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Background Cardiovascular toxicity as a consequence of nicotine from conventional tobacco cigarette smoking is well documented. However, little is known about the cardiovascular consequences of nicotine e-vaping. We review the literature and report a case series of three cases of major adverse cardiovascular clinical effects post nicotine e-vaping. Case summary Three patients with known peripheral arterial disease who switched from heavy cigarette smoking consumption to a high-intensity dose of nicotine e-vaping all developed further arterial complications within 6–30 months. Discussion With the recent epidemic of e-vaping in young individuals and the national outbreak of e-vaping use-associated lung injury (EVALI), the dangers of e-vaping are now coming to light. The pulmonary effects are now well described, and this paper highlights three new cases of cardiovascular toxicity associated with e-vaping. The potential role of nicotine e-vaping and the risk of coronavirus disease-2019 (COVID-19) will also be discussed.

Related the extremely transmittable abilities of SARS-CoV-2,a harmonious virus to the bat CoV, gets transmitted by three principal processes-- the inhalation of droplets from the SARS-CoV-2 infected person, contacting to the person, and by the surfaces and materials defiled with the virus. Whereupon bat Coronavirus is mostly like the pandemic causing virus SARS-CoV-2, bats are often deliberated and figured out as a possible primary host although no intermediate has not been defined yet in the wherewithal of transmission. The Spike Glycoprotein plays an important role in the case of penetration with the assistance of the ACE2 receptor and the Receptor Binding Domain. In the human body, infiltrating the nucleic acid into host cells, SARS-CoV-2 attacks one cell and one by one into the whole human body; therefore, infected cases are found symptomatic and asymptomatic considering the immune power. Patients with cardiovascular disease or diabetes proceed with their treatment with ACE2 often; therefore, there might be a high chance of getting infected. Whereas the SARS-CoV-2 infects the blood and then lungs, Antigens improvement can be better in order to avoid high-complicated effects. Currently, no vaccination or no accurate cure and treatment has not been defined. An explanation with analysis on SARS-CoV-2 has been performed from the aspect of virology, immunology and molecular biology. Several relevant figures have been included hereby in order to a better understanding of the very concept.

Recently, there has been a rise in the incidence of E-cigarette/Vaping-Associated Lung Injury (EVALI) in the United States, mostly involving tetrahydrocannabinol. Current treatment strategies for EVALI are aimed at controlling the inflammatory and infectious causes, in addition to supportive care. Although most patients improve with supportive measures, the long-term pulmonary effects of this illness are still not well defined. This report describes a case of EVALI resulting in progressive, irreversible destruction of the lung parenchyma that was treated with double lung transplantation.

Remote ischemic preconditioning (RIP) has been demonstrated to protect against ischemia-reperfusion-injury in different target organs. The mechanisms that eventually lead to these protective effects have been investigated in depth but are not yet fully elucidated. Although the effects of RIP seem to be promising in animal experiments and smaller clinical studies, they failed to achieve clinical significance in multicenter trials. These trials have mainly focused on the heart, the brain, and the kidneys, but only little is known concerning the effects of RIP on the lungs. This review will provide an overview on what is already published on RIP and its effects on the respiratory system. Different modes of RIP action have been assessed, like systemic, humoral, and neural responses. As mechanical ventilation, and especially one-lung ventilation, is harmful to the lungs, it is of great interest to find ways of protecting the respiratory system in clinical practice. Therefore, experimental as well as clinical trials have been performed to seek for protective devices. RIP is easy to perform and cheap to apply and is therefore a promising and interesting tool that might find its way into clinical practice in order to attenuate the detrimental effects of mechanical ventilation to the lungs. The present review will highlight and discuss recent experimental data especially on pulmonary effects of RIP.

Physical inactivity has caused serious effects on the health of the population, having an impact on the quality of life and the cost of healthcare for many countries. This has motivated government and private institutions to promote regular physical activity, which, paradoxically, can involve health risks when it is carried out in areas with poor air quality. This review collects information from studies conducted on healthy humans related to the pulmonary effects caused by the practice of physical activity when there is poor air quality. In addition, several challenges related to the technological and educational areas, as well as to applied and basic research, have been identified to facilitate the rational practice of exercise in poor air quality conditions.

An investigation into the potential toxicological effects of fracking sand dust (FSD), collected from unconventional gas drilling sites, has been undertaken, along with characterization of their chemical and biophysical properties. Using intratracheal instillation of nine FSDs in rats and a whole body 4-d inhalation model for one of the FSDs, i.e., FSD 8, and related in vivo and in vitro experiments, the effects of nine FSDs on the respiratory, cardiovascular and immune systems, brain and kidney were reported in the preceding eight tandem papers. Here, a summary is given of the key observations made in the organ systems reported in the individual studies. The major finding that inhaled FSD 8 elicits responses in extra-pulmonary organ systems is unexpected, as is the observation that the pulmonary effects of inhaled FSD 8 are attenuated relative to forms of crystalline silica more frequently used in animal studies, i.e., MIN-U-SIL® 5. An attempt is made to understand the basis for the extra-pulmonary toxicity and comparatively attenuated pulmonary toxicity of FSD 8.

The release of catecholamines is preceded by glucocorticoids during a stress response. We have shown that ozone-induced pulmonary responses are mediated through the activation of stress hormone receptors. To examine the interdependence of beta-adrenergic (βAR) and glucocorticoid receptors (GR), we inhibited βAR while inducing GR or inhibited GR while inducing βAR and examined ozone-induced stress-response. Twelve-week-old male Wistar-Kyoto rats were pretreated daily with saline or propranolol (PROP; βAR-antagonist; 10 mg/kg-i.p.; starting 7-days prior to exposure) followed-by saline or dexamethasone sulfate (DEX; GR-agonist; 0.02 mg/kg-i.p.; starting 1-day prior to exposure) and exposed to air or 0.8-ppm ozone (4hr/dayx2-days). In a second experiment, rats were similarly pretreated with corn-oil or mifepristone (MIFE; GR-antagonist, 30 mg/kg-s.c.) followed by saline or clenbuterol (CLEN; β(2)AR-agonist; 0.02 mg/kg-i.p.) and exposed. DEX and PROP+DEX decreased adrenal, spleen and thymus weights in all rats. DEX and MIFE decreased and increased corticosterone, respectively. Ozone-induced protein leakage, inflammation and IL-6 increases were inhibited by PROP or PROP+DEX and exacerbated by CLEN or CLEN+MIFE. DEX and ozone induced while MIFE reversed lymphopenia (MIFE>CLEN+MIFE). DEX exacerbated while PROP, MIFE or CLEN+MIFE inhibited ozone-induced hyperglycemia and glucose intolerance. Ozone inhibited glucose-mediated insulin release. In summary, 1) activating βAR, even with GR inhibition, exacerbated and inhibiting βAR, even with GR activation, attenuated ozone-induced pulmonary effects; and 2) activating GR exacerbated ozone systemic effects, but with βAR inhibition, this exacerbation was less remarkable. These data suggest the independent roles of βAR in pulmonary and dependent roles of βAR and GR in systemic effects of ozone.

Purpose This experimental sepsis model created with Escherichia coli aimed to investigate the histopathological effects of two different doses of ozone combined with antibiotherapy on lung tissue. Methods Rats were divided into 5 groups. Then sepsis was induced intraperitoneally in the first 4 groups. The 1st group was treated with cefepime, the 2nd and 3rd groups were treated with cefepime combined with ozone at a dose of 0.6 mg/kg and 1.1 mg/kg. Lung tissue sections were stained with hematoxylin-eosin and assessed under light microscope and scored between 0-4 in terms of histopathological findings. Results In the comparisons between Group 1 and Group 4 in terms of cellular damage (p=0.030), inflammation (p=0.000) and overall score (p=0.007), statistically significant positive effects were observed in favor of Group 1. In the comparisons of Groups 2 and 3 with Group 4, only positive effects were observed in terms of inflammation (p=0.020, p=0.012, respectively). Conclusion Although negative histopathological effects of ozone on tissue injury were detected, it was noteworthy that the increase in the ozone dose reduced the number of damaged parameters.

BACKGROUND: Our aim in this study was to compare the blood gas changes, the malondialdehyde (MDA) and endogenous antiox-idant glutathione (GSH) levels in blood and lung tissues after ischemia/reperfusion, the histopathological damage in lung tissue in rats provided respiratory support with mechanical ventilation after translaryngeal intubation and tracheostomy. METHODS: Group 1 rats were provided mechanical ventilator support after translaryngeal intubation, Group 2 mechanical ventilator support after tracheostomy, and Group 3 was the control group where rats were only anesthetized. Three groups were compared for blood gas changes, MDA, GSH, and histopathological changes. RESULTS: Blood gas evaluation showed a more marked increase in pO2 values and decline in pCO2 values in Group 2 than Group 1 (p0.05). In terms of histopathological scoring, the damage score in Group 1 was higher than in Group 2 (p

A wealth of literature exists regarding the pulmonary effects of ozone, a photochemical pollutant produced by the reaction of nitrogen oxide and volatile organic precursors in the presence of sunlight. This paper focuses on epidemiological panel studies and human clinical studies of ozone exposure, and discusses issues specific to this pollutant that may influence study design and interpretation as well as other, broader considerations relevant to ozone-health research. The issues are discussed using examples drawn from the wider literature. The recent panel and clinical literature is also reviewed. Health outcomes considered include lung function, symptoms, and pulmonary inflammation. Issues discussed include adversity, reversibility, adaptation, variability in ozone exposure metric used and health outcomes evaluated, co-pollutants in panel studies, influence of temperature in panel studies, and multiple comparisons. Improvements in and standardization of panel study approaches are recommended to facilitate comparisons between studies as well as meta-analyses. Additional clinical studies at or near the current National Ambient Air Quality Standard (NAAQS) of 70 ppb are recommended, as are clinical studies in sensitive subpopulations such as asthmatics.The pulmonary health impacts of ozone exposure have been well documented using both epidemiological and chamber study designs. However, there are a number of specific methodological and related issues that should be considered when interpreting the results of these studies and planning additional research, including the standardization of exposure and health metrics to facilitate comparisons among studies.

Background: Being exposed to cooking fumes, kitchen workers are occupationally at risk of multiple respiratory hazards. No conclusive evidence exists as to whether occupational exposure to these fumes is associated with acute and chronic pulmonary effects and symptoms of respiratory diseases. Objective: To quantify the exposure levels and evaluate possible chronic and acute pulmonary effects associated with exposure to cooking fumes. Methods: In this cross-sectional study, 60 kitchen workers exposed to cooking fumes and 60 unexposed employees were investigated. The prevalence of respiratory symptoms among these groups was determined through completion of a standard questionnaire. Pulmonary function parameters were also measured before and after participants' work shift. Moreover, air samples were collected and analyzed to quantify their aldehyde, particle, and volatile organic contents. Results: The mean airborne concentrations of formaldehyde, acetaldehyde, and acrolein was 0.45 (SD 0.41), 0.13 (0.1), and 1.56 (0.41) mg/m 3 , respectively. The mean atmospheric concentrations of PM 1 , PM 2.5 , PM 7 , PM 10 , and total volatile organic compounds (TVOCs) was 3.31 (2.6), 12.21 (5.9), 44.16 (16.6), 57 (21.55) μg/m 3 , and 1.31 (1.11) mg/m 3 , respectively. All respiratory symptoms were significantly (p

Introduction Year after year, we spend an increasing amount of time in a sitting position. Often, we sit with poor posture, as indicated by numerous pain syndromes within the musculoskeletal system. Several reports confirm that body posture and the amount of time spent in a seated position have extensive implications for our health. Previous studies and a literature review suggest there is limited knowledge regarding an ergonomic sitting position. Objective The aim of the study was to analyze the research relating to a proper sitting position and the consequences of incorrect sitting posture. A database search was conducted in Science Direct, Scopus, PubMed, Medline, and Google Scholar. Selection was made on the basis of titles, the abstracts and full texts of the studies. No limits were applied to the date of publication. Conclusions Incorrect sitting posture contributes to many disorders, especially in the cervical and lumbar spine. It also determines the work of the respiratory system. Most authors suggest that maintenance of the physiological curvature of the spine is crucial for the biomechanics of the sitting position, as well as the location of the head and position of the pelvis. It raises awareness of work-related hazards and the introduction of education on the principles of proper seating. It is necessary to draw attention to the risks associated with work performed in a sitting posture, and education on the principles of ergonomical sitting.

Background: Ozone increases IL-33 in the lungs, and obesity augments the pulmonary effects of acute ozone exposure. Objectives: We assessed the role of IL-33 in the augmented effects of ozone observed in obese mice. Methods: Lean wildtype and obese db/db mice were pretreated with antibodies blocking the IL-33 receptor, ST2, and then exposed to ozone (2 ppm for 3 hr). Airway responsiveness was assessed, bronchoalveolar lavage (BAL) was performed, and lung cells harvested for flow cytometry 24 hr later. Effects of ozone were also assessed in obese and lean mice deficient in γδ T cells and their wildtype controls. Results and Discussion: Ozone caused greater increases in BAL IL-33, neutrophils, and airway responsiveness in obese than lean mice. Anti-ST2 reduced ozone-induced airway hyperresponsiveness and inflammation in obese mice but had no effect in lean mice. Obesity also augmented ozone-induced increases in BAL CXCL1 and IL-6, and in BAL type 2 cytokines, whereas anti-ST2 treatment reduced these cytokines. In obese mice, ozone increased lung IL-13+ innate lymphoid cells type 2 (ILC2) and IL-13+ γδ T cells. Ozone increased ST2+ γδ T cells, indicating that these cells can be targets of IL-33, and γδ T cell deficiency reduced obesity-related increases in the response to ozone, including increases in type 2 cytokines. Conclusions: Our data indicate that IL-33 contributes to augmented responses to ozone in obese mice. Obesity and ozone also interacted to promote type 2 cytokine production in γδ T cells and ILC2 in the lungs, which may contribute to the observed effects of IL-33. Citation: Mathews JA, Krishnamoorthy N, Kasahara DI, Cho Y, Wurmbrand AP, Ribeiro L, Smith D, Umetsu D, Levy BD, Shore SA. 2017. IL-33 drives augmented responses to ozone in obese mice. Environ Health Perspect 125:246–253; http://dx.doi.org/10.1289/EHP272

Background: Inhaled crystalline silica may cause lung function decline. However, biological mechanisms associated with pulmonary effects in exposed workers have not been completely elucidated. Objectives: We aimed to investigate if crystalline silica exposed rock drillers had induced systemic inflammation compared to a group of referents. Methods: Serum samples were collected in 121 male rock drillers and 48 male referents after examination with spirometry in a cross-sectional study. Air samples were collected in a sub-sample of the drillers. Cumulative exposure to crystalline silica was calculated based on the measured air concentration of α-quartz and their occupational history. The interleukins IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, TNF and IFN(interferon)γ were measured. Results: Geometric mean current and cumulative exposure to crystalline silica were 36 µg/m3 and 234 µg/m3, respectively. The rock drillers had been exposed for 10.4 years on average. None of the cytokine concentrations differed significantly between the groups, but multiple linear regression analysis showed that IL-6 and IL-8 were negatively associated with being exposed. When stratifying the non-smoking exposed subjects into three equally large groups according to cumulative exposure, the highest exposed subjects had significantly lower concentrations of IL-12 and IL-6. IL-12 was also significantly associated with FEV1/FVC, suggesting lower concentrations by lower ratio. Conclusions: Surprisingly, there was a tendency towards lower pro-inflammatory cytokine concentrations in exposed workers. Whether these observations may be related to polarization towards M2 pulmonary macrophages remains to be elucidated.

Background The provision of guidance in ventilator therapy by continuous monitoring of regional lung ventilation, aeration and respiratory system mechanics is the main clinical benefit of electrical impedance tomography (EIT). A new application was recently described in critically ill patients undergoing diagnostic bronchoalveolar lavage (BAL) with the intention of using EIT to identify the region where sampling was performed. Increased electrical bioimpedance was reported after fluid instillation. To verify the accuracy of these findings, contradicting the current EIT knowledge, we have systematically analysed chest EIT data acquired under controlled experimental conditions in animals undergoing a large number of BAL procedures. Methods One hundred thirteen BAL procedures were performed in 13 newborn piglets positioned both supine and prone. EIT data was obtained at 13 images before, during and after each BAL. The data was analysed at three time points: (1) after disconnection from the ventilator before the fluid instillation and by the ends of fluid (2) instillation and (3) recovery by suction and compared with the baseline measurements before the procedure. Functional EIT images were generated, and changes in pixel electrical bioimpedance were calculated relative to baseline. The data was examined in the whole image and in three (ventral, middle, dorsal) regions-of-interest per lung. Results Compared with the baseline phase, chest electrical bioimpedance fell after the disconnection from the ventilator in all animals in both postures during all procedures. The fluid instillation further decreased electrical bioimpedance. During fluid recovery, electrical bioimpedance increased, but not to baseline values. All effects were highly significant (p

Nicotine is a highly addictive principal component of both tobacco and electronic cigarette that is readily absorbed in blood. Nicotine-containing electronic cigarettes are promoted as a safe alternative to cigarette smoking. However, the isolated effects of inhaled nicotine are largely unknown. Here we report a novel rat model of aerosolized nicotine with a particle size (~1 μm) in the respirable diameter range. Acute nicotine inhalation caused increased pulmonary edema and lung injury as measured by enhanced bronchoalveolar lavage fluid protein, IgM, lung wet-to-dry weight ratio, and high-mobility group box 1 (HMGB1) protein and decreased lung E-cadherin protein. Immunohistochemical analysis revealed congested blood vessels and increased neutrophil infiltration. Lung myeloperoxidase mRNA and protein increased in the nicotine-exposed rats. Complete blood counts also showed an increase in neutrophils, white blood cells, eosinophils, and basophils. Arterial blood gas measurements showed an increase in lactate. Lungs of nicotine-inhaling animals revealed increased mRNA levels of IL-1A and CXCL1. There was also an increase in IL-1α protein. In in vitro air-liquid interface cultures of airway epithelial cells, there was a dose dependent increase in HMGB1 release with nicotine treatment. Air-liquid cultures exposed to nicotine also resulted in a dose-dependent loss of barrier as measured by transepithelial electrical resistance and a decrease in E-cadherin expression. Nicotine also caused a dose-dependent increase in epithelial cell death and an increase in caspase-3/7 activities. These results show that the nicotine content of electronic cigarettes may have adverse pulmonary and systemic effects.

Background Cigarette smoke exposure can affect pulmonary lipid homeostasis and cause a progressive increase in pulmonary antibodies against oxidized low-density lipoproteins (OxLDL). Similarly, increased anti-OxLDL antibodies are observed in atherosclerosis, a pathology also tightly associated with smoking and lipid homeostasis disruption. Several immunization strategies against oxidized lipid species to help with their clearance have been shown to reduce the formation of atherosclerotic lesions. Since oxidized lipids are generated during cigarette smoke exposure, we investigated the impact of a prophylactic immunization protocol against OxLDL on the pulmonary effects of cigarette smoke exposure in mice. Methods Mice were immunized systemically with a mixture of human OxLDL (antigen source) and AddaVax (adjuvant) or PBS alone prior to the initiation of acute (2 week) or sub-chronic (8 weeks) cigarette smoke exposure protocols. Anti-OxLDL antibodies were measured in the bronchoalveolar lavage (BAL) fluid and serum by direct ELISA. Pulmonary impacts of cigarette smoke exposure and OxLDL immunization were assessed by measuring BAL inflammatory cells, lung functions, and changes in lung structure and gene levels of matrix/matrix-related genes. Results Immunization to OxLDL led to a marked increase in circulating and pulmonary antibodies against OxLDL that persisted during cigarette smoke exposure. OxLDL immunization did not exacerbate or reduce the inflammatory response following acute or sub-chronic exposure to cigarette smoke. OxLDL immunization alone had effects similar to cigarette smoke exposure on lung functions but OxLDL immunization and cigarette smoke exposure had no additive effects on these parameters. No obvious changes in lung histology, airspace or levels of matrix and matrix-related genes were caused by OxLDL immunization compared to vehicle treatment. Conclusions Overall, this study shows for the first time that a prophylactic immunization protocol against OxLDL can potentially have detrimental effects lung functions, without having additive effects over cigarette smoke exposure. This work sheds light on a complex dynamic between anti-OxLDL antibodies and the pulmonary response to cigarette smoke exposure.

The postoperative diagnosis and management of complications related to bariatric surgery requires a high degree of clinical suspicion in conjunction with swift implementation of diagnostic and therapeutic strategies. The most common medical complications related to bariatric surgery include venous thromboembolic events, cardiac complications, and nutritional deficiencies. These have all been observed in bariatric patients regardless of the type of surgery. The most common surgical complication related to the gastric band is band slippage, which requires take back to the operating room. The most common surgical complication related to the sleeve gastrectomy is staple line leak. Marginal ulcer, anastomotic leak, and bowel obstruction are all possible complications related to the gastric bypass. Lastly, critical care management of the bariatric patient requires particular attention to the cardiac and pulmonary effects of obesity toward respective physiologic functioning.

Summary Novel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury.

BACKGROUND: Silicosis is the most frequently occurring pneumoconiosis.AIM: Measurement of serum levels of Angiotensin converting enzyme (ACE), Copper (Cu) and Ceruloplasmin (Cp) in cement workers occupationally exposed to silica dust as biomarkers of exposure rather than biomarkers of effect for silicosis.METHODS: Plain chest X-ray & pulmonary functions were done for 30 silicotic and 42 non-silicotic workers and 42 controls. CT scan was done for the exposed groups. Serum levels of Cu, Cp and ACE were estimated.RESULTS: The results showed a higher significant difference between the exposed groups and controls, and between the two exposed groups regarding the mean levels of all measured biochemical parameters. The pulmonary functions were significantly lower among silicotic workers than controls and non-silicotic groups. There was a significant positive correlation between duration of employment and serum ACE and Cu.CONCLUSION: Since respirable dust exposure-linked lung fibrosis disease is non-curable, the biochemical parameters (Cu, ACE and Cp) can be used as exposure biomarkers to silica dust, providing a better way for early diagnosis of this deadly disease. Down regulating the inflammatory responses could potentially reduce the adverse clinical pulmonary effects of air pollution.

Patients who require general anesthesia to undergo a surgical procedure often require mechanical ventilation during the perioperative period. Ventilators incorporated into modern anesthesia machines offer various options for patient management. The unique effects of general anesthesia and surgery on pulmonary physiology must be considered when selecting an individualized plan for mechanical ventilation during the perioperative period. In this article, the pulmonary effects of general anesthesia are reviewed and available options for mechanical ventilation of the anesthetized patient during the perioperative period are presented.

Background Chronic heart failure (CHF) following coronary artery ligation and myocardial infarction in the rat leads to a homeostatic reduction in surface tension with associated alveolar type II cell hyperplasia and increased surfactant content, which functionally compensates for pulmonary collagen deposition and increased tissue stiffness. To differentiate the effects on lung remodelling of the sudden rise in pulmonary microvascular pressure (Pmv) with myocardial infarction from its consequent chronic elevation, we examined a hypertensive model of CHF. Methods Cardiopulmonary outcomes due to chronic pulmonary capillary hypertension were assessed at six and 15 weeks following abdominal aortic banding (AAB) in the rat. Results At six weeks post-surgery, despite significantly elevated left ventricular end-diastolic pressure, myocardial hypertrophy and increased left ventricular internal circumference in AAB rats compared with sham operated controls (p ≤ 0.003), lung weights and tissue composition remained unchanged, and lung compliance was normal. At 15 weeks post-surgery increased lung oedema was evident in AAB rats (p = 0.002) without decreased lung compliance or evidence of tissue remodelling. Conclusion Despite chronically elevated Pmv, comparable to that resulting from past myocardial infarction (LVEDP > 19 mmHg), there is no evidence of pulmonary remodelling in the AAB model of CHF.

Engineered nanomaterials are currently under review for their potential toxicity; however, their use in consumer/commercial products has continued to outpace risk assessments. In vitro methods may be utilized as tools to improve the efficiency of risk assessment approaches. We propose a framework to compare relationships between previously published in vitro and in vivo toxicity assessments of cadmium-selenium containing quantum dots (QDs) using benchmark dose (BMD) and dosimetric assessment methods. Although data were limited this approach was useful for identifying sensitive assays and strains. In vitro studies assessed effects of QDs in three pulmonary cell types across two mouse strains. Significant dose-response effects were modeled and a standardized method of BMD analysis was performed as a function of both exposure dose and dosimetric dose. In vivo studies assessed pulmonary effects of QD exposure across eight mouse strains. BMD analysis served as a basis for relative comparison with in vitro studies. We found consistent responses in common endpoints between in vitro and in vivo studies. Strain sensitivity was consistent between in vitro and in vivo studies, showing A/J mice more sensitive to QDs. Cell types were found to differentially take up QDs. Dosimetric adjustments identified similar sensitivity among cell types. Thus, BMD analysis can be used as an effective tool to compare the sensitivity of different strains, cell types, and assays to QDs. These methods allow for in vitro assays to be used to predict in vivo responses, improve the efficiency of in vivo studies, and allow for prioritization of nanomaterial assessments. This article is categorized under: Toxicology and Regulatory Issues in Nanomedicine > Toxicology of Nanomaterials Toxicology and Regulatory Issues in Nanomedicine > Regulatory and Policy Issues in Nanomedicine.

Airborne particulate matter (PM) is associated with adverse cardiorespiratory effects. To better understand source-orientated PM toxicity, a comparative study of the biological effects of fine PM (diameter≤2.5μm, PM2.5) collected during the winter season from Shanxi Province, China, and the Central Valley, California, United States, was conducted. The overarching hypothesis for this study was to test whether the chemical composition of PM on an equal mass basis from two urban areas, one in China and one in California, can lead to significantly different effects of acute toxicity and inflammation in the lungs of healthy young mice. Male, 8-week old BALB/C mice received a single 50μg dose of vehicle, Taiyuan PM or Sacramento PM by oropharyngeal aspiration and were sacrificed 24h later. Bronchoalveolar lavage, ELISA and histopathology were performed along with chemical analysis of PM composition. Sacramento PM had a greater proportion of oxidized organic material, significantly increased neutrophil numbers and elevated CXCL-1 and TNF-α protein levels compared to the Taiyuan PM. The findings suggest that Sacramento PM2.5 was associated with a greater inflammatory response compared to that of Taiyuan PM2.5 that may be due to a higher oxidice. Male, 8-week old BALB/C mice received a single 50μg dose of vehicle, Taiyuan PM or Sacramento PM by oropharyngeal aspiration and were sacrificed 24h later. Bronchoalveolar lavage, ELISA and histopathology were performed along with chemical analysis of PM composition. Sacramento PM had a greater proportion of oxidized organic material, significantly increased neutrophil numbers and elevated CXCL-1 and TNF-α protein levels compared to the Taiyuan PM. The findings suggest that Sacramento PM2.5 was associated with a greater inflammatory response compared to that of Taiyuan PM2.5 that may be due to a higher oxidized state of organic carbon and copper content.

Seminal studies have demonstrated that tracheally intubated, mechanically ventilated patients, positioned in supine horizontal position, are at a high risk of developing ventilator-associated pneumonia, through aspiration of gastric pathogens. In the 1990s, innovative clinical findings promoted a radical change in practice, through the use of the semirecumbent position in all mechanically ventilated patients. Here, we critically review the main indications, pulmonary effects, and controversies on the use of the semirecumbent position. Also, we will depict potential roles of prone and lateral positions in the prevention of ventilator-associated pneumonia. Our review will span from preclinical experimental insights to clinical evidence, and we will discuss potential controversies on the use of the semirecumbent position as the standard of care. We will also detail potential alternatives to ultimately improve outcomes of tracheally intubated and mechanically ventilated patients.

Background There is a fundamental gap of knowledge on the health effects caused by the interaction of engineered nanomaterials (ENM) with the gastro-intestinal tract (GIT). This is partly due to the incomplete knowledge of the complex physical and chemical transformations that ENM undergo in the GIT, and partly to the widespread belief that GIT health effects of ENM are much less relevant than pulmonary effects. However, recent experimental findings, considering the role of new players in gut physiology (e.g. the microbiota), shed light on several outcomes of the interaction ENM/GIT. Along with this new information, there is growing direct and indirect evidence that not only ingested ENM, but also inhaled ENM may impact on the GIT. This fact, which may have relevant implications in occupational setting, has never been taken into consideration. This review paper summarizes the opinions and findings of a multidisciplinary team of experts, focusing on two main aspects of the issue: 1) ENM interactions within the GIT and their possible consequences, and 2) relevance of gastro-intestinal effects of inhaled ENMs. Under point 1, we analyzed how luminal gut-constituents, including mucus, may influence the adherence of ENM to cell surfaces in a size-dependent manner, and how intestinal permeability may be affected by different physico-chemical characteristics of ENM. Cytotoxic, oxidative, genotoxic and inflammatory effects on different GIT cells, as well as effects on microbiota, are also discussed. Concerning point 2, recent studies highlight the relevance of gastro-intestinal handling of inhaled ENM, showing significant excretion with feces of inhaled ENM and supporting the hypothesis that GIT should be considered an important target of extrapulmonary effects of inhaled ENM. Conclusions In spite of recent insights on the relevance of the GIT as a target for toxic effects of nanoparticles, there is still a major gap in knowledge regarding the impact of the direct versus indirect oral exposure. This fact probably applies also to larger particles and dictates careful consideration in workers, who carry the highest risk of exposure to particulate matter.

Habitual smoking of marijuana is associated with multiple respiratory symptoms such as cough, sputum production, and wheezing .These symptoms are not significantly different from those exhibited by tobacco smokers. Furthermore, endobronchial biopsies of habitual smokers of marijuana and /or tobacco have shown that both marijuana and cigarette smoking cause significant bronchial mucosal histopathology and that these effects are additive. Although marijuana smokers have minimal changes in pulmonary function studies as compared to tobacco smokers, they may develop bullous disease and spontaneous pneumothoraces. The relationship between marijuana smoking and lung cancer remains unclear due to design limitations of the studies published so far. These findings should warn individuals that marijuana smoking may result in serious short-term and long-term respiratory complications, and habitual marijuana use should be viewed with caution. The medical literature so far does not support routine evaluation by pulmonary function tests or imaging studies; until more definitive data is available, we do not recommend the regular use of these tests in the evaluation of habitual marijuana smokers.

Malgre les efforts de preventions ainsi que la gratuite des traitements, la coinfection tuberculose/VIH reste toujours d’actualite en Guinee. L’objectif de cette etude etait de decrire l’epidemiologie de la tuberculose pulmonaire bacillifere selon le statut VIH des patients hospitalises dans le service des maladies infectieuses de Donka, Conakry. Il s’agissait d’une etude retrospective descriptive et analytique portant sur les dossiers des patients recus pour tuberculose pulmonaire bacillifere de janvier 2003 a decembre 2012. Durant cette periode, 1953 dossiers de tuberculoses ont ete colliges parmi lesquelles 346 etaient bacilliferes, soit 17,7 %. On notait une nette predominance masculine (59,7 %). La moyenne d’âge etait de 38±11 ans. La majorite des patients provenaient de la banlieue de Conakry et des prefectures environnantes (76,7 %). Les personnes sans profession etaient les plus representees (40,7 %). Le niveau d’instruction primaire a ete le plus frequemment retrouve (39,7 %). La serologie VIH etait positive chez 185 patients sur les 325 qui l’avaient effectuee, soit une seroprevalence de 56,9 %. La notion de contage tuberculeux a ete rapportee dans le groupe des seronegatifs a 21,4 % contre 6,5 % chez les seropositifs (p=0,0006). Il n’y avait pas de difference entre les deux groupes en ce qui concerne les manifestations cliniques. La moyenne du taux de CD4 etait comparable dans les deux groupes (p=0,05). La letalite etait plus elevee chez les patients co-infectes (30,4 % contre 15,56 %) (p=0,00037). Un renforcement de la prevention de la tuberculose chez les personnes vivant avec le VIH (PVVIH) par l’administration de l’isoniaside parait necessaire, d’ou l’interet d’une etude pilote sur ce sujet en Guinee.

The life expectancy of patients with cystic fibrosis (CF) has steadily increased over recent decades with a corresponding increase in the frequency of complications of the disease. Radiologists are increasingly involved with managing and identifying the pulmonary complications of CF. This article reviews the common manifestations of CF lung disease as well as updating radiologists with a number of less well-known complications of the condition. Early and accurate detection of the pulmonary effects of CF are increasingly important to prevent irreversible lung damage and give patients the greatest possibility of benefiting from the new therapies becoming available, which correct the underlying defect causing CF.

Background: Few studies have been performed on pulmonary effects of air pollution in the elderly—a vulnerable population with low reserve capacity—and mechanisms and susceptibility factors for potential effects are unclear. Objectives: We evaluated the lag structure of air pollutant associations with lung function and potential effect modification by DNA methylation (< or ≥ median) at 26 individual CpG sites in nine candidate genes in a well-characterized cohort of elderly men. Methods: We measured forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), and blood DNA methylation one to four times between 1999 and 2009 in 776 men from the Normative Aging Study. Air pollution was measured at fixed monitors 4 hr to 28 days before lung function tests. We used linear mixed-effects models to estimate the main effects of air pollutants and effect modification by DNA methylation. Results: An interquartile range (IQR) increase in subchronic exposure (3 to 28 days cumulated), but not in acute exposure (during the previous 4 hr, or the current or previous day), to black carbon, total and nontraffic particles with aerodynamic diameter ≤ 2.5 μm (PM2.5), carbon monoxide, and nitrogen dioxide was associated with a 1–5% decrease in FVC and FEV1 (p < 0.05). Slope estimates were greater for FVC than FEV1, and increased with cumulative exposure. The estimates slopes for air pollutants (28 days cumulated) were higher in participants with low (< median) methylation in TLR2 at position 2 and position 5 and high (≥ median) methylation in GCR. Conclusions: Subchronic exposure to traffic-related pollutants was associated with significantly reduced lung function in the elderly; nontraffic pollutants (particles, ozone) had weaker associations. Epigenetic mechanisms related to inflammation and immunity may influence these associations. Citation: Lepeule J, Bind MAC, Baccarelli AA, Koutrakis P, Tarantini L, Litonjua A, Sparrow D, Vokonas P, Schwartz JD. 2014. Epigenetic influences on associations between air pollutants and lung function in elderly men: the Normative Aging Study. Environ Health Perspect 122:566–572; http://dx.doi.org/10.1289/ehp.1206458

A substantial disparity in asthma prevalence and morbidity among urban children compared with their nonurban counterparts has been recognized for more than two decades. Because of the nature of urban neighborhoods, pest allergens, such as cockroach and mouse, are present in high concentrations in US urban housing and have both repeatedly been linked to asthma morbidity in sensitized children. In addition, there is a growing body of evidence demonstrating that concentrations of many pollutants are higher indoors than outdoors in both US and European urban communities and that exposures to indoor pollutants such as particulate matter (PM) and nitrogen dioxide (NO2 ) are independently associated with symptoms in children with asthma. Although environmental interventions are challenging to implement, when they reduce relevant indoor allergen and pollutant exposures, they are associated with clear improvements in asthma. Other modifiable risk factors in urban childhood asthma that have emerged include dietary and nutritional factors. Overweight and obese children, for example, may be more susceptible to the pulmonary effects of pollutant exposure. Insufficiency of vitamin D and folate has also emerged as modifiable risk factors for asthma morbidity in children. The identification of these modifiable risk factors for urban childhood asthma morbidity offers a ripe opportunity for intervention.

Objective To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity. Methods The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices. Results In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre- and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P

Anaesthesia management of patients with airway susceptibility remains a challenge in daily clinical practice due to the increased risk of perioperative bronchospasm. Therefore, understanding the mechanisms participating in the interaction between anaesthetic drugs and the lungs is essential in providing the optimal care for patients with chronic lung diseases. Experimental studies performed on various animal models mimicking airway susceptibility have played a key role in understanding the pathogenesis of lung diseases and have characterised the different pathways involved in the altered airway and lung tissue responses to anaesthetic agents. This narrative review highlights the progress that has been achieved by investigations in animal models and discusses the potential translation of these experimental findings to the clinical setting. The application of animal models with normal and allergically sensitised airways demonstrated that volatile and intravenous anaesthetic agents, muscle relaxants, analgesics and local anaesthetics exert their pulmonary effects via different neurosensorial pathways and through activating various receptors in the lungs. Attention is drawn to the significant differences in the pulmonary effects of anaesthetic agents between lungs with normal and those with susceptible airways. Extrapolating clear-cut conclusions from animal research to clinical practices should be made with caution, particularly for muscle relaxants, opioids and local anaesthetics wherein complex pathophysiological mechanisms are responsible for the potential respiratory effects of these agents. Animal models are of great importance in evaluating the potential interaction between anaesthetic drugs and the lungs, in identifying the pathways involved and in targeting preventive or treatment strategies to the lung compartment primarily involved.

1. Exposure to secondhand smoke (SHS) can occur in many places; however, regulations banning smoking may reduce the sources of exposure to SHS to personal areas such as the family car, a source of brief but potently intense exposure. 2. Fifteen non-smoking volunteers were exposed to sidestream SHS concentrations of 5000 µg/m(3), within a simulated car setting. The Fraction of Exhaled Nitric Oxide (FeNO) was calculated, dynamic flow volumes were assessed through spirometry; while airway impedance (Z), resistance (R), and reactance (X) was assessed through impulse oscillometry before and after exposure. 3. Exposure to sidestream SHS within this experimental condition did not affect dynamic flow volumes, however FENO decreased from 15.34 ppb to 11.15 ppb, (p0.001). Increases in airway resistance at R5Hz by 0.114 kPa/(L/s) (p = 0.002), at R10Hz by 0.093[kPa/(L/s)] (p = 0.006) and at R20Hz by 0.093[kPa/(L/s)] (p = 0.008) were noted. Correspondingly overall peripheral and central airway resistance was also found to increase by 40% (by 0.083 kPa/(L/s), p = 0.038) and 25% (by 0.045 kPa/(L/s), p = 0.047) respectively. 4. Brief but elevated exposure to sidestream SHS can alter airway resistance, and impedance indicating a potential additional mechanistic pathway between exposure to SHS and the development of respiratory disease. Further research is needed to verify these pilot results.

With rapid increasing usage of smart phones, social concerns have arisen about the possible effects of elec-tromagnetic fields emitted from wideband code division multiple access(WCDMA) mobile phones on human health.The number of people with self-reported electromagnetic hypersensitivity(EHS) who complain of various subjectivesymptoms such as headache, insomnia etc. has also recently increased. However, it is unclear whether EHS resultsfrom physiological or other origins. In this double-blinded study, we investigated physiological changes such as heartrate, respiration rate, and heart rate variability with real and sham exposures for 15 EHS and 17 non-EHS personsusing a module inside a dummy phone. Experiment was conducted using a WCDMA module with average powerof 24 dBm at 1950 MHz with the specific absorption rate of 1.57 W/kg using a headphone for 32 min. As a conclusion,WCDMA RF exposure did not have any effects on the physiological variables in either group. Key words: Smart phones, EHS, WCDMA, Physiological effects, Double-blinded

Objective To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). Methods A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints. Results WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93–100%) vs. 86% (77–92%), P = 0.001] and [95% (72–100%) vs. 90% (54–99%), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms. Conclusion At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings. Objectif: Comparer les performances de nouvel algorithme de l’OMS (2007) pour le diagnostic de la tuberculose pulmonaire (TBP) dans les zones a forte prevalence du VIH (WHO07) aux directives de l’OMS 2003 utilisees par le Programme National Ougandais de la Tuberculose (UgWHO03). Methodes: Une etude de cohorte observationnelle prospective a ete utilisee dans l’Initiative Reach Out VIH/SIDA de la paroisse de Mbuya, un Service d’Organisation contre le SIDA (ASO) en milieu urbain communautaire de bidonville et a l’Hopital Rural Gouvernemental du District de Kayunga. Les personnes nouvellement diagnostiquees avec le VIH et inscrites, ont eteevaluees pour la TBP. Le personnel de recherche a interviewe les patients et le personnel, et a observe les contraintes operationnelles. Resultats: WHO07 permet une reduction de la duree du diagnostic de PTB a frottis negatif avec une sensibilite accrue par rapport a UgWHO03 sur les deux sites. La duree pour le diagnostic de PTB a frottis negatif etait significativement plus courte dans le milieu urbain ASO que dans le milieu rural ASO (12,4 jours, comparea 28,5 jours, p = 0,003). La specificite et la sensibilite diagnostiques [intervalle de confiance 95% (IC)] pour la PTB a frottis negatif etaient plus elevees a l’Hopital Rural que dans la zone urbaine ASO: [98% (93–100%) contre 86% (77–92%), P = 0,001] et [95% (72–100%) contre 90% (54–99%), P > 0,05], respectivement. Les obstacles courants a l’implementation des algorithmes comprennent: les rendez-vous manques par les patients lors du suivi et le non respect des algorithmes par les agents des soins de sante. Conclusion: Sur les deux sites, WHO07 a permis une acceleration du diagnostic de la PTB a frottis negatif avec une precision diagnostique accrue par rapport a UgWHO03. WHO07 a plus accelere le diagnostic dans la zone urbaine ASO, mais avec une precision diagnostic plus elevee a l’Hopital Rural. Les obstacles a l’implementation devraient etre pris en compte lors de l’application des directives pour le diagnostic de la TB dans les pays a ressources limitees. Objetivo: Comparar el desempeno del nuevo algoritmo de diagnostico de la OMS (2007) para tuberculosis pulmonar (TBP) en emplazamientos con una alta prevalencia del VIH (WHO07) con respecto a las guias de la OMS del 2003 utilizadas por el Programa Nacional de Tuberculosis de Uganda (UgWHO03). Metodos: Se utilizo un diseno observacional de cohortes prospectivo en la Iniciativa Reach Out Mbuya Parish para el VIH/SIDA, una Organizacion de Servicios para el SIDA (OSS) urbana, y basada en la comunidad de y el Hospital Distrital Rural de Kayunga. Los pacientes recientemente diagnosticados fueron examinados en busca de TB pulmonar (TBP). El personal investigador entrevisto a los pacientes y al personal sanitario, y observo las limitaciones operativas. Resultados: En ambos emplazamientos WHO07 redujo el tiempo hasta el diagnostico de la TBP con baciloscopia negativa con una mayor sensibilidad que la UgWHO03. El tiempo hasta el diagnostico de la TBP con baciloscopia negativa era significativamente mas corto en la OSS urbana que en la OSS rural (12.4 versus 28.5 dias, P = 0.003). La especificidad y sensibilidad diagnostica [IC 95%] para la TBP con baciloscopia negativa eran mayores en el hospital rural comparadas con la OSS urbana: [98% (93–100%) versus 86% (77–92%), P = 0.001] y [95% (72–100%) versus 90% (54–99%), P > 0.05] respectivamente. Las barreras mas comunes para la implementacion de los algoritmos incluian el fallo de los pacientes para atender a las visitas de seguimiento y una adherencia pobre de los sanitarios a la hora de utilizar los algoritmos. Conclusion: En ambos emplazamientos, el WHO07 facilito el diagnostico de la TBP con baciloscopia negativa con mayor precision, comparado con la UgWHO03. El WHO07 acelero el diagnostico en la OSS rural, pero con una mayor precision diagnostica en el hospital rural. Las barreras para la implementacion deberian tomarse en cuenta al operativizar estas guias para el diagnostico de la TB en emplazamientos con pocos recursos.

to the editor: In a recent issue of the American Journal of Physiology-Lung Cellular and Molecular Physiology , we read with great interest the review article by Chun et al. ([2][1]) about potential pulmonary effects of electronic cigarettes (ECs). This is a timely topic, and the authors do a

The adverse pulmonary effects of asbestos are well accepted in scientific circles. However, the extrapulmonary consequences of asbestos exposure are not as clearly defined. In this review the potential for asbestos to produce diseases of the peritoneum, immune, gastrointestinal (GIT), and reproductive systems are explored as evidenced in published, peer-reviewed literature. Several hundred epidemiological, in vivo, and in vitro publications analyzing the extrapulmonary effects of asbestos were used as sources to arrive at the conclusions and to establish areas needing further study. In order to be considered, each study had to monitor extrapulmonary outcomes following exposure to asbestos. The literature supports a strong association between asbestos exposure and peritoneal neoplasms. Correlations between asbestos exposure and immune-related disease are less conclusive; nevertheless, it was concluded from the combined autoimmune studies that there is a possibility for a higher-than-expected risk of systemic autoimmune disease among asbestos-exposed populations. In general, the GIT effects of asbestos exposure appear to be minimal, with the most likely outcome being development of stomach cancer. However, IARC recently concluded the evidence to support asbestos-induced stomach cancer to be “limited.” The strongest evidence for reproductive disease due to asbestos is in regard to ovarian cancer. Unfortunately, effects on fertility and the developing fetus are under-studied. The possibility of other asbestos-induced health effects does exist. These include brain-related tumors, blood disorders due to the mutagenic and hemolytic properties of asbestos, and peritoneal fibrosis. It is clear from the literature that the adverse properties of asbestos are not confined to the pulmonary system.

As the world population expands, an increasing number of people are living in areas which may be threatened by natural disasters. Most of these major natural disasters occur in the Asian region. Pulmonary complications are common following natural disasters and can result from direct insults to the lung or may be indirect, secondary to overcrowding and the collapse in infrastructure and health-care systems which often occur in the aftermath of a disaster. Delivery of health care in disaster situations is challenging and anticipation of the types of clinical and public health problems faced in disaster situations is crucial when preparing disaster responses. In this article we review the pulmonary effects of natural disasters in the immediate setting and in the post-disaster aftermath and we discuss how this could inform planning for future disasters.

Marijuana is the most commonly used illicit drug around the world. It is most often consumed through smoking, placing the respiratory system in direct contact with the toxic constituents of the drug, which are similar to those of tobacco cigarettes. However, accurate study of the adverse effects of marijuana is difficult to perform, owing to marijuana's illegal status, variation in smoking technique, often short duration of use compared with tobacco and the frequently confounding factor of concomitant consumption of both marijuana and tobacco. Despite this, there is evidence to suggest that marijuana can impair lung function, damage large airway mucosa and possibly contribute to bullous disease, while its carcinogenic potential is controversial.

We are describing a case of acute onset of amiodarone-related pulmonary toxicity (amiodarone lung) presented with clinical findings of acute ingravescent dyspnea, and reversed after prompt drug discontinuation. A concise review of the characteristics of pulmonary toxicity is also provided. Lung adverse effects may occur approximately in 5-17% of treated patients, and are usually associated with older age, duration of the treatment, cumulative dosage, and probably previous co-existing lung disease may play a role. Such adverse pulmonary effects may occur either early (few days after starting treatment) or after several years, and onset of symptoms may be slowly insidious or acute, and dramatically pro- gressive. Thus, a high level of alertness is necessary in comorbid and elderly patients receiving amiodarone, even in an emergency setting, to consider this kind of adverse reaction among all possible differential diagnoses.

Introduccion. El tratamiento acortado estrictamente supervisado hace parte de una estrategia multifactorial adoptada por la Organizacion Mundial de la Salud para controlar la tuberculosis y en Colombia alcanza una cobertura de 70%. Objetivo. Establecer las caracteristicas clinicas, epidemiologicas y microbiologicas y el desenlace de la terapia antituberculosa, en una cohorte de pacientes nuevos con diagnostico de tuberculosis pulmonar con baciloscopia positiva en Cali, Colombia. Materiales y metodos. Se llevo a cabo un estudio descriptivo, anidado en un ensayo clinico de multicentrico, en el que se incluyeron 106 pacientes con tuberculosis pulmonar con baciloscopia positiva entre abril de 2005 y junio de 2006, a traves de instituciones de salud de la red publica de Cali que administraron el tratamiento antituberculoso. Se practico baciloscopia seriada, cultivo para micobacterias, prueba de sensibilidad a medicamentos antituberculosos de primera linea, radiografia de torax postero-anterior y lateral y prueba ELISA para VIH. Se recolecto informacion clinica y epidemiologica, y se hizo seguimiento por 30 meses, haciendo uso de incentivos de transporte y alimentacion. Resultados. La mayoria de los pacientes fueron hombres jovenes, con diagnostico hecho mas de nueve semanas despues del inicio de los sintomas y con baciloscopia muy positiva (2+ o 3+). La resistencia a cualquier medicamento fue de 7,5% y la resistencia inicial a los medicamentos de primera linea fue de 1,9%. La incidencia de efectos secundarios asociados al tratamiento fue de 8,5%. La infeccion concomitante con VIH fue de 5,7%. El 86,8% de los pacientes completo la terapia con diagnostico de curacion. Conclusiones. El periodo tan amplio comprendido entre el inicio de los sintomas y el diagnostico de la enfermedad, se ha identificado previamente como factor de riesgo para el abandono de terapia. Las caracteristicas epidemiologicas son similares a las descritas para los pacientes con tuberculosis pulmonar. Los hallazgos radiograficos indicativos de tuberculosis son diversos y no corresponden en su mayoria a cavernas. La infeccion concomitante con VIH fue identificada como parte del abordaje de la enfermedad por micobacterias en todos los casos.