Representation of Ethics in the Plastic Surgery Literature: A Systematic Review.

BACKGROUND: A 2009 systematic review demonstrated that ethical discourse was underrepresented in the plastic surgery literature; approximately one in 1000 articles contained ethical discussions. In the decade since, advances in plastic surgery and continued social progress have created new ethical dilemmas. However, it is unclear whether these developments have augmented the representation of ethics in the plastic surgery literature. A review of publications over the past decade can assess whether progress has been made and identify where deficits persist. METHODS: The authors searched eight bibliographic databases to identify peer-reviewed articles discussing ethical issues in plastic surgery over the past decade. Independent reviewers extracted characteristics and ethical principles from included articles. RESULTS: A total of 7097 articles were identified from the initial search and 531 articles were included for analysis. The principle of autonomy, present in 87.9 percent of articles, had the greatest representation, followed by beneficence (74.4 percent), nonmaleficence (72.3 percent), and justice (51.2 percent). Informed consent and face transplantation were the most prevalent topics discussed. Aesthetic surgery was the subdiscipline of plastic surgery with the greatest ethical discourse, representing 29.8 percent of all included articles. CONCLUSIONS: In the past decade, there was approximately a five-fold increase in plastic surgery publications that include ethical discourse, indicating a growing awareness of ethical implications by the plastic surgery community. However, representation of ethical principles remained uneven, and specific subdisciplines of plastic surgery were substantially underrepresented. Plastic surgeons should adopt a more comprehensive approach when framing ethical implications in clinical and research settings.

Visualising the past to plan the future: a network analysis of the largest European dermatology conference.

BACKGROUND: The annual conference of the European Academy of Dermatology and Venereology is one the largest dermatology conferences worldwide. OBJECTIVES: Network analysis can be used for in-depth insight into trending topics and underlying trends at the congress. MATERIALS & METHODS: Network analysis was employed to assess the entirety of the submitted abstracts to the congress in 2019. The data were processed, analysed, and visualised using easy-to-understand network graphs. Topics were then compared to their respective global burden (Disease Adjusted Life Years [DALYs]) and the number of respective publications on PubMed in the year 2018. RESULTS: Overall, 1,280 lecture titles and 1,941 poster titles were included in the final analysis. The most frequently used terms were "patients" (n = 473), "treatment" (n = 301), and "psoriasis" (n = 335). Relative to DALYs, "psoriasis" (+21.9%) among others, was rather over-represented, while "fungal skin diseases" (-7.6%) and "urticaria" (-6.4%) were under-represented. Compared to the relative number of PubMed publications in 2018, "psoriasis" (+20.3%), "acne" (+7.9%), and "alopecia" (+3.1%) were over-represented, while "melanoma" (-22.5%), "dermatitis" (-4.2%) and "pruritus" (-3.4%) were rather under-represented. CONCLUSION: The network analysis showed that the congress was a patient and therapy-centred event. An explanation for the particular focus on chronic inflammatory skin diseases and melanoma would be the introduction of new therapies at the congress. To delineate trends over time, a longitudinal network analysis including several congresses should be conducted and could be used to determine additional topics to be included in future events.

Gene-Centric Database Reveals Environmental and Lifestyle Relationships for Potential Risk Modification and Prevention.

The database at Nutrigenetics.net has been under development since 2007 to facilitate the identification and classification of PubMed articles relevant to human genetics. A controlled vocabulary (i.e., standardized terminology) is used to index these records, with links back to PubMed for every article title. This enables the display of indexes (alphabetical subtopic listings) for any given topic, or for any given combination of topics, including for genes and specific genetic variants. Stepwise use of such indexes (first for one topic, then for combinations of topics) can reveal relationships that are otherwise easily overlooked. These relationships include environmental and lifestyle variables with potential relevance to risk modification (both beneficial and detrimental), and to prevention, or at least to the potential delay of symptom onset for health conditions like Alzheimer disease among many others. Thirty-four specific genetic variants have each been mentioned in at least ≥1,000 PubMed titles/abstracts, and these numbers are steadily increasing. The benefits of indexing with standardized terminology are illustrated for genetic variants like MTHFR 677C-T and its various synonyms (e.g., rs1801133 or Ala222Val). Such use of a controlled vocabulary is also helpful for numerous health conditions, and for potential risk modifiers (i.e., potential risk/effect modifiers).

Paths taken by Brazilian Nursing for the development of terminological subsets.

OBJECTIVE: to discuss the paths taken by Brazilian Nursing in the development of terminological subsets of the International Classification for Nursing Practice. METHOD: documentary research, carried out in master's dissertations and doctoral theses, which developed terminological subsets, available at the Bank of Doctoral Theses and Master's Dissertations of the Under-graduation Personnel Improvement Coordination. The variables were analyzed were institution, year; academic level, type of health service, methodological approach, clientele, theoretical reference, validation of terms, cross mapping, modeling of new concepts, validation of statements, method used for elaboration, term collection, finalization and dissemination. RESULTS: 124 doctoral theses and master's dissertations were found, 91 were excluded and 33 were included, 23 (69.70%) of which were master's dissertations, with the highest production in 2014 (n=10; 30.30%), with emphasis on the Northeast (36.36%); the 'Primary Care' scenario, with six studies (18.18%); and the predominant clientele was cancer patients. As for the methodological characteristics, in 96% of the studies, the quantitative approach was used; in 2%, a qualitative approach; and 2% associated the quantitative and qualitative approaches. As for the type of study, 60% were methodological and 24% descriptive-exploratory, with the Horta model being the most used (36%). CONCLUSION: the paths are successful, yet still permeated by weaknesses in the validations and potentialities to standardize the language.

Edition of Portuguese health journals and its relationship with their visibility: a quantitative analysis

SUMMARY BACKGROUND Scientific journals play a fundamental role in the field of health sciences, contributing not only to the dissemination of scientific results but also to the progress of medicine and the training of researchers. The visibility of scientific production in the health area is fundamental to the development of medicine. This study aimed to find the relationship between the editorial quality of a sample of Portuguese scientific health journals and their national and international visibility. METHODS This is an analytical, transversal and, essentially, quantitative study, based on the analysis of the compliance with Latindex editorial quality criteria in a sample of 46 scientific health journals and ascertaining their national and international visibility. RESULTS The research showed that the global average of compliance with the criteria by the sample of journals is 91%. The average visibility of the sample is 24%. The hypothesis that the editing criteria are related to the visibility of a sample of Portuguese health journals is confirmed. CONCLUSION Despite the high rate of compliance with editorial quality criteria, the international visibility of the journals analyzed is still scarce. This reveals the need for the development of complementary competences.

RESUMO OBJETIVO No âmbito das ciências da saúde, as revistas científicas desempenham um papel fulcral, contribuindo — para além da divulgação dos resultados científicos — para o progresso da medicina e para a formação dos investigadores. A visibilidade da produção científica é fundamental para o desenvolvimento da medicina. O objetivo deste estudo foi averiguar a relação entre a qualidade editorial de uma população de revistas portuguesas científicas de saúde e a visibilidade nacional e internacional destas. MÉTODOS Estudo transversal analítico e essencialmente quantitativo, baseou-se na análise do cumprimento de critérios de qualidade editorial Latindex de uma população de 46 revistas científicas de saúde portuguesas e na verificação da respectiva visibilidade nacional e internacional. RESULTADOS A investigação revelou que a média global de cumprimento de critérios pela população de revistas situa-se nos 91%. A visibilidade média da população é de 24%. Confirma-se a hipótese de que os critérios de edição se relacionam com a visibilidade de uma população de revistas científicas de saúde portuguesas. CONCLUSÃO Apesar do elevado cumprimento de critérios de qualidade editorial, a visibilidade internacional das revistas analisadas é ainda escassa, o que aponta a necessidade de serem desenvolvidas competências complementares.

The development of search filters for adverse effects of medical devices in medline and embase.

BACKGROUND: Objectively derived search filters for adverse drug effects and complications in surgery have been developed but not for medical device adverse effects. OBJECTIVE: To develop and validate search filters to retrieve evidence on medical device adverse effects from ovid medline and embase. METHODS: We identified systematic reviews from Epistemonikos and the Health Technology Assessment (hta) database. Included studies within these reviews that reported on medical device adverse effects were randomly divided into three test sets and one validation set of records. Using word frequency analysis from one test set, we constructed a sensitivity maximising search strategy. This strategy was refined using two other test sets, then validated. RESULTS: From 186 systematic reviews which met our inclusion criteria, 1984 unique included studies were available from medline and 1986 from embase. Generic adverse effects searches in medline and embase achieved 84% and 83% sensitivity. Recall was improved to over 90%, however, when specific adverse effects terms were added. CONCLUSION: We have derived and validated novel search filters that retrieve over 80% of records with medical device adverse effects data in medline and embase. The addition of specific adverse effects terms is required to achieve higher levels of sensitivity.

Assessment of the quality of reporting in studies of acupuncture for patients with cancer using the STRICTA guidelines.

INTRODUCTION: There has been a burgeoning of research evaluating acupuncture for various symptoms of cancer and the side-effects associated with its treatment. A systematic review was conducted to examine the quality of reporting in published studies of acupuncture in cancer according to the STRICTA (STandards for Reporting Interventions in Clinical Trials of Acupuncture) guidelines. METHODS: Systematic review of published research of acupuncture for symptoms of cancer and the side-effects associated with its treatment. Databases searched were: Medline, CINAHL, Cochrane (all databases), Scopus, and PubMed from their inception to December 2014. Clinical trials, pilot/feasibility studies, observational studies, and case studies were included. Only full journal papers published in English were included. The quality of reporting was evaluated using STRICTA guidelines. Each included paper was assessed by two independent reviewers, with disagreements adjudicated by a third reviewer. RESULTS: 88 papers were identified which met the inclusion criteria. The median number of STRICTA items reported in trials with a control or comparator arm (n=47) was 14 out of 17 (range 8 to 17, IQR 4). For studies without a control or comparator arm the median was 11 out of a possible 15 (range 5 to 15, IQR 3). Key weaknesses in reporting included details of other components of treatments, and details of the acupuncturist administering treatments. CONCLUSIONS: Despite the widespread use of the STRICTA guidelines in acupuncture research, adherence remains poor for a few specific items. Further research is required to explore the reasons why authors fail to report those items, and to develop strategies to improve the adherence to the guidelines.

Análisis bibliométrico de las revistas médicas del Sistema de Clasificación de Revistas Mexicanas de Ciencia y Tecnología / Bibliometric analysis of the medical journals of the Classification System of Mexican Journals of Science and Technology

Resumen Introducción: El Sistema de Clasificación de Revistas Mexicanas de Ciencia y Tecnología (SCRMCYT) del Conacyt incluye el área de medicina y ciencias de la salud (MyCS). Objetivo: Se realizó un análisis bibliométrico de las revistas del MyCS del listado SCRMCYT-2018. Método: Se analizaron 12 características relacionadas con la indización en las bases de datos Web of Science Core Collection (WoSCC), Scopus y PubMed. Se analizó si la revista indizada tenía publicaciones indizadas recientes (años 2017 y 2018). Se analizaron los 50 artículos más citados de las revistas indizadas en Scopus y WoSCC. Resultados: De 35 revistas de MyCS incluidas en el SCRMCYT-2018, 31 (89 %) estaban indizadas en Scopus (22 con indización vigente en 2017 y 18 en 2018), 17 (49 %) en PubMed (10 vigentes en 2017 y 2018) y 12 (34 %) en WoSCC (12 vigentes en 2017 y ocho en 2018). Los 50 artículos más citados provenían de solo cuatro revistas indizadas en WoSCC y de cinco en Scopus; 60 % eran artículos de revisión. Conclusiones: Aproximadamente la mitad de las revistas de MyCS del SCRMCYT-2018 carecen de indización vigente en 2018, por lo que la relevancia nacional e internacional de estas revistas puede mejorar.

Abstract Introduction: CONACYT’s Mexican Science and Technology Journals Classification System (SCRMCYT) includes the area of medicine and health sciences (M&HS). Objective: A bibliometric analysis of M&HS journals listed in SCRMCYT in 2018 was performed. Method: Twelve characteristics related to indexation in the Web of Science Core Collection (WoSCC), Scopus, and PubMed databases were analyzed. Indexed journals were analyzed on whether they had recent indexed publications (2017 and 2018). Indexed journals’ 50 most-cited articles in WoSCC and Scopus were analyzed. Results: Of the 35 M&HS journals included in the 2018 SCRMCYT list, 31 (89 %) were indexed in Scopus (22 with indexed publications in 2017; 18 in 2018), 17 (49 %) in PubMed (10 with indexed publications in 2017 and 2018), and 12 (34 %) in WoSCC (12 with indexed publications in 2017; 8 in 2018). The 50 most-cited articles had been published only in 4 journals indexed in WoSCC and 5 in Scopus; 60 % were review articles. Conclusions: Approximately half the 2018 SCRMCYT M&HS journals lack publications indexed in 2018; this suggests that national and international relevance of these journals can be improved.

Profile and scientific output of researchers recipients of CNPq productivity grant in the field of medicine

SUMMARY BACKGROUND. This study aimed to evaluate the scientific production of researchers in the field of Medicine who receive a productivity grant from the CNPq. METHODS: The curriculum Lattes of 542 researchers with active grants from 2012 to 2014 were included in the analysis. Grants categories/levels were stratified into three groups according to the CNPq database (1A-B, 1C-D, and 2). RESULTS. There was a predominance of grants in category 2. During their academic career, Medicine researchers published 76512 articles, with a median of 119 articles per researcher (IQ, interquartile range, 77 to 174). Among the 76512 articles, 36584 (47.8%) were indexed in the Web of Science (WoS database). Researchers in Medicine were cited 643159 times in the WoS database, with a median of 754 citations (IQ, 356 to 1447). There were significant differences among the categories of grants concerning the number of citations in WoS (P <0.001). There was a significant difference in the number of times researchers were cited according to the specialty included in Medicine area. (P < 0.001). CONCLUSION. Strategies to improve the scientific output qualitatively possibly can be enhanced by the knowledge of the profile of researchers in the field of Medicine.

RESUMO OBJETIVO: O objetivo deste estudo foi avaliar a produção científica de pesquisadores da área de Medicina que recebem bolsa de produtividade do CNPq. MÉTODOS: Os currículos Lattes de 542 pesquisadores com bolsas ativas de 2012 a 2014 foram incluídos na análise. As categorias/níveis das bolsas de produtividade foram estratificadas em três grupos de acordo com a classificação do CNPq (1A-B, 1C-D e 2). RESULTADOS: Houve predomínio de bolsas na categoria 2. Durante a carreira acadêmica, pesquisadores da Medicina publicaram 76.512 artigos, com mediana de 119 artigos por pesquisador (Intervalo Interquartil, IQ, 77 a 174). Entre os 76.512 artigos, 36.584 (47,8%) foram indexados no banco de dados da Web of Science (WoS). Pesquisadores em Medicina receberam 643.159 citações no banco de dados de WoS, com uma mediana de 754 citações (IQ, 356 a 1.447). Houve diferenças significativas entre as categorias de bolsas em relação ao número de citações em WoS (P < 0,001). Houve uma diferença significativa no número de citações recebidas pelos pesquisadores de acordo com a especialidade incluída na área de Medicina (P < 0,001). CONCLUSÃO: Estratégias para melhorar qualitativamente a produção científica possivelmente podem ser aprimoradas pelo conhecimento do perfil dos pesquisadores no campo da Medicina.

Acupuncture in adults with Chemotherapy-Induced Peripheral Neuropathy: a systematic review.

OBJECTIVE: to analyze and synthesize knowledge about the effect of acupuncture on chemotherapy-induced peripheral neuropathy symptoms in adults with cancer. METHOD: the method used was a Systematic Review. Potential articles were identified by searching in the PubMed of National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central and Scopus. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses strategy, 607 articles were identified. After removing the duplicates, all titles and abstracts were reviewed, and seven articles were selected for full review. After the full review, five studies were selected for inclusion. RESULTS: of the five articles included, four were cohort studies and one was a quasi-experimental study. All articles showed that acupuncture was associated with an improvement in the peripheral neuropathy, but the type of protocol, use of medications, time of treatment, and different outcome measures made it difficult to compare the studies. CONCLUSION: the use of acupuncture appears to be associated with an improvement in the symptoms of chemotherapy-induced peripheral neuropathy and has no side effects. In order to improve the evidence about benefits associated with acupuncture, more experimental studies using both subjective and objective measures are needed.

Predictors of seizure reduction outcome after vagus nerve stimulation in drug-resistant epilepsy.

PURPOSE: To evaluate the predictors of seizure reduction outcome after vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy (DRE). METHODS: A meta-analysis was performed using relevant research from databases such as PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov. Studies were selected according to predefined inclusion and exclusion criteria. The quality of studies was evaluated by using the Newcastle-Ottawa Scale (NOS) scale. All data was pooled by STATA 12.0 software for meta-analysis. RESULTS: The review considered 1281 articles, and 16 articles with NOS score ≥6 were included in the analysis. The meta-analysis showed that at 6 m, 1, 2, 3, 4, 6 and 12 years after implantation, 33.99, 43.42, 46.50, 63.31, 52.71, 54.64, 70.37 and 82.90% of patients exhibited >50% reduction of seizure frequency after VNS. The duration of epilepsy showed a significant difference between the good responders and poor responders (p = 0.038), whereas age at VNS implantation (p = 0.305), age at seizure onset (p = 0.530), seizure type (p = 0.11), etiology (p = 0.187), and history of previous epilepsy surgery (p = 0.075) were not predictors of seizure reduction outcome after VNS. Several features about the electroencephalogram (EEG) feature and heart rhythm complexity (HRV) have not been analyzed by a sufficient number of studies. CONCLUSIONS: DRE patients with shorter duration of epilepsy may be better candidates for VNS rather than those who are younger at onset and implantation. Several EEG or HRV features may have predictive value but more research is needed.

Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience.

BACKGROUND: Hypnosis is a technique that could aid awake surgery protocols. The aim of the present study is to describe the results of a preliminary experience of a cohort of patients operated on with an original protocol of hypnosis-aided awake surgery (HAS). METHODS: All patients were operated on with the aid of HAS and their data were retrospectively reviewed. A thorough literature review was conducted to compare the results of HAS with the standard awake surgery protocol regarding 1) the incidence of intraoperative pain; 2) the overall incidence of complications; 3) the length of time in which the patients were suitable for intraoperative neuropsychological testing; and 4) the incidence of gross total resection. The comparison presented a notably high statistical impact (1-ß = 0.90-0.93 for α = 0.05; effect size, 0.5). RESULTS: The final cohort comprised 6 patients from our institution and 43 records retrieved in the relevant literature underwent HAS for intrinsic brain tumor treatment. This cohort was compared with cohorts of patients who were considered eligible through a literature review. HAS showed a statistically significant superiority in the first 3 outcome variables, whereas the incidence of gross total resection favored the standard awake approaches. CONCLUSIONS: According to the results, hypnosis-aided resection of intrinsic brain tumor located in eloquent areas is safe and effective, although dissociation phenomena deserve further investigation to be completely understood.

Retroclival Arachnoid Cysts: Case Series, Literature Review, and New Classification Proposal.

BACKGROUND: The retroclival region is among the rarest locations for an arachnoid cyst (AC), with only a few reported cases. No accepted classification system is available for these rare cysts. Such a classification system would solve the nomenclature problem and could result in easier and more systematic management. We reviewed and analyzed data from databases and reported studies of retroclival ACs (RACs) and have proposed a classification system. METHODS: A retrospective review of RACs was conducted in Marmara and Adiyaman University Hospitals, Turkey. Cysts in the prepontine and/or premedullary cisterns that spared the chiasmatic cistern were included. Additionally, the reported data were searched for relevant studies on cysts. The findings were analyzed to establish a clear nomenclature and classification system, and the clinical presentations, treatment strategies, and surgical approaches were reviewed. RESULTS: We identified 1 adult and 1 pediatric patient, and only the adult had undergone surgery. Additional data searches yielded 14 patients with RACs. The cysts were classified as type 1 if they had extended superiorly beyond the borders of the diencephalic leaf of the Liliequist membrane. If they had not extended, they were classified as type 2. Finally, type 2 cysts that had extended to the anterior spinal cistern were classified as type 3. CONCLUSIONS: RACs can be more easily and systematically managed using a simple clinical classification system. Together with the previously proposed suprasellar AC classification, our proposed RAC classification should be adequate to classify all ACs in the ventral midline cistern, which could solve the nomenclature problem.

Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-Analysis.

INTRODUCTION: Optimal surgical strategy for patients with tremor remains uncertain. We conducted a systematic review and meta-analysis evaluating randomized controlled trials of deep brain stimulation (DBS) and lesion surgery (LS) in the treatment of tremor. METHODS: We searched PubMed, Embase, and the Cochrane database to include randomized clinical trials with either LS, deep brain stimulation, or controls. The outcomes were the change in tremor score, quality of life, cognitive function, and neuropsychiatric function. We used standardized mean differences (SMDs) to pool the outcomes. RESULTS: Fifteen trials, including 1508 patients, met eligibility criteria. We observed no significant difference in change of tremor scale (SMD -0.07, 95% confidence interval [CI]: -0.38 to 0.24), quality of life (SMD -0.21, 95% CI: -0.69 to 0.27), cognitive function (SMD 0.06, 95% CI: -0.27 to 0.39), or neuropsychiatric function (SMD -0.15, 95% CI: -0.49 to 0.19) between LS and stimulation surgery. We observed heterogeneity across studies during indirect comparison of quality of life. We identified a possible effect modifier: improvement in quality of life correlated with duration of disease (P = 0.035). We found that focused-ultrasound LS was associated with a 0.70 SMD increase (P = 0.014) in quality of life versus DBS in an exploratory subgroup analysis by separating 2 studies with focused-ultrasound LS from other LS studies. CONCLUSIONS: Although the main analysis showed that LS and DBS were equally effective in the treatment of patients with tremor, an exploratory subgroup analysis indicated an improvement in quality of life with noninvasive focused-ultrasound surgery.

Effect of Intrawound Vancomycin on Surgical Site Infections in Nonspinal Neurosurgical Procedures: A Systematic Review and Meta-Analysis.

BACKGROUND: Applying vancomycin into the surgical site has been well-described in spinal neurosurgery, with extensive institutional experience and systematic reviews describing its effectiveness in reducing surgical site infections (SSIs). Its use in nonspinal neurosurgical procedures is a logical extension of those findings; however, recent studies have described varying degrees of success. We have summarized the effect of local vancomycin application on SSIs in nonspinal neurosurgical procedures and describe the quality of the supporting evidence. METHODS: MEDLINE, Embase, and Google Scholar were searched through June 2018. Information on study design, demographic data, exposure, and outcomes was extracted. The estimates were combined using random-effects models. RESULTS: Our search retrieved 9 studies for quantitative analysis. They assessed vancomycin use in craniotomy, cranioplasty, deep brain stimulator-related procedures, and ventriculoperitoneal shunt surgery. Most of the studies had serious methodological shortcomings that introduced confounding. We found an overall beneficial effect on SSI incidence (odds ratio, 0.25; 95% confidence interval, 0.12-0.52), which was seen across all subspecialties, except for cranioplasty. The use of vancomycin did not result in the emergence of resistant infections or in a significant increase in the proportion of infections caused by gram-negative organisms. CONCLUSIONS: Vancomycin use in nonspinal neurosurgery is not supported by high-quality evidence, limiting the strength of the conclusions that can be drawn on the topic. Nonetheless, we found an overall favorable effect on SSIs (except in the context of cranioplasty), which should be reproduced in a randomized controlled fashion.

The Efficacy of Gamma Knife Radiosurgery for Cavernous Malformations: A Meta-Analysis and Review.

OBJECTIVE: This meta-analysis is to evaluate the clinical efficacy of gamma knife radiosurgery (GKRS) for treating cavernous malformations. METHODS: PubMed, Ovid Embase, and Ovid Medline electronic databases were searched. The primary outcome is hemorrhage rate and this meta-analysis is performed. RESULTS: Nine studies are included in this meta-analysis. The overall risk ratio (RR) of hemorrhage rate of pre-GKRS and post-GKRS is 6.08 (95% confidence interval [CI], 5.04-7.35). The overall RR is 3.03 (95% CI, 2.65-4.11) between the hemorrhage rate of pre-GKRS and the first 2 years postradiosurgery, and the overall RR is 12.13 (95% CI, 1.73-85.07) comparing pre-GKRS with 2 years after GKRS. There is no significant difference of the hemorrhage rate between the first 2 years postradiosurgery and 2 years after GKRS (RR = 2.81; 95% CI, 0.20-13.42). The neurologic deficiency is the most common radiosurgery-related complication. CONCLUSIONS: Patients with cerebral cavernous malformations, especially ones that were deep seated and surgically inaccessible, seem to benefit from GKRS owing to a reduction of annual hemorrhage rate in the first 2 years and 2 years after, despite several cases that suffer from negative side effects of radiation.

Uso de ácido tranexámico en las hemorragias / Use of traxenamic acid in hemorrhages

RESUMEN Según las evidencias científicas actuales, la administración de un tratamiento simple y económico con propiedades antifibrinolíticas, como el ácido tranexámico pudiera reducir la pérdida sanguínea luego de un trauma y disminuir el riesgo asociado a transfusiones sanguíneas. El ácido tranexámico es un derivado sintético de la lisina con una actividad antifibrinolítica pura. Su mecanismo de acción se basa en la unión al enlace de la lisina del plasminógeno, lo que bloquea la unión de la fibrina al complejo activador del plasminógeno-plasmina.Ante tal evidencia, esta revisión se propone describir los resultados del empleo del ácido tranexámico según la evidencia disponible. Para ello se realizó una búsqueda en bases de datos como PubMed, SciELO y ClinicalKeys(AU)

ABSTRACT According to the present scientific evidence, the administration of a simple economic treatment with anti-fibrinolytic properties such as the tranexamic acid can reduce the blood loss after trauma, and decrease the risk associated to blood transfusions. Tranexamic acid is a synthetic derivative of lysine with pure anti-fibrinolytic activity. Its mechanism of action is based on the joining to the plasminogen lysine bond, which blocks the binding of fibrin to the activating complex of plasminogen-plasmin. This review was aimed at describing the results of the use of tranexamic acid based on available evidence. To this end, a literature search was made in PubMed, SciELO and Clinical Keys databases(AU)

El dilema de las reintervenciones quirúrgicas / The dilema of surgical reinterventions

RESUMEN Introducción: En la actualidad, la diversidad de criterios relacionados con las reintervenciones quirúrgicas constituyen un verdadero problema científico, por cuanto, resulta de gran importancia profundizar en torno a los principales aspectos cognoscitivos relacionados con este tema a fin de elevar la calidad asistencial y, con esa premisa, el índice de supervivencia, sobre todo en la población envejecida como grupo vulnerable. Objetivos: Identificar los factores que permitan reconocer las condiciones modificables que disminuyan las complicaciones y fallecimientos de los enfermos tributarios de un nuevo tratamiento quirúrgico para salir adelante y sobrevivir. Métodos: Revisión digital de publicaciones actualizadas en español e inglés en bases de datos: Google, Redalyc, PubMed, Medline, Lilacs, Elsevier. Resultados: Las complicaciones posquirúrgicas y las que requieren una reintervención en particular son de origen multifactorial. No existe una definición y una clasificación estandarizada de las complicaciones posquirúrgicas para notificarlas. Las más utilizadas son las objetivas de Clavien Dindo y Accordeon, basadas en la estratificación del tratamiento requerido, el riesgo y gravedad. Conclusiones: A pesar de que el gran avance tecnológico actual en los métodos diagnósticos y terapéuticos ha permitido que los pacientes con complicaciones posquirúrgicas sean reintervenidos con mayor seguridad, la morbilidad y la mortalidad a causa de estas continúan elevadas(AU)

ABSTRACT Introduction: Nowadays, the diverse criteria related to surgical reinterventions are a real scientific problem since it is very important to delve into the main cognitive aspects associated to this topic in order to raise the quality of medical assistance and thus the survival index in the old population as a vulnerable group. Objectives: To identify the factors that allow recognizing the modifiable conditions that lead to less complications and deaths of patients undergoing a new surgical treatment. Methods: Search of updated publications in English and Spanish made in Goggle, Redalyc, PubMed, Medline, Lilacs and Elsevier databases. Results: The postsurgical complications and those requiring surgical reintervention in particular are of multifactoral origin. There is neither one single definition nor one standardized classification of the postsurgical complications to notify them. The most used objective classifications are Claven Dindo and Accordeon, based on the stratification of the required treatment, the risk and the severity. Conclusions: In spite of the fact that the great technological advances in the diagnostic and therapeutic methods have allowed the reoperation of complicated patients with higher margin of safety, morbidity and mortality caused by such complications are still high(AU)

Lesões vasculares orais: avaliações clínicas, diagnósticas e terapêuticas / Lesiones vasculares bucales: evaluaciones clínicas, diagnósticas y terapéuticas / Oral vascular lesions: clinical, diagnostic and therapeutic evaluations

Introdução: As patologias vasculares acometem com alta incidência as regiões de cabeça e pescoço. Quando essas acometem a região oral, nota-se predileção por lábios, língua e comissura bucal, com predominância no sexo feminino. Objetivo: Analisar sobre as lesões vasculares orais, enfatizando as características clínicas, métodos de diagnósticos e abordagem terapêutica. Métodos: Trata-se de uma revisão literária, com busca bibliográfica, realizada nas bases de dados eletrônicos PubMED/Medline, Lilacs, Science Direct e SciELO (Scientific Eletronic Library), utilizando os descritores: Hemangioma, Malformações vasculares, escleroterapia e fotocoagulação, em português, inglês e espanhol, obtendo 262 artigos completos, dos quais 18 foram utilizados como base científica apropriada para tal tema, obedecendo aos critérios de inclusão e exclusão. Resultados: As lesões vasculares orais caracterizam-se clinicamente como lesões únicas do tipo nódular ou mancha, cuja coloração varia do vermelho intenso ao roxo e de tamanho variável. Para diagnosticar essas lesões, utilizam-se comumente exames clínicos associados à diascopia, sem na maioria dos casos necessitarem de exames complementares. A intervenção terapêutica justifica-se devido às deformidades estéticas, possíveis sangramentos, ulcerações e infecções. Para tais alterações, existem diversas modalidades terapêuticas, incluindo escleroterapia, crioterapia, remoção cirúrgica e terapia de fotocoagulação a laser. Conclusão: As lesões vasculares orais exibem caracteristicas clinicas peculiares, apresentando-se como nódulos ou manchas, cuja coloração varia do vermelho intenso ao roxo. A diascopia é a manobra semiotécnica mais utilizada e confiável para o estabelecimento do diagnóstico clínico dessas lesões. A utilização de soluções esclerosantes apresenta-se como o tratamento mais descrito na literatura, seguido da fotocoagulação a laser(AU)

Introducción: Las enfermedades vasculares afectan con alta incidencia las regiones de cabeza y cuello. Cuando estas afectan la región bucal, se nota predilección por labios, lengua y comisura bucal, con predominio en el sexo femenino. Objetivo: Analizar sobre las lesiones vasculares bucales, enfatizando en las características clínicas, los métodos de diagnóstico y el enfoque terapéutico. Métodos: Se realizó una revisión bibliográfica en las bases de datos PubMED/Medline, Lilacs, Science Direct e SciELO. Se utilizaron los descriptores hemangioma, malformaciones vasculares, escleroterapia y fotocoagulación, en portugués, inglés y español. Se obtuvieron 262 artículos completos, de los cuales 18 fueron utilizados como base científica apropiada para tal tema, según los criterios de inclusión y exclusión. Resultados: Las lesiones vasculares bucales se caracterizan clínicamente como lesiones únicas del tipo nódular o mancha, cuya coloración varía del rojo intenso al púrpura y de tamaño variable. Para diagnosticar estas lesiones, se utilizan comúnmente exámenes clínicos asociados a la diascopia, sin que en la mayoría de los casos necesiten exámenes complementarios. La intervención terapéutica se justifica debido a las deformidades estéticas, posibles sangrados, ulceraciones e infecciones. Para estas alteraciones existen diversas modalidades terapéuticas, incluyendo escleroterapia, crioterapia, remoción quirúrgica y terapia de fotocoagulación láser. Conclusiones: Las lesiones vasculares bucales muestran características clínicas peculiares, presentándose como nódulos o manchas, cuya coloración varía del rojo intenso al púrpura. La diacopia es la maniobra semiotécnica más utilizada y confiable para el establecimiento del diagnóstico clínico de estas lesiones. El uso de soluciones claras se presenta como el tratamiento más descrito en la literatura, seguido de la fotocoagulación láser(AU)

Introduction: Vascular disorders affect the head and neck regions with high incidence. When they affect the oral region, there is a predilection for lips, tongue and mouth commissure, predominantly in the female. Objective: To analyze oral vascular lesions, emphasizing the clinical characteristics, diagnostic methods and therapeutic approach. Methods: A bibliographic review was carried out in the databases PubMED/Medline, Lilacs, Science Direct andSciELO (Scientific Electronic Library). We used the descriptors hemangioma, vascular malformations, sclerotherapy and photocoagulation, in Portuguese, English and Spanish. We obtained 262 complete articles, of which 18 were used as appropriate scientific basis for this topic, based on the inclusion and exclusion criteria. Results: Oral vascular lesions are clinically characterized as single lesions of the nodes or blotches, whose color varies from deep red to purple and are of variable size. In order to diagnose these lesions, clinical examinations associated with the periodontal disease are commonly used, although in most cases they do not require complementary examinations. The therapeutic intervention is justified due to aesthetic deformities, possible bleeding, ulcerations and infections. For such changes, there are several therapeutic modalities, including sclerotherapy, cryotherapy, surgical removal and laser photocoagulation therapy. Conclusions: Oral vascular lesions show peculiar clinical characteristics, presenting as nodules or spots, whose coloration varies from intense red to purple. Diascopy is the most used and reliable semi-technical method for establishing the clinical diagnosis of these lesions. The use of sclerosing solutions is the most described treatment in the literature, followed by laser photocoagulation(AU)

Teorías y mecanismos que justifican el empleo de la cirugía metabólica en personas con diabesidad / Theories and mechanisms supporting the use of metabolic surgery in patients with diabesity

El empleo de la cirugía metabólica, como tratamiento capaz de revertir o mejorar la diabesidad, ha llamado la atención por las transformaciones inducidas en los pacientes sometidos a esta intervención. Esas transformaciones se tratan de explicar a través de los cambios anatómicos y fisiológicos que la intervención produce. Un mayor conocimiento de las teorías y los mecanismos que garantizan la pérdida de peso y una mejor respuesta metabólica puede contribuir al diseño de estrategias más efectivas. El objetivo es describir las teorías y mecanismos que tratan de explicar los cambios benéficos observados después de una cirugía metabólica en personas con diabesidad. Se utilizó como buscador de información científica Google Académico. Se emplearon como palabras clave: cirugía bariátrica, cirugía metabólica, obesidad, diabetes mellitus tipo 2 y diabesidad. Fueron evaluados artículos de revisión y de investigación en idioma español, portugués o inglés que tenían menos de 10 años de publicados, provenientes de diferentes bases de datos: PubMed, LILACS, Cochrane y SciElo y páginas web en general. Esto permitió el estudio de 110 artículos, de los cuales, 66 fueron referenciados. Los cambios inducidos por la cirugía metabólica y sus resultados en personas con diabesidad se han relacionado con diferentes teorías y mecanismos: teoría del intestino proximal y del intestino distal, por ejemplo. A lo anterior se suman los cambios en la microbiota intestinal y la mayor disponibilidad de ácidos biliares en el íleon. Las diferentes teorías se complementan entre sí y es difícil poder establecer cuál de ellas resulta de mayor utilidad, lo que también depende de la técnica quirúrgica empleada (restrictiva o restrictiva malabsortiva) y de sus mecanismos de acción(AU)

The use of metabolic surgery as a treatment capable of either reverting or improving diabesity has attracted attention due to the transformations induced in patients undergoing such intervention. These transformations have been attributed to the anatomical and physiological changes brought about by the surgery. Enriched knowledge about the theories and mechanisms ensuring weight loss and a better metabolic response may contribute to the design of more effective strategies. The objective is to describe the theories and mechanisms which intend to explain the beneficial changes observed after metabolic surgery in people with diabesity. Scientific information was obtained from the search engine Google Scholar using the key words bariatric surgery, metabolic surgery, obesity, type 2 diabetes mellitus and diabesity. Evaluation was conducted of review and research papers published in Spanish, Portuguese or English in the past 10 years on various databases (PubMed, LILACS, Cochrane, SciELO) and webpages. A total 110 papers were analyzed of which 66 were referenced. Changes induced by metabolic surgery and their results in people with diabesity have been associated to different theories and mechanisms, e.g. the proximal intestine hypothesis and the distal intestine hypothesis. To this are added the changes in the intestinal microbiota and a greater availability of bile acids in the ileum. The different theories complement one another, and it is hard to decide which is the most useful, for it also depends on the surgical technique used (restrictive or malabsorptive restrictive) and its mechanisms of action(AU)