Appropriateness of newborn screening for classic galactosaemia: a systematic review.

Currently, there is no universal agreement on galactosaemia screening, fundamentally because of the risk-benefit uncertainties. We conducted two exhaustive systematic searches in the main electronic databases (PubMed, Embase, Cochrane, etc.) to recover relevant information about the disease and screening test/s in order to support decision making in Spain. All of the 45 studies identified that covered disease issues were retrospective case series or cross-sectional analysis (level-4 evidence). Studies consistently found that the majority of patients presented characteristic symptomatology before diagnosis. Long term disabilities were not significantly correlated with age of diagnosis, onset of dietary restriction or strict diet compliance. The five studies that provided accuracy data used different cut-off points and verification tests, and thus differed in their definitions of a positive case (level-3b evidence). The estimated sensitivity was 100 % and the specificity 99.9 %. The false-positive rate ranged from 0.0005 % to 0.25 %, and the PPV from 0 % to 64.3 %. The comparative clinical effectiveness in relation to not screening or implementation of other programs is unknown. In summary, existing evidence remains insufficient to establish the appropriateness of newborn screening for galactosaemia screening, although health benefits could be expected if early diagnosis and treatment is achieved. If screening is implemented in Spain, it would be important that a pilot programme be implemented to assess false positive rate and ensure that early diagnosis is not delayed.

[Penile prosthesis for the treatment of erectile dysfunction]. / La prótesis de pene en el tratamiento de la disfunción eréctil.

The erectile dysfunction is a pathology that, with different degrees of intensity, affects nearly the 20% of the spanish adult men. The treatment is usually performed in stages, reserving the penile prosthesis for when other previous treatments have failed. The aim of this work is to evaluate, according to the state of present knowledge, the effectiveness and security of the penile prosthesis for the treatment of the erectile dysfunction. With this purpose 52 articles were selected, observing a 5 years prosthesis survival of 78-91% and a 3-8% of surgical complications. Mechanical failures and infection percentages were smaller in the semi-rigid prosthesis that in the inflatable ones, with high levels of postoperative satisfaction in patients as well as in their couples, even greater than in other treatments available at the present time. The penile prosthesis implantation must be reserved for the organic erectile dysfunction when previous treatments have failed, evaluating the risk-benefit relation and informing the patient of the results that are hoped to be obtained and of the possible complications that can arise. In view of the great concern of our society with the erectile function and the availability of effective drugs, an increase in the demand of penile prosthesis implantation is predictable in those patients highly motivated, but refractory to the less invasive treatments.

[Population screening for colorectal cancer: a systematic review]. / Cribado poblacional del cáncer colorrectal: una revisión sistemática.

INTRODUCTION: Colorectal cancer (CRC) is a serious public health problem due to its high frequency and the mortality it provokes. This disease presents a series of characteristics that make it an ideal candidate for population screening. The aim of the present study was to analyze current knowledge on the efficacy/effectiveness of CRC screening through the fecal occult blood test (FOBT), rectosigmoidoscopy and colonoscopy in individuals without symptoms of this disease. METHOD: We performed a systematic review of the literature on each of the methods of early detection. The databases consulted were MEDLINE and PREMEDLINE (1966-2002), Embase (1980-2002), HTA and Cochrane, among others. Articles were selected using explicit criteria and were classified according to their level of scientific evidence. RESULTS: The best validated test is the FOBT, with the greatest number of randomized controlled trials. The results on the sensitivity and specificity of this test and reduction in mortality from CRC varied widely, depending on the technique used. The decrease in mortality from CRC in groups that underwent screening through FOBT was between 15% and 33%. The number and quality of the studies performed to evaluate flexible sigmoidoscopy and colonoscopy as methods of early detection were much lower. Although the rate of detection of polyps is greater than with the FOBT, the value of these tests as screening techniques has not been analyzed through randomized controlled trials. CONCLUSION: Population screening for CRC reduces mortality from this disease. However, consensus is lacking on the screening method of choice and on the frequency with which screening should be performed. The method best supported by the evidence as a primary detection test is the FOBT. To date, sigmoidoscopy and colonoscopy should be used as diagnostic tests only, mainly because of their invasiveness.

[Vascular endoprostheses in the treatment of intracranial aneurysms: a systematic review]. / Las endoprótesis vasculares en el tratamiento de aneurismas intracraneales: una revisión sistemática.

OBJECTIVE: To evaluate the effectiveness and safety of endovascular prostheses (stents) in the treatment of intracranial aneurysms. MATERIAL AND METHODS: We performed a systematic review of the literature using the databases Medline, Embase, HTA, and the Cochrane Library. Relevant articles were selected by reading the abstracts found in the search and applying a series of inclusion and exclusion criteria. Afterwards, the entire text was read critically and the results were extracted and analyzed. RESULTS: Only ten series fulfilled the inclusion criteria established, and different methodological limitations were observed. A total of 287 lesions were treated; 76 of these were wide-neck aneurysms, and total or nearly total occlusion was achieved in approximately 77% of cases. Among the 281 patients included, 14 deaths (4.9%) and 48 complications (17.1%) occurred; 55% of the complications were of thromboembolic origin. Moreover, in 71 cases (24.7%) there were difficulties in placing the stent, stent displacement, or other technical problems. CONCLUSIONS: Despite the data reported in this review, the lack of methodologically sound studies with long-term follow-up as well as the methodological limitations and heterogeneity found in the observational studies included in this review make it impossible to reach definitive, categorical conclusions regarding the efficacy and safety of this technique. Therefore, it would be recommendable to initiate randomized clinical trials to compare this technique with other treatment options, using appropriate and homogeneous criteria for the selection of both patients and centers together with strict follow-up, registering, and evaluation of the results obtained.