Immune Response and Mortality Risk Relate to Distinct Lung Microbiomes in Patients with HIV and Pneumonia.

RATIONALE: The potential role of the airway microbiota in dictating immune responses and infection outcomes in HIV-associated pneumonia is largely unknown. OBJECTIVES: To investigate whether microbiologically and immunologically distinct subsets of patients with HIV and pneumonia exist and are related to mortality. METHODS: Bronchoalveolar lavage samples from Ugandan patients with HIV and pneumonia (n = 182) were obtained at study enrollment (following antibiotic treatment); patient demographics including 8- and 70-day mortality were collected. Lower airway bacterial community composition was assessed via amplification and sequencing of the V4 region of the 16S ribosomal RNA gene. Host immune response gene expression profiles were generated by quantitative polymerase chain reaction using RNA extracted from bronchoalveolar lavage fluid. Liquid and gas chromatography mass spectrometry was used to profile serum metabolites. MEASUREMENTS AND MAIN RESULTS: Based on airway microbiome composition, most patients segregated into three distinct groups, each of which were predicted to encode metagenomes capable of producing metabolites characteristically enriched in paired serum samples from these patients. These three groups also exhibited differences in mortality; those with the highest rate had increased ceftriaxone administration and culturable Aspergillus, and demonstrated significantly increased induction of airway T-helper cell type 2 responses. The group with the lowest mortality was characterized by increased expression of T-cell immunoglobulin and mucin domain 3, which down-regulates T-helper cell type 1 proinflammatory responses and is associated with chronic viral infection. CONCLUSIONS: These data provide evidence that compositionally and structurally distinct lower airway microbiomes are associated with discrete local host immune responses, peripheral metabolic reprogramming, and different rates of mortality.

Students' views regarding selecting medicine as a profession.

OBJECTIVE: To assess students' perceptions regarding merits and demerits of selecting medicine as a profession. METHOD: A cross sectional survey based on convenience sampling was done, where 300 students of both sexes were included, 150 from a medical profession and 150 from a non-medical profession. They were asked to fill a structured, pretested questionnaire, and the results were analyzed by SPSS 16.0. RESULTS: All medical students mentioned that they selected the medical profession because of personal interest. In addition to this 95% students believed this profession offers services to humanity. However, 87% students felt that their family had an influence in their career selection. Interestingly gender consideration, financial reward and overseas consideration ranked low in order. There was a statistically significant difference between the preclinical and clinical groups in their decision of reselecting medicine, if they were given a second chance (p = 0.001). Of those who did not opt for a medical career, 78% students mentioned that medical training is difficult and prolonged, 75% students felt that there is too much competition while 62% students expressed that doctors have excessive working hours. CONCLUSION: Our study concluded that reasons for joining medical profession are primarily based on personal interest, respect and honor, family influence and service to humanity. Financial gain is not a major consideration of many students in choosing medicine as a profession, however, long working hours and prolonged training discourages many students.