The objective of this study was to examine the incidence and therapy of chronic pain in a group o... more The objective of this study was to examine the incidence and therapy of chronic pain in a group of older patients with cystic fibrosis (CF). We identified two groups of patients followed at the CF Center at Children's Hospital (Boston); the first group consisted of all patients above the age of 5 years who died between 1984 and 1993, and the second was a cohort of 23 additional CF patients who had been referred to the Pain Treatment Service. Medical charts were reviewed for the etiology and therapy of all pain episodes requiring medical intervention. The incidence of chronic pain in this population increased sharply in the last 6 months of life. Headaches (55% of patients) and chest pain (65%) were frequently reported, although back pain (19%), abdominal pain (19%), and limb pain (16%) were also reported. In patients with headache, the main etiologies were hypercarbia or hypoxia, migraine, and sinusitis. The majority of chest pain was musculoskeletal, with pleuritis, pneumothora...
mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériter... more mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériterait d'être étudié.
mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériter... more mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériterait d'être étudié.
Thoracoabdominal asynchrony (TAA) and the ratio of time to peak tidal expiratory flow over total ... more Thoracoabdominal asynchrony (TAA) and the ratio of time to peak tidal expiratory flow over total expiratory time (T ME /T E ) have been used to assess airway obstruction in infants and adults. We obtained these measurements using calibrated respiratory inductance plethysmography (RIP) on 15 adolescents and young adults with cystic fibrosis (CF) and varying disease severity. The measurements were then compared to 15 normal age-matched controls. TAA was expressed as a phase angle () calculated from the abdominal (AB) and ribcage (RC) signals acquired from scalar strip chart recordings. Using CODAS (DATAQ Instruments, Akron, OH) software, the analog signals were digitized, and the differentiated sum (AB + RC) signal was used to calculate T ME /T E . Forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV 1 ) were obtained using RIP in all subjects.
Advances in the treatment and management of respiratory and pancreatic disorders have dramaticall... more Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of CF patients. The aim of this study was to evaluate the influence of the introduction of modern therapies on cost of pharmacologic treatment, clinical status and life expectancy of CF patients in Moscow over a ten year period. Methods: Medical records of patients in 1993 1994 (I period 35 subjects), 1997 1998 (II period 66) and 2003~004 (III period 87) were analysed. In 1993 pancreatic enzymes (Creon) were introduced into the treatment regimen, in 1998 Dornase alfa and ceftazidime, in 2003 cefepime and meropenem. In 1998 home IV treatment for planned antibiotic courses was started. Results: The annual cost of pharmacologic treatment of our patients in I, II, III periods was 1809.8, 4266.7 and 23,830.8 US dollars correspondingly. Of total costs 83, 35 and 9%% were from pancreatic enzymes; 17, 13 and 2%% from drugs classified as "other"; 0, 30, 72%% were from Dornase alfa; 0, 22, 16%% from mentioned antibiotics. Cost of home IV antibacterial therapy compared with inpatient was four times higher. Introduction of new therapies and ways of care were followed by the considerable increased life expectancy especially between I and II periods (16 and 27.9yrs) and increased number of patients >18yrs old (10.3%, 18.7% and 31.7%). Severity of disease, patients' age and chronic Ps.aeruginosa infection were important determinants of pharmacologic treatment cost. Conclusions: A greater number of studies should be performed to determine costs (including indirect costs and patient costs) and outcomes of therapies applied under everyday life conditions for patients with CE
Serum and/or cerebrospinal fluid (CSF) alpha interferon (aIFN) levels were determined in 31 neona... more Serum and/or cerebrospinal fluid (CSF) alpha interferon (aIFN) levels were determined in 31 neonates hospitalized for suspected sepsis. Final diagnosis was bacterial sepsis in 15, viral infection in 13 and no infection in 3. Among the 13 neonates with viral infection, enterovirus was isolated 5 times and coxsackievirus 4 times. No aIFN was found in cerebro-spinal fluid and/or serum among the neonates with bacterial sepsis or without infection. By contrast, in neonates with viral infection, CSF and/or serum aIFN levels were always elevated except in one case in which serum aIFN determination was not available. We conclude that in neonates, elevated levels of CSF and serum aIFN appear to be specific of viral infection, and that this might be helpful in the differential diagnosis of suspected sepsis.
Procalcitonin (PCT) concentration increases in bacterial infections but remains low in viral infe... more Procalcitonin (PCT) concentration increases in bacterial infections but remains low in viral infections and inflammatory diseases. The change is rapid and the molecule is stable, making it a potentially useful marker for distinguishing between bacterial and viral infections. PCT concentration was determined with an immunoluminometric assay on plasma collected at admission in 360 infants and children hospitalized for bacterial or viral infection. It was compared with C-reactive protein (CRP), interleukin 6 and interferon-alpha measured on the same sample. The mean PCT concentration was 46 microg/l (median, 17.8) in 46 children with septicemia or bacterial meningitis. PCT concentration was > 1 microg/l in 44 of 46 in this group and in 59 of 78 children with a localized bacterial infection who had a negative blood culture (sensitivity, 83%). PCT concentration was > 1 microg/l in 16 of 236 children with a viral infection (specificity, 93%). PCT concentration was low in 9 of 10 patients with inflammatory disease and fever. A CRP value > or =20 mg/l was observed in 61 of 236 patients (26%) with viral infection and in 105 of 124 patients (86%) with bacterial infection. IL-6 was > 100 pg/ml in 14% of patients infected with virus and in 53% with bacteria. A secretion of interferon-alpha was found in serum in 77% of viral infected patients and in 8.6% of bacterial infected patients. In this study a PCT value of 1 microg/l or greater had better specificity, sensitivity and predictive value than CRP, interleukin 6 and interferon-alpha in children for distinguishing between viral and bacterial infections. PCT values are higher in invasive bacterial infections, but the cutoff value of 1 microg/l indicates the severity of the disease in localized bacterial infection and helps to decide antibiotic treatment in emergency room. PCT may be useful in an emergency room for differentiation of bacterial vs. viral infections in children and for making decisions about antibiotic treatments.
End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in chi... more End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in childhood cancer. To examine this difference, we reviewed the medical care of a cohort of CF patients treated at Children's Hospital, Boston, to document the use of preventive, therapeutic, and palliative care in the month preceding death. We reviewed the medical records of 44 patients older than 5 years who died of CF-related respiratory failure for the years 1984 to 1993. Thirty-eight patients (86%) received opiates for the treatment of severe dyspnea and pain; the duration of opiate use varied from less than 1 hour to greater than 1 month. The dose of opiates varied from less than 5 mg per hour to greater than 30 mg per hour. Thirty-three patients (75%) continued to receive intravenous antibiotics in the last 12 hours of life; 32 (72%) continued to receive preventive or therapeutic oral medications in the last 12 hours of life. All patients were designated as do not resuscitate at the time of death; 43 of the patients died in the hospital with 1 patient dying at home under hospice care. The model of comfort care developed in childhood cancer does not adequately describe the combination of preventive, therapeutic, and palliative care given at the end of life for CF at our institution. The majority of CF patients continued to receive intravenous antibiotics and/or oral vitamin preparations while being treated with opiates for terminal pain and dyspnea. Small doses of opiates seem to be effective in the treatment of the pain and dyspnea at the end of life in CF.
The objective of this study was to examine the incidence and therapy of chronic pain in a group o... more The objective of this study was to examine the incidence and therapy of chronic pain in a group of older patients with cystic fibrosis (CF). We identified two groups of patients followed at the CF Center at Children's Hospital (Boston); the first group consisted of all patients above the age of 5 years who died between 1984 and 1993, and the second was a cohort of 23 additional CF patients who had been referred to the Pain Treatment Service. Medical charts were reviewed for the etiology and therapy of all pain episodes requiring medical intervention. The incidence of chronic pain in this population increased sharply in the last 6 months of life. Headaches (55% of patients) and chest pain (65%) were frequently reported, although back pain (19%), abdominal pain (19%), and limb pain (16%) were also reported. In patients with headache, the main etiologies were hypercarbia or hypoxia, migraine, and sinusitis. The majority of chest pain was musculoskeletal, with pleuritis, pneumothora...
mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériter... more mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériterait d'être étudié.
mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériter... more mucoviscidose pourrait être expliqué par une intensification de la réponse immunitaire et mériterait d'être étudié.
Thoracoabdominal asynchrony (TAA) and the ratio of time to peak tidal expiratory flow over total ... more Thoracoabdominal asynchrony (TAA) and the ratio of time to peak tidal expiratory flow over total expiratory time (T ME /T E ) have been used to assess airway obstruction in infants and adults. We obtained these measurements using calibrated respiratory inductance plethysmography (RIP) on 15 adolescents and young adults with cystic fibrosis (CF) and varying disease severity. The measurements were then compared to 15 normal age-matched controls. TAA was expressed as a phase angle () calculated from the abdominal (AB) and ribcage (RC) signals acquired from scalar strip chart recordings. Using CODAS (DATAQ Instruments, Akron, OH) software, the analog signals were digitized, and the differentiated sum (AB + RC) signal was used to calculate T ME /T E . Forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV 1 ) were obtained using RIP in all subjects.
Advances in the treatment and management of respiratory and pancreatic disorders have dramaticall... more Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of CF patients. The aim of this study was to evaluate the influence of the introduction of modern therapies on cost of pharmacologic treatment, clinical status and life expectancy of CF patients in Moscow over a ten year period. Methods: Medical records of patients in 1993 1994 (I period 35 subjects), 1997 1998 (II period 66) and 2003~004 (III period 87) were analysed. In 1993 pancreatic enzymes (Creon) were introduced into the treatment regimen, in 1998 Dornase alfa and ceftazidime, in 2003 cefepime and meropenem. In 1998 home IV treatment for planned antibiotic courses was started. Results: The annual cost of pharmacologic treatment of our patients in I, II, III periods was 1809.8, 4266.7 and 23,830.8 US dollars correspondingly. Of total costs 83, 35 and 9%% were from pancreatic enzymes; 17, 13 and 2%% from drugs classified as "other"; 0, 30, 72%% were from Dornase alfa; 0, 22, 16%% from mentioned antibiotics. Cost of home IV antibacterial therapy compared with inpatient was four times higher. Introduction of new therapies and ways of care were followed by the considerable increased life expectancy especially between I and II periods (16 and 27.9yrs) and increased number of patients >18yrs old (10.3%, 18.7% and 31.7%). Severity of disease, patients' age and chronic Ps.aeruginosa infection were important determinants of pharmacologic treatment cost. Conclusions: A greater number of studies should be performed to determine costs (including indirect costs and patient costs) and outcomes of therapies applied under everyday life conditions for patients with CE
Serum and/or cerebrospinal fluid (CSF) alpha interferon (aIFN) levels were determined in 31 neona... more Serum and/or cerebrospinal fluid (CSF) alpha interferon (aIFN) levels were determined in 31 neonates hospitalized for suspected sepsis. Final diagnosis was bacterial sepsis in 15, viral infection in 13 and no infection in 3. Among the 13 neonates with viral infection, enterovirus was isolated 5 times and coxsackievirus 4 times. No aIFN was found in cerebro-spinal fluid and/or serum among the neonates with bacterial sepsis or without infection. By contrast, in neonates with viral infection, CSF and/or serum aIFN levels were always elevated except in one case in which serum aIFN determination was not available. We conclude that in neonates, elevated levels of CSF and serum aIFN appear to be specific of viral infection, and that this might be helpful in the differential diagnosis of suspected sepsis.
Procalcitonin (PCT) concentration increases in bacterial infections but remains low in viral infe... more Procalcitonin (PCT) concentration increases in bacterial infections but remains low in viral infections and inflammatory diseases. The change is rapid and the molecule is stable, making it a potentially useful marker for distinguishing between bacterial and viral infections. PCT concentration was determined with an immunoluminometric assay on plasma collected at admission in 360 infants and children hospitalized for bacterial or viral infection. It was compared with C-reactive protein (CRP), interleukin 6 and interferon-alpha measured on the same sample. The mean PCT concentration was 46 microg/l (median, 17.8) in 46 children with septicemia or bacterial meningitis. PCT concentration was > 1 microg/l in 44 of 46 in this group and in 59 of 78 children with a localized bacterial infection who had a negative blood culture (sensitivity, 83%). PCT concentration was > 1 microg/l in 16 of 236 children with a viral infection (specificity, 93%). PCT concentration was low in 9 of 10 patients with inflammatory disease and fever. A CRP value > or =20 mg/l was observed in 61 of 236 patients (26%) with viral infection and in 105 of 124 patients (86%) with bacterial infection. IL-6 was > 100 pg/ml in 14% of patients infected with virus and in 53% with bacteria. A secretion of interferon-alpha was found in serum in 77% of viral infected patients and in 8.6% of bacterial infected patients. In this study a PCT value of 1 microg/l or greater had better specificity, sensitivity and predictive value than CRP, interleukin 6 and interferon-alpha in children for distinguishing between viral and bacterial infections. PCT values are higher in invasive bacterial infections, but the cutoff value of 1 microg/l indicates the severity of the disease in localized bacterial infection and helps to decide antibiotic treatment in emergency room. PCT may be useful in an emergency room for differentiation of bacterial vs. viral infections in children and for making decisions about antibiotic treatments.
End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in chi... more End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in childhood cancer. To examine this difference, we reviewed the medical care of a cohort of CF patients treated at Children's Hospital, Boston, to document the use of preventive, therapeutic, and palliative care in the month preceding death. We reviewed the medical records of 44 patients older than 5 years who died of CF-related respiratory failure for the years 1984 to 1993. Thirty-eight patients (86%) received opiates for the treatment of severe dyspnea and pain; the duration of opiate use varied from less than 1 hour to greater than 1 month. The dose of opiates varied from less than 5 mg per hour to greater than 30 mg per hour. Thirty-three patients (75%) continued to receive intravenous antibiotics in the last 12 hours of life; 32 (72%) continued to receive preventive or therapeutic oral medications in the last 12 hours of life. All patients were designated as do not resuscitate at the time of death; 43 of the patients died in the hospital with 1 patient dying at home under hospice care. The model of comfort care developed in childhood cancer does not adequately describe the combination of preventive, therapeutic, and palliative care given at the end of life for CF at our institution. The majority of CF patients continued to receive intravenous antibiotics and/or oral vitamin preparations while being treated with opiates for terminal pain and dyspnea. Small doses of opiates seem to be effective in the treatment of the pain and dyspnea at the end of life in CF.
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