The document discusses the microbiome in chronic obstructive pulmonary disease (COPD). It outlines several key learning objectives, including whether the lung microbiome changes in stable COPD and during exacerbations. Studies presented show the lung microbiome does change in COPD, with an increase in Proteobacteria and decrease in diversity. Bacterial colonization is more common in COPD patients even when stable. The microbiome also changes during exacerbations and with treatment. Altered microbiomes may impact disease progression through increased inflammation. Further research is still needed to fully understand the lung microbiome and its role in COPD.
BRN Symposium 03/06/16 Microbial dysbiosis in bronchiectasis and cystic fibrosisbrnmomentum
This document discusses microbial dysbiosis in cystic fibrosis (CF) and non-CF bronchiectasis. It finds that:
1) The microbiota in CF and bronchiectasis is stable over time but becomes less diverse during exacerbations or with antibiotic therapy.
2) Pseudomonas aeruginosa colonization in bronchiectasis is associated with worse outcomes like increased mortality, hospitalizations, and lung function decline compared to those without P. aeruginosa.
3) Culture-independent studies show the microbiota in bronchiectasis includes traditional pathogens like Haemophilus and Pseudomonas as well as anaerobes like Prevotella and Veillonella. Microbiome diversity is reduced
BRN Symposium 03/06/16 Certainties and uncertainties in the respiratory micro...brnmomentum
- The respiratory microbiome is a new frontier in medicine, but there are still many uncertainties regarding normal flora, sampling methods, disease states, and interactions.
- Studies have found similar microbiomes in healthy subjects' oropharynx and bronchial areas, but disease like COPD is associated with loss of diversity and overgrowth of Proteobacteria.
- Exacerbations of COPD are linked to increases in potential pathogens like Moraxella and decreases in diversity, though the role of bacteria-virus interactions is still unclear. Interventions aimed at the microbiome may be possible but the best approaches require more research.
BRN Symposium 03/06/16 Respiratory microbiome in IPF: Pathogenesis, Progressi...brnmomentum
This document discusses the role of the respiratory microbiome in idiopathic pulmonary fibrosis (IPF). It finds that IPF patients have a higher bacterial load in their lungs compared to healthy controls. A higher bacterial load is associated with worse lung function and increased risk of death in IPF patients. The microbiome changes and bacterial load further increases during acute exacerbations of IPF. Genetic factors like MUC5B may influence the microbiome in IPF. Overall, the document suggests the microbiome plays a role in IPF pathogenesis and progression, and acute exacerbations involve further changes to the respiratory microbiome.
BRN Symposium 03/06/16 The respiratory microbiome: a new frontier in medicinebrnmomentum
The document discusses the respiratory microbiome and some key uncertainties. It notes that while only about 5% of microorganisms are currently culturable, the microbiome is present. The microbiota of the lower respiratory tract is generally similar to that in the oropharynx, with bacteria like Firmicutes and Bacteroidetes present. However, disease states can disrupt the diversity and relative abundances of bacteria in the respiratory microbiome. Exacerbations of conditions like COPD are also associated with changes in the microbiome. Further research is needed to better understand microbiome interactions and how different bacteria may impact health and disease.
Human genetic susceptibility to mycobacterium tuberculosis 1Shweta Kaul
complete guide to the basics and all the guides for the human genetic susceptibility to mycobacterium tuberculosis for both masters and bachelors. This presentation includes the future perspectives and all the genes involved that had been identified till date for the disease susceptibility.
There is no single ideal test for the diagnosis of active tuberculosis. A combination of clinical suspicion, chest radiography, sputum smear microscopy, mycobacterial culture, and nucleic acid amplification tests are often used. While sputum smear microscopy can provide rapid results, its sensitivity is relatively low. Mycobacterial culture has higher sensitivity but results take longer. Nucleic acid amplification tests like PCR provide results within days and have high sensitivity and specificity, but cannot determine drug susceptibility. No single test is perfect, so a clinical and laboratory algorithm is required to make an accurate diagnosis of TB.
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
This document discusses disseminated fungal infections, including candidiasis. It notes that fungal infections in hospitals have increased dramatically due to rising immunosuppressed populations. Candida species are the most common cause. Risk factors include ICU stay, immunosuppression, and use of broad-spectrum antibiotics and catheters. Diagnosis relies on blood and tissue cultures but has low sensitivity. Early antifungal treatment improves outcomes, and options include fluconazole, amphotericin B, and echinocandins. Prevention strategies focus on hand hygiene and reducing unnecessary fluconazole use.
BRN Symposium 03/06/16 Microbial dysbiosis in bronchiectasis and cystic fibrosisbrnmomentum
This document discusses microbial dysbiosis in cystic fibrosis (CF) and non-CF bronchiectasis. It finds that:
1) The microbiota in CF and bronchiectasis is stable over time but becomes less diverse during exacerbations or with antibiotic therapy.
2) Pseudomonas aeruginosa colonization in bronchiectasis is associated with worse outcomes like increased mortality, hospitalizations, and lung function decline compared to those without P. aeruginosa.
3) Culture-independent studies show the microbiota in bronchiectasis includes traditional pathogens like Haemophilus and Pseudomonas as well as anaerobes like Prevotella and Veillonella. Microbiome diversity is reduced
BRN Symposium 03/06/16 Certainties and uncertainties in the respiratory micro...brnmomentum
- The respiratory microbiome is a new frontier in medicine, but there are still many uncertainties regarding normal flora, sampling methods, disease states, and interactions.
- Studies have found similar microbiomes in healthy subjects' oropharynx and bronchial areas, but disease like COPD is associated with loss of diversity and overgrowth of Proteobacteria.
- Exacerbations of COPD are linked to increases in potential pathogens like Moraxella and decreases in diversity, though the role of bacteria-virus interactions is still unclear. Interventions aimed at the microbiome may be possible but the best approaches require more research.
BRN Symposium 03/06/16 Respiratory microbiome in IPF: Pathogenesis, Progressi...brnmomentum
This document discusses the role of the respiratory microbiome in idiopathic pulmonary fibrosis (IPF). It finds that IPF patients have a higher bacterial load in their lungs compared to healthy controls. A higher bacterial load is associated with worse lung function and increased risk of death in IPF patients. The microbiome changes and bacterial load further increases during acute exacerbations of IPF. Genetic factors like MUC5B may influence the microbiome in IPF. Overall, the document suggests the microbiome plays a role in IPF pathogenesis and progression, and acute exacerbations involve further changes to the respiratory microbiome.
BRN Symposium 03/06/16 The respiratory microbiome: a new frontier in medicinebrnmomentum
The document discusses the respiratory microbiome and some key uncertainties. It notes that while only about 5% of microorganisms are currently culturable, the microbiome is present. The microbiota of the lower respiratory tract is generally similar to that in the oropharynx, with bacteria like Firmicutes and Bacteroidetes present. However, disease states can disrupt the diversity and relative abundances of bacteria in the respiratory microbiome. Exacerbations of conditions like COPD are also associated with changes in the microbiome. Further research is needed to better understand microbiome interactions and how different bacteria may impact health and disease.
Human genetic susceptibility to mycobacterium tuberculosis 1Shweta Kaul
complete guide to the basics and all the guides for the human genetic susceptibility to mycobacterium tuberculosis for both masters and bachelors. This presentation includes the future perspectives and all the genes involved that had been identified till date for the disease susceptibility.
There is no single ideal test for the diagnosis of active tuberculosis. A combination of clinical suspicion, chest radiography, sputum smear microscopy, mycobacterial culture, and nucleic acid amplification tests are often used. While sputum smear microscopy can provide rapid results, its sensitivity is relatively low. Mycobacterial culture has higher sensitivity but results take longer. Nucleic acid amplification tests like PCR provide results within days and have high sensitivity and specificity, but cannot determine drug susceptibility. No single test is perfect, so a clinical and laboratory algorithm is required to make an accurate diagnosis of TB.
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
This document discusses disseminated fungal infections, including candidiasis. It notes that fungal infections in hospitals have increased dramatically due to rising immunosuppressed populations. Candida species are the most common cause. Risk factors include ICU stay, immunosuppression, and use of broad-spectrum antibiotics and catheters. Diagnosis relies on blood and tissue cultures but has low sensitivity. Early antifungal treatment improves outcomes, and options include fluconazole, amphotericin B, and echinocandins. Prevention strategies focus on hand hygiene and reducing unnecessary fluconazole use.
Case report :systemic torulopsis after gastric bypass operationAhmed Bahnassy
This case report describes a 50-year old woman who developed a systemic Torulopsis glabrata infection after undergoing gastric bypass surgery for morbid obesity 5 months prior. CT imaging revealed pulmonary nodules, liver and splenic lesions, lymphadenopathy, and ascites. Biopsy results showed necrotizing granulomatous inflammation and heavy growth of T. glabrata. Despite treatment, the patient developed multi-organ failure and died. The report emphasizes that systemic fungal infections can be life-threatening complications after gastric bypass and highlights the CT imaging findings of disseminated T. glabrata infection.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
The document summarizes key points about invasive fungal infections:
1) It reviews different types of invasive fungi like Candida and Aspergillus species and how their local epidemiology is changing.
2) It discusses risk factors for invasive fungal infections in high risk groups like ICU patients, transplant recipients, and those taking biologics.
3) It describes the clinical manifestations of common fungal infections including candidemia, hepatosplenic candidiasis, aspergillosis, and their associated mortality rates.
Cefditoren pivoxil:a new antibiotic for the treatment of respiratory infectionsJordi Roig
Cefditoren pivoxil is a new oral cephalosporin antibiotic for the treatment of respiratory tract infections. It has high in vitro activity against common respiratory pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical trials showed that cefditoren was as effective as other antibiotics like amoxicillin-clavulanate, cefuroxime, and clarithromycin in treating conditions like acute otitis media, acute sinusitis, acute pharyngotonsillitis, and acute exacerbations of chronic bronchitis. Cefditoren demonstrated bactericidal activity against penicillin-resistant S. pneumoniae strains
Recurrent UTI: three febrile UTIs in six months or four total UTIs in one year.
8 to 30 percent of children with UTI experience on or more reinfections. Recurrent episodes of pyelonephritis can lead to renal scarring.
This document summarizes an investigation into an outbreak of Burkholderia cepacia infections caused by drug contamination at a hospital in China. Samples were taken from the hospital environment, medical instruments, and unopened drugs. Burkholderia cepacia was isolated from surgical instruments and two batches of analgesic gel. Pulsed-field gel electrophoresis showed that bacteria isolated from patients and the contaminated analgesic gel were homologous, confirming the outbreak. The outbreak was likely caused by water pollution during drug production or defects allowing improper disinfection.
Fungal infections caused by Candida and Aspergillus species are increasingly common in critically ill patients. These infections are associated with high morbidity and mortality. Clinicians must have a high index of suspicion given the challenges of diagnosis in ICU patients. Treatment is complicated by potential adverse drug reactions and interactions.
Urinary catheters can lead to complicated UTIs. CAUTIs occur in 3-10% of ICU patients per day and almost all by 30 days. Common organisms include Pseudomonas, Enterococcus, and E. coli. Risk factors include improper handwashing and maintenance. Symptoms with positive urine culture indicate CAUTI. Treatment involves removing the catheter, obtaining a urine sample, and starting antibiotics. Proper hand hygiene and following maintenance procedures can prevent CAUTIs. Antibiotics before procedures like cystoscopy may reduce UTIs but have a high number needed to treat. Vesicostomy and nephrostomy can also lead to UTIs, which are usually treated with oral antibiotics.
Microbiome & Infection Control - NJ FawcettNicola Fawcett
This document discusses the human microbiome and its role in infection prevention and control. It covers how antibiotics can disrupt the microbiome and increase risks of infection by multidrug-resistant organisms. Probiotics, prebiotics, synbiotics, and fecal microbiota transplant are presented as potential strategies for microbiome restoration and pathogen decolonization. The intact human microbiome is described as an important host defense against pathogen colonization and infection.
Hepatitis is inflammation of the liver that can be caused by infectious agents like viruses or bacteria, as well as non-infectious causes such as alcohol, drugs, autoimmune diseases, and metabolic disorders. Hepatitis B is a major global health problem, with the highest prevalence in the Western Pacific and African regions. In Nepal, the prevalence of Hepatitis B is estimated to be 0.9% on average. It is transmitted parenterally or sexually and can be acute or develop into chronic infection. Diagnosis involves liver function tests and detecting serum markers. Treatment depends on the stage of infection, while prevention involves immunization, safe injection practices, and health education.
The document discusses invasive fungal infections in critically ill patients. It notes that these infections have increased due to factors like immunosuppression from medical therapies. Common fungal pathogens include Candida species and Aspergillus. Diagnosis can be challenging as cultures often have low sensitivity. Biomarkers like galactomannan and beta-D-glucan can help but have limitations. Early treatment with antifungals is important to reduce mortality, though choice of agent depends on individual patient and infecting organism factors. Fungal infections should be considered in critically ill patients with persistent fever despite antibiotics.
Cirrhosis increases the risk of bacterial infections which are a leading cause of death in patients with liver disease. Bacterial infections commonly seen in cirrhosis include spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, and bacteremia. The pathogenesis involves bacterial translocation from the gut and impaired immune defenses in cirrhosis. Clinical features can include fever, abdominal pain, renal failure, and hepatic decompensation. Diagnosis involves identifying signs of infection and testing ascitic fluid or other body fluids by cell count, cultures, and other tests. Antibiotic prophylaxis is recommended for gastrointestinal bleeding and recurrent SBP based on increased mortality from infection in these high risk groups.
Diagnostics of tuberculosis: An insight into Genexpert 27 4-15Yahya Noori, Ph.D
This document discusses the GeneXpert diagnostic test for tuberculosis. It provides an overview of tuberculosis as the second leading infectious disease globally. It then discusses the GeneXpert test, noting that it can detect tuberculosis and rifampicin resistance in under 2 hours, much faster than traditional diagnostics. The document reviews studies showing high sensitivity and specificity of GeneXpert for pulmonary and extra-pulmonary tuberculosis. It concludes by outlining the current recommendations in Pakistan for using GeneXpert to diagnose tuberculosis in high-risk patient groups.
1) Transmission of ESBL-producing Enterobacteriaceae was higher within households (22.7% for E. coli, 25% for K. pneumoniae) than in hospitals (4.5% for E. coli, 8.3% for K. pneumoniae).
2) Importation of ESBL-producers into hospitals was as frequent as nosocomial transmission.
3) Transmission of ESBL-K. pneumoniae may have been more efficient in hospitals than ESBL-E. coli, despite more infection control measures for K. pneumoniae cases.
This document discusses treatment options for Legionnaires' disease, including macrolides versus fluoroquinolones. It summarizes several studies comparing these drug classes and finds azithromycin and levofloxacin to be equally effective with shorter treatment duration for fluoroquinolones. Severe Legionnaires' disease is associated with higher mortality, especially if initial appropriate treatment is delayed or inadequate. Prognostic factors for death include an APACHE score over 15, shock, immunosuppression, and acute renal failure.
Fungal infections in hematology patients: advances in prophylaxis and treatmentspa718
This document summarizes advances in prophylaxis and treatment of fungal infections in hematology patients. It discusses risk stratification approaches and various randomized controlled trials comparing different antifungal agents for prophylaxis. Trials showed posaconazole, micafungin, and voriconazole reduced incidence of invasive fungal infections compared to fluconazole or itraconazole in high-risk patients. The document also reviews empirical antifungal therapy approaches and measures of success in clinical trials comparing liposomal amphotericin B, voriconazole, and caspofungin.
Cancer is uncontrolled cell growth that can lead to tumor formation and be either benign or malignant. It will affect 1 in 3 people during their lifetime. Increased life expectancy and modern lifestyles contribute to higher cancer rates, which are expected to increase by 50% to 15 million new cases annually by 2020 according to a global report. Prevention through healthy lifestyle choices and public health action could reduce cancer incidence by a third worldwide.
Candidia Species Commonly (Opportunistic human Pathogens)
C.albicans
C.glabata
C.guilliermandii
C.krusei
C.lusitaniae
C.parapsilosis
C.tropicalis
Candiia Species Uncommonly: 18 species
Gut Microbiota in Lung Cancer_Indrawaty_Gizi.pdfIndahUdin1
The document discusses the role of gut microbiota in lung cancer development and immunotherapy. It finds that gut dysbiosis in lung cancer patients is characterized by decreased probiotics and increased pathogenic bacteria. Gut dysbiosis can disrupt the intestinal barrier and cause lung inflammation through various mechanisms like activating immune cells and reducing regulatory T cells in the lungs. Certain gut bacteria and their metabolites have also been associated with improved efficacy of immune checkpoint inhibitors used in lung cancer immunotherapy. Probiotics may help regulate lung immunity but some probiotic strains also carry risks like toxin production and antibiotic resistance. More research is needed to better understand the links between the gut microbiome and lung cancer prevention and treatment.
This document discusses chronic obstructive pulmonary disease (COPD) and long-acting beta-2 agonists for its treatment. It notes that COPD is a leading cause of death worldwide and its burden has increased significantly in recent decades. Long-acting beta-2 agonists like formoterol and salmeterol are recommended as first-line therapy for COPD as they provide smooth muscle relaxation and anti-inflammatory effects when dosed twice daily, improving symptoms and quality of life compared to short-acting treatments. The document reviews the mechanisms of benefit, formulations, and clinical studies of long-acting beta-2 agonists for COPD management.
Case report :systemic torulopsis after gastric bypass operationAhmed Bahnassy
This case report describes a 50-year old woman who developed a systemic Torulopsis glabrata infection after undergoing gastric bypass surgery for morbid obesity 5 months prior. CT imaging revealed pulmonary nodules, liver and splenic lesions, lymphadenopathy, and ascites. Biopsy results showed necrotizing granulomatous inflammation and heavy growth of T. glabrata. Despite treatment, the patient developed multi-organ failure and died. The report emphasizes that systemic fungal infections can be life-threatening complications after gastric bypass and highlights the CT imaging findings of disseminated T. glabrata infection.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
The document summarizes key points about invasive fungal infections:
1) It reviews different types of invasive fungi like Candida and Aspergillus species and how their local epidemiology is changing.
2) It discusses risk factors for invasive fungal infections in high risk groups like ICU patients, transplant recipients, and those taking biologics.
3) It describes the clinical manifestations of common fungal infections including candidemia, hepatosplenic candidiasis, aspergillosis, and their associated mortality rates.
Cefditoren pivoxil:a new antibiotic for the treatment of respiratory infectionsJordi Roig
Cefditoren pivoxil is a new oral cephalosporin antibiotic for the treatment of respiratory tract infections. It has high in vitro activity against common respiratory pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical trials showed that cefditoren was as effective as other antibiotics like amoxicillin-clavulanate, cefuroxime, and clarithromycin in treating conditions like acute otitis media, acute sinusitis, acute pharyngotonsillitis, and acute exacerbations of chronic bronchitis. Cefditoren demonstrated bactericidal activity against penicillin-resistant S. pneumoniae strains
Recurrent UTI: three febrile UTIs in six months or four total UTIs in one year.
8 to 30 percent of children with UTI experience on or more reinfections. Recurrent episodes of pyelonephritis can lead to renal scarring.
This document summarizes an investigation into an outbreak of Burkholderia cepacia infections caused by drug contamination at a hospital in China. Samples were taken from the hospital environment, medical instruments, and unopened drugs. Burkholderia cepacia was isolated from surgical instruments and two batches of analgesic gel. Pulsed-field gel electrophoresis showed that bacteria isolated from patients and the contaminated analgesic gel were homologous, confirming the outbreak. The outbreak was likely caused by water pollution during drug production or defects allowing improper disinfection.
Fungal infections caused by Candida and Aspergillus species are increasingly common in critically ill patients. These infections are associated with high morbidity and mortality. Clinicians must have a high index of suspicion given the challenges of diagnosis in ICU patients. Treatment is complicated by potential adverse drug reactions and interactions.
Urinary catheters can lead to complicated UTIs. CAUTIs occur in 3-10% of ICU patients per day and almost all by 30 days. Common organisms include Pseudomonas, Enterococcus, and E. coli. Risk factors include improper handwashing and maintenance. Symptoms with positive urine culture indicate CAUTI. Treatment involves removing the catheter, obtaining a urine sample, and starting antibiotics. Proper hand hygiene and following maintenance procedures can prevent CAUTIs. Antibiotics before procedures like cystoscopy may reduce UTIs but have a high number needed to treat. Vesicostomy and nephrostomy can also lead to UTIs, which are usually treated with oral antibiotics.
Microbiome & Infection Control - NJ FawcettNicola Fawcett
This document discusses the human microbiome and its role in infection prevention and control. It covers how antibiotics can disrupt the microbiome and increase risks of infection by multidrug-resistant organisms. Probiotics, prebiotics, synbiotics, and fecal microbiota transplant are presented as potential strategies for microbiome restoration and pathogen decolonization. The intact human microbiome is described as an important host defense against pathogen colonization and infection.
Hepatitis is inflammation of the liver that can be caused by infectious agents like viruses or bacteria, as well as non-infectious causes such as alcohol, drugs, autoimmune diseases, and metabolic disorders. Hepatitis B is a major global health problem, with the highest prevalence in the Western Pacific and African regions. In Nepal, the prevalence of Hepatitis B is estimated to be 0.9% on average. It is transmitted parenterally or sexually and can be acute or develop into chronic infection. Diagnosis involves liver function tests and detecting serum markers. Treatment depends on the stage of infection, while prevention involves immunization, safe injection practices, and health education.
The document discusses invasive fungal infections in critically ill patients. It notes that these infections have increased due to factors like immunosuppression from medical therapies. Common fungal pathogens include Candida species and Aspergillus. Diagnosis can be challenging as cultures often have low sensitivity. Biomarkers like galactomannan and beta-D-glucan can help but have limitations. Early treatment with antifungals is important to reduce mortality, though choice of agent depends on individual patient and infecting organism factors. Fungal infections should be considered in critically ill patients with persistent fever despite antibiotics.
Cirrhosis increases the risk of bacterial infections which are a leading cause of death in patients with liver disease. Bacterial infections commonly seen in cirrhosis include spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, and bacteremia. The pathogenesis involves bacterial translocation from the gut and impaired immune defenses in cirrhosis. Clinical features can include fever, abdominal pain, renal failure, and hepatic decompensation. Diagnosis involves identifying signs of infection and testing ascitic fluid or other body fluids by cell count, cultures, and other tests. Antibiotic prophylaxis is recommended for gastrointestinal bleeding and recurrent SBP based on increased mortality from infection in these high risk groups.
Diagnostics of tuberculosis: An insight into Genexpert 27 4-15Yahya Noori, Ph.D
This document discusses the GeneXpert diagnostic test for tuberculosis. It provides an overview of tuberculosis as the second leading infectious disease globally. It then discusses the GeneXpert test, noting that it can detect tuberculosis and rifampicin resistance in under 2 hours, much faster than traditional diagnostics. The document reviews studies showing high sensitivity and specificity of GeneXpert for pulmonary and extra-pulmonary tuberculosis. It concludes by outlining the current recommendations in Pakistan for using GeneXpert to diagnose tuberculosis in high-risk patient groups.
1) Transmission of ESBL-producing Enterobacteriaceae was higher within households (22.7% for E. coli, 25% for K. pneumoniae) than in hospitals (4.5% for E. coli, 8.3% for K. pneumoniae).
2) Importation of ESBL-producers into hospitals was as frequent as nosocomial transmission.
3) Transmission of ESBL-K. pneumoniae may have been more efficient in hospitals than ESBL-E. coli, despite more infection control measures for K. pneumoniae cases.
This document discusses treatment options for Legionnaires' disease, including macrolides versus fluoroquinolones. It summarizes several studies comparing these drug classes and finds azithromycin and levofloxacin to be equally effective with shorter treatment duration for fluoroquinolones. Severe Legionnaires' disease is associated with higher mortality, especially if initial appropriate treatment is delayed or inadequate. Prognostic factors for death include an APACHE score over 15, shock, immunosuppression, and acute renal failure.
Fungal infections in hematology patients: advances in prophylaxis and treatmentspa718
This document summarizes advances in prophylaxis and treatment of fungal infections in hematology patients. It discusses risk stratification approaches and various randomized controlled trials comparing different antifungal agents for prophylaxis. Trials showed posaconazole, micafungin, and voriconazole reduced incidence of invasive fungal infections compared to fluconazole or itraconazole in high-risk patients. The document also reviews empirical antifungal therapy approaches and measures of success in clinical trials comparing liposomal amphotericin B, voriconazole, and caspofungin.
Cancer is uncontrolled cell growth that can lead to tumor formation and be either benign or malignant. It will affect 1 in 3 people during their lifetime. Increased life expectancy and modern lifestyles contribute to higher cancer rates, which are expected to increase by 50% to 15 million new cases annually by 2020 according to a global report. Prevention through healthy lifestyle choices and public health action could reduce cancer incidence by a third worldwide.
Candidia Species Commonly (Opportunistic human Pathogens)
C.albicans
C.glabata
C.guilliermandii
C.krusei
C.lusitaniae
C.parapsilosis
C.tropicalis
Candiia Species Uncommonly: 18 species
Gut Microbiota in Lung Cancer_Indrawaty_Gizi.pdfIndahUdin1
The document discusses the role of gut microbiota in lung cancer development and immunotherapy. It finds that gut dysbiosis in lung cancer patients is characterized by decreased probiotics and increased pathogenic bacteria. Gut dysbiosis can disrupt the intestinal barrier and cause lung inflammation through various mechanisms like activating immune cells and reducing regulatory T cells in the lungs. Certain gut bacteria and their metabolites have also been associated with improved efficacy of immune checkpoint inhibitors used in lung cancer immunotherapy. Probiotics may help regulate lung immunity but some probiotic strains also carry risks like toxin production and antibiotic resistance. More research is needed to better understand the links between the gut microbiome and lung cancer prevention and treatment.
This document discusses chronic obstructive pulmonary disease (COPD) and long-acting beta-2 agonists for its treatment. It notes that COPD is a leading cause of death worldwide and its burden has increased significantly in recent decades. Long-acting beta-2 agonists like formoterol and salmeterol are recommended as first-line therapy for COPD as they provide smooth muscle relaxation and anti-inflammatory effects when dosed twice daily, improving symptoms and quality of life compared to short-acting treatments. The document reviews the mechanisms of benefit, formulations, and clinical studies of long-acting beta-2 agonists for COPD management.
This document summarizes research on the relationship between smoking and idiopathic pulmonary fibrosis (IPF). It finds that smoking is one of the strongest risk factors for developing IPF. Current and former smokers with IPF may have worse survival outcomes and more rapid lung function decline than non-smokers with IPF. The mechanisms by which smoking contributes to IPF are not fully understood but increased oxidative stress in smokers may promote disease progression. The document reviews the current understanding of IPF pathogenesis and the potential ways that smoking could influence these pathways and affect disease outcomes in IPF patients.
The document summarizes a mathematical model of cystic fibrosis (CF) that evaluates different intervention strategies to extend patient lifespan. The model assumes CF is caused by a genetic mutation that leads to thick mucus buildup and bacterial infection in the lungs. Without treatment, average lifespan is 25 years. The model finds that combining hypertonic saline, antibiotics (tobramycin and fosfomycin), and lung transplant can extend lifespan up to 49.5 years, a 24.5 year increase over no treatment. Further refinements could improve the model by accounting for individual variability and additional causes of mortality.
This document discusses the use of antibiotics in chronic obstructive pulmonary disease (COPD). It provides an overview of COPD, definitions, epidemiology and risk factors. It summarizes current research showing that long-term low-dose macrolide antibiotics can reduce COPD exacerbations. However, long-term antibiotic use may increase antibiotic resistance. The document also summarizes several studies that found 3 months of clarithromycin, moxifloxacin, doxycycline or azithromycin did not significantly reduce airway bacterial loads in stable COPD patients, though antibiotic resistance increased with all treatments.
1. This cross-sectional study aims to identify common organisms causing infections in COPD and asthma patients by sputum culture and determine the antimicrobial susceptibility patterns of isolated microorganisms.
2. Sputum samples will be collected from 100 COPD and asthma patients experiencing acute exacerbations at a hospital in Jodhpur, India. Samples will undergo culture and identification of bacteria/fungi followed by antimicrobial susceptibility testing.
3. Preliminary results from previous studies suggest bacteria like H. influenzae, S. pneumoniae, and M. catarrhalis commonly cause COPD exacerbations, while studies of asthma patient microbiota show alterations compared to healthy individuals.
This document discusses various causes of chronic cough in older adults, including chronic obstructive pulmonary disease (COPD), chronic upper airway cough syndrome, asthma, non-asthmatic eosinophilic bronchitis, and gastroesophageal reflux disease. It provides details on the pathogenesis, diagnosis, and treatment of COPD and examines other respiratory conditions that must be considered and excluded when diagnosing chronic bronchitis.
This document provides an overview of COPD (chronic obstructive pulmonary disease). It defines COPD and discusses its burden, risk factors, pathology, and history. It notes that COPD is characterized by airflow limitation caused by an inflammatory response in the lungs to noxious particles. The document outlines the learning objectives which are to understand COPD definition, burden, risk factors, and pathogenesis. It also discusses the prevalence of COPD internationally, underdiagnosis in the US, and the economic and social burden of the disease.
Pharmacotherapy of Chronic Obstructive Pulmonary Disease (COPD)Arvind Kumar
This document provides an overview of pharmacotherapy for chronic obstructive pulmonary disease (COPD). It discusses non-pharmacologic approaches like pulmonary rehabilitation and smoking cessation. Standard maintenance therapies include long-acting bronchodilators like tiotropium. Newer bronchodilators in development include once-daily long-acting beta-2 agonists. Anti-inflammatory treatments target mediators like leukotrienes, cytokines, proteases, and phosphodiesterase-4 inhibitors. Vaccines against influenza and pneumococcus are recommended to prevent exacerbations. Antibiotics are used to treat mild, moderate, and severe exacerbations based on risk factors.
This study investigated whether treatment with the proton pump inhibitor lansoprazole could reduce the frequency of common colds and exacerbations in patients with chronic obstructive pulmonary disease (COPD). The study found that patients taking lansoprazole had significantly fewer COPD exacerbations and a lower risk of frequent common colds compared to the control group. The results suggest that lansoprazole may help reduce airway inflammation and inhibit rhinovirus infection in COPD patients. However, the study was limited by a small sample size, lack of placebo control, and population that was almost entirely male and of Japanese ethnicity.
Respond to this discussion . Add some facts with at least 2 cita.docxcwilliam4
Respond to this discussion . Add some facts with at least 2 citations APA Format
Discussion: Community-Acquired Pneumonia
Case Study
HH is a 68-yr M who has been admitted to the medical ward with community-acquired pneumonia for the past three days. His PMH is
significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, including ceftriaxone 1 g IV q day (day 3) and
azithromycin 500 mg IV q day (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a
diet at this time, complaining of nausea and vomiting. Ht: 5'8" Wt: 89 kg Allergies: Penicillin (rash).
Diagnosis: Community-Acquired Pneumonia (CAP)
CAP is the term used to describe an acute infection of the lungs that develops outside the hospital setting by an immune-competent
individual who has not been recently hospitalized (Shoar & Musher, 2020). Adults with CAP typically present with cough, fever, sputum production or
shortness of breath, oxygen desaturation, confusion, leukocytosis or leukopenia, and pleuritic chest pain, along with the presence of an acute
infiltrate on the chest radiograph (Shoar & Musher, 2020).
Antibiotic suggested for CAP's empiric treatment is based on agents useful against CAP's major treatable bacterial causes. The bacterial
pathogens responsible for CAP include Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus
influenzae, Staphylococcus aureus, Legionella species, and Moraxella catarrhalis (Metlay et al., 2019).
The patient is on right treatment, his clinical status has improved, with decreased oxygen requirement. Recommended treatment plan for
patients with comorbidities such as alcoholism, COPD, post influenza, asplenia, diabetes mellitus, lung/liver/renal diseases include: Combination
of a beta-lactam (ceftriaxone 1 g IV q24h or cefotaxime 1 g IV q8h or ceftaroline 600 mg IV q12h) plus azithromycin 500 mg IV q24h (Donovan, 2019).
The therapy duration is a minimum of 5 days. The patient needs to be afebrile for 48-72 hours, controlled blood pressure, adequate oral intake, and
room air oxygen saturation of greater than 90% and treatment duration can be extended if symptoms are not recovered in some cases (Donovan,
2019).
In this case, the patient symptoms are improving, his oxygen requirement is decreased, but he is not tolerating a diet at this time,
complaining of nausea and vomiting. The patient received antibiotics for three days, so antibiotics need to be continued. With appropriate antibiotic
therapy, some improvement in the patient's clinical course is usually seen within 48 to 72 hours (File, 2020).
Health Needs and Treatment Regimen
The patient is not tolerating diet and complaining of nausea and vom.
Macrolide effects on the prevention of copd exacerbguidep
This document reviews the effects of macrolide antibiotics on preventing exacerbations in patients with chronic obstructive pulmonary disease (COPD). It summarizes several studies that have examined the impact of macrolides like erythromycin and clarithromycin on the frequency and severity of COPD exacerbations. The studies found that macrolide treatment reduced the number and rate of exacerbations as well as hospitalizations related to exacerbations. The document also discusses potential anti-inflammatory and other physiological mechanisms by which macrolides may help prevent COPD exacerbations.
The document discusses the role of oral mucolytics in the prevention of lower respiratory tract infections (LRTIs) in patients with chronic obstructive pulmonary disease (COPD). It summarizes the findings of clinical trials that show mucolytics reduce exacerbations in COPD patients not treated with inhaled corticosteroids. However, the largest trial (BRONCUS) found no difference in exacerbation rates between N-acetylcysteine and placebo in COPD patients, though a subgroup analysis found fewer exacerbations in patients not on inhaled corticosteroids with N-acetylcysteine. Given most COPD patients are now treated with inhaled corticosteroids, the role of mucolytics in
This document provides an overview of chronic obstructive pulmonary disease (COPD), including its definition, pathophysiology, epidemiology, and clinical correlates. It describes the main types of COPD such as chronic bronchitis and emphysema. Key points include that COPD is mainly caused by cigarette smoking and is characterized by irreversible airflow limitation. The document discusses the role of inflammation, proteinases, oxidative stress and genetic factors in COPD pathogenesis. It also outlines how COPD affects lung function and physiology through changes in volumes, capacities, elastic recoil and gas exchange.
A 28-year-old man presented with a 4-week history of dry cough and occasional blood in sputum. He had a history of Kaposi sarcoma 3 years prior. Bronchoscopy revealed caseating granulomas and Mycobacterium tuberculosis was identified from bronchial wash culture. The patient was started on anti-tuberculosis treatment and showed significant improvement after 6 weeks with resolution of symptoms and clearing of lung infiltrates on chest x-ray. Endobronchial tuberculosis can occur in adults and presents most commonly as mucosal erosions, which if not treated promptly can lead to bronchial stenosis.
Η Παθολόγος-Λοιμωξιολόγος κ. Ειρήνη Κουρμπέτη αναλύει την επίδραση των αντιβιοτικών στο μικροβίωμα του παχέος εντέρου. Η διάλεξη δόθηκε στα πλαίσια του 22ου Ελληνικού Συνεδρίου για το Ελικοβακτηρίδιο του πυλωρού και λοιπών λοιμώξεων του πεπτικού, Αθήνα 2017.
Ειρήνη Κουρμπέτη
Παθολογικό Ιατρείο
Χαραλάμπους 10
Χαλκίδα
Τηλέφωνα επικοινωνίας: 2221181058, 6983672427, 6932482338
http://peptiko.gr
Ο Ιπποκράτης ήδη από την αρχαιότητα είχε τονίσει ότι η κακή πέψη είναι η ρίζα όλων των δεινών, ενώ ιστορικά η συσχέτιση μεταξύ των μικροβίων του εντέρου και της υγείας προτάθηκε το 1907 από τον Metchnikoff, ο οποίος υπέθεσε ότι η αντικατάσταση των «σηπτικών» βακτηρίων του εντέρου από βακτήρια που παράγουν γαλακτικό οξύ θα μπορούσε να συμβάλει στη φυσιολογική λειτουργία του εντέρου, καθώς και στην παράταση του χρόνου της ζωής.
Τα μικρόβια των μικροχλωρίδων αποικίζουν σχεδόν κάθε επιφάνεια του ανθρώπινου σώματος η οποία εκτίθεται στο εξωτερικό περιβάλλον, όπως το δέρμα, η ουρογεννητική οδός, οι αναπνευστικοί ιστοί και η γαστρεντερική οδός.
Οι μικροβιακοί πληθυσμοί που αποικίζουν τον άνθρωπο έχουν ονομαστεί συλλογικά «ανθρώπινο μικροβίωμα» ή «ανθρώπινη μικροχλωρίδα». Το ανθρώπινο μικροβίωμα είναι ένα πολύπλοκο οικοσύστημα, το οποίο εκτιμάται ότι αποτελείται από περίπου 10^14 βακτηριακά κύτταρα, που είναι 10 φορές περισσότερα από το συνολικό αριθμό των κυττάρων στο ανθρώπινο σώμα.
Έχουν αποδοθεί πολλαπλές λειτουργίες στις μικροχλωρίδες, σημαντικότερες από τις οποίες είναι η σύνθεση βιταμινών (π.χ. βιταμίνη Κ και Β12, φυλλικό οξύ), ο μεταβολισμός χολικών αλάτων, ο καταβολισμός φυτικών ινών, βλέννης και λιπαρών οξέων, η ρύθμιση φλεγμονωδών αντιδράσεων και η ομοιόσταση του ανοσοποιητικού συστήματος. Έτσι, το ανθρώπινο μικροβίωμα αποκαλείται «υπερ-οργανισμός» ή «ξεχασμένο όργανο» ή «το εκτεταμένο γονιδίωμά μας».
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
This document discusses a study on the safety and efficacy of tiotropium bromide in patients with bronchial asthma. Tiotropium is a long-acting anticholinergic drug that works by blocking muscarinic receptors in the lungs. The study found that in patients with COPD (n=48), tiotropium significantly improved lung function measures (FEV1, FVC, FEV1/FVC ratio) compared to baseline, with few side effects. The document concludes that tiotropium provides measurable bronchodilation in asthma and is well tolerated, suggesting it may be a treatment option for bronchial asthma.
This document discusses the relationship between periodontal and respiratory diseases. It begins by describing the human respiratory system and its defense mechanisms. Key respiratory diseases like bacterial pneumonia and chronic obstructive pulmonary disease are explained. Evidence is presented that shows oral bacteria can cause respiratory infections by aspirating into the lungs or modifying surfaces to promote pathogen adhesion. Maintaining oral health through practices like toothbrushing and chlorhexidine use may help prevent respiratory infections by reducing oral bacterial loads and pathogen reservoirs. The document concludes by stating periodontal therapy may help improve lung function in COPD patients with chronic periodontitis.
Carbon monoxide protects neonatal mouse lungs from hyperoxia-induced arrest of alveolar development. Mice exposed to prolonged hyperoxia showed decreased lung volume, alveolar surface area, and impaired mitochondrial function compared to controls. However, mice also exposed to intermittent low doses of carbon monoxide demonstrated lung development and function similar to controls, with preserved weight gain, lung structure, and mitochondrial respiration. The study suggests carbon monoxide protects pulmonary mitochondria during oxidative stress and prevents arrest of alveolar growth caused by hyperoxia.
Similar to BRN Symposium 03/06/16 Microbiome in COPD: Pitfalls and Progress (20)
Este documento presenta las principales guías de práctica clínica sobre la tos crónica. Se discuten las definiciones, clasificaciones y epidemiología de la tos crónica. Luego, se resumen las recomendaciones de las Guías de la ERS de 2020, SEPAR de 2015 y Chest de 2016 sobre la evaluación, diagnóstico y tratamiento de la tos crónica, incluidos los corticosteroides inhalados, antiácidos, neuromoduladores y terapia conductual.
02_Palones_Cómo medimos la tos en la práctica clínicabrnmomentum
Este documento describe diferentes formas de medir la tos en la práctica clínica, incluyendo cuestionarios subjetivos como el Leicester Cough Questionnaire y monitores objetivos de tos como The LifeShirt®, PulmoTrack-CCTM y The Hull Automatic Cough Counter. Explica estudios de validación de estos monitores y concluye que aunque los cuestionarios son útiles, los monitores objetivos proporcionan medidas más precisas, si bien aún se necesita más investigación para su uso generalizado en la práctica clínica habitual.
03_Macías_Impacto de la tos crónica en la calidad de vida de los pacientesbrnmomentum
La tos crónica tiene un gran impacto en la calidad de vida de los pacientes, afectando su bienestar físico, psicológico y social. Afecta especialmente a las mujeres y causa incontinencia urinaria, fatiga, aislamiento social, problemas de sueño, ansiedad y depresión. También reduce la productividad laboral y genera molestias a familiares. Para evaluar todo esto, los médicos usan cuestionarios como el Leicester Cough Questionnaire y el Cough-Specific Quality of Life Questionnaire.
04_Crespo_Necesidades no cubiertas en la tos crónica. ¿Hacia dónde vamos?brnmomentum
1) Se discuten las definiciones de tos aguda, subaguda y crónica, así como los conceptos de síndrome de hipersensibilidad tusígena y tos crónica refractaria o inexplicada.
2) Se está trabajando en mejorar el diagnóstico y tratamiento mediante nuevos estudios, encuestas y ensayos clínicos. También en cuantificar objetivamente la tos y medir su impacto.
3) Aún falta crear guías unificadas, referentes expertos, unidades especializadas, y fomentar la investigación de nue
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Este documento describe un estudio prospectivo multicéntrico para desarrollar y validar un cuestionario que mida objetivamente la gravedad de la tos crónica. El estudio consta de 3 fases: 1) elaborar un borrador del cuestionario con aportes de pacientes y profesionales, 2) evaluar el borrador con expertos, y 3) validar el cuestionario comparándolo con medidas objetivas de la tos y cuestionarios existentes. El objetivo final es contar con una herramienta para cuantificar la gravedad de la tos crónica y así mejor
06_Arismendi_Rol de las Patologías Laríngea y Neurológicabrnmomentum
En este documento, la Dra. Ebymar Arismendi presenta los resultados de una evaluación multidisciplinaria de 39 pacientes con tos crónica refractaria o inexplicada. Se encontró que el 61% tenía tos refractaria y el 39% tos inexplicada. El 61% presentó patología laríngea como parálisis o paresia de la cuerda vocal, y algunos pacientes presentaron trastornos neurológicos como CANVAS o disautonomía. La evaluación multidisciplinaria que incluyó neumología, ORL, neurología, logoped
05_Maquillón_Ventilación no invasiva en la EPOC: realidad y retosbrnmomentum
Este documento resume un programa de ventilación mecánica domiciliaria en Chile entre 2008-2017. Encontró que las enfermedades pulmonares obstructivas crónicas, la hipoventilación por obesidad y las enfermedades neuromusculares fueron los diagnósticos más comunes. La mayoría de los pacientes se controlaron con monitoreo clínico simple y oximetría nocturna. La poligrafía y medición transcutánea de CO2 fueron útiles en algunos casos complejos. La adherencia al tratamiento fue alta y la sob
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1. La VMD se sugiere en las guías para pacientes con EPOC estable e hipercapnia crónica, aunque la evidencia es baja.
2. La experiencia en el HUGTiP muestra una reducción de la pCO2 en más del 50% de pacientes, sin encontrar comorbilidades asociadas al fracaso.
3. Estudios registrados analizan algoritmos ventilatorios para mejorar la pCO2 y el impacto económico de proyectos de asistencia integral con VMD.
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This document summarizes a presentation on investigating COPD from genetics to clinical aspects. It discusses young COPD, defined as COPD diagnosed in patients under 50 years old with over 10 pack-years of smoking. The presentation notes that COPD biomarkers are present in young adults with abnormal lung function. It finds that genetics related to lung development may play a role in early COPD onset. Accelerated aging also appears to influence COPD severity independently of patient age. The presentation concludes that a life course perspective is needed to understand COPD, and that young and old COPD may share phenotypic traits from common influences early in life.
05_Ausín_Monitorización del tratamiento con fármacos biológicos en asma gravebrnmomentum
Este documento resume una presentación sobre investigación médica aplicada en el asma. Se discutieron nuevos avances en terapias biológicas para el asma grave, incluyendo anticuerpos monoclonales dirigidos contra IL-5, IL-4R-IL-13, IgE e IL-5R. También se presentaron dos proyectos de investigación en curso en una unidad de asma: 1) el desarrollo y validación de una técnica analítica para medir concentraciones plasmáticas de fármacos anti-IL5/IL5R y
04_Muñoz_Impacto de la contaminación en el asma: estudio comparativo de pobla...brnmomentum
Este documento resume una presentación sobre la investigación médica aplicada al asma, con nuevos hallazgos. Se presentan los resultados de un estudio que muestra que durante el confinamiento por COVID-19, cuando la contaminación ambiental disminuyó drásticamente, personas sanas tuvieron menores niveles de estrés oxidativo, inflamación eosinofílica y respuesta Th2. También se revisan estudios previos sobre la relación entre la contaminación y el asma, concluyendo que la contaminación ambiental aumenta el riesgo y gravedad del asma
El documento resume una presentación sobre el asma no T2. Se describe que el asma no T2 representa un porcentaje significativo de los casos de asma y tiene características clínicas distintas al asma eosinofílico tradicional. Además, se discuten estudios en curso para mejor caracterizar el asma no T2 y sus posibles nuevos tratamientos como tezepelumab.
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This document outlines a study investigating the inflammatory and molecular fingerprints of different clinical endotypes of eosinophilic asthma. The study will recruit 150 patients total across 5 hospitals in Spain, with 50 patients classified into each of 3 endotype groups: allergic asthma, aspirin-exacerbated respiratory disease (AERD), and late-onset eosinophilic asthma. Patients will complete clinical assessments and provide blood and induced sputum samples at baseline and 1-year follow-up. Samples will be analyzed to characterize biomarkers and cellular profiles. The goal is to define the inflammatory signatures of each endotype and assess biomarker stability over time to identify predictors of asthma severity and control. A contract research organization will provide support with
04 BRN Research Forum Bronquiectasias. Parte IV por David de la Rosabrnmomentum
Este documento propone realizar un estudio multicéntrico para evaluar el coste-efectividad y el coste-utilidad del tratamiento con antibióticos inhalados en pacientes con bronquiectasias e infección bronquial crónica por Pseudomonas aeruginosa. El estudio compararía los costes y resultados clínicos de los pacientes antes y durante el tratamiento con antibióticos inhalados a lo largo de dos años para determinar si este tratamiento reduce los costes asociados a las exacerbaciones y mejora la calidad de vida de los pacientes.
02 BRN Research Forum Bronquiectasias. Parte II por Alicia Marínbrnmomentum
El documento presenta un estudio llamado Bronchi-Omics que analiza el microbioma bronquial de pacientes con bronquiectasias mediante técnicas de metagenómica. El estudio reclutó 165 pacientes y realizó un seguimiento de 12 meses para caracterizar la composición y variabilidad del microbioma, su relación con la gravedad de la enfermedad y marcadores de inflamación, y su aplicabilidad clínica. Los resultados mostraron una alta diversidad bacteriana dominada por Firmicutes y Proteobacteria. El microbioma parece identificar grup
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Osteoporosis - Definition , Evaluation and Management .pdf
BRN Symposium 03/06/16 Microbiome in COPD: Pitfalls and Progress
1. The Microbiome in COPD
Progress and Pitfalls
Sanjay Sethi MD
Professor of Medicine
Division Chief, Pulmonary, Critical Care and
Sleep Medicine
Assistant Vice President for Health Sciences
University at Buffalo, SUNY
ssethi@buffalo.edu
2. British Hypothesis
Mucus Hypersecretion
Infective
exacerbations
Fletcher and Peto BMJ 1977,1:1645-8
Ciba Guest Symposium 1959,
Thorax;14:286-99
3.
4. Learning Objectives
Does the lung microbiome change in Stable
COPD?
Does the lung microbiome impact disease
progression in COPD?
Does the lung microbiome change at
Exacerbation and with its treatment?
Does conventional microbiology have a role
in the microbiome era?
5. Learning Objectives
Does the lung microbiome change in Stable
COPD?
Does the lung microbiome impact disease
progression in COPD?
Does the lung microbiome change at
Exacerbation and with its treatment?
Does conventional microbiology have a role
in the microbiome era?
6. Microbiome Diversity in COPD
Cabrera-Rubio J Clin Micro 2012; 50 (11):3562
Six former smokers with
moderate COPD
No controls
Sputum, BAL, Bronchial biopsy
and Bronchial aspirates obtained
9. Are these Upper or Lower Airway
Samples?
Hilty et al, Plos ONE 5 (1): e58578
Erb-Downward et al PLoS ONE 6(2): e16384.
10. Bacterial Colonization
in Ex-smokers with COPD
Group % positive for PPM
>/=102/ml
Pathogens isolated Titer
1 (ex-smokers with
COPD)
34.6 % (9/26) 1) NTHI and HP
2) NTHI and SP
3) HP
4) PA
5) SA
6) NTHI
7) NTHI
8) HP
9) HP
3 x 102 2 x 102
7 x 104 2 x 104
1 x 102
6 x 102
1 x 102
1.5 x 104
5 x 105
6.5 x 105
3 x 105
2 (ex-smokers
without COPD)
0% (0/20)
3 (healthy non-
smokers)
6.7% (1/15) 1) HP 2 x 102
Sethi et al AJRCCM 2006, 173:991-8
• A sequential two-scope procedure was performed
• The right middle lobe was lavaged with 50 x 3 ml of
saline.
12. Contamination of Lower Airway Specimens
Sethi et al AJRCCM 2006, Charlson et al AJRCCM 2011
Unless measures are taken
- to avoid scope contamination
and
- control for environmental
contamination
- the results of Bronchoscopic
microbiome studies are
uninterpretable
13. Does the Lung Microbiome change
in Stable COPD?
Yes, by conventional microbiology
Current microbiome studies are inadequate
Increase in Proteobacteria
Decrease in Diversity
Similar Community structure changes are
seen in Bronchiectasis and Cystic Fibrosis
14. Learning Objectives
Does the lung microbiome change in Stable
COPD?
Does the lung microbiome impact disease
progression in COPD?
Does the lung microbiome change at
Exacerbation and with its treatment?
Does conventional microbiology have a role
in the microbiome era?
15. Bacterial Colonization
in Ex-smokers with COPD
Group % positive for PPM
>/=102/ml
Pathogens isolated Titer
1 (ex-smokers with
COPD)
34.6 % (9/26) 1) NTHI and HP
2) NTHI and SP
3) HP
4) PA
5) SA
6) NTHI
7) NTHI
8) HP
9) HP
3 x 102 2 x 102
7 x 104 2 x 104
1 x 102
6 x 102
1 x 102
1.5 x 104
5 x 105
6.5 x 105
3 x 105
2 (ex-smokers
without COPD)
0% (0/20)
3 (healthy non-
smokers)
6.7% (1/15) 1) HP 2 x 102
Sethi et al AJRCCM 2006, 173:991-8
• A sequential two-scope procedure was performed
• The right middle lobe was lavaged with 50 x 3 ml of
saline.
21. Learning Objectives
Does the lung microbiome change in Stable
COPD?
Does the lung microbiome impact disease
progression in COPD?
Does the lung microbiome change at
Exacerbation and with its treatment?
Does conventional microbiology have a role
in the microbiome era?
22. COPD Study Clinic
Aims
Dynamics of bacterial
infection in COPD
Hypothesis
Acquisition of new
strains of bacterial
pathogens is
associated with an
increased risk of
exacerbation
Clinic visits:
Monthly
Suspected exacerbation
At each visit:
Clinical evaluation
Serum sample
Sputum sample for
quantitative
bacteriology
23. Naturally Occurring Exacerbations:
Changes in the Microbiome
-150 -100 -50 0 50 100 150
Days Relative to Exacerbation
Exacerbationonset
Antibiotics only
Corticosteroids only
Antibiotics and
corticosteroids
Exacerbation treatment group
Huang et al, JCM, J Clin Microbiol. 2014 ;52(8):2813-23
24. Changes in Microbiome at
Exacerbation
Huang et al, JCM, J Clin Microbiol. 2014 ;52(8):2813-23
25. Bacterial Families Hang out Together
Le
ntisp
ha
erae
En
teroba
cteriace
ae
Ve
rru
co
micro
bia
Ve
rru
co
micro
bia su
bd
ivision 5
LD
1P
A grou
p
Ch
lamyd
iace
ae
Pa
rach
lamyd
iace
ae
WS3
un
cla
ssifie
d
BR
C1
C
ald
ith
rix
Aquifi
ca
e
G
em
m
at
im
ona
de
te
s
G
em
m
at
im
on
ad
et
es
Clo
stridia
ceae
Clo
stridia
ceae
Clo
stridia
ceae
Clo
stridiacea
e
Clostridiacea
e
Clostridiacea
e
Clostridiaceae
ClostridiaceaeClostridiaceaeClostrid
iace
ae
LachnospiraceaeLachnospiraceaeLachnospiraceaeLachnospiraceaeLachnospiraceaeLachnospiraceae
gutclo
ne
gro
up
gutclo
ne
gro
upCa
tab
acterCa
tab
acter
LachnospiraceaeLachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
Lachnospiraceae
LachnospiraceaeLachnospiraceaeLachnospiraceaeLachnospiraceae
Aer
oc
oc
ca
ce
ae
Aer
oc
oc
ca
ce
ae
Ae
ro
co
cc
ac
ea
e
Car
no
ba
cter
iace
ae
Ae
ro
co
cc
ac
ea
e
En
teroco
cc
ac
ea
e
En
teroco
cc
ac
ea
e
En
teroco
ccac
ea
e
En
teroco
ccac
ea
e
En
teroco
ccac
ea
e
En
ter
ococcaceae
En
teroco
cc
ac
ea
e
En
teroco
cc
ac
ea
e
En
teroco
cc
ac
ea
e
Lacto
bacillac
eae
Lacto
bacillaceae
Lacto
bacillaceae
Lacto
bacillaceae
Lacto
bacillaceae
Lacto
bacillace
ae
Lactobacillace
ae
Lac
tob
acillac
eae
Lac
tobacillac
eae
Lac
tobacillaceae
Lac
tobacillaceae
Lac
tobacillace
ae
Leuconostoc
aceae
Le
ucon
ostoc
aceae
Stre
ptoc
occaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococcaceae
Streptococca
ceae
Streptococca
ceae
Streptococcaceae
Strep
tococcaceae
Streptococcaceae
Streptococcacea
e
Bac
illi
Stre
ptococcaceae
Pa
eniba
cillac
eae
Sp
oro
lac
tob
acilla
ceae
Ca
ryo
phanaceae
Ba
cillac
ea
e
Ba
cillac
ea
e
Ba
cillac
ea
e
Ba
cillac
ea
e
Ba
cillace
ae
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Bac
illac
ea
e
Baci
lla
ce
ae
Baci
lla
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
aeSta
ph
yloc
oc
ca
ce
ae
Sta
ph
yloc
oc
ca
ce
ae
Baci
lla
ce
ae
Ha
loba
cillace
ae
Ha
loba
cillace
aeBa
cilla
ce
ae
Ba
cilla
ce
ae
Bac
illac
ea
e
Ba
cilla
ce
ae
Ha
loba
cilla
ce
ae
Fus
oba
cteriac
eae
Mycop
lasmataceae
Acholeplasmataceae
Ery
sipelotric
haceae
Ery
sipelo
tric
haceae
Erysipe
lotrichaceae
Erysipe
lotrichaceae
Clostridiaceae
Clostridiaceae
Clostridiaceae
Clostridiaceae
Clostridiaceae
ClostridiaceaePeptostreptococcaceaePeptostreptococcaceaePeptostreptococcaceae
ClostridiaceaeClostridiaceaeClostridiaceaePeptostreptococcaceae
ClostridiaceaeClostridiaceaePeptostreptococcaceae
Peptostreptoco
ccaceae
Peptostreptoco
ccaceae
Pep
tostrep
tococcaceae
Pep
tostrep
tococcaceae
Peptostre
ptococ
cac
eae
Pe
ptoc
oc
c/Ac
idam
inoc
oc
c
Pe
ptoc
c/A
cid
am
ino
co
cc
Pe
ptococ
c/A
cid
am
ino
co
cc
Pe
ptoc
oc
c/A
cid
am
ino
co
cc
Pe
pto
cc/Acid
am
ino
cocc
Pe
pto
cc/Acid
am
ino
cocc
Firm
icutes
Natrono
an
ae
robium
Sy
mbiob
ac
teria
Ba
cillace
ae
Firm
icu
tes
Pol
ya
ng
ia
ce
ae
Pol
ya
ng
ia
ce
ae
Pol
ya
ng
ia
ce
ae
Pol
ya
ng
ia
ce
ae
Pol
ya
ng
ia
ce
ae
Delta
pr
ot
eo
ba
cter
ia
Delta
pr
ot
eo
ba
cter
ia
Delta
pr
ot
eo
ba
cter
ia
Del
ta
pr
ot
eo
ba
cter
ia
Delta
pr
ot
eo
ba
cter
ia
Des
ulfoba
cter
ac
ea
e
Syn
tro
ph
ac
ea
e
Deltaproteo
ba
cteria
Des
ulfobu
lbac
ea
e
De
su
lfo
bu
lbac
ea
e
De
su
lfo
bu
lbac
ea
e
Des
ulfoba
cter
ac
ea
e
Deltaproteo
ba
cteria
D
esu
lfu
ro
m
onace
ae
G
eob
ac
te
ra
ce
ae
Syn
trop
ho
ba
ct
er
ac
ea
e
Del
ta
pr
ot
eo
ba
ct
er
ia
Syn
trop
ho
ba
ct
er
ac
ea
e
Del
ta
pr
ot
eo
ba
ct
er
iaD
elta
pro
te
obact
eria
De
su
lfo
ha
lobiac
ea
e
De
su
lfo
vib
rio
na
ce
ae
De
su
lfovib
rio
na
ce
ae
Rhodocyclaceae
Nitro
somonadaceae
Betaproteobacteria
Methylophilaceae
Rhodocyclaceae
Rhodocyclaceae
Neisseriaceae
Procabacteriaceae
Burkholderiaceae
Ralstoniaceae
Ralstoniaceae
Ralstoniaceae
Ralstoniaceae
Oxalobacteraceae
Oxalobacteraceae
Oxalobacteraceae
Oxalobacteraceae
Oxalobacteraceae
Oxalobacteraceae
Oxalobacteraceae
Oxalobacteraceae
Burkholderiaceae
Alcaligenaceae
Alcaligenaceae
Alcaligenaceae
Gammaproteobacteria
Xanthomonadaceae
Xanthomonadaceae
Xanthomonadaceae
Xanthomonadaceae
Xanthomonadaceae
Legionellaceae
Moraxellace
ae
Moraxellaceae
Moraxellaceae
Moraxellaceae
Pseud
omona
dac
eae
Pseud
omonadace
ae
Pseudomo
nadaceae
Pseudomo
nadaceae
Pseudomo
nadaceae
Ocean
osp
irilla
cea
e
Pseud
omona
dac
eae
Pis
cirick
ettsia
ceae
Pis
cirick
ettsia
ceae
Ga
mm
aproteobacte
ria
Me
thy
loc
occaceae
Ga
mm
ap
roteob
acter
ia
Ga
mm
ap
roteo
ba
cte
ria
Ga
mm
aproteobacte
ria
Gammaproteobacteria
Halomonadaceae
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Pse
ud
oa
lte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
eAl
tero
mon
ad
ac
ea
e
Ps
eu
do
altero
mon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Alteromon
ad
ac
ea
e
Al
tero
mon
ad
ac
ea
e
Al
tero
mon
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
She
wan
ellace
ae
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
G
am
m
ap
ro
te
ob
ac
te
ria
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Alte
ro
m
on
ad
ac
ea
e
Shew
an
el
la
ce
ae
Shew
anella
ce
ae
Shew
anella
ce
ae
G
am
m
apro
te
obact
eria
Vibriona
ce
ae
Vi
br
iona
ce
ae
Vibrio
na
ce
ae
Vibrio
na
ce
ae
Vibrio
na
ce
ae
Pa
ste
urellacea
e
Pa
ste
urellacea
e
Pa
ste
urellaceae
Pa
ste
urellacea
e
Pa
ste
ure
llaceae
Pa
ste
ure
llaceae
Paste
ure
llac
eae
Paste
ure
llac
eae
Paste
ure
llac
eae
Pa
ste
ure
llaceae
Pa
ste
ure
llaceae
Enterobac
teriace
ae
Enterobac
teriace
ae
Enterobacteriaceae
Enterobacteriaceae
EnterobacteriaceaeEnterobacteriaceaeEnterobacteriaceaeEnterobacteriaceaeEnterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteria
ceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriacea
e
Ente
roba
cteriaceae
Enterobacteria
ceae
Enterobacteriaceae
Enterobacteriaceae
Enterobac
teriace
ae
Enterobac
teriace
ae
Gammaproteobacteria
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterobacteriaceae
Enterob
acte
riaceae
Enterob
acte
riaceae
Ente
roba
cteriaceae
Enterobacteriaceae
Enterobacteria
ceaeEnterobacteriaceaeEnterobacteriaceaeEnterobacteriaceae
Enterobacteriaceae
Ente
robacteriaceae
Enterobacteria
cea
e
Entero
bac
teriace
ae
X6
04
12
.2
Ae
romon
ad
ac
ea
e
Ae
romon
ad
ac
ea
e
S3
92
32
.2
Ae
romon
ad
ac
ea
e
Ae
romon
ad
ac
ea
e
Ch
romatiac
ea
e
Gammaproteobacteria
Coxiellaceae
Coxiellaceae
Coxiellaceae
Thiotrichaceae
Thiotrichaceae
Chromatiaceae
Gam
map
roteobacteria
Ro
seococcaceae
Alph
ap
roteo
ba
cte
ria
Rickettsia
ceae
Rickettsia
ceae
Ca
ediba
cte
rac
eae
Alp
hapro
teo
bacte
ria
Alp
hapro
teo
bacte
ria
Rhodocyclaceae
Caulobac
terace
ae
Caulobac
tera
cea
e
Cau
lobacteraceae
Cau
loba
cteraceaeCaulobactera
cea
e
Alp
hapro
teo
bacte
ria
Bra
dyrhizobiaceae
Bra
dyrhizobiaceae
Ac
idob
ac
teria
Acido
ba
cter
iace
ae
Acido
ba
cter
iace
ae
Acido
ba
cter
iace
ae
Acido
ba
cter
iace
ae
Acido
ba
cter
ia
Acido
ba
cter
iace
ae
Acido
ba
cter
ia
ce
ae
Nitros
pina
ce
ae
Ac
idob
ac
teria
ce
ae
Ac
idob
ac
teria
De
lta
proteo
ba
cteria
De
lta
proteo
ba
cteria
NC
10
−2Un
cla
ss
ifie
d
Leptospiraceae
Leptospiraceae
Spirochaetaceae
Spirochaetaceae
Spirochaetaceae
Spirochaetaceae
Spirochaetaceae
Spirochaetaceae
Chlorobi
Cren
otrichace
ae
Ba
cte
roide
tes
Ba
cte
roide
tes
Sp
hin
go
ba
cte
ria
Ba
cte
roide
tes
Ba
cte
roide
tes
Ba
cte
roidetes
Ba
cte
roidetes
Ba
cte
roide
tes
Rik
enella
cea
e
Bacte
roidetes
Porph
yro
mo
nadaceae
Ba
cte
roidaceae
Ba
cte
roidaceae
Bacteroid
etes
Bacteroid
ete
s
Flavob
acteria
ceae
Flavob
acteria
cea
e
Blattab
acteria
cea
e
SphingobacteriaFlex
ibac
teraceae
Flam
meo
virgaceae
Flexiba
cteraceae
CrenotrichaceaeCrenotrich
aceaeCrenotrichaceaeCren
otrichace
ae
Helicobacteraceae
Helicobacteraceae
Epsilonproteobacteria
Helicobacteraceae
Campylobacteraceae
mgA−2
mgA−1
TM7−3
CyanobacteriaChloroplasts
Chloroplasts
Chloroplasts
Cop
ro
th
er
m
ob
ac
te
ria
Syn
er
gi
st
es
Syn
er
gi
st
es
Syn
er
gist
es
Syn
er
gi
stesOP9
Deh
aloc
oc
co
idet
es
Deh
aloc
oc
co
idetes
Deh
aloc
oc
co
idetes
Ana
er
olinea
e
Chlor
of
lexi
Cellulom
on
ad
ac
ea
e
M
icro
co
cc
ac
ea
e
M
icro
co
cc
ac
ea
e
Acido
ba
ct
er
ia
Act
in
om
yc
et
ac
ea
e
Bifido
ba
ct
er
ia
ce
ae
Bifido
ba
ct
er
ia
ce
ae
Bifi
do
ba
ct
er
ia
ce
ae
Acido
ba
cter
ia
Acido
ba
cter
ia
Cor
ioba
cter
iace
ae
Rub
ro
ba
cter
ac
ea
e
Ac
idob
ac
teria
0.01
Classes (tree branches):
Gammaproteobacteria
Verrucomicrobiae
Chlamydiae
Aquificae
gut clone group
Catabacter
Bacilli
Fusobacteria
Mollicutes
Symbiobacteria
Deltaproteobacteria
Betaproteobacteria
Alphaproteobacteria
Acidobacteria
N C 10− 2
Spirochaetes
Sphingobacteria
Bacteroidetes
Flavobacteria
Epsilonproteobacteria
m gA − 1
T M 7− 3
Cyanobacteria
OP9
Actinobacteria
Enterobacteriaceae
Pasteurellaceae
(Haemophilus-related)
Pseudomonadaceae
Moraxellaceae
Oxalobacteraceae (Betaproteobacteria)
Lactobacillus spp.
Streptococcaceae
(Lactobacillales)
Helicobacter
Campylobacter
(Epsilonproteobacteria)
Deltaproteobacteria
Staphylococcus spp.
Clostridiaceae/Lachnospiraceae (Clostridia)
Bacillaceae
Abundance
Higher Lower
Positive correlation
Negative correlation
Huang et al, JCM, J Clin Microbiol. 2014 ;52(8):2813-23
26. Antibiotics and Steroids have Differential Effects
on the Microbiome in AECOPD
Positive changes in relative abundance (log2) indicate an
increase in the latter time point compared.
Huang et al, JCM, J Clin Microbiol. 2014 ;52(8):2813-23
27. MAESTRAL Study: Clinical Failure Rates with Oral
Corticosteroid use
0
5
10
15
20
25
30
35
40
During therapy EOT 4 weeks post-
therapy
8 weeks post-
therapy
Clinicalfailure(%ofpatients)
Sethi et al, Infection 2016
28. Changes in Airway Microbiome
after Rhinovirus inoculation
Molyneaux; et al, Am J Respir Crit Care Med 188, 1224-1231.
*P < 0.001
29. Control: no significant
differences
Distribution of bacterial phyla at each time
point after rhinovirus (RV) inoculation.
Molyneaux et al, Am J Respir Crit Care Med 188, 1224-1231.
COPD: significant increases in
Proteobacteria (dark blue)
were observed on Day 15 (P =
2.2 × 10–16).
30. Bacterial Load (16s) and Inflammatory
Changes following Rhinovirus Infection
Molyneaux et al, Am J Respir Crit Care Med 188, 1224-1231.
p=0.08
p=0.0001
p=0.007
p=0.045p=0.001
p=0.07
31. Learning Objectives
Does the lung microbiome change in Stable
COPD?
Does the lung microbiome impact disease
progression in COPD?
Does the lung microbiome change at
Exacerbation and with its treatment?
Does conventional microbiology have a role
in the microbiome era?
34. Species vs Strain level Differentiation
Han et al Thorax 2013 Sethi et al NEJM 2008
35. NTHI Colonization vs Exacerbation
strains
•10 exacerbation strains
•7 colonization strains
•In vivo mouse model
•In vitro respiratory
epithelial cell line
Chin et al AJRCCM 2005
36. Does Conventional Microbiology have
a Role in the Microbiome Era?
Identifying a pathogen by sequence is the
first step
Immune and inflammatory consequences of
putative pathogens need to be determined
Ability to manipulate the pathogen in
culture is essential
Vaccine development
Pathogen virulence
37. Conclusions
The ability to assess the lung microbiome could
radically change our understanding of lung
disease and lung infection
COPD and COPD exacerbations are clearly
associated with changes in the lung
microbiome
Restoring the healthy lung microbiome could
make a significant difference in COPD
management
Maybe, the British were right all the time!
38. Acknowledgments
Co-Investigators
Tim Murphy
Charles Berenson
Karin Provost
Ilya Berim
Study coordinators
Nancy Evans
Karen Eschberger
Jane Maloney
Ellana Eberhardt
Laboratory personnel
Catherine Wrona
Lori Grove
Phyllis Lobbins
Regina Clare
Collaborators
Yvonne Huang (UCSF)
U of Iowa