Aneurysm of the superior labial artery.

This is a case report of a true and dissecting aneurysm of the superior labial artery in a 51-year-old patient without risk factors for vascular pathology. The patient complained of swelling of the upper lip, mostly on the left side. A Doppler ultrasonography was used in the diagnosis. The definitive treatment was surgical resection, and the histopathological analysis confirmed the diagnosis. The progress of the patient was satisfactory, leaving a slight change in sensitivity in the area. This seems to be the first reported case of true and dissecting aneurysm of the superior labial artery in the medical literature.

Effectiveness of testosterone replacement in men with obesity: a systematic review and meta-analysis.

OBJECTIVE: This systematic review evaluated the effect of testosterone replacement therapy (TRT) in men with obesity having low testosterone levels (LTLs). DESIGN AND METHODS: Search strategies were performed in MEDLINE, Embase, LILACS, and CENTRAL databases. Two reviewers selected the studies, assessed the risk of bias, and extracted data from the included studies. A random-effects model was used to pool results across studies, and the Grading of Recommendations Assessment, Development, and Evaluation was used to evaluate the certainty of evidence. RESULTS: A total of 16 randomized controlled trials were included. With moderate certainty of the evidence, no difference was found between TRT and placebo regarding total adverse events, TRT led to a 2-kg lean body mass gain and slightly improved low-density lipoprotein (LDL), without effects on the blood pressure. Due to imprecision/heterogeneity, effects in cardiovascular events (relative risk: 0.52, 95% CI: 0.26 to 1.05, 7 trials, 583 participants), high-density lipoprotein, hematocrit, prostate-specific antigen, HbA1c, and quality of life were unclear. TRT was effective for waist circumference and BMI; however, large between-study heterogeneity was found, with 95% prediction intervals crossing the null effect line. Meta-regression revealed that the average age of participants was a significant modifier for both outcomes. CONCLUSION: TRT slightly improved the lean body mass and LDL in men with obesity having LTLs but did not affect the blood pressure. The effects of TRT on cardiovascular events, HbA1c, and quality of life are unclear. The mean age of participants significantly modified the effect of TRT on weight loss.

Systematic review and meta-analysis of the safety of chloroquine and hydroxychloroquine from randomized controlled trials on malarial and non-malarial conditions.

BACKGROUND: Despite the expectations regarding the effectiveness of chloroquine (CQ) and hydroxychloroquine (HCQ) for coronavirus disease (COVID-19) management, concerns about their adverse events have remained. OBJECTIVES: The objective of this systematic review was to evaluate the safety of CQ and HCQ from malarial and non-malarial randomized clinical trials (RCTs). METHODS: The primary outcomes were the frequencies of serious adverse events (SAEs), retinopathy, and cardiac complications. Search strategies were applied to MEDLINE, EMBASE, LILACS, CENTRAL, Scopus, and Trip databases. We used a random-effects model to pool results across studies and Peto's one-step odds ratio (OR) for event rates below 1%. Both-armed zero-event studies were excluded from the meta-analyses. We used the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the certainty of evidence. RESULTS: One hundred and six RCTs were included. We found no significant difference between CQ/HCQ and control (placebo or non-CQ/HCQ) in the frequency of SAEs (OR: 0.98, 95% confidence interval [CI]: 0.76-1.26, 33 trials, 15,942 participants, moderate certainty of evidence). However, there was a moderate certainty of evidence that CQ/HCQ increases the incidence of cardiac complications (RR: 1.62, 95% CI: 1.10-2.38, 16 trials, 9908 participants). No clear relationship was observed between CQ/HCQ and retinopathy (OR: 1.63, 95% CI: - 0.4-6.57, 5 trials, 344 participants, very low certainty of evidence). CONCLUSIONS: CQ and HCQ probably do not increase SAEs, with low frequency of these adverse events on malarial and non-malarial conditions. However, they may increase cardiac complications especially in patients with COVID-19. No clear effect of their use on the incidence of retinopathy was observed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020177818.

Prevalência de insuficiência venosa superficial dos membros inferiores em pacientes obesos e não obesos / Prevalence of lower limbs superficial venous insufficiency in obese and non-obese patients

CONTEXTO: A insuficiência venosa crônica dos membros inferiores é a mais prevalente das doenças venosas. Muito se discute sobre sua etiologia e fisiopatologia. Vários fatores de risco têm sido associados ao seu desenvolvimento, como idade, sexo, dieta, entre outros. A obesidade é um problema de saúde pública e sua incidência tem aumentado. O ecocolor Doppler é um método útil para avaliar a presença de refluxo e/ou obstrução no sistema venoso. OBJETIVO: Comparar a prevalência de insuficiência venosa superficial e sintomas associados em pacientes obesos e não obesos. MÉTODOS: Após pesagem, medição da estatura e exame físico, os pacientes com índice de massa corpórea (IMC) <30 kg/m² e >35 kg/m² e queixas compatíveis com insuficiência venosa foram distribuídos nos grupos I e II, respectivamente. Foram submetidos à realização do ecocolor Doppler dos membros inferiores para avaliação da presença ou não de refluxo. RESULTADOS: Foram examinados 311 membros de 168 pacientes com 25-72 anos. Para análise estatística, foram consideradas queixas de varizes, dor, edema, dermatite, eczema e úlcera, associados ou não. Foi obtido um total de 109 e 104 membros com varizes nos grupos I e II, respectivamente. Queixas de varizes visíveis (p<0,001) e varizes visíveis com dor (p = 0,0118) foram mais prevalentes no grupo I. Queixas de varizes com edema (p<0,001), somente edema (p<0,001) e edema associado a dor (p<0,001) foram mais prevalentes no grupo II. Os dados não mostraram diferença estatisticamente significante na prevalência de varizes entre os grupos I e II. CONCLUSÃO: A prevalência de varizes é semelhante entre os obesos e não obesos; as queixas clínicas diferem entre os grupos e são compatíveis e dependentes da presença de insuficiência venosa.

BACKGROUND: Chronic venous insufficiency of the lower limbs is the most prevalent venous disease. There is an ongoing debate about its etiology and pathophysiology. Several risk factors have been associated with its development, such as age, sex and diet. Obesity is a public health problem and its prevalence has been increasing. Color Doppler ultrasonography is a useful method to evaluate the presence of reflux and/or obstruction of the venous system. OBJECTIVE: To compare the prevalence of superficial venous insufficiency and associated symptoms in obese and non-obese patients. METHODS: After weighing, height measurement and physical examination, patients with body mass index (BMI) <30 kg/m² and >35 kg/m² and complaints compatible with venous insufficiency were divided into groups I and II, respectively. They underwent color Doppler ultrasonography of the lower limbs, in order to assess the presence or absence of reflux. RESULTS: A total of 311 limbs of 168 patients 25 to 72 years old were examined. For statistical analysis, complaints of varicose veins, pain, swelling, dermatitis, eczema and ulcers, associated or not, were considered. A total of 109 and 104 limbs with varicose veins were obtained in groups I and II, respectively. The prevalence of visible varicose veins (p<0.001) and visible varicose veins with pain (p=0.0118) was higher in group I. Complaints of varicose veins with edema (p<0.001), only edema (p<0.001) and edema with pain (p<0.001) were more prevalent in group II. Data did not present significant statistical difference in the prevalence of varicose veins between groups I and II. CONCLUSION: The prevalence of varicose veins in obese and non-obese individuals is similar ; clinical complaints differ between groups and are consistent and dependent on the presence of venous insufficiency.