Paediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children.

Despite preventive guidelines, iatrogenic contrast-induced nephropathy (CIN) ranks third as a cause of hospital-acquired AKI, impacts significantly on morbidity and mortality, and is associated with longer stays in hospitals, with higher medical costs. [1][2][3][4] The rates of CIN vary, depending on the study definitions employed and underlying risk factors, and range from 0.6% to 30% or higher among risk groups. [5][6][7][8] CIN is also associated with increased duration of hospitalisation and early and late mortality. In-hospital mortality due to CIN ranges from 7% to 22%. [9] McCullough et al. [9] reported early mortality of 1.1% in controls, 7.1% in CIN patients, and 35% in CIN patients that required dialysis. Owing to increased comorbidities, hospitalised patients have increased risk for developing CIN compared with ambulatory patients .[10]Inflammation and endothelial dysfunction, together with reactive oxygen species (ROS), are implicated in the pathogenesis of CIN. [8] Iodinated contrast media directly injures the renal tubular epithelium by producing ROS radicals that cause intra-renal vasoconstriction leading to ischaemia and death of tubular cells. [8,10,11] Serum albumin is an important antioxidant that reduces the formation of oxygen free radicals and is important in expanding intravascular volume. [12,13] However, the role of serum albumin in reducing the incidence of CIN remains unexplored.Sub-Saharan Africa has a dearth of data on rates of CIN. This study investigated the rates of CIN together with the influence of serum albumin, albuminuria, age, haemoglobin, and glomerular filtration rate (GFR) levels on CIN and patient outcomes. Methods Study design, setting and populationThis study was a prospective observational study conducted at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, from 1 July 2014 to 30 July 2015. Ethical approval was obtained from the human research ethics committee (HREC) of the University of the Witwatersrand and informed written consent was obtained from all patients. We consecutively recruited hospitalised patients undergoing computed tomography (CT) and angiography from the Divisions of Radiology and Cardiology, respectively. The following exclusion criteria were used: <18 years of age; evidence of pre-existing AKI (clinical or laboratory); end-stage renal disease (ESRD); renal replacement therapy (RRT); prior contrast media administration in the preceding 7 days; pregnancy; or incomplete data. Study proceduresThe study physician reviewed participants' medical records and examined the participants in order to determine pre-existing risk factors for CIN. The medical records were reviewed to determine patient duration of hospitalisation, dialysis requirements and mortality. Study phlebotomists collected blood samples prior to and post contrast media administration. Pre contrast, urine was collected and analysed for microalbuminuria using the Chemistrip Micral 30 immune assay test (Roche 11544039172). Serum creatinine was analysed using the Jaff...

Objective To assess the diagnostic accuracy of the urine lipoarabinomannan (LAM) test among ambulatory HIV-infected persons. Design Cross-sectional Methods HIV-infected persons consecutively presenting to the HIV Clinic at Tembisa Main Clinic in Ekhuruleni, South Africa were screened for symptoms of tuberculosis (TB), and asked to provide sputum and blood samples for smears for acid-fast bacilli (AFB) and mycobacterial culture, and a urine specimen for a LAM enzyme-linked immunosorbent assay (ELISA). Fine needle aspirates were obtained from participants with enlarged lymph nodes, and sent for histopathology. Non-pregnant participants underwent chest x-ray. Results 422 HIV-infected participants were enrolled with median age 37 years [interquartile range (IQR) 31-44 years], median CD4+ T-cell count 215 cells/μL (IQR 107-347 cells/μL), and 212 (50%) receiving antiretroviral therapy (ART). 30 (7%) had active TB: 18 with only pulmonary TB (PTB), 5 with only extrapulmonary TB (ETB), and 7 with both PTB and ETB. 27% (95% CI 12-48%) of TB cases were sputum AFB-positive. The sensitivity and specificity of the urine LAM compared to the gold standard of positive bacteriology or histopathology were 32% (95% confidence interval [CI] 16-52%) and 98% (95% CI 96-99%) respectively. Urine LAM had higher sensitivity in TB cases with higher bacillary burdens, though these differences were not statistically significant. Conclusions The sensitivity of urine LAM testing is inadequate to replace mycobacterial culture. In contrast to prior research on the urine LAM, this study was conducted among less sick, ambulatory HIV-infected patients presenting for routine care.

Undiagnosed TB among HIV-infected ambulatory patients was associated with low CD4+ T-cell counts regardless of ART status. TB screening algorithms which include CD4+ T-cell count and hemoglobin testing may be an effective way to identify HIV-infected clinic attendees at highest risk of undiagnosed TB. Isoniazid preventive therapy and TB infection control are essential for reducing occurrence of HIV-associated TB even after ART initiation.

Posttraumatic carotid cavernous fistulae are abnormal direct hole communications between the intracavernous carotid artery and the cavernous sinus that can result from both blunt and penetrating trauma. They can be challenging lesions to treat and a variety of modalities and approaches have been proposed since endovascular treatment has become the standard treatment. An analysis of the angioarchitecture of 32 consecutive patients treated in our service demonstrated that seven could be classified as small hole, eight medium and 17 large. Different size fistulae required varying endovascular tools. Small fistulae were best treated using coils and large and medium lesions with balloons. Large lesions were more likely to require multiple tools in order to achieve closure and had a lower chance of ipsilateral carotid preservation. All patients in the series were cured with a carotid preservation rate of 66%. There was no permanent morbidity associated with endovascular treatment.

BackgroundIntensified case finding (ICF) and earlier antiretroviral therapy (ART) initiation are strategies to reduce burden of HIV-associated tuberculosis (TB). We describe incidence of and associated factors for TB among HIV-positive individuals with CD4 counts > 350 cells/μl in South Africa.MethodsProspective cohort study of individuals recruited for a TB vaccine trial. Eligible individuals without prevalent TB were followed up at 6 and 12 months after enrolment. Cox proportional hazards regression was used to determine factors associated with risk of incident TB.ResultsSix hundred thirty-four individuals were included in the analysis [80.9 % female, 57.9 % on ART, median CD4 count 562 cells/μl (IQR 466–694 cells/μl)]. TB incidence was 2.7 per 100 person-years (pyrs) (95 % CI 1.6–4.4 per 100 pyrs) and did not differ significantly between those on ART and those not on ART [HR 0.65 (95 % CI 0.24–1.81)]. Low body mass index (BMI <18.5 kg/m2) was associated with incident TB [HR 3.87 (95 % CI 1.09–13.73)]. Half of the cases occurred in the first 6 months of follow up and may have been prevalent or incubating cases at enrolment.ConclusionsTB incidence was high and associated with low BMI. Intensified case finding for TB should be strengthened for all HIV positive individuals regardless of their CD4 count or ART status.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1598-8) contains supplementary material, which is available to authorized users.

Musculoskeletal involvement by TB is rare in comparison to other forms of the disease. It most commonly involves the spine but can also involve large weight-bearing joints, long bones, the skull and the soft tissues. Characteristic appearances of musculoskeletal TB are described for numerous imaging modalities in this paper but it is also highlighted that when based on imaging appearances alone, there is always a differential diagnosis, including other infections and malignancies. Awareness of of TB as a possible cause of vertebral body lesions, arthritis and synovitis, long bone lesions and soft tissue collections will allow clinicians to consider TB based on imaging and will sometimes be characteristic enough to allow for a trial of therapy, thereby avoiding biopsy. This paper specifically describes the imaging appearances on both basic modalities such as plain radiographs and ultrasound for those working in resource-restricted areas, as well as on high-end modalities such as CT and MRI for those with access to these. Tuberculosis is no longer a disease limited to the developing world and radiologists in the developed world must be able to make this diagnosis in both immigrants and the native population.

Radiologists in developing countries cite numerous reasons for poor research output including heavier workloads, poor remuneration (resulting in "brain drain"), poor infrastructure, language barriers, lack of modern imaging equipment, and a disease spectrum that may be of little interest to journals and readers in the developed world. On the other hand, large populations of patients suffering from distinctive diseases, cost-effective healthcare systems, and a set-up with highly centralised tertiary referral hospitals, may be seen as advantages to those willing to tap into this as a data source for research. The lack of resources may even stimulate cost-effective innovations relevant to the needs of poor communities. This paper challenges preconceived ideas and identifies advantages for radiologists in developing countries to producing good research and publications. It also cautions against "annexation of sites" by stakeholders from developed countries, and suggests simple solutions to maximise research output without a significant financial cost.