Non-HFE hemochromatosis

Hereditary hemochromatosis (HH) is an autosomal recessive disorder classically related to HFE mutations. However, since 1996, it is known that HFE mutations explain about 80% of HH cases, with the remaining around 20% denominated non-HFE hemochromatosis. Nowadays, four main genes are implicated in the pathophysiology of clinical syndromes classified as non-HFE hemochromatosis: hemojuvelin (HJV, type 2Ajuvenile HH), hepcidin (HAMP, type 2B juvenile HH), transferrin receptor 2 (TFR2, type 3 HH) and ferroportin (SLC40A1, type 4 HH). The aim of this review is to explore molecular, clinical and management aspects of non-HFE hemochromatosis

Risk of pneumonia in patients with COPD initiating fixed dose inhaled corticosteroid (ICS) / long-acting bronchodilator (LABD) formulations containing extrafine beclometasone dipropionate versus patients initiating LABD without ICS

Professor Dave Singh is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC). Jaco Voorham is acknowledged for his contribution to protocol development. We would also like to acknowledge Ms. Shilpa Suresh (MSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication. This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was funded by Chiesi Farmaceutici S.p.A.Peer reviewedPublisher PD

Aspergillosis of the central nervous system

The authors report an unusual case involving a 38 year-old man who developed a intracranial abscess caused by Aspergillus of the parietal lobe. Cerebral aspergilloma of an initial pulmonary origin developed in a patient with "Fungus Ball" secondary to tuberculosis sequelae. The diagnosis was made through the isolation of Aspergillus from the secretion of the brain abscesses. The patient was treated with drainage of the abscesses and Amphotericin B. He presented a progressive regression of the radiological images (brain and pulmonary) over a period of 55 days. This report emphasizes the importance of combined anti-fungal therapy and surgical resection as a treatment for cerebral aspergilloma. Furthermore, an early initiation of therapy should improve the prognosis in such cases

Interclass difference in pneumonia risk in COPD patients initiating fixed dose inhaled treatment containing extrafine particle beclometasone versus fine particle fluticasone

Acknowledgements Professor Dave Singh is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC). Jaco Vooriham is acknowledged for his contribution to protocol development. We would also like to acknowledge Ms. Shilpa Suresh (MSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.Peer reviewedPublisher PD

Air pollution from biomass burning and asthma hospital admissions in a sugar cane plantation area in Brazil

Objective: To evaluate the association between the total suspended particles (TSPs) generated from preharvest sugar cane burning and hospital admission due to asthma ( asthma hospital admissions) in the city of Araraquara.Design: An ecological time-series study. Total daily records of asthma hospital admissions (ICD 10th J15) were obtained from one of the main hospitals in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. the daily concentration of TSP (mu g/m(3)) was obtained using Handi-vol equipment (Energetica, Brazil) placed in downtown Araraquara. the local airport provided the daily mean figures of temperature and humidity. the daily number of asthma hospital admissions was considered as the dependent variable in Poisson's regression models and the daily concentration of TSP was considered the independent variable. the generalised linear model with natural cubic spline was adopted to control for long-time trend. Linear terms were used for weather variables.Results: TSP had an acute effect on asthma admissions, starting 1 day after TSP concentrations increased and remaining almost unchanged for the next four days. A 10 mu g/m(3) increase in the 5-day moving average (lag1-5) of TSP concentrations was associated with an increase of 11.6% (95% CI 5.4 to 17.7) in asthma hospital admissions.Conclusion: Increases in TSP concentrations were definitely associated with asthma hospital admissions in Araraquara and, despite using sugar cane alcohol to reduce air pollution from automotive sources in large Brazilian urban centres, the cities where sugar cane is harvested pay a high toll in terms of public health.Univ São Paulo, Fac Med, Lab Poluicao Atmosfer Expt, Nucleo Estudos Epidemiol Ambiental, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Grp Fisiopatol Resp & Poluicao Ambiental, São Paulo, BrazilUniv Catolica Santos, Programa Posgrad Saude Coletiva, Santos, SP, BrazilUniv Santo Amaro, Fac Med, Programa Pediat Ambiental, São Paulo, BrazilABC, Fac Med, Dept Saude Coletividade, Santo Andre, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Grp Fisiopatol Resp & Poluicao Ambiental, São Paulo, BrazilWeb of Scienc

Commencement of fixed dose ICS of varying particle size as a predictor of pneumonia in COPD patients

Grant Support: This study was funded by Chiesi Farmaceutici S.p.A. David Price has grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Theravance and UK National Health Service; is a peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline.Postprin

Recommendations for the pharmacological treatment of COPD: questions and answers

ABSTRACT The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities

Recommendations for the pharmacological treatment of COPD: questions and answers

ABSTRACT The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities