Agentes potencialmente terapéuticos contra el SARS-CoV-2: revisión rápida de la evidencia.

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bias, the websites: www.clinicaltrials.gov and http://apps.who.int/trialsearch were searched to identify in-progress or unpublished clinical trials.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.

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.

Agentes potencialmente terapéuticos contra el SARS-CoV-2: revisión rápida de la evidencia

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.

Pyoderma gangrenosum: a review with special emphasis on Latin America literature.

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.

Pyoderma gangrenosum: a review with special emphasis on Latin America literature

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.

Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome.

BACKGROUND: Several studies have shown a relationship between psoriasis and metabolic syndrome (MS), but no meta-analysis has been restricted to studies that adjusted for confounders. OBJECTIVE: To determine the association between psoriasis and MS. METHODS: A systematic review and meta-analysis of observational studies on psoriasis and MS in adults was performed from MEDLINE, Scopus, SciELO, Google Scholar, Science Direct, and LILACS from inception to January 2016. We performed a random effects model meta-analysis for those studies reporting adjusted odds ratios (ORs) with 95% confidence intervals (CIs). The subgroup analysis was related to geographic location, diagnosis criteria and risk of bias. RESULTS: In all, 14 papers including a total of 25,042 patients with psoriasis were analyzed. We found that MS was present in 31.4% of patients with psoriasis (OR, 1.42; 95% CI, 1.28-1.65). Middle Eastern studies (in Israel, Turkey, and Lebanon) (OR, 1.76, 95% CI, 0.86-2.67) reported a greater risk for MS than European studies (in Germany, Italy, the United Kingdom, Norway, and Denmark) (OR, 1.40; 95% CI, 1.25-1.55). LIMITATIONS: Few adjusted studies existed, and there was inconsistency between publications. CONCLUSION: Because of the increased risk for MS, clinicians should consider screening patients with psoriasis for metabolic risk factors.

[Hand, foot, and mouth disease in a hospital in Callao in 2016]. / Enfermedad de mano, pie y boca en un hospital del Callao, 2016.

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.

Adult T-cell leukemia/lymphoma in a Peruvian hospital in human T-lymphotropic virus type 1 (HTLV-1) positive patients.

BACKGROUND: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive neoplasm of T-lymphocytes associated with human T-lymphotropic virus type I (HTLV-1) infection. As HTLV-1 is endemic in native ethnics in South America, and its infection leads to several chronic diseases as ATLL with poor prognosis, we aimed to present three ATLL cases and to review current literature. CASE REPORTS: Two cases were from the mountains of Peru, while one was from an endemic harbor of the country. An acute ATLL patient presented with multipapular infiltration of the skin and died 2 weeks after admission because of septic shock. The two chronic ATLL patients presented with erythematous plaques and erythroderma. They had swollen lymph nodes, lymphocytosis, and atypical lymphocytes on blood smear, with normal biochemical results. They both passed away a few months after diagnosis. COMMENTS: ATLL is developed after years of HTLV-1 carrier status; therefore, physicians should know the principal clinical and laboratory findings in order to make prompt diagnosis. Prognosis is still poor in aggressive and indolent variants, with survival rates from months to a few years. Treatment based on chemotherapy, antiretroviral, and allogeneic stem cell transplantation are improving survival rates but with limited results.

Enfermedad de mano, pie y boca en un hospital del Callao, 2016 / Hand, foot, and mouth disease in a hospital in Callao in 2016

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.

Nocebo effect in randomized clinical trials of antidepressants in children and adolescents: systematic review and meta-analysis.

OBJECTIVE: To compare the incidence of adverse events between active and placebo arms of randomized clinical trials in depressive children and adolescents (C&A) with antidepressant treatments, in order to look for similarities in both groups that allow to establish a possible nocebo effect. METHODS: Systematic search strategy (January 1974-March 2013) in electronic databases, conference abstracts, and reference list of systematic reviews and included studies to identify parallel randomized placebo-controlled trials of antidepressants in C&A (<19 years) with major depressive disorder, and one or more interventions of any orally administered antidepressant. The pooled adverse events were calculated based on a fixed-effect model and statistical analysis involved the risk ratio (RR) of adverse events, with 95% confidence intervals (95% CI). RESULTS: Sixteen studies were included in the review, of which seven studies with a sample of 1911 patients had data to include in the meta-analysis. There was similar risk for the incidence of adverse events between non-active and active group (global RR 1.04, 95% CI: 0.97-1.11). CONCLUSION: Depressive C&A allocated to placebo or active group had similar risk to develop adverse events. These similarities in both groups are attributed to the nocebo effect. It is of note that defining "nocebo" effects is challenging in clinical populations because adverse effects may be attributed to the intervention or may be manifestation of the disease itself. The inclusion of a no-treatment arm may be warranted. Nocebo effects are likely when adverse events of placebo mimic the adverse events of active treatment, as was the case here.