Effect of clinical treatments for metabolic syndrome on albuminuria: a systematic review protocol

Introduction:Metabolic syndrome (MetS) predicts cardiovascular disease, and patients with this condition and type 2 diabetes have increased albuminuria, significantly impacting cardiovascular mortality and kidney disease progression. A considerable number of interventions to control MetS exist and are considered efficient, including the use of medication and changes in lifestyle. However, which approaches are effective in controlling albuminuria remains unclear. This systematic review protocol aims to map in the available literature whether lifestyle, medication, and surgical intervention for MetS have an impact on reducing albuminuria in adult patients. Methods: The Joanna Briggs Institute methodology for systematic reviews will be followed. Cochrane Database of Systematic Reviews, Scopus, Embase, and MEDLINE/PubMed databases will be used. For the Gray Literature, the DART-Europe E-theses Portal. There will be no language restriction. Studies written after 2009 will be included due to the consensus and definition of metabolic syndrome. This review will include studies considering pharmacological and non-pharmacological treatments for controlling albuminuria in patients with MetS. Studies where MetS is described in children and adolescents, animals, pregnant women, and patients with type 1 diabetes will be excluded. First, the selection will be based on reading the title and summary of the texts retrieved in the search strategy, followed by reading the relevant texts in full by two reviewers. After the selection of the studies, the extraction of the data, analysis, and synthesis will be conducted according to the JBI methodology

Estrategias de apropiación social del conocimiento en salud: revisión sistemática / A Systematic Review of Strategies for the Social Appropriation of Health Knowledge / Estratégias para a apropriação social do conhecimento em saúde: uma revisão sistemática

Las enfermedades no transmisibles son un problema de salud pública que afecta los siste-mas de salud y carga las economías y la sociedad. Existen estrategias para la prevención de estas enfer-medades, como la apropiación social del conocimiento, por medio del empoderamiento de las comu-nidades y la mejora de sus indicadores en salud. El objetivo del artículo es describir las metodologías empleadas en el diseño de estrategias de apropiación social del conocimiento en salud en la prevención de enfermedades no transmisibles en adultos en el mundo. Materiales y métodos: revisión sistemática de artículos de estrategia de apropiación social del conocimiento en salud, buscados en las bases de datos Google Scholar, ovid, Biblioteca Virtual en Salud, Medline, ebsco y SciELO. Los criterios de inclusión fue-ron publicaciones en revistas indexadas entre 2016 y 2021, en idioma inglés, portugués y español, con temáticas de intervenciones en salud. Resultados: se revisaron 39 artículos, 36 con diseño cualitativo, dos mixtos y uno transversal. El enfoque metodológico utilizado para el diseño de las estrategias fue la metodología de investigación participativa basada en la comunidad o community-based participatory research. Se establecieron cuatro fases comunes, tituladas diagnóstico comunitario, diseño de la inter-vención, implementación y evaluación. Conclusiones: la metodología indicada ha sido la más utilizada en población de alto riesgo social, económico y de salud. La tendencia investigativa permitió identificar la importancia del diagnóstico comunitario como puerta de entrada en el diseño, implementación y evaluación de las estrategias creadas conjuntamente.

Noncommunicable diseases are a public health issue that burdens health systems, econo-mies, and society. These diseases can be prevented by using several methods, such as the social appro-priation of knowledge, empowerment of communities, and improvement of their health indicators. This review seeks to describe the methodologies used in designing strategies for the social appropriation of health knowledge in the prevention of noncommunicable diseases in adults worldwide. Materials and methods: A systematic review of articles containing social appropriation of health knowledge strategy was made searching the following databases Google Scholar, ovid, Virtual Health Library, Medline, ebsco, and SciELO. With the following criteria: publications in journals indexed between 2016 and 2021; writ-ten in English, Portuguese, and Spanish; and addressing health intervention topics. Results: A total of 39 articles were reviewed, of which 36 were qualitative, 2 mixed, and 1 cross-sectional. The methodological approach used to develop the strategies was community-based participatory research (cbpr). Based on the characteristics shared by the various phases of the studies, four common characteristics were identi-fied: community diagnosis, intervention design, implementation, and evaluation. Conclusions: cbpr is the most widely used method for the social appropriation of health knowledge for the adult population, par-ticularly in populations at high social, economic, and health risks. The research trend made it possible to recognize the significance of community diagnosis as a stepping stone to the design, implementation, and evaluation of jointly developed strategies.

as doenças não transmissíveis são um problema de saúde pública que afeta os sistemas de saúde e sobrecarrega as economias e a sociedade. Existem estratégias para a prevenção dessas doenças como a apropriação social do conhecimento, por meio do empoderamento das comunidades e melhoria de seus indicadores de saúde. O objetivo é descrever as metodologias utilizadas no desenho de estraté-gias de apropriação social do conhecimento em saúde na prevenção de doenças não transmissíveis em adultos em todo o mundo. Materiais e métodos: revisão sistemática de artigos sobre a estratégia de apro-priação social do conhecimento em saúde. A busca foi realizada nas bases de dados Google acadêmico, ovid, Biblioteca Virtual em Saúde, Medline, ebsco e SciELO. Os critérios de inclusão foram os seguintes: publicações em periódicos indexados entre 2016 e 2021, idioma inglês, português e espanhol e temas de intervenções em saúde. Resultados: foram revisados 39 artigos, 36 com delineamento qualitativo, 2 mistos e 1 transversal. A abordagem metodológica utilizada para desenhar as estratégias foi a metodo-logia de pesquisa participativa de base comunitária ou community-based participatory research (cbpr). Foram estabelecidas quatro fases comuns, intituladas diagnóstico comunitário, desenho de intervenção, implementação e avaliação. Conclusões: a metodologia cbpr tem sido a mais utilizada em uma população de alto risco social, econômico e de saúde. A tendência investigativa permitiu identificar a importância do diagnóstico comunitário como porta de entrada para o desenho, implementação e avaliação de estra-tégias criadas em conjunto.

Evolución de la osteosíntesis de los huesos largos y fijación por enclavado intramedular flexible / Evolution of Long Bone Osteosynthesis and Flexible Intramedullary Nail Fixation

Introducción: Se presenta la evolución histórica y científica de la osteosíntesis de huesos largos realizada con dos tipos de implantes intramedulares: Pines o varillas flexibles y clavos rígidos. Objetivo: Publicar un artículo científico que sirva de soporte teórico y práctico al personal en formación y, como punto de referencia y consulta a los ortopédicos y traumatólogos. Métodos: Se realiza una revisión bibliográfica retrospectiva de artículos sobre fracturas de los miembros publicadas en revistas de traumatología nacionales y extranjeras indexadas en las bases de datos MEDLINE y certificadas por el organismo de Ciencia Tecnología y Medio Ambiente, así como libros de relevancia sobre este tema y experiencias de los autores. Dadas las diferencias entre los dos tipos de implantes se estudiaron por separado la osteosíntesis con pines flexibles (Rush) y la realizada con clavos rígidos (Küntscher). Se seleccionaron las siguientes variables para el estudio: reducción, vía de acceso, penetración del implante, estabilidad, bloqueo, metal usado y consolidación. La fecha de incorporación de las innovaciones tecnológicas a la práctica quirúrgica fue enmarcada en tres momentos generacionales en el período de tiempo comprendido desde 1939 hasta la actualidad. Conclusiones: Esta revisión permitió identificar dos tipos de implantes intramedulares: los pines flexibles y los clavos rígidos. El estudio de sus características permitió organizarlos en generaciones para poder ubicar en el tiempo su contribución a los conocimientos que permiten devolver al paciente su vida activa(AU)

Introduction: This article discuses the historical and scientific evolution of long bone osteosynthesis performed with two types of intramedullary implants, flexible pins or rods and rigid nails. Objective: To publish a scientific article that serves as theoretical and practical support for staff in training and, as a point of reference and consultation for orthopedists and traumatologists. Methods: A retrospective bibliographic review of articles is carried out on limb fractures published in local and foreign trauma journals indexed in the MEDLINE databases and certified by CITMA, as well as relevant books on this topic and experiences of the authors. Given the differences between the two types of implants, we separately studied the osteosynthesis with flexible pins (Rush) from that performed with rigid pins (Küntscher). The variables selected for the study were reduction, access route, implant penetration, stability, locking, metal used, and consolidation. The inclusion of technological innovations to surgical practice was framed in three generational moments from 1939 to the present. Conclusions: Thow types of intramedullary implants were identifies from this revision: flexible pins and rigid nails. The study of their characteristics allowed to organize them into generations in order to locate their contribution to the knowledge allowing the patient to return to an active life over time(AU)

Introdução dos alimentos no primeiro ano de vida e prevenção da alergia alimentar: quais as evidências? / Introduction of food in the first year of life and food allergy prevention: what is the evidence?

Objetivo: A incidência das doenças alérgicas cresceu nas últimas décadas. Na tentativa de conter o aumento da alergia alimentar (AA) ao longo dos anos, estratégias de prevenção vêm sendo implementadas. Para promover um melhor entendimento dos dilemas que permeiam a introdução alimentar no primeiro ano de vida, esse artigo trata de uma revisão bibliográfica narrativa sobre a introdução dos alimentos complementares no primeiro ano de vida e possíveis associações com a prevenção primária da alergia alimentar. Fonte dos dados: Publicações relevantes foram pesquisadas nas bases de dados Cochrane Library, MEDLINE, PubMed, Guidelines International Network, National Guidelines Clearinghouse e revisadas recomendações do guia e do consenso nacional de alergia alimentar. Resultados: Estudos observacionais diversos e ensaios clínicos randomizados estão disponíveis, bem como recomendações publicadas por organizações científicas; no entanto, de qualidade variável. Foram consideradas as recomendações de diretrizes de prática clínica classificadas como de alta qualidade e publicações recentes ainda não categorizadas de forma sistemática em sua qualidade, mas internacionalmente reconhecidas como relevantes para a atenção primária. Conclusão: Até o momento, não há evidências consistentes de que a introdução precoce, antes dos 6 meses, dos alimentos alergênicos, contribua para a prevenção de alergia a alimentos na população geral.

Objective: The incidence of allergic diseases has increased in recent decades. In an attempt to contain the increase in food allergy (AA) over the years, prevention strategies have been implemented. To promote a better understanding of the dilemmas that permeate the introduction of food in the first year of life, this article deals with a narrative literature review on the introduction of complementary foods in the first year of life and possible associations with the primary prevention of food allergy. Data source: Relevant publications were searched in the Cochrane Library, MEDLINE, PubMed, Guidelines International Network, National Guidelines Clearinghouse, and revised recommendations from the national food allergy guide and consensus. Results: Several observational studies and randomized controlled trials are available, as well as recommendations. published by scientific organizations; however, of variable quality. Recommendations from clinical practice guidelines classified as high quality and recent publications not yet systematically categorized in their quality, but internationally recognized as relevant to primary care, were considered. Conclusion: To date, there is no consistent evidence that the early introduction, before 6 months, of allergenic foods contributes to the prevention of food allergy in the general population.

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Effectiveness of different health delivery agents of parenting stimulation interventions on child development outcomes among children aged 0 to 36 months: a systematic review protocol

Objective: This review will evaluate the effectiveness of different health delivery agents of parenting stimulation interventions versus usual care, no intervention, or a different type of delivery agent on child development outcomes among children aged 0 to 36 months. Introduction: Stimulation interventions vary in terms of implementation. While some interventions are delivered by professionals, most are delivered by non-professionals. Several prior systematic reviews on this topic have been conducted; however, no known study has evaluated the effectiveness of stimulation interventions on child development by type of delivery agent. Inclusion criteria: This review will consider randomized controlled trials assessing parenting stimulation interventions delivered by different health delivery agents. These will be compared to usual care, no intervention, or a different delivery agent, targeted at caregiver-child dyads of children aged 0 to 36 months. The outcomes will include motor, language, cognitive, and socio-emotional development. The review will exclude studies including children with specific characteristics, interventions that do not focus on parenting, and protocols of randomized clinical trials. Methods: The review will include both published and unpublished studies. The key information sources to be searched are: MEDLINE, APA (PsycNet), Embase, Scopus, Web of Science Core Collection, CINAHL, VHL Regional Portal, Google Scholar, Science Direct, Theses Canada Portal, and Library and Archives Canada. Studies in English, Spanish, and Portuguese will be included. Critical appraisal and data extraction will be conducted using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.

Extração de recomendações farmacológicas para subsidiar o processo de adaptação de guias de prática clínica utilizados no tratamento da fibrilação atrial não valvar - uma revisão sistemática de guias de prática clínica / Extraction of pharmacological recommendations to support the process of adaptation of clinical practice guides used in the treatment of non-valvular atrial fibrillation a systematic review of clinical practice guidelines

A fibrilação atrial (FA) não valvar é a arritmia cardíaca mais comum em adultos, principalmente na população idosa. Para o tratamento da FA, recomenda-se a utilização de guias de prática clínica (GPCs), que são documentos que apresentam as melhores e mais atualizadas evidências para o tratamento dos pacientes acometidos por essa arritmia. Todavia, o processo de desenvolvimento dos GPCs requer recursos humanos, financeiros e tempo. Assim, a adaptação dos referidos documentos é uma opção para reduzir a duplicação de esforços e possibilitar sua adequação para uso local. O objetivo deste trabalho foi elaborar uma matriz de recomendações farmacológicas para subsidiar o processo de adaptação de GPCs utilizados no tratamento da fibrilação atrial não valvar. Para tanto, aplicou-se o método ADAPTE: revisão sistematizada de GPCs, avaliação e seleção dos GPCs de qualidade e elaboração da matriz. Foram considerados elegíveis 26 GPCs com recomendações farmacológicas para assistência primária da fibrilação atrial não valvar em adultos, publicados em inglês, espanhol ou português no período de abril de 2014 a abril de 2019 e indexados às bases de referência: MEDLINE, Embase, Cochrane Library e em 12 bases de dados específicas. A qualidade dos GPCs, foi avaliada pela aplicação do instrumento Appraisal of Guidelines for Research & Evaluarion II (AGREE II), sendo considerados de alta qualidade aqueles que apresentaram nota igual ou superior a 60 % no domínio Rigor de desenvolvimento. Todas as etapas foram realizadas por, pelo menos, 2 avaliadores e em caso de discrepância, um terceiro avaliador participou do processo. Dos 26 GPCs avaliados apenas 7 (26,9%) foram considerados de alta qualidade. A maioria dos GPCs utiliza o escore CHA2DS2-VASc, que indica a profilaxia tromboembólica em pacientes com FA não valvar a partir da pontuação 1 (fator de risco não sexual) e sugere a anticoagulação com anticoagulantes de ação direta. Houve pouca ênfase à complexidade da profilaxia de eventos tromboembólicos em idosos. Esta matriz visa contribuir para que sejam realizadas discussões e adaptações de GPCs destinado ao tratamento da FA não valvar com ênfase nas demandas e necessidades locais

Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, especially in the elderly population. For the treatment of AF, the use of clinical practice guidelines (CPGs) is recommended, which are documents that present the best and most up-to-date evidence for the treatment of patients who are affected by this arrhythmia. However, the CPGs development process requires human, financial and time resources. However, the adaptation of documents is an option to reduce the duplication of efforts and make it possible to adapt them for any local use. The objective of this work was to elaborate a matrix of pharmacological treatment to support the process of adaptation of CPGs used in the treatment of non-valvular atrial fibrillation. Therefore, the ADAPTE method was applied: systematic review of CPGs, evaluation and selection of quality CPGs and matrix definition. Twenty-six CPGs were considered eligible with pharmacological recommendations for primary care of non-valvular atrial fibrillation valid in adults, published in English, Spanish or Portuguese from April 2014 to April 2019 and indexed to the following reference databases: MEDLINE, Embase, Cochrane Library and in 12 specific databases. The quality of the CPGs was assessed by applying the Assessment of Guidelines for Research and Assessment II (AGREE II) instrument, being considered of high those who had a grade equal to or greater than 60% in the domain Rigour of development. All steps were performed by a least 2 evaluators and in case of discrepancy, a third evaluator participated in the process. Of the 26 CPGs evaluated, only 7 (26.9%) were considered to be of high quality. Most CPGs use the CHA2DS2-VASc score, which indicates thromboembolic prophylaxis in patients with non-valvular AF from score 1 (non-sexual risk factor), and suggest anticoagulation with direct-acting anticoagulants. There was little emphasis on the complexity of prophylaxis for thromboembolic events in the elderly. This matrix aims to contribute to discussion and adaptations of CPGs for the treatment of non-valvar AF with the emphasis on local demands and needs

Principales secuelas neurológicas del COVID-19: una revisión exploratoria / Main neurological sequelae of COVID-19: an exploratory review

El presente trabajo tiene como propósito realizar una revisión sistemática exploratoria que nos permita evidenciar el panorama actual de las distintas secuelas neurológicas ocasionadas por el COVID-19 en los pacientes. Se realizó una búsqueda de la literatura a través de las bases de datos PubMed, Scielo, Medline, Web of Science y Scopus. La búsqueda bibliográfica se llevó a cabo en febrero de 2022. Se identificaron 60 artículos, 10 estaban duplicados y en la fase revisión se excluyeron 9, debido a su diseño metodológico; 2 artículos fueron descartados por incongruencias en la validez de los instrumentos de recolección de datos, por tanto, se utilizaron 39 estudios científicos para la obtención de datos, análisis de resultados y fueron sometidos a evaluación de calidad. Se incluyeron 33 estudios observacionales, 2 estudios de caso, 3 artículos de revisión y 1 metaanálisis. Atendiendo a aspectos metodológicos, el 92,4% son estudios observacionales (descriptivos o de prevalencia analítica o de corte), solamente 3 de ellos (7,6%) se asumen como prospectivos en la direccionalidad del diseño. Se destacan fundamentalmente las siguientes secuelas neurológicas: síndrome neurovascular, encefalopatías, migrañas, ansiedad, depresión, disfunciones olfativas y/o gustativas, sintomatología sensorial, polineuropatía y miopatía, neuralgia y parálisis facial, la fisiopatogénesis de está afectaciones neurologicas, son asociadas pricipalmente al síndrome de respuesta inflamatoria sistemica resultante por la infección con SARS-CoV-2. Se recomienda continuar con investigaciones orientadas a las secuelas por COVID-19, para encauzar el tratamiento y evitar complicaciones graves por esta enfermedad(AU)

The purpose of this study is to carry out an exploratory systematic review that allows us to demonstrate the current panorama of the different neurological sequelae caused by COVID-19 in patients. A literature search was performed through the PubMed, Scielo, Medline, Web of Science and Scopus databases. The bibliographic search was carried out in February 2022. 60 articles were identified, 10 were duplicates and in the review phase 9 were excluded due to their methodological design; 2 articles were discarded due to inconsistencies in the validity of the data collection instruments, therefore, 39 scientific studies were used to obtain data, analyze the results and were subjected to quality evaluation. 33 observational studies, 2 case studies, 3 review articles and 1 meta-analysis were included. Regarding methodological aspects, 92.4% are observational studies (descriptive or analytical or cut-off prevalence), only 3 of them (7.6%) are assumed to be prospective in the directionality of the design. The following neurological sequelae stand out fundamentally: neurovascular syndrome, encephalopathies, migraines, anxiety, depression, olfactory and/or taste dysfunctions, sensory symptomatology, polyneuropathy and myopathy, neuralgia and facial paralysis, the physiopathogenesis of these neurological affections, are mainly associated with the syndrome of systemic inflammatory response resulting from infection with SARS-CoV-2. It is recommended to continue with research aimed at the sequelae of COVID-19, to guide treatment and avoid serious complications from this disease(AU)

COVID-19 en el adulto mayor: características clínicas e impacto sobre la salud mental / COVID-19 in the elderly: clinical features and impact on mental health

El propósito de esta revisión fue analizar la literatura existente con el fin de identificar los principales aspectos de la en- fermedad ocasionada por el SARS-CoV-2, así como su impacto en la salud mental del adulto mayor y su relación con la mortalidad en esta población en riesgo. Se revisó la información a partir de artículos de revistas electrónicas a través de las bases de datos Pubmed, Medline, Scopus y Google Scholar para el período julio 2020 a junio 2021. Entre los aspectos relevantes se encontró da- tos alarmantes, los pacientes con comorbilidades en este grupo de edad tenían 6 veces más probabilidad de ser hospitalizados y 12 veces más probabilidad de morir que una persona sin comorbili - dades. La salud mental es un importante factor en esta pandemia, se ha demostrado deterioro en estado general y enfermedades mentales debido a la ansiedad y aislamiento social secundario a la pandemia en este grupo...(AU)

Vacinas COVID-19 e suas implicações imunológicas: uma revisão de literatura / COVID-19 vaccines and immunological implications: A literature review

A COVID-19 e seus mecanismos imunológicos são, atualmente, temas de grande relevância mundial. Suas manifestações clínicas e as perigosas complicações decorrentes da tempestade de citocinas motivaram a criação de vacinas contra o SARS-CoV-2 em um ritmo acelerado, gerando desconfianças e diferentes níveis de eficácia e segurança. Este estudo trata-se de um artigo de revisão que abordou pesquisas publicadas no período de 2020 e 2021, utilizando as bibliotecas eletrônicas SciELO (Scientific Electronic Library Online), PubMed, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e MEDLINE com o rastreamento específico por meio dos seguintes descritores: vacinas COVID-19, SARS-CoV-2, imunologia do COVID-19. Questões como o mecanismo imunológico, eficácia e efeitos adversos das vacinas disponíveis no mercado mundial atual foram amplamente discutidas.

COVID-19 and immunological mechanisms currently are topics of great worldwide relevance. Clinical manifestations and the dangerous complications resulting from a cytokine storm motivated the creation of vaccines against SARS-CoV-2 at an accelerated pace, generating suspicions and different levels of efficacy and safety. This is a review article addressing research published in 2020 and 2021. The electronic libraries SciELO (Scientific Electronic Library Online), PubMed, LILACS (Latin American and Caribbean Literature in Health Sciences), and MEDLINE were used for specific screening with the following descriptors: COVID- 19 vaccines, SARS-CoV-2, immunology of COVID-19. Issues such as the immunological mechanism, efficacy, and adverse effects of vaccines currently available on the world market are widely discussed.

Eficacia y seguridad de la combinación de fexofenadina con montelukast en el tratamiento de la rinitis alérgica / Efficacy and safety of combined therapy of fexofenadine and montelukast for the treatment of allergic rhinitis

El propósito de este trabajo fue revisar la literatura científica que evalúa la eficacia y seguridad de las monoterapias de fexofenadina y montelukast, la terapia combinada (fija o en asociación) de montelukast - fexofenadina, así como de montelukast con otros antihistamínicos de segunda generación en el tratamiento de la rinitis alérgica. Se realizó una estrategia de búsqueda bibliográfica de múltiples etapas, en donde se identificaron estudios basados en ensayos clínicos y estudios no aleatorizados (ensayo controlado no aleatorizado, controlado antes-después, de series de tiempo interrumpidas, con controles históricos, de cohorte, de casos y controles, estudio transversal, y series de casos) en pacientes con rinitis alérgica, en las bases de datos MEDLINE/ PubMed, Scopus, Web of Science, Biblioteca Cochrane, Redalyc y Colección BVS y debido a la cantidad de resultados obtenidos se incluyó la búsqueda en Hinari. Con base en esta revisión se concluye que las combinaciones de antihistamínicos de segunda generación y antagonistas de leucotrienos y, en particular, la combinación fija de fexofenadina ­ montelukast es eficaz, segura y favorece la adherencia al tratamiento, y a largo plazo también ayuda a alcanzar el objetivo terapéutico.

The purpose of this work was to review the scientific literature that evaluates the efficacy and safety of monotherapies of fexofenadine and montelukast, the combined therapy (fixed-dose or separate drug combinations) of montelukast-fexofenadine, as well as the use of montelukast together with other second-generation antihistamines in the treatment of allergic rhinitis. A multistage literature search strategy was designed, including clinical trials and non-randomized studies (non-randomized controlled trial, controlled before-after study, interrupted time series study, historical control study, cohort study, case-control study, crosssectional study, and case series) evaluating patients with allergic rhinitis. The databases MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, Redalyc, BVS Collection, and, due to the number of results obtained, Hinari were included. Based on this review, the conclusion is that the combinations of secondgeneration antihistamines with leukotriene antagonists and, in particular, the fixed combination of fexofenadine-montelukast are effective, safe and promote treatment adherence. In the long term, they also help achieve therapeutic goals.

Limb length in bariatric surgery of Roux-en-Y gastric bypass (RYGB): An integrative review / Longitud del asa intestinal en la cirugía bariátrica de bypass gástrico en Y de Roux (BGYR): Una revisión integradora

Introduction: Roux-en-Y gastric bypass is considered the gold standard surgical technique for obesity. The variation in limb length may be related to metabolic improvement and nutritional deficiencies. However, the ideal measurement still a controversial subject in the literature. This study aims to perform an integrative literature review and associate the optimal limb length, considering the maximum weight loss with the minimum nutritional complications. Methods: Integrative literature review conducted using electronic searches (1992 - 2020) in databases MEDLINE/Pubmed and BVS (Biblioteca Virtual da Saúde)/LILACS, through the terms "(bariatric surgery) AND (limb length)".A total of 340 articles were found, 26 articles were included in this review. Results: Current evidence supports using shorter limb lengths in patients with BMI < 50 kg/m2, and longer limbs in patients with severe type 2 diabetes mellitus and/or dyslipidemia or superobese patients (BMI >= 50 kg/m2), considering the benefits in comorbidities resolution. A shorter common limb increases the inci-dence of nutritional disorders. There is a wide variation in jejunoileal length among patients. Conclusion: Measuring the intraoperative jejunoileal length and individualizing the surgery may bring benefits in weight loss, comorbidities resolution, and reduce the incidence of nutritional disorders. However, more randomized controlled trials are needed on this topic.

Introducción: el bypass gástrico en Y de Roux se considera la técnica quirúrgica estándar de oro para la obesidad. La variación en la longitud del asa intestinalpuede estar relacionada con la mejora metabólica y las deficiencias nutricionales, sin embargo, la longitud ideal sigue siendo un tema controvertido en la literatura. El objetivo de este estudio es realizar una revisión integradora de la literatura y asociar la longitud ideal del asa intestinal, considerando la máxima pérdida de peso con las mínimas complicaciones nutricionales. MaterialesyMétodos: revisión bibliográfica integradora realizada mediante búsquedas electrónicas (1992 - 2020) en bases de datos MEDLINE/Pubmed y BVS (Biblioteca Virtual da Saúde) / LILACS, a través de los términos "(bariatric surgery) AND (limb length)". Se encon-traron un total de 340 artículos, 26 artículos fueron incluidos en esta revisión.Resultados: la evidencia actual respalda el uso de asas intestinales más cortas en pacientes con IMC < 50 kg/m2 y asas intestinales más largas en pacientes con diabetes mellitus tipo 2 grave y/o dislipidemia o pacientes superobesos (IMC > = 50 kg/m2), considerando los beneficios en la resolución de comorbilidades. La asa común más corto aumenta la incidencia de trastornos nutricionales. Existe una amplia variación en la longitud yeyunoileal entre los pacientes. Conclusiones: la medición de la longitud yeyunoileal intraoperatoria y la individualización de la cirugía pueden traer beneficios en la pérdida de peso, la resolución de comorbilidades y reducir la incidencia de trastornos nutricionales. Sin embargo, se necesitan más ensayos controlados aleatorios sobre este tema.

Revisión de casos, series de casos y estudios de prevalencia de zoofilia en la población general / Review of cases, case series and prevalence studies of zoophilia in the general population

RESUMEN Introducción: El conocimiento de la frecuencia de comportamientos zoofílicos en la población general es escaso. Objetivo: Revisar casos, series de casos y estudios de prevalencia de zoofilia en adultos de la población general. Métodos: Se realizó una revisión en las bases de datos de MEDLINE, a través de PubMed, Scopus y la Biblioteca Virtual en Salud de publicaciones desde enero de 2000 hasta diciembre de 2017. Resultados: Se revisaron 13 trabajos (10 informes de casos, 2 series de casos y 1 estudio transversal). Entre los casos se describió a 12 pacientes; las series de casos sumaron a 1.556 personas y el estudio transversal incluyó a 1.015 participantes e informó de una prevalencia de comportamientos zoofílicos del 2%. Conclusiones: Es escasa la información sobre la prevalencia de comportamientos zoofílicos en la población general. Es probable que internet permita investigar mejor estos comportamientos en los próximos años.

ABSTRACT Background: Information about the frequency of zoophilic behaviour in the general population is scarce. Objective: To review cases, case series and prevalence studies of zoophilia in adults in the general population. Methods: A review of publications was carried out in MEDLINE via PubMed, Scopus and the Biblioteca Virtual en Salud [Virtual Health Library] ranging from January 2000 to December 2017. Results: Thirteen papers were reviewed (ten case reports, two case series and one cross-sectional study). Twelve patients were described, the case series totalled 1,556 people and the cross-sectional study included 1,015 participants and reported a prevalence of zoophilic behaviour of 2%. Conclusions: Information on the prevalence of zoophilic behaviour in the general population is limited. The Internet will probably be a valuable tool for further investigating these behaviours in coming years.

Estructura factorial del Síndrome de Cotard: revisión sistemática de reportes de caso / Factor Structure of Cotard's Syndrome: Systematic Review of Case Reports

RESUMEN Introducción: El síndrome de Cotard es de rara aparición en la clínica psiquiátrica. Debido a esto, la información actual se basa principalmente en reportes y series de casos. Objetivo: Analizar las características psicopatológicas y la agrupación de los síntomas de los casos de síndrome de Cotard reportados en la literatura médica. Métodos: Se realizó en la base de datos MEDLINE/PubMed una búsqueda sistemática de la literatura de todos los casos de síndrome de Cotard reportados desde 2005 hasta enero de 2018. Se recolectaron variables demográficas y las características clínicas de cada caso. Se realizó un análisis factorial exploratorio de los síntomas. Resultados: La búsqueda identificó 86 artículos, de los cuales 69 eran potencialmente relevantes. Luego de la revisión de los textos completos, se seleccionaron 55 artículos para la revisión sistemática, entre los cuales se hallaron 69 casos. En el grupo de más edad con síndrome de Cotard fueron más frecuentes los diagnósticos de depresión mayor (p < 0,001) y trastorno mental orgánico (p = 0,004). El análisis factorial exploratorio arrojó 3 factores: depresión psicótica, en la que se incluye a los pacientes con delirios de culpa (0,721), ideas suicidas (0,685), delirios de condena (0,662), delirio nihilista del cuerpo (0,642), depresión (0,522) y delirios hipocondriacos (0,535); delirante-alucinatorio, con pacientes que sufrían delirio de inmortalidad (0,566), alucinaciones visuales (0,545) y delirio nihilista de la existencia (0,451), y mixto, con pacientes que sufrían delirio nihilista de los conceptos (0,702), ansiedad (0,573) y alucinaciones auditivas (0,560). Conclusiones: La psicopatología del síndrome de Cotard es más compleja que la simple asociación con el delirio de estar muerto, ya que abarca una estructura factorial organizada en 3 factores.

ABSTRACT Introduction: Cotard's syndrome is a rare psychiatric condition. As a result, current information is mainly based on reports and case series. Objective: To analyse the psychopathological characteristics and the grouping of the symptoms of the Cotard's syndrome cases reported in the medical literature. Methods: A systematic review of the literature of all reported cases of Cotard's syndrome from 2005 to January 2018 was performed in the MEDLINE/PubMed database. Demographic variables and clinical characteristics of each case were collected. An exploratory factor analysis of the symptoms was performed. Results: The search identified 86 articles, of which 69 were potentially relevant. After reviewing the full texts, 55 articles were selected for the systematic review, in which we found 69 cases. We found that the diagnosis of major depression (P < 0.001) and organic mental disorder (P =0.004) were more frequent in the older group with Cotard's syndrome. An exploratory factor analysis extracted 3 factors: psychotic depression, in which it includes patients with delusions of guilt (0.721), suicidal ideas (0.685), delusions of damnation (0.662), nihilistic delusions of the body (0.642), depression (0.522), and hypochondriacal delusions (0.535); delusive-hallucinatory, with patients who presented delusions of immortality (0.566), visual hallucinations (0.545) and nihilistic delusions of existence (0.451), and mixed, with patients who presented nihilistic delusions of concepts (0.702), anxiety (0.573), and auditory hallucinations (0.560). Conclusions: The psychopathology of Cotard's syndrome is more complex than the simple association with the delusion of being dead, since it encompasses a factorial structure organised into 3 factors.

Visibilidad de la Revista Cubana de Angiología y Cirugía Vascular en el período 2014-2018 / Visibility of the cuban journal of angiology and vascular surgery in the period from 2014 to 2018

Introducción: La Revista Cubana de Angiología y Cirugía Vascular tiene como misión contribuir al desarrollo de la especialidad, mediante la publicación de artículos científicos nacionales y extranjeros de alta calidad. Objetivo: Evaluar la visibilidad de la Revista Cubana de Angiología y Cirugía Vascular en el período 2014-2018. Métodos: Se realizó un estudio descriptivo, observacional y retrospectivo sobre la visibilidad alcanzada en el período 2014-2018. La muestra estuvo constituida por todos los tipos de artículos publicados en la Revista Cubana de Angiología y Cirugía Vascular en la etapa estudiada y se tomó como referencia la base de datos SciELO regional. Resultados: La Revista Cubana de Angiología y Cirugía Vascular entre 2014 y 2018 publicó un total de 110 trabajos científicos con una frecuencia semestral. Los años 2015 y 2017 fueron los de mayor cantidad de publicaciones, mientras que en 2014 y 2018 se contribuyó, con más publicaciones, con otras revistas cubanas. Los artículos originales resultaron la modalidad que más aportó con un total de 45, equivalente a un 40,9 por ciento. Conclusiones: La revista podría mejorar su visibilidad si se indexara en más bases de datos como Scopus y Medline, y se introdujera en redes sociales científicas como LinkedIn y Research Gate(AU)

Introduction: The Revista Cubana de Angiología y Cirugía Vascular [Cuban Journal of Angiology and Vascular Surgery] has the mission of contributing to the development of the specialty, by publishing high-quality national and foreign scientific articles. Objective: To assess the visibility of the Cuban Journal of Angiology and Vascular Surgery in the period from 2014 to 2018. Methods: A descriptive, observational and retrospective study was carried out about the visibility achieved in the period from 2014 to 2018. The sample consisted of all the types of articles published in the Cuban Journal of Angiology and Vascular Surgery during the stage studied. The regional database SciELO was used as a reference. Results: The Cuban Journal of Angiology and Vascular Surgery, between 2014 and 2018, published a total of 110 scientific papers in a biannual frequency. The years 2015 and 2017 were the ones with the greatest amounts of publications, while, in 2014 and 2018, other Cuban journals were contributed with more publications. Original articles are the modality that contributed the most, with a total of 45, accounting for 40.9 percent. Conclusions: The journal could improve its visibility if it were indexed in more databases, such as Scopus and Medline, and if it were introduced in scientific social media, such as LinkedIn and Research Gate(AU)

Imunopatologia da COVID-19 e suas implicações clínicas / COVID-19 immunopathology and its clinical implications

Compreender os mecanismos imunopatológicos envolvidos na evolução da COVID-19 é um desafio para a ciência mundial. A observação da existência de formas clínicas diferentes da doença, podendo ocorrer desde manifestações leves até formas graves, demonstra a complexidade da resposta imune desenvolvida frente à infecção pelo SARS-CoV-2. Nesta revisão da literatura, utilizamos as bases de dados PubMed, MEDLINE, LILACS, SciELO a partir de dezembro de 2019, quando surgiram os primeiros casos da doença. A relação entre as diferentes formas clínicas da COVID-19 com o desenvolvimento da resposta imune foi amplamente discutida. As diferenças da evolução da COVID-19 em crianças e idosos foram avaliadas focalizando aspectos da resposta imune que podem conferir prognóstico favorável ou risco de desenvolvimento de formas clínicas graves. Particularidades da infecção pelo SARS-CoV-2 em pacientes com imunossupressão e em portadores de asma foram analisadas. Os mecanismos imunopatológicos envolvidos no desenvolvimento das formas graves da COVID-19 foram abordados com ênfase no fenômeno "tempestade de citocinas".

Understanding the immunopathological mechanisms involved in the evolution of COVID-19 is a challenge for science worldwide. The observed existence of several clinical forms of the disease with mild to severe manifestations demonstrates the complexity of the immune response to SARS-CoV-2 infection. In this literature review, we searched the PubMed, MEDLINE, LILACS, SciELO databases for studies published after December 2019, when the first cases of the disease were described. The relationship between the different clinical forms of COVID-19 and the development of immune response was widely discussed. The differences in the evolution of COVID-19 in children and elderly were evaluated focusing aspects of the immune response that may confer favorable prognosis or risk of developing severe clinical forms. Particularities of SARS-CoV-2 infection in patients with immunosuppression and in asthma patients were analyzed. The immunopathological mechanisms involved in the development of severe forms of COVID-19 were addressed, with emphasis on the cytokine storm phenomenon.

A popularização diagnóstica do autismo: uma falsa epidemia? / The diagnostic popularization of autism: a false epidemic? / La popularización diagnóstica del autismo: ¿una falsa epidemia?

Atualmente, aponta-se que a prevalência de crianças diagnosticadas com Transtorno do Espectro Autista é de uma criança para cada sessenta e oito. Diante disso, aventa-se a possibilidade de uma epidemia. Este trabalho tem como objetivo tecer considerações a respeito do aumento de crianças diagnosticadas com Transtorno do Espectro Autista contemporaneamente. A partir de uma investigação teórica, procurou-se conjecturar hipóteses para esse fenômeno e suas devidas implicações para a prática clínica do psicólogo. Foram realizadas pesquisas em bases de dados como PubMed, Medline e Biblioteca Virtual em Saúde ­ Psicologia Brasil. Os dados epidemiológicos encontrados apontaram para um aumento significativo do diagnóstico nos últimos anos, o que provocou uma questão sobre essa possível epidemia. Esses achados nos fizeram supor que tal aumento se edifique pela articulação entre as perspectivas psiquiátrica e social. A discussão dessa hipótese sustenta, então, que a prática do psicólogo diante da demanda referente ao sofrimento na infância deve ser pautada por um posicionamento ético e por uma clínica atenta ao cuidado...(AU)

Currently, estimates point to the prevalence of children diagnosed with Autism Spectrum Disorder (ASD) of one child every sixty-eight. The possibility of an epidemic is considered. This study makes some considerations about the increase in children diagnosed with ASD in the last decades. As a theoretical investigation, we thought of hypotheses for this phenomenon and its implications for the psychology clinical practice and searched databases such as Pubmed, Medline and BVS-PSI. The epidemiological data found indicated a significant increase in diagnosis in recent years, which raised a question about this possible epidemic. These findings have led us to suppose that such an increase is built by the articulation between the psychiatric and social perspectives. Our hypothesis holds that the psychologist's practice for suffering in childhood should be guided by an ethical stance and a clinic attentive to care...(AU)

Currently, estimates point to the prevalence of children diagnosed with Autism Spectrum Disorder (ASD) of one child every sixty-eight. The possibility of an epidemic is considered. This study makes some considerations about the increase in children diagnosed with ASD in the last decades. As a theoretical investigation, we thought of hypotheses for this phenomenon and its implications for the psychology clinical practice and searched databases such as Pubmed, Medline and BVS-PSI. The epidemiological data found indicated a significant increase in diagnosis in recent years, which raised a question about this possible epidemic. These findings have led us to suppose that such an increase is built by the articulation between the psychiatric and social perspectives. Our hypothesis holds that the psychologist's practice for suffering in childhood should be guided by an ethical stance and a clinic attentive to care...(AU)

Imunoterapia no câncer - inibidores do checkpoint imunológico / Immunotherapy and immune checkpoint inhibitors in cancer

O objetivo deste trabalho é fazer uma revisão atual do tratamento de alguns tipos de câncer com imunoterapia e inibidores do checkpoint imunológico. As fontes de dados incluíram artigos originais, revisões e publicações indexados nos bancos de dados PubMed, MEDLINE, LILACS, SciELO e publicações online nos últimos 20 anos. Os checkpoints imunológicos normalmente impedem o organismo de montar uma resposta imune contra células normais. Alguns tipos de câncer podem adquirir estes checkpoints de tal forma que estas células tumorais não são reconhecidas pelo sistema imune, e isto impede que ele seja ativado. A inibição dos checkpoints imunológicos pode melhorar a sobrevida de pacientes com malignidades avançadas. Isto inclui melanoma maligno, carcinoma renal, linfoma e câncer pulmonar de células não pequenas. Uma extraordinária quantidade de investigações pré-clínicas e clínicas estão explorando o potencial terapêutico das moléculas coestimulatórias positivas e negativas. Aqui, nós revisamos o estado atual do nosso conhecimento dos mecanismos co-estimulatórios da célula T e a inibição dos checkpoints, primariamente do CTLA-4 e do PD-1.

This paper aims to review current treatment of some types of cancer with immunotherapy and immune checkpoint inhibitors. Data sources included original articles, reviews and related texts published over the past 20 years in PubMed, MEDLINE, LILACS and SciELO databases and other online publications. Immune checkpoints normally prevent the body from developing an immune response against healthy cells. Some types of cancer may acquire these checkpoints so that the tumor cells are not recognized by the immune system, preventing it from being activated. Immune checkpoint inhibitors may improve the survival of some patients with advanced malignant tumors, including malignant melanoma, renal cell carcinoma, lymphoma and non-small cell lung cancer. An extraordinary amount of preclinical and clinical investigation is exploring the therapeutic potential of negative and positive costimulatory molecules. Herein, we review the current status of our understanding of T-cell costimulatory mechanisms and checkpoint inhibitors, primarily of CTLA-4 and PD-1.

Sibilância em lactentes: o que mudou? / Wheezing in infants: what has changed?

O objetivo deste artigo foi avaliar a prevalência e fatores de risco para sibilância recorrente e asma em lactentes. Foi realizada pesquisa de artigos originais, revisões, consensos indexados e publicações on-line, nos últimos 15 anos, nos bancos de dados PubMed, MEDLINE, LILACS e SciELO. Conhecer a prevalência de sibilância recorrente e os fatores a ela associados é imprescindível, visto a sibilância recorrente ser uma das principais manifestações clínicas da asma na infância, sendo inclusive considerada por alguns autores como sinônimo desta doença, somado ao fato de que alguns dos fatores associados à sibilância no primeiro ano de vida também o são ao desenvolvimento de asma em crianças e adolescentes. A realização e aprofundamento de pesquisas sobre a sibilância e a asma na infância se fazem necessárias, e podem colaborar com a implantação de políticas públicas de saúde e programas educacionais objetivando o diagnóstico precoce de asma, e a adoção de medidas preventivas que favoreçam seu controle e evolução.

The objective of this study was to evaluate the prevalence and risk factors of recurrent wheezing and asthma in infants. MEDLINE (via PubMed), LILACS, and SciELO databases were searched for original articles, reviews, indexed guidelines, and online resources published in the past 15 years. It is essential to know the prevalence of recurrent wheezing and its associated factors, since recurrent wheezing is one of the main clinical manifestations of childhood asthma, being considered by some authors a synonym of this disease. Also, some factors associated with wheezing in the first year of life may influence the development of asthma in children and adolescents. Further research on wheezing and asthma in childhood is needed and may contribute to the implementation of public health policies and educational programs aimed at the early diagnosis of asthma and to the adoption of preventive measures to improve asthma control and reduce disease burden.

Eficacia y seguridad del uso de hierro en el tratamiento de la falla cardiaca: revisión sistemática / Efficacy and safety of the use of iron in the treatment of heart failure: A systematic review

Resumen Introducción: La falla cardiaca asociada a deficiencia de hierro se relaciona directamente con disminución de parámetros funcionales y, por ende, con deterioro de la calidad de vida y pobre pronóstico de los pacientes que la padecen. Se ha encontrado que la corrección de la deficiencia de hierro mejora a corto plazo la clase funcional y otros parámetros de la enfermedad. Objetivo: Evaluar la eficacia y la seguridad del uso de hierro en el tratamiento de la falla cardiaca. Métodos: De seleccionaron ensayos clínicos que evaluaran el uso de hierro en administración intravenosa u oral vs. placebo en el contexto de pacientes con falla cardíaca y a su vez se eligieron pacientes que concomitantemente sufrieran anemia ferropénica. En la búsqueda se incluyeron bases de datos como MEDLINE (PubMed), Embase, Cochrane Central Register of Clinical trials (CENTRAL), LILACS y WPRIM. Resultados: De 10.729 títulos obtenidos 6 fueron elegibles con 835 pacientes, de los cuales 520 fueron tratados con terapia férrica y 315 con placebo o terapia convencional de falla cardiaca. Debido a la heterogeneidad de los resultados no fue posible hacer un metaanálisis. Conclusión: Se identificó mejoría significativa en múltiples parámetros evaluados, tales como el test de caminata de 6 minutos, clase funcional de la New York Heart Association, consumo máximo de oxígeno (VO2 máx.) y valoración global subjetiva. Por consiguiente, la terapia férrica es una opción segura y eficaz en el manejo de pacientes con falla cardiaca ya que mejora significativamente su capacidad funcional, calidad de vida y múltiples parámetros paraclínicos.

Abstract Introduction: Heart failure combined with iron deficiency is directly related with the reduction in functional parameters and, as consequence, with a deterioration in the quality of life and poor prognosis in the patients that suffer from it. It has been found that correction of the iron deficiency improves the functional class and other parameters of the disease in the short-term. Objective: To evaluate the efficacy and safety of the use of iron in the treatment of heart failure. Methods: Clinical trials were selected that evaluated the use of administering intravenous or oral iron vs. placebo in the context of patients with cardiac failure and at the same time, patients were selected that concomitantly suffered from iron deficiency anaemia. The search was made in data bases such as MEDLINE (PubMed), Embase, Cochrane Central Register of Clinical trials (CENTRAL), LILACS and WPRIM. Results: Of the 10,729 articles obtained, only 6 were eligible with 835 patients, of which 520 were treated with iron therapy and 315 with a placebo or conventional heart failure therapy. Due to the heterogeneity of the results, it was not possible to perform a meta-analysis. Conclusion: A significant improvement was identified in several of the parameters evaluated, such as the 6-minute walk test, the New York Heart Association functional class, maximum oxygen uptake (VO2 max.), and an overall subjective evaluation. This showed that iron therapy is a safe and effective option in the management of patients with heart failure since there was a significant improvement in their functional capacity, quality of life, and several para-clinical parameters.