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Effect of bronchoalveolar lavage-directed therapy on Pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis: a randomized trial.

Effect of bronchoalveolar lavage-directed therapy on Pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis: a randomized trial.

JAMA. 2011 Jul 13;306(2):163-71

Authors: Wainwright CE, Vidmar S, Armstrong DS, Byrnes CA, Carlin JB, Cheney J, Cooper PJ, Grimwood K, Moodie M, Robertson CF, Tiddens HA,

Early pulmonary infection in children with cystic fibrosis leads to increased morbidity and mortality. Despite wide use of oropharyngeal cultures to identify pulmonary infection, concerns remain over their diagnostic accuracy. While bronchoalveolar lavage (BAL) is an alternative diagnostic tool, evidence for its clinical benefit is lacking.

PMID: 21750293 [PubMed - indexed for MEDLINE]

HIV infection and thromboembolism.

HIV infection and thromboembolism.

J Assoc Physicians India. 2011 Jun;59:380-2

Authors: Basavanagowdappa H, Babu MS, Karuturi S

An increased incidence of venous thromboembolic disorder has been described in the setting of underlying HIV infection. Various abnormalities leading to hypercoagulable state have been reported in HIV patients with thrombotic disease. We hereby report a HIV patient with venous thromboembolism who had normal CD4 count with decreased protein C and protein S and increased serum homocysteine levels.

PMID: 21751595 [PubMed - indexed for MEDLINE]

Active albuterol or placebo, sham acupuncture, or no intervention in asthma.

Active albuterol or placebo, sham acupuncture, or no intervention in asthma.

N Engl J Med. 2011 Jul 14;365(2):119-26

Authors: Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, Kirsch I, Israel E, Kaptchuk TJ

In prospective experimental studies in patients with asthma, it is difficult to determine whether responses to placebo differ from the natural course of physiological changes that occur without any intervention. We compared the effects of a bronchodilator, two placebo interventions, and no intervention on outcomes in patients with asthma.

PMID: 21751905 [PubMed - indexed for MEDLINE]

Distinguishing tuberculosis from Mycobacterium avium complex disease using an interferon-gamma release assay.

Distinguishing tuberculosis from Mycobacterium avium complex disease using an interferon-gamma release assay.

Int J Tuberc Lung Dis. 2011 May;15(5):635-40

Authors: Ra SW, Lyu J, Choi CM, Oh YM, Lee SD, Kim WS, Kim DS, Shim TS

The QuantiFERON®-TB Gold (QFT-G) test can be used to distinguish between tuberculosis (TB) and non-tuberculous mycobacterial disease, but a high background TB infection rate may pose a problem. Although the QuantiFERON®-TB (QFT) test, the first-generation QFT-G test, employs a non-specific PPD antigen, avium sensitin is also used as a stimulating antigen.

PMID: 21756514 [PubMed - in process]

Neonatal chlamydial pneumonia induces altered respiratory structure and function lasting into adult life.

Respiratory dysfunction in adults has been correlated with neonatal Chlamydia trachomatis pneumonia in several studies, but a causal association has not been clearly demonstrated. In this study, we examined radial alveolar counts (RACs) by microscopy, and airway and parenchymal lung function using a small animal ventilator in juvenile (5 weeks age) and adult (8 weeks age) BALB/c mice challenged as neonates with Chlamydia muridarum (C. mur) on day 1 or day 7 after birth, representing saccular (human pre-term neonates) and alveolar (human term neonates) stages of lung development, respectively. Pups challenged with C. mur on either day 1 or 7 after birth demonstrated significantly enhanced airway hyperreactivity and lung compliance, both as juveniles (5 weeks age) and adults (8 weeks age), compared with mock-challenged mice.

Moreover, mice challenged neonatally with Chlamydia displayed significantly reduced RACs, suggesting emphysematous changes. Antimicrobial treatment during the neonatal infection induced early bacterial clearance and partially ameliorated the Chlamydia-induced lung dysfunction as adults.

These results suggest that neonatal chlamydial pneumonia, especially in pre-term neonates, is a cause of respiratory dysfunction continuing into adulthood, and that antimicrobial administration may be partially effective in preventing the adverse respiratory sequelae in adulthood.

The results of our studies also emphasize the importance of prenatal screening and treatment of pregnant women for C. trachomatis in order to prevent the infection of neonates.

Laboratory Investigation advance online publication, 18 July 2011; doi:10.1038/labinvest.2011.103 published online 18 July 2011.

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