Chest
Poster PresentationsTREATMENT OUTCOME OF TUBERCULOSIS UNDER DIRECTLY OBSERVED TREATMENT SHORT COURSE (DOTS) IN PATIENTS PRESENTING AT CHEST TB HOSPITAL, AMRITSAR
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Abstract
PURPOSE: The present study was undertaken to determine the treatment outcome of DOTS as prescribed under RNTCP. Side effects and radiological improvement was also noted.
METHODS: A total of 150 cases of tuberculosis on the basis of history, sputum & radiological examination were selected. They were divided into three categories under RNTCP. All the patients were administered standard regimens of antitubercular drugs as prescribed under DOTS. Sputum of all patients was examined before the start
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Assessment of hospitalization rates, factors associated with hospitalization and in-patient mortality in pediatric patients with cystic fibrosis
2022, Journal of the National Medical AssociationCystic fibrosis (CF), an inherited autosomal recessive disease that results in the accumulation of mucus and damage primarily to the respiratory and digestive tracts is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. In the United States, it has been estimated that CF occurs in 1 out of 3500 infants. The objective of this study was to explore the patient and hospital characteristics associated with CF hospitalizations and inpatient mortality in pediatric CF patients.
Utilizing the National Inpatient Sample database from 2008 to 2017, a retrospective cohort study was conducted to analyze the hospitalization rates, associated factors, and the inpatient mortality of CF patients 0–17 years of age. Hospitalizations with a diagnosis of CF were identified with ICD-9-CM and ICD-10-CM codes. Adjusted survey logistic regression models were utilized to determine factors associated with CF hospitalizations and in-hospital deaths in CF patients.
There were a total of 98,660 (about 0.2%) CF hospitalizations in patients 17 years of age or younger during the study period. Non-Hispanic (NH) White CF patients had the highest prevalence of CF (26.30 per 10,000 hospitalizations). The prevalence of inpatient deaths were highest among those identified as NH-Others and NH-Blacks (71.35 and 68.83 per 10,000 CF hospitalizations, respectively. When compared with NH-White category, those belonging to NH-Black, Hispanic and Other racial/ethnic sub-group had reduced odds of being hospitalized with CF.
Despite our finding of an increased likelihood of being hospitalized for CF among NH-White and male pediatric patients, no association between race or sex and CF inpatient death was observed when adjusted for covariates. More research is needed to determine the impact of sex and race on CF mortality rates.
No gender differences in growth patterns in a cohort of children with cystic fibrosis born between 1986 and 1995
2019, Clinical NutritionA higher mortality rate at young ages has been reported in cystic fibrosis (CF) girls compared to boys. The reasons of this gap remain unclear but may be related to a different evolution of the disease, in terms of growth and lung function throughout childhood and adolescence. This study aimed at investigating gender differences in growth patterns in a cohort of children with CF through a longitudinal study, and as secondary objectives, to evaluate gender differences in forced expiratory volume in one second (FEV1) trend and transplant-free survival.
We performed an historical cohort study of 203 CF patients born between 1986 and 1995. Weight and height were recorded from the time of CF diagnosis to the age of 18 years. Generalized estimated equations were used to evaluate the effect of gender on changes in z-score of BMI-for-age and z-score of height-for-age and FEV1. Transplant-free survival to age 18 was computed by the Kaplan–Meier estimator.
Girls did not show a worse growth pattern as compared to boys. The odds of being underweight [Odds Ratio (OR) for girls: 0.85, 95% CI: 0.51; 1.39] or stunted [OR for girls: 0.79, 95% CI: 0.42; 1.49] were not significantly different between genders. FEV1 trend was also similar in boys and girls, as well as the probability of surviving to age 18 without receiving lung transplantation (boys: 0.88, 95% CI: 0.82–0.95, girls: 0.92, 0.87–0.98, P = 0.26).
In a cohort of children with CF born between 1986 and 1995, no gender differences in growth patterns were observed. This finding suggests that CF girls and boys have benefited equally from the advances in treatments that have occurred over the last three decades.
Up-to-date and projected estimates of survival for people with cystic fibrosis using baseline characteristics: A longitudinal study using UK patient registry data
2018, Journal of Cystic FibrosisCystic fibrosis (CF) is the most common inherited disease in Caucasians, affecting around 10,000 individuals in the UK today. Prognosis has improved considerably over recent decades with ongoing improvements in treatment and care. Providing up-to-date survival predictions is important for patients, clinicians and health services planning.
Flexible parametric survival modelling of UK CF Registry data from 2011 to 2015, capturing 602 deaths in 10,428 individuals. Survival curves were estimated from birth; conditional on reaching older ages; and projected under different assumptions concerning future mortality trends, using baseline characteristics of sex, CFTR genotype (zero, one, two copies of F508del) and age at diagnosis.
Male sex was associated with better survival, as was older age at diagnosis, but only in F508del non-homozygotes. Survival did not differ by genotype among individuals diagnosed at birth. Median survival ages at birth in F508del homozygotes were 46 years (males) and 41 years (females), and similar in non-homozygotes diagnosed at birth. F508del heterozygotes diagnosed aged 5 had median survival ages of 57 (males) and 51 (females). Conditional on survival to 30, median survival age rises to 52 (males) and 49 (females) in homozygotes. Mortality rates decreased annually by 2% during 2006–2015. Future improvements at this rate suggest median survival ages for F508del homozygous babies of 65 (males) and 56 (females).
Over half of babies born today, and of individuals aged 30 and above today, can expect to survive into at least their fifth decade.
Evidence before this study
We searched PubMed with terms “(cystic fibrosis survival) and (projection OR model OR registry OR United Kingdom OR UK)” to identify relevant studies on survival estimates for individuals with cystic fibrosis (CF). We also considered the most recent annual report from the UK Cystic Fibrosis Registry (Cystic Fibrosis Trust, 2016), a review by Buzzetti and colleagues (2009), the chapter on Epidemiology of Cystic Fibrosis by MacNeill (2016), the study of MacKenzie and colleagues (2014), and references therein. There have been many studies of factors associated with survival in CF; most have focused on identifying risk factors, and only a few have presented estimated survival curves, which are the focus of this work. The most recent study of survival in the UK is by Dodge and colleagues (2007), who used data obtained from CF clinics and the national death register, and gave an estimate of survival for babies born in 2003. We found no previous studies that have obtained detailed information on survival using UK Cystic Fibrosis Registry data. Jackson and colleagues obtained survival estimates for the US and Ireland using registry data (Jackson et al., 2011). MacKenzie and colleagues used US Cystic Fibrosis Foundation Patient Registry data from 2000 to 2010 to project survival for children born and diagnosed with CF in 2010, accounting for sex, genotype and age at diagnosis (MacKenzie et al., 2014). Previous studies on estimated survival in CF have become out of date or have not accounted for the full range of patient characteristics available at birth. Few have presented conditional survival estimates (Dodge et al., 2007).
Added value of this study
This is the first study to yield detailed survival statistics using the UK Cystic Fibrosis Registry, which is one of the largest national CF registries outside of the US and has almost complete coverage of the UK CF population. The primary goal was to leverage the long-term follow-up of the nearly complete UK CF population available in the Registry for the purposes of producing accurate, precise predictions in the modern era of CF care. Estimates are presented from birth and conditional on survival to older ages. These are the first conditional estimates in CF to also account for genotype, sex and age at diagnosis, which were each included in the modelling using a flexible approach. Projections are also provided under different scenarios based on downward trends in mortality rates. Our use of flexible parametric survival models is novel in this field, and our approach could be used to provide modern survival statistics for other chronic diseases and disorders.
Implications of all the available evidence
Our estimates of future survival in CF under a range of different scenarios are based on data on nearly all individuals living with the disease in the UK in recent times, reflective of a modern era of care, and are most appropriate for the families of babies being born in the present day with CF. Conditional estimates inform patients who have already reached an older age, and their clinicians. Over half of babies born today, and of individuals aged 30 years and above alive today, can expect to survive into their fifth decade. Insights based on our survival projections can be used to inform future needs in CF health care provision.
Cystic fibrosis mortality trend in Italy from 1970 to 2011
2015, Journal of Cystic FibrosisSurvival in cystic fibrosis (CF) has progressively improved and the female-gender disadvantage first described many years ago remains controversial.
To describe the mortality trend due to CF in Italy over the last decades; to verify the female-mortality disadvantage; to compare the comorbidities reported in death certificates of CF patients with those of the general population.
Mortality data were extracted from the database of underlying cause of death (1970–2011) and multiple causes of death (2003–2011) of the Italian National Institute of Statistics. Age-standardized mortality ratio (SMR) was calculated to compare the mortality between genders. The association between CF and other contributing causes of death was verified by calculating the age- and gender-adjusted proportional mortality ratio (PMR).
During the study period, 1947 death certificates reported CF as the underlying cause of death. Mortality rate due to CF decreased in newborns and children and by the end of the 1990s also in adolescents and young adults. Adult mortality started to increase in the early 1990s. Over the whole period an excess in mortality was observed in young CF females (1–29 years). The multiple causes of death database included 531 certificates with CF listed as cause of death. Pneumonia, chronic lower respiratory diseases, pulmonary heart disease and diseases of pulmonary circulation, aspergillosis, sepsis, renal failure, diabetes, malnutrition and amyloidosis were more frequently reported in CF death certificates compared to those of the general population (PMR > 1).
This mortality trend provides evidence of a consistent improvement in survival, although the excess female-mortality persists despite aggressive treatment of CF lung disease. Several extra-pulmonary conditions associated with CF contributed to the morbidity leading to death.
Rate of improvement of CF life expectancy exceeds that of general population-Observational death registration study
2014, Journal of Cystic FibrosisIt is unclear why cystic fibrosis (CF) survival has improved. We wished to quantify increases in CF median age of death in the context of general population survival improvement.
Death registration data analysis (US, England & Wales (E&W)—1972–2009).
CF median age of death is higher in US than E&W and greater for males, opposite to that of death from all causes. CF median age of death has increased by 0.543 life years per year (E&W, US combined (95% confidence interval 0.506, 0.582)). The difference in median age at death between those dying from all causes and CF decreased in both territories. CF median age of death for males is greater than for females in both territories. This gap has not narrowed.
The median age of death of people with CF is improving more rapidly than that of the general population in US and E&W.
Estrogen and the cystic fibrosis gender gap
2014, SteroidsCystic fibrosis (CF) is the most frequent inherited disease in Caucasian populations and is due to a defect in the expression or activity of a chloride channel encoded by the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Mutations in this gene affect organs with exocrine functions and the main cause of morbidity and mortality for CF patients is the lung pathology in which the defect in CFTR decreases chloride secretion, lowering the airway surface liquid height and increasing mucus viscosity. The compromised ASL dynamics leads to a favorable environment for bacterial proliferation and sustained inflammation resulting in epithelial lung tissue injury, fibrosis and remodeling. In CF, there exist a difference in lung pathology between men and women that is termed the “CF gender gap”. Recent studies have shown the prominent role of the most potent form of estrogen, 17β-estradiol in exacerbating lung function in CF females and here, we review the role of this hormone in the CF gender dichotomy.