Increasing Non-tuberculous Mycobacteria Infections in Veterans With COPD and Association With Increased Risk of Mortality

Background: There are limited data on the epidemiology of Non-tuberculous mycobacteria (NTM) infections among patients with COPD, particularly in the veteran population. This study examined the prevalence, incidence, and mortality of pulmonary NTM infections among veterans with COPD population in the United States.Methods: We analyzed nationwide data from Veterans Affairs Hospitals from 2001 to 2015. First, we determined the incidence and prevalence rates and geographic distribution of NTM infections among veterans with COPD and then we evaluated the association between NTM infections with mortality among veterans with COPD. Pulmonary NTM and COPD diagnosis were defined based on charting claims for each condition on ≥2 occasions and ≥30 days apart. COPD diagnoses had to precede diagnosis of NTM. Cox Proportional-Hazards Regression was performed to determine the dependency of survival time of COPD patients with NTM.Results: The incidence and prevalence rates of NTM rose over the study period, with a sharp rise in incidence after 2012. The areas with the highest NTM period prevalence were Puerto Rico (370), followed by Florida (351) and District of Columbia (309) in 100,000 COPD population. Mortality registered for those patients with COPD Patients and NTM infection was 1.43 times higher compared to those that were uninfected.Conclusions: NTM rates have been increasing in veterans with COPD since 2012. NTM infection is associated with increased risk of mortality. This highlights the importance of identifying preventable risk factors associated with NTM infections in subjects with COPD

Noncoding RNAs: New Players in Pulmonary Medicine and Sarcoidosis

Noncoding RNAs (ncRNAs) are coded by 98% of human genomic DNA. They are grouped into two major classes according to length: small ncRNAs and long ncRNAs. They regulate genome organization, stability, and physiological processes that maintain cellular homeostasis. Recently, great interest has emerged in ncRNAs because of their significant roles in the development of inflammatory diseases, including sarcoidosis. Some have been introduced as novel markers for disease activity, such as increased levels of microRNA-34a in peripheral blood mononuclear cells of patients with sarcoidosis, re-emphasizing the inflammatory component in sarcoidosis. They are also important factors in the outcome of sarcoidosis. Dysregulation of microRNA-let7f leads to overexpression of profibrotic factors and could be related to the pathogenesis of pulmonary fibrosis in patients with sarcoidosis, owing to their stimulatory effect on collagen expression and deposition. However, many unanswered questions remain about the association of ncRNAs and sarcoidosis. By understanding the functions of ncRNAs in T-helper cell type 1 and T-helper cell type 17, we may uncover the mechanism of action of those cells in sarcoidosis. Further translational research is needed to define the RNA gene fingerprint of different sarcoidosis stages

Body habitus in patients with and without bronchiectasis and non-tuberculous mycobacteria

Female gender, tall stature, presence of bronchiectasis are associated with pulmonary nontuberculous mycobacterial (NTM) infections. The biologic relationship between the body habitus and NTM infection is not well defined and the body habitus profile of the patients with NTM and concurrent bronchiectasis is completely unknown. We conducted a case control study at the Miami VA Healthcare System and the University of Illinois Medical Center on patients with pulmonary NTM infections between 2010 and 2015. We compared pulmonary NTM subjects with and without bronchiectasis. NTM infection was confirmed by using the American Thoracic Society/ Infectious Disease Society of America criteria. Standard radiological criteria were used to define bronchiectasis in chest CT-scan. Two hundred twenty subjects with pulmonary NTM were enrolled in the study. Sixty six subjects (30%) had bronchiectasis on CT scan of the chest. Subjects in the bronchiectasis group included more women (p = 0.002) and were significantly older (p = 0.005). Those patients who had bronchiectasis tended to have a significantly lower weight (less than 50kg) and height ≤155 cm (p <0.0001 and p = 0.018, respectively). Kaplan-Meier analysis confirmed that subjects who had bronchiectasis were shorter and weighed less, after adjusting for gender. This study defines a new sub-phenotype of NTM subjects with bronchiectasis who tend to be short with lower body weight. Further studies are needed to better understand and define the body habitus profiles of this new sub-phenotype and their clinical implications

Evaluación de destrezas en cirugía laparoscópica: estudio de patrones de movimiento mediante el uso de acelerómetros.

El entrenamiento de la cirug&iacute;a laparosc&oacute;pica debe hacerse mediante un programa escalonado, que incluya laboratorios de pr&aacute;ctica y el uso de modelos virtuales o inanimados. Dentro de estos programas, se hace necesario disponer de par&aacute;metros objetivos de evaluaci&oacute;n que permitan monitorear el desarrollo de destrezas y determinar el punto en el cual el cirujano en formaci&oacute;n puede pasar al pr&oacute;ximo nivel de ense&ntilde;anza, con su participaci&oacute;n en cirug&iacute;as in vivo. En esta investigaci&oacute;n se plantea el an&aacute;lisis de patrones de movimientos mediante la utilizaci&oacute;n de un equipo de f&aacute;cil disponibilidad, como lo es el iPOD Touch de cuarta generaci&oacute;n de Apple&reg;. Este dispositivo cuenta con aceler&oacute;metros que registran el movimiento en tres ejes (x,y,z) y permiten una aproximaci&oacute;n a la calidad de los movimientos ejecutados por el cirujano durante la realizaci&oacute;n de una tarea determinada.AbstractLaparoscopic surgical training should be done through a phased program that includes practical labs and the use of virtual or inanimate models. Within these programs, it is necessary to have objective evaluation parameters that could monitor the development of skills, and serve to establish the level at which the surgeon in training can proceed to the next level of education, including participation during actual surgery. In this research we present an analysis of movement patterns using readily available equipment, such as the iPOD Touch fourth generation of Apple &reg;. This device has accelerometers sensors of movement in three axes (x, y, z) allowing an approximation of the quality of movements of the surgeon during the performance of any particular task

Lung health in era of climate change and dust storms

Dust storms are strong winds which lead to particle exposure over extensive areas. These storms influence air quality on both a local and global scale which lead to both short and long-term effects. The frequency of dust storms has been on the rise during the last decade. Forecasts suggest that their incidence will increase as a response to the effects of climate change and anthropogenic activities. Elderly people, young children, and individuals with chronic cardiopulmonary diseases are at the greatest risk for health effects of dust storms. A wide variety of infectious and non-infectious diseases have been associated with dust exposure. Influenza A virus, pulmonary coccidioidomycosis, bacterial pneumonia, and meningococcal meningitis are a few examples of dust-related infectious diseases. Among non-infectious diseases, chronic obstructive pulmonary disease, asthma, sarcoidosis and pulmonary fibrosis have been associated with dust contact. Here, we review two molecular mechanisms of dust induced lung disease for asthma and sarcoidosis. We can also then further understand the mechanisms by which dust particles disturb airway epithelial and immune cells. •Dust storms provide a vital role on Earth.•The health impact of dust storms is principally determined by the particle size.•The immune system plays a vital role in dust exposure.•Association between dust and sarcoidosis has been proposed.•Prevention and reduction of particle exposure is of paramount importance

Increasing Non-tuberculous Mycobacteria Infections in Veterans With COPD and Association With Increased Risk of Mortality

Background: There are limited data on the epidemiology of Non-tuberculous mycobacteria (NTM) infections among patients with COPD, particularly in the veteran population. This study examined the prevalence, incidence, and mortality of pulmonary NTM infections among veterans with COPD population in the United States. Methods: We analyzed nationwide data from Veterans Affairs Hospitals from 2001 to 2015. First, we determined the incidence and prevalence rates and geographic distribution of NTM infections among veterans with COPD and then we evaluated the association between NTM infections with mortality among veterans with COPD. Pulmonary NTM and COPD diagnosis were defined based on charting claims for each condition on ≥2 occasions and ≥30 days apart. COPD diagnoses had to precede diagnosis of NTM. Cox Proportional-Hazards Regression was performed to determine the dependency of survival time of COPD patients with NTM. Results: The incidence and prevalence rates of NTM rose over the study period, with a sharp rise in incidence after 2012. The areas with the highest NTM period prevalence were Puerto Rico (370), followed by Florida (351) and District of Columbia (309) in 100,000 COPD population. Mortality registered for those patients with COPD Patients and NTM infection was 1.43 times higher compared to those that were uninfected. Conclusions: NTM rates have been increasing in veterans with COPD since 2012. NTM infection is associated with increased risk of mortality. This highlights the importance of identifying preventable risk factors associated with NTM infections in subjects with COPD