Ambrisentan use in a HIV-1 infected patient with end-stage renal disease and pulmonary hypertension: minimal removal by hemodialysis - a case report.

BACKGROUND: Ambrisentan is a selective endothelin receptor antagonist used for the treatment of pulmonary arterial hypertension (PAH). Little is known about ambrisentan removal by hemodialysis in patients with end-stage renal disease (ESRD). CASE PRESENTATION: A 53-year-old woman with HIV/hepatitis C virus (HCV) co-infection, PAH and ESRD on regular hemodialyis was admitted in our hospital due to refractory heart failure while on treatment with bosentan (125 mg twice daily) and tadalafil (20 mg once daily) for PAH and antiretroviral treatment (cART) including darunavir/cobicistat (800/150 mg once daily). Excessive exposure to bosentan due to drug interactions between bosentan and darunavir/cobicistat was suspected. Bosentan was replaced by ambrisentan, with progressive improvement in her clinical condition. Pre- and postdialyzer cocentrations of ambrisentan in plasma were determined and hemodialysis extraction ratio for ambrisentan was 2%. CONCLUSIONS: Our results suggest that hemodialysis results in minimal ambrisentan removal, and therefore no specific ambrisentan dosage adjustment seems to be required in ESRD patients undergoing hemodialysis.

Definition of Episodic Dyspnea in Cancer Patients: A Delphi-Based Consensus among Spanish Experts: The INSPIRA Study.

BACKGROUND: Episodic dyspnea is an increasingly recognized phenomenon that occurs frequently in patients with cancer. Although numerous definitions have been proposed to describe episodic dyspnea, to date, no common widely accepted definition in Spanish has yet emerged. Without a clear well-accepted definition, it is difficult to design rigorous clinical trials to evaluate candidate treatments for this emerging entity and to compare outcomes among studies. OBJECTIVE: The aim of the study was to reach a consensus definition of episodic dyspnea in the Spanish language based on professional criteria in cancer patients. DESIGN: A two-round Delphi study. SETTING/SUBJECTS: Sixty-one Spanish specialists in medical oncology, radiation oncology, pneumology, palliative care, and pain management participated in the study. MEASUREMENTS: Sixteen different questions on dyspnea-related terminology, including the definition of episodic dyspnea, were assessed. RESULTS: The panel of experts reached a consensus on 75% of the 16 assessments proposed: 56.25% in agreement and 18.75% in disagreement. The term that most panelists considered most appropriate to define dyspnea exacerbation was dyspnea crisis. The panelists disagreed that dyspnea exacerbation is equivalent to dyspnea at effort and that the presence of dyspnea at rest is required for exacerbation to occur. However, there was wide agreement that exacerbation may or may not be predictable and can be triggered by comorbidities as well as emotional, environmental, or effort factors. CONCLUSIONS: The broad consensus reached in this study is a necessary first step to design high-quality methodological studies to better understand episodic dyspnea and improve treatment.

Síndrome hepatopulmonar y enfermedad pulmonar intersticial difusa: una asociación poco conocida / Hepatopulmonary Syndrome and Diffuse Interstitial Lung Disease: An Unusual Combination

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Association of influenza-like illness and climatic parameters with hemoptysis.

BACKGROUND: Although some authors have suggested that there is some seasonal periodicity of hemoptysis, or relation to respiratory tract infections, the association of influenza or climatic parameters with hemoptysis has been poorly investigated. Our aim was to describe the relationship between influenza and climatic parameters with severe hemoptysis that required bronchial artery embolization (BAE). METHODS: All consecutive subjects with at least one episode of hemoptysis that required BAE during a 5-y period were included. We applied a general multivariable additive seemingly causal model corresponding to a lagged variable autoregressive model with the exogenous variables as monthly mean temperature, lagged monthly mean temperature (-1), and monthly mean influenza activity, and the number of embolizations as the endogenous variable. RESULTS: We found a significant association between severe hemoptysis requiring BAE and low monthly mean temperature and influenza activity. Other climatic factors, such as atmospheric pressure, rainfall, relative humidity, or wind speed, failed to show significant association with the occurrence of life-threatening hemoptysis. CONCLUSIONS: There is a strong long running relationship between severe hemoptysis and low monthly mean temperature. A weaker association of hemoptysis with influenza activity was also found.

[Ostearticular tuberculosis. Study of 53 cases]. / Tuberculosis osteoarticular: estudio de 53 casos.

BACKGROUND AND OBJECTIVE: To analyze the characteristics of bone and joint tuberculosis in a Spanish university hospital. PATIENTS AND METHOD: Retrospective study (1984-2006) in a university hospital. All patients had microbiologically and/or histologically proved osteoarticular tuberculosis. Patients with clinical and radiological criteriae, positive tuberculin test responding to antituberculous treatment were not excluded despite negative cultures. RESULTS: We attended 53 patients with osteoarticular tuberculosis (35 males/18 females; mean age: 52 years). Bone tuberculosis involved axial skeleton in 37 patients (71%), peripheral distribution in 12 (21%) and both locations in 4 (8%). Mean time to diagnosis was 8 months. Most common involved joints were knee and ankle. An extraarticular involvement was found in 12 patients (22%) and multifocal bone infection in 6 (11%). Risk factors were present in 22 patients (42%), and 15% were immigrants. The diagnosis was established by a positive culture in 40 cases (75%), and 33 (62%) had suggestive histology. Complications of tuberculosis included medullar compression (9.4%), abscess (12%) and fistulae (9.4%). Spine involvement required surgical intervention in 27% and peripheral involvement in 56%. Curation was achieved in 33 patients (62.3%), curation with secuelae in 19 cases (35.9%) and no consolidation of arthrodesis in one case. CONCLUSIONS: Bone and joint tuberculosis is still common in our area and should be particularly considered in immigrants. Diagnosis delay is remarkable. Complications are present in one third of patients. Surgical treatment is often required.

Tuberculosis osteoarticular: estudio de 53 casos / Ostearticular tuberculosis. Study of 53 cases

Fundamento y objetivo: Analizar las características de la tuberculosis osteoarticular en un hospital universitario. Pacientes y método: Se ha realizado un estudio retrospectivo (1984-2006) de los pacientes con tuberculosis osteoarticular atendidos en el Hospital Universitario Germans Trias i Pujol de Badalona (Barcelona). Se incluyó a todos los pacientes con diagnóstico microbiológico y/o histológico, y también a los que tenían criterios clínicos y radiológicos indicativos, prueba de la tuberculina positiva (derivado proteico purificado) y respuesta favorable al tratamiento antituberculoso. Resultados: Se recogieron 53 casos de tuberculosis osteoarticular (35 eran varones). La edad media de los pacientes era de 52 años. La localización de la infección tuberculosa fue: esqueleto axial en 37 casos (71%), periférica en 12 (21%) y mixta en 4 (8%). El tiempo medio transcurrido hasta el diagnóstico fue de 8 meses. Las articulaciones más afectadas fueron la rodilla y el tobillo. Se halló simultáneamente otra localización extraarticular activa en 12 pacientes (22%) e infección ósea multifocal en 6 (11%). En 22 casos (42%) se observó algún factor de riesgo. El 15% eran inmigrantes. El diagnóstico se estableció por el resultado positivo del cultivo en 40 casos (75%) y 33 (62%) tuvieron histología compatible. Las complicaciones más frecuentes fueron la compresión medular (9,4%) y la formación de abscesos (12%) y fístulas (9,4%). Se intervino quirúrgicamente al 27% de los pacientes con afectación vertebral y al 56% de aquéllos con formas periféricas. Se obtuvo curación en 33 casos (62,3%), curación con secuelas en 19 (35,9%) y mala consolidación de la artrodesis en uno. Conclusiones: La tuberculosis osteoarticular es una infección prevalente en nuestro entorno y debe tenerse especialmente en cuenta en la población inmigrante. La demora hasta el diagnóstico es importante y sus complicaciones condicionan que más de la tercera parte de los pacientes precise tratamiento quirúrgico

Background and objective: To analyze the characteristics of bone and joint tuberculosis in a Spanish university hospital. Patients and method: Retrospective study (1984-2006) in a university hospital. All patients had microbiologically and/or histologically proved osteoarticular tuberculosis. Patients with clinical and radiological criteriae, positive tuberculin test responding to antituberculous treatment were not excluded despite negative cultures. Results: We attended 53 patients with osteoarticular tuberculosis (35 males/18 females; mean age: 52 years). Bone tuberculosis involved axial skeleton in 37 patients (71%), peripheral distribution in 12 (21%) and both locations in 4 (8%). Mean time to diagnosis was 8 months. Most common involved joints were knee and ankle. An extraarticular involvement was found in 12 patients (22%) and multifocal bone infection in 6 (11%). Risk factors were present in 22 patients (42%), and 15% were immigrants. The diagnosis was established by a positive culture in 40 cases (75%), and 33 (62%) had suggestive histology. Complications of tuberculosis included medullar compression (9.4%), abscess (12%) and fistulae (9.4%). Spine involvement required surgical intervention in 27% and peripheral involvement in 56%. Curation was achieved in 33 patients (62.3%), curation with secuelae in 19 cases (35.9%) and no consolidation of arthrodesis in one case. Conclusions: Bone and joint tuberculosis is still common in our area and should be particularly considered in immigrants. Diagnosis delay is remarkable. Complications are present in one third of patients. Surgical treatment is often required