Browsing by Author "Castro Rodríguez, José Antonio"

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    A cluster randomized trial of interferon ß-1a for the reduction of transmission of SARS-Cov-2: protocol for the Containing Coronavirus Disease 19 trial (ConCorD-19)
    (2021) Iturriaga, Carolina; Eiffler, Nat; Aniba, Rad; Pérez Mateluna, Guillermo; Meyer, Jessica K. V.; Severino Cuevas, Nicolás Felipe; Borzutzky Schachter, Arturo; Perret Pérez, Cecilia; Castro Rodríguez, José Antonio; García-Huidobro Munita, Diego Nicolás; Iturriaga, Carolina; Eiffler, Nat; Aniba, Rad; Pérez Mateluna, Guillermo; Meyer, Jessica K. V.; Severino Cuevas, Nicolás Felipe; Borzutzky Schachter, Arturo; Perret Pérez, Cecilia; Castro Rodríguez, José Antonio; García-Huidobro Munita, Diego Nicolás; Iturriaga, Carolina; Eiffler, Nat; Aniba, Rad; Pérez Mateluna, Guillermo; Meyer, Jessica K. V.; Severino Cuevas, Nicolás Felipe; Borzutzky Schachter, Arturo; Perret Pérez, Cecilia; Castro Rodríguez, José Antonio; García-Huidobro Munita, Diego Nicolás; Iturriaga, Carolina; Eiffler, Nat; Aniba, Rad; Pérez Mateluna, Guillermo; Meyer, Jessica K. V.; Severino Cuevas, Nicolás Felipe; Borzutzky Schachter, Arturo; Perret Pérez, Cecilia; Castro Rodríguez, José Antonio; García-Huidobro Munita, Diego Nicolás
    Abstract Background SARS-CoV-2 infection rapidly spreads in populations due to the high rates of community transmission. Interrupting the shedding of SARS-CoV-2 may reduce the incidence of Coronavirus Disease 19 (COVID-19). Herein we provide a protocol for a cluster randomized trial that will examine the effectiveness of treatment with interferon (IFN) ß-1a compared to standard of care in limiting the transmission of SARS-CoV-2. Co-primary objectives are to determine whether IFN therapy reduces (a) the proportion of infected cases shedding SARS-CoV-2 at day 11 post randomization and (b) the incidence of transmission of SARS-CoV-2 infection from index cases to treatment-eligible household post-exposure contacts at day 11 after randomization. Secondary objectives include assessing the impact of IFN treatment on duration of viral clearance, hospitalizations and fatalities, and evaluating the safety of IFN treatment. Methods Three hundred and ten households, each including an index case with a recent COVID-19 diagnosis and at least one asymptomatic treatment-eligible household contact, will be randomized to receive 3 doses of 125 μg IFN ß-1a by subcutaneous administration (days 1, 6, and 11), or standard of care. All participants will be followed until day 29. Discussion The results from this trial will identify whether IFN ß treatment of mild or moderate COVID-19 cases accelerates viral clearance and prevents disease progression and whether IFN ß treatment of post-exposure contacts of COVID-19 cases reduces transmission of infection. Trial Registration: This trial is registered at ClinicalTrials.gov NCT04552379; date of registration September 17, 2020.
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    A new childhood asthma phenotype: obese with early menarche.
    (2016) Castro Rodríguez, José Antonio
    Three concomitant phenomena occur in the later years of childhood: increases in the incidence ofasthma, obesity and early menarche. This article is an overview of the current epidemiologic, basic,genetic and epigenetic evidence about this relationship. As a consequence we propose that obese girlswho have an early menarche ( 11 years of age) constitute a new asthma phenotype in childhood. Futurestudies need to be carried out in order to find the best control and treatment of this new asthmaphenotype.
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    A systematic review of long-acting β2-agonists versus higher doses of inhaled corticosteroids in asthma
    (2012) Castro Rodríguez, José Antonio; Rodrigo, Gustavo J.
    OBJECTIVE: To compare the efficacy of inhaled corticosteroids (ICS) plus long-acting β2 agonist (LABA) versus higher doses of ICS in children/adolescents with uncontrolled persistent asthma. METHODS: Randomized, prospective, controlled trials published January 1996 to January 2012 with a minimum of 4 weeks of LABA+ICS versus higher doses of ICS were retrieved through Medline, Embase, Central, and manufacturer’s databases. The primary outcome was asthma exacerbations requiring systemic corticosteroids; secondary outcomes were the pulmonary function test (PEF), withdrawals during the treatment period, days without symptoms, use of rescue medication, and adverse events. RESULTS: Nine studies (n = 1641 patients) met criteria for inclusion (7 compared LABA+ICS versus double ICS doses and 2 LABA+ICS versus higher than double ICS doses). There was no statistically significant difference in the number of patients with asthma exacerbations requiring systemic corticosteroids between children receiving LABA+ICS and those receiving higher doses of ICS (odds ratio = 0.76; 95% confidence interval: 0.48–1.22, P = .25, I2 = 16%). In the subgroup analysis, patients receiving LABA+ICS showed a decreased risk of asthma exacerbations compared with higher than twice ICS doses (odds ratio = 0.48; 95% confidence interval: 0.28–0.82, P = .007, I2= 0). Children treated with LABA+ICS had significantly higher PEF, less use of rescue medication, and higher short-term growth than those on higher ICS doses. There were no other significant differences in adverse events. CONCLUSIONS: There were no statistically significant group differences between ICS+LABA and double doses of ICS in reducing the incidence of asthma exacerbations but it did decrease the risk comparing to higher than double doses of ICS.
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    Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta‐analysis
    (2020) Castro Rodríguez, José Antonio; Pincheira, Mauricio A.; Escobar‐Serna, Diana P.; Sossa‐Briceño, Monica P.; Rodriguez‐Martinez, Carlos E.
    International guidelines have recommended the use of inhaled beta-2 agonists and systemic corticosteroids (SCs) as the first-line treatment for acute asthma.
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    Advantage of inhaled corticosteroids as additional therapy to systemic corticosteroids for pediatric acute asthma exacerbations: a cost-effectiveness analysis
    (2020) Carlos E. Rodriguez-Martinez; Monica P. Sossa-Briceño; Castro Rodríguez, José Antonio
    Objective: Although the efficacy of systemic corticosteroids (SCs) in acute asthma exacerbations is well established, the fact that many children still require admission to hospital and that SCs have a slow onset of action are cause of concern. For this reason, the use of inhaled corticosteroids (ICS) as a therapy added to SCs has been explored, with no clarity about its cost-effectiveness. The aim of the present study was to evaluate the cost-effectiveness of ICS in addition to SCs (ICS + SCs) compared to standard therapy with SCs for treating pediatric asthma exacerbations. Methods: A decision-analysis model was developed to estimate the cost-effectiveness of SCs compared to ICS + SCs for treating pediatric patients with acute asthma exacerbations. Effectiveness parameters were obtained from a systematic review of the literature. Cost data obtained from hospital bills and from the national manual of drug prices. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome of the model was avoidance of hospital admission. Results: For the base-case analysis, the model showed that compared to SCs, therapy with ICS + SCs was associated with lower total costs (US$88.76 vs.US$97.71 average cost per patient) and a lower probability of hospital admission (0.9060 vs. 0.9000), thus showing dominance. Conclusions: This study shows that compared with standard therapy with SCs, ICS + SCs for treating pediatric patients with acute asthma exacerbations is the preferred strategy because it was associated with a lower probability of hospital admission, at lower total treatment costs.
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    Airway tone dysfunction among pre-schoolers with positive asthma predictive index: A case-control study
    (2017) Lezana, V.; Gajardo, A.; Bofill, L.; Gutiérrez, M.; Mora, S.; Castro Rodríguez, José Antonio
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    Another Predictive Score for Childhood Asthma: The Search Remains
    (2014) Castro Rodríguez, José Antonio
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    Asthma and COVID‐19 in children: A systematic review and call for data
    (2020) Castro Rodríguez, José Antonio; Forno, Erick
    Whether asthma constitutes a risk factor for coronavirus disease-2019 (COVID-19) is unclear. Here, we aimed to assess whether asthma, the most common chronic disease in children, is associated with higher COVID-19 risk or severity in pediatric populations.
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    Asthma in Latin America
    (2015) Forno, E.; Gogna, M.; Cepeda, A.; Yanez, A.; Sole, D.; Cooper, P.; Avila, L.; Soto, M.; Castro Rodríguez, José Antonio; Celedon, J.
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    Automated chart review utilizing natural language processing algorithm for asthma predictive index
    (2018) Kaur, Harsheen; Sohn, Sunghwan; Wi, Chung-Il; Ryu, Euijung; Park, Miguel A.; Bachman, Kay; Kita, Hirohito; Croghan, Ivana; Castro Rodríguez, José Antonio; Voge, Gretchen A.
    Abstract Background Thus far, no algorithms have been developed to automatically extract patients who meet Asthma Predictive Index (API) criteria from the Electronic health records (EHR) yet. Our objective is to develop and validate a natural language processing (NLP) algorithm to identify patients that meet API criteria. Methods This is a cross-sectional study nested in a birth cohort study in Olmsted County, MN. Asthma status ascertained by manual chart review based on API criteria served as gold standard. NLP-API was developed on a training cohort (n = 87) and validated on a test cohort (n = 427). Criterion validity was measured by sensitivity, specificity, positive predictive value and negative predictive value of the NLP algorithm against manual chart review for asthma status. Construct validity was determined by associations of asthma status defined by NLP-API with known risk factors for asthma. Results Among the eligible 427 subjects of the test cohort, 48% were males and 74% were White. Median age was 5.3 years (interquartile range 3.6–6.8). 35 (8%) had a history of asthma by NLP-API vs. 36 (8%) by abstractor with 31 by both approaches. NLP-API predicted asthma status with sensitivity 86%, specificity 98%, positive predictive value 88%, negative predictive value 98%. Asthma status by both NLP and manual chart review were significantly associated with the known asthma risk factors, such as history of allergic rhinitis, eczema, family history of asthma, and maternal history of smoking during pregnancy (p value < 0.05). Maternal smoking [odds ratio: 4.4, 95% confidence interval 1.8–10.7] was associated with asthma status determined by NLP-API and abstractor, and the effect sizes were similar between the reviews with 4.4 vs 4.2 respectively. Conclusion NLP-API was able to ascertain asthma status in children mining from EHR and has a potential to enhance asthma care and research through population management and large-scale studies when identifying children who meet API criteria.Abstract Background Thus far, no algorithms have been developed to automatically extract patients who meet Asthma Predictive Index (API) criteria from the Electronic health records (EHR) yet. Our objective is to develop and validate a natural language processing (NLP) algorithm to identify patients that meet API criteria. Methods This is a cross-sectional study nested in a birth cohort study in Olmsted County, MN. Asthma status ascertained by manual chart review based on API criteria served as gold standard. NLP-API was developed on a training cohort (n = 87) and validated on a test cohort (n = 427). Criterion validity was measured by sensitivity, specificity, positive predictive value and negative predictive value of the NLP algorithm against manual chart review for asthma status. Construct validity was determined by associations of asthma status defined by NLP-API with known risk factors for asthma. Results Among the eligible 427 subjects of the test cohort, 48% were males and 74% were White. Median age was 5.3 years (interquartile range 3.6–6.8). 35 (8%) had a history of asthma by NLP-API vs. 36 (8%) by abstractor with 31 by both approaches. NLP-API predicted asthma status with sensitivity 86%, specificity 98%, positive predictive value 88%, negative predictive value 98%. Asthma status by both NLP and manual chart review were significantly associated with the known asthma risk factors, such as history of allergic rhinitis, eczema, family history of asthma, and maternal history of smoking during pregnancy (p value < 0.05). Maternal smoking [odds ratio: 4.4, 95% confidence interval 1.8–10.7] was associated with asthma status determined by NLP-API and abstractor, and the effect sizes were similar between the reviews with 4.4 vs 4.2 respectively. Conclusion NLP-API was able to ascertain asthma status in children mining from EHR and has a potential to enhance asthma care and research through population management and large-scale studies when identifying children who meet API criteria.Abstract Background Thus far, no algorithms have been developed to automatically extract patients who meet Asthma Predictive Index (API) criteria from the Electronic health records (EHR) yet. Our objective is to develop and validate a natural language processing (NLP) algorithm to identify patients that meet API criteria. Methods This is a cross-sectional study nested in a birth cohort study in Olmsted County, MN. Asthma status ascertained by manual chart review based on API criteria served as gold standard. NLP-API was developed on a training cohort (n = 87) and validated on a test cohort (n = 427). Criterion validity was measured by sensitivity, specificity, positive predictive value and negative predictive value of the NLP algorithm against manual chart review for asthma status. Construct validity was determined by associations of asthma status defined by NLP-API with known risk factors for asthma. Results Among the eligible 427 subjects of the test cohort, 48% were males and 74% were White. Median age was 5.3 years (interquartile range 3.6–6.8). 35 (8%) had a history of asthma by NLP-API vs. 36 (8%) by abstractor with 31 by both approaches. NLP-API predicted asthma status with sensitivity 86%, specificity 98%, positive predictive value 88%, negative predictive value 98%. Asthma status by both NLP and manual chart review were significantly associated with the known asthma risk factors, such as history of allergic rhinitis, eczema, family history of asthma, and maternal history of smoking during pregnancy (p value < 0.05). Maternal smoking [odds ratio: 4.4, 95% confidence interval 1.8–10.7] was associated with asthma status determined by NLP-API and abstractor, and the effect sizes were similar between the reviews with 4.4 vs 4.2 respectively. Conclusion NLP-API was able to ascertain asthma status in children mining from EHR and has a potential to enhance asthma care and research through population management and large-scale studies when identifying children who meet API criteria.
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    Bronchial Hyperreactivity to Methacholine in Atopic Versus Nonatopic Asthmatic Schoolchildren and Preschoolers
    (2010) Castro Rodríguez, José Antonio; Navarrete Contreras, Pamela; Holmgren Palmen, Nils Linus Anders; Sánchez Díaz, Ignacio; Caussade Larraín, Marie Solange
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    Caregiver's depressive symptoms and asthma control in children from an underserved community
    (2017) Rioseco Castillo, Andrea; Serrano Honeyman, Carolina; Celedón, Juan C.; Padilla Pérez, Oslando; Puschel Illanes, Klaus; Castro Rodríguez, José Antonio
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    Challenges of COVID-19 in children in low-and middle-income countries
    (2020) Heather, Zar; Dawa, J.; Fischer, G. B.; Castro Rodríguez, José Antonio
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    Children under 12 months could benefit from a therapeutic trial with bronchodilators if the clinical response is positive
    (2015) Rodríguez-Martínez, Carlos E.; Castro Rodríguez, José Antonio
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    Clinical, functional, and epidemiological differences between atopic and nonatopic asthmatic children from a tertiary care hospital in a developing country
    (2007) Castro Rodríguez, José Antonio; Ramírez, Ana M.; Toche, Paola; Pavón, Dolores; Pérez, María A.; Girardi, Guido B.; García-Marcos, Luis
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    Comparison of the bronchodilating effects of albuterol delivered by valved vs. non-valved spacers in pediatric asthma
    (2012) Rodriguez-Martinez, Carlos E.; Sossa-Briceño, Monica P.; Castro Rodríguez, José Antonio
    Introduction: Inhaled therapy using a metered-dose inhaler (MDI) with attachedvalved holding chamber has been increasingly recognized as the optimal method fordelivering bronchodilators for asthma treatment. However, mainly due to the highcost of these valved holding chambers in many developing countries, the use of non-valved spacers is frequent, despite the scarce evidence that supports their efficacy. Theaim of this study was to compare the bronchodilator response to albuteroladministered by MDI with and without a valved spacer.Methods: In a randomized, two-period, two-sequence crossover clinical trial, weanalyzed 31 stable asthmatic children (6–18 yrs of age) on two consecutive days, whowere randomly assigned to receive 100 lg of albuterol MDI through either a locallyproduced valved spacer or a non-valved spacer. The next day, a crossover treatmentwas employed through the use of the other spacer. Spirometry was recorded beforeand after each albuterol administration.Results: As we were not able to identify any sequence or carryover effect, we tested fortreatment effects in both periods. No significant differences in the absolute change inFEV1(0.20 ± 0.17 vs. 0.18 ± 0.16, p = 0.63), FVC (0.07 ± 0.13 vs. 0.07 ± 0.16,p = 0.88), or MMEF (0.49 ± 0.31 vs. 0.43 ± 0.39, p = 0.53) after bronchodilatoradministration were found between the use of valved and non-valved spacers.Conclusions: In stable asthmatic children, albuterol administered through MDI usinga non-valved spacer produces a bronchodilator response similar to that of a spacerwith a valve that requires an inhalatory opening pressure (with flows between 2 and32 l/min) that even toddlers with bronchial obstruction can easily generate.
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    Comparison of three combined pharmacological approaches with tiotropium monotherapy in stable moderate to severe COPD: A systematic review
    (2012) Rodrigo, Gustavo J.; Plaza, Vicente; Castro Rodríguez, José Antonio
    Background: Guidelines recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICS) and their combinations for maintenance treatment of moderate to severe COPD. However, there are limited data supporting combination therapy. Methods: This systematic review assessed the efficacy of three therapeutic approaches: tiotropium plus long-acting beta2-agonist (LABA) (“dual” therapy), LABA/ICS (“combined” therapy), and tiotropium plus LABA/ICS (“triple” therapy), all compared with tiotropium monotherapy. Randomized controlled trials were identified after a search of different databases of published and unpublished trials. Results: Twenty trials (6803 participants) were included. “Dual” therapy showed significant improvements in forced volume in the first second (FEV1), health-related quality of life (HRQoL), and dyspnea. However, it failed to reduce the risk of COPD exacerbations. Compared with tiotropium, “combined” therapy presented modest but significant effects on FEV1, HRQoL, and dyspnea. Again, there was no significant difference in exacerbations, but it was associated with a significant increase of serious adverse effects (SAE) (number need to treat for harm [NNTH] ¼ 20; 95% CI: 11e119). Finally, “triple therapy” increased FEV1, improved HRQoL (both benefits exceeded minimal important differences) and decrease COPD exacerbations in anon-significant way. (Odds ratio [OR] ¼ 0.57; 95% CI: 0.24 to 1.37, p ¼ 0.21). Conclusions: “Dual” and “triple” therapy seem like the most promising for patients with moderate to very severe COPD. However, data are still scarce and studies too short to generate a strong recommendation. Future studies should examine long-term efficacy and safety.