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Screening for active tuberculosis in high-risk groups.

OBJECTIVE: To evaluate an active case-finding strategy among drug users (DUs), economically disadvantaged individuals and recent immigrants from hyperendemic countries, a population at high risk of developing tuberculosis (TB).

METHODS: Retrospective, observational study carried out by the Tuberculosis Unit of the City of Barcelona from September 2009 to December 2012. All participants underwent chest X-ray and were screened for symptoms.

RESULTS: Of 5982 participants screened, 30 TB cases were detected (total prevalence 0.5%): 26 were pulmonary, 8 were smear-positive and 2 were resistant to multiple drugs. Directly observed treatment was advised for 19 patients (63%). TB prevalence in the recent immigrants group was significantly greater (1.77%) than in all other groups studied: economically disadvantaged individuals 0.30% (RR 5.9, 95%CI 2.30-15.14); DUs 0.62% (RR 2.05, 95%CI 0.91-4.64), non-recent immigrants 0.41% (RR 4.31, 95%CI 1.68-11.4); and all native-born individuals 0.41% (RR 4.33, 95%CI 1.71-10.92). The rate was much greater than the estimated prevalence for the general population of the city (∼20 cases/100 000 population).

CONCLUSIONS: In high-risk groups, active case finding can be used as a public health intervention to detect a large number of TB cases.

Epidemiology of extra-pulmonary tuberculosis in the United States: high rates persist in the post-HIV era.

The incidence of tuberculosis (TB) in the United States has declined following a logarithmic pattern, with few exceptions. One exception was during the acquired immunodeficiency syndrome (AIDS) epidemic, which was thought to have caused the deviation. However, since then, alternative explanations have been proposed, including the increased burden of chronic diseases, immigration, and the increase in the use of immune suppressant medications.

METHODS: Epidemiological data of the Center for Disease Control and Prevention (CDC) and the Bureau of the Census were analyzed regarding TB incidence, human immunodeficiency virus (HIV) infection, immigration status, and age for the period 1953-2011.

RESULTS: Data analysis identified a deviation from the logarithmic decline in TB cases that started in the mid-2000s. This divergence did not appear to be related to HIV status. The overall decline in TB cases since 1953 has been almost exclusively due to a reduction in pulmonary TB (PTB) and not to extra-pulmonary TB (EPTB).

CONCLUSIONS: The HIV/AIDS epidemic likely played a significant role in the 1979-1985 deviation, but not subsequently. Furthermore, EPTB as a proportion of total TB cases has remained high. Further studies to delineate the etiologies of these findings are needed.

The Effects of Marijuana Exposure on Respiratory Health in U.S. Adults.

Given the inconclusive science on the long-term effects of marijuana exposure on lung function, the increasing tetrahydrocannabinol composition of marijuana over time and the increasing legal accessibility of the substance, continued investigation is needed.

Objectives: To determine the association between recent and long-term marijuana smoke exposure with spirometric parameters of lung function and symptoms of respiratory health in a large cohort of U.S. adults.

Methods: This is a cross-sectional study of U.S. adults who participated in the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey cycles, using the data from the standardized spirometry and survey questions performed during these years.

Measurements and Main Results: In the combined 2007-2010 cohorts, 59.1% had used marijuana at least once in their lifetime and 12.2% had used in the past month. For each additional day of marijuana use in the prior month, there were no associated changes in mean percent predicted FEV1 (0.002% ± 0.04%, P=0.9) but there was an associated increase in mean percent predicted FVC (0.13% ± 0.03%, P<0.01) and decrease in mean FEV1/FVC (-0.1% ± 0.04%, P<0.01). In multivariable regressions, 1-5 and 6-20 joint-years of marijuana use were not associated with an FEV1/FVC < 70% (OR 1.1, 95% confidence interval (CI) 0.7-1.6, P=0.8 and OR 1.2, 95% CI 0.8-1.8, p=0.4, respectively) while > 20 joint-years were associated with a FEV1/FVC <70% (OR 2.1, 95% CI 1.1-3.9, P=0.02). For each additional marijuana joint-year smoked, there was no associated change in mean percent predicted FEV1 (0.02% ± 0.02%, P=1.0), but there was an increase in mean percent predicted FVC (0.07% ± 0.02%, P<0.01) and a decrease in mean FEV1/FVC (-0.03% ± 0.01%, P=0.02).

Conclusions: In a large cross-section of U.S. adults, lifetime marijuana use up to 20 joint-years is not associated with adverse changes in spirometric measures of lung health. While > 20 joint-years of marijuana exposure was associated with a two-fold increased odds of a FEV1/FVC < 70%, this was the result of an increase in FVC rather than the disproportional decrease in FEV1 seen with obstructive lung diseases.

Antibiotic treatment for nontuberculous mycobacteria lung infection in people with cystic fibrosis.

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Nontuberculous mycobacteria are mycobacteria, other than those in the Mycobacterium tuberculosis complex, and are commonly found in the environment. Nontuberculous mycobacteria species (most commonly Mycobacterium avium complex and Mycobacterium abscessus) are isolated from the respiratory tract of approximately 5% to 20% of individuals with cystic fibrosis; they can cause lung disease in people with cystic fibrosis leading to more a rapid decline in lung function and even death in certain circumstances. Although there are guidelines for the antimicrobial treatment of nontuberculous mycobacteria lung disease, these recommendations are not specific for people with cystic fibrosis and it is not clear which antibiotic regimen may be the most effective in the treatment of these patients.

OBJECTIVES: The objective of our review was to compare antibiotic treatment to no antibiotic treatment, or to compare different combinations of antibiotic treatment, for nontuberculous mycobacteria lung infections in people with cystic fibrosis. The primary objective was to assess the effect of treatment on lung function and pulmonary exacerbations and to quantify adverse events. The secondary objectives were to assess treatment effects on the amount of bacteria in the sputum, quality of life, mortality, nutritional parameters, hospitalizations and use of oral antibiotics.

SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search: 13 November 2014.We also searched a register of ongoing trials and the reference lists of relevant articles and reviews. Date of last search: 24 September 2014.

SELECTION CRITERIA: Any randomized controlled trials comparing nontuberculous mycobacteria antibiotics to no antibiotic treatment, as well as one nontuberculous mycobacteria antibiotic regimen compared to another nontuberculous mycobacteria antibiotic regimen, in individuals with cystic fibrosis.   DATA COLLECTION AND ANALYSIS: Data were not collected because no completed trials were identified by the searches.

MAIN RESULTS: No completed trials were identified by the searches, but one ongoing trial was identified, which may be eligible for inclusion in this review when completed.

AUTHORS' CONCLUSIONS: This review did not find any evidence for the effectiveness of different antimicrobial treatment for nontuberculous mycobacteria lung disease in people with cystic fibrosis. Until such evidence becomes available, it is reasonable for clinicians to follow the American Thoracic Society guidelines for the diagnosis and treatment of nodular or bronchiectatic pulmonary disease due to Mycobacterium avium complex or Mycobacterium abscessus in patients with cystic fibrosis.

Computational modeling of the obstructive lung diseases asthma and COPD.

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Asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway obstruction and airflow limitation and pose a huge burden to society. These obstructive lung diseases impact the lung physiology across multiple biological scales. Environmental stimuli are introduced via inhalation at the organ scale, and consequently impact upon the tissue, cellular and sub-cellular scale by triggering signaling pathways. These changes are propagated upwards to the organ level again and vice versa.

In order to understand the pathophysiology behind these diseases we need to integrate and understand changes occurring across these scales and this is the driving force for multiscale computational modeling.

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