1,721,473 research outputs found
Chronic beryllium disease: a model for pulmonary sarcoidosis?
No full textChronic beryllium disease (CBD) and pulmonary sarcoidosis are two distinct chronic disorders, sharing the pathological lung hallmark of the non-caseating granuloma and the immunological feature of T cell activation at the site of disease. However, while CBD is a rare occupational disease in which the cause, i.e. the inhalation of beryllium, is well known since a long time, the etiology of sarcoidosis, which is far more common in the general population, is still unknown. Since granuloma formation requires the presence of an immunogenic initiating antigen, it has been hypothesized that sarcoidosis is an antigen-triggered (auto)immune disease. Furthermore, while the study of large populations exposed to beryllium did made possible the identification of distinct genetic susceptibility factors in CBD, only recently the role of some genetic polymorphisms in sarcoidosis has been unraveled. Therefore, it seems likely that the advancement in the understanding of the immuno-pathogenesis of CBD will also help to design focused genetic studies to finally identify the etiology of sarcoidosis. Moreover, it is also possible that some cases of sarcoidosis are instead been caused by the inhalation of beryllium in genetically susceptible individuals
Should individuals who are tuberculin skin test negative and positive to RD1-IFN-gamma assay receive preventive therapy? From the authors
No full textNon disponibil
Treating idiopathic pulmonary fibrosis: current opportunities and future challenges
No full textNon disponibile
Tuberculosis diagnostic tests: Sensitivity, specificity, and comparing apples with apples
No full textNon disponibil
Clinical trials of investigational agents for IPF: a review of a Cochrane report
No full textThe magnitude of treatment effect can be assessed by a number of methods. One reliable method of collectively analysing data from randomised clinical trials is that used in Cochrane reviews. These systematic reviews identify and analyse the available evidence using the reliable method of meta-analysis. These often combine data from studies to provide robust evaluations of overall treatment effects. In 2003, a review of data from studies of corticosteroid use in IPF patients found no evidence of a treatment effect. Similarly, very little evidence was found to support the use of immunomodulatory agents. A recent update of these Cochrane reviews failed to identify any new evidence supporting the use of corticosteroids in IPF. However, a review of non-steroid agents for the treatment of IPF identified data from 15 RCTs that was suitable for analysis. Two trials of interferon gamma-1b were pooled and analysed, but no treatment effect was observed in terms of survival. Meta-analysis of three Phase III studies of pirfenidone treatment in IPF patients suggested that progression-free survival was significantly increased by 30%, demonstrating a reduction in the decline of lung function in IPF patients. In addition, there are numerous ongoing trials investigating potential therapeutic agents which provides hope for IPF patients and their doctors
Role of in vitro tests in the diagnosis of latent tubercular infections
No full textRecent advancements in the understanding of pathogenetic mechanisms in tuberculosis infection, allowed the identification of target molecules and antigens, playing a crucial role in an effective M. tuberculosis immune control. Thanks to this new information, the diagnostic approach to latent tuberculosis infection may be complemented today with two new blood assays, based on the detection and the quantification of the key cytokine interferon-gamma by peripheral blood T cells stimulated with M. tuberculosis-specific antigens. These new tests, QuantiFERON-TB Gold and T-SPOT.TB, being certainly more specific than the tuberculin skin test and probably more sensitive in some subgroups of patients, might represent a crucially relevant tool to achieve to goal of global tuberculosis control. Both assays have logistic advantages over the skin test, thus making them ideal candidates in situations where the tests need to be repeated over time (like in the setting of occupational medicine). In particular, the limited occurrence of the so-called "boosting" effect, the fact that there is no need for a return visit, the reduced variability in reading and reporting of the results and the quantitative response obtained with these assays are all elements that, altogether with the high specificity in BCG-vaccinated individuals, should favor the inclusion of these assays in the process of evaluation of the biologic risk for health care workers. Nonetheless, since these tests have been recently introduced in clinical practice, there are several aspects that still need to be clarified, such as the meaning of the quantitative responses and the interpretation of indeterminate results. It's therefore desirable that new documents will be produced soon to guide the use of these new tests in clinical routine
An update on the diagnosis of tuberculosis infection
No full textTargeted testing and treatment of individuals with latent tuberculosis infection at increased risk of progression to active disease is a key element of tuberculosis control. This strategy is limited by the poor specificity of the tuberculin skin test in populations vaccinated with bacille Calmette-Guérin and its low sensitivity in immunosuppressed persons, who are at highest risk of progression. Two blood tests (T-SPOT.TB and QuantiFERON-TB Gold), based on detection of IFN-gamma released by T cells in response to M. tuberculosis-specific antigens, may offer an improvement on the skin test. However, validation is challenging due to the lack of a diagnostic gold standard. This critical appraisal of published evidence summarizes the diagnostic accuracy of the new tests. The blood tests have operational advantages over the skin test because no return visit is required, results are available by the next day, and repeated testing does not cause boosting. Both tests are significantly more specific than the skin test in populations vaccinated with bacille Calmette-Guérin. The data suggest that T-SPOT.TB may be more sensitive than the skin test. Data in groups at high risk of progression to disease are scarce, and more research is needed in these populations, but it is clear that T-SPOT.TB performs better than the skin test in young children and HIV-infected people with active tuberculosis. Incorporation of these tests into programs for targeted testing of latent tuberculosis infection will reduce false-positive and false-negative results inherent in tuberculin testing, equipping clinicians with more accurate tools for tuberculosis control and elimination in the 21st century
Diagnosing latent tuberculosis infection: guess who's coming to dinner?
No full textComment on "Within-subject variability and boosting of T-cell interferon-gamma responses after tuberculin skin testing." [American Journal of Respiratory and Critical Care Medicine, 2009
Management of Idiopathic Pulmonary Fibrosis
No full textIdiopathic pulmonary fibrosis (IPF) is one of the most challenging diseases for chest physicians for a number of reasons, including the complexity of the diagnostic process, which requires close interaction with different specialists, and the almost invariably poor prognosis, with a 5-year survival of ∼20%. Moreover, until recently, IPF has lacked effective therapies. Following two decades of clinical trials, most of which have produced negative results, pirfenidone, a compound with broad antifibrotic, antiinflammatory, and antioxidant properties, and nintedanib, an orally available, small molecule tyrosine kinase inhibitor with selectivity for vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF), and fibroblast growth factor (FGF) receptors, have proved equally effective in slowing down functional decline and disease progression
with an acceptable safety profile. However, neither pirfenidone nor nintedanib is a cure for IPF;neither drug improves lung function and the disease continues to progress in most patients despite treatment. Likewise, the modalities for the follow-up of IPF patients are poorly defined. Accordingly, all decisions related to patient management need to be extensively
discussed and agreed upon with the patients and their families. As a result, few respiratory disorders require ofchest physicians more interactive skills and more dedication than IPF
- …
