Concepts for the Development of Person-Centered, Digitally Enabled, Artificial Intelligence–Assisted ARIA Care Pathways (ARIA 2024)

Abstract The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own lives based on their lived experiences. Improving healthcare safety, quality, and coordination, as well as quality of life, is an important aim in the care of patients with chronic conditions. Person-centered care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (1) digital care pathways for rhinitis and asthma multimorbidity and (2) digitally enabled, person-centered care.1 It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally enabled, patient-centered care. The paper includes (1) Allergic Rhinitis and its Impact on Asthma (ARIA), a 2-decade journey, (2) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (3) mHealth impact on airway diseases, (4) From guidelines to digital care pathways, (5) Embedding Planetary Health, (6) Novel classification of rhinitis and asthma, (7) Embedding real-life data with population-based studies, (8) The ARIA-EAACI (European Academy of Allergy and Clinical Immunology) strategy for the management of airway diseases using digital biomarkers, (9) Artificial intelligence, (10) The development of digitally enabled, ARIA person-centered care, and (11) The political agenda. The ultimate goal is to propose ARIA 2024 guidelines centered around the patient to make them more applicable and sustainable.info:eu-repo/semantics/publishedVersio

Concepts for the Development of Person-Centered, Digitally Enabled, Artificial Intelligence–Assisted ARIA Care Pathways (ARIA 2024)

Funding Information: This work has received funding from ARIA (Allergic Rhinitis and its Impact of Asthma); CATALYSE (Climate Action To Advance HeaLthY Societies in Europe), the European Union\u2019s Horizon Europe research and innovation program under grant agreement no. 101057131; FRAUNHOFER Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany; University of Porto, Portugal; and MASK-air, which has been supported by EU grants (Impact of air Pollution on Asthma and Rhinitis [POLLAR] project of the European Institute of Innovation and Technology Health; Structural and Development Funds, R\u00E9gion Languedoc Roussillon and Provence-Alpes-C\u00F4te d\u2019Azur; Twinning, European Innovation Partnership on Active and Healthy Ageing, DG Sant\u00E9 and DG Connect); educational grants from Mylan-Viatris, Allergologisk Laboratorium K\u00F8benhavn, GlaxoSmithKline, Novartis, Stallerg\u00E8nes-Greer, and Noucor; and funding from Breathing Together Onlus Association (Associazione Respiriamo Insieme Onlus), Italy; Esp\u00EDritu Santo University, Samborond\u00F3n, Ecuador; Finnish Anti-Tuberculosis Association Foundation and Tampere Tuberculosis Foundation; GA 2 LEN; German Allergy Society AeDA (\u00C4rzteverband Deutscher Allergologen); IPOKRaTES (International Postgraduate Organization for Knowledge transfer, Research and Teaching Excellent Students) Lithuania Fund; Polish Society of Allergology (POLSKIE TOWARZYSTWO ALLERGOLOGICZNE); and University of Li\u00E8ge, Belgium. Funding Information: Conflicts of interest: J. Bousquet reports personal fees from Cipla, Menarini, Mylan, Novartis, Purina, Sanofi-Aventis, Teva, Noucor, other from KYomed-Innov, and other from Mask-air-SAS, outside the submitted work. M. Blaiss reports personal fees from Sanofi, personal fees from Regeneron, personal fees from ALK, personal fees from Merck, personal fees from AstraZeneca, personal fees from GSK, personal fees from Prollergy, personal fees from Lanier Biotherapeutics, and nonfinancial support from Bryn Phama, outside the submitted work. J. Lity\u0144ska reports personal fees from Evidence Prime Sp. z o.o., outside the submitted work. T. Iinuma reports grants from Sanofi, outside the submitted work. P. Tantilipikorn reports grants from Abbott, other from GSK, and other from Sanofi Aventis, outside the submitted work. T. Haahtela reports personal fees from Orion Pharma, outside the submitted work. Publisher Copyright: © 2024 The AuthorsThe traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients’ resources and abilities to be experts in their own lives based on their lived experiences. Improving healthcare safety, quality, and coordination, as well as quality of life, is an important aim in the care of patients with chronic conditions. Person-centered care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (1) digital care pathways for rhinitis and asthma multimorbidity and (2) digitally enabled, person-centered care.1 It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally enabled, patient-centered care. The paper includes (1) Allergic Rhinitis and its Impact on Asthma (ARIA), a 2-decade journey, (2) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (3) mHealth impact on airway diseases, (4) From guidelines to digital care pathways, (5) Embedding Planetary Health, (6) Novel classification of rhinitis and asthma, (7) Embedding real-life data with population-based studies, (8) The ARIA-EAACI (European Academy of Allergy and Clinical Immunology) strategy for the management of airway diseases using digital biomarkers, (9) Artificial intelligence, (10) The development of digitally enabled, ARIA person-centered care, and (11) The political agenda. The ultimate goal is to propose ARIA 2024 guidelines centered around the patient to make them more applicable and sustainable.proofinpres

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Message

Greetings!&#x0D; Research develops several virtues: inquisitiveness, attention to detail, patience, critical thinking and a passion for knowledge. Research should also be relevant and timely. During the past few months, much more than at any period in our lifetime, there has been an explosion of studies, reviews, editorials, and other manuscripts released online or published in peer reviewed journals. Some have been released to the media prior to the actual publication of the complete research. The COVID-19 pandemic has spurred bogus, pseudo and ground-breaking research. But more than anything, the pandemic has motivated everyone to ask questions and to pay more attention to Science.&#x0D; The Philippine Society of Otolaryngology-Head and Neck Surgery is committed to support all activities related to research. It hosts workshops on medical writing and sponsors the annual interesting case, descriptive, analytical and surgical technique-instrument innovation contests. Its journal, thanks to the indefatigable Editor-in-Chief Dr. Lapeña, publishes papers that contribute to the promotion and enhancement of the practice of otolaryngology. The Society is also grateful to all the contributors, board of editors and peer reviewers who contribute to the journal’s success. We look forward to working again with all of you in the upcoming issues.&#x0D; Good reading to all!</jats:p

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Greetings!&#x0D; This year marks the 64th year of the Philippine Society of Otolaryngology-Head and Neck Surgery. It is a defining year, marked by both national and international events that changed and will most likely continue to change medical practice, public health policy, socio-economic concepts and structures. The SARS-coronavirus-2 (COVID-19) pandemic crashed into the first quarter of 2020 unannounced and with great fury. This great unknown served as the impetus for a flurry of research into every aspect of the disease – its origins, biology, clinical course, and treatment. It initiated an unprecedented interest in research, not just among scientists and clinicians, but most especially amongst the general population.&#x0D; But what is RESEARCH? Re-search - to look again at the past with spectacles, to look at the past with new eyes, to look at the present with a microscope, and to look at the far distance with binoculars – all to better see &amp; perhaps to find answers to our questions. Research fuels the evidence base of our understanding of diseases and the principles of our clinical and surgical practice. Our specialty of Otolaryngology, during this time of the pandemic, will be at the forefront of an exciting time for a renewed quest for knowledge. And what better vehicle to transport us into this new and uncharted world than the Philippine Journal of Otolaryngology Head and Neck Surgery? It is a testament to the unparalleled dedication of the editor-in-chief and editorial staff and the enthusiasm of the contributors, that every year the PJOHNS publishes interesting case reports, relevant descriptive and analytical studies, papers on surgical techniques &amp; instrument innovations, and insightful commentaries.&#x0D; The journal is a platform for our questions and hypotheses. The journal is a venue for our discoveries. But most importantly, the journal is a celebration of our passion for Otolaryngology.&#x0D;                 Good reading to all!&#x0D;  &#x0D; Cecilia Gretchen S. Navarro – Locsin, MD&#x0D; President&#x0D; Philippine Society of Otolaryngology – Head and Neck Surgery</jats:p

Double Ectopic Thyroid Gland in a 10-Year-Old Filipino Boy

Objective:                   To present a case of a double ectopic thyroid gland in a 10-year old boy and discuss the pros and cons of the different management options that were available.&#x0D; Methods&#x0D; Design:           Case Report&#x0D; Setting:           Tertiary Hospital in Metro Manila&#x0D; Subject:          One (1)&#x0D; Results:           A 10-year-old boy presented with hoarseness and easy fatigability for 6 years. Rigid endoscopy and CT scan showed an infraglottic mass originating from the anterior tracheal wall causing obstruction. Biopsy revealed thyroid tissue with atypia. Thyroid scintigraphy showed uptake in the submental and midline anterior neck. Thyroid hormone levels were consistent with hypothyroidism. Levothyroxine returned hormone levels to normal and resulted in complete regression of the mass with no symptoms of dyspnea, stridor or bleeding.&#x0D; Conclusion:    The management of ectopic thyroid presents a challenge as there are no guidelines for optimal treatment. Thyroid hormone insufficiency is a frequent occurrence, and emphasis must be given to its monitoring. Surgery in a critical airway lesion such as this may be reserved for cases where the patient experiences dyspnea and stridor or lack of response to thyroid hormone treatment.&#x0D; Keywords:  Ectopic thyroid, direct laryngoscopy, thyroid hormone, levothyroxine</jats:p

Left Hemifacial Lymphatic Malformation in a Nine-Year-Old Boy

The diagnosis of lymphatic malformations can present problems with diagnosis and treatment. Non-response to a chosen procedure can magnify the initial problems or create new ones. We present such a case.&#x0D;  &#x0D; CASE REPORT&#x0D;             A 9-year-old boy initially presented with a 3-year history of soft upper eyelid mass with red-violet discoloration after hitting his head on a wooden post. About 2 years before this presentation, progressive enlargement in size of the mass with extension to the left maxillary and left scalp region prompted an ophthalmologic consult, and Magnetic Resonance Imaging (MRI) of the orbit and Magnetic Resonance Angiography (MRA) of intracranial vessels revealed a venous-lymphatic malformation. (Figure 1) He was then referred to our institution for further management.&#x0D;             The patient was noted to have a 4x2 cm reddish vascular mass over the left eyelid with no thrill or bruit and a surrounding 9x9 cm bluish left facial swelling in the periorbital region extending to the maxillary area corresponding to the MRI images. A repeat MRI/MRA showed a prominent branch of the left external carotid artery coursing towards the mass. (Figure 2)&#x0D; An angiogram of the neck for possible coil insertion into the prominent vessel from the external carotid artery was performed by interventional radiology. However, the left common carotid, left external carotid, and left vertebral arteries showed no evidence of high- or low-flow arteriovenous malformation. (Figure 3) This favored a hypovascular, space-occupying lesion consistent with a cystic lymphatic malformation and the boy was referred back to our service for possible surgery.&#x0D; Meanwhile, the mass continuously increased in size and by the time he was seen again in our clinic, the mass measured 15x15x20 cm occupying the left hemifacial area from the midportion of the parietal bone superiorly to the body of the mandible inferiorly, with violaceous skin discoloration and verrucous infraorbital lesions. (Figure 4) The patient was not considered a good candidate for surgical excision due to the size of the mass relative to his body, and initial sclerotherapy was planned to possibly decrease the size of the mass enough for excision of any residuals.&#x0D; Percutaneous Sclerotherapy was performed using a guidewire-catheter replacement technique. An initial drainage of 800mL of non-clotting serosanguinous fluid was followed by infusion of 3% sodium tertradecyl sulfate, followed by 99% ethanol infusion. There was gross decrease in the size of the mass after the procedure. (Figure 5) A pigtail drainage catheter was maintained to continuously drain fluid from the lesion. On the 10th hospital day, the boy had febrile episodes associated with enlargement of the left hemifacial mass. Blood cultures showed no bacterial growth. Culture of the pigtail catheter tip grew Morganella morganii. Amikacin 170mg IV every 8 hours was started but fever was unrelenting. Wound cultures grew Methicillin Resistant Staphylococcus Aureus, and Co-trimoxazole 40mg/200mg per 5ml Pediatric Suspension, 10ml every 12 hours and Metronidazole 200mg/5mL oral suspension, 5mL every 8 hours were initiated.&#x0D; During this month-long post-operative period, the mass continued to expand to its preoperative size. (Figure 6) Due to lack of funds, the antibiotics were given by mouth and the patient was discharged. On 3-month follow up, the mass had grown to even larger than the pre-embolization stage.&#x0D;  &#x0D; DISCUSSION&#x0D;             Lymphatic malformations (LM) are made up of variously dilated lymphatic channels or cysts, lined by endothelial cells with a lymphatic phenotype.1  Histologically, LM is classified into the macrocystic type, consisting of cysts larger than 2 cm with clear boundaries, and the microcystic type consisting of cysts smaller than 2 cm that appear diffuse and sprouted without clear boundaries. The two types coexist in the combined type.2  &#x0D;             A 5-stage clinicoradiologic staging system has been devised by de Serres et al. based on cervical LM laterality and relationship to the hyoid bone predicting operative risk and surgical outcome.3 The higher the clinicoradiologic stage, the greater the potential risk of intraoperative and postoperative complications.  In general, bilateral microcystic suprahyoid LMs are more difficult to treat than infrahyoid LMs, especially when there are microcystic LMs involving the oral cavity, tongue, and/or pharynx. In this case, confirming whether it was a high-flow or a low-flow disease presented a dilemma early on. We relied on the initial MRI/MRA findings of a possible arterial feeding vessel, considering that MRI/MRI is more than 90% accurate in the diagnosis of high-flow vascular anomalies.4 However, during angiography for coil insertion, there were no feeding vessels found and a low-flow disease was considered. Thus, there were further delays in management associated with these procedures.&#x0D;             In our case, the patient had a unilateral suprahyoid LM that has a complication rate of 41% with an average of 1.5 procedures to treat and cure the disease.3 The possible complications that were considered included facial nerve palsy, seroma, exsanguination and most importantly, functional compromise due to the projected large post-operative defect and location of the mass which could affect function of the left eye, feeding problems and long term facial disfigurement.5&#x0D;             Considering these possible complications, we planned to attempt initial sclerotherapy before considering surgery. However, we encountered infection of the pigtail site and wound, and sclerotherapy failed to decrease the size of the mass. At the moment, subjecting the patient to repeat sclerotherapy may have a higher chance of failure.&#x0D;             Noting that the treatment of lymphatic malformation should be directed towards preservation of functional and aesthetic integrity,5 we present our case for consideration.</jats:p

Cost-Effectiveness Analysis of Pneumococcal Vaccination with the Pneumococcal Polysaccharide NTHi Protein D Conjugate Vaccine in the Philippines

AbstractObjectivesTo compare the cost-effectiveness of a universal mass vaccination (UMV) program with a 2 + 1 schedule of a 10-valent pneumococcal polysaccharide nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) against two strategies: 1) a no-vaccination strategy and 2) a pneumococcal 13-valent conjugate vaccine (PCV13) 2 + 1 strategy in the Philippines.MethodsA published Markov cohort model was adapted to simulate the epidemiological and economic burden of pneumococcal diseases (meningitis, bacteremia, pneumonia, and acute otitis media) within a projected birth cohort in 2012 of 1,812,137 newborns over lifetime. Analyses were conducted at an annual discount rate of 5% from the perspective of the Philippine government. The current evaluation was updated with the best available local/regional clinical epidemiological data and published efficacy evidence.ResultsCompared with the no-vaccination strategy, the PHiD-CV 2 + 1 UMV program was projected to prevent 3,343 deaths due to invasive pneumococcal diseases and pneumonia and 326,862 cases of pneumococcal diseases, resulting in an incremental cost-effectiveness ratio of 50,913 pesos/quality-adjusted life-year gained, which was considered to be highly cost-effective according to the threshold recommended by the World Health Organization. In comparison with the PCV13 2 + 1 strategy, the PHiD-CV 2 + 1 strategy was estimated to have a substantial reduction in acute otitis media (127,680 cases) and therefore a cost saving of potential 92.5 million pesos assuming price parity between PHiD-CV and PCV13 (US $1 = 42.13 pesos in 2012).ConclusionsThe PHiD-CV 2 + 1 UMV program is projected to be cost-effective, compared with no vaccination, and would provide substantial savings with higher quality-adjusted life-year gains as compared with the PCV13 2 + 1 strategy in the context of the Philippines