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A Breath of Fresh Air 2014 / Une Boufee D’air Frais 2014

ABSTRACT: The worldwide burden of tuberculosis has continued to rise. The management of TB has become more difficult with the emergence of MDR-TB (multidrug resistant tuberculosis) and XDR-TB (extensively drug resistant tuberculosis). MDR/XDR-TB has rendered the treatment of this disease extremely challenging as the treatment requires the use of medications that are less effective, more toxic, more costly, and have to be given for a longer duration (usually at least 18 months). MDR-TB is associated with decreased cure rates and increased rates of relapse than fully susceptible tuberculosis. XDR-TB is associated with even worse treatment outcomes than MDR-TB. There is an urgent need for new anti-TB drugs. Fortunately, new medications for the treatment of tuberculosis are currently completing phase III trials and can be released on a compassionate basis to tuberculosis centres. We present a case of a patient with XDR-TB in which bedaquiline, one such medication, was included in his treatment regimen. The drug was released from Janssen Pharmaceutica on compassionate grounds. We believe that this is the first case in Canada in which bedaquiline was used. Our patient is a 22-year-old male with XDR-TB isolated from pleural fluid. Because of the pattern of drug resistance and numerous drug adverse effects (ototoxicity from amikacin, bone marrow suppression from linezolid and severe neuropathy from clarithromycin and cycloserine), his treatment was very difficult. Bedaquiline was added in April 2013 to his treatment regimen following the recommended schedule. He completed 6 months of bedaquiline without any untoward side effects in October 2013. Follow-up computed tomography scans and chest radiography have shown resolution of the pleural effusion with no parenchymal or lymphatic disease.

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PROVIDER: S-EPMC4029142 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Project description:AimTo provide a Portuguese version of the Multidimensional Dyspnea Profile (MDP), investigating its validity and reliability in Brazilian patients with COPD.MethodsThis was a cross-sectional study for translation and linguist validation of the Portuguese MDP version for patients with COPD. The process occurred according to the protocol of Mapi Research Trust, Lyon, France. Three scores of MDP were used for the analysis: the immediate unpleasantness of dyspnea (A1); the "immediate perception domain" (S) (sum of A1 plus the sensory descriptors) and the "emotional response domain" (A2) (sum of the emotional descriptors). The questionnaires COPD assessment Test (CAT), Hospital Anxiety and Depression scale (HADS) and Medical Research Council scale (MRC) were used as anchors to investigate MDP's validity. Internal consistency was assessed with Cronbach's alpha. Test-retest reliability was assessed with intraclass correlation coefficient (ICC) and concurrent validity was assessed with Spearman correlation coefficients.ResultsThirty patients with moderate-severe COPD were studied for MDP's validation analysis (43% male, 63±8years, body mass index [BMI] 27±6Kg/m2, forced expiratory volume in the first second [FEV1] 48±15%predicted, six-minute walking test [6MWT] 464±84m and 84±16%predicted), whereas 10 patients were excluded from the test-retest reliability analysis due to missing data, resulting in a sample of 20 subjects for this purpose (50% male, 62±8years, BMI 27±6Kg/m2, FEV1 48±15%predicted, 6MWT 452±93m and 82±19%predicted). Both samples were similar regarding general characteristics (P>0,05 for all variables). MDP presented strong correlations, i.e., ICC intra-rater: A1: 0.77 (0.48-0.90), S: 0.78 (0.52-0.91), and A2: 0.85 (0.66-0.94), with high internal consistency (Cronbach's α 0.86, 0.88 and 0.92 respectively); and ICC inter-rater: A1: 0.74 (0.46-0.89), S: 0.75 (0.48-0.89) and A2: 0.91 (0.78-0.96) with Cronbach's α 0.85, 0.86 and 0.95 respectively.ConclusionThe Portuguese version of the MDP is the first valid and reliable instrument to assess dyspnea multidimensionally in Portuguese-speaking patients with COPD.

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A Breath of Fresh Air 2014 / Une Boufee D’air Frais 2014

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