Predictors of short-term LAMA ineffectiveness in treatment naïve patients with moderate to severe COPD.

BACKGROUND: No specific (only subgroup) recommendations for the use of long-acting muscarinic antagonists in chronic obstructive pulmonary disease (COPD) exist. The aim of this exploratory hypothesis generating study was to assess whether different phenotypic/endotypic characteristics could be determinants of the short-term ineffectiveness of the initial tiotropium bromide monotherapy in treatment naïve moderate to severe COPD patients. METHODS: A total of 51 consecutively recruited COPD patients were followed for 3 months after the initial evaluation and prescribed initial treatment (tiotropium). Short-term treatment ineffectiveness was assessed as a composite measure comprising COPD exacerbations, need for additional treatment, and no improvement in functional parameters, e.g. 6­min walking test (6MWT), body-mass index, airflow obstruction, dyspnea, and exercise (BODE) index and forced expiratory volume in 1 s (FEV1), and as single components. RESULTS: Treatment ineffectiveness was significantly associated with baseline hemoglobin level, COPD assessment test (CAT) score, modified Medical Research Council (mMRC) scale and BODE index (p = 0.002). Incident exacerbation during the follow-up was associated with baseline bronchoalveolar lavage fluid (BALF) alpha-amylase level and CAT score (p < 0.001), and change in treatment with leukocyte count, 6MWT desaturation and fatigue (p < 0.001). No improvement in 6MWT was associated with baseline CAT score, body mass index, mMRC, fatigue, 6MWT and BODE index (p = 0.002). No improvement in BODE index was associated with leukocyte count, serum interleukin 8 (IL-8) and BALF albumin levels (p < 0.001); and no improvement in FEV1 with CAT score, baseline vital capacity and BALF tumor necrosis factor alpha (TNF-alpha) level (p < 0.001). CONCLUSION: Our results suggest that there is a possibility to identify predictors of short-term tiotropium ineffectiveness in patients with moderate to severe COPD.

Clinical course and outcome predictors in pauci-immune ANCA-positive renal-limited vasculitis.

Our aim was to assess the clinical course and outcome of ANCA-positive, pauci-immune renal limited vasculitis, their correlation with laboratory and histopathologic parameters recorded at initial and follow up testing, and to identify the possible outcome predictors. The study included 17 patients with renal biopsy, clinical, serologic and histopathologic parameters meeting the criteria for pauci-immune ANCA-positive glomerulonephritis without extrarenal manifestations of the disease. Creatinine clearance, 24-hour proteinuria and ANCA titer by ELISA method were determined at disease onset, during treatment and at the end of follow up. In 15 patients, the diagnosis was verified by kidney biopsy. Data were processed by Spearman correlation coefficient and Mann-Whitney test, and survival by Kaplan-Meier test. Lower percentage of glomeruli affected with vasculitis, better initial renal function as measured by serum creatinine or creatinine clearance, and lower chronicity on biopsy were identified as favorable indicators of kidney function outcome. Therapy responders had highest initial and lowest final 24-h proteinuria. The highest level of final 24-h proteinuria was recorded in dialysis dependent patients. The cumulative one-year and two-year patient and kidney survival rate was 64% and 50%, and 64% and 38%, respectively.

Newer antipsychotics and glucose metabolism: a comparison between olanzapine and risperidone.

In order to estimate the degree of glucose tolerance impairment, oral glucose tolerance test was conducted in the group of 15 schizophrenic patients taking olanzapine, the group of 15 schizophrenic patients taking risperidone and in the group of 14 healthy volunteers. In the olanzapine group the tolerance was impaired in 33% of the patients, contrary to the risperidone group in which impairment amounted to 20% of the patients. The authors discuss possible mechanisms responsible for impaired glucose tolerance in patients taking newer antipsychotic drugs.

Diagnostic value of a peroral sucrose permeability test in children with recurrent upper abdominal pain.

The access of ingested sucrose into blood and urine indicates the presence of mucosal lesions in the upper gastrointestinal tract. The study involved 42 children, aged 5-15, having recurrent upper abdominal pain and 43 peers with minor extra-abdominal complaints. Sucrose in urine was determined by thin layer chromatography. The test was positive in 27 out of 42 children having recurrent abdominal pain (64.3%) and in none of the control children (chi2 = 37.6, p < 0.0001). When correlated with endoscopic findings it was falsely negative in 12 out of 38 patients with endoscopically verified lesions of the stomach or duodenum and falsely positive in 1 out of 4 without lesions. Sensitivity of the test was 68.4%, specificity 97.9%, positive predictive value 96.3%. The test cannot be used as an alternative to endoscopy, but may serve for screening of candidates for it.