panel physician - uc san diego continuing medical … is a panel physician? ... worldmapper.com...
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Panel PhysicianPanel PhysicianJuarez, MexicoJuarez, Mexico
What is a Panel Physician?What is a Panel Physician?A local Medical Doctor Selected by the US A local Medical Doctor Selected by the US
Department of State Department of State for the Medical Examination for the Medical Examination of Visa Immigrant Applicantsof Visa Immigrant Applicants
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50,000 Applicants a year50,000 Applicants a yearMexican Citizens applying for a US VisaMexican Citizens applying for a US Visa
All ages All ages From From aall over Mexicoll over Mexico
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Tuberculosis (TB)Tuberculosis (TB)
Mycobacterium Mycobacterium TuberculosisTuberculosis
Tuberculosis (TB)Tuberculosis (TB)
Affects the Affects the lungslungs
AirborneAirborne
HHighly ighly contagiouscontagious
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TB in the WorldTB in the World
Asia · Africa · Eastern EuropeSource: Tuberculosis deaths in 2002. Source: Tuberculosis deaths in 2002. Worldmapper.comWorldmapper.com. 2002. 2002
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TB in MexicoTB in Mexico
Public Health ProblemPublic Health Problem
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20072007
CDC Guidelines requires CDC Guidelines requires to screen Visa Applicants to screen Visa Applicants for LTBIfor LTBIand Active TBand Active TB
Offer Treatment toOffer Treatment toActive TB PatientsActive TB Patients
TBTB
How do we Screen How do we Screen
Source: Targeted Tuberculin Testing and Treatment Source: Targeted Tuberculin Testing and Treatment fofo Latent Tuberculosis Infection. MMWR 2000Latent Tuberculosis Infection. MMWR 2000
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ScreeningScreening
Depending of ageDepending of age
Based on clinical and Based on clinical and radiological examinationradiological examination
Smear and CultureSmear and CultureSmear and Culture Smear and Culture
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TreatmentTreatment
We offer Directly We offer Directly Observed Therapy Observed Therapy to Applicants with to Applicants with A ti TB DiA ti TB DiActive TB DiseaseActive TB Disease
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ObjectiveObjective
Evaluate IGRA's sensitivity and Evaluate IGRA's sensitivity and specificity compared with TST in specificity compared with TST in
Mexican Mexican immigrants with abnormal immigrants with abnormal Chest XChest X--Ray and Ray and Health Care WorkersHealth Care Workers
onon o ro r Panel Ph sician ClinicPanel Ph sician Clinic fromfromon on our our Panel Physician ClinicPanel Physician Clinic, from , from December December 2010 to 2010 to December December 20112011
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SelectionSelection
Applicants with abnormal Applicants with abnormal Chest XChest X--Ray Ray
ANDAND
Health Care Workers from the PanelHealth Care Workers from the PanelHealth Care Workers from the Panel Health Care Workers from the Panel Clinic Clinic
MethodologyMethodology
All participants receivedAll participants received
Tuberculin Tuberculin Skin Test Skin Test (TST(TST))
ff GGInterferon Interferon Gamma Gamma Release Assay (IGRA)Release Assay (IGRA)
IGRA: IGRA: QuantiFERONQuantiFERON®®--TB Gold InTB Gold In--Tube Method • Tube Method • CellestisCellestis Inc.Inc.
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MethodologyMethodology
First group First group included included 46 46 subjects with subjects with abnormal abnormal CXRCXR
20 male20 male
26 female26 female
MethodologyMethodology
Second groupSecond groupincluded 30 HCWincluded 30 HCW
21 men21 men
9 women9 women
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Results HCWResults HCW
Table 1
General Characteristics of HCW Participants
n % Mean (SD) Range
CharacteristicSex Male 21 71
Female 9 29Age (years) 39 (12) 23 - 64Diagnosis of other diseaseDiagnosis of other disease
Yes 2 6.5No 29 93.5
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Results HCWResults HCW
Table 2
Results TST & IGRA tests - HCWTest % Mean (SD) Range
TST Positive 35.5TST Negative 64.5
PPD Indurations measure (mm) 5.9 (8.6) 0 -25IGRA Positive 16.7
IGRA Negative 83.3IGRAs IU/ 0.66 (2.0) -0.28 – 10.0( )
Results HCWResults HCW
Table 3
IGRA
TST Positive Negative Total
Positive 3 7 10
Negative 2 18 20
Total 5 25 30
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Results Results Abnormal CRXAbnormal CRX
Table 4General Characteristics of
Abnormal Chest X-Ray Participants n % Mean
(SD) Range
CharacteristicSex Male 20 42.6
Female 27 57.4Age (years) 40 (22) 2 – 81Di i f th diDiagnosis of other disease
Yes 11 23.4No 36 76.6
Results Abnormal CRXResults Abnormal CRX
Table 5
Results TST & IGRA tests – Abnormal CRXTest % Mean (SD) Range
TST Positive 32.6TST Negative 67.4
IGRA Positive 34.0IGRA Negative 66.0
IGRAs IU/ 3.9 (2.9) 0.58 – 7.9( )
P = < 0.0001P = < 0.0001
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Results Abnormal CRXResults Abnormal CRX
Table 6
IGRA
TST Positive Negative Total
Positive 11 4 15
Negative 5 26 31
Total 16 30 46
ResultsResults
Table 8HCW Abnormal C-XR
Sensitivity 29.2 (95% CI 1.3-57.1) 72.7 (95% CI 50.0-95.4)Specificity 90.3 (95% CI 77.6-100) 84.3 (95% CI 72.7-96.9)
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ConclusionConclusion
In our Study, IGRA’s showed a higher In our Study, IGRA’s showed a higher sensitivity in subjects with Abnormal sensitivity in subjects with Abnormal
Chest XChest X--RayRay
Thank YouThank You
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Table 1General Characteristics of Health Care Workers
Participants n % Mean (SD) Range
CharacteristicSex Male 22 71
Female 9 29Age (years) 31 100 39 (12) 23 - 64
Age groups (years)
2 – 14 0 015 – 19 0 020 – 29 10 32.330 – 39 7 22.640 – 49 5 16.1
50 – 59 7 22.6≥ 60 2 6.4
BMI (Kg/mt2) 31 27.4 (3.8) 22.0 – 37.0
BMI groups (Kg/mt2)
<18.5 0 018 5 – 24 9 7 22 618.5 – 24.9 7 22.625.0 – 29.9 14 45.2
≥ 30 10 32.2
Diagnosis of other disease
Yes 2 6.5No 29 93.5
Other diseases: Diabetes 2 100
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Table xGeneral Characteristics of
Abnormal Chest X-Ray Participants n % Mean (SD) Range
CharacteristicSex Male 20 42.6
Female 27 57.4Age (years) 47 100 40 (22) 2 – 81
A ( )Age groups (years)
2 – 14 8 17.015 – 19 3 6.420 – 29 4 8.530 – 39 3 6.440 – 49 9 19.250 – 59 12 25.5
≥ 60 8 17.0*BMI (Kg/mt2) 38 27.4 (5.6) 17.8 – 38.5
*BMI groups (Kg/mt2)
< 18.5 1 2.618.5 – 24.9 11 28.225 0 29 9 11 28 225.0 – 29.9 11 28.2
≥ 30 16 41
Diagnosis of other disease
Yes 11 23.4No 36 76.6
Other diseases: Diabetes 4 36.4Hypertension 2 18.2
Diabetes & Hypertension 2 18.2VIH 1 9.1
Other chronic conditions 2 18.2
* Only participants 15 years old of age and older