Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups - The Romanian Experience.

Introduction: Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas. Methods: The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests. Results: The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1). Discussion: These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

A Transcriptomic Biomarker Predicting Linezolid-Associated Neuropathy During Treatment of Drug-Resistant Tuberculosis.

Background: Neuropathic adverse events occur frequently in linezolid-containing regimens, some of which remain irreversible after drug discontinuation. Objective: We aimed to identify and validate a host RNA-based biomarker that can predict linezolid-associated neuropathy before multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment initiation and to identify genes and pathways that are associated with linezolid-associated neuropathy. Methods: Adult patients initiating MDR/RR-TB treatment including linezolid were prospectively enrolled in 3 independent cohorts in Germany. Clinical data and whole blood RNA for transcriptomic analysis were collected. The primary outcome was linezolid-associated optic and/or peripheral neuropathy. A random forest algorithm was used for biomarker identification. The biomarker was validated in an additional fourth cohort of patients with MDR/RR-TB from Romania. Results: A total of 52 patients from the 3 identification cohorts received linezolid treatment. Of those, 24 (46.2%) developed peripheral and/or optic neuropathies during linezolid treatment. The majority (59.3%) of the episodes were of moderate (grade 2) severity. In total, the expression of 1,479 genes differed significantly at baseline of treatment. Suprabasin (SBSN) was identified as a potential biomarker to predict linezolid-associated neuropathy. In the validation cohort, 10 of 42 (23.8%) patients developed grade ≥3 neuropathies. The area under the curve for the biomarker algorithm prediction of grade ≥3 neuropathies was 0.63 (poor; 95% confidence interval: 0.42 - 0.84). Conclusions: We identified and preliminarily validated a potential clinical biomarker to predict linezolid-associated neuropathies before the initiation of MDR/RR-TB therapy. Larger studies of the SBSN biomarker in more diverse populations are warranted.

[Update regarding the role of biomarkers in early diagnosis of non-small cell bronchopulmonary cancer]. / Actualitati privind rolul markerilor tumorali in detectia precoce a neoplasmului bronhopulmonar NSCC.

Early diagnosis of lung cancer by non-invasive methods has a low sensibility: 60% of peripheral cancers could be diagnosed by computed tomography, 60% of the central ones by sputum cytology. More specific for detecting central microinvasive lesions could be bronchoscopy with autofluorescence, but this is a method with a low number of patients to be performed on, because of the specific technique. For all these reasons there are some other methods to be tried in this respect--one of them is to find one or more molecules--tumoral markers--which have to be specific in establishing the risk of developing lung cancer, to make an early diagnosis of cancer and to predict the evolution under treatment. The detecting tumoral markers in sputum, blood, bronchoalveolar lavage was not so largely explored related to the final goal--the possibility of identifying and quantifying the most specific ones for the screening of lung cancer. The present paper has as purpose to make an review of tumoral markers--"classical" markers as: CEA, NSE, TPA, beta2 microglobulina, CA 125, CA 15-3--considered not such a high sensibility and specificity for lung cancer screening versus new molecules, studied intensively as: SCC-Ag, CYFRA 21-1, ferritin, sIL-2R, CCK-BB, glycosyltransferases. Those new molecules have a higher sensibility, but also could have a higher specificity for each type of lung cancer.

[Left bronchial resection with bronchial anastomosis in a patient with posttraumatic bronchial stenosis]. / Rezectia bronsica stânga cu bronhoanastomoza la un pacient cu stenoza bronsica posttraumatica.

We present the case of a 25 year old patient, who suffered a car accident two month before he came to our hospital. At that moment, he had multiple costal fractures and left haemothorax, resolved by surgical means. At the actual presentation: dullness in the inferior half of left hemithorax, abolished breath sounds at this level. Radiologic--left lung atelectasis, bronchoscopic examination revealed--complete stenosis of the main left bronchus, while computer tomography has shown complete obstruction of the main left bronchus, at 1.7-2 cm from the carina. Fibrosis after posttraumatic bronchial disruption was the cause of the stenosis. Surgical treatment was the choice, with segmental resection of the main left bronchus and reanastomosis; the permeability was maintained on a month after the surgical intervention.

[Sequential approach in a case of tracheal hemangioma: segmental tracheal resection after Nd-YAG laser application]. / Abord secvential intr-un caz de hemangiom traheal: rezectie traheala segmentara precedata de Nd-YAG laser.

Tracheal tumors of malignant or benign origin are very rare. The symptoms may mimic asthmatic crisis, dyspnea at rest or light efforts appear only when the tumor obstructs 60% of the tracheal diameter. We present the case of a 50 year old patient, ex-smoker with symptoms present 5 years before admittance with dyspnea and small hemoptysis. Diagnosis was based on bronchoscopic examination, CT scan and histological examination of the resection sample revealing a rare benign tracheal tumor: a hemangioma. The sequential treatment of the disease is presented: interventional endoscopy and surgical resection. The excellent postoperative evolution emphasized the diagnostic and therapeutic value of bronchoscopy as well as surgery in benign tracheal tumors.