[Assessment of the completeness of medical imaging request forms in a sub-Saharan African setting]. / Évaluation de la conformité des demandes d'examens d'imagerie médicale : une expérience en Afrique subsaharienne.

UNLABELLED: The technical quality, interpretation, and clinical utility of diagnostic imaging examinations can increase considerably when the request forms are correctly filled out. This study sought to evaluate the completeness of these request forms at the Women and Children's Hospital in Yaoundé, Cameroon, to the 8 criteria established by the French High Health Authority (HAS, France). METHODS: This cross-sectional study evaluated 118 request forms for ultrasounds, 110 for conventional radiography, and 34 for computed tomography (CT scans), all completed by physicians at our university-affiliated hospital. They were sampled consecutively three days a week for several weeks, on days randomly selected at the beginning of each week, to minimize bias and ensure that as many different physicians as possible were assessed. We doubled the sample size recommended by the HAS. Conformity was defined by the presence of the required data on the request forms (data classified as either administrative or clinical). RESULTS: Overall, 52 request forms (19.8%) had all 5 administrative items, but only 9.2% had all 3 clinical components. Only 3 forms (1.1%) were 100% complete, including all 8 items; 85% included at least 5 components, and 35.1% had 6. The patient's last name was always included. Only 4.2% of the request forms included the prescriber's telephone number; 8% did not include the date and 17.2% (n = 45) did not state the clinical findings. On 30% of the forms, symptoms were the only clinical information listed; 23.7% (n = 62) stated the purpose of the examination (that is, the diagnosis to be confirmed or ruled out). The rate of missing information was highest in the requests for conventional radiography (49.5% compared to 38% with ultrasound and 12.3% for CT scans). CONCLUSION: The request forms for imaging examinations provided inadequate administrative and clinical data, especially those for conventional radiography. This missing information makes it harder to perform and interpret these examinations. An electronic request form with mandatory fields might improve the overall quality of the forms.

Descriptive epidemiology of dengue transmission in Uttar Pradesh.

We report epidemiology of dengue infection as revealed through a hospital based surveillance for dengue infection over a 3 year period in Lucknow, U.P., India. In 2003-2005, children with acute febrile encephalopathy (AFE) and in 2005-2006, children with acute undifferentiated febrile illness (AUFI) were enrolled. IgM antibodies to dengue were tested by ELISA in acute serum. A total of 118/563 (20.9%) patients tested positive for dengue antibodies. Dengue transmission occurred round the year in the Lucknow region with peak in postmonsoon season and occurred equally in rural and urban areas. All the surrounding districts were affected, with no distinct high prevalence areas.

Dengue encephalopathy in children in Northern India: clinical features and comparison with non dengue.

BACKGROUND: Acute febrile encephalopathy (AFE) is a common cause of childhood hospital admissions in Lucknow. In recent years, many patients have been hospitalized with AFE and hemorrhagic manifestations, some of whom were proven to have dengue viral infection. OBJECTIVES: To (i) define the role of dengue encephalopathy (DE) as a cause of AFE in children in Lucknow, (ii) document features of dengue hemorrhagic fever (DHF) in them and (iii)compare clinical features of definite dengue and non dengue AFE. STUDY DESIGN: Prospective study at a teaching hospital in northern India. Children between 1-12 years of age hospitalized with fever and altered consciousness of 2 weeks or less duration were enrolled after excluding bacterial and tuberculous meningitis and frank hepatic encephalopathy. Clinical and laboratory details were charted. Haemagglutination inhibition (HI) test for dengue and Japanese encephalitis viruses in paired sera and IgM antibody capture ELISA for dengue were done. Real time PCR was done in those samples testing positive for dengue IgM. Those with either positive HI test or positive dengue PCR in CSF or serum were considered definite dengue infection and features of DHF were charted in them. Those negative for IgM antibodies after 5 days of illness or whenever done, HI test, were considered definite non dengue. Clinical and laboratory features were compared between definite dengue and non dengue groups. RESULTS: A total of 265 patients of AFE were enrolled over a 2 year period. HI test was positive in 15/49 (30.6%) and IgM in 52/238 (21.8%) patients thus tested. A total of 62 patients were positive for dengue antibodies by either test. Real time PCR assay for dengue virus genome was positive in 28/42 (69%) tested -- 21/29 (72.4%) in CSF and 9/15 (60%) in serum. A total of 39 patients met the criteria for definite dengue infection of which only 2 fulfilled the WHO criteria for DHF. Comparing DE and non DE, rash, bleeding, swelling over body, and hepatomegaly were significantly more common and meningeal signs less frequent in DE. Mean platelet counts and serum albumen were lower and liver enzymes and INR were significantly higher in DE. CONCLUSIONS: Dengue viral infection is a cause of AFE in children in this region. Majority of DE here appears to be due to viral invasion of brain as suggested by high PCR positivity in CSF and lack of WHO criteria for DHF. Differentiating features of DE include swelling and hepatic dysfunction.