Uloga Ivana Merza u liturgijskoj obnovi

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Tuberculosis and HIV - Features of the co-infection [TB und HIV-Besonderheiten der Ko-infektion]

The human immunodeficiency virus (HIV) epidemic has allowed the incidence of tuberculosis to rise globally and particularly in sub-Saharan Africa. Diagnosis and treatment of tuberculosis is more complex in patients with HIV/AIDS. Sputum smear microscopy is performing poorly in HIV-infected individuals, who are often started on antituberculosis treatment on clinical grounds. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs to be administered concomittantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution inflammatory syndrome. Current guidelines recommend starting antiretroviral treatment within a few weeks of antituberculosis therapy for patients with CD4 cell counts < 350 cells/μl. © 2011 by Verlag Hans Huber, Hogrefe AG, Bern.Revie

Therapeutic bronchoscopy for treatment-resistant COPD

[No abstract available]Articl

Transthoracic ultrasound for chest wall, pleura, and the peripheral lung

Thoracic ultrasonography can be performed by means of the most basic ultrasound (US) equipment. In healthy individuals, US can visualize the chest wall, the diaphragm and the pleura but not the lung parenchyma. The main domain of thoracic US is the investigation of chest wall abnormalities, pleural thickening and pleural tumours, and the qualitative and quantitative description of pleural effusions. US can visualize lung tumours, pulmonary consolidations and other parenchymal pulmonary processes provided they abut the pleura. US is the ideal tool to assist with thoracentesis and drainage of effusions. US-assisted fine needle aspiration and cutting needle biopsy of lesions arising from the chest wall, pleura and peripheral lung are safe and have a high yield in the hands of chest physicians. US may also guide aspiration and biopsy of diffuse pulmonary infiltrates, consolidations and lung abscesses, provided the pleura is abutted. Advanced applications of transthoracic US include the diagnosis of a pneumothorax and pulmonary embolism. Copyright © 2009 S. Karger AG, Basel.Articl

Medical treatment of tuberculosis-update 2011 [Medikamentöse therapie der tuberkulose-update 2011]

Tuberculosis is the second most common cause of death from an infectious disease after HIV/AIDS and the leading cause of death from an infectious disease in HIV-co-infected patients. Currently, drug susceptible TB is treated with a four drug regimen given over a period of two months followed by two drugs for four months. Drug resistant tuberculosis requires more complex and longer treatment with alternative substances. New antituberculosis drugs are currently being developed and investigated and are urgently needed to treat drug susceptible and drug resistant TB. © 2011 by Verlag Hans Huber, Hogrefe AG, Bern.Revie

Pyrazinamide pharmacokinetics and efficacy in adults and children

Pyrazinamide (PZA) is an essential sterilizing drug and with rifampicin enables six-month short-course antituberculosis chemotherapy. Despite routine use for nearly forty years uncertainty remains regarding the most appropriate PZA dosage for children. In view of this uncertainty literature relating to the efficacy and pharmacokinetics of PZA in children treated for tuberculosis and in adult volunteers and patients was reviewed. Making use of the PZA maximum concentration (Cmax) following various PZA dosages in different groups straight line regression of concentration on dosage was fitted through the origin by least squares and weighted for the numbers of subjects. The fitted line offers an approximation of the likely PZA Cmax that would result from a particular dosage. The slopes of Cmax/dosage of the fitted lines are 1.32 (SE 0.099) for paediatric patients, 1.36 (SE 0.051) for adult volunteers and 1.35 (SE 0.037) for adult patients; there is little difference between the Cmax concentrations achieved in children and adults, whether patients or healthy volunteers, following various mg/kg body weight dosages, suggesting that children and adults receiving the same mg/kg body weight PZA dosage will reach a similar Cmax. Children can receive the same mg/kg body weight PZA dosage as adults. © 2011 Elsevier Ltd. All rights reserved.Article in Pres

Non-responding 'tension pneumothorax' following stab wounds

[No abstract available]Articl

The pharmacokinetics and pharmacodynamics of rifampicin in adults and children in relation to the dosage recommended for children

The dosages of antituberculosis agents recommended for treatment of childhood tuberculosis often reflect those for adult patients with similar mg/kg body weight dosages and ranges advised. Literature relating to the pharmacokinetics and pharmacodynamics of rifampicin (RMP) is reviewed and the serum concentrations reached by adults, both patients and healthy volunteers and children, established or not established on RMP, compared. Straight line regression of maximum RMP serum concentrations (Cmax) on dosage, weighted for the number of individuals, found slopes (SE) of 1.025 (0.067) and 0.881 (0.046) respectively for adult volunteers not established and established on RMP (P = 0.076), and similarly 0.748 (0.057) and 0.684 (0.038) respectively for adult patients (P &lt; 0.001) and 0.622 (0.050) and 0.368 (0.041) respectively for children (P &lt; 0.001). These results indicate that for equivalent RMP dosages adult patients reach a lower Cmax than adult volunteers and that adults, both volunteers and patients established on RMP reach higher Cmax values than children; children established on RMP require approximately twice the mg/kg body weight dosage of RMP to reach serum concentrations equivalent to those of adults. It is noteworthy that many adult patients receiving currently recommended RMP dosages also do not reach the often recommended RMP 2 h serum concentration of 8 μg/mL. © 2011 Elsevier Ltd. All rights reserved.Article in Pres

Accuracy of pleural puncture sites: A prospective comparison of clinical examination with ultrasound

Study objective: To assess the value of chest ultrasonography vs clinical examination for planning of diagnostic pleurocentesis (DPC). Design: Prospective comparative study. Setting: Pulmonary unit of a tertiary teaching hospital. Patients and participants: Sixty-seven consecutive patients referred to 30 physicians of varying degrees of experience for DPC. Interventions: Based on clinical data and examination, physicians determined whether and where a DPC should be performed. Selected puncture sites were evaluated with ultrasound and considered accurate when ≥ 10 mm fluid perpendicular to the skin were present. Measurements and results: In 172 of 255 cases (67%), a puncture site was proposed. Twenty-five sites (15%) were found to be inaccurate on ultrasound examination, and a different, accurate site was established in 20 of these cases. Physicians were unable to locate a puncture site in 83 cases (33%). Among these, ultrasound demonstrated an accurate site in 45 cases (54%), while a safe tap was truly impossible in 38 cases (46%). Overall, ultrasound prevented possible accidental organ puncture in 10% of all cases and increased the rate of accurate sites by 26%. The sensitivity and specificity for identifying a proper puncture site with clinical examination compared to ultrasound as the "gold standard" were 76.6% and 60.3% (positive and negative predictive values, 85.5% and 45.8%, respectively). Risk factors associated with inaccurate clinical site selection were as follows: small effusion (p < 0.001), evidence of fluid loculation on chest radiography (p = 0.01; relative risk, 7.8; 95% confidence interval, 1.9 to 32.9), and sharp costodiaphragmatic angle on chest radiography (p < 0.001; relative risk, 7.0; 95% confidence interval, 2.3 to 15.2). Experienced physicians did not perform better than physicians in training. Conclusions: Puncture site selection with bedside ultrasonography increases the yield of and potentially reduces complication rate in DPC. Physician experience does not predict the accuracy of selected puncture sites.Articl