Dr Victor Tang and Assoc Prof Frank Gaillard ◉ ◈ et al.
Addison Mitchell McConnell Jr. (born February 20, 1942) is an American politician. A member of the Republican Party, he has served since 1985 as United States senator for Kentucky, and since January 20, 2021, as Senate Minority Leader, having previously held the same position from 2007 to 2015. MAC infection is a serious condition that can cause damage to the lungs. MAC infection is not contagious. Common signs and symptoms of MAC lung disease include fatigue, chronic cough, shortness of breath, night sweats, coughing up blood and weight loss. Symptoms may persist or worsen despite being treated for another lung condition. See full list on help.syncromsp.com. Platform Installer, Size, and Checksum Date Notes; Microsoft Windows 64-bit: chimera-1.15-win64.exe Size: 152310162 bytes MD5: 6a68ab59b9ef89f6372cfc. If a patient’s RX reads.25 pl OS.25 pl OD with a 2.50 ADD and is having double vision when reading what is the medical term for the problem there are 2? Reply Ernie July 29, 2012 at 3:46 pm.
Pulmonary Mycobacterium avium complex (MAC) infection is a type of non-tuberculous mycobacterial (NTM) infection. It is relatively common and continues to pose significant therapeutic challenges. In addition, the role of MAC in pulmonary pathology remains controversial in many instances.
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Epidemiology
MAC infections often occur in patients with a pre-existing pulmonary disease or those with depressed immunity. However, it is also seen frequently in otherwise healthy patients, with a predilection for older women who deliberately suppress the cough reflex (Lady Windermere syndrome) 1-3.
Associations
A number of patient groups have been associated with increased risk of pulmonary MAC. They include 2,3:
- elderly, white, thin women: nodular bronchiectatic form (see below)
- middle-aged or elderly males who are smokers (often with COPD) or alcoholics: upper lobe cavitary form (see below)
- immunocompromised patients, e.g. AIDS
- patients with cystic fibrosis: MAC isolated in up to 13% of patients
- patients with alpha-1-antitrypsin deficiency
- other causes of bronchiectasis
- chronic obstructive pulmonary disease (COPD)
Isolation of MAC from a patient's lung is not pathognomonic of infection, as colonization is common, and thus microbiology needs to be correlated with clinical and radiographic appearances 2,3.
Clinical presentation
Pulmonary MAC infection is typically insidious, with a chronic cough usually productive of purulent sputum being most common. Little blob & the cloud empire mac os. Hemoptysis and constitutional symptoms are not typical 2.
Pathology
Mycobacterium avium and Mycobacterium intracellulare are now considered together, and referred to as Mycobacterium avium complex (MAC) or Mycobacterium avium-intracellulare complex (MAIC). They cannot be distinguished on the grounds of human pathologic manifestation or imaging features, and are treated similarly, although M. avium has a predilection for chickens whereas M. intracellulare prefers rabbits 2,3.
They are ubiquitous organisms, found in both fresh and salt water, but do not tend to cause human disease. Patients with MAC infection, unlike those with pulmonary tuberculosis, are not contagious 2.
Variants
- hot tub lung: granulomatous pneumonitis from exposure to aerosolized Mycobacterium avium complex (MAC) organisms in contaminated water (may not necessarily imply infection) 4
Radiographic features
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Three main forms of pulmonary MAC infections are recognized 3,5,6:
- upper lobe fibrocavitary pattern/cavitary form (classic infection)
- nodular bronchiectatic form/bronchiectatic form (non-classic infection)
- mixed form
In upper lobe cavitary form, thin-walled cavities with overall volume loss and fibrosis are the dominant feature, often also with features of endobronchial spread with tree-in-bud opacities seen elsewhere. Atomos mac os.
In the nodular or non-classic manifestation, the dominant feature is bronchiectasis with associated centrilobular nodules. Unlike pulmonary tuberculosis, there is no predilection for the upper lobes. In elderly white females, the right middle lobe and lingula are particularly affected.
Plain radiograph
Bronchiectasis, seen as tram-track opacities and ring shadows, may be evident. Patchy airspace opacities are also common. Pleural effusions are uncommon 2. Upper zone cavities may also be seen with associated volume loss and scarring 3.
CT
The most common findings of MAC infections include 1,2:
- bronchiectasis and bronchial wall thickening: most common findings
- small centrilobular nodules and tree-in-bud appearance
- patchy consolidation
- a predilection for the right middle lobe and lingula is seen particularly in elderly white women
- pleural thickening may be seen, usually adjacent to parenchymal change
- upper lobe cavitation may also be seen, although it is more characteristic of pulmonary tuberculosis
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Treatment and prognosis
Many treatment regimes have been published, with no clear gold-standard evident, although as is the case with pulmonary TB, multi-drug therapy is ideal to avoid resistance 2.
In patients who are unable to tolerate medical management, and who have an adequate respiratory reserve, resection of affected portions of the lung may be undertaken. Complications of surgery include bronchopleural fistulas, hemoptysis and empyema2.
In patients in whom isolates of MAC are not clearly pathogenic, follow-up is required, keeping in mind that evidence of radiographic progression may take a number of years to be convincing 3.
Prognosis depends on the form of the disease. In the upper lobe cavitary form, lung destruction is usually progressive and can lead to respiratory failure and death if successful treatment is not instituted.
In patients with the nodular bronchiectatic form (Lady Windermere syndrome) the disease is much more indolent, however, eventually, this form may also lead to enough parenchymal damage to result in respiratory failure and death 3.
Differential diagnosis
- Mycobacterium tuberculosis pulmonary infection:
- bronchiectasis is less commonly the dominant feature 1
- changes usually in the upper lobes 1
- see other causes of bronchiectasis
The underlying pulmonary abnormality (e.g. COPD, pneumoconiosis) may dominate the radiographic appearance.
- 1. Primack SL, Logan PM, Hartman TE et-al. Pulmonary tuberculosis and Mycobacterium avium-intracellulare: a comparison of CT findings. Radiology. 1995;194 (2): 413-7. Radiology (abstract) - Pubmed citation
- 2. Field SK, Fisher D, Cowie RL. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Chest. 2004;126 (2): 566-81. doi:10.1378/chest.126.2.566 - Pubmed citation
- 3. Müller NL, Franquet T, Lee KS et-al. Imaging of pulmonary infections. Lippincott Williams & Wilkins. (2007) ISBN:078177232X. Read it at Google Books - Find it at Amazon
- 4. Hartman TE, Jensen E, Tazelaar HD et-al. CT findings of granulomatous pneumonitis secondary to Mycobacterium avium-intracellulare inhalation: 'hot tub lung'. AJR Am J Roentgenol. 2007;188 (4): 1050-3. doi:10.2214/AJR.06.0546 - Pubmed citation
- 5. Kim TS, Koh WJ, Han J et-al. Hypothesis on the evolution of cavitary lesions in nontuberculous mycobacterial pulmonary infection: thin-section CT and histopathologic correlation. AJR Am J Roentgenol. 2005;184 (4): 1247-52. doi:10.2214/ajr.184.4.01841247 - Pubmed citation
- 6. Martinez S, McAdams HP, Batchu CS. The many faces of pulmonary nontuberculous mycobacterial infection. AJR Am J Roentgenol. 2007;189 (1): 177-86. doi:10.2214/AJR.07.2074 - Pubmed citation
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In 2007, a talented pair of scientist-programmers called Mekentosj released Papers, a Mac OS X app that did for scientific literature what iTunes did for music. They followed the desktop version with an iOS app that works as a standalone program or in conjunction with your Mac. The combination of Papers with an iPad is pretty good when it comes to catching up on your reading. Still, that was then and this is now, as they say, and a new and rebuilt Papers 2 is here to take over your research management needs.
Yes, new and rebuilt. Papers 2's innards have been redone from the ground up, and as we'll see in a bit, this has resulted in some teething trouble. Despite the internal changes, Papers 2 still has the same great Mac user experience that has won the company both Ars Technica and (several) Apple Design Awards.
Adding papers works in the same way it did before. If you already have a paper, you can drag and drop your PDFs onto the icon or the app. You can also import them from the search function, which works as a front end to a range of databases and repositories, including PubMed, Google Scholar, arXiv, and more. You can also now import directly from a scanner, which is a neat touch. If you're an existing Papers user, you can transfer your current library, and bidirectional syncing with iOS devices will also let you copy over data from your phone or iPad. For new users, Papers 2 will cost you $79, with a 50 percent discount for existing users, as well as price breaks for undergraduates—site licenses are also an option.
Unlike in 2007, Papers is no longer the only game in town in 2011. Probably its closest competitor is the cross-platform Mendeley, which we've looked at in the past—and that's still the best option for those of you who don't use OS X. Mendeley also had some features that Papers didn't; it supported a much wider range of documents than just scientific papers, and has social networking functions that allow you to find and share papers. Thankfully Mekentosj doesn't suffer from not-invented-here syndrome, and Papers 2 has adopted some of these.
Advertisement In addition to journal or newspaper articles, there is now support for patents, bills, laws, reports, and even media files. Back when I reviewed the first version of Papers, I wouldn't have appreciated how useful this is. Since moving into the field of science policy, however, the expansion of categories has proved invaluable, and gives Papers 2 an appeal to researchers beyond the life sciences.
Another feature that seems inspired by Mendeley is Livfe (pronounced 'life'), which brings social networking features to the app. I can't really comment on how it works as it has been closed to the bulk of Papers 2 users since the app launched a couple of months ago.
Probably the coolest new feature is Magic Manuscripts. You can throw away your copy of Endnote, because Papers 2 now integrates with most Mac OS X word processors (particularly Word and Pages) to let you find references, cite them in your document, and format bibliographies. Manuscripts runs in your menubar, and is activated by a keyboard shortcut that brings up a little search window that floats over your Word or Pages document. Papers will also keep track of different manuscripts you have or are working on, which is a neat touch. It integrates well into your workflow and is probably worth the upgrade price on its own. I'm a giant fan.
Unfortunately, it's not all kittens and sunshine. Because of the completely rewritten back end, lots of functionality from Papers 1 hasn't made the jump yet. For one, there's no way as of yet to merge authors or publications. This is really quite annoying, because JM Gitlin is considered a different author from Jonathan M. Gitlin. Likewise, differences in abbreviations of journals result in multiple entries. This function will be added back, but it cannot come too soon.
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Another really neat feature of Papers 1 was the ability to see the most recent 50 publications for each journal, which was a great alternative to subscribing to the journal's mailing list. This is also currently missing, although it too should reappear sooner or later. Being able to save custom searches is also currently missing, but bringing this back (as well as better DOI searching) remains high on the list of things being worked on, according to Alex Griekspoor, one of the original pair behind Mekentosj.
Support for users with multiple computers is still not where I'd like it to be. Mendeley uses a central server to store your database, which means you can keep your home and work computers perfectly synced. My current workaround involves using my iPad to shuttle references from work to home, which works pretty well. In the past, users have put their Papers database in a Dropbox folder, but this is not recommended. As with the features above, multiple computer support is also on the to do list for Mekentosj, and the furious rate of point upgrades—we're already at 2.0.6—tells me that they're not resting on their laurels.
So, should you upgrade? If you'd asked me when the app launched in March, I'd have said not just yet. Now, though, I think that enough functionality has been restored, and the added features are enticing enough, that you should take the plunge.