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Anton-Păduraru DT, Azoicăi AN, Trofin F, Mîndru DE, Murgu AM, Bocec AS, Iliescu Halițchi CO, Ciongradi CI, Sȃrbu I, Iliescu ML. Diagnosing Cystic Fibrosis in the 21st Century-A Complex and Challenging Task. Diagnostics (Basel) 2024; 14:763. [PMID: 38611676 PMCID: PMC11012009 DOI: 10.3390/diagnostics14070763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Cystic fibrosis (CF) is a chronic and potentially life-threatening condition, wherein timely diagnosis assumes paramount significance for the prompt initiation of therapeutic interventions, thereby ameliorating pulmonary function, addressing nutritional deficits, averting complications, mitigating morbidity, and ultimately enhancing the quality of life and extending longevity. This review aims to amalgamate existing knowledge to provide a comprehensive appraisal of contemporary diagnostic modalities pertinent to CF in the 21st century. Deliberations encompass discrete delineations of each diagnostic modality and the elucidation of potential diagnostic quandaries encountered in select instances, as well as the delineation of genotype-phenotype correlations germane to genetic counseling endeavors. The synthesis underscores that, notwithstanding the availability and strides in diagnostic methodologies, including genetic assays, the sweat test (ST) retains its position as the preeminent diagnostic standard for CF, serving as a robust surrogate for CFTR functionality. Prospective clinical investigations in the realm of CF should be orchestrated with the objective of discerning novel diagnostic modalities endowed with heightened specificity and sensitivity.
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Affiliation(s)
- Dana-Teodora Anton-Păduraru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Alice Nicoleta Azoicăi
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Felicia Trofin
- Department of Preventive Medicine and Interdisciplinarity—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania
| | - Dana Elena Mîndru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Alina Mariela Murgu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Ana Simona Bocec
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
| | - Codruța Olimpiada Iliescu Halițchi
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
| | - Carmen Iulia Ciongradi
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
- 2nd Department of Surgery, Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania
| | - Ioan Sȃrbu
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
- 2nd Department of Surgery, Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania
| | - Maria Liliana Iliescu
- Department of Preventive Medicine and Interdisciplinarity—Public Health and Health Management, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania;
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Dubot P, Liang J, Dubs J, Missiak Y, Sarazin C, Couderc F, Caussé E. Sweat chloride quantification using capillary electrophoresis. Pract Lab Med 2018; 13:e00114. [PMID: 30623007 PMCID: PMC6317274 DOI: 10.1016/j.plabm.2018.e00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/06/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022] Open
Abstract
Background Cystic fibrosis (CF) is the less rare and severe genetic disease among the European population. Biochemical diagnosis of CF is based on the demonstration of increased chloride concentration in sweat samples, obtained during the sweat test (ST). WynSep developed a capillary electrophoresis with contactless conductivity detection (CE-C4D) able to measure sweat chloride with a low sample volume. We evaluated the clinical feasibility of this device in a cohort of patients suspected of CF, in comparison with the common coulometric method (ChloroChek chloridometer). Methods We determined sweat chloride concentration of 65 samples from patients referred to our institution to undergo a sweat test. Each sample was submitted to coulometric method first, then WynSep-CE, with or without internal standard (IS) subject to sufficient volume sample. Results A total of 53 samples were analysed by both coulometric and WynSep-CE (using IS) methods. The method validation showed comparable analytical performances for both methods; no false positive or false negative was recorded. The two methods showed a high correlation (r = 0.993, p < 0.001) and a close agreement was demonstrated by two different statistical tests (Bland-Altman and Passing-Bablok). Conclusions WynSep-CE is an accurate, fast, easy-to-use and an appropriate method for CF diagnosis.
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Affiliation(s)
- Patricia Dubot
- Laboratoire de Biochimie, Institut Fédératif de Biologie, Hôpital Purpan, 330, av de Grande Bretagne TSA 40031, 31059 Toulouse Cedex 9, France
| | - Jing Liang
- WynSep SAS, Prologue 1, 815 La Pyrénéenne, 31670 Labège, France
| | - Jacobé Dubs
- WynSep SAS, Prologue 1, 815 La Pyrénéenne, 31670 Labège, France
| | - Yohann Missiak
- Laboratoire de Biochimie, Institut Fédératif de Biologie, Hôpital Purpan, 330, av de Grande Bretagne TSA 40031, 31059 Toulouse Cedex 9, France
| | - Cédric Sarazin
- WynSep SAS, Prologue 1, 815 La Pyrénéenne, 31670 Labège, France
| | - François Couderc
- Laboratoire de Chimie Analytique et Spectrométrie de Masse, IMRCP, UMR, 5623 Toulouse, France
| | - Elizabeth Caussé
- Laboratoire de Biochimie, Institut Fédératif de Biologie, Hôpital Purpan, 330, av de Grande Bretagne TSA 40031, 31059 Toulouse Cedex 9, France
- Corresponding author.
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Gomez CCS, Marson FAL, Servidoni MF, Ribeiro AF, Ribeiro MÂGO, Gama VAL, Costa ET, Ribeiro JD, Vieira Junior FU. Evaluation of continuous constant current and continuous pulsed current in sweat induction for cystic fibrosis diagnosis. BMC Pulm Med 2018; 18:153. [PMID: 30217179 PMCID: PMC6137935 DOI: 10.1186/s12890-018-0696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
Background The sweat test (ST) is the gold standard for the diagnosis of cystic fibrosis (CF). However, little is known about sweat induction using different types of currents and waves. In this context, our objective was to develop a device to induce sweat and compare the use of continuous constant current (CCC) and continuous pulsed current (CPC) in individuals with CF and healthy controls. Methods A prospective cross-sectional study with experimental intervention. The variables of gender, ethnicity, age, and body mass index (BMI) were considered. The method of Gibson and Cooke was used, and the following markers were evaluated: sweat weight, electrical impedance, sufficient sweat amount, and CF diagnosis. Triangular (TPC) or sinusoidal (SPC) pulsed current was applied to the right arm, and CCC was applied to the left arm. Results The study analyzed 260 individuals, 141/213 (54.2%) were female participants, 135/260 (51.9%) were Caucasians. The distribution of individuals by concentration of chloride at the ST was: (CF) 26/260 (10%); (borderlines) 109/260 (41.9%); (healthy) 97/260 (37.3%); (insufficient weight in sweat) 28/260 (10.8%). No association was observed between the sufficient sweat amount to perform the ST when we compared the currents. However, the SPC showed a higher amount of sweat weight. Using Bland and Altman plot considering the agreement between the sweat chloride values achieved from CPC [SPC and TPC] and CCC, there was no proportional bias and mean values are unrelated and only explain less than 8% of the variation. Moreover, TPC presented higher electrical impedance when compared with SPC and CCC. SPC presented lower electrical impedance and higher sweat weight than CCC. Male participants presented lower electrical impedance and higher sweat weight with CCC and TPC, and higher sweat weight with SPC. Conclusions The evaluated currents are safe and able to induce and produce sweat in sufficient quantities for the ST. SPC presented lower electrical impedance when compared with other currents. The use of SPC is recommended to induce sweat in patients with sweat problems. Finally, ethnicity, gender, age and BMI did not influence sweat induction at the ST, and no side effect was observed in our study. Electronic supplementary material The online version of this article (10.1186/s12890-018-0696-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carla Cristina Souza Gomez
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil. .,Center for Research in Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil. .,Center for Research in Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil. .,Department of Medical Genetics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.
| | - Maria Fátima Servidoni
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.,Center for Research in Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.,Gastrocentro - Endoscopy Unit, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-872, Brazil
| | - Antônio Fernando Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.,Center for Research in Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil
| | - Maria Ângela Gonçalves Oliveira Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.,Center for Research in Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil
| | - Veruska Acioli Lopes Gama
- Center for Biomedical Engineering, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-970, Brazil.,Department of Biomedical Engineering, Faculty of Electrical and Computer Engineering, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-881, Brazil.,Federal Institute of Education, Science and Technology of Sao Paulo, Campus Campinas, km 143.5, Campinas, São Paulo, 13069-901, Brazil
| | - Eduardo Tavares Costa
- Center for Biomedical Engineering, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-970, Brazil.,Department of Biomedical Engineering, Faculty of Electrical and Computer Engineering, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-881, Brazil
| | - José Dirceu Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil.,Center for Research in Pediatrics, School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-887, Brazil
| | - Francisco Ubaldo Vieira Junior
- Center for Biomedical Engineering, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-970, Brazil.,Department of Biomedical Engineering, Faculty of Electrical and Computer Engineering, University of Campinas, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas, São Paulo, 13083-881, Brazil.,Federal Institute of Education, Science and Technology of Sao Paulo, Campus Campinas, km 143.5, Campinas, São Paulo, 13069-901, Brazil
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Faria AG, Marson FAL, de Souza Gomez CC, Ribeiro MÂGDO, Morais LB, de Fátima Servidoni M, Bertuzzo CS, Sakano E, Goto M, Paschoal IA, Pereira MC, Hessel G, Levy CE, Toro AADC, Peixoto AO, Simões MCR, Lomazi EA, Nogueira RJN, Ribeiro AF, Ribeiro JD. Erratum to: Quality of sweat test (ST) based on the proportion of sweat sodium (Na) and sweat chloride (Cl) as diagnostic parameter of cystic fibrosis: are we on the right way? Diagn Pathol 2017; 12:22. [PMID: 28241768 PMCID: PMC5327522 DOI: 10.1186/s13000-017-0611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alethéa Guimarães Faria
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil. .,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil. .,Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil. .,Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Tessália Vieira de Camargo, 126, Barão Geraldo, Cidade Universitária Zeferino Vaz, CEP: 13083-887, Campinas, São Paulo, Brazil.
| | | | - Maria Ângela Gonçalves de Oliveira Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lucas Brioschi Morais
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maria de Fátima Servidoni
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carmen Sílvia Bertuzzo
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Eulália Sakano
- Department of Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maura Goto
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Ilma Aparecida Paschoal
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mônica Corso Pereira
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gabriel Hessel
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carlos Emílio Levy
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | | | | | - José Dirceu Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Faria AG, Marson FAL, Gomez CCS, Servidoni MDF, Ribeiro AF, Ribeiro JD. Thirty Years of Sweat Chloride Testing at One Referral Center. Front Pediatr 2017; 5:222. [PMID: 29124052 PMCID: PMC5662556 DOI: 10.3389/fped.2017.00222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/03/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To conduct a descriptive analysis of the sweat test (ST), associating ST results with epidemiological data, CFTR (cystic fibrosis transmembrane conductance regulator) mutations and reasons to indicate the ST, as well as correlating sweat sodium and sweat chloride concentrations in subjects. METHODS Retrospective survey and descriptive analysis of 5,721 ST at a university referral center. RESULTS The inclusion of the subjects was based on clinical data related with cystic fibrosis (CF) phenotype. The samples were grouped by (i) sweat chloride concentrations (mEq/L): <30: 3,249/5,277 (61.6%); ≥30 to <60: 1,326/5,277 (25.1%); ≥60: 702/5,277 (13.3%) and (ii) age: (Group A--GA) 0 to <6 months; (Group B--GB) ≥6 months to <18 years; (Group C--GC) ≥18 years. Digestive symptoms showed higher prevalence ratio for the CF diagnosis as well as association between younger age and higher values of sweat chloride, sweat sodium, and chloride/sodium ratio. The indication of ST due to respiratory symptoms was higher in GB and associated with greater age, lower values of sweat chloride, sweat sodium, and chloride/sodium ratio. There was higher prevalence of ST with sweat chloride levels <30 mEq/L in GB, ≥60 mEq/L in GC, and with borderline level in GB. There was positive correlation between sweat sodium and sweat chloride. Sweat chloride/sweat sodium and sweat sodium-sweat chloride indexes showed association with sex, reason for ST indication, and CFTR mutations. Sex alters some values presented in the ST. The number of ST/year performed before and after the newborn screening implementation was the same; however, we observed a higher number of borderlines values. A wide spectrum of CFTR mutation was found. Severe CFTR mutations and F508del/F508del genotype were associated with highest probability of ST chloride levels ≥60 mEq/L, and the absence of CFTR mutations identified was associated with borderline ST and respiratory symptoms. CONCLUSIONS ST data showed wide variability dependent on age, sex, reason for examination indication, CFTR mutations, and weight of the collected sweat sample. Sweat sodium concentration is directly correlated with sweat chloride levels and it could be used as a quality parameter.
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Affiliation(s)
- Alethéa Guimarães Faria
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Maria de Fátima Servidoni
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - José Dirceu Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil
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