Deep learning in the diagnosis for cystic lesions of the jaws: a review of recent progress.

Cystic lesions of the gnathic bones present challenges in differential diagnosis. In recent years, artificial intelligence (AI) represented by deep learning (DL) has rapidly developed and emerged in the field of dental and maxillofacial radiology (DMFR). Dental radiography provides a rich resource for the study of diagnostic analysis methods for cystic lesions of the jaws and has attracted many researchers. The aim of the current study was to investigate the diagnostic performance of DL for cystic lesions of the jaws. Online searches were done on Google Scholar, PubMed, and IEEE Xplore databases, up to September 2023, with subsequent manual screening for confirmation. The initial search yielded 1862 titles, and 44 studies were ultimately included. All studies used DL methods or tools for the identification of a variable number of maxillofacial cysts. The performance of algorithms with different models varies. Although most of the reviewed studies demonstrated that DL methods have better discriminative performance than clinicians, further development is still needed before routine clinical implementation due to several challenges and limitations such as lack of model interpretability, multicentre data validation, etc. Considering the current limitations and challenges, future studies for the differential diagnosis of cystic lesions of the jaws should follow actual clinical diagnostic scenarios to coordinate study design and enhance the impact of AI in the diagnosis of oral and maxillofacial diseases.

Kidney collecting system anatomy applied to endourology - a narrative review

ABSTRACT Objective: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. Material and Methods: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. Results: Renal collecting system could be divided in four groups: A1 - kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 - KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 - KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 - KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. Conclusion: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries.

Antecedentes de Andragogía en el proceso de gestión de personas mayores por profesionales de enfermería

Introducción: La gestión del cuidado de enfermería en personas mayores es todo un desafío en la actualidad para la profesión y más aún desde un enfoque andragógico. Objetivo: Exponer la fundamentación de los antecedentes de la andragogía en el proceso de gestión del cuidado de personas mayores por profesionales de enfermería. Métodos: Se realizó una revisión con el método de análisis bibliográfico a través de una búsqueda realizada entre los años 2010 al 2022, donde se consultaron bases de datos especializadas y se seleccionaron 33 publicaciones científicas sobre el tema. Resultados: El cuidado de personas mayores requiere una mirada transdisciplinaria y profesionales comprometidos con su cuidado. El profesional de enfermería responsable de la gestión debe considerar valores, actitudes y conocimientos de la disciplina que brindan una visión distinta y específica de la gestión de los cuidados. El avance científico ha permitido el incremento de la expectativa de vida de las personas, produciéndose un aumento significativo de personas mayores en el mundo manteniendo un adecuado cuidado como eslabón importante. La andragogía se encarga de la educación entre, para y por adultos y la asume como su objeto de estudio y realización, vista o concebida esta, como autoeducación, por lo cual, cobra importancia en los cuidados, pues interpreta el hecho educativo como un hecho andragógico, donde la educación y los cuidados se realizan como autoeducación. Conclusiones: Resulta importante la ejecución de investigaciones que beneficien el desarrollo del profesional de enfermería, para ayudar a disminuir las brechas que constan en la formación investigativa de estos profesionales y en las estructuras organizativas en las que estos se incorporan, dado en el proceso de gestión del cuidado de personas mayores desde un enfoque andragógico como mecanismo esencial.

Introduction: The management of nursing care in older people is a challenge for the profession today and even more so from an andragogical approach. Objective: To present the foundation of the background of andragogy in the process of managing the care of elderly people by nursing professionals. Methods: A review was carried out using the bibliographic analysis method through a search carried out between the years 2010 to 2022, where specialized databases were consulted and 33 scientific publications on the topic were selected. Results: Caring for the elderly requires a transdisciplinary approach and professionals committed to their care. The nursing professional responsible for the management must consider values, attitudes and knowledge of the discipline that provide a different and specific vision of care management. Scientific advances have allowed an increase in people's life expectancy, producing a significant increase in the number of older people in the world, maintaining adequate care as an important link. Andragogy is responsible for education among, for and by adults and assumes it as its object of study and realization, seen or conceived, as self-education, which is why andragogy gains importance in care, since it interprets the educational fact as an andragogical fact, where education and care are carried out as self-education. Conclusions: It is important to carry out research that benefits the development of nursing professionals, to help reduce the gaps that exist in the research training of these professionals and in the organizational structures in which they are incorporated, given in the care management process of older people from an andragogical approach as an essential mechanism.

A contribuição de terapeutas ocupacionais no domínio da gestão de risco e desastres: um protocolo de revisão de escopo / Contribution of occupational therapists to the field of risk and disaster management: a scoping review protocol

Resumo Introdução Desastres trazem consequências humanas, socioeconômicas e ambientais e agravam situações de vulnerabilidade. Tanto países centrais, altamente industrializados, como países com dificuldades econômicas estão sujeitos a esses eventos. No Brasil, a pandemia de COVID-19 e o rompimento de barragens evidenciam dificuldades em se antecipar e responder esses tipos de eventos. Ações da terapia ocupacional no campo das emergências e desastres são escassas na literatura, notadamente na esfera da prevenção. Objetivo Explorar as evidências da contribuição de terapeutas ocupacionais no domínio da gestão de risco e desastres a partir das características, prioridades e principais áreas de interesse da produção intelectual em terapia ocupacional. Método Uma pesquisa abrangente será conduzida nos periódicos Disasters, Hazards & Crisis in Public Policy, International Journal of Mass Emergencies and Disasters, and Risk, International Journal of Risk Reduction e Journal of Contingencies and Crisis Management, assim como nas bases de dados Occupational Therapy Literature Search Service (OTDBASE), PubMed e Web of Science. Critérios de inclusão Ações e experiências no âmbito da terapia ocupacional, notadamente aquelas de terapeutas ocupacionais na gestão de riscos e desastres, encontradas em estudos revisados por pares, que adotem métodos quantitativos, qualitativos e mistos, nos idiomas espanhol, inglês e português, sem restrição temporal. A abordagem preconizada pelo Joanna Briggs Institute (JBI) para seleção de estudos, avaliação crítica, extração e síntese de dados será utilizada.

Abstract Introduction Disasters bring human, socioeconomic, and environmental consequences and exacerbate situations of vulnerability. Both highly industrialized core countries and those facing economic difficulties are subject to these events. In Brazil, the COVID-19 pandemic and the collapse of dams highlight difficulties in anticipating and responding to these types of events. Actions of occupational therapy in the field of emergencies and disasters are scarce in the literature, notably in the sphere of prevention. Objective To explore the evidence of the contribution of occupational therapists in the field of risk management and disasters based on the characteristics, priorities, and main areas of interest of intellectual production in occupational therapy. Method A comprehensive search will be conducted in the journals Disasters, Hazards & Crisis in Public Policy, International Journal of Mass Emergencies and Disasters, and Risk, International Journal of Risk Reduction, and Journal of Contingencies and Crisis Management, as well as in the databases Occupational Therapy Literature Search Service (OTDBASE), PubMed, and Web of Science. Inclusion Criteria Actions and experiences in the field of occupational therapy, notably those of occupational therapists in risk and disaster management, found in peer-reviewed studies adopting quantitative, qualitative, and mixed methods, in Spanish, English, and Portuguese, without temporal restriction. The approach advocated by the Joanna Briggs Institute (JBI) for study selection, critical appraisal, and data collection and synthesis will be used.

Interoception and pediatric occupational therapy practice: a protocol for a scoping review / Interocepção e prática da terapia ocupacional pediátrica: um protocolo para uma revisão de escopo

Abstract Introduction Interoception is relatively new within pediatric occupational therapy practice. Interoception allows us to feel and interpret internal body sensations and is related to our ability to regulate emotions and behavior. It is associated with other functions including sensory processing, self-regulation and executive functioning, making it important for everyday participation in life activities. Pediatric occupational therapists are considering interoception as part of intervention but there is limited research to understand how and why occupational therapists use interoception in clinical practice. Objectives The aim of this protocol is to describe the methodology and analyses to be used to undertake a scoping review. Method This paper presents the protocol for a scoping review. A search of literature from ten electronic databases (Ovid Medline, Ovid Embase, Ovid PsycINFO, ERIC, Scopus, CINAHL, ProQuest Dissertations & Theses Global, AMED, OTDBASE and Google Scholar), grey literature and article reference searching was conducted. Title and abstract screening was completed before full-text review. Selected articles met stringent inclusion criteria. The PRISMA-ScR Checklist was used alongside the Crowe Critical Appraisal Tool to ensure robust data extraction and synthesis from selected studies. Results A total of 2449 articles were retrieved. Eighteen articles were included in the review. A narrative synthesis approach will be used to synthesise data. Conclusion Findings from this scoping review will inform future research related to interoception and pediatric occupational therapy practice to support clinicians to consider evidence to underpin practice.

Resumo Introdução A interocepção é relativamente nova na prática da terapia ocupacional pediátrica. A interocepção nos permite sentir e interpretar sensações internas do corpo e está relacionada à nossa capacidade de regular emoções e comportamentos. Está associado a outras funções, incluindo processamento sensorial, autorregulação e funcionamento executivo, tornando-o importante para a participação diária nas atividades da vida. Os terapeutas ocupacionais pediátricos estão considerando a interocepção como parte da intervenção, mas há pesquisas limitadas para entender como e por que os terapeutas ocupacionais usam a interocepção na prática clínica. Objetivos O objetivo deste protocolo é descrever a metodologia e as análises a serem utilizadas para realizar uma revisão de escopo. Método Este artigo apresenta o protocolo para uma revisão de escopo. Foi realizada uma pesquisa de literatura em dez bases de dados eletrônicas (Ovid Medline, Ovid Embase, Ovid PsycINFO, ERIC, Scopus, CINAHL, ProQuest Dissertations & Theses Global, AMED, OTDBASE e Google Scholar), literatura cinzenta e pesquisa de referências de artigos. A triagem do título e do resumo foi concluída antes da revisão do texto completo. Os artigos selecionados atenderam a critérios de inclusão rigorosos. A lista de verificação PRISMA-ScR foi usada juntamente com a Crowe Critical Appraisal Tool para garantir a extração e síntese robusta de dados dos estudos selecionados. Resultados Foram recuperados 2.449 artigos. Dezoito artigos foram incluídos na revisão. Uma abordagem de síntese narrativa será usada para sintetizar os dados. Conclusão Os resultados desta revisão de escopo informarão pesquisas futuras relacionadas à interocepção e à prática de terapia ocupacional pediátrica para apoiar os médicos a considerarem evidências para sustentar a prática.

Roles and competencies of nurses and physicians in shared decision-making in cardiac surgery: A scoping review.

AIM: Identification and synthesis of research data related to the roles and competencies of physicians and nurses that are prerequisites for careful shared decision-making with patients potentially undergoing cardiac surgery. DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA Extension for Scoping Reviews. METHODS: PubMed, EMBASE and CINAHL were searched from inception dates up to March 2022, to identify primary studies published in a peer-reviewed journal. Study selection, assessment of the methodological quality and data extracting of the included studies were done by at least two independent researchers. To describe the findings of the studies, an emergent synthesis approach was used to visualize a descriptive representation of professional roles and competencies in shared decision-making, in an overview. RESULTS: The systematic search revealed 10,055 potential papers, 8873 articles were screened on title and abstract and 76 full texts were retrieved. Eight articles were included for final evaluation. For nurses and physicians, 26 different skills were identified in the literature to practice shared decision-making in cardiac surgery. The skills that emerged were divided into five professional roles: moderator; health educator; data collector; psychological supporter and translator. CONCLUSIONS: This review specifies the professional roles and required competencies related to shared decision-making in cardiac surgery. Further research is needed to compare our findings with other clinical areas and from there to arrive at a professional division of roles between the different clinical disciplines involved. IMPACT: The visualization of generic shared decision-making competencies and roles should establish the professional division of positions between various clinical physician and nurse disciplines in order to create a treatment plan based on evidence, values, preferences and the patient's personal situation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Historia de la hipertensión arterial: revisión narrativa / History of high blood pressure: narrative review

Introducción: La medición de la presión arterial es uno de los procedimientos más realizados en la práctica clínica. La presente revisión narrativa pretende sintetizar los aspectos relevantes que rodearon la definición de la hipertensión arterial, el recorrido histórico del tratamiento de esta y el aporte de los estudios a la disminución de la mortalidad por enfermedad cardiovascular en el tiempo. Metodología: Revisión narrativa de la historia de la hipertensión arterial, desde el reconocimiento de la presión arterial alta como un factor asociado al riesgo cardiovascular y la evolución histórica del tratamiento hasta los hallazgos significativos del estudio SPRINT, publicado en 2015. Resultados: Hasta hace aproximadamente 50 años la hipertensión arterial era conocida como una patología esencial, es decir, esta condición no siempre fue considerada como una enfermedad. El descubrimiento de la presión sanguínea ha sido atribuido a Stephen Hales, poeta, orador y sacerdote nacido en Inglaterra. La primera medición de la presión sanguínea e incidentalmente de la presión del pulso la realizó en 1733 en animales. Se describe el origen de la presión arterial, la hipertensión arterial, el camino recorrido para el reconocimiento de esta condición como enfermedad y posteriormente su tratamiento, hasta llegar al estudio SPRINT en 2015, el cual fue contundente en demostrar el beneficio de reducir la cifra de presión arterial sistólica objetivo en una población no diabética. Conclusión: Los resultados de esta revisión narrativa exponen cómo el reconocimiento de la presión arterial alta como un factor de riesgo cardiovascular permitió el avance en la investigación científica para determinar el tratamiento y las cifras de presión arterial que favorecen la reducción de la mortalidad y morbilidad por esta causa.

Background: Blood pressure measurement is one of the most performed procedures in clinical practice. This narrative review aims to expose the relevant aspects surrounding the definition of arterial hypertension, the historical path of its treatment, and the contribution of studies to the decrease in mortality due to cardiovascular disease over time. Methodology: Narrative review of the history of arterial hypertension from recognizing high blood pressure as a factor associated with cardiovascular risk to the historical evolution of treatment up to the SPRINT study published in 2015. Results: Until about 50 years ago, arterial hypertension was known as an essential pathology; this condition was not always considered a disease. The discovery of blood pressure has been attributed to Stephen Hales, a poet, orator and priest born in England. The first measurement of blood pressure and incidentally pulse pressure was made in 1733 in animals. The origin of blood pressure, arterial hypertension, and the path travelled for recognizing this condition as a disease and later its treatment until reaching the SPRINT study in 2015, which demonstrated the benefit of reducing the target systolic blood pressure figure in a non-diabetic population. Conclusion: This narrative review demonstrates that the recognition of high blood pressure as a cardiovascular risk factor allowed progress in scientific research to determine the treatment and blood pressure figures that favor the reduction of mortality and morbidity from this cause.

¿Cuántos Tipos de Revisiones de la Literatura Existen? Enumeración, Descripción y Clasificación. Revisión Cualitativa / How Many Types of Literature Reviews are There? Listings, Description and Classification

La expansión y consolidación de la práctica clínica basada en la evidencia ha llevado entre otras, a la necesidad de realizar una variedad cada vez mayor de tipos de revisión de la literatura científica; lo que permite avanzar en el conocimiento y comprender la amplitud de la investigación sobre un tema de interés, teniendo en cuenta que una de las propiedades del conocimiento es su carácter acumulativo. Sin embargo, la diversidad de la terminología utilizada genera confusión de términos y conceptos. El objetivo de este manuscrito fue proporcionar un listado de los tipos de revisiones de la literatura más frecuentemente utilizados con sus características y algunos ejemplos de ellas. Revisión cualitativa. Se examinaron de forma dirigida las bases de datos PubMed, WoS y Scopus, en búsqueda de términos asociados a tipos de revisiones y síntesis de la literatura científica. Se encontraron 21 tipos de revisión; y 29 variantes y sinonimias asociadas; las que ilustran los procesos de cada una de ellas. Se da una descripción general de las características de cada cual, junto con las fortalezas y debilidades percibidas. No obstante, se verificó que sólo algunos tipos de revisión poseen metodologías propias y explícitas. Este enfoque, proporciona un punto de referencia para quienes realizan o interpretan revisiones en el ámbito sanitario, y sugiere dos tipos de propuestas de clasificación.

SUMMARY: The expansion and consolidation of evidence-based clinical practice has led, among other things, to the need to carry out an increasing variety of types of literature reviews, which allows advancing in knowledge and understanding the breadth of research on a topic of interest. However, the diversity of the terminology used generates confusion of terms and concepts. The aim of this manuscript was to provide a list of the most frequently used review types with their characteristics and some examples. Qualitative review. PubMed, WoS and Scopus databases were examined in a directed way, searching for terms associated with types of reviews and syntheses of the scientific literature. Twenty-one types of review, and 29 variants and associated synonymies were found; those that illustrate the processes of each of them. An overview of the characteristics of each is given, along with perceived strengths and weaknesses. However, it was verified that only some types of review have their own explicit methodologies. This approach, provides a point of reference for those who perform or interpret reviews in the health field and suggests two classification proposals.

Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews.

BACKGROUND: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs. METHODS: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome. RESULTS: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55-0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79-0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87-1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28-1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed. CONCLUSION: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making.

Narrativas sobre competição esportiva: reflexões e perspectivas / Narratives about sports competition: reflections and perspectives / Narrativas sobre la competición deportiva: reflexiones y perspectivas

Analisar as concepções sobre competição esportiva em publicações acadêmicas brasileiras é o foco deste trabalho. Utilizando-se da revisão sistemática, do tipo estado da arte, foram analisados 175 artigos no recorte temporal 2010-2020 (11 anos) em 14 revistas da área da Educação Física. Há parcimônia dos/as autores/as quanto a complexidade da competição e foram salutares indicativas do rememorar a essência do tema; independente da área de conhecimento específico, foram recorrentes indicativos de um processo respeitoso e pedagógico da competição aos praticantes. Ademais, confirmam que amadores e profissionais; homens e mulheres; idosos e jovens, todos podem (e devem) ter a opção da experiência esportiva no âmbito competitivo (AU).

Analyzing the concepts about sports competition in Brazilian academic publication is the objective of this paper. Using the state-of-art systematic review, 175 articles were considered from 14 Physical Education Journals from 2010 to 2020 (11 years). There is parsimony by the authors regarding the complexity of the competition and greetings indicative of remembering the essence of the theme; regardless of the area of specific knowledge, there were recurrent indicators of a respectful and pedagogical process of the competition for practitioners. Also, it was confirmed that amateurs and professionals; men and women; elderly and young; everyone can (and should) have the possibility of sporting experience in the competitive environment (AU).

Analizar las concepciones sobre la competición deportiva en las publicaciones académicas brasileñas es el foco de este trabajo. Utilizando la revisión sistemática del tipo estado del arte, se buscarán 175 artículos en el período de 2010-2020 en 14 revistas del área de Educación Física. Hay parcimônia a la complejidad de la competición y fueron saludos indicativos de recordar la esencia del tema; independientemente del área de conocimiento específico, fueron recurrentes indicativos para un proceso respetuoso y pedagógico de la competencia por practicantes. También confirman que los atletas aficionados y profesionales; hombres y mujeres; ancianos y jóvenes, todos pueden (y deben) tener la opción de la experiencia deportiva en el entorno competitivo

Narrativas sobre competição esportiva: reflexões e perspectivas / Narratives about sports competition: reflections and perspectives / Narrativas sobre la competición deportiva: reflexiones y perspectivas

Analisar as concepções sobre competição esportiva em publicações acadêmicas brasileiras é o foco deste trabalho. Utilizando-se da revisão sistemática, do tipo estado da arte, foram analisados 175 artigos no recorte temporal 2010-2020 (11 anos) em 14 revistas da área da Educação Física. Há parcimônia dos/as autores/as quanto a complexidade da competição e foram salutares indicativas do rememorar a essência do tema; independente da área de conhecimento específico, foram recorrentes indicativos de um processo respeitoso e pedagógico da competição aos praticantes. Ademais, confirmam que amadores e profissionais; homens e mulheres; idosos e jovens, todos podem (e devem) ter a opção da experiência esportiva no âmbito competitivo.

Analyzing the concepts about sports competition in Brazilian academic publication is the objective of this paper. Using the state-of-art systematic review, 175 articles were considered from 14 Physical Education Journals from 2010 to 2020 (11 years). There is parsimony by the authors regarding the complexity of the competition and greetings indicative of remembering the essence of the theme; regardless of the area of specific knowledge, there were recurrent indicators of a respectful and pedagogical process of the competition for practitioners. Also, it was confirmed that amateurs and professionals; men and women; elderly and young; everyone can (and should) have the possibility of sporting experience in the competitive environment.

Analizar las concepciones sobre la competición deportiva en las publicaciones académicas brasileñas es el foco de este trabajo. Utilizando la revisión sistemática del tipo estado del arte, se buscarán 175 artículos en el período de 2010-2020 en 14 revistas del área de Educación Física. Hay parcimônia a la complejidad de la competición y fueron saludos indicativos de recordar la esencia del tema; independientemente del área de conocimiento específico, fueron recurrentes indicativos para un proceso respetuoso y pedagógico de la competencia por practicantes. También confirman que los atletas aficionados y profesionales; hombres y mujeres; ancianos y jóvenes, todos pueden (y deben) tener la opción de la experiencia deportiva en el entorno competitivo.

Systemic oncological treatments in patients with advanced pancreatic cancer: a scoping review and evidence map.

PURPOSE: To identify, describe, and organise currently available evidence regarding systemic oncological treatments (SOTs) (chemotherapy, targeted/biological therapies, and immunotherapy) compared to best supportive care (BSC) for patients with advanced pancreatic cancer (PC). METHODS: We conducted a scoping review and evidence mapping, adhering to PRISMA-ScR checklist. We searched MEDLINE, EMBASE, Cochrane Library, Epistemonikos, PROSPERO, and clinicaltrials.gov for eligible studies. We included systematic reviews (SRs), randomised controlled trials (RCTs), quasi-experimental, and observational studies evaluating SOTs compared to BSC or no treatment in patients with advanced PC. Two independent reviewers performed the screening process and data extraction. We developed evidence maps as an interactive visualization display, including the assessed interventions and outcomes. RESULTS: Of the 50,601 records obtained from our search, we included 43 studies: 2 SRs, 16 RCTs, 4 quasi-experimental studies, 20 observational studies, and 1 protocol for a quasi-experimental study. Forty-two studies reported survival-related outcomes and most favoured SOTs, while five reported toxicity and most favoured BSC. Other patient-centred outcomes, such as quality of life, were scarcely reported. CONCLUSIONS: This study highlights the current evidence gaps in studies assessing treatments for patients with advanced PC, mainly the lack of reports of non-survival-related outcomes, pointing out research areas that need further attention to make better recommendations for these patients.

Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI.

Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.

A Critical Systematic Review for Inhaled Corticosteroids on Lung Cancer Incidence: Not Yet Concluded Story.

BACKGROUND: To systematically review studies on inhaled corticosteroids (ICS) and lung cancer incidence in chronic airway disease patients. METHODS: We conducted electronic bibliographic searches on OVID-MEDLINE, EM- BASE, and the Cochrane Database before May 2020 to identify relevant studies. Detailed data on the study population, exposure, and outcome domains were reviewed. RESULTS: Of 4,058 screened publications, 13 eligible studies in adults with chronic obstructive pulmonary disease (COPD) or asthma evaluated lung cancer incidence after ICS exposure. Pooled hazard ratio and odds ratio for developing lung cancer in ICS exposure were 0.81 (95% confidence interval, 0.64 to 1.02; I2=95.7%) from 10 studies and 1.02 (95% confidence interval 0.50 to 2.07; I2=94.7%) from three studies. Meta-regression failed to explain the substantial heterogeneity of pooled estimates. COPD and asthma were variously defined without spirometry in 11 studies. Regarding exposure assessment, three and 10 studies regarded ICS exposure as a time-dependent and fixed variable, respectively. Some studies assessed ICS use for the entire study period, whereas others assessed ICS use for 6 months to 2 years within or before study entry. Smoking was adjusted in four studies, and only four studies introduced 1 to 2 latency years in their main or subgroup analysis. CONCLUSION: Studies published to date on ICS and lung cancer incidence had heterogeneous study populations, exposures, and outcome assessments, limiting the generation of a pooled conclusion. The beneficial effect of ICS on lung cancer incidence has not yet been established, and understanding the heterogeneities will help future researchers to establish robust evidence on ICS and lung cancer incidence.

Uso y resultados del astegolimab en el manejo del asma severa: ¿qué se conoce?

El asma es una enfermedad inflamatoria crónica de las vías respiratorias que acarrea elevados costos en salud, afecta sustancialmente la calidad de vida y, dependiendo de ciertos factores de riesgo asociados, disminuye la capacidad funcional de quien lo padece. Para el 2019, el asma afectó a 262 millones de personas (4,3 % de la población mundial) y causó 461 000 muertes. Se estima que habrá 100 millones de personas adicionales con asma para el año 2025. El asma severa es un fenotipo resistente a corticoides que ocasiona mayor número de exacerbaciones, afecta sustancialmente la calidad de vida y capacidad funcional del afectado. Su manejo inicialmente se encamina a suprimir los síntomas, y este ha ido evolucionando hasta la comprensión, aún no completa, de los sistemas intrínsecos de su generación, con lo cual se han estudiado nuevas formas de incidir en su manejo, mediante la modulación de la respuesta inmune y la cascada inflamatoria, con la generación de medicamentos biológicos. A raíz del estudio e identificación de endotipos y fenotipos variados, se han diseñado este tipo de medicamentos, con distintos mecanismos de acción, que han demostrado una utilidad sólida en los últimos años. No obstante, existe evidencia de que se ha encontrado resistencia incluso a estos medicamentos, por lo que ha sido necesario seguir investigando nuevas dianas terapéuticas. El astegolimab es un novedoso anticuerpo monoclonal Ig G2 humano que bloquea la señalización de IL-33 al dirigirse a ST2, su receptor, por consiguiente, controla la respuesta inflamatoria en el asma severa. Actualmente, se encuentra en realización de ensayo clínico fase 2b, aunque experimentaciones previas han encontrado resultados positivos y significativos respecto a la inmunomodulación, función pulmonar, sintomatología y calidad de vida. En la actualidad, casi no existe literatura que haya analizado el potencial del astegolimab en el asma grave, y están disponibles prácticamente solo los ensayos que lo han evaluado y algunas revisiones que han compartido su farmacocinética y farmacodinamia. Sobre la base de lo anterior, el objetivo de esta revisión consiste en sintetizar evidencia relacionada con los resultados del uso del astegolimab en asma severa, discutiendo aspectos epidemiológicos y fisiopatológicos que resalten la necesidad del desarrollo de un fármaco seguro, eficaz y eficiente.

Asthma is a chronic inflammatory disease of the respiratory tract which causes high health costs, substantially affects the quality of life and, depending on certain associated risk factors, reduces the functional capacity of the sufferer. By 2019, asthma affected 262 million people (4.3 % of the world's population) and caused 461,000 deaths. It is estimated that there will be an additional 100 million people with asthma by 2025. Severe asthma is a phenotype resistant to corticosteroids which causes a greater number of exacerbations and substantially affects the quality of life and functional capacity of the affected person. Its management was initially aimed at suppressing the symptoms and then evolved to understand, although not completely, the intrinsic systems of its generation. Thus, new ways of influencing its management have been studied by modulating the immune response and the inflammatory cascade with the generation of biological drugs. As a result of the study and identification of various endotypes and phenotypes, drugs with different mechanisms of action have been designed and have demonstrated to be considerably useful in recent years. However, there is evidence that resistance even to these drugs has occurred, being necessary to continue researching new therapeutic targets. Astegolimab is a novel human IgG2 monoclonal antibody that blocks IL-33 signaling by targeting ST2, its receptor, thus controlling the inflammatory response in severe asthma. A phase 2b clinical trial is currently undergoing, although previous results have found positive and significant results regarding immunomodulation, pulmonary function, symptomatology and quality of life. At present, there is almost no literature that has analyzed the potential of astegolimab in severe asthma, and practically only trials that have evaluated it and some reviews that have shared its pharmacokinetics and pharmacodynamics are available. Based on the above, the aim of this review is to synthesize evidence related to the results of the use of astegolimab in severe asthma and discuss epidemiological and pathophysiological aspects that highlight the need for the development of a safe, effective and efficient drug.

Riesgo cardiovascular en pacientes recuperados de COVID-19 a corto y mediano plazo: ¿qué concluye la evidencia actual?

El riesgo y enfermedades cardiovasculares en pacientes recuperados de COVID-19 es un campo de análisis reciente en la literatura médica mundial y de vital importancia, porque existe una gran cantidad de pacientes con complicaciones una vez terminada la fase aguda de la enfermedad. El gran espectro del daño al miocardio en esta enfermedad puede variar desde una elevación asintomática de los niveles de troponinas cardíacas, hasta la aparición de una miocarditis fulminante y/o shock circulatorio, lo que puede dejar secuelas significativas. A pesar de que no existe una estrategia clara para abordar los eventos cardíacos que aparecen durante la COVID-19, y teniendo en cuenta que el manejo se hace principalmente para controlar los síntomas del paciente a medida que surgen, el objetivo de este trabajo fue conocer y recopilar la evidencia actual en esta temática, de tal manera que se pueda ofrecer al lector una guía de consulta en español que contribuya al desarrollo de su profesión sanitaria. La metodología utilizada fue una búsqueda de literatura en bases de datos como Medline, Scopus, Science Direct, con una ventana de tiempo entre 2019 y 2022. Los principales resultados revelaron que dentro de los mecanismos moleculares y fisiopatológicos implicados en este síndrome pos-COVID, se encuentra la afectación del sistema renina-angiotensina-aldosterona, al estar ligado el tropismo del SARS-Cov-2 a la enzima convertidora de angiotensina 2. Esto ocasiona una alteración de la respuesta neuro-humoral del sistema cardiovascular, renal y digestivo, lo que genera déficit en las vías de señalización y ocasiona lesión directa sobre corazón, pulmones y otros órganos. El síndrome pos-COVID-19, en general, se define como la aparición o persistencia de los síntomas posteriores a 3 o 4 semanas de aparecida la fase aguda de la enfermedad. Entonces, esta podría considerarse como una ventana de tiempo de riesgo y seguimiento estricto, para valorar de forma personalizada el riesgo entre los distintos grupos de pacientes, sobre todo de aquellos con antecedentes personales de enfermedad cardiovascular. Los principales resultados revelaron la presencia de trastornos como la insuficiencia cardiaca, las arritmias, la pericarditis y la miocarditis, que requieren de detección precoz y que se presentan días e incluso semanas posteriores a la fase aguda de la COVID-19.

Cardiovascular risk and diseases among patients recovered from COVID-19 is a recent field of study in the world medical literature and is also of vital importance because a large number of patients develop complications once the acute phase of the disease is over. The broad spectrum of myocardial injury in cardiovascular diseases can range from the asymptomatic elevation of cardiac troponin levels to the development of fulminant myocarditis and/or circulatory shock, which can leave significant sequelae. Despite the fact that there is no clear strategy to treat cardiac events that occur during COVID-19 infection and taking into account that treatment is mainly aimed at relieving patients' symptoms as they arise, the objective of this work was to find out and collect current evidence on this subject, so that readers can be offered a reference guide in Spanish that contributes to the development of their health profession. The methodology used was a literature search in databases including Medline, Scopus and ScienceDirect within a time window between 2019 and 2022. The main results revealed that the molecular and pathophysiological mechanisms involved in post-COVID-19 syndrome include the renin-angiotensin-aldosterone system since SARS-CoV-2 tropism is linked to angiotensin-converting enzyme 2. This causes an alteration of the neurohumoral response of the cardiovascular, renal and digestive systems, generating deficits in the signaling pathways and causing direct damage to the heart, lungs and other organs. PostCOVID-19 syndrome, in general, is defined as the occurrence or persistence of symptoms three or four weeks after the acute phase of the disease. This could then be considered as a time window of risk and strict follow-up to assess in a personalized way the risk among the different groups of patients, especially those with a past history of cardiovascular disease. The main results revealed disorders such as heart failure, arrhythmias, pericarditis and myocarditis, which require early detection and occur days or even weeks after the acute phase of COVID-19.

Fracturas osteocondrales de la rodilla

Introducción: Las fracturas osteocondrales que afectan la articulación de la rodilla se presenta de forma aislada o asociada a otras afecciones traumáticas. El diagnóstico inicial es en ocasiones difícil de realizar por la convergencia de signos clínicos e imagenológicos. Objetivo: Brindar información actualizada sobre los elementos más importantes de esta enfermedad traumática. Métodos: La búsqueda y el análisis de la información se realizó en un periodo de 31 días (del primero al 31 de agosto de 2021) y se emplearon las siguientes palabras del idioma ingles: osteochondral lesions, osteochondral fractures, osteochondral injuries a partir de la información obtenida se realizó una revisión bibliográfica de un total de 315 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. Resultados: Se hace referencia al mecanismo de producción, aspecto artroscópico, localización, características en cuanto a extensión, profundidad, clasificación y desplazamiento. Se describen las modalidades imagenológicas empleadas en el diagnóstico y su utilidad. Con relación al diagnóstico diferencial se describen un grupo de enfermedades con características similares. Se mencionan las modalidades de tratamiento basadas en el tamaño y tiempo de evolución. Conclusiones: Las fracturas osteocondrales son lesiones frecuentes, para su diagnóstico se necesita de un alto índice de sospecha, ya que el diagnóstico clínico e imagenológico inicial no son concluyentes en la mayoría de los pacientes por estar combinada con otras afecciones.

Introduction: Osteochondral fractures that affect the knee joint occur in isolation or associated with other traumatic conditions. The initial diagnosis is sometimes difficult to make due to the convergence of clinical and imaging signs. Objective: To provide updated information on the most important elements of this traumatic entity. Methods: The search and analysis of the information was carried out in a period of 31 days (from August the first to the 31st, 2021) and the following words of the English language were used: osteochondral lesions, osteochondral fractures, osteochondral injuries from the Information obtained, a bibliographic review of a total of 315 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference manager. Results: Reference is made to the mechanism of production, arthroscopic appearance, location, characteristics in terms of extension, depth, classification and displacement. The imaging modalities used in diagnosis and their usefulness are described. Regarding the differential diagnosis, a group of entities with similar characteristics are described. Treatment modalities based on size and time of evolution are mentioned. Conclusions: Osteochondral fractures are frequent injuries, for their diagnosis a high index of suspicion is needed, since the initial clinical and imaging diagnosis are not conclusive in most patients because they are combined with other conditions.

Evolución histórica de la prótesis bucomaxilofacial en Camagüey

Introducción: Los principios en que se sustenta el proceso revolucionario cubano y su Sistema Nacional de Salud, es tratar de dar solución a las necesidades de la población y Cuba dentro de sus limitaciones de desarrollo, ha producido cambios en las condiciones de salud, a través de su política estatal. Objetivo: Describir la evolución histórica de la prótesis bucomaxilofacial en la provincia Camagüey. Métodos: Se realizó una revisión de la de literatura, para recopilar los datos de la historia de la prótesis bucomaxilofacial. Se ejecutó una búsqueda de la literatura en las bases de datos Pubmed, Medline, Cochrane, SciELO, Hinari y prensa escrita donde se expusieran las evidencias disponibles sobre los antecedentes de prótesis bucomaxilofacial en Cuba y en la provincia Camagüey. Resultados: En Cuba la prótesis maxilofacial antes del triunfo revolucionario prácticamente no se realizaba. El 14 de junio de 1999 se crea la Red Asistencial Nacional de Rehabilitación de la Cara y Prótesis Bucomaxilofacial y en el año 2001 el Programa de Rehabilitación de la Cara y Prótesis Bucomaxilofacial, con una cobertura para todos los pacientes del país con esta necesidad de atención. En Camagüey con la creación en abril de 1975 de la consulta multidisciplinaria de Estomatología se inició la atención a los pacientes con defectos bucomaxilofacial. Esto permitió rehabilitar en esos momentos a estos enfermos con los recursos disponibles. Conclusiones: El análisis y las valoraciones realizadas determinaron que la prótesis en la provincia Camagüey ha tenido un gran desarrollo tanto asistencial como docente e investigativo, aunque no se cuenta con un servicio dedicado a la prótesis bucomaxilofacial, se han realizados labores de rehabilitación a pacientes con estos defectos, que le han permitido recuperar la estética, el estado psíquico funcional con alto grado de aceptación y satisfacción y el logro de su reincorporación a la vida social.

Introduction: The principles on which the Cuban revolutionary process and its National Health System are based, is to try to provide a solution to the needs of the population, and Cuba within its development limitations, has produced changes in health conditions, through of its state policy. Objective: To describe the historical evolution of the bucomaxillofacial prosthesis in Camagüey. Methods: A review of the literature was carried out to collect the data on the history of the bucomaxillofacial prosthesis. A search of the literature was carried out in the Pubmed, Medline, Cochrane, SciELO, Hinari and written press databases where the available evidence on the history of oral-maxillofacial prostheses in Cuba and in the Camagüey province was exposed. Results : In Cuba, before the revolutionary triumph, maxillofacial prostheses were practically not performed. On June 14, 1999, the National Assistance Network for the Rehabilitation of the Face and Bucomaxillofacial Prosthesis was created, and in 2001 the Program for the Rehabilitation of the Face and Bucomaxillofacial Prosthesis, with coverage for all patients in the country with this need for care. In Camagüey, with the creation in April 1975 of the multidisciplinary Dentistry consultation, care began for patients with oral-maxillofacial defects. This made it possible to rehabilitate these patients at that time with the resources available. Conclusions: The analysis and the evaluations carried out determined that the prosthesis in Camagüey province has had a great development in terms of care, teaching and research, although there is no service dedicated to oral and maxillofacial prostheses, rehabilitation work has been carried out on patients with these defects, which have allowed them to recover their aesthetics, their functional mental state with a high degree of acceptance and satisfaction, and the achievement of their reincorporation into social life.

Evaluación multimodal del hematoma subdural crónico

Introducción: El hematoma subdural crónico es la complicación tardía más frecuente del trauma craneoencefálico. Su diagnóstico precoz y el tratamiento oportuno permiten la evolución favorable y curación de los pacientes. Objetivo: Sistematizar los diferentes ejes de clasificación del hematoma subdural crónico, que permitan la evaluación multimodal con una orientación más precisa de la técnica quirúrgica. Métodos: Se realizó una revisión bibliográfica en las principales bases de datos disponibles, centrada en las diferentes clasificaciones clínicas y radiológicas del hematoma subdural crónico y se seleccionaron 26 artículos. Se escogieron las principales clasificaciones y escalas y se aplicaron en 22 pacientes, obteniéndose resultados preliminares. Resultados: Las escalas de evaluación clínica de Bender, Marckwalder y la clasificación de Gordon Firing son las más conocidas, sin embargo, existen clasificaciones tomográficas que tienen en cuenta la densidad, la homogeneidad del hematoma que son de gran importancia en la selección de la técnica quirúrgica. La presencia de membranas y tabiques aparecen solo incluidas dentro de la valoración de la densidad del hematoma. Existen otras con valor predictivo que identifican aquellos factores relacionados con las recurrencias, desde antes de la cirugía, las mismas se consideran un factor de mal pronóstico para la evolución final de los pacientes con este tipo de hematomas. Conclusiones: La evaluación preoperatoria exige de la aplicación de múltiples escalas, la identificación y caracterización de las membranas es importante para personalizar la técnica quirúrgica, en busca de disminuir la morbilidad y mortalidad posoperatoria.

Introduction: Chronic subdural hematoma is the most frequent late complication of cranioencephalic trauma. The early diagnosis and correct treatment allow the recovery of patients. Objective: To systematize the different criteria of classification of chronic subdural hematoma that leads the multimodal evaluation for more effective selection of surgical technique. Methods: A review of literature about chronic subdural hematoma was done in the main database focused on different clinical and radiological classifications and 26 articles were selected. The main classifications and scales were chosen and applied to 22 patients, obtaining preliminary results. Results : Benders, Marckwalder and Gordon Firing scales are the most common, nevertheless there are tomographic classifications that include density, homogeneity of hematoma that are of great importance in the selection of the surgical technique. The presence of membranes and septum are only included in the evaluation of hematoma density. There are some others with predictive value that identify those factors related to recurrences before surgery that are considered a bad prognosis to the final evolution of these patients with this type of hematoma. Conclusions: The previous evaluation to surgery requires the use of different scales, the identification and characterization of membranes are important to select the optimum surgical technique to decrease morbidity and mortality after surgery.

Apoio social on-line: questões teóricas, metodológicas, benefícios sociais e recomendações / Online social support: Theoretical and methodological issues, social and health benefits, and recommendations

RESUMO As plataformas de apoio social on-line (fóruns de discussão, grupos no Facebook, salas de chat etc.) são cada vez mais utilizadas por pessoas com doenças crônicas e seus cuidadores, que desejam falar com pessoas com problemas semelhantes fora da sua rede tradicional. O objetivo desta revisão de literatura foi apresentar as intervenções de apoio social on-line descritas na literatura científica recente, para: 1) orientar as organizações que desejam desenvolver tal intervenção ou melhorar um programa existente; e 2) identificar caminhos de pesquisa para pesquisadores e recomendações para planejadores de saúde. Foram analisados 59 artigos científicos apresentando intervenções de apoio social on-line (2006-2016), usando uma grade enfatizando as concepções teóricas de apoio social, as plataformas web utilizadas e suas funcionalidades, o processo de design e avaliação das intervenções, os métodos de participação e animação estabelecidos pelas organizações, os impactos documentados das intervenções nas populações e, finalmente, as vias de pesquisa e as recomendações para os planejadores de saúde. Uma metodologia narrativa foi usada para destacar os desafios de desenvolvimento e implementação para apoiar nossas organizações parceiras no desenvolvimento ou melhoria de suas intervenções de apoio social on-line.

ABSTRACT Online social support platforms (discussion forums, Facebook groups, chat rooms, etc.) are increasingly used by people living with chronic diseases and their caregivers, who aspire to exchange with people living with similar problems outside their traditional network. The objective of this literature review is to present online social support interventions described in recent scientific literature, to: 1) guide organizations that want to develop such intervention or improve an existing program, and 2) identify research avenues for researchers and recommendations for health planners. Some 59 scientific articles presenting online social support interventions (2006-2016) were analyzed using a grid emphasizing the theoretical conceptions of social support, the web platforms used and their functionalities, the design process and evaluation of the interventions, the methods of participation and animation set up by the organizations, the documented impacts of the interventions on the populations, and finally the lines of research and the recommendations for the field planners. A narrative methodology was used to highlight development and implementation challenges to support our partner organizations in developing or improving their online social support interventions.