American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2006
ReviewAn official ATS statement: hepatotoxicity of antituberculosis therapy.
Drug-induced liver injury (DILI) is a problem of increasing significance, but has been a long-standing concern in the treatment of tuberculosis (TB) infection. The liver has a central role in drug metabolism and detoxification, and is consequently vulnerable to injury. The pathogenesis and types of DILI are presented, ranging from hepatic adaptation to hepatocellular injury. ⋯ Some experts recommend biochemical monitoring for those older than 35 years. Treatment should be interrupted and, generally, a modified or alternative regimen used for those with ALT elevation more than three times the upper limit of normal (ULN) in the presence of hepatitis symptoms and/or jaundice, or five times the ULN in the absence of symptoms. Priorities for future studies to develop safer treatments for LTBI and for TB disease are presented.
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Am. J. Respir. Crit. Care Med. · Oct 2006
Randomized Controlled Trial Multicenter StudyA multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation.
Duration of weaning from mechanical ventilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care. ⋯ The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning process.
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Am. J. Respir. Crit. Care Med. · Oct 2006
Comparative StudyClinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease.
The clinical features and outcome of macrolide-resistant Mycobacterium avium complex (MAC) lung disease are not known. ⋯ Macrolide resistance rarely occurs in patients also receiving ethambutol and a rifamycin. Macrolide-resistant MAC lung disease requires aggressive drug and surgical therapy for cure.
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Am. J. Respir. Crit. Care Med. · Oct 2006
Comparative StudyMutations of DNAI1 in primary ciliary dyskinesia: evidence of founder effect in a common mutation.
Primary ciliary dyskinesia (PCD) is a rare, usually autosomal recessive, genetic disorder characterized by ciliary dysfunction, sino-pulmonary disease, and situs inversus. Disease-causing mutations have been reported in DNAI1 and DNAH5 encoding outer dynein arm (ODA) proteins of cilia. ⋯ A total of 10% of patients with PCD are estimated to harbor mutations in DNAI1; most occur as a common founder IVS1+2_3insT or in exons 13, 16, and 17. This information is useful for establishing a clinical molecular genetic test for PCD.