Rodriguez Portal J.A.,Respiratory Unit
Advances in Clinical Chemistry | Year: 2012
Malignant pleural mesothelioma (MPM) is an extremely aggressive tumor which develops in the epithelial lining of the lungs. Exposure to asbestos is the most influential risk factor for developing this disease. Despite recent advances in the treatment of other types of cancer, patients with mesothelioma currently face a poor prognosis. Therefore, it is highly important to develop an early diagnostic method with the greatest challenge on screening techniques to detect the disease at a subclinical stage. Early detection is critical for the development of more effective therapies in these patients. Unfortunately, radiologic studies have not proven effective. Biomarkers might be a useful adjunct tool among populations previously exposed to asbestos. This review will provide an update of recent progress in serum biomarkers (osteopontin (OPN), soluble mesothelin (SM), and megakaryocyte potentiating factor (MPF)) to diagnose, detect, and monitor MPM. Of these, SM has demonstrated the greatest diagnostic potential although MPF may serve as an equal alternative. Despite recent studies, it is apparent that long-term large-cohort research is required to conclusively demonstrate the usefulness of these markers in this disease. Copyright 2012, Elsevier Inc.
Crimi C.,University of Catania |
Noto A.,Messina University |
Princi P.,National Research Council Italy |
Esquinas A.,Intensive Care Unit |
Nava S.,Respiratory Unit
European Respiratory Journal | Year: 2010
Although noninvasive ventilation (NIV) is becoming very popular, little is known about its pattern of clinical and technical utilisation in different environments. We conducted a web-based survey in Europe to identify the perceived pattern of NIV utilisation and the reason for choosing a specific ventilator and interface type in four common clinical scenarios: acute hypercapnic respiratory failure (AHRF), cardiogenic pulmonary oedema (CPE), de novo hypoxic respiratory failure and weaning/post-extubation failure (W/PE). A response was obtained from 272 (51.3%) out of 530 selected European physicians involved in NIV practice. The NIV utilisation rate was higher for pulmonologists than intensivists/anesthesiologists (p<0.05). The most common indication for all the physicians was AHRF (48%). Physicians were more likely to use NIV dedicated ventilator in AHRF and CPE and an intensive care unit (ICU) ventilator with NIV module in de novo hypoxic respiratory failure and W/PE, mainly because of the possibility of using the double circuit and inspiratory oxygen fraction control. Overall, the oro-nasal mask was the most frequently used interface, irrespective of clinical scenarios. The use of NIV in Europe is generally relatively high, especially among pulmonologists and in AHRF. Dedicated NIV ventilators and ICU ventilators with NIV modules are preferably in AHRF and in de novo hypoxic respiratory failure, respectively, together with oro-nasal masks. Copyright©ERS 2010.
Elphick H.E.,Respiratory Unit
The Cochrane database of systematic reviews | Year: 2013
The most serious complications of cystic fibrosis (CF) relate to respiratory insufficiency. Oxygen supplementation therapy has long been a standard of care for individuals with chronic lung diseases associated with hypoxemia. Physicians commonly prescribe oxygen therapy for people with CF when hypoxemia occurs. However, it is unclear if empiric evidence is available to provide indications for this therapy with its financial costs and often profound impact on lifestyle. To assess whether oxygen therapy improves the longevity or quality of life of individuals with CF. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Latest search of Group's Trials Register: 15 May 2013. Randomized or quasi-randomized controlled trials comparing oxygen, administered at any concentration, by any route, in people with documented CF for any time period. Authors independently assessed the risk of bias for included studies and extracted data. This review includes 11 published studies (172 participants); only one examined long-term oxygen therapy (28 participants). There was no statistically significant improvement in survival, lung, or cardiac health. There was an improvement in regular attendance at school or work in those receiving oxygen therapy at 6 and 12 months. Four studies examined the effect of oxygen supplementation during sleep by polysomnography. Although oxygenation improved, mild hypercapnia was noted. Participants fell asleep quicker and spent a reduced percentage of total sleep time in rapid eye movement sleep, but there were no demonstrable improvements in qualitative sleep parameters. Six studies evaluated oxygen supplementation during exercise. Again, oxygenation improved, but mild hypercapnia resulted. Participants receiving oxygen therapy were able to exercise for a significantly longer duration during exercise. Other exercise parameters were not altered by the use of oxygen. There are no published data to guide the prescription of chronic oxygen supplementation to people with advanced lung disease due to CF. Short-term oxygen therapy during sleep and exercise improves oxygenation but is associated with modest and probably clinically inconsequential hypercapnia. There are improvements in exercise duration, time to fall asleep and regular attendance at school or work. There is a need for larger, well-designed clinical trials to assess the benefits of long-term oxygen therapy in people with CF administered continuously or during exercise or sleep or both. However, we do not expect any new research to be undertaken in this area any time soon and do not plan to update this review again until any new evidence does become available.
Marcus R.,Tel Aviv University |
Paul M.,Tel Aviv University |
Paul M.,Rabin Medical Center |
Elphick H.,Respiratory Unit |
Leibovici L.,Tel Aviv University
International Journal of Antimicrobial Agents | Year: 2011
β-Lactam-aminoglycoside combinations are commonly used despite lack of evidence of a clinical benefit. In this study, all randomised controlled trials (RCTs) assessing directly the clinical implications of synergism by comparing a β-lactam with the same β-lactam in combination with an aminoglycoside as empirical or definitive therapy for any type of infection and clinical scenario were compiled. A systematic search was undertaken to identify all trials regardless of language, date or publication status. The primary outcomes assessed were all-cause mortality and clinical failure regardless of antibiotic modifications. Risk of bias was evaluated and its effect was assessed through sensitivity analyses. Two reviewers applied inclusion criteria and extracted the data independently. A fixed-effect meta-analysis was performed. Fifty-two RCTs were identified assessing patients with febrile neutropenia, pneumonia, abdominal infections, bacteraemia, endocarditis or cystic fibrosis. Only five trials were double-blinded. All-cause mortality was similar with monotherapy versus combination therapy [risk ratio (RR) = 0.96, 95% confidence interval (CI) 0.78-1.18, 28 trials, 3756 episodes]. Clinical failure regardless of antibiotic modifications was not significantly different (RR = 0.88, 95% CI 0.74-1.05, 27 trials, 2500 episodes). Treatment failure including antibiotic addition/modification occurred more frequently with monotherapy (RR = 1.20, 95% CI 1.12-1.28, 48 trials, 6643 episodes). There were no significant differences with regard to bacterial or fungal superinfections or development of antibiotic-resistant strains. Combination therapy resulted in a significantly higher incidence of adverse events, mainly nephrotoxicity. Overall, no clinical benefit was found for the use of a β-lactam with an aminoglycoside compared with a β-lactam alone. Treatment with β-lactams as monotherapy entailed more antibiotic regimen modifications in open trials. © 2010 Elsevier B.V. and the International Society of Chemotherapy.
Elphick H.E.,Respiratory Unit
Cochrane database of systematic reviews (Online) | Year: 2012
Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to colonisation of the lungs with the fungus Aspergillus fumigatus and affects around 10% of people with cystic fibrosis. ABPA is associated with an accelerated decline in lung function. High doses of corticosteroids are the main treatment for ABPA; although the long-term benefits are not clear, their many side effects are well-documented. A group of compounds, the azoles, have activity against Aspergillus fumigatus and have been proposed as an alternative treatment for ABPA. Of this group, itraconazole is the most active. A separate antifungal compound, amphotericin B, has been employed in aerosolised form to treat invasive infection with Aspergillus fumigatus, and may have potential for the treatment of ABPA. Antifungal therapy for ABPA in cystic fibrosis needs to be evaluated. The review aimed to test the hypotheses that antifungal interventions for the treatment of ABPA in cystic fibrosis: 1. improve clinical status compared to placebo or standard therapy (no placebo); 2. do not have unacceptable adverse effects.If benefit was demonstrated, we aimed to assess the optimal type, duration and dose of antifungal therapy. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.In addition, pharmaceutical companies were approached.Date of the most recent search of the Group's Trials Register: 09 February 2012. Published or unpublished randomised controlled trials, where antifungal treatments have been compared to either placebo or no treatment, or where different doses of the same treatment have been used in the treatment of ABPA in people with cystic fibrosis. Two trials were identified by the searches; neither was judged eligible for inclusion in the review. No completed randomised controlled trials were included. At present, there are no randomised controlled trials to evaluate the use of antifungal therapies for the treatment of ABPA in people with cystic fibrosis. Trials with clear outcome measures are needed to properly evaluate this potentially useful treatment for cystic fibrosis.