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Purpose: As training of trachoma graders using live participants grows increasingly difficult and expensive, alternative ways are needed possibly through replacement of field grading with photography. However, minimum specifications for a camera system capable of capturing high quality images have not been defined. This study compared images captured using four smartphones with those from a Nikon SLR camera for image quality and assessment of trachomatous inflammation – follicular (TF). Methods: The smartphones – Samsung Galaxy S8 (S8), Techno Camon 17 pro (TC), Infinix Note 10 pro (IN), Huawei p30 pro (HP) – were chosen for their availability and likelihood of good performance based on specifications without external attachments. All smartphones were used in random order for each participant. Results: 129 children in Kongwa, Tanzania were enrolled (32.8% TF prevalence). The SLR camera had the least percent of ungradable images (3.1%), followed by the S8 (14%), HP (23.4%), IN (65.9%), and TC (71.2%). The S8 and the HP were significantly more likely to take ungradable images if they were used toward the end of the camera rotation. Agreement between the SLR and field grade was kappa = 0.73. Agreement between the field grade and gradable images from the S8 (0.68) and HP (0.8) was measured. Conclusions: Published specifications did not predict the success of using different smartphones for everted eyelid photographs; proprietary post-processing software likely influenced gradeability. Smartphones, though we cannot recommend those tested in this study, may be viable for capturing images for trachoma provided the quality of images from the field are adequate. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association between the severity of trachomatous conjunctival scarring (TS) of the upper eyelid conjunctiva and trachomatous trichiasis (TT) severity in TT surgical patients. Methods: A cross-sectional study was conducted amongst adults with TT who were referred to surgical camps in Bahi District, Tanzania, for TT surgery. Participants underwent ocular examination. The presence and severity of TS was evaluated in photographs of the everted upper eyelid. TT severity was assessed at the time of the ocular exam based on the number of lashes touching the globe and/or evidence and extent of epilation. Ordinal logistic models were used to examine the association between the severity of TS and TT severity. Results: A total of 627 eyes of 388 participants were included. Mean age was 65 years (ranging from 21–98), 81% were females, and 62% had bilateral TT. 93% of eyes with any TT had at least moderate TS; 62% of eyes had severe TS. An increase in TS severity was associated with an increase in the severity of TT. Using as a reference eyes with none to mild TS, in eyes with moderate TS the odds of increased severity of TT was 1.30 (95% CI 0.67–2.51), in eyes with severe TS the odds was 4.20 (95% CI 2.23–7.92). Conclusion: In cases of trachomatous trichiasis presenting for surgery, the severity of TT was significantly associated with the severity of TS with almost all cases of TT having moderate or severe scarring. [ABSTRACT FROM AUTHOR]

Clinical trials for retinitis pigmentosa (RP) likely require long follow-ups because of the slow progression of RP. Understanding patients' attitudes toward participation in a long trial and their acceptability of strategies aimed at promoting retention/compliance is important for assessing feasibility and resource needs and optimizing trial design. A crowdsourcing survey to adult RP patients was administered on social media in 2020 July-November. Patient enthusiasm level of study participation, acceptability of attending clinic visits every 4–5 months for 45-months, tele-visits with doctors, and of receiving text messages for medication reminders and for reporting missed dosages were surveyed. Among the 1473 respondents, over 95% use email or a mobile phone and receive text messages; 1157 (79%) respondents were very/somewhat enthusiastic about participation, among them, 80.6% were "very willing" to attend clinic visits every 4–5 months for 45 months; 90.3% were "very willing" to have tele-visits; 64.7% and 77.1% were willing to receive text reminders to take medication and messages surveying missed doses, respectively. The youngest age group (18–30) (22.1%) and oldest age group (70+) (26.1%) compared to the 41–50 years age group (14%) and women (23.5%) compared to men (14.2%) were statistically significantly more likely not to report high willingness to participate in clinical visits for 45 months. A trial requiring 4-years of commitment is feasible although retention can be challenging. Strategies including supplementing in-clinic visits with tele-visits and frequent communications may facilitate retention. This study also demonstrates a methodology useful for planning clinical trials for chronic diseases. [ABSTRACT FROM AUTHOR]

Xpert MTB/RIF Ultra (Ultra)-detected rifampicin-resistant tuberculosis (TB) is often programmatically confirmed using MTBDR plus . There are limited data on discordant results, including when re-tested using newer methods, like FluoroType MTBDR (FT-MTBDR) and targeted deep sequencing. MTBDR plus rifampicin-susceptible isolates from people with Ultra rifampicin-resistant sputum were identified from a South African programmatic laboratory. FT-MTBDR and single molecule-overlapping reads (SMOR; rpoB , inhA , katG ) on isolate DNA were done (SMOR was used as a reference standard). Between 1 April 2021 and 30 September 2022, 8% (109/1347) of Ultra rifampicin-resistant specimens were MTBDR plus -susceptible. Of 89% (97/109) isolates with a sequenceable rpoB , SMOR resolved most in favor of Ultra (79% [77/97]). Sputum with lower mycobacterial load was associated with Ultra false-positive resistance (46% [11/24] of "very low" Ultra had false resistance vs 12% [9/73; P = 0.0004] of ≥"low"), as were Ultra heteroresistance calls (all wild-type probes, ≥1 mutant probe) (62% [23/37 vs 25% 15/60] for Ultra without heteroresistance calls; P = 0.0003). Of the 91% (88/97) of isolates successfully tested by FT-MTBDR, 55% (48/88) were FT-MTBDR rifampicin-resistant and 45% (40/88) susceptible, translating to 69% (47/68) sensitivity and 95% (19/20) specificity. In the 91% (99/109) of isolates with inhA and katG sequenced, 62% (61/99) were SMOR isoniazid-susceptible. When Ultra and MTBDR plus rifampicin results are discordant, Ultra is more likely to be correct, and FT-MTBDR agrees more with Ultra than MTBDR plus ; however, lower load and the Ultra heteroresistance probe pattern were risk factors for Ultra false rifampicin-resistant results. Most people with Ultra-MTBDR plus discordant resistance results were isoniazid-susceptible. These data have implications for drug-resistant TB diagnosis., Competing Interests: The authors declare no conflict of interest.