Palliation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is associated with a progressive course with a variable illness trajectory causing death either from respiratory failure or complications from its comorbities. Palliative care benefits patients throughout all stages of COPD, with a goal to manage patients' symptom burden which can reduce physical, psychological, and social complications. Dyspnea is the most common and distressing symptom patients with end stage COPD experience, which responds only partially to therapy and eventually becomes refractory to routine care. Palliative management goals aim at relieving refractory symptoms, improving function, and enhancing quality of life in patients with advanced illness and high symptom burden. Caregivers and informed patients can utilize palliative care resources to provide effective relief from refractory dyspnea and help patients maintain a dignified quality-of-life until the end of life. This review is focused on identifying current deficiencies in palliative care provided to patients with advanced COPD with attempts to overcome these. We hope to increase awareness of palliative care in advanced COPD to healthcare providers caring for this population of patients.

Temporal trends of sulphadoxine-pyrimethamine (SP) drug-resistance molecular markers in Plasmodium falciparum parasites from pregnant women in western Kenya.

BACKGROUND: Resistance to sulphadoxine-pyrimethamine (SP) in Plasmodium falciparum parasites is associated with mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes and has spread worldwide. SP remains the recommended drug for intermittent preventive treatment for malaria in pregnancy (IPTp) and information on population prevalence of the SP resistance molecular markers in pregnant women is limited. METHODS: Temporal trends of SP resistance molecular markers were investigated in 489 parasite samples collected from pregnant women at delivery from three different observational studies between 1996 and 2009 in Kenya, where SP was adopted for both IPTp and case treatment policies in 1998. Using real-time polymerase chain reaction, pyrosequencing and direct sequencing, 10 single-nucleotide polymorphisms (SNPs) of SP resistance molecular markers were assayed. RESULTS: The prevalence of quintuple mutant (dhfr N51I/C59R/S108N and dhps A437G/K540E combined genotype) increased from 7% in the first study (1996-2000) to 88% in the third study (2008-2009). When further stratified by sample collection year and adoption of IPTp policy, the prevalence of the quintuple mutant increased from 2.4% in 1998 to 44.4% three years after IPTp policy adoption, seemingly in parallel with the increase in percentage of SP use in pregnancy. However, in the 1996-2000 study, more mutations in the combined dhfr/dhps genotype were associated with SP use during pregnancy only in univariable analysis and no associations were detected in the 2002-2008 and 2008-2009 studies. In addition, in the 2008-2009 study, 5.3% of the parasite samples carried the dhps triple mutant (A437G/K540E/A581G). There were no differences in the prevalence of SP mutant genotypes between the parasite samples from HIV + and HIV- women over time and between paired peripheral and placental samples. CONCLUSIONS: There was a significant increase in dhfr/dhps quintuple mutant and the emergence of new genotype containing dhps 581 in the parasites from pregnant women in western Kenya over 13 years. IPTp adoption and SP use in pregnancy only played a minor role in the increased drug-resistant parasites in the pregnant women over time. Most likely, other major factors, such as the high prevalence of resistant parasites selected by the use of SP for case management in large non-pregnant population, might have contributed to the temporally increased prevalence of SP resistant parasites in pregnant women. Further investigations are needed to determine the linkage between SP drug resistance markers and efficacy of IPTp-SP.

Subtypes of Cryptosporidium spp. in mice and other small mammals.

DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene has been used extensively in subtyping Cryptosporidium hominis in humans and Cryptosporidium parvum in humans and ruminants. In this study, nucleotide sequences of the gp60 gene were obtained from seven Cryptosporidium species and genotypes related to the two species. Altogether, seven subtype families were detected, including four new subtype families. These data should be useful in studies of the transmission and zoonotic potential of cryptosporidiosis in mice and small wild mammals.