Safety and tolerability of inhaled antibiotics in patients with bronchiectasis.

INTRODUCTION: Bronchiectasis is typically treated with inhaled antibiotics in clinical practice. However, there is a striking lack of standardised procedures for the preparation of noncommercial solutions. We used biochemical parameters to analyse the safety and tolerability of inhaled antibiotics in patients with bronchiectasis, and determined potential associations between the inhaled antibiotics used and adherence to the medications and quality of life. METHODS: We conducted a literature review, biochemical testing, and a pilot study of patients admitted to our hospital with noncystic fibrosis bronchiectasis. The MEDLINE database was searched for studies involving inhaled antibiotics to treat bronchiectasis. We analysed the pH, osmolality, and sodium and chloride ion concentrations of the antibiotics used. The pilot study included patients receiving inhaled antibiotic treatment. Demographic data, adherence, and quality of life were recorded and assessed. We determined potential associations between the study variables. RESULTS: The literature review identified 429 articles: 106 included precise instructions for diluting antibiotics, and 18 reported data on the biochemical parameters analysed. Laboratory results showed that some antibiotic dilutions were outside the range of tolerability, especially those involving dry powders for intravenous infusion, which must be diluted for their inhalation. Adherence was good in more than 80% of the patients, and higher in men and older patients. Men reported better quality of life. No associations were found between the antibiotics used and the other variables. CONCLUSION: Regarding the biochemical parameters analysed, there is a lack of information on the tolerability and biochemical safety of noncommercial dilutions of inhaled antibiotics used to treat bronchiectasis.

Validation of a novel and accurate ApoE4 assay for automated chemistry analyzers.

The allele ε4 of the apolipoprotein E gene (APOE ε4) is the major genetic risk factor for non-dominantly inherited Alzheimer's Disease (AD). Current techniques for APOE ε4 carriers identification show good accuracy but have several disadvantages that limit its implementation in a clinical laboratory. These include the need for sample preprocessing, poor automation, low throughput, requirement of additional equipment, and high cost. We followed ISO 13485 guidelines to validate the e4Risk test, a new latex-enhanced immunoturbidimetric blood assay for apolipoprotein E4 (ApoE4) determination in human plasma samples. The test showed high performance in terms of lot to lot variability, precision, interferences, reagents stability, prozone, and detectability. Furthermore, diagnostic accuracy is almost equal (99%) to the gold standard, APOE ε4 genotyping by polymerase chain reaction (PCR). Furthermore, we demonstrated that the e4Risk test can be adapted to any clinical chemistry analyzer, including the high throughput analyzers present in most hospitals and clinical laboratories. The e4Risk test versatility, low cost, and easiness provides an excellent solution for APOE ε4 carriers identification using the same blood sample drawn for biochemical diagnostic work-up of AD patients, which can have important advantages for patient stratification in clinical trials, preventative strategies for AD, and clinical assessment of risk for brain amyloidosis.

Prevalence, Incidence, and Sex Ratio of Transsexualism in the Autonomous Region of Madrid (Spain) According to Healthcare Demand.

In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.

Prevalencia de hiperandrogenismo y síndrome de ovario poliquístico en transexuales de mujer a hombre / Prevalence of hyperandrogenism and polycystic ovary syndrome in female to male transsexuals

INTRODUCCIÓN: La prevalencia de hiperandrogenismo (HA), que incluye el síndrome de ovario poliquístico (SOP), es alta en los pacientes transexuales de mujer a hombre (TMH). Este hecho se ha relacionado con el síndrome metabólico (SM), lo que parece aumentar la morbimortalidad cardiovascular a lo largo del tratamiento hormonal cruzado (THC). OBJETIVOS: Determinar la prevalencia de HA y SOP en pacientes TMH antes del inicio del THC, y su asociación con el SM y sus componentes, la insulinorresistencia (IR) y otros factores de riesgo cardiovascular (RCV). MATERIALES Y MÉTODOS: Setenta y siete TMH fueron valorados clínica y analíticamente para HA antes de iniciar el THC. También se determinaron los factores de RCV, la IR y otros parámetros del SM. RESULTADOS: La prevalencia de HA fue del 49,4% (el 73,7% de ellos con SOP [criterios de Rotterdam]), y del total de la muestra el 36,4% presentaron SOP. La prevalencia global de SM fue del 38,4 y 51,7% (criterios ATP-III e IDF, respectivamente). Los pacientes con HA frente a aquellos sin HA presentaban SM (criterios ATP-III e IDF, respectivamente) en el 36,8 y 57,9% frente al 25,6 y 41% (p < 0,0001 y p < 0,01, respectivamente). El 54,5% de los pacientes tenía normopeso (índice de masa corporal [IMC] 18,5-24,9 kg/m2), el 26% sobrepeso (IMC 25-29,9 kg/m2) y el 19,5% eran obesos (IMC ≥ 30 kg/m2). Al ajustar por el IMC la comparación de parámetros hormonales, metabólicos y antropométricos mostró diferencias estadísticamente significativas en los valores de glucemia, HOMA-IR y perímetro abdominal (p < 0,001), así como en los de colesterol-HDL (HDL) (p = 0,033), pero no en las concentraciones de testosterona total o de testosterona libre calculada. Del total de la muestra el 27,3% presentaron niveles de HDL por debajo de 50mg/dl. CONCLUSIONES: El HA y el SOP son muy prevalentes en la población TMH. HA y SOP se relacionan con el desarrollo temprano de SM, IR y otros factores de RCV, de consecuencias desconocidas en la edad adulta

INTRODUCTION: Prevalence of hyperandrogenism (HA), including the polycystic ovary syndrome (PCOS), in female-to-male transsexuals (FMT) is high. This has been related to metabolic syndrome (MS), which appears to increase cardiovascular morbidity and mortality throughout cross-sex hormone (CSH) therapy. OBJECTIVES: To assess the prevalence of HA and PCOS in FMT patients before the start of CSH therapy, and their association to MS and its components, insulin resistance (IR) and other cardiovascular risk (CVR) factors. MATERIALS AND METHODS: Seventy-seven FMTs underwent clinical and biochemical assessment for HA before the start of CSH therapy. CVR, IR, and other MS parameters were also assessed. RESULTS: Prevalence of HA was 49.4% (73.7% were cases of PCOS [Rotterdam criteria]), and prevalence of PCOS in the overall sample was 36.4%. Prevalence of MS was 38.4% and 51.7% according to ATP-III and IDF criteria respectively). MS (according to ATP-III and IDF criteria respectively) was found in 36.8% and 57.9% as compared to 25.6% and 41% of patients with and without HA respectively (p < 0.0001 and P < 0.01 respectively). Of total patients, 54.5% had normal weight (body mass index [BMI] 18.5-24.9 kg.m-2), 26% were overweight (BMI 25-29.9 kg.m-2), and 19.5% were obese (BMI ≥ 30 kg.m-2). After adjusting for BMI, the comparison of hormonal, metabolic, and anthropometric parameters showed statistically significant differences in plasma glucose, HOMA-IR, and abdominal circumference (P < 0.001 for all), as well as HDL cholesterol (HDL) (P = 0.033), but not in total testosterone or calculated free testosterone levels. In the total sample, 27.3% had HDL levels less than 50mg/dL. CONCLUSIONS: Overall HA, and PCOS in particular, are highly prevalent in FMTs. HA and PCOS are related to early development of SM, IR, and other CVR factors with unknown consequences in adulthood