Auscultation of velcro crackles is associated with usual interstitial pneumonia

Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables. We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: "presence" or "nonpresence" of bilateral Velcro crackles. Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern. In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care

Acute exacerbations of idiopathic pulmonary fibrosis: Does clinical stratification or steroid treatment matter?

Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is defined as a sudden acceleration of the disease with the appearance of pulmonary infiltrates superimposed on the characteristic pattern of IPF that leads to a significant decline in lung function. It has high in-hospital mortality rates, despite medical treatment with systematic steroids. We sought to investigate whether there were in-hospital mortality differences according to clinical stratification (AE, suspected AE, or AE of known cause) and/or treatment with systemic steroids. We reviewed the clinical characteristics and outcomes of patients with IPF admitted to our hospital during the years 2003-2014 due to a worsening of their clinical status. We identified 50 IPF patients, 9 with AE (18%), 12 with suspected exacerbation (24%), and 29 with AE of known cause (58%), mostly respiratory infections. In-hospital mortality was similar in the three groups (33% vs. 17% vs. 34%, respectively). Likewise, we did not find differences between them with respect to the use of systemic steroids (length of treatment duration or total dose). Nevertheless, there was an independent association between in-hospital mortality and high average daily steroid dose. We did not observe significant differences in prognosis or use of systemic steroids according to current diagnostic stratification groups in patients hospitalized because of an exacerbation of IPF

Adherencia al tratamiento de pacientes con artritis reumatoidea que reciben medicamentos biológicos

Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR’87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR

Participación laboral en espondiloartritis axial radiográfica y no radiográfica

Introducción: las limitaciones laborales son un punto importante a considerar en el tratamiento de la espondiloartritis axial (EspAax) dado que esta enfermedad afecta a las personas en la etapa más productiva de la vida. Objetivos: describir la situación laboral en pacientes con EspAax de Argentina, incluyendo la espondilitis anquilosante (EA) y la espondiloartritis axial no radiográfica (EspAax-nr), y evaluar los factores asociados a la pérdida de productividad laboral (PPL) en esta cohorte nacional y los factores asociados a estar empleado

Deep learning-based lesion subtyping and prediction of clinical outcomes in COVID-19 pneumonia using chest CT

The main objective of this work is to develop and evaluate an artificial intelligence system based on deep learning capable of automatically identifying, quantifying, and characterizing COVID-19 pneumonia patterns in order to assess disease severity and predict clinical outcomes, and to compare the prediction performance with respect to human reader severity assessment and whole lung radiomics. We propose a deep learning based scheme to automatically segment the different lesion subtypes in nonenhanced CT scans. The automatic lesion quantification was used to predict clinical outcomes. The proposed technique has been independently tested in a multicentric cohort of 103 patients, retrospectively collected between March and July of 2020. Segmentation of lesion subtypes was evaluated using both overlapping (Dice) and distance-based (Hausdorff and average surface) metrics, while the proposed system to predict clinically relevant outcomes was assessed using the area under the curve (AUC). Additionally, other metrics including sensitivity, specificity, positive predictive value and negative predictive value were estimated. 95% confidence intervals were properly calculated. The agreement between the automatic estimate of parenchymal damage (%) and the radiologists' severity scoring was strong, with a Spearman correlation coefficient (R) of 0.83. The automatic quantification of lesion subtypes was able to predict patient mortality, admission to the Intensive Care Units (ICU) and need for mechanical ventilation with an AUC of 0.87, 0.73 and 0.68 respectively. The proposed artificial intelligence system enabled a better prediction of those clinically relevant outcomes when compared to the radiologists' interpretation and to whole lung radiomics. In conclusion, deep learning lesion subtyping in COVID-19 pneumonia from noncontrast chest CT enables quantitative assessment of disease severity and better prediction of clinical outcomes with respect to whole lung radiomics or radiologists' severity score

Asociación entre Artritis Reumatoidea y otras enfermedades autoinmunes

Objetivos: determinar la frecuencia de enfermedades autoinmunes (EAI) en pacientes con Artritis Reumatoidea (AR) y comparar la frecuencia de EAI entre pacientes con AR y sin AR ni otra EAI reumatológica. Material y Métodos: estudio multicéntrico, observacional, analítico, retrospectivo. Se incluyeron pacientes consecutivos con AR (ACR/EULAR 2010) y como grupo control pacientes con diagnóstico inicial de Osteoartritis primaria (OA).

Becoming TED speakers in school: student development through participation in TED-Ed clubs

This case study explores adolescents’ experiences of participating in TED-Ed Clubs in Buenos Aires, Argentina. TED-Ed Clubs is a school-based, extracurricular program in which 12- to 18-year-old youth develop and deliver a “TED-style” talk to their peers, teachers and parents. In particular, we explore changes in participants’ self-development, communication skills and overall school experience. We conducted in-depth interviews with teachers, principals and focus groups of students from 8 representative schools. We find that students struggled considerably to establish what they had to say that was worth sharing with others, and—after a long process of self-reflection—ended up developing talks which were deeply personal in nature. Overcoming the challenge of finding and presenting a topic provided participating adolescents with a sense of accomplishment and pride. In addition, all participants reported changes in relationships with peers and adults, particularly with regards to discovering new sides of themselves and others through listening empathetically. Teachers also reported seeing their students through new lenses as they revealed new sides of themselves which had not been shown in other academic spaces. Overall, we find that the TED-Ed Clubs program appears to create new spaces in schools where adolescents can grow as individuals, and develop their own voice.Fil: Furman, Melina Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de San Andrés. Escuela de Educación; ArgentinaFil: Taylor, Ines. Universidad de San Andrés. Escuela de Educación; ArgentinaFil: Merpert, Ariel. Clubes TED-Ed; ArgentinaFil: Yatche, Tobias Fabián. Clubes TED-Ed; ArgentinaFil: Jacob, Mariana. Clubes TED-Ed; ArgentinaFil: Ottaviano, Melania Liliana. Clubes TED-Ed; ArgentinaFil: Benegas, Celina. Universidad de San Andrés; ArgentinaFil: Luzuriaga, Mariana. Universidad de San Andrés. Escuela de Educación; Argentin

Becoming TED Speakers in School: Student Development Through Participation in TED-Ed Clubs

This case study explores adolescents’ experiences of participating in TED-Ed Clubs in Buenos Aires, Argentina. TED-Ed Clubs is a school-based, extracurricular program in which 12- to 18-year-old youth develop and deliver a “TED-style” talk to their peers, teachers and parents. In particular, we explore changes in participants’ self-development, communication skills and overall school experience. We conducted in-depth interviews with teachers, principals and focus groups of students from 8 representative schools. We find that students struggled considerably to establish what they had to say that was worth sharing with others, and—after a long process of self-reflection—ended up developing talks which were deeply personal in nature. Overcoming the challenge of finding and presenting a topic provided participating adolescents with a sense of accomplishment and pride. In addition, all participants reported changes in relationships with peers and adults, particularly with regards to discovering new sides of themselves and others through listening empathetically. Teachers also reported seeing their students through new lenses as they revealed new sides of themselves which had not been shown in other academic spaces. Overall, we find that the TED-Ed Clubs program appears to create new spaces in schools where adolescents can grow as individuals, and develop their own voice.Fil: Furman, Melina Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de San Andrés. Escuela de Educación; ArgentinaFil: Taylor, Ines. Universidad de San Andrés. Escuela de Educación; ArgentinaFil: Merpert, Ariel. Clubes TED-Ed; ArgentinaFil: Yatche, Tobias Fabián. Clubes TED-Ed; ArgentinaFil: Jacob, Mariana. Clubes TED-Ed; ArgentinaFil: Ottaviano, Melania Liliana. Clubes TED-Ed; ArgentinaFil: Benegas, Celina. Universidad de San Andrés; ArgentinaFil: Luzuriaga, Mariana. Universidad de San Andrés. Escuela de Educación; Argentin

A pilot study to evaluate early predictive value of thorax perfusion-CT in advanced NSCLC

Background: The role of perfusion computed tomography (pCT) in detecting changes in tumor vascularization as part of a response to antiangiogenic therapy in non-small cell lung cancer (NSCLC) remains unclear. Methods: In this prospective pilot study (IMPACT trial, NCT02316327), we aimed to determine the ability of pCT to detect early changes in blood flow (BF), blood volume (BV), and permeability (PMB), and to explore whether these changes could predict the response at day +42 in patients with advanced, treatment-naive, non-squamous NSCLC treated with cisplatin and gemcitabine plus bevacizumab. Results: All of the perfusion parameters showed a consistent decrease during the course of treatment. The BV difference between baseline and early assessment was significant (p = 0.013), whereas all perfusion parameters showed significant differences between baseline and day +42 (p = 0.003, p = 0.049, and p = 0.002, respectively). Among the 16 patients evaluable for efficacy, a significant decline in BV at day +7 from baseline was observed in tumors with no response (p = 0.0418). Conclusions: Our results confirm that pCT can capture early changes in tumor vasculature. A substantial early decline of BV from baseline might identify tumors less likely responsive to antiangiogenic-drugs.This research was funded by F. Hoffmann-La Roche Ltd. (Basel, Switzerland