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Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el manejo quirúrgico de la obesidad en adultos en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo quirúrgico de la obesidad en adultos en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 7 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y cuando fue considerado pertinente estudios primarios en Medline y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas. El flujograma fue diseñado en la fase final o última reunión en base a las recomendaciones formuladas previamente. Finalmente, la GPC fue aprobada con Resolución N° 115 IETSI ESSALUD 2020. Resultados: La presente GPC abordó 7 preguntas clínicas, divididas en a temas de manejo quirúrgico de pacientes con obesidad. En base a dichas preguntas se formularon 6 recomendaciones (3 fuertes y 3 condicionales), 18 BPC, y 2 flujogramas. Conclusión: El presente artículo resume la metodología, las recomendaciones basadas en evidencias, y los puntos de buena práctica clínica de la GPC para manejo quirúrgico de la obesidad en adultos en EsSalud.
Introduction: This article summarizes the clinical practice guideline (CPG) for the surgical management of obesity in adults in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for the surgical management of obesity in adults in EsSalud. Material and Methods: A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant- primary studies were performed in Medline and CENTRAL during 2019. Evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice. The flowchart was designed in the final phase or last meeting based on the previously formulated recommendations. Finally, the CPG was approved with Resolution No. 115 - IETSI - ESSALUD - 2020. Results: The present CPG addressed 7 clinical questions, divided into topics of surgical management of patients with obesity. Based on these questions, 6 recommendations (3 strong and 3 conditional), 18 GCP, and 2 flowcharts were formulated. Conclusion: This article summarizes the methodology, evidence-based recommendations, and good clinical practice points of the CPG for the surgical management of obesity in adults in EsSalud.
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ABSTRACT Myracrodruon urundeuva Allemão, Anacardiaceae, is a medicinal plant widely found in Brazil, especially in the northern region. In our previous study, the ethanolic extract from leaves of M. urundeuva showed antiviral activity against simian rotavirus SA-11. Here, the crude extract was subjected to fractionations in order to subsequently work with more concentrated and pure bioactive compounds, which were analyzed by TLC and HPLC methods to support a better understanding of their virucidal effect. The antiviral activity was evaluated using a rotavirus infection model in MA-104 cells treated with the maximum non-cytotoxic concentration of the crude extract and its fractions. Data were expressed as the percentage inhibition of viral replication calculated by the inhibition of cytopathic effect in the treated cells compared to untreated controls after 48 h of incubation. First, we conducted a fractionation, generating five fractions (F1–F5) which were submitted to antiviral assay. Then, the fraction that showed the highest virucidal effect (F3, PI = 75%) was subjected to a larger partition, yielding eighteen subfractions, which were submitted to new antiviral assays. Terpenes, flavonoids and tannins were the major secondary metabolites detected by TLC analysis in F3. SF1, a flavonoid-enriched fraction, showed the strongest in vitro activity against rotavirus (PI = 92%), preventing cytopathic effect. Chromatographic profiles were obtained by HPLC for the crude extract and SF1, the most potent subfraction. Overall, our data point to the potential anti-rotavirus activity of flavonoid-enriched fraction (SF1) of M. urundeuva leaves, corroborating the traditional use of this species to treat diarrhea and broadening our perspectives on in vivo assays in mice with SF1 isolated or associated with other fractions.