Transition of adolescents with severe asthma from pediatric to adult care in Spain: the STAR consensus

OBJECTIVE

To assess the consensus level among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care.

METHODS

A 61-item survey was developed based on guidelines for other chronic pathologies, covering transition planning, preparation, effective transfer, and follow-up. A two-round Delphi process assessed the consensus level among 98 experts (49 pediatricians, 24 allergists and 25 pulmonologists). Consensus was established with ≥70% agreement.

RESULTS

Forty-two items (70%) reached consensus. No age range to initiate the transition was agreed upon by the panelists. The main goal to achieve during the transition identified by the experts is that adolescents gain autonomy to manage their severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient's autonomy, and identifying home environment factors. They agreed that the adult healthcare team should have expertise in severe asthma, biologics and management of adolescent patients. Pediatric and adult healthcare teams should share clinical information, agree on the criteria to maintain the biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult healthcare professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, treatment adherence and attendance to healthcare appointments.

CONCLUSION

This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

[Onychomycosis by yeast not common in diabetics of a health center]

BACKGROUND

Mexican diabetic population frequently presents mycosis under foot hyperkeratosis; however, in another type of onychomycosis as the ones that is assumed Candida albicans is the causal agent, it is unknown the frequency, the prevalence and if another Candida species or other yeasts are found.

OBJECTIVE

Evaluate the frequency of yeasts causing onychomycosis in diabetic patients looked after in public institutions of health of the State of Hidalgo, Mexico, and its association with clinical epidemiological variables.

MATERIALS AND METHODS

An observational, descriptive and transversal study was made on 261 patients, from which one nail sample of each one was obtained, used to isolate and identify dermatophytes and yeasts; the results were statistically correlated with 24 epidemiological parameters. The clinical study was done through interrogation and by medical exploration in order to evaluate Tinea pedis and onychomycosis.

RESULTS

Onychomycosis were caused by Candida guilliermondii, Candida parapsilosis, Candida glabrata, Candida krusei, Candida spp., Kodamaea ohmeri, Prototheca wickerhamii and unidentified yeasts. The prevalence for general onychomycosis, by dermatophytes, mixed onychomycosis and by yeasts were: 24.1, 19.5, 2.3 and 14.6%, respectively. Patients with significant probability to be diagnosed as having onychomycosis by yeasts are those wearing open shoes (2.59%); technicians and professionals (10.49%) and alcohol drinkers (3.72%).

CONCLUSION

The fact that Candida albicans is not present in this study as causal agent of onychomycosis, and emerging and non-common yeasts were indeed isolated, creates new challenges. It is remarked the clinical criterion that when onychomycosis is suspected in diabetics, the diagnosis for culturing dermatophytes and yeasts should be included.

[Hypersensitivity reactions to non-steroidal anti-inflammatory drugs and tolerance to alternative drugs]

INTRODUCTION

Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions to drugs. The prevalence varies from 0.6 to 5.7% in general population, but there are no data available in children. The aim of this study is to determine the frequency of patients diagnosed with hypersensitivity to NSAIDs, and describe their clinical characteristics, type of hypersensitivity, and tolerance to alternative drugs.

METHODS

Retrospective study was conducted on children with suspected hypersensitivity to NSAIDs from January 2012 to December 2013. The diagnosis was confirmed by oral drug provocation test (DPT) to the drug involved in the group with a history of one episode, while in the group with a history of more than one episode with the same drug the diagnosis was based on clinical data. Subsequently, a DPT with acetylsalicylic acid (ASA) was done in order to classify hypersensitivity into selective or multiple. In those cases with a positive result, a DPT was performed with alternative drugs.

RESULTS

Out of a total of 93 children studied, 26 were diagnosed with hypersensitivity to NSAIDs: 7 confirmed by oral DPT, and 19 based on clinical data. Multiple hypersensitivity was diagnosed in 50% of patients. Ibuprofen was involved in all reactions. The most common clinical manifestation was angioedema (44%). Acetaminophen was the best tolerated alternative drug.

CONCLUSIONS

More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity. Acetaminophen is a safe alternative in children with hypersensitivity to NSAIDs. Meloxicam may be an alternative in cases that do not tolerate acetaminophen.

[Perinatal outcomes in immigrant women]

OBJECTIVES

To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns.

PATIENTS AND METHODS

All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated.

RESULTS

There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01).

CONCLUSIONS

In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate.

Expulsión espontánea de un cálculo salival submandibular

Sialolithiasis rarely occurs in children and usually affects the submandibular salivary gland. Because of its rarity, its clinical expression is frequently missed and diagnosis is delayed. We describe the case of a 9-year-old boy with submandibular sialolithiasis who presented spontaneous passage of a large salivary stone. We review the clinical findings and etiopathogenesis of sialolithiasis in children, as well as diagnostic imaging techniques and several therapeutic approaches to stone extraction.

Blue-light regulation of phytoene dehydrogenase (carB) gene expression in Mucor circinelloides

The carB gene, encoding the phytoene dehydrogenase of Mucor circinelloides, was isolated by heterologous hybridisation with a probe derived from the corresponding gene of Phycomyces blakesleeanus. The cDNA and genomic copies complemented phytoene dehydrogenase defects in Escherichia coli and in carB mutants of M. circinelloides, respectively. Fluence-response curves for transcript accumulation were constructed after different blue-light pulses. The level of carB mRNA accumulation reached values up to 150-fold higher than basal levels in darkness. Several elements in the promoter of this gene resemble a consensus sequence identified in Neurospora crassa (APE) which is essential for blue-light regulation. Comparison of the available phytoene dehydrogenase sequences from plants, fungi, algae and bacteria suggests that the two known types of phytoene dehydrogenase are more closely related to each other than previously thought.