Spatio-Temporal Pattern of Tuberculosis Distribution in Romania and Particulate Matter Pollution Associated With Risk of Infection.

The study proposes a dynamic spatio-temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012-2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio-economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.

Asthma characteristics and biomarkers from the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) longitudinal profiling study.

BACKGROUND: Asthma is a heterogeneous disease and development of novel therapeutics requires an understanding of pathophysiologic phenotypes. The purpose of the ADEPT study was to correlate clinical features and biomarkers with molecular characteristics, by profiling asthma (NCT01274507). This report presents for the first time the study design, and characteristics of the recruited subjects. METHODS: Patients with a range of asthma severity and healthy non-atopic controls were enrolled. The asthmatic subjects were followed for 12 months. Assessments included history, patient questionnaires, spirometry, airway hyper-responsiveness to methacholine, fractional exhaled nitric oxide (FENO), and biomarkers measured in induced sputum, blood, and bronchoscopy samples. All subjects underwent sputum induction and 30 subjects/cohort had bronchoscopy. RESULTS: Mild (n = 52), moderate (n = 55), severe (n = 51) asthma cohorts and 30 healthy controls were enrolled from North America and Western Europe. Airflow obstruction, bronchodilator response and airways hyperresponsiveness increased with asthma severity, and severe asthma subjects had reduced forced vital capacity. Asthma control questionnaire-7 (ACQ7) scores worsened with asthma severity. In the asthmatics, mean values for all clinical and biomarker characteristics were stable over 12 months although individual variability was evident. FENO and blood eosinophils did not differ by asthma severity. Induced sputum eosinophils but not neutrophils were lower in mild compared to the moderate and severe asthma cohorts. CONCLUSIONS: The ADEPT study successfully enrolled asthmatics across a spectrum of severity and non-atopic controls. Clinical characteristics were related to asthma severity and in general asthma characteristics e.g. lung function, were stable over 12 months. Use of the ADEPT data should prove useful in defining biological phenotypes to facilitate personalized therapeutic approaches.

[Therapeutic pneumothorax--an effective adjuvant method in treating multidrug-resistant tuberculosis]. / Pneumotoraxul terapeutic--mijloc adjuvant eficace în tratamentul tuberculozei multirezistente.

Treatment of multidrug-resistant TB is difficult, even when all alternative drugs are at hand, due to important side effects and high cost, buying seldom efficient. Therapeutic pneumothorax (TP) proved its efficacy in pre-antibiotic era, so one can assume that it can be applied with the same success in multidrug resistant TB. Three MDR TB cases are presented (resistance to 2, 3 and 4 drugs), with unilateral lesions, in which TP was applied as a help for the drug treatment which was guided by the antibiogram. Favorable results were obtained in all 3 cases, with constant bacteriological negativity. In one of the cases (with 4 drugs resistance), treatment was completed after 3 months by a lobectomy; they were all considered healed after 18 months. In conclusion, in some cases of MDR TB, the TP (if there are no pleural adherences) may lead to good results. This presentation aims to remind the pulmonologists the favourable effects of TP in selected cases.

[The bacterial spectrum in bronchopulmonary infections]. / Spectrul bacterian al infectiilor bronhopulmonare.

UNLABELLED: This study aimed to establish the bacterial profile of bronchopulmonary infections confirmed by the cytobacteriological examination of sputum, in order to find therapeutical guidelines for empirical treatment. We included in the study 408 patients with clinical signs of bronchopulmonary infection (cough and mucopurulent sputum, fever) among which 294 hospitalised patients (5.5% of the 5280 admitted in 1997) and 114 outpatients. The sputum samples collected respecting the decontamination methods were examined cytobacteriologically (smear, culture and antibiogram). The spectrum of isolated bacteria was the following: H. influenzae--198 cases, anaerobes--54, Kl. pneumoniae--53, Ps. aeruginosa--50, S. pneumoniae--17. Analyzing the diseases for which the bacterial examination was performed, we found the following distribution: COPD--66, bacterial infections in TB patients--61, chronic suppurations--33, bronchiectasis--37, pulmonary abscess--24. We noticed the high frequency of H. influenzae and important numbers of anaerobes, Kl. pneumoniae and Ps. aeruginosa especially in COPD patients and patients with chronic suppurations. We performed antibiograms for establishing the sensitivity of bacterial samples (S. aureus, Kl. pneumoniae, Ps. aeruginosa, beta-lactamase-positive H. influenzae). Most of them were multidrug-resistant. CONCLUSIONS: 1. The cytobacteriological study of sputum may be useful for choosing the right treatment, especially for the patients with multiple antibiotic treatments and infected with multidrug resistant bacteria; 2. Knowing the bacterial spectrum in certain respiratory diseases allows the choice of empirical treatment for bronchopulmonary infections in uncomplicated cases.

[The results of using a simplified questionnaire for determining the prevalence of bronchial asthma]. / Rezultatele utilizarii unui chestionar simplificat pentru stabilirea prevalentei astmului bronsic.

UNLABELLED: The aim of the study was to assign the asthma prevalence in a Romanian region, by using a simplified questionnaire, easy to fill in by every subject without specialized help. The study included 508 subjects, 280 women (55.1%) and 238 men (44.9%). The subjects proceeded from different industrial areas (cement factory, rubber processing factory, fur and leather manufacture) and from a village (214 subjects). 203 subjects, having symptoms compatible with asthma, performed lung function tests with a Flow Screen Jaeger device, determining VC, FEV1, FEV1% VC, MEF50, MEF25, and pharmacodynamic test if needed (bronchoconstrictor or bronchodilator). RESULTS: about 40% of the subjects mentioned the wheezing, among them 18% wheezing and dyspnea. "Asthmatic bronchitis" is present at 14.8% of the subjects, including 4.5% patients with bronchial asthma diagnosed by a physician (underdiagnosis). The asthma symptoms are more frequent in the factories with exposure to inhaled allergens and air pollution. The most discriminative symptom association for asthma was: wheezing and breathlessness and a history of dyspnea in the last year. These symptoms suggest that the prevalence of asthma could be 10.43%. The positive bronchodilator or bronchoconstrictor function test associated with wheezing, present at 7.48% of the population, seems to better evaluate the prevalence of asthma, which approaches other data already published. The questionnaire we used proved that it can select with acceptable accuracy the individuals to be further investigated with lung function tests.

[Diffuse interstitial pneumopathy after the treatment with gold salts of a patient with rheumatoid polyarthritis]. / Pneumopatie interstitiala difuza dupa tratament cu saruri de aur la un bolnav cu poliartrita reumatoida.

We present the case of a male patient with sero-negative rheumatoid arthritis, treated with gold salts, admitted for clinical symptoms and chest X-ray alterations suggesting an interstitial lung disease. This was confirmed by complex lung function tests and fiber bronchoscopy with broncho-alveolar lavage. Considerations are made about the etiology of interstitial lung disease (pulmonary determination of the rheumatoid arthritis or secondary to the gold salts therapy), about the treatment and long-term prognosis, and about the good clinical, functional and radiological evolution under treatment.

[Mediastinal pseudotumor]. / Falsa tumoare mediastinala.

A case of mediastinum vascular abnormality is presented consisting in the right side location of the aortic crutch and descending aorta. Besides an abnormality of brachiocephalic trunk issue and position is described. The possible diagnosis errors are discussed.