RESUMEN
INTRODUCTION: Amoniquinolines such as hydroxycholorquine have shown to inhibit SARS-CoV2 replication in-vitro. However, their benefit in clinical terms are controversial. OBJECTIVES: To synthesize the available evidence regarding the use of aminoquinolines for treating patients with COVID-19. METHODS: A systematic review was undertaken. Five databases were searched for randomized trials assessing chloroquine o hydroxychloroquine in the treatment of patients infected with SARS-CoV-2. All studies were assessed using the criteria endorsed by the Cochrane Collaboration. Metaanalyses were undertaken whenever possible. RESULTS: The literature search yielded 852 references, and 5 randomized trials were included. All were at high risk of bias. All studies included several cointerventions, such as antibiotics, steroids and antivirals and only two of them included critically-ill patients. When meta-analyses were conducted, aminoquinolines showed no benefit in terms of viral clearance or clinical improvement. However, a significant increase in the incidence of adverse events was observed (RR 3.11,95CI% 1.64-5.89, p < 0.001). DISCUSSION: The inhibitory properties of aminoquinolines do not seem to translate in clinical benefits amongst patients with COVID-19. The perceived high risk of bias of included studies along the significant increase in terms of adverse events recommends against the routine use of these drugs for treating patients with COVID-19.
INTRODUCCIÓN: Las aminoquinolinas como hidroxicloroquina han mostrado eficacia en inhibir la replicación del SARS-CoV-2 in vitro. Sus efectos en pacientes reales son controversiales. OBJETIVOS: Sintetizar la evidencia disponible respecto al uso de aminoquinolinas en el tratamiento de pacientes con COVID-19. METODOLOGÍA: Revisión sistemática de la literatura de ensayos clínicos aleatorizados (ECA) que evaluaron la eficacia de cloroquina o hidroxicloroquina en el tratamiento de pacientes infectados con SARS-CoV-2. Se buscó evidencia en 5 bases de datos, sólo incluyendo ECAs que fueron evaluados mediante los criterios de calidad de la colaboración Cochrane. Los resultados fueron sintetizados en un metaanálisis siempre que fue posible. RESULTADOS: Se evaluaron 852 referencias, incluyéndose 5 ensayos clínicos aleatorizados con alto riesgo de sesgo. Sólo dos estudios incluyeron pacientes críticamente enfermos. No se apreciaron beneficios en términos de aclaramiento viral o mejoría clínica al realizar el metaanálisis. Se detectó un incremento significativo en la incidencia de reacciones adversas (RR 3,11, IC95% 1,64-5,89, p < 0,001), si bien la mayoría fueron reportadas como leves. DISCUSIÓN: Las aminoquinolinas poseen efectos inhibitorios in vitro que no han demostrado traducirse en beneficios clínicos. El incremento significativo en la incidencia de reacciones adversas asociado a la baja calidad de los estudios evaluados no permite recomendar este tratamiento para pacientes con COVID-19.
Asunto(s)
Humanos , Tratamiento Farmacológico de COVID-19 , Aminoquinolinas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Cloroquina , SARS-CoV-2 , Aminoquinolinas/efectos adversosRESUMEN
INTRODUÇÃO: O tratamento do queloide representa um desáfio terapêutico, com resultados muitas vezes frustrantes. Terapias adjuvantes mais eficazes são necessárias para reduzir as altas taxas de recidivas. Essa pesquisa é baseada em uma modalidade conjunta com a aplicação de imiquimode 5 por cento creme associada à cirurgia, tendo como objetivo a avaliação do tratamento e recidiva da cicatriz queloidiana. MÉTODO: Estudo prospectivo que avaliou 14 pacientes em um total de 25 queloides, com um seguimento mínimo de 6 meses. Foi realizada excisão intralesional e iniciada a aplicação do imiquimode 5 por cento creme no dia da cirurgia e mantido por dois meses. A avaliação da cicatriz foi analisada por meio de uma Escala de Avaliação (paciente e um observador - regente de serviço de Cirurgia Plástica), sinais de recidiva e também do tamanho da cicatriz no pré e pós-operatório. RESULTADOS: Após o acompanhamento de 6 meses, houve melhora da cicatriz por parte do paciente em 72 por cento e para o observador em 88 por cento, tendo uma taxa de recidiva de 8 por cento e redução da área cicatricial (p=0,0053). CONCLUSÃO: O uso do Imiquimode 5 por cento creme no pós-operatório da cirurgia de ressecção do queloide diminuiu significativamente sua recidiva na avaliação de 6 meses.
INTRODUCTION: The treatment of keloids represents a therapeutic challenge, with results often disappointing. More effective adjuvant therapies are needed to reduce high rates of relapse. This research is based on a combined modality with application of imiquimod 5 percent cream combined with surgery, having as objective the evaluation of treatment and recurrence of keloid scar. METHODS: This prospective study evaluated 14 patients at a total of 25 keloids, with a minimum follow up of 6 months. Intralesional excision was performed and initiated the application of imiquimod 5 percent cream on the day of surgery and continued for two months. The evaluation of the scar was analyzed by an Assessment Scale (patient and an observer - ruler of service Plastic Surgery), signs of relapse and also the size of the scar in the pre-and postoperatively. RESULTS: After 6 months of follow up, patients showed an improvement of 72 percent and 88 percent in the ruler's analysis, with a recurrence rate of 8 percent and reduction of scar area (p = 0.0053). CONCLUSION: The use of Imiquimode 5 percent cream in the post surgery for resection of the keloid recurrence decreased significantly in their evaluation of 6 months.
Asunto(s)
Humanos , Aminoquinolinas , Cicatriz , Complicaciones Intraoperatorias , Queloide , Complicaciones Posoperatorias , Recurrencia , Terapéutica , Técnicas y Procedimientos Diagnósticos , Métodos , Pacientes , Estudios ProspectivosRESUMEN
Lesões decorrentes da infecção pelo papilomavírus humano na infância, em especial as verrugas anogenitais, são um importante problema epidemiológico e terapêutico. O tratamento das verrugas anogenitais na infância é um desafio terapêutico. Os tratamentos convencionais geralmente são dolorosos e necessitam de anestesia geral. O imiquimode, um imunomodulador tópico, constitui uma alternativa terapêutica. Serão descritos quatro casos tratados com sucesso utilizando creme de imiquimode a 5 por cento aplicado topicamente.
In children, lesions caused by the human papillomavirus (HPV) constitute a significant epidemiological issue and a therapeutic dilemma, particularly in the case of anogenital warts. The treatment of anogenital warts in children is a challenge, since standard treatments are generally painful and require the patient to be anesthetized. Imiquimod, a topical immune response modifier, constitutes an alternative therapeutic agent for the treatment of HPV. The present report describes four cases in which treatment with topically applied imiquimod 5 percent cream was implemented with successful results.