Latent tuberculosis infection among patients with and without type-2 diabetes mellitus: results from a hospital case-control study in Atlanta.

OBJECTIVE: The purpose of this study is to compare the prevalence of latent TB infection (LTBI) among patients with type-2 diabetes mellitus (T2DM) to healthy controls without T2DM. To achieve this objective, we conducted a case-control study in a large hospital in Atlanta from 2016 to 2019. RESULTS: We enrolled 98 cases; 119 potential controls were screened, 84 of which had HbA1c ≥ 5.7% and one did not have QFT result, leaving 34 (28.6%) individuals enrolled as controls. LTBI prevalence was 9.2% among cases and 14.7% among controls (crude odds ratio 0.59, 95% CI 0.19-2.04). After adjusting for age and sex, the adjusted odds of LTBI among patients with T2DM was 0.45 (95% CI 0.13, 1.71) times the controls. We did not observe a statistically significant association between LTBI and T2DM. However, we reported a positive correlation between HbA1c level and nil count among individuals with LTBI (R2 = 0.55, p < 0.01). In addition, we reported a high prevalence of LTBI among adults with T2DM and family members without T2DM.

Analysis of Opioid Use Following Curative Cancer Treatment at a Large Urban Safety-net Hospital.

OBJECTIVES: This study examined the pattern of use and factors predicting prolonged prescription opioid medications among cancer patients following treatment with curative intent. MATERIALS AND METHODS: Patients diagnosed with cancer over a 3-year period at a large urban safety-net hospital were included. Univariate and multivariate analyses was used to identify factors associated with continued opioid use. RESULTS: Of the 199 patients included in the study, 38% continued to receive an opioid prescription well beyond the acute diagnosis and treatment phase. Mean age was 60.3 years, with a female preponderance (63%). Surgical resection only (31.6%) and the combination of surgery, chemotherapy, and radiation (19.7%) were the commonest treatment modalities. Pain-related comorbidities predating cancer diagnosis were reported in 53.3% of the patients, and about 33% were also on pain-modifying medications (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.92-6.77; Fisher exact test P<0.001). Average number of prescriptions received per patient was 4.8 (range, 1 to 31), over an average of 9.5 months (range, 1.2 to 28.1 mo). Mean morphine milligram equivalents prescribed per prescription was 319 mg (range, 48 to 2475 mg). According to multivariate model, patients who received chemotherapy (OR, 7.25; 95% CI, 2.09-25.17; P=0.0018), or pain-modifying medications (OR, 4.61; 95% CI, 2.25-9.44; P<0.0001) were significantly more likely to continue to receive prescriptions for opioids. DISCUSSION: Treatment with chemotherapy, pain-modifying medications, cancer stage, and interval between diagnosis and treatment are the best predictors for continuous opioid use. The current epidemic of opioid misuse and abuse makes examination current practices and identifification of areas of improvement imperative.