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  • Congestive heartfailure (CHF) and sleep apnea-hypopnea syndrome (SAHS) are two conditions highly prevalent in the general population that often co-exist in the same patient. Patients with CHF often present disordered breathing during sleep that is characterized by episodes of central or obstructive apneas, whereas patients with SAHS suffer significant cardiovascular sequelae. The pathophysiological interactions between the two conditions involve both mechanical and neural effects, implicating the sympathetic nervous system. The application of non-invasive ventilation for the treatment of SAHS has beneficial effects on the concurrent CHF, providing new therapeutic horizons for this syndrome. Pneumon 2005,18(1):26-33.
     
  • Fungal infections have become an important problem in intensive care units (ICU) as a consequence of the relative insensitivity of available diagnostic methods, the delay in instituting therapy, the high cost and the poor prognosis associated with high mortality. Empirical treatment has been recommended for ICU patients who have identifiable predisposing factors for developing fungal infections and high suspicion without positive cultures for fungal species. The administration of empirical antifungal therapy is associated with some principal questions: which is the right time to initiate treatment, which drug, at what dose and for how long. The responsiveness, the toxicity and the daily cost of treatment are parameters to be taken into account in order to choose chemotherapy as precise guidelines are still not available. In this review the empirical therapy of fungal infections in ICU and the proposed therapeutic strategies to overcome problems arising in everyday practice are discussed. Pneumon 2005, 18(1):34-45.
     
  • Smoking causes significant health and economic consequences. The control of workers' smoking habit is a crucial point of health promotion in the workplace. Tobacco smoke can interact with other chemical hazards in the workplace increasing the risk for the development of lung cancer and Chronic Obstructive Pulmonary Disease (COPD). Workers' smoking habit has significant social determinants. Blue-collar workers present higher smoking prevalence and they are heavier smokers than white collar ones. Also blue-collar workers have higher rates of exposure to Environmental Tobacco Smoke (ETS). Some studies have shown that smoking restrictions and bans have a positive influence on the control of workers' smoking habit. However an effective antismoking campaign must not be partial but on the contrary integrated into a broader context of occupational health promotion and safety in the workplace. Pneumon 2005, 18(1):46-52.
     
  • Invasive techniques have been extensively used for the diagnosis of respiratory diseases. Among them bronchoscopy is the most common. In the past few years an increasing interest has been focused on the application of non invasive techniques as a tool in the diagnostic procedure of airway diseases. Among them, induced sputum has received much attention. Airway inflammation plays an important role in the pathogenesis of airway diseases such as asthma and chronic obstructive pulmonary disease. Induced sputum has been used in the evaluation of the inflammatory process but significantly less in the diagnostic procedure. However, the clarification of pending methodological problems and mainly the non invasive nature of the procedure is very promising in terms of using induced sputum for the diagnostic assessment of respiratory diseases. Pneumon 2005, 18(1):53-61.
     
  • Pleural effusions accompanying malignant disease pose a common diagnostic and therapeutic problem. Three types of neoplasms (lung and breast cancer and the lymphomas) account for 75% of secondary malignant effusions. Rarely, a tumour-associated effusion may not be due to direct involvement of the pleura by the malignancy (paramalignant effusion). The main symptoms are dyspnoea and dull chest pain, but 25% of cases may be asymptomatic at
     
  • Mass immigration from developing countries to industrialized countries entails the risk of spreading resistant strains of mycobacteria, which is associated with serious epidemiological, social and economic consequences. In the face of continuing large-scale immigration to Greece, we surveyed the number of new bacteriologically confirmed cases of tuberculosis; single resistance to isoniazid or rifampin; and multi-drug resistance, i.e. resistance to at least isoniazid and rifampin, of M. tuberculosis strains that were isolated from the first culture of sputum of immigrants in the period 1993-2002. To allow better insight, immigrants were separated to foreigners coming from South-Eastern Asia and Africa, and Greek immigrants to the Former Soviet Union who returned to their country. Findings were compared to relative data from native Greek patients in the same period. The number of newly diagnosed tuberculosis cases in native Greeks and returning Greek immigrants is constantly decreasing, probably due to higher living standards in Greece, whereas TB incidence among foreigners coming from South-Eastern Asia and Africa is rising, which may be attributed to the introduction of more effective surveillance systems in our country. Resistance of M. tuberculosis strains to isoniazid and rifampin is increasing in all three groups, most significantly in repatriated Greeks. Multidrug resistance also shows a significant increase in all three groups, particularly in repatriated Greeks. Pneumon 2005, 18(1):74-83.
     
  • There are no recent data on smoking habits of high-school students in Greece. The primary objective of the study was to determine the prevalence of smoking among high-school students in Northern Greece. The smoking habits of 9,276 high-school students [4,525 boys and 4,751 girls], aged between 15-18 years, in 6 cities of Northern Greece were examined. Study data were collected using a questionnaire. It was found that 32.6% of boys and 26.7% of girls are smokers. 43.3% had started smoking before the age of 14. The mean age for starting smoking was 14.4±1.9 years for the boys and 14.9±1.6 years for the girls. 25.4% of the students smoke 6 to 10 cigarettes per day and 20.7% 16 to 20 cigarettes per day. 40.2% reported that they smoke out of spite; Parents are aware that their offspring smoke in a proportion of 36.7%. Social standards and parental example were found to be the main determinants for starting smoking. The majority of the students [95.2%] stated that they are aware of the hazards associated with smoking. In conclusion, young people should be targeted with a well-planned integrated anti-smoking policy and not just an initiative for raising awareness of smoking hazards. Pneumon 2005, 18(1):99-104.
     
  • Acute chest syndrome (ACS) is the most common cause of death and the second most common cause of hospitalization of adults with sickle cell anemia. We present a case of acute chest syndrome with rapid deterioration to acute respiratory failure and need for mechanical ventilation. New data about the pathogenesis of ACS influence the current treatment of the disease, while priority remains in the clinical practice, to prevent progression of sickle cell crisis to acute chest syndrome. Pneumon 2005, 18(1):105-110.
     
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