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1.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 40: e2020415, 2022. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1250810

RESUMEN

ABSTRACT Objective: To perform a systematic literature review to analyze existing data on the neurological effects of coronavirus on newborns. Data sources: We followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and searched the PubMed and Embase platforms for the keywords [brain damage OR pregnancy OR developmental outcomes] and [coronavirus OR SARS-CoV-2 OR SARS-CoV OR MERS-CoV] between January 1, 2000 and June 1, 2020. Data synthesis: Twenty-three reports described the course of pregnant women exposed to SARS-CoV-2, SARS-CoV, or MERS-CoV during the gestational period, eight to SARS-CoV-2, eight to SARS-CoV, and seven to MERS-CoV. No data were found on abnormalities in brain development or on a direct link between the virus and neurological abnormalities in the human embryo, fetus, or children. Spontaneous miscarriage, stillbirth, and termination of pregnancy were some complications connected with SARS/MERS-CoV infection. SARS-CoV-2 is not currently associated with complications in the gestational period. Conclusions: The literature has no data associating exposure to coronavirus during pregnancy with brain malformations and neurodevelopmental disorders. However, despite the lack of reports, monitoring the development of children exposed to SARS-CoV-2 is essential given the risk of complications in pregnant women and the potential neuroinvasive and neurotropic properties found in previous strains.


RESUMO Objetivo: Realizar uma revisão sistemática da literatura para analisar os dados existentes sobre os efeitos neurológicos do coronavírus em recém-nascidos. Fontes de dados: Esta revisão seguiu as diretrizes dos Principais Itens para Relatar Revisões Sistemáticas e Meta-Análises (Preferred Reported Items for Systematic Review - PRISMA) e dos Protocolos dos Principais Itens para Relatar Revisões Sistemáticas e Meta-Análises (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols - PRISMA-P), pesquisando as plataformas PubMed e Embase pelas palavras-chave [brain damage (dano cerebral) OU pregnancy (gravidez) OU developmental outcomes (alterações de desenvolvimento)] e [coronavirus (coronavírus) OU SARS-CoV-2 OU SARS-CoV OU MERS-CoV] entre 1º de janeiro de 2000 e 1º de junho de 2020. Síntese dos dados: Vinte e três relatos descreveram a evolução de mulheres grávidas expostas ao SARS-CoV-2, SARS-CoV ou MERS-CoV durante o período gestacional, oito ao SARS-CoV-2, oito ao SARS-CoV e sete ao MERS-CoV. Não foram encontrados dados sobre anormalidades no desenvolvimento cerebral ou sobre uma ligação direta entre o vírus e alterações neurológicas no embrião, feto ou crianças. Abortamento espontâneo, morte fetal e interrupção da gravidez foram algumas das complicações relacionadas à infecção por SARS/MERS-CoV. Até o momento, o SARS-CoV-2 não está associado a complicações no período gestacional. Conclusões: Não há dados na literatura que associem a exposição ao coronavírus durante a gravidez com malformações cerebrais e distúrbios do neurodesenvolvimento. No entanto, apesar da falta de relatos, o monitoramento do desenvolvimento de crianças expostas ao SARS-CoV-2 é essencial devido ao risco de complicações em gestantes e às potenciais propriedades neuroinvasivas e neurotrópicas encontradas em cepas anteriores.

2.
Arq. bras. oftalmol ; 84(3): 249-257, May-June 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1248973

RESUMEN

ABSTRACT Purpose: Paraoxonase-1 activity is associated with age-related macular degeneration. Two polymorphisms (L55M and Q192R) were shown to increase paraoxonase-1 activity and have been implicated in the development of age-related macular degeneration. The results of studies that have examined these polymorphisms are conflicting, showing no effect, as well as increased or decreased risk. Therefore, this meta-analysis was conducted to determine the effect of these polymorphisms on age-related macular degeneration. Methods: PubMed, EBSCO, LILACS, and Scopus databases, as well as and the retrieved bibliographies of publications were searched for case-control studies that examined for paraoxonase-1 polymorphisms and age-related macular degeneration. Data were analyzed using the Comprehensive Meta-Analysis Version 2.2 and the NCSS Statistical Version 2020 software. Genotype distributions were extracted and, depending on the level of heterogeneity, fixed effects or random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) for the heterozygous, homozygous, dominant, recessive, and allelic genetic models. Results: Overall, for the L55M polymorphism, none of the genetic models demonstrated a significant association. However, for non-Asian populations, a significant association was determined for the heterozygous and dominant genetic models (ORrange=1.24-1.27, p<0.05). For the Asian population, the heterozygous, dominant, and allelic genetic models demonstrated a benefit/protective factor (ORrange=0.29-0.35, p<0.05). For the Q192R polymorphism, none of the genetic models demonstrated a significant association. However, when the cohort was grouped by ethnicity, a significant association was determined in the Asian population for the recessive and allelic genetic models (ORrange=1.63-2.08, p<0.05). However, for the non-Asian population, there was no association observed. Also, there was no identifiable risk when the cohort was stratified into exudative and non-exudative cases. Conclusions: The paraoxonase-1L55M polymorphism increases the risk of developing age-related macular degeneration in non-Asian populations, whereas in Asian populations, the polymorphism exerts a protective effect. However, for the paraoxonase-1 Q192R polymorphism, only the Asian population demonstrated a risk of developing age-related macular degeneration.


RESUMO Objetivo: A atividade da paraoxonase1 está associada à degeneração macular relacionada à idade. Dois polimorfismos (L55M e Q192R) mostraram aumentar a atividade da paraoxonase1 e foram implicados no desenvolvimento da degeneração macular relacionada à idade. Os estudos que examinaram esses polimorfismos apresentaram resultados conflitantes: nenhum efeito, risco aumentado ou diminuído. Assim, esta meta-análise foi realizada para determinar o efeito desses polimorfismos na degeneração macular relacionada à idade. Métodos: Foi feita uma busca nos bancos de dados PubMed, EBSCO, LILACS e SCOPUS, bem como nas bibliografias compiladas das publicações, buscando-se estudos caso-controle que tivessem analisado os polimorfismos da paraoxonase1 e a degeneração macular relacionada à idade. Os dados foram analisados com software Comprehensive Meta-Analysis, versão 2.2, e NCSS Statistical, versão 2020. As distribuições de genótipos foram extraídas e, dependendo do nível de heterogeneidade, modelos de efeitos fixos ou aleatórios foram utilizados para calcular razões de probabilidade (RPs) combinadas, com intervalos de confiança de 95% (IC 95%) para os modelos genéticos heterozigoto, homozigoto, dominante, recessivo e alélico. Resultados: Em geral, nenhum dos modelos genéticos demonstrou associação significativa para o polimorfismo L55M. Entretanto, em populações não asiáticas, foi determinada uma associação significativa para os modelos genéticos heterozigoto e dominante (RPfaixa=1,24-1,27, p<0,05). Para a população asiática, os modelos heterozigoto, dominante e alélico mostraram um fator benéfico ou protetor (RPfaixa=0,29-0,35, p<0,05). Para o polimorfismo Q192R, nenhum dos modelos genéticos demonstrou qualquer associação significativa. Porém, quando a coorte foi agrupada por etnia, determinou-se uma associação significativa na população asiática para os modelos genéticos recessivo e alélico (RPfaixa=1,63-2,08, p<0,05). Contudo, nenhuma associação foi observada para a população não asiática. Não houve risco identificável quando a coorte foi estratificada em exsudativa e não exsudativa. Conclusões: Determinamos que o polimorfismo L55M da paraoxonase1 de fato aumenta o risco de desenvolvimento de degeneração macular relacionada à idade em populações não asiáticas, enquanto que em populações asiáticas, esse polimorfismo tem um efeito protetor. Porém, para o polimorfismo Q192R da paraoxonase1, apenas a população asiática demonstrou risco de desenvolver degeneração macular relacionada à idade.

3.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(3): 324-336, May-June 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1249184

RESUMEN

Objective: Acceptance and commitment therapy (ACT) is a third-wave psychological intervention that has attracted considerable clinical and research attention. A previous meta-analysis of ACT trials in psychosis reported a large effect size of ACT against overall psychotic symptomatology. However, there were critical methodological issues in the review that justify replication. Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) testing ACT vs. any comparator condition in a sample of adults with psychosis. The outcome of interest was overall psychotic symptomatology. Results: The search identified seven published and eight unpublished trials (of which we were able to obtain data from one). Data on symptomatology were extracted from six trials that involved 274 participants. The summary effect size (Hedge's G) for overall symptomatology was small and not significant (-0.21, 95%CI -0.60-0.18). Trials were generally rated as having a high risk of bias. Safety reporting was inadequate across included trials. Conclusions: Our observed effect size contrasted with that reported in a previous meta-analysis; differences were likely explained by errors in data extraction. The findings of this review suggest that there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology. Systematic review registration: CRD42018097200

4.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(3): 314-323, May-June 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1249197

RESUMEN

Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

5.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(3): 306-313, May-June 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1249200

RESUMEN

Objective: To evaluate the efficacy and safety of Morinda officinalis oligosaccharide (MOO) capsules for depressive disorder. Methods: Eight electronic databases were searched for relevant studies from inception to April 19, 2020. Randomized controlled trials comparing MOO capsules with antidepressants were included. Data analysis was conducted using Review Manager 5.3 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of the studies was evaluated by two researchers using the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) software. Results: Seven studies involving 1,384 participants were included in this study. The effect of MOO capsules for moderate depressive disorder was not different from that of antidepressants (risk ratio [RR] = 0.99, 95%CI 0.92-1.06). Regarding adverse events, no significant difference was found between MOO capsules and antidepressants (RR = 0.84, 95%CI 0.65-1.07). In addition, the quality of evidence related to these adverse events was rated as low. Conclusion: This systematic review suggests that the efficacy of MOO capsules in the treatment of mild to moderate depression is not inferior to that of conventional antidepressants, which may provide a new direction for clinical alternative selection of antidepressants. However, more high-quality research and detailed assessments are needed.

6.
Rev. invest. clín ; 73(2): 100-110, Mar.-Apr. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1251870

RESUMEN

ABSTRACT Background: Recently, studies had shown that incretin-based therapies could reduce the levels of pro-inflammatory markers. The data on the effects of incretin-based therapies on serum high-sensitivity C-reactive protein (hs-CRP) in type 2 diabetes (T2DM) were inconsistent. Objective: The objective of the study was to assess the effects of incretin-based therapies on hs-CRP in patients with T2DM by meta-analysis. Methods: We searched PubMed, EMBASE, the Cochrane Collaboration Library, and Web of Science to identify the eligible randomized clinical trials until August 2019. The pooled standard mean differences (SMD) were calculated by random-effects model using STATA 11.0. Results: Twenty-five studies with 28 randomized controlled trials were finally included into the meta-analysis. Meta-analysis revealed a significant reduction in hs-CRP following treatment with incretin-based regimens compared to controls (SMD = −0.452, p < 0.001). Subgroup analysis of different class of incretin-based drugs showed that therapy with both dipeptidyl peptidase 4 inhibitors (DPP-4Is, SMD = −0.338, p = 0.026) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs, SMD = −0.544, p = 0.003) caused significant reductions in hs-CRP. Besides, there was a significant reduction in hs-CRP with an intervention duration more than 24 weeks (SMD = −0.465, p = 0.001), while no significant difference with <24 weeks. Meta-regression analyses showed that better glycemic control and more body mass index (BMI) decline were associated with hs-CRP reduction after incretin-based therapies. Conclusions: This meta-analysis suggests that incretin-based therapies, both GLP-1 RAs and DPP-4Is, can cause a significant reduction in hs-CRP in patients with T2DM, which is related to long intervention duration, better glycemic control, and more BMI decline.

7.
Arch. endocrinol. metab. (Online) ; 65(2): 198-211, Mar.-Apr. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1248816

RESUMEN

ABSTRACT Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Our objective was to evaluate the efficacy of exercise interventions in DPN patients from randomized controlled trials. The primary outcomes were the risk of falls, fear of falling, balance and quality of life. Two reviewers independently selected studies from Embase, Medline, LILACS, CENTRAL, and PEDro. They assessed the risk of bias and extracted data from the trials. The relative risk (RR) and the differences between means (MD) were calculated with a 95% confidence interval (CI) and used as the effect size. We used a random-effects model to pool results across studies, and the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the certainty of evidence. Eight trials were included. No clear effect was observed in the risk of falls (RR: 0.93, 95% CI: 0.41 to 2.09, 79 participants, 1 trial, low-certainty evidence). Regarding fear of falling, using the Falls Efficacy Scale, a small difference in favor of the intervention was observed (MD: −2.42, 95%, CI: −4.7 to −0.15, 3 trials, 185 participants, low-certainty evidence). The meta-analysis of balance using the unipedal stance test showed a small difference in favor of the intervention. One study evaluated quality of life, and in the mental score there was a MD in favor of the intervention. In DPN patients, a combination of gait, balance, and functional training improved balance, the fear of falling, quality of life in the mental score, but not the risk of falls.

8.
Säo Paulo med. j ; 139(2): 123-126, Mar.-Apr. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1181009

RESUMEN

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

9.
Hematol., Transfus. Cell Ther. (Impr.) ; 43(1): 58-64, Jan.-Mar. 2021. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1154302

RESUMEN

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.

10.
Int. braz. j. urol ; 47(2): 237-250, Mar.-Apr. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1154443

RESUMEN

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.

11.
Int. braz. j. urol ; 47(2): 359-373, Mar.-Apr. 2021. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1154467

RESUMEN

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.

12.
J. bras. nefrol ; 43(1): 34-40, Jan.-Mar. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1154647

RESUMEN

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.

13.
Rev. Fac. Med. (Bogotá) ; 69(1): e203, Jan.-Mar. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1250753

RESUMEN

Abstract Introduction: Since the first COVID-19 cases were reported, the disease's clinical and epidemiological characteristics have continuously been studied, although they have not been yet defined. Objective: To estimate the epidemiological profile of pediatric patients with COVID-19, as well as their clinical, laboratory and radiological characteristics. Materials and methods: A living systemic review was conducted in the PubMed, Scopus and SciELO databases. Observational studies describing clinical, radiological, and laboratory characteristics of pediatric patients with COVID-19 and published between January 1, 2020, and July 20, 2020, were considered for the search; there were no language restrictions. Government, epidemiological, and pre-print papers were also considered. Meta-analyses of single proportion (frequentist approach) and two proportions (Bayesian method) were carried out. The study registration and protocol are available at https://osf.io/y43wm and https://osf.io/r8ktv, respectively. Results: 13 studies, with a total of 9 152 patients, were retrieved. The Bayesian meta-analysis reported that males are more affected by the disease: OR 1.24 (HDI95%: 1.09-1.4). The proportion results calculated by means of the frequentist meta-analysis are: 52% cough (95%CI: 50-55), 0% death (95%CI: 0-0.1), 16% high aspartate transaminase levels (95%CI: 13-19), and 60% lung changes observed in chest X-ray (95%CI: 57-64). Conclusions: Based on the current data, it is not possible to describe accurately the clinical and epidemiological characteristics of COVID-19 in the pediatric population. However, evidence suggests that males are more affected by the disease and that lung alterations in imaging studies are more frequent than clinical signs such as cough and fever. Laboratory test results are not conclusive and show that different organs and systems of the human body may be affected by SARS-CoV-2. The results reported here must be compared to prospective controlled studies conducted in larger samples and a more rigorous design.


Resumen Introducción. Desde que se reportaron los primeros casos de COVID-19, sus características clínicas y epidemiológicas han sido constantemente estudiadas, pero aún no han sido definidas. Objetivo. Estimar el perfil epidemiológico, así como las características clínicas, radiológicas y de laboratorio en pacientes pediátricos con COVID-19. Materiales y métodos. Se realizó una revisión sistemática viva en las bases de datos PubMed, Scopus y SciELO; para la búsqueda se consideraron estudios observacionales publicados entre enero 1 de 2020 y julio 20 de 2020, sin restricción de idioma, que describieran características clínicas, radiológicas y de laboratorio en población pediátrica con COVID-19; también se incluyeron reportes gubernamentales y epidemiológicos, y artículos publicados en formato pre-print. Se realizaron metaanálisis de proporción única (método frecuentista) y de dos proporciones (método bayesiano). El registro y el protocolo del estudio están disponibles en https://osf.io/y43wm y https://osf.io/r8ktv, respectivamente. Resultados. Se encontraron 13 estudios, con un total de 9 152 pacientes. El metaanálisis bayesiano reportó una mayor afectación del sexo masculino: OR: 1.2 (HDI95%: 1.09-1.4). Los resultados de la proporción calculada por el metaanálisis frecuentista fueron: tos 52% (IC95%: 50-55), muerte 0% (IC95%: 0-0.1), niveles elevados de aspartato aminotransferasa 16% (IC95%: 13-19) y alteraciones pulmonares evidenciadas mediante estudios de imagen 60% (IC95%: 57-64). Conclusiones. Con los datos actuales no es posible describir con exactitud las características clínicas y epidemiológicas de la COVID-19 en población pediátrica. Sin embargo, existen indicios de una mayor afectación al sexo masculino, y de que las anormalidades pulmonares detectadas en radiografías y tomografías del tórax son más frecuentes que signos clínicos como la tos y la fiebre. Los resultados de laboratorio no son concluyentes y reflejan que diferentes órganos y sistemas son afectados por el SARS-CoV-2. Los hallazgos del presente estudio deben ser contrastados con estudios prospectivos controlados, con un mayor número de pacientes y un diseño más riguroso.

14.
Rev. Fac. Med. (Bogotá) ; 69(1): e204, Jan.-Mar. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1250754

RESUMEN

Abstract Introduction: The use of early screening questionnaires for chronic obstructive pulmonary disease (COPD) in primary health care could improve underdiagnosis. Several instruments are currently available, but there is scant information on their diagnostic performance. Objective: To determine the validity of different questionnaires for COPD diagnosis. Materials and methods: A systematic review and a meta-analysis of diagnostic test accuracy were carried out. A search of the literature published between July 1, 1997, and June 30, 2019 was performed in PubMed, EMBASE, and LILACS databases using MeSH and DeCS terms and the PICO strategy. Based on the inclusion and exclusion criteria, two reviewers selected the articles for complete analysis. Article quality was assessed using the QUADAS instrument. Results: 19 articles were included for analysis. Overall results were: sensitivity: 68.1% (95%CI: 66.7% -69.4%); specificity: 64.9% (95%CI: 64.3-65.5); positive likelihood ratio: 2.024 (95%CI: 1.7152.388); negative likelihood ratio: 0.407 (95%CI: 0.289-0.573); and receiver operating characteristic area under the curve (ROC AUC): 0.75. The COPD-PS questionnaire reported the highest performance with sensitivity of 0.673 (95%CI: 0.653-0.692), specificity of 0.663 (95%CI: 0.65.5- 0.651), and ROC AUC of 0.750. It was followed by LFQ with sensitivity of 0.840 (95%CI: 0.806-0.871), specificity of 0.312 (95%CI: 0.289-0.336), and ROC AUC of 0.730. Finally, CDQ had sensitivity of 0.798 (95%CI: 0.764-0.829), specificity of 0.517 (95%CI: 0.495-0.538), and ROC AUC of 0.727. Conclusion: Clinical prediction instruments for COPD diagnosis have an acceptable performance. The COPD-PS, LFQ and CDQ questionnaires show a similar performance.


Resumen Introducción. El uso de cuestionarios de predicción clínica para el diagnóstico de la enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria en salud podría mejorar el subdiagnóstico de esta enfermedad. Hoy en día existen varios instrumentos de este tipo; sin embargo, hay poca información sobre su rendimiento diagnóstico. Objetivo. Determinar la validez del uso de los diferentes cuestionarios de predicción clínica para el diagnóstico de la EPOC. Materiales y métodos. Se realizó una revisión sistemática con metaanálisis de prueba diagnóstica en las bases de datos PubMed, EMBASE y LILACS a partir de la estrategia PICO y utilizando términos MeSH y DeCS. Se incluyeron los estudios publicados entre julio 1 de 1997 y junio 30 de 2019. Dos revisores seleccionaron los artículos para análisis completo con base en los criterios de inclusión y exclusión. La calidad de los artículos se evaluó con el instrumento QUADAS. Resultados. Se incluyeron 19 artículos para el análisis. En cuanto a la evaluación global de los cuestionarios se obtuvieron los siguientes datos: sensibilidad: 68.1% (IC95%: 66.7-69.4); especificidad: 64.9% (IC95%: 64.3-65.5); razón de verosimilitud positiva: 2.024 (IC95%: 1.715-2.388); razón de verosimilitud negativa: 0.407 (IC95%: 0.289-0.573) y el área bajo la curva de características del receptor (ACOR): 0.75. El cuestionario COPD-PS reportó el mayor rendimiento -sensibilidad: 0.673 (IC95%: 0.653-0.692), especificidad: 0.663 (IC95%: 0.655-0.671) y ACOR: 0.750-; seguido de LFQ -sensibilidad: 0.840 (IC95%: 0.806-0.871), especificidad: 0.312 (IC95%: 0.289-0.336) y ACOR: 0,730-, y CDQ -sensibilidad: 0.798 (IC95%: 0.764-0.829), especificidad: 0.517 (IC95%: 0.495-0.538) y ACOR: 0.727-. Conclusión. Los instrumentos de predicción clínica para el diagnóstico de EPOC tienen un rendimiento aceptable, pues los valores de sensibilidad obtenidos a través de estos son superiores a los de la evaluación individual de la sintomatología respiratoria que se puede hacer a través de la historia clínica habitual.

15.
Trends psychiatry psychother. (Impr.) ; 43(1): 1-8, Jan.-Mar. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1156991

RESUMEN

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.

16.
Rev. colomb. anestesiol ; 49(1): e501, Jan.-Mar. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1149799

RESUMEN

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.

17.
Cad. Ibero Am. Direito Sanit. (Impr.) ; 10(1): 113-128, jan.-mar.2021.
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1151017

RESUMEN

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.

18.
Saude e pesqui. (Impr.) ; 14(1): 161-173, jan-mar 2021.
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1252953

RESUMEN

Investigamos publicações científicas sobre o padrão prescritivo de medicamentos para hipertensão arterial sistêmica e uso de diretrizes na atenção primária em saúde por revisão sistemática e meta-análise. Os artigos foram selecionados nas bases de dados PubMed, Web of Science e LILACS, de acordo com as declarações PRISMA, de 2004 a 2020. A revisão sistemática mostrou um padrão de prescrição superior para terapia combinada (52,9%). A metanálise confirmou a superioridade para a terapia combinada (OR 1,76; IC 1,29 - 2,41). Foi observada maior prevalência de monoterapia no estudo Sueco (98%) e terapia combinada no Nigeriano (98%). Maior frequência prescritiva de inibidores da enzima de conversão da angiotensina em Trinidade (64%); diuréticos (64%), betabloqueadores (63%) e bloqueadores dos canais de cálcio (53%) na Nigéria; e bloqueadores dos receptores da angiotensina (43%) em Portugal. Quanto ao uso das diretrizes, 53% dos estudos relataram a sua utilização na prescrição de anti-hipertensivos na atenção primária em saúde.


We investigated scientific publications on the prescription pattern of systemic hypertension drugs and use of guidelines in primary health care by systematic review and meta-analysis. Articles were selected in the PubMed, Web of Science and LILACS databases, according to the PRISMA statements, from 2004 to 2020. The systematic review showed a higher prescription pattern for combination therapy (52,9%). The meta-analysis confirmed the superiority of prescription for combination therapy (OR 1.76, CI 1.29 - 2.41). Was observed higher monotherapy prevalence in the Swedish study (98%) and combined therapy in Nigerian (98%). Higher frequency prescriptive of angiotensin-converting enzyme inhibitors in Trinidad (64%); diuretics (64%), beta blockers (63%), and calcium channel blockers (53%) in Nigeria; and angiotensin-receptor blockers (43%) in Portugal. Regarding the use of guidelines, 50% the studies reported their use for the prescription of antihypertensive in primary health care.

19.
Rev. bras. ativ. fís. saúde ; 26: 1-12, mar. 2021. fig
Artículo en Inglés | LILACS | ID: biblio-1248137

RESUMEN

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


Asunto(s)
Sueño , Anciano , Protocolos , Conducta Sedentaria , Actividad Motora
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