Vitamin D deficiency in pediatric patients using antiepileptic drugs: systematic review with meta-analysis.

OBJECTIVES: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. SOURCE OF DATA: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. SUMMARY OF DATA: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI=0.25-0.41; I2=92%, p<0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI=0.21-0.47; I2=86%, p<0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI=0.40-0.64; I2=76%, p<0.01). CONCLUSIONS: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.

Polymorphism in GRHL2 gene may contribute to noise-induced hearing loss susceptibility: a meta-analysis.

INSTRUCTION: Noise-induced hearing loss is a leading occupational disease caused by gene-environment interaction. The Grainy Like 2, GRHL2, is a candidate gene. In this regard, many studies have evaluated the association between GRHL2 and noise-induced hearing loss, although the results are ambiguous and conflicting. OBJECTIVE: The purpose of this study was to identify a precise estimation of the association between rs3735715 polymorphism in GRHL2 gene and susceptibility of noise-induced hearing loss. METHODS: A comprehensive search was performed to collect data up to July 8, 2018. Finally, 4 eligible articles were included in this meta-analysis comprising 2410 subjects. The pooled odds ratios with 95% confidence intervals were used to evaluate the strength of the association. RESULTS: Significant association was found in the overall population in the dominant model (GA/AA vs. GG, odds ratio=0.707, 95% confidence interval=0.594-0.841) and allele model (G allele vs. A allele, odds ratio=1.189, 95% confidence interval=1.062-1.333). When stratified by source of the subjects, we also found association between rs3735715 and noise-induced hearing loss risk in the dominant model (GA/AA vs. GG, odds ratio=0.634, 95% confidence interval=0.514-0.783) and allele model (G allele vs. A allele, odds ratio=1.206, 95% confidence interval=1.054-1.379). CONCLUSION: Rs3735715 polymorphism in GRHL2 gene may influence the susceptibility of noise-induced hearing loss. Additional large, well-designed and functional studies are needed to confirm this association in different populations.

Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis.

INTRODUCTION: Currently, several different concentrations of saline are recommended for use in nasal irrigation. Increasing studies show that nasal irrigation with hypertonic saline is more effective than traditional saline in the treatment of rhinosinusitis, but there have been few systematic analyses of the effect of nasal irrigation with hypertonic saline on chronic rhinosinusitis. OBJECTIVE: We sought to compare the effects of hypertonic saline and isotonic saline in the treatment of rhinosinusitis in order to provide a reference for clinical nasal irrigation for chronic rhinosinusitis treatment. METHODS: Medline, cochrane library, EMBASE, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wanfang database, and other databases were searched, and the searching was supplemented by manual searches for relevant references to treatment of rhinosinusitis by saline nasal irrigation. The last retrieval date was March 2018. The included studies were evaluated for quality, and data were extracted for meta-analysis using RevMan 5.3. RESULTS: Seven studies were included. Effects favoring hypertonic saline on nasal symptoms were greater in 4 subgroups. These were (1) patients with nasal secretion (SMD=1.52; 95% CI: 1.04, 2.00; p<0.01), (2) patients with congestion (SMD=1.52; 95% CI: 1.04, 2.00; p<0.01), (3) patients with headache (SMD=0.82; 95% CI: 0.38, 1.26; p<0.01), (4) patients with overall symptomatic relief (SMD=1.63; 95% CI: 0.83, 2.44; p<0.01). However, no difference was shown in smell improvement (SMD=0.47; 95% CI: -0.65, 1.59; p=0.41) and radiologic scores improvement (SMD=2.44; 95% CI: -3.14, 8.02; p<0.01). Besides, hypertonic saline showed greater improvement in mucociliary clearance time scores than did the isotonic saline group (SMD=1.19; 95% CI: 0.78, 1.60; p<0.01). Hypertonic saline brought greater minor adverse effects. CONCLUSION: Compared with isotonic saline, hypertonic saline nasal irrigation for the treatment of chronic rhinosinusitis is significantly more effective and has mild side effects in improving nasal symptoms and ciliary movement, but there is no significant difference in imaging findings and smell improvement. Although hypertonic saline is worthy of widespread use in clinical practice, it is still necessary to further study the exact manner and concentration of nasal irrigation.

Does topical application of tranexamic acid reduce intraoperative bleeding in sinus surgery during general anesthesia?

INTRODUCTION: Tranexamic acid is a hemostatic agent, which inhibits fibrin degradation, which may be beneficial in controlling bleeding during surgery. OBJECTIVES: The purpose of this study was to provide a meta-analysis and review of the effects of tranexamic acid on hemorrhage and surgical fields and side effects on patients during endoscopic sinus surgery. METHODS: Two authors independently searched six databases (Medline, Scopus, Embase, Web of Science, Google Scholar and Cochrane library) from the start of article collection until July 2018. Postoperative complications such as intraoperative bleeding, operative time, hypotension, nausea, vomiting, and coagulation profile were included in the analysis of tranexamic acid (Treatment Group) and placebo (Control Group) during the operation. RESULTS: The amount of blood loss during surgery was statistically lower in the treatment group compared to the placebo group, and the surgical field quality was statistically higher in the treatment group than in the placebo group. On the other hand, there was no significant difference in operation time, hemodynamics, or coagulation profile between groups. In addition, tranexamic acid had no significant effect on vomiting and thrombosis compared to the Control Group. CONCLUSION: This meta-analysis has shown that topical administration of tranexamic acid can reduce the amount of bleeding during surgery and improve the overall quality of the surgery. Hemodynamic instability during surgery, vomiting after surgery, or abnormal clotting profile were not reported. Additional studies are needed to confirm the results of this study because there are fewer studies.

[Noninvasive hemoglobin monitoring in clinical trials: a systematic review and meta-analysis]. / Monitorização não invasiva da hemoglobina em ensaios clínicos: uma revisão sistemática e metanálise.

BACKGROUND AND OBJECTIVES: The measurement of Hb by co-oximetry is an innovative technique that offers efficiency and agility in the processing of information regarding the measurement of Hemoglobin concentration (Hb) obtained through continuous, non-invasive and rapid monitoring. Because of this attribute, it avoids unnecessary exposures of the patient to invasive procedures by allowing a reduction in the number of blood samples for evaluation and other unnecessary therapies. It also helps to make decisions about the need for transfusion and how to handle it. The objective of this study is to compare the performance offered to obtain Hb values between the Masimo Corporation (Irvine, CA, USA) instrument and the standard gold tool (laboratory examination). CONTENTS: The study corresponds to a systematic review followed by meta-analysis, which included fully registered full-text clinical trials published from 1990 to 2018. PubMed, Cochrane, Medline, Embase and Web of Science databases were investigated. The mean overall difference found between the non-invasive and invasive methods of hemoglobin monitoring was 0.23 (95% CI -0.16, 0.62), that is, it did not present statistical significance (p = 0.250). The results of the analysis of heterogeneity within and between the studies indicated high levels of inconsistency (Q = 461.63, p < 0.0001, I2 = 98%), method for Hb values. CONCLUSIONS: Although the mean difference between noninvasive measurements of Hb and the gold standard method is small, the co-oximeter can be used as a non-invasive "trend" monitor in detecting unexpected responses at Hb levels.

The efficacy and safety of ciclesonide for the treatment of perennial allergic rhinitis: a systematic review and meta-analysis.

INTRODUCTION: Allergic rhinitis is a chronic inflammatory disease which affects 1 out of 6 individuals. Perennial allergic rhinitis accounts for 40% of AR cases. Ciclesonide is one of the relatively new intranasal steroid for allergic rhinitis. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of ciclesonide in the treatment of perennial allergic rhinitis. METHODS: We searched Pubmed, Scientific Citation Index, Embase, Clinical Trial Registries for randomized controlled trials and Cochrane Central Register of Controlled Trials to find out the randomized controlled Trial comparing ciclesonide with placebo for PAR. RESULTS: Eight studies were included. In comparison with placebo groups, ciclesonide groups significantly decreased Reflective Total Nasal Symptom Score (MD=-0.56; 95% CI -0.72 to 0.39, p<0.00001) with heterogeneity (p=0.19, I2=24%), Instantaneous Total Nasal Symptom Score (MD=-0.57; 95% CI -0.75 to -0.39, p<0.00001) with heterogeneity (p=0.34, I2=11%). A significant effect for Reflective Nasal Symptom Score Subtotal (MD=-0.15; 95% CI -0.18 to -0.13, p<0.00001) with heterogeneity (p=0.12, I2=24%) was also demonstrated. Rhinoconjunctivitis quality of life questionnaire score (RQLQs) (MD=-0.27; 95% CI -0.39 to -0.15, p<0.00001) with heterogeneity (p=0.58, I2=0%) in the treatment of ciclesonide was also significantly reduced. In addition, the difference in Treatment-Emergent Adverse Events between the two groups was not significant. CONCLUSION: Ciclesonide can improve perennial allergic rhinitis without increasing adverse events. Ciclesonide may be another valuable choice for perennial allergic rhinitis in the future.

Self-inflicted burns in Brazil: systematic review and meta-analysis / Queimaduras autoprovocadas no Brasil: revisão sistemática e meta-análise

ABSTRACT Introduction: burns represent a pivotal component of trauma in Brazil, accounting for 2 million incidents and 2,500 deaths annually. Self-intentional burns are associated with a worse prognosis, larger burned surface area, higher infection rates, and death. The lack of studies on the issue of self-immolation raises epidemiological questions regarding Brazilian victims. This study aimed to investigate the profile of burn events associated with self-injurious behavior among Brazilian victims. Methods: this systematic review was performed according to PRISMA 2020 guidelines and evaluated the correlation between self-injurious behavior as a cause of burns in Brazilian victims and its epidemiological implications in the last 20 years (2003-2023). The MeSH terms "Burns", "Self-Injurious Behavior", "Epidemiology" and "Brazil" were queried in the PubMed/MEDLINE, SciELO, and Cochrane Library databases, and, after selection by inclusion/exclusion criteria, the most relevant studies were critically analyzed. Results: From 1,077 pre-selected studies, 92 were potentially eligible, resulting in 7 manuscripts incorporated in this review. From 3,510 burned victims assembled in the pool of selected studies, 311 cases displayed self-injurious behavior. Burned patients who attempted to burn their lives have a higher risk of death (p<0.05; RR=5.1 [3.2-8.1]) and larger burned surface area (p<0.05; MD=19.2 [10-28.2]), compared to accidental cases. Moreover, the female gender was at a higher risk of attempting self-immolation (p<0.05; RR=4.01 [2.9-5.5]). Conclusion: our results show that self-inflicted burn cases were associated with a larger burned surface area and a higher risk of death, and the female gender was identified as a relevant risk factor in Brazil.

RESUMO Introdução: Queimaduras representam um componente fundamental do trauma no Brasil, sendo responsáveis por 2 milhões de incidentes e 2.500 mortes anualmente. Queimaduras autointencionais estão associadas a pior prognóstico, maior superfície corporal queimada, maiores taxas de infecção e morte. A falta de estudos sobre a problemática da autoimolação levanta questões epidemiológicas em relação às vítimas brasileiras. O estudo se objetivou investigar o perfil das queimaduras associados ao comportamento autolesivo entre vítimas brasileiras. Métodos: Esta revisão sistemática foi realizada de acordo com as diretrizes PRISMA 2020 e avaliou a correlação entre comportamento autolesivo como causa de queimaduras em vítimas brasileiras e suas implicações epidemiológicas nos últimos 20 anos (2003-2023). Os termos MeSH "Burns", "Self-Injurious Behavior", "Epidemiology" e "Brazil" foram elencados no PubMed/MEDLINE, SciELO e Cochrane Library e, após seleção por critérios de inclusão/exclusão, os estudos mais relevantes foram analisados criticamente. Resultados: Dos 1.077 estudos pré-selecionados, 92 foram potencialmente elegíveis, resultando em 7 manuscritos incorporados nesta revisão. Das 3.510 vítimas queimadas reunidas no conjunto de estudos selecionados, 311 casos apresentaram comportamento autolesivo. Pacientes que tentaram autoimolação apresentam maior risco de morte (p<0,05; RR=5,1 [3,2-8,1]) e maior superfície corporal queimada (p<0,05; MD=19,2 [10-28,2]), em comparação com casos acidentais. Ademais, o sexo feminino apresentou maior risco para tentativa de autoimolação (p<0,05; RR=4,01 [2,9-5,5]). Conclusão: Nossos resultados mostram que os casos de queimaduras autoprovocadas foram associados a uma maior área de superfície corporal queimada e a um maior risco de morte, e o sexo feminino foi identificado como um fator de risco relevante no Brasil.

Levosimendana e Fibrilação Atrial: Uma Metanálise de Ensaios Clínicos Randomizados / Levosimendan and Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials

Resumo Fundamento A fibrilação atrial (FA) é uma complicação prevalente associada à levosimendana; no entanto, permanece incerto se existem disparidades nos efeitos da levosimendana na FA não pós-operatória e pós-operatória. Objetivos Este estudo teve como objetivo avaliar o efeito da levosimendana na FA não pós-operatória e pós-operatória conduzindo uma metanálise de ensaios clínicos randomizados (ECR). Métodos PubMed, Embase, Biblioteca Cochrane e outras bases de dados foram pesquisadas. Pares de revisores identificaram ECRs que compararam levosimendana e placebo ou outras terapias, e os resultados relataram dados de eventos de FA. Foram utilizados modelos de efeitos aleatórios (com nível de significância de 5%). Resultados Foram incluídos 29 ensaios elegíveis compreendendo 6.550 participantes, onze dos quais avaliaram a incidência de FA não pós-operatória e 18 incluíram FA pós-operatória. A análise revelou que a levosimendana elevou significativamente o risco de FA no grupo não pós-operatório (OR, 1,62; IC 95%: 1,19-2,20; p=0,002) e reduziu a incidência de FA no grupo pós-operatório (OR, 0,65; IC 95%: 0,44-0,96; p=0,03). A ocorrência de FA diminuiu mais significativamente em pacientes que usaram levosimendana após cirurgia cardíaca (OR, 0,53; IC 95%: 0,32-0,88; p=0,02) do que em pacientes que usaram levosimendana antes da cirurgia cardíaca (OR, 0,67; IC 95%: 0,42-1,06; p=0,09). O risco de FA foi significativamente elevado pela grande dose em bolus de levosimendana (dose em bolus ≥12 μg/kg) (OR, 1,44; IC 95%: 1,10-1,88; p=0,004) e diminuído pela pequena dose em bolus de levosimendana (dose em bolus <12 μg/kg) (OR, 0,64; IC 95%: 0,34-1,20; p=0,16). Conclusão A levosimendana foi associada a um aumento da incidência de FA não pós-operatória. O emprego da levosimendana foi eficaz na prevenção da FA pós-operatória.

Abstract Background Atrial fibrillation (AF) is a prevalent complication associated with levosimendan; however, it remains uncertain whether there are any disparities in the effects of levosimendan on non-postoperative and postoperative AF. Objectives This study aimed to evaluate the levosimendan effect on non-postoperative and postoperative AF by conducting a meta-analysis of randomized control trials (RCTs). Methods PubMed, Embase, Cochrane Library, and other databases were searched. Pairs of reviewers identified RCTs that compared levosimendan and placebo or other therapies, and the results reported AF events data. Random effects models were used (at a significance level of 5%). Results Twenty-nine eligible trials comprising 6550 participants were included, eleven of which evaluated the non-postoperative AF incidence, and 18 included postoperative AF. The analysis revealed that levosimendan elevated the AF risk significantly in the non-postoperative group (OR, 1.62; 95% CI: 1.19-2.20; p=0.002) and reduced the AF incidence in the postoperative group (OR, 0.65; 95% CI: 0.44-0.96; p=0.03). AF occurrence decreased more significantly in patients who used levosimendan after cardiac surgery (OR, 0.53; 95% CI: 0.32-0.88; p=0.02) than in patients who used levosimendan before cardiac surgery (OR, 0.67; 95% CI: 0.42-1.06; p=0.09). Moreover, The AF risk was significantly elevated by levosimendan large bolus dose (bolus dose≥12 μg/kg) (OR, 1.44; 95% CI: 1.10-1.88; p=0.004) and decreased by small bolus dose of levosimendan (bolus dose<12 μg/kg) (OR, 0.64; 95% CI: 0.34-1.20; p=0.16). Conclusion Levosimendan was linked to an increased non-postoperative AF incidence. The employment of levosimendan was effective in preventing postoperative AF.

[Tutorial for performing systematic review and meta-analysis with interventional anesthesia studies]. / Tutorial para execução de revisões sistemáticas e metanálises com estudos de intervenção em anestesia.

BACKGROUND AND OBJECTIVE: The systematic review of randomized clinical trials is crucial to assess the safety and effectiveness of intermediate procedures. The objective of this article is to present a tutorial for the planning and execution of systematic review and meta-analysis of randomized clinical trial studies. CONTENT: The systematic literature review is the type of research that organizes, criticizes, and integrates available evidence published in the health field. Systematization leads to less bias, however, the quality of systematic reviews may not always be perceived due to the way it is described in the articles. The information disclosed in the articles is not always free of bias. The steps for carrying out a systematic review include design, protocol registration, implementation, mathematical analysis of results, and dissemination. PRISMA statement has improved the quality of systematic review reports by providing a list of items to be described, and this article emphasizes the key steps for performing a systematic review of interventions. CONCLUSION: The evidence generated through a systematic review can provide the clinician with greater confidence in decision making at the moment of clinical practice and optimize the benefits to his patients, serving as a tool to assist managers in making decisions regarding the implementation of new strategies in favor of the public health.

Prophylactic central neck dissection and local recurrence in papillary thyroid microcarcinoma: a meta-analysis.

INTRODUCTION: For papillary thyroid microcarcinoma patients, the reported incidence of lymph node metastasis is as high as 40%, and these occur mainly in the central compartment of the neck. Because these metastases are difficult to detect using ultrasonography preoperatively, some authors advocate routine central neck dissection in papillary thyroid microcarcinoma patients at the time of initial thyroidectomy. OBJECTIVE: To evaluate whether prophylactic central neck dissection can decrease the local recurrence rate of papillary thyroid microcarcinoma after thyroidectomy. METHODS: The publicly available literature published from January 1990 to December 2017 concerning thyroidectomy plus prophylactic central neck dissection versus thyroidectomy for papillary thyroid microcarcinoma was retrieved by searching the national and international online databases. A meta-analysis was performed after the data extraction process. RESULTS: Four studies were finally included with a total of 727 patients, of whom, 366 cases underwent thyroidectomy plus prophylactic central neck dissection and 361 cases received thyroidectomy only. As shown by the meta-analysis results, the recurrence rates in cases of thyroidectomy plus prophylactic central neck dissection were approximately 1.91% and were significantly lower than those with thyroidectomy only (OR=0.24, 95% CI [0.10, 0.56], p=0.0009). CONCLUSION: For patients with papillary thyroid microcarcinoma, thyroidectomy plus prophylactic central neck dissection is a safe and efficient procedure and it results in lower recurrence rate. Since the evidences are of low quality (non-randomized studies), further randomized trials are needed.

Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies.

OBJECTIVE: To identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality. SOURCES: This review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel-Haenszel model for heterogeneity estimation. A confidence level of 95% was considered. SUMMARY OF FINDINGS: The qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar<7 at the fifth minute, low and very low birth weight, gestational age≤37 weeks, and caesarean delivery. CONCLUSION: The most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.

Ablação por Cateter para Fibrilação Atrial em Pacientes com Fração de Ejeção do Ventrículo Esquerdo ≤ 45%: Uma Metanálise de Ensaios Clínicos Randomizados / Catheter Ablation for Atrial Fibrillation in Patients with Left Ventricular Ejection Fraction ≤ 45%: A Meta-Analysis of Randomized Controlled Trials

Resumo Fundamento A fibrilação atrial (FA) e a insuficiência cardíaca (IC) coexistem frequentemente, resultando em desfechos adversos. No entanto, permanecem controvérsias quanto à eficácia da ablação por cateter (AC) em pacientes com FA com disfunção ventricular esquerda grave. Objetivos O objetivo deste estudo foi realizar uma metanálise de ensaios prospectivos randomizados e controlados para avaliar a eficácia da AC versus terapia médica (TM) em pacientes com FA com fração de ejeção do ventrículo esquerdo (FEVE) ≤45%. Métodos Procuramos na literatura estudos que comparassem AC com TM em pacientes com FA com FEVE ≤45%. Foi realizada uma metanálise de 7 ensaios clínicos, incluindo 1.163 pacientes com FA e IC. A análise de subgrupo foi realizada com base na FEVE basal. Todos os testes foram bilaterais; apenas o valor p <0,05 foi considerado estatisticamente significativo. Resultados Descobrimos que a AC estava associada a menor mortalidade por todas as causas (taxa de risco: 0,52, IC 95%: 0,37 a 0,72; p<0,01) e maiores melhorias na FEVE (diferença média: 4,80%, IC 95%: 2,29% a 7,31%; p<0,01) em comparação com TM. Os pacientes do grupo AC apresentaram menor risco de hospitalização por IC e recorrência de FA e qualidade de vida significativamente melhor do que aqueles do grupo TM. Os resultados da análise de subgrupo indicaram que pacientes com disfunção ventricular esquerda mais leve melhoraram a FEVE após a ablação de FA (diferença média: 6,53%, IC 95%: 6,18% a 6,88%; p<0,01) em comparação com pacientes com doença mais grave (diferença média : 2,02%, IC 95%: 0,87% a 3,16%; p<0,01). Conclusões Nossa metanálise demonstrou que a AC foi associada a melhorias significativas nos resultados de pacientes com FA com FEVE ≤45%. Além disso, pacientes com FA com disfunção ventricular esquerda mais leve poderiam se beneficiar mais com a AC.

Abstract Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist, resulting in adverse outcomes. However, controversies remain regarding the efficacy of catheter ablation (CA) in AF patients with severe left ventricular dysfunction. Objectives The purpose of this study was to perform a meta-analysis of prospective randomized controlled trials to evaluate the efficacy of CA versus medical therapy (MT) in AF patients with left ventricular ejection fraction (LVEF) ≤45%. Methods We searched the literature for studies that compared CA to MT in AF patients with LVEF ≤45%. A meta-analysis of 7 clinical trials was performed, including 1163 patients with AF and HF. Subgroup analysis was performed based on baseline LVEF. All tests were 2-sided; only the p-value <0.05 was considered statistically significant. Results We found that CA was associated with lower all-cause mortality (risk ratio: 0.52, 95% CI: 0.37 to 0.72; p<0.01) and greater improvements in LVEF (mean difference: 4.80%, 95% CI: 2.29% to 7.31%; p<0.01) compared to MT. Patients in the CA group had a lower risk of HF hospitalization and AF recurrence and a significantly better quality of life than those in the MT group. The results of subgroup analysis indicated that patients with milder left ventricular dysfunction improved LVEF after AF ablation (mean difference: 6.53%, 95% CI: 6.18% to 6.88%; p<0.01) compared to patients with more severe disease (mean difference: 2.02%, 95% CI: 0.87% to 3.16%; p<0.01). Conclusions Our meta-analysis demonstrated that CA was associated with significant improvements in outcomes of AF patients with LVEF ≤45%. Additionally, AF patients with milder left ventricular dysfunction could benefit more from CA.

Descortinando Estudos em Masculinidades: uma análise sobre o catálogo de teses e dissertações da Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Unveiling Studies in Masculinities: an analysis of the theses and dissertations catalog of the Coordination for the Improvement of Higher Education Personnel Foundation / Découvrant des Études sur les Masculinités: analyse du catalogue de thèses et de mémoires de la Fondation Coordination pour l'Amélioration du Personnel de l'Enseignement Supérieur / Revelando Estudios sobre Masculinidades: un análisis del catálogo de tesis de la Fundación Coordinación para el Perfeccionamiento del Personal de Educación Superior

A Psicologia como campo de saber é chamada para compreender processos de invisibilização e subalternização de experiências, tais como o processo de masculinização de homens. A partir da análise de pesquisas em masculinidade(s) e sobre homens realizadas pelos programas de Pós-Graduação em Psicologia no Brasil disponíveis no Catálogo de Teses e Dissertações da Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, compreendemos a importância de se introduzir critérios socioculturais como filtros em catálogos de indexação de pesquisas. Essa estratégia possibilita entender quem tem pesquisado sobre determinado campo teórico e dialogar de maneira mais afinado com as(os) interlocutoras(es) em uma pesquisa, auxiliando na promoção da inserção social, critério de avaliação estabelecido por essa fundação

Psychology as a field of knowledge is called upon to understand processes of invisibilization and subalternization of experiences, such as the process of masculinization of men. Based on an analysis of research into masculinity(ies) and men carried out by Postgraduate Programs in Psychology in Brazil, available in the Theses and Dissertations Catalog of the Coordination for the Improvement of Higher Education Personnel (CAPES) Foundation, we understood the importance of introducing sociocultural criteria as filters in search indexing catalogs. This strategy makes it possible to understand who has been researching a given theoretical field and to engage in a more attuned dialogue with the interlocutor(s) in a piece of research, helping to promote social inclusion, an evaluation criterion established by CAPES

La Psicología como campo de conocimiento se utiliza para comprender los procesos de invisibilidad y subordinación de experiencias, como el proceso de masculinización de los hombres. A partir del análisis de estudios sobre masculinidad(es) y sobre hombres realizados por los Programas de Posgrado en Psicología en Brasil, disponibles en el Catálogo de Tesis de la Coordinación para el Perfeccionamiento del Personal de Educación Superior, entendemos la importancia de introducir criterios culturales, como filtros en los catálogos de indexación de búsqueda. Esta estrategia permite comprender a quienes vienen investigando sobre un determinado campo teórico y dialogar más de cerca con el(los) interlocutor(es) en una investigación, contribuyendo a promover la inclusión social, criterio de evaluación establecido por esta entidad

La Psicología como campo de conocimiento se utiliza para comprender los procesos de invisibilidad y subordinación de experiencias, como el proceso de masculinización de los hombres. A partir del análisis de estudios sobre masculinidad(es) y sobre hombres realizados por los Programas de Posgrado en Psicología en Brasil, disponibles en el Catálogo de Tesis de la Coordinación para el Perfeccionamiento del Personal de Educación Superior, entendemos la importancia de introducir criterios culturales, como filtros en los catálogos de indexación de búsqueda. Esta estrategia permite comprender a quienes vienen investigando sobre un determinado campo teórico y dialogar más de cerca con el(los) interlocutor(es) en una investigación, contribuyendo a promover la inclusión social, criterio de evaluación establecido por esta entidad

Mycobacterium tuberculosis latent infection in healthcare students: systematic review of prevalence / Infecção latente por Mycobacterium tuberculosis em estudantes da área da saúde: revisão sistemática de prevalência / Infección latente por Mycobacterium tuberculosis en estudiantes de la salud: revisión sistemática de la prevalencia

ABSTRACT Objective: The aim of this study was to synthesize the evidence on the prevalence of latent Mycobacterium tuberculosis infection (LTBI) among undergraduate health care students. Methods: A systematic review of prevalence with meta-analysis was conducted. Prospective and retrospective cohorts and cross-sectional studies involving probable exposure to M. tuberculosis during undergraduate education, along with the tuberculin skin test (TST) or interferon-γ release assay (IGRA) for investigation of latent tuberculosis were searched. Searches were conducted in MEDLINE, CINAHL, EMBASE, LILACS, Scopus, and Web of Science databases. Independent reviewers were responsible for the selection and inclusion of studies. Data were extracted, critically appraised, and synthesized using the JBI approach. PRISMA was used to report the study. Results: Twenty-two studies were analyzed. The overall prevalence in healthcare undergraduate students was 12.53%. Conclusion: The prevalence of LTBI in undergraduate health students was high for such a highly educated population. Screening with TST and/or IGRA and chemoprophylaxis, when necessary, should be provided to undergraduate health students when in contact with respiratory symptomatic patients.

RESUMO Objetivo: O objetivo deste estudo foi sintetizar as evidências sobre a prevalência de infecção de Mycobacterium tuberculosis (ILTB) entre estudantes de graduação da área da saúde. Método: Foi realizada uma revisão sistemática de prevalência com metanálise. Coortes prospectivas e retrospectivas e estudos transversais envolvendo provável exposição a M. tuberculosis durante a graduação, juntamente com o teste tuberculínico (TT) ou ensaio de liberação de interferon-γ (IGRA) para investigação de tuberculose latente foram pesquisados. As buscas foram realizadas nas bases de dados MEDLINE, CINAHL, EMBASE, LILACS, Scopus e Web of Science. Revisores independentes foram responsáveis pela seleção e inclusão dos estudos. Os dados foram extraídos, avaliados criticamente e sintetizados utilizando a abordagem JBI. PRISMA foi usado para relatar o estudo. Resultados: Vinte e dois estudos foram analisados. A prevalência geral em estudantes de graduação da área da saúde foi de 12,53%. Conclusão: A prevalência de ILTB em estudantes de graduação em saúde foi alta para uma população com alto nível de escolaridade. Triagem com TT e/ou IGRA e quimioprofilaxia, quando necessária, deve ser fornecida aos estudantes de graduação da área da saúde quando em contato com pacientes sintomáticos respiratórios.

RESUMEN Objetivo: El objetivo de este estudio fue sintetizar la evidencia sobre la prevalencia de infección latente por Mycobacterium tuberculosis (ILTB) entre estudiantes universitarios de la salud. Métodos: Se realizó una revisión sistemática de la prevalencia con metanálisis. Cohortes prospectivas y retrospectivas y estudios transversales que involucran exposición probable a M tuberculosis durante la educación universitaria, junto con la prueba cutánea de tuberculina (TST) o el ensayo de liberación de interferón-γ (IGRA) para la investigación de tuberculosis latente. Las búsquedas se realizaron en las bases de datos MEDLINE, CINAHL, EMBASE, LILACS, Scopus y Web of Science. Revisores independientes fueron responsables de la selección e inclusión de los estudios. Los datos se extrajeron, se evaluaron críticamente y se sintetizaron utilizando el enfoque JBI. Se utilizó PRISMA para informar el estudio. Resultados: Se analizaron veintidós estudios. La prevalencia global en estudiantes universitarios en salud fue del 12,53%. Conclusión: La prevalencia de LTBI en estudiantes universitarios de salud fue alta para una población con un nivel educativo tan alto. Se debe proporcionar tamizaje con TST y/o IGRA y quimioprofilaxis, cuando sea necesario, a los estudiantes universitarios en salud cuando estén en contacto con pacientes sintomáticos respiratorios.

Revolutionizing early Alzheimer's disease and mild cognitive impairment diagnosis: a deep learning MRI meta-analysis / Revolucionando a doença de Alzheimer precoce e o diagnóstico de comprometimento cognitivo leve: uma metanálise de aprendizagem profunda por ressonância magnética

Abstract Background The early diagnosis of Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains a significant challenge in neurology, with conventional methods often limited by subjectivity and variability in interpretation. Integrating deep learning with artificial intelligence (AI) in magnetic resonance imaging (MRI) analysis emerges as a transformative approach, offering the potential for unbiased, highly accurate diagnostic insights. Objective A meta-analysis was designed to analyze the diagnostic accuracy of deep learning of MRI images on AD and MCI models. Methods A meta-analysis was performed across PubMed, Embase, and Cochrane library databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on the diagnostic accuracy of deep learning. Subsequently, methodological quality was assessed using the QUADAS-2 checklist. Diagnostic measures, including sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and area under the receiver operating characteristic curve (AUROC) were analyzed, alongside subgroup analyses for T1-weighted and non-T1-weighted MRI. Results A total of 18 eligible studies were identified. The Spearman correlation coefficient was -0.6506. Meta-analysis showed that the combined sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.84, 0.86, 6.0, 0.19, and 32, respectively. The AUROC was 0.92. The quiescent point of hierarchical summary of receiver operating characteristic (HSROC) was 3.463. Notably, the images of 12 studies were acquired by T1-weighted MRI alone, and those of the other 6 were gathered by non-T1-weighted MRI alone. Conclusion Overall, deep learning of MRI for the diagnosis of AD and MCI showed good sensitivity and specificity and contributed to improving diagnostic accuracy.

Resumo Antecedentes O diagnóstico precoce da doença de Alzheimer (DA) e do comprometimento cognitivo leve (CCL) continua sendo um desafio significativo na neurologia, com métodos convencionais frequentemente limitados pela subjetividade e variabilidade na interpretação. A integração da aprendizagem profunda com a inteligência artificial (IA) na análise de imagens de ressonância magnética surge como uma abordagem transformadora, oferecendo o potencial para insights diagnósticos imparciais e altamente precisos. Objetivo Uma metanálise foi projetada para analisar a precisão diagnóstica do aprendizado profundo de imagens de ressonância magnética em modelos de DA e CCL. Métodos Uma metanálise foi realizada nos bancos de dados das bibliotecas PubMed, Embase e Cochrane seguindo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), com foco na precisão diagnóstica do aprendizado profundo. Posteriormente, a qualidade metodológica foi avaliada por meio do checklist QUADAS-2. Medidas diagnósticas, incluindo sensibilidade, especificidade, razões de verossimilhança, razão de chances diagnósticas e área sob a curva característica de operação do receptor (area under the receiver operating characteristic curve [AUROC]) foram analisadas, juntamente com análises de subgrupo para ressonância magnética ponderada em T1 e não ponderada em T1. Resultados Um total de 18 estudos elegíveis foram identificados. O coeficiente de correlação de Spearman foi de -0,6506. A metanálise mostrou que a sensibilidade e a especificidade combinadas, a razão de verossimilhança positiva, a razão de verossimilhança negativa e a razão de chances de diagnóstico foram 0,84, 0,86, 6,0, 0,19 e 32, respectivamente. A AUROC foi de 0,92. O ponto quiescente do resumo hierárquico da característica de operação do receptor (hierarchical summary of receiver operating characteristic [HSROC]) foi 3,463. Notavelmente, as imagens de 12 estudos foram adquiridas apenas por ressonância magnética ponderada em T1, e as dos outros 6 foram obtidas apenas por ressonância magnética não ponderada em T1. Conclusão Em geral, a aprendizagem profunda da ressonância magnética para o diagnóstico de DA e CCL mostrou boa sensibilidade e especificidade e contribuiu para melhorar a precisão diagnóstica.

Gestational diabetes mellitus prevalence in Brazil: a systematic review and meta-analysis / Prevalência de diabetes gestacional no Brasil: revisão sistemática e metanálise / Prevalencia de diabetes gestacional en Brasil: revisión sistemática y metaanálisis

Abstract: This study estimates gestational diabetes mellitus prevalence in Brazil. A systematic review was conducted with articles published between 2010 and 2021 on the PubMed, Scopus, Google Scholar, SciELO, LILACS and Virtual Health Library databases, as well as gray literature. Data were extracted using a standardized instrument together with the risk of bias assessment tool proposed by Hoy et al. A meta-analysis with robust variance and random effects was developed. Heterogeneity was verified using I2 and publication bias was assessed using funnel plot and Egger's test. Prevalence according to risk of bias, diagnostic criteria and country's regions was determined by subgroup analyses. A total of 32 studies were included, representing 21,942 women. gestational diabetes mellitus pooled prevalence was 14% (95%CI: 11.0; 16.0), considerably higher than estimates from previous studies. Regarding risk of bias, studies with low, medium, and high risk showed a pooled prevalence of 12%, 14% and 14%, respectively. Overall GRADE certainty of evidence rating was low. Most studies used the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria or the adapted IADPSG, showing a pooled prevalence of 15% and 14%, respectively. As for region, the pooled prevalence was higher in the Southeast (14%) and lower in the Central-West (9%). This is the first systematic review to provide evidence on gestational diabetes mellitus prevalence at a national level and to demonstrate considerable heterogeneity among articles and the influence of region, diagnostic criteria and study quality on the referred indicator.

Resumo: Este artigo estimou a prevalência da diabetes gestacional no Brasil. Foi realizada uma revisão sistemática e metanálise com artigos publicados de 2010 até 2021 nas bases de dados PubMed, Scopus, Google Scholar, SciELO, LILACS e Biblioteca Virtual em Saúde, além de literatura cinzenta. Os dados foram extraídos usando um instrumento padronizado juntamente com o instrumento de avaliação de risco de viés de Hoy et al. Posteriormente, foi desenvolvida uma metanálise com variância robusta e efeitos aleatórios. A heterogeneidade foi verificada pelo uso do I2 e o viés de publicação foi avaliado pelo gráfico de funil e pelo teste de Egger. Análises de subgrupos foram realizadas para determinar a prevalência de acordo com o risco de viés, critérios diagnósticos e regiões do país. Ao todo, 32 estudos foram incluídos nesta metanálise, totalizando 21.942 mulheres. A prevalência combinada de diabetes gestacional no Brasil foi de 14% (IC95%: 11,0; 16,0), consideravelmente superior às estimativas de estudos anteriores. Em relação ao risco de viés, estudos com baixo, médio e alto risco mostraram prevalência combinada de 12%, 14% e 14%, respectivamente. Em relação à certeza da evidência (abordagem GRADE), a classificação geral foi baixa. A maioria dos estudos utilizou os critérios do Grupo de Estudo da Associação Internacional de Diabetes na Gravidez (IADPSG) e do IADPSG adaptado, mostrando uma prevalência combinada de 15% e 14%, respectivamente. Em relação às regiões, a prevalência combinada foi maior no Sudeste (14%) e menor no Centro-oeste (9%). Esta foi a primeira revisão sistemática a fornecer evidências sobre a prevalência de diabetes gestacional em nível nacional, demonstrando considerável heterogeneidade entre os artigos e a influência da região, dos critérios diagnósticos e da qualidade dos estudos sobre o referido indicador.

Resumen: Este artículo estimó la prevalencia de diabetes gestacional en Brasil. Se realizó una revisión sistemática y metaanálisis con artículos publicados del 2010 al 2021 en las bases de datos PubMed, Scopus, Google Scholar, SciELO, LILACS y Biblioteca Virtual en Salud, además de literatura gris. Los datos se extrajeron usando un instrumento estandarizado junto con el instrumento de evaluación del riesgo de sesgo de Hoy et al. Posteriormente, se desarrolló un metaanálisis con varianza robusta y efectos aleatorios. La heterogeneidad se verificó mediante el I2, y el sesgo de publicación se evaluó por medio del gráfico en embudo y la prueba de Egger. Se realizaron análisis de subgrupos para determinar la prevalencia según el riesgo de sesgo, criterios diagnóstico y regiones del país. En total, se incluyeron 32 estudios en este metaanálisis, con un total de 21.942 mujeres. La prevalencia combinada de diabetes gestacional en Brasil fue del 14% (IC95%: 11,0; 16,0), considerablemente más alta que las estimaciones de estudios anteriores. Con relación al riesgo de sesgo, los estudios con riesgo bajo, medio y alto mostraron una prevalencia combinada del 12%, del 14% y del 14%, respectivamente. En cuanto a la certeza de la evidencia (enfoque GRADE), la clasificación general fue baja. La mayoría de los estudios utilizó los criterios del Grupo de Estudio de la Asociación Internacional de Diabetes en el Embarazo (IADPSG) y del IADPSG adaptado, lo que muestra una prevalencia combinada del 15% y del 14%, respectivamente. Con relación a las regiones, la prevalencia combinada fue mayor en el Sudeste (14%) y menor en el Centro-Oeste (9%). Esta fue la primera revisión sistemática que proporcionó evidencias sobre la prevalencia de diabetes gestacional en el ámbito nacional, lo que demuestra una considerable heterogeneidad entre los artículos y la influencia de la región, los criterios diagnósticos y la calidad de los estudios sobre este indicador.

Effect of Unna's boot on venous ulcer healing: a systematic review and meta-analysis / Efecto de la bota de Unna en la cicatrización de úlceras venosas: revisión sistemática y metanálisis / Efeito da Bota de Unna na cicatrização de úlceras venosas: revisão sistemática e metanálise

ABSTRACT Objective: To analyze the effect of Unna's Boot on the healing of venous ulcers compared to other therapies. Methods: Systematic Review carried out in the databases Scopus, Embase, Cochrane Library, Web of Science, PubMed, Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, and grey literature. Population - adult patients with venous ulcers; Intervention- Unna's Boot (UB); Control - other compression therapies (CT); Outcome- healing; Designs- randomized clinical trial, cohort study, and case control, published from 2001 to 2024. The effect of the intervention, risk of bias, and quality of evidence were evaluated. Registered with PROSPERO (CRD42021290077). Results: A total of 39 studies were included, with 5.151 patients. The majority (71.8%) were randomized controlled trials (RCT). UB was used as intervention/control in eight studies. When comparing CTs, only 1 study with UB showed a superior effect (p < .001) in healing, compared with high compression elastic bandage. In the quality of evidence analysis, 27 studies were assessed as having a high risk of bias. Conclusion: No superiority of UB was found in the healing of venous ulcers when compared to other CTs.

RESUMEN Objetivo: Analizar el efecto de la Bota de Unna en la cicatrización de úlceras venosas en comparación con otras terapias. Métodos: Revisión sistemática realizada en las bases de datos Scopus, Embase, Biblioteca Cochrane, Web de la Ciencia, PubMed, Índice acumulativo de literatura de enfermería y salud afines, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, y literatura gris. Población - pacientes adultos con úlceras venosas; Intervención- Bota de Unna (BU); Control: otras terapias de compresión (TC); Resultado- curación; Diseños: ensayo clínico aleatorizado, estudio de cohorte y casos y controles, publicado del 2002 al 2023. Se evaluaron el efecto de la intervención, el riesgo de sesgo y la calidad de la evidencia. Registrada en PRÓSPERO (CRD42021290077). Resultados: Se incluyeron 39 estudios, con 5.151 pacientes. La mayoría (71,8%) fueron ensayos controlados aleatorios (ECA). La BU se utilizó como intervención/control en ocho estudios. Al comparar TC, sólo 1 estudio con BU mostró un efecto superior (p < .001) en la curación, en comparación con el vendaje elástico de alta compresión. En el análisis de la calidad de la evidencia, se evaluó que 27 estudios tenían un alto riesgo de sesgo. Conclusión: No se encontró superioridad de la BU en la curación de úlceras venosas en comparación con otras TC.

RESUMO Objetivo: Analisar o efeito da Bota de Unna na cicatrização de úlceras venosas em comparação com outras terapias. Métodos: Revisão Sistemática realizada nas bases de dados Scopus, Embase, Cochrane Library, Web of Science, PubMed, Cumulative Index of Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, e de literatura cinzenta. População- pacientes adultos com úlcera venosa; Intervenção- Bota de Unna (BU); Controle- outras terapias compressivas (TC); Desfecho- cicatrização; Delineamentos- ensaio clínico randomizado, estudo de coorte e caso controle, publicados de 2002 a 2023. Avaliaramu-se efeito da intervenção, risco de viés e qualidade da evidência. Registrada no PROSPERO (CRD42021290077). Resultados: Foram incluídos 39 estudos, com 5.151 pacientes. A maioria (71,8%) era ensaios clínicos randomizados (ECR). A BU foi utilizada como intervenção/controle em oito estudos. Na comparação entre TC, somente 1 estudo com BU apresentou efeito superior (p < .001) na cicatrização, comparado com atadura elástica de alta compressão. Na análise de qualidade da evidência, 27 estudos foram avaliados com alto risco de viés. Conclusão: Não foi encontrada superioridade da BU na cicatrização de úlceras venosas quando comparada com outras TC.

Mirabegron and Anticholinergics in the Treatment of Overactive Bladder Syndrome: A Meta-analysis / Mirabegron e anticolinérgicos no tratamento da síndrome da bexiga hiperativa: metanálise

Abstract Objective To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB). Data Source Systematic searches were conducted in EMBASE, PUBMED, Cochrane, and LILACS databases from inception to September 2021. We included RCTs, women with clinically proven OB symptoms, studies that compared mirabegron to antimuscarinic drugs, and that evaluated the efficacy, safety or adherence. Data Collection RevMan 5.4 was used to combine results across studies. We derived risk ratios (RRs) and mean differences with 95% CIs using a random-effects meta-analytic model. Cochrane Collaboration Tool and GRADE was applied for risk of bias and quality of the evidence. Data Synthesis We included 14 studies with a total of 10,774 patients. Fewer total adverse events was reported in mirabegron group than in antimuscarinics group [RR 0.93 (0.89-0.98)]. The risk of gastrointestinal tract disorders and dry mouth were lower with mirabegron [RR 0,58 (0.48-0.68); 9375 patients; RR 0.44 (0.35-0.56), 9375 patients, respectively]. No difference was reported between mirabegron and antimuscarinics drugs for efficacy. The adherence to treatment was 87.7% in both groups [RR 0.99 (0.98-1.00)]. Conclusion Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.

Resumo Objetivo Comparar o uso de mirabegrom com anticolinérgicos para o tratamento da bexiga hiperativa (BH). Fonte de Dados Buscas sistemáticas foram realizadas nas bases de dados EMBASE, PUBMED, Cochrane e LILACS desde o início até setembro de 2021. Incluímos ECR, mulheres com sintomas de BH clinicamente comprovados, estudos que compararam mirabegrom a medicamentos antimuscarínicos e avaliaram a eficácia, segurança ou adesão. Coleta de Dados RevMan 5.4 foi usado para combinar os resultados entre os estudos. Derivamos razões de risco (RRs) e diferenças médias com intervalo de confiança (IC) de 95% usando um modelo meta-analítico de efeitos aleatórios. Cochrane Collaboration Tool e GRADE foi aplicado para risco de viés e qualidade da evidência. Síntese dos Dados Foram incluídos 14 estudos com um total de 10.774 pacientes. Menos eventos adversos totais foram relatados no grupo mirabegrom do que no grupo antimuscarínicos [RR: 0,93 (0,89-0,98)]. O risco de distúrbios do trato gastrointestinal e boca seca foram menores com mirabegrom [RR: 0,58 (0,48-0,68); 9.375 pacientes; RR: 0,44 (0,35-0,56), 9.375 pacientes, respectivamente]. Nenhuma diferença foi relatada entre mirabegrom e drogas antimuscarínicos para eficácia. A adesão ao tratamento foi de 87,7% em ambos os grupos [RR: 0,99 (0,98-1,00)]. Conclusão Mirabegrom e antimuscarínicos têm eficácia e taxas de adesão comparáveis, porém o mirabegrom apresentou menos eventos adversos totais e isolados.

Prevalência de anemia em gestantes das Américas: uma revisão rápida com metanálise / Prevalence of anemia in pregnant women in the Americas: a rapid review with meta-analysis

A anemia em gestantes é um relevante problema de ampla expansão geográfica, típica de grandes centros urbanos que atinge diversos países, como os da América. Estimar a prevalência nas Américas de anemia materna e anemia ferropriva em gestantes.Revisão rápida com busca no Medline, via PubMed, Scopus, Web of Science, SciELO, Lilacs e Open Grey. Incluíram-se estudos do tipo transversal, que estimassem a prevalência de anemia materna e anemia ferropriva. Foram realizadas metanálises com efeito randômico. 5.148 artigos foram encontrados, apenas 39 atenderam aos critérios de elegibilidade. As metanálises apresentaram prevalência de 30% (IC95%: 28%; 32%. I2: 99,4%) para anemia materna e frequência de 32% (IC95%: 25%; 40%. I2: 96,6%) para anemia ferropriva.Anemia materna é um evento frequente na população das Américas, com 30% para anemia materna e 32% para anemia ferropriva, destacando a necessidade de medidas de prevenção e promoção à saúde mais eficazes.

Anemia in pregnant women is a relevant problem of wide geographical expansion, typical of large urban centers and that affects several countries, such as America. To estimate the prevalence of maternal anemia and iron deficiency anemia in pregnant women in the Americas.Rapid review with search in Medline, Pubmed, Scopus, Web of Science, SciELO, Lilacs and Open Grey databases. Cross-sectional studies that estimated the prevalence of maternal anemia and iron deficiency anemia were included. Random-effects meta-analyses were conducted. 5148 articles were found, only 30 met the eligibility criteria. Meta-analyses showed a prevalence of 30% (95%CI: 28%; 32%. I2: 99.4%) for maternal anemia and a frequency of 32% (95%CI: 25%; 40%. I2: 96.6%) for iron deficiency anemia. Maternal anemia is a frequent event in the population of the Americas, with prevalence of 30% for maternal anemia and 32% for iron deficiency anemia, highlighting the need for more effective prevention and health promotion measures.

Use of fibers in childhood constipation treatment: systematic review with meta-analysis.

OBJECTIVE: To gather current evidence on the use of fiber for constipation treatment in pediatric patients. SOURCE OF DATA: Systematic review with meta-analysis of studies identified through Pubmed, Embase, LILACS and Cochrane databases published up to 2016. INCLUSION CRITERIA: Randomized controlled trials; patients aged between 1 and 18 years and diagnosed with functional constipation receiving or not drug treatment for constipation; articles published in Portuguese, English, Spanish, French, and German in journals accessible to the researchers. SYNTHESIS OF DATA: A total of 2963 articles were retrieved during the search and, after adequate evaluation, nine articles were considered relevant to the study objective. A total of 680 children were included, of whom 45% were boys. No statistical significance was observed for bowel movement frequency, stool consistency, therapeutic success, fecal incontinence, and abdominal pain with fiber intake in patients with childhood constipation. These results should be interpreted with care due to the high clinical heterogeneity between the studies and the methodological limitation of the articles selected for analysis. CONCLUSIONS: There is a scarcity of qualified studies to evaluate fiber supplementation in the treatment of childhood constipation, generating a low degree of confidence in estimating the real effect of this intervention on this population. Today, according to the current literature, adequate fiber intake should only be recommended for functional constipation, and fiber supplementation should not be prescribed in the diet of constipated children and adolescents.