Negative Impact Factors in HIV-Tuberculosis.

About one quarter of all tuberculosis (TB) deaths are among people living with HIV. Tuberculosis is a leading infectious cause of death among persons infected with HIV and the outcome of TB treatment is poorer in these patients. Objective: To identify the factors associated with a poor tuberculosis outcome in patients with HIV-TB coinfection. Material and methods: This is a retrospective cohort study using data from the local TB registry for 2009-2016. We performed descriptive statistics as well as univariate and multivariate analysis. Results: During the study period we identified 86 patients (4.76% of all patients registered for TB treatment) with HIV-TB who had a mean age of 35.05±9.10 years and were mostly male (73.25%). More than half of patients were current drug users (51.16%) and 22.10% homeless. The mean CD4 value was 179.11±204.76/mm3 and 69.76% of patients received antiretroviral treatment during TB treatment. Viral hepatitis was present in 61.62% of cases, and 77.9% of patients were new TB cases. Pulmonary TB was noted in 72 cases, with confirmation by culture being obtained in 84.44% of cases. Treatment success was achieved in 63.95% of cases, 22.09% of patients died, 8.13% abandoned treatment, and 5.81% were lost to follow up. Several factors related to poor outcome were identified by univariate analysis, including drug use (OR=3.14, p=0.027), homeless status (OR=3.01, p=0.039) and viral hepatitis (OR=2.93, p=0.045). Multivariate analysis revealed marginal insignificance for homeless status (p=0.06) and drug use (p=0.86). Conclusion: A special attention and dedicated programs should be considered for patients who are intravenous drug users or those without a stable home.

Protocol for the EARCO Registry: a pan-European observational study in patients with α1-antitrypsin deficiency.

RATIONALE AND OBJECTIVES: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that leads to an increased risk of emphysema and liver disease. Despite extensive investigation, there remain unanswered questions concerning the natural history, pathophysiology, genetics and the prognosis of the lung disease in association with AATD. The European Alpha-1 Clinical Research Collaboration (EARCO) is designed to bring together researchers from European countries and to create a standardised database for the follow-up of patients with AATD. STUDY DESIGN AND POPULATION: The EARCO Registry is a non-interventional, multicentre, pan-European, longitudinal observational cohort study enrolling patients with AATD. Data will be collected prospectively without interference/modification of patient's management by the study team. The major inclusion criterion is diagnosed severe AATD, defined by an AAT serum level <11 µM (50 mg·dL-1) and/or a proteinase inhibitor genotype ZZ, SZ or compound heterozygotes or homozygotes of other rare deficient variants. Assessments at baseline and during the yearly follow-up visits include lung function testing (spirometry, body plethysmography and diffusing capacity of the lung), exercise capacity, blood tests and questionnaires (symptoms, quality of life and physical activity). To ensure correct data collection, there will be designated investigator staff to document the data in the case report form. All data will be reviewed by the EARCO database manager. SUMMARY: The EARCO Registry aims to understand the natural history and prognosis of AATD better with the goal to create and validate prognostic tools to support medical decision-making.

Analysis of bronchoalveolar lavage fluid in a first Romanian pulmonary alveolar proteinosis cohort.

The features of bronchoalveolar lavage fluid (BALF) components and the severity of pulmonary alveolar proteinosis (PAP) were analyzed in the first Romanian cohort of patients admitted to "Marius Nasta" Institute of Pneumophtisiology, Bucharest, Romania. A six-year follow-up study based on bronchoalveolar lavage (BAL) data was performed between January 2007 to December 2012. Study cohort consisted in 20 inpatients diagnosed with PAP, based on BALF cytological findings and÷or on histopathological findings. Demographic, medical history, tobacco use, clinical and radiological features, disease progression with or without whole lung lavage (WLL) therapy were collected. Disease severity was evaluated by pulmonary function testing including spirometry, blood gas analysis, plethysmography, and diffusing capacity of the lung for carbon monoxide (DLCO), also known as transfer factor (TLCO). The cellular profile of all BALF specimens was analyzed. Statistical analysis made by SPSS version 17.0 included Student's t-test, chi-square test and ANOVA. Mean age of the subjects was 43±16.59 years, with male predominance (n=12; 60%). Diagnosis of PAP was facilitated by fiberbronchoscopy (FBS) with BAL in 90% of cases. Cytological findings of BALF revealed lower macrophages (57.26±18.19%), with a preponderance of neutrophils (17.75±19.44%) and lymphocytes (21.8±16.12%). Lower oxygen partial pressure was identified in elders, comparing to younger patients (p=0.038). Patients treated by WLL had a lower total lung capacity (TLC) and DLCO versus those who did not required WLL (p=0.009, respectively p=0.056). The severity of pulmonary abnormalities provided WLL indication was not influenced by BALF cellularity.

Influence of smoking on sleep and obstructive sleep apnea syndrome.

The various ill effects that tobacco smoking has on health have been largely studied, particularly on vascular, neoplastic, and respiratory diseases. Lately, the discussion about the negative impact of cigarette smoking moved towards sleep medicine. Tobacco consumption has been associated with sleep disordered architecture, both during regular intake and after withdrawal. Its effects on sleep disordered breathing (SDB) and especially obstructive sleep apnea syndrome (OSAS) still remain a matter of debate. It is unclear whether smoking represents a risk factor for OSAS or whether smoking cessation has any beneficial effects on OSAS and its therapy. There seems to be a synergistic effect between smoking and OSAS, both causing an increase in cardiovascular morbidity. Future studies are needed in order to establish the strength of this association. We aim to review the literature regarding the consequences of smoking on sleep architecture and SDB, adding emphasis on OSAS clinical implications and treatment.

Vertebral bone metastasis in breast cancer: a case report.

BACKGROUND: We report here a case of a 66-year-old woman with a very aggressive form of breast carcinoma, having both liver and bone dissemination points. CASE DESCRIPTION: The patient was admitted for a rapid onset disk-herniation-like syndrome, but which on further investigation proved to be in fact a metastatic case of breast cancer. We found evidence of disseminations at least in the lumbar vertebral bodies and the liver. Pathological analysis of the available vertebral metastasis revealed a HER2+ molecular pattern, accordingly to the newly evolving molecular typing of breast cancers. Despite a rapid treatment instauration, the patient reacted poorly to taxanes and octeoclast inhibitors, and died after less than 11 months from admitting to the hospital. CONCLUSIONS: This is a rare case of an aggressive breast carcinoma identified initially after the vertebral metastases themselves that induced a non-specific symptomatology.