ABSTRACT
BACKGROUND: Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached. AIM: To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis. METHODS: Seven hundred and twenty-eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA-classes. RESULTS: A six-class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non-allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA-classes. CONCLUSION: Novel severe phenotypes of participants with co-occurrence of ocular, nasal and bronchial symptoms, and exacerbation-prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.
Subject(s)
Asthma/diagnosis , Eye Diseases/immunology , Latent Class Analysis , Adult , Algorithms , Asthma/classification , Conjunctivitis , Eye Diseases/pathology , Female , Humans , Male , Middle Aged , Phenotype , PortugalABSTRACT
OBJECTIVES: To evaluate the knowledge, attitudes and difficulties of family doctors in the indication of oral anti-coagulation treatment (OCT) in patients with non-valvular auricular fibrillation (NVAF). DESIGN: Transversal descriptive study.Setting. Area 11 of Madrid primary care.Participants. 250 doctors by simple randomised sampling. MAIN MEASUREMENTS: After a pilot study at a health centre, mailing of a questionnaire with a subsequent re-mailing. This collected social and personal details, knowledge of the question, attitudes and difficulties. RESULTS: 157 (62.8%) replied; 91 were women (58.0%); mean age was 39 (SD, 6.0). 97 had reviewed the question recently (61.8%). 110 thought that the anti-aggregation criteria were clear (70.1%; CI, 62.2-77.0%), 107 that the oral anti-coagulation criteria were (68.2%; CI, 60.2-75.2%), 132 that the OCT risks were (84.1%; CI, 77.2-89.2%), and 74 that risk factors of cerebrovascular accident were clear (47.1%; CI, 39.2-55.2%). Initially 96 doctors gave anti-aggregants and referred to cardiology (61.1%; CI, 53.0-68.7%), and 29 began OCT (18.5%; CI, 12.9-25.6%). 134 thought that we avoided initiating OCT (85.3%; CI, 78.6-90.3%), giving as the main reasons the difficulty of monitoring and of requesting further tests, the risks involved and OCT not being up-to-date. CONCLUSIONS: Most professionals have the criteria for OCT in NVAF clear, although they continue to avoid the initiation of OCT. The majority approach is to give anti-aggregants and refer to Cardiology, given the risk of the therapy and the difficulties involved in monitoring and requesting further tests.
Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Administration, Oral , Adult , Anticoagulants/adverse effects , Attitude of Health Personnel , Cross-Over Studies , Female , Humans , Male , Physicians, Family , Pilot Projects , Platelet Aggregation Inhibitors/therapeutic use , Primary Health Care , Random Allocation , Referral and Consultation , Risk Factors , Stroke/chemically induced , Surveys and QuestionnairesABSTRACT
Objetivo. Evaluar los conocimientos, actitudes y dificultades de los médicos de familia para la indicación de tratamiento anticoagulante oral (TAO) en pacientes con fibrilación auricular no valvular (FANV).Diseño. Estudio descriptivo transversal. Emplazamiento. Área 11 de Atención Primaria de Madrid. Participantes. Muestra de 250 médicos por muestreo aleatorio simple. Mediciones principales. Envío de un cuestionario con un reenvío posterior, tras "pilotaje" previo en un centro de salud, que recogía variables sociodemográficas, conocimientos sobre el tema, actitudes y dificultades. Resultados. Contestaron 157 personas (62,8 per cent), 91 mujeres (58,0 per cent), con una edad media de 39 años (desviación estándar [DE], 6,0). De ellas, 97 han revisado el tema recientemente (61,8 per cent). Creen que están claros los criterios de antiagregación 110 encuestados (70,1 per cent; intervalo de confianza [IC], 62,2-77,0); los de anticoagulación oral 107 (68,2 per cent; IC, 60,275,2); los riesgos del TAO 132 (84,1 per cent; IC, 77,2-89,2), y los factores de riesgo de accidente cerebrovascular 74 (47,1 per cent; IC, 39,2-55,2). Inicialmente antiagregan y derivan a cardiología 96 de los encuestados (61,1 per cent; IC, 53,0-68,7) e inician TAO 29 (18,5 per cent; IC, 12,9-25,6). Creen que evitamos iniciar TAO 134 de los encuestados (85,3 per cent; IC, 78,6-90,3), señalando como principales causas la dificultad del seguimiento y para solicitar pruebas complementarias, los riesgos y la falta de actualización. Conclusiones. La mayoría de los profesionales tiene claros los criterios de TAO en la FANV, aunque siguen evitando iniciar TAO, siendo la actitud mayoritaria antiagregar y derivar a cardiología, debido al riesgo de esta terapia y a la dificultad para hacer el seguimiento y solicitar pruebas complementarias (AU)
Subject(s)
Adult , Male , Female , Humans , Risk Factors , Cross-Over Studies , Physicians, Family , Platelet Aggregation Inhibitors , Pilot Projects , Surveys and Questionnaires , Referral and Consultation , Random Allocation , Primary Health Care , Stroke , Attitude of Health Personnel , Atrial Fibrillation , Anticoagulants , Administration, OralABSTRACT
The locaization of pulmonary nodules by the hook wire technique has allowed accurate resection of small and nonsuperficial pulmonary nodules by video-assisted thoracoscopic surgery. Hook wire localization has been shown efficacious and safe with principal complications limited to pneumothorax, wire dislocation, and localized intrapulmonary hemorrhage. We report a case of massive gas embolism complicating this procedure. The probable causative mechanisms and possible methods for avoidance are discussed.
