Attendee interactive significado de anoxia

Summary: advances in the care of cystic fibrosis (CF) have increased life expectancy for patients living with this disease. More women are now living through their reproductive years, and there is an increased need for CF providers to address sexual and reproductive health (SRH) and family planning. A recent survey concluded both CF providers and patients believe SRH discussions are important and CF providers have a key role in providing this care.1 selection of contraceptive options must take into consideration many factors, such as safety, efficacy, adherence, comorbid conditions, and concomitant medications.


Oral contraceptives (OC) are the most commonly used method of birth control in the CF population.2 OC options include combined oral contraceptives (cocs), which contain ethinyl estradiol (EE) plus a progestin component, and progestin only pills (pops).Significado de anoxia both EE and progestins are metabolized by the cytochrome (CYP) P450 pathway, primarily the CYP3A4 isoenzyme. This results in several potential drug interactions that could decrease the effectiveness of oral hormonal contraceptives. Drugs that are CYP3A4 inducers increase the metabolism of EE and progestins, which leads to reduced blood levels of these steroid hormones, and consequently the potential for contraceptive failure. The most notable of such interactions is with lumacaftor, which is a strong inducer of CYP3A4.3 according to the prescribing information for lumacaftor/ivacaftor, hormonal contraceptives should not be relied upon as an effective form of birth control. To date there are no data on the effect of lumacaftor on nonoral hormonal contraceptives, such as injectables, transdermal patches, and implants.Significado de anoxia studies conducted in women with epilepsy taking other strong CPY3A4 inducers (such as carbamazepine, phenobarbital, and phenytoin) can help guide contraception selection for women with CF taking lumacaftor.4 another concern for women with CF is the potential interaction between antibiotics and oral contraceptives. With the exception of rifampin, antibiotics have not been shown to decrease efficacy of oral contraceptives.5,6 however, studies have not been conducted in women with CF, who may be at increased risk for contraceptive failure due to higher doses of antibiotics, potentially decreased absorption of exogenous steroid hormones, and the health implications of an unintended pregnancy. The US medical eligibility criteria for contraceptive use does not include guidelines on selecting contraceptives for women with CF.7 in the absence of formal recommendations, providers must also consider disease-specific factors, such as diabetes, bone health, and venous access devices, when selecting the most appropriate contraceptive option.References: 1.Significado de anoxia kazmerski TM, borrero S, tuchman LK, et al. Provider and patient attitudes regarding sexual health in young women with cystic fibrosis. Pediatrics. 2016;137(6):e20154452. 2. Roe AH, traxler S, schreiber CA, et al. Contraception in women with cystic fibrosis: A systematic review of the literature. Contraception. 2016;93:3-10. 3. Orkambi [package insert]. Boston, MA: vertex pharmaceuticals incorporated; 2016. 4. Dutton C, foldvary-schaefer N. Contraception in women with epilepsy: pharmacokinetic interactions, contraceptive options, and management. Int rev neurobiol. 2008;83:113-34. 5. Dickinson BD, altman RD, nielsen NH, et al. Drug interactions between oral contraceptives and antibiotics. Obstet and gynecol. 2001;98:853-60. 6.Significado de anoxia toh S, mitchell AA, anderka M, et al. Antibiotics and oral contraceptive failure – A case-crossover study. Contraception. 2001;83:418-25. 7. Centers for disease control and prevention. U.S. Medical eligibility criteria for contraceptive use, 2010. MMWR recomm rep. 2010;59(RR-4):1-86.

Summary: women with cystic fibrosis (CF) are now reaching reproductive age as medical management of their disease advances.1 while over 90% of men with CF are infertile due to congenital absence of the vas deferens, the majority of female CF patients have normal reproductive anatomy.1,2 women with CF have long been thought infertile due to a significant reduction in the water content of the cervical mucus, theoretically blocking sperm penetration into the reproductive system, and due to disruptions in the hypothalamic-pituitary-ovarian axis causing delayed menarche and theoretical ovulatory dysfunction.1,2,3 as medical treatment for CF and obstetric care have advanced, however, women with CF are reaching reproductive age and are often able to fulfill reproductive potential.Significado de anoxia the majority of women with CF develop normal menstrual cycles with likely corresponding fertility,1,2,4,5 and approximately 50-75% of women with CF who attempt pregnancy are able to conceive.1,2,5,6,7,8 women with CF are sexually active at rates similar to the general population,5 and most would like to have children.9,10 qualitative data from interviews about decision-making around pregnancy indicate that women with CF are thoughtful about timing of pregnancies and disclose that ill-timed or unintended pregnancies would frequently prompt them and their providers to consider termination.11 however, a survey from 2009 estimates that one quarter of pregnancies among women with CF are unplanned.4 physiologic changes of pregnancy, while easily compensated for in healthy women, can negatively impact the health of women with CF, especially at times when health status is suboptimal.Significado de anoxia these changes can lead to increased hospitalizations, chronic hypoxia, fetal growth restriction, preterm delivery, diabetes, cardiac decompensation, and even death.12 optimization of disease status is crucial in improving pregnancy outcomes; thus reducing unintended, ill-timed pregnancies in this population could have meaningful public health implications. Effective contraception would enable women with CF to optimize their health prior to attempting pregnancy. Unfortunately, women with CF tend to underutilize the most effective methods of contraception with 70% using combined oral contraceptive pills, condoms, and natural family planning.4,5,8 accordingly, they are at risk of unplanned pregnancy.Significado de anoxia published data on appropriate contraceptive methods to use in women with CF are inadequate. Safety data and interactions with disease processes are unknown, and the CDC’s U.S. Medical eligibility criteria for contraceptive use does not specify guidelines for offering contraception to women affected by CF.13 A recent systematic review detailed the data available regarding contraceptive efficacy, safety and preferences for women with CF.14 while data regarding contraception for this population are incomplete, it is important to utilize the existing information to assist women in reaching reproductive life goals. In this presentation we will review CF and its impact on the menstrual cycle, fertility, and pregnancy.Significado de anoxia we will review the available data on hormonal contraception – its safety and efficacy – and discuss the theoretical impact hormonal contraception has on the CF disease course.References: 1. Ahmad A, ahmad A, patrizio P. Cystic fibrosis and fertility. Curr opin obstet gynecol. 2013;25:167-72. 2. Seublinvong VJ, whittaker LA. Fertility and pregnancy: common concerns of the aging cystic fibrosis population. Clin chest med. 2007;28:433-43. 3. Tam A, morrish D, wadsworth S, et al. The role of female hormones on lung function in chronic lung diseases. BMC womens health. 2011;11:24. 4. Gatiss S, mansour D, doe S, et al. Provision and contraception services and advice for women with cystic fibrosis.Significado de anoxia J fam plann reprod health care. 2009;35(3):157-60. 5. Sawyer SM, phelan PD, bowes G. Reproductive health in young women with cystic fibrosis: knowledge, behavior and attitudes. J adolesc health. 1995;17(1):46-50. 6. Sweezey NB, ratjen F. The cystic fibrosis gender gap: potential roles of estrogen. Pediatr pulmonol. 2014;49:309-17. 7. Tsang A, moriarty C, towns S. Contraception, communication and counseling for sexuality and reproductive health in adolescents and young adults with CF. Paediatr respir rev. 2010;11:84-9. 8. Plant BJ, goss CH, tonelli MR, et al. Contraceptive practices in women with cystic fibrosis. J cyst fibrosis. 2008;7:412-4. 9. Fair A, griffiths K, osman LM. Attitudes to fertility issues among adults with cystic fibrosis in scotland.Significado de anoxia the collaborative group of scottish adult CF centres. Thorax. 2000;55(8):672-7. 10. Korzeniewska A, grzelewski T, jerzynska J, et al. Sexual and reproductive health knowledge in cystic fibrosis female patients and their parents. J sex med. 2009;6(3):770-6. 11. Simcox AM, hewison J, duff AJ, et al. Decision-making about pregnancy for women with cystic fibrosis. Br J health psychol. 2009;14:323-42. 12. Thorpe-beeston, JG. Contraception and pregnancy in cystic fibrosis. J R soc med. 2009;102:S3-S10. 13. Centers for disease control and prevention, US medical eligibility criteria for contraceptive use, 2010. 14. Roe A, traxler S, schreiber C. Contraception in women with cystic fibrosis: a systematic review of the literature.Significado de anoxia contraception. 2016;93(1):3-10.

Summary: cystic fibrosis (CF) is an autosomal, recessive, life-long inherited systemic disorder of exocrine glands and secretory organs, resulting in obstructive airways disease, liver and biliary disease, and pancreatic and intestinal dysfunction. Although theoretically gender-neutral, females are at a disadvantage from puberty onward. Prior to the identification of the CFTR gene as the cause of the disease, corey et al reported on data in the canadian CF registry in 1996.1 over a 20-year reporting period, there was an 8-year difference in the median survival between men and women with CF. An analysis based on the USA CFF registry estimated the gap to be approximately 3 years.2 in the UK, the survival and mortality were evaluated for CF patients between 1947 and 2003.Significado de anoxia in 2003, the median age of survival was around 32 years old for females compared with 42 for males.3 this presentation will explore the factors that may be underlying the “gender gap” or difference in survival as well as in the pathophysiology of CF between male and female patients. One hypothesis to explain the differential burden of inflammatory and obstructive disease in men and women with CF is the influence of sex hormones on ion transport or inflammatory cytokines. If estradiol, testosterone, or progesterone were involved, then outcomes between men and women may begin to diverge during or after puberty. Sutton et al performed a cohort study for a 10-year period using the united states cystic fibrosis foundation patient registry (CFFPR) to determine if the decline in lung function or rate of pulmonary exacerbations changes differentially in men versus women with CF after puberty versus prepuberty while adjusting for variables known to impact outcomes.4 of the 2,689 male and 2,448 females included in their analysis of lung function and rate of pulmonary exacerbations, no difference in percent predicted FEV1 pre- or postpuberty emerged.Significado de anoxia instead, there was a higher rate of pulmonary exacerbation in women (1.17 ± 1.35 exacerbations per year in women versus 0.95 ± 1.27 in men; P 0.001) despite controlling for morphometrics, comorbidities, and microbiologic variables. The disparity between men and women appears to begin approximately 6 years after the onset of puberty. In addition, the prevalence of P. Aeruginosa was higher in women relative to men, perhaps contributing to the overall infectious burden with time. The influence of sex hormones during and after puberty is likely to be multifactorial at the cell, tissue, organ, or organism level, and represent only a small aspect of the modifier genetic potential in each individual.Significado de anoxia the pulmonary epithelium is a target for steroid hormones, and data are accumulating for 17?Estradiol (E2) as a major factor. Our group5 demonstrated a combination of estradiol and progesterone increased chloride secretion in rabbit fetal bronchial airway epithelial cells. Similarly, a cocktail of estrogen and progesterone increased basal short-circuit current as well as amiloride- and ouabain-sensitive currents in alveolar epithelial cells. This latter study also showed, that these hormones increased the mrna expression levels of ?- and ?-enac subunits and the na+/K+-atpase b1 subunit.6 tarran’s laboratory showed a decrease in UTP-induced nasal potential difference during high estrogen blood levels in CF and non-CF female patients.Significado de anoxia E2 decreased ca2+ signalling and impaired ASL volume homeostasis through the estrogen receptor era.7 in CF bronchial epithelial cell lines as well as primary bronchial cells from CF female patients, E2 decreased significantly ASL height and targeting specifically enac and the na+/K+ atpase through the activation of the pkcd in order to increase na+ and obligatory water absorption.8 estrogen affects many other biologic processes in inflammation, infection, and fluid balance. Estrogen promotes conversion of P. Aeruginosa from a nonmucoid to mucoid phenotype and CF exacerbations in women peak at a point of high estrogen in the ovulatory cycle.9 whether or not the sex hormones directly modify ion and fluid balance in CF tissues, it is possible that this effect could be overcome by therapeutic interventions.Significado de anoxia verma et al10 suggested a decade ago that the gender gap in childhood and adolescence closes when both sexes receive standardized aggressive treatments in a single clinical center. Furthermore, the use of oral contraceptives (ocps) beginning in emerging adults with CF could mitigate that gap as well. Kernan et al in the UK11 analysed data from 681 females of whom 42% had taken ocps for varying periods of time. No differences were found in either annual change in % FEV1, BMI, and total days of intravenous antibiotic use over a 5-year study period in 57 females exposed to and 57 females not exposed to ocps, nor in outcomes over a 3-year period of OCP exposure and a 3-year period of no OCP exposure in the same patient (exposure followed by nonexposure, n=527; nonexposure followed by exposure, n=523).Significado de anoxia in summary, estradiol, progesterone, and possibly testosterone, can modify CF pathogenesis. The most recent in vitro and in vivo data from cells, animal models, and CF cohorts, will be reviewed in this symposium. Ultimately, prospective studies of the effects of exogenous sex hormones on CF outcomes in the age of CFTR modulators may be necessary.References: 1. Corey M, farewell V. Determinants of mortality from cystic fibrosis in canada, 1970-1989. Am J epidemiol. 1996;143:1007-17. 2. Rosenfeld M, davis R, fitzsimmons S, et al. Gender gap in cystic fibrosis mortality. Am J epidemiol. 1997;145:794-803. 3. Dodge JA, lewis PA, stanton M et al. Cystic fibrosis mortality and survival in the UK: 1947-2003.Significado de anoxia eur respir J. 2007;29:522-6. 4. Sutton S, rosenbluth D, raghavan D, et al. Effects of puberty on cystic fibrosis related pulmonary exacerbations in women versus men. Pediatr pulmonol. 2014;49:28-35. 5. Zeitlin PL, loughlin GM, guggino WB. Ion transport in cultured fetal and adult rabbit tracheal epithelia. Am J physiol. 1988;254:C691-8. 6. Laube M, kuppers E, thome UH. Modulation of sodium transport in alveolar epithelial cells by estradiol and progesterone. Pediatr res. 2011;69:200-5. 7. Coakley RD, sun H, clunes LA, et al. 17beta-estradiol inhibits ca2+-dependent homeostasis of airway surface liquid volume in human cystic fibrosis airway epithelia. J clin invest. 2008;118:4025-35. 8. Saint-criq V, kim SH, katzenellenbogen JA, et al.Significado de anoxia non-genomic estrogen regulation of ion transport and airway surface liquid dynamics in cystic fibrosis bronchial epithelium. PLoS ONE. 2013;8:e78593. 9. Chotirmall SH, smith SG, gunaratnam C, et al. Effect of estrogen on pseudomonas mucoidy and exacerbations in cystic fibrosis. N engl J med. 2012;366:1978-86. 10. Verma N, bush A, buchdahl R. Is there still a gender gap in cystic fibrosis? Chest. 2005;128:2824-34. 11. Kernan NG, alton EW, cullinan P, et al. Oral contraceptives do not appear to affect cystic fibrosis disease severity. Eur respir J. 2013;41:67-73.