Saturday, March 30, 2013

Vitamin D Levels Tied to Lung Health

Serum vitamin D levels had a significant positive correlation with pulmonary function, most prominently in patients with a history of tuberculosis (TB), data from a large cross-sectional study showed.

In the subgroup of patients with a history of pulmonary tuberculosis, the absolute difference in FEV1 by 25-OHD level was four times greater than the difference in the overall population, they wrote in the Journal of Clinical Endocrinology & Metabolism.

"The precise mechanism for this phenomenon remains unknown, but it has been suggested that vitamin D accelerates recovery from infection by enhancing innate immunity via upregulation of antimicrobial peptides," they added.
Observational studies of vitamin D and respiratory function have yielded mixed results. Clinical trials of vitamin D supplements as prophylaxis against respiratory disease also failed to demonstrate a definitive association, the authors said.

Comparing the top and bottom quartiles of 25-OHD, the authors found a difference of 229 mL for FEV1 in the subgroup of participants with a history of pulmonary TB (P<0 .01="" p="">
The study had some limitations, namely that it was cross-sectional so reverse causality could not be ruled out. Also, the overall low 25-OHD levels in the participants limited the authors' ability to adequately estimate optimal vitamin D levels for lung function. Finally, data on sun exposure and dietary or supplementary vitamin D intake were not available.

To read the full article on Medpage Today, click here.

Friday, March 29, 2013

Mckenna Rapid Fire Words!!

I think her decent vocabulary is from having two parents who never shut up :)

Emerging CF Pathogen Is Transmissible

A bacterial species increasingly responsible for lung infections in cystic fibrosis patients can be transmitted from person to person, although probably not directly, researchers said.
Genomic analysis of Mycobacterium abscessus isolates taken from clusters of infected CF patients found almost no sequence differences -- in fact, less than is normally found in isolates taken from a single individual -- "strongly indicating between-patient transmission," according to Julian Parkhill, PhD, of the Wellcome Trust Sanger Institute in Hinxton, England, and colleagues.
"Comprehensive environmental sampling" in the hospitals where these patients were housed failed to identify a source for these nontuberculous mycobacteria, whereas the patients had "numerous opportunities for within-hospital transmission from other individuals," Parkhill and colleagues wrote online in The Lancet.
"Although the exact transmission route is yet to be established, our epidemiological analysis suggests that it could be indirect," they added.
M. abscessus has recently been identified as a major cause of illness in CF patients, whose sticky lung secretions create a favorable environment for bacteria to flourish. Parkhill and colleagues noted that M. abscessus is hard to eradicate, requiring long treatment with toxic antibiotic combinations that often ultimately fail.
Some 3% to 10% of CF patients in the U.S. and Europe are currently infected with the organism, which has also been linked to dermal infections from tattoo inks and equipment.
In the case of CF patients, reasons for the pathogen's rapid emergence have been unclear. Possible factors include greater infestation in shower heads and the unintended consequences of chronic antibiotic therapy in these patients. Eliminating other bacteria may provide a previously unavailable foothold for mycobacteria, and some antibiotics may impair normal host-defense mechanisms.
In addition, person-to-person transmission has been suspected but never proven, Parkhill and colleagues indicated. Their current study aimed to find evidence that it contributes to the organism's spread.
They obtained 168 M. abscessus isolates from 31 patients seen from 2007 to 2011 at a CF treatment clinic housed at Papworth Hospital in Cambridge, England, and performed whole-genome sequence analyses as well as antimicrobial susceptibility tests.
The genomic analyses indicated that some of the isolates were virtually identical, differing by only 10 base pairs or less. It appeared that these isolates had infected a total of 11 patients in two separate outbreaks.
As an example, Parkhill and colleagues cited the case of one patient, whose isolates had genetic diversity that "was entirely encompassed within that of [another patient], indicating immediate relatedness by direct descent."
These isolates were of the subspecies massiliense, one of the three major subspecies of M. abscessus previously identified.
The researchers also examined patterns of antimicrobial susceptibility as a clue to the organism's recent genetic evolution. They found that several patients whose records indicated no previous exposure to long-term macrolides or aminoglycosides nevertheless carried M. abscessus isolates that resisted amikacin and clarithromycin.
These findings, too, suggested transmission between individuals. Parkhill and colleagues suggested that it was likely that these mycobacterial strains had picked up resistance elements as a result of coinfection with resistant organisms in some individual.
Parkhill and colleagues sought to exclude the possibility that the outbreaks originated with environmental contamination either at Papworth Hospital or elsewhere in the community. They determined that patients within the outbreak clusters did not live near each other or share water supplies, and tests of the hospital's water supply and equipment (including shower heads, bronchoscopes, and dishwashers) were all negative.
On the other hand, they found that, prior to becoming infected, each of the outbreak patients had been at the clinic simultaneously with a patient who was infected at the time. The exceptions, of course, were the initial cases in each outbreak cluster, whose route of acquisition of M. abscessusremains a mystery.
Finally, the researchers estimated mutation rates for the isolates, which indicated that the outbreak strains shared a common ancestor during "the period when opportunities existed for hospital-associated transmission." Other isolates not associated with the outbreaks were likely to have been genetically distinct for several decades.
But Parkhill and colleagues argued that transmission from close patient-to-patient contact was unlikely because of strict patient segregation policies in place at the Papworth clinic. "Patients are advised not to meet socially and are cared for in individual rooms," they wrote.
They suggested that "fomite contamination" -- in which the organism moves from person to another via an inanimate object -- was a more probable route of transmission. M. abscessus can survive severe physical and chemical assaults as well as dessication, they noted.
Another possibility is that aerosol generation during physiotherapy and lung function testing and other procedures in CF patients produce contaminated aerosols that subsequent patients breathe in.
The researchers added that, as a result of their findings, infection control procedures have been strengthened at Papworth. Steps taken include continuous sputum screening of all patients for nontuberculous mycobacteria, treating infected outpatients in a dedicated clinic with single-use rooms, and negative air pressure in inpatient rooms.
They indicated that it was too early to say whether these measures had reduced mycobacterial infections.

Thursday, March 28, 2013

Thankful Thursday: Eskimo Kisses & TOBI

It's thankful Thursday time! We all have so much to be thankful for and we love to take this opportunity just to write down each and everything that comes to mind. Please take this time to share with us what you're thankful for as well. If you have a blog expressing your thankfulness, please share the link! Without further ado, here's what we're thankful for:

Mandi's List:

I'm thankful for expected blessings. God is so good. Sometimes he blesses us in ways we never expect and it's always awe inspiring. I am so thankful my God is one who blesses me in ways I could never dream of.

I'm thankful for eskimo kisses. Mckenna has been giving eskimo kisses for the last few weeks. It is so stinkin' cute to watch her move her head back in forth in the uncoordinated way toddlers do. The control to gently glide her nose against yours just simply isn't there and usually results in something on either of our faces banging together clumsily. I love it!

I'm thankful for apples, PB, and marshmallows. If you've never had the combo...try it. Try it NOW!

Ronnie's List:

I'm thankful for neighborhood and city parks. Mckenna and I go to some type of playground or play area at least once a day. It gives her a good opportunity to socialize with other kids and gives me a good opportunity not to play entertainer for an hour or so. I also love to see her try new things like a bigger slide or maybe the way she climbs steps :) 

I'm thankful for clinical trials. There are a couple of really exciting research studies/clinical trials being done at my clinic that I'm really pumped about. I can't start the first one until I'm done with this current cycle of Cayston, but I'm excited for when the time comes!

I'm thankful for new options. The FDA recently approved the TOBI podhaler for the CF community. This will significantly cut the delivery time of inhaled tobramycin. Anything that we can do that will give us some time back in our day is a very, very good thing.

So, what are you thankful for today?

Tuesday, March 26, 2013

Did God Give Me Cystic Fibrosis?

Once in a while I get questions that really get me thinking. This was such a question. I'm no theologian or Bible scholar, but I have a deep love for God and believe in His deep love for me. I also don't think He makes mistakes. Most importantly, I don't think I need to know all of the answers. I only need to know one thing...God is in control and His eternal plan is a perfect one.


I just finished having a really deep intense discussion with my 14 year old son (with CF) about God. Little by little he has started to share with me his doubts about God. After much probing by me I realized that some of his doubts are coming from the fact that he doesn't "get" how God who is suppose to be loving gave this disease to people. I answered his questions as best I could.  
You seem to have such a strong faith now; did you ever question if there was a God and how people could have this disease? If so how did your questions get answered?Any insight is appreciated!

That's a tough one. My perspective on this may be a little different though...
Problem is, I never once thought the CF was a terrible disease. I simply was raised to believe the opposite and my mom did a great job of always pointing out the opportunities that CF afforded me (I'm not saying that you're not doing that). She was always quick to point out the man that CF was molding me into. Quick to remind me of all the people I would have never met had it not been for this disease.
As far as my faith, I don't think God gave me CF. Sure, He allowed it to happen as He could have stopped it, but He didn't. I believe that CF is more of a tool used by God to shape my heavenly body than it is to destroy my earthly one.

He also promises to work ALL things for the good of those who love Him. It never says that everything that happens is good, but we serve a God that can take 100 bad things and shape them into something that brings Him ultimate glory. And that's what this life is all about for me. God shaping me into the man that will ultimately receive the joy of worshipping Him for eternity.
I don't get caught up too much in my suffering or the suffering of those around me. This life on earth is but a blink of an eye, and in the big picture, pretty "insignificant". I'm not living for the here and now, but the later and forever.
The one time I questioned God and His works was when my 16 year old cousin died in a roll-over car accident. It was sudden. We didn't have anytime to prepare. She was young, vibrant, beautiful and had a huge heart for the Lord. I wondered how in the world God could ever use that for His glory. I questioned why He would take someone who could end up doing so much for His Kingdom here on earth. I brought these and many other questions to my pastor.
What he said solidified my view on my own life. He said that each of us have a race to run. Some run it faster than others. Because some run faster, they will finish the race first (die). We're all running towards the same finish line, and as all of the other runners, the goal is to cross the line. Whether we finish first or last is of no consequence to God, it's that we finished and finished well. He watches how we are running. Once we cross that finish line we will be in His presence and get to hear the words that we all want to hear more than anything, "Well done, good and faithful servant."
When I took the focus off the death of my cousin and the sadness it created for me, I was able to see the joy it was bringing to her and to my Savior. He wants us in His presence more than anything else. The fact that my cousin got to see His face before me may be because she ran such a darn good race!! I may also never know why she was taken from this earth so soon, but I do have faith that God is true to His word and will work ALL things for the good of those who love Him and have been called according to HIS purpose.
So, why does God allow me to have CF? I don't know. I do however know that He doesn't make mistakes. I do know that He views me as a perfect creation formed in His image. And finally, I do know that one day, all will be revealed to me and will be more clear than it could ever be here on earth.
Like I said, this is a tough one, but hopefully something I said here will help you and your son.