Browsing by Author "Perez, Geovanny F. "

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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 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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    Genes, environment, and developmental timing: New insights from translational approaches to understand early origins of respiratory diseases
    (2021) Gutierrez, Maria J. ; Perez, Geovanny F. ; Gomez, Jose L. ; Rodriguez‐Martinez, Carlos E. ; Castro‐Rodriguez, Jose A. ; Nino, Gustavo
    Over the past decade, "omics" approaches have advanced our understanding of the molecular programming of the airways in humans. Several studies have identified potential molecular mechanisms that contribute to early life epigenetic reprogramming, including DNA methylation, histone modifications, microRNAs, and the homeostasis of the respiratory mucosa (epithelial function and microbiota). Current evidence supports the notion that early infancy is characterized by heightened susceptibility to airway genetic reprogramming in response to the first exposures in life, some of which can have life-long consequences. Here, we summarize and analyze the latest insights from studies that support a novel epigenetic paradigm centered on human maturational and developmental programs including three cardinal elements: genes, environment, and developmental timing. The combination of these factors is likely responsible for the functional trajectory of the respiratory system at the molecular, functional, and clinical levels.