Background and Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I 2 =53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I 2 =0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I 2 =0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I 2 =68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I 2 =0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I 2 =57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.
Sr. Editor. Las inmunodeficiencias primarias (IDP) incluyen un conjunto de trastornos hereditarios de la función del sistema inmunitario (1). Según clasificación de la International Union of Immunological Societies (IUIS) estos trastornos se pueden dividir en nueve categorías: inmunodeficiencias combinadas, deficiencias predominantemente de anticuerpos, inmunodeficiencias combinadas con síndromes bien definidos, enfermedades de desregulación inmune, defectos congénitos del número, función o ambos del sistema fagocítico; defectos de la inmunidad innata, desordenes autoinflamatorios, deficiencias del complemento e inmunodeficiencias por fenocopias (2). Fuentes de financiamiento: Autofinanciado Conflicto de intereses: El autor declara no tener ningún conflicto de intereses.
a Médico cirujano; b médico inmunólogo clínico alergólogo.
Background Different prophylactic and episodic clotting factor treatments are used in the management of hemophilia. A summarize of the evidence is needed inform decision-making. Objective To compare the effects of factor replacement therapies in patients with hemophilia. Methods We performed a systematic search in PubMed, Central Cochrane Library, and Scopus. We included randomized controlled trials (RCTs) published up to December 2020, which compared different factor replacement therapies in patients with hemophilia. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42021225857). Results Nine RCTs were included in this review, of which six compared episodic with prophylactic treatment, all of them performed in patients with hemophilia A. Pooled results showed that, compared to the episodic treatment group, the annualized bleeding rate was lower in the low-dose prophylactic group (ratio of means [RM]: 0.27, 95% CI: 0.17 to 0.43), intermediate-dose prophylactic group (RM: 0.15, 95% CI: 0.07 to 0.36), and high-dose prophylactic group (RM: 0.07, 95% CI: 0.04 to 0.13). With significant difference between these subgroups (p = 0.003, I2 = 82.9%). In addition, compared to the episodic treatment group, the annualized joint bleeding rate was lower in the low-dose prophylactic group (RM: 0.17, 95% CI: 0.06 to 0.43), intermediate-dose prophylactic group (RM of 0.14, 95% CI: 0.07 to 0.27), and high-dose prophylactic group (RM of 0.08, 95% CI: 0.04 to 0.16). Without significant subgroup differences. The certainty of the evidence was very low for all outcomes according to GRADE methodology. The other studies compared different types of clotting factor concentrates (CFCs), assessed pharmacokinetic prophylaxis, or compared different frequencies of medication administration. Conclusions Our results suggest that prophylactic treatment (at either low, intermediate, or high doses) is superior to episodic treatment for bleeding prevention. In patients with hemophilia A, the bleeding rate seems to have a dose-response effect. However, no study compared different doses of prophylactic treatment, and all results had a very low certainty of the evidence. Thus, future studies are needed to confirm these results and inform decision making.
Con el objetivo de determinar el perfil de sensibilización a aeroalérgenos en pacientes pediátricos con asma y/o rinitis alérgica se realizó un estudio transversal en 411 pacientes usando una prueba cutánea de alergia. Se analizó la edad, sexo, nivel de IgE total y eosinófilos. La edad media fue de 8,1 ± 3,7 años y el 60,6% fueron varones. La media de los eosinófilos y el nivel de IgE total fue de 450,1 ± 377,3 células/mm3 y 861,7 ± 757,6 IU/mL, respectivamente. Los ácaros fueron los alérgenos sensibilizantes más frecuentes (79,8%) y el Dermatophagoides farinae (65,2%) fue el más común. La polisensibilización estuvo presente en el 76,2% de los pacientes. La sensibilización se evidenció en la mayoría de los pacientes con asma y/o rinitis alérgica y estuvo asociada con la edad, grupos etarios y nivel de IgE total.
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