7 results on '"Pinto, Lancelot"'
Search Results
2. Xpert MTB/RIF and pulmonary tuberculosis: time to delve deeper?
- Author
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Pinto LM and Udwadia ZF
- Subjects
- Female, Humans, Male, Bronchoalveolar Lavage Fluid microbiology, Mycobacterium tuberculosis isolation & purification, Sputum microbiology, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Pulmonary diagnosis
- Published
- 2013
- Full Text
- View/download PDF
3. Scoring systems using chest radiographic features for the diagnosis of pulmonary tuberculosis in adults: a systematic review.
- Author
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Pinto LM, Pai M, Dheda K, Schwartzman K, Menzies D, and Steingart KR
- Subjects
- Humans, Lung diagnostic imaging, Observational Studies as Topic, Odds Ratio, Radiography, Thoracic standards, Randomized Controlled Trials as Topic, Reproducibility of Results, Sensitivity and Specificity, Severity of Illness Index, Radiography, Thoracic methods, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary diagnostic imaging
- Abstract
Chest radiography for the diagnosis of active pulmonary tuberculosis (PTB) is limited by poor specificity and reader inconsistency. Scoring systems have been employed successfully for improving the performance of chest radiography for various pulmonary diseases. We conducted a systematic review to assess the diagnostic accuracy and reproducibility of scoring systems for PTB. We searched multiple databases for studies that evaluated the accuracy and reproducibility of chest radiograph scoring systems for PTB. We summarised results for specific radiographic features and scoring systems associated with PTB. Where appropriate, we estimated pooled performance of similar studies using a random effects model. 13 studies were included in the review, nine of which were in low tuberculosis (TB) burden settings. No scoring system was based solely on radiographic findings. All studies used systems with various combinations of clinical and radiological features. 11 studies involved scoring systems that were used for making decisions concerning hospital respiratory isolation. None of the included studies reported data on intra- or inter-reporter reproducibility. Upper lobe infiltrates (pooled diagnostic OR 3.57, 95% CI 2.38-5.37, five studies) and cavities (diagnostic OR range 1.97-25.66, three studies) were significantly associated with PTB. Sensitivities of the scoring systems were high (median 96%, IQR 93-98%), but specificities were low (median 46%, IQR 35-50%). Chest radiograph scoring systems appear useful in ruling out PTB in hospitals, but their low specificity precludes ruling in PTB. There is a need to develop accurate scoring systems for people living with HIV and for outpatient settings, especially in high TB burden settings.
- Published
- 2013
- Full Text
- View/download PDF
4. Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis.
- Author
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Pinto LM, Dheda K, Theron G, Allwood B, Calligaro G, van Zyl-Smit R, Peter J, Schwartzman K, Menzies D, Bateman E, Pai M, and Dawson R
- Subjects
- Adult, Cohort Studies, Female, HIV Infections complications, Health Personnel education, Health Personnel standards, Humans, Logistic Models, Lung microbiology, Male, Middle Aged, Multivariate Analysis, Reproducibility of Results, Sensitivity and Specificity, South Africa, Sputum microbiology, Tuberculosis, Pulmonary complications, Lung diagnostic imaging, Mycobacterium tuberculosis isolation & purification, Radiography, Thoracic methods, Tuberculosis, Pulmonary diagnosis
- Abstract
Rationale: Chest radiography is sometimes the only method available for investigating patients with possible pulmonary tuberculosis (PTB) with negative sputum smears. However, interpretation of chest radiographs in this context lacks specificity for PTB, is subjective and is neither standardized nor reproducible. Efforts to improve the interpretation of chest radiography are warranted., Objectives: To develop a scoring system to aid the diagnosis of PTB, using features recorded with the Chest Radiograph Reading and Recording System (CRRS)., Methods: Chest radiographs of outpatients with possible PTB, recruited over 3 years at clinics in South Africa were read by two independent readers using the CRRS method. Multivariate analysis was used to identify features significantly associated with culture-positive PTB. These were weighted and used to generate a score., Results: 473 patients were included in the analysis. Large upper lobe opacities, cavities, unilateral pleural effusion and adenopathy were significantly associated with PTB, had high inter-reader reliability, and received 2, 2, 1 and 2 points, respectively in the final score. Using a cut-off of 2, scores below this threshold had a high negative predictive value (91.5%, 95%CI 87.1,94.7), but low positive predictive value (49.4%, 95%CI 42.9,55.9). Among the 382 TB suspects with negative sputum smears, 229 patients had scores <2; the score correctly ruled out active PTB in 214 of these patients (NPV 93.4%; 95%CI 89.4,96.3). The score had a suboptimal negative predictive value in HIV-infected patients (NPV 86.4, 95% CI 75,94)., Conclusions: The proposed scoring system is simple, and reliably ruled out active PTB in smear-negative HIV-uninfected patients, thus potentially reducing the need for further tests in high burden settings. Validation studies are now required.
- Published
- 2013
- Full Text
- View/download PDF
5. The use of an automated quantitative polymerase chain reaction (Xpert MTB/RIF) to predict the sputum smear status of tuberculosis patients.
- Author
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Theron G, Pinto L, Peter J, Mishra HK, Mishra HK, van Zyl-Smit R, Sharma SK, and Dheda K
- Subjects
- Bacteriological Techniques, Humans, Predictive Value of Tests, Sensitivity and Specificity, Automation, Polymerase Chain Reaction methods, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary microbiology
- Abstract
Xpert MTB/RIF-generated cycle-threshold (C(T)) values have poor clinical utility as a rule-in test for smear positivity (cut-point ≤20.2; sensitivity 32.3%, specificity 97.1%) but moderately good rule-out value (cut-point >31.8; negative predictive value 80.0%). Thus, 20% of individuals with C(T) values >31.8 were erroneously ruled out as smear-negative. This group had a significantly lower sputum bacillary load relative to correctly classified smear-positive patients (C(T) ≤ 31.8; P < .001). These data inform on public health and contact tracing strategies.
- Published
- 2012
- Full Text
- View/download PDF
6. Immunodiagnosis of tuberculosis: state of the art.
- Author
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Pinto LM, Grenier J, Schumacher SG, Denkinger CM, Steingart KR, and Pai M
- Subjects
- Antitubercular Agents therapeutic use, Humans, Immunologic Tests instrumentation, Interferon-gamma Release Tests, Latent Tuberculosis, Mycobacterium tuberculosis isolation & purification, Practice Guidelines as Topic, Predictive Value of Tests, Serologic Tests, Time Factors, Tuberculosis, Pulmonary blood, Tuberculosis, Pulmonary immunology, World Health Organization, Immunologic Tests methods, Tuberculosis, Pulmonary diagnosis
- Abstract
Undiagnosed and mismanaged tuberculosis (TB) continues to fuel the global TB epidemic. Rapid, accurate and early diagnosis of TB is therefore a priority to improve TB case detection and interrupt transmission. Although considerable improvements have been made in TB diagnostics, there are two major gaps in the existing diagnostics pipeline: (1) lack of a simple accurate point-of-care test that can be used for rapid diagnosis at the primary care level; (2) lack of a biomarker (or combination of biomarkers) that can be used to identify latently infected individuals who will benefit most from preventive therapy. Currently available commercial serological (antibody detection) tests are inaccurate and do not improve patient outcomes. Despite this evidence, dozens of serological tests are sold and used in countries (e.g. India) with weak regulatory systems, especially in the private sector. Recognizing the threat posed by these suboptimal tests, a World Health Organization (WHO) Expert Group has strongly recommended against the use of serological tests for the diagnosis of pulmonary and extra-pulmonary TB. Another WHO Expert Group has discouraged the use of interferon-γ release assays for active pulmonary TB diagnosis in low- and middle-income countries. All existing tests for latent TB infection appear to have only modest predictive value and further research is needed to identify highly predictive biomarkers., (Copyright © 2011 S. Karger AG, Basel.)
- Published
- 2012
- Full Text
- View/download PDF
7. A patient with hypercoagulable state due to tuberculosis.
- Author
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Mark PL, Ashok PP, Deshpande RB, and Mahashur AA
- Subjects
- Humans, Male, Middle Aged, Thrombophilia etiology, Tuberculosis, Miliary complications, Tuberculosis, Pulmonary complications
- Abstract
A 55-year-old male patient presented with status epilepticus following prolonged fever. Investigations revealed miliary opacities in lungs that were diagnosed as tubercular after thoracoscopic lung biopsy. Wide derangement of coagulation parameters was found, indicating a pro-coagulent state. There was evidence of widespread thrombosis.
- Published
- 2009
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