Beyond forced exhalation: impulse oscillometry as a promising tool for bronchial hyperresponsiveness evaluation.

Introduction: The multiple forced expiratory maneuvers that must be performed during methacholine test require a high degree of collaboration and can lead to fatigue. However, impulse oscillometry (IOS) is a noninvasive test, quick and easy to perform, that does not require effort-dependent maneuvers.Objectives: The primary endpoint was to evaluate the relationship between IOS and spirometry during the methacholine test. The secondary endpoint was to study the predictive value of baseline IOS in the development of bronchial hyperreactivity.Methods: Observational, prospective, cross-sectional study, with recruitment of consecutive patients from the pulmonology department with clinical suspicion of bronchial asthma with negative bronchodilator test and normal FeNO.Results: Twenty-five patients were included, with a mean age of 49 ± 18 years. Thirteen patients (52%) had a positive methacholine test. The correlation between IOS indices and FEV1 was significant (p < 0.05) in all cases. The indices with the highest predictive power were R5-20 and AX. The optimal cutoff points were an increase of greater than 32.96% in R5, greater than 120.83% for X5, an increase of 30.30 [kPa l-1s-1] in R5-20, and an increase of 1.01 [kPa l-1] for AX. Baseline oscillometry demonstrated a strong predictive value in the development of bronchial hyperreactivity, with a sensitivity of 61.5% and a specificity of 91.7%, using the cut-off point of 160.0% for R5.Conclusions: IOS may be a valuable alternative to forced spirometry in detecting bronchial hyperreactivity during the methacholine test, showing a good correlation between both tests.

Understanding Severe Asthma Through Small and Big Data in Spanish Hospitals: The PAGE Study.

BACKGROUND: Data on the prevalence of severe asthma (SA) are limited. Electronic health records (EHRs) offer a unique research opportunity to test machine learning (ML) tools in epidemiological studies. Our aim was to estimate the prevalence of SA among asthma patients seen in hospital asthma units, using both ML-based and traditional research methodologies. Our secondary objective was to describe patients with nonsevere asthma (NSA) and SA over a follow-up of 12 months. METHODS: PAGE is a multicenter, controlled, observational study conducted in 36 Spanish hospitals and split into 2 phases: a cross-sectional phase for estimation of the prevalence of SA and a prospective phase (3 visits in 12 months) for the follow-up and characterization of SA and NSA patients. A substudy with ML was performed in 6 hospitals. Our ML tool uses EHRead technology, which extracts clinical concepts from EHRs and standardizes them to SNOMED CT. RESULTS: The prevalence of SA among asthma patients in Spanish hospitals was 20.1%, compared with 9.7% using the ML tool. The proportion of SA phenotypes and the features of patients followed up were consistent with previous studies. The clinical predictions of patients' clinical course were unreliable, and ML found only 2 predictive models with discriminatory power to predict outcomes. CONCLUSION: This study is the first to estimate the prevalence of SA in hospitalized asthma patients and to predict patient outcomes using both standard and ML-based research techniques. Our findings offer relevant insights for further epidemiological and clinical research in SA.

PAGE Study: Summary of a Study Protocol to Estimate the Prevalence of Severe Asthma in Spain Using Big Data Methods.

BACKGROUND AND OBJECTIVES: Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. METHODS: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. RESULTS: This manuscript describes the study design and protocol. CONCLUSIONS: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools.

Understanding Severe Asthma Through Small and Big Data in Spanish Hospitals: The PAGE Study

Background: Data on the prevalence of severe asthma (SA) are limited. Electronic health records (EHRs) offer a unique research opportunity to test machine learning (ML) tools in epidemiological studies. Our aim was to estimate the prevalence of SA among asthma patients seen in hospital asthma units, using both ML-based and traditional research methodologies. Our secondary objective was to describe patients with nonsevere asthma (NSA) and SA over a follow-up of 12 months. Methods: PAGE is a multicenter, controlled, observational study conducted in 36 Spanish hospitals and split into 2 phases: a cross-sectional phase for estimation of the prevalence of SA and a prospective phase (3 visits in 12 months) for the follow-up and characterization of SA and NSA patients. A substudy with ML was performed in 6 hospitals. Our ML tool uses EHRead technology, which extracts clinical concepts from EHRs and standardizes them to SNOMED CT. Results: The prevalence of SA among asthma patients in Spanish hospitals was 20.1%, compared with 9.7% using the ML tool. The proportion of SA phenotypes and the features of patients followed up were consistent with previous studies. The clinical predictions of patients’ clinical course were unreliable, and ML found only 2 predictive models with discriminatory power to predict outcomes. Conclusion: This study is the first to estimate the prevalence of SA in hospitalized asthma patients and to predict patient outcomes using both standard and ML-based research techniques. Our findings offer relevant insights for further epidemiological and clinical research in SA (AU)

Antecedentes: Los datos sobre la prevalencia del asma grave (SA) son limitados. La implantación de las historias clínicas electrónicas (EHR) ofrece una oportunidad única de investigación con tecnologías de aprendizaje máquina (ML) en los estudios epidemiológicos. El objetivo fue estimar la prevalencia del SA entre los pacientes atendidos en las unidades de asma hospitalarias, utilizando el ML como la metodología de investigación tradicional. Los objetivos secundarios fueron describir los pacientes con asma no grave (NSA) y con SA durante un período de seguimiento de 12 meses. Métodos: El estudio PAGE es un estudio multicéntrico, controlado y observacional realizado en 36 hospitales españoles y dividido en dos fases: una primera fase transversal para la estimación de la prevalencia de AS, y una segunda fase prospectiva (3 visitas en 12 meses) para el seguimiento y caracterización de los pacientes con SA y NSA. Se incluyó un subestudio con ML en 6 hospitales. Resultados: Se obtuvo una prevalencia de SA del 20,1% entre los pacientes asmáticos, frente al 9,7% de la herramienta ML. La proporción de fenotipos de SA y las características de los pacientes en seguimiento fueron consistentes con estudios anteriores. Las predicciones clínicas de la evolución de los pacientes fueron poco fiables, mientras que el ML sólo encontró dos modelos predictivos con potencial discriminatorio para predecir resultados. Conclusión: Este estudio es el primero en estimar la prevalencia del SA, en una población hospitalaria de pacientes con asma, y en predecir los resultados de los pacientes utilizando técnicas estándar y de ML (AU)

PAGE Study: Summary of a Study Protocol to Estimate the Prevalence of Severe Asthma in Spain Using Big Data Methods

Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. Methods: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. Results: This manuscript describes the study design and protocol. Conclusions: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools (AU)

Novedades en las guías sobre el tratamiento del asma grave / The latest developments in the guidelines on severe asthma treatment

Las guías de práctica clínica (GPC) aparecieron con el fin de homogenizar el diagnóstico y tratamiento del asma; inicialmente como un consenso de expertos, y posteriormente incluyendo para sus afirmaciones y recomendaciones técnicas de medicina basada en la evidencia, e incorporar en sus actualizaciones frecuentes, los cambios en el conocimiento fisiopatológico y en el manejo de la enfermedad. En el 2019 se han realizado actualizaciones de las tres principales GPC incluyendo el tratamiento del paciente con asma grave no controlada, el uso de fármacos biológicos y otros procedimientos

The clinical practice guidelines (CPG) appeared with the intention to homogenize the asthma diagnosis and treatment, initially as an expert consensus, and afterwards including evidence based medicine data for its affirmations and technical recommendations incorporating advances in knowledge and management of the disease in their frequent updates. In 2019 the 3 principal CPG, have updates including the management of non-controlled severe asthma patients, biological treatments use and other procedures

20 años en asma / 20 years in asthma

No disponible

Autoimmune diseases and asthma

No disponible

Mepolizumab for the treatment of eosinophilic granulomatosis with polyangiitis: our experience

No disponible

[Acute lymphoblastic leukemia: comparison of traditional treatment with intensive therapy methods]. / Leucemia linfoblástica aguda: comparación de los resultados del tratamiento clásico con terapias intensivas.

In this study we compare two different therapies for the treatment of non-B acute lymphoblastic leukemia (ALL). Forty-four children diagnosed as having non-B ALL were treated by one of two methods: 20 children were treated from 1981 to 1984 according to the PETHEMA 7/78 protocol and 24 children were treated from 1984 to 1987 following the BFM 83 protocol. These treatments differ in that BFM 83 includes a higher number of cytostatics, uses intravenous methotrexate at moderate doses as "reservoirs" treatment and a lower dose of holocranial radiotherapy. The BFM 83 treatment resulted in a significant improvement in survival (48% versus 92% p < 0.05), as well as in the absence of further events (45% versus 88%, p < 0.01).

[Review of 54 cases of idiopathic thrombocytopenic purpura. Evaluation of the response to treatment]. / Revisión de 54 casos de púrpura trombocitopénica idiopática. Valoración de la respuesta al tratamiento.

Fifty four cases of idiopathic thrombocytopenic purpura with an evolution longer than six months are reported. Total remission was achieved in 96.2% of patients, half of them without treatment. Etiologic agent, clinical features and response to different ways of treatment are analyzed.

[The treatment results in children with malignant mesenchymal tumors according to the protocols of the International Society of Pediatric Oncology (SIOP)]. / Resultados del tratamiento de niños con tumores mesenquimales malignos según protocolos de la Sociedad Internacional de Oncología Pediátrica (SIOP).

OBJECTIVE: To evaluate the SIOP protocols in the treatment of mesenchymal tumors. PATIENTS AND METHODS: We present the results obtained in 28 children diagnosed at a single pediatric hematology-oncology unit of having malignant mesenchymal tumors. These diagnoses were made between April 1981 and June 1994 and the children were treated following the consecutive SIOP protocols which have the objective of curing the disease with minimal sequelae. The first four patients with rhabdomyosarcoma were treated with MMT-SIOP 75, the next 9 children, also diagnosed with rhabdomyosarcoma, were treated with MMT-SIOP 84. During the same period of time, there was a case of synovial sarcoma treated only with surgical excision. The last 14 patients were included in the current protocol, initiated in 1989. Eleven of these patients had rhabdomyosarcoma and 3 synovial sarcoma. RESULTS: Overall survival and event-free survival at 5 years were 58% and 36%, respectively. Toxicity never was an important factor, although it was increasingly frequent and severe as protocols evolved. CONCLUSIONS: We conclude that our results are similar to those obtained in patients treated with SIOP protocols.

[Ocular infiltration in the anterior chamber in a female infant with acute non-lymphoblastic leukemia]. / Infiltración de la cámara anterior ocular en una paciente con leucemia no linfoblástica aguda.

Unlike myeloid sarcoma, ocular involvement is unusual in acute non-lymphoblastic leukemia.A 9-month-old female infant with acute non-lymphoblastic leukemia M5 and evidence of active central nervous system (CNS) disease showed infiltration of the anterior chamber during therapy. At that time, the CNS disease was in completed remission. She was treated with topical corticosteroids, chemotherapy and bilateral ocular radiotherapy (total dose 1,000 cGy). The ocular manifestations responded well to treatment but hematologic response was poor. The patient died a few months later. Any ophthalmic manifestation in children with leukemia should be detected and treated early. Radiotherapy is warranted in infiltration of the anterior chamber of the eye. The presence of ocular, central CNS or bone marrow involvement indicates poor prognosis in acute childhood leukemia.

[Aggressive fibromatosis in childhood: retrospective analysis of four cases]. / Fibromatosis agresiva en la infancia: análisis retrospectivo de 4 casos.

OBJECTIVE: Aggressive fibromatosis is a rare illness in children. We analyzed the records of four patients, taken from a total of 505, all of which had different types of tumours, over a period of ten years. In the four cases, three were male and one female. Their ages ranged from 0-7 years old. We also did a review of this pathology. RESULTS: The illness may present itself a a painless mass found particularly in the pelvic area, knee, buttock and anterior mediastinum, respectively. Two of these cases presented lysis of osseous tissue shown in radiologic assays. The diagnosis was histological in every case. The only treatment was surgical in all of them. Two of the cases required only one intervention to achieve remission and up to now there has been no record of further illness. At the time of writing this paper the patients are alive after a follow-up period of thirty months. CONCLUSIONS: Up to now, no other alternative forms of treatment have been convincing. Adjuvant radiation and chemotherapy are probably beneficial, but the precise indication for its use is not well defined.

[Treatment of infantile acute lymphoblastic leukemia with protocol ALL-BFM 83]. / Tratamiento de la leucemia aguda linfoblástica infantil con el protocolo ALL-BFM 83.

The outcome of 63 children with non-B acute lymphoblastic leukemia treated with ALL-BFM 83 protocol is analyzed. 95% achieved complete remission with the initial treatment. For the entire group the event free survival (EFS) was 66% (+/- 9%) at 48 months. These results were close to those obtained by the BFM group. Haematological toxicity was the main adverse effect, but there where no therapy related deaths. Persistence of more than 1,000 blast cells per microl in peripheral blood after 7th days of prednisone monotherapy, and spleen size greater than or equal to 5 cm under the costal margin, were identified as independent risk factors of high significance. The EFS in patients with poor clinical response to steroids (greater than or equal to 1,000 blast/microl at day 8) was 22% (+/- 18%), instead of 69% (+/- 12%) in those with adequate response.