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Pulmonary AND Pneumonia, recurrent or persistent [keywords]
- Cryptosporidiosis: An under-recognized public health problem. [Journal Article]
- Trop Parasitol 2012 Jul; 2(2):91-8.
Cryptosporidium spp. is under recognized as an important pathogen causing diarrhea in children and HIV-infected individuals with associated high morbidity and mortality. In endemic areas, most symptomatic infections are in childhood and in immunocompromised adults. The immune status of the host plays a critical role in determining the severity of cryptosporidiosis. Infection is self-limited in immunocompetent hosts, but can be severe and persistent in the immunocompromised such as AIDS patients or malnourished children. Cryptosporidiosis in developing countries is a major cause of acute and persistent diarrhea in children and is associated with subsequent impairment in growth, physical fitness, and cognitive function. Despite recognition of the importance of immune status, the correlates of protective immunity in cryptosporidiosis in humans are poorly understood, and treatment modalities are limited.
- The role of daytime sleepiness in psychosocial outcomes after treatment for obstructive sleep apnea. [Journal Article]
- Sleep Disord 2013.:140725.
We investigated the role of daytime sleepiness and sleep quality in psychosocial outcomes of patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Thirty-seven individuals with moderate to severe OSA and compliant with CPAP treatment for at least 3 months were compared to 27 age- and education-matched healthy controls. The OSA group and the control group were studied with overnight polysomnography (PSG) and compared on measures of daytime sleepiness (Epworth Sleepiness Scale), sleep quality (Pittsburg Sleep Quality Index), mood (Beck Depression Inventory, Profile of Mood States), and functional outcomes (Functional Outcomes of Sleep Questionnaire). After CPAP treatment, the OSA group improved on sleep quality and sleepiness. As a group, they did not differ from controls on sleep architecture after CPAP. The OSA group also showed significant improvements in functional outcomes and was comparable to controls on mood and functional outcomes. Persistent difficulties included lowered activity level and residual sleepiness in some individuals. Sleepiness was found to be a significant predictor of mood and affective states, while both sleepiness and sleep quality predicted functional outcomes. These results highlight the importance of assessment and intervention targeting psychosocial functioning and sleepiness in individuals with OSA after treatment.
- Characteristics, stability and outcomes of the gold 2011 copd groups in the eclipse cohort. [JOURNAL ARTICLE]
- Eur Respir J 2013 Jun 13.
The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies patients with COPD into four groups (A to D).We explored the characteristics, stability and relationship to outcomes of these groups within the ECLIPSE study (n=2101).Main results showed that: (1) these groups differed in several clinical, functional, imaging and biological characteristics in addition to those used for their own definition; (2) A and D groups were relatively stable over time, whereas groups B and C showed more temporal variability; (3) the risk of exacerbation over 3 years increased progressively from A to D, whereas that of hospitalization and mortality were lowest in A, highest in D and intermediate and similar in B and C, despite the former having milder airflow limitation. The prevalence of comorbidities and persistent systemic inflammation were highest in group B.The different longitudinal behaviour of group A vs. B and C vs. D (each pair with similar FEV1 values) supports the GOLD 2011 proposal of assessing COPD patients by more than FEV1 only. However the assumption that symptoms does not equate to risk appears to be naïve, as groups B and C carry equally poor clinical outcomes, though for different reasons.