Respirology : official journal of the Asian Pacific Society of Respirology
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Comparative Study
Health care-associated pneumonia in haemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy.
Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care-associated pneumonia (HCAP), and thus recommend treatment with broad-spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad-spectrum antibiotics versus narrow-spectrum antibiotics. ⋯ This study is the first to our knowledge to describe clinical outcomes in patients with haemodialysis as their only HCAP risk factor. Narrow-spectrum antibiotics may be safe in haemodialysis patients with no other HCAP risk factors. HCAP therapy delayed de-escalation to oral antibiotics was associated with increased duration of intravenous antibiotics and length of stay.
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Multidrug-resistant (MDR) tuberculosis (TB) denotes bacillary resistance to at least isoniazid and rifampicin. Extensively drug-resistant (XDR) TB is MDR-TB with additional bacillary resistance to any fluoroquinolone and at least one second-line injectable drugs. Rooted in inadequate TB treatment and compounded by a vicious circle of diagnostic delay and improper treatment, MDR-TB/XDR-TB has become a global epidemic that is fuelled by poverty, human immunodeficiency virus (HIV) and neglect of airborne infection control. ⋯ Immunotherapy may also have a role in the future. New diagnostics, drugs and vaccines are required to meet the challenge, but science alone is insufficient. Difficult MDR-TB/XDR-TB cannot be tackled without achieving high cure rates with quality DOTS and beyond, and concurrently addressing poverty and HIV.
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Meta Analysis
Obstructive sleep apnoea and the risk of type 2 diabetes: a meta-analysis of prospective cohort studies.
There has been increasing recognition that obstructive sleep apnoea (OSA) is associated with incident type 2 diabetes. The aim of this study was to assess the association between the severity of OSA and the risk of type 2 diabetes by performing a meta-analysis of all available prospective cohort studies. ⋯ This meta-analysis indicates that moderate-severe OSA is associated with an increased risk of type 2 diabetes, and this appears to be an independent risk factor for the development of diabetes.
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Identifying citation classics in the field is one of the key methodologies used to conduct a systematic evaluation of research performance. The objective of this study was to determine the most frequently cited articles published in journals that are placed under the 'respiratory system' subject category (Institute for Scientific Information (ISI) Journal Citation Reports) and to compare them with the most frequently cited respiratory-related articles published in any journal, regardless of subject category. The authors utilized the ISI Journal Citation Reports: Science Edition 2010 database in April 2012 to determine the most frequently cited articles by respiratory system subject category and by respiratory-related keywords. ⋯ The median numbers of citations for the top 50 cited articles stratified by respiratory system subject category and respiratory-related keywords were 841.5 and 2701, respectively. Half of the top 50 cited articles identified by respiratory-related keywords were published in general medical or basic science journals, whereas only three out of these were published in journals under the respiratory system subject category in ISI Journal Citation Reports. In summary, respiratory-related articles published in general medical or science journals attracted more citations than those published in the specific respiratory journals.