One-step vs 2-step gestational diabetes mellitus screening and pregnancy outcomes: an updated systematic review and meta-analysis.

OBJECTIVE: This was a systematic review and meta-analysis comparing maternal and neonatal outcomes of patients screened with the 1-step or 2-step screening method for gestational diabetes mellitus. DATA SOURCES: PubMed, Scopus, Cochrane, ClinicalTrials.gov, and LILACS were searched from inception up to September 2022. STUDY ELIGIBILITY CRITERIA: Only randomized controlled trials were included. Studies that had overlapping populations were excluded (International Prospective Register of Systematic Review registration number: CRD42022358903). METHODS: Risk ratios were computed with 95% confidence intervals by 2 authors. Unpublished data were requested. Large for gestational age was the primary outcome. RESULTS: The search yielded 394 citations. Moreover, 7 randomized controlled trials met the inclusion criteria. A total of 54,650 participants were screened for gestational diabetes mellitus by either the 1-step screening method (n=27,163) or the 2-step screening method (n=27,487). For large for gestational age, there was no significant difference found between the groups (risk ratio, 0.99; 95% confidence interval, 0.93-1.05; I2=0%). Newborns of patients who underwent 1-step screening had higher rates of neonatal hypoglycemia (risk ratio, 1.24; 95% confidence interval, 1.14-1.34; I2=0%) and neonatal intensive care unit admissions (risk ratio, 1.13; 95% confidence interval, 1.04-1.21; I2=0%) than newborns of patients who underwent 2-step screening. Patients in the 1-step screening method group were more likely to be diagnosed with gestational diabetes mellitus (risk ratio, 1.73; 95% confidence interval, 1.44-2.09; I2=80%) than patients in the 2-step screening method group. In addition, among trials that tested all patients before randomization and excluded patients with pregestational diabetes mellitus, newborns were more likely to have macrosomia (risk ratio, 1.27; 95% confidence interval, 1.21-1.34; I2=0%). Overall risk of bias assessment was of low concern. CONCLUSION: Large for gestational age did not differ between patients screened using the 1-step screening method and those screened using the 2-step screening method. However, patients randomized to the 1-step screening method had higher rates of neonatal hypoglycemia and neonatal intensive care unit admission and maternal gestational diabetes mellitus diagnosis than the patients randomized to the 2-step screening method.

The association of lipoprotein(a) and coronary artery calcium in asymptomatic patients: a systematic review and meta-analysis.

AIMS: Lipoprotein(a) [Lp(a)] is an atherogenic lipid particle associated with increased risk for coronary heart disease (CHD) events. Coronary artery calcium (CAC) score is a tool to diagnose subclinical atherosclerosis and guide clinical decision-making for primary prevention of CHD. Studies show conflicting results concerning the relationship between Lp(a) and CAC in asymptomatic populations. We conducted a meta-analysis to evaluate the association of Lp(a) and CAC in asymptomatic patients. METHODS AND RESULTS: We systematically searched PubMed, Embase, and Cochrane until April 2023 for studies evaluating the association between Lp(a) and CAC in asymptomatic patients. We evaluated CAC > 0 Agatston units, and CAC ≥ 100. Lp(a) was analysed as a continuous or dichotomous variable. We assessed the association between Lp(a) and CAC with pooled odds ratios (OR) adopting a random-effects model. A total of 23 105 patients from 18 studies were included in the meta-analysis with a mean age of 55.9 years, 46.4% female. Elevated Lp(a) increased the odds of CAC > 0 [OR 1.31; 95% confidence intervals (CI) 1.05-1.64; P = 0.02], CAC ≥100 (OR 1.29; 95% CI 1.01-1.65; P = 0.04; ), and CAC progression (OR 1.43; 95% CI 1.20-1.70; P < 0.01; ). For each increment of 1 mg/dL in Lp(a) there was a 1% in the odds of CAC > 0 (OR 1.01; 95% CI 1.01-1.01; P < 0.01). CONCLUSION: Our findings of this meta-analysis suggest that Lp(a) is positively associated with a higher likelihood of CAC. Higher Lp(a) levels increased the odds of CAC >0. These data support the concept that Lp(a) is atherogenic, although with high heterogeneity and a low level of certainty. PROTOCOL REGISTRATION: CRD42023422034. KEY FINDINGS: Asymptomatic patients with elevated Lp(a) had 31% higher chances of having any coronary calcification (CAC > 0) and 29% higher chances of having more advanced calcification (CAC > 100). It increased the chances of having progression of coronary calcification over time by 43%. For each 1 mg/dL of Lp(a) there was an increment of 1% chance of having coronary calcification.

We conducted a meta-analysis to evaluate the association between Lp(a) and coronary calcification in asymptomatic patients without a known history of coronary artery disease.

A Case of Painful Growing Abdominal Wall Mass during Pregnancy Requiring Resection in the Second Trimester.

Desmoid fibromatosis (DF) is a rare and locally aggressive neoplasm. We present a case of a 28-year-old previously healthy multigravida who noticed a lump in her abdomen near the umbilicus two months before becoming pregnant. It underwent rapid growth during pregnancy, causing pain and discomfort. Targeted ultrasound of the area showed an irregular mass measuring 0.9 × 1.7 × 1.4 cm. The origin of the mass was unclear, suggesting a connection with the intra-abdominal contents. An MRI done three weeks later revealed a subcutaneous ovoid mass measuring 3.0 × 2.3 × 3.0 cm, which was significantly larger. Due to pain and rapid growth, surgical resection was done at 25 weeks of pregnancy. Histopathological examination revealed a desmoid tumor. The patient had an uneventful recovery and term vaginal delivery without complications. Hence, our case serves as evidence that DF tumors can be surgically managed during pregnancy with minimal to no complications.

Glucose control and psychosocial outcomes with use of automated insulin delivery for 12 to 96 weeks in type 1 diabetes: a meta-analysis of randomised controlled trials.

BACKGROUND: Glycaemic control of Type 1 Diabetes Mellitus (T1DM) remains a challenge due to hypoglycaemic episodes and the burden of insulin self-management. Advancements have been made with the development of automated insulin delivery (AID) devices, yet, previous reviews have only assessed the use of AID over days or weeks, and potential benefits with longer time of AID use in this population remain unclear. METHODS:  We performed a systematic review and meta-analysis of randomised controlled trials comparing AID (hybrid and fully closed-loop systems) to usual care (sensor augmented pumps, multiple daily insulin injections, continuous glucose monitoring and predictive low-glucose suspend) for adults and children with T1DM with a minimum duration of 3 months. We searched PubMed, Embase, Cochrane Central, and Clinicaltrials.gov for studies published up until April 4, 2023. Main outcomes included time in range 70-180 mg/dL as the primary outcome, and change in HbA1c (%, mmol/mol), glucose variability, and psychosocial impact (diabetes distress, treatment satisfaction and fear of hypoglycaemia) as secondary outcomes. Adverse events included diabetic ketoacidosis (DKA) and severe hypoglycaemia. Statistical analyses were conducted using mean differences and odds ratios. Sensitivity analyses were performed according to age, study duration and type of AID device. The protocol was registered in PROSPERO, CRD42022366710. RESULTS: We identified 25 comparisons from 22 studies (six crossover and 16 parallel designs) including a total of 2376 participants (721 in adult studies, 621 in paediatric studies, and 1034 in combined studies) which were eligible for analysis. Use of AID devices ranged from 12 to 96 weeks. Patients using AID had 10.87% higher time in range [95% CI 9.38 to 12.37; p < 0.0001, I2 = 87%) and 0.37% (4.77 mmol/mol) lower HbA1c (95% CI - 0.49% (- 6.39 mmol/mol) to - 0.26 (- 3.14 mmol/mol); p < 0·0001, I2 = 77%]. AID systems decreased night hypoglycaemia, time in hypoglycaemia and hyperglycaemia and improved patient distress, with no increase in the risk of DKA or severe hypoglycaemia. No difference was found regarding treatment satisfaction or fear of hypoglycaemia. Among children, there was no difference in glucose variability or time spent in hypoglycaemia between the use of AID systems or usual care. In sensitivity analyses, results remained consistent with the overall analysis favouring AID. CONCLUSION: The use of AID systems over 12 weeks, regardless of technical or clinical differences, improved glycaemic outcomes and diabetes distress without increasing the risk of adverse events in adults and children with T1DM.

Impact of sex on ventral hernia repair outcomes: A systematic review and meta-analysis.

BACKGROUND: Given the variability in abdominal physiology and hernia presentation between sexes, better comprehension of sex-related differences in outcomes would tailor surgical approach and counseling regarding postoperative outcomes. This meta-analysis aims to appraise the effect of sex on the outcomes of ventral hernia repair. METHODS: A literature search in PubMed, EMBASE and Cochrane selected studies comparing outcomes of ventral hernia repair between sexes. Postoperative outcomes were assessed by pooled and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS: We screened 3128 studies, reviewed 133, and included 18 observational studies, which encompassed 220,799 patients following ventral hernia repair. Postoperative chronic pain was significantly higher in female (OR 1,9; 95% CI 1,64-2,2; p â€‹< â€‹0,001). There were no significant differences in complications, readmission, or recurrence rates between females and males. CONCLUSION: Female sex is associated with a higher risk of postoperative chronic pain following ventral hernia repair.

The Single-Syringe Versus the Double-Syringe Techniques of Adenosine Administration for Supraventricular Tachycardia: A Systematic Review and Meta-Analysis.

INTRODUCTION: The intravenous double-syringe technique (DST) of adenosine administration is the first-line treatment for stable supraventricular tachycardia (SVT). Alternatively, the single-syringe technique (SST) was recently found to be potentially beneficial in several studies. This study aimed to perform a meta-analysis of the SST versus the DST of adenosine administration for the treatment of SVT. METHODS: We assessed EMBASE, PubMed, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSIs) comparing the DST to the SST of adenosine administration in patients with SVT. Outcomes included termination rate, termination rate at first dose, total administered dose, adverse effects, and discharge rate. RESULTS: We included four studies (three RCTs and one NRSI) with a total of 178 patients, of whom 99 underwent the SST of adenosine administration. No significant difference was found between treatment groups regarding termination rate, termination rate restricted to RCTs, total administered dose, and discharge rate. Termination rate at first dose (odds ratio 2.87; confidence interval 1.11-7.41; p = 0.03; I2 = 0%) was significantly increased in patients who received the SST. Major adverse effects were observed in only one study. CONCLUSIONS: The SST is probably as safe as the DST and at least as effective for SVT termination, SVT termination at first dose, and discharge rate from the emergency department. However, definitive superiority of one technique is not feasible given the limited sample size. REGISTRATION: PROSPERO identifier nº CRD42022345125.

Diagnostic Accuracy of ECG to Detect Left Ventricular Hypertrophy in Patients with Left Bundle Branch Block: A Systematic Review and Meta-analysis.

Background: Electrocardiographic (ECG) criteria to detect left ventricular hypertrophy (LVH) in patients with left bundle branch block (LBBB) remain under debate. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of different ECG criteria for diagnosing LVH in patients with LBBB. Methods: We searched PubMed, Embase, Cochrane, and LILACS for articles evaluating the diagnostic accuracy of ECG criteria for LVH in patients with LBBB published between 1984 and 2023. Echocardiogram, magnetic resonance imaging, or autopsy were used as the reference standard for diagnosis of LVH. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The co-primary outcomes were sensitivity, specificity, the diagnostic odds ratio, and likelihood ratios, estimated using a bivariate generalized linear mixed model for each ECG criterion. The prespecified protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Results: We included 12 studies with a total of 1023 patients. We analyzed 10 criteria for LVH on ECG, including the Sokolow-Lyon criterion, the Cornell criterion, the RaVL (R wave in aVL) criterion, the Gubner-Ungerleider criterion, and the Dálfo criterion, among others. The Dalfó criterion was used for 487 patients and had the highest pooled sensitivity of 86% (95% confidence interval [CI] 57%-97%). All the other criteria had poor sensitivities. The Gubner-Ungerleider criterion and the RV5 or RV6 > 25 mm criterion had the highest specificities, with the former being used for 805 patients, obtaining a specificity of 99% (95% CI 80%-100%) and the latter being used for 355 patients, obtaining a specificity of 99% (95% CI 94%-100%). Conclusions: In patients with LBBB, the use of ECG criteria had poor performance for ruling out LVH, mostly due to low sensitivities. None of the criteria analyzed demonstrated a balanced tradeoff between sensitivity and specificity, suggesting that ECG should not be used routinely to screen for LVH.

Contexte: Les critères électrocardiographiques (ECG) visant à détecter une hypertrophie ventriculaire gauche (HVG) chez les patients présentant un bloc de branche gauche (BBG) font encore l'objet de discussions. Nous avons réalisé une synthèse des publications et une méta-analyse afin d'évaluer l'exactitude diagnostique de différents critères ECG pour le diagnostic de l'HVG chez les patients présentant un BBG. Méthodologie: Nous avons effectué une recherche dans les bases de données PubMed, Embase, Cochrane et LILACS afin de recenser les articles publiés entre 1984 et 2023 portant sur l'évaluation de l'exactitude de critères ECG pour le diagnostic d'une HVG chez les patients présentant un BBG. L'échocardiographie, l'imagerie par résonance magnétique et l'autopsie ont servi de normes de référence pour le diagnostic de l'HVG. Le risque de biais a été évalué au moyen de l'outil QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). Les principaux critères d'évaluation étaient la sensibilité, la spécificité, le risque relatif approché diagnostique et les rapports de vraisemblance, estimés au moyen d'un modèle linéaire mixte généralisé à deux variables pour chaque critère ECG. Le protocole défini au préalable a été enregistré dans le registre international de revues systématiques prospectives PROSPERO. Résultats: Nous avons recensé 12 études, comptant au total 1 023 patients. Nous avons analysé 10 critères pour le diagnostic d'HVG à l'ECG, notamment l'indice de Sokolow-Lyon, l'indice de Cornell, l'onde R en aVL, l'indice de Gubner-Ungerleider et l'indice de Dálfo. Ce dernier a été utilisé pour 487 patients et avait la sensibilité regroupée la plus élevée, soit 86 % (intervalle de confiance [IC] à 95 % : 57-97 %). La sensibilité de tous les autres critères était faible. L'indice de Gubner-Ungerleider et le critère de l'onde R en V5 ou V6 > 25 mm étaient associés aux spécificités les plus élevées. Le premier a été utilisé pour 805 patients et présentait une spécificité de 99 % (IC à 95 % : 80-100 %). Le second a été utilisé pour 355 patients et présentait une spécificité de 99 % (IC à 95 % : 94-100 %). Conclusions: Chez les patients présentant un BBG, l'utilisation de critères ECG a été associée à un rendement médiocre pour exclure un diagnostic d'HVG, principalement en raison de la faible sensibilité de ces critères. Aucun des critères analysés n'offrait un compromis équilibré entre la sensibilité et la spécificité, ce qui porte à croire que l'ECG ne devrait pas être utilisée systématiquement pour dépister une HVG.

Influence of personal mastery on mobility disability among older adults: A systematic review.

PURPOSE: Personal mastery is a psychological resource recognized as a domain of quality of life that helps individuals cope with life strains. Despite its relevance, there is a lack surrounding the relationship between mobility disability and personal mastery. This study aimed to investigate the influence of personal mastery on mobility disability among older adults and identify the mechanisms that underlie this influence. METHODS: A systematic review was conducted by searching four databases (i.e., PubMed, Scopus, ScienceDirect, and the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information) using combinations of the following words: mastery, personal mastery, self-control, mobility, disability, older adults, older people, and aging. We summarized and analyzed the findings of cross-sectional and longitudinal/prospective studies. RESULTS: Twenty-one studies were included. There was high heterogeneity in how the studies had assessed mobility disability. Although a majority of the studies had used the Pearlin's Self-Mastery Scale (PSMS) to assess personal mastery, there were variations in the number of response anchors and scoring strategies that were used. Nevertheless, findings revealed that personal mastery influences mobility disability by acting as a protective resource against adverse outcomes among older adults. The authors of the reviewed articles had provided physiological and behavioral explanations for their findings. CONCLUSIONS: Higher level of personal mastery can protect older adults from mobility disability, because it confers a sense of personal control, which in turn promotes positive physiological functioning and health behaviors. This knowledge contributes to the maintenance of physical functioning in old age.

Relações entre sedentarismo e mobilidade com e sem dupla tarefa em idosos usuários da atenção básica em saúde / Relationships between sedentarism and mobility with and without double task among older adult users of primary health care

Os efeitos do sedentarismo nos sistemas musculoesquelético e neuromuscular podem influenciar negativamente o desempenho dos idosos em atividades com dupla-tarefa, o que aumenta o risco de quedas, declínio funcional e morte. O objetivo foi investigar as relações entre sedentarismo e mobilidade com e sem dupla tarefa em idosos usuários da atenção básica em saúde. Trata-se de estudo transversal, com 139 idosos que frequentam três unidades matriciais de saúde aleatoriamente selecionadas, em Uberaba, Minas Gerais. O sedentarismo foi avaliado pelo International Physical Activity Questionnaire (IPAQ), sendo classificados como sedentários os idosos inativos ou insuficientemente ativos. O estado cognitivo foi avaliado pela Prova Cognitiva de Leganés. A mobilidade com e sem dupla tarefa, bem como, a força muscular foram avaliadas por testes de desempenho físico. As características sociodemográficas e o número de medica- mentos foram avaliados por autorrelato. Os modelos multivariados foram testados por regressão linear múltipla em blocos, com intervalo de confiança de 95%. A maioria era mulheres (81,3%); idade média 66,96 (8,24) anos; 17,3% eram sedentários. Pior desempenho na mobilidade com dupla tarefa motora (p=0,040) e com dupla tarefa cognitiva (p=0,040) foi observado entre os idosos sedentários. O sedentarismo foi preditor de baixa mobilidade com dupla-tarefa motora e cognitiva controlado por variáveis sociodemográficas, entretanto, tais efeitos não se mantiveram após inclusão de variáveis de saúde. Não foram observadas relações entre sedentarismo e mobilidade sem dupla tarefa. Conclui-se que o sedentarismo influencia a mobilidade com dupla tarefa motora e cognitiva em idosos, porém outras condições de saúde podem interferir nessas relações.(AU)

The effects of sedentarism on the musculoskeletal and neuromuscular systems may negatively influence performance of older adults in dual-task activities, which increases risk of falls, functional decline, and death. The objective was to investigate the relationships between sedentarism and mobility with and without double tasks among older adult usersof primary health care. This is a cross-sectional study with 139 older adults from three health care units randomly selected in the city of Uberaba, Minas Gerais. Sedentarism was identified by the International Physical Activity Questionnaire (IPAQ). Inactive or insuf- ficiently active elderly individuals were classified as sedentary. Cognitive status was assessed by the Leganés Cognitive Test. Mobility with and without double tasks, as well as, muscle strength were assessed by physical performance tests. Sociodemographic characteristics and number of medications were assessed by self-report. Multiple linear regressions were performed in blocks, with 95% confidence interval. Most participants were women (81.3%); whose average age was 66.96 (8.24) years; 17.3% were sedentary. Poorer performance in mobility with double motor task (p = 0.040) and double cognitive task (p = 0.040) was observed among sedentary participants. In multivariate models, physical inactivity influenced the motor and cognitive double-tasks performance controlled by sociodemographic variables; however, such effects were not remained after inclusion of health variables. No relationships were observed between sedentarism and mobility without double tasks. In conclusion, sedentarism influences mobility with dual motor and cognitive tasks among older adults, but other health conditions may play a role in these relationships.(AU)

The effects of Pilates method on pelvic floor muscle strength in patients with post-prostatectomy urinary incontinence: A randomized clinical trial.

AIMS: To assess the effects of a Pilates exercise program compared to conventional pelvic floor muscle training (PFMT) protocol on pelvic floor muscle strength (PFMS) in patients with post-prostatectomy urinary incontinence. METHODS: Patients were randomized into three treatment groups (G1: Pilates, G2: electrical stimulation combined with PFMT, and G3: control group). Duration of therapy was 10 weeks. Baseline assessment included the 24 h pad-test and the ICI-Q questionnaire. PFMS was measured using a manometric perineometry device at baseline and 4 months after radical prostatectomy (RP). The level of significance was P < 0.05. RESULTS: One hundred twenty three patients were randomized and 104 patients completed the study protocol (G1: n = 34; G2: n = 35; G3: n = 35). Post-treatment assessment showed statistically significant improvements in maximum strength in G2, increased endurance in G1 and G2, and increment of muscle power in all three groups (P < 0.05). However, there were no significant differences in the mean changes of maximum strength, endurance, and muscle power between groups after treatment (P > 0.05). G1 and G2 achieved a higher number of fully continent patients than G3 (P < 0.05). At the end of treatment, 59% of patients in G1, 54% in G2, and 26% in G3 were continent (no pads/day). CONCLUSIONS: Improvements in PFMS parameters were distinct among active treatment groups versus controls, but did not predict recovery of urinary continence at final assessment. The Pilates method promoted similar outcomes in the proportion of fully continent patients when compared to conventional PFMT 4 months after RP.

Assessment instruments of functioning in Brazilian elderly and the ICF: a systematic review / Instrumentos de avaliação da funcionalidade em idosos brasileiros e a CIF: uma revisão sistemática da literatura

Abstract Introduction: Under the new conceptual model described by the International Classification of Functioning Disability and Health (ICF) for a biopsychosocial health analysis, it is necessary to consider that it is not arising only from biological conditions, but also environmental, social, cultural and politics involved in this process. Objective: To review the publications that had the Brazilians elderly functioning as outcome by analyzing the instruments used and to verify its consistency with the ICF model. Methods: A systematic review of the Brazilian literature on elderly was performed in SciELO, PubMed, Scopus, and Lilacs databases. Publications starting in 2001, in English, Portuguese or Spanish, studies with experimental design or intervention, having the Brazilian elderly as the only subject. For evaluating the quality of the papers, the Downs and Black checklist were used. Results: From 3070 items first found in the research, 29 articles remained for this study. Of these, 25 instruments were used to measure the eldery functioning. The frequency of the ICF domains were: health condition (0.28%), body structure and function (1.71%), activity (82.34%), participation (3.42%), environmental factors (12.25%) and personal factors (0%). Conclusion: Despite the ICF be much discussed today, it was possible to detect remaining gaps in the studies about the subject. The results of this study indicate that the conceptual model has not being fully and equitably used when it comes to the eldery functioning.

Resumo Introdução: Sob o novo modelo conceitual descrito pela Classificação Internacional de Funcionalidade Incapacidade e Saúde (CIF), para uma análise biopsicossocial da saúde, torna-se necessário considerar que ela não é advinda apenas das condições biológicas, mas também de fatores ambientais, sociais, culturais e políticos envolvidos neste processo. Objetivo: Revisar as publicações que possuem como desfecho a funcionalidade de idosos brasileiros analisando os instrumentos utilizados para sua avaliação e verificar sua coerência com o modelo da CIF. Métodos: Foi realizada uma pesquisa de revisão sistemática da literatura, nas bases de dados SciELO, PubMed, Scopus e Lilacs. Foram incluídas publicações a partir de 2001, nos idiomas inglês, português ou espanhol, estudos com desenho experimental ou de intervenção, tendo como sujeitos de estudo apenas idosos brasileiros. Para a avaliação da qualidade dos artigos incluídos, foi utilizado o Checklist de Downs e Black. Resultados: Dos 3070 artigos encontrados, após leitura minuciosa, restaram 29. Destes, foram selecionados 25 instrumentos que foram utilizados para medir a funcionalidade do idoso, onde a frequência dos domínios da CIF foi: condição de saúde (0,28%), função e estrutura do corpo (1,71%), atividade (82,34%), participação (3,42%), fatores ambientais (12,25%) e fatores pessoais (0%). Conclusão: Apesar da CIF ser muito discutida na atualidade, foi possível detectar lacunas ainda existentes nos estudos acerca do tema. Os resultados da presente pesquisa apontam que o modelo conceitual não está sendo utilizado em sua totalidade e de forma equânime quando se trata de funcionalidade em idosos.

Lentigo maligno na face: um desafio na conduta / Lentigo maligna on the face: a challenging conduct

Resumo O lentigo maligno é um melanoma in situ, de crescimento radial e lento, que acomete áreas fotoexpostas principalmente em idosos. Quando acomete a pálpebra, devido à proximidade a um órgão nobre, a conduta é controversa, porém a cirurgia é o método mais usado, com margens que variam de acordo com a referência utilizada. Terapias conservadoras são descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirúrgica e citar opções de tratamentos não cirúrgicos para o lentigo maligno da face.

Abstract Lentigo maligna is a melanoma in situ, of slow radial growth, which affects sun-exposed areas, especially in the elderly. When it affects the eyelid, due to the proximity to a noble organ, the conduct is controversial, but surgery is the method most commonly used, with with margins varying according to the reference used. Conservative treatments are described, such as imiquimod 5% and radiotherapy. This report aims to demonstrate the lack of studies on the surgical margin, and to name nonsurgical treatment options for lentigo maligna of the face.

Is pilates as effective as conventional pelvic floor muscle exercises in the conservative treatment of post-prostatectomy urinary incontinence? A randomised controlled trial.

AIMS: To verify the efficacy of a Pilates exercise program compared to conventional pelvic floor muscle exercise (PFME) protocol in the conservative treatment of post-prostatectomy urinary incontinence (PPUI). METHODS: Baseline assessment was performed four weeks postoperatively and included 24 hr pad test, bladder diary, and the ICIQ-SF. Patients were randomised into three groups: Pilates (G1), PFME combined with anal electrical stimulation (G2), and a control group (G3). Both treatment groups had to perform 10 weekly treatment sessions. Primary outcomes were mean reduction of daily pads and mean reduction of ICIQ-SF score four months after surgery. The significance level was set at P < 0.05. RESULTS: 85 patients completed the study. Differences between treatment groups (G1 and G2) in terms of mean reduction in daily pad usage, 24 hr pad test, and ICIQ-SF scores were not statistically significant (P > 0.05). The control group differed from G1 in daily pad usage (P = 0.01) and ICIQ-SF score (P = 0.0073). Intergroup comparisons revealed that 57.7% of the volunteers in G1 and 50% of the individuals from G2 no longer used pads by the end of the treatment period (P = 0.57). In the control group, 22.6% were not using pads four months after surgery, with statistical difference compared to G1 (P < 0.05). CONCLUSIONS: The Pilates exercise program proved to be as effective as conventional PFME to speed up continence recovery in PPUI. It also achieved a higher rate of fully continent patients when compared to the control group in the short-term. Neurourol. Urodynam. 35:615-621, 2016. © 2015 Wiley Periodicals, Inc.

Febre na infância: roteiro de investigaçäo diagnóstica / Fever in child: Guideline for diagnosis research

Os autores objetivaram, neste trabalho, fornecer ao pediatra informaçöes sobre algumas correntes acerca da febre, orientando o manuseio de um sinal täo comum em serviços de emergência, pronto-socorro e consultórios. Baseados em uma proposta prática, que facilita a abordagem de crianças em qualquer faixa etária, apresentam esquemas de investigaçäo e terapia, considerando as particularidades inerentes a cada grupo específico de pacientes

Laboratório de tomografia computadorizada e raios-x convencional do Cefet-PR / Computadorized tomography laboratory and conventional x-rays of Cefet-PR

O presente trabalho diz respeito a uma das atividades de pesquisa realizada no CEFET-PR. Esta envolve a formação de um Laboratório de Controle de Qualidade em Imagens Radiológicas, a montagem de um Tomógrafo Computadorizado e um equipamento de Raios-X Convencional, doados à nossa Instituição. Uma vez instalados, buscar-se-á uma modernização das diversas partes dos equipamentos, incluindo os seus sistemas de detecção, software e hardware, com o propósito de aumentar a resolução e qualidade da imagem.

Presented Paper is concerned with the development of X-ray Laboratory at CEFET-PR organized recently. Our activity is focusing mainly at advancement and hospital practice application of lmage Quality Program for X-ray and Tomograph scanning. At the same time we are working on modernization of installed Xray equipment donated to our lnstitution. We deal with X-ray detectors, software and hardware, which configuration and parameters affect the image quality as well.