RESUMEN
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
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Asma/diagnóstico , Asma/prevención & control , Asma/epidemiología , Pruebas de Función Respiratoria/métodos , México/epidemiologíaRESUMEN
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.
Asunto(s)
Asma/diagnóstico , Asma/prevención & control , Niño , Preescolar , Femenino , Humanos , Masculino , MéxicoRESUMEN
OBJECTIVE: To compare the efficacy and safety of levocabastine nasal spray asid cetirizine oral for the treatment of perennial allergic rhinitis in children. MATERIAL AND METHODS: In this randomized, prospective experimental, open clinical trial. We studied 30 children with ages between 6 and 16 years with perennial allergic rhinitis. Group 1, 17 subjects (7 female, 10 male) received cetirizine once daily, 5 mg children weientig less dian 30 k asid 10 mg in children weighing more trw' 30 k during 15 days. Group 2, 13 subjects (7 male, 6 female) received levocabastine 2 puffs BID on each nostril during tbe same time. A nasal symptoms score, nasal peal: flow vid eosinophils in a nasal smear were performed before and after treatment. RESULTS: There were no statistical differences in age, weight, height and arid duration of symptoms. Both groups showed improvement of symptoms via nasal peak flow with no differences between them (intergroup); nasal eosinophils remained unchanged. We for third statistical differences pre vid postreatment in each group (intragroup): Group 1, nasal congestion p = 0.002, ocular itch p = 0.01, sneezing p = 0.007, nasal secretion p = 0.01, nasal itch O = 0.009, total points O = 0.0005. Group 2, nasal congestion O = 0.02, ocular itch p = 0.05, sneezing p = 0.01, nasal secretion p = 0.01, nasal itch p = 0.04, total points p = 0.005. Significant differences were found in nasal peal' flow in Group 1 (p = 0.01) but no differences in eosinophils between file two groups. Side effects: 3 subjects in Group 1 (drowsiness, 1 appetite increase said 1 rhinorrea with epistaxis) vide 1 in Group 2 sensation of facial edema. CONCLUSION: Bofil drugs are effective the clinical relief of symptoms of perennial allergic rhinitis in children vied levocabastine has less side effects.
Asunto(s)
Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Piperidinas/uso terapéutico , Rinitis/tratamiento farmacológico , Adolescente , Cetirizina/efectos adversos , Niño , Eosinofilia/tratamiento farmacológico , Eosinofilia/inmunología , Femenino , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Humanos , Masculino , Piperidinas/efectos adversos , Estudios Prospectivos , Rinitis/inmunologíaRESUMEN
Asthmatic crisis is one of the most frequent urgencies in children. One of the most difficult decision for a physician is to determine what patient requires only ambulatory treatment and what patient needs hospital treatment. Many investigators have developed predictive scores, but to date conclusions are confusing. The purpose of the present study was to compare the value of arterial oxygen saturation versus peak expiratory flow rate measurements as predictors of the outcome of the asthmatic crisis in children. We performed a prospective, longitudinal, observational, comparative study in 50 children (30 males, 20 female), with ages between 6 and 18 years old, with the presence of a moderate asthmatic crisis. We measured arterial oxygen saturation and peak expiratory flow rate at the moment of their arrival to urgencies and at 30 minutes, 2, 4 and 24 hours after the administration of nebulized albuterol (100 mcg/k/dose). We found significant differences on baseline arterial oxygen saturation and the registrations taken at 2, 4, and 24 hours posttreatment (0.01), and we could only find significant differences between baseline peak expiratory flow rate and the registrations taken at 24 hours pretreatment. In conclusion arterial oxygen saturation is a better predictor than peak expiratory flow rate in the evolution of the asthmatic crisis in children.
Asunto(s)
Oxígeno/sangre , Ápice del Flujo Espiratorio , Estado Asmático/fisiopatología , Adolescente , Albuterol/farmacología , Albuterol/uso terapéutico , Antiasmáticos/farmacología , Antiasmáticos/uso terapéutico , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Presión Parcial , Ápice del Flujo Espiratorio/efectos de los fármacos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estado Asmático/sangre , Estado Asmático/tratamiento farmacológico , Estado Asmático/epidemiologíaRESUMEN
Allergen skin testing is one of the preferred in vivo methods for assessing the presence of specific IgE antibodies against an allergen. This article review the clinical applications, techniques, reagents, evaluation, and safety of skin testing to help the allergologist to its better clinical use.
Asunto(s)
Hipersensibilidad/diagnóstico , Pruebas Cutáneas , Alérgenos , Humanos , Hipersensibilidad/inmunología , Inmunoglobulina E/inmunología , Indicadores y Reactivos , Pruebas Cutáneas/efectos adversos , Pruebas Cutáneas/clasificación , Pruebas Cutáneas/métodosRESUMEN
Clonal studies define the proteic sequence of several allergens leading to the recombination and the use of them for immunotherapy extracts. It has been possible to clone the receptors for IgE in basophils and mast cells and the regulation mechanisms had been delucidates. In a near future it will be possible to design recombinant molecules for the specific inhibition of synthesis and receptors of IgE and avoid the signal transmissions and the release of mediators. The diagnosis of several diseases is based in molecular techniques, inclusive in uterus. Genes for various diseases had been cloned in immunology, recombinations with gamma interferon had been used for treatment of subjects with atopic dermatitis and chronic granulomatous disease.
Asunto(s)
Biología Molecular , Alérgenos/química , Alérgenos/genética , Clonación Molecular , Técnicas Genéticas , Objetivos , Humanos , Hipersensibilidad/genética , Hipersensibilidad/inmunología , Síndromes de Inmunodeficiencia/diagnóstico , Síndromes de Inmunodeficiencia/genética , Complejo Mayor de Histocompatibilidad/genética , Biología Molecular/métodos , Receptores de IgE/antagonistas & inhibidores , Receptores de IgE/genéticaRESUMEN
Clonal studies define the proteic sequence of several allergens leading to the recombination and the use of them for immunotherapy extracts. It has been possible to clone the receptors for IgE in basophils and mast cells and the regulation mechanisms had been delucidated. In a near future it will be possible to design recombinant molecules for the specific inhibition of synthesis and receptors of IgE and avoid the signal transmissions and the release of mediators. The diagnosis of several diseases is based in molecular techniques, inclusive in uterus. Genes for various diseases had been cloned in immunology; recombinations with gamma interferon had been used for treatment of subjects with atopic dermatitis and chronic granulomatous disease.
Asunto(s)
Biología Molecular/métodos , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapia , Enfermedades del Sistema Inmune/diagnóstico , Enfermedades del Sistema Inmune/terapiaRESUMEN
Methotrexate represents a new therapeutic modality in patients with corticoresistant asthma. Its mechanism of action is the competitive inhibition of the folate reducing enzyme, converting folic acid in tetrahydrofolate during the S phase of the cell cycle. It is 50% fixed to albumin and excreted by glomerular filtration and proximal tubule secretion.