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Lessons to learn from MERS-CoV outbreak in South Korea

Since the first identification of Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) in 2012 the virus has infected 1289 humans with approximately 40% mortalities. Currently South Korea is experiencing the hospital-associated outbreak of MER-CoV that has infected 126 human cases and 13 deaths, as of 12 June 2015, following the return of a MERS infected patient from Middle East. The episode is characterized unique being the largest cluster of patients linked to the single introduction of virus that involves three generations of virus transmission. Human-to-human transmission though was observed on several occasions in past, it is documented as non-sustainable event. The recent outbreak including the healthcare workers, index case’s roommates and their caregivers, raises several co...

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium.

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Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium.

Respir Care. 2015 Jun 30;

Authors: Vrijsen B, Chatwin M, Contal O, Derom E, Janssens JP, Kampelmacher MJ, Muir JF, Pinto S, Rabec C, Ramsay M, Randerath WJ, Storre JH, Wijkstra PJ, Windisch W, Testelmans D

Abstract
During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Symposium on Sleep-Disordered Breathing. Numerous European experts took part in this session and discussed (1) NIV in amyotrophic lateral sclerosis (when to start NIV, NIV and sleep, secretion management, and what to do when NIV fails), (2) recent insights in NIV and COPD (high-intensity NIV, NIV in addition to exercise training, and NIV during exercise training), (3) monitoring of NIV (monitoring devices, built-in ventilator software, leaks, and asynchronies) and identifying events during NIV; and (4) recent and future developments in NIV (target-volume NIV, electromyography-triggered NIV, and autoregulating algorithms).

PMID: 26130816 [PubMed - as supplied by publisher]

Effects on health of air pollution: a narrative review.

Effects on health of air pollution: a narrative review.

Intern Emerg Med. 2015 Jul 2;

Authors: Mannucci PM, Harari S, Martinelli I, Franchini M

Abstract
Air pollution is a complex and ubiquitous mixture of pollutants including particulate matter, chemical substances and biological materials. There is growing awareness of the adverse effects on health of air pollution following both acute and chronic exposure, with a rapidly expanding body of evidence linking air pollution with an increased risk of respiratory (e.g., asthma, chronic obstructive pulmonary disease, lung cancer) and cardiovascular disease (e.g., myocardial infarction, heart failure, cerebrovascular accidents). Elderly subjects, pregnant women, infants and people with prior diseases appear especially susceptible to the deleterious effects of ambient air pollution. The main diseases associated with exposure to air pollutants will be summarized in this narrative review.

PMID: 26134027 [PubMed - as supplied by publisher]

Surgical Intervention for Non-Small-Cell Lung Cancer Patients with Pleural Carcinomatosis: Results From the Japanese Lung Cancer Registry in 2004.

A subset of non-small-cell lung cancer (NSCLC) patients with malignant pleural effusion and/or malignant pleural nodules is now classified as stage IV and is generally considered a contraindication to surgery. However, several reports have demonstrated that the prognosis of patients with pleural carcinomatosis first detected at thoracotomy is relatively favorable. The aim of this study was to describe the results of surgical intervention in NSCLC patients with pleural carcinomatosis in Japan.

METHODS: In 2010, the Japanese Joint Committee of Lung Cancer Registry conducted a nationwide registration of lung cancer patients who underwent surgery in 2004. Using this database, we performed a retrospective study focused on pleural carcinomatosis. We examined the clinicopathological features, the current status of therapy, and surgical outcomes in patients with pleural carcinomatosis.

RESULTS: Among the 11,420 registered NSCLC patients, 329 (2.9%) patients had pleural carcinomatosis. The median survival time and 5-year survival rate of 313 patients without other metastatic disease were 34.0 months and 29.3%, respectively. Primary tumor resection was performed in 256 (81.8%) patients, and macroscopic complete resection was achieved in 152 (48.6%) patients, with 5-year survival rates of 33.1% and 37.1%, respectively. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (p < 0.001), best stage nodal status (p = 0.002), and the presence or absence of gross residual tumor (p = 0.013) were independent predictors of survival.

CONCLUSION: In our surgical registry for NSCLC, patients with pleural carcinomatosis accounted for 2.9%, and macroscopic complete resection for them was associated with better survival.

Inflammatory Diseases of the Lung Induced by Conventional Cigarette Smoke: A Review.

Smoking induced lung diseases were extremely rare prior to the twentieth century. With commercialization and introduction of machine-made cigarettes, worldwide use skyrocketed and several new pulmonary diseases have been recognized. The majority of pulmonary diseases caused by cigarette smoke (CS) are inflammatory in origin.

Airway epithelial cells and alveolar macrophages have altered inflammatory signaling in response to CS, which leads to recruitment of lymphocytes, eosinophils, neutrophils, and mast cells to the lungs - depending on the signaling pathway (NFκB, AMPK, JNK, p38 and STAT3) activated. Multiple proteins are up-regulated and secreted in response to CS exposure, and many of these have immunomodulatory activities which contribute to disease pathogenesis. In particular, metalloproteases (MMP)-9 and -12, surfactant (SP-D), antimicrobial peptides (LL-37 and human beta defensin 2), and interleukins (IL)-1, -6, -8 and -17 have been found in higher quantities in the lungs of smokers with ongoing inflammation. However, many underlying mechanisms of smoking induced inflammatory diseases are not yet known.

We review here the known cellular and molecular mechanisms of CS induced diseases, including chronic obstructive pulmonary disease (COPD), respiratory bronchiolitis-interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), acute eosinophilic pneumonia, chronic rhinosinusitis, pulmonary Langerhans' cell histiocytosis, and chronic bacterial infections. We also discuss inflammation induced by second-hand and third-hand smoke exposure, and the pulmonary diseases that result.

New targeted anti-inflammatory therapeutic options are currently under investigation, and hopefully will yield promising results for the treatment of these highly prevalent smoking induced diseases.

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