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Diagnosis and management of nontuberculous mycobacterial lung infections

Abstract The diagnosis and management of nontuberculous mycobacterial (NTM) lung infection remains difficult even among experienced clinicians. Both the incidence and prevalence are likely expected to rise with an aging population. Careful assessment of clinical, radiologic, and microbiologic studies is warranted before initiating therapy, which is often complicated by significant drug side effects and limited sputum conversion rates. Indications to treat are best based on a number of factors, including specific NTM species, NTM lung-infection–associated symptoms, advanced bronchiectatic or cavitary disease, expected tolerance of therapy, and related comorbidities. Surgical resection of localized disease or refractory infection may warrant consideration, but should be done by an...

New technique enables increasingly accurate PET scan to detect cancer and heart conditions

(University of Eastern Finland) A novel technique which reduces image degradation caused by respiratory motion during a PET scan was developed in a recent study at the University of Eastern Finland. The new technique is based on bioimpedance measurement and it allows for image reconstruction at a specific phase of the patient's breathing pattern. This, in turn, makes it possible to reduce image degradation caused by motion. (Source: EurekAlert! - Cancer)

Cost-effectiveness of initiating extrafine- or standard size-particle inhaled corticosteroid for asthma in two health-care systems: a retrospective matched cohort study.

CONCLUSIONS: Initiating ICS therapy for asthma as extrafine-particle ICS seems the dominant treatment option (less costly and more effective) compared with standard size-particle ICS in both the UK and the US. PMID: 25297072 [PubMed - in process] (Source: Primary Care)

Systemic steroids in COPD-the beauty and the beast.

The recommendations regarding the use of systemic steroids in COPD differ substantially depending on the phase of the disease. In moderate and severe acute exacerbations oral steroids are advocated based on the findings of several placebo-controlled trials that have been performed in secondary-care settings : these studies showed that systemic steroids improve lung function, dyspnoea and gas exchange. In addition, steroid use resulted in fewer treatment failures, a lower relapse rate and shorter hospital stays . Importantly, giving steroids orally is non-inferior to the i.v. application and an 8-week treatment is not superior to a 2-week therapy.

Recently, it could even be shown that 5-day treatment is non-inferior to a 14-day course. In the trial with longer term therapy hyperglycemia requiring treatment was identified as considerable side effect, in the other trials no major adverse events were observed.

 

Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis.

CONCLUSIONS: Our meta-analysis supports that LUS, when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. General practitioners and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians. PMID: 24758612 [PubMed - indexed for MEDLINE] (Source: Respiratory Care)

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