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1.
J. bras. pneumol ; 48(1): e20210393, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360541

ABSTRACT

ABSTRACT Objective: Studies in the literature regarding the use of remdesivir to treat COVID-19 patients have shown conflicting results. This study sought to answer questions related to the use of remdesivir for the treatment of patients hospitalized with moderate to severe COVID-19. Methods: This was a systematic review and meta-analysis including phase 3 randomized clinical trials (RCTs) and observational cohort studies selected from various databases, comparing patients hospitalized with moderate to severe COVID-19 receiving remdesivir and controls. Results: A total of 207 studies were retrieved, 9 of which met the eligibility criteria and were included in the study. The meta-analysis using RCTs alone showed no statistically significant differences regarding mortality or use of mechanical ventilation/extracorporeal membrane oxygenation between remdesivir and control groups, and the quality of evidence was moderate and low, respectively. The use of remdesivir increased the recovery rate by 6% (95% CI, 3-9); p = 0.004) and the clinical improvement rate by 7% (95% CI, 1-14); p = 0.02). Additionally, no significant differences in mortality were found between remdesivir and control groups when the meta-analysis used observational cohort studies alone (risk difference = −0.01 (95% CI, −0.02 to 0.01; p = 0.32), the quality of evidence being moderate, and the risk of adverse events was 4% ([95% CI, −0.08 to 0.01]; p = 0.09). Conclusions: The use of remdesivir for the treatment of patients with moderate to severe COVID-19 had no significant impact on clinically important outcomes.


RESUMO Objetivo: Estudos na literatura sobre o uso de remdesivir no tratamento de pacientes com COVID-19 têm apresentado resultados divergentes. O objetivo deste estudo foi responder a perguntas a respeito do uso de remdesivir no tratamento de pacientes hospitalizados com COVID-19 moderada a grave. Métodos: Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos controlados randomizados (ECR) de fase 3 e estudos observacionais de coorte recuperados de diversos bancos de dados, comparando pacientes hospitalizados com COVID-19 moderada a grave recebendo remdesivir a controles. Resultados: Foram recuperados 207 estudos, dos quais 9 preencheram os critérios de elegibilidade e foram incluídos no estudo. A meta-análise somente dos ECR não mostrou diferenças estatisticamente significativas entre os grupos remdesivir e controle quanto à mortalidade ou ao uso de ventilação mecânica/oxigenação por membrana extracorpórea, e a qualidade das evidências foi moderada e baixa, respectivamente. O uso de remdesivir aumentou a taxa de recuperação em 6% (IC95%: 3-9; p = 0,004) e a taxa de melhora clínica em 7% (IC95%: 1-14; p = 0,02). Além disso, não foram observadas diferenças significativas entre os grupos remdesivir e controle quanto à mortalidade quando a meta-análise concentrou-se apenas nos estudos observacionais de coorte [diferença de risco = −0,01 (IC95%: −0,02 a 0,01); p = 0,32; qualidade das evidências: moderada], e o risco de eventos adversos foi de 4% (IC95%: −0,08 a 0,01; p = 0,09). Conclusões: O uso de remdesivir no tratamento de pacientes com COVID-19 moderada a grave não teve impacto significativo em desfechos clinicamente importantes.


Subject(s)
Humans , COVID-19/drug therapy , Antiviral Agents/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Treatment Outcome , Alanine/analogs & derivatives , Observational Studies as Topic , SARS-CoV-2
2.
Int. braz. j. urol ; 47(4): 705-729, Jul.-Aug. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1286767

ABSTRACT

ABSTRACT Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.

3.
J. bras. pneumol ; 47(5): e20210236, 2021. tab, graf
Article in English | LILACS | ID: biblio-1346405

ABSTRACT

ABSTRACT Objective: Chloroquine or hydroxychloroquine has demonstrated no effect on the treatment of hospitalized COVID-19 patients. This study aimed to answer questions related to the use of hydroxychloroquine for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection and in the treatment of patients with mild COVID-19 in terms of hospitalization, adverse events, and mortality. Methods: This was a systematic review and meta-analysis of phase 3 randomized clinical trials, selected from various databases, which compared patients who received hydroxychloroquine for SARS-CoV-2 prophylaxis or treatment of mild COVID-19 cases with controls. Results: A total number of 1,376 studies were retrieved. Of those, 9 met the eligibility criteria and were included in the study. No statistically significant differences were found between the hydroxychloroquine and control groups in terms of pre- or post-exposure prophylaxis of SARS-CoV-2 infection. The use of hydroxychloroquine increased the risk of adverse events by 12% (95% CI, 6-18%; p < 0.001), and the number needed to harm was 9. In addition, no significant differences were found between the hydroxychloroquine and control groups regarding hospitalization (risk difference [RD] = −0.02; 95% CI, −0.04 to 0.00; p = 0.14) or mortality (RD = 0.00; 95% CI, −0.01 to 0.02; p = 0.98) in the treatment of mild COVID-19. Conclusions: The use of hydroxychloroquine for prophylaxis of SARS-CoV-2 infection or treatment of patients with mild COVID-19 is not recommended.


RESUMO Objetivo: A cloroquina ou hidroxicloroquina não apresentou nenhum efeito no tratamento de pacientes hospitalizados com COVID-19. O objetivo deste estudo foi responder a questões a respeito do uso de hidroxicloroquina na profilaxia da infecção por SARS-CoV-2 pré ou pós-exposição e no tratamento de pacientes com COVID-19 leve no tocante à hospitalização, eventos adversos e mortalidade. Métodos: Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos controlados aleatórios de fase 3 que foram selecionados por meio de buscas em diversos bancos de dados e que compararam controles e pacientes que receberam hidroxicloroquina para profilaxia de SARS-CoV-2 ou tratamento de COVID-19 leve. Resultados: Foram identificados 1.376 estudos. Destes, 9 preencheram os critérios de elegibilidade e foram incluídos no estudo. Não foram encontradas diferenças significativas entre os grupos hidroxicloroquina e controle quanto à profilaxia da infecção por SARS-CoV-2 pré ou pós-exposição. O uso de hidroxicloroquina aumentou o risco de eventos adversos em 12% (IC95%: 6-18%; p < 0,001), e o número necessário para prejudicar foi 9. Não foram encontradas diferenças significativas entre os grupos hidroxicloroquina e controle quanto à hospitalização [diferença de risco (DR) = −0,02; IC95%: −0,04 a 0,00; p = 0,14] e mortalidade (DR = 0,00; IC95%: −0,01 a 0,02; p = 0,98) no tratamento de COVID-19 leve. Conclusões: Não é recomendado o uso de hidroxicloroquina nem na profilaxia da infecção por SARS-CoV-2 nem no tratamento de pacientes com COVID-19 leve.


Subject(s)
Humans , Coronavirus Infections , COVID-19/drug therapy , SARS-CoV-2 , Hydroxychloroquine/therapeutic use
4.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1468-1471, Nov. 2020.
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143647

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Amyloidosis/drug therapy , Antibodies, Monoclonal/therapeutic use , Brazil
5.
Rev. Assoc. Med. Bras. (1992) ; 66(9): 1172-1178, Sept. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136362

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Encephalitis , Hashimoto Disease , Brazil
6.
Rev. Assoc. Med. Bras. (1992) ; 65(5): 578-585, May 2019.
Article in English | LILACS | ID: biblio-1012969

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Laparoscopy/methods , Adrenalectomy/methods , Peritoneum/surgery , Retroperitoneal Space/surgery , Reproducibility of Results , Treatment Outcome , Laparoscopy/standards , Adrenal Gland Neoplasms/surgery , Adrenalectomy/standards
7.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 535-540, Apr. 2019.
Article in English | LILACS | ID: biblio-1003065

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Cystitis, Interstitial/drug therapy , Pentosan Sulfuric Polyester/therapeutic use , Administration, Intravesical , Brazil , Dimethyl Sulfoxide/therapeutic use , Chondroitin Sulfates/therapeutic use , Treatment Outcome , Botulinum Toxins, Type A/therapeutic use , Diterpenes/therapeutic use , Clinical Decision-Making , Hyaluronic Acid/therapeutic use , Lidocaine/therapeutic use , Mycobacterium bovis
8.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 509-517, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003064

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize procedures to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Female , Ovarian Neoplasms/diagnostic imaging , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/methods , Neoplasm Recurrence, Local/diagnostic imaging , Brazil , Reproducibility of Results , Sensitivity and Specificity , Clinical Decision-Making
9.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 568-575, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003063

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Female , Uterine Cervical Neoplasms/diagnostic imaging , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/methods , Brazil , Magnetic Resonance Imaging , Uterine Cervical Neoplasms/pathology , Sensitivity and Specificity , Clinical Decision-Making , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Staging
10.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 487-492, Apr. 2019.
Article in English | LILACS | ID: biblio-1003062

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Thiazoles/administration & dosage , Muscarinic Antagonists/administration & dosage , Urinary Bladder, Overactive/drug therapy , Adrenergic beta-3 Receptor Agonists/administration & dosage , Acetanilides/administration & dosage , Pyrrolidines/administration & dosage , Benzilates/administration & dosage , Benzofurans/administration & dosage , Brazil , Drug Therapy, Combination , Tolterodine Tartrate/administration & dosage , Solifenacin Succinate/administration & dosage , Clinical Decision-Making , Mandelic Acids/administration & dosage , Antidepressive Agents/administration & dosage , Nortropanes/administration & dosage
11.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 518-523, Apr. 2019. tab
Article in English | LILACS | ID: biblio-1003060

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Female , Pelvis/blood supply , Varicose Veins/therapy , Pelvic Pain/therapy , Embolization, Therapeutic/methods , Syndrome , Brazil , Reproducibility of Results , Treatment Outcome , Chronic Pain , Clinical Decision-Making
12.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 530-534, Apr. 2019.
Article in English | LILACS | ID: biblio-1003055

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Psoriasis/drug therapy , Dermatologic Agents/administration & dosage , Immunosuppressive Agents/administration & dosage , Antibodies, Monoclonal/administration & dosage , Psoriasis/pathology , Time Factors , Severity of Illness Index , Brazil , Methotrexate/administration & dosage , Methotrexate/adverse effects , Treatment Outcome , Cyclosporine/administration & dosage , Cyclosporine/adverse effects , Acitretin/administration & dosage , Acitretin/adverse effects , Dermatologic Agents/adverse effects , Clinical Decision-Making , Immunosuppressive Agents/adverse effects , Antibodies, Monoclonal/adverse effects
13.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 493-508, Apr. 2019. tab
Article in English | LILACS | ID: biblio-1003057

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Psoriasis/drug therapy , Etanercept/administration & dosage , Immunologic Factors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Psoriasis/pathology , Time Factors , Severity of Illness Index , Brazil , Risk Factors , Treatment Outcome , Etanercept/adverse effects , Clinical Decision-Making , Immunologic Factors/adverse effects , Antibodies, Monoclonal/adverse effects
14.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 295-315, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003028

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Workplace/psychology , Depressive Disorder/diagnosis , Depressive Disorder/therapy , Occupational Diseases/psychology , Psychiatric Status Rating Scales , Brazil , Mass Screening/standards , Surveys and Questionnaires , Risk Factors , Early Diagnosis , Clinical Decision-Making , Occupational Diseases/diagnosis , Occupational Diseases/therapy
15.
Rev. Assoc. Med. Bras. (1992) ; 65(2): 100-104, Feb. 2019.
Article in English | LILACS | ID: biblio-990322

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Male , Female , Biopsy/methods , Laparoscopy/methods , Kidney/pathology , Kidney Diseases/pathology , Retroperitoneal Space , Tomography, Emission-Computed , Practice Guidelines as Topic , Kidney Diseases/diagnostic imaging
16.
Rev. Assoc. Med. Bras. (1992) ; 64(12): 1061-1068, Dec. 2018. tab
Article in English | LILACS | ID: biblio-976822

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Kidney Transplantation/methods , Living Donors , Nephrectomy/methods , Evidence-Based Medicine , Nephrectomy/standards
17.
Rev. Assoc. Med. Bras. (1992) ; 64(11): 963-982, Nov. 2018. tab
Article in English | LILACS | ID: biblio-976806

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Male , Female , Adult , Aged , Deep Brain Stimulation/methods , Depressive Disorder/therapy , Obsessive-Compulsive Disorder/therapy , Brazil , Treatment Outcome , Evidence-Based Medicine , Middle Aged
18.
Rev. Assoc. Med. Bras. (1992) ; 64(10): 876-881, Oct. 2018. tab
Article in English | LILACS | ID: biblio-976785

ABSTRACT

SUMMARY The minimally invasive procedures (mips) for the treatment of symptoms of benign prostatic hyperplasia (bph) are presented as attractive techniques due to their ease of accomplishment and the possibility of outpatient treatment. This guideline aims to present recommendations that may assist in decision making in patients with benign prostatic hyperplasia and indication of the different minimally invasive therapies. For this, a systematic review of the literature was performed, with the descriptors according to the pico: patient with benign prostatic hyperplasia, minimally invasive therapy, clinical outcome and adverse events. With no time restriction, in medline, cochrane central and lilacs databases via vhl, 1,007 papers were retrieved, of which 16 were selected to respond to clinical doubt. Details of the methodology and results of this guideline are set out in annex I


Subject(s)
Humans , Male , Prostatic Hyperplasia/surgery , Minimally Invasive Surgical Procedures/methods , Urinary Tract/surgery , Urination Disorders/surgery , Practice Guidelines as Topic , Minimally Invasive Surgical Procedures/classification , Minimally Invasive Surgical Procedures/adverse effects , Evidence-Based Medicine
19.
Rev. Assoc. Med. Bras. (1992) ; 64(9): 778-782, Sept. 2018. tab
Article in English | LILACS | ID: biblio-976852

ABSTRACT

SUMMARY Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.


RESUMO Hérnias discais lombares são manifestações comuns das doenças degenerativas da coluna, sendo a principal causa de dor lombar irradiada. Esta diretriz seguiu padrão de uma revisão sistemática com recuperação de evidências com base no movimento da Medicina Baseada em Evidências. Utilizamos a forma estruturada de formular a pergunta sintetizada pelo acrônimo P.I.C.O., em que o P corresponde à Hérnia de disco lombar, I à intervenção Tratamento com hidrodiscectomia percutânea, C comparando com Outras modalidades de tratamento, O de desfecho de Evolução clínica e complicações. A partir da pergunta estruturada, identificamos os descritores que constituíram a base da busca da evidência nas bases de dados Medline-PubMed (636 trabalhos) e, assim, após os critérios de elegibilidade (inclusão e exclusão), oito trabalhos foram selecionados para responder à dúvida clínica. Os detalhes da metodologia e dos resultados desta diretriz estão expostos no Anexo I.


Subject(s)
Humans , Diskectomy, Percutaneous/methods , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/surgery , Low Back Pain/surgery , Evidence-Based Medicine , Lumbar Vertebrae/surgery
20.
Rev. Assoc. Med. Bras. (1992) ; 64(7): 568-574, July 2018. tab
Article in English | LILACS | ID: biblio-976836

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Colorectal Neoplasms/drug therapy , Panitumumab/therapeutic use , Antineoplastic Agents/therapeutic use , Colorectal Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Practice Guidelines as Topic , Clinical Trials, Phase III as Topic , Evidence-Based Medicine
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