October 2005

The tuberculin skin test is the most frequently used method for detecting asymptomatic latent tuberculosis infection. There is growing interest in other diagnostic tests for latent infection that might be simpler to administer, but the tuberculin skin test remains the preferred modality because of its ease of use and low cost. The decision to perform an annual test or a single test depends on the population each specific patient represents. Interpretation of the reaction to the test should be done by trained health care professionals, keeping in mind that factors such as immunization can cause false-negative or false-positive results.

Coronary artery disease is the leading cause of death in patients with diabetes. Platelets play a major role in the pathophysiology and clinical manifestations of ischemic heart disease. It is well known that platelets in diabetic patients are hyperreactive, with exaggerated adhesion, aggregation, and thrombin generation. Aspirin and other antiplatelet agents have been shown to reduce the incidence of ischemic events in patients with and without diabetes, whether or not they have a history of cardiovascular disease. This article reviews the latest recommendations for the use of antiplatelet therapy in the primary and secondary prevention of cardiovascular events in diabetic patients.

Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality and a considerable drain on health care resources in the industrialized world. In some patients the disease is inherited, but the vast majority of cases are caused by cigarette smoking. Recognizing the signs and symptoms and understanding the disease progression will facilitate a timely diagnosis. Although the disease is incurable, encouraging patients to stop smoking and providing supplemental oxygen can enhance survival. Significant advances in management as outlined by the authors notwithstanding, efforts to reduce the prevalence of cigarette smoking hold the most promise for reducing the disease burden and associated costs.