Publications by authors named "Paula Anderson"

42 Publications

Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial.

Clin Nutr 2021 Jun 12;40(6):3859-3867. Epub 2021 May 12.

Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Background & Aims: Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point.

Methods: A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and <1.8 en% n-6 LA or 3) a Control diet with typical American intakes of both EPA+DHA (<150 mg/day) and 7 en% from n-6 LA. Methods used to achieve diet change to week 16 include diet education, diet counseling, supply of specially prepared foods, self-monitoring and access to online diet materials. Only study oils and website materials were provided for the follow-up week 16 to week 22 periods. Diet adherence was assessed by multiple 24 h recalls administered throughout the trial. Diet acceptability was assessed in a subset of participants at 4 time points by questionnaire.

Results: At week 16 H3 and H3L6 diet groups significantly increased median n-3 EPA+DHA intake from 48 mg/2000 kcals at baseline to 1484 mg/2000 kcals (p < 0.0001) and from 44 mg/2000 kcals to 1341 mg/2000 kcals (p < 0.0001), respectively. In the Control group, EPA+DHA intake remained below the typical American intake with baseline median at 60 mg/2000 kcals and 80 mg/2000 kcals (p = 0.6) at week 16. As desired, LA intake was maintained in the H3 and Control group with baseline median of 6.5 en% to 7.1 en% (p = 0.4) at week 16 and from 6.5 en% to 6.8 en% (p = 1.0) at week 16, respectively. In the H3L6 group, n-6 LA decreased from 6.3 en% at baseline to 3.2 en% (p < 0.0001) at week 16. There were no significant changes in BMI or diet acceptability throughout the trial or between diet groups.

Conclusions: We find this diet method to be acceptable to research participants and successful in altering dietary n-3 EPA+DHA with and without concurrent decreases in n-6 LA. If n-6 LA of less than 3 en% is desired, additional techniques to limit LA may need to be employed.
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http://dx.doi.org/10.1016/j.clnu.2021.04.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293619PMC
June 2021

SARS-CoV-2 aerosol generation during respiratory equipment reprocessing.

Antimicrob Resist Infect Control 2021 05 27;10(1):82. Epub 2021 May 27.

Escola de Enfermagem da Universidade de São Paulo, Av Dr Enéas de Carvalho Aguiar, 419, Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil.

Aerosolization may occur during reprocessing of medical devices. With the current coronavirus disease 2019 pandemic, it is important to understand the necessity of using respirators in the cleaning area of the sterile processing department. To evaluate the presence of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the air of the sterile processing department during the reprocessing of contaminated medical devices. Air and surface samples were collected from the sterile processing department of two teaching tertiary hospitals during the reprocessing of respiratory equipment used in patients diagnosed with coronavirus disease 2019 and from intensive care units during treatment of these patients. SARS-CoV-2 was detected only in 1 air sample before the beginning of decontamination process. Viable severe acute respiratory syndrome coronavirus 2 RNA was not detected in any sample collected from around symptomatic patients or in sterile processing department samples. The cleaning of respiratory equipment does not cause aerosolization of SARS-CoV-2. We believe that the use of medical masks is sufficient while reprocessing medical devices during the coronavirus disease 2019 pandemic.
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http://dx.doi.org/10.1186/s13756-021-00955-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156569PMC
May 2021

SARS-CoV-2 reinfection caused by the P.1 lineage in Araraquara city, Sao Paulo State, Brazil.

Rev Inst Med Trop Sao Paulo 2021 23;63:e36. Epub 2021 Apr 23.

Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.

Reinfection by the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2) has been reported in many countries, suggesting that the virus may continue to circulate among humans despite the possibility of local herd immunity due to massive previous infections. The emergence of variants of concern (VOC) that are more transmissible than the previous circulating ones has raised particular concerns on the vaccines effectiveness and reinfection rates. The P.1 lineage was first identified in December 2020 in Manaus city and is now globally spread. We report the first case of reinfection of SARS-CoV-2 caused by the P.1 variant outside of Manaus. The potential of these new variants to escape naturally and vaccine- induced immunity highlights the need for a global vigilance.
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http://dx.doi.org/10.1590/S1678-9946202163036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075619PMC
May 2021

Prolonged presence of replication-competent SARS-CoV-2 in mildly symptomatic individuals: A report of two cases.

J Med Virol 2021 09 23;93(9):5603-5607. Epub 2021 Apr 23.

Instituto de Medicina Tropical de Sao Paulo, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil.

It has been estimated that individuals with COVID-19 can shed replication-competent virus up to a maximum of 20 days after initiation of symptoms. The majority of studies that addressed this situation involved hospitalized individuals and those with severe disease. Studies to address the possible presence of SARS-CoV-2 during the different phases of COVID-19 disease in mildly infected individuals, and utilization of viral culture techniques to identify replication-competent viruses, have been limited. This report describes two patients with mild forms of the disease who shed replication-competent virus for 24 and 37 days, respectively, after symptom onset.
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http://dx.doi.org/10.1002/jmv.27021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250959PMC
September 2021

Associations Between Religious/Spiritual Coping and Depression Among Adults with Cystic Fibrosis: A 12-Month Longitudinal Study.

J Relig Health 2021 Aug 11;60(4):2646-2661. Epub 2021 Feb 11.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Individuals with cystic fibrosis (CF) face a challenging disease, and depression is a significant concern. Many patients draw on religious/spiritual resources to assist them in managing the demands of chronic illness; however, these coping efforts rarely have been evaluated among adults with CF. This longitudinal study examined relationships between distinct types of positive and negative religious/spiritual coping at baseline (assessed with the RCOPE) and depression screening outcomes 12 month later (assessed with the Hospital Anxiety and Depression Scale). In logistic regression analyses controlling for disease severity (FEV% predicted), lower likelihood of depression caseness at 12 months was predicted by higher general religiousness at baseline, greater use of benevolent religious reappraisal coping, greater use of spiritual connection coping, and lower spiritual discontent. Results suggest that distinct aspects religious/spiritual coping have differential associations with subsequent depression outcomes. Findings extend prior research to an important, understudied medical population, and address a clinically meaningful outcome.
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http://dx.doi.org/10.1007/s10943-021-01185-xDOI Listing
August 2021

Ruptured Retinal Arterial Macroaneurysm.

Asia Pac J Ophthalmol (Phila) 2021 Jan-Feb 01;10(1):129

Queen Elizabeth Hospital, Adelaide, South Australia, Australia.

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http://dx.doi.org/10.1097/APO.0000000000000356DOI Listing
January 2021

Nucleoprotein-based ELISA for detection of SARS-COV-2 IgG antibodies: Could an old assay be suitable for serodiagnosis of the new coronavirus?

J Virol Methods 2021 04 13;290:114064. Epub 2021 Jan 13.

LIM-52, Institute of Tropical Medicine, School of Medicine, Clinical Hospital, University of São Paulo, Brazil; Department of Infection Diseases, Clinical Hospital, School of Medicine, University of São Paulo, Brazil.

Objectives: We evaluated the performance of a nucleoprotein-based enzyme-linked immunosorbent assay (ELISA) for detection of IgG antibodies to SARS-CoV-2.

Methods: The ELISA was based on serum IgG reactivity to a 46-kDa protein derived from the recombinant SARS-CoV2 nucleoprotein. Assay sensitivity was assessed using serum samples from 134 COVID-19 confirmed cases obtained > 15 days after symptom onset. Specificity was determined by testing sera from 94 healthy controls. Cross-reactivity was evaluated with sera from 96 individuals with previous dengue or zika virus-confirmed infections, with 44 sera from individuals with confirmed infections to other respiratory viruses or with bacterial and fungal infections that cause pneumonia and with 40 sera negative for SARS-CoV-2 nucleoprotein by commercial ELISA kits.

Results: The majority of subjects were male and ≥ 60 years old. Assay sensitivity was 90.3 % (95 % confidence interval 84.1 %-94.2 %) and specificity was 97.9 % (92.6 %-99.4 %). There was no cross-reactivity with sera from individuals diagnosed with dengue, zika virus, influenza virus, rhinovirus, adenovirus, respiratory syncytial virus, seasonal coronavirus, Mycobacterium tuberculosis, Staphylococcus (S. aureus and coagulase-negative), Streptococcus pneumoniae, Klebsiella pneumoniae and the fungus Aspergillus fumigatus. The level of concordance of our test with results from commercial ELISA kits was 100 %.

Conclusion: The nucleoprotein-based ELISA was specific for detection of IgG anti-nucleoprotein antibodies to SARS-CoV-2. It utilizes a frequently employed low expense assay protocol and is easier to perform than other currently available commercial SARS-CoV2 antibody detection tests.
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http://dx.doi.org/10.1016/j.jviromet.2021.114064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804377PMC
April 2021

Performance of at-home self-collected saliva and nasal-oropharyngeal swabs in the surveillance of COVID-19.

J Oral Microbiol 2020 Dec 9;13(1):1858002. Epub 2020 Dec 9.

Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil.

: SARS-CoV-2 quickly spreads in the worldwide population, imposing social restrictions to control the infection, being the massive testing another essential strategy to break the chain of transmission. : To compare the performance of at-home self-collected samples - saliva and combined nasal-oropharyngeal swabs (NOP) - for SARS-CoV-2 detection in a telemedicine platform for COVID-19 surveillance. : We analyzed 201 patients who met the criteria of suspected COVID-19. NOP sampling was combined (nostrils and oropharynx) and saliva collected using a cotton pad device. Detection of SARS-COV-2 was performed by using the Altona RealStar® SARS-CoV-2 RT-PCR Kit 1.0.  Results: There was an overall significant agreement (κ coefficient value of 0.58) between saliva and NOP. Considering results in either sample, 70 patients positive for SARS-CoV-2 were identified, with 52/70 being positive in NOP and 55/70 in saliva. This corresponds to sensitivities of 74.2% (95% CI; 63.7% to 83.1%) for NOP and 78.6% (95% CI; 67.6% to 86.6%) for saliva. : Our data show the feasibility of using at-home self-collected samples (especially saliva), as an adequate alternative for SARS-CoV-2 detection. This new approach of testing can be useful to develop strategies for COVID-19 surveillance and for guiding public health decisions.
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http://dx.doi.org/10.1080/20002297.2020.1858002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733974PMC
December 2020

Introduction of human gammaherpesvirus 8 genotypes A, B, and C into Brazil from multiple geographic regions.

Virus Res 2020 01 30;276:197828. Epub 2019 Nov 30.

Laboratory of Molecular Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-360, Brazil. Electronic address:

Variations in the open reading frame (ORF) K1 gene sequence of human gammaherpesvirus 8 (HHV-8) has led to the identification of 6 major genotypic clades (A, B, C, D, E, and F) in specimens isolated from around the world. These clades exhibit clear clustering among individuals in different ethnic groups and from different geographic regions. The human population of Brazil varies greatly in ethnicity because of multiple immigration events from Africa, Europe, Asia, and indigenous communities. However, there is scant information about the HHV-8 genotypes currently circulating in Brazil. Here, we describe HHV-8 genotypic diversity in isolates from Brazilian HIV-infected patients living with Kaposi's sarcoma (KS) by analysis of the complete ORF-K1 region. We also identified the most likely geographic origins of these different Brazilian genotypes. We extracted HHV-8 DNA (24 positive samples) from individuals with HIV/KS from the states of São Paulo and Rio de Janeiro, amplified the ORF-K1 gene using nested PCR (about 870 base pairs), performed sequencing and phylogenetic analysis, and then calculated the mean genetic distances of Brazilian sequences from sequences in other regions of the world (523 sequences analyzed). Phylogenetic analysis showed that genotypes C, A, and B were present in 45.8 %, 29.2 % and 25 % of the isolates from Brazil, respectively. These isolates grouped into separate clades, rather than a single monophyletic cluster. Mean genetic distance analyses suggested that these genotypes were introduced into the Brazil multiple times from different geographical regions. HHV-8/A isolates appear to be from Ukraine, Russia, and the Tartar ethnic group; HHV-8/B isolates appear to be from Congo and Democratic Republic of the Congo; and HHV-8/C isolates appear to be from Australia, Algeria, England, and French Guiana. These results contribute to a better understanding of the genetic diversity and origins of HHV-8 strains circulating in Brazil, and will provide a foundation for further epidemiological and evolutionary studies of HHV-8.
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http://dx.doi.org/10.1016/j.virusres.2019.197828DOI Listing
January 2020

Longitudinal associations between gratitude and depression 1 year later among adult cystic fibrosis patients.

J Behav Med 2020 08 28;43(4):596-604. Epub 2019 Jun 28.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Individuals with cystic fibrosis (CF) are confronted by a range of difficult physical and psychosocial sequelae. Gratitude has drawn growing attention as a psychosocial resource, but it has yet to be examined among adults with CF. The current investigation evaluated longitudinal associations between trait gratitude and subsequent outcomes from depression screening 12 months later, adjusting for disease severity (FEV% predicted) and other significant clinical or demographic covariates. Participants were 69 adult CF patients recruited from a regional adult treatment center. They completed a validated measure of gratitude (Gratitude Questionnaire-6) at baseline and a screening measure of depression (Hospital Anxiety and Depression Scale) at 12-month follow-up. In a logistic regression analysis controlling for disease severity, higher levels of baseline gratitude were associated with reduced likelihood of depression caseness at 12 months (OR .83, 95% CI .73-.91, p = .001). Gratitude remained predictive after adjusting for other psychosocial resource variables (i.e., perceived social support and positive reframing coping). Findings offer an initial indication of the potential salutary role of dispositional gratitude in an understudied clinical population.
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http://dx.doi.org/10.1007/s10865-019-00071-yDOI Listing
August 2020

Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics.

Rev Inst Med Trop Sao Paulo 2019 4;61:e19. Epub 2019 Apr 4.

Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.
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http://dx.doi.org/10.1590/S1678-9946201961019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453419PMC
April 2019

Persistent Adherence to Airway Clearance Therapy in Adults With Cystic Fibrosis.

Respir Care 2019 Jul 19;64(7):778-785. Epub 2019 Mar 19.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Background: Airway clearance therapy (ACT) is a core component of daily treatment for cystic fibrosis (CF). However, surprisingly little is known about sustained or persistent use of ACT over time among adults with CF. This longitudinal study examined persistent adherence to ACT over 12 months and its modifiable predictors, drawing on aspects of Social Cognitive Theory and the Theory of Planned Behavior.

Methods: Subjects were drawn from a regional CF center in the southern United States. Predictor variables evaluated at baseline included self-efficacy for ACT (ie, self-confidence in overcoming barriers), outcome expectations (ie, perceived necessity of ACT and concerns about its disruptive effects), and subjective norms (ie, perceptions of being influenced by others). The Cystic Fibrosis Treatment Questionnaire (CFTQ) was used to assess self-reported adherence to ACT at baseline, at 6 months, and at 12 months.

Results: The mean age of subjects was 27.2 ± 9.1 y, and mean FEV% predicted was 65.5 ± 24.8. Forty-six percent of subjects reported persistent use of ACT (classified as adherent at all assessment periods). In bivariate analyses, all social cognitive predictor variables assessed at baseline were significantly related to persistent adherence (all < .03), except subjective norms. In logistic regression analyses that modeled the effects of these predictors simultaneously while controlling for FEV%, fewer baseline concerns about ACT (odds ratio = 0.82, 95% CI 0.69-0.99) and greater self-efficacy (odds ratio = 1.09, 95% CI 1.01-1.18) remained significant independent predictors.

Conclusions: This longitudinal study addresses an important gap in the literature regarding adherence to ACT over time (12 mo) in a routine clinical setting. Persistent adherence was problematic. As anticipated, social cognitive variables (self-confidence and perceived concerns) predicted self-reported persistence, and these may represent practical targets for intervention.
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http://dx.doi.org/10.4187/respcare.06500DOI Listing
July 2019

Evaluation of serological cross-reactivity between yellow fever and other flaviviruses.

Int J Infect Dis 2019 Apr 17;81:4-5. Epub 2019 Jan 17.

Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Hospital das Clinicas HCFMUSP (LIM52), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Electronic address:

Objectives: This study was performed to determine whether neutralizing antibodies against yellow fever virus (YFV) generated by YFV vaccine could interfere in the specificity of dengue virus (DENV) and Zika virus (ZIKV) IgG ELISA tests.

Methods: Seventy-nine pairs of serum samples (pre- and post-vaccination), collected during the years 1997-1998 from children with no history of yellow fever disease who had been vaccinated against YFV, were tested. The seroconversion post-vaccination was evaluated through plaque reduction neutralization test (PRNT), and four different commercial ELISA kits were used for the detection of DENV and ZIKV IgG antibodies.

Results: A cross-reactivity rate of 3.9% with DENV IgG antibodies was found only with the Dengue Virus IgG Dx Select kit (Focus Diagnostics).

Conclusions: As several countries have local transmission of multiple arboviruses, the absence of cross-reactivity or minimum cross-reactivity of YFV neutralizing antibodies with DENV and ZIKV antigens is a relevant finding, since the interpretation of sero-epidemiological investigations would be seriously impacted in many regions where YFV vaccination is mandatory.
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http://dx.doi.org/10.1016/j.ijid.2019.01.023DOI Listing
April 2019

Effectiveness of essential amino acid supplementation in stimulating whole body net protein anabolism is comparable between COPD patients and healthy older adults.

Metabolism 2017 Apr 20;69:120-129. Epub 2016 Dec 20.

Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A.

Background: The development of effective nutritional strategies in support of muscle growth for patients with chronic obstructive pulmonary disease (COPD) remains challenging. Dietary essential amino acids (EAAs) are the main driver of postprandial net protein anabolism. In agreement, EAA supplements in healthy older adults are more effective than supplements with the composition of complete proteins. In patients with COPD it is still unknown whether complete protein supplements can be substituted with only EAAs, and whether they are as effective as in healthy older adults.

Methods: According to a double-blind randomized crossover design, we examined in 23 patients with moderate to very severe COPD (age: 65±2 years, FEV: 40±2% of predicted) and 19 healthy age-matched subjects (age: 64±2 years), whether a free EAA mixture with a high proportion (40%) of leucine (EAA mixture) stimulated whole body net protein gain more than a similar mixture of balanced free EAAs and non-EAAs as present in whey protein (TAA mixture). Whole body net protein gain and splanchnic extraction of phenylalanine (PHE) were assessed by continuous IV infusion of L-[ring-H]-PHE and L-[ring-H]-tyrosine, and enteral intake of L-[N]-PHE (added to the mixtures).

Results: Besides an excellent positive linear relationship between PHE intake and net protein gain in both groups (r=0.84-0.91, P<0.001), net protein gain was 42% higher in healthy controls and 49% higher in COPD patients after intake of the EAA mixture compared to the TAA mixture (P<0.0001). These findings could not be attributed to the high LEU content, as in both groups net protein gain per gram EAA intake was lower for the EAA mixture (P<0.0001). Net protein gain was higher in COPD patients for both mixtures due to a 40% lower splanchnic extraction (P<0.0001), but was similarly related to dietary PHE (i.e. EAA) plasma appearance.

Conclusions: In COPD patients, similarly to healthy older adults, free EAA supplements stimulate whole body protein anabolism more than free amino acid supplements with the composition of complete proteins. Therefore, free EAA supplements may aid in the prevention and treatment of muscle wasting in this patient population.
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http://dx.doi.org/10.1016/j.metabol.2016.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351771PMC
April 2017

Contemporary national trends of cystic fibrosis hospitalizations and co-morbidities in the United States.

Adv Respir Med 2016 ;84(6):316-323

University of Arkansas for Medical Sciences, USA.

Introduction: Cystic fibrosis (CF) is a life-limiting multisystemic genetic disease. Patients with CF have a high rate of hospitalization. We attempt to ascertain national trends of inpatient stays, prevalence of various co-morbidities during hospitalizations, outcomes and discharge disposition among CF patients.

Material And Methods: Data from the National Inpatient Sample (NIS) was used to identify all hospitalizations of patients with CF and their demographic characteristics from 2003 to 2013. Prevalence and effects of various co-morbidities like acute kidney injury (AKI) were determined. Detailed sub-group analysis was performed for individuals with lung transplant.

Results: The annual rate of hospitalization per 1,000 CF patients in the U.S. increased from 994 in 2003 to 1,072 in 2013. The overall in-hospital mortality was 1.5%; median age at death was 27 years. In-hospital mortality trended down from 1.9% to 1.2% from 2003 to 2013 (p-value for trend: 0.002). The median length of stay was 7 days. The prevalence of chronic liver disease and AKI was 3.7% and 3.8% respectively. Multivariate adjusted odds of mortality for AKI was 1.74 (95% CI 1.57-1.93, p < 0.001). Patients with prior lung transplantation accounted for 6.5% of hospitalizations. These patients had a significantly higher prevalence of AKI.

Conclusions: The annual hospitalization rates of CF patients is increasing over the years. Females with CF constitute a higher proportion of hospitalized patients despite a higher male preponderance of males with CF in the community. AKI is associated with a significantly higher in-hospital mortality. Lung transplant recipients have a higher prevalence of AKI and mortality.
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http://dx.doi.org/10.5603/ARM.2016.0041DOI Listing
January 2016

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.

Am J Gastroenterol 2016 11 2;111(11):1630-1636. Epub 2016 Aug 2.

University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.

Objectives: Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.

Methods: We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.

Results: FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.

Conclusions: Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.
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http://dx.doi.org/10.1038/ajg.2016.286DOI Listing
November 2016

Alterations in whole-body arginine metabolism in chronic obstructive pulmonary disease.

Am J Clin Nutr 2016 06 4;103(6):1458-64. Epub 2016 May 4.

Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX; and Departments of Geriatrics and.

Background: Chronic obstructive pulmonary disease (COPD) is a condition characterized by systemic low-grade inflammation that could increase the production of nitric oxide (NO), of which arginine is the sole precursor. Arginine is derived from the breakdown of protein and through the conversion of citrulline to arginine (de novo arginine production).

Objective: Our objective was to study whole-body arginine and citrulline and related metabolism in stable COPD patients.

Design: With the use of stable isotope methodology, we studied whole-body arginine and citrulline rates of appearance, de novo arginine (citrulline-to-arginine flux) and NO (arginine-to-citrulline flux) production, protein synthesis and breakdown rates, and plasma amino acid concentrations in a heterogeneous group of patients with moderate-to-severe COPD [n = 23, mean ± SE age: 65 ± 2 y, forced expiratory volume in 1 s (FEV1): 40% ± 2% of predicted], and a group of healthy older adults (n = 19, mean ± SE age: 64 ± 2 y, FEV1: 95% ± 4% of predicted).

Results: Although plasma arginine and citrulline concentrations were comparable between COPD patients and controls, whole-body arginine (P = 0.015) and citrulline (P = 0.026) rates of appearance were higher in COPD patients and related to a 57% greater de novo arginine production (P < 0.0001). Despite a higher whole-body arginine clearance in COPD patients (P < 0.0001), we found no difference in NO production.

Conclusion: In stable patients with moderate-to-severe COPD, endogenous arginine production is upregulated to support a higher arginine utilization that is unrelated to whole-body NO production. This trial was registered at clinicaltrials.gov as NCT01173354 and NCT01172314.
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http://dx.doi.org/10.3945/ajcn.115.125187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880996PMC
June 2016

Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial.

Anesthesiol Res Pract 2016 2;2016:6918327. Epub 2016 Feb 2.

Department of Anesthesiology, Centro Médico Campinas, Rua Edilberto Luis Pereira da Silva 150, Campinas, SP, Brazil.

Aim. A double-blind, randomized, placebo-controlled trial was designed to evaluate the efficacy of continuous intraoperative infusion of S(+)-ketamine under intravenous anesthesia with target-controlled infusion of remifentanil and propofol for postoperative pain control. Methods. Forty-eight patients undergoing laparoscopic cholecystectomy were assigned to receive continuous S(+)-ketamine infusion at a rate of 0.3 mg·kg(-1)·h(-1) (n = 24, intervention group) or an equivalent volume of saline at the same rate (n = 24, placebo group). The same target-controlled intravenous anesthesia was induced in both groups. Pain was assessed using a 0 to 10 verbal numeric rating scale during the first 12 postoperative hours. Pain scores and morphine consumption were recorded in the postanesthesia care unit (PACU) and at 4 and 12 hours after surgery. Results. Pain scores were lower in the intervention group at all time points. Morphine consumption did not differ significantly between groups during PACU stay, but it was significantly lower in the intervention group at each time point after PACU discharge (P = 0.0061). At 12 hours after surgery, cumulative morphine consumption was also lower in the intervention group (5.200 ± 2.707) than in the placebo group (7.525 ± 1.872). Conclusions. Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy under target-controlled intravenous anesthesia provided better postoperative pain control than placebo, reducing morphine requirement. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02421913.
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http://dx.doi.org/10.1155/2016/6918327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755104PMC
March 2016

Duplication of inferior vena cava: a rare but clinically significant anatomical variation.

N Z Med J 2014 Nov 7;127(1405):84-6. Epub 2014 Nov 7.

Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 555, Little Rock, AR 72205, USA.

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November 2014

Models of cancer survivorship health care: moving forward.

Am Soc Clin Oncol Educ Book 2014 :205-13

From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA.

The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving. We provide examples of three different models of survivorship care from a cancer center, a community setting, and a country-wide health care system, followed by a description of the ASCO Cancer Survivorship Compendium, a tool to help providers understand the various models of survivorship care available and integrate survivorship care into their practices in a way that fits their unique needs.
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http://dx.doi.org/10.14694/EdBook_AM.2014.34.205DOI Listing
November 2015

Invasive Salmonellosis by the Very Rare Salmonella choleraesuis in a Returning Traveler on a Tumor Necrosis Factor- α Inhibitor.

Case Rep Med 2014 23;2014:934657. Epub 2014 Feb 23.

Department of Infectious Diseases, St. Francis Hospital, Hartford, CT 06105, USA.

Salmonella choleraesuis is one of the least commonly reported nontyphoidal salmonellae in the United States, accounting for only 0.08% and ranking lower than 20th place among all human source salmonellosis reported to the CDC in 2009. In the state of Connecticut, only 12 cases have been reported since 1998 and our case is the only case since 2008. We report a case of invasive Salmonellosis caused by Salmonella choleraesuis in a patient on an antitumor necrosis factor- α agent (adalimumab) who recently returned from a trip to the Dominican Republic.
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http://dx.doi.org/10.1155/2014/934657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970466PMC
April 2014

Hydrolyzed casein and whey protein meals comparably stimulate net whole-body protein synthesis in COPD patients with nutritional depletion without an additional effect of leucine co-ingestion.

Clin Nutr 2014 Apr 1;33(2):211-20. Epub 2013 Jul 1.

Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, USA; Center for Translational Research in Aging & Longevity, Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Background & Aims: Muscle wasting commonly occurs in COPD, negatively affecting outcome. The aim was to examine the net whole-body protein synthesis response to two milk protein meals with comparable absorption rates (hydrolyzed casein (hCAS) vs. hydrolyzed whey (hWHEY)) and the effects of co-ingesting leucine.

Methods: Twelve COPD patients (GOLD stage II-IV) with nutritional depletion, were studied following intake of a 15 g hCAS or hWHEY protein meal with or without leucine-co-ingestion, according to a double-blind randomized cross-over design. The isotopic tracers L-[ring-(2)H5]-Phenylalanine, L-[ring-(2)H2]-Tyrosine, L-[(2)H3]-3-Methylhistidine (given via continuous intravenous infusion), and L-[(15)N]-Phenylalanine (added to the protein meals) were used to measure endogenous whole-body protein breakdown (WbPB), whole-body protein synthesis (WbPS), net protein synthesis (NetPS), splanchnic extraction and myofibrillar protein breakdown (MPB). Analyses were done in arterialized-venous plasma by LC/MS/MS.

Results: WbPS was greater after intake of the hCAS protein meal (P < 0.05) whereas the hWHEY protein meal reduced WbPB more (P < 0.01). NetPS was stimulated comparably, with a protein conversion rate greater than 70%. Addition of leucine did not modify the insulin, WbPB, WbPS or MPB response.

Conclusions: Hydrolyzed casein and whey protein meals comparably and efficiently stimulate whole-body protein anabolism in COPD patients with nutritional depletion without an additional effect of leucine co-ingestion. This trial was registered at clinicaltrials.gov as NCT01154400.
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http://dx.doi.org/10.1016/j.clnu.2013.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883994PMC
April 2014

Cystic fibrosis: a clinician's tool for management of care advancing into the adult population.

J Am Acad Nurse Pract 2012 Nov 9;24(11):625-32. Epub 2012 Jul 9.

White River Surgery Clinic, Batesville, AR 72501, USA.

Purpose: To discuss the role of the nurse practitioner in medical management of adult patients with cystic fibrosis (CF).

Data Sources: A systematic literature review was done by searching online databases: CINAHYL, OVID, and Medline. The Cystic Fibrosis Foundation (CFF) guidelines were reviewed. Tables were compiled for recommended screening and treatment for adult CF patients.

Conclusions: Comorbidities occur among adult CF patients and include: CF-related diabetes (CFRD), fertility issues, CF liver disease (CFLD), and CF bone disease. Diabetes management is reviewed. Current fertility surgical treatments for males and recommendations for females are discussed. Ursodiol is the main treatment regimen for those affected. Bone disease and CF has multiple etiologies and the focus of treatment is based on appropriate vitamin D replacement and bisphosphonates. New standards for vitamin D replacement are discussed.

Implications For Practice: Clinicians must be familiar with the current treatments and regimens of adults with CF including comorbidities. The CF adult population is expanding and care is extending beyond the CF clinic. More healthcare providers must be educated on the best practices of adult CF care. The importance of early identification and treatment of CF comorbidities cannot be overestimated.
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http://dx.doi.org/10.1111/j.1745-7599.2012.00763.xDOI Listing
November 2012

Synchronization of ovarian stimulation with follicle wave emergence in patients undergoing in vitro fertilization with a prior suboptimal response: a randomized, controlled trial.

Fertil Steril 2012 Oct 20;98(4):881-7.e1-2. Epub 2012 Jul 20.

Department of Obstetrics, Gynecology and Reproductive Sciences, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Objective: To test the hypothesis that synchronizing initiation of ovarian stimulation with follicle wave emergence would optimize IVF/intracytoplasmic sperm injection (ICSI) outcomes in patients with a prior suboptimal response.

Design: Prospective, randomized, controlled trial.

Setting: Academic and private reproductive endocrinology and infertility centers.

Patient(s): Eighty women ≤ 43 years of age with a history of a suboptimal response.

Intervention(s): Initiation of recombinant FSH/GnRH antagonist/recombinant LH/hCG on day 1 (n = 39) or day 4 (n = 41).

Main Outcome Measure(s): Numbers of clinical and biochemical pregnancies, follicles ≥ 10 and ≥ 15 mm, oocytes collected, fertilized oocytes, cleavage stage embryos, and blastocysts; serum E(2) concentrations. Outcomes were compared between treatment groups.

Result(s): The numbers of follicles that developed to ≥ 10 and ≥ 15 mm and serum E(2) were greater when recombinant FSH was initiated on day 1 (5.4, 4.3, 5,827.2 pmol/L) versus day 4 (3.6, 2.5, 4,230.1 pmol/L). The numbers of collected, metaphase II, and fertilized oocytes; cleavage stage embryos; and blastocysts were not different between groups. When we evaluated only those cycles that proceeded to oocyte pick-up, a lower implantation rate (16.1%, 56.0%), biochemical pregnancy rate (PR) (16.1%, 48.0%), and clinical PR (12.9% vs. 36.0%) were detected in the day 1 group versus day 4 group.

Conclusion(s): Synchronizing initiation of ovarian stimulation with follicle wave emergence in patients with a prior suboptimal response resulted in an increase in the number of dominant follicles and serum E(2) concentrations; however, improvements in oocyte, embryo, or pregnancy outcomes did not occur.

Clinical Trial Registration Number: NCT00439829.
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http://dx.doi.org/10.1016/j.fertnstert.2012.06.051DOI Listing
October 2012

Measurement of colorectal cancer test use with medical claims data in a safety-net health system.

Am J Med Sci 2013 Feb;345(2):99-103

Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA.

Background: Optimizing colorectal cancer (CRC) screening requires identification of unscreened individuals and tracking screening trends. A recent National Institutes of Health State of the Science Conference, "Enhancing Use and Quality of CRC Screening," cited a need for more population data sources for measurement of CRC screening, particularly for the medically underserved. Medical claims data (claims data) are created and maintained by many health systems to facilitate billing for services rendered and may be an efficient resource for identifying unscreened individuals. The aim of this study, conducted at a safety-net health system, was to determine whether CRC test use measured by claims data matches medical chart documentation.

Methods: The authors randomly selected 400 patients from a universe of 20,000 patients previously included in an analysis of CRC test use based on claims data 2002-2006 in Tarrant Co, TX. Claims data were compared with medical chart documentation by estimation of agreement and examination of test use over/underdocumentation.

Results: The authors found that agreement on test use was very good for fecal occult blood testing (κ = 0.83, 95% confidence interval: 0.75-0.90) and colonoscopy (κ = 0.91, 95% confidence interval: 0.85-0.96) and fair for sigmoidoscopy (κ = 0.39, 95% confidence interval: 0.28-0.49). Over- and underdocumentations of the 2 most commonly used CRC tests--colonoscopy and fecal occult blood testing--were rare.

Conclusions: Use of claims data by health systems to measure CRC test use is a promising alternative to measuring CRC test use with medical chart review and may be used to identify unscreened patients for screening interventions and track screening trends over time.
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http://dx.doi.org/10.1097/MAJ.0b013e31824dd1b6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479334PMC
February 2013

Performance evaluation of two methods using commercially available reagents for PCR-based detection of FMR1 mutation.

J Mol Diagn 2012 Sep 2;14(5):476-86. Epub 2012 Jul 2.

Division of Molecular Diagnostics, Department of Pathology, Molecular Diagnostics Laboratory, Virginia Commonwealth University, Richmond, Virginia 23298-0248, USA.

The current workflow for clinical Fragile X testing is time consuming and labor intensive. Recently developed PCR-based methods simplify workflow, amplify full mutation alleles, and improve sensitivity for detecting low-level mosaicism. We evaluated the performance characteristics and workflow of two methods using commercially available reagents for determining FMR1 mutation status. We also tested each method's ability to detect mosaicism (range, 100% to 1% for males; 50% to 1% for females). One method used reagents from Asuragen (AmplideX FMR1 PCR, research use only). The second method used analyte specific reagents from Abbott Molecular, including FMR1 Primer 1 (for repeat sizing) and FMR1 Primer 2 (for screening of expanded alleles). Each reaction was evaluated for accuracy, precision, correlation with previous results, and workflow. Both methods performed equally well in accuracy and precision studies using NIST standards and previously characterized Coriell samples. Both methods showed 100% concordance with results from a previous consensus study and for previously analyzed patient samples. The Asuragen reagents were able to detect full mutation mosaicism down to 5% and premutation mosaicism to 1%. The Abbott Molecular Primer 2 reagents were able to detect both full mutation and premutation mosaicism down to 25%. Both PCR-based methods for the determination of FMR1 mutation status performed well, with expected results in their final diagnoses, and differed significantly only in their workflow.
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http://dx.doi.org/10.1016/j.jmoldx.2012.03.005DOI Listing
September 2012

Lubiprostone for constipation in adults with cystic fibrosis: a pilot study.

Ann Pharmacother 2011 Sep 18;45(9):1061-6. Epub 2011 Aug 18.

Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Background: Constipation is prevalent in the cystic fibrosis (CF) population and yet there are few data demonstrating the effectiveness of currently used treatments. Lubiprostone is a laxative that works by activating the type 2 chloride channel in the gastrointestinal tract and thus has the potential to be especially effective for constipation associated with CF.

Objective: To evaluate the effectiveness of lubiprostone for the treatment of constipation in adults with CF.

Methods: In this pilot study, participants acted as their own controls and comparisons were made between run-in and treatment periods. During the 2-week run-in period, participants continued their usual treatment for constipation; during the 4-week treatment period, participants received lubiprostone 24 μg twice daily. Efficacy outcomes included spontaneous bowel movement frequency, Bristol Stool Scale scores, and Patient Assessment of Constipation Symptoms (PAC-SYM) survey scores. Outcomes were assessed during both the run-in and treatment periods (0, 2, and 4 weeks of treatment). Safety outcomes included spirometry, body weight, and serum chemistry.

Results: Seven participants completed the study. Mean (SD) baseline forced expiratory volume in 1 second was 83.0% (9.4) of predicted and body mass index was 24.0 (2.8) kg/m², indicating an overall healthy, well-nourished group of adults with CF. Lubiprostone improved overall symptoms of constipation as measured by PAC-SYM survey scores (1.18 [0.56], 0.54 [0.27], and 0.44 [0.36] at 0, 2, and 4 weeks, respectively; p < 0.001). Spontaneous bowel movement frequency and Bristol Stool Scale scores were not statistically significantly different between periods. There were no differences in safety measures. Transient chest tightness and shortness of breath were reported by 2 separate participants, although neither participant withdrew due to these adverse effects.

Conclusions: Lubiprostone may be an effective option for the treatment of constipation in adults with CF.
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http://dx.doi.org/10.1345/aph.1Q219DOI Listing
September 2011

Global left atrial strain correlates with CHADS2 risk score in patients with atrial fibrillation.

J Am Soc Echocardiogr 2011 May 7;24(5):506-12. Epub 2011 Apr 7.

Department of Clinical Physiology, Cardiac and Vascular Sciences, Sundsvall Hospital and Karolinska Institute, Stockholm, Sweden.

Background: The aim of this cross-sectional study was to explore the association between echocardiographic parameters and CHADS2 score in patients with nonvalvular atrial fibrillation (AF).

Methods: Seventy-seven subjects (36 patients with AF, 41 control subjects) underwent standard two-dimensional, Doppler, and speckle-tracking echocardiography to compute regional and global left atrial (LA) strain.

Results: Global longitudinal LA strain was reduced in patients with AF compared with controls (P < .001) and was a predictor of high risk for thromboembolism (CHADS2 score ≥ 2; odds ratio, 0.86; P = .02). LA strain indexes showed good interobserver and intraobserver variability. In sequential Cox models, the prediction of hospitalization and/or death was improved by addition of global LA strain and indexed LA volume to CHADS2 score (P = .003).

Conclusions: LA strain is a reproducible marker of dynamic LA function and a predictor of stroke risk and cardiovascular outcomes in patients with AF.
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http://dx.doi.org/10.1016/j.echo.2011.02.012DOI Listing
May 2011

Emerging therapies in cystic fibrosis.

Authors:
Paula Anderson

Ther Adv Respir Dis 2010 Jun;4(3):177-85

Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

The life expectancy of people with cystic fibrosis (CF), a lethal inherited disease, has been greatly extended by advances in therapy. Currently, there are a number of potential drugs for treatment of CF lung disease in clinical trials. These therapies are targeted at all points in the pathogenesis of lung disease, from gene transfer to drugs that treat mucus, infection and inflammation in the airways. An exciting development is that of modulation of the abnormal protein that causes CF, the cystic fibrosis transmembrane conductance regulator (CFTR), where drugs are targeted at specific defects in CFTR transcription, processing or functioning. Inhaled therapies are being developed to augment airway surface liquid height, either by modulating the abnormal ion channel function in the airway epithelial cell or by rehydrating with osmotic agents. Anti-inflammatory therapy is also of great interest in CF and there are several candidate drugs in clinical trials. A number of antibacterial agents formulated for inhalation are at various stages of study or newly approved, which should improve options for chronic management of airway infection. Hopefully, many of these potential therapies will come to market and will further extend the life expectancy of people with CF.
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http://dx.doi.org/10.1177/1753465810371107DOI Listing
June 2010

Use of the chloride channel activator lubiprostone for constipation in adults with cystic fibrosis: a case series.

Ann Pharmacother 2010 Mar 23;44(3):577-81. Epub 2010 Feb 23.

College of Pharmacy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

Objective: To describe the use of lubiprostone for constipation in 3 adults with cystic fibrosis (CF).

Case Summary: This case series describes the use of lubiprostone for the treatment of constipation in 3 adults with CF (mean +/- SD length of therapy 17.3 +/- 1.5 mo). All 3 patients were prescribed lubiprostone 24 microg twice daily after hospitalization for treatment of intestinal obstruction. Patient 1 continues on chronic polyethylene glycol (PEG) 3350 and lubiprostone and has not had a recurrence of obstruction. Patient 2 requires aggressive chronic therapy with PEG 3350, lubiprostone, and methylnaltrexone. She has had 1 recurrence of obstruction. Patient 3 continues with lubiprostone taken several times per week with good control of constipation and no recurrence of obstruction to date. The adverse effect profile has been tolerable in all 3 patients.

Discussion: CF is caused by a genetic mutation resulting in a dysfunctional or absent CF transmembrane conductance regulator that normally functions as a chloride channel. This results in viscous secretions in multiple organ systems including the lungs and intestinal tract. Accumulation of viscous intestinal contents contributes to constipation, which is common among adults with CF and can sometimes lead to intestinal obstruction. Lubiprostone is indicated for chronic constipation and works by activating type 2 chloride channels (ClC-2) in the intestinal tract. Because it utilizes an alternate chloride channel, lubiprostone may be especially effective for constipation in patients with CF.

Conclusions: Lubiprostone provides an additional option for the treatment of constipation in adults with CF. Its use in the CF population deserves further study.
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http://dx.doi.org/10.1345/aph.1M642DOI Listing
March 2010
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