Factors associated with sarcopenic obesity in Brazilian adults and older people: Systematic review and meta-analysis of observational studies.

AIM: Sarcopenic obesity (SO) is characterized by the coexistence of the loss of muscle mass and function with excess adipose tissue. Its prevalence has increased concomitantly with population aging, becoming one of the most significant challenges for public health, threatening the quality of life and the physical and mental health of the elderly population. METHODS: This study estimated the prevalence and factors associated with SO among adults and the elderly in Brazil's macro-regions, utilizing MEDLINE, Embase, Web of Science, and the Virtual Health Library databases. Primary outcomes included SO prevalence overall and by subgroups, with secondary outcomes identifying associated factors. RESULTS: A systematic review of 33 studies with 10 266 participants up to July 2023 showed a 17% prevalence of SO (95% confidence interval: 13-21%), using a random effects meta-analysis. The Central-West region had the highest occurrence (27%). Dual-energy X-ray absorptiometry (26%) and bioimpedance (6%) were the top diagnostic methods. Protective factors were chronic kidney disease and healthy lifestyles; risk factors included socioeconomic status, functionality, lifestyle, biochemical parameters, and comorbidities such as osteoarthritis and apnea. CONCLUSIONS: The prevalence of SO in Brazil is significant, emerging as a critical public health problem. It is essential to direct attention to changes in prevalence rates in the coming years, given the rising obesity trends and the absolute increase in the elderly population. Geriatr Gerontol Int 2024; 24: 661-674.

Assessing the impact of arsenic, lead, mercury, and cadmium exposure on glycemic and lipid profile markers: A systematic review and meta-analysis protocol.

The toxicity of metals presents a significant threat to human health due to the metabolic changes they induce. Thus, it is crucial to understand the impact of exposure to toxic elements on glycemic and lipid profiles. To this end, we developed a systematic review protocol registered in PROSPERO (CRD42023393681), following PRISMA-P guidelines. This review aims to assess environmental exposure to arsenic, cadmium, mercury, and lead in individuals aged over ten years and elucidate their association with glycemic markers such as fasting plasma glucose, glycated hemoglobin, as well as lipid parameters including total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein cholesterol. Articles published in the MEDLINE (PubMed), EMBASE, Web of Science, LILACS, and Google Scholar databases until March 2024 will be included without language restrictions. The modified Newcastle-Ottawa scale will be employed to assess the quality of the included studies, and the results will be presented through narrative synthesis. If adequate data are available, a meta-analysis will be conducted. This review can help understand the metabolic responses to exposure to toxic elements and the associated health risks.

Effect of lower limb resistance training on ICF components in chronic stroke: A systematic review and meta-analysis of RCTs.

BACKGROUND: Resistance training (RT) effectively promotes functional independence after stroke. OBJECTIVES: To investigate the effect of lower limb RT on body structure and function (muscle strength, postural balance), activity (mobility, gait) and participation (quality of life, impact of stroke on self-perceived health) outcomes in individuals with chronic stroke. METHODS: Six databases were searched from inception until September 2022 for randomized controlled trials comparing lower limb RT to a control intervention. The random-effects model was used in the meta-analyses. Effect sizes were reported as standardized mean differences (SMD). Quality of evidence was assessed using the GRADE approach. RESULTS: Fourteen studies were included. Significant improvements were found in body structure and function after lower limb RT: knee extensors (paretic side - SMD: 1.27; very low evidence), knee flexors (paretic side - SMD: 0.51; very low evidence; non-paretic side - SMD: 0.52; low evidence), leg press (paretic side - SMD: 0.83; very low evidence) and global lower limb muscle strength (SMD: -1.47; low evidence). No improvement was found for knee extensors (p = 0.05) or leg press (p = 0.58) on the non-paretic side. No improvements were found in the activity domain after lower limb RT: mobility (p = 0.16) and gait (walking speed-usual: p = 0.17; walking speed-fast: p = 0.74). No improvements were found in the participation domain after lower limb RT: quality of life (p > 0.05), except the bodily pain dimension (SMD: 1.02; low evidence) or the impact of stroke on self-perceived health (p = 0.38). CONCLUSION: Lower limb RT led to significant improvements in the body structure and function domain (knee extensors and flexors, leg press, global lower limb muscle strength) in individuals with chronic stroke. No improvements were found in the activity (mobility, gait [walking speed]) or participation (quality of life, impact of stroke on self-perceived health) domains. PROSPERO REGISTRATION NUMBER: CRD42021272645.

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND & AIMS: Conventional endoscopic mucosal resection (CEMR) is the established method for the resection of non-pedunculated colorectal lesions (NPCRL) ≥ 10 mm. In the last decade, underwater endoscopic mucosal resection (UEMR) has been introduced as a potential alternative. The aim of this systematic review with meta-analysis is to compare the recurrence and safety of UEMR and CEMR by analyzing only randomized controlled trials (RCTs). METHODS: We systematically searched PubMed, Cochrane Library and EMBASE until April 2023. Studies met the following inclusion criteria: (1) RCTs, (2) comparing UEMR with CEMR, (3) NPCRL ≥ 10 mm, and (4) reporting the outcomes of interest. Primary outcomes were recurrence and safety. Secondary outcomes were en bloc, R0, complete resection, clipping and adverse events per type. RESULTS: Five RCTs were included. UEMR was associated with a lower recurrence rate (OR: 0.56; 95% CI: 0.32-0.97). Thus, the RR of recurrence was 1.7 times higher in the CEMR group (95% CI, 1.04-2.77). There was no significant difference in the pooled safety analysis. UEMR showed better en bloc resection rates (OR: 1.54; 95% CI: 1.15-2.07), but subgroup analysis showed comparable rates in lesions ≥ 20 mm. R0 resection was higher in UEMR (OR: 1.72; 95% CI: 1.23-2.41). Other outcomes were not different between the 2 groups. CONCLUSIONS: UEMR is as safe as CEMR, with a higher overall R0 rate and a higher en bloc resection rate for lesions < 20 mm, leading to a lower overall recurrence rate. The results of this meta-analysis support the widespread use of UEMR.

A systematic review and meta-analysis assessing antiretroviral therapy for treatment-experienced HIV adult patients using an optimized background therapy approach: is there evidence enough for a standardized third-line strategy?

BACKGROUND: The World Health Organization (WHO) has identified the need for evidence on third-line antiretroviral therapy (ART) for adults living with HIV/AIDS, given that some controversy remains as to the best combinations of ART for experienced HIV-1-infected patients. Therefore, we conducted a systematic review and meta-analysis to (i) assess the efficacy of third-line therapy for adults with HIV/AIDS based on randomized controlled trials (RCT) that adopted the "new antiretroviral (ARV) + optimized background therapy (OBT)" approach and (ii) address the key issues identified in WHO's guidelines on the use of third-line therapy. METHODS: MEDLINE, EMBASE, LILACS, ISI Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for RCTs assessing third-line ARV therapy that used an OBT approach between 1966 and 2015. Data was extracted using an Excel-structured datasheet based on the Consolidated Standards of Reporting Trials (CONSORT) recommendations. The primary outcome of this meta-analysis was the proportion of patients reaching undetectable HIV RNA levels (< 50 copies/mL) at 48 weeks of follow-up. Included studies were evaluated using the Cochrane's Risk of Bias assessment tool. Summarized evidence was rated according to the GRADE approach. RESULTS: Eighteen trials assessing 9 new ARV + OBT combinations defined as third-line HIV therapy provided the efficacy data: 7 phase IIb trials and 11 phase III trials. Four of the 18 trials provided extension data, thus resulting in 14 trials providing 48-week efficacy data. In the meta-analysis, considering the outcome regarding the proportion of patients with a viral load below 50 copies/ml at 48 weeks, 9 out of 14 trials demonstrated the superiority of the new combination being studied (risk difference = 0.18, 95% CI 0.13-0.23). The same analysis stratified by the number of fully active ARVs demonstrated a risk difference of 0.29 (95% CI 0.12-0.46), 0.28 (95% CI 0.17-0.38) and 0.17 (95% CI 0.10-0.24) respectively from zero, one, and two or more active drugs strata. Nine of the 18 trials were considered to have a high risk of bias. CONCLUSIONS: Efficacy results demonstrated that the groups of HIV-experienced patients receiving the new ARV + OBT were more likely to achieve viral suppression when compared to the control groups. However, most of these trials may be at a high risk of bias. Thus, there is still not enough evidence to stipulate which combinations are the most effective for therapeutic regimens that are to be used sequentially due to documented multi-resistance.

Vitamin D deficiency and cardiometabolic risk factors in adolescents: systematic review and meta-analysis.

Vitamin D deficiency is associated with an increase in the occurrence of cardiometabolic events, but the evidence of this relationship in adolescence is still limited. Thus, we analyzed the association between vitamin D deficiency and cardiometabolic risk factors in adolescents. Observational studies were searching in PubMed/Medline, Embase, Scopus, Web of Science, Science Direct, Lilacs, and Google Scholar database. Random effects models were used to summarize standardized mean differences for as a summary measure. The certainty of the evidence was verified using the Cochrane recommendations. A total of 7537 studies were identified, of which 32 were included in the systematic review and 24 in the meta-analysis.Vitamin D deficiency was associated with increased systolic pressure (SMD = 0.22; 95%CI = 0.10; 0.34), diastolic pressure (SMD = 0.23; 95%CI = 0.10; 0.35), glycemia (SMD = 0.13; 95%CI = 0.05; 0.12), and insulin (SMD = 0.50; 95%CI = 0.15; 0.84), an increase in the HOMA index (SMD = 0.48; 95%CI = 0.36; 0.60), high triglyceride values (SMD = 0.30; 95%CI = 0.11; 0.49), and reduced HDL concentrations (SMD= -0.25; 95%CI = -0.46; -0.04). No statistically significant association was observed for glycated hemoglobin, LDL cholesterol, and total cholesterol. Most of the studies presented low and moderate risks of bias, respectively. The certainty of the evidence was very low for all the outcomes analyzed. Vitamin D deficiency was associated with increased exposure to the factors linked to the occurrence of cardiometabolic diseases in adolescents. Systematic Review Registration: PROSPERO (record number 42,018,086,298).

Clinical and CT patterns to predict EGFR mutation in patients with non-small cell lung cancer: A systematic literature review and meta-analysis.

PURPOSE: This study aims to determine if the presence of specific clinical and computed tomography (CT) patterns are associated with epidermal growth factor receptor (EGFR) mutation in patients with non-small cell lung cancer. METHODS: A systematic literature review and meta-analysis was carried out in 6 databases between January 2002 and July 2021. The relationship between clinical and CT patterns to detect EGFR mutation was measured and pooled using odds ratios (OR). These results were used to build several mathematical models to predict EGFR mutation. RESULTS: 34 retrospective diagnostic accuracy studies met the inclusion and exclusion criteria. The results showed that ground-glass opacities (GGO) have an OR of 1.86 (95%CI 1.34 -2.57), air bronchogram OR 1.60 (95%CI 1.38 - 1.85), vascular convergence OR 1.39 (95%CI 1.12 - 1.74), pleural retraction OR 1.99 (95%CI 1.72 - 2.31), spiculation OR 1.42 (95%CI 1.19 - 1.70), cavitation OR 0.70 (95%CI 0.57 - 0.86), early disease stage OR 1.58 (95%CI 1.14 - 2.18), non-smoker status OR 2.79 (95%CI 2.34 - 3.31), female gender OR 2.33 (95%CI 1.97 - 2.75). A mathematical model was built, including all clinical and CT patterns assessed, showing an area under the curve (AUC) of 0.81. CONCLUSIONS: GGO, air bronchogram, vascular convergence, pleural retraction, spiculated margins, early disease stage, female gender, and non-smoking status are significant risk factors for EGFR mutation. At the same time, cavitation is a protective factor for EGFR mutation. The mathematical model built acts as a good predictor for EGFR mutation in patients with lung adenocarcinoma.

Effects of Aquatic Exercise in Post-exercise Hypotension: A Systematic Review and Meta-Analysis.

BACKGROUND: Post-exercise hypotension (PEH) can be an important non-pharmacological strategy in the treatment of arterial hypertension. Both aerobic and resistance exercises produce PEH, but it is not clear if the exercise environment can lead to a higher PEH. OBJECTIVE: This meta-analysis investigated whether a session of aquatic exercise (AE) induces PEH in comparison with control conditions such as land exercise (LE) or rest in hypertensive subjects. METHODS: The present systematic review and meta-analysis was conducted using the following electronic databases: PubMed, Google Scholar, and EMBASE. Ambulatory blood pressure measurements made in randomized clinical trials were pooled to compare PEH induced by AE with LE and rest conditions in hypertensive subjects. RESULTS: Data from four trials were included, which comprised 127 participants (94 women and 33 men). A 24-h analysis did not detect significant differences between AE and LE or rest for either systolic blood pressure (SBP) or diastolic blood pressure (DBP). Monitoring during the night showed that AE induced significant PEH in comparison with LE for SBP [-8.6 (-15.0 to -1.5) mmHg (p = 0.01)]. For DBP, the AE had pronounced PEH during the night in comparison with LE [-3.7 (-4.7 to -2.8) mmHg, p = 0.000] and rest [-1.7 (-1.9 to -0.8) mmHg, p = 0.000]. There were no differences in daytime values. CONCLUSION: AE showed a higher PEH effect than LE sessions and rest conditions. PEH was observed in both SBP and DBP during the night. The number of studies was low, but all studies included in this meta-analysis used 24-h monitoring. The understanding of clinical relevance of AE, inducing a higher PEH, depends on a standardization of exercise protocols plus a rigorous monitoring of blood pressure. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration: CRD42021271928.

Non-specific effect of omega-3 fatty acid supplementation on autistic spectrum disorder: systematic review and meta-analysis.

METHODS: We searched seven databases and found 13 eligible controlled trials that use omega-3 supplementation in children and adolescents with ASD.Data extraction: We collected details on study design, intervention time, supplement dosage, and the autism assessment scale. Meta-analyses and subgroup analysis were conducted according to the autism symptoms. RESULTS: Omega-3 and omega-6 supplementation improved ASD symptoms according to the Aberrant Behavior Checklist (standard mean difference - SMD = -0.13; CI 95% = -0.34, -0.02). However, using subgroup analysis, we observed no efficacy in terms of improvements in hyperactivity (SMD = -0.03; CI 95%: -0.43, 0.36), irritability (SMD = -0.18; CI 95%: -0.51, 0.15), stereotypy (SMD = -0.03; CI 95%: -0.43, 0.36), inappropriate speech (SMD = -0.68; CI 95%: -1.49, 0.14), lethargy (SMD = -0.22; CI 95%: -0.58, 0.14), and social function (SMD = -0.71; IC 95%: -1.56, 0.14). W-3 and w-6 supplementation also showed no efficacy according to the Social Responsiveness Scale (SMD = 0.08; CI 95%: -0.23, 0.39). The adverse effects were classified as mild and equally distributed between the placebo and intervention groups. CONCLUSIONS: Despite w-3 and w-6 supplementation showing minimal beneficial effects in the treatment of autism, the subgroup analyses indicated that there is a lack of evidence on the beneficial role of w-3 and w-6 in treating ASD.Systematic Review Registration: PROSPERO number CRD42020146116.

Looking for Crumbs in the Obesity Forest: Anti-obesity Interventions and Obesity-Associated Cardiometabolic Traits in the Mexican Population. History and Systematic Review With Meta-Analyses.

Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthesizes the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without an inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, covering alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting metabolism-associated traits such as BMI, weight, waist circumference, triglycerides, glucose, among others. Only the studies with at least 3 months of treatment were included in the meta-analyses in order to reduce placebo effects. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43 national, and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and the implemented strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium-to-high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like pure water instead of sweet beverages decrease triglycerides and systolic blood pressure. Dark chocolate showed the highest effect for BMI and high blood pressure, and treatment with insulin increased weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different cardiometabolic associated traits, which should be analyzed in detail in the population living near the Mexico-U.S. border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population's treatment response. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020221436, identifier: CRD42020221436.

Magnetic resonance versus computed tomography for the detection of retroperitoneal lymph node metastasis due to testicular cancer: A systematic literature review.

INTRODUCTION: It is essential to see if MRI can be used as an alternative to CT for the detection of retroperitoneal lymphadenopathy in patients with testicular neoplasms. By doing so, the amount of radiation received by these young patients might be reduced. MATERIAL AND METHODS: A systematic literature review was carried out in 5 databases between January 1984 until December 2020. The articles included were randomized and non-randomized clinical trials, cross-sectional studies, cohort, case and control, and retrospective studies that compare the accuracy of MRI against CT to detect retroperitoneal lymph nodes in patients with testicular neoplasms. RESULTS: The search string initially retrieved 222 non duplicated papers from which a total of 3 studies of diagnostic accuracy were included for analysis. These articles evaluated a total of 127 patients with testicular neoplasm; the sample size per study ranged from 25 to 52 patients, with a mean age between 29-34 years. MRI presented a sensitivity ranging from 98-80% and specificity of 100 % when read by an experienced radiologist. However, when it was read by a radiologist with 1 year of experience, the sensitivity dropped to 78 % and specificity to 91%. CONCLUSION: This systematic literature review shows a knowledge gap since not much has been published regarding this topic; therefore, randomized clinical trials are mandatory. Research on when to use MRI over CT is necessary to reduce radiation exposure. The authors strongly suggest that readers start researching on this subject.

Systematic review and meta-analysis of the epidemiology of vancomycin-resistance Staphylococcus aureus isolates.

BACKGROUND: Vancomycin­resistant Staphylococcus aureus (VRSA) is a serious public health challenging concern worldwide. OBJECTIVES: Therefore, the objective of present study of 62 published studies was to evaluate the prevalence of VRSA based on different years, areas, isolate source, antimicrobial susceptibility testing, and the genetic determinants. METHODS: We searched the relevant articles that focused on the prevalence rates of VRSA in PubMed, Scopus, Embase, and Web of Science from 2000 to 2019. Statistical analyses were conducted using STATA software (version 14.0). RESULTS: The prevalence of VRSA was 2% before 2006, 5% in 2006-2014, and 7% in 2015-2020 that showed a 3.5-fold increase in the frequency of VRSA between before 2006 and 2020 years. The prevalence of VRSA was 5% in Asia, 1% in Europe, 4% in America, 3% in South America, and 16% in Africa. The frequencies of VRSA isolated from clinical, non-clinical, and mixed samples were 6%, 7%, and 14%, respectively. The prevalence of VRSA was 12% using disk diffusion agar method, 7% using MIC-base methods, and 4% using mixed-methods. The prevalence of vanA, vanB, and vanC1 positive were 71%, 26%, and 4% among VRSA strains. The most prevalent genotype was staphylococcal cassette chromosomemec (SCCmec) II, which accounted for 57% of VRSA. The most prevalent staphylococcal protein A (spa) types were t002, t030, and t037. CONCLUSION: The prevalence of VRSA has been increasing in recent years particularly in Africa/Asia than Europe/America. The most prevalent of genetic determinants associated with VRSA were vanA and SCCmec II. This study clarifies that the rigorous monitoring of definite antibiotic policy, regular surveillance/control of nosocomial-associated infections and intensive surveillance of vancomycin-resistance are required for preventing emergence and further spreading of VRSA.

Rectovaginal group B streptococcus colonization among pregnant women in Nicaragua: a systematic review and meta-analysis.

BACKGROUND: Maternal colonization with group B Streptococcus (GBS) is a predictor of neonatal sepsis. In Nicaragua, neonatal sepsis is a major cause of hospitalization, but it can be prevented with intrapartum antibiotic prophylaxis. We undertook this study to estimate the pooled prevalence of rectovaginal GBS colonization among pregnant women 35-40-week gestation in Nicaragua, and sensitivity of GBS isolates to various antibiotics. METHODS: We systematically searched electronic databases of peer-reviewed and unpublished literature using prespecified search terms. We included English- and Spanish-language studies of rectovaginal GBS colonization and/or antibiotic sensitivity of GBS isolates that followed internationally-recognized diagnostic standards, from various sites and years. Two reviewers independently abstracted data and assessed risk of study bias. We then meta-analyzed the pooled prevalence of rectovaginal GBS colonization and antibiotic sensitivity of GBS isolates. We performed subgroup analyses by geographic location, urbanicity, and study risk of bias. MAIN RESULTS: Prevalence of rectovaginal GBS colonization from 13 samples in 11 studies was 0.14 (95% CI: 0.09, 0.21). Effect size heterogeneity was identified between coastal (0.12 [95% CI: 0.07, 0.19]) and central study sites (0.23 [95% CI: 0.18, 0.28]), and between predominantly rural (0.06 [95% CI: 0.02, 0.10]) and urban (0.28 [95% CI: 0.19, 0.37]) samples of pregnant women. GBS sensitivity to penicillin, the first-line antibiotic for intrapartum prophylaxis, was 0.89 (95% CI: 0.71, 1.00) based on seven studies. CONCLUSIONS: Maternal GBS colonization was substantial in some study sites. Most GBS isolates are sensitive to recommended antibiotics, and intrapartum antibiotic prophylaxis may effectively prevent neonatal sepsis in Nicaragua.

The impact of the HPV vaccine on the world: initial outcomes and challenges / O impacto da vacina contra o HPV no mundo: resultados iniciais e desafios

Introduction: Human papillomavirus (HPV) infection can be considered an epidemic in the world and in Brazil. This infection accounts for virtually all cases of cervical cancer, most malignant anal, vaginal and oropharyngeal tumors, and a large number of cases of cancer of the penis and vulva. The most effective way to prevent this infection is through vaccination. Several countries, including Brazil, have already introduced this vaccine into the public vaccination programs and are observing the real-life results of decreasing HPV-associated diseases. Objective: To evaluate the effectiveness of HPV vaccination in preventing virus-induced diseases in countries that have adopted it for a longer time, in a different scenario from clinical studies. Methods: This is a bibliographic review study in journal databases PubMed, LILACS, SciELO and Scopus, with publications dated from 2000 to 2019. The research was restricted to articles in English and Portuguese and studies conducted in humans. Ten studies that were considered relevant were selected. Furthermore, additional articles found by free search were selected. After this phase, the chosen publications were obtained in full for reassessment of their methodology and results. Results: The HPV vaccine demonstrated its effectiveness in reducing the incidence of HPV infection and/or anogenital warts and/or precancerous lesions in the seven countries analyzed by the study: Australia, Brazil, Denmark, United States of America, New Zealand, Czech Republic and Sweden. The impact was bigger in countries that introduced it earlier, such as Australia, where the vaccine virtually eliminated the incidence of genital warts in women aged under 21 years. Although Brazil implemented the vaccine a few years ago, a preliminary study was conducted in Campos dos Goytacazes, RJ, where the vaccine was implemented in 2010, showing a 55% reduction in the incidence of genital warts for women aged under 21 years old, between 2007 and 2012. Conclusion: The HPV vaccine is highly effective in protecting against HPV infection and disease in the countries where it has been implemented, with better results than those seen in clinical trials

Introdução: A infecção pelo papilomavírus humano (HPV) pode ser considerada uma epidemia no mundo e no Brasil. Essa infecção responde por virtualmente todos os casos de câncer de colo de útero, pela maioria dos tumores malignos anais, vaginais e orofaríngeos e por um grande número dos casos de câncer de pênis e vulva. A forma mais eficaz de prevenção dessa infecção é por meio da vacinação. Vários países, entre eles o Brasil, já introduziram essa vacina na rede pública e começaram a observar os resultados na vida real de diminuição das doenças HPV induzidas. Objetivo: Avaliar a eficácia da vacinação contra o HPV na prevenção de doenças induzidas pelo vírus em países que a adotaram há mais tempo, em um cenário diferente dos estudos clínicos. Métodos: Estudo de revisão bibliográfica em bases de dados de periódicos PubMed, LILACS, SciELO e Scopus, com publicações no período de 2000 a 2019. A pesquisa restringiu-se a artigos de língua inglesa e portuguesa e com estudos realizados em seres humanos. Foram selecionados dez trabalhos considerados relevantes. Além disso, foram escolhidos artigos adicionais pesquisados por busca livre. Após essa fase, as publicações selecionadas foram obtidas na íntegra para reavaliação da metodologia e dos resultados. Resultados: A vacina contra o HPV demonstrou sua eficácia na redução da incidência de infecção pelo HPV e/ou verrugas anogenitais e/ou lesões pré-cancerosas nos sete países analisados pelo estudo: Austrália, Brasil, Dinamarca, Estados Unidos da América, Nova Zelândia, República Tcheca e Suécia. O impacto foi maior em países que introduziram a vacina mais precocemente, como na Austrália, onde ela virtualmente eliminou a incidência de verrugas genitais em mulheres abaixo de 21 anos. Ainda que o Brasil tenha implementado a vacina há poucos anos, um estudo preliminar foi realizado no município de Campos dos Goytacazes (RJ), onde a vacina foi introduzida em 2010, demonstrando redução na incidência de verrugas genitais em 55% para mulheres abaixo de 21 anos de idade, no período entre 2007 e 2012. Conclusão: A vacina contra o HPV é muito eficaz na proteção contra a infecção e as doenças induzidas pelo HPV nos países em que foi implementada, com resultados melhores que os observados nos ensaios clínicos.

Obesity and overweight decreases the effect of vitamin D supplementation in adults: systematic review and meta-analysis of randomized controlled trials.

Overweight and obesity are associated with vitamin D deficiency (VitD), which are both important health problems. Reduced serum vitamin D levels has been registered in all phases of life and is commonly associated with the genesis of overweight and obesity. Thus, the objective of this review with meta-analysis was to investigate and evidence the efficacy of vitamin D supplementation in vitamin D. Interventional studies were searched for in 5 databases, without restriction of publication date or language. The absolute mean difference was used as a summary measure of the selected studies. A total of 2370 studies were identified, of which 18 descriptive articles were eligible - based on criteria and variables of selection and exclusion. Then the data were synthesized and submitted to meta-analysis. The results evidence that after supplementation individuals with obesity presented increased serum vitamin D 39.83 nmol/L (95% CI: 34.06-45.61) in relation to the control/placebo group. However, the obese state decreased serum vitamin D concentration by -38.17 nmol/L (95% CI: -59.90/-16.44) compared to the normal weight group. In addition, increasing the dose of VitD supplementation does not appear to contribute significantly to increased serum VitD levels. The study observed that obesity in adults reduced the effect of vitamin D supplementation. Therefore, research should be developed on the optimal dose of vitamin D supplementation for people with obesity.Systematic Review Registration: PROSPERO number CRD42018091.

Short-term effects of fine particulate matter pollution on daily health events in Latin America: a systematic review and meta-analysis.

OBJECTIVES: Ambient air pollution is among the leading risks for health worldwide and by 2050 will largely overcome deaths due to unsafe sanitation and malaria, but local evidence from Latin America (LA) is scarce. We aimed to summarize the effect of short-term exposure to fine particulate air pollution (PM2.5) on morbidity and mortality in Latin America and evaluate evidence coverage and quality, using systematic review and meta-analysis. METHODS: The comprehensive search (six online databases and hand-searching) identified studies investigating the short-term associations between PM2.5 and daily health events in LA. Two reviewers independently accessed the internal validity of the studies and used random-effect models in the meta-analysis. RESULTS: We retrieved 1628 studies. Nine were elected for the qualitative analysis and seven for the quantitative analyses. Each 10 µg/m3 increments in daily PM2.5 concentrations was significantly associated with increased risk for respiratory and cardiovascular mortality in all-ages (polled RR = 1.02, 95% CI, 1.02-1.02 and RR = 1.01, 95% CI , 1.01-1.02, respectively). CONCLUSIONS: Short-term exposure to PM2.5 in LA is significantly associated with increased risk for respiratory and cardiovascular mortality. Evidence is concentrated in few cities and some presented high risk of bias.

Effect of co-culture of mesenchymal stem/stromal cells with pancreatic islets on viability and function outcomes: a systematic review and meta-analysis.

The maintenance of viable and functional pancreatic islets is crucial for successful islet transplantation from brain-dead donors. To overcome islet quality loss during culture, some studies have co-cultured islets with mesenchymal stem/stromal cells (MSC). However, it is still uncertain if MSC-secreted factors are enough to improve islet quality or if a physical contact between MSCs and islets is needed. Therefore, we performed a systematic review and meta-analysis to clarify the effect of different culture contact systems of islets with MSCs on viability and insulin secretion outcomes. Pubmed and Embase were searched. Twenty studies fulfilled the eligibility criteria and were included in the qualitative synthesis and/or meta-analysis. For both outcomes, pooled weighted mean differences (WMD) between islet cultured alone (control group) and the co-culture condition were calculated. Viability mean was higher in islets co-cultured with MSCs compared with islet cultured alone [WMD = 18.08 (95% CI 12.59-23.57)]. The improvement in viability was higher in islets co-cultured in indirect or mixed contact with MSCs than in direct physical contact (P <0.001). Moreover, the mean of insulin stimulation index (ISI) was higher in islets from co-culture condition compared with islet cultured alone [WMD = 0.83 (95% CI 0.54-1.13)], independently of contact system. Results from the studies that were analyzed only qualitatively are in accordance with meta-analysis data. Co-culture of islets with MSCs has the potential for protecting islets from injury during culture period. Moreover, culture time appears to influence the beneficial effect of different methods of co-culture on viability and function of islets.

Efficacy and safety of human papilloma virus vaccine in cervical cancer prevention: systematic review and meta-analysis / Eficacia y seguridad de la vacuna contra el virus de papiloma humano para la prevención del cáncer de cuello uterino: revisión sistemática y metaanálisis

Introduction. Cervical cancer is the third most common cancer worldwide. The human papilloma virus (HPV) has been identifed as the etiologic agent of cervical and other anogenital cancers. The aim was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of HPV vaccines in preventing cervical intraepithelial neoplasias (CIN) grades 2 and 3, adenocarcinoma in situ (CIN2+) and cervical cancer. Materials and Methods. Major bibliographic databases were searched in July 2011 without any temporal nor language restrictions. Randomizedcontrolled trials that evaluated the efficacy of HPV vaccines against CIN2+ and cervical cancer were included. Results. Four of the 168 publications found were included in a meta-analysis. Among vaccinated women, the relative risk (RR) of developing CIN2+ lesions was 0.45 (95% CI 0.38 to 0.54) for HPV 16, 0.14 (0.08 to 0.25) for HPV 18, and 0.79 (0.68 to 0.93) for oncogenic serotypes not included in the vaccines 31/33/45/52/58. All studies had acceptable safety profiles. Conclusions. Vaccines currently available are effective, safe and capable of preventing CIN2+ lesions, although long term efficacy has not yet been fully tested.(AU)

Introducción. El cáncer de cuello uterino es el tercer tipo de cáncer en frecuencia en el mundo. El virus de papiloma humano (HPV, por su sigla en inglés) se ha identificado como causa de éste y otros cánceres anogenitales. El objetivo del presente trabajo es evaluar, mediante una revisión sistemática y metaanálisis, la eficacia y seguridad de las vacunas contra HPV para la prevención de neoplasias intraepiteliales (CIN) de grados 2, 3 y adenocarcinoma in situ (CIN2+) y el cáncer de cuello uterino. Materiales y métodos. Se realizó una búsqueda sistemática en las principales bases de datos durante julio de 2011 sin restricciones temporales o idiomáticas. Se incluyeron ensayos clínicos controlados aleatorizados que evaluaran la eficacia de la vacuna contra el desarrollo de CIN2 + y cáncer de cuello uterino. Resultados. Se confeccionó un metaanálisis con 4 de las 168 publicaciones halladas. Mediante el análisis por intención de tratar se observó, para mujeres vacunadas, un riesgo relativo (RR) de contraer lesiones CIN2+ asociadas a HPV 16 de 0,45 (IC 95% 0,38-0,54); a HPV 18 de 0,14 (0,08-0,25) y por serotipos oncogénicos 31/33/45/52/58 no incluidos en la vacuna de 0,79 (0,68-0,93). Todos los estudios mostraron perfiles de seguridad aceptables. Conclusiones. Las vacunas disponibles actualmente mostraron ser eficaces y seguras para la prevención de lesiones CIN2+; sin embargo, resta probar su eficacia a largo plazo.(AU)

Efficacy and safety of human papilloma virus vaccine in cervical cancer prevention: systematic review and meta-analysis / Eficacia y seguridad de la vacuna contra el virus de papiloma humano para la prevención del cáncer de cuello uterino: revisión sistemática y metaanálisis

Introduction. Cervical cancer is the third most common cancer worldwide. The human papilloma virus (HPV) has been identifed as the etiologic agent of cervical and other anogenital cancers. The aim was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of HPV vaccines in preventing cervical intraepithelial neoplasias (CIN) grades 2 and 3, adenocarcinoma in situ (CIN2+) and cervical cancer. Materials and Methods. Major bibliographic databases were searched in July 2011 without any temporal nor language restrictions. Randomizedcontrolled trials that evaluated the efficacy of HPV vaccines against CIN2+ and cervical cancer were included. Results. Four of the 168 publications found were included in a meta-analysis. Among vaccinated women, the relative risk (RR) of developing CIN2+ lesions was 0.45 (95% CI 0.38 to 0.54) for HPV 16, 0.14 (0.08 to 0.25) for HPV 18, and 0.79 (0.68 to 0.93) for oncogenic serotypes not included in the vaccines 31/33/45/52/58. All studies had acceptable safety profiles. Conclusions. Vaccines currently available are effective, safe and capable of preventing CIN2+ lesions, although long term efficacy has not yet been fully tested.

Introducción. El cáncer de cuello uterino es el tercer tipo de cáncer en frecuencia en el mundo. El virus de papiloma humano (HPV, por su sigla en inglés) se ha identificado como causa de éste y otros cánceres anogenitales. El objetivo del presente trabajo es evaluar, mediante una revisión sistemática y metaanálisis, la eficacia y seguridad de las vacunas contra HPV para la prevención de neoplasias intraepiteliales (CIN) de grados 2, 3 y adenocarcinoma in situ (CIN2+) y el cáncer de cuello uterino. Materiales y métodos. Se realizó una búsqueda sistemática en las principales bases de datos durante julio de 2011 sin restricciones temporales o idiomáticas. Se incluyeron ensayos clínicos controlados aleatorizados que evaluaran la eficacia de la vacuna contra el desarrollo de CIN2 + y cáncer de cuello uterino. Resultados. Se confeccionó un metaanálisis con 4 de las 168 publicaciones halladas. Mediante el análisis por intención de tratar se observó, para mujeres vacunadas, un riesgo relativo (RR) de contraer lesiones CIN2+ asociadas a HPV 16 de 0,45 (IC 95% 0,38-0,54); a HPV 18 de 0,14 (0,08-0,25) y por serotipos oncogénicos 31/33/45/52/58 no incluidos en la vacuna de 0,79 (0,68-0,93). Todos los estudios mostraron perfiles de seguridad aceptables. Conclusiones. Las vacunas disponibles actualmente mostraron ser eficaces y seguras para la prevención de lesiones CIN2+; sin embargo, resta probar su eficacia a largo plazo.