The TB Surge intervention: an optimized approach to TB case-finding in Nigeria.

INTRODUCTION: TB remains one of the leading causes of death in Nigeria, and despite progress in treatment coverage, a 56% gap in national case notifications remains. This gap is attributable in part to underdiagnosis due to missed cases in health facilities. The TB Surge intervention presented an opportunity to address barriers to optimal case detection in public health facilities. METHODS: KNCV Nigeria implemented the TB Surge intervention under the USAID-funded TB-LON Project in 1,041 public facilities from June 2020 to September 2022. Trained ad-hoc staff screened hospital attendees, linked identified presumptive TB cases to diagnosis and confirmed TB cases to treatment. Data were reported using the Commcare application. Robust project monitoring was used to address gaps. RESULTS: Of a total of 12,195,874 hospital attendees screened for TB, 729,369 identified as presumptive TB were tested and 65,029 TB cases were diagnosed; 8% of the TB cases were children. Overall TB yield was 9%. Medical ward service delivery point had the highest TB yield of 21%. The number needed to test was 11 and the number needed to screen was 188. CONCLUSION: The TB Surge intervention was of strategic importance in addressing missed cases and barriers to prompt TB diagnosis in health facilities.

INTRODUCTION: La TB reste l'une des principales causes de décès au Nigeria et, malgré les progrès réalisés en matière de couverture thérapeutique, il subsiste un écart de 56% dans la déclaration des cas à l'échelon national. Cet écart s'explique en partie par le sous-diagnostic dû aux cas manqués dans les centres de santé. L'intervention TB Surge a permis de lever les obstacles à la détection optimale des cas dans les centres de santé publique. MÉTHODES: KNCV Nigeria a mis en œuvre l'intervention TB Surge dans le cadre du projet TB-LON financé par l'USAID dans 1 041 centres publics de juin 2020 à septembre 2022. Le personnel ad hoc formé a dépisté les personnes présentes à l'hôpital, lié les cas de TB présomptifs identifiés au diagnostic et les cas de TB confirmés au traitement. Les données ont été communiquées à l'aide de l'application Commcare. Un suivi rigoureux du projet a permis de combler les lacunes. RÉSULTATS: Sur un total de 12 195 874 patients hospitalisés ayant fait l'objet d'un dépistage de la TB, 729 369 cas présumés de TB ont été testés et 65 029 cas de TB ont été diagnostiqués ; 8% des cas de TB étaient des enfants. Le rendement global de la TB était de 9%. Le point de prestation de services du service médical a enregistré le taux de TB le plus élevé (21%). Le nombre de tests nécessaires était de 11 et le nombre de dépistages nécessaires de 188. CONCLUSION: L'intervention TB Surge a été d'une importance stratégique pour traiter les cas non détectés et les entraves à un diagnostic rapide de la TB dans les centres de santé.

Association Between the Framingham Risk Score and Carotid Artery Intima-Media Thickness in Patients With Human Immunodeficiency Virus.

Cardiovascular diseases (CVD) are more prevalent among HIV-infected subjects. We examined the associations between carotid artery intima-media thickness (CIMT), conventional CVD risk factors, and HIV-related risk factors among Hispanics with HIV infection. This cross-sectional study involved 96 consecutive HIV patients on stable antiretroviral therapy and without history of CVD in a university-based outpatient clinic who underwent carotid ultrasound evaluation. Increased CIMT was defined as common carotid artery-CIMT values greater than or equal to seventy-fifth percentile for the patient's age, sex, and race/ethnicity based on CIMT nomograms from large population studies. The sample was comprised of 96 Hispanic Americans aged 39.7 ± 11.9, 89% of whom were men, 64% were on a protease inhibitor, and 11% had increased CIMT (95% confidence intervals 5.9% to 19.6%). In univariable analysis, increased CIMT was significantly associated (p <0.05) with older age, metabolic syndrome, intermediate/high Framingham risk score, HIV infection duration ≥5 years, integrase inhibitors, and protease inhibitors. In multivariable analysis, only Framingham risk score (p = 0.009) was independently associated with increased CIMT. The median common carotid artery-CIMT value was significantly greater in patients with intermediate/high compared with those with low Framingham risk score (0.60 vs 0.49 mm; p <0.001). In conclusion, given the significant association between increased CIMT and Framingham risk score, adherence to prevention guidelines to reduce CVD risk factor burden in this population is strongly recommended.

Metabolite Cross-Feeding between Rhodococcus ruber YYL and Bacillus cereus MLY1 in the Biodegradation of Tetrahydrofuran under pH Stress.

Bacterial consortia are among the most basic units in the biodegradation of environmental pollutants. Pollutant-degrading strains frequently encounter different types of environmental stresses and must be able to survive with other bacteria present in the polluted environments. In this study, we proposed a noncontact interaction mode between a tetrahydrofuran (THF)-degrading strain, Rhodococcus ruber YYL, and a non-THF-degrading strain, Bacillus cereus MLY1. The metabolic interaction mechanism between strains YYL and MLY1 was explored through physiological and molecular studies and was further supported by the metabolic response profile of strain YYL, both monocultured and cocultured with strain MLY1 at the optimal pH (pH 8.3) and under pH stress (pH 7.0), through a liquid chromatography-mass spectrometry-based metabolomic analysis. The results suggested that the coculture system resists pH stress in three ways: (i) strain MLY1 utilized acid metabolites and impacted the proportion of glutamine, resulting in an elevated intracellular pH of the system; (ii) strain MLY1 had the ability to degrade intermediates, thus alleviating the product inhibition of strain YYL; and (iii) strain MLY1 produced some essential micronutrients for strain YYL to aid the growth of this strain under pH stress, while strain YYL produced THF degradation intermediates for strain MLY1 as major nutrients. In addition, a metabolite cross-feeding interaction with respect to pollutant biodegradation is discussed.IMPORTANCERhodococcus species have been discovered in diverse environmental niches and can degrade numerous recalcitrant toxic pollutants. However, the pollutant degradation efficiency of these strains is severely reduced due to the complexity of environmental conditions and limitations in the growth of the pollutant-degrading microorganism. In our study, Bacillus cereus strain MLY1 exhibited strong stress resistance to adapt to various environments and improved the THF degradation efficiency of Rhodococcus ruber YYL by a metabolic cross-feeding interaction style to relieve the pH stress. These findings suggest that metabolite cross-feeding occurred in a complementary manner, allowing a pollutant-degrading strain to collaborate with a nondegrading strain in the biodegradation of various recalcitrant compounds. The study of metabolic exchanges is crucial to elucidate mechanisms by which degrading and symbiotic bacteria interact to survive environmental stress.

Cardiovascular Magnetic Resonance Imaging for Structural and Valvular Heart Disease Interventions.

The field of percutaneous interventions for the treatment of structural and valvular heart diseases has been expanding rapidly in the last 5 years. Noninvasive cardiac imaging has been a critical part of the planning, procedural guidance, and follow-up of these procedures. Although echocardiography and cardiovascular computed tomography are the most commonly used and studied imaging techniques in this field today, advances in cardiovascular magnetic resonance imaging continue to provide important contributions in the comprehensive assessment and management of these patients. In this comprehensive paper, we will review and demonstrate how cardiovascular magnetic resonance imaging can be used to assist in diagnosis, treatment planning, and follow-up of patients who are being considered for and/or who have undergone interventions for structural and valvular heart diseases.

Inappropriate utilization of SPECT myocardial perfusion imaging on the USA-Mexico border.

BACKGROUND: The American College of Cardiology/American Society of Nuclear Cardiology published revised appropriate use criteria (AUC) for SPECT MPI in 2009. We assessed adherence to these guidelines and factors associated with inappropriate utilization at the University Medical Center. METHODS: The AUC was applied retrospectively to 420 SPECT MPI studies. Two-sample t test, Fisher's exact test, and multivariable logistic regression models were used for analysis. RESULTS: There were 322 appropriate (86%) and 54 (14%) inappropriate studies. The odds of having an inappropriate test increased with younger age (P < .001) and female gender (P < .001). Subjects with diabetes (P = .007) and chest pain (P < .001) were less likely to have an inappropriate test. Academic outpatients were three times more likely to have an inappropriate study (P = .123), while community PCPs were 5.6 times (P = .011) and community cardiologists eight times more likely to order inappropriate tests (P = .031). CONCLUSIONS: Inappropriate SPECT MPI in low risk younger women is an important issue on the USA-Mexico border. Initiatives to reduce inappropriate SPECT MPI should focus on a few indications and evaluation of cardiovascular symptoms in younger age women in outpatient/community practices.

Risk of cardiovascular events with hormonal contraception: insights from the Danish cohort study.

Hormonal contraception in the form of combined oral contraceptive pills is the most widely used reversible form of contraception in the US. Oral contraceptive (OC) pills have long been associated with risk of venous thromboembolism (VT) and arterial thrombosis (AT). There are more recent publications on risk of venous thromboembolism than arterial thrombosis. Many of the studies on AT have been contradictory in terms of results. The Danish cohort study is the largest study to date on the risk of AT in users of oral contraceptive pills. The study suggests that a lower estrogen dose may be better for preventing myocardial infarction and possibly thrombotic stroke but there is no significant difference according to progestin type for risk of thrombotic stroke or myocardial infarction. It challenges results of previous studies that show incremental risk of arterial thrombosis with smoking. The absolute and relative risks of arterial thrombosis in Danish women who used hormonal contraception were shown to be low. VT is more common than AT in women of reproductive age but AT is associated with a higher risk of mortality and disability. The decision to use hormonal contraceptives and the choice of formulation should be individualized based on patient's age and known risk factors for both VT and AT.