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Posaconazole therapy in children with cystic fibrosis and Aspergillus-related lung disease.

泊沙康唑治疗儿童囊性纤维化和曲霉菌相关肺病。

  • 影响因子:2.79
  • DOI:10.1093/mmy/myz015
  • 作者列表:"Patel D","Popple S","Claydon A","Modha DE","Gaillard EA
  • 发表时间:2020-01-01
Abstract

:There is emerging evidence for the role of posaconazole in the management of Aspergillus-related cystic fibrosis (CF) lung disease. The tolerability and efficacy of posaconazole in paediatric CF is not well established. We report a prospective study over a fifty-three month period evaluating the safety, tolerability, and efficacy of posaconazole in pediatric CF. Fourteen children (seven males, median age 13 years, range 3-17 years) received a total of twenty-three courses of posaconazole (13 oral suspension and 10 tablet formulation). Of these patient episodes, nine received posaconazole for emerging or active allergic bronchopulmonary aspergillosis (ABPA) and two required a combination of posaconazole and systemic corticosteroids for difficult-to-treat ABPA. A subgroup of patients (n = 12) with persistent isolates of Aspergillus fumigatus, in the absence of serological markers of ABPA, received posaconazole monotherapy for pulmonary exacerbations not responding to conventional broad-spectrum antibiotic treatment. Posaconazole levels, full blood count, electrolytes, and liver function were monitored on day 7 of treatment and then monthly. Posaconazole was well tolerated in all but three patients. Therapeutic plasma levels >1 mg/l were achieved in all receiving the tablet formulation in comparison to 60% on the liquid preparation. There was a modest but significant improvement in FEV1 (% predicted) demonstrated for the cohort as a whole (p = 0.015) following posaconazole therapy. Posaconazole is well tolerated in children as young as six years old, improvements in lung function are observed, and therapeutic plasma levels are readily achieved in patients taking the tablet formulation and in adherent patients taking the liquid formulation.

摘要

: 泊沙康唑在曲霉菌相关囊性纤维化 (CF) 肺病治疗中的作用有新的证据。泊沙康唑在儿科CF中的耐受性和疗效尚未确定。我们报告了一项为期 53 个月的前瞻性研究,评价了泊沙康唑在儿童CF中的安全性、耐受性和疗效。14 名儿童 (7 名男性,中位年龄 1 3 岁,范围 3-17 岁) 总共接受了 23 个疗程的泊沙康唑 (1 3 个口服混悬液和 10 片制剂)。在这些患者发作中,9 例因新发或活动性过敏性支气管肺曲霉病 (ABPA) 接受了泊沙康唑,2 例因难以治疗的ABPA需要联合泊沙康唑和全身性皮质类固醇。在缺乏ABPA血清学标志物的情况下,持续分离出烟曲霉的患者亚组 (n = 12),接受泊沙康唑单药治疗对常规广谱抗生素治疗无反应的肺部加重。在治疗第 7 天,然后每月监测泊沙康唑水平、全血细胞计数、电解质和肝功能。除 3 例患者外,所有患者对泊沙康唑的耐受性良好。与液体制剂的 60% 相比,所有接受片剂制剂的治疗血浆水平均达到> 1 mg/l。泊沙康唑治疗后,整个队列 (p = 0.015) 的FEV1 (% 预测值) 有适度但显著的改善。泊沙康唑在 6 岁的儿童中耐受性良好,观察到肺功能改善,并且在服用片剂制剂的患者和服用液体制剂的粘附患者中很容易达到治疗性血浆水平。

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影响因子:2.79
发表时间:2020-01-01
来源期刊:Medical mycology
DOI:10.1093/mmy/myz015
作者列表:["Patel D","Popple S","Claydon A","Modha DE","Gaillard EA"]

METHODS::There is emerging evidence for the role of posaconazole in the management of Aspergillus-related cystic fibrosis (CF) lung disease. The tolerability and efficacy of posaconazole in paediatric CF is not well established. We report a prospective study over a fifty-three month period evaluating the safety, tolerability, and efficacy of posaconazole in pediatric CF. Fourteen children (seven males, median age 13 years, range 3-17 years) received a total of twenty-three courses of posaconazole (13 oral suspension and 10 tablet formulation). Of these patient episodes, nine received posaconazole for emerging or active allergic bronchopulmonary aspergillosis (ABPA) and two required a combination of posaconazole and systemic corticosteroids for difficult-to-treat ABPA. A subgroup of patients (n = 12) with persistent isolates of Aspergillus fumigatus, in the absence of serological markers of ABPA, received posaconazole monotherapy for pulmonary exacerbations not responding to conventional broad-spectrum antibiotic treatment. Posaconazole levels, full blood count, electrolytes, and liver function were monitored on day 7 of treatment and then monthly. Posaconazole was well tolerated in all but three patients. Therapeutic plasma levels >1 mg/l were achieved in all receiving the tablet formulation in comparison to 60% on the liquid preparation. There was a modest but significant improvement in FEV1 (% predicted) demonstrated for the cohort as a whole (p = 0.015) following posaconazole therapy. Posaconazole is well tolerated in children as young as six years old, improvements in lung function are observed, and therapeutic plasma levels are readily achieved in patients taking the tablet formulation and in adherent patients taking the liquid formulation.

翻译标题与摘要 下载文献
影响因子:1.80
发表时间:2020-02-01
DOI:10.1016/j.parint.2019.04.015
作者列表:["Gonçales JP","Nobrega CGO","Nascimento WRC","Lorena VMB","Peixoto DM","Costa VMA","Barbosa CS","Solé D","Sarinho ESC","Souza VMO"]

METHODS::The relationship between the cellular immune response during Trichuris trichiura infection and asthma has not yet been established. In this study, the cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL-17A were evaluated in asthmatic children harboring T. trichiura. For this assessment, asthmatic and non-asthmatic children (ISAAC questionnaire) were submitted to parasitological tests and blood samples were cultured (mitogen stimulation) for cytokine measurements in the supernatant. Asthma frequencies were similar in infected and uninfected children, but IL-4, IL-6, TNF-α and IL-10 levels were high in the infected asthmatic children. Additionally, infected non-asthmatic children exhibited high levels of these cytokines in relation to uninfected non-asthmatic children; however, cytokine levels were lower when compared with infected and asthmatic children. Therefore, T. trichiura infection positively modulated the pro- and anti-inflammatory cytokines in asthmatic children, but a background of asthma seemed to narrow the production of cytokines induced by this helminth.

翻译标题与摘要 下载文献
影响因子:3.51
发表时间:2020-02-01
DOI:10.1007/s00787-019-01336-2
作者列表:["van der Schans J","Cao Q","Bos EH","Rours GIJG","Hoekstra PJ","Hak E","de Vries TW"]

METHODS::In a recent meta-analysis, we found that atopic diseases, like asthma and allergic rhinitis, occur more frequently prior to the onset of attention-deficit/hyperactivity disorder (ADHD). Our aim was to determine the temporal order of the association between daily fluctuations in atopic disease symptoms and in ADHD symptoms in individual participants. In this observational study among 21 participants, age 7-16 years, we performed a replicated time-series analysis of symptom fluctuations in asthma and/or allergic rhinitis and ADHD. Data were collected through parents who filled in a daily online questionnaire during up to 50 days. In each individual, we investigated the temporal order of fluctuations in atopic disease symptoms and ADHD symptoms using a vector autoregressive (VAR) model while using sleep problems and medication use as covariates. For 16 out of 21 participants, we constructed a VAR model. For a majority of the participants, significant associations were detected between atopic disease symptoms and ADHD symptoms. The results were heterogeneous; the direction, sign, and timing of the relationship between ADHD, atopy, sleep problems, and medication use varied between individuals. This study provides additional evidence that the symptom expression of atopy and ADHD are related. However, the connection between both diseases in children is found to be heterogeneous within our study population.

翻译标题与摘要 下载文献
呼吸过敏性疾病方向

当空气中的花粉、细菌等过敏原通过呼吸作用进入到肺部,就容易引起鼻子、咽喉、气管等部位出现不适的症状,可能引发多种呼吸过敏性疾病的发作。其中主要包括外源性过敏性肺泡炎、变应性支气管肺曲霉菌病、哮喘及过敏性鼻炎。

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