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Principles of Rehabilitation and Reactivation: Pulmonary Hypertension

Most recently, a specialized and carefully monitored exercise training and rehabilitation program has been recommended as add-on to medical treatment in patients with pulmonary arterial hypertension (class I, level of evidence A). Three prospective randomized, controlled trials, 10 prospective uncontrolled trials, 2 retrospective studies and 2 case series in more than 470 patients with severe pulmonary hypertension (PH) and right heart failure reported beneficial effects of a specialized exercise training and rehabilitation program, i.e. significant improvement in symptoms, exercise capacity, cardiorespiratory function and quality of life, compared with untrained controls. All training studies reported an acceptable safety profile, and some uncontrolled studies showed excellent 1- and 2-ye...

Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway

Background: Despite recent advances in microbiological techniques, the etiology of community-acquired pneumonia (CAP) is still not well described. We applied polymerase chain reaction (PCR) and conventional methods to describe etiology of CAP in hospitalized adults and evaluated their respective diagnostic yields. Methods: 267 CAP patients were enrolled consecutively over our 3-year prospective study. Conventional methods (i.e., bacterial cultures, urinary antigen assays, serology) were combined with nasopharyngeal (NP) and oropharyngeal (OP) swab samples analyzed by real-time quantitative PCR (qPCR) for Streptococcus pneumoniae, and by real-time PCR for Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis and 12 types of respiratory viruses. Results: Etiology was establis...

BCG and infection with Mycobacterium tuberculosis

Michelsen and colleagues1 usefully add to the evidence for the protective effect of BCG against active TB. However, we are puzzled by the conclusion that BCG also prevents Mycobacterium tuberculosis (Mtb) infection. Others have similarly used interferon gamma release assay (IGRA) responses as a surrogate for Mtb infection with similar conclusions.2 3 A positive IGRA response represents a previous interaction with Mtb that was sufficient to lead to an acquired immune response. The authors demonstrate a reduced incidence of IGRA response in individuals vaccinated with BCG despite continued risk of Mtb exposure. The authors’ hypothesis that BCG directly protects against TB infection implies it must limit interaction between Mtb and its host. Although not suggested how this could occur, ...

The clinical spectrum of pulmonary aspergillosis

The clinical presentation of Aspergillus lung disease is determined by the interaction between fungus and host. Invasive aspergillosis develops in severely immunocompromised patients, including those with neutropenia, and increasingly in the non-neutropenic host, including lung transplant recipients, the critically ill patients and patients on steroids. A high index of suspicion is required in patients without the classical risk factors as early presentation is usually silent and non-specific, pyrexia uncommon and timely treatment is crucial for survival. Invasive aspergillosis has also been diagnosed in normal hosts after massive exposure to fungal spores. Chronic pulmonary aspergillosis affects patients without obvious immune compromise, but with an underlying lung condition such as COPD...

Overlap of obstructive sleep apnea and bronchial asthma: Effect on asthma control

Conclusion A high index of suspicion is warranted for the overlap of OSA and asthma, particularly in the presence of obesity, GERD, and in patients with severe asthma. Individualized therapy addressing these moderating factors is warranted for optimal health outcomes. Recognition and treatment of OSA in asthmatics is an important element in improving asthma control. (Source: Egyptian Journal of Chest Diseases and Tuberculosis)

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