ABSTRACT
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.
Subject(s)
Asthma/diagnosis , Asthma/prevention & control , Child , Child, Preschool , Female , Humans , Male , MexicoABSTRACT
The objective of the study was to determine the coefficients of ileal apparent digestibility (CIAD) of sorghum protein and amino acids (AA) in weaned piglets and growing pigs. Digestibility coefficients were estimated using the regression and difference methods for the weaned piglets; and the direct and difference methods for the growing pigs. To test the hypothesis that CP and AA digestibility of sorghum is lower in weaned piglets than in growing pigs, two experiments were conducted. In experiment one, 20 weaned piglets were fitted with a 'T' cannula at 21 days of age and were fed for 2 weeks one of five dietary treatments: a reference or control diet providing 200 g of CP/kg from casein (C) as the sole protein source, and four casein-sorghum (C-S) diets kept isoproteic to C by the appropriate adjustment of C and maize starch proportions; the amount of sorghum (S) in these diets was 135, 307, 460 and 614 g/kg. In experiment 2, fifteen castrated pigs weighing 57.8 ± 2.8 kg were used and randomly allotted to one of three dietary treatments: a reference casein-maize starch diet containing C as the sole protein source, a C-S diet, both diets containing 160 g of CP/kg, and a fortified S diet containing 68 g of CP/kg. In piglets the CIAD for CP and AA decreased linearly (P < 0.05) as the amount of S in the diet increased. The average ileal digestibility of AA from C was 0.858 ± 0.111, and decreased to 0.663 ± 0.191 at the higher S level. The CIAD estimated using the regression or difference methods were similar for leucine, cysteine, glutamic acid, serine, alanine and tyrosine, and different for the other AA. In growing pigs the CIAD of protein and AA (except alanine and cysteine) were similar (P > 0.05) for the C and the C-S diets, but higher (P < 0.05) than those for the S diet. The CIAD for S obtained by the difference method were higher (P < 0.05) than those obtained using the direct method, except for lysine, isoleucine, valine, methionine, threonine and cysteine. The results indicate that except for lysine and cysteine, growing pigs' ability to digest AA and protein is superior than weaned piglets.
ABSTRACT
La etiología de la hiperrespuesta de la vía aérea es variada. Algunos autores mencionan la participación de la alergia a alimentos en los pacientes con procesos crónicos del aparato respiratorio. Se estudiaron a 26 niños con diagnóstico de hiperrespuesta de la vía aérea y alergia a alimentos diagnosticada por: pruebas cutáneas positivas a diversos alimentos y reto simple ambulatorio a alimentos. Se les indicó dieta de restricción alimentaria, principalmente la leche de vaca, que fue sustituida por semihidrolizado de proteínas, durante 12 semanas. Se registraron la intensidad de los síntomas: rinorrea, obstrucción nasal, tos y sibilancias durante el periodo de estudio. Se realizaron pruebas cutáneas a diversos alimentos y reto simple ambulatorio con leche de vaca. Se aplicó la prueba de Chi cuadrada para el análisis estadístico. El 23 por cinto de los pacientes fueron del sexo femenino, el 76.9 por ciento del sexo masculino, de seis meses a tres años de edad, con un promedio de 19.5 meses de edad. El 76 por ciento de los pacientes tenían antecedentes heredo-familiares de alergia. La alimentación con leche materna sólo se ofreció hasta el 5o. mes de vida al 38.4 por ciento. Para el 6o. mes de vida el 100 por ciento ya había iniciado ablactación. La mayoría de los pacientes tenían intensidad 4-5 de los síntomas al inicio del estudio: 96.2 por ciento de los niños con rinorrea y obstrucción nasal y 88.5 por ciento con tos y sibilancias. En 45 por ciento se reportó IgE elevada. El reto ambulatorio a alimentos fue positivo en 42.3 por ciento de los niños. La intensidad de los síntomas mejoró al final del periodo de la dieta de restricción en la mayoría de los niños (88.5 por ciento) con una p<0.0001. De nuestro estudio concluimos que la dieta de restricción de alimentos es un recurso que demostró efectividad en el tratamiento de los niños con hiperrespuesta de la vía aérea y alergia a alimentos
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Food Hypersensitivity/diagnosis , Food Hypersensitivity/immunology , Food Hypersensitivity/physiopathologyABSTRACT
Every time they exist more demonstrations of the paper than performs the line monocytes-macrophage in the patogenesis of the bronchial asthma. The mononuclear phagocytes cells, as the alveolar macrophages, also they can be activated during allergic methods. The monocytes macrophages are possible efficient inductors of the inflammation; this due to the fact that they can secrete inflammatory mediators, between those which are counted the pre-forming granules of peptides, metabolites of oxidation activation, activator of platelets activator and metabolites of the arachidonic acid. The identification of IL-1 in the liquidate of the bronchial ablution of sick asthmatic, as well as the identification of IL-1 in the I bronchioalveolar washing of places of allergens cutaneous prick, supports the activation concept mononuclear of phagocytic cells in allergic sufferings.
