Tuberculosis (TB) may produce abnormalities in the peripheral blood, including anemia. However, the evolution of TB-associated anemia with short-term combination anti-TB chemotherapy has not been well elucidated. The aim of this study was to characterize TB-associated anemia by clarifying its prevalence, characteristics, and evolution, through involving large numbers of patients with TB. The medical records of adult patients with TB diagnosed between June 2000 and May 2001 were reviewed. Among 880 patients with TB, 281 (31.9%) had anemia on diagnosis of TB, however, the hemoglobin concentration was less than 10 g/dL in only 45 patients (5.0%). Anemia was more frequently associated with the female and old age. Good treatment response, young age (≤65 yr-old) and initial high hemoglobin were the predictive factor for resolution of anemia. In 202 patients with anemia (71.9%), anemia was normocytic and normochromic. During or after anti-TB treatment, anemia was resolved in 175 (64.6%) out of 271 patients without iron intake. The mean duration of resolution from the initiation of anti-TB treatment was 118.8±113.2 days. In conclusion, anemia is a common hematological abnormality in patients with TB and close observation is sufficient for patients with TB-associated anemia, because TB-associated anemia is usually mild and resolves with anti-TB treatment.

C uring drug-sensitive tuberculosis (TB) takes 6 to 9 months of combination therapy despite the availability of antibiotics with potent in vitro activity, yet other pulmonary infectious diseases can be cured with single drugs that have similar mechanisms of action with only 3 to 14 days of treatment. One hypothesis used to explain the extended duration required with TB therapy is that subpopulations of bacteria become phenotypically drug tolerant in response to specific local microenvironmental conditions determined by the pathology of individual lesions (37). Understanding the features of these microenvironments and the conditions that generate tolerance may allow a rational design of drug regimens capable of shortening the time required to achieve a durable TB cure, but the methods used to evaluate new regimens have changed little and rely heavily on murine models of tuberculosis that typically have less complex lung pathology than human lesions. Premature discontinuation of treatment in humans results in disease relapse and the presence of cavities, and advanced lung pathology is strongly correlated with relapse (7,19,23). Only the rabbit and nonhuman primate models of pulmonary tuberculosis develop similar heterogeneous pathology, including the formation of cavitary disease. Guinea pigs, and some newer mouse models, develop more highly organized lesions, but these do not progress to cavities (for a comprehensive review of the comparative pathology of tuberculosis animal models, see reference 2).Nonterminal monitoring procedures, such as live imaging modalities, are increasingly being applied during TB drug efficacy experiments in animals and in human clinical trials (12,32,40,52). Structural and/or functional features observed in imaging modalities such as computed tomography (CT) and positron emission tomography (PET) are particularly attractive because they can be measured serially in a single subject at many time points during treatment. Computed tomography (CT) can add highly detailed information to the characteristic features of pulmonary tuberculosis visualized using conventional chest X-rays (1). CT scanning is typically used to monitor patients, assist in diagnosis, and assess surgical options for drug-resistant cases of disease (26), but there have been few examinations of the rate of change in CT findings during chemotherapy. The most detailed study of TB chemotherapy in patients (25) examined high-resolution CT scans from patients undergoing TB chemotherapy for up to 20 months. Old fibrotic lesions could be distinguished from active lesions, and criteria for the state of metabolic activity of lesions were proposed. However, that study did not sequentially

Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.

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Abstract:The Korean government has established a national plan for the promotion of zero energy buildings to respond to climate change and energy crises. To achieve this plan, several energy efficiency policies for new and existing buildings have been developed. The Building Energy Efficiency Certification System (BEECS) aims to promote the spread of high energy-efficient buildings by evaluating and certifying building energy performance. This study discussed Korean building energy efficiency policies and analyzed especially the influence of the BEECS on the actual energy consumption of a residential building and calculated energy performance of non-residential buildings. The BEECS was evaluated to have influence on gas and district heating consumption in residential buildings. For non-residential buildings, a decreasing trend was shown in calculated primary energy consumption in the years since the BEECS has been enacted. Appropriate improvements of the certification system were also discussed by analyzing relationship between building characteristics and their energy consumptions.

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Recent reports using a breathing simulator system have suggested that mesh nebulizers provide more effective medication delivery than jet nebulizers. In this study, the performances of jet and mesh nebulizers were evaluated by comparing their aerosol drug delivery efficiencies in mice. We compared four home nebulizers: two jet nebulizers (PARI BOY SX with red and blue nozzles), a static mesh nebulizer (NE-U22), and a vibrating mesh nebulizer (NE-SM1). After mice were exposed to salbutamol aerosol, the levels of salbutamol in serum and lung were estimated by ELISA. The residual volume of salbutamol was the largest at 34.6% in PARI BOY SX, while the values for NE-U22 and NE-SM1 mesh nebulizers were each less than 1%. The salbutamol delivery efficiencies of NE-U22 and NE-SM1 were higher than that of PARI BOY SX, as the total delivered amounts of lung and serum were 39.9% and 141.7% as compared to PARI BOY SX, respectively. The delivery efficiency of the mesh nebulizer was better than that of the jet nebulizer. Although the jet nebulizer can generate smaller aerosol particles than the mesh nebulizer used in this study, the output rate of the jet nebulizer is low, resulting in lower salbutamol delivery efficiency. Therefore, clinical validation of the drug delivery efficiency according to nebulizer type is necessary to avoid overdose and reduced drug wastage.

Toxocariasis is one of the causes of pulmonary eosinophilic infiltrate that is increasing in Korea. This study was designed to identify the prevalence of toxocara seropositivity in patients with unexplained pulmonary patchy infiltrate and to evaluate associated factors. We evaluated 102 patients with unexplained pulmonary patchy infiltrate on chest computed tomography (CT) scan. As a control set, 116 subjects with normal chest CT were also evaluated. History of allergic disease, drug use, parasitic disease and raw cow liver intake were taken. Blood eosinophil count and total IgE level were measured. Specific serum IgG antibody to Toxocara canis larval antigen and specific IgG antibodies to 4 other parasites were measured by enzyme-linked immunosorbent assay (ELISA). In the infiltrate group, 66.7% subjects were toxocara seropositive whereas 22.4% of the control group were seropositive (p<0.001). In the infiltrate group, patients with a history of eating raw cow liver (odds ratio [OR], 7.8) and patients with eosinophilia (OR, 5.2) had a higher incidence of toxocara seropositivity. Thirty-five percent of toxocara seropositive patients with infiltrate exhibited migrating infiltrate and 48% had decreased infiltrate on the follow-up CT. We recommend that toxocara ELISA should be performed in patients with unexplained pulmonary patchy infiltrate, and that the eating of raw cow liver should be actively discouraged.