Vulnerable populations, including homeless persons, high-risk drug and alcohol users, prison inmates and other marginalised populations, contribute a disproportionate burden of tuberculosis (TB) cases in low-incidence settings. Drivers of this disease burden include an increased risk of both TB transmission in congregate settings, and progression from infection to active disease. Late diagnosis and poor treatment completion further propagate the epidemic and fuel the acquisition of drug resistance. These groups are therefore a major priority for TB control programmes in low-incidence settings. Targeted strategies include active case finding (ACF) initiatives and interventions to improve treatment completion, both of which should be tailored to local populations. ACF usually deploys mobile X-ray unit screening, which allows sensitive, high-throughput screening with immediate availability of results. Such initiatives have been found to be effective and cost-effective, and associated with reductions in proxy measures of transmission in hard-to-reach groups. The addition of point-of-care molecular diagnostics and automated X-ray readers may further streamline the screening pathway. There is little evidence to support interventions to improve adherence among these risk groups. Such approaches include enhanced case management and directly observed treatment, while video-observed therapy (currently under evaluation) appears to be a promising tool for the future. Integrating outreach services to include both case detection and case-management interventions that share a resource infrastructure may allow cost-effectiveness to be maximised. Integrating screening and treatment for other diseases that are prevalent among targeted risk groups into TB outreach interventions may further improve cost-effectiveness. This article reviews the existing literature, and highlights priorities for further research.
The plasma-derived atherogenic index (AIP) is associated with an increasing risk for cardiovascular diseases. Whether an increased AIP may predict the complexity of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), according to available research, has never been investigated before.
Data regarding the outcome of patients with ventricular tachyarrhythmias related to arterial hypertension (AHT) and smoking is limited. The study sought to assess the prognostic impact of AHT and smoking on survival in patients presenting with ventricular tachyarrhythmias.
Alterations in thyroid hormone levels occur in patients with acute neurological disease states. The aim of this study is to study changes in thyroid hormones in patients with brain death (BD).
Nicotine is associated with increased incidence of periodontal disease and poor response to therapy. This article aimed at identifying the expression of matrix metalloproteinases 2 (MMPs2) and vascular endothelial growth factor (VEGF) proteins on extracellular matrix, fibrous distribution and angiogenetic development in periodontitis caused by nicotine effects on periodontal membrane.
We have read with great interest the article by Cetin et al. [1] on “Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients”, which is an important cross-sectional study. However, we have some suggestions about this study. The authors [1] did not explain whether patients who received antiaggregant and anticoagulant treatment were involved in or excluded from this study. Antiaggregant and anticoagulant drugs may influence the platelet indices [2]. The authors also did not mention how the blood sample was anticoagulated for the whole blood count or the time elapsed after collection for measurement of the time of platelet indices. Lance et al. [3] reported that platelets stored in citrate are significantly smaller compared to those stored in ethylenediaminetetraacetic acid (EDTA). Platelets swell until 120 min in EDTA and until 60 min in citrate [3]. Timing is important when measuring platelet indices. The optimal measuring time of mean platelet volume (MPV) is 120 min after veinpuncture because MPV increases over time. It was also reported that this increase was proportional with the delay in time [4]. The authors found that the levels of MPV, platelet distribution width (PDW), and plateletcrit (PCT) are significantly higher in the first group than in other groups. In the discussion PCT and PDW are emphasised, but there is no debate about MPV. Plateletcrit is a measure of total platelet mass (total platelet mass = platelet count × MPV/107). They did not find significant differences for platelet counts among the groups. Therefore, we think that MPV is the most effective parameter on PCT. Lastly, they performed multivariate logistic regression analysis, and the respective odds ratios with 95% confidence intervals were calculated. Did the authors compare the young ST elevation myocardial infarction (STEMI) group with a non-young STEMI group or a control group? It would be useful if the authors reported clearly about this analysis.