Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening

Background

Refugees are at increased risk of developing tuberculosis (TB) soon after resettlement. Targeting high-risk populations for latent tuberculosis infection (LTBI) screening and treatment is an important measure towards eliminating TB in low incidence countries, however, there are low rates of screening and treatment completion in the LTBI cascade of care. The authors hypothesized that an interferon-gamma release assay (IGRA) screening strategy would lead to a higher proportion of refugees completing LTBI screening and treatment, compared to sequential screening with tuberculin skin test (TST) and confirmatory IGRA.

Methods

This retrospective cohort study included eligible refugees screened with a sequential strategy versus a solo-IGRA strategy at different time periods from a centralized refugee clinic. The primary outcome was the proportion completing LTBI screening in each cohort.

Results

A total of 471 subjects were included (240 in sequential screening, 231 in solo-IGRA screening). 54% of refugees completed LTBI screening with sequential testing, compared to 85% of those screened with a solo-IGRA. Time to completing screening was also shorter in the solo-QFT group (difference 16.5 days, p < 0.01, 95% confidence interval 9.3, 23.7). There was a higher incidence of LTBI diagnosis in the solo-IGRA group (41 versus 20, p = 0.002). Screening completion was predicted by solo-IGRA screening (aOR 3.74, 95% confidence interval 2.30, 6.09; p < 0.001) and if refugees were privately-sponsored (aOR 2.81, 95% confidence interval 1.53, 5.15; p = 0.001). Treatment completion rates did not differ between groups.

Conclusion

This study has identified fewer dropouts in the LTBI cascade of care if a solo-IGRA strategy is used for screening. An IGRA should be strongly considered as the screening method for refugees arriving in low-incidence settings if resources are available.

Effects of beta-blockers for congestive heart failure in pediatric and congenital heart disease patients: a meta-analysis of published studies

AIM

The effects of beta-blockers in pediatric and congenital heart disease (CHD) patients suffering from heart failure are controversial. We performed a meta-analysis to determine whether beta-blockers are effective for heart failure in pediatric and CHD patients.

METHODS

We searched for clinical trials focusing on clinical on clinical and ventricular functional/dimensional changes after beta-blocker therapy in PubMed (from its inception to August 2013) and bibliographies of identified studies. Studies investigating any of three beta blockers (carvedilol, bisoprolol, and extended release metoprolol succinate) which are known to be effective in adult patients with heart failure were included.

RESULTS

Of the 158 screened, 17 (N.=476) fulfilled the study criteria and were analyzed. Beta-blockers were associated with significant improvements in left ventricular (LV) ejection fraction (EF) (12.47%; 95% CI, 10.36 to 14.61), fraction shortening (5.75%; 95% CI, 4.42 to 7.08), LV end-diastolic dimension (-2.91 mm; 95% CI, -5.46 to -0.36), and LV systolic dimension (-4.03 mm; 95% CI, -6.81 to -1.25). No significant change in the pooled mean difference of the right ventricular (RV) EF (3.50%; P=0.08) was observed. However, the RV EF in the untreated group showed a deteriorating trend (-3%), which was different from the trend in the treatment group. There was a significant reduction in the incidence of clinical worsening (odds ratio, 2.15; 95% CI, 1.27 to 3.66).

CONCLUSION

Beta-blocker therapy was associated with a significant improvement of echocardiographic parameters in patients with systemic LV failure. However, the use of beta-blockers did not provide significant benefits in terms of improving the EF in patients with RV failure. Nonetheless, beta-blockers may be effective to prevent the clinical deterioration of pediatric and CHD patients with heart failure.

Eye injuries among pennant squash players and their attitudes towards protective eyewear

A questionnaire survey on eye injuries and attitudes towards protective eyewear was conducted among 165 metropolitan pennant squash players; 163 (99%) valid responses were received. The incidence of eye injuries in the survey sample was found to be 17.5 per 100,000 playing hours with a significant proportion (26%) indicating that they had suffered at least one eye injury. Racquets were more common as the source of injury (61%) than squash balls. A large proportion of those injured consulted a doctor (63%) with approximately one-third (or 5% of the total survey sample) having been admitted to hospital for the injury. Only 8% of the sample used appropriate protective eyewear with an additional 2% believing their prescription lenses were a form of protection. The main reason given for using protective eyewear was previous injury to self or others (65% of cases). Doctors and media promotion rated poorly in causing players to use eyewear (6% for each). Most respondents believed eyewear to be of benefit, but fewer than half felt that eyewear should be made compulsory for all players. Only 6% of players said that they would give up the game if use of eyewear was made compulsory.

Nutritional assessment by comparative growth achievement in Malay children below school age

Measurements of child growth have become the most accepted means of assessing the protein-calorie nutritional status of economically developing populations. International reference standards have been suggested for a number of body measurements, but there has been little evaluation of their applicability in South-East Asia.In order to delineate the present range of nutritional standards in West Malaysia, and to aid in the development of guidelines for further nutritional work in this region, anthropometric tests were made on 3 groups of children below school age belonging to the Malay ethnic group and living under diverse conditions. Children of Malaysian Army personnel differed significantly in most measurements from rural village children in Trengganu and children from a small urban elite in Kuala Lumpur. Measurements for the latter group approximated to internationally used standards of height and weight. Parental height data suggest that these differences are not primarily genetic. Anaemia, malaria, and ascariasis were common among the Trengganu children.Weight and height emerge as the measurements that are most sensitive in differentiating between the groups; arm circumferences and skinfold measurements are also useful because they are relatively independent of age. Measurement of chest and head circumferences and of crown-rump lengths appeared to be of little value.

Central nervous system activity associated with the pain evoked by bradykinin and its alteration by morphine and aspirin

Synthetic bradykinin, a nonapeptide formed from alpha-2 globulin in plasma, injected intra-arterially or intraperitoneally in cats in doses of 10-50 mug, evoked activity in the central nervous system in pathways associated with the signaling of pain. Similar injections of bradykinin in intact normal cats and dogs evoked manifestations of pain, and in conscious humans elicited verbal reports of pain perceived in the area of injection. Single unit activity was recorded in the medial reticular formation of the brainstem, in the medial thalamus and, more laterally, among the posterior group nuclei and the suprageniculate nucleus. Bradykinin did not evoke any cortical or subcortical slow potentials such as those evoked by electrical stimulation of the foot pads. When bradykinin was given together with the electrical stimulus, the responses evoked by the latter were blocked. Morphines uppressed bradykinin-evoked activity. Aspirin caused marked fluctuations in activity, unrelated to the bradykinin injection; the bradykinin block of evoked potentials could no longer be observed after aspirin dosage. The results are discussed in terms of the peripheral and central sites of analgesic action and the likelihood of the existence of chemosensitive pain receptors.