Asthma exacerbations in a tertiary hospital: clinical features, triggers, and risk factors for hospitalization

Background: The risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients who experience asthma exacerbations. We also assessed potential triggers of exacerbations and possible predictors of hospitalization. Methods: A retrospective, noninterventional cohort study was conducted in adult patients who attended the emergency department of a tertiary hospital with an asthma exacerbation during 2014. Results: The study population comprised 831 patients (888 events). Most episodes occurred in January and May. Respiratory infection was the trigger in 523 events. In 34.21% of cases, the eosinophil count was ≥260/mm3 (≥400/mm3 in 20.7%), which was significantly associated with allergic asthma (P<.0001). The risk factors for hospitalization were older age (OR, 1.58; 95%CI, 1.46-1.71), no previous diagnosis of asthma (OR, 1.40; 95%CI, 1.06-1.86), poorly controlled asthma (OR, 1.78; 95%CI, 1.10-2.88), respiratory infection (OR, 2.65; 95%CI, 1.95-3.62), and severe exacerbation with more treatment requirements. The rate of hospitalization was significantly lower in patients with ≥400 eosinophils/mm3 (P<.001). Conclusion: Older age, absence of a previous asthma diagnosis, uncontrolled disease, and concomitant chronic obstructive pulmonary disease are frequent among patients presenting at the emergency department with asthma exacerbations. Various features were associated with a higher risk of admission. Blood eosinophilia should be considered a marker of asthma, but not a predictor of hospitalization (AU)

Introducción: Los factores de riesgo de las exacerbaciones de asma no se conocen por completo. El objetivo de este estudio fue determinar las características epidemiológicas y clínicas de los pacientes con exacerbaciones de asma, los potenciales factores desencadenantes y los posibles predictores de hospitalización. Métodos: Se llevó a cabo un estudio de cohorte retrospectivo, no intervencionista, en pacientes adultos que acudieron al Servicio de Urgencias de un hospital terciario con una exacerbación de asma durante el año 2014. Resultados: Se incluyeron 831 pacientes (888 eventos). El mayor número de episodios ocurrió en Enero y Mayo. La infección respiratoria se consideró como desencadenante en 523 eventos. 34,21% tenían ≥260 eosinófilos/mm3 (20,7% ≥ 400 eosinófilos/mm3), estando lo cual asociado significativamente con el asma alérgica (p<0,0001). Los factores de riesgo para la hospitalización fueron: edad avanzada [OR: 1,58 (IC 95%: 1,46 a 1,71)]; ausencia de diagnóstico previo de asma [OR: 1,40 (IC 95%: 1,06-1,86)]; mal control del asma [OR: 1,78 (IC 95%: 1,10-2,88)]; infección respiratoria [OR: 2,65 (IC 95%: 1,95-3,62)]; y crisis graves con mayor necesidad de tratamiento. En los asmáticos con ≥ 400 eosinófilos/mm3, la tasa de hospitalización fue menor (p <0,001). Conclusión: La edad avanzada, la ausencia de un diagnóstico de asma previo, el mal control de la enfermedad o el padecer EPOC de forma concomitante son frecuentes entre los pacientes que acuden al Servicio de Urgencias con exacerbaciones de asma. Se detectaron algunas características asociadas con un mayor riesgo de ingreso. La eosinofilia periférica debe ser considerada como un marcador de asma, pero no como un predictor de la hospitalización (AU)

Delayed allergic reaction to terbinafine with a positive lymphocyte transformation test

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Asthma exacerbations in a tertiary hospital: clinical features, triggers, and risk factors for hospitalization.

BACKGROUND: Risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients with an asthma exacerbation, potential triggers, and possible predictors of hospitalization. METHODS: A retrospective, non-interventional cohort study was conducted in adult patients who attended the Emergency Department of a tertiary hospital with an asthma exacerbation during 2014. RESULTS: 831 patients (888 events) were included. The highest number of episodes occurred in January and May. Respiratory infection was considered the trigger in 523 events. 34.21% had ≥260 eosinophils/mm3 (20.7%≥400 eosinophils/mm3), significantly associated with allergic asthma (p<0.0001). Risk factors for hospitalization were: older age [OR:1.58 (95% CI 1.46-1.71)]; no previous diagnosis of asthma [OR:1.40(95% CI 1.06-1.86)]; poorly controlled asthma[OR:1.78 (95% CI 1.10-2.88)]; respiratory infection [OR:2.65 (95% CI 1.95-3.62)]; and severe crisis with more treatment requirements. Of those asthmatics with ≥400 eosinophils/mm3, the rate of hospitalization was lower (p<0.001). CONCLUSION: Older age, absence of a previous asthma diagnosis, uncontrolled disease or concomitant COPD are frequent among patients presenting to the ED with asthma exacerbations. There were some features associated with higher risk of admission. Blood eosinophilia should be considered as a marker of asthma, but not as a predictor of hospitalization.

Large changes in Pluto's atmosphere as revealed by recent stellar occultations.

Pluto's tenuous nitrogen atmosphere was first detected by the imprint left on the light curve of a star that was occulted by the planet in 1985 (ref. 1), and studied more extensively during a second occultation event in 1988 (refs 2-6). These events are, however, quite rare and Pluto's atmosphere remains poorly understood, as in particular the planet has not yet been visited by a spacecraft. Here we report data from the first occultations by Pluto since 1988. We find that, during the intervening 14 years, there seems to have been a doubling of the atmospheric pressure, a probable seasonal effect on Pluto.

Therapeutic options for capillary papillary hemangiomas.

PURPOSE: To describe the results and therapeutic complications of treatment of papillary capillary hemangiomas over the last 13 years. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Five cases of unilateral capillary papillary hemangiomas were reviewed. Three patients had von Hippel-Lindau disease, and two had no associated familial or systemic disease. METHODS: Two patients were treated with argon green laser, one patient received argon green and diode photocoagulation, and two patients underwent argon green photocoagulation and diode transpupillary thermotherapy (TTT); two eyes also underwent vitreoretinal surgery. Follow-up ranged from 1 to 13 years. MAIN OUTCOME MEASURES: The presence of exudative retinal detachment associated with the activity of the hemangioma and the visual acuity were the two main parameters. RESULTS: Prompt argon green laser treatment was the most effective therapy; -II was ineffective. Vitreoretinal surgery, transscleral drainage, and argon endolaser photocoagulation in one case resolved bullous retinal detachment secondary to tumor exudation. Pretreatment visual acuity (VA) levels ranged from 20/25 to counting fingers; posttreatment VA levels ranged from 20/25 to light perception. CONCLUSIONS: If left untreated, papillary hemangiomas may evolve to exudative retinal detachment and marked VA decreases. Although we have not established an ideal therapy, we recommend appropriate treatment on diagnosis. Close follow-up and multiple treatments with argon laser are likely the best therapeutic course.

The role of vitreoretinal surgery in the treatment of posttraumatic macular hole.

PURPOSE: To determine if vitreoretinal surgery is successful in closing traumatic macular holes and subsequently improving visual acuity. Blunt trauma may result in a macular hole when it causes traumatic separation of the vitreous from the retina, contusion necrosis, or subfoveal hemorrhage. Like idiopathic macular holes, traumatic macular holes are surrounded by a ring of subretinal fluid and result in severely diminished visual acuity. METHODS: Fourteen eyes with full-thickness posttraumatic macular holes were treated. The patients ages ranged from 15 years to 36 years (mean, 22 years). Preoperative best corrected visual acuity ranged from 20/200 to 20/50 (mean, 20/80). A pars plana vitrectomy and posterior hyaloid dissection were performed, followed by complete fluid-gas exchange and instillation of 0.1 mL of platelet concentrate just over the macular hole. A final flushing with 25% sulfur hexafluoride was done. The postoperative follow-up period ranged from 6 months to 28 months (average, 13 months). RESULTS: Successful anatomic macular hole closure was achieved 6 months after surgery in 13 years (92.86%). Visual acuity improved four or more lines on the Snellen chart within 6 weeks after surgery in every eye with a closed hole; a final visual acuity of 20/20 was achieved in two eyes (15.3%). The mean postoperative visual acuity was 20/30. No intraoperative or postoperative complications were noted, and the lens remained clear in all eyes during the follow up period. CONCLUSION: Our results suggest that intraoperative application of platelet concentrate in combination with vitrectomy may be useful in managing posttraumatic full-thickness macular holes, thus improving anatomic and visual outcomes. The greater recovery of visual acuity obtained in this study compared with that obtained in other series of idiopathic macular holes could be related to the young age of the patients with traumatic macular holes and the early diagnosis and treatment.