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Classifying new anti-TB drugs: rationale and future perspectives.

Int J Infect Dis. 2016 Nov 3;:

Authors: Tiberi S, Scardigli A, Centis R, D'Ambrosio L, Muñoz-Torrico M, Salazar-Lezama MÁ, Spanevello A, Visca D, Zumla A, Migliori GB, Luna JA

Abstract
The classification of anti-tuberculosis (TB) drugs is important as it serves the clinician in building an appropriate anti-TB regimen for multidrug (MDR-) and extensively drug resistant (XDR-) TB cases which do not fulfil criteria for the shorter MDR-TB regimen. The World Health Organization (WHO) has recently approved a revision of the classification of new anti-TB drugs based on current evidence on each drug. In the previous WHO guidelines the drug choice was based on their efficacy and toxicity, in a step-down manner from Group 1, including first-line drugs and Group 2-5 including second- line drugs, to Group 5 including drugs with potentially limited efficacy or limited clinical evidence. In the revised WHO classification, exclusively aimed at managing drug-resistant cases, medicines were again listed in a hierarchical order from Group A to D. In parallel, a possible future classification was independently proposed. Aim of the present viewpoint is to describe the evolution in WHO TB classifications (taking into account an independently proposed new classification) and recent changes in WHO guidance, while commenting on the differences among them. The latest evidence on the ex-Group five drugs is also discussed.

PMID: 27818361 [PubMed - as supplied by publisher]

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Stem/progenitor cells and obstructive sleep apnea syndrome - new insights for clinical applications.

World J Stem Cells. 2016 Oct 26;8(10):332-341

Authors: Micheu MM, Rosca AM, Deleanu OC

Abstract
Obstructive sleep apnea syndrome (OSAS) is a widespread disorder, characterized by recurrent upper airway obstruction during sleep, mostly as a result of complete or partial pharyngeal obstruction. Due to the occurrence of frequent and regular hypoxic events, patients with OSAS are at increased risk of cardiovascular disease, stroke, metabolic disorders, occupational errors, motor vehicle accidents and even death. Thus, OSAS has severe consequences and represents a significant economic burden. However, some of the consequences, as well as their costs can be reduced with appropriate detection and treatment. In this context, the recent advances that were made in stem cell biology knowledge and stem cell - based technologies hold a great promise for various medical conditions, including respiratory diseases. However, the investigation of the role of stem cells in OSAS is still recent and rather limited, requiring further studies, both in animal models and humans. The goal of this review is to summarize the current state of knowledge regarding both lung resident as well as circulating stem/progenitor cells and discuss existing controversies in the field in order to identify future research directions for clinical applications in OSAS. Also, the paper highlights the requisite for inter-institutional, multi-disciplinary research collaborations in order to achieve breakthrough results in the field.

PMID: 27822340 [PubMed - in process]

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Clinical Characterization and Treatment Patterns for the Frequent Exacerbator Phenotype in Chronic Obstructive Pulmonary Disease with Severe or Very Severe Airflow Limitation.

COPD. 2016 Nov 8;:1-8

Authors: Blasi F, Neri L, Centanni S, Falcone F, Di Maria G

Abstract
Chronic obstructive pulmonary disease (COPD) patients experiencing several episodes of acute clinical derangement suffer from increased morbidity, mortality, and accelerated decline in lung function. Nevertheless, the relationship between co-morbidity profile and exacerbation rates in the frequent exacerbator phenotype is poorly characterized, and evidence-based management guidelines are lacking. We sought to evaluate the co-morbidity profile and treatment patterns of "frequent exacerbators" with severe or very severe airflow limitation. We conducted a cross-sectional, multicenter study in 50 Italian hospitals. Pulmonologists abstracted clinical information from medical charts of 743 COPD frequent exacerbators. We evaluated the exacerbation risk and center-related variations in diagnostic testing. One-third of patients (n = 210) underwent a bronchodilator response test, and 163 (22%) received a computerized tomography (CT) scan; 35 had a partial response to bronchodilators, while 119 had a diagnosis of emphysema; 584 (79%) lacked sufficient diagnostic testing for classification. Only 17% of patients did not have any coexistent disease. Cardiovascular conditions were the most frequent co-morbidities. A history of heart failure [odds ratio (OR): 1.89; 95% confidence interval (CI) 1.48-2.3] and affective disorders (OR: 1.66; 95% CI 1.24-2.1) was associated with the frequency of exacerbations. Center membership was strongly associated with exacerbation risk, independent of casemix (variance partition coefficient = 29.6%). Examining the regional variation in health outcomes and health care behavior may help identify the best practices, especially when evidence-based recommendations are lacking and uncertainties surround clinical decision-making.

PMID: 27824270 [PubMed - as supplied by publisher]

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Excess medical costs in patients with asthma and the role of comorbidity.

Eur Respir J. 2016 Oct 6;:

Authors: Chen W, Lynd LD, FitzGerald JM, Marra CA, Balshaw R, To T, Tavakoli H, Sadatsafavi M, Canadian Respiratory Research Network

Abstract
Asthmatic patients frequently have comorbidities, but the role of comorbidities in the economic burden of asthma is unclear. We examined the excess direct medical costs, including asthma- and comorbidity-related costs, in patients with asthma.We created a propensity score-matched cohort of patients newly diagnosed with asthma and non-asthmatic comparison subjects, both aged 5-55 years, from health administrative data (1997-2012) in British Columbia, Canada. Health services use records were categorised into 16 major disease categories based on International Classification of Diseases codes. Excess costs (in 2013 Canadian dollars ($)) were estimated as the adjusted difference in direct medical costs between the two groups.Average overall excess costs were estimated at $1058/person-year (95% CI 1006-1110), of which $134 (95% CI 132-136) was attributable to asthma and $689 (95% CI 649-730) to major comorbidity classes. Psychiatric disorders were the largest component of excess comorbidity costs, followed by digestive disorders, diseases of the nervous system, and respiratory diseases other than asthma. Comorbidity-attributable excess costs greatly increased with age but did not increase over the time course of asthma.These findings suggest that both asthma and comorbidity-related outcomes should be considered in formulating evidence-based policies and guidelines for asthma management.

PMID: 27824603 [PubMed - as supplied by publisher]