (1.04; 95% CI: 0.96-1.51), failed (1.71; 95% CI: 1.35-2.73), and died (1.12; 95% CI: 0.87-1.60) were higher in Lower Egypt than in Upper Egypt.
UNASSIGNED: TB incidence decreased in Egypt over the last two decades, but treatment outcomes were unsatisfactory, with variations across the different regions. To achieve TB eradication in Egypt, efforts should be made to sustain the TB control strategy by improving treatment outcomes and intensifying case finding and surveillance reporting.
استعراض منهجي وتحليل تلوي لمعدل انتشار السل ومعدلات الإصابة به ونتائج علاجه في مصر.
محمد أسامه نور، سامح أسامه نور.
UNASSIGNED: يُعَد السل مرضًا مداريًّا مهملًًا يُعرَف بأنه سبب رئيسي للمراضة والوفيات. ويتسم فَهْم خصائصه الوبائية وعبئه بأهمية بالغة في التدخلات المستهدفة.
UNASSIGNED: هدفت هذه الدراسة الى تسليط الضوء على معدل انتشار السل ومعدل الإصابة به ونتائج علاجه في مصر خلال العقدين الماضيين.
UNASSIGNED: لإجراء هذا الاستعراض المنهجي والتحليل التلوي، بحثنا في قواعد البيانات Medline/Pub Med وResearchGate وGoogle Scholar وScopus. وبحثنا في قواعد البيانات المحلية عن الدراسات غير المنشورة، وتقارير الوكالات الدولية، مع تطبيق معايير واضحة للإدراج والاستبعاد. وشمل البحث معدل الانتشار، ومعدل الإصابة، ونتائج العلاج، وعمر المرضى وجنسهم ومكان إقامتهم، ونوع السل. وحُُلِِّلت البيانات باستخدام الإصدار 16,0 من برنامج STATA. وحُُسبت التقديرات الُمُجمََّعة بفاصل الثقة ٪95 باستخدام نموذج التأثيرات العشوائية. واستُُخدمت نسبة الأرجحية بفاصل ثقة ٪95 بمثابة مقياس تأثير للمتغيرات ذات الصلة بالموضوع. وقُُيِِّمت التغايُُرِِيََّة على مستوى الدراسات باستخدام الاختبار الإحصائي I² مع تحليل المجموعات الفرعية.
UNASSIGNED: استوفى ما مجموعه 23 دراسة من 22 من أصل 27 محافظة، شملت 139,597 نسمة ، شروط الأهلية دون أي تحيز في النشر. وبلغ معدل الانتشار الُمُجمََّع 8,70 (فاصل الثقة ٪95: 5,80–12,41، I² = 92,7٪)، وبلغ معدل الإصابة الُمُجمََّع 9,10 (فاصل الثقة ٪95: 6,65–14,86، I² = 95,5٪) لكل 100,000 نسمة. وأظهرت نحو ٪82,6 من الحالات شفاءها أو اكتمال علاجها، وأظهرت ٪4,4 من الحالات فشالًا في العلاج، وتُُوفي ٪3,9 من الحالات. وفي تحليلات المجموعات الفرعية، كانت أرجحية انتشار السل أعلى بين الذكور منها بين الإناث (2,05؛ فاصل الثقة ٪95: 1,44–3,28)، وانتشاره بين أولئك الذين يعيشون في مناطق ريفية أكثر ممن يعيشون في مناطق حضرية (1,29؛ فاصل الثقة ٪95: 0,61–1,97)، وانتشاره في صعيد مصر والقاهرة الكبرى أكثر من شمال مصر ومنطقة الدلتا (1,85؛ فاصل الثقة ٪95: 0,97–4,15). وكانت أرجحية انتشار السل الرئوي أعلى من احتمالات انتشار السل خارج الرئة (2,43؛ فاصل الثقة ٪95: 1,63–5,71). وكانت أرجحية شفاء الحالات أو اكتمال علاجها (1,04؛ فاصل الثقة ٪95: 0,96–1,51)، وفشل العلاج (1,71؛ فاصل الثقة ٪95: 1,35–2,73)، والوفاة (1,12؛ فاصل الثقة ٪95: 0,87–1,60) أعلى في شمال مصر منها في صعيد مصر.
UNASSIGNED: انخفض معدل الإصابة بالسل في مصر على مدار العقدين الماضيين، ولكن نتائج العلاج لم تكن مُُرضية، مع وجود اختلافات بين المناطق المختلفة. ولاستئصال السل في مصر، ينبغي بذل الجهود لمواصلة استراتيجية مكافحة السل، من خلال تحسين نتائج العلاج وتكثيف تق ي صِّي الحالات والإبلاغ عن الترصُُّد.
Analyse systématique et méta-analyse de la prévalence et de l’incidence de la tuberculose et issue thérapeutique en Égypte : aperçu actualisé.
UNASSIGNED: La tuberculose est une cause majeure de morbidité et de mortalité dans le monde. Il est essentiel d\'en comprendre l\'épidémiologie et d\'appréhender le fardeau qu\'elle représente pour mener des interventions ciblées.
UNASSIGNED: Mettre en évidence la prévalence et l\'incidence de la tuberculose ainsi que les issues du traitement en Égypte au cours des deux dernières décennies.
UNASSIGNED: Pour réaliser la présente analyse systématique et méta-analyse, nous avons effectué des recherches dans les bases de données Medline/PubMed, ResearchGate, Google Scholar et Scopus. Nous avons également consulté les bases de données locales afin de trouver des études non publiées, ainsi que les rapports des agences internationales, en appliquant des critères d\'inclusion et d\'exclusion précis. La recherche a porté sur la prévalence, l\'incidence, les résultats du traitement, l\'âge, le genre et le lieu de résidence des patients, ainsi que sur le type de tuberculose. Les données ont été analysées à l\'aide du logiciel STATA version 16.0. Les estimations globales avec intervalle de confiance (IC) à 95 % ont été calculées à l\'aide d\'un modèle à effets aléatoires. L\'odds ratio (OR) avec IC à 95 % a été utilisé comme mesure de l\'effet pour les variables associées. La statistique I², combinée à une analyse de sous-groupes, a été utilisée pour mesurer l\'hétérogénéité entre les études.
UNASSIGNED: Au total, 23 études provenant de 22 gouvernorats sur 27 et réalisées auprès de 139 597 participants répondaient aux critères d\'admissibilité sans biais de publication. La prévalence globale était de 8,70 (IC à 95 % : 5,80-12,41, I² = 92,7 %) et l\'incidence globale était de 9,10 (IC à 95 % : 6,65-14,86, I² = 95,5 %) pour 100 000 personnes. Près de 82,6 % des cas ont été guéris ou ont terminé leur traitement, 4,4 % ont connu un échec thérapeutique et 3,9 % sont décédés. Dans les analyses de sous-groupes, les probabilités de prévalence de la tuberculose étaient plus élevées chez les hommes que chez les femmes (2,05 ; IC à 95 % : 1,44-3,28), chez les personnes vivant en zone rurale qu\'en zone urbaine (1,29 ; IC à 95 % : 0,61-1,97), en Haute Égypte et dans le Grand Caire qu\'en Basse Égypte et dans la région du Delta (1,85 ; IC à 95 % : 0,97-4,15). Les probabilités de prévalence de la tuberculose pulmonaire étaient plus élevées que celles de la tuberculose extrapulmonaire (2,43 ; IC à 95 % : 1,63-5,71). Les probabilités de guérison ou d\'achèvement du traitement (1,04 ; IC à 95 % : 0,96-1,51), d\'échec thérapeutique (1,71 ; IC à 95 % : 1,35-2,73) et de décès (1,12 ; IC à 95 % : 0,87-1,60) étaient plus élevées en Basse Égypte qu\'en Haute Égypte.
UNASSIGNED: L\'incidence de la tuberculose a diminué en Égypte ces vingt dernières années, mais les résultats du traitement n\'étaient pas satisfaisants, avec des variations d\'une région à l\'autre. Dans l\'objectif de parvenir à l\'éradication de la tuberculose en Égypte, il est nécessaire de déployer des efforts pour soutenir la stratégie de lutte antituberculeuse en améliorant les résultats du traitement et en renforçant la recherche de cas et les rapports issus de la surveillance.

暂无摘要。

OBJECTIVE: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB.
METHODS: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18 years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation.
RESULTS: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients.
CONCLUSIONS: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken.

BACKGROUND: The World Health Organization recommends house-to-house case searches as an option to evidence whether the elimination of trachomatous trichiasis (TT) has been reached. We sought to determine the number of trachoma-endemic countries and districts that will require either documented full geographic coverage (DFGC) or TT-only surveys.
METHODS: We conducted a secondary analysis of data from the Trachoma Atlas to identify evaluation units (EUs) that require house-to-house case searches or TT-only surveys to demonstrate achievement of the elimination of TT.
RESULTS: There were 1710 EUs with TT above the elimination prevalence target in all trachoma-endemic countries. Of those EUs, 852 (49.8%) do not have a future survey planned and will therefore potentially have to evidence through DFGC or TT-only surveys whether the elimination prevalence target for TT has been reached.
CONCLUSIONS: Of the large number of EUs that require TT-related activities, nearly half of them will need to evidence that every household in the EU has been visited by a case finder and all confirmed cases managed. Given that this is a relatively new way to evidence elimination, and countries face different sociopolitical challenges, cross-country learning and improved guidance is key to support global elimination.

BACKGROUND: In Iran, the Integrated Electronic Health Record system, called SEPAS, has been established to store all patient encounters of individuals referring to healthcare facilities.
OBJECTIVE: We aimed to develop a model for cleaning SEPAS and applying its data in other databases.
METHODS: We used cancer data from SEPAS as the sample. We developed a guideline to identify codes for cancer-related diagnoses and services in the database. Furthermore, we searched the SEPAS database based on ICD-10 and the diagnosis description in English and Farsi in an Excel sheet. We added codes and descriptions of pharmaceuticals and procedures to the list. We applied the above database and linked it to the patient records to identify cancer patients. A dashboard was designed based on this information for every cancer patient.
RESULTS: We selected 5,841 diagnostic codes and phrases, 9,300 cancer pharmaceutics codes, and 452 codes from cancer-specific items related to the diagnostic procedures and treatment methods. Linkage of this list to the patient list generated a database of about 197,164 cancer patients for linkage in the registry database.
CONCLUSIONS: Patient registries are one of the most important sources of information in healthcare systems. Data linkage between Electronic Health Record Systems (EHRs) and registries, despite its challenges, is profitable. EHRs can be used for case finding in any patient registry to reduce the time and cost of case finding.

Half of women with depression in the perinatal period are not identified in routine care, and missed cases reflect inequalities in other areas of maternity care. Case finding (screening) for depression in pregnant women may be a cost-effective strategy to improve identification, and targeted case finding directs finite resources towards the greatest need. We compared the cost-effectiveness of three case-finding strategies: no case finding, universal (all pregnant women), and targeted (only pregnant women with risk factors for antenatal depression, i.e. history of anxiety/depression, age < 20 years, and adverse life events). A decision tree model was developed to represent case finding (at around 20 weeks gestation) and subsequent treatment for antenatal depression (up to 40 weeks gestation). Costs include case finding and treatment. Health benefits are measured as quality-adjusted life years (QALYs). The sensitivity and specificity of case-finding instruments and prevalence and severity of antenatal depression were estimated from a cohort study of pregnant women. Other model parameters were derived from published literature and expert consultation. The most cost-effective case-finding strategy was a two-stage strategy comprising the Whooley questions followed by the PHQ-9. The mean costs were £52 (universal), £61 (no case finding), and £62 (targeted case finding). Both case-finding strategies improve health compared with no case finding. Universal case finding is cost-saving. Costs associated with targeted case finding are similar to no case finding, with greater health gains, although targeted case finding is not cost-effective compared with universal case finding. Universal case finding for antenatal depression is cost-saving compared to no case finding and more cost-effective than targeted case finding.

Rationale: A significant proportion of individuals with chronic obstructive pulmonary disease (COPD) and asthma remain undiagnosed. Objectives: The objective of this study was to evaluate symptoms, quality of life, healthcare use, and work productivity in subjects with undiagnosed COPD or asthma compared with those previously diagnosed, as well as healthy control subjects. Methods: This multicenter population-based case-finding study randomly recruited adults with respiratory symptoms who had no previous history of diagnosed lung disease from 17 Canadian centers using random digit dialing. Participants who exceeded symptom thresholds on the Asthma Screening Questionnaire or the COPD Diagnostic Questionnaire underwent pre- and post-bronchodilator spirometry to determine if they met diagnostic criteria for COPD or asthma. Two control groups, a healthy group without respiratory symptoms and a symptomatic group with previously diagnosed COPD or asthma, were similarly recruited. Measurements and Main Results: A total of 26,905 symptomatic individuals were interviewed, and 4,272 subjects were eligible. Of these, 2,857 completed pre- and post-bronchodilator spirometry, and 595 (21%) met diagnostic criteria for COPD or asthma. Individuals with undiagnosed COPD or asthma reported greater impact of symptoms on health status and daily activities, worse disease-specific and general quality of life, greater healthcare use, and poorer work productivity than healthy control subjects. Individuals with undiagnosed asthma had symptoms, quality of life, and healthcare use burden similar to those of individuals with previously diagnosed asthma, whereas subjects with undiagnosed COPD were less disabled than those with previously diagnosed COPD. Conclusions: Undiagnosed COPD or asthma imposes important, unmeasured burdens on the healthcare system and is associated with poor health status and negative effects on work productivity.

UNASSIGNED: Case finding for low mood is essential in primary care, but it is time-consuming using current depression inventories. The Burns Depression Scale Today (BDST) is a short, simple inventory which assesses mood for today, and we aimed to validate it in this study.
UNASSIGNED: Consecutive patients with emotional distress seen in a single primary care clinic by one of the authors over 22 months were eligible for this retrospective audit (N = 160). Multiple visits (N = 421) from the same patient were included in the study. The index test was BDST, which assesses the patient\'s mood for today. The reference standard was the 9-item Patient Health Questionnaire (PHQ-9), which assesses mood over the past 2 weeks. PHQ-9 had a cut-off point of ≥10 and BDST had a cut-off point of ≥6 for a significant mood issue.
UNASSIGNED: The median age of patients was 35 years, and 63% of the cohort were women. The median BDST score was 8, indicative of moderately low mood, and the median PHQ-9 score was 15, indicative of moderately severe depression. For patients with a BDST score ≥6, the likelihood ratio of a positive test was 2.67. The sensitivity was 85% (95% confidence interval [CI]: 89%-96%) and the specificity was 68% (95% CI: 60%-76%). The area under the curve was 84% (95% CI: 80%-87%).
UNASSIGNED: This audit validates BDST against PHQ-9 and finds it an excellent case-finding tool compared to PHQ-9. This is the first validation study of BDST.