Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis.

This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.

Association between APOE Genotype with Body Composition and Cardiovascular Disease Risk Markers Is Modulated by BMI in Healthy Adults: Findings from the BODYCON Study.

Body mass index (BMI) has been suggested to play an important role in the relationship between the APOLIPOPROTEIN (APO)E genotype and cardiovascular disease (CVD) risk. Using data from the BODYCON cross-sectional study (n = 360 adults) we assessed the association between body composition and CVD risk markers according to APOE genotype, with examination of the role of BMI. In this study cohort, the APOE2/E3 group had lower fasting blood lipids than APOE4 carriers and APOE3/E3 group (p ≤ 0.01). After stratifying the group according to BMI, APOE4 carriers in the normal BMI subgroup had a higher lean mass compared with the APOE3/E3 group (p = 0.02) whereas in the overweight/obese subgroup, the android to gynoid percentage fat ratio was lower in APOE4 carriers than APOE3/E3 group (p = 0.04). Fasting lipid concentrations were only different between the APOE2/E3 and other genotype groups within the normal weight BMI subgroup (p ≤ 0.04). This finding was associated with a lower dietary fibre and a higher trans-fat intake compared with APOE4 carriers, and a lower carbohydrate intake relative to the APOE3/E3 group. Our results confirm previous reports that BMI modulates the effect of APOE on CVD risk markers and suggest novel interactions on body composition, with diet a potential modulator of this relationship.

Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas.

PURPOSE: Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. METHODS: We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. RESULTS: The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. CONCLUSIONS: This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.

Efectos de la dieta mediterránea en el tratamiento de la artritis reumatoide / Effects of Mediterranean diet on the treatment of rheumatoid arthritis

INTRODUCCIÓN Se ha planteado que factores ambientales y relacionados con el estilo de vida pueden contribuir a la severidad y progresión de la inflamación en la artritis reumatoide. Una intervención que genera un alto interés, debido a sus supuestas propiedades antiinflamatorias es la dieta mediterránea. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales sólo uno corresponde a un ensayo aleatorizado. Concluimos que la dieta mediterránea podría hacer poca o nula diferencia en el dolor articular o actividad de la enfermedad, y aumentar levemente el peso en pacientes con artritis reumatoide, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si la dieta mediterránea tiene algún efecto sobre la funcionalidad, rigidez matinal o calidad de vida, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

INTRODUCTION It has been suggested that environmental and lifestyle factors might contribute to the severity and progression of inflammation in rheumatoid arthritis. An intervention generating high interest due to its supposed anti-inflammatory properties is the Mediterranean diet. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including four primary studies, of which only one corresponded to a randomized trial. We concluded Mediterranean diet may make little or no difference in pain or disease activity and may slightly increase weight in rheumatoid arthritis patients, but the certainty of the evidence is low. On the other hand, it was not possible to clearly establish whether Mediterranean diet has any effect on functionality, morning stiffness or quality of life as the certainty of the existing evidence has been assessed as very low.

Efectividad de las intervenciones digitales basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual: protocolo de revisión sistemática / Effectiveness of digital interventions based on mobile phones for the prevention of sexually transmitted infections: A systematic review protocol

INTRODUCCIÓN Las infecciones de transmisión sexual, incluida el VIH, son un importante problema de salud pública. Cada día más de un millón de personas contraen una infección de transmisión sexual. Los sistemas de salud están buscando soluciones para mejorar la educación y lograr cambios en el comportamiento de las personas para prevenir infecciones de transmisión sexual. Las intervenciones digitales basadas en tecnologías móviles en salud (M-health), en especial las basadas en teléfonos móviles, podrían ser una importante herramienta en salud pública para la prevención de infecciones de transmisión sexual/VIH. Esta revisión sistemática resume la evidencia sobre la efectividad de las intervenciones basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual/VIH. MÉTODOS Y ANÁLISIS El protocolo fue diseñado y será reportado en concordancia con la directriz "Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)". Se incluirán ensayos controlados aleatorizados que evalúen el efecto de las intervenciones basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual/VIH. Las intervenciones de interés serán aquellas dirigidas a usuarios de teléfonos móviles, basada en cualquier función o aplicación que pueda usarse o enviarse y que hayan sido diseñadas para educar, promocionar o modificar conductas para reducir comportamiento sexual de riesgo y prevención de infecciones de transmisión sexual incluyendo VIH. La búsqueda electrónica para identificar los estudios se realizará en el Registro Cochrane Central de ensayos controlados (CENTRAL), en EMBASE y MEDLINE/PubMed. Se evaluará el riesgo de sesgo utilizando la herramienta recomendada por la colaboración Cochrane. Se realizará metanálisis y se presentarán los datos mediante el método GRADE.

INTRODUCTION Sexually transmitted infections, including HIV, are an important public health problem. Every day, over one million persons become infected with a sexually transmitted infection (STI). Health systems are searching for solutions to improve sex education and change the sexual behavior of people in order to prevent them. In public health, digital interventions based on mobile health technologies (M-health), especially those based on mobile phones, might be a crucial tool for the prevention of STIs and HIV. This systematic will review and summarize the evidence on the effectiveness of mobile phone-based interventions for the prevention of STIs and HIV. METHODS AND ANALYSIS The protocol was designed and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The protocol will include randomized controlled trials that assess the effect of interventions based on mobile phones for the prevention of STIs/HIV. The interventions of interest will be those targeting mobile phone users and should consist of providing information by mobile phone through any function or application that can be used or sent to, and that has been designed to educate, promote or modify sexual behaviors and prevent STIs, including HIV. The data sources to identify these studies will be the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE. The risk of bias will be assessed using the tool recommended by Cochrane. Finally, a meta-analysis will be done and data will be presented following the GRADE method.

PET-CT para el manejo de pacientes con cáncer testicular tipo seminoma con masa residual post quimioterapia / PET-CT for the management of testicular seminoma patients with post-chemotherapy residual masses

INTRODUCCIÓN En pacientes con cáncer testicular avanzado tipo seminoma que tienen lesiones residuales post quimioterapia de más de 3 cm, el PET-CT podría seleccionar un subgrupo susceptible de ser manejado con seguimiento, evitando una resección quirúrgica innecesaria de tumor no viable. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron 11 estudios primarios, de los cuales, ninguno es un ensayo aleatorizado. Concluimos que el uso de PET-CT en la evaluación de masas residuales post quimioterapia en pacientes con cáncer testicular tipo seminoma podría evitar un porcentaje importante de cirugías innecesarias (certeza de la evidencia baja). Además, el uso de PET-CT podría presentar balances riesgo/beneficio y costo/beneficio favorables en el manejo de pacientes con cáncer testicular tipo seminoma. Sin embargo, se requieren revisiones sistemáticas y estudios primarios que evalúen directamente el impacto diagnóstico del test.

INTRODUCTION The use of PET-CT could select a subgroup of advanced testicular seminoma patients that display post-chemotherapy residual masses measuring >3 cm and could be managed with surveillance, avoiding unnecessary surgical resection of unviable tumor masses. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews that included eleven primary studies; none of these were randomized trials. We concluded the assessment of postchemotherapy residual masses by PET-CT in testicular seminoma patients may prevent unnecessary surgeries, but the certainty of the evidence is low. Furthermore, PET-CT could also offer a favorable risk/benefit and cost/benefit ratio for the management of testicular seminoma patients. However, systematic reviews and primary studies assessing the direct diagnostic impact of PET-CT are required.

¿Resección transuretral bipolar o monopolar para hiperplasia prostática benigna? / Bipolar or monopolar transurethral resection for benign prostatic hyperplasia?

INTRODUCCIÓN: La resección transuretral es el método de elección para la resolución endoscópica de la uropatía obstructiva baja por hiperplasia benigna de la próstata menor a 80cc. Tradicionalmente esta ha sido realizada con asas de resección que utilizan energía monopolar. El uso de energía bipolar ha desplazado la tecnología precedente en el último tiempo. Se dispone a evaluar la eficacia y seguridad de ambas tecnologías para la técnica. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyen 32 estudios primarios, de los cuales 31 corresponden a ensayos aleatorizados. Concluimos que, si bien podrían no existir diferencias de eficacia entre ambas técnicas, la utilización de energía bipolar disminuye la incidencia de síndrome post resección transuretral y probablemente disminuye el riesgo de sangrado que requiere transfusión.

INTRODUCTION: Transurethral resection is currently considered as standard endoscopic treatment for lower urinary tract obstruction due to benign hyperplasia under 80 cc. Monopolar resection loops has been traditionally used but bipolar energy has recently displaced precedent technology. The purpose of this summary is to evaluate the efficacy and safety of both technologies. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews including 32 primary studies, among them 31 randomized trials. We concluded although there may be no difference in terms of efficacy among both techniques, the use of bipolar energy reduces the incidence of transurethral resection syndrome and probably reduces the risk of bleeding that requires red blood cell transfusion.

¿Constituyen los cannabinoides una alternativa terapéutica para insomnio? / Do cannabinoids constitute a therapeutic alternative for insomnia?

INTRODUCCIÓN: Se ha planteado que la estimulación del sueño con cannabinoides podría constituir una alternativa terapéutica en pacientes con insomnio. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen tres estudios primarios, de los cuales dos corresponden a ensayos aleatorizados. Concluimos que no está claro si los cannabinoides tienen un efecto en la severidad del insomnio o en la calidad del sueño; que podrían no tener efecto en la conciliación del sueño, despertar del sueño ni comportamiento durante vigilia, y probablemente se asocian a efectos adversos frecuentes.

INTRODUCTION: It has been suggested that cannabinoids would constitute a therapeutic alternative for patients with insomnia. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including three studies overall, of which two were randomized trials. We concluded it is not clear whether cannabinoids have an effect on insomnia severity or on sleep quality; that they might have no effect on sleep conciliation, sleep awakening or behavior during wakefulness, and are probably associated with frequent adverse effects.

¿Son los cannabinoides un tratamiento efectivo para la fibromialgia? / Are cannabinoids effective for fibromyalgia?

INTRODUCCIÓN: Se postula que los cannabinoides pudieran tener beneficios en la fibromialgia, sin embargo, su efectividad clínica sigue siendo un tema de discusión. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos quince revisiones sistemáticas que en conjunto incluyen dos ensayos aleatorizados pertinentes. Concluimos que no está claro si los cannabinoides tienen beneficios en la fibromialgia porque la certeza de la evidencia es muy baja. Por otra parte, están asociados a efectos adversos frecuentes.

INTRODUCTION: Cannabinoids have been proposed as a therapeutic alternative for fibromyalgia. However, their clinical effectiveness is a matter of debate. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified fifteen systematic reviews including two randomized trials overall. We concluded it is not clear whether cannabinoids have any benefit in fibromyalgia because the certainty of the evidence is very low. On the other hand, they are associated to frequent adverse effects.

¿Son efectivos los probióticos en prevenir infecciones del tracto urinario? / Are probiotics effective in preventing urinary tract infection?

INTRODUCCIÓN: La infección del tracto urinario es la infección bacteriana más común y su recurrencia es frecuente. Entre las variadas medidas que potencialmente disminuirían este riesgo se ha planteado el uso de probióticos. Sin embargo, no está claro si realmente son efectivos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos seis revisiones sistemáticas que en conjunto incluyeron nueve estudios, entre ellos siete ensayos aleatorizados. Concluimos que no está claro si los probióticos disminuyen el riesgo de infección urinaria sintomática, porque la certeza de la evidencia es muy baja.

INTRODUCTION: Urinary tract infection is the most common bacterial infection and recurrences are common. Probiotics have been proposed as an alternative to decrease this risk. However, it is not clear if they are really effective. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified six systematic reviews including nine studies overall, of which seven were randomized trials. We concluded it is not clear whether probiotics decrease the risk of symptomatic urinary tract infection, because the certainty of the evidence is very low.

Tomografía computarizada sin contraste para el diagnóstico de hemorragia subaracnoidea no traumática / Non-contrast computed tomography for the diagnosis of non-traumatic subarachnoid hemorrhage

INTRODUCCIÓN: La hemorragia subaracnoidea es una urgencia neuroquirúrgica que requiere un diagnóstico oportuno, debido a su gravedad y a la existencia de medidas terapéuticas que son efectivas cuando se llevan a cabo a tiempo. La secuencia diagnóstica más utilizada para descartarla es la tomografía computarizada sin contraste, que de ser negativa es seguida de una punción lumbar. Sin embargo, se ha planteado que la tomografía computarizada sin contraste negativa podría bastar por sí sola. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron nueve estudios primarios. Concluimos que la exactitud diagnóstica de la tomografía computarizada sin contraste es probablemente muy alta, aunque aún existen estudios que evalúen el impacto clínico de basar las decisiones clínicas únicamente en este test.

INTRODUCTION: Subarachnoid hemorrhage is a neurosurgical emergency that requires timely diagnosis due to its severity and the existence of therapeutic measures that are effective when carried out in time. The most used diagnostic sequence to rule it out is computed tomography without contrast which, if negative, is followed by lumbar puncture. However, it has been suggested that a negative non-contrast computed tomography (without blood) may rule out the diagnosis. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including nine studies. We concluded the diagnostic accuracy of non-contrast computed tomography is probably very high, but the clinical impact of relying only on this test has not yet been evaluated.

Apendicectomía laparoscópica versus cirugía abierta para la apendicitis complicada / Laparoscopic versus open appendectomy for complicated appendicitis

INTRODUCCIÓN El tratamiento de la apendicitis aguda por vía laparoscópica reduce el riesgo de infección de la herida operatoria, disminuye el tiempo de hospitalización y acelera el retorno a las actividades. Sin embargo, aumenta el riesgo de infecciones intraabdominales, lo cual constituye uno de las principales riesgos del tratamiento quirúrgico laparoscópico de la apendicitis complicada. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos seis revisiones sistemáticas que en conjunto incluyen 55 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que la laparoscopía, en comparación con la cirugía abierta, probablemente disminuye el tiempo de estadía hospitalaria, y podría disminuir el riesgo de infección de la herida operatoria, pero no está claro si existen diferencias en la incidencia de absceso intraabdominal porque la certeza de la evidencia es muy baja.

INTRODUCTION The treatment of acute appendicitis using laparoscopy reduces the risk of wound infection, hospitalization time and return to normal activity. However, it increases the risk of intra-abdominal abscess, which is one the main complications of complicated appendicitis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified six systematic reviews including 55 studies overall, of which four were randomized trials. We concluded that the used of laparoscopy, compared to open appendectomy, probably reduces the time of hospital stay, and may reduce the risk of wound infection, but there's no clarity regarding the incidence of intra-abdominal abscess due to the very low certainty of the evidence available.

Genetic, Genomic and Epigenomic Studies of Balkan Endemic Nephropathy (Ben).

BEN is a primary, chronic tubulointerstitial nephritis characterized with chronic anemia, absence of edema, xantoderma, normal blood pressure and normal findings on the fundus oculi. The disease is distributed in restricted areas in Bulgaria, Romania, Croatia, Bosnia, Former Yugoslavia. Despite numerous studies on genetic and environmental factors and their possible involvement in BEN, its etiopathogenesis still remains elusive. Our recent study aim to elucidate the possible epigenetic component in BEN development. Whole genome DNA array methylation analysis was applied to compare the methylation profiles of male and female BEN patients from endemic regions in Bulgaria and Serbia and healthy controls. All three most prominent candidate genes with aberrations in the epigenetic profile discovered with this study are involved in the inflammatory/immune processes and oncogenesis. These data are in concordance with the reported pathological alterations in BEN. This research supports the role of epigenetic changes in BEN pathology. Exome sequencing of 22.000 genes with Illumina Nextera Exome Enrichment Kit revealed three mutant genes (CELA1, HSPG2, and KCNK5) in BEN patients which encode proteins involved in basement membrane/extracellular matrix and vascular tone, tightly connected to process of angiogenesis. We suggest that an abnormal process of angiogenesis plays a key role in the molecular pathogenesis of BEN.

Descripción de las publicaciones de la Revista Otorrinolaringología y Cirugía de Cabeza y Cuello durante los años 2003 a 2008 / Description of articles published in the journal Revista Otorrinolaringología y Cirugía de Cabeza y Cuello from 2003 to 2008

Introducción: La literatura médica ha aumentado exponencialmente en los últimos años, y la otorrinolaringología no ha estado ajena a este fenómeno. Sin embargo estudios internacionales revelan que la mayoría de los artículos publicados en revistas de esta especialidad corresponden a diseños de estudio con un alto riesgo de sesgo. Objetivo: Evaluar las publicaciones de la Revista Otorrinolaringología y Cirugía de Cabeza y Cuello, con respecto al diseño de los estudios incluidos, tema de la especialidad a la cual se refieren y lugar donde se realizaron los estudios. Material y método: Se realizó un estudio retrospectivo donde dos revisores analizaron de manera independiente todos los artículos publicados en esta revista durante los años 2003 a 2008. Resultados: El diseño de serie de casos fue el más utilizado, con 62,9 por ciento. El 31,4 por ciento de los trabajos abordó un tema de otología/otoneurología y 78,1 por ciento de los artículos fueron realizados en un centro formador de especialistas en otorrinolaringología. Discusión: Los artículos publicados en la revista seleccionada corresponden principalmente a estudios con alto riesgo de sesgo. En la actualidad existe un desbalance importante entre los temas que están siendo estudiados, y también entre los centros donde se está llevando a cabo la investigación en otorrinolaringología.

Introduction: Medical literature has experienced an important growth in past years, and otorhinolaryngology has not been the exception. However, international studies have revealed that most articles published in journals of this specialty correspond to study designs with a high risk of bias. Aim: To evaluate all articles published in the journal of Revista Otorrinolaringología y Cirugía de Cabeza y Cuello, according to the study design, area of the specialty that is involved and place where the studies were conducted. Material and method: Two reviewers independently analyzed the original articles published in this journal from 2003 to 2008. Results: Case series design was the most commonly used, with 62.9 percent of the studies. 31.4 percent of the articles were about otology/neurotology and 78.1 percent were performed in an educational and academic center where otorhinolaryngology specialists are trained. Discussion: Articles published in the selected journal corresponded mainly to studies with a high risk of bias. There is an imbalance in the areas of the specialty that have been studied, and also in the places where these studies have been conducted.

[How can an internist keep updated in the XXIst century?]. / ¿Podemos mantenernos actualizados en medicina en el siglo XXI?

The amount of information in health care has steadily grown in the past years and this trend will probably continue in the near future. Traditional ways to keep updated are no longer sufficient, particularly in broad areas of knowledge as Internal Medicine or Family Medicine. Therefore, it is necessary to use new approaches. The present article describes five proposals for the clinician that tries to maintain updated but feels overwhelmed by the amount of available information.

¿Podemos mantenernos actualizados en medicina en el siglo XXI? / How can an internist keep updated in the XXIst century?

The amount of information in health care has steadily grown in the past years and this trend will probably continue in the near future. Traditional ways to keep updated are no longer sufficient, particularly in broad areas of knowledge as Internal Medicine or Family Medicine. Therefore, it is necessary to use new approaches. The present article describes five proposals for the clinician that tries to maintain updated but feels overwhelmed by the amount of available information.

Análisis crítico de un artículo: la profilaxis primaria de peritonitis bacteriana espontánea disminuye la aparición de síndrome hepatorrenal y mejora la sobrevida en pacientes cirróticos avanzados / Critically appraised article: primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis

Background & Aims: Norfloxacin is highly effective in preventing spontaneous bacterial peritonitis recurrence in cirrhosis, but its role in the primary prevention of this complication is uncertain. Methods: Patients with cirrhosis and low protein ascitic levéis (<15 g/L) with advanced liver failure (Child-Pugh score >9 points with serum bilirubin level >3 mg/dL) or impaired renal function (serum creatinine level >1.2 mg/dL, blood urea nitrogen level >25 mg/dL, or serum sodium level <130 mEq/L) were included in a randomized controlled trial aimed at comparing norfloxacin (35 patients) vs placebo (33 patients) in the primary prophylaxis of spontaneous bacterial peritonitis. The main end points of the trial were 3-month and 1-year probability of survival. Secondary end points were 1-year probability of development of spontaneous bacterial peritonitis and hepatorenal syndrome. Results: Norfloxacin administration reduced the 1-year probability of developing spontaneous bacterial peritonitis (7 percent vs 61 percent, P <0.001) and hepatorenal syndrome (28 percent vs 41 percent, P 0.02), and improved the 3-month (94 percent vs 62 percent, P 0.003) and the 1-year (60 percent vs 48 percent, P 0.05) probability of survival compared with placebo. Conclusions: Primary prophylaxis with norfloxacin has a great impact in the clinical course of patients with advanced cirrhosis. It reduces the incidence of spontaneous bacterial peritonitis, delays the development of hepatorenal syndrome, and improves survival.

Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos / Critically appraised article: Levofloxacin to Prevent Bacterial Infection in Patients with Cancer and Neutropenia

Background: The prophylactic use of fluoroquinolones in patients with cancer and neutropenia is controversial and is not a recommended intervention. Methods: We randomly assigned 760 consecutive adult patients with cancer in whom chemotherapy-induced neutropenia (<1000 neutrophils per cubic millimeter) was expected to occur for more than seven days to receive either oral levofloxacin (500 mg daily) or placebo from the start of chemotherapy until the resolution of neutropenia. Patients were stratified according to their underlying disease (acute leukemia vs solid tumor or lymphoma). Results: An intention-to-treat analysis showed that fever was present for the duration of neutropenia in 65 percent of patients who received levofloxacin prophylaxis, as compared with 85 percent of those receiving placebo (243 of 375 vs 308 of 363; relative risk, 0.76; absolute difference in risk, -20 percent; 95 percent confidence interval, -26 to -14 percent; P=0.001). The levofloxacin group had a lower rate of microbiologically documented infections (absolute difference in risk, -17 percent; 95 percent confidence interval, -24 to -10 percent; P <0.001), bacteremias (difference in risk, -16 percent; 95 percent confidence interval, -22 to -9 percent; P <0.001), and single-agent gram-negative bacteremias (difference in risk, -7 percent; 95 percent confidence interval, -10 to -2 percent; P <0.01) than did the placebo group. Mortality and tolerability were similar in the two groups. The effects of prophylaxis were also similar between patients with acute leukemia and those with solid tumors or lymphoma. Conclusions: Prophylactic treatment with levofloxacin is an effective and well-tolerated way of preventing febrile episodes and other relevant infection-related outcomes in patients with cancer and profound and protracted neutropenia. The long-term effect of this intervention on microbial resistance in the community is not known.