Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma

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Refinement of the nasalisation technique for nasal polyposis.

BACKGROUND: Radical ethmoidectomy for nasal polyposis (nasalisation) tends to offer better results than functional ethmoidectomy in terms of recurrence. We have been performing the nasalisation technique since 2004, but late complications such as mucoceles were noted in several patients. We implemented some modifications to the nasalisation technique in order to reduce the complication rate while obtaining a similar recurrence rate. METHODOLOGY AND PRINCIPAL: Retrospective study on the files of patients operated for diffuse nasal polyposis after 24months of follow-up. Group A included 45 patients (90 sides) operated with the classical nasalisation technique, and group B included 74 patients (148 sides) operated with the modified technique. RESULTS: Preoperative endoscopic grading results did not show any significant difference between groups. Recurrence rates at 24months of postoperative follow-up were of 22.2% and of 18.9% for group A and B respectively. This difference was not statistically significant. Complication rates were of 37.8% and 8.8% for Group A and Group B respectively. Complication rate was significantly lower for group B (P=0.002, standard deviation of 0.467). CONCLUSIONS: The modified nasalisation technique offers the same functional results than the classical technique, but with a significant reduction of the late complication rate.

Transnasal endoscopic approach in the treatment of Graves ophthalmopathy: the value of a medial periorbital strip.

OBJECTIVES: Present our experience with orbital decompression using an endoscopic transnasal approach and test whether preservation of an anteroposterior periorbital strip overlying the medial rectus muscle can reduce the incidence of postoperative diplopia. PATIENT AND METHODS: Retrospective, descriptive study conducted on 16 patients with Graves ophthalmopathy operated on with orbital decompression between 2004 and 2009. RESULTS: Twelve women and four men (mean age, 34.6 years), a total of 30 orbits, were operated. A medial periorbital strip along the medial rectus muscle was preserved in 13 patients. A single case (7.7%) presented postoperative diplopia. The mean reduction of proptosis was 4.3mm. CONCLUSIONS: The endoscopic transnasal approach provides comparable results to those obtained with other techniques. The incidence of postoperative diplopia seems to decrease when an anteroposterior periorbital periosteal strip is preserved along the medial rectus muscle.