Duplex ultrasound for diagnosing symptomatic carotid stenosis in the extracranial segments.

BACKGROUND: Carotid artery stenosis is an important cause of stroke and transient ischemic attack. Correctly and rapidly identifying patients with symptomatic carotid artery stenosis is essential for adequate treatment with early cerebral revascularization. Doubts about the diagnostic value regarding the accuracy of duplex ultrasound (DUS) and the possibility of using DUS as the single diagnostic test before carotid revascularization are still debated. OBJECTIVES: To estimate the accuracy of DUS in individuals with symptomatic carotid stenosis verified by either digital subtraction angiography (DSA), computed tomography angiography (CTA), or magnetic resonance angiography (MRA). SEARCH METHODS: We searched CRDTAS, CENTRAL, MEDLINE (Ovid), Embase (Ovid), ISI Web of Science, HTA, DARE, and LILACS up to 15 February 2021. We handsearched the reference lists of all included studies and other relevant publications and contacted experts in the field to identify additional studies or unpublished data. SELECTION CRITERIA: We included studies assessing DUS accuracy against an acceptable reference standard (DSA, MRA, or CTA) in symptomatic patients. We considered the classification of carotid stenosis with DUS defined with validated duplex velocity criteria, and the NASCET criteria for carotid stenosis measures on DSA, MRA, and CTA. We excluded studies that included < 70% of symptomatic patients; the time between the index test and the reference standard was longer than four weeks or not described, or that presented no objective criteria to estimate carotid stenosis. DATA COLLECTION AND ANALYSIS: The review authors independently screened articles, extracted data, and assessed the risk of bias and applicability concerns using the QUADAS-2 domain list. We extracted data with an effort to complete a 2 × 2 table (true positives, true negatives, false positives, and false negatives) for each of the different categories of carotid stenosis and reference standards. We produced forest plots and summary receiver operating characteristic (ROC) plots to summarize the data. Where meta-analysis was possible, we used a bivariate meta-analysis model. MAIN RESULTS: We identified 25,087 unique studies, of which 22 were deemed eligible for inclusion (4957 carotid arteries). The risk of bias varied considerably across the studies, and studies were generally of moderate to low quality. We narratively described the results without meta-analysis in seven studies in which the criteria used to determine stenosis were too different from the duplex velocity criteria proposed in our protocol or studies that provided insufficient data to complete a 2 × 2 table for at least in one category of stenosis. Nine studies (2770 carotid arteries) presented DUS versus DSA results for 70% to 99% carotid artery stenosis, and two (685 carotid arteries) presented results from DUS versus CTA in this category. Seven studies presented results for occlusion with DSA as the reference standard and three with CTA as the reference standard. Five studies compared DUS versus DSA for 50% to 99% carotid artery stenosis. Only one study presented results from 50% to 69% carotid artery stenosis. For DUS versus DSA, for < 50% carotid artery stenosis, the summary sensitivity was 0.63 (95% confidence interval [CI] 0.48 to 0.76) and the summary specificity was 0.99 (95% CI 0.96 to 0.99); for the 50% to 69% range, only one study was included and meta-analysis not performed; for the 50% to 99% range, the summary sensitivity was 0.97 (95% CI 0.95 to 0.98) and the summary specificity was 0.70 (95% CI 0.67 to 0.73); for the 70% to 99% range, the summary sensitivity was 0.85 (95% CI 0.77 to 0.91) and the summary specificity was 0.98 (95% CI 0.74 to 0.90); for occlusion, the summary sensitivity was 0.91 (95% CI 0.81 to 0.97) and the summary specificity was 0.95 (95% CI 0.76 to 0.99). For sensitivity analyses, excluding studies in which participants were selected based on the presence of occlusion on DUS had an impact on specificity: 0.98 (95% CI 0.97 to 0.99). For DUS versus CTA, we found two studies in the range of 70% to 99%; the sensitivity varied from 0.57 to 0.94 and the specificity varied from 0.87 to 0.98. For occlusion, the summary sensitivity was 0.95 (95% CI 0.80 to 0.99) and the summary specificity was 0.91 (95% CI 0.09 to 0.99). For DUS versus MRA, there was one study with results for 50% to 99% carotid artery stenosis, with a sensitivity of 0.88 (95% CI 0.70 to 0.98) and specificity of 0.60 (95% CI 0.15 to 0.95); in the 70% to 99% range, two studies were included, with sensitivity that varied from 0.54 to 0.99 and specificity that varied from 0.78 to 0.89. We could perform only a few of the proposed sensitivity analyses because of the small number of studies included. AUTHORS' CONCLUSIONS: This review provides evidence that the diagnostic accuracy of DUS is high, especially at discriminating between the presence or absence of significant carotid artery stenosis (< 50% or 50% to 99%). This evidence, plus its less invasive nature, supports the early use of DUS for the detection of carotid artery stenosis. The accuracy for 70% to 99% carotid artery stenosis and occlusion is high. Clinicians should exercise caution when using DUS as the single preoperative diagnostic method, and the limitations should be considered. There was little evidence of the accuracy of DUS when compared with CTA or MRA. The results of this review should be interpreted with caution because they are based on studies of low methodological quality, mainly due to the patient selection method. Methodological problems in participant inclusion criteria from the studies discussed above apparently influenced an overestimated estimate of prevalence values. Most of the studies included failed to precisely describe inclusion criteria and previous testing. Future diagnostic accuracy studies should include direct comparisons of the various modalities of diagnostic tests (mainly DUS, CTA, and MRA) for carotid artery stenosis since DSA is no longer considered to be the best method for diagnosing carotid stenosis and less invasive tests are now used as reference standards in clinical practice. Also, for future studies, the participant inclusion criteria require careful attention.

Can Enhanced Techniques Improve the Diagnostic Accuracy of Transvaginal Sonography and Magnetic Resonance Imaging for Rectosigmoid Endometriosis? A Systematic Review and Meta-analysis.

OBJECTIVE: Our aim was to perform a systematic review and meta-analysis of the most commonly used examinations for rectosigmoid lesions of deeply infiltrating endometriosis, transvaginal sonography (TVS) and magnetic resonance imaging (MRI), to compare their diagnostic accuracy and enhanced or non-enhanced techniques. METHODS: A systematic search was performed until March 2018 without time or language restrictions. Eligibility criteria included studies that compared the accuracy of TVS and MRI for diagnosis of rectosigmoid endometriosis. The quality of the studies was assessed by means of Quality Assessment of Diagnostic Accuracy Studies-2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Bivariate and hierarchical analysis were performed. The difference in the accuracy of TVS and MRI was tested, and heterogeneity was addressed by means of meta-regression, sensitivity, or subgroup analysis. RESULTS: A total of 1754 studies were screened; 105 studies were eligible, and 11 studies were included in the meta-analysis. Overall pooled sensitivity, specificity, and area under the receiver operating characteristic curve were 0.80, 0.94, and 0.95, respectively. The measures for MRI were 0.82, 0.94, and 0.95, respectively. There was no statistical difference between the accuracy values of TVS and MRI (P = 0.90). The use of bowel preparation and vaginal contrast could enhance the accuracy of MRI. Along with rectosigmoid prevalence, bowel and vaginal contrast explained a significant proportion of the statistical heterogeneity. CONCLUSIONS: Both TVS and MRI showed high diagnostic accuracy for rectosigmoid deeply infiltrating endometriosis lesions. There is no strong evidence suggesting that the two diagnostic methods might differ in specificity or sensitivity, but enhanced techniques may increase the accuracy measures.

Age-related maximum heart rate among ischemic and nonischemic heart failure patients receiving ß-blockade therapy.

BACKGROUND: Equations to predict maximum heart rate (HR(max)) in heart failure (HF) patients receiving ß-adrenergic blocking (BB) agents do not consider the cause of HF. We determined equations to predict HR(max) in patients with ischemic and nonischemic HF receiving BB therapy. METHODS AND RESULTS: Using treadmill cardiopulmonary exercise testing, we studied HF patients receiving BB therapy being considered for transplantation from 1999 to 2010. Exclusions were pacemaker and/or implantable defibrillator, left ventricle ejection fraction (LVEF) >50%, peak respiratory exchange ratio (RER) <1.00, and Chagas disease. We used linear regression equations to predict HR(max) based on age in ischemic and nonischemic patients. We analyzed 278 patients, aged 47 ± 10 years, with ischemic (n = 75) and nonischemic (n = 203) HF. LVEF was 30.8 ± 9.4% and 28.6 ± 8.2% (P = .04), peak VO(2) 16.9 ± 4.7 and 16.9 ± 5.2 mL kg(-1) min(-1) (P = NS), and the HR(max) 130.8 ± 23.3 and 125.3 ± 25.3 beats/min (P = .051) in ischemic and nonischemic patients, respectively. We devised the equation HR(max) = 168 - 0.76 × age (R(2) = 0.095; P = .007) for ischemic HF patients, but there was no significant relationship between age and HR(max) in nonischemic HF patients (R(2) = 0.006; P = NS). CONCLUSIONS: Our study suggests that equations to estimate HR(max) should consider the cause of HF.

Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses.

BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are widely used for chronic central serous chorioretinopathy (cCSCR), but their effectiveness remains unclear. This research was conducted to evaluate the efficacy of this drugs for cCSCR. METHODS: This is a review of randomized clinical trials (RCT) comparing MRAs to placebo in adults with cCSCR, using the effects of MRAs on best-corrected visual acuity (BCVA) and adverse events as primary outcomes and the effects of MRAs on anatomical parameters as secondary outcomes: central subfield thickness (CST), subretinal fluid height (SFH) and central choroidal thickness (CCT). Our all-language online search included Medline (via PubMed), Central, Embase, Lilacs, Ibecs, and RCT registers platforms, as late as May 2021. We used the Cochrane risk-of-bias tool (version 2) to assess the methodological quality of each study and synthesized the results in meta-analyses using a random-effects model. RESULTS: The search identified 302 records, five of which were eligible, totaling 225 cCSCR patients (aged 45-62 years; M/F ratio 3.1:1) treated for 1 to 12 months with spironolactone (50 mg/day) or eplerenone (50 mg/day) vs. placebo. Moderate-certainty evidence suggests MRAs result in little to no improvement in BCVA compared to placebo (SMD 0.22; 95% CI - 0.04 to 0.48; studies = 5; comparisons = 6; participants = 218; I2 = 0%). Very low-certainty evidence suggests that, when compared to placebo, MRAs have a very uncertain impact on adverse effects (no meta-analysis was performed), and CST (MD 18.1; 95% CI - 113.04 to 76.84; participants = 145; studies = 2; I2 = 68%). MRAs also result in little to no difference in SFH (SMD - 0.35; 95% CI - 0.95 to 0.26; studies = 5; comparisons = 6; participants = 221; I2 = 76%; moderate certainty) and CCT (MD - 21.23; 95% CI - 64.69 to 22.24; participants = 206; studies = 4; comparisons = 5; I2 = 85%; low certainty). CONCLUSION: MRAs have little to no effect on BCVA. Evidence for adverse events and CST is very uncertain. MRAs also have little to no effect on SFH and CCT. These findings should be considered when prescribing MRAs for cCSCR. This research was previous registration in the PROSPERO platform (CRD42020182601).

Comparison of the printed and online administration of the Behavioral Regulation in Exercise Questionnaire (BREQ-2).

OBJECTIVE: To compare the traditional printed form of the Behavioral Regulation in Exercise Questionnaire with a proposed online form in terms of validity, reliability, and applicability. METHODS: A crossover design study was conducted with 157 undergraduate students. Half of the sample answered the printed questionnaire first and then answered the online questionnaire 7 days later, while the other half of the sample did the inverse. Cronbach's alpha was used to analyze the internal consistency of both the online and printed questionnaires. The construct validity was analyzed by confirmatory factor analysis, using a weighted least square mean and adjusted variance estimation and oblique rotation. The quality of the model was tested with fit indices. RESULTS: The confirmatory factor analysis showed the 19-item structure with five factors: χ2 of 230.718; degrees of freedom of 142; χ2/degrees of freedom of 1.625; comparative fit index of 0.978 and root mean square error of approximation of 0.073. All items presented factorial loads above 0.5. There was also excellent consistency between the formats of administration in all dimensions, with Cronbach's alpha values above 0.70. The stability between the formats of administration varied between 0.78 (95%CI: 0.69-0.85) and 0.84 (95%CI: 0.77-0.89), suggesting desirable confidence between both formats of administration. CONCLUSION: The five-factor model of the online Behavioral Regulation in Exercise Questionnaire shows internal consistency both in terms of the scale dimensions as well as in terms of the total items.

Study of anesthetics for euthanasia in rats and mice: A systematic review and meta-analysis on the impact upon biological outcomes (SAFE-RM).

AIM: To summarize the knowledge on the effect of anesthetics employed right before euthanasia on biological outcomes. DATA SOURCE: A systematic review of the literature to find studies with isoflurane, ketamine, halothane, pentobarbital, or thiopental just before euthanasia of laboratory rats or mice. STUDY SELECTION: Controlled studies with quantitative data available. DATA EXTRACTION: The search, data extraction, and risk of bias (RoB) were performed independently by two reviewers using a structured form. For each outcome, an effect size (ES) was calculated relative to the control group. Meta-analysis was performed using robust variance meta-regression for hierarchical data structures, with adjustment for small samples. DATA SYNTHESIS: We included 20 studies with 407 biological outcomes (110 unique). RoB analysis indicated that 87.5% of the domains evaluated showed unclear risk, 2% high risk, and 10.5% low risk. The effect size for all anesthetics considered together was 0.99 (CI95% = 0.75-1.23; p < 0.0001). Sub-analyses indicate high effect sizes for pentobarbital (1.14; CI95% = 0.75-1.52; p < 0.0001), and isoflurane (1.01; CI95% = 0.58-1.44; p = 0.0005) but not for ketamine (1.49; CI95% = -7.95-10.9; p = 0.295). CONCLUSION: We showed that anesthetics interfere differently with the majority of the outcomes assessed. However, our data did not support the use of one anesthetic over others or even the killing without anesthetics. We conclude that outcomes cannot be compared among studies without considering the killing method. This protocol was registered at Prospero (CRD42019119520). FUNDING: There was no direct funding for this research.

Acute Behavior of Oxygen Consumption, Lactate Concentrations, and Energy Expenditure During Resistance Training: Comparisons Among Three Intensities.

Purpose: This study aimed to compare the oxygen consumption, lactate concentrations, and energy expenditure using three different intensities during the resistance training sessions. Methods: A total of 15 men (22.9 ± 2.61 years) experienced in resistance training underwent 3 sessions composed of 8 exercises (chest press, pec deck, squat, lat pull-down, biceps curl, triceps extension, hamstring curl, and crunch machine), which were applied in the same order. The weight lifted differed among the sessions [high session: 6 sets of 5 repetitions at 90% of 1-repetition maximum (1-RM); intermediary session: 3 sets of 10 repetitions at 75% of 1-RM; and low session: 2 sets of 15 repetitions at 60% of 1-RM]. The oxygen consumption (VO2)-during and after (excess post-exercise oxygen consumption (EPOC)) the session, blood lactate concentration, and energy expenditure (i.e., the sum of aerobic and anaerobic contributions, respectively) were assessed. Results: The VO2 significantly decreased in the function of the weight lifting (F (2.28) = 17.02; p < 0.01; η G 2 = 0.32). However, the aerobic contributions significantly increase in the function of the weight lifting (F (2.28) = 79.18; p < 0.01; η G 2 = 0.75). The anaerobic contributions were not different among the sessions (p > 0.05; η G 2 < 0.01). Thus, the total energy expenditure during the session (kcal) significantly increased in the function of the weight lifting (F (2.28) = 86.68; p < 0.01; η G 2 = 0.75). The energy expenditure expressed in time unit (kcal·min-1) was higher in low session than in high session (F (2.28) = 6.20; p < 0.01; η G 2 = 0.15). Conclusion: The weight lifted during resistance training-induced different physiological responses, which induced higher energy expenditure per unit of time during the low session.

Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis.

This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran's Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Reliability of questionnaire The International Fitness Scale: a systematic review and meta-analysis.

Objective To perform a systematic literature review and meta-analysis to investigate the reliability of The International Fitness Scale questionnaire for assessing overall physical fitness and related components. Methods PubMed®, BIREME, SciELO, EMBASE, SPORTDiscus, LILACS and Cochrane databases were searched using the following search terms: "The International Fitness Scale", "International Fitness Scale" and "IFIS". Article selection and data extraction were performed according to the following eligibility criteria: reliability and/or validity study of the measure tools of The International Fitness Scale; adoption of the The International Fitness Scale as a reference criterion (gold standard) and being an original article. Quality of the study was considered based on Assessment of Reliability Studies. Data analysis used Kappa coefficient of agreement, Cochran and the Higgins I2 test. Sensitivity analysis was conducted using the withdrawal model. Results A total of seven articles were included in the analysis. Test-retest reliability coefficients ranged from 0.40 to 0.99, with most studies achieving values ≥0.60, indicative of moderate to substantial reliability. Conclusion In spite of appropriate test-retest scores attributed to most reliability indicators, heterogeneity among the studies remained high. Therefore, further studies with low risk of bias are needed to support the reliability of the self-reported The International Fitness Scale.

Exercise training modalities for heart transplant recipients: a systematic review and network meta-analysis protocol.

INTRODUCTION: Heart transplantation is the gold standard treatment for selected patients with end-stage heart failure. Although this procedure can improve quality and prolong life expectancy, several of these patients persist with decreased exercise tolerance. Evidence suggests that exercise training can bring multifactorial benefits to heart transplant (HTx) recipients. However, it is unclear that exercise modality should be preferred. Therefore, the aim of this systematic review and network meta-analysis is to compare the efficacy and safety of different training modalities in HTx recipients. METHODS AND ANALYSIS: We will perform a comprehensive literature search in PubMed/MEDLINE, Embase, The Cochrane Library, CINAHL, Scopus, SportDISCUS, Web of Science Core Collection and PEDro from inception until November 2020. Two registries (ClinicalTrials.gov and REBEC) will also be searched for potential results in unpublished studies. There will be no restriction on language, date of publication, publication status or sample size. We will include randomised controlled trials enrolling adult HTx recipients with the presence of at least one exercise training group, which might be compared with another training modality and/or a non-exercise control group for a minimum of 4 weeks of intervention. The primary outcomes will be peak oxygen consumption and occurrence of adverse events. As secondary outcomes, the interaction between pulmonary ventilation, pulmonary perfusion and cardiac output, oxygen uptake efficiency slope, heart rate response, oxygen pulse, peak blood pressure and peak subjective perception of effort. In addition, we will evaluate the 6 min walking distance, health-related quality of life, endothelial function, muscle strength, body fat percentage and lean mass. Risk of bias will be assessed using the Cochrane RoB V.2.0 tool, and we plan to use the Confidence in Network Meta-Analysis tool to assess confidence in the results. All materials (raw data, processed data, statistical code and outputs) will be shared in a public repository. ETHICS AND DISSEMINATION: Given the nature of this study, no ethical approval will be required. We believe that the findings of this study may show which is the most efficacious and safe physical training modality for HTx recipients. The completed systematic review and network meta-analysis will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020191192.

Can intensity in strength training change caloric expenditure? Systematic review and meta-analysis.

INTRODUCTION: Strength training (ST) is considered an important strategy for maintaining body weight, as it promotes an increase in total energy expenditure (EE). However, the combination and manipulation of variables (intensity and volume) allow for different training adaptations. However, it remains unclear as to what is the most important variable between volume or intensity for example number of sets, repetitions, or total load for maximizing EE during ST. Several studies have analyzed the EE response in ST, but still unclear the variable is able to increase EE in the ST. OBJECTIVE: This review aimed to investigate the effect of ST on EE in adults using a systematic literature review and subsequent meta-analysis. METHODS: The search was performed on the electronic databases using the following keywords: strength training (resistance training; strength training; strength training method) and energy expenditure (energy metabolism; energy expenditure; caloric expenditure, caloric cost) with 'AND' and 'OR' combination. Manual searches of references were also conducted for additional relevant studies. After evaluating the inclusion and exclusion criteria, the selected studies were analysed according to strength training methods and the training variables used to measure EE. RESULTS: We identified two ST methods from the literature review: circuit training (CT) and traditional training (TT). Meta-analysis showed a significant effect on EE increase, which favour TT when compared with CT [-0·99 (95%CI: -1·96, -0·02), P<0·01] with I2 of 89% (P<0·01). After adjusting for bias risk, no significant differences were found in EE associated with intensity [-0·40, 95% CI (0·98, 0·18), P = 0·18). CONCLUSION: The present review and meta-analysis indicated that the intensity of exercise does not seem to be associated with an increase of EE in ST.

COVID-19 and patients with immune-mediated inflammatory diseases undergoing pharmacological treatments: a rapid living systematic review.

BACKGROUND: Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of infection. OBJECTIVE: To assess whether patients undergoing pharmacological treatment for IMID present higher risk of worse outcomes when diagnosed with COVID-19. DESIGN AND SETTING: Rapid systematic review conducted in the medical school of the Federal University of São Paulo (SP), Brazil. METHODS: We searched CENTRAL, MEDLINE, EMBASE, LILACS, SCOPUS, Web of Science, L·OVE, ClinicalTrials.gov and WHO-ICTRP for studies evaluating patients diagnosed with COVID-19 who were undergoing pharmacological treatment for IMID. Two authors selected studies, extracted data and assessed risk of bias and certainty of evidence, following the Cochrane recommendations. RESULTS: We identified 1,498 references, from which one cohort study was included. This compared patients with and without rheumatic diseases (RD) who all had been diagnosed with COVID-19. Those with RD seemed to have higher chances of hospitalization and mortality, but no statistical difference was detected between the groups: hospitalization: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.6 to 2.29; mortality rate: OR 1.53; 95% CI 0.33 to 7.11 (very low certainty of evidence). Patients with RD were three times more likely to require admission to intensive care units (ICUs), with invasive mechanical ventilation (IMV), than those without RD: OR 3.72; 95% CI 1.35 to 10.26 (for both outcomes; very low certainty of evidence). CONCLUSION: Patients undergoing pharmacological treatment for IMID seem to present higher chances of requiring admission to ICUs, with IMV. Additional high-quality studies are needed to analyze the effects of different treatments for IMID.

SARS-CoV-2 and arbovirus infection: a rapid systematic review.

BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. PROTOCOL REGISTRATION NUMBER IN THE PROSPERO DATABASE: CRD42020183460.

Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis.

A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%-99%; n = 4410), cough (61%, 95% CI 39%-81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%-55%; n = 3778), dyspnea (26%, 95% CI 12%-41%; n = 3700), headache in 12% (95% CI 4%-23%, n = 3598 patients), sore throat in 10% (95% CI 5%-17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%-17%, n = 1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83-1.03 × 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54-45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%-1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.

Content and Face Validity of the Mackey Childbirth Satisfaction Rating Scale Questionnaire Cross-culturally Adapted to Brazilian Portuguese.

OBJECTIVE: The aim of this study was to determine the content and face validity of the Mackey Childbirth Satisfaction Rating Scale (MCSRS) questionnaire cross-culturally adapted to Brazilian Portuguese. METHODS: The MCSRS is a questionnaire with 34 items related to childbirth satisfaction. The forward- and back-translated versions were compared with the original material, and 10 experts analyzed each item according to the following criteria: clarity, semantic equivalence, appropriateness, and cultural relevance. The final version was presented to 10 mothers for face validation to ensure the questionnaire would suit the target population. RESULTS: The total of 34 items assessed by experts for clarity, semantic equivalence, appropriateness, and relevance showed positive agreement of 0.85, 0.92, 0.97 and 0.97; negative agreement of 0.13, 0.09, 0.04 and 0.04; and total agreement of 0.75; 0.85, 0.94 and 0.94, respectively. Multilevel linear modeling was applied with crossed random effects and with nested random effects for each judge. The intercept of each criterion was as follows: clarity, 0.87; semantic equivalence, 0.92; appropriateness, 0.96; and cultural relevance, 0.96. The overall mean of agreement was 92.8%. The face validity measurement yielded 80% of agreement on the items, all of them clearly understood. CONCLUSION: The final version of the Brazilian Portuguese MCSRS questionnaire had face and content validity confirmed. This instrument of evaluation of maternal satisfaction during childbirth was validated to be applied in the Brazilian female population.

OBJETIVO: O objetivo deste estudo foi determinar a validação de face e conteúdo da Escala Mackey de Avaliação da Satisfação com o Parto (MCSRS, na sigla em inglês), transculturalmente adaptada para o português brasileiro. MéTODOS: O MCSRS é um questionário com 34 itens relacionados à satisfação com o parto. As versões traduzida e retrotraduzida foram comparadas com o material original, e 10 especialistas analisaram cada item de acordo com os seguintes critérios: clareza, equivalência semântica, pertinência e relevância cultural. A versão final foi apresentada a 10 mães para validação de face, para garantir que o questionário fosse adequado à população-alvo. RESULTADOS: O total de 34 itens avaliados por especialistas para clareza, equivalência semântica, pertinência e relevância apresentou concordância positiva de 0,85, 0,92, 0,97 e 0,97; concordância negativa de 0,13, 0,09, 0,04 e 0,04; e concordância total de 0,75; 0,85, 0,94 e 0,94, respectivamente. A modelagem linear multinível foi aplicada com efeitos aleatórios cruzados e com efeitos aleatórios aninhados para cada juiz. A intercepção de cada critério foi a seguinte: clareza, 0,87; equivalência semântica, 0,92; pertinência, 0,96; e relevância cultural, 0,96. A média geral de concordância foi de 92,8%. A mensuração da validade de face foi 80% de concordância nos itens, todos claramente entendidos. CONCLUSãO: A versão final do questionário MCSRS do português brasileiro teve validade de face e conteúdo confirmada. Este instrumento de avaliação da satisfação materna durante o parto foi validado para ser aplicado na população feminina brasileira.

Factors Associated With Medication Adherence In Elderly Retired Outpatients In São Paulo, Brazil.

OBJECTIVE: To evaluate medication adherence and associated socioeconomic factors in elderly Brazilians. METHODOLOGY: This observational study was conducted with 159 elderly retired in an outpatient clinic in the city of São Paulo. Treatment adherence was assessed with the questions from the Morisky Green Levine Medication Adherence Questionnaire, and medications were classified using the Anatomical Therapeutic Chemical system. Statistical tests and adjusted Poisson regression models were used to analyze variables. RESULTS: The study population was mostly female (67.5%), had an average age of, and took an average of 6.5 medications per day. The most commonly used drugs were agents acting on the renin-angiotensin system (67.9%), statins (62.3%), antithrombotic agents (48.4%), and biguanides (37.1%) for the treatment of hypertension (76.7%), dyslipidemia (54.1%), and diabetes (47.8%). The rate of adherence was below 60% in the groups of participants that were analyzed except for the high household income category, which had a rate of 75.8%. CONCLUSION: Medication adherence among the elderly was low in all categories except for the high household income category, a relevant finding that will help to understand medication adherence patterns in elderly Brazilians.

Reliability, Validity, and Ability to Identity Fall Status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in Older Adults Who Live in Nursing Homes.

BACKGROUND AND PURPOSE: In any given year, 28% to 35% of older adults experience falls. In nursing home environments, the annual rate of falls increases to 30% to 50%. Our objective was to verify and compare the reliability, validity, and ability to identify falls of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest for older adults who live in nursing homes. METHODS: This was a cross-sectional study. Older adults (n = 49; aged 62-90 years; mean = 77.8; standard deviation = 7.2) were recruited from a nonprofit nursing home. All participants were assessed by 2 physiotherapists using the BBS, BESTest, Mini-BESTest, and Brief-BESTest. The interrater and test-retest (7-14 days) reliability were assessed using intraclass correlation coefficients (ICCs [2, 1]). Minimal detectable changes at the 95% confidence level were established. To analyze each test's ability to identify fall status, we used receiver operating characteristic (ROC) curves, whose statistical significance we verified using the area under the ROC curve (AUC) and respective 95% confidence intervals (CIs). The diagnostic likelihood ratios (positive and negative) and 95% CI were used to verify posttest probability. We used Fagan's nomogram to show the posttest probability of each balance test. Validity was assessed using kappa coefficients and the prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS: Interrater and test-retest reliability for the total scores were good to excellent across all 4 tests (ICC interrater value = 0.992-0.994 and ICC test-retest value = 0.886-0.945). All tests were also able to identify fall status (AUC = 0.712-0.762) and were in good agreement with each other (kappa coefficient for individuals with fall risk = 0.679-0.957 and individuals with no fall risk = 0.135-0.143; PABAK = 83.7%-98%). CONCLUSION: All balance tests presented similar reliability, reproducibility, and validity. This suggests that any of these tests can be used in clinical practice. However, the Brief-BESTest is the quickest and easiest test to perform.

Accuracy of Doppler ultrasound in the diagnosis of giant cell arteritis: a systematic review and meta-analysis

Abstract Background Giant cell arteritis (GCA) is the most common primary systemic vasculitis in people 50 years of age and over, and it is considered a medical emergency due to the potential risk of permanent visual loss. Color Doppler ultrasound (CDU) of the temporal arteries is a rapid, noninvasive method to diagnose GCA. This study aims to determine the diagnostic accuracy of the halo sign in temporal arteries by CDU in people with suspected GCA. Methods The systematic literature review included the search for publications in the following electronic databases: PubMed, Embase, CENTRAL, LILACS, WHO ICTRP, ClinicalTrials.gov, gray literature up to December 2022, and no date or language restrictions were applied. We analyzed studies including patients over 50 years of age with suspected GCA evaluating CDU of temporal arteries as a diagnostic tool against clinical diagnosis as a standard reference. Paper titles and abstracts were selected by two investigators independently for all available records. The quality of the studies was assessed using the Quality of Diagnostic Accuracy Studies tool (QUADAS-2) and the R software (version 4.2.1) was used for data analysis. The protocol of this review is registered with PROSPERO (CRD42016033079). Results Twenty-two studies including 2893 participants with suspected GCA who underwent temporal artery CDU were evaluated. The primary analysis results showed a sensitivity of 0.76 [95% confidence interval (95 CI) 0.69-0.81] and specificity of 0.93 (95 CI 0.89-0.95) when the halo sign was compared to clinical diagnosis. The sensitivity value of 0.84 (95 CI 0.72-0.92) and specificity of 0.95 (95 CI 0.88-0.98) were found in five studies involving 1037 participants that analyzed the halo sign and temporal artery compression sign. A sensitivity of 0.86 (95 CI 0.78-0.91) and specificity of 0.95 (95 CI 0.89-0.98) were found in four studies with 603 participants where the halo sign was evaluated CDU on temporal and axillary arteries. Conclusion The detection of the halo sign by CDU of temporal arteries has good accuracy for the diagnosis of cranial GCA. The compression sign in temporal arteries and the addition of axillary arteries assessment improves the diagnostic performance of CDU for GCA. Trial registration PROSPERO CRD42016046860.

The effect of high-intensity interval training on post-exercise oxygen consumption: a meta-analysis / Efecto del entrenamiento de intervalos de alta intensidad sobre el consumo de oxígeno después delejercicio: metaanálisis / Efeito do treinamento intervalado de alta intensidade sobre o consumo de oxigênio depois do exercício: metanálise

ABSTRACT Introduction: The objective of this study was to present a systematic review and meta-analysis to compare total excess post-exercise oxygen consumption (EPOC) for two training intervention models in healthy individuals, and the secondary objective was to understand whether oxygen consumption after exercise could really promote a meaningful help. Design: To design a meta-analysis review to compare two training intervention models (experimental: high-intensity interval training; and control: continuous moderate-intensity) and their effects on total EPOC in healthy individuals. Participants: Seventeen studies were considered to be of good methodological quality and with a low risk of bias. Methods: Literature searches were performed using the electronic databases with no restriction on year of publication. The keywords used were obtained by consulting Mesh Terms (PubMed) and DeCS (BIREME Health Science Descriptors). Results: The present study findings showed a tendency (random-effects model: 0.87, 95%-CI [0.35,1.38], I2=73%, p<0.01) to increase EPOC when measured following high-intensity interval training. Conclusions: Our study focused on the analysis of high- and moderate-intensity oxygen uptake results following exercise. Despite the growing popularity of high-intensity interval training, we found that the acute and chronic benefits remain limited. We understand that the lack of a standard protocol and standard training variables provides limited consensus to determine the magnitude of the EPOC. We suggest that longitudinal experimental studies may provide more robust conclusions. Another confounding factor in the studies investigated was the magnitude (time in minutes) of VO2 measurements when assessing EPOC. Measurement times ranged from 60 min to 720 min. Longitudinal studies and controlled experimental designs would facilitate more precise measurements and correct subject numbers would provide accurate effect sizes. Systematic reviewb of Level II studies.

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RESUMO Introdução: O objetivo deste estudo foi apresentar uma revisão sistemática e metanálise para comparar os efeitos de dois modelos de intervenção de treinamento sobre o consumo excessivo de oxigênio pós-exercício (EPOC) em indivíduos saudáveis em treinamento, e o objetivo secundário foi entender se o consumo de oxigênio depois de exercício realmente pode proporcionar ajuda substancial. Objetivo: Elaborar uma revisão de metanálise para comparar um modelo de treinamento de duas intervenções (experimental: treinamento intervalado de alta intensidade, e controle: contínuo de intensidade moderada) e o efeito sobre o EPOC total em indivíduos saudáveis. Participantes: Os 17 estudos foram considerados de boa qualidade metodológica e baixo risco de viés. Métodos: As buscas bibliográficas foram realizadas nos bancos de dados eletrônicos sem restrição de ano de publicação. Os descritores usados foram obtidos em MeSH (PubMed) e DeCS (Descritores em Ciências da Saúde da BIREME). Resultados: Os achados do presente estudo mostraram uma tendência (modelo de efeitos aleatórios: 0,87, IC 95% [0,35;1,38], I ² = 73%, p < 0,01) de aumento do EPOC quando as medidas foram realizadas depois de treinamento intervalado de alta intensidade. Conclusões: Nosso estudo concentrou-se na análise dos resultados de alta e moderada intensidade no consumo de oxigênio depois do exercício. Apesar da crescente popularidade do treinamento intervalado de alta intensidade, descobrimos que os benefícios agudos e crônicos permanecem limitados. Entendemos que a falta de um protocolo e variáveis padronizadas de treinamento fornecem consenso limitado para determinar a magnitude do EPOC. Sugerimos que estudos experimentais longitudinais podem fornecer conclusões mais robustas. Outro fator de confusão nos estudos investigados foi a magnitude (tempo em minutos) das medidas do VO2na avaliação do EPOC. Os tempos de medição variaram de 60 a 720 min. Estudos longitudinais e projetos experimentais controlados facilitariam medições mais precisas e números corretos de indivíduos forneceriam tamanhos de efeito precisos. Nível de evidência II; Revisão sistemáticabde Estudos.

Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM for frail older adults: A randomized feasibility clinical trial.

BACKGROUND: Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit Plus™ (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre-frail older adults. METHODS: This study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I). RESULTS: Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p < 0.05). CONCLUSION: The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling. This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016.