Impact of multidrug resistance on experimental empyema by Pseudomonas aeruginosa.

BACKGROUND: Pseudomonas aeruginosa is a cause of infections of the lower respiratory tract among patients with chronic lung disorders. It is questionable whether virulence of this species may be influenced by multidrug resistance (MDR). OBJECTIVES: To define the impact of MDR in experimental lung infection. METHODS: Experimental empyema was induced in rabbits by MDR (group A, n = 16) and by susceptible isolates (group B, n = 10). Pleural fluid was sampled for quantitative culture and estimation of cell apoptosis and of tumor necrosis factor-alpha (TNFα) and malondialdehyde (MDA). Survival was recorded. Cytokine production was stimulated in U937 monocytes by samples of pleural fluid. Whole blood of rabbits was incubated with the isolates; induction of apoptosis was assessed. RESULTS: Survival of group A was prolonged compared to group B. This was accompanied by lower bacterial counts of the inoculated pathogens in pleural fluid and in the lungs of group A compared with group B. Early apoptosis of neutrophils of pleural fluid of group A was lower compared with group B. Pleural fluid concentrations of TNFα and MDA did not differ between the groups. Cytokine production by U937 monocytes after stimulation with pleural fluid was greater in group B than in group A. The susceptible isolate induced apoptosis of neutrophils in vitro at a greater rate than the MDR isolate. CONCLUSIONS: Experimental empyema by susceptible P. aeruginosa is accompanied by greater mortality compared with MDR P. aeruginosa. This phenomenon may be attributed to the different growth pattern of the pathogens or to their interaction with the innate immune system.

Targeted therapies in interstitial lung disease secondary to systemic autoimmune rheumatic disease. Current status and future development.

Autoimmune rheumatic diseases (ARD) are characterized by systemic manifestations and multiple organ involvement, including the lung. Interstitial Lung Disease (ILD) is a cardinal manifestation of lung involvement in patients with ARD and is associated with significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are used as first -line treatment. Targeted therapies, such as biological disease modifying antirheumatic drugs (DMARDS) and anti- fibrotic agents are new treatment options. In this review we discuss the role of targeted therapies in patients with ILD secondary to ARD.

Determinants of continuous positive airway pressure compliance in a group of Greek patients with obstructive sleep apnea.

OBJECTIVE: The aim of the study was to investigate the patients' characteristics that correlate with greater compliance to CPAP use. METHODS: Patients diagnosed with OSAHS and treated with CPAP, who had at least one follow-up visit in the Sleep Clinic during one year, were included in the study. Demographic data, history of symptoms, comorbidities, Body Mass Index (BMI), Epworth Sleepiness Scale questionnaire (ESS), were obtained from patients before and under CPAP use. All variables were correlated with average daily CPAP use. Objective and subjective compliance were estimated and a cut off point of 4.5h/d was used to distinguish 'more compliant' from less 'compliant' patients. RESULTS: Ninety eight patients, with a mean age (+/-SD) of 55.5 (+/-11.1) years were examined. Patients' symptoms improved after CPAP use. The objective compliance was 5.3+/-1.6h/d whereas the subjective compliance was higher. Only 25% of patients were characterized as 'more compliant'. Compliance was positively correlated in a significant way with age and female gender, and negatively correlated with neck circumference, preexisting nasal problems and minimum saturation during sleep. Patients with arterial hypertension showed a trend to better compliance. Weight gain was more frequently observed in 'less compliant' patients. CONCLUSION: To our knowledge this is the first study examining parameters of CPAP compliance in a Greek population of OSAHS patients. Age, gender and minimum saturation during sleep were related to better compliance whereas higher neck circumference and preexisting nasal problems were the parameters related to a worse adherence to treatment.