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BACKGROUND: This study sought to evaluate the impact of elexacaftor-tezacaftor-ivacaftor (ETI) on lung structural abnormalities in adults with cystic fibrosis (awCF) with a specific focus on the reversal of bronchial dilatations. METHODS: Chest computed tomography (CT) performed prior to, and ≥12â months after initiation of ETI were visually reviewed for possible reversal of bronchial dilatations. AwCF with and without reversal of bronchial dilatation (the latter served as controls with 3 controls per case) were selected. Visual Brody score, bronchial and arterial diameters, and lung volume were measured on CT. RESULTS: Reversal of bronchial dilatation was found in 12/235 (5%) awCF treated with ETI. Twelve awCF with and 36 without reversal of bronchial dilatations were further analyzed (male=56%, mean age=31.6±8.5â years, F508del/F508del CFTR =54% and mean %predicted forced expiratory volume in 1â s=58.8%±22.3). The mean±sd Brody score improved overall from 79.4±29.8 to 54.8±32.3 (p<0.001). Reversal of bronchial dilatations was confirmed by a decrease in bronchial lumen diameter in cases from 3.9±0.9â mm to 3.2±1.1â mm (p<0.001), whereas it increased in awCF without reversal of bronchial dilatation (from 3.5±1.1â mm to 3.6±1.2â mm, p=0.002). Reversal of bronchial dilatations occurred in cylindrical (not varicose or saccular) bronchial dilatations. Lung volumes decreased by -6.6±10.7% in awCF with reversal of bronchial dilatation but increased by +2.3±9.6% in controls (p=0.007). CONCLUSION: Although bronchial dilatations are generally considered irreversible, ETI was associated with reversal, which was limited to the cylindrical bronchial dilatations subtype, and occurred in a small subset of awCF. Initiating ETI earlier in life may reverse early bronchial dilatations.
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BACKGROUND: The European Medicines Agency has approved the cystic fibrosis transmembrane conductance regulator (CFTR) modulator combination elexacaftor-tezacaftor-ivacaftor (ETI) for people with cystic fibrosis (pwCF) carrying at least one F508del variant. The United States Food and Drug Administration (FDA) also approved ETI for pwCF carrying one of 177 rare variants. METHODS: An observational study was conducted to evaluate the effectiveness of ETI in pwCF with advanced lung disease that were not eligible to ETI in Europe. All patients with no F508del variant and advanced lung disease (defined as having a percent predicted forced expiratory volume (ppFEV1)<40 and/or being under evaluation for lung transplantation) and enrolled in the French Compassionate Program initiated ETI at recommended doses. Effectiveness was evaluated by a centralized adjudication committee at 4-6â weeks in terms of clinical manifestations, sweat chloride concentration and ppFEV1. RESULTS: Among the first 84 pwCF included in the program, ETI was effective in 45 (54%) and 39 (46%) were considered to be non-responders. Among the responders 22/45 (49%) carried a CFTR variant that is not currently approved by FDA for ETI eligibility. Important clinical benefits, including suspending the indication for lung transplantation, a significant decrease in sweat chloride concentration by a median [IQR] -30 [-14;-43]mmol·l-1 (n=42; p<0.0001) and an improvement in ppFEV1 by+10.0 [6.0; 20.5] (n=44, p<0.0001), were observed in those for whom treatment was effective. CONCLUSION: Clinical benefits were observed in a large subset of pwCF with advanced lung disease and CFTR variants not currently approved for ETI.
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Importance: A new treatment for cystic fibrosis combining 3 CFTR modulators-elexacaftor (ELX), tezacaftor (TEZ), and ivacaftor (IVA)-has recently been approved for cystic fibrosis treatment. The cutaneous adverse effects following treatment with this combination are poorly described in the literature. Objective: To describe the clinicopathological features and treatment response of ELX-TEZ-IVA-associated acneiform eruptions in patients with cystic fibrosis. Design, Setting, and Participants: This case series study was conducted in the Dermatology Department of Cochin Hospital, Paris, France, from July 2021 to June 2022 in collaboration with the Cochin Reference Center for Cystic Fibrosis. Referred patients were examined by senior dermatologists. All patients with cystic fibrosis treated with ELX-TEZ-IVA and referred for an acneiform rash were included. Exposures: Treatment with ELX-TEZ-IVA. Main Outcomes and Measures: Onset of acneiform rash, type of lesions, and degree of severity, as well as treatments initiated and response, were evaluated. When performed, skin biopsies were reviewed. Results: This study included 16 patients (11 women [68.7%]) with a median (range) age of 27 (22-38) years. Six patients (37.5%) developed new-onset acneiform rashes, whereas 10 patients (62.5%) had a relapse (5 patients) or worsening (5 patients) of previous acne. The median (range) onset of acneiform rash was 45 (15-150) days. At inclusion, 11 patients (68.7%) had facial hyperseborrhea, 15 patients (93.7%) had noninflammatory lesions, and 14 (87.5%) had inflammatory lesions of seborrheic regions. Four patients (25.0%) had severe acne with deep inflammatory lesions and pitted scars. A specific pathological pattern of necrotizing infundibular crystalline folliculitis was observed in 4 patients. Topical acne treatments, antibiotics, and isotretinoin were used successfully in these patients, resulting in partial or complete remission in 12 patients (85.7% of patients reevaluated). Conclusions and Relevance: This case series study found that acneiform eruption is an adverse event associated with ELX-TEZ-IVA treatment in patients with cystic fibrosis. Most patients developed mild lesions. However, isotretinoin treatment may be necessary in some patients. The mechanism of ELX-TEZ-IVA-associated acneiform eruption is currently unknown, but the observation of necrotizing infundibular crystalline folliculitis in biopsied patients may guide further exploration.
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Acne Vulgar , Erupções Acneiformes , Fibrose Cística , Exantema , Foliculite , Adulto , Feminino , Humanos , Acne Vulgar/tratamento farmacológico , Acne Vulgar/induzido quimicamente , Erupções Acneiformes/induzido quimicamente , Fibrose Cística/tratamento farmacológico , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/efeitos adversos , Combinação de Medicamentos , Exantema/induzido quimicamente , Foliculite/induzido quimicamente , Isotretinoína , Mutação , Masculino , Adulto JovemRESUMO
BACKGROUND: Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is the second most common cause of optic nerve-related permanent visual loss in adults. AIM: We aimed to analyze the efficacy of the noninvasive and minimally invasive therapeutic options of NAION. METHODS: We performed a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to 10 June 2019 to identify the studies that report on the effect of different therapies on visual acuity (VA) and visual field (VF). Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for these outcomes. The efficacy of steroids was investigated in quantitative, oxygen, steroid plus erythropoietin (EPO), levodopa/carbidopa, memantine, and heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) therapies and other therapeutic modalities in qualitative synthesis. RESULTS: Thirty-two studies were found to be eligible. We found that steroid therapy compared to control did not improve VA (p = 0.182, WMD = 0.14, 95% CI: -0.07, 0.35) or VF (p = 0.853, WMD = 0.16, 95% CI: -1.54, 1.86). Qualitative analysis could be performed for oxygen, steroid plus EPO, and HELP as well, however, none of them showed VA and VF benefit. Two individual studies found memantine and levodopa beneficial regarding VA. CONCLUSION: Our systematic review did not reveal any effective treatment. Further investigations are needed to find therapy for NAION.
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Neuropatia Óptica Isquêmica , Adulto , Humanos , Levodopa/uso terapêutico , Memantina/uso terapêutico , Neuropatia Óptica Isquêmica/tratamento farmacológico , Neuropatia Óptica Isquêmica/cirurgia , Oxigênio , Esteroides/uso terapêutico , Acuidade VisualRESUMO
In Sub-Saharan Africa, African giant pouched rats (Cricetomys gambianus) are trained to identify TB patients by smelling sputum. We conducted a systematic review and meta-analysis of the data to see if this novel method is comparable to traditional laboratory screening and detection methods like Ziehl-Neelsen stain-based assays (ZN) and bacterial culture. The search and data processing strategy is registered at PROSPERO (CRD42019123629). Medline via PubMed, EMBASE, Web of Science, and Cochrane Library databases were systematically searched for the keywords "pouched rat" and "tuberculosis". Data from 53,181 samples obtained from 24,600 patients were extracted from seven studies. Using sample-wise detection, the sensitivity of the studies was 86.7% [95% CI 80.4-91.2%], while the specificity was 88.4% [95% CI 79.7-93.7%]. For patient-wise detection, the sensitivity was 81.3% [95% CI 64.0-91.4%], while the specificity was 73.4% [95% CI 62.8-81.9%]. Good and excellent classification was assessed by hierarchical summary receiver-operating characteristic analysis for patient-wise and sample-wise detections, respectively. Our study is the first systematic review and meta-analysis of the above relatively inexpensive and rapid screening method. The results indicate that African giant pouched rats can discriminate healthy controls from TB individuals by sniffing sputum with even a higher accuracy than a single ZN screening.
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Técnicas de Laboratório Clínico/métodos , Mycobacterium tuberculosis/isolamento & purificação , Olfato , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Animais , Humanos , Mycobacterium tuberculosis/fisiologia , Reprodutibilidade dos Testes , Roedores , Sensibilidade e Especificidade , Tuberculose Pulmonar/microbiologiaRESUMO
Sexual dysfunction, following spinal cord injury (SCI), is highly dependent on the extent of injury. SCI disrupts the supraspinal innervation of the reproductive organs; resulting in structural and functional deficits. Relating the extent of SCI to these changes could eventually improve diagnoses and treatment planning of sexual dysfunction following SCI. In the present study, following chronic SCI of different severities (1/3 dorsal SCI (1/3 SCI), 2/3 dorsal SCI (2/3 SCI), and complete transection (Tx)) at T8 spinal level, histological changes of seminiferous tubules parameters in testis were examined. The diameter of seminiferous tubules (DST) and epithelial height of seminiferous tubules (HST) were significantly decreased in all SCI groups compared to control and sham. In addition, DST in 2/3 SCI and Tx groups and HST in Tx group were significantly decreased in comparison with 1/3 SCI animals. Nonetheless, the diameter of seminiferous tubules' lumen decreased significantly in 2/3 SCI and Tx compared to control, sham, and 1/3 SCI groups. Concerning cellular component, the number of spermatocytes and spermatids layers significantly decreased in both 1/3 and 2/3 SCI in comparison to normal. However, Tx had the most prominent deteriorating effect on these layers; indicating impairment in the process of spermatogenesis. These results show that the spinal tracts are part of the neural circuitries innervating the testis and responsible for their structural support. These tracts are mainly distributed between the lateral and ventral funiculi at T8 spinal level. Consequently, sparing ventral funiculi in the SCI prevents the severe decline in spermatogenesis.
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Hormônio Foliculoestimulante/farmacologia , Espermatogênese/efeitos dos fármacos , Traumatismos da Medula Espinal/fisiopatologia , Medula Espinal/fisiopatologia , Animais , Masculino , Tamanho do Órgão/fisiologia , Ratos Sprague-Dawley , Medula Espinal/efeitos dos fármacos , Testículo/patologia , Testículo/fisiopatologia , Testosterona/farmacologiaRESUMO
Although an extensive research is being undertaken, the ideal bone graft and evaluation method of the bone formation draw still a warranted attention. The purpose of this study was to develop a novel multimodal radiomics evaluation method, utilizing X-ray computed tomography (CT) and single photon emission computed tomography (SPECT) with Tc-99m-Methyl diphosphonate (Tc-99m-MDP) tracer. These modalities are intended to provide quantitative data concerning the mineral bone density (after evaluation it is referred to as opacity) and the osteoblast activity, at the same time. The properties of bone formation process within poly (methyl methacrylate)-based bone cement graft (PMMA) was compared to that of albumin coated, sterilized, antigen-extracted freeze-dried human bone grafts (HLBC), in caudal vertebrae (C5) of rats. The animals were scanned at 3 and 8 weeks after surgery. In both groups, the mean opacity increased, while the mean Tc-99m-MDP activity decreased. The later parameter was significant (n = 4, p = 0.002) only in HLBC group. The linear regression analysis of PMMA-treated group variables (mean opacity increase; mean Tc-99m-MDP activity decrease), revealed a negative correlation with the medium strength (r = 0.395, p = 0.605). Whereas, it showed strong positive correlation when HLBC group variables were analyzed (r = 0.772, p = 0.012). These results indicate that using HLBC grafts is advantageous in terms of the osteoblast activity and bone vascularization over PMMA cement. Using this regression analysis method, we were able to distinguish characteristics that otherwise could not be distinguished by a regular data analysis. Hence, we propose utilizing this novel method in preclinical tests, and in clinical monitoring of bone healing, in order to improve diagnosis of bone-related diseases.
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Processamento de Imagem Assistida por Computador/métodos , Osteogênese , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Animais , Feminino , Ratos , Ratos WistarRESUMO
BACKGROUND: Timely response should be provided when patients contact the cystic fibrosis (CF) centre in between scheduled visits. Little data exist on unplanned patient-initiated contacts in CF adults. METHODS: A two-stage prospective study was undertaken from 1 January to 31 December 2015 at Cochin Hospital, Paris (France). The first stage included all adults (≥18â¯years) who initiated unplanned contacts to the CF centre over four months. Four physicians and three nurses systematically recorded unplanned patient-initiated contacts. The data was analysed to determine why and how patients contacted the CF centre and time spent responding to their request(s). The second stage (one physician, three nurses) lasted twelve months and explored whether high contact frequency was associated with disease severity, using multivariate logistic regression. RESULTS: In the first stage, 259 of 410 patients (63%) initiated at least one unplanned contact, corresponding to 1067 contacts over 4â¯months. Patients favoured email with physicians (61% of contacts) and telephone with nurses (87% of contacts). Total time spent by the 7 caregivers on providing responses was 8â¯h/work week. Reasons for contacting the CF centre varied greatly, but <20% of contacts were directly related to symptom management. In the second stage, 180 of 212 patients (85%) initiated 1876 contacts over 12â¯months. Factors associated with ≥5â¯contacts/year were female sex, FEV1â¯≤â¯30% predicted, ≥5 physician visits/year, andâ¯≥â¯1 hospital admission/year. CONCLUSIONS: Answering unplanned patient-initiated contacts represented a significant workload for CF caregivers. Increased disease severity was associated with high contact frequency.
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Agendamento de Consultas , Fibrose Cística/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Carga de TrabalhoRESUMO
Background: The prevention and control of hypertension is an essential component for reducing cardiovascular disease burden. Hypertension is an important public health issue, yet few studies have examined its current status among the Lebanese population. Objective: To examine the prevalence, awareness, treatment and control of hypertension and its associated risk factors among Lebanese adults. Methods: A cross-sectional study was conducted between December 2014, and May 2015, on adults from the five districts of Lebanon. Multistage sampling was used to enroll participants. Hypertension was defined as an average of two blood pressure (BP) measurements with systolic/diastolic blood pressure of at least 140/90 mm Hg, using an automated digital device, or the use of antihypertensive medication. A questionnaire was used to assess hypertension risk factors, awareness, treatment and control. Results: Of the 1362 Lebanese adults interviewed, 399 (29.3%) had hypertension. Of these, 106 (26.5%) were aware of their condition. Sixty-nine patients (65%) of those aware, were receiving treatment, and 38 (55%) participants from those treated were controlled. The significant risk factors were sex, gender, age, family history of hypertension, obesity, and a low level of education. Conclusions: Hypertension is prevalent among the Lebanese adult population and is multifactorial, but remains incompletely recognized, leading to insufficient control. Hypertension was highly prevalent in males in the age category 18-29 years. These findings show that improvements in detection, treatment, and control of hypertension among Lebanese adults, is much needed.
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OBJECTIVE: To investigate the short-term adverse events and effectiveness of lumacaftor/ivacaftor combination treatment in adults with cystic fibrosis (CF) and severe lung disease in a real life setting. METHODS: A multicentre observational study investigated adverse events, treatment discontinuation, FEV1 and body mass index (BMI) one month and three months after lumacaftor/ivacaftor initiation in adults with CF and FEV1 below 40% predicted. RESULTS: Respiratory adverse events (AEs) were reported by 27 of 53 subjects (51%) and 16 (30%) discontinued treatment. The mean absolute change in FEV1 was +2.06% after one month of treatment (P=0.086) and +3.19% after 3 months (P=0.009). BMI was unchanged. CONCLUSIONS: Treatment with lumacaftor/ivacaftor in patients with CF and severe lung disease was discontinued more frequently than reported in clinical trials, due to respiratory AEs. Nevertheless, the patients who continued treatment had an increase in lung function comparable to what was observed in pivotal trials.
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Aminofenóis , Aminopiridinas , Benzodioxóis , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística , Quinolonas , Adulto , Aminofenóis/administração & dosagem , Aminofenóis/efeitos adversos , Aminopiridinas/administração & dosagem , Aminopiridinas/efeitos adversos , Benzodioxóis/administração & dosagem , Benzodioxóis/efeitos adversos , Fibrose Cística/diagnóstico , Fibrose Cística/tratamento farmacológico , Fibrose Cística/genética , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Feminino , França , Humanos , Masculino , Moduladores de Transporte de Membrana/administração & dosagem , Moduladores de Transporte de Membrana/efeitos adversos , Mutação , Avaliação de Processos e Resultados em Cuidados de Saúde , Quinolonas/administração & dosagem , Quinolonas/efeitos adversos , Testes de Função Respiratória/métodos , Índice de Gravidade de Doença , Suspensão de Tratamento/estatística & dados numéricosRESUMO
BACKGROUND/OBJECTIVES: Currently, factors that promote the occurrence of pancreatitis episodes in patients affected with cystic fibrosis (CF) and pancreatic sufficiency (PS) are largely unknown. METHODS: Six genes involved in pancreatitis or in ion transport into the pancreatic duct were investigated by next generation sequencing in 59 adult CF-PS patients with two identified CF mutations. Data on predisposing environmental factors were also recorded. RESULTS: 19 experienced at least one episode of acute pancreatitis (AP) (AP+) and 40 patients did not (AP-). No influence of environmental factor was evidenced. No specific CFTR genotype was found predictive of pancreatitis. Patients sharing the same CFTR genotype may or may not experience AP episodes. Frequent and rare missense variants were found in 78.9% patients in group AP+ and 67.5% in group AP- but a few of them were pathogenic. CONCLUSIONS: AP or recurrent AP (RAP) is a frequent complication in our series of adult CF-PS patients. The majority of mild CFTR mutations found in group AP+ were located in the first transmembrane region. No clear other genetic factor could be found predictive of AP/RAP. Further experiments in large homogenous cohorts of CF-PS patients, including whole genome sequencing, may identify genetic predisposing factors to pancreatitis.
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Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística/complicações , Fibrose Cística/genética , Predisposição Genética para Doença/genética , Mutação/genética , Pancreatite/etiologia , Pancreatite/genética , Adulto , Idade de Início , Fibrose Cística/epidemiologia , Feminino , Genótipo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/metabolismo , Pancreatite/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND AND AIMS: Pseudomonas aeruginosa (Pa) infection in cystic fibrosis (CF) patients is associated with worse long-term pulmonary disease and shorter survival, and chronic Pa infection (CPA) is associated with reduced lung function, faster rate of lung decline, increased rates of exacerbations and shorter survival. By using exome sequencing and extreme phenotype design, it was recently shown that isoforms of dynactin 4 (DCTN4) may influence Pa infection in CF, leading to worse respiratory disease. The purpose of this study was to investigate the role of DCTN4 missense variants on Pa infection incidence, age at first Pa infection and chronic Pa infection incidence in a cohort of adult CF patients from a single centre. METHODS: Polymerase chain reaction and direct sequencing were used to screen DNA samples for DCTN4 variants. RESULTS: A total of 121 adult CF patients from the Cochin Hospital CF centre have been included, all of them carrying two CFTR defects: 103 developed at least 1 pulmonary infection with Pa, and 68 patients of them had CPA. DCTN4 variants were identified in 24% (29/121) CF patients with Pa infection and in only 17% (3/18) CF patients with no Pa infection. Of the patients with CPA, 29% (20/68) had DCTN4 missense variants vs 23% (8/35) in patients without CPA. Interestingly, p.Tyr263Cys tend to be more frequently observed in CF patients with CPA than in patients without CPA (4/68 vs 0/35), and DCTN4 missense variants tend to be more frequent in male CF patients with CPA bearing two class II mutations than in male CF patients without CPA bearing two class II mutations (P = 0.06). CONCLUSIONS: Our observations reinforce that DCTN4 missense variants, especially p.Tyr263Cys, may be involved in the pathogenesis of CPA in male CF.
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Fibrose Cística/genética , Fibrose Cística/microbiologia , Complexo Dinactina/genética , Mutação de Sentido Incorreto , Infecções por Pseudomonas/genética , Adolescente , Adulto , Criança , Pré-Escolar , Cisteína/metabolismo , Fibrose Cística/complicações , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Fatores Sexuais , Tirosina/metabolismo , Adulto JovemRESUMO
Bronchial artery embolization is the recommended therapy for massive hemoptysis in patients with cystic fibrosis (CF). We report on two cases of multiple renal infarcts and renin-associated hypertension and hypokalemia occurring in CF adults after bronchial artery embolizations. These complications were presumably related to crossing of small calibrated microspheres through arteriovenous anastomoses. Although hypokalemia resolved rapidly, hypertension persisted at least 6 months and its control required multiple antihypertensive agents. Physicians should be aware of this potentially severe, but previously unreported, complication of bronchial artery embolization.
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Artérias Brônquicas , Fibrose Cística/complicações , Embolização Terapêutica/efeitos adversos , Hemoptise/terapia , Hipertensão/complicações , Renina/sangue , Adulto , Pressão Sanguínea/fisiologia , Broncoscopia , Fibrose Cística/sangue , Feminino , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Little data exist on causes of death in cystic fibrosis (CF) patients in the era of lung transplantation. METHODS: Deaths in CF patients in France (2007-2010) were identified using the French CF Registry and causes of deaths were determined based on medical files by a mortality adjudication committee. RESULTS: Of 256 deaths, half occurred after lung transplantation and were related to early or late complications of transplantation, whereas half occurred in patients who did not receive lung transplantation and were primarily related to respiratory failure or massive hemoptysis. Among patients who did not receive lung transplantation, only 19% died while waiting on a lung transplantation list. Lack of listing for lung transplantation was primarily related to late, or to lack of transplantation referral, rather than to contraindication to transplantation. CONCLUSIONS: These data suggest that improvement in transplantation referral strategies may result in transplantation-related survival benefits.
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Fibrose Cística/mortalidade , Transplante de Pulmão , Encaminhamento e Consulta/normas , Sistema de Registros , Insuficiência Respiratória/mortalidade , Adulto , Causas de Morte/tendências , Fibrose Cística/complicações , Fibrose Cística/cirurgia , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Prognóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto JovemRESUMO
BACKGROUND: Azithromycin reduces exacerbations in cystic fibrosis (CF) patients. Our aim was to investigate its association with nontuberculous mycobacteria isolation and macrolide susceptibility. METHODS: From 2006 to 2010, all adult CF subjects at Cochin Hospital (Paris, France) harboring at least one positive NTM isolate were identified (Cases). In a nested case-control study, each Case was individually matched for age and gender with up to 4 CF adults with no NTM isolate (Controls). Clinical data at the time of first NTM isolate (index date) in Cases were compared with those of Controls using multivariate conditional regression analysis. RESULTS: CF subjects with positive NTM isolates (Cases, n=41) were matched to 155 Controls. Among Cases, 48.7% had isolates from Mycobacterium avium complex and 58.5% from Mycobacterium abscessus complex, and 31 Cases fulfilled the 2007 American Thoracic Society criteria for NTM infection (ATS+ Cases). Cases and ATS+ Cases were more likely to have low body mass index and colonization with Aspergillus fumigatus. Azithromycin was associated with a two-fold reduction in NTM isolates. Only one M. avium complex isolate had acquired macrolide resistance. CONCLUSION: These data suggest that azithromycin is a primary prophylaxis for NTM infection in CF adults.
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Azitromicina/administração & dosagem , Fibrose Cística/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/prevenção & controle , Micobactérias não Tuberculosas/isolamento & purificação , Adulto , Antibacterianos/administração & dosagem , Fibrose Cística/complicações , Fibrose Cística/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Peripherally inserted central catheters (PICCs) are increasingly used in patients with cystic fibrosis (CF) or with non-CF bronchiectasis, but little data exist on catheter-related complications in this setting. METHODS: Prospective follow-up of consecutive PICCs inserted for intravenous (IV) antibiotics in adults with CF or with non-CF bronchiectasis at Cochin Hospital (Paris, France). RESULTS: Between March 2009 and December 2011, 182 PICCs were prescribed in 117 adults (67 CF and 50 non-CF patients). Ultrasound-guided placement of catheter was successful in 174/182 (95.6%) procedures; no insertion complication occurred. The mean ± SD catheter dwell time was 15 ± 9 days. No catheter-associated bloodstream infection occurred; main complications were symptomatic upper limb deep vein thrombosis (2%), catheter obstruction (18%) and persistent pain after catheter insertion (18%). Patients' satisfaction was high and PICC could be used to perform antibiotic courses in most patients. CONCLUSIONS: PICCs were generally safe for performing IV antibiotic courses in patients with CF or non-CF bronchiectasis, but prolonged pain and/or catheter obstruction occurred in approximately 20% of cases.
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Antibacterianos/administração & dosagem , Bronquiectasia/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Fibrose Cística/tratamento farmacológico , Administração Intravenosa , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/diagnóstico , Bronquiectasia/microbiologia , Obstrução do Cateter/etiologia , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Fibrose Cística/diagnóstico , Fibrose Cística/microbiologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Paris , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto JovemRESUMO
BACKGROUND: The 6 min walk test (6MWT) provides prognostic information in various respiratory diseases, but limited data exist in cystic fibrosis (CF) adults. METHODS: Consecutive CF adults who performed 6MWT at Cochin Hospital (Paris, France) over 12 years were analyzed. The cut-off 6 min walking distance (6MWD) value that best predicted a combined endpoint (death without transplant or lung transplant) was established using a receiver operating curve. Determinants of low 6MWD or of desaturation (SpO2 ≤ 90%) during 6MWT were examined using multivariate logistic regressions. Prognostic value of these variables was assessed using Kaplan-Meier and Cox analyses. RESULTS: 6MWT was performed in 286 CF adults (median: age, 28 yr; FEV1, 45% predicted) of whom 14% (n = 40) had lung transplant and 6% (n = 18) died without transplant. 6MWD correlated with FEV1% predicted (r = 0.43; P < 0.001), but markedly differed in subjects within the same range of FEV1. A 6MWD ≤ 475 m predicted death or transplant and was mostly found in patients with FEV1 ≤ 60% predicted. Desaturation during the 6MWT occurred in 29% of patients, exclusively in subjects with FEV1 ≤ 60% predicted. Both 6MWD ≤ 475 m and desaturation during the 6MWT were independent predictors of death or transplant. CONCLUSION: The 6MWT provides prognostic information in CF adults, especially in subjects with FEV1 ≤ 60% predicted.
Assuntos
Fibrose Cística/fisiopatologia , Teste de Esforço/métodos , Adulto , Fibrose Cística/sangue , Fibrose Cística/mortalidade , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Oxigênio/sangue , Prognóstico , Curva ROC , Caminhada/fisiologiaRESUMO
BACKGROUND: Although transplantation is known to impair glucose tolerance, evolution of pre-existing diabetes after lung transplantation (LT) in cystic fibrosis (CF) has never been described. OBJECTIVES: We aimed to assess the outcome of CF-related diabetes (CFRD) after LT, with the hypothesis that suppressing chronic inflammatory foci may improve glucose tolerance in some patients. METHODS: In a retrospective study of 29 CF diabetic patients treated with insulin and undergoing LT, CFRD control was assessed 3 months before LT and 1 (n = 27) and 2 (n = 18) years after LT by measuring insulin dosage, fasting blood glucose and glycosylated hemoglobin (HbA1c) levels. Patients with HbA1c ≤7% and an insulin dose ≤1 UI/kg/day were defined as having controlled CFRD (group A). Other patients were assigned to group B. RESULTS: Before LT, 19 (65.5%) patients were in group A. At 2 years, 6 of 10 (60%) patients who were in group B prior to LT had moved into group A, which then comprised 77.8% of all patients. Insulin could have been stopped in 5 patients. Uncontrolled CFRD before LT (OR = 16) and a long delay between the diagnosis of CFRD and LT (OR = 1.3) were significant predictors of uncontrolled CFRD at 1 year. CONCLUSIONS: LT does not seem to worsen CFRD in some patients, suggesting that in some cases, glucose tolerance may be improved by the suppression of chronic pulmonary infection.