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Säo Paulo med. j ; 139(2): 123-126, Mar.-Apr. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1181009


ABSTRACT BACKGROUND: Despite widespread usage of central blood pressure assessment its predictive value among elderly people remains unclear. OBJECTIVE: To ascertain the capacity of central hemodynamic indices for predicting future all-cause and cardiovascular hard outcomes among elderly people. DESIGN AND SETTING: Systematic review and meta-analysis developed at the Del Cuore cardiology clinic, in Antonio Prado, Rio Grande do Sul, Brazil. METHODS: 312 full-text articles were analyzed, from which 35 studies were included for systematic review. The studies included needed to report at least one central hemodynamic index among patients aged 60 years or over. RESULTS: For all-cause mortality, aortic pulse wave velocity (aPWV) and central systolic blood pressure (SBP) were significant, respectively with standardized mean difference (SMD) 0.85 (95% confidence interval, CI 0.69-1.01; I2 96%; P < 0.001); and SMD 0.27 (95% CI 0.15-0.39; I2 77%; P 0.012). For cardiovascular mortality brachial-ankle PWV (baPWV), central SBP and carotid-femoral PWV (cfPWV) were significant, respectively SMD 0.67 (95% CI 0.40-0.93; I2 0%; P 0.610); SMD 0.65 (95% CI 0.48- 0.82; I2 80%; P 0.023); and SMD 0.51 (95% CI 0.32-0.69; I2 85%; P 0.010). CONCLUSIONS: The meta-analysis results showed that aPWV was promising for predicting all-cause mortality, while baPWV and central SBP demonstrated consistent results in evaluating cardiovascular mortality outcomes. Thus, the findings support usage of central blood pressure as a risk predictor for hard outcomes among elderly people. REGISTRATION NUMBER IN PROSPERO: RD42018085264

Int. braz. j. urol ; 47(2): 237-250, Mar.-Apr. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1154443


ABSTRACT Objective: The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU. Materials and Methods: A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed. Results: Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively. Conclusions: The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly.

Int. braz. j. urol ; 47(2): 359-373, Mar.-Apr. 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1154467


ABSTRACT Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. Conclusions: The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.

J. bras. nefrol ; 43(1): 34-40, Jan.-Mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1154647


ABSTRACT Aim: Current guidelines do not address between-person variability in markers of bone and mineral metabolism across subgroups of patients, nor delineate treatment strategies based upon such factors. Methods: A cross sectional study was carried out to analyze data from 20,494 United States Veterans and verify the variability of Vitamin D (25(OH)D) and parathyroid hormone (PTH) levels across race and stage of chronic kidney disease. Results: PTH levels were higher in Black Americans (BA) than White Americans (WA) at all levels of 25(OH)D and across eGFR strata. There was a progressive decline in PTH levels from the lowest (25(OH)D < 20) to highest quartile (25(OH)D >=40) in both BA (134.4 v 90 pg/mL, respectively) and WA (112.5 v 71.62 pg/mL) (p<0.001 for all comparisons). Conclusion: In this analysis, higher than normal 25(OH)D levels were well tolerated and associated with lower parathyroid hormone values in both blacks and whites. Black Americans had higher PTH values at every level of eGFR and 25(OH)D levels suggesting a single PTH target is not appropriate.

RESUMO Objetivo: as diretrizes atuais não abordam a variabilidade entre as pessoas nos marcadores do metabolismo ósseo e mineral em subgrupos de pacientes, nem traçam estratégias de tratamento com base em tais fatores. Métodos: realizamos um estudo transversal para analisar dados de 20.494 veteranos de guerra dos Estados Unidos e verificar a variabilidade nos níveis de vitamina D (25 (OH) D) e hormônio da paratireóide (PTH) entre a raça e o estágio da doença renal crônica. Resultados: os níveis de PTH foram maiores em americanos negros (AN) do que em americanos brancos (AB) em todos os níveis de 25 (OH) D e em todos os estratos de TFGe. Houve um declínio progressivo nos níveis de PTH do quartil mais baixo (25 (OH) D <20) para o quartil mais alto (25 (OH) D> = 40) em AN (134,4 v 90 pg/mL, respectivamente) e AB (112,5 v 71,62 pg/mL) (p <0,001 para todas as comparações). Conclusão: Nesta análise, níveis de 25 (OH) D acima do normal foram bem tolerados e associados a valores mais baixos do hormônio da paratireóide em negros e brancos. Os americanos negros tinham valores de PTH mais altos em todos os níveis de TFGe e 25 (OH) D, sugerindo que uma única meta de PTH não é apropriado.

Trends psychiatry psychother. (Impr.) ; 43(1): 1-8, Jan.-Mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1156991


Abstract Despite major advances in the study of the brain, investigations on neurochemistry in vivo still lack the solid ground of more established methods, such as structural and functional magnetic resonance imaging. Proton magnetic resonance spectroscopy (MRS) is a technique that might potentially fill in this gap. Nevertheless, studies using this approach feature great methodological heterogeneity, such as varying voxel of choice, differences on emphasized metabolites, and absence of a standardized unit. In this study, we present a methodology for creating a systematic review and meta-analysis for this kind of scientific evidence using the prototypical case of attention-deficit/hyperactivity disorder. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO), CRD42018112418.

J. bras. psiquiatr ; 70(1): 59-67, Jan.-Mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1180819


ABSTRACT Objective: This study comprises a systematic review and meta-analysis that aimed to estimate the prevalence of dementia in long-term care institutions (LTCIs). Methods: We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Original transversal and longitudinal articles published until July 2020 were eligible in this review. Databases PubMed/MedLine, Web of Science, Scopus and ScienceDirect were searched. Overall prevalence and confidence intervals were estimated. Heterogeneity was calculated according to the index of heterogeneity (I2). Results: One hundred seventy-five studies were found in all databases and 19 studies were meta-analyses, resulting in an overall prevalence of 53% (CI 46-59%; p < 0.01) of demented older adults living in LTCIs. Conclusion: Prevalence of dementia is higher in older adults living in LTCIs than those living in general communities. This data shows a worrying reality that needs to be changed. There is a need for a better understanding of the elements that cause this increase in dementia in LTCFs to direct actions to improve the quality of life and health of institutionalized elderly.

RESUMO Objetivo: Esta revisão sistemática e metanálise objetiva estimar a prevalência de demência em instituições de longa permanência para idosos (ILPIs). Métodos: Utilizou-se o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Artigos originais transversais e longitudinais publicados até julho de 2020 foram elegíveis para esta revisão. As buscas foram conduzidas por meio das bases de dados do PubMed/MedLine, Web of Science, Scopus e Science Direct. A prevalência geral e o intervalo de confiança foram estimados. A heterogeneidade foi calculada de acordo com o índice de heterogeneidade (I2). Resultados: Cento e setenta e cinco estudos foram encontrados em todas as bases de dados e 19 estudos foram analisados, resultando em uma prevalência geral de idosos com demência de 53% (IC 46-59%; p < 0,01) que habitam em ILPIs. Conclusão: A prevalência de demência é maior em idosos moradores de ILPIs que em idosos da população geral. Tal dado mostra uma realidade preocupante e que precisa ser modificada. Há necessidade de melhor entendimento dos elementos que causam esse aumento de demência nas ILPIs para direcionar ações para melhorar a qualidade de vida e a saúde dos idosos institucionalizados.

Rev. bras. ativ. fís. saúde ; 26: 1-12, mar. 2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1248137


Recent systematic reviews highlighted important relationships between combinations of movement behaviors (ie. sleep, sedentary behaviour, and physical activity) and health outcomes among children and adolescents. However, it is unclear whether similar relationships occur in older adults. Therefore, the purpose of this protocol was to describe the aims and methods for a systematic review to sum-marize the studies examining the relationships between movement behaviors and health outcomes in older adults.A systematic review will be developed based on searches of articles in seven electronic databases and references of retrieved articles, contact with authors, and study repositories. Eligibility criteria: observational or experimental studies examining the association of at least two movement behaviours (sleep, sedentary behaviour, and physical activity) with health outcomes in older adults (≥ 60 years old). Selection of the studies and extraction of the data will be carried out by two reviewers independently. Characteristics of the study, participants, methods of combinations, and main results will be extracted and described. Risk of bias and level of evidence in the studies will be assessed according to the study quality tool of the US National Heart, Lung, and Blood Institute and the GRADE guidelines. The data will be synthesized using random effects meta-analysis for results that are sufficiently homogeneous in terms of statistical, clinical, and methodological characteristics. If not, then a narrative synthesis will be conducted. The results of this review may provide insights to improve current guidelines on 24-hour cycle in older adults, as well as guide future studies in this research field

Recentes revisões sistemáticas têm demonstrado haver uma relação entre combinações de sono, comportamento sedentário e atividade física e desfechos de saúde em crianças e adolescentes. Entretanto, ainda permanece incerto se essas relações ocorrem de forma similar em idosos. Portanto, este protocolo objetivou descrever os objetivos e métodos de uma revisão sistemática que sumarizará os estudos que examinaram a relação entre combinações de sono, comportamento sedentário e atividade física e desfechos de saúde em idosos. Uma revisão sistemática será desenvolvida com base nas buscas de artigos em sete bases de dados, nas referências dos artigos incluídos, em contato com os autores e em repositório de estudos. Como critérios de inclusão, estudos observacionais ou experimentais analisando a associação entre a combinação de pelo menos dois dos três comportamentos (sono, comportamento sedentário e atividade física) com desfechos de saúde em idosos (≥ 60 anos). O processo de seleção e extração dos dados será realizado por dois revisores de forma independente. As características dos estudos, participantes, métodos de combinação dos comportamentos e principais resultados serão extraídos e descritos. O risco de viés e o nível de evidência serão analisados, respectivamente, pela ferramenta de avaliação de qualidade do US National Heart, Lung, and Blood Institute e pelo guideline GRADE. Os dados serão sintetizados usando metanálise com efeitos randômicos quando os resultados apresentaram suficiente homogeneidade estatística, clínica e metodológica. Do contrário, os resultados serão apresentados por meio de síntese narrativa. Os resultados desta revisão podem fornecer informações para aprimorar as diretrizes do ciclo das 24 horas, bem como podem fornecer informações para futuros estudos nesse campo de pesquisa

Rev. SOBECC ; 26(1): 60-67, 31-03-2021.
Article in Portuguese | LILACS, BDENF - Nursing | ID: biblio-1223950


Objetivo: Identificar a ocorrência e os fatores de risco determinantes para o desenvolvimento do diagnóstico de enfermagem risco de hipotermia perioperatória. Método: Revisão integrativa, usando o acrônimo PIO (pacientes, intervenção, outcomes/desfecho), em que P=pacientes adultos e idosos; I=cirurgias eletivas; O=fatores de risco associados à hipotermia perioperatória. A revisão foi conduzida e reportada com base no Check-list Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), seguindo-se as sete etapas propostas pelo método PRISMA. Resultados: A busca gerou 854 artigos, sendo retirados os duplicados e os sem relevância. Após aplicação dos critérios de exclusão, 13 artigos foram submetidos à análise final. Índice de massa corporal baixo, idade avançada e tempo cirúrgico prolongado foram os fatores mais relacionados ao desenvolvimento de hipotermia nos pacientes cirúrgicos. O manejo da hipotermia colabora para diminuição dos riscos de eventos adversos cardíacos, complicações infecciosas, sangramentos e traz maior conforto para o paciente. Conclusão: O enfermeiro precisa agir antes do quadro hipotérmico se instalar, reconhecendo os fatores de risco inerentes ao paciente e identificando quais tecnologias do cuidado aplicar.

Objective: To identify the occurrence and the risk factors that determine the development of the nursing diagnosis 'risk for perioperative hypothermia'. Method: Integrative review, using the acronym PIO (patients, intervention, outcomes), in which P=adult and older adults; I=elective surgeries; O=risk factors associated with perioperative hypothermia. The review was conducted and reported based on the Check-list Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA), following the seven steps proposed by the PRISMA method. Results: The search generated 854 articles, excluding duplicates and non-relevant titles. After applying the exclusion criteria, 13 articles were submitted to the final analysis. Low body mass index, advanced age and prolonged surgical time were the factors most related to the development of hypothermia in surgical patients. The management of hypothermia helps to reduce the risk of adverse cardiac events, infectious complications, and bleeding, besides bringing greater comfort to patients. Conclusion: Nurses need to act before the hypothermic condition sets in, recognizing the risk factors inherent to each patient and identifying which care technologies to apply.

Objetivo: Identificar la ocurrencia y los factores de riesgo que determinan el desarrollo del Diagnóstico de Enfermería Riesgo de Hipotermia Perioperatoria. Método: Revisión integrativa, utilizando el acrónimo PIO (Pacientes, Intervención, Outcomes/Resultado), donde P=pacientes adultos y ancianos; I=cirugías electivas; O=factores de riesgo asociados a hipotermia perioperatoria. La revisión se llevó a cabo y se informó utilizando los elementos de informe preferidos de la lista de verificación para revisiones sistemáticas y metaanálisis (Check-list Preferred Reporting Items for Systematic Reviews and Meta-Analyses ­ PRISMA), siguiendo los siete pasos propuestos por el método PRISMA. Resultados: La búsqueda generó 854 artículos, eliminando los duplicados y los no relevantes. Tras aplicar los criterios de exclusión, se sometieron 13 artículos al análisis final. El bajo índice de masa corporal, la edad avanzada y el tiempo quirúrgico prolongado fueron los factores más relacionados con el desarrollo de hipotermia en los pacientes quirúrgicos. El manejo de la hipotermia ayuda a reducir los riesgos de eventos cardíacos adversos, complicaciones infecciosas, hemorragias y brinda mayor comodidad al paciente. Conclusión: La enfermera debe actuar antes de que se presente la condición hipotérmica, reconociendo los factores de riesgo inherentes al paciente e identificando qué tecnologías de atención aplicar.

Humans , General Surgery , Perioperative Nursing , Hypothermia , Diagnosis , Infections , Intraoperative Care
Cad. Ibero Am. Direito Sanit. (Impr.) ; 10(1): 113-128, jan.-mar.2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1151017


Objetivo: levantar as iniciativas de diálogo institucional intersetorial no escopo da judicialização da saúde, estabelecidas desde a criação do Fórum da Saúde pelo Conselho Nacional de Justiça, em 2010. Metodologia: foi realizada uma revisão sistemática de literatura por meio da aplicação dos critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) entre 2010 e 2018. Resultados: foram selecionados sete artigos científicos que apontaram para a existência de diversas iniciativas exitosas no diálogo institucional e intersetorial, repercutindo de forma relevante sobre a redução das ações judiciais em saúde e sobre a mitigação da judicialização da saúde. Conclusão: depreende-se que o fenômeno da judicialização da saúde, por sua complexidade e pela multiplicidade de atores e interesses circunscritos a ele, pode ser manejado e mitigado por vias que favoreçam a interdisciplinaridade entre Direito e Saúde.

Objective: this study aimed to raise the initiatives of intersectorial institutional dialogue within the scope of the judicialization of health established since the creation of the Forum of Health by the National Council of Justice in 2010. Method: a systematic review of literature was conducted through the application of the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: seven scientific articles selected pointed to the existence of several successful initiatives in the institutional and intersectorial dialogue, with a relevant repercussion on the reduction of health judicial actions and on the mitigation of health judicialization. Conclusion: it is understood that the phenomenon of health judicialization, due to its complexity and the multiplicity of actors and interests circumscribed to it, can be managed, and mitigated by ways that favor the interdisciplinarity between Law and Health.

Objetivo: elevar las iniciativas de diálogo institucional intersectorial dentro del alcance de la judicialización de la salud establecida desde la creación del Foro de Salud por el Consejo Nacional de Justicia en 2010. Metodología: se realizó una revisión sistemática de literatura a través de la aplicación de los criterios de los Elementos de Informes Preferidos para Revisiones Sistemáticas y Metaanálisis. Resultados: se seleccionaron siete artículos científicos que señalaron la existencia de varias iniciativas exitosas en el diálogo institucional e intersectorial, con una repercusión relevante en la reducción de las acciones judiciales de salud y en la mitigación de la judicialización de la salud. Conclusión: se entiende que el fenómeno de la judicialización de la salud, debido a su complejidad y la multiplicidad de actores e intereses circunscritos a él, puede ser manejado y mitigado de maneras que favorezcan la interdisciplinariedad entre la Ley y la Salud.

Rev. colomb. anestesiol ; 49(1): e501, Jan.-Mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1149799


Abstract Introduction Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using "AMSTAR" and "Systematic Reviews" as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of a SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.

Resumen Introducción Tomar decisiones basadas en la evidencia ha sido un reto para profesionales de la salud; se requiere tener herramientas y habilidades para apreciar la evidencia críticamente y evaluar la validez de los resultados. Las revisiones sistemáticas de la literatura (RSL) han sido muy usadas para dar respuesta a preguntas del ámbito clínico. Se han desarrollado herramientas que apoyan la apreciación de la calidad de los estudios. El AMSTAR es una de estas, validada y soportada por evidencia reproducible que orienta la calidad metodológica de las RSL. Objetivos Mostrar un abordaje histórico, teórico y de guía práctica para la apreciación crítica de las revisiones sistemáticas con el AMSTAR, orientar las bases argumentales para su uso, según los componentes de esta estructura metodológica en investigación en salud, y proporcionar ejemplos prácticos sobre cómo aplicar esta lista de chequeo. Métodos Realizamos una revisión no exhaustiva de literatura en PubMed y The Cochrane Library con los términos libres "AMSTAR" y "revisiones sistemáticas'', sin límite de idioma o año de publicación; también, recolectamos información de expertos en evaluación de la calidad de la evidencia. Conclusiones El AMSTAR es un instrumento validado y soportado por evidencia reproducible para la evaluación de la validez interna de las revisiones sistemáticas de la literatura. Consiste en 16 ítems que evalúan de manera global la calidad metodológica de una RSL. Actualmente, se usa de manera indiscriminada y predilecta, pero no está exenta de limitaciones y futuras actualizaciones basadas en nuevos estudios de reproducibilidad y validación.

Hematol., Transfus. Cell Ther. (Impr.) ; 43(1): 58-64, Jan.-Mar. 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1154302


ABSTRACT Background: The allogeneic transfusion-related immunomodulation (TRIM) may be responsible for an increase in survival of renal transplants but in contrast it could increase the rate of bacterial infections or the recurrence rate of tumors post-operatively. Objective: This review focuses in the implications of perioperative allogeneic transfusions on the immune-inflammatory response of surgical transfused patients. Results: ABTs modify immune functions in recipients including decrease of the number of lymphocytes; decrease the CD4 cells; decrease the CD4/CD8 T-cell ratio; decrease NK cells; and decrease the lymphocyte response to mitogens. TRIM effects may be mediated by allogeneic white cells present in blood products; soluble peptides present in transfused plasma; and/or biologic mediators released into the supernatant of blood units. A recent systematic review and meta-analysis including 36 clinical observational studies (n = 174,036) concluded that perioperative ABTs not only decreased overall survival and reduced colorectal cancer-specific survival. Furthermore ABTs increased the rate of infectious, cardiac, pulmonary and anastomotic complications in colorectal cancer patients undergoing surgery. Conclusions: It has been demonstrated by laboratory tests that TRIM is associated with transfusion recipient immune alterations but its influence in colorectal cancer recurrence after resection remains controversial though may exist. Surgical techniques reducing intraoperative blood loss have limited the number of ABTs perioperatively, however increase in mortality continues to be reported in literature after ABT in colorectal cancer surgery. Poor survival associated to TRIM in colorectal cancer might be due to higher number of allogeneic transfused units and/or prolonged length of blood storage.

Arq. ciências saúde UNIPAR ; 25(1): 53-59, jan-abr. 2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1151416


O referido trabalho tem como objetivo analisar e avaliar a atual conjuntura das pesquisas científicas na busca da imunização eficaz contra a malária, destacando os principais mecanismos imunológicos e moleculares subjacentes à referida proteção, bem como, as perspectivas a curto e médio prazo. O presente estudo de revisão selecionou pesquisas nas bases de dados da Medical Literature Analysis and Retrieval System Online (Medline), National Library of Medicine (Pubmed), Scientific Electronic Library Online (SciELO), Web of Science e Scopus. Foram combinados os termos Malaria, Immunization, Vaccine and Epidemiology, com seus sinônimos remissivos e outros descritores associados, no período compreendido entre janeiro e julho de 2019. Como fator preponderante dos critérios de inclusão, foram selecionadas revisões sistemáticas com ou sem metanálise, publicadas nos últimos 5 anos, que discorressem detalhadamente sobre o tema, ou que apresentassem informações estatísticas ou históricas relevantes, relacionada ao tema. Como critérios de exclusão foram considerados: materiais literários e científicos, anteriores ao período de 2014 e que não apresentassem informações estatísticas ou histórica relevantes ao tema, ou que, não se adequassem à temática da pesquisa. Após a aplicação dos critérios de inclusão e exclusão, foi realizada a análise e seleção dos artigos. Dos 451 artigos identificados, 44 foram selecionados. As informações extraídas dos referidos trabalhos convergem no sentido de que a erradicação da malária é uma tarefa demasiadamente complexa, a qual não será alcançada com as vacinas atuais, havendo necessidade do desenvolvimento de ferramentas imunizadoras de maior eficácia. Apesar dos esforços, atualmente ainda não existe uma vacina eficaz na prevenção da infecção, mas vários estudos se encontram em andamento nessa vertente, tornando promissor o surgimento de uma vacina eficaz contra o parasita.

This study aims at analyzing and evaluating the current status of scientific research in the search for effective immunization against malaria, highlighting the key immunological and molecular mechanisms of such protection and the short- and medium-term perspectives. The search and selection of studies took place in the databases of the Medical Literature Analysis and Retrieval System Online (Medline); National Library of Medicine (Pubmed); Scientific Electronic Library Online (SciELO); Web of Science; and Scopus. The terms Malaria, Immunization, Vaccine, and Epidemiology were used, with their corresponding cross-referenced synonyms and other associated descriptors, including the period from January to July 2019. As a main factor in the inclusion criteria, systematic reviews with or without meta-analysis published in the last 5 years, presenting a detailed discourse about the topic, or relevant statistical or historical information related to the topic were selected. The following exclusion criteria were considered: literary and scientific materials, prior to 2014, and without statistical or historical information relevant to the theme, or which did not fit the research theme. After applying the inclusion and exclusion criteria, the articles were analyzed and selected. From a total of 451 identified articles, 44 were selected. The information extracted from the referred studies converge in the sense that malaria eradication is an overly complex task, which will not be achieved with the current vaccines, requiring the development of more effective immunizing tools. Despite all the efforts, there is no effective vaccine for preventing infection yet, but several studies are being developed in this area, making the emergence of an effective vaccine against the disease promising.

Rev. bras. cir. cardiovasc ; 36(1): 86-93, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155807


Abstract Introduction: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. High-intensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderate-intensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. Methods: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Meta-analysis was performed using the random-effects, generic inverse variance method. Results: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. Conclusion: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

Humans , Heart Transplantation , High-Intensity Interval Training , Exercise , Exercise Tolerance , Heart Rate
Rev. bras. cir. cardiovasc ; 36(1): 78-85, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155798


Abstract Introduction: The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed. Results: Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome. Conclusion: This review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.

Humans , Coronary Artery Disease/surgery , Percutaneous Coronary Intervention , Coronary Artery Bypass , Treatment Outcome , Propensity Score
Rev. habanera cienc. méd ; 20(1): e3193, ene.-feb. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1156690


RESUMEN Introducción: La Enfermedad de Chagas es una zoonosis parasitaria causada porTrypanosoma cruzi, un protozoario que se transmite principalmente de manera vectorial al ser humano. Estudios de campo predicen que un tercio de un estimado de 18 millones de personas infectadas en Latinoamérica morirán de Enfermedad de Chagas. Objetivo: El objetivo de este estudio fue determinar la seroprevalencia de la infección por Trypanosoma cruzi y factores asociados en población del municipio de Cumaral, Meta, Colombia. Material y Métodos: Se realizó un estudio descriptivo de tipo transversal, en el cual se recolectaron sueros de toda persona habitante del municipio de Cumaral por más de seis meses y que habitara en área urbana o rural. Se utilizó el método de ELISA de extractos totales (Primera prueba) para la detección de IgG antiTripanosoma cruzy; a los positivos se les realizó prueba confirmatoria por ELISA recombinante; los resultados dudosos fueron enviados al Instituto Nacional de Salud para su confirmación mediante la inmunofluorescencia indirecta. Para el análisis de la información se utilizó el paquete estadístico Prism versión 8.2.1 para MacOS. Resultados: En la tamización de la prueba para Chagas del presente estudio, resultó positivo 2,7 % de los evaluados; al contrastar los sujetos con resultado positivo con los negativos, se observaron diferencias en la edad, la escolaridad y el material de las paredes de sus viviendas. Conclusiones: Los resultados proporcionan información útil de condiciones de vivienda y seroprevalencia de la enfermedad, que ayudan a evaluar la efectividad del acuerdo que facilita y fortalece el acceso al diagnóstico y tratamiento de la enfermedad.

ABSTRACT Introduction: Chagas disease is a parasitic zoonosis caused byTrypanosoma cruzi, a vector-born protozoan that is transmitted to humans. Field studies predict that one-third of around 18 millionT cruzi-infected humans will die of Chagas disease in Latin America. Objective: To determine the seroprevalence of the infection with Trypanosoma cruzi and to identify some risk factors associated with this condition in Cumaral, Meta, Colombia. Material and Methods: A descriptive, cross-sectional study was conducted. Blood samples were collected from subjects that had been living in urban and rural areas of Cumaral municipality for more than six months. An ELISA-IgG method with total extracts (first test) was used for the detection of Trypanosoma cruzy IgG. A recombinant-based ELISA was performed as a confirmatory test. Doubtful results were sent to the National Institute for Health for confirmation by indirect immunofluorescence assay. Prism 8 for MacOS (version 8.2.1) was used for statistical analysis. Results: In the screening for Chagas disease, 2,7 % of all the cases tested were positive. When comparingsubjects with positiveandnegative results, differences between age, scholarship and materials used in the construction of house walls were evidenced. Conclusions: The results provide useful information about housing conditions and seroprevalence of the disease that help to evaluate the effectiveness of the arrangement that provides and strengthens the access to the diagnosis and treatment of the disease.

Braz. dent. j ; 32(1): 16-25, Jan.-Feb. 2021. tab, graf
Article in English | LILACS-Express | LILACS, BBO - Dentistry | ID: biblio-1180723


Abstract The aim of this study was to assess and compare RANK, RANKL, and OPG immunoexpression in dentigerous cyst, odontogenic keratocyst, and ameloblastoma. The protocol was registered in PROSPERO (CRD42018105543). Seven databases (Embase, Lilacs, LIVIVO, PubMed, Scopus, SciELO, and Web of Science) were the primary search sources and two databases (Open Grey and Open Thesis) partially captured the "grey literature". Only cross sectional studies were included. The JBI Checklist assessed the risk of bias. A meta-analysis with random effects model estimated the values from the OPG and RANKL ratio reported by the individual studies and respective 95% confidence intervals. The heterogeneity among studies was assessed with I2 statistics. Only nine studies met the inclusion criteria and were considered in the analyses. The studies were published from 2008 to 2018. Two studies presented low risk of bias, while seven studies presented moderate risk. The meta-analysis showed the highest OPG>RANKL ratio for dentigerous cyst (ES=43.3%; 95% CI=14.3-74.8) and odontogenic keratocyst (ES=36.8%; 95% CI=18.8-56.7). In contrast, the highest OPG<RANKL ratio was found for ameloblastoma (ES=73.4%; 95% CI=55.4-88.4) and it was higher in the stromal region compared to the odontogenic epithelial region. The results may explain the aggressive potential of ameloblastoma from the higher OPG<RANKL ratio in this tumor, while it was lower for dentigerous cyst and odontogenic keratocyst.

Resumo O objetivo deste estudo foi avaliar e comparar a imunoexpressão de RANK, RANKL e OPG em cisto dentígero, ceratocisto odontogênico e ameloblastoma. O protocolo foi registrado no PROSPERO (CRD [Oculto]). Sete bancos de dados (Embase, Lilacs, LIVIVO, PubMed, Scopus, SciELO e Web of Science) foram as principais fontes de pesquisa e duas bases de dados (Open Grey e Open Thesis) capturaram parcialmente a "literatura cinza". Apenas estudos transversais foram incluídos. A ferramenta JBI avaliou o risco de viés. Uma metanálise com modelo de efeitos aleatórios estimou os valores da razão OPG e RANKL relatados pelos estudos individuais e seus respectivos intervalos de confiança de 95%. A heterogeneidade entre os estudos foi avaliada por meio do teste I2. Apenas nove estudos preencheram os critérios de inclusão e foram considerados nas análises. Os estudos foram publicados entre 2008 e 2018. Dois estudos apresentaram baixo risco de viés, enquanto sete estudos apresentaram risco moderado. A meta-análise mostrou a maior razão OPG> RANKL para cisto dentígero (ES=43,3%; IC95%=14,3-74,8) e ceratocisto odontogênico (ES=36,8%; IC95%=18,8-56,7). Por outro lado, a maior razão OPG <RANKL foi encontrada para ameloblastoma (ES=73,4%; IC95%=55,4-88,4) e foi maior na região estromal em comparação com a região epitelial odontogênica. Os resultados podem explicar o potencial agressivo do ameloblastoma devido a uma maior proporção OPG <RANKL nesse tumor, enquanto tal proporção foi menor no cisto dentígero e no ceratocisto odontogênico.

Medisur ; 19(1): 157-165, tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1180840


RESUMEN Fundamento: La hiperplasia prostática benigna es el tumor benigno más frecuente en hombres. El aceite extraído de la semilla de calabaza (Curcubita pepo) se emplea en el tratamiento de los síntomas asociados a dicha enfermedad. Sin embargo, los estudios en humanos son escasos, y la evidencia disponible, insuficiente. Objetivos: determinar la efectividad de la semilla de calabaza en el tratamiento de la hiperplasia prostática benigna realizar revisión sistemática y meta-análisis. Métodos: se realizó revisión sistemática y meta-análisis, de la literatura existente en las bases de datos Pubmed/Medline, Ebsco, Scopus y Scielo. Fueron seleccionados los ensayos clínicos aleatorizados, en cualquier idioma, que evaluaron la efectividad de fitomedicamentos compuestos por la Cucurbita pepo, comparándolo con un placebo; en pacientes con diagnóstico de hiperplasia prostática comprobado; y con un tiempo de evaluación mayor a seis meses. Resultados: la población total estudiada en los estudios seleccionados fue de 1403 hombres, todos mayores de 50 años. Todos los estudios evaluaron la efectividad del aceite de la semilla de calabaza. La diferencia de medias global fue significativa (DM: -0,76 IC 95%: -1,40; -0,13; I 2 =26,75 %). No se encontró una mejoría significativa en cuanto a la calidad de vida, parámetros uroflujométricos, volumen residual, valores del antígeno prostático de superficie y el tamaño de la próstata. Conclusión: Los resultados mostraron, con un nivel de evidencia moderado, que los fitomedicamentos basados en la semilla de calabaza o su extracto no se asoció con una mejoría clínica ni funcional de la hiperplasia prostática benigna.

ABSTRACT Background: Benign prostatic hyperplasia is the most common benign tumor in men. The oil extracted from the pumpkin seed (Curcubita pepo) is used to treat the symptoms associated with this disease. However, human studies are few, and insufficient available evidence. Objectives: to determine the effectiveness of pumpkin seed in the treatment of benign prostatic hyperplasia. To carry out a systematic review and meta-analysis on it. Methods: a systematic review and meta-analysis of the existing literature in the Pubmed / Medline, Ebsco, Scopus and Scielo databases were carried out. Randomized clinical trials were selected, in any language that evaluated the effectiveness of phytomedicines composed of Cucurbita pepo, comparing it with a placebo; in patients with a proven diagnosis of prostatic hyperplasia; and with an evaluation time greater than six months. Results: the total population in the selected studies was 1403 men, all over 50 years of age. All studies evaluated the effectiveness of pumpkin seed oil. The global mean difference was significant (MD: -0.76 95% CI: -1.40, -0.13, I2 = 26.75%). No significant improvement was found in terms of quality of life, uroflowmetric parameters, residual volume, prostate surface antigen values, and prostate size. Conclusion: The results showed, with a moderate level of evidence, that phytomedicines based on pumpkin seed or its extract were not associated with a clinical or functional improvement of benign prostatic hyperplasia.

ABCS health sci ; 46: e021301, 09 fev. 2021. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1147213


The purpose of the study was to investigate the prevalence of overweight and obesity among young Brazilian aged 5 to 19 years through systematic review and metaanalysis of data available in the literature. An electronic search was conducted for articles in the MedLine/PubMed, Scopus, Web of Science, Scielo e Lilacs published from 2000 to 2018 were selected using predefined inclusion/exclusion criteria. Measures of heterogeneity and variability were calculated, and random effect model were used to estimate pooled prevalence rates. Forest-plots graphs were generated by sex and age. Meta-regression models were fitted to identify possible sources of heterogeneity in the prevalence estimates. Of the 1,002 articles initially identified 26 met the inclusion criteria. In children (5-9 years) the pooled prevalence rates of verweight were 16.2% (95%CI 13.2-19.3; Q=411.7, p<0.001; I2=97.8%) in girls and 14.4% (95%CI 11.5-17.3; Q=403.9, p<0.001; I2=97.7%) in boys. Obesity, 9.2% (95%CI 5.9-12.3; Q=1111.7, p<0.001; I2=99.2%) and 9.0% (95%CI 5.5-12.5; Q=1413.1, p<0.001; I2=99.4%), respectively. Regarding adolescents (10-19 years), in girls 16.4% (95%CI 15.1-17.7; Q=245.6, p<0.001; I2=92.3%) for overweight and 6.2% (95%CI 4.9-7.5; Q=842.9, p<0.001; I2=97.7%) for obesity. In boys, 15.3% (95%CI 13.4-17.1; Q=493.7, p<0.001; I2=96.2%) and 6.7% (95%CI 5.0-8.5; Q=1200.4, p<0.001; I2=98.4%), respectively. Geographic region, year of data collection and diagnostic criteria had a significant impact on the heterogeneity of the prevalence of overweight and obesity. The review identified increasing trends in the prevalence rates, highlighting the urgent need to promote healthy lifestyles from the young ages, in order to effectively address the presence of excess body weight.

O objetivo do estudo foi investigar a prevalência de sobrepeso e obesidade em jovens brasileiros entre 5 e 19 anos através de revisão sistemática e metanálise de dados disponibilizadas na literatura. Foi realizada busca eletrônica nas bases de dados MedLine/PubMed, Scopus, Web of Science, Scielo e Lilacs publicados de 2000 a 2018, utilizando critérios de inclusão/ gerados por sexo e idade. Modelos de metarregressão foram ajustados para identificar exclusão pré-definidos. Medidas de heterogeneidade e variabilidade foram calculadas e modelos de efeito aleatório foram usados para estimar taxas de prevalência global. Gráficos forest-plots foram possíveis fontes de heterogeneidade. Dos 1002 estudos identificados inicialmente 26 atenderam os critérios de inclusão. Nas crianças (5-9 anos) as taxas de prevalência global de sobrepeso foram equivalentes a 16,2% (IC95% 13,2-19,3; Q=411,7, p<0,001; I2=97,8%) nas moças e 14,4% (IC95% 11,5-17,3; Q=403,9, p<0,001; I2=97,7%) nos rapazes. No caso da obesidade, 9,2% (IC95% 5,9-12,3; Q=1111,7, p < 0,001; I2=99,2%) e 9,0% (IC95% 5,5-12,5; Q=1413,1, p<0,001; I2=99,4%), respectivamente. Referente aos adolescentes (10-19 anos), nas moças 16,4% (IC95% 15,1-17,7; Q=245,6, p<0,001; I2=92,3%) para sobrepeso e 6,2% (IC95% 4,9-7,5; Q=842,9, p<0,001; I2=97,7%) para obesidade. Nos rapazes, 15,3% (IC95% 13,4-17,1; Q=493,7, p<0,001; I2=96,2%) e 6,7% (IC95% 5,0-8,5; Q=1200,4, p<0,001; I2=98,4%), respectivamente. Região geográfica, ano de coleta dos dados e critérios diagnósticos impactaram significativamente na heterogeneidade das prevalências. Foram identificadas tendências crescentes nas taxas de prevalência, ressaltando a necessidade urgente de promover estilos de vida saudáveis desde as idades jovens, a fim de abordar com eficácia a presença do excesso de peso corporal.

Humans , Male , Female , Child , Adolescent , Brazil , Nutritional Status , Overweight/epidemiology , Child Nutrition , Adolescent Nutrition , Obesity/epidemiology , Feeding Behavior , Life Style
Femina ; 49(2): 121-128, 20210228.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1224070


Objetivo: Traçar um perfil epidemiológico do medo do parto em gestantes em Santos, correlacionando as variáveis idade, escolaridade, estado civil, paridade, perdas gestacionais prévias e intercorrências gestacionais. Métodos: Estudo transversal, realizado em programa pré-natal de risco habitual em cinco Unidades Básicas de Saúde de Santos, com coleta de dados entre novembro de 2019 e fevereiro de 2020. Critérios de inclusão: idade gestacional maior ou igual a 28 semanas, maiores de 18 anos, preferência por parto vaginal, alfabetizadas em português. A amostra foi de 67 participantes, que responderam ao Questionário sobre o Medo Percebido do Parto (QMPP), versão portuguesa do Wijma Delivery Expectancy/Experience Questionnaire versão A, e a uma ficha com dados sociodemográficos. Resultados: A pontuação média no QMPP foi 79,3. Observou-se uma prevalência de 31,4% de gestantes com escore maior ou igual a 85, que compreende medo do parto intenso e tocofobia. A pontuação no QMPP apresentou correlação fraca positiva com idade. Conclusão: A prevalência de medo do parto no presente estudo se assemelhou àquela observada em metanálises internacionais. Este estudo pode embasar tanto futuras pesquisas sobre medo do parto no Brasil como projetos públicos para diagnóstico e tratamento dessa condição nas gestantes brasileiras.

Objective: To obtain an epidemiologic profile of the pregnancies affected by fear of childbirth in Santos, correlating variables such as: age, schooling, marriage status, parity, previous gestational losses, and pregnancy complications. Methods: Transversal study located in five polyclinics in Santos, in habitual risk prenatal program. The data was collected between November 2019 and February 2020. Inclusion criteria: gestational age equal or greater than 28 weeks, women older than 18 years, wish for vaginal birth, alphabetized in Portuguese. The final sample was 67 participants, which completed the Questionário sobre o Medo Percebido do Parto, Portuguese version of Wijma Delivery Expectancy/Experience Questionnaire version A, and a sheet with sociodemographic data. Results: The average score on QMPP was 79,3. It was found a prevalence of 31,4% of pregnant women with scores equal or greater than 85, which comprehends intense fear of childbirth and tocophobia. The QMPP score presented a weak positive correlation with age. Conclusion: The prevalence of fear of childbirth obtained in this study resembles the results of international metanalysis. This study can base future research about fear of childbirth in Brazil, as well as public projects to diagnose and treat this condition in Brazilian women.

São Paulo; s.n; 20210219. 100 p.
Thesis in Portuguese | LILACS, BBO - Dentistry | ID: biblio-1147709


O objetivo desta revisão sistemática foi avaliar se o fluxo digital rende melhores resultados do que o fluxo convencional na construção de coroas unitárias sobre implantes quando são avaliadas as variáveis tempo de moldagem, a preferência do paciente, a eficiência do tempo e tempo de ajuste da peça. As bases de dados MEDLINE, Embase e Cochrane foram eletronicamente pesquisadas até dia 19 de junho de 2019, juntamente com a busca manual. Apenas estudos clínicos avaliando o fluxo de trabalho digital versus o convencional em coroas unitárias sobre implantes foram incluídos. O tempo de moldagem foi avaliado por meio de meta-análise, enquanto os demais fatores foram reportados pela análise descritiva. Entre as 1334 publicações inicialmente identificadas,10 estudos foram incluídos. O modelo de efeito misto revelou uma redução estatisticamente significante no tempo de moldagem digital quando comparado ao tempo de moldagem convencional na meta-análise principal. (DP: 8.22 [95%IC:5.48,10.96]). As análises comparando o tempo de moldagem digital imediata versus o convencional (DP:3.84 [95%IC:3.30,4.39]) e comparando o tempo de moldagem digital regular versus convencional (DP:10.67 [95%IC:5.70,15.65]) também mostraram uma redução estatisticamente significante no tempo de moldagem quando empregada a moldagem digital. A média do tempo de moldagem no fluxo digital variou entre 6min e 39 segundos e 20min, enquanto no fluxo convencional variou entre 11.7min e 28.47min. Os pacientes demonstraram maior preferência pela moldagem digital. O tempo médio de ajuste da peça utilizando o fluxo de trabalho digital variou entre 1.96min e 14min, enquanto no fluxo convencional variou entre 3.02min e 12min. A eficiência do tempo no fluxo digital de trabalho variou entre 36.8min e 185.4min, enquanto no fluxo convencional variou entre 55.6 min e 332min. Considerando o tempo de moldagem, a preferência do paciente e a eficiência do tempo, o fluxo de trabalho digital demonstrou melhor eficiência clínica. Considerando o tempo de ajuste da peça protética, dois trabalhos demonstraram que o ajuste protético foi mais rápido no fluxo digital e três trabalhos demonstraram que o ajuste protético foi mais rápido no fluxo convencional.

Efficiency , Patient Preference