TEN-YEAR OUTCOMES OF TIPS FOR BUDD-CHIARI SYNDROME: SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Budd-Chiari syndrome (BCS) results from the obstruction of the hepatic venous flow, usually at the level of the hepatic vein or inferior vena cava. When left untreated, it can progress with several complications, including liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) appears to be effective in a subgroup of BCS patients. OBJECTIVE: To perform a systematic review and meta-analysis of TIPS effectiveness in BCS treatment, considering the survival rate, reduction in portosystemic pressure, need for liver transplantation, technical failure, and shunt dysfunction for up to 10 years of follow-up. METHODS: We evaluated 17 studies published in PubMed, Science Direct, Web of Science, and SCOPUS databases, which used TIPS as a treatment for BCS, comprising 618 subjects between 18 and 78 years old. We assessed the bias risk by the NOS, NHI, and JBI scales for cohort stu-dies, before-after studies, and case series, respectively. We conducted the meta-analyses by extracting the number of events and the total patients evaluated to perform the proportion meta-analyses using the R software ("meta" package - version 4.9-6). RESULTS: The pooled results (95%CI) showed a 19% (25.9-12.5%) rate of portosystemic pressure reduction, 6% (1-12%) rate for the need for liver transplants despite the use of TIPS, 2% (1-6%) technical failure rate, 30% (18-46%) shunt dysfunction rate, and 88% (81-93%) for the mean frequency of patients alive between 1 and 10 years after the procedure. We stratified survival rate and found an 86% (74-93%) prevalence of living subjects during less than five years, 92% (83-97%) at five years, and a 77% frequency (68-83%) of patients alive ten years after the TIPS placement. CONCLUSION: TIPS is an effective treatment for BCS, providing a high 10-year frequency of living patients and a significant decrease in portosystemic pressure. The need for liver transplants after TIPS and the technical failure rate is low.

Association and Risk Factors of Osteonecrosis of Femoral Head in Sickle Cell Disease: A Systematic Review.

OBJECTIVE: The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS: The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to "Osteonecrosis", "Necrosis avascular" and "Aseptic necrosis" and "Femoral head" and "sickle cell disease" and "risk factor" and "predictor". RESULTS: Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION: For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.

Efeito do treinamento intervalado de alta intensidade versus treinamento contínuo na composição corporal: uma revisão sistemática com meta-análise / Effect of high-intensity interval training versus continuous training on body composition: A systematic review with meta-analysis

A Obesidade é um fator de risco para doenças cardiovasculares e a sua prevalência cresce a cada ano atingindo mais de 2 bilhões de adultos no mundo. As principais recomendações para perda de gordura concentram-se em exercícios de estados estacionários de intensidades moderadas. Entretanto, essas diretrizes não conseguem ser atendidas pela maior parte da população adulta. Sendo assim, novas modalidades ou intensidades de exercícios vem sendo propostas na tentativa de promover perdas mais significativas da gordura corporal. Foi realizado uma revisão sistemática com meta-análise com o objetivo de comparar os efeitos do treinamento intervalado de alta intensidade (HIIT) e do treinamento contínuo nos desfechos: massa corporal total, percentual de gordura, índice de massa corporal e circunferência de cintura de indivíduos com sobrepeso e/ou obesidade. As buscas foram realizadas nas bases de dados Pubmed, Science Direct, PEDro, Scielo e Cochrane Library. A análise foi restrita a ensaios clínicos randomizados em adultos com 18 anos de idade ou mais e com excesso de peso corporal. As meta-análises foram conduzidas utilizando o software Review Manager para modelos de efeitos aleatórios com o método do inverso da variância para os dados contínuos, os dados foram apresentados por diferença da média e IC95%. Quatorze estudos foram incluídos para a análise meta-analítica, houve redução significativa para o grupo CONT para circunferência de cintura (1,19 cm; IC95%: 0,34­2,04; p= 0,006; I²= 0%). Em conclusão, o HIIT não se mostrou melhor estatisticamente em relação ao CONT para alterar os marcadores da composição corporal.

Obesity is a risk factor for cardiovascular disease and its prevalence grows each year reaching more than 2 billion adults worldwide. The main recommendations for fat loss are concentrated in steady-state exercises of moderate intensity. However, these guidelines cannot be met by most of the adult population. Thus, new modalities or exercise intensities are being proposed in an attempt to promote weight or fat loss. A systematic review with meta-analysis was conducted to compare the effects of high-intensity interval training (HIIT) and continuous training on outcomes: total body mass (TBM), fat percentage (%F), body mass index (BMI), and waist circumference ( WC) of overweight and / or obesity. Searches were conducted in Pubmed, Science Direct, PEDro, Scielo and Cochrane Library. The analysis was restricted to randomized clinical trials in adults 18 years of age or older and overweight. Meta-analyses were conducted using Review Manager software for random effects models with the inverse variance method for continuous data, and results were pre-sented by mean difference and 95%CI. Fourteen studies were included for the meta-analytic analysis, there was a significant reduction for the CONT group for CC (1.19 cm; 95%CI: 0,34­2,04; p= 0,006; I²= 0%). In conclusion, HIIT was not statistically better in relation to CONT to alter the markers of body composition.