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Rationale and Objectives To investigate for differences in metabolic concentrations and ratios between patients with systemic lupus erythematosus (SLE) without (group SLE) and those with neurological symptoms (group NPSLE) compared to a healthy control (group HC) in three normal-appearing brain regions: the frontal white matter, right insula (RI), and occipital gray matter and whether changes in any of the metabolites or metabolic ratios are correlated to disease activity and other clinical parameters. Materials and Methods Twenty patients with SLE (18 women and 2 men, age range 23.4–64.6 years, mean age 43.9 years), 23 NPSLE patients (23 women, age range 23.7–69.8 years, mean age 42.4 years), and 21 HC (19 women and 2 men, age range 21.0–65.7 years, mean age 43.4 years) were included. All subjects had conventional brain magnetic resonance imaging and 1H single-voxel spectroscopy, clinical assessment, and laboratory testing. Results NPSLE patients had significantly reduced N-acetylaspartate (NAA)/creatine compared to HC (P = .02) and SLE patients (P = .01) in the RI. Lower glutamine/creatine levels were also detected in RI in both patient groups and in frontal white matter in NPSLE patients compared to HC (P = .01, P = .02). NAA/Cr ratio in the RI was significantly negatively correlated with the Systemic Lupus Erythematosus Disease Activity Index (r = −0.41; P = .008), and patients with active SLE symptoms also had a trend toward lower NAA/creatine ratios (1.02 vs 1.12; P = .07). Conclusions The present data support previous findings of abnormal metabolic changes in normal-appearing regions in the brain of both SLE and NPSLE patients and raise the possibility that especially NAA, glutamine, and glutamate may be additional biomarkers for cerebral disease activity in SLE patients as these early metabolic changes occur in the brain of SLE patients before neurologic and imaging manifestations become apparent.

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Background: The Tulane Student-Run Tuberculosis (TB) Program provides TB risk evaluation, skin testing (TST), and referrals at six homeless shelters and rehabilitation facilities. To date, there has been no evaluation of the program’s patient profile. The objective of this study was to determine the symp-toms and risk factors for TB present in the program's clients, calculate follow-up rates for TST reading, and determine factors associated with an increased rate of missing reading appointments.  Methods: This retrospective chart review examines the prevalence of risk factors and TB symptoms, evaluates risk stratification, and determines barriers to follow-up for TST over a 33-month period. Rel-ative risks (RR) were calculated to determine the association between risk stratification, positive TST, and loss to follow-up. Z-values were calculated, and p-values were determined as the area of the dis-tribution outside of +/- z. P-values <0.05 were considered statistically significant.  Results: Of 6,198 individuals seen, 479 were referred to higher care, 238 received 30-day clearances, 34 deferred testing, and four were sent to the hospital. Of 5,443 TSTs placed, 4,155 were read and 214 were positive. Individuals who had any risk factors were at significantly increased risk of not attending TST reading (RR 2.14, 95% Confidence interval [CI] 1.96-2.34, p<0.01) and, for those who did attend, of having a positive TST (RR 1.52, 95% CI 1.17-1.98, p<0.01). Higher risk of no-show and positive TST was also seen in homeless individuals (RR 3.44, 95% CI 2.92-4.07, p<0.01 and RR 2.10, 95% CI 1.52-2.90, p<0.01, re-spectively) and those with intermediate-risk stratification (RR 1.25, 95% CI 1.11-1.41, p<0.01 and RR 1.32, 95% CI 1.01-1.72, p=0.04, respectively).  Conclusions: Individuals experiencing homelessness and those with intermittent TB risk stratification are at increased risk for positive TST. Both homelessness and the presence of any TB risk factors in-crease the risk of loss to follow-up.