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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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.

Role of the chemokines RANTES, monocyte chemotactic proteins-3 and -4, and eotaxins-1 and -2 in childhood asthma.

Eosinophil recruitment into the airways is a feature of asthma in children. However, the mechanisms by which these cells migrate into the airways are not fully understood. The present study investigated the presence of the eosinophil-activating chemokines regulated on activation, normal T-cell expressed and secreted (RANTES), monocyte chemotactic proteins (MCP)-3 and -4, and eotaxins-1 and -2 in the bronchoalveolar lavage (BAL) fluid obtained from both asthmatic (n=10, age 6-10 yrs) and normal children (n=10, age 5-10 yrs). Measurements of chemokines in BAL fluid showed that levels of RANTES, MCPs-3 and -4, and eotaxins-1 and -2 were significantly increased in fluid obtained from asthmatic children when compared with normal children. Among the different chemokines, RANTES was the cytokine released in greatest quantities in BAL fluid from asthmatic children. There was a significant correlation between the concentrations of MCP-4 and eosinophil numbers in BAL fluid and a trend between both chemokines MCP-3 and eotaxin-2 and eosinophils. Interestingly, the levels of most chemokines correlated with one another. These findings suggest that RANTES monocyte chemotactic proteins-3 and -4, and eotaxins-1 and -2 may regulate eosinophil trafficking into the airways of asthmatic children in a coordinated manner.

[Observer variability in the radiologic interpretation of interstitial lung disease]. / Variabilidad de observadores en la interpretación radiológica de la afección pulmonar intersticial.

OBJECTIVES: To study intra and interobserver variability of two pediatric neumologists in X-ray readings of interstitial lung disease (ILD), to determine the effect of clinical data on the readings, and to evaluate their interpretation in terms of the histopathology diagnosis. DESIGN: Prospective, cross sectional, comparative, blinded. SETTING: The Instituto Nacional de Pediatria of Mexico City. MATERIAL AND METHODS: Chest X-rays of 45 ILD pediatric patients with diagnosis confirmed by open lung biopsy were read by the two observers three times at two weeks intervals and in a randomized fashion. The observers were blinded to previous readings of both observers as well as to the diagnosis. The first two readings were done with no clinical information given to the observers, but some was given for the third reading (age of inception, length of evolution, and main symptoms at time of the X-rays). A classification in one of 5 patterns (lineal, reticular, reticulonodular, grounded glass, honeycomb) was established by the observers. Associations of patterns with anatomopathological diagnosis was explored. Weighted kappa was used in the statistical analysis. RESULTS: With one exception, good agreement (Kw 0.57-0.88) was found intra and interobservers. CONCLUSION: We believe the low variability is the result of the 15 years of shared experience of the two observers participating in this study.

Esclerosis hepato-portal: 10 anos de experiencia el el Instituto Nacional de Pediatria / Hepatoportal sclerosis. 10 years of experience in the National Institute of Pediatrics

Objetive: To assess the frecuency and clinical picture of Hepatoportal Sclerosis in a population of Mexican children of the Instituto Nacional de Pediatría, México City. Background: Hepatoportal Sclerosis is a disease of unknown etiology. It's diagnosis is difficut. The main clinical presentation is splenomegaly with or without hematemesis (portal hypertension). Splenoportography and liver histology study are the best procedures for diagnosis and must be performed by experts. Methods: We studied 7/106 children with portal hypertension during a period of 10 years, who were seen at the Instituto Nacional de Pediatría, México city. Inclusion criteria were specifical findings of splenoportography and histologic changes in liver biopsy. Results: We found 7/106 children. The main clinical manifestation were splenomegaly and hematemesis. We did not find any previous history of contact with arsenisc, vinyl chloride or copper sulfate. In 6/7 children a porto-systemic shunt was performed. Only one received propranolol and sclerotheraphy. At the time of this report all children have shown a good clinical course.

Esclerosis hepato-portal: 10 anos de experiencia el el Instituto Nacional de Pediatria / Hepatoportal sclerosis. 10 years of experience in the National Institute of Pediatrics

Objetive: To assess the frecuency and clinical picture of Hepatoportal Sclerosis in a population of Mexican children of the Instituto Nacional de Pediatría, México City. Background: Hepatoportal Sclerosis is a disease of unknown etiology. Its diagnosis is difficut. The main clinical presentation is splenomegaly with or without hematemesis (portal hypertension). Splenoportography and liver histology study are the best procedures for diagnosis and must be performed by experts. Methods: We studied 7/106 children with portal hypertension during a period of 10 years, who were seen at the Instituto Nacional de Pediatría, México city. Inclusion criteria were specifical findings of splenoportography and histologic changes in liver biopsy. Results: We found 7/106 children. The main clinical manifestation were splenomegaly and hematemesis. We did not find any previous history of contact with arsenisc, vinyl chloride or copper sulfate. In 6/7 children a porto-systemic shunt was performed. Only one received propranolol and sclerotheraphy. At the time of this report all children have shown a good clinical course. (AU)

[Hepatoportal sclerosis. 10 years of experience at the National Institute of Pediatrics]. / Esclerosis hepato-portal. 10 años de experiencia en el Instituto Nacional de Pediatría.

OBJECTIVE: To assess the frequency and clinical picture of Hepatoportal Sclerosis in a population of Mexican children of the Instituto Nacional de Pediatría, México City. BACKGROUND: Hepatoportal Sclerosis is a disease of unknown etiology. It's diagnosis is difficult. The main clinical presentation is splenomegaly with or without hematemesis (portal hypertension). Splenoportography and liver histology study are the best procedures for diagnosis and must be performed by experts. METHODS: We studied 7/106 children with portal hypertension during a period of 10 years, who were seen at the Instituto Nacional de Pediatría, México city. Inclusion criteria were specific findings of splenoportography and histologic changes in liver biopsy. RESULTS: We found 7/106 children. The main clinical manifestation were splenomegaly and hematemesis. We did not find any previous history of contact with arsenic, vinyl chloride or copper sulfate. In 6/7 children a porto-systemic shunt was performed. Only one received propranolol and sclerotherapy. At the time of this report all children have shown a good clinical course.

[Eradication of Helicobacter pylori in patients with recurrent abdominal pain using a triple drug treatment]. / Erradicación del Helicobacter pylori en pacientes con dolor abdominal recidivante con un triple esquema de tratamiento.

BACKGROUND: Different antibiotics, antagonist H2 and others have been used for elimination and/or eradication of Helicobacter pylori. AIMS: Evaluate elimination of Helicobacter pylori with amoxicillin, bismuth subsalicylate and ranitidine; and the improvement of recurrent abdominal pain. METHOD: 20 children with recurrent abdominal pain associated to gastritis and histologic identification of Helicobacter pylori were studied under a period of 18 months (January 1992 to June 1993), at Instituto Nacional de Pediatría, México, D.F. All children were treated simultaneously with: Amoxicillin, 15 days, plus ranitidine and bismuth subsalicylate for one month. RESULTS: Helicobacter pylori was eliminated in 14 of 20 children studied. All these children had an important improvement of recurrent abdominal pain. CONCLUSION: Elimination of Helicobacter pylori and clinical improvement was present in 14 of 20 children studied (70%).

[Prune belly syndrome associated with cystic adenomatoid malformation of the lung and pulmonary sequestration]. / Síndrome de "prune belly" asociado a malformación adenomatoide quística pulmonar y secuestro pulmonar.

The "prune belly" syndrome classically described in males, has also been described in female patients with a variable incidence. Associations with multiple respiratory tract malformations have been reported which together with urinary tract anomalies and renal failure are often the cause of early mortality. We report the case of a female patient with prune belly in association with cystic adenomatoid malformation of the lung and pulmonary sequestration with a favorable clinical evolution following medical and surgical treatment.

[Foreign bodies in digestive tract of pediatric patients]. / Cuerpos extraños en vías digestivas en el paciente pediátrico.

We present our experience in the endoscopic management of 421 children with upper gastrointestinal foreign bodies. Only in the 1% of the cases (5 patients) we had complications who needs surgical intervention. We found a 1.5:1 ratio in male/female and the highest prevalence in the 2 to 5 years group. Most common foreign bodies were coins and small metallic objects (59%) followed by small plastic by objects (35%) and seeds, fish bones and meat in 6%, meat in 6%.

Osler-Weber-Rendu disease in an infant.

A 23-month-old girl with Osler-Weber-Rendu (OWR) disease manifested by hemoptysis died of massive pulmonary hemorrhage. Autopsy showed predominant respiratory tract involvement, but telangiectatic vessels were also present in other sites. Skin lesions were absent. A grandfather had died after bleeding by mouth following physical exertion. This disease seldom appears in children and hemorrhage usually manifests after 30 years of age.