When Comes such Another? Asma Jahangir 1952 –2018

On the 11th of February this year death vanquished Pakistan’s Asma Jahangir: Nothing else could. Her name will endure; yet one cannot go on to say “death thou art dead” for the vacuum in the field where this indomitable and intellectually gifted lawyer fought and won her battles for the forgotten and ignored, the resource-less, and – above all – for the politically and socially persecuted is felt more gravely with each passing day: Asma Jahangir was a convinced human rights activist. There are many such, but she was a uniquely effective and successful one.

The Diagnostic Accuracy of Determine™ Tb Lam Antigen in Detection of Extra Pulmonary Tuberculosis Eptb

Background: TB remains a key global health challenge; particularly Extra pulmonary Tuberculosis (EPTB) and is also a major cause of morbidity and mortality in sub-Saharan Africa. The increasing incidence of EPTB compounded by difficulties in making a timely diagnosis portends to poor prognosis and increased mortality. Delays in diagnosis and misdiagnosis of EPTB in suspected patients account for mortality as well. Challenges in diagnosis of EPTB are mainly due to disease related factors, the paucibacillary nature of disease and challenges with sample collection and processing. Reference standard test such as TB culture, geneXpert and histology which are used in the diagnosis of EPTB are insensitive (depending upon organ sites suspected), take time and specialized laboratory equipment. Emerging diagnostics utilizing pathogen derived biomarkers such as the urine LAM antigen which are rapid, unsophisticated, require minimal laboratory set-up and highly adaptable both in the field and outpatient departments thus become an appealing option. The LAM antigen has been studied in the diagnosis of PTB with varying sensitivities and specificities. This study evaluated the diagnostic utility of the LAM antigen in the diagnosis of EPTB compared to the current reference standard tests. Methods: This prospective validation study was carried out between June 2015-April 2016 at The Aga Khan University Hospital, Nairobi and its satellite clinics. The main objective was to determine the sensitivity, specificity and predictive values of the LAM antigen compared to reference standard tests which included TB culture (solid and liquid media), histology and geneXpert suspected to have EPTB. Patients with at least 1 positive reference standard test were defined as cases of EPTB. We enrolled participants aged > 14 years who were clinically suspected to have EPTB by the primary attending physician. Participants with active or evidence of PTB and those having concomitant PTB and EPTB, as well as those who were unable to provide a urine specimen for LAM antigen testing or sample specimen for reference standard testing were excluded. Urine sample was obtained and tested with the LAM antigen. A grade 2 and above cut-off point was defined as a positive LAM antigen test. Laboratory personnel carrying out the reference test were blinded to results of LAM antigen. In addition, an independent reader reported 24 LAM strips was blinded to the results of both the reference tests and results of LAM antigen test done by the principal investigator. Sensitivity (Sn), specificity (Sp), positive and negative predictive values (NPV,