BackgroundDue to frequent infections in cystic fibrosis (CF) patients, repeated respiratory cultures are obtained to inform treatment. When patients are unable to expectorate sputum, clinicians obtain throat swabs as a surrogate for lower respiratory cultures. There is no clear data in adult subjects demonstrating the adequacy of throat swabs as a surrogate for sputum or BAL. Our study was designed to determine the utility of throat swabs in identifying lung colonization with common organisms in adults with CF.MethodsAdult CF subjects (n = 20) underwent bronchoscopy with BAL. Prior to bronchoscopy, a throat swab was obtained. A sputum sample was obtained from subjects who were able to spontaneously expectorate. All samples were sent for standard microbiology culture.ResultsUsing BAL as the gold standard, we found the positive predictive value for Pseudomonas aeruginosa to be 100% in both sputum and throat swab compared to BAL. However, the negative predictive value for P. aeruginosa was 60% and 50% in sputum and throat swab, respectively. Conversely, the positive predictive value for Staphylococcus aureus was 57% in sputum and only 41% in throat swab and the negative predictive value of S. aureus was 100% in sputum and throat swab compared to BAL.ConclusionsOur data show that positive sputum and throat culture findings of P. aeruginosa reflect results found on BAL fluid analysis, suggesting these are reasonable surrogates to determine lung colonization with P. aeruginosa. However, sputum and throat culture findings of S. aureus do not appear to reflect S. aureus colonization of the lung.

Anatomy has long been a topic of interest amongst both those in medicine and those not. The understanding of biology, in terms of the function and structure of the organs and other structures of the body, has dramatically changed over time, and has been closely related to both scientific improvement and religious feeling.There is no doubt that gross anatomy is one of the preclinical cornerstones of medical education, but the way in which it has been taught has changed over the years. As early as the 16 th century, Vesalius stated that anatomy could only be taught by dissection, however, alternative options for cadaveric study are certainly more available now than when this statement was made.Current teaching methods incorporate the tried and tested cadaveric based dissection, but has more recently been super ceded by the use of computer based imaging and the change to self-orientated or problem based learning. The shift towards the latter has led to a perceived suffering to the gain of anatomical and pathological knowledge of new doctors and surgeons. This paper aims to describe the history of anatomy teaching and review the current evidence for and against the current methods used for its deliverance.Keywords: Anatomy, Medical education, Surgical practice, Teaching. ANATOMY; WHY BOTHER?Human anatomy refers specifically to the consideration of the various structures that make up the human body. This can be separated into systematic or regional anatomy sections; the first describing certain characteristics for instance osteology; focusing on the human skeleton, and angiology; looking at the vascular system. The latter description, regional anatomy, takes into account all of the individual systems and notes how they interact and function together in a certain region e.g. the lower limb, or the thorax. In addition to this anatomy encompasses both adult and embryological anatomy, as well as applied and clinical anatomy; the direct application of the pathological conditions which may occur, and a practical application of anatomy [1].There is no doubt that gross anatomy is one of the preclinical cornerstones of medical education [2,3]. Every doctor must grasp the concepts of anatomy to aid in appropriate diagnosis and management of their patient, as well as communication with peers and patients, and it comes as no surprise that anatomy and surgical practice must be interrelated.Doctors need to have a firm understanding of anatomy and this should be based on a theoretical knowledge, a practical 3D application of this knowledge, as well as an appropriate bedside or clinical application on the patient [4].Current perception is that anatomy knowledge in inadequate, with a belief amongst senior surgical program directors in the UK feeling that knowledge of anatomy was lacking, or in need of a refresher course, in a total of 91% of new doctors. This was further supplemented with 52% feeling that anatomical knowledge was significantly less in new Likewise, there has been an increase in anatomical competence related...

Exploring probiotic use in a regional cystic fibrosis consortium Dear Editor Studies in cystic fibrosis (CF) patients have reported reduced rates of pulmonary exacerbation and hospitalization with probiotic use [1,2]. Furthermore, regular intake of probiotics has been associated with improvements in gastrointestinal (GI) symptoms, levels of inflammatory markers, and quality of life in this population [3]. However, little has been published about clinical use of probiotics in CF, and a recent review highlighted the need to better understand the appropriate role of these agents in long-term disease management [4]. Some patients take probiotics without supervision, and prescriptions of these formulations are not tracked in the United States Cystic Fibrosis Patient Registry (USCFPR). We therefore designed a survey to explore the rationale for patient probiotic use and to look for associations between reported intake of these products and patient characteristics, care patterns and health status within a regional consortium of CF centers in Northern New England. The study population comprised 575 adult and pediatric patients over 6 years of age at 4 CF centers (Dartmouth

Background Serum levels of hepcidin-25, a peptide hormone that reduces blood iron content, are elevated when patients with cystic fibrosis (CF) develop pulmonary exacerbation (PEx). Because hepcidin-25 is unavailable as a clinical laboratory test, we questioned whether a onetime serum iron level was associated with the subsequent number of days until PEx, as defined by the need to receive systemic antibiotics (ABX) for health deterioration. Methods Clinical, biochemical, and microbiological parameters were simultaneously checked in 54 adults with CF. Charts were reviewed to determine when they first experienced a PEx after these parameters were assessed. Time to ABX was compared in subgroups with and without specific attributes. Multivariate linear regression was used to identify parameters that significantly explained variation in time to ABX. Results In univariate analyses, time to ABX was significantly shorter in subjects with Aspergillus-positive sputum cultures and CF-related diabetes (CFRD). Multivariate linear regression models demonstrated that shorter time to ABX was associated with younger age, lower serum iron level, and Aspergillus sputum culture positivity. Conclusions Serum iron, age, and Aspergillus sputum culture positivity are factors associated with shorter time to subsequent PEx in CF adults.

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