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  • In this study, we tested two rapid molecular methods for the typing of Mycobacterium tuberculosis isolates in the National Tuberculosis Reference Service in Athens, Greece. Randomly amplified polymorphic DNA (RAPD) analysis with three different and/or one arbitrary primers and restriction fragment length polymorphism (RFLP), using non radioactive IS6110 probes, were used comparatively for the molecular typing of the isolates. We found that the PCR-based methods used could successfully type both related and unrelated strains. When the methods were compared for cost effectiveness and simplicity, the RAPD analysis with the IRIS primer was found to be the more convenient to our laboratory. The RAPD methods depend on nonspecific priming and PCR conditions, in a reference laboratory however, we compare strains in the same run and under the same PCR conditions. Pneumon 2000, 13 (2): 102-107
     
  • During the first 25 years of life, the lungs and the respiratory system undergo a phase of growth and maturation until maximal function is reached. Throughout the remainder of life, aging is associated with a progressive decline in lung performance. Normal aging of the respiratory system is attributed to structural changes of the chest wall (rib calcification, osteoporosis, vertebral fractures, narrowing of intervertebral disk spaces, increased dorsal kyphosis, “barrel chest” etc ), of the lung parenchyma (dilatation of alveoli, enfargement of airspaces, decrease in gas-exchange surface area and loss of supporting tissue for pelipheral airways) and of the respiratory muscles (decrease in muscle mass, decrease in the number of muscle fibres type II and motor units, alterations in neuromuscular junctions, decreased synthesis of myosin and decline in mitochondrial respiratory chain function). Age-related structural changes result in various functional alterations, such as increased chest wall stiffness, decreased lung elastic recoil and increased lung compliance, gas-trapping, hyperinflation and reduction of respiratory muscle strengrh. Furthermore, forced expiratory volume in one second (FEV1), vital capacity and expiratory flows at low lung volumes decline with a characteristic pattern in the flow-volume loop, indicating small airway dysfunction. Low ventilation-perfusion ratio (VA/Q) zones emerge as a result of premature closing of dependent airways and lead to an increase in VA/Q heterogeneity. Carbon monoxide diffusion decreases with age, reflecting a loss in surface area. Despite these extensive functional derangements, the respiratory system remains capable of maintaining adequate gas exchange at rest and on exertion, during the entire human lifespan, with only a mild decrease in arterial oxygen tension (PaO2) but without change in arterial carbon dioxide tension (PaCO2). However, aging tends to diminish the reserve of the respiratory system in cases of acute disease. In addition, the age-related diminished physical activity and the consequent deconditioning, the decreased sensitivity of respiratory centres to hypoxia/hypercapnia and the diminished ability to perceive added resistive and elastic loads, all may result in a blunted ventilatory response under various life-threatening clinical conditions (such as acute respiratory failure, heart failure and hydrostatic pulmonary edema, infection or bronchoconstriction) and therefore, lesser awareness of the disease and delayed diagnosis with possibly hazardous consequences. Pneumon 2000, 13 (2): 108-122
     
  • Our comparative economical study on cost differences between two discrete salbutamol (S) and beclomethazone dipropionate (BDP) release inhalers (metered dose inhalers, MDI vs breath actuated inhalers, BAI) resulted in the following conclusions. MDI seems to be 14% more expensive when it is used to release S by asthmatic patients, without any social insurance coverage, in comparison with the breath actuated device (BAI). When the devices under study where used to release BDP we also found cost difference. Pneumon 2000, 13 (2): 123-136
     
  • Maximum oxygen consumption (VO2 peak) during cardiopulmonary exercise test (CPET) is commonly used to assess working capacity in patients with cystic fibrosis (CF). The determinants of oxygen consumption after exercise in these patients are unknown. We assessed indices of oxygen kinetics during CPET and early recovery and explored their relation to disease severity measured by Schwachman’s score (SS). Nineteen patients with CF (10 male/9female, aged 24±13, SS 71±14) and 11 healthy subjects (3 male / 8 female aged 29±4) underwent a maximum CPET on a treadmill. Breath by breath analysis was used for measuring oxygen consumption (VO2), carbon dioxide production (VCO2) and ventilation. Maximum oxygen consumption (VO2 peak) and early recovery first degree slope (VO2/t-slope) for VO2 were calculated. Peak oxygen consumption was significantly lower in CF patients compared to healthy subjects (21±8 vs 35±8 ml/kg/mI p<0.01). In the CF group, VO2/t-slope correlated to VO2 peak (r=0.92, p<0.001), as well as to SS (r=0.86, p<0.001). We conclude that in CF patients, the prolonged oxygen kinetics during early recovery from maximal exercise is related to the disease severity. Pneumon 2000, 13 (2): 137-143
     
  • Oxidative stress contributes to airway inflammation and exhaled hydrogen peroxide (H2O2) is elevated in patients with bronchiectasis. However, the precise role of H2O2 in the pathophysiology of inflammatory processes remains unclear. We determined the concentration of exhaled H2O2 in 30 patients with documented bronchiectasis (24 male, mean age 39 ± 2.5 yrs, FEV1 69 ± 4 % pred) and studied the relation between levels of exhaled H2O2 and extent of the disease by high resolution computed tomographic scan (HRCT), spirometry and cellular population obtained from induced sputum. Additionally steroid treated patients were compared with steroid naοve. Exhaled H2O2 levels were significantly elevated in patients with bronchiectasis compared to 15 normal subjects (12 men, age 34 ± 4 yrs, FEV1 95 ± 3 % pred) (1.1 ± 0.1 μM vs. 0.3 ± 0.04 μM, p<0.0001). There was a significant positive correlation between H2O2, percentage of neutrophils in induced sputum and extent of the disease, as defined by the HRCT scoring scale system (r=0.9, p<0.0001 and r=0.66 p<0.0001, respectively). A significant negative correlation was found between H2O2 and FEV1 % pred (r=-0.42, p<0.05). Patients who were on inhaled steroids had similar values with steroid naοve (1.15 ± 0.15 μM vs. 1.02 ± 0.1 μM, p=0.12). In conclusion, patients with bronchiectasis in stable condition showed increased levels of exhaled H2O2. Hydrogen peroxide levels could be an index of the inflammation, obstruction and extent of the disease. Pneumon 2000, 13 (2): 144-153
     
  • Adenosine deaminase (ADA) is a widely used marker in the differential diagnosis of tuberculous effusion and there is evidence that its production is linked to Τ cells and monocytes. Both cell types are present in tuberculous effusions but are also present in malignant effusions where ADA activity is low. Furthermore, data on the correlation between ADA and Τ cells in tuberculous effusions are conflicting and based on small numbers of patients. We undertook this study to examine cell subsets in tuberculous effusion and their correlation to ADA. Pleural fluid from 73 patients was examined (thirty-seven patients with tuberculous and thirty-six patients with malignant effusion). The ΑΡΑΑΡ immunocytochemical method was used to examine Τ cells (CD3, CD4, CDB, CD25) and macrophages (CD68) while ADA activity was measured by the Guisti colometric method. Our results showed that CD3+, CD4+ and CD25+ cells and ADA were significantly higher in tuberculous effusion (p<0.001 for all measurements) while CD68+ were significantly lower (p<0.001). Νο differences were noted in CD68+ counts. Νο correlation was found betwween ADA and CD3 (r=0.18), CD4 (r=0.05), CD8 (r=0.09), CD25 (r=0.06), CD68 (r=0.04). Tuberculous effusion is characterized by high ADA activity and increased numbers of CD4+ Τ cells, but no correlation exists between ADA activity and cell numbers. Pneumon 2000, 13 (2): 154-160
     
  • The aim of the present study was the detection of H. pylori IgG, lgM, lgA antibodies in the serum of two groups of individuals. The first group consisted of 39 COPD patients and the second group consisted of 59 healthy individuals, 29 of whom were smokers and 30 non-smokers.The detection of H. pylori antibodies in the serum was performed using ELISA.The results did not confirm that there is a statistical difference in the incidence of H. pylori infection between the two groups. There is also no significant difference in the incidence of H. pylori infection (old or recent) between the subgroups of healthy individuals (smokers/non-smokers). Although smoking is a known contributor to the pathogenesis of peptic ulcer disease, it does not influence the incidence of H. pylori infection. Pneumon 2000, 13 (2): 161-165
     
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