ABSTRACT
Sonography has proven to be valuable diagnostic imaging equipment in the work-up of patients infected with acquired immune deficiency syndrome (AIDS) and tuberculosis (TB) coinfection. An extensive literature search was conducted between 1994 and 2021 for original peer-reviewed articles in the English language on ultrasound application in the diagnosis of extrapulmonary TB (EPTB), ultrasound application in infectious diseases in resource-constrained settings, point-of-care ultrasound in resource-scarce settings among others, across various electronic databases including MEDLINE, PubMed, POPLINE, Scopus and Google Scholar, among others and some gray literature were also retrieved. Emerging themes were identified by their recurrence in literature. Ultrasound imaging is a rapid diagnostic tool and can accurately identify and characterize pathologic findings in patients infected with HIV/AIDS and TB co-infection, such as enlarged lymph nodes, pericarditis, and pleural effusion, among others for prompt patient management. Ultrasonography is cheaper and portable; interfacing software has become more users friendly and image quality significantly improved, making it possible for the provision of imaging services in an increasing number of clinical settings in resource-limited settings where access to diagnostic imaging is scarce. The use of focused assessment with sonography for HIV (FASH) for prompt diagnosis of EPTB in regions with a high incidence of HIV/AIDS and TB co-infection will aid in prompt diagnosis and treatment of patients with undifferentiated TB, thus impacting on morbidity and mortality. The training and deployment of sonographers in endemic regions with a high prevalence of HIV/AIDS and TB co-infection, to diagnose EPTB using FASH protocol is a viable option that is in line with the global drive for intensified case finding and treatment algorithm, with a view to meeting the sustainable development goals target of ending HIV and TB epidemics and achieving universal health coverage.
ABSTRACT
Diagnostic reference levels (DRLs) provide benchmarks for dose optimisation. We aimed to propose DRLs for paediatric head computed tomography (CT) in Nigeria and assess if facilities adapt protocols to age-specific standardisations. Volume CT dose index (CTDIvol) and dose-length-product (DLP) of at least 20 paediatric patients per age group were extracted from 11 facilities and used to propose DRLs. Kruskal-Wallis and Median tests were used to assess the contribution of age to paediatric dose variations. CTDIvol (mGy)/DLP (mGy.cm) ranged 16-31/100-1603 (newborn), 10-92/75-4072 (1-y-old), 10-81/169-2603 (5-y-olds) and 14-86/119-3945 (≥10-y-olds). The 75th percentile CTDIvol/DLP values were 27/1040, 37/988, 48/1493 and 54/1824 for newborn, 1-y, 5-y, ≥10-y-olds, respectively. Age accounted for 18.4 and 5.3% variations in median CTDIvol and DLP, respectively. Paediatric head CT doses in Nigeria are higher than reported internationally, suggesting a need for dose optimisation interventions.
