1
|
Peghin M, Los-Arcos I, Hirsch HH, Codina G, Monforte V, Bravo C, Berastegui C, Jauregui A, Romero L, Cabral E, Ferrer R, Sacanell J, Román A, Len O, Gavaldà J. Community-acquired Respiratory Viruses Are a Risk Factor for Chronic Lung Allograft Dysfunction. Clin Infect Dis 2020; 69:1192-1197. [PMID: 30561555 PMCID: PMC7797743 DOI: 10.1093/cid/ciy1047] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/11/2018] [Indexed: 01/30/2023] Open
Abstract
Background The relationship between community-acquired respiratory viruses (CARVs) and chronic lung allograft dysfunction (CLAD) in lung transplant recipients is still controversial. Methods We performed a prospective cohort study (2009–2014) in all consecutive adult patients (≥18 years) undergoing lung transplantation in the Hospital Universitari Vall d’Hebron (Barcelona, Spain). We systematically collected nasopharyngeal swabs from asymptomatic patients during seasonal changes, from patients with upper respiratory tract infectious disease, lower respiratory tract infectious disease (LRTID), or acute rejection. Nasopharyngeal swabs were analyzed by multiplex polymerase chain reaction. Primary outcome was to evaluate the potential association of CARVs and development of CLAD. Time-dependent Cox regression models were performed to identify the independent risk factors for CLAD. Results Overall, 98 patients (67 bilateral lung transplant recipients; 63.3% male; mean age, 49.9 years) were included. Mean postoperative follow-up was 3.4 years (interquartile range [IQR], 2.5–4.0 years). Thirty-eight lung transplant recipients (38.8%) developed CLAD, in a median time of 20.4 months (IQR, 12–30.4 months). In time-controlled multivariate analysis, CARV-LRTID (hazard ratio [HR], 3.00 [95% confidence interval {CI}, 1.52–5.91]; P = .002), acute rejection (HR, 2.97 [95% CI, 1.51–5.83]; P = .002), and cytomegalovirus pneumonitis (HR, 3.76 [95% CI, 1.23–11.49]; P = .02) were independent risk factors associated with developing CLAD. Conclusions Lung transplant recipients with CARVs in the lower respiratory tract are at increased risk to develop CLAD.
Collapse
Affiliation(s)
- Maddalena Peghin
- Infectious Diseases Research Group, Vall d'Hebron Research Institute, Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid.,Infectious Diseases Clinic, Department of Medicine, University of Udine and Santa Maria Misericordia Hospital, Italy
| | - Ibai Los-Arcos
- Infectious Diseases Research Group, Vall d'Hebron Research Institute, Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona.,Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Switzerland
| | - Gemma Codina
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid.,Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona
| | - Víctor Monforte
- Department of Pulmonology and Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona
| | - Carles Bravo
- Department of Pulmonology and Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona
| | - Cristina Berastegui
- Department of Pulmonology and Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona
| | - Alberto Jauregui
- Department of Thoracic Surgery, Hospital Universitari Vall d'Hebron, Barcelona
| | - Laura Romero
- Department of Thoracic Surgery, Hospital Universitari Vall d'Hebron, Barcelona
| | - Evelyn Cabral
- Infectious Diseases Research Group, Vall d'Hebron Research Institute, Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d' Hebron Research Institute, Barcelona
| | - Judith Sacanell
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d' Hebron Research Institute, Barcelona
| | - Antonio Román
- Department of Pulmonology and Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona.,Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar Len
- Infectious Diseases Research Group, Vall d'Hebron Research Institute, Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid
| | - Joan Gavaldà
- Infectious Diseases Research Group, Vall d'Hebron Research Institute, Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid
| |
Collapse
|
2
|
Peghin M, Hirsch HH, Len Ó, Codina G, Berastegui C, Sáez B, Solé J, Cabral E, Solé A, Zurbano F, López‐Medrano F, Román A, Gavaldá J. Epidemiology and Immediate Indirect Effects of Respiratory Viruses in Lung Transplant Recipients: A 5-Year Prospective Study. Am J Transplant 2017; 17:1304-1312. [PMID: 27615811 PMCID: PMC7159570 DOI: 10.1111/ajt.14042] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 01/25/2023]
Abstract
The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009-2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRs during seasonal changes and from LTRs with upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSs were analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSs were collected from 98 patients with a 23.6% positivity rate and mean follow-up of 3.4 years (interquartile range 2.5-4.0 years). Approximately half of URTIDs (47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRs with LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case-control analysis, AR was associated with RVs (hazard ratio [HR] 6.54), Pseudomonas aeruginosa was associated with LRTID (HR 8.54), and cytomegalovirus (CMV) replication or disease was associated with URTID (HR 2.53) in the previous 3 mo. There was no association between RVs and Aspergillus spp. colonization or infection (HR 0.71). In conclusion, we documented a high incidence of RV infections in LTRs. LRTID produced significant lung function abnormalities. Associations were observed between AR and RVs, between P. aeruginosa colonization or infection and LRTID, and between CMV replication or disease and URTID.
Collapse
Affiliation(s)
- M. Peghin
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain,Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain
| | - H. H. Hirsch
- Transplantation & Clinical VirologyDepartment Biomedicine (Haus Petersplatz)University of BaselBaselSwitzerland,Division Infection DiagnosticsDepartment Biomedicine (Haus Petersplatz)University of BaselBaselSwitzerland,Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | - Ó. Len
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain,Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain
| | - G. Codina
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Department of MicrobiologyHospital Universitari de la Vall d'HebronBarcelonaSpain
| | - C. Berastegui
- Department of Pulmonology and Lung Transplant UnitHospital Universitari de la Vall d'HebronBarcelonaSpain,CIBER de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | - B. Sáez
- Department of Pulmonology and Lung Transplant UnitHospital Universitari de la Vall d'HebronBarcelonaSpain,CIBER de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | - J. Solé
- Department of Thoracic SurgeryHospital Universitari de la Vall d'HebronBarcelonaSpain
| | - E. Cabral
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain
| | - A. Solé
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Lung Transplant UnitHospital Universitario y Politécnico La FeValenciaSpain
| | - F. Zurbano
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Division of PneumologyHospital Universitario Marqués de ValdecillaIDIVALUniversity of CantabriaSantanderSpain
| | - F. López‐Medrano
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Department of Infectious DiseasesHospital Universitario 12 de OctubreMadridSpain
| | - A. Román
- Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland,CIBER de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | - J. Gavaldá
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain,Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain
| |
Collapse
|
3
|
Braga D, Setti A, Eberlin M, Cabral E, Lo Turco E, Iaconelli A, Borges E. Lipid profile as a non-invasive tool to predict endometrial receptivity – a pilot study. Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Gavaldà J, Cabral E, Perez-Romero P, Len O, Aydillo T, Campins M, Quintero J, Peghin M, Nieto J, Charco R, Pahissa A, Cordero E. Immunogenicity of pandemic influenza A H1N1/2009 adjuvanted vaccine in pediatric solid organ transplant recipients. Pediatr Transplant 2013; 17:403-6. [PMID: 23692602 DOI: 10.1111/petr.12084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 01/06/2023]
Abstract
The aim of this study was to assess the immunogenicity of a vaccine against this virus in a prospective cohort of transplanted pediatric patients without previous influenza infection who received one dose of MF59®-adjuvanted pandemic H1N1/2009 vaccine. Seventeen patients who were being regularly followed up at the Outpatient Clinic of the Children's Transplant Unit (liver and kidney transplantation) in Hospital Universitari Vall d'Hebron (Barcelona) were included. Seroconversion was demonstrated in 15 of 17 (88.2%) vaccinated children. There were no rejection episodes or major adverse events. The MF59(®) -adjuvanted pandemic H1N1/2009 vaccine was safe and elicited an adequate response.
Collapse
Affiliation(s)
- J Gavaldà
- Department of Infectious Diseases, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
López-Medrano F, Cordero E, Gavaldá J, Cruzado JM, Marcos MÁ, Pérez-Romero P, Sabé N, Gómez-Bravo MÁ, Delgado JF, Cabral E, Carratalá J. Executive summary. Management of influenza infection in solid-organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2013; 31:528-34. [PMID: 23528340 DOI: 10.1016/j.eimc.2013.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
Solid organ transplant (SOT) recipients are at greater risk than the general population for complications and mortality from influenza infection. We have conducted a systematic review to assess the management and prevention of influenza infection in SOT recipients. Recommendations are provided about the procurement of organs from donors with influenza infection. We highlight the importance of the possibility of influenza infection in any SOT recipient presenting upper or lower respiratory symptoms, including pneumonia. The importance of early antiviral treatment of SOT recipients with suspected or confirmed influenza infection and the necessity of annual influenza vaccination are emphasized. The microbiological techniques for diagnosis of influenza infection are reviewed. Guidelines for the use of antiviral prophylaxis are provided. Recommendations for household contacts of SOT recipients with influenza infection and health care workers are also included. Antiviral dose adjustment guidelines are presented for cases of impaired renal function and for pediatric populations.
Collapse
Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre (i+12), Departamento de Medicina, Universidad Complutense, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
López-Medrano F, Cordero E, Gavaldá J, Cruzado JM, Marcos MÁ, Pérez-Romero P, Sabé N, Gómez-Bravo MÁ, Delgado JF, Cabral E, Carratalá J. Management of influenza infection in solid-organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2013; 31:526.e1-526.e20. [PMID: 23528341 DOI: 10.1016/j.eimc.2013.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at greater risk than the general population for complications and mortality from influenza infection. METHODS Researchers and clinicians with experience in SOT infections have developed this consensus document in collaboration with several Spanish scientific societies and study networks related to transplant management. We conducted a systematic review to assess the management and prevention of influenza infection in SOT recipients. Evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the procurement of organs from donors with suspected or confirmed influenza infection. We highlight the importance of the possibility of influenza infection in any SOT recipient presenting upper or lower respiratory symptoms, including pneumonia. The importance of early antiviral treatment of SOT recipients with suspected or confirmed influenza infection and the necessity of annual influenza vaccination are emphasized. The microbiological techniques for diagnosis of influenza infection are reviewed. Guidelines for the use of antiviral prophylaxis in inpatients and outpatients are provided. Recommendations for household contacts of SOT recipients with influenza infection and health care workers in close contact with transplant patients are also included. Finally antiviral dose adjustment guidelines are presented for cases of impaired renal function and for pediatric populations. CONCLUSIONS The latest scientific information available regarding influenza infection in the context of SOT is incorporated into this document.
Collapse
Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre (i+12), Departamento de Medicina, Universidad Complutense, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Menezes CBA, Silva BP, Sousa IMO, Ruiz ALTG, Spindola HM, Cabral E, Eberlin MN, Tinti SV, Carvalho JE, Foglio MA, Fantinatti-Garboggini F. In vitro and in vivo antitumor activity of crude extracts obtained from Brazilian Chromobacterium sp isolates. ACTA ACUST UNITED AC 2012; 46:65-70. [PMID: 23090123 PMCID: PMC3854353 DOI: 10.1590/s0100-879x2012007500167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/15/2012] [Indexed: 11/22/2022]
Abstract
Natural products produced by microorganisms have been an important source of new substances and lead compounds for the pharmaceutical industry. Chromobacterium violaceum is a Gram-negative β-proteobacterium, abundant in water and soil in tropical and subtropical regions and it produces violacein, a pigment that has shown great pharmaceutical potential. Crude extracts of five Brazilian isolates of Chromobacterium sp (0.25, 2.5, 25, and 250 µg/mL) were evaluated in an in vitro antitumor activity assay with nine human tumor cells. Secondary metabolic profiles were analyzed by liquid chromatography and electrospray ionization mass spectrometry resulting in the identification of violacein in all extracts, whereas FK228 was detected only in EtCE 308 and EtCE 592 extracts. AcCE and EtCE 310 extracts showed selectivity for NCI/ADR-RES cells in the in vitro assay and were evaluated in vivo in the solid Ehrlich tumor model, resulting in 50.3 and 54.6% growth inhibition, respectively. The crude extracts of Chromobacterium sp isolates showed potential and selective antitumor activities for certain human tumor cells, making them a potential source of lead compounds. Furthermore, the results suggest that other compounds, in addition to violacein, deoxyviolacein and FK228, may be involved in the antitumor effect observed.
Collapse
Affiliation(s)
- C B A Menezes
- Centro Pluridisciplinar de Pesquisas Químicas, Biológicas e Agrícolas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Gavaldà J, Cabral E, Alonso E, Perez-Romero P, Pérez A, Quintero J, Campins M, Vilalta R, Alonso A, Len O, Navarro M, Nieto J, Jara P, Charco R, Pahissa A, Cordero E. Influenza A H1N1/2009 infection in pediatric solid organ transplant recipients. Transpl Infect Dis 2012; 14:584-8. [PMID: 22998763 DOI: 10.1111/tid.12005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/22/2012] [Accepted: 07/04/2012] [Indexed: 12/27/2022]
Abstract
AIM AND METHOD The aim of this study was to describe the clinical characteristics and outcome of pandemic influenza A H1N1/2009 (pH1N1) infection, in a retrospective cohort of pediatric patients with kidney and/or liver transplant and confirmed pH1N1 infection from June to December 2009, diagnosed in 2 Spanish teaching hospitals. RESULTS Forty-nine patients were included. Pneumonia was diagnosed in 4 patients (8.2%), and 3 of them required respiratory support. There were no related deaths. CONCLUSION Antiviral treatment within 48 h was associated with a lower likelihood of pneumonia (0/38, 0%) than treatment started after 48 h (4/11, 36.3%) (P < 0.01).
Collapse
Affiliation(s)
- J Gavaldà
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Padilla B, Bayog D, Uy NL, Gueco I, Nazareno-Rosales L, Chua A, Almazan-Gomez L, Bonzon D, Balmores B, Cabral E. The Philippines is not the site for incentivized organ donation. Am J Transplant 2012; 12:1956. [PMID: 22741756 DOI: 10.1111/j.1600-6143.2012.04118.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
10
|
Cordero E, Perez-Ordoñez A, Aydillo TA, Torre-Cisneros J, Gavalda J, Lara R, Segura C, Len O, Cabral E, Gasch A, Pachon J, Perez-Romero P. Therapy with m-TOR inhibitors decreases the response to the pandemic influenza A H1N1 vaccine in solid organ transplant recipients. Am J Transplant 2011; 11:2205-13. [PMID: 21831151 DOI: 10.1111/j.1600-6143.2011.03692.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Concern has been raised regarding the response to vaccination in solid organ transplant recipients (SOTR) undergoing immunosuppressant regimens and the possibility of rejection related to the immune response associated with pandemic influenza H1N1-2009 vaccination. The goal of this study was to assess the immunogenicity, efficacy and safety of the pandemic vaccine in SOTR. We performed a multicenter prospective study in SOTR receiving the pandemic vaccine. Immunological response was determined in serum 5 weeks after vaccination by microneutralization assays, and immunoglobulins were measured by ELISA. Three hundred and forty-six SOTR were included. Preexisting seroprotection was detected in 13.6% of cases and rates of seroconversion and seroprotection after vaccination were 73.1% and 82.9%, respectively. Patients with baseline antibody titers had better geometric mean titers (GMT)-post after pandemic vaccination (339.4 vs. 121.4, p < 0.001). Younger age, liver disease and m-TOR inhibitor therapy were independently associated with lower seroprotection and GMT-post. There were no major adverse effects or rejection episodes. Pandemic vaccine was safe in SOTR and elicited an adequate response, although lower than in healthy individuals. This is the first study describing a decreased response after vaccination in patients receiving mTOR inhibitors who presented lower seroprotection rates and lower GMT-post.
Collapse
Affiliation(s)
- E Cordero
- Unit of Infectious Disease, Microbiology and Preventive Medicine, Institute of Biomedicine of Sevilla (IBiS), University Hospital Virgen del Roc´ıo/CSIC/University of Sevilla, Sevilla, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Antunes HS, Herchenhorn D, Araujo CM, Cabral E, Ferreira EMDS, Small IA, Rampini MP, Teich N, Rodrigues PC, Silva TGPD, Dias LF, Ferreira CGM. Phase III trial of low-level laser therapy to prevent induced oral mucositis in head and neck cancer patients submitted to concurrent chemoradiation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba5524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5524 Background: Oral mucositis (OM) remains a limiting factor in in head and neck squamous cell carcinomas (HNSCC) patients (pts) treated with chemoradiation (CRT) leading to pain, dysphagia, and weight loss. Low-level laser therapy (LLLT) emerges as a promising, preventive therapy of CRT-induced OM. Yet, a definitive randomized trial supporting its use is lacking. This study was designed to assess the efficacy of LLLT in reducing the incidence and/or severity of OM. Methods: Assuming OM grade (G3) for placebo 0.4 (P0); LLLT 0.15 (P1) ; β=0.2; α=0.05, sample size was 94 pts. From Jun 2007 to Dec 2010, 47 LLLT and 47 placebo pts bearer of HNSCC of nasopharynx, oropharynx and hipopharynx entered a prospective, randomized, double blind, placebo-controlled, phase III trial. CRT consisted of conventional RT 70.2 Gy (1.8Gy/d, 5 times/wk) + concurrent cisplatin 100 mg/m2 every 3 wks. Main endpoints were OM incidence and severity, RT interruptions due to OM and pain intensity. The LLLT used daily was a diode InGaAlP (660nm-100mW-4J/cm²). OM evaluation was done by WHO and OMAS scale. Results: Mean age was 54.6 and 87.2% of pts were male. Primary site: oropharynx (74 pts), nasopharynx (9 pts), hypopharynx (11 pts). In the LLLT arm the incidence of OM G 3/4 was only 6.4% versus 48% in the placebo arm; HR of 0.13 (IC 95%, p<0.001). Besides in the LLLT arm 51% of pts did not have ulcers versus 17% in placebo arm (p<0.001). LLLT pts had less severe pain (p=0.012), used less narcotic analgesic, HR 0.33 (IC 95%, p<0.001) and required less gastrostomia, HR 0.037 (IC 95%, p= 0.005). No LLLT pts had RT interrupted due to OM. EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 were applied. Results clearly favored the LLLT arm. In QLQ-C30 benefit was seen in both physical and emotional functioning (p=0.037), fatigue (p=0.011), pain (p=0.043); and in QLQ-H&N35, pain (p=0.007), swallowing (p=0.001) and trouble with social eating (p=0.026). Conclusions: Our results indicate that upfront LLLT in HNSCC pts submitted to CRT is an effective tool in reducing G 3/4 OM, oral pain, use of narcotic and gastrostomia. QoL data supports the efficacy findings. Thereby LLLT should be the new standard of care in this setting.
Collapse
Affiliation(s)
- H. S. Antunes
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - D. Herchenhorn
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - C. M. Araujo
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - E. Cabral
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - E. M. d. S. Ferreira
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - I. A. Small
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - M. P. Rampini
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - N. Teich
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - P. C. Rodrigues
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - T. G. P. d. Silva
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - L. F. Dias
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - C. G. M. Ferreira
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| |
Collapse
|
12
|
Antunes HS, Herchenhorn D, Araujo CM, Cabral E, Ferreira EMDS, Small IA, Rampini MP, Teich N, Rodrigues PC, Silva TGPD, Dias LF, Ferreira CGM. Phase III trial of low-level laser therapy to prevent induced oral mucositis in head and neck cancer patients submitted to concurrent chemoradiation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba5524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
13
|
Sordé R, Falcó V, Lowak M, Domingo E, Ferrer A, Burgos J, Puig M, Cabral E, Len O, Pahissa A. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. ACTA ACUST UNITED AC 2010; 171:166-72. [PMID: 20876397 DOI: 10.1001/archinternmed.2010.347] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP. METHODS A prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed. RESULTS A total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test. CONCLUSION When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.
Collapse
Affiliation(s)
- Roger Sordé
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Rothschild C, Cabral E, Garanito M. THROMBOCYTOPENIA: ANALYSIS OF 317 PATIENTS. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01979.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Cabral E. No going back. Mexican women find opportunity and obstacles in a changing economy. Ford Found Rep 1994; 25:11-7. [PMID: 12288277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|
16
|
Salomé M, Cabral E. A locally most powerful unbiased test for the proportion of mixture. Stat Probab Lett 1991. [DOI: 10.1016/0167-7152(91)90054-u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Cabral E, Gomes Filho JM, Gansl RC, Silveira PA, Menosi SF, Zanichelli MA, Tobos K, Pozzi D. [Acute lymphoblastic leukemia. Preliminary study of 2 therapeutic regimens, one without prophylactic radiotherapy of central nervous system involvement]. Rev Hosp Clin Fac Med Sao Paulo 1979; 34:222-6. [PMID: 297264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
18
|
Gansl RC, Cabral E, Gomes Filho JM, Silveira PA, Gualandro SF, Zanichelli MA, Pozzi D. [Treatment of acute myeloid leukemia in the young and adult with aracytin and thioguanine]. Rev Hosp Clin Fac Med Sao Paulo 1979; 34:207-10. [PMID: 297263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|