- Publikační typ
- tisková chyba MeSH
This is the second in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on establishing and maintaining health. The guidance is produced using an evidence-based framework and with wide stakeholder engagement, including people from the CF community. Authors provided a narrative description of their topic and statements, which were more directive. These statements were reviewed by a Delphi exercise, achieving good levels of agreement from a wide group for all statements. This guidance reinforces the importance of a multi-disciplinary CF team, but also describes developing models of care including virtual consultations. The framework for health is reinforced, including the need for a physically active lifestyle and the strict avoidance of all recreational inhalations, including e-cigarettes. Progress with cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy is reviewed, including emerging adverse events and advice for dose reduction and interruption. This paper contains guidance that is pertinent to all people with CF regardless of age and eligibility for and access to modulator therapy.
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
The discovery of modulators that target cystic fibrosis transmembrane conductance regulator (CFTR) protein has opened the era of CF curative treatment. Although this therapy is termed mutation specific, strikingly a level of therapeutic response differs among patients with the identical CFTR genotype. We presume that the therapeutic response is also affected by non-CFTR genes, called disease modifying. Responsiveness of a CF patient to the modulator therapy is being investigated in vitro by using a intestinal organoids that are obtained from rectal biopsies. The proposed project aims to set organoids from the Czech CF patients who carry the most common CFTR genotype. Modifying genes that can contribute to individualised response will be selected on the grounds of changes in transcriptomic profiles which will be generated from organoids at the extremes of responses to the stimultation with CFTR modulators. Genotyping of SNPs in these genes will follow. The project output is to use organoids and modifying gene genotypes to identify suitable subjects for particular modulator therapy.
Objev modulátorů, které cílí na transmembránový regulátor vodivosti asociovaný s cystickou fibrózou (CFTR), otevřel etapu kauzální léčby CF. I když se tato terapie nazývá mutačně specifická, liší se míra odpovědi na léčbu i mezi těmi pacienty, kteří mají identický CFTR genotyp. Lze tak předjímat, že odpověď k léčbě ovlivňují ještě další geny nad rámec genu CFTR, tzv. geny modifikující onemocnění. Zda bude konkrétní pacient reagovat na léčbu modulátory CFTR, se zkouší in vitro predikovat na modelu intestinálních organoidů, získaných z rektálních biopsií. Navrhovaný projekt počítá s přípravou organoidů od českých pacientů s CF, kteří nesou nejčastější CFTR genotyp. Modifikující geny, které se mohou podílet na individualizované odpovědi k léčbě, vytipujeme na základě rozdílů v transkriptomových profilech, jež budou generovány z organoidů reagujících nejlépe a nejhůře na stimulaci CFTR modulátory. Dále srovnáme polymorfismy těchto genů. Výstupem projektu bude stratifikace pacientů coby vhodných kandidátů k dané léčbě na základě organoidů i znalosti genotypu modifikujících genů.
- Klíčová slova
- cystická fibróza, cystic fibrosis, organoidy, léky modulující CFTR, organoids, CFTR modulator drugs, modifikující geny, modifying genes,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
This is the final of four papers updating standards for the care of people with CF. That this paper "Planning a longer life" was considered necessary, highlights how much CF care has progressed over the past decade. Several factors underpin this progress, notably increased numbers of people with CF with access to CFTR modulator therapy. As the landscape for CF changes, so do the hopes and aspirations of people with CF and their families. This paper reflects the need to consider people with CF not as a "problem" to be solved, but as a success, a potential and a voice to be heard. People with CF and the wider CF community have driven this approach, reflecting many of the topics in this paper. This exercise involved wide stakeholder engagement. People with CF are keen to contribute to research priorities and be involved in all stages of research. People with CF want healthcare professionals to respect them as individuals and consider the impact of our actions on the world around us. Navigating life presents challenges to all, but for people with CF these challenges are heightened and complex. In this paper we highlight the concerns and life moments that impact people with CF, and events that the CF team should aim to support, including the challenges around having a family. People with CF and their care teams must embrace the updated standards outlined in these four papers to enjoy the full potential for a healthier life.
- MeSH
- cystická fibróza * terapie MeSH
- kvalita života MeSH
- lidé MeSH
- standardní péče MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The major cause of mortality in people with cystic fibrosis (pwCF) is progressive lung disease characterised by acute and chronic infections, the accumulation of mucus, airway inflammation, structural damage and pulmonary exacerbations. The prevalence of Pseudomonas aeruginosa rises rapidly in the teenage years, and this organism is the most common cause of chronic lung infection in adults with cystic fibrosis (CF). It is associated with an accelerated decline in lung function and premature death. New P. aeruginosa infections are treated with antibiotics to eradicate the organism, while chronic infections require long-term inhaled antibiotic therapy. The prevalence of P. aeruginosa infections has decreased in CF registries since the introduction of CF transmembrane conductance regulator modulators (CFTRm), but clinical observations suggest that chronic P. aeruginosa infections usually persist in patients receiving CFTRm. This indicates that pwCF may still need inhaled antibiotics in the CFTRm era to maintain long-term control of P. aeruginosa infections. Here, we provide an overview of the changing perceptions of P. aeruginosa infection management, including considerations on detection and treatment, the therapy burden associated with inhaled antibiotics and the potential effects of CFTRm on the lung microbiome. We conclude that updated guidance is required on the diagnosis and management of P. aeruginosa infection. In particular, we highlight a need for prospective studies to evaluate the consequences of stopping inhaled antibiotic therapy in pwCF who have chronic P. aeruginosa infection and are receiving CFTRm. This will help inform new guidelines on the use of antibiotics alongside CFTRm.
- MeSH
- antibakteriální látky * aplikace a dávkování terapeutické užití MeSH
- aplikace inhalační MeSH
- cystická fibróza * komplikace mikrobiologie farmakoterapie MeSH
- lidé MeSH
- protein CFTR * genetika MeSH
- pseudomonádové infekce * farmakoterapie MeSH
- Pseudomonas aeruginosa * účinky léků izolace a purifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- cystická fibróza * MeSH
- individualizovaná medicína MeSH
- kolforsin farmakologie MeSH
- lidé MeSH
- mutace MeSH
- protein CFTR genetika MeSH
- střevní sliznice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
Following the COVID-19 infection, the sternum dislocation and wound dehiscence resulted in an infection complicating the recovery of an immunosuppressed patient after bilateral lung transplantation. Anaerobic culture (96 h) of milky cloudy wound secretion resulted in the growth of pinpoint haemolytic colonies identified as Metamycoplasma hominis (formerly Mycoplasma hominis). The search for the endogenous source of the infection found the bacterium exclusively in the patient's sputum, making a possible link to donor lung M. hominis colonization. Unfortunately, the donor samples were no longer available. The wound infection was successfully treated with 17 days of clindamycin despite the continuous PCR detection of M. hominis in the sputum after the end of the treatment.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- COVID-19 diagnóza MeSH
- hostitel s imunodeficiencí MeSH
- infekce chirurgické rány * mikrobiologie farmakoterapie diagnóza MeSH
- klindamycin terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- Mycoplasma hominis * genetika izolace a purifikace MeSH
- mykoplazmové infekce * mikrobiologie diagnóza farmakoterapie MeSH
- SARS-CoV-2 genetika izolace a purifikace MeSH
- sputum mikrobiologie MeSH
- transplantace plic * škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
This review aims to explore the role of professional diagnostic rapid testing of acute respiratory infections (ARIs), especially COVID-19 and influenza, ensuring proper disease management and treatment in Europe, and particularly in Czech Republic, Poland, and Romania. The paper was constructed based on a review of scientific evidence and national and international policies and recommendations, as well as a process of validation by four experts. The development of new testing technologies, treatment options, and increased awareness of the negative multidimensional impact of ARI profiles transformed differential diagnosis into a tangible and desirable reality. This review covers the following topics: (1) the multidimensional impact of ARIs, (2) ARI rapid diagnostic testing platforms and their value, (3) the policy landscape, (4) challenges and barriers to implementation, and (5) a set of recommendations illustrating a path forward. The findings indicate that rapid diagnostic testing, including at the point of care (POC), can have a positive impact on case management, antimicrobial and antibiotic stewardship, epidemiological surveillance, and decision making. Integrating this strategy will require the commitment of governments and the international and academic communities, especially as we identified room for improvement in the access and expansion of POC rapid testing in the focus countries and the inclusion of rapid testing in relevant policies.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
This is the third in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on recognising and addressing CF health issues. The guidance was produced with wide stakeholder engagement, including people from the CF community, using an evidence-based framework. Authors contributed sections, and summary statements which were reviewed by a Delphi consultation. Monitoring and treating airway infection, inflammation and pulmonary exacerbations remains important, despite the widespread availability of CFTR modulators and their accompanying health improvements. Extrapulmonary CF-specific health issues persist, such as diabetes, liver disease, bone disease, stones and other renal issues, and intestinal obstruction. These health issues require multidisciplinary care with input from the relevant specialists. Cancer is more common in people with CF compared to the general population, and requires regular screening. The CF life journey requires mental and emotional adaptation to psychosocial and physical challenges, with support from the CF team and the CF psychologist. This is particularly important when life gets challenging, with disease progression requiring increased treatments, breathing support and potentially transplantation. Planning for end of life remains a necessary aspect of care and should be discussed openly, honestly, with sensitivity and compassion for the person with CF and their family. CF teams should proactively recognise and address CF-specific health issues, and support mental and emotional wellbeing while accompanying people with CF and their families on their life journey.
- MeSH
- cystická fibróza * terapie MeSH
- lidé MeSH
- společnosti lékařské MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
We report the first described case of pulmonary tularaemia in the pediatric patient receiving infliximab for ulcerative colitis. We highlight the importance of considering Francisella tularensis in diagnostically challenging cases of persistent respiratory symptoms to facilitate early diagnosis and adequate therapy. The TCR-γδ + DN T cells are gaining important role in clinical practice. Polymerase chain reaction assays and serology guarantee early recognition.
- MeSH
- dítě MeSH
- Francisella tularensis * genetika MeSH
- idiopatické střevní záněty * diagnóza farmakoterapie MeSH
- infliximab škodlivé účinky MeSH
- lidé MeSH
- mladiství MeSH
- polymerázová řetězová reakce MeSH
- tularemie * diagnóza farmakoterapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
