Use of nitrous oxide in the treatment of major depressive disorder and treatment-resistant major depressive disorder: A systematic review and meta-analysis nitrous oxide in depressive disorders.

Major Depressive Disorder (MDD) has, as a conventional treatment, pharmacological therapy with selective monoamine reuptake inhibitors. However, the medication does not always have a rapid action for exacerbated cases, and moreover, it is estimated that 15 to 30% of patients do not respond effectively to conventional treatment, leading to 'treatment-resistant depressive mood disorder' (TRD). Thus, it is necessary to search for new therapeutic methods for exacerbated and resistant cases. The objective of the study was to evaluate the therapeutic effects of nitrous oxide (N2O) in patients with MDD and TRD. The study was characterized as a systematic review of randomized clinical trials. Search strategy was developed using the keywords "nitrous oxide," "treatment-resistant depression," "Depression disorder," and their synonyms, searched in the databases MEDLINE, EMBASE, LILACS, and American Psychological Association. Four articles were included in the systematic review, with two of them being utilized for the meta-analysis, which comprised a total of 23 patients with MDD and 86 with TRD. A standardized mean difference (SMD) for the HDRS score at 24 h of -2.36 was found, with a 95% confidence interval (CI) of -3.37 to -1.34 (p < 0.0001; I2 = 46%). For the evaluation of the score after one week, an SMD of -0.60, 95% CI of -1.13 to -0.07 (p = 0.03; I2 = 0%) was found. In conclusion, N2O has a rapid action for managing decompensated patients, with a potential therapeutic effect for TRD. However, more studies needed to determine N2O's effectiveness duration.

Evaluation of N-acetyl-ß-D-glucosaminidase as a prognostic marker for diabetic nephropathy in type 2 diabetics: systematic review and meta-analysis.

OBJECTIVE: This review aimed to assess the utility of urinary N-acetyl-ß-D-glucosaminidase (uNAG) as a prognostic biomarker for nephropathy in patients with type 2 diabetes mellitus. METHODS: The search for relevant studies was conducted across multiple databases, including PubMed (Medline), EMBASE, LILACS, CENTRAL, IBECS, and gray literature. We employed a random effects model to calculate the standardized mean difference and 95% confidence interval. Furthermore, we assessed heterogeneity using Cochrane's Q test and Higgins' I2 statistics. RESULTS: This review included a total of 16 articles involving 1669 patients, with 13 being case-control studies and three being cohorts. The meta-analysis conducted across all studies revealed significant heterogeneity. However, subgroup analysis of four studies indicated that an increase in uNAG among normoalbuminuric patients was associated with the development of macroalbuminuria (DMP = - 1.47; 95% CI = - 1.98 to 0.95; p < 0.00001; I2 = 45%). Conversely, it did not demonstrate effectiveness in predicting the development of microalbuminuria (DMP = 0.26; 95% CI = - 0.08 to 0.60; p = 0.13; I2 = 17%). CONCLUSIONS: Elevated uNAG levels in normoalbuminuric patients may indicate an increased risk for the development of macroalbuminuria, but not microalbuminuria. However, the high heterogeneity observed among the studies highlights the necessity for further research to validate these findings.

Pet-saúde na identificação do conhecimento de gestantes sobre aleitamento materno / Pet-saúde in identifying the knowledge of pregnant women about breastfeeding / Pet-salud en la identificación del conocimiento de gestantes sobre amamantamiento materno

Objetivou-se identificar o conhecimento sobre aleitamento materno de vinte gestantes em acompanhamento pré-natal na atenção primária à saúde de Uberaba, Minas Gerais. O estudo é de caráter transversal e descritivo e foi desenvolvido em julho de 2011, por meio de entrevista estruturada, cuja análise baseou-se na estatística descritiva. As questões relacionadas às recomendações difundidas na mídia e serviços de saúde, como o momento ideal para a primeira mamada, a duração recomendada de aleitamento materno exclusivo e o uso de bicos artificiais, apresentaram maior número de acertos que de erros; as questões ligadas ao manejo do aleitamento materno, como duração de uma mamada, intervalo entre as mamadas e manutenção e aumento da produção láctea, apresentaram maior número de erros que de acertos. A maioria das mulheres não soube responder as questões relacionadas ao manejo de complicações e intercorrências mamárias como ingurgitamento mamário e fissuras mamilares, as quais também não apresentaram respostas corretas. Esta situação reflete a falta de preparo dos profissionais de saúde para a atuação em aleitamento materno. Neste contexto, o trabalho desenvolvido pelo Programa de Educação pelo Trabalho para a Saúde - PET-Saúde ganha destaque.

The objective was to identify the knowledge about breastfeeding of 20 pregnant women in prenatal care in primary health care at Uberaba, Minas Gerais. It was a cross-sectional descriptive study developed in July 2011 through structured interviews, which analysis was based on descriptive statistics. Issues related to the recommendations widespread in the media and health services, as the ideal time to first feeding, the recommended duration of exclusive breastfeeding and use of artificial pacifiers and bottles had more hits than errors. Issues related to the management of breastfeeding as the feeding duration, interval between feedings and the maintenance and increasing of milk production had more errors than hits. Most women could not answer questions relating to the management of complications and problems like breast engorgement and nipple fissures, which also showed no incorrect answers. This situation reflects the lack of ability of health professionals to promote breastfeeding. In this context the work of Programa de Educação pelo Trabalho para a Saúde - PET-Saúde is highlighted.

El objetivo fue identificar el conocimiento sobre la lactancia materna de 20 gestantes en control prenatal en la atención primaria a la salud en Uberaba, Minas Gerais. Se trató de un estudio transversal y descriptivo, desarrollado en julio de 2011, a través de entrevista estructurada, cuyo análisis se basó en la estadística descriptiva. Las cuestiones relacionadas con las recomendaciones difundidas en los medios de comunicación y servicios de salud, como el momento ideal para la primera mamada, la duración recomendada de amamantamiento materno exclusivo y el uso de chupetes y biberones presentaron más aciertos que errores. Las cuestiones relacionadas con el manejo de la lactancia materna como la duración de una mamada, el intervalo entre ellas y mantenimiento y aumento de la producción láctea presentaron mayor número de errores que aciertos. La mayoría de las mujeres no supo responder las preguntas relativas al manejo de complicaciones y problemas como la congestión mamaria y grietas en el pezón, pero tampoco hubo respuestas incorrectas. Esta situación refleja la falta de preparación por parte de los profesionales de salud para la acción sobre la lactancia materna. En este contexto, el trabajo desarrollado por el Programa de Educación por el Trabajo para la Salud - PET-Salud - se destaca.