Vaginosis citolítica: actualización diagnóstica y terapéutica / Cytolytic vaginosis: diagnostic and therapeutic update

El objetivo es conocer el abordaje diagnóstico y terapéutico de la vaginosis citolítica. Para ello se hizo una búsqueda sistemática de la literatura médica mediante las bases de datos: PubMed, Central, etc. Se limitó a ensayos clínicos aleatorizados, metaanálisis y revisiones bibliográficas, con disponibilidad del texto completo para evaluarlos en su totalidad e incluirlos en la revisión; publicados entre 1980 y 2021. Se incluyeron 27 publicaciones. La vaginosis citolítica es un trastorno infradiagnosticado. En mujeres con síntomas y signos de candidiasis vulvovaginal, que no responden a la terapia, se debe considerar la probabilidad de estar en presencia de una vaginosis citolítica. El tratamiento obliga a elevar el pH vaginal a valores básicos y a disminuir el número excesivo de Lactobacillus, resultando de utilidad las duchas vaginales con bicarbonato de sodio y/o un tratamiento con antibióticos derivados de la penicilina junto a un inhibidor de ß-lactamasas o doxiciclina en las pacientes alérgicas a la penicilina. Finalmente, se concluye que la vaginosis citolítica es una afección común, frecuentemente se diagnostica de forma errónea porque se confunde con la candidiasis vulvovaginal; se caracteriza por producir un cuadro clínico similar. El tratamiento se enfoca en disminuir el número de Lactobacillus y la elevación del pH vaginal.

The objective is to know the diagnostic and therapeutic approach of cytolytic vaginosis. A systematic search of the medical literature was carried out using the following databases: Medline via PubMed, Central, and Cochrane Database of Systematic Reviews, among others. The search was limited to randomized clinical trials, meta-analyses, and literature reviews that had the full text available for full evaluation and inclusion in the review; published between 1980 and 2021. Twenty-seven publications were included. Cytolytic vaginosis is a frequently underdiagnosed disorder, which mimics Candida vaginitis. In women with symptoms and signs of vulvovaginal candidiasis who do not respond to antifungal therapy, the possibility of cytolytic vaginosis should be considered. The treatment of this condition requires raising the vaginal pH to basic values and reducing the excessive number of Lactobacillus, resulting in useful vaginal douches with sodium bicarbonate and/or treatment with antibiotics derived from penicillin together with a ß-lactamases inhibitor or doxycycline in patients allergic to penicillin. Finally, we conclude that cytolytic vaginosis is a common condition, frequently misdiagnosed because it is confused with vulvovaginal candidiasis, since it is characterized by producing a similar clinical picture. Treatment focuses on reducing the number of Lactobacillus and raising vaginal pH.

Ensaios clínicos randomizados sobre procedimentos de enfermagem registrados por enfermeiros no Brasil: estudo bibliométrico / Randomized clinical trials on nursing procedures recorded by nurses in Brazil: bibliometric study

Objetivo: Caracterizar os Ensaios Clínicos Randomizados sobre procedimentos de Enfermagem registrados por enfermeiros no Brasil. Métodos: Estudo bibliométrico, que aconteceu por meio do acesso à plataforma digital de Registro Brasileiro de Ensaios Clínicos entre os anos de 2010 e 2021, no qual foram incluídos 65 ensaios registrados por enfermeiros. A análise dos dados ocorreu com auxílio do software R. Resultados: Constatou-se aumento dos registros acerca dos procedimentos de enfermagem ao longo dos anos, em que a maioria das pesquisas foi oriunda da região Sudeste, por profissionais com titulação de doutor, vinculados a instituições públicas, e sobre a população estudada ocorreu predominância de pacientes. A maior parte dos estudos foi realizada na atenção secundária, com ênfase no procedimento de punção venosa e arterial. Conclusão: A caracterização dos ensaios clínicos randomizados sobre procedimentos de enfermagem pode contribuir para evidenciar os avanços e as lacunas das condutas desses profissionais na assistência à saúde. Verifica-se o crescimento no desenvolvimento de ensaios clínicos randomizados com o passar dos anos, no entanto sua incorporação à prática clínica ainda representa um desafio. Descritores: Ensaios Clínicos Controlados Aleatórios como Assunto; Cuidados de Enfermagem; Pesquisa em Enfermagem Clínica

Objective: To characterize the Randomized Clinical Trials on Nursing procedures registered by nurses in Brazil.Methods: Bibliometric study, which took place through access to the digital platform of the Brazilian Registry of Clinical Trials between the years 2010-2021, in which 65 trials registered by nurses were included. Data analysis occurred with the aid of the software R. Results: There was an increase in records about nursing procedures over the years, in which most of the research came from the southeast region, by professionals with PhD degree, linked to public institutions, and on the population studied there was a predominance of patients. Most studies were conducted in secondary care, with emphasis on venous and arterial puncture. Conclusion: The characterization of randomized clinical trials on nursing procedures can contribute to highlight the advances and gaps in the conduct of these professionals in health care. There is a growth in the development of randomized clinical trials over the years, so its incorporation into clinical practice still represents a challenge. Descriptors: Randomized Controlled Trials as Subject; Nursing care; Clinical Nursing Research

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract Background: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. Methods: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. Conclusion: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO registration: CRD42022339628 PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID=339628

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Características e efeitos de programas de exercício físico para idosos durante a pandemia de COVID-19: revisão integrativa / Characteristics and effects of physical exercise programs for older adults during the COVID-19 pandemic: an integrative review

Objetivo: Avaliar as características de programas de exercício físico para idosos e seus efeitos durante a pandemia de COVID-19. Métodos: revisão integrativa, realizada entre os meses de janeiro a março de 2022. As buscas foram realizadas no MEDLINE via PubMed, Lilacs via BVS, PEDro e Cochrane Library. Foram incluídos artigos experimentais (ensaios clínicos randomizados, ensaios não randomizados ou estudos quase-experimentais) publicados de 2019 a 2021, sem restrição de idioma, e que utilizaram programas de exercício físico para idosos (> 60 anos) em sua intervenção. A seleção dos estudos foi realizada através da leitura de título e resumo, e seguida da leitura do texto completo. Os artigos selecionados tiveram seus resultados extraídos com auxílio de um formulário on-line, tabulados com a utilização de planilha eletrônica e analisados qualitativa e quantitativamente. Resultados: Foram identificados 113 estudos; 7 preencheram os critérios de elegibilidade e foram incluídos na revisão, todos ensaios clínicos randomizados. Os programas de exercícios foram em maior frequência, multicomponente (resistência, equilíbrio, flexibilidade e aeróbico), entregues de forma on -line, sendo realizados de 2 a 7 vezes na semana, com duração entre 30 e 50 min. Efeitos significativos foram observados na função física, composição corporal, triglicerídeo sanguíneo, incidência de quedas, atividade física e capacidade funcional.Conclusões: Os programas de exercício físico utilizados durante a pandemia da COVID-19 apresentaram resultados promissores para a população idosa, se mostrando uma alternativa viável para a manutenção das funções físicas, mentais e cognitivas dos idosos em momentos de calamidade pública.

Objective: To evaluate the characteristics of physical exercise programs for older adults and their effects during the COVID-19 pandemic. Methods: An integrative review was conducted between January and March 2022. A search was conducted in MEDLINE via PubMed, Lilacs via BVS, PEDro, and Cochrane Library. Experimental articles (randomized clinical trials, non-randomized trials, or quasi-experimental studies) published from 2019 to 2021, with no language restriction, and that used physical exercise programs for older adults (> 60 years) in their intervention were included. The studies were selected by reading the title, abstract, and full text. The selected articles had their results extracted using an online form, tabulated using an electronic spreadsheet, and analyzed qualitatively and quantitatively. Results: 113 studies were identified; 7 met the eligibility criteria and were included in the review, all randomized controlled trials. The multi-component exercise programs were more frequent (resistance, balance, flexibility, and aerobic), delivered remotelyand performed 2 to 7 times a week, lasting between 30 and 50 minutes. Significant effects were observed on physical function, body composition, blood triglycerides, the incidence of falls, physical activity, and functional capacity. Conclusions: The physical exercise programs used during the COVID-19 pandemic showed promising results for older adults. The programs proved to be a viable alternative for maintaining the physical, mental, and cognitive functions of older adults in times of public calamity.

Recomendações para o rastreamento do câncer de mama no Brasil do Colégio Brasileiro de Radiologia, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia / Recommendations for breast cancer screening in Brazil from the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations

Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline, EMBASE, Cochrane Library, EBSCO, CINAHL e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos, deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos ou, ainda, portadoras de mutação genética ou com forte história familiar, beneficiam-se do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível. (AU)

Objective: To present the update of the recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published in Medline, Embase, Cochrane Library, Ebsco, Cinahl and Lilacs between January 2012 and July 2022 was searched. Recommendations were based on this evidence, by consensus of the expert committee of the three entities. Recommendations: Annual mammographic screening is recommended for women aged between 40 and 74 years old. Above 75 years should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast câncer, chest irradiation before age 30, carriers of genetic mutation or with a strong family history, benefit from complementary screening, being considered individually. Tomosynthesis is an evolution of mammography and should be considered in screening, whenever accessible and available. (AU)

Toxina botulínica para prevenção de migrânea: overview de revisões sistemáticas / Botulinum toxin for the prevention of migraine: overview of systematic reviews

Contextualização: A migrânea, também conhecida por enxaqueca, é um distúrbio sensorial relacionado a fatores genéticos, psicológicos e anatômicos, que afeta cerca de 10% dos adultos, trazendo impacto pessoal, social e econômico. Objetivos: Sumarizar as evidências de revisões sistemáticas, referentes à efetividade da toxina botulínica para prevenção de migrânea. Métodos: Trata-se de overview de revisões sistemáticas. Procedeu-se à busca em três bases eletrônicas de dados: Cochrane - Central de Registros de Ensaios Clínicos ­ CENTRAL (2023), PubMed (1966-2023) e EMBASE (1974-2023), sendo utilizados os descritores MeSH "Migraine disorders" e "Botulinum toxins". Todas as revisões sistemáticas de ensaios clínicos randomizados (ECRs) em humanos foram incluídas. O desfecho primário de análise foi a melhora clínica. Resultados: Foram recuperadas 21 revisões sistemáticas e, diante dos critérios de inclusão, 4 foram incluídas, totalizando 94 ECRs (n = 16.104 participantes). Os estudos sugerem que a toxina botulínica pode ser benéfica na redução do número de crises, intensidade de dor e melhora na qualidade de vida dos pacientes. Entretanto, a evidência é limitada. Discussão: Embora os estudos incluídos tragam benefícios favoráveis à toxina botulínica para prevenção da migrânea, a evidência é de baixa qualidade, diante da heterogeneidade, fragilidades metodológicas e riscos nas análises desses estudos. Sugere-se a comparação da efetividade da toxina botulínica com outras intervenções disponíveis, objetivando melhor elucidação da questão. Conclusão: Parece haver algum benefício da toxina botulínica para prevenção de crises de migrânea, mas a evidência até o momento é limitada, sendo recomendada a comparação com outras terapêuticas utilizadas para prevenção da migrânea.

Efeito da manobra de recrutamento alveolar no pós-operatório imediato de cirurgia cardíaca: uma revisão sistemática / Effect of the alveolar recruitment maneuver in the immediate postoperative period of cardiac surgery: a systematic review

Introdução: as cirurgias cardíacas são as intervenções de escolha em níveis mais avançados das doenças cardiovasculares, e complicações pulmonares podem ocorrer como consequência das alterações fisiológicas causadas pela circulação extracorpórea, pela anestesia e pela incisão esterno torácica. A fisioterapia atua com o intuito de prevenir e tratar essas complicações, através da utilização de uma das técnicas de expansão pulmonar mais utilizadas na reversão de hipoxemia e atelectasias, a manobra de recrutamento alveolar, com o objetivo de abrir alvéolos colapsados e aumentar as trocas gasosas. Objetivo: revisar sistematicamente os efeitos da manobra, na relação PaO2/FiO2, SatO2, o tempo de ventilação mecânica, o tempo de internamento, a incidência de atelectasia, a pressão arterial média e a frequência cardíaca. Metodologia: revisão de ensaios clínicos controlados e randomizados nas bases de dados PubMed, Cochrane Library, LILACS e PEDro. Foram incluídos estudos que utilizaram a manobra como prevenção de complicações pulmonares, publicados em inglês e português. Resultados: foram incluídos 4 estudos, publicados entre os anos 2005 e 2017. O nível de pressão da manobra variou entre 30 cmH2O a 40 cmH2O. Os estudos mostraram que a manobra foi estatisticamente relevante na relação PaO2/FiO2, SatO2 e na redução da incidência de atelectasias, sem impacto no tempo de ventilação mecânica, no tempo de internamento, na pressão arterial média e na frequência cardíaca. Conclusão: a manobra de recrutamento pode ser considerada como uma técnica a ser utilizada na prevenção de alterações pulmonares, porém não é possível afirmar se os benefícios da manobra perduraram em longo prazo.

Introduction: Cardiac surgeries are the interventions of choice in more advanced levels of cardiovascular disease, and pulmonary complications can occur as a result of physiological changes caused by cardiopulmonary bypass, anaesthesia and the sternum thoracic incision. Physiotherapy acts with the aim of preventing and treating these complications, through the use of one of the most used lung expansion techniques in the reversal of hypoxemia and atelectasis, the alveolar recruitment maneuver, with the objective of opening collapsed alveoli and increasing gas exchanges. Objective: To systematically review the effects of the maneuver on the PaO2/FiO2 ratio, SatO2, duration of mechanical ventilation, length of hospitalization, incidence of atelectasis, mean arterial pressure and heart rate. Methodology: Review of controlled and randomized clinical trials in PubMed, Cochrane Library, LILACS and PEDro databases. Studies that used the maneuver to prevent pulmonary complications, published in English and Portuguese, were included. Results: 4 studies, published between 2005 and 2017, were included. The maneuver pressure level ranged from 30 cmH2O to 40 cmH2O. The studies showed that the maneuver was statistically relevant in relation to PaO2/FiO2, SatO2 and in reducing the incidence of atelectasis, with no impact on the duration of mechanical ventilation, length of hospitalization, mean arterial pressure and heart rate. Conclusion: The recruitment maneuver can be considered as a technique to be used in the prevention of pulmonary alterations; however, it is not possible to state whether the benefits of the maneuver lasted in the long term.

O reparo pode aumentar a sobrevida de restaurações que apresentam falhas quando comparado com a substituição em ambas as dentições? Revisão Sistemática e Meta-Análise / Can repair increase the survival of failed restorations when compared with replacement in both dentitions? Systematic Review and Meta-Analysis

O objetivo desta revisão sistemática foi coletar e comparar os dados de sobrevida após o reparo e substituição para restaurações com falhas em dentes decíduos e permanentes. As buscas foram realizadas em dez/2020 e atualizado em abr/2022 de forma sistemática nas bases de dados PubMed/MEDLINE, Scopus, Web of Science, Embase, OpenSigle e ProQuest. Dois revisores independentes calibrados (kappa=0,87) avaliados como critérios de inclusão: (1) estudos de reparo e substituição, (2) dados de sucesso, longevidade ou sobrevivência, (3) ensaios clínicos controlados aleatoriamente; e para os critérios de exclusão (1) perda para acompanhamento superior a 30%, (2) acompanhamento inferior a 12 meses, (3) dentes anteriores. A ferramenta RoB 2 foi utilizada para avaliar o risco de viés, enquanto que a certeza da evidência foi medida por meio da ferramenta GRADE. Foi identificado 4.070 publicações potencialmente relevantes, entretanto apenas três estudos apresentaram todos os critérios para elegibilidade e foram incluídos na análise qualitativa. Nenhum estudo reportou a taxa de sucesso das intervenções na dentição decídua. Foi coletado um tempo padrão de acompanhamento entre os estudos, e a taxa de sobrevivência agregada foi de 99% após três anos. Não houve diferença estatisticamente significativa entre as abordagens e nenhuma heterogeneidade entre os estudos foi apontada. Todos os estudos incluídos apresentaram alto risco de viés, além de que a certeza da evidência para a medida do desfecho sucesso foi muito baixa. É importante ressaltar que devido à longevidade similar de ambas as técnicas, é fortemente recomendado realizar a técnica de reparo para restaurações que apresentam falha, uma vez que esta técnica está associada à odontologia de intervenção mínima. Mais estudos clínicos bem delineados são necessários para aumentar a certeza da evidência. Registro do RS: Esta revisão sistemática foi registrada na plataforma Prospero (CRD42021238063)

The use of zygomatic implants in severe maxillary atrophy: a systematic and meta-analysis review of randomised clinical trials / El uso de implantes zigomáticos para atrofia maxilar severa: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

SUMMARY: Conventional implant treatment cannot always be used to rehabilitate edentulous patients with advanced maxillary atrophic. Zygomatic dental implants have been used over the past 20 years as an alternative treatment solution to bone grafting. The purpose of this meta-analysis is to evaluate the implant and prosthetic survival rate in non-oncologic patients with a severely atrophic maxilla. This review also aims to better understand the rate of peri-operative complications in this cohort of patients. A multi-database (PubMed, MEDLINE, EMBASE, and CINAHAL) focused systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Any randomised control trials studies involving human participants treated with zygomatic osseous implants were included. After eliminating duplicates, a total of 4 studies met the inclusion criteria for this meta-analysis review. With all the studies included there was a total of 174 patients treated with zygomatic osseous implants. The overall implant success rate was 98.03 %. The prosthetic success rate was 96.4 %. The most frequent peri-operative complication was sinusitis. Based on the limited data available in literature, zygomatic dental implants represent a valid alternative to bone augmenting procedure. However, they are not without risks and longer follow-ups are required to confirm the validity of the treatment in long term.

Los tratamientos convencionales con implantes no siempre pueden ser usados para rehabilitar pacientes edentulos con atrofia maxilar avanzada. Los implantes dentales zigomáticos son usados por los pasados 20 años como alternativa de tratamiento a las reconstrucciones óseas. El objetivo de este meta-análisis es evaluar la sobrevida de implantes y prótesis en pacientes no oncológicos con maxila severamente atrófica. Esta revisión también pretende entender al promedio de complicaciones peri operatorias en esta cohorte de pacientes. Una búsqueda sistemática en bases de datos múltiples (PubMed, MEDLINE, EMBASE y CINAHAL) fue desarrollada de acuerdo a recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Cualquier estudio clínico aleatorizado de participantes humanos donde se utilizaron los implantes zigomáticos fueron incluidos. Después de eliminar duplicados, un total de 4 estudios cumplieron los criterios de inclusión para esta meta análisis. Con todos los estudios incluidos se obtuvieron 174 pacientes tratados con implantes zigomáticos. El promedio de éxito fue de 98,03 %. El promedio de éxito de la rehabilitación fue de 96,4 %. La complicación mas frecuente fue la sinusitis. Basados en los datos limitados en la literatura, los implantes zigomáticos representan una alternativa valida a los procedimientos de aumento óseo. Sin embargo, estos no están libres de riesgos y seguimientos de mayores periodos son necesarios para confirmar la validez de los tratamientos en el largo plazo.

Efeitos da terapia assistida com animais no manejo da dor: protocolo de revisão sistemática / Effects of assisted therapy with animals for pain management: systematic review protocol

OBJETIVO: Avaliar os ensaios clínicos randomizados existentes na literatura sobre os efeitos da terapia assistida com animais no manejo da dor, em pessoas com quadros álgicos, comparando-a ao tratamento convencional ou a outras intervenções não farmacológicas. MÉTODO: Trata-se de um protocolo de revisão sistemática reportado segundo o Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). O protocolo foi registrado na International Prospective Register of Systematic Reviews (PROSPERO). A busca será realizada em bases de dados variadas, combinando os descritores 'Animal Assisted Therapy', 'Pain Management' e 'Controlled Clinical Trial' e suas variações. Serão incluídos apenas ensaios clínicos randomizados e o gerenciamento dos resultados se dará nos softwares EndNote e Rayyan. A ferramenta Cochrane Collaboration Risk of Bias 2 será utilizada para avaliação do risco de viés, e a ferramenta Grading of Recommendations, Assessment, Development and Evaluation (GRADE) será utilizada para avaliação da certeza de evidência. Se possível, a metanálise será realizada para determinar o efeito da terapia assistida com animais sobre a intensidade da dor.

OBJECTIVE: To evaluate the existing randomized clinical trials in the literature on the effects of Animal Assisted Therapy on pain management in people with pain when compared to conventional treatment or other non-pharmacological interventions. METHOD: Systematic Review, reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO). The search will be carried out in various sources of information, combining the descriptors 'Animal Assisted Therapy', 'Pain Management', and 'Controlled Clinical Trial' and their variations. Only randomized clinical trials will be included, and results will be managed in EndNote and Rayyan software. The assessment of bias risk will be carried out by the Cochrane Collaboration Risk of Bias 2 tool, and the assessment of the certainty of evidence by the Grading of Recommendations, Assessment, Development, and Evaluation. If possible, a meta-analysis will be performed to determine the effect of Assisted Therapy with Animals on pain intensity.

Meta-analysis of the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates / 中华儿科杂志

Objective: To systematically evaluate the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates. Methods: Eight databases in either Chinese or English, including PubMed, the Cochrane Library, Embase, Medline, Scopus, CNKI, Wanfang and VIP, were searched to extract the studies on the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates published from the establishment of each database to December 2022. The Meta-analysis was performed using Stata 14.0 statistical software. Results: A total of 9 studies were included in this Meta-analysis, including 6 retrospective cohort studies, 2 prospective cohort studies and 1 randomized controlled trial (RCT) study, involving 9 143 premature infants. The Meta-analysis showed that prenatal steroid exposure increased the risk of late preterm neonatal hypoglycemia (RR=1.55, 95%CI 1.25-1.91, P<0.001). The similar correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates was all found in the following subgroups: North America (RR=1.57, 95%CI 1.37-1.80, P<0.001), enrolling pregnant women with gestational diabetes (RR=1.62, 95%CI 1.26-2.08, P<0.001), A-grade literature quality (RR=1.43, 95%CI 1.14-1.79, P=0.002), criteria for hypoglycemia ≤40 mg/dl (1 mg/dl=0.056 mmol/L, RR=1.49, 95%CI 1.28-1.73, P<0.001), sample size of 501-1 500 (RR=1.69, 95%CI 1.19-2.40, P=0.003) and >1 500 (RR=1.65, 95%CI 1.48-1.83, P<0.001), steroid injection dosage and frequency of 12 mg 2 times (RR=1.66, 95%CI 1.50-1.84, P<0.001), the time interval from antenatal corticosteroid administration to delivery of 24-47 h (RR=1.98, 95%CI 1.26-3.10, P=0.003), unadjusted gestational age (RR=1.78, 95%CI 1.02-3.10,P=0.043) and unadjusted birth weight (RR=1.80, 95%CI 1.22-2.66, P=0.003). Meta-regression results showed that steroid injection frequency and dose were the main sources of high heterogeneity among studies (P=0.030). Conclusion: Prenatal steroid exposure may be a risk factor for hypoglycemia in late preterm neonates.

Clinical value of mesh prophylaxis for parastomal hernia based on evidence-based medicine / 中华外科杂志

The incidence of parastomal hernia is substantially high, significantly affecting the quality of life of patients with stoma. How to effectively solve the problem of parastomal hernia is a long-term focus of hernia and abdominal wall surgery and colorectal surgery. The European Hernia Society guidelines on prevention and treatment of parastomal hernia published in 2018 has recommended the use of a prophylactic mesh to prevent parastomal hernia for the first time. In the following 5 years, more randomized controlled trials of multi-center, large-sample, double-blind, long-term follow-up have been published, and no significant effect of mesh prophylaxis has been observed on the incidence of parastomal hernia. However, whether mesh could decrease surgical intervention by limiting the symptoms of parastomal hernias would become a potential value of prophylaxis, which requires further research to elucidate.

Effectiveness and Safety of Chinese Medicine at Shenque (CV 8) for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials / 中国结合医学杂志

BACKGROUND@#Primary dysmenorrhea (PD) is the most common complaint associated with menstruation and affects up to three-quarters of women at some stage of their reproductive life. In Chinese medicine, navel therapy, treatment provided at Shenque (CV 8), is used as a treatment option for PD.@*OBJECTIVE@#To evaluate the effect of navel therapy on pain relief and quality of life in women with PD, compared with Western medicine (WM).@*METHODS@#China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed and Wanfang Database, MEDLINE, the Cochrane Library, Embase, Web of Science, and the International Clinical Trial Registry of the U.S. National Institutes of Health were searched from their inceptions to April 1, 2021. Randomized controlled trials (RCTs) assessing therapeutic effects of navel therapy on PD were eligible for inclusion. RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool.@*RESULTS@#Totally 24 RCTs involving 2,614 participants were identified. Interventions applied to acupuncture point CV 8 included: herbal patching, moxibustion or combined navel therapy (using at least 2 types of stimulation). Compared to placebo, there was a significant effect in favor of navel therapy on reducing overall menstrual symptom scores at the end of treatment [mean difference: -0.82, 95% confidence interval (CI): -1.00 to -0.64, n=90; 1 RCT]. As compared with Western medicine, navel therapy had a superior effect on pain intensity as assessed by Visual Analogue Scale at the end of treatment [standardized mean difference (SMD): -0.64, 95% CI: -1.22 to -0.06, I2=80%, n=262; 3 RCTs]; on symptom resolution rate at 3-month follow-up (risk ratio: 1.94, 95% CI: 1.47 to 2.56, n=1527, I2=38%; 13 RCTs); and on global menstrual symptoms score at the end of treatment (SMD: -0.67, 95% CI: -0.90 to -0.45, I2=63%, n=990; 12 RCTs). Subgroup analyses showed either a better or an equivalent effect comparing navel therapy with Western medicine. No major adverse events were reported. The methodological quality of included trials was poor overall.@*CONCLUSIONS@#Navel therapy appears to be more effective than Western medicine in decreasing menstrual pain and improving overall symptoms of PD. However, these findings need to be confirmed by well-designed clinical trials with adequate sample size (Systematic review registration at PROSPERO, No. CRD42021240350).

Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.@*METHODS@#The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).@*RESULTS@#Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).@*CONCLUSION@#This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.

Network Meta-analysis of oral Chinese patent medicine in adjuvant treatment of rotavirus gastroenteritis in children / 中国中药杂志

This study aimed to evaluate the efficacy and safety of various oral Chinese patent medicines in the adjuvant treatment of rotavirus gastroenteritis(RVGE) in children based on network Meta-analysis. Randomized controlled trial(RCT) of oral Chinese patent medicine in the adjuvant treatment of RVGE in children was retrieved from the databases such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science from database inception to October 22, 2022. The quality of the included RCT was evaluated according to the Cochrane risk-of-bias tool, and the data were analyzed by RevMan 5.4 and Stata 16 software. Sixty-three RCTs were included, with 11 oral Chinese patent medicines involved, including Xingpi Yanger Granules, Weichang'an Pills, Qiuxieling Mixture, Erxieting Granules, and Changyanning Granules/Syrup. The results of the network Meta-analysis showed that in terms of clinical total effective rate, the top 3 optimal interventions were Changyanning Granules/Syrup, Xiaoer Guangpo Zhixie Oral Liquid, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the anti-diarrheal time, the top 3 optimal interventions were Shenling Baizhu Granules, Qiuxieling Mixture, and Shuangling Zhixie Oral Liquid combined with conventional western medicine. In terms of the antiemetic time, the top 3 optimal interventions were Changyanning Granules/Syrup, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the antipyretic time, the top 3 optimal interventions were Shenling Baizhu Granules, Xiaoer Shuangjie Zhixie Granules, and Qiuxieling Mixture combined with conventional western medicine. In terms of the negative conversion rate of rotavirus, the top 3 optimal interventions were Xingpi Yanger Granules, Erxieting Granules, and Cangling Zhixie Oral Liquid combined with conventional western medicine. In terms of reducing creatine kinase isoenzyme MB(CK-MB) level, the top 3 optimal interventions were Weichang'an Pills, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of adverse reactions, no se-rious adverse reactions were reported in all studies. Oral Chinese patent medicines in the adjuvant treatment of children with RVGE have their own advantages, Specifically, Changyanning Granules/Syrup + conventional western medicine focuses on improving the clinical total effective rate and shortening the antiemetic time, Shenling Baizhu Granules + conventional western medicine on shortening the anti-diarrheal time and antipyretic time, Xingpi Yanger Granules + conventional western medicine on improving the negative conversion rate of rotavirus, and Weichang'an Pills + conventional western medicine on reducing the CK-MB level. Limited by the quantity and quality of literature included in this study, the results need to be verified by high-quality RCT with a larger sample size.

Meta-analysis of Simotang Oral Liquid in treatment of functional dyspepsia in adults / 中国中药杂志

This study was conducted to evaluate the efficacy and safety of Simotang Oral Liquid in the treatment of functional dyspepsia in adults. "Simotang Oral Liquid" "Simotang" "Si Mo Tang" "Si Mo Tang Oral Liquid" were used for retrieval of the relevant papers from CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Springer Link, and Web of Science from database inception to June 2021. Randomized controlled trial(RCT) of Simotang Oral Liquid in the treatment of functional dyspepsia in adults was screened out for Meta-analysis which was conducted in RevMan 5.3. A total of 16 RCTs were included. Meta-analysis showed that compared with the control group, Simotang Oral Liquid increased the total response rate and lowered the traditional Chinese medicine syndrome scores, serum cholecystokinin(CCK), serum nitric oxide(NO), and incidence of adverse reactions. However, the serum substance P(SP) had no statistical difference between the two groups. Simotang Oral Liquid is effective and safe in the treatment of functional dyspepsia in adults. However, this study has evidence and limitations, so the conclusions need to be further verified by large sample and multicenter clinical studies.

Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

BACKGROUND@#Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.@*METHODS@#We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects.@*RESULTS@#Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%).@*CONCLUSION@#Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

INTRODUCTION@#Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AADs.@*METHOD@#Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores.@*RESULTS@#Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25-0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25-0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07-0.30) for combined CBA and RFA, 0.20 (95% CI=0.10-0.41) for hot-balloon ablation, 0.43 (95% CI=0.15-1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18-0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy.@*CONCLUSION@#The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis.