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L'essentiel de la littérature réçente en Pneumologie

Dans cette rubrique on vous propose une revue de la littérature à travers une sélection d'abstracts d'articles originaux.
On essaiera de vous tenir informé des dernières nouveautés de recherche en matière de Pneumologie. On ne vous fournit que le résumé de l'article et le lien correspondant, pour accéder à l'article en full text vous devez être inscrits à la revue correspondante.
Cliquez ici pour consulter la liste des revues de Pneumologie disponibles en libre accès.



The Effects of Marijuana Exposure on Respiratory Health in U.S. Adults. Imprimer Envoyer
Samedi, 20 Décembre 2014 06:22

Given the inconclusive science on the long-term effects of marijuana exposure on lung function, the increasing tetrahydrocannabinol composition of marijuana over time and the increasing legal accessibility of the substance, continued investigation is needed.

Objectives: To determine the association between recent and long-term marijuana smoke exposure with spirometric parameters of lung function and symptoms of respiratory health in a large cohort of U.S. adults.

Methods: This is a cross-sectional study of U.S. adults who participated in the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey cycles, using the data from the standardized spirometry and survey questions performed during these years.

Measurements and Main Results: In the combined 2007-2010 cohorts, 59.1% had used marijuana at least once in their lifetime and 12.2% had used in the past month. For each additional day of marijuana use in the prior month, there were no associated changes in mean percent predicted FEV1 (0.002% ± 0.04%, P=0.9) but there was an associated increase in mean percent predicted FVC (0.13% ± 0.03%, P<0.01) and decrease in mean FEV1/FVC (-0.1% ± 0.04%, P<0.01). In multivariable regressions, 1-5 and 6-20 joint-years of marijuana use were not associated with an FEV1/FVC < 70% (OR 1.1, 95% confidence interval (CI) 0.7-1.6, P=0.8 and OR 1.2, 95% CI 0.8-1.8, p=0.4, respectively) while > 20 joint-years were associated with a FEV1/FVC <70% (OR 2.1, 95% CI 1.1-3.9, P=0.02). For each additional marijuana joint-year smoked, there was no associated change in mean percent predicted FEV1 (0.02% ± 0.02%, P=1.0), but there was an increase in mean percent predicted FVC (0.07% ± 0.02%, P<0.01) and a decrease in mean FEV1/FVC (-0.03% ± 0.01%, P=0.02).

Conclusions: In a large cross-section of U.S. adults, lifetime marijuana use up to 20 joint-years is not associated with adverse changes in spirometric measures of lung health. While > 20 joint-years of marijuana exposure was associated with a two-fold increased odds of a FEV1/FVC < 70%, this was the result of an increase in FVC rather than the disproportional decrease in FEV1 seen with obstructive lung diseases.

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Epidemiology of extra-pulmonary tuberculosis in the United States: high rates persist in the post-HIV era. Imprimer Envoyer
Samedi, 20 Décembre 2014 06:22

The incidence of tuberculosis (TB) in the United States has declined following a logarithmic pattern, with few exceptions. One exception was during the acquired immunodeficiency syndrome (AIDS) epidemic, which was thought to have caused the deviation. However, since then, alternative explanations have been proposed, including the increased burden of chronic diseases, immigration, and the increase in the use of immune suppressant medications.

METHODS: Epidemiological data of the Center for Disease Control and Prevention (CDC) and the Bureau of the Census were analyzed regarding TB incidence, human immunodeficiency virus (HIV) infection, immigration status, and age for the period 1953-2011.

RESULTS: Data analysis identified a deviation from the logarithmic decline in TB cases that started in the mid-2000s. This divergence did not appear to be related to HIV status. The overall decline in TB cases since 1953 has been almost exclusively due to a reduction in pulmonary TB (PTB) and not to extra-pulmonary TB (EPTB).

CONCLUSIONS: The HIV/AIDS epidemic likely played a significant role in the 1979-1985 deviation, but not subsequently. Furthermore, EPTB as a proportion of total TB cases has remained high. Further studies to delineate the etiologies of these findings are needed.

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Screening for active tuberculosis in high-risk groups. Imprimer Envoyer
Samedi, 20 Décembre 2014 06:22

OBJECTIVE: To evaluate an active case-finding strategy among drug users (DUs), economically disadvantaged individuals and recent immigrants from hyperendemic countries, a population at high risk of developing tuberculosis (TB).

METHODS: Retrospective, observational study carried out by the Tuberculosis Unit of the City of Barcelona from September 2009 to December 2012. All participants underwent chest X-ray and were screened for symptoms.

RESULTS: Of 5982 participants screened, 30 TB cases were detected (total prevalence 0.5%): 26 were pulmonary, 8 were smear-positive and 2 were resistant to multiple drugs. Directly observed treatment was advised for 19 patients (63%). TB prevalence in the recent immigrants group was significantly greater (1.77%) than in all other groups studied: economically disadvantaged individuals 0.30% (RR 5.9, 95%CI 2.30-15.14); DUs 0.62% (RR 2.05, 95%CI 0.91-4.64), non-recent immigrants 0.41% (RR 4.31, 95%CI 1.68-11.4); and all native-born individuals 0.41% (RR 4.33, 95%CI 1.71-10.92). The rate was much greater than the estimated prevalence for the general population of the city (∼20 cases/100 000 population).

CONCLUSIONS: In high-risk groups, active case finding can be used as a public health intervention to detect a large number of TB cases.

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