Background RotaTeq™ (RV5; Merck & Co. Inc., USA) and Rotarix™ (RV1, GlaxoSmithKline, Belgium) vaccines, developed to prevent rotavirus diarrhea in children under five years old, were both introduced into national immunization programs in 2006. As many countries in Latin America and the Caribbean have included either RV5 or RV1 in their routine childhood vaccination programs, we conducted a systematic review and meta-analysis to analyze efficacy, safety and effectiveness data from the region.MethodsWe conducted a systematic search in PubMed, EMBASE, Scielo, Lilacs and the Cochrane Central Register, for controlled efficacy, safety and effectiveness studies published between January 2000 until December 2011, on RV5 and RV1 across Latin America (where both vaccines are available since 2006). The primary outcome measures were: rotavirus-related gastroenteritis of any severity; rotavirus emergency department visits and hospitalization; and severe adverse events.ResultsThe results of the meta-analysis for efficacy show that RV1 reduced the risk of any-severity rotavirus-related gastroenteritis by 65% (relative risk (RR) 0.35, 95% confidence interval (CI) 0.25; 0.50), and of severe gastroenteritis by 82% (RR 0.18, 95%CI 0.12; 0.26) versus placebo. In trials, both vaccines significantly reduced the risk of hospitalization and emergency visits by 85% (RR 0.15, 95%CI 0.09; 0.25) for RV1 and by 90% (RR 0.099, 95%CI 0.012; 0.77) for RV5. Vaccination with RV5 or RV1 did not increase the risk of death, intussusception, or other severe adverse events which were previously associated with the first licensed rotavirus vaccine. Real-world effectiveness studies showed that both vaccines reduced rotavirus hospitalization in the region by around 45–50% for RV5 (for 1 to 3 doses, respectively), and, by around 50–80% for RV1 (for 1 to 2 doses, respectively). For RV1, effectiveness against hospitalization was highest (around 80–96%) for children vaccinated before 12 months of age, compared with 5–60% effectiveness in older children. Both vaccines were most effective in preventing more severe gastroenteritis (70% for RV5 and 80–90% for RV1) and severe gastroenteritis (50% for RV5 and 70–80% for RV1).ConclusionThis systematic literature review confirms rotavirus vaccination has been proven effective and well tolerated in protecting children in Latin America and the Caribbean.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0771-y) contains supplementary material, which is available to authorized users.
OBJETIVO: Evaluar el rendimiento del estudio clínico ecográfico propuesto por el CLAP. MATERIAL Y MÉTODO: Estudio descriptivo que evalúa el riesgo de asociación de pequeño para edad gestacional (PEG) con factore de riesgo y hallazgos ecográficos. RESULTADOS: Se encontró correlación entre factores de riesgo y las circunferencias craneana (CC) y abdominal (CA) menor dle percentil 5 con PEG. CONCLUSIONES: Existe una asociación significativamente entre los factores de riesgo y la presencia de feto pequeño para la edad gestacional. La alta especificidad y valor predictivo negativo de la CC y la CA hacen a esta biometría útil para la evaluación del crecimiento fetal.
This study was conducted to evaluate usefulness of the physiologic stability index (PSI) in a pediatric intensive care Unit (PICU) of a University based hospital at Santiago, Chile. Subjects include all patients (n=152) consecutively admited to our PICU between april 1987 and august 1988. The PSI system was applied during the first four days from admission. The age of the patients ranged from 10 days to 15 years. Scores obtained from survivors and non survivors were compared using an analysis of variance. For maximum PSI, survivors had significantly lower scores (9.39 points) that non survivors (21.71 points). Multiple logistic regression was used to display associations between mean obtained scores and probability of death and a curve was plotted which is similar to that obtained in previous experiences from other countries. (Key words: physiologic stability index, PSI, mortality, pediatric intensive care.)El paciente critico necesita y recibe una cantidad enorme de jecursos para mantener sus posibilidades de sobrevivencia y para ayudar su progreso hacia una recuperation satisfactoria.Se han llevado a cabo variados esfuerzos para evaluar el funcionamiento de las unidades de cuidados intensivos (UCI) pediatricas y se han desarrollado diferentes sistemas para clasificar los pacientes que ingresan a ellas, determinar sus necesidades y su pronostico. Los sistemas desarrollados para clasificar a los pacientes estan destinados a calificar la severidad de la enfermedad, los requerimientos terapeuticos, la eficacia del tratamiento y el pronostico'~3. Debido a la gran variedad de causas de hospitalizacion en las CCI pediatricas el sistema para calificar a los pacientes debe ser lo suficientemente versatil para ser aplicado a diferentes problemas y edades. Existen varios indices de calificacion de gravedad de los pacientes, como por ejemplo el Sistema de Clasificacion Ch'nica (CCS) o la puntuacion basada en Intervention Terapeutlca (TISS), que miden en forma indirecta la severidad de la enfermedad en base a una evaluation de las necesidades terapeuticas. Knaus desarrollo, ademas, un sistema de clasificacion basado en alteraciones fisiologicas (APACHE) aplicable a los adultos. Sin embargo, estos procedimientos de evaluation no existian para pediatri'a hasta el ano 1984 en que se publico la validation de un indice de estabilidad fisiologica para ser aplicado en nifios (PSI) 4 ' 5 . Este indice clasifica la severidad de la enfermedad a partir del grado de alteration de 7 grandes sistemas fisiologicos e incluye 34 variables adaptadas a pacientes menores de un ano y mayores de un afto. Los objetivos de este trabajo fueron ensayar la factibilidad de aplicar el PSI a los pacientes que ingresen a nuestra unidad de cuidados intensivos pediatricos, evaluar los criterios de ingreso a dicha unidad en base a las calificaciones promedio de los pacientes ingresados y el funcionamiento de la misma correlacionando la mortalidad con las calificaciones asignadas. MATERIAL Y METODOSe aplico el PSI a todos los pacientes (n=152) que ingresaro...
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