SANI definition of Clinical Remission in Severe Asthma: a Delphi consensus

: Severe Asthma affects about 10% of the asthmatic population, and it is characterized by a low lung function and a higher count of blood leucocytes, mainly eosinophils. To date, various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. The aim of this work is to highlight a consensus for asthma remission using a Delphi method. In the context of SANI (Severe Asthma Network Italy), accounting for 57 Severe Asthma Centers and more then 2200 patients, a Board of six expert drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. 32 statements have been included in the R1 questionnaire, and then submitted to a panel of 80 experts, which used a 5-points Likert scale to measure their agreement to each statement. Then, an Interim Analysis of R1 data have been performed, items were discussed and considered to produce a consistent questionnaire for the round 2 (R2) of the analysis. After this, the Board set the R2 questionnaire, which included only the important key topics. Panelists have been asked to vote the statements in the R2 questionnaire afterwards. During R2, the criteria of complete clinical remission (the absence of need for OCS, symptoms, exacerbations/attacks, and a pulmonary function stability) and those of partial clinical remission (the absence of need for OCS, and 2 out of 3 criteria: the absence of symptoms, exacerbations/attacks, and a pulmonary stability) were confirmed. This SANI Delphi Analysis defined a valuable, independent and easy to use tool to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

<p>Abstract</p> <p>Background</p> <p>The Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.</p> <p>Methods</p> <p>Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis.</p> <p>Results</p> <p>The studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2).</p> <p>Conclusions</p> <p>FSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.</p

Retrospective monitoring in the management of persistent asthma

BACKGROUND: There is still considerable disagreement on several aspects of monitoring asthma with symptom score and peak expiratory flow (PEF). OBJECTIVE: To investigate patient adherence to a retrospective diary-card monitoring method in patients with poorly controlled persistent asthma, in a clinical management setting; to develop improved methods for fast manual entry data into a computer; and to generate real-time informative graphs of the data. METHODS: In 115 consecutive adult patients we applied a diary-card monitoring method in which the patient records symptom score and PEF. We analyzed the diary cards of 84 patients. We used SigmaPlot software to graph the data, and linear regression to analyze the relationship between days of expected diary-card completion and days of actual correct diary-card completion (completed entries). RESULTS: Linear regression gave an overall correlation coefficient (r2) of 0.65. Surprisingly, the r2 values in the patients with mild, moderate, and severe asthma were 0.24, 0.44, and 0.99, respectively, revealing a striking correlation between adherence and severity. Moreover, when we arbitrarily set 75% as the minimum acceptable rate of days of completed diary-card entries, 68% of the patients were in the over-75% category. Remarkably, 100% of the patients with severe asthma were above the 75% cut-off. The graphing method we tested proved user-friendly, flexible, and quick, allowing computerized processing of 30 days of data sets in 5 min, and generation of high-quality selfexplanatory graphs that facilitate rapid management decision making via visual pattern recognition. CONCLUSIONS: In a clinical setting, retrospective monitoring of patients with moderate and severe persistent asthma by symptom score and PEF is feasible, and patient adherence appears to be good, particularly in patients with severe asthma. We recommend a lower priority on retrospective monitoring in patients with mild persistent asthma. Monitoring should be carried out according to a definite follow-up protocol. Improving the quality and standardization of the monitoring graph is a priority. Key words: severe asthma; symptom score; PEF; monitoring; adherence; diary. [Respir Care 2011;56(5):633– 643. © 2011 Daedalus Enterprises