Lung function in adult patients with cystic fibrosis after using the eFlow® rapid for one year

Background

The new generation nebuliser PARI eFlow^® rapid allows a highly efficient aerosol delivery at reduced inhalation time. However, lung function data during long-term use of this device are not available until now.

Methods

70 clinically stable adult cystic fibrosis patients participated in this observation study. Lung function tests were performed prospectively 12 weeks after and again 9 to 12 months after switching the inhalation device from a conventional jet nebulizer to the PARI eFlow^® rapid. Lung function data were collected retrospectively from the visits 1 year as well as 12 weeks prior to the switch-over. Lung function data for all time points were only available for 59 patients. Treatment time and patient''s satification were recorded for both conventional and new nebuliser in all 70 patients.

Results

After 1 year of inhalation with eFlow^® rapid, the mean change in FEV1% was -- 1.4% (n = 59 patients). The decrease in FEV1 was smaller than the change in FEV1 after 1 year of inhalation with the conventional jet nebuliser (control period, -3.1%), although this difference was not statistically significant. The same effect was seen in MEF25[%] ''(-2.6% with conventional nebuliser compared to --1.6% after eFlow^® rapid). Concerning the FVC, there was a greater improvement after 1 year of inhalation with the eFlow^® rapid than with the jet nebuliser (+ 2.9% vs. +1.1%). For PEF%, there was an increase during the control period, whereas after inhalation with eFlow^® rapid there was a decrease (+1.1% vs. --2.9%). All changes were not significantly different. The eFlow^® rapid reduced total daily inhalation time by two-thirds (conventional nebuliser: 31.1 min/day; eFlow^® rapid: 10.2 min/day, n = 70 patients)

Conclusion

Inhalation with the new nebuliser eFlow rapid does not alter FEV1, FVC or PEF significantly after 1 year of inhalation. The treatment time could be reduced significantly by the eFlow^® rapid.     

Sero-epidemiological and behavioural survey of HIV,HBV and HCV amongst indian armed forces trainees

Background: Information on the emerging epidemics of Human immunodeficiency virus (HIV), Hepatitis B (HBV) and C (HCV) viruses in younger age groups in India is scanty due to paucity of representative, population based surveys and varied estimation methodology. This study was done to assess the point prevalence of HIV, HBV and HCV infections alongwith the epidemiological factors associated with these infections. Attitudes, beliefs and behaviour related to sexual and injecting drug practices, with a view to assess the need for introduction of screening program for the new entrants of the armed forces was also studied.     

Reduced expression of Bax in small cell lung cancer cells is not sufficient to induce cisplatin-resistance

Resistance to cisplatin in the course of chemotherapy contributes to the poor prognosis of small cell lung cancer (SCLC). B cell lymphoma-2 is the founding member of a large family of proteins that either promote or inhibit apoptosis. We aimed at investigating if the pro-apoptotic members Bad, Bax, Bim and Bid are involved in cisplatin-resistance. - Cisplatin-resistance in the SCLC cell line H1339 was induced by repetitive exposure to cisplatin. Protein expression was quantified by Western Blot and immuno-fluorescence analysis. Protein expression was altered using siRNA interference. - Four cycles of 0.5 μg/ml cisplatin led to partial cisplatin-resistance in H1339 cells. The expression of Bad, Bim and Bid was comparable in naive and resistant cells while the expression of Bax was reduced in the resistant clone. But, reducing Bax expression in naive cells did not lead to altered cisplatin sensitivity neither in H1339 nor in H187 SCLC cells. - We conclude that the reduced Bax expression after exposure to cisplatin is not sufficient to induce cisplatin-resistance in SCLC cells.     

Awareness of risk factors for coronary heart disease following interventional cardiology procedures: A key concern for nursing practice

Cardiovascular risk factor modification to prevent progression of coronary heart disease is important for patients following percutaneous coronary intervention. The aims of this study were to assess patient's awareness of modifiable cardiac risk factors and examine if patients with modifiable risk factors were more likely to identify these risk as amenable to change. Awareness of risk factors was measured using the Indiana Cardiac Rehabilitation Knowledge Questionnaire in a cohort of prospective, consecutive participants post percutaneous coronary intervention. Completed questionnaires were received from 75% of the participants. The majority were able to identify high cholesterol (87%), smoking (83%) and hypertension (82%) as modifiable risk factors. Less than half (46%) of the respondents identified diabetes as a modifiable risk factor. Only a third of participants recognized all six modifiable risk factors. A large proportion of patients who were smokers, or who had high cholesterol or hypertension, identified these as risk factors. A third of people with documented diabetes did not recognize this condition as a risk factor for heart disease. The findings have important implications for nursing practice in terms of directing educational efforts for the modification of risk factors for coronary heart disease.     

Bench-to-bedside review: The role of glycosaminoglycans in respiratory disease

The extracellular matrix (ECM) plays a significant role in the mechanical behaviour of the lung parenchyma. The ECM is composed of a three-dimensional fibre mesh that is filled with various macromolecules, among which are the glycosaminoglycans (GAGs). GAGs are long, linear and highly charged heterogeneous polysaccharides that are composed of a variable number of repeating disaccharide units. There are two main types of GAGs: nonsulphated GAG (hyaluronic acid) and sulphated GAGs (heparan sulphate and heparin, chondroitin sulphate, dermatan sulphate, and keratan sulphate). With the exception of hyaluronic acid, GAGs are usually covalently attached to a protein core, forming an overall structure that is referred to as proteoglycan. In the lungs, GAGs are distributed in the interstitium, in the sub-epithelial tissue and bronchial walls, and in airway secretions. GAGs have important functions in lung ECM: they regulate hydration and water homeostasis; they maintain structure and function; they modulate the inflammatory response; and they influence tissue repair and remodelling. Given the great diversity of GAG structures and the evidence that GAGs may have a protective effect against injury in various respiratory diseases, an understanding of changes in GAG expression that occur in disease may lead to opportunities to develop innovative and selective therapies in the future.     

Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo

Background Solar lentigines are common sun‐induced benign melanocytic proliferation that presents a significant cosmetic worrying for many middle‐aged and elderly patients. Although the newer photoselective lasers have become the mainstay of treatment, cryotherapy and trichloroacetic acid (TCA) solution are inexpensive alternatives in the treatment of solar lentigines. The purpose of this study was to assess the efficacy of cryotherapy compared with TCA 33% on solar lentigines of the back of the hands (SLBH) in patients presenting to dermatologic clinic of our hospital. Methods Each hand of 25 women with SLBH was treated randomly with either cryotherapy or TCA 33% solution. Photographs of the hands were taken prior to and 2 months following the treatment. The response and side‐ effect rate were compared. Results Cryotherapy was more likely to produce substantial lightening of the solar lentigines than TCA 33% solution (P = 0.025) but more painful and took more time to heal. Post‐inflammatory hyperpigmentation (PIH) was almost equal in two types of treatment (P > 0.05). Statistically, the better results were seen in fairer Fitzpatrick's skin types (P = 0.00). Conclusion Cryotherapy shows better results than TCA 33% solution in the treatment of SLBH particularly in lower Fitzpatrick skin types. PIH is the major complication of each type of treatments particularly in darker Fitzpatrick skin types. Generally, the major criterion for treatment of SLBH with cryotherapy or TCA is Fitzpatrick's skin type of patients.