Breath tests in diagnosis of pulmonary tuberculosis.

Since the time of Hippocrates, physicians have known that the odour of human breath can provide clues to diagnosis. In the past, hydrogen peroxide which is a marker of inflammatory diseases and oxidative stress was the most studied substance in the exhaled breath which was detectable in the liquid that obtained by condensing or cooling. The advantages of breath analysis are that it is convenient, non-invasive, and could be performed with children as well as mechanically ventilated patients. Today, exhaled nitric oxide has been studied extensively, especially in relation to asthma. More than a thousand different volatile organic compounds have been observed in low concentrations in normal human breath. Alkanes and methylalkanes have been increasingly used by physicians as a novel method to diagnose many diseases without discomforts of invasive procedures. Although the limitations of measurement of exhaled nitric oxide in direct diagnosis of infectious pulmonary TB, it may have potential development as a cost-effective replacement of chest radiological examination in screening algorithms. None of the individual exhaled volatile organic compound alone is specific for disease. Exhaled breath analysis techniques may be available to diagnose and monitor the diseases in home setting when their sensitivity and specificity are expected to improve in the future. Here, we also discussed some patents related to the topic.

Parasitic pneumonia and lung involvement.

Parasitic infestations demonstrated a decline in the past decade as a result of better hygiene practices and improved socioeconomic conditions. Nevertheless, global immigration, increased numbers of the immunocompromised people, international traveling, global warming, and rapid urbanization of the cities have increased the susceptibility of the world population to parasitic diseases. A number of new human parasites, such as Plasmodium knowlesi, in addition to many potential parasites, have urged the interest of scientific community. A broad spectrum of protozoal parasites frequently affects the respiratory system, particularly the lungs. The diagnosis of parasitic diseases of airway is challenging due to their wide varieties of clinical and roentgenographic presentations. So detailed interrogations of travel history to endemic areas are critical for clinicians or pulmonologists to manage this entity. The migrating adult worms can cause mechanical airway obstruction, while the larvae can cause airway inflammation. This paper provides a comprehensive review of both protozoal and helminthic infestations that affect the airway system, particularly the lungs, including clinical and roentgenographic presentations, diagnostic tests, and therapeutic approaches.

Lung cancer chemotherapy, new treatment and related patents.

The majority of patients with lung cancer present with advanced stage which contributes to death of more people than any other malignancy in the world. The discovery of a number of lung cancer-molecular alterations contributes to uniquely targeted therapies with specific inhibitors for non-small cell lung cancer such as erlotinib, gefitinib and crizotinib. Pemetrexed has statistically shown significantly reduced adverse side effects of drug compared with docetaxel. V1801, an analog of gefitinib may overcome gefitinib resistance in patients with non-small cell lung cancer. Thymosin α1, an immunomodulator significantly improves patient's quality of life by enhancing T-cell function, stimulation of Tcell maturation and differentiation. Various novel compounds and chemotherapeutics were introduced in 2013 patents such as taxane, quinazoline, arylamino purine, benzodiazepine, pyrrolopyrimidine, nitrobenzamide, cyclopropane amide, 4-iodo-3-nitrobenzamide, heteroaryl (alkyl) dithiocarbamate, and histone deacetylase in treating non-small-cell lung cancer and piperidine, piperazine, picoplatin, and arsenic trioxide in treating small-cell lung cancer.

Breath tests in respiratory and critical care medicine: from research to practice in current perspectives.

Today, exhaled nitric oxide has been studied the most, and most researches have now focused on asthma. More than a thousand different volatile organic compounds have been observed in low concentrations in normal human breath. Alkanes and methylalkanes, the majority of breath volatile organic compounds, have been increasingly used by physicians as a novel method to diagnose many diseases without discomforts of invasive procedures. None of the individual exhaled volatile organic compound alone is specific for disease. Exhaled breath analysis techniques may be available to diagnose and monitor the diseases in home setting when their sensitivity and specificity are improved in the future.

Novel compounds and drugs and recent patents in treating multidrug-resistant and extensively drug-resistant tuberculosis.

A number of recent studies revealed that successful treatment of the patients with MDR/XDR- TB was not achieved due to high resistant rates to many second-line drugs such as kanamycin and prothionamide including poor adherence of the lengthy treatment. Many new drugs and compounds such as benzothiazinones, meropenem, PA-824, isoflavonoids, rhein, PNU-100480, TMC207, SQ109, OPC-67683, AZD5847, and linezolid are currently in development pipeline. According to very few patents in new compounds and drugs against MDR/XDRMycobacterium tuberculosis bacilli have been currently introduced, so inventors must be encouraged to contribute to this area worldwide.

Systemic sclerosis with hemoptysis and a huge lung cavity.

Systemic sclerosis or scleroderma is associated with distal vasculitis, Raynaud's phenomenon, and inflammation of internal organs and the skin. We present on a 58-year-old Thai woman with systemic sclerosis who came to the 10(th) Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand in 2009 and presented with hemoptysis and a solitary huge-lung cavity as the predominant clinical manifestations which spontaneously resoluted 2 months later. This case demonstrates a solitary huge-lung cavity with hemoptysis and looked like from non-tuberculous Mycobacterial infections or malignancy with spontaneous resolution of hemoptysis and the lung cavity, which does not need invasive investigations.

Human genetic influence on susceptibility of tuberculosis: from infection to disease.

There is substantial evidence from studies on racial variation in susceptibility to tuberculosis (TB) that human genetic variation is an important determinant of the outcome of infection with Mycobacterium tuberculosis (M tb). In only a minority of cases is there an obvious identifiable risk factor such as human immunodeficiency virus (HIV) infection, advanced age, diabetes, corticosteroid usage or alcohol abuse. In the remainder, a complex interaction of genetic and environmental factors causes the development of clinical TB. Assessment of the contribution of genetics of host resistance to human TB is a long-standing challenge of human genetics research. Several studies demonstrated the association of various human leukocyte antigens (HLA) with disease susceptibility in different ethnic populations. There are likely to be many more TB-susceptibility genes to be identified.

Moraxella catarrhalis pneumonia in an AIDS patient: a case report.

Moraxella catarrhalis pneumonia, although in the immunocompromised patients is very uncommon for community-acquired pneumonia (CAP). It demonstrates a potential pathogen with high mortality when the presence of heavy numbers of organisms, intracellularly and extracellularly, in the sputum Gram's stained smears confirmed by cultures. In 2007, the authors reported a case of a 28-year-old Thai single male patient with acquired-immunodeficiency syndrome (AIDS) and Moraxella catarrhalis pneumonia who dramatically responded to two weeks of oral Amoxyclav (Amoxycillin trihydrate 500 milligrams + Clavulanic acid (Potassium clavulanate) 125 milligrams) treatment at 625 milligrams every 8 hours and then discharged. The present case report describes clinical and initial chest roentgenographic presentations of Moraxella catarrhalis pneumonia in AIDS patient. The importance of chest roentgenographic pictures, CD4/CD8-T lymphocyte ratio, sputum Gram's stainings, cultures with susceptibility testing in establishing a diagnosis, and protective vaccine are discussed.