Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis.

OBJECTIVE: To estimate the accuracy of pelvic magnetic resonance imaging (MRI) in the diagnosis of deeply infiltrating endometriosis (DIE). METHODS: A comprehensive search of the Medline, Pubmed, Lilacs, Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, and ISI Web of Science databases was conducted from January 1990 to December 2013. The medical subject headings (MeSHs) and text words "deep endometriosis", "deeply infiltrating endometriosis", "DIE", "magnetic resonance", and "MRI" were searched. Studies that compared the parameters of pelvic MRIs with those of paraffin-embedded sections for the diagnosis of DIE were included. RESULTS: Twenty studies were analyzed, which included 1,819 women. Pooled sensitivity and specificity were calculated across eight subgroups: for all sites, these were 0.83 and 0.90, respectively; for the bladder, 0.64 and 0.98, respectively; for the intestine, 0.84 and 0.97, respectively; for the pouch of Douglas, 0.89 and 0.94, respectively; for the rectosigmoid, 0.83 and 0.88, respectively; for the rectovaginal, 0.77 and 0.95, respectively; for the uterosacral ligaments, 0.85 and 0.80, respectively; and for the vagina and the posterior vaginal fornix, 0.82 and 0.82, respectively. CONCLUSION: In summary, pelvic MRI is a useful preoperative test for predicting the diagnosis of multiple sites of deep infiltrating endometriosis.

The prevalence of human papillomavirus in ovarian cancer: a systematic review.

OBJECTIVE: We performed a systematic review and a meta-analysis to estimate the prevalence of human papillomavirus (HPV) in ovarian cancer. METHODS: A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, Grey literature and EMBASE was performed for articles published from January 1990 to March 2012. The following MeSH (Medical Subject Headings) terms were searched: "ovarian tumor" or "ovarian cancers" and "HPV" or "human papillomavirus." Included were case-control and cross-sectional studies, prospective or retrospective, that evaluated clinical ovarian cancer and provided a clear description of the use of in situ hybridization, Southern blot hybridization, and polymerase chain reaction. The statistical analysis was performed using REVMAN 5.0. RESULTS: In total, 24 primary studies were included in this meta-analysis. Studies from 11 countries on 3 continents contained data on HPV and ovarian cancer, including 889 subjects. Overall, the HPV prevalence in patients with ovarian cancer was 17.5 (95% confidence interval [CI], 15.0%-20.0%). Human papillomavirus prevalence ranged from 4.0% (95% CI, 1.7%-6.3%) in Europe to 31.4% (95% CI, 26.9%-35.9%) in Asia. An aggregate of 4 case-control studies from Asia showed an odds ratio of 2.48 (95% CI, 0.64-9.57). CONCLUSIONS: We found a high prevalence of HPV-positive DNA in ovarian cancer cases, but the role of HPV in ovarian cancer remains inconclusive. Further studies are needed to control case to answer this question.

Bifidobacterium lactis CCT 7858 Improves Gastrointestinal Symptoms by Antibiotics Treatment: a Double-Blind, Randomized, Placebo-Controlled Trial.

Diarrhea is one of the most frequent side effects of antibiotic treatment and occurs in 25 to 40% of patients in use. One potential strategy to prevent this side effect is the concurrent use of probiotics. This study evaluated the efficacy of the strain Bifidobacterium lactis CCT 7858 in the prevention of diarrhea and improvement of gastrointestinal symptoms in hospitalized patients using antibiotics. This was a randomized, blinded, placebo-controlled clinical trial. This study included 104 patients in antibiotic treatment. Patients were randomized into two groups: placebo (maltodextrin) and intervention (strain Bifidobacterium lactis CCT 7858 at 9 × 1010 CFU concentration; GABBIA® Biotecnology, Santa Catarina, Brazil). Patients were supplemented depending on the duration of antibiotic therapy, and both were evaluated with scales in two moments: before and after treatment. We included 104 hospitalized patients. In follow-up, 38 (74.5%) of the B. lactis group have no reported diarrhea. In secondary outcomes, in five day strong abdominal distension was reported in 4 (7,3) placebo group and not reported in B. lactis. Abdominal noises, nausea, and vomiting were not registered in any group. B. lactis strain has been considered safe and with several benefits, including reduction of soft stools and gastrointestinal symptoms how abdominal noise, pain and distension, as well reduction of diarrhea.

Respiratory Outcomes After 6 Months of Hospital Discharge in Patients Affected by COVID-19: A Prospective Cohort.

Background: Considering millions of people affected by Coronavirus disease 2019 (COVID-19), long-lasting sequelae can significantly impact health worldwide. Data from prospective studies in lower-middle-income countries on persistent lung dysfunction secondary to COVID-19 are lacking. This work aims to determine risk factors and the impact of persistent lung dysfunctions in COVID-19 survivors. Methods: Observational and prospective cohort of patients admitted to a tertiary hospital from June 2020 to November 2020. Persistence of chest CT scan alterations, desaturation in the six-minute walk test (6MWT), forced expiratory volume in one second (FEV1), lung carbon monoxide diffusion (DLCO), and maximum inspiratory pressure (MIP) were measured 6 months after hospital discharge. Additionally, the Barthel index (BI) and the Modified Medical Research Council (mMRC) Dyspnea Scale were used to determine the impact of lung dysfunction in activities of daily living (ADL). Results: It was included 44 patients. Sixty percent had persistent lung CT scan abnormalities. From 18 to 43% of patients had at least one pulmonary function dysfunction, a decrease in FEV1 was the least prevalent (18%), and a reduction in DLCO and MIP was the most frequent (43%). In general, female gender, comorbidity index, and age were associated with worse lung function. Additionally, the presence of lung dysfunction could predict worse BI (r-square 0.28) and mMRC (r-square 0.32). Conclusion: Long-term lung dysfunction is relatively common in survivors from severe COVID-19 and impacts negatively on ADL and the intensity of dyspnea, similar to studies in high-income countries.

Effects of different probiotic strains B. lactis, L. rhamnosus and L. reuteri on brain-intestinal axis immunomodulation in an endotoxin-induced inflammation.

The study evaluated the effects of supplementation with three different probiotic strains Bifidobacterium lactis (LACT GB™), Lactobacillus rhamnosus (RHAM GB™) and Lactobacillus reuteri (REUT GB™) on brain-intestinal immunomodulation in an animal model of LPS-induced inflammation. Fifty mice Balb/C were distributed into five groups: control; lipopolysaccharide (LPS); LPS + B. lactis (LACT GB™); LPS + L. rhamnosus (RHAM GB™); and LPS + L. reuteri (REUT GB™). The animals were supplemented with their respective probiotic microorganisms daily, for 30 days, at a concentration of 1 × 109 CFU/animal/day. After 30 days of supplementation, animals received the inflammatory insult by LPS (15 mg/kg). Behavioral tests, oxidative stress and inflammation were performed, as well as gut and brain histology. In the behavioral test, LPS + B. lactis group was less anxious than the other groups. Serum interleukin IL-1ß and IL-6 levels increased in all groups that received the LPS insult, and there was a reduction in inflammation in the supplemented groups when compared to the LPS group in brain and gut. There is a reduction in myeloperoxidase activity and oxidative stress in groups supplemented with probiotics. In intestine histological analysis occurs damage to the tissue integrity in the LPS group, in the other hand, occurs preservation of integrity in the probiotic supplemented animals. In the brain, infiltrates of perivascular inflammatory cells can be seen in the LPS group. The three probiotic studies showed efficient immunomodulating activity and ensured integrity of the intestinal barrier function, even after the severe insult by LPS. These results show the important role of probiotics in the gut-brain axis. Graphical abstract illustratively represents the gut-brain axis and how different probiotic strains influence the immunomodulatory response releasing different pro- and anti-inflammatory cytokines, and their role in the balance of dysbiosis.

Efficacy of infliximab in treatment-resistant depression: A systematic review and meta-analysis.

BACKGROUND: Treatment-resistant depression (TRD) denotes the therapeutic failure of at least two evidence-based, dose-based, and time-appropriate treatment regiments for major depressive disorder (MDD). Studies have suggested that alterations in proinflammatory cytokines play an important role in the pathophysiology of TRD, as well as a significant relationship between the number of failed treatment and the levels of tumor necrosis factor-alpha (TNF-α). OBJECTIVE: Performed a systematic review and meta-analysis to evaluate the potential effect of the TNF-inhibitor Infliximab adjunct treatment in MDD, through randomized controlled trials (RCT). METHODS: A search in the electronic databases was proceeded, on MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, Web of Science, IBECS, LILACS, PsycINFO, Congress Abstracts, and Grey literature (Google Scholar and the British Library) for studies published until April 2019. A search strategy was developed using the terms: "Mood disorder" OR "Depressive Disorder" OR "Bipolar disorder" AND "Infliximab" OR "tumor necrosis factor antagonist" as text words and Medical Subject Headings (i.e., MeSH and EMTREE). The therapeutic effects of adjunctive treatment with Infliximab were analyzed. The meta-analysis was performed including the results of the Hamilton Scale for Depression (HAM-D). RESULTS: Four primary studies were included in the systematic review, with a total of 152 patients. The meta-analysis did not show a statistically significant effect of Infliximab as an adjuvant treatment for TRD. LIMITATIONS: Articles in this meta-analysis originate from the same country. The main treatments used were different among the included studies. CONCLUSION: Infliximab was not efficient in reducing depressive symptoms according to the HAM-D, only when the patients already had increased inflammatory genes, including TNF and C-reactive protein (CRP).

Evaluation of the dopaminergic system with positron-emission tomography in alcohol abuse: A systematic review.

OBJECTIVE: Performed a systematic review to evaluated the dopaminergic system in alcohol abuse in a systematic review in humans. METHOD: A search of the electronic databases was proceeded, on MEDLINE, EMBASE, Cochrane Library, Insight and Gray literature (Google Scholar and the British Library) for studies published until August 2018. A search strategy was developed using the terms: "dopamine" and "ethanol" or ""alcohol"," and "positron-emission tomography" as text words and Medical Subject Headings (i.e., MeSH and EMTREE) and searched. RESULTS: We found 293 studies. After reading titles and abstracts 235 were considered irrelevant, as they did not meet the inclusion criteria. For the reading of the full text, 50 studies were analyzed. Of these 41 were excluded with reasons by study design, patient population, intervention and outcomes. Nine studies were included in our qualitative synthesis. Four studies have resulted in a reduction in availability only at the D2 receptor in different brain regions. Concerning the D3 receptor alone only one study reported this finding and four studies reported a decrease in both receptors. CONCLUSION: Changes in D2 receptors in several brain regions in human alcoholics were found in a systematic review.

O uso das redes sociais pelos órgãos gestores do Sistema Único de Saúde

Objetivo: o presente estudo tem como objetivo compreender como ocorre o uso das redes sociais por gestores do Sistema Único de Saúde em nível municipal, estadual e nacional e seu alcance para a população. Métodos: trata-se de um estudo documental de métodos mistos e descritivo, realizado nas redes sociais Instagram, Facebook e Twitter da Secretaria Municipal de Saúde de Criciúma, Secretaria Estadual de Saúde de Santa Catarina e Ministério da Saúde. Considerou-se na análise quantitativa o número de publicações, curtidas, seguidores e comentários, e na análise qualitativa o conteúdo das postagens, comentários, respostas aos comentários e engajamento. Resultados: os resultados indicaram o baixo alcance da população nas redes sociais dos órgãos investigados e o destaque no número de postagens em âmbito nacional. Ainda, no que se refere ao conteúdo das postagens, o Ministério da Saúde destaca publicações educativas, enquanto as secretarias municipal e estadual apresentam mais postagens relacionadas a repasses financeiros e compra de novos equipamentos. Conclusão: foi possível identificar que, apesar da importância das redes sociais no acesso e disseminação de informações, avanços ainda são necessários para contemplar as potencialidades e fortalecimento dos serviços de saúde a partir da internet.

[Meta analysis of the use of Bayesian networks in breast cancer diagnosis]. / Metanálise do uso de redes bayesianas no diagnóstico de câncer de mama.

The aim of this study was to determine the accuracy of Bayesian networks in supporting breast cancer diagnoses. Systematic review and meta-analysis were carried out, including articles and papers published between January 1990 and March 2013. We included prospective and retrospective cross-sectional studies of the accuracy of diagnoses of breast lesions (target conditions) made using Bayesian networks (index test). Four primary studies that included 1,223 breast lesions were analyzed, 89.52% (444/496) of the breast cancer cases and 6.33% (46/727) of the benign lesions were positive based on the Bayesian network analysis. The area under the curve (AUC) for the summary receiver operating characteristic curve (SROC) was 0.97, with a Q* value of 0.92. Using Bayesian networks to diagnose malignant lesions increased the pretest probability of a true positive from 40.03% to 90.05% and decreased the probability of a false negative to 6.44%. Therefore, our results demonstrated that Bayesian networks provide an accurate and non-invasive method to support breast cancer diagnosis.

Meta-analysis identifies tumor necrosis factor-alpha and interleukin-1 beta as diagnostic biomarkers for bacterial and aseptic meningitis.

BACKGROUND: Meningitis is a complex and severe acute infectious disease of the central nervous system and is caused mainly by bacteria and viruses. However, the distinction between aseptic and bacterial meningitis can be difficult for clinicians because the symptoms and the results of laboratory assays are often similar and overlapping, particularly when the use of antibiotics is administered prior to examining the cerebrospinal fluid. METHODS: We determined the accuracy of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1ß) for the differential diagnosis between bacterial and aseptic meningitis. A comprehensive search was performed for papers published from January 1989 to July 2013. Prospective or retrospective studies and cerebrospinal fluid (CSF) TNF-α and/or IL-1ß cytokine concentrations for differential diagnosis distinguishing bacterial from aseptic meningitis were included. RESULTS: A statistical analysis was performed using Revman and Meta-Disc. This systematic review showed that TNF-α has a sensitivity of 80.5%, specificity of 94.9%, diagnostic odds ratio (DOR) of 71.7, and area under the curve (AUC) = 0.942; IL-1ß showed a sensitivity of 86.0%, specificity of 92.3%, DOR of 53.5, and AUC = 0.975. CONCLUSION: Therefore, TNF-α and IL-1ß are useful markers for the prediction of the bacterial meningitis and levels may represent an accurate method that is useful for the differentiation between bacterial and aseptic meningitis.

Metanálise do uso de redes bayesianas no diagnóstico de câncer de mama / Meta analysis of the use of Bayesian networks in breast cancer diagnosis / Metaanálisis del uso de los modelos bayesianos en el diagnóstico de cáncer de mama

O objetivo deste estudo foi avaliar a acurácia das redes bayesianas no apoio ao diagnóstico de câncer de mama. Foram realizadas revisão sistemática e metanálise, que incluíram artigos e relatórios publicados entre Janeiro de 1990 e Março de 2013. Foram incluídos estudos transversais prospectivos e retrospectivos que avaliaram a acurácia do diagnóstico de lesões de mama (condição alvo) usando as redes bayesianas (teste em avaliação). Quatro estudos primários que incluíram 1.223 lesões de mama foram analisados, 89,52% (444/496) dos casos de câncer de mama e 6,33% (46/727) das lesões benignas foram positivas tendo-se como base a análise das redes bayesianas. A área dentro da curva SROC (característica de operação do receptor sumária) foi 0,97, com um valor Q* de 0,92. O uso de redes bayesianas no diagnóstico de lesões malignas aumentou a probabilidade pré-teste para um verdadeiro positivo de 40,03% para 90,05% e diminuiu a probabilidade de um falso negativo para 6,44%. Portanto, nossos resultados demonstraram que as redes bayesianas oferecem um método acurado e não invasivo no apoio ao diagnóstico de câncer de mama.

The aim of this study was to determine the accuracy of Bayesian networks in supporting breast cancer diagnoses. Systematic review and meta-analysis were carried out, including articles and papers published between January 1990 and March 2013. We included prospective and retrospective cross-sectional studies of the accuracy of diagnoses of breast lesions (target conditions) made using Bayesian networks (index test). Four primary studies that included 1,223 breast lesions were analyzed, 89.52% (444/496) of the breast cancer cases and 6.33% (46/727) of the benign lesions were positive based on the Bayesian network analysis. The area under the curve (AUC) for the summary receiver operating characteristic curve (SROC) was 0.97, with a Q* value of 0.92. Using Bayesian networks to diagnose malignant lesions increased the pretest probability of a true positive from 40.03% to 90.05% and decreased the probability of a false negative to 6.44%. Therefore, our results demonstrated that Bayesian networks provide an accurate and non-invasive method to support breast cancer diagnosis.

El objetivo de este estudio fue evaluar la exactitud de las redes bayesianas para apoyar el diagnóstico de cáncer de mama. Se realizó una revisión sistemática y un metaanálisis, que incluyeron artículos y estudios publicados entre enero de 1990 y marzo de 2013. Se incluyeron estudios transversales prospectivos y retrospectivos, que evaluaron la exactitud del diagnóstico de lesiones mamarias (condición de destino), utilizando redes bayesianas (prueba de evaluación). Se analizaron cuatro estudios que incluyeron 1.223 lesiones de mama primarias, un 89,52% (444/496) de los casos de cáncer de mama, y un 6,33% (46/727) de las lesiones benignas se tomaron como base de análisis de las redes bayesianas. El área bajo la curva SROC (característica operativa del receptor) fue de un 0,97, con un valor de Q* de un 0,92. El uso de las redes bayesianas en el diagnóstico de las lesiones malignas aumentó la probabilidad pre test de un verdadero positivo desde un 40,03% a un 90,05%, y la disminución de la probabilidad de un falso negativo de un 6,44%. Por lo tanto, nuestros resultados demuestran que las redes bayesianas ofrecen un método preciso y no invasivo en el apoyo del diagnóstico del cáncer mamario.