Methodological and users' surveys on the use of the LILACS database in Cochrane reviews identified desirable improvements to the database.

BACKGROUND: Latin American and Caribbean Health Sciences Literature (LILACS) is the main reference database in the region; however, the way in which this resource is used in Cochrane systematic reviews has not been studied. OBJECTIVES: To assess the search methods of Cochrane reviews that used LILACS as a source of information and explore the Cochrane community's perceptions about this resource. METHODS: We identified all Cochrane reviews of interventions published during 2019, which included LILACS as a source of information, and analysed their search methods and also ran a survey through the Cochrane Community. RESULTS: We found 133 Cochrane reviews that reported the full search strategies, identifying heterogeneity in search details. The respondents to our survey highlighted many areas for improvement in the use of LILACS, including the usability of the search platform for this purpose. DISCUSSION: The use and reporting of LILACS in Cochrane reviews demonstrate inconsistencies, as evidenced by the analysis of search reports from systematic reviews and surveys conducted among members of the Cochrane community. CONCLUSION: With better guidance on how LILACS database is structured, information specialists working on Cochrane reviews should be able to make more effective use of this unique resource.

[Stage at diagnosis of prostate cancer in an institutional hospital. Review and comparison of national and international data]. / Etapa al diagnóstico de cáncer de próstata en un hospital institucional. Revisión y comparación de datos nacionales e internacionales.

INTRODUCTION: Prostate cancer (PCa) is a disease with a high prevalence and incidence worldwide. Screening has pursued the early diagnosis of this disease to provide early treatment. We sought to characterize patients from a local hospital with respect to diagnosis and staging and to compare these results with previously reported data. METHODS: We conducted a retrospective analysis of patients diagnosed with PCa at an institutional hospital. Clinical variables were collected at the time of diagnosis, staging methods, TNM stage, and histological grade. RESULTS: 129 patients were included in the analysis. The median PSA (ng/mL) at diagnosis was 7.29. The histological grade was classified as ISUP 1 in 37.5%. An MRI was performed in 42.19% of the patients, being classified mostly as PIRADS 4 (21.09%). PET-CT PSMA staging was used mainly in the high-risk group, preferring contrast-enhanced CT and bone scintigraphy in the other groups. 6.25% were classified as N1 and 9.37% as M1. CONCLUSION: The stage at diagnosis in our series is somewhat higher than that reported by developed countries but considerably lower than that published by other Latin American countries and even from other hospitals in our country. It is of great national relevance to have clear protocols for screening and access to PSA to reduce the cases diagnosed in advanced stages.

The GRADE approach, Part 2: Evidence to decision frameworksoutlining decision-making in health. / Metodología GRADE, parte 2: de la evidencia a la decisión—esquematizando la toma de decisiones en salud.

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology provides a framework for assessing the certainty of the evidence and making recommendations. The Evidence to Decision Framework (EtD) is a transparent and structured system for formulating health recommendations. Once the problem is identified and the certainty of the evidence is assessed, EtD provides several criteria for formulating a recommendation. These criteria include the trade-off between benefits and harms, patients values and preferences, acceptability, feasibility, resource use, and impact on equity. The resulting recommendations may differ in strength (strong or weak) and direction (for or against). The process is transparent, allowing other users to adjust the framework of recommendations by modifying the criteria to fit the desired context through an adaptation-adoption process. Given the extensive information available on EtD and the GRADE methodology in general, this narrative review seeks to explain the main concepts involved in decision-making in health by using simplified and friendly descriptions, accompanied by practical examples, thus facilitating its understanding by inexperienced readers.

La metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) provee un método para valorar la certeza de la evidencia y para la formulación de recomendaciones que ayuden en la toma de decisiones en salud. Una vez identificado el problema y valorada la certeza de la evidencia, los marcos de la evidencia a la decisión (Evidence to decision frameworks o EtD) utilizan un sistema transparente y estructurado para formular recomendaciones, en que se consideran criterios como el balance entre beneficios y daños, valores y preferencias de los pacientes, aceptabilidad, factibilidad, equidad y uso de recursos para establecer una recomendación en salud. Esta podrá tener distinta fuerza (fuertes o débiles) y dirección (a favor o en contra). La transparencia de este proceso permite que otros usuarios puedan adaptar un marco de recomendaciones según el contexto deseado, mediante un proceso de adaptación-adopción. Ante la extensa información disponible sobre marcos de la evidencia a la decisión y la metodología GRADE en general, esta revisión narrativa busca entregar una explicación acerca de los principales conceptos involucrados en la toma de decisiones en salud, a través de descripciones simplificadas, amigables y con ejemplos prácticos, con el fin de facilitar su entendimiento por lectores inexpertos.

Efficacy of methadone for the management of postoperative pain in laparoscopic cholecystectomy: A randomized clinical trial. / Eficacia de la metadona para el tratamiento del dolor postoperatorio en colecistectomía laparoscópica: ensayo clínico aleatorizado.

BACKGROUND: Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. METHODS: We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). RESULTS: Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. CONCLUSION: Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.

INTRODUCCIÓN: El manejo del dolor postoperatorio contribuye a reducir la morbilidad postoperatoria y los reingresos no programados. Pocos ensayos clínicos aleatorizados han evaluado la eficacia de la administración intraoperatoria de metadona en comparación con otros opioides como morfina, para el tratamiento del dolor postoperatorio, como para proporcionar evidencia de su uso regular o incluirse en guías clínicas. MÉTODOS: Realizamos un ensayo clínico aleatorizado comparando el uso de metadona intraoperatoria para evaluar su impacto sobre el dolor postoperatorio. Ochenta y seis pacientes sometidos a colecistectomía laparoscópica electiva fueron asignados para recibir metadona (0,08 mg/kg) o morfina (0,08 mg/kg). RESULTADOS: El grupo de pacientes que recibió metadona requirió menos morfina de rescate en la unidad de cuidados post-anestésicos para el manejo del dolor posoperatorio, en comparación con el grupo morfina (p = 0,0078). Los pacientes del grupo metadona reportaron menos dolor a los 5 y 15 minutos, y a las 12 y 24 horas postoperatorias, además de presentar menos episodios de náuseas. El tiempo de despertar entre ambos grupos fue equivalente. CONCLUSIÓN: El uso intraoperatorio de metadona es superior a morfina en el manejo del dolor postoperatorio, apoyando su uso como parte de la estrategia de manejo multimodal del dolor para colecistectomía laparoscópica bajo anestesia total endovenosa con remifentanilo.

The GRADE approach, Part 1: how to assess the certainty of the evidence. / Metodología GRADE, parte 1: cómo evaluar la certeza de la evidencia.

The certainty of the evidence for interventions is the certainty or confidence that the true effect is within a particular range or relative to a threshold. In the new pyramid of evidence, systematic reviews represent the magnifying glass through which this certainty is evaluated. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach arises in response to the existence of multiple evidence classification systems, and it offers a transparent and structured process to develop and present summaries of evidence considering its certainty and, in a second step, the strength of the recommendations that they inform. The GRADE process begins with an explicit question that includes all important and critical outcomes explicitly. The main domains used to assess the certainty of the evidence are risk of bias, inconsistency, indirectness of evidence, imprecision, and publication bias. The factors that can increase the certainty of the evidence are dose-response gradient, large magnitude of an effect, and effect of plausible residual confounding. Finally, the Summary of Findings tables summarize the process in a simplified way and with controlled language. This narrative reviews purpose is to address the GRADE approachs theoretical and practical underlying concepts in a simplified way and with practical examples.

La certeza de la evidencia para las intervenciones es la seguridad o confianza de que el verdadero efecto se encuentra dentro de un rango particular o en relación con un umbral. En la nueva pirámide de la evidencia, las revisiones sistemáticas representan la lupa a través de la cual se evalúa dicha certeza. La metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) surge como respuesta a la existencia de múltiples sistemas de clasificación de la evidencia y ofrece un proceso transparente y estructurado para desarrollar y presentar resúmenes de evidencia considerando la certeza de esta y, en un segundo paso, la fuerza de las recomendaciones que informan. El proceso GRADE comienza con una pregunta explícita, que incluye las especificaciones de todos los desenlaces importantes y críticos. Los principales dominios que se utilizan para valorar la certeza de la evidencia son: 1. El riesgo de sesgo, 2. La inconsistencia, 3. Evidencia indirecta, 4. Imprecisión, y 5. El sesgo de publicación. Los factores que pueden aumentar la certeza de la evidencia son: 1. Gradiente dosis respuesta, 2. Gran magnitud del efecto, 3. Efecto de los potenciales factores de confusión residual. Finalmente, las tablas de resumen de hallazgos (Summary of Findings) sintetizan el proceso de manera simplificada y con un lenguaje controlado. El objetivo general de esta revisión narrativa es abordar los principales conceptos básicos teóricos y prácticos de la metodología GRADE de manera simplificada y con ejemplos prácticos.

Etapa al diagnóstico de cáncer de próstata en un hospital institucional. Revisión y comparación de datos nacionales e internacionales / Stage at diagnosis of prostate cancer in an institutional hospital. Review and comparison of national and international data

INTRODUCCIÓN: El cáncer prostático (CaP) es una patología de alta prevalencia e incidencia mundial. El tamizaje ha perseguido el diagnóstico precoz de esta enfermedad para otorgar tratamientos oportunos. Nosotros buscamos caracterizar los pacientes de un hospital local respecto al diagnóstico y etapificación, y comparar estos resultados con datos previamente reportados. MATERIAL Y MÉTODO: Análisis retrospectivo de pacientes diagnosticados con CaP en un hospital institucional. Se recolectaron variables clínicas al momento del diagnóstico, los métodos de etapificación, el estadío según TNM y grado histológico. RESULTADOS: Se incluyeron 129 pacientes en el análisis. La mediana de APE (ng/mL) al diagnóstico fue de 7,29. El grado histológico fue clasificado como ISUP 1 en 37,5%. Se realizó una resonancia magnética multiparamétrica de próstata (RMmp) en el 42,19% de los pacientes, siendo clasificados como PIRADS 4 en mayor proporción (21,09%). La etapificación con PET-CT PSMA se utilizó principalmente en el grupo de alto riesgo y ante dudas frente a etapificación con medios convencionales. Se prefirió la Tomografía computada (TC) contrastada y la cintigrafía ósea en los otros grupos. 6,25% fue catalogado N1 y 9,37% M1. CONCLUSIÓN: La etapa al diagnóstico de nuestra serie es algo mayor a lo reportado por países desarrollados, pero considerablemente menor a lo publicado por otros países de Latinoamérica e inclusive de otros hospitales de nuestro país. Pareciera ser de gran relevancia nacional contar con protocolos claros de tamizaje y acceso a APE con el fin de disminuir los casos diagnosticados en etapas avanzadas.

INTRODUCTION: Prostate cancer (PCa) is a disease with a high prevalence and incidence worldwide. Screening has pursued the early diagnosis of this disease to provide early treatment. We sought to characterize patients from a local hospital with respect to diagnosis and staging and to compare these results with previously reported data. METHODS: We conducted a retrospective analysis of patients diagnosed with PCa at an institutional hospital. Clinical variables were collected at the time of diagnosis, staging methods, TNM stage, and histological grade. RESULTS: 129 patients were included in the analysis. The median PSA (ng/mL) at diagnosis was 7.29. The histological grade was classified as ISUP 1 in 37.5%. An MRI was performed in 42.19% of the patients, being classified mostly as PIRADS 4 (21.09%). PET-CT PSMA staging was used mainly in the high-risk group, preferring contrast-enhanced CT and bone scintigraphy in the other groups. 6.25% were classified as N1 and 9.37% as M1. CONCLUSION: The stage at diagnosis in our series is somewhat higher than that reported by developed countries but considerably lower than that published by other Latin American countries and even from other hospitals in our country. It is of great national relevance to have clear protocols for screening and access to PSA to reduce the cases diagnosed in advanced stages.

Divertículo de Meckel complicado como presentación de abdomen agudo: reporte de un caso y revisión de la literatura / Complicated meckel´s diverticulum presenting as acute abdomen. Case report and a review of the literature

El divertículo de Meckel (DM) es la regresión incompleta del conducto onfalomesentérico y representa la malformación congénita gastrointestinal más común, en alrededor de 2% de la población. Hasta un 4 a 6% se puede complicar, incluyendo sangrado gastrointestinal, obstrucción o inflamación diverticular. Al realizar una apendicectomía en blanco, debe explorarse como diagnóstico diferencial en el intraoperatorio. Se presenta el caso de un paciente operado por abdomen agudo de probable origen apendicular, sin embargo en el intraoperatorio se evidenció el apéndice cecal sano, pero cursando con una diverticulitis de Meckel. Se presenta además, una breve revisión de la literatura.

Meckel´s diverticulum is the most common congenital gastrointestinal malformation, present in 2% of the population, and is formed through incomplete regression of the omphalomesenteric duct. 4 to 6% show symptoms such as gastrointestinal bleeding, intestinal obstruction or diverticular inflammation. It should be considered in the differential diagnosis during surgery for suspected appendicitis. We present the case of a patient undergoing acute abdomen surgery for suspected appendicitis whose cecal appendix was healthy but who was found to have Meckel´s diverticulitis. We also present a brief review of the literature.