Browsing by Author "Izcovich, Ariel"
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Publication Effectiveness and safety of the tetravalent TAK-003 dengue vaccine: a systematic review(2024) Bengolea, AgustIn; Scigliano, Clara; Ramos, Jose; Rada, Gabriel; Catalano, Hugo; Izcovich, ArielIn Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to evaluate the effectiveness and safety of the TAK-003 tetravalent dengue vaccine in this context. A systematic review of randomized controlled trials comparing the effectiveness and safety of the vaccine with placebo in the general population was conducted. The search was carried out in Epistemonikos, and two researchers independently assessed the studies. Risk of bias was evaluated using the Cochrane Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was assessed using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the dengue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine's safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.Item First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)(2018) Pons-Estel, Bernardo; Bonfa, Eloisa; Soriano, Enrique R.; Izcovich, Ariel; Popoff, Federico; Criniti, Juan M.; Vásquez, Gloria; Massardo, Loreto; Duarte, Margarita; Barile-Fabris, Leonor A.; García, Mercedes A.; Amigo, Mary-Carmen; Espada, Graciela; Catoggio, Luis J.; Sato, Emilia Inoue; Levy, Roger A.; Acevedo Vásquez, Eduardo M.; Chacón-Díaz, Rosa; Galarza-Maldonado, Claudio M.; Iglesias Gamarra, Antonio J.; Molina, José Fernando; Neira, Oscar; Silva, Clovis A.; Vargas Peña, Andrea; Gómez-Puerta, José A.; Scolnik, Marina; Pons-Estel, Guillermo J.; Ugolini-Lopes, Michelle R.; Savio, Verónica; Drenkard, Cristina; Alvarellos, Alejandro J.; Ugarte-Gil, Manuel F.; Babini, Alejandra; Cavalcanti, André; Cardoso Linhares, Fernanda Athayde; Haye Salinas, Maria Jezabel; Fuentes-Silva, Yurilis J.; Montandon de Oliveira E Silva, Ana Carolina; Eraso Garnica, Ruth M.; Herrera Uribe, Sebastián; Gómez-Martín, Diana; Robaina Sevrini, Ricardo; Quintana, Rosana M.; Gordon, Sergio; Fragoso-Loyo, Hilda; Rosario, Violeta; Saurit, Verónica; Appenzeller, Simone; Torres Dos Reis Neto, Edgard; Cieza, JorgeSystemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Publication Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline(2025) Lamelas, Pablo; Pompeu, Michel; Izcovich, Ariel; Bottaro, Federico; Tisi Baña, Matias; Sosa Liprandi, María Inés; Lanas, Fernando; Vilca Mejia, Omar Asdrúbal; Zuñiga Luna, Mauricio; Aubanel, Patricia; Munera, Ana; Contreras Reyes, Juan; Bagur, Rodrigo; Whitlock, Richard; Garcia Garcia, Héctor; Mamas Mamas; Cohen, Mauricio G.; Ricalde, Alejandro; Abizaid, Alexandre; Mendiz, Oscar; Araya, Mario; Costa, Ricardo; Santaera, Omar; Hidalgo, Pedro; Caldonazo, Tulio; Baranchuk, Adrian; Ragusa, Martin Alberto; SOLACI; SIACBackground Severe left main coronary artery disease (LMD) poses a major treatment challenge in Latin America, where both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used. Methods This guideline was developed de novo using the GRADE approach. A multidisciplinary panel reviewed evidence from a systematic review of randomized trials comparing PCI and CABG, incorporating a comprehensive literature search of patient values and preferences and outcome utilities. Thresholds were assigned for each clinical outcome, from small to large effect. Results Five randomized trials enrolling 4612 patients were included. At 30 days, PCI resulted in a large reduction in major bleeding and a small reduction in strokes. At 5 years, PCI was associated with a small to moderate increase of spontaneous myocardial infarction and a moderate to large increase in repeat revascularization. No important differences in short- or long-term mortality were observed between PCI and CABG. The overall certainty of evidence was rated low. There was a notable variability in patient values and a close call on the balance of effects. Conclusions For patients in Latin America with severe left main coronary artery disease, the guideline panel suggests either PCI or CABG. This is a conditional recommendation, based on low certainty in the evidence (⨁⨁◯◯). It applies when both procedures are clinically and anatomically appropriate and can be performed at centers meeting acceptable standards. The decision should be made through a shared decision-making process involving the patient and the multidisciplinary care team.