Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review and GRADE assessments.

BACKGROUND: Infantile haemangiomas (IH) are soft swellings of the skin that occur in 3-10% of infants. When haemangiomas occur in high-risk areas or when complications develop, active intervention is necessary. OBJECTIVE: To update a Cochrane Review assessing the interventions for the management of IH in children. METHODS: We searched for randomized controlled trials in CENTRAL, MEDLINE, Embase, LILACS, AMED, PsycINFO, CINAHL and six trials registers up to February 2017. We included 28 trials (1728 participants) assessing 12 interventions. RESULTS: We downgraded evidence from high to moderate/low for issues related to risk of bias and imprecision. Oral propranolol (3 mg kg-1 daily) probably improves clinician-assessed clearance vs placebo [risk ratio (RR) 16·61, 95% confidence interval (CI) 4·22-65·34; moderate quality of evidence (QoE)]; we found no evidence of a difference in terms of serious adverse events (RR 1·05, 95% CI 0·33-3·39; low QoE). We found the chance of reduction of redness may be improved with topical timolol maleate (0·5% gel applied twice daily) when compared with placebo (RR 8·11, 95% CI 1·09-60·09; low QoE). We found no instances of bradycardia or hypotension for this comparison. CONCLUSIONS: Our key results indicate that oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution, or both, without an increase in harm.

Evaluation of concordance among three cardiac output measurement techniques in adult patients during cardiovascular surgery postoperative care.

INTRODUCTION: The standard method for cardiac output measuring is thermodilution although it is an invasive technique. Transesophageal Echocardiography (TEE) offers a dynamic and functional alternative to thermodilution. OBJECTIVE: Analyze concordance between two TEE methods and thermodilution for cardiac output assessment. METHODS: Observational concordance study in cardiovascular surgery patients that required pulmonary artery catheter. TEE cardiac output measurement at both mitral annulus (MA) and left ventricle outflow tract (LVOT) were performed. Results were compared with thermodilution. Correlation was evaluated by Lin's concordance correlation coefficient and Bland-Altman analysis. Statistical analysis was undertaken in STATA 13.0. RESULTS: Twenty-five patients were enrolled. Fifty two percent of patients were male, median age and ejection fraction was 63 years and 35% respectively. Median thermodilution, LVOT and MA -measured cardiac output was 3.25 L/min, 3.46 L/min and 8.4 L/min respectively. Different values between thermodilution and MA measurements were found (Lin concordance=0.071; Confidence Interval 95%=-0.009 to 0.151; Spearman's correlation=0.22) as values between thermodilution and LVOT (Lin concordance=0.232; Confidence Interval 95%=-0.12 a 0.537; Spearman's correlation 0.28). Bland-Altman analysis showed greater difference between MA measurements and thermodilution (DM=-0.408; Bland-Altman Limits=-0.809 to -0.007), than the other echocardiographic findings (DM=0.007; Bland-Altman Limits=-0.441 to 0.428). CONCLUSION: Results from cardiac output measurement by doppler and 2D-TEE on both MA and LVOT do not correlate with those obtained by thermodilution.

Adverse events associated with the use of recommended vaccines during pregnancy: an overview of systematic reviews

Introduction: Maternal immunization is aimed at reducing morbidity and mortality in pregnant women and their newborns. Updated evidence synthesis of maternal-fetal outcomes is constantly needed to ensure that the risk-benefit of vaccination during pregnancy remains positive. Methods: An overview of systematic reviews (OoSRs) was performed. We searched The Cochrane Library, MEDLINE and EMBASE for SRs including recommended vaccines for maternal immunization reporting the following: abortion, stillbirth, chorioamnionitis, congenital anomalies, microcephaly, neonatal death, neonatal infection, preterm birth (PTB), low birth weight (LBW), maternal death and small for gestational age (SGA) from 2010 to April 2019. Quality and overlap of SRs was assessed. Results: Seventeen SRs were identified, eight of them included meta-analysis; quality was high in three SRs, moderate in six SRs, low in two SRs, and critically low in six SRs. Stillbirth and PTB were the most frequently reported outcomes by 15 and 13 SRs, respectively, followed by abortion (9 SRs), congenital anomalies (9 SRs), SGA (8 SRs), neonatal death (8 SRs), LBW (4 SRs), chorioamnionitis (3 SRs), maternal death (1 SR). SRs included mainly observational evidence for influenza and Tdap vaccines (11 SRs and 4 SRs, respectively); limited evidence was found for hepatitis (1 SR), yellow fever (1 SR), and meningococcal (1 SR) vaccines. Most of the SRs found no effect. Eight SRs found benefit/protection of influenza vaccine (for stillbirth, neonatal death, preterm birth, LBW), or Tdap vaccine (for preterm birth and SGA); one found a probable risk (chorioamnionitis/Tdap). The SRs for Hepatitis B, meningococcal and yellow fever vaccines were inconclusive. Conclusions: Definite risks were not identified for any vaccine and outcome; however better evidence is needed for all outcomes and vaccines. The available evidence in the SRs to support vaccine safety was based mainly on observational data. More RCTs with adequate reporting of maternal-fetal outcomes and larger high-quality observational studies are needed. (AU)

Evaluation of concordance among three cardiac output measurement techniques in adult patients during cardiovascular surgery postoperative care / Evaluación de la concordancia de tres técnicas de medición del gasto cardiaco en pacientes adultos durante el postoperatorio de cirugía cardiaca

Introduction: The standard method for cardiac output measuring is thermodilution although it is an invasive technique. Transesophageal Echocardiography (TEE) offers a dynamic and functional alternative to thermodilution. Objective: Analyze concordance between two TEE methods and thermodilution for cardiac output assessment. Methods: Observational concordance study in cardiovascular surgery patients that required pulmonary artery catheter. TEE cardiac output measurement at both mitral annulus (MA) and left ventricle outflow tract (LVOT) were performed. Results were compared with thermodilution. Correlation was evaluated by Lin's concordance correlation coefficient and Bland- Altman analysis. Statistical analysis was undertaken in STATA 13.0. Results: Twenty-five patients were enrolled. Fifty two percent of patients were male, median age and ejection fraction was 63 years and 35% respectively. Median thermodilution, LVOT and MA -measured cardiac output was 3.25 L/min, 3.46 L/min and 8.4 L/min respectively. Different values between thermodilution and MA measurements were found (Lin concordance=0.071; Confidence Interval 95%=−0.009 to 0.151; Spearman's correlation=0.22) as values between thermodilution and LVOT (Lin concordance=0.232; Confidence Interval 95%=−0.12 a 0.537; Spearman's correlation 0.28). Bland- Altman analysis showed greater difference between MA measurements and thermodilution (DM=−0.408; Bland-Altman Limits=−0.809 to −0.007), than the other echocardiographic findings (DM=0.007; Bland-Altman Limits=−0.441 to 0.428). Conclusion: Results from cardiac output measurement by doppler and 2D-TEE on both MA and LVOT do not correlate with those obtained by thermodilution (AU)

Introducción: El cálculo del gasto cardiaco se realiza por termodilución, y su principal desventaja es el carácter invasivo. La ecocardiografía transesofágica (ETE) representa una alternativa dinámica y funcional a la termodilución. Objetivo: Analizar la concordancia entre dos métodos de ETE y termodilución para la evaluación del gasto cardiaco. Métodos: Estudio observacional de concordancia en pacientes de cirugía cardiovascular con requerimiento de catéter de arteria pulmonar. Se realizó medición de gasto cardiaco por ETE en anillo mitral (AM) y en el tracto de salida del ventrículo izquierdo (TSVI). Los resultados se compararon con la termodilución. La concordancia fue evaluada por el coeficiente de correlación concordancia de Lin y analizada por el método de Bland-Altman. Los análisis estadísticos se realizaron en STATA 13.0. Resultados: Se incluyeron 25 pacientes. El 52% fueron hombres, con mediana de edad de 63años y fracción de eyección del 35%. La mediana de gasto cardiaco por termodilución, AM y TSVI fue de 3,25, de 3,46 y de 8,4L/min, respectivamente. Se encontraron diferentes valores entre termodilución y AM (concordancia de Lin=0,071; IC95%: −0,009 a 0,151), así como entre termodilución y TSVI (concordancia de Lin=0,232; IC95%: −0,12 a 0,537). El análisis de Bland-Altman muestra una diferencia entre la medición por AM y termodilución importante (DM=−0,408; Bland-Altman Limits=−0,809 a −0,007), así como entre las dos medidas por ETE (DM=0,007; Bland-Altman Limits=−0,441 a 0,428). Conclusión: Los resultados en la medición del gasto cardiaco por doppler y ETE bidimensional tanto a nivel del anillo mitral como del TSVI no son concordantes con la termodilución (AU)