Vitamin D supplementation in primary allergy prevention: Systematic review of randomized and non-randomized studies.

BACKGROUND: To date, a systematic review of the evidence regarding the association between vitamin D and allergic diseases development has not yet been undertaken. OBJECTIVE: To review the efficacy and safety of vitamin D supplementation when compared to no supplementation in pregnant women, breastfeeding women, infants, and children for the prevention of allergies. METHODS: Three databases were searched through January 30, 2016, including randomized (RCT) and nonrandomized studies (NRS). Two reviewers independently extracted data and assessed the certainty in the body of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Among the 1932 articles identified, one RCT and four NRS were eligible. Very low certainty in the body of evidence across examined studies suggests that vitamin D supplementation for pregnant women, breastfeeding women, and infants may not decrease the risk of developing allergic diseases such as atopic dermatitis (in pregnant women), allergic rhinitis (in pregnant women and infants), asthma and/or wheezing (in pregnant women, breastfeeding women, and infants), or food allergies (in pregnant women). We found no studies of primary prevention of allergic diseases in children. CONCLUSION: Limited information is available addressing primary prevention of allergic diseases after vitamin D supplementation, and its potential impact remains uncertain.

Prebiotics for the prevention of allergies: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Prevalence of allergic diseases in infants is approximately 10% reaching 20 to 30% in those with an allergic first-degree relative. Prebiotics are selectively fermented food ingredients that allow specific changes in composition/activity of the gastrointestinal microflora. They modulate immune responses, and their supplementation has been proposed as an intervention to prevent allergies. OBJECTIVE: To assess in pregnant women, breastfeeding mothers, and infants (populations) the effect of supplementing prebiotics (intervention) versus no prebiotics (comparison) on the development of allergic diseases and to inform the World Allergy Organization guidelines. METHODS: We performed a systematic review of studies assessing the effects of prebiotic supplementation with an intention to prevent the development of allergies. RESULTS: Of 446 unique records published until November 2016 in Cochrane, MEDLINE, and EMBASE, 22 studies fulfilled a priori specified criteria. We did not find any studies of prebiotics given to pregnant women or breastfeeding mothers. Prebiotic supplementation in infants, compared to placebo, had the following effects: risk of developing eczema (RR: 0.68, 95% CI: 0.40 to 1.15), wheezing/asthma (RR, 0.37; 95% CI: 0.17 to 0.80), and food allergy (RR: 0.28, 95% CI: 0.08 to 1.00). There was no evidence of an increased risk of any adverse effects (RR: 1.01, 95% CI: 0.92 to 1.10). Prebiotic supplementation had little influence growth rate (MD: 0.92 g per day faster with prebiotics, 95% CI: 0 to 1.84) and the final infant weight (MD: 0.10 kg higher with prebiotics, 95% CI: -0.09 to 0.29). The certainty of these estimates is very low due to risk of bias and imprecision of the results. CONCLUSIONS: Currently available evidence on prebiotic supplementation to reduce the risk of developing allergies is very uncertain.

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2016 revision

BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines. METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

World Allergy Organization-McMaster University Guidelines for allergic disease prevention (GLAD-P): vitamin D

BACKGROUND: The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20-30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic diseases. OBJECTIVE: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations addressing the use of vitamin D in primary prevention of allergic diseases. METHODS: Our WAO guideline panel identified the most relevant clinical questions and performed a systematic review of randomized controlled trials and non-randomized studies (NRS), specifically cohort and case-control studies, of vitamin D supplementation for the prevention of allergic diseases. We also reviewed the evidence about values and preferences, and resource requirements (up to January 2015, with an update on January 30, 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. RESULTS: Having reviewed the currently available evidence, the WAO guideline panel found no support for the hypothesis that vitamin D supplementation reduces the risk of developing allergic diseases in children. The WAO guideline panel suggest not using vitamin D in pregnant women, breastfeeding mothers, or healthy term infants as a means of preventing the development of allergic diseases. This recommendation does not apply to those mothers and infants who have other indications for prophylactic or therapeutic use of vitamin D. The panel's recommendations are conditional and supported by very low certainty evidence. CONCLUSIONS: WAO recommendations about vitamin D supplementation for the prevention of allergic diseases support parents, clinicians and other health care professionals in their decisions whether or not to use vitamin D in preventing allergic diseases in healthy, term infants.(AU)

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): probiotics

BACKGROUND: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. OBJECTIVE: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. METHODS: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. RESULTS: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. CONCLUSIONS: WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.

Early manifestations of autism spectrum disorders. Experience of 393 cases in a paediatric neurology.

INTRODUCTION: Autism spectrum disorders are group of conditions characterised by qualitative impairments in social communication, interaction, and imagination, and by a restricted range of interests and typical repetitive behaviours. Frequently, there is a delay in the age of detection, and therefore in starting multidisciplinary evaluations and interventions, which may result in a poorer prognosis and reduced quality of life for both children and parents. The aim of our study was to describe clinical and epidemiological data including the age of detection and main initial complaints present in children with autism disorders referred to a paediatric neurology centre. PATIENTS AND METHODS: A total of 393 medical records of consecutive cases diagnosed with an autism spectrum disorder were reviewed. RESULTS: Autism was diagnosed in 82.1% of the cases, unspecified pervasive disorder in 9.9%, Asperger syndrome in 4.8%, and Rett syndrome in 3%. Sixty percent of autistic children presented with a language disorder as their main complaint. The average age of detection was 4 years. CONCLUSIONS: Compared with other countries, age of detection is delayed. Primary care-based screening and surveillance are required in order to improve prognosis and quality of life of children with an autism spectrum disorder.

[Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source]. / Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización.

INTRODUCTION: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. PATIENTS AND METHODS: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. RESULTS: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3%) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95% CI: 0.46-0.73) and 0.55 (95% CI: 0.44-0.68) respectively. An ANC>or=10,000/microl had a sensitivity and specificity of 9% (95% CI: 1-21) and 92.5% (95% CI: 86-98) respectively. A WBC>or=15,000/microl had a sensitivity and specificity of 13.6% (95% CI: 1-28) and 85% (95% CI: 77-93) respectively. CRP showed an AUC of 0.71 (95% CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53% [95% CI: 29-76] and specificity of 85% [95% CI: 75-94]). ESR>or=20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95% CI: 0.37-0.7), 38% (95% CI: 16-62) and 75% (95% CI: 65-85) respectively. CONCLUSIONS: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants<90 days old with fever without source of infection.

Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización / Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source

Introducción: El clínico usa con frecuencia la cuenta total de leucocitos en sangre, la velocidad de sedimentación globular (VSG) y la proteína C reactiva (PCR) para tratar de detectar infecciones bacterianas serias (IBS) en lactantes con fiebre sin foco aparente. El objetivo es evaluar los valores diagnósticos de estas pruebas en lactantes con fiebre. Pacientes y métodos: Análisis de pacientes de 0 a 90 días de edad, previamente sanos, evaluados por fiebre sin foco. El desenlace de interés fue la presencia o ausencia de una IBS (uroinfección, bacteriemia, neuroinfección, neumonía, enteritis) y su relación con la cuenta de leucocitos, VSG y PCR. Resultados: Cumplieron criterios de inclusión 103 pacientes. De éstos, 22 (21,3 %) presentaron una IBS, siendo la uroinfección la más común. Los neutrófilos totales y los leucocitos resultaron en valores del área bajo la curva de las características operador receptor (abc-ROC) de 0,6 (intervalo de confianza del 95 % [IC 95 %] : 0,46-0,73) y 0,55 (IC 95 %: 0,44-0,68), respectivamente. La sensibilidad y especificidad de la cuenta de neutrófilos ≥ 10.000/μl fue del 9 % (IC 95 %: 1-21) y del 92,5 % (IC 95 %: 86-98), respectivamente, mientras que la cuenta total de leucocitos ≥ 15.000/μl presentó un 13,6 % (IC 95 %: 1-28) y un 85 % (IC 95 %: 77-93), respectivamente. La PCR presentó el abc-ROC de 0,71 (IC 95 %: 0,55-0,86) con punto de corte a 2 mg/dl (sensibilidad del 53 % [IC 95 %: 29-76] y especificidad del 85 % [IC 95 %: 75-94]), mientras que la VSG ≥ 20 mm/h concluyó con abc-ROC de 0,53 (IC 95 %: 0,37-0,7), sensibilidad del 38 % (IC 95 %: 16-62) y especificidad del 75 % (IC 95 %: 65-85). Conclusiones: Ninguno de estos parámetros, comúnmente usados por los clínicos, alcanza valores diagnósticos aceptables para detectar IBS en niños de 0 a 90 días de edad con fiebre (AU)

Introduction: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. Patients and methods: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. Results: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3 %) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95 % CI: 0.46-0.73) and 0.55 (95 % CI: 0.44-0.68) respectively. An ANC ≥ 10,000/μl had a sensitivity and specificity of 9 % (95 % CI: 1-21) and 92.5 % (95 % CI: 86-98) respectively. A WBC ≥ 15,000/μl had a sensitivity and specificity of 13.6 % (95 % CI: 1-28) and 85 % (95 % CI: 77-93) respectively. CRP showed an AUC of 0.71 (95 % CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53 % [95 % CI: 29-76] and specificity of 85 % [95 % CI: 75-94]). ESR ≥ 20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95 % CI: 0.37-0.7), 38 % (95 % CI: 16-62) and 75 % (95 % CI: 65-85) respectively. Conclusions: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants < 90 days old with fever without source of infection (AU)

Exoftalmos unilateral y lupus eritematoso sistémico / Unilateral exophthalmos and systemic lupus erythematosus

No disponible

[Gastric lavage in healthy term newborns: a randomized controlled trial]. / Lavado gástrico en recién nacidos sanos: un ensayo clínico aleatorio.

INTRODUCTION: Gastric lavage is still used in Mexico and other countries without evidence to support this practice. We performed a randomized controlled trial to test the hypothesis that elimination of amniotic fluid from the stomach of the newborn reduces nausea and vomiting and improves tolerance on the first feedings of breast or formula milk. PATIENTS AND METHODS: A randomized, single-blind, controlled trial was conducted in a rural general hospital in the north of Mexico. Eligible healthy term newborns were randomly allocated to receive gastric lavage (n = 63) or observation (n = 61). The primary outcome measures were the presence of nausea and/or emesis in the first 24 hours of life and the breastfeeding failure rate, evaluated by a nurse blinded to the group assignment. RESULTS: Of the 63 patients in the gastric lavage group, 13 had at least one episode of nausea or vomiting compared with 15 out of 61 patients in the control group (relative risk: 0.84; 95 % CI: 0.43 to 1.61). Breastfeeding failure occurred in seven mother-child pairs in the gastric lavage group compared with five in the control group (P = 0.8; relative risk: 0.96; 95 % CI: 0.86 to 1.08). Other variables such as sex or cesarian section rate were unrelated to outcome. There were no complications that could be attributed to the procedure. All the newborn infants were discharged without problems. CONCLUSIONS: Gastric aspiration or lavage in the healthy full-term newborn is a common procedure that should be abandoned as it confers no advantages.

Lavado gástrico en recién nacidos sanos: un ensayo clínico aleatorio / Gastric lavage in healthy term newborns: a randomized controlled trial

Introducción: El lavado gástrico es un método que aún se utiliza en México y otras regiones del mundo sin una evidencia que lo sustente. Se planeó un ensayo aleatorio controlado para probar la hipótesis de que la aspiración del líquido amniótico del estómago del neonato reduce la náusea y el vómito y que produce un incremento en la tolerancia a la primera toma de leche materna o fórmula. Pacientes y métodos: Ensayo aleatorio simple ciego realizado en un hospital general rural en el norte de México. Los recién nacidos sanos elegibles fueron distribuidos de manera aleatoria para realizarles un lavado gástrico (n = 63) o simple observación (n = 61). Los resultados que había que evaluar fueron el porcentaje de neonatos con vómito/náusea en las primeras 24 h de vida y la tasa de fracaso de amamantamiento. Esto fue evaluado por una enfermera de manera ciega en el grupo al que fue asignado el recién nacido. Resultados: De los 63 pacientes en el grupo de lavado gástrico, 13 presentaron al menos un episodio de náusea o vómito, comparado con 15 de los 61 del grupo control (riesgo relativo [RR]: 0,84; intervalo de confianza [IC] del 95 %: 0,43-1,61). Siete parejas madre-recién nacido en el grupo de lavado gástrico no completaron una alimentación exitosa al seno materno, comparado con cinco en el grupo control (p = 0,8; RR: 0,96; IC 95 %: 0,86-1,08). Otras variables como el sexo del neonato o la tasa de obtención por cesárea no tuvieron efecto sobre el resultado principal. No se comunicaron complicaciones atribuidas al procedimiento. Todos los neonatos fueron dados de alta sin complicaciones. Conclusiones: El lavado o aspirado gástrico en el recién nacido de término y sano es un procedimiento común que debe anularse como práctica diaria en el cunero, ya que no representa ventaja alguna

Introduction: Gastric lavage is still used in Mexico and other countries without evidence to support this practice. We performed a randomized controlled trial to test the hypothesis that elimination of amniotic fluid from the stomach of the newborn reduces nausea and vomiting and improves tolerance on the first feedings of breast or formula milk. Patients and methods: A randomized, single-blind, controlled trial was conducted in a rural general hospital in the north of Mexico. Eligible healthy term newborns were randomly allocated to receive gastric lavage (n = 63) or observation (n = 61). The primary outcome measures were the presence of nausea and/or emesis in the first 24 hours of life and the breastfeeding failure rate, evaluated by a nurse blinded to the group assignment. Results: Of the 63 patients in the gastric lavage group, 13 had at least one episode of nausea or vomiting compared with 15 out of 61 patients in the control group (relative risk: 0.84; 95 % CI: 0.43 to 1.61). Breastfeeding failure occurred in seven mother-child pairs in the gastric lavage group compared with five in the control group (P = 0.8; relative risk: 0.96; 95 % CI: 0.86 to 1.08). Other variables such as sex or cesarian section rate were unrelated to outcome. There were no complications that could be attributed to the procedure. All the newborn infants were discharged without problems. Conclusions: Gastric aspiration or lavage in the healthy full-term newborn is a common procedure that should be abandoned as it confers no advantages

Los criterios de Ottawa para tobillo: valoración en un servicio de urgencias en México / The Ottawa ankle rules: evaluation in a pediatric emergency setting in mexico

Introducción: Las lesiones de tobillo son una causa frecuente de consulta en el departamento de emergencias. El objetivo del presente estudio es valorar el uso de los criterios de Ottawa para tobillo en nuestro país, para así reducir costes y tiempo de espera en la sala de urgencias. Pacientes y métodos: Se aplicaron los criterios de Ottawa en pacientes de 0 a 18 años de edad con lesiones de tobillo. La medida principal fue la radiografía y/o la evolución clínica a través de contacto telefónico. La presencia de fractura significativa mediante uno de éstos, era el resultado adverso a evaluar. Resultados: Se incluyeron 111 pacientes con edades de 3 a 18 años, 15 por ciento de los cuales presentaron fracturas de tobillo. La sensibilidad y el valor predictivo negativo de los criterios de tobillo de Ottawa fueron del 100 por ciento. Aplicarlos hubiese disminuido un 5,4 por ciento la realización de radiografías. Conclusiones: Se ratifica la sensibilidad y aplicabilidad de los criterios de Ottawa para tobillo en niños en Hispanoamérica, aunque con menor ahorro en el uso de radiografías que en otros países (AU)

[The Ottawa ankle rules: evaluation in a pediatric emergency setting in Mexico]. / Los criterios de Ottawa para tobillo: valoración en un servicio de urgencias en México.

INTRODUCTION: Pediatric ankle injuries are a common complaint in the emergency setting. The objective of this study was to prospectively validate the Ottawa ankle rules (OAR) in children in Mexico. This could reduce costs and waiting times in the emergency room. PATIENTS AND METHODS: The authors applied the OAR to all patients aged 0 to 18 years old with an acute ankle injury. The main outcome measure was radiograph and/or clinical outcome determined through telephone contact. The presence of fracture was considered an adverse outcome. RESULTS: One hundred and eleven patients, aged 3-18 years, were enrolled. The prevalence of fractures was 15 %. The sensitivity and negative predictive value of the OAR were 100 %. Use of the OAR would have reduced the radiography rate by 5.4 %. CONCLUSIONS: The sensitivity and applicability of the OAR in children in Latin-America are confirmed, although reduction in the use of radiography is lower than in other countries.