Meta-Analysis of Breast Cancer Risk in Levonorgestrel-Releasing Intrauterine System Users.

To map and assess evidence regarding use of the levonorgestrel-releasing intrauterine system (LNG-IUS) and its association with breast cancer, we conducted a systematic review and meta-analysis. A search strategy was developed using the terms "Levonorgestrel-releasing," "LNG-IUS," "intrauterine system," and "breast cancer. The electronic databases searched were MEDLINE, Embase, Cochrane Library, Latin American & Caribbean Health Sciences Literature, and Google Scholar for studies published until August 2020. We included observational studies: prospective or retrospective cohort, case-control, and cross-sectional. A total of 494 studies were identified, 294 studies were evaluated by title and abstract, and 262 were excluded because they did not meet the inclusion criteria. A total of 32 studies were read in full, and 24 were excluded. Thus, eight studies were included in the systematic review. The meta-analysis included four studies (two cohort and two case-control studies). Two subgroup analyses were performed for different study designs. The estimated relative risk for the two cohort studies (144,996 cases), with moderate-quality evidence, was 0.93 (95% confidence interval [CI], 0.840-1.03). The odds ratio estimated for the two case-control studies (5556 cases and 35987 controls), with moderate-quality evidence, was 1.07 (95% CI, 0.91-1.26). Evidence of an increased risk of breast cancer was not observed in levonorgestrel-releasing intrauterine system users.

Rapid assessment of the ichthyofauna of the southern Guiana Shield tributaries of the Amazonas River in Pará, Brazil

The Northern Pará Drainage System encompasses the left-bank tributaries of the Amazonas River in the southern Guiana Shield region of Pará state, Brazil. Five of the region's state protected areas are considered strategic for the conservation of its biodiversity. In the present study, we assessed the ichthyofauna of the five state protected areas of the Northern Pará Drainage System. Seven expeditions were conducted between January 2008 and January 2009, which surveyed stretches of the Cuminá, Cuminapanema, Curuá, Jari, Mapuera, Nhamundá, and Paru rivers. These surveys yielded 286 species belonging to 38 families and eight orders, including seven new records of fish species for Brazil, six of which are also new records for the Amazon basin. Our results provide a valuable database for future research and conservation programs in the protected areas of the region. (AU)

Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis.

BACKGROUND: The objective of the study was to verify the accuracy of hyperbilirubinaemia as a marker for acute perforated appendicitis. METHODS: A comprehensive search of the MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts and Grey literature from January 1969 to July 2014. We included cross-sectional and cohort studies, prospective and retrospective, which evaluated hyperbilirubinaemia level in perforated appendicitis and compared them with histological analysis of all appendectomy specimens. RESULTS: Eleven studies were analysed, which included 5395 patients. Pooled sensitivity was 54.6% (95% confidence interval (CI), 42.8-65.8) and specificity was 70.0% (95% CI, 54.7-81.9%) using STATA. The diagnostic odds ratio was 2.82 (95% CI, 1.38-5.72%). Summary receiver operating characteristic curves were constructed. The area under the curve was 0.65. CONCLUSION: This meta-analysis showed that the value of hyperbilirubinaemia alone cannot predict acute perforated appendicitis.

Weekly fluconazole therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis.

OBJECTIVE: To investigate the efficacy, compared to placebo, of fluconazole 150 mg weekly, given for six months as prophylaxis against recurrent vulvovaginal candidiasis (RVVC). STUDY DESIGN: A quantitative systematic review was performed, and randomized controlled trials were included. We conducted searches at Medline, EMBASE, Lilacs, Cochrane Library and ICI Web of Science from 1980 to March 2012. We used the odds ratio (OR) with confidence intervals (CI) of 95% using a random effects model of Mantel-Haenszel. The software used was Review Manager version 5.0. RESULTS: Through the search strategies we identified 249 articles, of which only two were part of the meta-analysis. Fluconazole was more effective than placebo in reducing symptomatic episodes of VVC, immediately after treatment (OR 0.10, 95% CI 0.03-0.34), 3 months after treatment (OR 0.23, 95% CI 0.07-0.74) and 6 months after treatment (OR 0.39, 95% CI 0.24-0.64). CONCLUSION: Weekly treatment with fluconazole (150 mg) for six months is effective against RVVC.

Accuracy of telomerase in estimating breast cancer risk: a systematic review and meta-analysis.

OBJECTIVE: To determine the accuracy of telomerase activity in predicting a higher risk for breast cancer. STUDY DESIGN: A quantitative systematic review was performed. Studies that detected telomerase activities in breast tissue were included. RESULTS: Twenty-five primary studies were analyzed, which included 2395 breast lesions. The proportion of breast cancer was 60.8%. Eighty-two percent (1193/1455) of breast cancer cases and 18% (169/940) of benign lesions cases were positive for telomerase activity. For breast cancer vs benign or normal breast tissue, the pooled likelihood ratio for the presence of telomerase activity was 4.5 (95% confidence interval [CI], 3.1-6.5) and the post-test probability was 88% (95% CI, 83-91). For breast cancer vs benign or normal tissue, the area under the summary receiver operating characteristic (SROC) curve was 0.89 with the Q* point value of 0.82. CONCLUSION: Our systematic review showed that telomerase activity was significantly present in breast cancer when compared with normal breast tissue or benign breast lesions.

Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review.

OBJECTIVE: To estimate the diagnostic accuracy of magnetic resonance in ovarian tumors. STUDY DESIGN: A quantitative systematic review was performed. Studies that compared magnetic resonance and paraffin sections within subjects for diagnosis of ovarian tumors were included. RESULTS: Fifteen primary studies were analyzed, which included 1267 ovarian masses. For borderline or malignant ovarian cancer vs benign ovarian lesions, the pooled likelihood ratio for the occurrence of a positive magnetic resonance result was 6.6 (95% confidence interval, 4.7-9.2) and the posttest probability for borderline or malignant diagnosis was 77% (95% confidence interval, 70-82). Because specificity and likelihood ratio positive were heterogeneous, a random effect model was used and a summary receiver operating characteristic curve was generated. For borderline or malignant ovarian cancer vs benign ovarian lesions, the area under curve was 0.9526. CONCLUSION: Magnetic resonance seems to be a useful preoperative test for predicting the diagnosis of pelvic masses.