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BackgroundUltrasound can rapidly identify abnormal signs, which in high prevalence settings, are highly suggestive of extra-pulmonary tuberculosis (EPTB). Unfortunately experienced sonographers are often scarce in these settings.MethodsA protocol for focused assessment with sonography for HIV-associated tuberculosis (FASH) which can be used by physicians who are relatively inexperienced in ultrasound was developed.ResultsThe technique as well as normal and pathological findings are described and the diagnostic and possible therapeutic reasoning explained. The protocol is intended for settings where the prevalence of HIV/TB co-infected patients is high.ConclusionFASH is suitable for more rapid identification of EPTB even at the peripheral hospital level where other imaging modalities are scarce and most of the HIV and TB care will be delivered in the future.

The objective of this study is to summarize the features of patients with Lupus erythematosus in Saudi Arabia. Racial differences of patients and predictors of mortality are assessed. Ninety-three patients treated for SLE at the University Hospital in Jeddah were reviewed. Frequencies of clinical manifestations, causes of admission and causes of death were analysed. Variables predicting mortality were assessed by logistic regression and survival probabilities were estimated by the Kaplan-Meier method. The most frequent presenting symptoms were arthritis (68%) and fever (58%). Renal involvement was seen in 61% of patients. The majority of patients (61%) showed ANA titers higher than 1:1280. C4 levels were significantly lower in patients who died during the observation period than in survivors. The overall five-year survival rate was 92%. Variables predicting early death (<2 years after diagnosis) were young age at diagnosis, male sex and skin involvement. Death after more than two years correlated with older age at diagnosis and renal involvement. Patients of African descent had higher rates of neurological involvement and renal failure. The mortality in this group was highest, though this was not statistically significant. The overall survival in our cohort compares with mortality rates reported from western countries. However, renal disease tends to be common and has a severe prognosis, and thus merits additional attention.

BackgroundThe BED IgG-Capture Enzyme Immunoassay (cBED assay), a test of recent HIV infection, has been used to estimate HIV incidence in cross-sectional HIV surveys. However, there has been concern that the assay overestimates HIV incidence to an unknown extent because it falsely classifies some individuals with non-recent HIV infections as recently infected. We used data from a longitudinal HIV surveillance in rural South Africa to measure the fraction of people with non-recent HIV infection who are falsely classified as recently HIV-infected by the cBED assay (the long-term false-positive ratio (FPR)) and compared cBED assay-based HIV incidence estimates to longitudinally measured HIV incidence.Methodology/Principal FindingsWe measured the long-term FPR in individuals with two positive HIV tests (in the HIV surveillance, 2003–2006) more than 306 days apart (sample size n = 1,065). We implemented four different formulae to calculate HIV incidence using cBED assay testing (n = 11,755) and obtained confidence intervals (CIs) by directly calculating the central 95th percentile of incidence values. We observed 4,869 individuals over 7,685 person-years for longitudinal HIV incidence estimation. The long-term FPR was 0.0169 (95% CI 0.0100–0.0266). Using this FPR, the cross-sectional cBED-based HIV incidence estimates (per 100 people per year) varied between 3.03 (95% CI 2.44–3.63) and 3.19 (95% CI 2.57–3.82), depending on the incidence formula. Using a long-term FPR of 0.0560 based on previous studies, HIV incidence estimates varied between 0.65 (95% CI 0.00–1.32) and 0.71 (95% CI 0.00–1.43). The longitudinally measured HIV incidence was 3.09 per 100 people per year (95% CI 2.69–3.52), after adjustment to the sex-age distribution of the sample used in cBED assay-based estimation.Conclusions/SignificanceIn a rural community in South Africa with high HIV prevalence, the long-term FPR of the cBED assay is substantially lower than previous estimates. The cBED assay performs well in HIV incidence estimation if the locally measured long-term FPR is used, but significantly underestimates incidence when a FPR estimate based on previous studies in other settings is used.