BACKGROUND Several international guidelines on immunotherapy exist, but they only apply partially... more BACKGROUND Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. OBJECTIVES To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related...
... Gaeta TJ, Clark S, Pelletier AJ, Camargo CA. ... Larenas-Linnemann, Désirée a ; Ortega-Martel... more ... Gaeta TJ, Clark S, Pelletier AJ, Camargo CA. ... Larenas-Linnemann, Désirée a ; Ortega-Martell, José Antonio b ; del Río-Navarro, Blanca c ; Rodríguez-Pérez, Noel d ... e ; Hidalgo-Castro, Emilia María c ; Huerta-Hernández, Rosa Elena b ; Macías-Weinmann, Alejandra e ; Oyoqui ...
The geometric characteristics of synthetic macrofibers are important because they affect the beha... more The geometric characteristics of synthetic macrofibers are important because they affect the behavior of fiber-reinforced concrete (FRC). Because there is a lack of specific, relevant publications in Brazil, the European standard EN14889-2:2006 was adopted as a reference to perform the characterization. Thus, an experimental plan was developed to assess the adequacy of testing procedures for the qualification of synthetic macrofibers for use in FRC. Two types of macrofibers were evaluated. The length measurement was performed using two methods: the caliper method, which is a manual measurement, and the digital image analysis method using the ImageJ software for image processing. These aforementioned methods were used to determine the diameter together with the density method, which is an indirect method that uses the developed length obtained by one of the previous methods. The statistical analyses revealed that the length results are similar regardless of the method used. However, the macrofibers must be pre-stretched to maximize the accuracy of caliper measurements. The caliper method for diameter determination has the disadvantage of underestimating the macrofiber cross-section because of the pressure applied by the load claws. In contrast, the digital image analysis method obtains the projected diameter in a single plane, which overestimate the diameter because the macrofibers are oriented with the pressure of the scanner cover. Thus, these techniques may result in false projections of the diameters that will depend on the level of torsion in the macrofibers. It was concluded that both the caliper method using previously stretched macrofibers and the digital imaging method can be used to measure length. The density method presented the best results for the diameter determination because these results were not affected by the method chosen to determine the length.
BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partiall... more BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998.OBJECTIVES: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system.METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE.RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions.CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence.
Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)
Several international guidelines on immunotherapy exist, but they only apply partially in Mexico.... more Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading ...
ABSTRACT Background Several international guidelines exist on allergen immunotherapy (AIT) –eg Am... more ABSTRACT Background Several international guidelines exist on allergen immunotherapy (AIT) –eg American, European, British, Spanish, Italian- but local conditions that reign in each country limit their applicability. We present the steps we followed to develop a National Guideline on AIT, taking into account local legislation, extracts available, costs and patient preference. Methods Firstly a Nation-wide survey on the practice of skin testing and AIT was undertaken among all members of Mexican Allergist Societies. Secondly, based on the replies obtained with the survey clinical questions were formulated on critical points and issues susceptible for improvement, as diagnosed by the survey. Thirdly, all 6 Regional Allergist Societies were visited to obtain the opinion of their members on the clinical questions concerning how immunotherapy could best be practiced under local Mexican conditions. This led to the Consensed experience. Fourthly, 6 experts looked for the replies to the clinical questions reviewing the literature and assigning quality of evidence to the articles on the specific issues treated by each clinical question. Results To develop the final document the GRADE approach was used. For each clinical question both, knowledge from the local consensed experience and the evidence-based replies were taken into account, as well as cost, patient preference and safety to make a set of recommendations and suggestions on the most crucial aspects of skin testing and AIT. Forming centers of allergists in Mexico corrected the final draft. The final document came out as the January issue of Revista Mexicana Alergia and was presented by the authors in a National Course on Immunotherapy (May 2011), with—apart from the lectures—a more workshop-like part to allow for practical exercising and discussion. The updated questions on allergen immunotherapy for the final board exam are based on the Guideline. Allergy-residents developed a slide-show. In 2012 Regional Allergist Societies shall be visited again. Conclusions We present a democratic way of how a National Guideline can be developed, supported by evidence-based medicine and local experience in a country where little is legislated on this respect and quality improvement has to be stimulated by the professional community. We show how implementation can be enhanced.
BACKGROUND Several international guidelines on immunotherapy exist, but they only apply partially... more BACKGROUND Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. OBJECTIVES To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related...
... Gaeta TJ, Clark S, Pelletier AJ, Camargo CA. ... Larenas-Linnemann, Désirée a ; Ortega-Martel... more ... Gaeta TJ, Clark S, Pelletier AJ, Camargo CA. ... Larenas-Linnemann, Désirée a ; Ortega-Martell, José Antonio b ; del Río-Navarro, Blanca c ; Rodríguez-Pérez, Noel d ... e ; Hidalgo-Castro, Emilia María c ; Huerta-Hernández, Rosa Elena b ; Macías-Weinmann, Alejandra e ; Oyoqui ...
The geometric characteristics of synthetic macrofibers are important because they affect the beha... more The geometric characteristics of synthetic macrofibers are important because they affect the behavior of fiber-reinforced concrete (FRC). Because there is a lack of specific, relevant publications in Brazil, the European standard EN14889-2:2006 was adopted as a reference to perform the characterization. Thus, an experimental plan was developed to assess the adequacy of testing procedures for the qualification of synthetic macrofibers for use in FRC. Two types of macrofibers were evaluated. The length measurement was performed using two methods: the caliper method, which is a manual measurement, and the digital image analysis method using the ImageJ software for image processing. These aforementioned methods were used to determine the diameter together with the density method, which is an indirect method that uses the developed length obtained by one of the previous methods. The statistical analyses revealed that the length results are similar regardless of the method used. However, the macrofibers must be pre-stretched to maximize the accuracy of caliper measurements. The caliper method for diameter determination has the disadvantage of underestimating the macrofiber cross-section because of the pressure applied by the load claws. In contrast, the digital image analysis method obtains the projected diameter in a single plane, which overestimate the diameter because the macrofibers are oriented with the pressure of the scanner cover. Thus, these techniques may result in false projections of the diameters that will depend on the level of torsion in the macrofibers. It was concluded that both the caliper method using previously stretched macrofibers and the digital imaging method can be used to measure length. The density method presented the best results for the diameter determination because these results were not affected by the method chosen to determine the length.
BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partiall... more BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998.OBJECTIVES: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system.METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE.RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions.CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence.
Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)
Several international guidelines on immunotherapy exist, but they only apply partially in Mexico.... more Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading ...
ABSTRACT Background Several international guidelines exist on allergen immunotherapy (AIT) –eg Am... more ABSTRACT Background Several international guidelines exist on allergen immunotherapy (AIT) –eg American, European, British, Spanish, Italian- but local conditions that reign in each country limit their applicability. We present the steps we followed to develop a National Guideline on AIT, taking into account local legislation, extracts available, costs and patient preference. Methods Firstly a Nation-wide survey on the practice of skin testing and AIT was undertaken among all members of Mexican Allergist Societies. Secondly, based on the replies obtained with the survey clinical questions were formulated on critical points and issues susceptible for improvement, as diagnosed by the survey. Thirdly, all 6 Regional Allergist Societies were visited to obtain the opinion of their members on the clinical questions concerning how immunotherapy could best be practiced under local Mexican conditions. This led to the Consensed experience. Fourthly, 6 experts looked for the replies to the clinical questions reviewing the literature and assigning quality of evidence to the articles on the specific issues treated by each clinical question. Results To develop the final document the GRADE approach was used. For each clinical question both, knowledge from the local consensed experience and the evidence-based replies were taken into account, as well as cost, patient preference and safety to make a set of recommendations and suggestions on the most crucial aspects of skin testing and AIT. Forming centers of allergists in Mexico corrected the final draft. The final document came out as the January issue of Revista Mexicana Alergia and was presented by the authors in a National Course on Immunotherapy (May 2011), with—apart from the lectures—a more workshop-like part to allow for practical exercising and discussion. The updated questions on allergen immunotherapy for the final board exam are based on the Guideline. Allergy-residents developed a slide-show. In 2012 Regional Allergist Societies shall be visited again. Conclusions We present a democratic way of how a National Guideline can be developed, supported by evidence-based medicine and local experience in a country where little is legislated on this respect and quality improvement has to be stimulated by the professional community. We show how implementation can be enhanced.
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Papers by Alan Estrada