Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain.

Purpose: To determine the clinical and economic impact of inhaled corticosteroid (ICS) withdrawal in Spanish patients with COPD receiving triple therapy (TT) with ICS, long-acting ß2-agonist (LABA), and long-acting muscarinic antagonist (LAMA). Patients and Methods: This was an observational, retrospective study of BIG-PAC database medical records. Patients aged ≥40 years receiving TT from 2016 to 2018 were followed for 1 year. Two cohorts were identified: patients continuing TT (ICS+LABA+LAMA), and patients receiving TT with ICS withdrawn (LABA+LAMA). Variables included medication, exacerbations (moderate and severe), pneumonia, mortality, health resource use (HRU), and cost per patient/year. Cohorts were compared using propensity score matching (PSM). Multivariate statistical analysis using analysis of covariance and Cox proportional risks was conducted. Results: Of 6541 patients included, 5740 (87.8%) continued TT and 801 (12.2%) had ICS withdrawn. Patients with ICS withdrawal were younger, had lower disease burden, higher ICS doses, and more exacerbations compared with those continuing ICS. PSM matched 795 patients in each cohort. Mean age was 68.5 years (SD: 11.2), 69.9% were male, and mean Charlson index was 2.0. Patients with ICS withdrawal had more total exacerbations in the 12 months following withdrawal compared with patients continuing TT (36.6% vs 31.4%; p=0.030). No significant differences were found for pneumonia (3.3% vs 3.6%; p=0.583) and mortality (9.9% vs 7.5%; p=0.092). Median time to first exacerbation was shorter in patients with ICS withdrawal compared with those continuing ICS (HR: 0.69, 95% CI: 0.57-0.83; p<0.001). Mean health cost per patient/year among patients with ICS withdrawal was higher than those continuing TT (€2993 vs €2130; p<0.001). Conclusion: ICS withdrawal in patients with COPD receiving TT was associated with increased exacerbations, HRU, and costs compared with continuing TT, with health and economic impacts on patients and the Spanish National Healthcare System, respectively. Pneumonia and mortality rates were similar between groups.

Projective geometric model for automatic determination of X-ray-emitting source of a standard radiographic system.

BACKGROUND AND OBJECTIVE: Currently, many orthopedic operations are planned by analyzing X-rays. The exact position of the focus is needed to calculate the real size of an object that is represented in conical projection, although in practice, this position is difficult to determine using current X-ray commercial systems. In this paper, a new geometric model is proposed in order to determine accurately, practically, and economically the location of the emitting source of commercial imaging systems using a single standard X-ray image. METHOD: The method requires a specific reference locator object to be positioned in the visual field of radiographic image. Because this object cannot implement ideal geometric points, but instead works with small spheres, it was necessary to experimentally validate the proposed methodology. The implemented software that was developed to validate the model was used in four series of tests. In these tests, we studied the influence on the final result of: 1. the selection of a specific set of markers in radiography, 2. the focus position variation in relation to radiograph and 3. the possible rotated angle of locator object about Z axis. RESULTS: The results for 164 tests that were performed with this software showed that the expected error for 99.5% of values ranges with maximum error of [-0.35%, +0.39%], which shows that the model is independent of the design of locator object and its position and orientation in the radiographic field. The software used to validate the proposed model has been found useful to verify its reliability, effectiveness, ease of implementation, and accuracy. CONCLUSIONS: This model is effective to calculate the precise position of the X-ray focus of any standard radiographic system accurately.

[Interstitial lung disease]. / Enfermedad pulmonar intersticial.

Molecular investigation into the physiopathology of interstitial lung diseases has gained special interest through the trials carried out in the last decade. These trials seem to point at the role played by certain molecules, such as cytokines (transforming growth factor, platelet derived growth factor) and integrins, in the processes that lead to pulmonary fibrosis during the course of interstitial lung disease. They also demonstrate the important role that angiotensin II plays in increasing the secretion of transforming growth factor by several cells. The above-mentioned studies allow new therapeutic approaches to be considered which will possibly improve the serious prognosis of such diseases once they have reached the last stage of their course: pulmonary fibrosis.

Enfermedad pulmonar intersticial / Interstitial lung disease

El estudio molecular de la fisiopatología de las enfermedades pulmonares intersticiales cobra especial interés en diversos estudios desarrollados en la última década. En dichos estudios parece destacar el papel de varias moléculas, como las citocinas (factor de transformación del crecimiento, factor de crecimiento derivado de plaquetas) y las integrinas en los procesos que llevan al desarrollo de una fibrosis pulmonar durante la evolución de una enfermedad pulmonar intersticial, así como se demuestra el importante papel que desempeña la angiotensina II en la estimulación de la secreción del factor de transformación del crecimiento por diversas células. Dichos estudios permiten plantear nuevos enfoques terapéuticos que, posiblemente, mejoren el mal pronóstico de estas enfermedades cuando han alcanzado la fase final de su evolución, la fibrosis pulmonar (AU)

Riesgos del neonato de madres adolescentes / Risk of newborn adolescent mothers

Se realizó un estudio prospectivo en el Hospital Enrique Tejera, Valencia, Estado Carabobo con 252 neonatos de madres de diferentes grupos etarios (17 o menos años de edad y 18-24 años). Utilizando el enfoque de riesgo de la Organización Panamericana de la Salud, se estableció asociación entre la edad materna (menor igual a 17 años, grupo de estudio y 18-24 años, grupo control), con las variables de las madres (procedencia, situación conyugal, situación socioeconómica, grado de instrucción, y asistencia al control prenatal) y las variables neonatales (Apgar, peso al nacer, malformaciones congénitas, infecciones neonatales, mortalidad neonatal inmediata y otras complicaciones neonatales como distress respiratorio, lecciones no infecciosas de piel, ictericia de origen no precisada), encontrándose asociación estadísticamente significativa, (Chi cuadrado mayor de 3.84), entre la edad materna menor o igual a 17 años, con las variables:procedencia rural, situación económica V y la inasistencia control prenatal y entre la edad 18-24 años con las variables: procedencia urbana y situación económica III. Se concluye que el neonato hijo de madre adolescente no representa un grupo de riesgo per se siempre y cuando se le ofrezca la atención adecuada tanto al binomi madre-feto como al recién nacido.