Evaluation of Functional and Joint Health and Associated Factors in Adults With Hemophilia From a Developing Country With Government-Backed Efforts to Improve Hemophilia Care.

Introduction Hemophilic arthropathy affects people with hemophilia (PwH) and causes joint dysfunction and disability. Brazil has a unique situation and implemented policies to improve health care for PwH. The aim of this study was to evaluate the Functional Independence Score in Hemophilia (FISH), Hemophilia Joint Health Score (HJHS), and associated factors among adult PwH attending a Hemophilia Comprehensive Care Center in Brazil. Methods A post hoc analysis was conducted, including 31 patients who had submitted to a physical evaluation during a previously published cross-sectional study performed from June 2015 to May 2016 at the Brasília Blood Center Foundation, Brazil. Results The mean age was 30.8±9.4 years, and 80.6% had severe hemophilia. FISH was 27.0±3.8, and HJHS 18.0±10.8. The ankle was the most often affected joint (25/31, 80.6%). There were significant correlations between FISH and HJHS scores and the Hemophilia Quality of Life Questionnaire for Adults. Patients with severe hemophilia (P = 0.029) and PwH aged ≥ 30 years (P = 0.049) had lower FISH scores. Monthly household income > 2 Brazilian minimum wages was independently associated with improved HJHS (P = 0.033). The factors simultaneously associated with better HJHS and FISH were age < 30 years (P = 0.021) and monthly household income < 2 minimum wages (P = 0.013). Conclusion FISH and HJHS showed favorable scores despite being performed in a country with unfavorable socioeconomic conditions. In addition to hemophilia severity and age, monthly household income was independently associated with functional and articular state of PwH. The results highlight the importance of the free provision of coagulation factors in Brazil.

Effectiveness of training programs based on mindfulness in reducing psychological distress and promoting well-being in medical students: a systematic review and meta-analysis.

BACKGROUND: Medical schools have used mindfulness meditation as a strategy to assist students in stress management. This study aimed to seek evidence regarding the effectiveness of mindfulness-based training programs in reducing psychological distress and promoting the well-being of medical students. METHODS: We conducted a systematic review and meta-analysis. Cochrane Library, Embase, PubMed/MEDLINE, PsycINFO/PsycNet, LILACS/BVS, ERIC (ProQuest), Web of Science, OpenGrey, and Google Scholar were searched for randomized clinical trials published until March 2022, without time or language restrictions. Two authors independently screened the articles, extracted data using a standardized extraction form, and assessed the methodological quality of the included studies using the Cochrane's Risk of Bias 2 (ROB 2) tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Of the 848 articles retrieved, 8 met the inclusion criteria. Mindfulness-based training improved the outcomes: mindfulness (small post-intervention effect: SMD = 0.29; 95% CI: 0.03 to 0.54; p = 0.03; I2 = 46%; high evidence quality, and small effect at follow-up: SMD = 0.37; 95% CI: 0.04 to 0.70; p = 0.03; I2 = 53%; low evidence quality), psychological well-being/health (there was no statistically significant difference between the groups in the post-intervention effect: SMD = - 0.27; 95% CI: - 0.67 to 0.13; p = 0.18; I2 = 76%; moderate evidence quality, and a significant difference at follow-up: SMD = - 0.73; 95% CI: - 1.23 to - 0.23; p = 0.004; I2 = 61%; low evidence quality), and stress (small post-intervention effect: SMD = - 0.29; CI of 95%: - 0.56 to - 0.02; p = 0.04; I2 = 57%; moderate evidence quality, and moderate effect at follow-up: SMD = - 0.45, 95% CI: - 0.67 to - 0.22, p = 0.0001, I2 = 0%, moderate evidence quality). The quality of evidence for the anxiety, depression, and resilience outcomes is low and for the empathy outcome, very low. CONCLUSION: The results indicate that the students who participated in the mindfulness training perceived improvements in the stress and psychological distress symptoms and improved health perception and psychological well-being. However, the significant heterogeneity among studies should be considered when interpreting these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020153169.

Eficácia e segurança do acetato de megestrol para o tratamento da anorexia nos cuidados paliativos: revisão rápida de evidências / Efficacy of the megestrol acetate in the treatment of anorexia in palliative care: a rapid response review of evidence

Acetato de Megestrol (AM). Indicação: Tratamento da Síndrome anorexia-caquexia (SAC) em doentes crônicos em fase de cuidados paliativos. Objetivo: Avaliar a eficácia e segurança do uso do AM em doentes crônicos sob cuidados paliativos. Métodos: Foi realizada uma revisão rápida de revisões sistemáticas, com levantamento bibliográfico nas bases de dados PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web Of Science e em registros de revisões sistemáticas e ensaios clínicos. A qualidade metodológica dos estudos incluídos foi avaliada com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: A busca recuperou um total de 2.370 após exclusão das duplicatas; 1003 estudos foram triados pelo título e resumo, de acordo com os critérios de inclusão previamente estabelecidos. Dezesseis RSs foram selecionadas para leitura completa, sendo que, destas, apenas 1 RS foi classificado com alta qualidade metodológica. Após a análise dos ECR das RSs excluídas, um ECR foi incluído considerando os critérios de inclusão. Dois estudos adicionais publicados posteriormente a RS de Ruiz-Garcia et al. Conclusão: Com base nas evidências disponíveis, o AM proporciona leve ganho de peso e melhora o apetite, porém esses resultados não refletem melhoria na qualidade de vida dos pacientes, além de haver risco considerável de desenvolver fenômenos tromboembólicos

Megestrol acetate (MA). Indication: treatment of anorexia-cachexia syndrome (ACS) in chronic diseases patients, under palliative care. Objective: Evaluate the efficacy and safety of the use of Megestrol Acetate to treat ACS in patients under palliative care. Methods: Rapid review protocol of Systematic Reviews and Clinical Trials. A literature Search was performed in PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web of Science databases and in clinical trials records, following a predefined strategy. The methodological quality of the selected articles was assessed through AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2) tool. Results: the search resulted in 2,370 articles, after the duplicates exclusion. 1003 were analyzed by tittle and abstracts according the inclusion criteria. 16 were selected for full text reading, and only one considered to have high methodological quality. After the analyses of the Randomized Clinical Trials of the excluded Systematic Reviews, one RCT was included. Two additional studies published after the SR of Ruiz-Garcia et al were also included. Conclusion: based on available evidence, the MA promoted a small gain in body weight and a slight appetite improvement, although these results did not imply an enhancement in their quality of life. Moreover, there is a considerable risk of causing thromboembolic disorders

Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone-Patellar Tendon-Bone Graft: A Randomized Controlled Trial.

Background: Lower limb muscle strength symmetry has been suggested as an essential criterion for the safe return to sports after anterior cruciate ligament (ACL) reconstruction. Limited evidence is available regarding the most effective intervention to achieve symmetry after reconstruction with contralateral bone-patellar tendon-bone (BPTB) graft. Purpose: To verify whether unilateral isotonic resistance exercise is more effective than bilateral exercise for obtaining postoperative functional and muscular strength symmetry between the donor limb and reconstructed limb for patients who received BPTB graft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 88 patients were randomly divided into a control group (n = 44) and an intervention group (n = 44). All participants performed an 8-week exercise program starting at the beginning of the fourth postoperative month and were evaluated before and after the program. The control group performed bilateral exercises, and the intervention group performed unilateral exercises for the donor limb only (the limb with the greatest disability). The primary outcome was muscle strength (peak torque and hamstrings to quadriceps [H:Q] ratio), and the secondary outcomes were range of motion (ROM; goniometry), KT-1000 arthrometer side-to-side difference in anteroposterior knee laxity, and objective (single-leg hop test) and subjective (Lysholm score) functionality. Results: Both groups improved significantly from before to after the exercise program. The improvements were significantly greater in the intervention group regarding peak torque, H:Q ratio, flexion ROM, single-leg hop test, and Lysholm score in the donor limb (P < .001 for all), and the improvements were significantly greater in the control group regarding peak torque and single-leg hop test in the reconstructed limb (P < .001 for both). Comparison between the groups showed significantly increased symmetry regarding peak torque, H:Q ratio, and single-leg hop test in the intervention group compared with the control group (P < .001), with large effect sizes (>0.80) except for the H:Q ratio. Conclusion: Although postoperative, bilateral, isotonic resistance exercise provided better strength gains to the reconstructed limb, unilateral exercise was more effective in obtaining functional and muscle strength between-limb symmetry in patients who underwent ACL reconstruction with contralateral BPTB graft. Registration: Brazilian Registry of Clinical Trials (number RBR-22rnjh).

Transcutaneous Nerve Electrostimulation (TENS) in Pain Relief During Labor: A Scope Review.

OBJECTIVE: To map health evidence on the effectiveness of transcutaneous nerve electrostimulation (TENS) therapy in pain relief during delivery. METHODS: This is a scoping review in the PubMed, LILACS, Cochrane, VHL, PEDRO, and SciELO databases, through the descriptors electric stimulation, transcutaneous and labor, obstetric and their synonyms. RESULTS: A total of 263 studies were identified, of which 54 duplicates were excluded. After sorting by titles and abstracts, there were 24 articles for reading, remaining 6. The six studies evaluated the reduction of pain through the visual analogue scale (VAS). CONCLUSION: The findings indicate that the use of TENS as a nonpharmacological strategy for pain relief in labor has positive results.

OBJETIVO: Mapear evidências em saúde sobre a eficácia da terapia por estimulação elétrica nervosa transcutânea (TENS, na sigla em inglês) no alívio da dor durante o parto. MéTODOS: Trata-se de uma revisão de escopo nas bases de dados PubMed, LILACS, Cochrane, VHL, PEDRO e SciELO, através dos descritores estimulação eléctrica, transcutânea e trabalho, obstetrícia e os seus sinônimos. RESULTADOS: Foram identificados 263 estudos, dos quais 54 duplicados foram excluídos. Após a classificação por títulos e resumos, 24 artigos foram selecionados para leitura, restando 6. Os seis estudos avaliaram a redução da dor através da escala visual analógica (EVA). CONCLUSãO: Os resultados indicam que a utilização de TENS como estratégia não farmacológica para o alívio da dor no parto tem resultados positivos.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review

ABSTRACT BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review.

BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.

The management of lower back pain using pilates method: assessment of content exercise reporting in RCTs.

PURPOSE: To evaluate the quality of the reporting of exercise interventions with Pilates method for the treatment of lower back pain (LBP) in adults. MATERIALS AND METHODS: Two independent evaluators selected randomized controlled trials (RCTs) of moderate and high methodological quality included in a Cochrane Systematic Review (SR) and from an additional updated search in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus. Three assessment tools (Consensus on Therapeutic Exercise Training (CONTENT) scale, Template for Intervention Description and Replication (TIDieR) checklist and Consensus on Exercise Reporting Template (CERT) checklist) were utilized by three pairs of two independent researchers trained. The scales' concordance was measured using the Kappa coefficient. RESULTS: Ten RCTs were included. The CONTENT scale score was 5.3 (± 1.33) out of 9 points; the TIDieR checklist was 8.5 (± 1.71) out of 12 points and the CERT checklist was 9.5 (± 3.62) out of 19 points. The CONTENT and CERT had moderate concordance, while there was fair concordance between the other tools. CONCLUSIONS: The overall reporting quality for the Pilates exercises in ten moderate-to-high quality RTCs for the management of LBP was low according to CONTENT scale and CERT checklist and high according to TIDieR checklist.Implications for RehabilitationReporting of Pilates exercise program in moderate-to-high quality RCTs for the management of lower back pain remains incomplete.Pilates exercise program should be personalized and contextualized to individual participants.There may be a need to consider adding to or combining the information available from various trials.

Dosage of resistance exercises in fibromyalgia: evidence synthesis for a systematic literature review up-date and meta-analysis.

Several studies have examined the effect of different types of exercise on people with fibromyalgia. The aim of this study was to identify which dosage of resistance training is effective to reduce pain in women with fibromyalgia. Two authors independently selected studies included in a Cochrane Systematic Review and from an updated search up to May 2021 using the following databases: Embase, Central, Lilacs, PEDro, Current Controlled Trials, and WHO International Clinical Trials Registry Platform, Scopus and ISI Web of Science. Inclusion criteria were randomized clinical trials (RCTs) with female patients (18 years of age or older) diagnosed with fibromyalgia according to the American College of Rheumatology (ACR) criteria and the intervention, resistance exercises for pain reduction. The pain outcome value was extracted from studies for meta-analysis. Nine RCTs were included. Compared to the control groups, resistance exercise groups demonstrated a clinically and statistically significant effect on pain reduction when each exercise was performed in 1-2 sets or 3-5 sets of 4-12 or 5-20 repetitions twice a week, for 8-12 weeks, at intensities of 40-80% with one repetition maximum or perceived exertion. Resistance training exercises are effective to reduce pain in women with fibromyalgia when performed at moderate-to-high intensity in 1-2 sets of 4-20 repetitions twice a week, for 8-12 weeks. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform, CRD42018095205.

The impact of a low-calorie, low-glycemic diet on systemic lupus erythematosus: a systematic review.

BACKGROUND: Diet plays a critical role in Systemic Lupus Erythematosus (SLE) patients, impacting on the microbiota composition and, consequently, on the immune response. The objective was to analyze and verify the diet effect on SLE patients. METHODS: This is a systematic review performed at the Evidences-based Health Lab, Escola Superior em Ciências da Saúde, Brasília (DF), Brazil. In March, 2021, five databases, and grey literature, through JSTOR, Open Grey, and Google Scholar were searched. Randomized Clinical Trials in which SLE patients with calorie restricted, low glycemic index or other diet involving the joint adequacy of these aspects, compared with placebo or different types of diet, were included. RESULTS: It was identified in the databases 758 articles; 132 were duplicated; 616 references were screened, and 604 were excluded. After reading the title and abstract, 12 articles were included for full-text reading. After the full-text reading, three studies were included for quantitative analysis. The diet improved the quality of life at 6 (MD 16.30; 5.91;26.69) and 12 weeks (MD 14.60; 0.88;28.32). The GRADE was used to evaluate the quality of evidence. CONCLUSION: There is low evidence that the diet has a positive impact on the quality of life of SLE patients. Trial registration PROSPERO-CRD4202012208.

Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

Functional and joint evaluation in a prospective cohort of patients with severe haemophilia.

INTRODUCTION: Arthropathy is the main morbidity of haemophilia. Periodic joint health assessment enables a better understanding of the limitations of these patients. OBJECTIVE: To evaluate the functional and joint performance in patients with haemophilia at one-year follow-up, as well as its association with prophylactic treatment and attendance at scheduled consultations at a haemophilia treatment centre. METHODS: This prospective cohort study included patients with severe haemophilia aged 7 years or more and treated at Fundação Hemocentro de Brasília, Brazil, from January 2014 to December 2018. The Hemophilia Joint Health Score and Functional Independence Score in Hemophilia were assessed at the first consultation and after a one-year follow-up. RESULTS: The study included 69 patients. The mean age at study recruitment was 22.5 ± 4.5 years, 62.3% of patients aged 18 years or older, and 29 patients were receiving primary prophylaxis (38.0%). There was a positive correlation between HJHS and age and a negative correlation between FISH and age. The worsening HJHS was associated with non-primary prophylaxis and non-attendance at scheduled multidisciplinary consultations. The worsening FISH was associated with non-primary prophylaxis. The correlation between FISH and treatment adherence was significant for the delta. CONCLUSION: The older the patient with haemophilia, the higher the probability of a worsening of the HJHS. In the presence of more arthropathies, the older the patient, the worse the FISH. Patients receiving primary prophylaxis show better results in the HJHS and FISH when compared to patients receiving secondary prophylaxis and/or on-demand treatment.

Intervention reporting and dissemination of information for the management of hand osteoarthritis.

INTRODUCTION: A variety of exercise programs are recognized to be effective for the management of hand osteoarthritis (HOA). It is important to report the essential elements of these exercise programs for clinicians to replicate properly and facilitate their implementation with individuals who suffers from HOA, especially if they are found to be effective programs. PURPOSE OF THE STUDY: The objective of this article was to assess content reporting using three exercise reporting standardized assessment tools among exercise interventions randomized controlled trials (RCTs) involving individuals with HOA. STUDY DESIGN: A descriptive study was used. METHODS: Two pairs of trained assessors independently identified, selected, and scored the reporting quality of the exercise programs of RCTs on the management of HOA using three standardized assessment tools: the Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist to review the quality of reporting of 11 RCTs included in a recent Ottawa Panel guideline. RESULTS: Based on consensus reached by two different pairs of reviewers and an arbitrator, the mean total scores for the 11 included exercise programs were reported as follows: the mean total score for the CERT, CONTENT, and TIDieR was 10.58/19 ± 4.34, 3.27/9 ± 1.90, and 5.92/12 ± 2.54, respectively. The overall Pearson's Correlation (r) between the methodological quality and intervention reporting was 0.86, 0.71, and 0.54 for moderate-to-high RCTs and 0.47, 0.79, and 0.42 for fair-to-poor methodological quality for the CERT checklist, CONTENT scale, and TIDieR checklist, respectively. CONCLUSIONS: The intervention reporting in the management of HOA is poor among low-, moderate-, and high-quality clinical trials. The least reported information was intervention parameters related to behavior change. Improving reporting is recommended to ensure replication of effective exercise programs to enhance quality of life of individuals with HOA.

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis.

STUDY DESIGN: A systematic review and single-arm meta-analysis of randomized clinical trials. OBJECTIVE: The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). SUMMARY OF BACKGROUND DATA: There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. METHODS: On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. RESULTS: The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2 = 77%, τ2 < 0.0015, P < 0.01). CONCLUSION: Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.Level of Evidence: 1.

The impact of a low-calorie, low-glycemic diet on systemic lupus erythematosus: a systematic review

Abstract Background: Diet plays a critical role in Systemic Lupus Erythematosus (SLE) patients, impacting on the microbiota composition and, consequently, on the immune response. The objective was to analyze and verify the diet effect on SLE patients. Methods: This is a systematic review performed at the Evidences-based Health Lab, Escola Superior em Ciências da Saúde, Brasília (DF), Brazil. In March, 2021, five databases, and grey literature, through JSTOR, Open Grey, and Google Scholar were searched. Randomized Clinical Trials in which SLE patients with calorie restricted, low glycemic index or other diet involving the joint adequacy of these aspects, compared with placebo or different types of diet, were included. Results: It was identified in the databases 758 articles; 132 were duplicated; 616 references were screened, and 604 were excluded. After reading the title and abstract, 12 articles were included for full-text reading. After the full-text reading, three studies were included for quantitative analysis. The diet improved the quality of life at 6 (MD 16.30; 5.91;26.69) and 12 weeks (MD 14.60; 0.88;28.32). The GRADE was used to evaluate the quality of evidence. Conclusion: There is low evidence that the diet has a positive impact on the quality of life of SLE patients. Trial registration PROSPERO—CRD4202012208.

Environmental cleaning to prevent COVID-19 infection. A rapid systematic review

ABSTRACT BACKGROUND: Faced with a pandemic, all healthcare actions need to reflect best practices, in order to avoid high transmissibility, complications and even hospitalizations. For hospital environments, the products recommended and authorized by regulatory institutions for environmental cleaning and disinfection need to be highly effective. OBJECTIVE: To identify, systematically evaluate and summarize the best available scientific evidence on environmental cleaning to prevent COVID-19 infection. DESIGN AND SETTING: A systematic review of studies analyzing cleaning products that inactivate coronavirus, conducted within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL and LILACS databases, for articles published up to May 27, 2020, relating to studies evaluating cleaning products that inactivate coronavirus in the environment. RESULTS: Seven studies were selected. These analyzed use of 70% alcohol, detergent, detergent containing iodine, household bleach, sodium hypochlorite, hydrogen peroxide, chlorine dioxide, glutaraldehyde, ultraviolet irradiation and plasma air purifier. The effectiveness of treating sewage with sodium hypochlorite and chlorine dioxide was also evaluated. CONCLUSION: Disinfection of environments, especially those in ordinary use, such as bathrooms, needs to be done constantly. Viral inactivation was achieved using chlorine-based disinfectants, alcohol, detergents, glutaraldehyde, iodine-containing detergents, hydrogen peroxide compounds and household bleaches. Alcohol showed efficient immediate activity. In sewage, sodium hypochlorite had better action than chlorine dioxide. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/YC5P4 in the Open Science Framework.

Environmental cleaning to prevent COVID-19 infection. A rapid systematic review.

BACKGROUND: Faced with a pandemic, all healthcare actions need to reflect best practices, in order to avoid high transmissibility, complications and even hospitalizations. For hospital environments, the products recommended and authorized by regulatory institutions for environmental cleaning and disinfection need to be highly effective. OBJECTIVE: To identify, systematically evaluate and summarize the best available scientific evidence on environmental cleaning to prevent COVID-19 infection. DESIGN AND SETTING: A systematic review of studies analyzing cleaning products that inactivate coronavirus, conducted within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL and LILACS databases, for articles published up to May 27, 2020, relating to studies evaluating cleaning products that inactivate coronavirus in the environment. RESULTS: Seven studies were selected. These analyzed use of 70% alcohol, detergent, detergent containing iodine, household bleach, sodium hypochlorite, hydrogen peroxide, chlorine dioxide, glutaraldehyde, ultraviolet irradiation and plasma air purifier. The effectiveness of treating sewage with sodium hypochlorite and chlorine dioxide was also evaluated. CONCLUSION: Disinfection of environments, especially those in ordinary use, such as bathrooms, needs to be done constantly. Viral inactivation was achieved using chlorine-based disinfectants, alcohol, detergents, glutaraldehyde, iodine-containing detergents, hydrogen peroxide compounds and household bleaches. Alcohol showed efficient immediate activity. In sewage, sodium hypochlorite had better action than chlorine dioxide. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/YC5P4 in the Open Science Framework.

Pregnancy-related acute kidney injury: mortality and survival of patients treated at a maternal intensive care unit.

INTRODUCTION: Pregnancy-related acute kidney injury (AKI) can be defined as the abrupt decline in renal function during pregnancy or the postpartum period. It remains a relevant cause of fatal complications in obstetric patients. This study aimed to determine the incidence of pregnancy-related AKI in a maternal intensive care unit (ICU) as well as the associated risk factors for dialysis therapy and maternal mortality according to the KDIGO classification system. METHODS: Retrospective analysis of observational data prospectively collected from January/2014 to April/2016 in a maternal ICU in a public tertiary maternal hospital in Brasília, Federal District, Brazil. All consecutive patients diagnosed with pregnancy-related AKI were included. Cases of renal failure before pregnancy or kidney transplantation were excluded. RESULTS: Of the 619 admitted patients, pregnancy-related AKI was present in 172 cases (27.8%). One hundred and ten patients were classified as KDIGO 1 (64.0%), 43 as KDIGO 2 (20.9%) and 22 as KDIGO 3 (15.1%). KDIGO stages 2 and 3 were less frequent than KDIGO stage 1 in patients with gestational hypertension (p = 0.0010). Thirteen patients required hemodialysis (7.6%). Higher APACHE II (p = 0.0399) and SOFA (p = 0.0297) scores, hypovolemic shock (p = 0.0189) and septic shock (p = 0.0204) were independently associated with dialysis therapy (hemodialysis in all cases), 15 patients died (8.7%). Time to death was shorter in patients with a higher KDIGO stage (p = 0.002). Norepinephrine (p = 0.0384) and hemodialysis therapy (p = 0.0128) were independently associated with maternal mortality. CONCLUSIONS: The incidence of pregnancy-related AKI remains high in the maternal ICU setting. Septic shock, hypovolemic shock, and higher APACHE II and SOFA scores were independently associated dialysis therapy (hemodialysis in all cases). KDIGO stages 2 and 3 were less frequent than KDIGO stage 1 in patients with gestational hypertension. Norepinephrine and hemodialysis therapy were independently associated with maternal mortality in patients with pregnancy-related AKI. KDIGO stage 3 was associated with higher maternal mortality.

Infecção e óbitos de profissionais da saúde por COVID-19: revisão sistemática / Infección y muerte de profesionales de la salud por COVID-19: revisión sistemática / Infection and death in healthcare workers due to COVID-19: a systematic review

Resumo Objetivo Identificar as evidências quanto à infecção pelo SARS-CoV-2 e óbitos dos profissionais de saúde e fatores de risco relacionados. Métodos Realizou-se uma revisão sistemática buscando-se artigos nas bases de dados Scopus, Portal Regional da BVS, Pubmed e Embase, relacionados à infecção e óbito de profissionais da saúde envolvidos no tratamento de pacientes com a COVID-19. Não houve restrição quanto a data de publicação, idioma ou tipo de estudo. Para a busca foi considerado publicações até 14 de abril de 2020. Resultados Foram incluídos 28 artigos. Os fatores de risco mais citados foram: escassez, uso inadequado ou não uso de equipamentos de proteção individual, sobrecarga de trabalho, contato próximo com pacientes e/ou colegas de trabalho potencialmente contaminados, procedimento com risco de geração de aerossol, diagnóstico tardio e renovação de ar ambiente inadequado. De acordo com cada país, o número de profissionais infectados variou de 1.716 a 17.306. Quanto aos óbitos, existem dados de até 605 profissionais falecidos no mundo inteiro. As evidências encontradas são editoriais, estudos transversais e de coorte. Conclusão As evidências identificadas demonstram um alto número de profissionais infectados e que foram a óbito, sendo a sobrecarga do sistema de saúde um fator significativo.

Resumen Objetivo Identificar evidencias sobre la infección por SARS-CoV-2 y muerte de profesionales de la salud y factores de riesgo relacionados. Métodos Se realizó una revisión sistemática en busca de artículos en las bases de datos Scopus, Portal Regional de la BVS, Pubmed y Embase, relacionados con la infección y muerte de profesionales de la salud involucrados en el tratamiento de pacientes con COVID-19. No hubo restricción respecto a la fecha de publicación, idioma ni tipo de estudio. Para la búsqueda se consideraron publicaciones hasta el 14 de abril de 2020. Resultados Se incluyeron 28 artículos. Los factores de riesgo más mencionados fueron: escasez, uso inadecuado o falta de uso de equipos de protección individual; sobrecarga de trabajo; contacto cercano con pacientes o compañeros de trabajo potencialmente contaminados; procedimientos con riesgo generador de aerosoles; diagnóstico tardío y renovación inadecuada del aire interior. El número de profesionales infectados varió de 1.716 a 17.306, de acuerdo con cada país. Respecto a las muertes, hay datos de 605 profesionales fallecidos en todo el mundo. La evidencia se encontró en editoriales, estudios transversales y de cohorte. Conclusión Las evidencias identificadas demuestran un alto número de profesionales infectados y fallecidos, y la sobrecarga del sistema de salud es un factor significativo.

Abstract Objective To identify evidences regarding infection by SARS-CoV-2 and deaths of healthcare workers and related-risk factors. Methods We conducted a systematic review by searching the following databases SCOPUS, VHL Regional Portal, PubMed and Embase. We included studies on infection and death of healthcare workers who delivery care for COVID-19 patients. There were no restriction on date of publication, idiom, or type of study. The search was conducted until April 14, 2020. Results A total of 28 articles were selected. Most mentioned risk factors were: scarcity, inadequate use or non-usage of personal protective equipment, work overload, close contact with potentially infected patients and/or coworkers, risk for aerosol-generating procedures, late diagnosis and inadequate air renovation. According to each country, the number of infected workers ranged from 1,716 to 17,306. Concerning deaths, there are data of up to 605 healthcare workers who died of COVID-19 all over the world. Evidences found were editorials, cross-sectional, and cohort studies. Conclusion Studies identified showed high number of infection and deaths among healthcare workers. Overload of health system was a significant factor.