Insulin versus oral agents in the management of Cystic Fibrosis Related Diabetes: a case based study

BACKGROUND: Insulin is the recommend therapeutic agent of choice for the management of Cystic Fibrosis Related Diabetes (CFRD), despite only sub-optimal reductions in glycemic control and increased morbidity and mortality reported by centers using this agent. The newer insulin sensitizing agents demonstrated to have anti-inflammatory mechanisms may provide an alternative management option for CFRD. METHODS: A prospective case based therapeutic comparison between insulin, sulfonylurea, metformin and thiazolidinedione was observed over one decade with 20 CFRD patients diagnosed using American Diabetes Association guideline standards. Patients entering the study elected treatment based on risk and benefit information provided for treatment options. Patients receiving organ transplant or requiring combination diabetic medications were excluded from the study. RESULTS: No statistical advantage was achieved regarding overall glycemic control for oral agents over insulin. Additional outcome measures including changes in weight, liver function testing and FEV(1 )were not statistically significant. CONCLUSION: Insulin alone may not be the only therapeutic option in managing CFRD. Oral hypoglycemic agents were equally effective in treating CFRD and may provide an alternative class of agents for patients reluctant in using insulin

Partitioning core and satellite taxa from within cystic fibrosis lung bacterial communities

Cystic fibrosis (CF) patients suffer from chronic bacterial lung infections that lead to death in the majority of cases. The need to maintain lung function in these patients means that characterising these infections is vital. Increasingly, culture-independent analyses are expanding the number of bacterial species associated with CF respiratory samples; however, the potential significance of these species is not known. Here, we applied ecological statistical tools to such culture-independent data, in a novel manner, to partition taxa within the metacommunity into core and satellite species. Sputa and clinical data were obtained from 14 clinically stable adult CF patients. Fourteen rRNA gene libraries were constructed with 35 genera and 82 taxa, identified in 2139 bacterial clones. Shannon–Wiener and taxa-richness analyses confirmed no undersampling of bacterial diversity. By decomposing the distribution using the ratio of variance to the mean taxon abundance, we partitioned objectively the species abundance distribution into core and satellite species. The satellite group comprised 67 bacterial taxa from 33 genera and the core group, 15 taxa from 7 genera (including Pseudomonas (1 taxon), Streptococcus (2), Neisseria (2), Catonella (1), Porphyromonas (1), Prevotella (5) and Veillonella (3)], the last four being anaerobes). The core group was dominated by Pseudomonas aeruginosa. Other recognised CF pathogens were rare. Mantel and partial Mantel tests assessed which clinical factors influenced the composition observed. CF transmembrane conductance regulator genotype and antibiotic treatment correlated with all core taxa. Lung function correlated with richness. The clinical significance of these core and satellite species findings in the CF lung is discussed

phases I and III)

Background: Asthma is a common chronic illness in childhood. The aim of the study was to examine time trends in the prevalence of asthma using the ISAAC questionnaire in 6- to 12-year-old schoolchildren in Istanbul and factors affecting asthma prevalence.Methods: Two cross-sectional surveys were performed, 9 years apart (1995 and 2004) using the ISAAC protocol. The survey conducted in 1995 was repeated in 2004 using the same questionnaire in the same age group, in the same schools in the same season. The 2500 questionnaires were distributed to the children to be completed by their parents at home.Results: A total of 2387 children (response rate 95.5%) in the 2004 study and 2216 children (response rate 94.3%) in 1995 were included in the final analysis. The overall lifetime prevalence of wheeze increased from 15.1% to 25.3%; prevalence odds ratio (POR) = 1.91, 95% confidence interval (95% CI) = 1.64-2.21, and P < 0.001. The overall 12-month prevalence of wheeze increased from 8.2% to 11.3%; POR = 1.43, 95% CI = 1.18-1.75, and P < 0.001. The prevalence of asthma increased significantly from 9.8% to 17.8%; POR = 1.99, 95% CI = 1.67-2.36, and P < 0.001. In both 1995 and 2004, family history of asthma, eczema diagnosed by a physician, food allergy diagnosed by a physician, frequent otitis, frequent sinusitis were associated significantly with high risk for asthma.Conclusions: In the 9-year period from 1995 to 2004, the prevalence of asthma symptoms has increased in 6- to 12-year-old schoolchildren in Istanbul. Risk factors affecting asthma prevalence remained unchanged during the 9-year period