Post-infectious Pulmonary Complications: Establishing Research Priorities to Advance the Field. An Official American Thoracic Society Workshop Report.

Continued improvements in the treatment of pulmonary infections have paradoxically resulted in a growing challenge of individuals with post-infectious pulmonary complications (PIPCs). PIPCs have been long recognized after tuberculosis but recent experiences, such as the SARS-CoV-2 pandemic, have underscored the importance of PIPCs following other lower respiratory tract infections. Independent of the causative pathogen, most available studies of pulmonary infections focus on short-term outcomes rather than long-term morbidity among survivors. In this document, we establish a conceptual scope for PIPCs with discussion of globally significant pulmonary pathogens and an examination of how these pathogens can damage different components of the lung, resulting in a spectrum of PIPCs. We also review potential mechanisms for the transition from acute infection to PIPC, including the interplay between pathogen-mediated injury and aberrant host responses, which together result in PIPCs. Finally, we identify cross-cutting research priorities for the field to facilitate future studies to establish the incidence of PIPCs, define common mechanisms, identify therapeutic strategies, and ultimately reduce the burden of morbidity in survivors of pulmonary infections.

Critical illness due to infection in people living with HIV.

People living with HIV comprise a substantial number of the patients admitted to intensive care. This number varies according to geography, but all areas of the world are affected. In lower-income and middle-income countries, the majority of intensive care unit (ICU) admissions relate to infections, whereas in high-income countries, they often involve HIV-associated non-communicable diseases diagnoses. Management of infections potentially resulting in admission to the ICU in people living with HIV include sepsis, respiratory infections, COVID-19, cytomegalovirus infection, and CNS infections, both opportunistic and non-opportunistic. It is crucial to know which antiretroviral therapy (ART) is appropriate, when is the correct time to administer it, and to be aware of any safety concerns and potential drug interactions with ART. Although ART is necessary for controlling HIV infections, it can also cause difficulties relevant to the ICU such as immune reconstitution inflammatory syndrome, and issues associated with ART administration in patients with gastrointestinal dysfunction on mechanical ventilation. Managing infection in people with HIV in the ICU is complex, requiring collaboration from a multidisciplinary team knowledgeable in both the management of the specific infection and the use of ART. This team should include intensivists, infectious disease specialists, pharmacists, and microbiologists to ensure optimal outcomes for patients.

Negotiating a traditional food space for the Gujarati diaspora in New Jersey: Prohibitions, linkages, and acceptances.

Food practices directly or indirectly depend on tradition and the rituals that sustain a commonality of communal purpose. By invoking tradition and embracing accepted values through prescribed participation, a transnational and to a certain extent her or his progeny, are anchored to a cultural community. Émigrés must decide from a pastiche of food choices from "here" or from "home," that will mark family and self-identity. This research seeks to assess the multiplicity of issues affecting the food cultural landscape of Gujarati transnationals and their descendants in New Jersey, US. The overall objective is to understand the motivations behind their overt and potentially covert food behaviors. Twenty-seven self-identified Gujarati Indian transnationals and their descendants were recruited through a non-probability sampling in northern New Jersey, US for five focus groups and follow-up individual interviews. Two Foundational Themes were distilled from the data: Collective Borders and Connectivity to Food, as well as four Emotive Themes: Food and Family Dynamics; Performance; Shame, Guilt & Anxiety; and Strength, Perseverance or Flexibility. Food choices enabled this diasporic community to negotiate between the competing forces of continuity and change, providing them with a template to adapt to their new surroundings while preserving native traditions. The arena of food and food choices was used by the participants to strike a pragmatic balance between individuation and collectivity, stability and change, and tradition and modernity. A clear understanding of the issues facing transnationals as they transition into a new country can help with their planning and processes of adjustment, which includes strategies to overcome pitfalls. The findings of this study can also inform the external community about the benefits of welcoming émigrés into their society.

Limitations of life-sustaining therapies in South Africa.

PURPOSE: Limitations of life sustaining therapies (LLST) are frequent in intensive care units (ICUs), but no previous studies have examined end-of-life (EOL) care and LLST in South Africa (SA). MATERIALS AND METHODS: This study evaluated LLST in SA from the data of a prospective, international, multicentre, observational study (Ethicus-2) and compared practices with countries in the rest of the world. RESULTS: LLST was relatively common in SA, and withholding was more frequent than withdrawing therapy. However, withdrawing and withholding therapy were less common, while failed CPR was more common, than in many other countries. No patients had an advance directive. Primary reasons for LLST in SA were poor quality of life, multisystem organ failure and patients' unresponsiveness to maximal therapy. Primary considerations for EOL decision-making were good medical practice and patients' best-interest, with the need for an ICU bed only rarely considered. CONCLUSIONS: Withholding was more common than withdrawing treatment both in SA and worldwide, although both were significantly less frequent in SA compared with the world average.

Cigarette Smoking as a Risk Factor for Tuberculosis in Adults: Epidemiology and Aspects of Disease Pathogenesis.

It has been noted by the World Health Organisation that cases of tuberculosis in 2022 globally numbered 10.6 million, resulting in 1.3 million deaths, such that TB is one of the infectious diseases causing the greatest morbidity and mortality worldwide. Since as early as 1918, there has been an ongoing debate as to the relationship between cigarette smoking and TB. However, numerous epidemiological studies, as well as meta-analyses, have indicated that both active and passive smoking are independent risk factors for TB infection, development of reactivation TB, progression of primary TB, increased severity of cavitary disease, and death from TB, among several other considerations. With this considerable body of evidence confirming the association between smoking and TB, it is not surprising that TB control programmes represent a key potential preventative intervention. In addition to coverage of the epidemiology of TB and its compelling causative link with smoking, the current review is also focused on evidence derived from clinical- and laboratory-based studies of disease pathogenesis, most prominently the protective anti-mycobacterial mechanisms of the alveolar macrophage, the primary intracellular refuge of M. tuberculosis. This section of the review is followed by an overview of the major strategies utilised by the pathogen to subvert these antimicrobial mechanisms in the airway, which are intensified by the suppressive effects of smoke inhalation on alveolar macrophage function. Finally, consideration is given to a somewhat under-explored, pro-infective activity of cigarette smoking, namely augmentation of antibiotic resistance due to direct effects of smoke per se on the pathogen. These include biofilm formation, induction of cellular efflux pumps, which eliminate both smoke-derived toxicants and antibiotics, as well as gene modifications that underpin antibiotic resistance.

Fluoroquinolonas respiratorias como antibiótico de primera línea en neumonía adquirida en la comunidad, posición en contra / Respiratory fluoroquinolones as first-line antibiotic in community acquired pneumonia, position against

Las fluoroquinolonas respiratorias, son efectivas contra la mayoría de los posibles patógenos de neumonía adquirida en la comunidad (NAC), tienen biodisponibilidad adecuada y baja toxicidad. Podrían ser consideradas una opción de primera línea para la NAC. Ciprofloxacina muestra tasas bajas de resistencia a S. pneumoniae, pero un aumento creciente de resistencia para enterobacterias. Existe aumento de la resistencia a quinolonas del neumococo en varios países, en Hong Kong llegó al 13.3 %. En Argentina la resistencia a levofloxacina fue 2% en 2004. Preocupa la coexistencia de resistencia de S. pneumoniae a penicilina y macrólidos. En pacientes que necesitan internación por su gravedad, se puede usar fluoroquinolonas como tratamiento alternativo. Las quinolonas son activas ®in vitro¼ contra Myobacterium tuberculosis, el uso de estos antibióticos con sospecha de NAC que en realidad padecen tuberculosis se asocia a retraso en el diagnóstico y creciente resistencia a fluoroquinolonas. No hay evidencias las quinolonas como primera opción en el paciente ambulatorio con NAC, produzca mejores resultados que losBeta-lactámicos. Esa indicación ocasionaría un aumento importante en el consumo de esas drogas, lo que traería como consecuencia, un aumento de la resistencia del neumococo y otros gérmenes sin una clara ventaja terapéutica.

The newer fluoroquinolones are active against most of the potencial pathogens of community acquired pneumonia (CAP), and have high bioavailability and low toxicity. They could be considered a first line option for CAP. Ciprofloxacin presents low resistance rates for S.pneumoniae, but an increasing incidence of resistance among enterobacteriaceae.Quinolones’ resistance is growing, in Hong Kong achieved 13.3%. In Argentina resistance to levofloxacin was 2% in 2004. The coexistence of S. pneumoniae resistant to penicillinand macrolides is worrisome. Fluoroquinolones could be an alternative for those CAP patients that need to be admitted because of their severity of illness. Quinolones are active ®invitro¼ against Myobacterium tuberculosis, the use of these antibiotics for CAP suspicion in patients with tuberculosis has been associated with a delay in the therapy and worseningof resistance to fluoroquinolones. There are not evidences supporting that the use of these antibiotics as the first line of therapy in the outpatient with CAP produces better results than beta-lactams. The indiscriminate use may produce a significant increase in the use of quinolones and as a consequence to an increase of resistance of pneumococcus and other microorganisms, without a clear advantage.