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Background The efficacy of mepolizumab is well documented in severe eosinophilic asthma (SEA), although the stringent selection criteria adopted by SEA clinical trials limits the generalizability of results. Objective Our study evaluated the effectiveness and safety of mepolizumab in patients with SEA in Spain. The primary efficacy endpoint was the change in the rate of clinically significant asthma exacerbations 12 months after starting mepolizumab compared to the baseline rate in the 12 months prior to treatment. Patients were stratified by baseline blood eosinophil counts. Methods We conducted a multicentric observational cohort study of SEA patients treated with mepolizumab across 24 specialized hospital asthma units in Spain. Severe exacerbation rate, lung function, oral corticosteroid use (OCS) and asthma control test (ACT) were retrospectively collected and compared during the 12-month pre- and post-mepolizumab treatment. Adverse events were also investigated. Results A total of 318 patients with SEA were included (mean age: 56.6 years, 69.2% female). Exacerbation rates decreased by 77.5%, and 50.6% of patients did not suffer any exacerbations during the 12 months of treatment. The difference in forced expiratory volume in 1 s (FEV1) pre- and post-bronchodilator after starting mepolizumab was 0.21 (0.46) L (95% CI 0.14–0.27) (p < 0.001). Exacerbations and lung function significantly improved across all eosinophil subgroups. Among the 98 patients on OCS, 47.8% were able to discontinue this treatment and the mean daily dose was decreased by 59.9%. The baseline ACT score was 14.1, increasing by a mean (SD) of 6.7 points (1.9) at 12 months. Adverse events related to mepolizumab were uncommon. Conclusions This real-world study of SEA patients confirms that mepolizumab is effective in reducing clinically meaningful exacerbations, improving lung function, and decreasing OCS dependence and mean OCS dose at 12 months, irrespective of baseline eosinophil counts. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-021-01597-9.

The efficacy of mepolizumab is well documented in severe eosinophilic asthma (SEA), although the stringent selection criteria adopted by SEA clinical trials limits the generalizability of results.Our study evaluated the effectiveness and safety of mepolizumab in patients with SEA in Spain. The primary efficacy endpoint was the change in the rate of clinically significant asthma exacerbations 12 months after starting mepolizumab compared to the baseline rate in the 12 months prior to treatment. Patients were stratified by baseline blood eosinophil counts.We conducted a multicentric observational cohort study of SEA patients treated with mepolizumab across 24 specialized hospital asthma units in Spain. Severe exacerbation rate, lung function, oral corticosteroid use (OCS) and asthma control test (ACT) were retrospectively collected and compared during the 12-month pre- and post-mepolizumab treatment. Adverse events were also investigated.A total of 318 patients with SEA were included (mean age: 56.6 years, 69.2% female). Exacerbation rates decreased by 77.5%, and 50.6% of patients did not suffer any exacerbations during the 12 months of treatment. The difference in forced expiratory volume in 1 s (FEV1) pre- and post-bronchodilator after starting mepolizumab was 0.21 (0.46) L (95% CI 0.14-0.27) (p0.001). Exacerbations and lung function significantly improved across all eosinophil subgroups. Among the 98 patients on OCS, 47.8% were able to discontinue this treatment and the mean daily dose was decreased by 59.9%. The baseline ACT score was 14.1, increasing by a mean (SD) of 6.7 points (1.9) at 12 months. Adverse events related to mepolizumab were uncommon.This real-world study of SEA patients confirms that mepolizumab is effective in reducing clinically meaningful exacerbations, improving lung function, and decreasing OCS dependence and mean OCS dose at 12 months, irrespective of baseline eosinophil counts.

Resumen Todas las actuaciones médicas tienen una curva de aprendizaje, pero el razonamiento clínico se mantiene como un elemento clave en cualquiera de ellas. Los médicos experimentados manejan una gran cantidad de información en cualquier proceso clínico. Para conseguir la máxima eficiencia en la utilización de esta información, los clínicos emplean una serie de estrategias que les permiten combinar datos y sintetizarlos en un número reducido de hipótesis diagnósticas, evaluar los riesgos y los beneficios de realizar nuevos procedimientos diagnósticos y aplicar determinados tratamientos, y formular planes en el manejo del paciente. Uno de los objetivos principales de cualquier docente médico es promover el desarrollo de una forma de razonar experta en sus estudiantes. Sin embargo, enseñar estas habilidades cognitivas no es tarea sencilla porque no existe una teoría completa y ampliamente aceptada acerca de los procesos de razonamiento clínico, e incluso los médicos más experimentados a menudo no son conscientes de los métodos de razonamiento que utilizan para alcanzar un diagnóstico. Desde hace más de cuarenta años se ha investigado en este campo. En este artículo se revisan las bases científicas y las teorías propuestas a lo largo de este período acerca del modo de razonar de los clínicos. También se analiza la evolución de las estructuras del conocimiento y se examinan algunos errores frecuentes en razonamiento diagnóstico. Por último, se proponen algunas recomendaciones prácticas específicas para ayudar a los principiantes a fortalecer sus habilidades de razonamiento diagnóstico. Summary There is a learning curve in almost everything doctors do, but judgment remains a key determinant of the value of any clinical intervention. Expert physicians manage huge amounts of information to ensure the quality of patient care by using a set of efficient reasoning strategies. These strategies allow them to combine and synthesize data into a few diagnostic hypotheses, assess benefits and risks of additional diagnostic procedures and treatments, and articulate plans for patient management. A major goal of the medical educators is to foster the development of expert clinical reasoning in apprentices. However, teaching these cognitive skills is a difficult task because there is no generally accepted inclusive theory of the clinical reasoning process and even the most seasoned clinicians are often unaware of the reasoning methods that lead them to achieve accurate diagnoses. Research in this field has been carried out for over 40 years. In this paper we review the scientific background and theories proposed throughout this time about how clinicians reason. We also analyze the evolution of knowledge structures and examine some common errors in diagnostic reasoning. Finally, we provide several practical and specific recommendations to help learners strengthen their diagnostic reasoning skills.

Programa de doctorado: Avances en Medicina Interna, [ES]Objetivos: Identificar las reactividades cruzadas entre el polen de artemisa (endemismo canario Artemisia canariensis) y alimentos de origen vegetal en el área norte y centro de Gran Canaria, así como analizar las características clínicas de los pacientes alérgicos a mostaza en dicha área. Material y Métodos: Se diseñó un estudio con dos grupos de pacientes, uno de alérgicos al polen de artemisa y otro de alérgicos a mostaza. A todos ellos se les realizó un cuestionario clínico, prick test con alérgenos inhalados y alimentarios, extracción de suero para pruebas de laboratorio, y en algunos de ellos pruebas de provocación oral controlada doble ciego contra placebo (POCDCCP) con mostaza.

Programa de doctorado Avances en Medicina Interna El asma es un problema de salud mundial que afecta en la actualidad a alrededor de 300 millones de personas de cualquie r edad, sexo, grupo étnico y país. Se caracteriza esta afección por una considerable heterogeneidad, que viene determinada por interacci ones genéticas y ambientales, mecanismos fisiopatológicos, exposicio nes ambientales, comorbilidades, edad, gravedad de la enfermedad de base, accesibilidad a los servicios sanitarios y cuidados recibidos, fact ores psicológicos, respuesta al tratamiento y características de la enfermedad, incluidas las exacerbaciones y la muerte, así como la cronicidad.

Programa de doctorado: Salud pública: Epidemiología, nutrición y planificación [ES]La presente Tesis Doctoral plantea la hipótesis de que la variabilidad genética de las proteínas surfactantes A y D (SP-A y SP-D) pueden influir en la susceptibilidad y pronóstico de diversas enfermedades pulmonares. Esas variantes podrían utilizarse como marcadores para identificar a los subgrupos de individuos con mayor predisposición a desarrollar una de estas enfermedades o a presentar formas más graves de la enfermedad. Las proteínas SP-A y SP-D, además de ser cruciales para permitir el intercambio gaseoso alveolar, son componentes del sistema inmunitario innato e intervienen en la primera línea de defensa del pulmón y en la respuesta pro y antiinflamatoria.