Legislative History: An Act to Exempt Illegally Employed Minors from Worker\u27s Compensation Coverage (HP297)(LD 418)

https://digitalmaine.com/legishist115/1417/thumbnail.jp

Ticarcillin hypersusceptibility in pseudomonas aeruginosa in cystic fibrosis

Background: A subpopulation of Pseudomonas aeruginosa (PsA) exists in cysticfibrosis (CF) patients that&nbsp; is&nbsp; hypersusceptible&nbsp; to&nbsp; ticarcillin,&nbsp; a&nbsp; carboxypenicillin,&nbsp; in&nbsp; vitro (Tichs strain)&nbsp; defined&nbsp; as&nbsp; a minimum inhibitory concentration (MIC) ≤4μg/ml. Methods: In a retrospective cohort study, isolates of PsA from CF (23),&nbsp; non-cystic fibrosis bronchiectasis (NCFB) (17) and control (18) patients were analysed. MICs for each isolate were determined using agar dilution against six antibiotics and interpreted using EUCAST breakpoints. Prevalence of Tichs in&nbsp; each&nbsp; cohort&nbsp; was&nbsp; calculated.&nbsp; A&nbsp; point&nbsp; prevalence&nbsp; survey&nbsp; was&nbsp; conducted&nbsp; in&nbsp; CF&nbsp; to&nbsp; review&nbsp; the&nbsp; patients’ clinical progress following PsA isolation. Results: Prevalence of the Tichs strain in PsA was 48%, 76% and 0% in the CF, NCFB and control cohorts respectively. A statistically significant difference in geometric mean MIC was seen between the Tichs and non-Tichs&nbsp; cohorts in CF for ticarcillin (as expected) and temocillin (p=0.041and p=0.036 respectively). A similar trend was observed in NCFB for ticarcillin (p=0.038) and temocillin (p=0.067), although statistical significance was not reached for the latter.In&nbsp; CF,&nbsp; the&nbsp; Tichs&nbsp; strain&nbsp; demonstrated&nbsp; lower&nbsp; MICs&nbsp; to&nbsp; all antibiotics&nbsp; tested&nbsp; apart&nbsp; from&nbsp; gentamicin compared&nbsp; to&nbsp; their&nbsp; non-Tichs counterparts. Those&nbsp; who&nbsp; had the Tichs strain&nbsp; in&nbsp; CF&nbsp; had&nbsp; fewer&nbsp; antibiotics (13.9&nbsp; days&nbsp; versus&nbsp; 23.5&nbsp; days,&nbsp; Tichs&nbsp; and&nbsp; non-Tichs respectively)&nbsp; although&nbsp; this&nbsp; result&nbsp; was&nbsp; not&nbsp; statistically significant p=0.202. Conclusion: Our&nbsp; data&nbsp; supports&nbsp; the&nbsp; existence&nbsp; of&nbsp; a&nbsp; Tichs strain&nbsp; of&nbsp; PsA&nbsp; in&nbsp; our&nbsp; CF&nbsp; and&nbsp; NCFB&nbsp; patient populations. This strain correlated with reduced MICs to temocillin in CF, to which PsA would normally be resistant, which may be of clinical relevance.</p

Cardiovascular and musculskeletal co-morbidities in patients with alpha 1 antitrypsin deficiency

Background Determining the presence and extent of co-morbidities is fundamental in assessing patients with chronic respiratory disease, where increased cardiovascular risk, presence of osteoporosis and low muscle mass have been recognised in several disease states. We hypothesised that the systemic consequences are evident in a further group of subjects with COPD due to Alpha-1 Antitrypsin Deficiency (A1ATD), yet are currently under-recognised. Methods We studied 19 patients with PiZZ A1ATD COPD and 20 age, sex and smoking matched controls, all subjects free from known cardiovascular disease. They underwent spirometry, haemodynamic measurements including aortic pulse wave velocity (aPWV), an independent predictor or cardiovascular risk, dual energy X-ray absorptiometry to determine body composition and bone mineral density. Results The aPWV was greater in patients: 9.9(2.1) m/s than controls: 8.5(1.6) m/s, p = 0.03, despite similar mean arterial pressure (MAP). The strongest predictors of aPWV were age, FEV1% predicted and MAP (all p < 0.01). Osteoporosis was present in 8/19 patients (2/20 controls) and was previously unsuspected in 7 patients. The fat free mass and bone mineral density were lower in patients than controls (p < 0.001). Conclusions Patients with A1ATD related COPD have increased aortic stiffness suggesting increased risk of cardiovascular disease and evidence of occult musculoskeletal changes, all likely to contribute hugely to overall morbidity and mortality

Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?

Background Patients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. We hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors. Methods Thirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation. Results On commencement of rehabilitation aortic PWV was increased in patients compared with controls (p < 0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p < 0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p < 0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p < 0.01). Total cholesterol and ISWT also improved (p < 0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP. Conclusion Cardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD

Association between HbA1c and the development of cystic fibrosis‐related diabetes

Aims To examine HbA1c as a predictor of risk for future development of cystic fibrosis‐related diabetes and to assess the association with the development of retinopathy in people with cystic fibrosis‐related diabetes. Methods A 7‐year retrospective longitudinal study was conducted in 50 adults with cystic fibrosis, comparing oral glucose tolerance test results with HbA1c values in predicting the development of cystic fibrosis‐related diabetes. Retinal screening data were also compared with HbA1c measurements to assess microvascular outcome. Results An HbA1c value ≥37 mmol/mol (5.5%; hazard ratio 3.49, CI 1.5–8.1) was significantly associated with the development of dysglycaemia, as defined by the oral glucose tolerance test over a 7‐year period. Severity of diabetic retinopathy was associated with a higher HbA1c and longer duration of cystic fibrosis‐related diabetes. Conclusion There is a link between HbA1c level and the future development of dysglycaemia in cystic fibrosis based on oral glucose tolerance test, as well as microvascular outcomes. Although current guidance does not advocate the use of HbA1c as a diagnostic tool in cystic fibrosis‐related diabetes, it may be of clinical use in determining individuals at risk of future development of cystic fibrosis‐related diabetes

Sox7 controls arterial specification in conjunction with hey2 and efnb2 function

Supramolecular & Biomaterials Chemistr