Severe asthma and eligibility for biologics in a Brazilian cohort.

OBJECTIVE: This study aims to describe the eligibility for biologic therapies for severe asthma (SA) in a cohort of patients attending the Program for Control of Asthma (ProAR) in Bahia, Brazil. METHODS: Data from SA patients (≥18 years old) attending the ProAR, that were included in a case-control study conducted from 2013 to 2015, were used to reassess patients according to a modified ERS/ATS 2014 SA criteria. Patients were then classified according to the eligibility for SA biological therapy based on current prescription labels. RESULTS: From 544 patients in the cohort, 531 (97.6%) were included and 172 (32.4%) were identified as SA patients according to the ERS/ATS 2014 modified criteria. Of these 172 patients, 69 (40.1%) were ineligible for any of the biologicals approved for asthma (omalizumab, mepolizumab, reslizumab and benralizumab), 60 (34.9%) patients were eligible for one of the biological therapies, and 10 (5.8%) patients were eligible for all biological therapies. CONCLUSIONS: More than half of patients with SA were eligible for biologic therapy in our study, but none of them received this form of treatment. Almost half of them were not eligible to any of the approved biologics, however. The variability and overlap in patients' eligibility highlight the importance of evaluating each patient individually for a more personalized treatment approach. While there is a need to increase access for some of those eligible that may really need a biologic treatment, continuous efforts are required to develop alternatives to those who are not eligible.

Can you hear me now? A genetic model of otitis media with effusion.

Otitis media with effusion (OME) is characterized by the occurrence of fluid in the middle-ear cavity in the absence of any signs of acute ear infection and occurs most frequently in children with auditory or eustachian tube dysfunction. Its chronic form is an important clinical issue for pediatricians and otologists alike. The study by Depreux et al. in this issue of the JCI shows that absence of the transcriptional activator Eya4 in knockout mice results in abnormal structuring of the eustachian tube, thus predisposing these animals to OME (see the related article beginning on page 651). The development of this genetics-based animal model is an important advance for understanding OME and for exploring new avenues of treatment.

Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence.

OBJECTIVES: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. METHOD: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. RESULTS: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. DISCUSSION: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.

Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence / Tendência da prevalência de asma autorreferida no Brasil de 2003 a 2013 em adultos e fatores associados à prevalência

ABSTRACT Objectives: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. Method: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. Results: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. Discussion: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.

RESUMO Objetivos: Determinar a tendência da prevalência de diagnóstico de asma autorreferida e descrever os fatores associados à asma em adultos brasileiros. Método: Estudo transversal de análise de dados de três pesquisas domiciliares nacionais: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 e Pesquisa Nacional de Saúde (PNS) 2013. Participantes entre 18 e 45 anos foram incluídos. A análise de tendência da prevalência do diagnóstico de asma foi realizada utilizando modelo logístico linear. Aplicou-se o modelo de regressão logística hierárquico para selecionar fatores significativamente associados à prevalência de asma. Resultados: A prevalência do diagnóstico de asma foi de 3,6% (2003), 3,7% (2008) e 4,5% (2013), apresentando tendência de elevação significativa. A prevalência do diagnóstico de asma também se elevou quando analisada por sexo (variação anual entre homens: 2,47%, p < 0,003; mulheres: 2,16%, p < 0,001), área urbana (variação anual: 2,15% p < 0,001), plano de saúde (variação anual sem plano: 2,18%, p < 0,001; com plano: 1,84%, p = 0,014) e regiões geográficas (variação anual Norte: 4,68%, p < 0,001; Nordeste 4,14%, p < 0,001; e Sudeste 1,84%, p = 0,025). Sexo feminino, obesidade, viver em áreas urbanas e depressão foram associados positivamente com a prevalência de diagnóstico de asma. Discussão: PNAD e PNS são bases populacionais representativas de adultos brasileiros que possibilitam a investigação da prevalência de asma. De 2003 a 2013, a prevalência de diagnóstico autorreferido de asma aumentou, especialmente nas regiões Norte e Nordeste. Sexo, região geográfica e área de residência (urbana/rural), obesidade e diagnóstico de depressão parecem desempenhar papéis significativos na epidemiologia da asma no Brasil.

How is the children's implant profile used in the Cochlear Implant Candidacy Process?

OBJECTIVE: The complex process of cochlear implant candidacy assessment at The Children's Hospital of Philadelphia (CHOP) is guided by a modified version of the Children's Implant Profile (ChIP) that has been used world wide over the past 18 years. The aim of this study is to analyze the use of the modified ChIP (mChIP) in the candidacy process by the CHOP Cochlear Implant Program. Of special interest were those cases in which the recommendation regarding implantation appeared inconsistent with the mChIP score. These were further analyzed to understand the real-life decision processes. METHODS: This retrospective study involved 121 children assessed for cochlear implant candidacy at CHOP over a 2-year period. The mChIP ratings of No Concern, Some Concern and Great Concern were assigned values of 1, 2 and 3, respectively. Values of 1.5 and 2.5 were used when the check mark was on the boundary between two categories. An average score was calculated and the relationships between mChIP scores and the recommendation regarding implantation were examined. RESULTS: Eighty-seven children were considered suitable for cochlear implantation; implantation was not recommended for 20. Another 14 cases in which one or more areas of the mChIP had not been completed were excluded. Using a criterion based solely on the mean score would correctly predict 75% of the team's recommendations to implant and 75% of recommendations not to implant. Examination of the cases where implantation was not recommended illuminated the decision-making process. CONCLUSIONS: A statistical analysis of the mChIP fails to capture the complexity of the decision-making process. Most important, it appears that the team's practice is generally to recommend implantation when there is at least a modest prospect of benefit, unless there are absolute contraindications or many areas of Great Concern.

Cisto epidermóide de orelha externa e hipoacusia: relato de caso / Epidermoid cyst of the external ear and hearing loss: case report

O cisto epidermóide é um raro tumor benigno que pode desenvolver-se em qualquer região do corpo humano. Cerca de 7 por cento destes cistos ocorrem em região de cabeça e pescoço mais frequentemente apresentam...

Epidermoid cysts are rar tumors that may occur anywhere in the body. About 7 per cent of them are found in the head and neck region. This type of lesion presents symptoms more frequently in pacients between 15 and 35 years, but can be seen in all age ranges...