Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA).

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA), is a rare ANCA-associated systemic vasculitis. Its overlapping features with other vasculitic or eosinophilic diseases, and the wide and heterogeneous range of clinical manifestations, often result in a delay to diagnosis. OBJECTIVE: To identify red flags that raise a suspicion of EGPA to prompt diagnostic testing and to present an evidence-based clinical checklist tool for use in routine clinical practice. METHODS: Systematic literature review and expert consensus to identify a list of red flags based on clinical judgement. GRADE applied to generate a strength of recommendation for each red flag and to develop a checklist tool. RESULTS: 86 studies were included. 40 red flags were identified as relevant to raise a suspicion of EGPA and assessed by the experts as being clinically significant. Experts agreed that a diagnosis of EGPA should be considered in a patient aged ≥6 years with a blood eosinophil level >1000 cells/µL if untreated and >500 cells/µL if previously treated with any medication likely to have altered the blood eosinophil count. The presence of asthma and/or nasal polyposis should reinforce a suspicion of EGPA. Red flags of asthma, lung infiltrates, pericarditis, cardiomyopathy, polyneuropathy, biopsy with inflammatory eosinophilic infiltrates, palpable purpura, digital ischaemia and ANCA positivity, usually anti-myeloperoxidase, among others, were identified. CONCLUSION: The identification of a comprehensive set of red flags could be used to raise a suspicion of EGPA in patients with eosinophilia, providing clinicians with an evidence-based checklist tool that can be integrated into their practice.

Estudio descriptivo y abstinencia al año en una consulta de tabaquismo / Descriptive study and abstinence at one year of a smoking consultation

Objetivos: Estudio retrospectivo de datos procedentes de revisiónde historias clínicas, obteniendo: características demográficas y de tabaquismo,diferencias en función del género, abstinencia obtenida y predictoresde abstinencia.Pacientes y métodos: Se trata de una consulta individual basada enel tratamiento farmacológico y psicológico mínimo. A los pacientes seles realizó una anamnesis sobre antecedentes y tabaquismo, el test deFagerström, peso y CO en aire espirado. El seguimiento se realizó segúnel esquema propuesto por la SEPAR.Resultados: Sobre datos de 225 historias, la edad media fue de 47 ±10 años, siendo el 57% varones. El 7,4% no presentaba otras enfermedadesaparte del tabaquismo. La media del test de Fagerström, cigarrillos/día,paquetes año y CO fueron de 6,74 ± 2,10, 33,74 ± 15,77, 36,89 ± 20,23 y31,36 ± 15,91 respectivamente. Encontramos diferencias significativas enfunción del sexo en los paquetes-año (p = 0,009), CO (p = 0,004) y test deFagerström (p = 0,003). La abstinencia máxima se alcanzó a las tres semanasy fue del 83%, a los seis meses fue del 37% y al año del 28%.Conclusiones: Concluimos que consultan similar proporción de varonesy mujeres, en edad media, con enfermedades producidas por el tabacoy con alta dependencia a la nicotina; encontramos diferencias porgénero y obtenemos buenos resultados a corto plazo, aunque son menoresa seis meses y un año

Objectives: Retrospective study of data from clinical history review,obtaining: demographic and smoking characteristics, differences basedon gender, abstinence obtained and abstinence predictors.Patients and methods: This is an individual consultation based onminimum drug and psychological treatment. The patients wereadministered an anamnesis on background and smoking, the Fagerströmtest, weight and CO in exhaled air. Follow-up was done according to theSEPAR proposed schedule.Results: Based on data from 225 histories, mean age was 47 ± 10years, 57% being men. Atotal of 7.4% had no other diseases except forsmoking. The mean of the Fagerström test, cigarettes/day, packs per yearand CO were 6.74 ± 2.10, 33.74 ± 15.77, 36.89 ± 20.23 and 31.36 ±15.91 respectively. We found significant differences according to genderin packs-year (p = 0.009), CO (p = 0.004) and Fagerström test (p = 0.003).Maximum abstinence was reached at three weeks and was 83%. It was37% at six months and 28% at one year.Conclusions: We conclude that a similar proportion of consultationfrom men and women who are middle aged, with diseases producedby tobacco and with high dependence to nicotine. We found differencesby gender and obtained good short-term results, although they are lessat six months and one year

[Demographic study of tobacco addiction in Health District 5, Valencia, Spain]. / Estudio demográfico del tabaquismo en el Area de Salud 5 de Valencia.

OBJECTIVES: To determine the number of smokers, their demographic characteristics, and the stages of change among patients visiting health care centers. PATIENTS AND METHODS: Descriptive cross-sectional study carried out at 7 primary health care centers in Health District 5 of the Autonomous Community of Valencia. RESULTS: An interview was given to 3633 people with a mean (SD) age of 55 (19) years, (range: 14-96 years). Women made up 61.7%, and 65% were seeking medical attention. Twenty-three per cent were current smokers (mean age 41.8 [15.2] years), 17.2% ex-smokers (60.6 [16.2] years), and 59.8% never smokers (58.4 [18.8] years). The stages of change were pre-contemplation for 32.1%, contemplation for 4.9%, chronic contemplation for 12.2%, preparation to quit for 6.8%, action for 2.3%, maintenance for 15.1%, and termination for 26.7%. According to current recommendations, it seems that between 23.6% and 44.7%, depending on category definitions, needed specific attention concerning tobacco dependence. CONCLUSIONS: Twenty-three per cent of the patients attended by the primary care physician were smokers. More than half did not want to quit smoking and 1 in 10 were prepared to do so. Between 23.6% and 44.7% of the people who came to the primary care center needed specific attention concerning tobacco dependence.