Browsing by Author "Rada, Gabriel"
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Item Definition of Uveitis Refractory to Treatment: A Systematic Review in the Absence of a Consensus(2020) Valenzuela, Rodrigo A.; Flores, Iván; Pujol, Myriam; Llanos, Carolina; Carreño, Ester; Rada, Gabriel; Herbort Jr, Carl P.; Cuitino, Loreto; Urzúa, CristhianPurpose: To evaluate the different definition of refractoriness in uveitis in the literature. Methods: We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018. Results: Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity. Conclusions: The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.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.Publication Local injection of botulinum toxin for the prevention of hypertrophic scars and keloids: an overview of reviews(2025) Silva, Iván; Ramos, José; Peña, Javiera; Novillo, Francisco; Rada, GabrielIntroduction: Hypertrophic scars and keloids arise from an abnormal healing process in the skin, significantly affecting the quality of life. There is a wide array of treatment options available, but they often come with high costs and yield inconsistent results. Botulinum toxin is one such option that is thought to have a preventive effect, although evidence from multiple reviews have not provided a clear answer. Our objective is to compile evidence from systematic reviews of randomized controlled trials concerning the impact of local botulinum toxin injection on preventing hypertrophic scars and keloid formation following surgical skin trauma. Methods: We conducted an overview of reviews following the Preferred Reporting Items for Overviews of Reviews (PRIOR) reporting guidelines. We searched for the Epistemonikos Database up to January 2024. Quality was assessed using the AMSTAR-2 tool. We compared reviews addressing similar questions, calculated the covered area and corrected covered area to assess overlap, and explored reasons for differences between reviews. Results: Fifteen systematic reviews were included. All were classified as having low or critically low confidence according to AMSTAR-2. The covered area was 28.38%, and the corrected covered area was 23.26%, indicating very high overlap. Findings of the included reviews showed a beneficial effect on scar appearance and patient satisfaction, but in adverse events the direction of effect varied. Conclusion: Botulinum toxin could be an alternative for preventing hypertrophic scars and keloids after surgical skin trauma, but given the low confidence of the reviews, these results should be interpreted with caution. Introducción: Las cicatrices hipertróficas y los queloides resultan de un proceso de cicatrización anómalo que puede afectar significativamente la calidad de vida. Existen diversas alternativas terapéuticas; sin embargo, suelen implicar altos costos y resultados poco predecibles. La toxina botulínica se ha propuesto como tratamiento preventivo, aunque la evidencia disponible no ha permitido establecer conclusiones definitivas. El objetivo de este estudio fue sintetizar la evidencia proveniente de revisiones sistemáticas de ensayos clínicos aleatorizados sobre el efecto de la inyección local de toxina botulínica en la prevención de cicatrices hipertróficas y queloides posteriores a trauma quirúrgico cutáneo. Métodos: Se realizó una revisión panorámica siguiendo las directrices PRIOR (Preferred Reporting Items for Overviews of Reviews). Se buscó en la base de datos Epistemonikos hasta enero de 2024. La calidad de las revisiones se evaluó mediante la herramienta AMSTAR-2. Se compararon revisiones con preguntas similares, se calcularon el área cubierta y el área cubierta corregida para determinar el grado de superposición, y se exploraron las causas de las diferencias entre las revisiones. Resultados: Se incluyeron quince revisiones, todas con nivel de confianza bajo o críticamente bajo según AMSTAR-2. El área cubierta fue de 28,38% y el área cubierta corregida del 23,26%, lo que indica una superposición elevada. Las revisiones reportaron un efecto beneficioso sobre la apariencia de las cicatrices y la satisfacción del paciente; no obstante, los resultados respecto a eventos adversos fueron variables.