Browsing by Author "Nino, Gustavo"

Now showing 1 - 6 of 6
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    Bedside clinical assessment predicts recurrence after hospitalization due to viral lower respiratory tract infection in young children
    (BMJ PUBLISHING GROUP, 2020) Arroyo, Maria; Salka, Kyle P.; Perez, Geovanny F.; Rodriguez Martinez, Carlos E.; Castro Rodriguez, Jose A.; Nino, Gustavo
    -Infants requiring hospitalization due to a viral lower respiratory tract infection (LRTI) have a high risk of developing recurrent respiratory illnesses in early life and asthma beyond childhood. Notably, all validated clinical scales for viral LRTI have focused on predicting acute severity instead of recurrence. We present a novel clinical approach combining individual risk factors with bedside clinical parameters to predict recurrence after viral LRTI hospitalization in young children. A retrospective longitudinal cohort of young children (<= 3 years) designed to define clinical predictive factors of recurrent respiratory illnesses within 12 months after hospitalization due to PCR-confirmed viral LRTI. Data collection was through electronic medical record. We included 138 children hospitalized with viral LRTI. Using automatic stepwise logistic model selection, we found that the strongest predictors of recurrence in infants hospitalized for the first time were severe prematurity (<= 32 weeks' gestational age, OR=5.19; 95% CI 1.76 to 15.32; p=0.002) and a clinical score that weighted hypoxemia, subcostal retractions and wheezing (OR=3.33; 95% CI 1.59 to 6.98; p<0.001). After the first hospitalization, the strongest predictors of subsequent episodes were wheezing (OR=5.62; 95% CI 1.03 to 30.62; p=0.04) and family history of asthma (OR=5.39; 95% CI 1.04 to 27.96; p=0.04). We found that integrating individual risk factors (eg, prematurity or family history of asthma) with bedside clinical assessment (eg, wheezing, subcostal retractions or hypoxemia) can predict the risk of recurrence after viral LRTI hospitalization in infants. This strategy may enable clinically oriented subsetting of infants with viral LRTI based on individual predictors for recurrent respiratory illnesses during early life.
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    Cost-effectiveness analysis of phenotypic-guided versus guidelines-guided bronchodilator therapy in viral bronchiolitis
    (2021) Rodriguez Martinez, Carlos E.; Nino, Gustavo; Castro Rodríguez, José Antonio; Pérez, Geovanny F.; Sossa Briceño, Mónica P.; Buendia, Jefferson A.
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    Cost-effectiveness analysis of phenotypic-guided vs. guidelines-guided bronchodilator therapy in viral bronchiolitis (Preprint)
    (2020) Rodriguez Martinez, Carlos ; Nino, Gustavo ; Castro Rodriguez, Jose ; Perez, Geovanny F. ; Sossa-Briceño, Monica ; Buendia, Jefferson
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    Cost-utility analysis of daily versus intermittent inhaled corticosteroids in mild-persistent asthma
    (2015) Rodriguez-Martinez, Carlos E.; Nino, Gustavo; Castro Rodríguez, José Antonio
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    For which infants with viral bronchiolitis could it be deemed appropriate to use albuterol, at least on a therapeutic trial basis?
    (2021) Rodríguez Martínez, Carlos E.; Nino, Gustavo; Castro-Rodriguez, José A.; Acuña-Cordero, Ranniery; Sossa-Briceño, Mónica P.; Midulla, Fabio
    Although there is increasing evidence showing that infants with viral bronchiolitis exhibit a high degree of heterogeneity, a core uncertainty shared by many clinicians is with regard to understanding which patients are most likely to benefit from bronchodilators such as albuterol. Based on our review, we concluded that older infants with rhinovirus (RV) bronchiolitis, especially those with a nasopharyngeal microbiome dominated by Haemophilus influenzae; those affected during nonpeak months or during non-respiratory syncytial virus (RSV) predominant months; those with wheezing at presentation; those with clinical characteristics such as atopic dermatitis or a family history of asthma in a first-degree relative; and those infants infected with RSV genotypes ON1 and BA, have the greatest likelihood of benefiting from albuterol. Presently, this patient profile could serve as the basis for rational albuterol administration in patients with viral bronchiolitis, at least on a therapeutic trial basis, and it could also be the starting point for future targeted randomized clinical trials (RCTs) on the use of albuterol among a subset of infants with bronchiolitis.
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    The use of β2-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines
    (2020) Nino, Gustavo; Rodríguez-Martínez, Carlos E.; Castro Rodríguez, José Antonio
    Despite scientific evidence proving that inhaled β2-adrenergic receptor (β2-AR) agonists can reverse bronchoconstriction in all ages, current guidelines advocate against the use of β2-AR bronchodilators in infants with viral bronchiolitis because clinical trials have not demonstrated an overall clinical benefit. However, there are many different types of viral bronchiolitis, with variations occurring at an individual and viral level. To discard a potentially helpful treatment from all children regardless of their clinical features may be unwarranted. Unfortunately, the clinical criteria to identify the infants that may benefit from bronchodilators from those who do not are not clear. Thus, we summarised the current understanding of the individual factors that may help clinicians determine the highest probability of response to β2-AR bronchodilators during viral bronchiolitis, based on the individual immunobiology, viral pathogen, host factors and clinical presentation.