RESUMEN
Exacerbations have a negative impact on inflammatory diseases of the airways and, in patients with bronchiectasis, severe exacerbations are associated with increased morbidity and mortality. Exacerbations are also associated with a decline in quality of life and lung function, greater local and systemic inflammation and clinically more severe forms of the disease. As a consequence, the majority of therapeutic clinical trials carried out in patients with bronchiectasis are aimed at preventing exacerbations, but there is a scarcity of scientific evidence on the best treatment once they occur. All of these elements, combined with the great heterogeneity of bronchiectasis and the influence of geographical and microbiological factors on its clinical presentations and aetiologies, mean that the recommendations of therapeutic guidelines vary. An international group of experts has now reached agreement on the definition of exacerbation in bronchiectasis for the inclusion of patients in clinical trials, although its validity in clinical practice has yet to be demonstrated.
Asunto(s)
Bronquiectasia , Calidad de Vida , Adulto , Antibacterianos/uso terapéutico , Bronquiectasia/tratamiento farmacológico , HumanosRESUMEN
STUDY OBJECTIVE: There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old. METHODS: Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. RESULTS: From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. CONCLUSIONS: The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Apnea Obstructiva del Sueño , Anciano , Anciano de 80 o más Años , Presión de las Vías Aéreas Positiva Contínua/métodos , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Apnea Obstructiva del Sueño/psicología , Apnea Obstructiva del Sueño/terapia , RonquidoRESUMEN
Nine isolates from Argyrolobium uniflorum, Lotus creticus , Medicago sativa (Tunisia) and Lotus arabicus (Senegal) were analysed by multilocus sequence analysis (MLSA) of five housekeeping genes (recA, atpD, glnA, gltA and thrC), the 16S rRNA gene and the nodulation gene nodA. Analysis of the individual and concatenated gene sequences demonstrated that the nine new strains constituted three stable, well-supported (bootstrap and gene sequence similarity values) monophyletic clusters, A, B and C, all belonging to the branch of the genus Ensifer, regardless of the phylogenetic reconstruction method used (maximum likelihood, maximum-parsimony, neighbour-joining). The three groups were further characterized by API 100 auxanographic tests, host specificity and nodA gene sequence analysis. On the basis of these data, clusters A and C are suggested as representing two novel species within the genus Ensifer, for which the names Ensifer numidicus sp. nov. (type strain ORS 1407(T)=LMG 24690(T)=CIP 109850(T)) and Ensifer garamanticus sp. nov. (type strain ORS 1400(T)=LMG 24692(T)=CIP 109916(T)) are proposed. The cluster B strains were assigned to Ensifer adhaerens genomovar A.