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Corticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literatura

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dc.contributor.advisorPerez, Juan Carlos
dc.contributor.advisorJagua, Andrés
dc.creatorRodríguez Calderón, Yazmín Astrid
dc.creator.degreeEspecialista en Pediatría
dc.date.accessioned2014-01-16T18:04:59Z
dc.date.available2014-01-16T18:04:59Z
dc.date.created2013-09-23
dc.date.issued2013
dc.descriptionAntecedentes: El tratamiento de los espasmos infantiles generalmente se realiza con ACTH a pesar de perfil de efectos secundarios y el alto costo financiero. Se ha propuesto el uso de los corticoides como primera línea de tratamiento para la enfermedad, no obstante no existe certeza sobre la eficacia de este esquema. Objetivos: Evaluar la eficacia del uso de los corticoides comparados con la ACTH como primera línea de tratamiento en el manejo de pacientes con espasmos infantiles. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se efectuó en las bases de datos Pubmed, Embase, Ovid, LiLaCs y en el registro de ensayos clínicos de Estados Unidos. Se incluyeron estudios en portugués, ingles y español, no se fijo límite de tiempo para la publicación. Se realizó un análisis de riesgo de sesgo y de calidad de la evidencia utilizando el programa GRADEPRO. Se estimaron OR y sus respectivos intervalos de confianza al 95%. Resultados: Se incluyeron 4 estudios, un ensayo clínico y tres estudios de cohorte retrospectiva. Dos estudios aportaron evidencia de calidad moderada y alta. No se encontraron diferencias en la eficacia a corto plazo entre el uso de los corticoides y la ACTH sobre desenlaces clínicos o electroencefalográficos. No se encontraron estudios de seguridad a largo plazo. La seguridad a corto plazo no mostró diferencias. Conclusiones: Es muy probable que el uso de los corticoides como primera línea de tratamiento puedan reemplazar el uso de la ACTH, se requiere estudios de seguridad a largo plazo. La decisión de su uso rutinario debería estar basada en un análisis de costo efectividad y bajo la mirada del balance riesgo/beneficio.spa
dc.description.abstractBackground: The treatment of infantile spasms usually performed with ACTH despite side effect profile and the high financial cost. It has been proposed the use of corticosteroids as first-line treatment for the disease, although there is uncertainty about the effectiveness of this scheme. Objectives: To evaluate the efficacy of corticosteroids compared with ACTH as first-line treatment in the management of patients with infantile spasms. Methodology: We conducted a systematic review of the literature. The search was conducted in the databases Pubmed, Embase, Ovid, LILACS and the registration of clinical trials in the United States. We included studies in Portuguese, English and Spanish, no fixed time limit for publication. An analysis of risk of bias and quality of evidence using the program GRADEPRO. OR were estimated and their confidence intervals at 95%. Results: We included four studies, clinical trials and three retrospective cohort studies. Two studies provided evidence of moderate and high quality. No differences were found in the short-term efficacy between the use of corticosteroids and ACTH on clinical outcomes or EEG. No studies of long-term safety. The short-term safety showed no difference. Conclusions: It is likely that the use of corticosteroids as first-line treatment can replace the use of ACTH, safety studies required long term. The routine use decision should be based on an analysis of costeffectiveness and under the gaze of the risk / benefit balance.eng
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dc.identifier.doihttps://doi.org/10.48713/10336_4824
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/4824
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de medicinaspa
dc.publisher.programEspecialización en Pediatríaspa
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dc.rights.ccAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectEspasmos infantilesspa
dc.subjectcorticoidesspa
dc.subjectadrenocorticotropinaspa
dc.subjectrevisión sistemática como tópicospa
dc.subject.decsCORTICOESTEROIDES - ADMINISTRACIÓN & DOSIFICACIÓNspa
dc.subject.decsGASTROENTERELOGÓIAspa
dc.subject.decsHORMONA ADRENOCORTICOTRÓPICA - ADMINISTRACIÓN & DOSIFICACIÓNspa
dc.subject.keywordInfantile spasmseng
dc.subject.keywordcorticosteroidseng
dc.subject.keywordACTHeng
dc.subject.keywordtopically systematic revieweng
dc.titleCorticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literaturaspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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