RESUMEN
This article explores the challenges associated with diagnosing and managing eating disorders such as anorexia nervosa amongst adolescents and adults with cystic fibrosis. It reviews the known risk factors, generic verses disease specific eating disorder risk screening tools and considers the ethical dilemmas associated with critically low body mass indices. A case review is included to illustrate the complexities of managing both conditions in the context of declining respiratory function.
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Anorexia Nerviosa/fisiopatología , Fibrosis Quística/psicología , Conducta Alimentaria , Adolescente , Adulto , Humanos , Manejo de Atención al Paciente , Medición de Riesgo , Factores de RiesgoAsunto(s)
Oclusión Coronaria/diagnóstico , Fibrosis Quística/complicaciones , Isquemia Miocárdica/diagnóstico , Angioplastia Coronaria con Balón , Oclusión Coronaria/terapia , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/terapia , Stents , Troponina/sangreRESUMEN
RATIONALE AND OBJECTIVES: Blood-based studies have demonstrated the potential of immunological assays to detect tuberculosis. However lung fluid sampling may prove superior as it enables simultaneous microbiological detection of mycobacteria to be performed. Until now this has only been possible using the expensive and invasive technique of broncho-alveolar lavage. We sought to evaluate an immunoassay using non-invasive induced-sputum to diagnose active tuberculosis. METHODS AND RESULTS: Prospective cohort study of forty-two spontaneous sputum smear-negative or sputum non-producing adults under investigation for tuberculosis. CD4 lymphocytes specific to purified-protein-derivative of Mycobacterium tuberculosis actively synthesising interferon-gamma were measured by flow cytometry and final diagnosis compared to immunoassay using a cut-off of 0.5%. Sixteen subjects (38%) were HIV-infected (median CD4 count [range] = 332 cells/microl [103-748]). Thirty-eight (90%) were BCG-vaccinated. In 27 subjects diagnosed with active tuberculosis, the median [range] percentage of interferon-gamma synthetic CD4+ lymphocytes was 2.77% [0-23.93%] versus 0% [0-2.10%] in 15 negative for active infection (p<0.0001). Sensitivity and specificity of the immunoassay versus final diagnosis of active tuberculosis were 89% (24 of 27) and 80% (12 of 15) respectively. The 3 positive assays in the latter group occurred in subjects diagnosed with quiescent/latent tuberculosis. Assay performance was unaffected by HIV-status, BCG-vaccination or disease site. Combining this approach with traditional microbiological methods increased the diagnostic yield to 93% (25 of 27) alongside acid-fast bacilli smear and 96% (26 of 27) alongside tuberculosis culture. CONCLUSIONS: These data demonstrate for the first time that a rapid immunological assay to diagnose active tuberculosis can be performed successfully in combination with microbiological methods on a single induced-sputum sample.
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Infecciones por VIH/complicaciones , Seronegatividad para VIH , Esputo/microbiología , Tuberculosis/diagnóstico , Adulto , Ensayo de Inmunoadsorción Enzimática , Citometría de Flujo , Humanos , Persona de Mediana Edad , Sensibilidad y Especificidad , Tuberculosis/complicaciones , Tuberculosis/inmunología , Tuberculosis/microbiologíaRESUMEN
Global initiatives have been launched to develop improved tuberculosis chemotherapy. New drugs and potential treatment-shortening regimens require careful assessment in clinical trials, but existing markers of treatment outcome-clinical cure and relapse-require prolonged follow-up of patients. There is, therefore, a need to find alternative biomarkers or surrogate endpoints predictive of response. Effective treatment requires drugs with sterilising activity to produce clinical cure without relapse, and thus a useful biomarker for a drug under trial must predict the likelihood of relapse. We explore the strengths and weaknesses of existing biomarkers, which assess either host response or mycobacterial load. Change in mycobacterial burden is likely to be the best indicator of treatment outcome, but the optimum study techniques remain undefined. Finally, we propose methods to assess candidate markers, and how these candidate markers could be implemented in future clinical trials.