Juan José Yepes-Nuñez | Universidad de los Andes (Colombia) (original) (raw)

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Papers by Juan José Yepes-Nuñez

Objectives: The aim of the study was to develop a Grading of Recommendations, Assessment, Develop... more Objectives: The aim of the study was to develop a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) summary of findings (SoF) table format that displays the critical information from a network meta-analysis (NMA). Study Design and Setting: We applied a user experience model for data analysis based on four rounds of semistructured interviews. Results: We interviewed 32 stakeholders who conduct or use MA. Four rounds of interviews produced six candidate NMA-SoF tables. Users found a final NMA-SoF table that included the following components highly acceptable: (1) details of the clinical question (PICO), (2) a plot depicting network geometry, (3) relative and absolute effect estimates, (4) certainty of evidence, (5) ranking of treatments, and (6) interpretation of findings. Conclusion: Using stakeholder feedback, we developed a new GRADE NMA-SoF table that includes the relevant components that facilitate understanding NMA findings and health decision-making. Ó

Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have al... more Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. Methods: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. Results: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence.

Background: The prevalence of allergic diseases is approximately 10 % in infants whose parents an... more Background: The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20-30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic diseases. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations addressing the use of vitamin D in primary prevention of allergic diseases. Methods: Our WAO guideline panel identified the most relevant clinical questions and performed a systematic review of randomized controlled trials and non-randomized studies (NRS), specifically cohort and case-control studies, of vitamin D supplementation for the prevention of allergic diseases. We also reviewed the evidence about values and preferences, and resource requirements (. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. Results: Having reviewed the currently available evidence, the WAO guideline panel found no support for the hypothesis that vitamin D supplementation reduces the risk of developing allergic diseases in children. The WAO guideline panel suggest not using vitamin D in pregnant women, breastfeeding mothers, or healthy term infants as a means of preventing the development of allergic diseases. This recommendation does not apply to those mothers and infants who have other indications for prophylactic or therapeutic use of vitamin D. The panel's recommendations are conditional and supported by very low certainty evidence.

Background: The prevalence of allergic diseases in infants, whose parents and siblings do not hav... more Background: The prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10 % and reaches 20-30 % in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Prebioticsnon-digestible oligosaccharides that stimulate growth of probiotic bacteriahave been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of prebiotics in the prevention of allergy. Methods: The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy. We performed a systematic review of randomized controlled trials of prebiotics, and reviewed the evidence about patient values and preferences, and resource requirements (up to January 2015, with an update on July 29, 2015). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. Results: Based on GRADE evidence to decision frameworks, the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants. Both recommendations are conditional and based on very low certainty of the evidence. We found no experimental or observational study of prebiotic supplementation in pregnant women or in breastfeeding mothers. Thus, the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding, at this time.

Background: Allergic diseases are considered a health burden because of their high and constantly... more Background: Allergic diseases are considered a health burden because of their high and constantly increasing prevalence, high direct and indirect costs, and undesirable effects on quality of life. Probiotics have been suggested as an intervention to prevent allergic diseases. Objective: We sought to synthesize the evidence supporting use of probiotics for the prevention of allergies and inform World Allergy Organization guidelines on probiotic use. Methods: We performed a systematic review of randomized trials assessing the effects of any probiotic administered to pregnant women, breast-feeding mothers, and/or infants. Results: Of 2403 articles published until December 2014 identified in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, 29 studies fulfilled a priori specified inclusion criteria for the analyses. Probiotics reduced the risk of eczema when used by women during the last trimester of pregnancy (relative risk [RR], 0.71; 95% CI, 0.60-0.84), when used by breast-feeding mothers (RR, 0.57; 95% CI, 0.47-0.69), or when given to infants (RR, 0.80; 95% CI, 0.68-0.94). Evidence did not support an effect on other allergies, nutrition status, or incidence of adverse effects. The certainty in the evidence according to the Grading of Recommendation Assessment Development and Evaluation approach is low or very low because of the risk of bias, inconsistency and imprecision of results, and indirectness of available research.

Parietaria pollen has never been considered as a significant cause of pollinosis in Chile; theref... more Parietaria pollen has never been considered as a significant cause of pollinosis in Chile; therefore, the sensitization to Parietaria study has never been included in the study of patients with clinical suspicion of pollinosis in this region. The objective of this study was to describe the clinical characteristics of pollinosis caused by Parietaria in the Valparaíso region, related to air concentrations of this kind of pollen. A cross-sectional study was performed in the city of Valparaíso. It consisted of two stages: In the first, pollen grains were counted between 1999 and 2001. In the second, a sensitization profile on a patient population diagnosed with ARC (allergic rhinoconjunctivitis) was evaluated. Parietaria judaica (P. judiaca) presented pollination all year long, with aggravation in the spring and summer, and with values reaching 80 grains/m 3 (weekly average). These findings determined the transience of the symptoms in this population, which is mainly perennial with seasonal aggravations. A total of 72 atopic subjects were obtained during the whole sample recollection period. P. judaica was the second most frequent cause of sensitization (60 %) after Dermatophagoides in the sample overall. Also, in monosensitized subjects, it was the first cause of pollen sensitization. P. judaica represents the second cause of allergy in Valparaíso and the first cause of pollinosis. These findings suggest the importance of P. Mardones (&) Á M

Background: Allergic diseases are very common, with the estimated cumulative prevalence in Colomb... more Background: Allergic diseases are very common, with the estimated cumulative prevalence in Colombia for asthma and allergic rhinitis being 22.7% and 31.3% respectively, and with a clear upward trend. A major social as well as economic impact associated with allergic disease has been described. Because in Colombia there are no studies that assess the Health-Related Quality of Life (HRQOL) in allergic respiratory diseases, our aim is to describe the HRQOL in subjects with respiratory allergy and its association with clinical control variables. Methods: A prospective descriptive study was conducted among 76 Colombian subjects with rhinitis and asthma/allergic rhinitis. In order to evaluate the HRQOL, the instruments Kidscreen-27 and SF-36 were applied. The scores obtained in the HRQOL fields were correlated with the following clinical variables: peak expiratory flow (PEF) and peak nasal inspiratory flow (PNIF). Results: In children, the better HRQL domain is present in the school environment (55.9) and the worst in psychological well-being (39.9). For adults the worst HRQL was found in the emotional function domain (55.6) while the physical function (81.7) had the best. There were no statistical differences between groups of asthma/allergic rhinitis and allergic rhinitis. Subjects with allergic asthma showed a strong correlation between the mental health domain and PEF values (r = −0717, p = 0.046). Conclusion: Mental health is more affected than physical health in Colombian subjects with respiratory allergy. There was a strong correlation between the mental health domain and the values of PEF in patients with asthma/allergic rhinitis.

Estimación de la calidad de vida relacionada con la salud y medidas de utilidad en una población ... more Estimación de la calidad de vida relacionada con la salud y medidas de utilidad en una población de pacientes colombianos con lupus eritematoso sistémico

Books by Juan José Yepes-Nuñez

En las últimas décadas del siglo XIX y primeras del siglo XX, la biomedicina europea avanzaba en ... more En las últimas décadas del siglo XIX y primeras del siglo XX, la biomedicina europea avanzaba en una dirección marcada por el descubrimiento de que algunos microorganismos, a través de sus toxinas, producían enfermedad en los animales superiores y el hombre. Se había observado que existía una capacidad de respuesta en el huésped, oponiéndose a la invasión, que se denominó inmunidad y pronto se trató de utilizar el principio de la "lucha contra lo externo, con las propias fuerzas del individuo" con fines terapéuticos.