Eficacia y seguridad de la inmunoglobulina humana usada en monoterapia en pacientes pediátricos con el síndrome inflamatorio multisistémico asociado a COVID-19: un análisis crítico de la evidencia actual

Objective: To determine the efficacy and safety of human immunoglobulin (HI) used as monotherapy, compared with corticosteroids, in pediatric patients with multisystem inflammatory syndrome (MIS) associated with COVID-19. Methods: systematic search carried out with evidence published up to April 20, 2022 in PubMed, The Cochrane Library and LILACS databases, the selection of documents focused on clinical practice guidelines (CPG), ETS, systematic reviews and clinical trials. randomized controlled trials (RCTs) in phase III. This process was complemented with a search on the web pages of organizations that carry out CPG and ETS. RCT registries were also consulted at www.ClinicalTrials.gov to identify any that are ongoing or not yet published. Results: Two CPGs prepared by the WHO and the NIH, an observational study and an ongoing phase III RCT, were analyzed. The WHO and the NIH do not recommend the use of HI in monotherapy for the treatment of SIM. An observational study found no difference between HI and corticosteroids in mortality, morbidity, and adverse events in pediatric MIS patients. Finally, a phase III RCT was identified in the process of recruiting pediatric participants with SIM, and it will seek to compare the effect of corticosteroids with HI. Conclusion: There is no evidence that the use of HI in monotherapy is more effective and safe than the use of corticosteroids in monotherapy for the treatment of pediatric patients with MIS associated with COVID-19.Objetivo: determinar la eficacia y seguridad de la inmunoglobulina humana (IH) usada en monoterapia, en comparación con corticoesteroides, en pacientes pediátricos con síndrome inflamatorio multisistémico (SIM) asociado a COVID-19. Métodos: búsqueda sistemática realizada con evidencia publicada hasta el 20 de abril de 2022 en bases de datos de PubMed, The Cochrane Library y LILACS, la selección de documentos se centró en guías de práctica cínica (GPC), ETS, revisiones sistemáticas y ensayos clínicos aleatorizados (ECA) de fase III. Este proceso se complementó con una búsqueda en páginas web de organizaciones que realizan GPC y ETS. También se consultó registros de ECA en www.ClinicalTrials.gov para identificar alguno en curso o aún no publicado. Resultados: Se analizaron dos GPC elaboradas por la OMS y el NIH, un estudio observacional y un ECA fase III en curso. La OMS y de la NIH no recomiendan el uso de la IH en monoterapia para el tratamiento de SIM. Un estudio observacional no encontró diferencias entre la IH y los corticoesteroides en la mortalidad, morbilidad y eventos adversos de pacientes pediátricos con el SIM. Finalmente, se identificó un ECA fase III en proceso de reclutamiento de participantes pediátricos con el SIM, y buscará comparar el efecto de corticoesteroides con la IH. Conclusión: No hay evidencia que el uso de la IH en monoterapia sea más eficaz y segura que el uso de corticoesteroides en monoterapia para el tratamiento de pacientes pediátricos con el SIM asociado a COVID-19

Low prevalence of ideal cardiovascular health in Peru.

BACKGROUND: The prevalence of and factors associated with ideal cardiovascular health (ICH) by sociodemographic characteristics in Peru is not well known. METHODS: The American Heart Association's ICH score comprised 3 ideal health factors (blood pressure, untreated total cholesterol and glucose) and 4 ideal health behaviours (smoking, body mass index, high physical activity and fruit and vegetable consumption). ICH was having 5 to 7 of the ideal health metrics. Baseline data from the Center of Excellence in Chronic Diseases, a prospective cohort study in adults aged ≥35 years in 4 Peruvian settings, was used (n=3058). RESULTS: No one met all 7 of ICH metrics while 322 (10.5%) had ≤1 metric. Fasting plasma glucose was the most prevalent health factor (72%). Overall, compared with ages 35-44 years, the 55-64 years age group was associated with a lower prevalence of ICH (prevalence ratio 0.54, 95% CI 0.40 to 0.74, P<0.001). Compared with those in the lowest tertile of socioeconomic status, those in the middle and highest tertiles were less likely to have ICH after adjusting for sex, age and education (P<0.001). CONCLUSION: There is a low prevalence of ICH. This is a benchmark for the prevalence of ICH factors and behaviours in a resource-poor setting

Manual para la evaluación de tecnologías sanitarias, versión corta

The objective of this article is to present the methodological guidelines established in the manual of Short Health Technology Assessment, which were developed by the Peruvian National Network of Health Technology Assessments. The purpose of the manual is to standardize the methodologies of development of Short Health Technology Assessments between institutions of health technology assessment. This manual seeks to contribute to evidence-informed decision-making to improve the population's access to safe and effective health technologies in PeruEl objetivo de este artículo es presentar las pautas metodológicas establecidas en el manual de Evaluaciones Tecnológicas Sanitarias Cortas, que fueron desarrolladas por la Red Nacional de Evaluación de Tecnologías Sanitarias del Perú. El propósito del manual es estandarizar las metodologías de desarrollo de las Evaluaciones Tecnológicas Sanitarias Cortas entre las instituciones de evaluación de tecnologías de salud. Con la elaboración de este manual se busca contribuir a la toma de decisiones informada en evidencia para mejorar el acceso de la población a tecnologías sanitarias seguras y eficaces en el país

Implementation tells us more beyond pooled estimates: Secondary analysis of a multicountry mhealth trial to reduce blood pressure

Background: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. Objective: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country. Methods: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. Results: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants’ stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. Conclusions: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake.Fil: Carrillo-Larco, Rodrigo M.. Universidad Peruana Cayetano Heredia; Perú. Imperial College London; Reino UnidoFil: Jiwani, Safia S.. Universidad Peruana Cayetano Heredia; PerúFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Kanter, Rebecca. Institute of Nutrition of Central America and Panama; Guatemala. Universidad de Chile; ChileFil: Beratarrechea, Andrea Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Institute for Clinical Effectiveness and Health Policy; ArgentinaFil: Irazola, Vilma. Institute for Clinical Effectiveness and Health Policy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Martinez, Homero. Nutrition International; Canadá. Hospital Infantil de Mexico Federico Gomez; MéxicoFil: Miranda, J. Jaime. Cronicas Centro de Excelencia En Enfermedades Crónicas; Perú. Universidad Peruana Cayetano Heredia; PerúFil: Alasino, Adrían. Funprecal; ArgentinaFil: Budiel Moscoso, Berneth Nuris. Universidad Peruana Cayetano Heredia; PerúFil: Carrara, Carolina. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Espinoza Surichaqui, Jackelyn. Universidad Peruana Cayetano Heredia; PerúFil: Giardini, Gimena. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Guevara, Jesica. Institute of Nutrition of Central America And Panama Guatemala; GuatemalaFil: Morales Juárez, Analí. Institute of Nutrition of Central America And Panama Guatemala; GuatemalaFil: Lázaro Cuesta, Lorena. Funprecal; ArgentinaFil: Lewitan, Dalia. Institute For Clinical Effectiveness And Health Policy; ArgentinaFil: Palomares Estrada, Lita. Universidad Peruana Cayetano Heredia; PerúFil: Martínez Ramírez, Carla. Universidad Peruana Cayetano Heredia; PerúFil: de la Cruz, Gloria Robles. Universidad Peruana Cayetano Heredia; PerúFil: Salguero, Julissa. Institute Of Nutrition Of Central America And Panama Guatemala; GuatemalaFil: Saravia Drago, Juan Carlos. Universidad Peruana Cayetano Heredia; PerúFil: Urtasún, María. Institute For Clinical Effectiveness And Health Policy; ArgentinaFil: Zavala Loayza, José Alfredo. Universidad Peruana Cayetano Heredia; Per