Invasive Aspergillosis in a Patient With Diabetes Mellitus as the Only Risk Factor: Case Report and Literature Review.

Infection by Aspergillus covers a broad clinical spectrum, including invasive pulmonary aspergillosis (IPA) and its disseminated extrapulmonary form, invasive aspergillosis (IA). It typically occurs in severely immunocompromised hosts, but it sometimes affects the immunocompetent population, especially patients with acute diseases being treated at the intensive care unit (ICU) and less often those with chronic conditions. In this article, we report the case of a 50-year-old male, with diabetes mellitus (DM) as the only risk factor, treated for IPA and IA with cardiac and central nervous system (CNS) involvement at a high complexity institution in Cali-Colombia. Clinical presentation and radiological findings are unspecific and require a high level of suspicion. To confirm the case, histological or cytological of the fungus is required; histopathological examination of lung tissue is the gold standard, but it is difficult to perform due to respiratory compromise and high risk of bleeding, so bronchoscopy and bronchoalveolar lavage (BAL) plays an essential role in the diagnostic process. A diagnostic algorithm that includes risk assessment, symptoms, imaging findings, and isolation in cultures is essential to allow the diagnosis and initiation of treatment promptly, which includes a combination of surgery and antifungal medications for long periods, even life-long treatment.

Aspirin desensitization in NSAID-exacerbated respiratory disease and its outcomes in the clinical course of asthma: A systematic review of the literature and meta-analysis.

BACKGROUND: Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) might benefit from aspirin desensitization (AD) as an alternative treatment to standard care. However, there is conflicting evidence regarding its role in bronchial symptoms and asthma exacerbations. OBJECTIVE: To analyze the clinical effects of AD in terms of lung function, systemic and inhaled steroid use, the frequency of acute asthma exacerbations, and adverse effects in patients with NERD and asthma. METHODOLOGY: We identified randomized clinical trials (RCTs) from PubMed, EMBASE, SCOPUS, and EBSCO. We also searched the RCT references for additional studies. Studies comparing AD to placebo in patients with a previous history of pulmonary symptoms triggered by ASA or other NSAIDs or with a positive provocation test to ASA were included. PRIMARY RESULTS: Five studies with 210 participants with NERD were included in this review. The study duration ranged from 3 to 6 months. Overall, the risk of bias across the included RCTs was low. We identified 3 studies evaluating lung function, 2 of which reported a significant improvement in FEV1 in the AD group after 6 months, while the other reported no difference among the treatments. Due to high heterogeneity, we did not pool the results. The remaining primary outcomes were reported only in a single study each, hindering their interpretation. Secondary outcomes revealed reduced symptom and medication scores in patients with AD. CONCLUSIONS: Due to the small number of studies included in this systematic review, conclusions should be made with caution. AD shows a trend towards improving lung function (FEV1) following 6 months of treatment, although no conclusions can be made regarding the use of corticosteroids or the frequency of acute exacerbations. AD appears to reduce both symptom and medication scores. Additional RCTs are needed to fully assess the efficacy of AD in reducing bronchial symptoms in patients with NERD.

Use of monoclonal antibodies for allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis: literature review.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction (HR) mediated by antigens to Aspergillus fumigatus. It is estimated that 2-15% of patients with cystic fibrosis (CF) and between 1% and 5% of asthmatics develop ABPA, affecting approximately 4.8 million people worldwide. The goals of treatment are controlling inflammation, reducing the number of exacerbations and limiting the progression of lung damage. Systemic steroids are therefore used as the mainstay therapy, along with antifungal medications. However, many patients do not respond or develop side effects to treatment. In this scenario, biological drugs such as Omalizumab, Mepolizumab, Benralizumab and Dupilumab have been implemented in clinical practice, even though there is a lack of scientific evidence to support their use. We performed a literature review of the studies carried out which analyzed biologics for the management of ABPA in adult populations with asthma and CF. To our knowledge this is the first literature review that included all biologics. We included a total of 32 studies, all but one were descriptive studies, and the vast majority evaluated the use of Omalizumab. Biologics appeared to have more benefit for patients with ABPA and asthma than CF, specifically at decreasing the frequency of acute exacerbations and by having a steroid-sparing effect. Although a decrease in serum IgE level is considered a measure of therapy success, values may not decline as expected in the context of a significant clinical improvement, highlighting the importance of measuring patient-oriented outcomes. As evidence comes mainly from case series and case reports, randomized controlled trials are needed to evaluate further the safety and efficacy of biologics in ABPA.The reviews of this paper are available via the supplemental material section.

Conocimientos, prácticas, actitudes y opiniones sobre limitación del esfuerzo terapéutico en niños del personal de salud del departamento de pediatría de un hospital universitario en Colombia / Knowledge, Practices, Attitudes and Opinions towards End of Life Care in Children, of Pediatric Healthcare Providers, at a General Hospital in Colombia

Introducción: Conceptos como limitación del esfuerzo terapéutico (LET) son de vital importancia para la práctica diaria. Objetivo: Identificar conocimientos, prácticas, actitudes y opiniones sobre LET en un servicio de pediatría. Método: Estudio observacional descriptivo de corte transversal. Encuesta estructurada. Resultados: Se evaluaron 121 encuestas (80% de la población). El 96% de las personas conocen el término LET, el 91,5% ha estado en contacto con al menos un caso, pero solo el 25% considera haber recibido capacitación en el tema durante su formación; en el 86 % de los casos la decisión de LET se tomó en junta multidisciplinaria o en conjunto con la familia. Conclusiones: Las personas encuestadas están familiarizadas con el término LET; son muy pocas las que recibieron capacitación durante su entrenamiento. Es necesario el desarrollo de herramientas educativas y apoyo respecto a cuidados paliativos pediátricos para el personal de salud a cargo de pacientes pediátricos.

Introduction: Concepts like End of Life Care (ELC) are vital for daily practice. Objective: To identify the knowledge, practices, attitudes and opinions about ELC in a Pediatric Service. Method: Descriptive observational cross-sectional study. Structured survey. Results: 121 surveys (80% of the population) were evaluated. 96% of the people know the term ELC, 91.5% have been in contact with at least one case, but only 25% consider having received training in the subject during their training, in 86% of cases the decisión to ELC was taken in a multidisciplinary meeting or in conjunction with the family. Conclusions: Respondents are familiar with the term ELC, very few are trained during their training. We consider it necessary to develop educational tools and support with regard to pediatric palliative care for health personnel in charge of pediatric patients.