The clinical relevance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic obstructive ...
Community Case-Finding Identifies Undiagnosed COPD And Asthma, Improving Outcomes
Photo Credit: Kenishirotie
Community case-finding can identify undiagnosed COPD or asthma, with subsequent guideline-directed therapy by pulmonologists or primary care improving health outcomes.
Patients with undiagnosed COPD or asthma can be found in the community by targeting their symptoms using case-finding. Once they are identified, guideline-directed therapy by a pulmonologist or, to a lesser extent, usual care by a primary care practitioner can improve people's health situation.
"Up to 70% of the patients with COPD or asthma remain undiagnosed in the community," claimed Dr. Shawn Aaron, MD, FRCPC, from the Ottawa Hospital Research Institute, in Canada. "The US national health and nutritional examination survey of 2007–2012 revealed that 13% of the randomly selected adults had obstructive lung disease, with 71% being undiagnosed." Next, a study that was published in December 2023 showed that people with undiagnosed COPD or asthma have a poorer quality-of-life, a greater need for healthcare utilization, and poorer work productivity, compared with healthy age-matched controls. Here, the UCAP study (NCT03148210), short for 'undiagnosed COPD and asthma in the population' aimed to answer three questions related to this clinical problem:
Through case-finding, 2,857 adults with respiratory symptoms and no history of diagnosed lung disease underwent spirometry, revealing that 21% of them had undiagnosed asthma or COPD. To answer the last question, 508 patients with previously undiagnosed asthma or COPD were randomly assigned 1:1 to a guideline-based treatment, provided by a pulmonologist and asthma/COPD educator, or to usual care, provided by the patients' primary care practitioner. The primary outcome was the annual rate of patient-initiated healthcare utilization events for respiratory illness. Dr. Aaron mentioned that 92% and 60% of the patients had started medication for COPD or asthma during the study in the 'pulmonologist' and 'primary care practitioner' arms, respectively. The incidence rate ratio for the primary outcome measure was 0.48 in favor of the 'pulmonologist' arm (P<0.001). Also, quality-of-life scores improved significantly in both groups over the 12-month study duration.
"We can improve healthcare utilization, symptoms, and quality-of-life in patients with undiagnosed COPD or asthma through guideline-directed treatment by a pulmonologist/educator," summarized Dr. Aaron. "With usual care, the results are less remarkable but still significant. This is important because, in the real world, not everyone can see a lung specialist."
Medical writing support was provided by Robert van den Heuvel.
Copyright ©2024 Medicom Medical Publishers
Who Is Victor Martinez-Hernandez? Rachel Morin's Killer Is An Illegal Immigrant Who Murdered Another Woman
A migrant from El Salvador has been charged in the brutal rape and murder of Maryland mom Rachel Morin. 23-year-old Victor Martinez-Hernandez has been accused killing Morin on a Maryland hiking trail last year.
Rachel Morin's (L) killer Victor Martinez-Hernandez (R) is an illegal immigrant who murdered another woman (Harford County Sheriff's Office) Cops matched Martinez-Hernandez's DNA to the crime scene, following which he was tracked down in Tulsa, Oklahoma, on Friday, June 14, according to Harford County Sheriff Jeffrey Gahler, New York Post reported. "Rachel's murderer is no longer a free man and, hopefully, he will never have the opportunity to walk free again," Gahler said.
Who is Victor Martinez-Hernandez?Police said that Martinez-Hernandez has connections to Salvadoran street gangs and has a violent history. In fact, he is believed to have committed at least one other murder.
"Victor Hernandez did not come to this country to make a better life for him or his family, he came here to escape the crimes he committed in El Salvador. He came here to murder Rachel and God-willing, no one else," Gahler said. "But that should have never been allowed to happen."
Martinez-Hernandez allegedly crossed into the United States illegally back in February 2023, after he killed another young woman. He was in the US for six months before attacking and killing Morin while she was walking alone on the Ma & Pa Heritage Trail in Bel Air.
"We all suspected that Rachel was not his first victim," Gahler said, according to Fox News. "It is my understanding that this suspect, this monster, fled to the United States illegally after committing the brutal murder of a young woman in El Salvador a month earlier, in January of 2023."
Morin's naked body had suffered very severe trauma, so much so that her family said it looked as though "her head had been smashed in with a rock." About a month after Morin was murdered, Martinez-Hernandez's DNA was matched by officials to a sample found at the scene of a home invasion and assault in Los Angeles.
"Once in our country, and likely emboldened by his anonymity, he brutally attacked a nine-year-old girl and her mother during a home invasion in March of 2023 in Los Angeles," Gahler said. "And as everyone I believe is aware, that was our first DNA match linking Rachel's case to the one in Los Angeles."
Gahler said that they were able to identify the suspect only in May. After tracking down Martinez-Hernandez in Tulsa two weeks back, an arrest warrant was finally executed on Friday, just before midnight.
The suspect has now been taken into custody, and booked on first-degree murder and first-degree rape charges. A motive for the murder has not been revealed.
Morin's mother, Patricia Morin, thanked investigators for finally tracking down her daughter's killer. "At some of the points during this, I didn't think that we were ever going to have an answer and that it would be a cold case," Patricia said. "At one point when things looked really bleak and hopeless, the lead detective told me, 'Patience will win in the end.'"
'American citizens are not safe because of their failed immigration policies'Gahler addressed the crisis at the Southern border, and directed his comments to the White House and to "both members of Congress." "We are 1800 miles of the southern border," Gahler said. "And American citizens are not safe because of their failed immigration policies."
"This is the second time in two years that an innocent Harford County woman has lost her life to a criminal in our country illegally," he added. "In both cases, they are suspects from El Salvador with ties to criminal gangs. This should not be happening."
Toronto Blue Jays Top Prospect Orelvis Martinez Suspended For Violating PED Policy
Toronto Blue Jays infielder Orelvis Martinez has been suspended 80 games for violating MLB's performance-enhancing drug policy, the league announced Sunday.
Martinez, who is ranked as the No. 2 prospect in Toronto's farm system and the No. 68 prospect in all of baseball, made his big league debut on Friday. He then tested positive for Clomiphene, a fertility drug that is on the league's banned substance list.
The 22-year-old released a statement accepting his punishment, while also explaining why he was taking Clomiphene. As it turns out, Martinez and his girlfriend had been trying to start a family for two years, and he was prescribed Rejun 50 while in the Dominican Republic this past offseason.
"We wanted to keep this matter private, even within our family, and trusted the doctor who assured us this treatment did not include performance-enhancing drugs," Martinez said. "Therefore, I made the mistake of not disclosing this to my team or the MLBPA."
The Blue Jays released a statement of their own, as executive vice president and general manager Ross Atkins assured that the club is standing with Martinez.
"We were both surprised and disappointed to learn of Orelvis Martinez's suspension," Atkins said. "We will do everything in our power to ensure Orelvis has learned from his mistake."
Martinez was called up on Tuesday when All-Star shortstop Bo Bichette hit the injured list, but he did not make his MLB debut until Friday's game against the Cleveland Guardians. He went 1-for-3 with a single and a strikeout.
The infielder hit 28, 30 and 28 home runs with 87, 76 and 94 RBI in each of the past three minor league seasons.
Martinez was batting .260 with 16 home runs, 46 RBI and an .867 OPS through 63 Triple-A contests in 2024.
Instead of injecting life into a Blue Jays offense in desperate need of a spark, Martinez now won't be eligible to join the club again until September.
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