ABSTRACT
RESUMEN El Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social de Salud (EsSalud) ha desarrollado siete informes breves mediante revisiones rápidas de evidencia sobre los agentes potencialmente terapéuticos contra el SARS-CoV-2 con la finalidad de brindar información actual y relevante para los decisores, clínicos, investigadores y la comunidad académica en el Perú. Los agentes terapéuticos evaluados incluyeron cloroquina/hidroxicloroquina, lopinavir/ritonavir, tocilizumab, oseltamivir, interferón, atazanavir y plasma anti-SARS-CoV-2. La identificación de evidencia incluyó la revisión de las bases electrónicas PubMed y Cochrane Library. Adicionalmente, se realizó una búsqueda manual en las páginas web de grupos dedicados a la investigación y educación en salud, así como, en las principales sociedades o instituciones especializadas, como la Organización Mundial de la Salud (OMS) y los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés). Asimismo, para disminuir el sesgo de publicación, se buscó en las páginas web www.clinicaltrials.gov y http://apps.who.int/trialsearch, para identificar ensayos clínicos en desarrollo o que no hayan sido publicados aún. Finalmente, se consideró extraer información con una estrategia de «bola de nieve¼ mediante la revisión de las listas de referencias de las revisiones sistemáticas, estudios primarios y revisiones narrativas que sean de relevancia. A la fecha de la última revisión (27 de marzo de 2020), no se dispone de evidencia para recomendar un medicamento específico para el tratamiento de pacientes con COVID-19. Se necesita de mayor evidencia, preferentemente ensayos clínicos de buena calidad, para la toma de decisiones terapéuticas contra el SARS-CoV-2.
ABSTRACT The Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) of the Seguro Social de Salud (EsSalud) has completed seven brief reports by means of rapid reviews of evidence regarding the potentially effective therapies against SARS-CoV-2 in order to provide current and relevant information for decision makers, clinicians, researchers and the academic community in Peru. The therapeutic agents evaluated were chloroquine/hydroxychloroquine, lopinavir/ritonavir, tocilizumab, oseltamivir, interferon, atazanavir and anti SARS-CoV-2 serum. Evidence identification included the review of PubMed and Cochrane Library electronic databases. Additionally, manual search was carried out on websites from groups dedicated to research and education on health, as well as in the main specialized societies or institutions, such as, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). Furthermore, in order to reduce publication bias, the websites: www.clinicaltrials.gov and http://apps.who.int/trialsearch were searched to identify in-progress or unpublished clinical trials. Finally, a "snowball" strategy was performed by reviewing the reference lists of the systematic reviews, primary studies and selected narrative reviews to identify relevant information. The latest review (March 27, 2020) showed that there is no evidence to recommend any medication for patients´ treatment with COVID-19. More evidence, preferably high-quality randomized clinical trials, is needed for decision-making against SARS-CoV-2.
Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Antiviral Agents/administration & dosage , Peru , Pneumonia, Viral/virology , Treatment Outcome , Coronavirus Infections/virology , Pandemics , COVID-19ABSTRACT
Abstract Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
Subject(s)
Humans , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/pathology , Prevalence , Pyoderma Gangrenosum/therapy , Pyoderma Gangrenosum/epidemiology , Diagnosis, Differential , Latin America/epidemiologyABSTRACT
RESUMEN La enfermedad de mano, pie y boca (EMPB) es una enfermedad exantemática viral, causada principalmente por Coxsackie A16, con una sintomatología típica consistente en fiebre; exantema pápulo-vesicular en manos, pies y genitales; y un enantema ulceroso en boca. En el verano del 2016 se presentó una diversidad de casos en un hospital del Callao en niños y adultos, con una sintomatología compatible con EMPB; el diagnóstico fue clínico, se aplicó terapia de soporte con resolución final de síntomas. En la última década se han presentado reportes en algunos países con una afectación atípica causada por el Coxsackie A6, produciendo lesiones más extensas y en adultos. Sin embargo, el diagnóstico sigue siendo clínico, solo necesitando confirmación virológica en casos atípicos o cuando el diagnóstico no es claro. La importancia de este reporte radica en describir los casos del Callao ocurridos en el verano del 2016, para servir de apoyo a los profesionales de la salud en el diagnóstico y manejo de pacientes con similar sintomatología.
ABSTRACT Hand, foot, and mouth disease (HFMD) is an exanthematous viral disease caused mainly by Coxsackie A16 with a typical symptomatology of fever, papulovesicular rash on the hands, feet, and genitals, and an ulcerous enanthem in the mouth. In the summer of 2016, a variety of cases presented at a hospital in Callao in children and adults with a symptomatology consistent with HFMD. A clinical diagnosis was made, and support therapy was applied, resulting in the resolution of symptoms. In the last decade, reports have emerged in some countries of an atypical involvement caused by Coxsackie A6, producing lesions that are more widely distributed in adults. However, the diagnosis remains clinical, only requiring virological confirmation in atypical cases or when the diagnosis is unclear. The importance of this report stems from its description of the cases in Callao that occurred in the summer of 2016 and serve as an example for health professionals in the diagnosis and management of patients with similar symptomatology.