Blood eosinophils levels in a Colombian cohort of biomass-and tobacco-related COPD patients.

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of illness and death among adults. In 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy incorporated blood eosinophils as a biomarker to identify patients at increased risk of exacerbations which, with the history of exacerbations during the previous year, allows identification of patients who would benefit from anti-inflammatory treatment to reduce the risk of future exacerbations. The aim of this study was to describe demographic and clinical characteristics, eosinophil counts, and exacerbations in a cohort of COPD patients stratified by clinical phenotypes (non-exacerbator, frequent exacerbator, asthma-COPD overlap) in a Colombian cohort at 2600 meters above sea level. Methods: A descriptive analysis of a historical cohort of patients with a confirmed diagnosis of moderate to severe COPD (FEV1/FVC < 0.7 and at least one risk factor for COPD) from two specialized centers with comprehensive disease management programs was performed from January 2015 to March 2019. Data were extracted from medical records 1 year before and after the index date. Results: 200 patients were included (GOLD B: 156, GOLD E: 44; 2023 GOLD classification); mean age was 77.9 (SD 7.9) years; 48% were women, and 52% had biomass exposure as a COPD risk factor. The mean FEV1/FVC was 53.4% (SD 9.8), with an FEV1 of 52.7% (20.7). No differences were observed between clinical phenotypes in terms of airflow limitation. The geometric mean of absolute blood eosinophils was 197.58 (SD 2.09) cells/µL (range 0 to 3,020). Mean blood eosinophil count was higher in patients with smoking history and frequent exacerbators. At least one moderate and one severe exacerbation occurred in the previous year in 44 and 8% of patients, respectively; during the follow-up year 152 exacerbations were registered, 122 (80%) moderate and 30 (20%) severe. The highest rate of exacerbations in the follow-up year occurred in the subgroup of patients with the frequent exacerbator phenotype and eosinophils ≥300 cells/µL. Discussion: In this cohort, the frequency of biomass exposure as a risk factor is considerable. High blood eosinophil count was related to smoking, and to the frequent exacerbator phenotype.

[Quality of clinical practice guidelines published in nutrition in hospitalized oncological adult patients]. / Calidad de las guías de práctica clínica publicadas en nutrición de pacientes hospitalizados adultos oncológicos.

BACKGROUND: There is a high variability in clinical practice regarding nutritional care which could affect nutritional status of oncological patients. This variability can be diminished following evidence based recommendations from clinical practice guidelines (CPG) with good methodological quality in its development. OBJECTIVE: To review and evaluate the quality of published guidelines in nutrition in hospitalized oncological adult patients. METHODS: A search of CPGs was conducted in MEDLINE, EMBASE, GIN, TripDatabase and pages of recognized guidelines developers. CPGs published between 2003 and 2012 were included. Four independent reviewers assessed the quality of CPGs using the AGREE II instrument. Characteristics of assessed guidelines were extracted and analyzed. RESULTS: 22 CPGs met selection criteria. 90% of guidelines are written in English. There was great variability in quality scores for each domain. Highest rated domain was "clarity of presentation" (median 65.95, range 19.40 to 93.10) while the lowest was "Applicability" (median 21.20, range 0 to 77.10). Sixteen guidelines scored low on "rigour of development" and six had an acceptable or good quality. Only five documents can be considered as "good quality guidelines" because they showed high performance in all domains. CONCLUSION: It was found a wide range of methodological quality scores of evaluated CPGs. Highest rated guidelines are made by agencies that develop guidelines but these are little known in our country. Most of the assessed guidelines have methodological weaknesses, which can affect the quality of the recommendations they make and its validity.

Calidad de las guías de práctica clínica publicadas en nutrición de pacientes hospitalizados adultos oncológicos / Quality of clinical practice guidelines published in nutrition in hospitalized oncological adult patients

Introducción: Existe alta variabilidad en la práctica clínica en nutrición que podría afectar el estado nutricional del paciente oncológico. Esta variabilidad disminuye con el uso de recomendaciones válidas basadas en la evidencia proveniente de guías de práctica clínica (GPC) con adecuada calidad metodológica en su elaboración. Objetivo: Revisar y evaluar la calidad de las guías publicadas en nutrición de pacientes adultos oncológicos hospitalizados. Métodos: Una búsqueda de GPC fue realizada en MEDLINE, EMBASE GIN, TripDatabase y páginas de elaboradores reconocidos de guías. Se incluyeron guías basadas en la evidencia publicadas entre 2003 y 2012. Cuatro revisores independientes evaluaron la calidad de las GPC usando el instrumento AGREE II. Las características de las guías evaluadas fueron extraídas y analizadas. Resultados: Fueron seleccionadas 22 GPC. Un 90% de las guías están escritas en inglés. Hubo gran variabilidad en los puntajes de calidad de cada dominio. El dominio mejor puntuado fue "Claridad de la presentación" (mediana 65,95, rango 19,40-93,10) mientras que el más bajo fue "Aplicabilidad" (mediana 21,20, rango 0,077,10). Dieciséis guías puntuaron bajo en "Rigor metodológico" y seis presentaron una calidad aceptable o buena. Cinco GPC presentaron un alto desempeño en todos los dominios y fueron consideradas de alta calidad. Conclusión: Hubo un amplio rango de puntajes de calidad metodológica de las GPC. Las guías mejor puntuadas son elaboradas por entidades desarrolladores de guías, pero poco conocidas en nuestro medio. Muchas GPC presentan debilidades metodológicas que pueden afectar la calidad de las recomendaciones que emiten y por lo tanto su validez (AU)

Background: There is a high variability in clinical practice regarding nutritional care which could affect nutritional status of oncological patients. This variability can be diminished following evidence based recommendations from clinical practice guidelines (CPG) with good methodological quality in its development. Objective: To review and evaluate the quality of published guidelines in nutrition in hospitalized oncological adult patients. Methods: A search of CPGs was conducted in MEDLINE, EMBASE, GIN, TripDatabase and pages of recognized guidelines developers. CPGs published between 2003 and 2012 were included. Four independent reviewers assessed the quality of CPGs using the AGREE II instrument. Characteristics of assessed guidelines were extracted and analyzed. Results: 22 CPGs met selection criteria. 90% of guidelines are written in English. There was great variability in quality scores for each domain. Highest rated domain was "clarity of presentation" (median 65.95, range 19.40 to 93.10) while the lowest was "Applicability" (median 21.20, range 0 to 77.10). Sixteen guidelines scored low on "rigour of development" and six had an acceptable or good quality. Only five documents can be considered as "good quality guidelines" because they showed high performance in all domains. Conclusion: It was found a wide range of methodological quality scores of evaluated CPGs. Highest rated guidelines are made by agencies that develop guidelines but these are little known in our country. Most of the assessed guidelines have methodological weaknesses, which can affect the quality of the recommendations they make and its validity (AU)