Exploring Clinical Remission in Moderate Asthma - Perspectives from Asia, the Middle East, and South America.

INTRODUCTION: Clinical remission is a relatively new concept in asthma but recent research initiatives suggest it could be an ambitious and achievable therapeutic target for patients with asthma. METHODS: In this modified Delphi study (comprising two online surveys, completed either side of a virtual scientific workshop), the opinions of a panel of respiratory physicians were evaluated to summarize perspective statements on key therapeutic outcomes and criteria for on-treatment clinical remission in patients with moderate asthma. An agreement threshold was pre-defined as agreement by ≥ 75% of participants. RESULTS: Surveys 1 and 2 were completed by 20 and 18 participants, respectively. Most participants (95%) agreed with the concept of clinical remission in moderate asthma and that this should be a desirable treatment goal (90%). Based on a composite measure of 4-6 desirable therapeutic outcomes, current understanding of clinical remission was considered as 12 months with no exacerbations, no oral corticosteroids, no daytime or night-time asthma symptoms (Asthma Control Test score ≥ 20 or Asthma Control Questionnaire score ≤ 0.75), stable lung function, and no treatment-related adverse events. No agreement was reached on the role of relievers in defining therapeutic outcomes or on the wider use of biomarkers and airway hyperresponsiveness for defining asthma remission in clinical practice. CONCLUSIONS: In line with recent consensus statements from the United States and Europe, there was a high level of agreement on the elements of clinical remission among a panel of respiratory physicians from Asia, the Middle East, and South America. Extension of the concept of clinical remission to patients with moderate asthma was considered aligned with the potential of clinical remission as a goal of therapy.

Beneficial effects of ketogenic diet in obese diabetic subjects.

OBJECTIVE: Obesity is closely linked to the incidence of type II diabetes. It is found that effective management of body weight and changes to nutritional habits especially with regard to the carbohydrate content and glycemic index of the diet have beneficial effects in obese subjects with glucose intolerance. Previously we have shown that ketogenic diet is quite effective in reducing body weight. Furthermore, it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects. In this study the effect of ketogenic diet in obese subjects with high blood glucose level is compared to those with normal blood glucose level for a period of 56 weeks. MATERIALS AND METHODS: A total of 64 healthy obese subjects with body mass index (BMI) greater than 30, having high blood glucose level and those subjects with normal blood glucose level were selected in this study. The body weight, body mass index, blood glucose level, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, urea and creatinine were determined before and at 8, 16, 24, 48, and 56 weeks after the administration of the ketogenic diet. RESULTS: The body weight, body mass index, the level of blood glucose, total cholesterol, LDL-cholesterol, triglycerides, and urea showed a significant decrease from week 1 to week 56 (P < 0.0001), whereas the level of HDL-cholesterol increased significantly (P < 0.0001). Interestingly these changes were more significant in subjects with high blood glucose level as compared to those with normal blood glucose level. The changes in the level of creatinine were not statistically significant. CONCLUSION: This study shows the beneficial effects of ketogenic diet in obese diabetic subjects following its long-term administration. Furthermore, it demonstrates that in addition to its therapeutic value, low carbohydrate diet is safe to use for a longer period of time in obese diabetic subjects.

Post-test probability for pulmonary embolism after ventilation-perfusion scan assessed by nuclear medicine physicians.

OBJECTIVE: The objective of this prospective study was to compare assessments of pre- and post-ventilation-perfusion (V/Q) scan probabilities for pulmonary embolism (PE) by the nuclear medicine physician and the referring physician. MATERIALS AND METHODS: Seventy-nine patients (41 females, 38 males, mean age 49 years) referred for V/Q scans over a period of 6 months and suspected of PE were included in the study. The pre-test likelihood was determined independently by a consultant nuclear physician and a referring physician prior to the V/Q scan. The scan was performed according to a standard protocol using 8 view technetium-99m diethylenetriamine pentaacetic acid aerosol ventilation study followed by a technetium-99m macroaggregated albumin perfusion study. The scan was interpreted according to prospective investigation of pulmonary embolism diagnosis criteria. The post-scan probability was calculated. The probability of PE was quoted as low, intermediate and high. Agreement or disagreement in assessing the pre- and post-scan probability was classified according to the degree of difference (no difference: 0; minor difference: 1, and major difference: 2 grades). RESULTS: The agreement between the nuclear medicine and referring physicians on clinical probability of PE was moderate (63%) before the scan and good (90%) after the scan. The disagreement in assessing the clinical probability between the referring physician and the nuclear medicine physician was predominantly minor. Only 5 and 1% of the disagreement was major in pre-scan and post-scan probabilities, respectively. CONCLUSION: The data show that nuclear medicine physicians can use the assessment of pre-scan clinical likelihood to determine the post-scan probability of PE.