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Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation., Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version., Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication., Conclusions: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Objective: To characterize P. aeruginosa strains isolated from bronchoalveolar lavage fluid of cystic fibrosis (CF) patients over a 3 year period., Material and Methods: A prospective follow-up study was carried out in a population of cystic fibrosis patients. The random amplified polymorphic DNA (RAP.D) technique was used to amplify DNA of P. aeruginosa strains isolated from bronchoalveolar lavage fluid samples of five CF patients from the Servicio de Neumología y Cirugía del Tórax del Instituto Nacional de Pediatría (Mexico City Chest Clinic of the National Pediatrics Institute) in Mexico City, between June 1996 and June 2002. Amplification patterns were established for each isolate to accurately identify all strains and to carry out an epidemiological analysis of P. aeruginosa among the selected CF patients., Results: Eighteen different DNA amplification patterns were defined and used to identify each P. aeruginosa strain isolated from the different bronchoalveolar lavage samples. No correlation was observed between the different P. aeruginosa strain genotypes and mucoid or non-mucoid phenotypes, as strains with different phenotypes showed similar amplification patterns. Several strains with different amplification patterns were identified in samples obtained from the same patient, suggesting coinfection with ore than one P. aeruginosa strain. Two siblings with CF shared similargenotypes, suggesting the occurrence of cross- contamination. Similar genotypes of P. aeruginosa strains were isolated throughout the study period., Conclusion: Genotypic characterization of P. aeruginosa strains in CF patients allows more accurate epidemiological analyses of this important host-agent relationship.

Background: Juvenile polyposis (JP) is a frequent cause of lower gastrointestinal bleeding. It is present in 3-4% of the population < 21 years of age and represents 90% of all polyps in childhood. The most common complaints are hematoquezia, abdominal pain, and polyp prolapse., Methods: A descriptive, observational, transversal study of 225 children with histopatologic diagnosis of JP seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría, between January 1985 and December 2000. Variables studied included age of presentation, gender, frequency, clinical manifestations, type, location, and diagnostic and therapeutic methods., Results: Frequency was one polyp per 162 patient seen during the same period (0.61%) and age 2 to 8 years (82%), a total of 235 patients, 120 females and 273 total polyps were found rectum the most common site 82% (224 polyps) followed by sigmoid. Mean distance from anal margin was 6.5 cm. Of all polyps, 82.9% were in the first 10 cm of anal margin. Of all patients, 92.3% had a single polyp and 7.7% had multiple polyps. A baritated study was made in 39 patients (16.6%) with diagnostic efficacy of 74%. No additional baritated studies were needed because of high diagnostic and therapeutic efficacy of the rectosigmoidoscopy., Conclusions: Rectosigmoidoscopy and colonoscopy remain as the diagnosis and therapeutic method in children with JP.

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.

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.

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%).

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.

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%.