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Stagg H.R.,University College London | Brown J.,Foundation Medicine | Brown J.,University College London | Ibraim E.,Marius Nasta Institute of Pulmonology | And 9 more authors.
PLoS ONE | Year: 2015

Globally, there is substantial concern regarding the challenges of treating complex drug resistance patterns in multidrug resistant tuberculosis cases. Utilising data from three different settings (Estonia, Latvia, Romania) we sought to contrast drug susceptibility profiles for multidrug resistant tuberculosis cases, highlight the difficulties in designing universal regimen, and inform future regimen selection. Demographic and microbiological surveillance data for multidrug resistant tuberculosis cases from 2004-13 were analysed. High levels of additional resistance to currently recommended second line drugs were seen in all settings, with extensive variability between countries. Accurate drug susceptibility testing and drug susceptibility testing data are vital to inform the development of comprehensive, flexible, multidrug resistant tuberculosis guidance. © 2015 Stagg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Migliori G.B.,Care and Research Institute | Zellweger J.P.,Competence Center | Abubakar I.,Public Health England | Ibraim E.,Marius Nasta Institute of Pulmonology | And 30 more authors.
European Respiratory Journal | Year: 2012

The European Centre for Disease Prevention and Control (ECDC) and the European Respiratory Society (ERS) jointly developed European Union Standards for Tuberculosis Care (ESTC) aimed at providing European Union (EU)-tailored standards for the diagnosis, treatment and prevention of tuberculosis (TB). The International Standards for TB Care (ISTC) were developed in the global context and are not always adapted to the EU setting and practices. The majority of EU countries have the resources and capacity to implement higher standards to further secure quality TB diagnosis, treatment and prevention. On this basis, the ESTC were developed as standards specifically tailored to the EU setting. A panel of 30 international experts, led by a writing group and the ERS and ECDC, identified and developed the 21 ESTC in the areas of diagnosis, treatment, HIV and comorbid conditions, and public health and prevention. The ISTCs formed the basis for the 21 standards, upon which additional EU adaptations and supplements were developed. These patient-centred standards are targeted to clinicians and public health workers, providing an easy-to-use resource, guiding through all required activities to ensure optimal diagnosis, treatment and prevention of TB. These will support EU health programmes to identify and develop optimal procedures for TB care, control and elimination.


Hofmann S.,University of Kiel | Fischer A.,University of Kiel | Till A.,University of Kiel | Muller-Quernheim J.,Albert Ludwigs University of Freiburg | And 21 more authors.
European Respiratory Journal | Year: 2011

Sarcoidosis is a complex systemic inflammatory disease of unknown aetiology that is influenced by a variety of genetic and environmental factors. To identify further susceptibility loci for sarcoidosis, a genome-wide association study (GWAS) was conducted in 381 patients and 392 control individuals based on Affymetrix 100k GeneChip data. The top 25 single-nucleotide polymorphisms (SNPs) were selected for validation in an independent study panel (1,582 patients versus 1,783 controls). Variant rs10484410 on chromosome 6p12.1 was significantly associated, with a Bonferronicorrected p-value of 2.90×10 -2 in the validation sample and a nominal p-value of 2.64×10 -4 in the GWAS. Extensive fine mapping of the novel locus narrowed down the signal to a region comprising the genes BAG2, C6orf65, KIAA1586, ZNF451 and RAB23. Verification of the sarcoidosis-associated nonsynonymous SNP rs1040461 in a further independent case-control sample and quantitative mRNA expression studies point to the RAB23 gene as the most likely risk factor. RAB23 is proposed to be involved in antibacterial defence processes and regulation of the sonic hedgehog signalling pathway. The identified association of the 6p12.1 locus with sarcoidosis implicates this locus as a further susceptibility factor and RAB23 as a potential signalling component that may open up new perspectives in the pathophysiology of sarcoidosis. Copyright©ERS 2011.


PubMed | University of Latvia, Imperial College London, University of Tartu, Foundation Medicine and 4 more.
Type: Journal Article | Journal: PloS one | Year: 2015

Globally, there is substantial concern regarding the challenges of treating complex drug resistance patterns in multidrug resistant tuberculosis cases. Utilising data from three different settings (Estonia, Latvia, Romania) we sought to contrast drug susceptibility profiles for multidrug resistant tuberculosis cases, highlight the difficulties in designing universal regimen, and inform future regimen selection. Demographic and microbiological surveillance data for multidrug resistant tuberculosis cases from 2004-13 were analysed. High levels of additional resistance to currently recommended second line drugs were seen in all settings, with extensive variability between countries. Accurate drug susceptibility testing and drug susceptibility testing data are vital to inform the development of comprehensive, flexible, multidrug resistant tuberculosis guidance.


Nemes R.M.,Marius Nasta Institute Of Pulmonology | Ianosi E.S.,University of Medicine and Pharmacy of Targu Mures | Pop C.S.,University of Bucharest | Postolache P.,Grigore T. Popa University of Medicine and Pharmacy | And 4 more authors.
Romanian Journal of Morphology and Embryology | Year: 2015

Tuberculosis (TB) of the tongue is not a common finding diagnosis, even if consider endemic areas. Tuberculosis of the tongue sometimes can mimic lingual neoplasm. Oral tuberculosis is rarely primary as mechanism, and frequently secondary to pulmonary tuberculosis. There are many suspect lesions that can be classified as tuberculosis, such as tumor mass, ulcerative lesion or fissure. It is very important for diagnosis to perform histopathological examination of the biopsy. We present here the case of a 74-year-old man who developed lingual tuberculosis with a tumor aspect concomitant with pulmonary tuberculosis. Histopathological and immunohistochemical examinations established the diagnosis of lingual tuberculosis. © 2015, Editura Academiei Romane. All rights reserved.


Migliori G.B.,Care and Research Institute | Sotgiu G.,University of Sassari | D'Ambrosio L.,Care and Research Institute | Centis R.,Care and Research Institute | And 12 more authors.
European Respiratory Journal | Year: 2012

In spite of the growing awareness of emerging drug-resistant Mycobacterium tuberculosis , the extent of inappropriate tuberculosis (TB) case management may be underestimated, even in Europe. We evaluated TB case management in the European Union/ European Economic Area countries, with special focus on multidrug-resistant (MDR) and extensively drug-resistant (XDR)-TB, using a purposely developed, standardised survey tool. National reference centres in five countries representing different geographical, socioeconomic and epidemiological patterns of TB in Europe were surveyed. 40 consecutive, original clinical TB case records (30 MDR/XDR-TB cases) were reviewed in each of the five countries. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards. Deviations from international standards of TB care were observed in the following areas: surveillance (no information available on patient outcomes); infection control (lack of respiratory isolation rooms/procedures and negative-pressure ventilation rooms); clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration); laboratory support; and diagnostic/treatment algorithms. Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug resistance. Copyright©ERS 2012.


Postolache P.,Grigore T. Popa University of Medicine and Pharmacy | Cojocaru D.-C.,Grigore T. Popa University of Medicine and Pharmacy | Olaru M.,Constantin Brâncusi University | Todea D.,University of Medicine and Pharmacy, Cluj-Napoca | Nemes R.-M.,Marius Nasta Institute of Pulmonology
2013 E-Health and Bioengineering Conference, EHB 2013 | Year: 2013

Smoking is a major public health problem with medical, social, and financial implications. We conducted a retrospective analysis of data resulting from enrollment and completion of a smoking cessation program of a number of 399 subjects of both gender, who presented consecutively in 2009 to the Smoking Cessation Counseling Medical Office of the Iasi Clinical Rehabilitation Hospital. The treatment for smoking cessation was represented either by bupropion or varenicline, administered by the usual scheme. Smoking severity was quantified by pack - years, determining the carbon monoxide in the exhaled air, both at baseline and at the end of the treatment period, and by Fagerström test for nicotine dependence. In female patients, the severity of smoking was significantly lower (P = 0.000) but their male counterparts responded better to treatment. Also, varenicline seemed to have a stronger therapeutic effect then bupropion while their adverse effects were similar. © 2013 IEEE.


Nemes R.-M.,Marius Nasta Institute of Pulmonology | Postolache P.,Grigore T. Popa University of Medicine and Pharmacy | Olaru M.,Constantin Brâncusi University | Todea D.,University of Medicine and Pharmacy, Cluj-Napoca | Cojocaru D.-C.,Grigore T. Popa University of Medicine and Pharmacy
2013 E-Health and Bioengineering Conference, EHB 2013 | Year: 2013

Chronic obstructive pulmonary disease (COPD) currently occupies sixth place in the list of morbidity causes in the world adult population and is catching third in 2020; smoking is the most important cause. COPD mortality reaches 200-300%ooo for the age group 45-64 years, 6% of deaths in men and 4% of deaths in women. Mortality from the disease is increasing at 3rd place in 2020, the disease having higher mortality statistics as expected. Positive diagnosis of COPD is given by objectifying functional bronchial obstruction by performing spirometry in a patient who is smoker or exposed to pollutants. Investigation of the respiratory function in patients with COPD is essential. Spirometry is considered to be the most reproducible, inexpensive, and the routine test for measuring airflow limitation. © 2013 IEEE.


Bumbacea R.S.,Elias Emergency Hospital | Bumbacea R.S.,Carol Davila University of Medicine and Pharmacy | Petrutescu B.,Elias Emergency Hospital | Bumbacea D.,Carol Davila University of Medicine and Pharmacy | And 3 more authors.
Pneumologia | Year: 2013

Used since 1929 in medical practice, nowadays four chemical varieties of intravascular iodine based radiocontrast media (I-RCM) are available: ionic monomers with high osmolarity, ionic dimers with low osmolarity, non-ionic monomers with low osmolarity and non-ionic iso-osmolar dimers. Increasing prescription of I-RCMs augments the number of reported hypersensitivity reactions. I-RCM induced hypersensitivity reactions can be clasified in two types: immediate hypersensitivity reactions (IHRs - occurring within the first hour) and delayed hypersensitivity reactions (DHRs - occurring between 1 hour and 7 days). IHRs usually present as urticaria and angioedema but may associate severe respiratory and cardiovascular symptoms. Risk factors for an IHRs include a prior immediate reaction, personal history of atopic diseases (mainly asthma) and treatment with beta blocking agents. Diagnostic tests for IHRs include blood tests (serum tryptase) and skin tests (prick and intradermal) performed 2 to 6 months after IHR. High osmolarity of the I-RCM is the factor most strongly associated with IHRs. Primary prevention of IHRs involves the use of non-ionic low-osmolar or iso-osmolar agents for all intravascular procedures. DHRs are usually mild to moderate in severity, transient and self-limiting, presenting as maculopapular rash in more than 50% of cases. As with IHRs, the most important risk factor for DHRs is a previous reaction to I-RCM. Assessment of DHRs includes skin prick tests, intradermal and patch tests. Due to extensive cross-reactivity between I-RCM, a change of product is no guarantee against a repeated reaction. Current premedication procedures in patients with previous severe reactions can reduce symptoms, but may not prevent recurrent reactions.


MihAltan F.,Marius Nasta Institute of Pulmonology | Deleanu O.,Marius Nasta Institute of Pulmonology
Pneumologia | Year: 2016

Last black box on adaptive servoventilation in central apnoea syndrome generate many connective problems concerning the alternative therapies. The authors are starting from two recent French articles on this same subject and are trying to see what is missing and what we have to do.

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