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Background Nontuberculous mycobacterium (NTM) infections are increasingly frequent due to the human engineering environment, the susceptibility of the hosts, and the improvement of diagnostic techniques to detect and typify them. The most common pathogenic specie is the Mycobacterium Avium complex, which usually causes chronic lung disease in immunocompetent patients. The current antimicrobial treatment is long (12-18 months), with high toxicity (due to the use of antituberculosis drugs), low cure taxa (50-55%) and high reinfection taxa (up to 40%). Recent studies have demonstrated the existence of cross-immunity between TBC and MAC from the application of BCG vaccines in multiple murine models, nonhuman primates and human subjects. These studies have revealed an inhibition in the replication and growth of MAC- infected cells, opening a gap to induce the treatment of these patients with BCG immunotherapy. Objective The purpose of the present study is to demonstrate the effectiveness of BCG vaccine against tuberculosis as induction immunotherapy for the treatment of pulmonary infections due to Mycobacterium Avium Complex. Methods Design and setting: A multicentre, superiority, randomized, double-blinded and controlled clinical trial will be performed among eight hospitals of Catalonia. Intervention: A stratified by radiological pattern sample will be performed in order to generate two therapy groups (A and B) with participants >18 years old. Patients from group A (n = 108) will receive intradermal placebo (two dose) followed by oral antibiotic until microbiological healing and 12 months since that moment while group B patients will be stratified in two groups that will receive two different dose of BCG vaccine followed by the same antibiotic guideline, group B-I (n = 108) and group B-II (n = 108). Treatment will last maximum 18 months, depending on the time it takes for the patient to reach microbiological healing (rarely happens after 6 months). Main outcome will be disease resolution, defined as the negativization of sputum culture and maintained disappearance of symptoms for at least twelve months since it occurs. One follow-up visit per month (4 weeks) will be scheduled after diagnosis for both groups, and will consist mainly in clinical examination of symptoms and monitoring of hepatic function, EKG and sputum culture

In Malta, respiratory medicine is quite a popular speciality. It is attractive because of the interesting case mix and the interventional element of the speciality. To understand the training system in Malta, it helps to first have some background knowledge of Malta. Malta is a tiny Mediterranean island, just 316 km2 in area, with one main teaching hospital, Mater Dei Hospital, with a second smaller hospital on the sister island of Gozo. Scattered across the island are regional health centres, and two smaller oncology and rehabilitation hospitals. These cater for the 420 000 people living there. With tourism, the population increases significantly. We communicate in both Maltese and English, and teaching (both at medical school and at a postgraduate level) is in English., N/A

Respiratory tract infections are the most common infections of childhood but are, in the main, caused by common viruses and result in a relatively benign course. The great majority can be managed by simple, supportive measures. Recourse to antibiotics is often unnecessary and, indeed, encourages antibiotic resistance that is fast becoming the greatest microbiological challenge of the 21st century. This article will outline the key features of common childhood respiratory infections and indicate the appropriateness, or otherwise, of antibiotics for each individual infection., peer-reviewed

Bilateral simultaneous spontaneous pneumothorax, although rare, constitutes a grave emergency when it occurs. One of the strongest arguments in favour of prompt closed catheter drainage in the treatment of massive pneumothorax is the possibility that another pneumothorax may occur on the opposite side. The purpose of this paper is to report a case of simultaneous bilateral pneumothorax which presented as an acute medical emergency requiring immediate intervention. This is a condition which requires prompt treatment. Immediate needle decompression of one or both sides is a life-saving procedure. This has to be followed however by tube thoracotomies which have to be carried out bilaterally. It was felt that open thoracotomy or talc poudrage should not be undertaken in the present case as the reactive effusion produced by the intercostal tube was such that a chemical pleurodesis was likely. The lungs have remained completely expanded., peer-reviewed