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ABSTRACT Objective: To compare the presence of neutralizing antibodies against SARS-CoV-2 found in the breast milk and blood of vaccinated lactating women with those not vaccinated. Data source: The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42021287554 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort, case-control, and cross-sectional studies that evaluated antibodies against SARS-CoV-2 in the milk and blood of vaccinated mothers and had as control group unvaccinated mothers were eligible. Health Sciences Descriptors (DeCs), Medical Subject Headings (MeSH) and Emtree descriptors were used for the Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System Online (Medline/Pubmed), and Embase databases, respectively. In the Web of Science and Scopus, the strategy was adapted. No restrictions on the publication period and language were set. Data synthesis: The search identified 233 records, of which 128 duplicates and 101 papers that did not meet the inclusion criteria were excluded. Hence, four cohort studies were eligible. Nursing mothers vaccinated with the Pfizer-BioNTech and Moderna vaccines showed antibodies against SARS-CoV-2 in their blood and breast milk. Conclusions: Vaccinated lactating women had higher levels of immunoglobulin G (IgG) and A (IgA) in serum and breast milk than unvaccinated women.
RESUMO Objetivo: Comparar a presença de anticorpos neutralizantes contra o SARS-CoV-2 no leite materno e no sangue das lactantes vacinadas em relação àquelas não vacinadas. Fontes de dados: Foi efetuado registro no International Prospective Register of Systematic Reviews — PROSPERO (CRD42021287554) e foram seguidas as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Foram elegíveis estudos de coorte, caso-controle e transversais que avaliaram anticorpos contra o SARS-CoV-2 no leite e no sangue de lactantes vacinadas e tiveram como grupo controle lactantes não vacinadas. Utilizaram-se os Descritores em Ciências da Saúde (DeCs), Medical Subject Heading (MeSH) e Emtree para as bases Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online (Medline/PubMed) e Embase, respectivamente. Na Web of Science e Scopus foi feita adaptação da estratégia. Não foram estabelecid as restrições quanto ao período de publicação e idioma. Síntese dos dados: As buscas identificaram 233 registros. Foram excluídos 128 duplicados e 101 fora dos critérios de inclusão, e quatro estudos de coorte foram elegíveis. As lactantes vacinadas com Pfizer-BioNTech e Moderna apresentaram anticorpos contra SARS-CoV-2 no sangue e no leite materno. Conclusões: As mulheres lactantes vacinadas apresentaram níveis mais elevados de imunoglobulina G (IgG) e A (IgA) no soro e no leite materno em comparação com as mulheres não vacinadas.
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Resumen Objetivo: El objetivo de esta revisión sistemática con metaanálisis es sintetizar la evidencia científica disponible sobre los efectos de la terapia manual aplicada de forma aislada en comparación a otras intervenciones en el dolor, la capacidad funcional, la impresión global de mejoría y severidad de síntomas autopercibida en personas con fibromialgia. Metodología: Se realizó una revisión sistemática y metaanálisis con búsqueda electrónica en MEDLINE, WoS, SCOPUS, PEDro, CENTRAL y LILACS. Resultados: Once estudios cumplieron con los criterios de selección y seis fueron incluidos en una síntesis cuantitativa. El dolor al terminar el tratamiento tuvo una diferencia de medias de -0.42 (IC al 95% -1.14, 0.30, p = 0.25), el estado funcional al terminar el tratamiento tuvo una diferencia de medias de -0.15 (IC al 95% -0.69, 0.40, p = 0.60), la impresión global de salud al terminar el tratamiento tuvo una diferencia de media de -1.13 (IC al 95% -1.68, -0.57 p = <0.00) y posterior a doce meses una diferencia de media de -0.48 (IC al 95% -0.78, -0.19 p = <0.00), la impresión global de severidad después de la intervención tuvo una diferencia de medias de -0.62 (IC al 95% -1.22, -0.03, p = 0.04) y posterior a doce meses una diferencia de medias de -0.43 (IC al 95% -1.18, 0.32, p = 0.26). Conclusiones: La terapia manual aislada es una intervención que podría mejorar significativamente la autopercepción del estado global de mejoría y severidad de síntomas a corto plazo en comparación a agentes físicos placebo. Sin embargo, no es mejor que otras intervenciones para disminuir el dolor y mejorar la capacidad funcional.
Abstract Objective: The aim of this systematic review with meta-analysis is to synthesize the available scientific evidence on the effects of manual therapy applied in isolation in comparison to other interventions on pain, functional capacity, global impression of improvement, and self-perceived severity of symptoms in people with fibromyalgia. Methodology: A systematic review with meta-analysis was conducted with electronic search of MEDLINE, WoS, SCOPUS, PEDro, CENTRAL, and LILACS. Results: Eleven studies met the selection criteria and six were included in a quantitative synthesis. Pain at the end of treatment had a mean difference of -0.42 (95% CI -1.14, 0.30, p = 0.25), functional status at the end of treatment had a mean difference of -0.15 (95% CI - 0.69, 0.40, p = 0.60), the global impression of health at the end of treatment had a mean difference of -1.13 (95% CI -1.68, -0.57 p = <0.00) and a mean difference of -0.48 after twelve months (95% CI -0.78, -0.19 p = <0.00), the global impression of severity after the intervention had a mean difference of -0.62 (95% CI -1.22, -0.03, p = 0.04 ) and a mean difference of -0.43 after twelve months (95% CI -1.18, 0.32, p = 0.26). Conclusions: Isolated manual therapy is an intervention that could significantly improve the self-perception of the global state of improvement and severity of symptoms in the short term compared to sham physical agents. However, it is not better than other interventions to reduce pain and improve functional capacity.
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La importancia de la motivación académica en la educación universitaria, ha sido de gran interés en la investigación educativa, dado que se encuentra a la base del éxito académico, al estar relacionada con la autorregulación del aprendizaje. Por ello, esta revisión sistemática tiene por objetivo analizar los hallazgos de la producción científica relacionada con la motivación académica en la educación superior, publicada entre los últimos 5 años (2016-2021) en las bases de datos Web of Science, Scopus y SciELO, con el fin de orientar la toma de decisiones en los procesos educativos de la educación superior. El método corresponde a una revisión sistemática, de corte cualitativo, de análisis documental definidas en categorías y subcategorías emergentes. Los principales hallazgos indican que existe gran interés por abordar la motivación académica a partir de diferentes tipos de estudio metodológicos como son los descriptivos, relaciones/correlaciones, perfiles con análisis de conglomerados, modelos de ecuaciones estructurales. También, se encuentran, aunque en menor medida, investigaciones sobre creación y validación de instrumentos para medir la motivación académica en la educación superior. Se cree que los resultados de esta revisión pueden constituir un aporte a la elaboración de nuevas propuestas de constructos teóricos e instrumentos sobre motivación académica para la formación universitaria.
The importance of academic motivation in university education has been of great interest in educational research, since it is at the base of academic success, as it is related to self-regulation of learning. Therefore, this systematic review aims to analyze the findings of the scientific production related to academic motivation in higher education, published between the last 5 years (2016-2021) in the Web of Science, Scopus and SciELO databases. in order to guide decision-making in the educational processes of higher education. The method corresponds to a systematic, qualitative review of documentary analysis defined in emerging categories and subcategories. The main findings indicate that there is great interest in addressing academic motivation from different types of methodological study such as descriptive, relationships/correlations, profiles with cluster analysis, structural equation models. There is also, although to a lesser extent, research on the creation and validation of instruments to measure academic motivation in higher education. It is believed that the results of this review may constitute a contribution to the development of new proposals for theoretical constructs and instruments on academic motivation for university education.
A importância da motivação académica no ensino universitário tem sido de grande interesse nas pesquisas educacionais, tendo em vista que ela está na base do sucesso académico, pois está relacionada à autorregulação da aprendizagem. Portanto, esta revisão sistemática tem como objetivo analisar os achados da produção científica relacionada à motivação acadêmica no ensino superior, publicados entre os últimos 5 anos (2016-2021) nas bases de dados Web of Science, Scopus e SciELO, a fim de orientar a tomada de decisão nos processos educacionais no ensino superior. O método corresponde a uma revisão sistemática, qualitativa, de análise documental definida em categorias e subcategorias emergentes. Os principais resultados indicam que existe um grande interesse em abordar a motivação académica a partir de diferentes tipos de estudos metodológicos, tais como estudos descritivos, relações/correlações, perfis com análise de clusters e modelos de equações estruturais. Existe também, embora em menor escala, investigação sobre a criação e validação de instrumentos de medida da motivação académica no ensino superior. Acredita-se que os resultados desta revisão possam constituir um contributo para o desenvolvimento de novas propostas de constructos teóricos e de instrumentos sobre motivação académica para o ensino universitário.
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Abstract Varicella-zoster virus infections have increased glob ally, with complications such as postherpetic neuralgia and neurological sequelae. The recombinant vaccine against herpes zoster is proposed as a preventive strat egy. This systematic review evaluates its effectiveness and safety in healthy and high-risk populations. A sys tematic review of randomized controlled trials com paring the effectiveness and safety of the vaccine was conducted. The search was carried out in Epistemonikos. Two researchers independently assessed the eligibility of the studies and the risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A meta-analysis of ho mogeneous results was conducted, and the certainty of the evidence was evaluated using GRADE. A minimally contextualized approach was adopted using predeter mined thresholds. Nine randomized controlled trials were selected. The vaccine demonstrated a significant reduction in the incidence of herpes zoster in high-risk populations (risk difference of 140 fewer per 1000) with high certainty. However, in healthy populations, the effect was trivial (28 fewer per 1000). No significant dif ferences were observed in postherpetic neuralgia in any of the populations analyzed. Adverse events increased in both populations, though no discrepancies in serious adverse events were noted. In high-risk populations, where the incidence of herpes zoster and its complica tions is higher, the vaccine demonstrated effectiveness in lowering the incidence of the disease, though not in that of postherpetic neuralgia. Conversely, in healthy populations, the impact of the vaccine was trivial. Indi vidualized and informed recommendations are crucial when considering this vaccine.
Resumen Las infecciones por el virus de la varicela-zóster han aumentado globalmente, con complicaciones como neu ralgia postherpética y secuelas neurológicas. La vacuna recombinante contra el herpes zóster se propone como estrategia preventiva. Esta revisión sistemática evalúa su efectividad y seguridad en poblaciones sanas y de alto riesgo. Se realizó una revisión sistemática de ensayos controlados aleatorios que comparaban la efectividad y seguridad de la vacuna. La búsqueda se efectuó en Epistemonikos. Dos investigadores evaluaron indepen dientemente la elegibilidad de los estudios y se evaluó el riesgo de sesgo con la herramienta Cochrane Risk of Bias 2. Se realizó un metanálisis de resultados homogéneos y se evaluó la certeza de la evidencia mediante GRADE. Se adoptó un enfoque mínimamente contextualizado utilizando umbrales predeterminados. Se seleccionaron 9 ensayos controlados aleatorios. La vacuna demostró una reducción significativa en la incidencia de herpes zóster en poblaciones de alto riesgo (diferencia de riesgo de 140 menos por 1000) con alta certeza. Sin embargo, en poblaciones sanas, el efecto fue trivial (28 menos por 1000). No se observaron diferencias significativas en la incidencia de neuralgia postherpética en ninguna de las poblaciones. En cuanto a la seguridad, se registró un aumento de eventos adversos en ambas poblaciones, aunque no se presentaron diferencias en los eventos adversos graves. En poblaciones de alto riesgo, donde la incidencia de herpes zóster y sus complicaciones es más alta, la vacuna demostró eficacia en la reducción de la inciden cia de la enfermedad, aunque no en la de la neuralgia postherpética. Por otro lado, en población sana, el impac to de la vacuna fue trivial. Es crucial adoptar un enfoque individualizado e informado al recomendar esta vacuna.
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Introducción. Las lesiones musculoesqueléticas traen consecuencias en los profesionales quirúrgicos, y más aún en cirujanos de cabeza y cuello, que conllevan gran carga de discapacidad y ausentismo laboral, ocasionando retiro temprano, restricciones o modificaciones en la práctica quirúrgica. Métodos. Se seleccionaron publicaciones de las bases de datos Pubmed, Embase y LILACS. Se incluyeron todos los estudios que midieron la prevalencia de lesiones musculoesqueléticas y la presencia de riesgo ergonómico, síntomas asociados, uso de escalas de medición y estrategias de prevención. Los efectos estimados de los estudios se mostraron con intervalo de confianza del 95 %. Resultados. Se encontraron 438 estudios. Después de la revisión, se incluyeron 7 estudios, con un total de 868 pacientes. Se estimó mediante un metaanálisis de efectos aleatorios una prevalencia del 81 %. Conclusiones. Los problemas posturales en cirujanos de cabeza y cuello tienen una prevalencia de 81 %. Esto genera un gran impacto en su salud física y mental, aumentando las incapacidades y pérdida de años laborales. Las herramientas utilizadas para la evaluación son heterogéneas y algunos estudios no incluyen datos como los años de práctica y el nivel de entrenamiento.
Introduction. Musculoskeletal injuries have consequences for surgical professionals, and even more so for head and neck surgeons, which entail a large burden of disability and absenteeism from work, causing early retirement, restrictions or modifications in surgical practice. Methods. Publications were selected from the Pubmed, Embase and LILACS databases. All studies that measured the prevalence of musculoskeletal injuries and the presence of ergonomic risk, associated symptoms, use of measurement scales and prevention strategies were included. The estimated effects of the studies were shown with a 95% confidence interval. Results. 438 studies were found. After the review, seven studies were included, with a total of 868 patients. A prevalence of 81% was estimated through a random effects meta-analysis. Conclusions. Postural problems in head and neck surgeons have a prevalence of 81%. This generates a great impact on their physical and mental health, increasing disabilities and loss of working years. The tools used for evaluation are heterogeneous and some studies do not include data such as years of practice and level of training.
Subject(s)
Humans , Meta-Analysis , Musculoskeletal Pain , Systematic Review , Risk , Surgeons , Head , NeckABSTRACT
Abstract This article aims to analyze the prevalence of reporting and notification of violence in children and adolescents in the work of clinical health professionals. The search was performed in six electronic databases and the gray literature for studies published until June 1, 2022. Estimates of interest were calculated using random effects meta-analyses. Two reviewers independently evaluated the potentially eligible studies according to the following criteria: cross-sectional studies carried out with health professionals who provided clinical care for children and adolescents and dealt with violence cases. Two reviewers extracted data on included trial characteristics, methods, and outcomes. Expectations of interest were transformed using random effects meta-analyses. The meta-analysis of the prevalence of reports of violence performed with 42 articles was 41%. The notification meta-analysis occurred with 39 articles and was 30%. About one in two health professionals face situations of violence against children and adolescents in their clinical practice (41%), and approximately one in three health professionals report the cases (30%).
Resumo O objetivo do artigo é analisar a prevalência de relato e notificação de violência em crianças e adolescentes no trabalho de profissionais clínicos da saúde. A busca foi realizada em seis bases de dados eletrônicas e na literatura cinzenta para estudos publicados até 1º de junho de 2022. As estimativas de interesse foram calculadas usando meta-análises de efeitos aleatórios. Dois revisores avaliaram de maneira independente os estudos potencialmente elegíveis de acordo com os seguintes critérios: estudos transversais com profissionais da saúde que prestavam atendimentos clínicos voltados a crianças e adolescentes e que se depararam com casos de violência. Dois revisores extraíram dados sobre as características dos estudos incluídos, métodos e resultados. As estimativas de interesse foram calculadas usando meta-análises de efeitos aleatórios. A meta-análise de prevalência de relato de violência realizada com 42 artigos foi de 41%. A meta-análise da notificação ocorreu com 39 artigos e foi de 30%. Aproximadamente um a cada dois profissionais da saúde se deparam com situações de violência contra crianças e adolescentes em sua prática clínica (41%) e cerca de um a cada três profissionais da saúde notificam os casos (30%).
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Resumen En Argentina, el virus del dengue ha experimentado un aumento en los últimos años. Este estudio se propone realizar una revisión sistemática para evaluar la efec tividad y seguridad de la vacuna TAK-003 tetravalente contra el dengue en este contexto. Se llevó a cabo una revisión sistemática de ensayos clínicos controlados aleatorizados que comparaban la efectividad y seguridad de la vacuna con placebo en la población general. La búsqueda se efectuó en Episte monikos y dos investigadores evaluaron los estudios de manera independiente. El riesgo de sesgo se evaluó con la herramienta Rob 2 de Cochrane. Se realizó un metaa nálisis de los resultados y la certeza en la evidencia se evaluó mediante la metodología GRADE. Concluimos, con alta certeza de evidencia, que la vacuna tetravalente contra el dengue reduce las infec ciones graves (RR 0.17, IC 95% 0.12 a 0.24) e infecciones por el virus del dengue (RR 0.40, IC 95% 0.36 a 0.45) en una población de ≤17 años. La vacuna podría no incre mentar el riesgo de eventos adversos serios, aunque es importante destacar la baja certeza de evidencia (RR 1.04, IC 95%: 0.69-1.55). La aplicación de la vacuna tetravalente contra el dengue disminuye el riesgo de infecciones graves y no graves por el dengue en esa población. No obstante, existe baja certeza en la evidencia en relación a la se guridad de la vacuna. La decisión de la vacunación debe considerar la magnitud de los beneficios en función del riesgo de infección.
Abstract In Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to assess the effectiveness and safety of the tetravalent dengue vaccine TAK-003 in this context. A systematic review of randomized controlled clini cal trials comparing the effectiveness and safety of the vaccine with a placebo in the general population was conducted. The search was carried out on Epistemoni kos, and two investigators independently evaluated the studies. Bias risk was assessed using Cochrane's Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was evaluated using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the den gue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population aged ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine's safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.
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Abstract Extracellular vesicles (EV) are spherical structures limited by membranes and shed by several cell types. Specifically, outer membrane vesicles (OMVs) are nanometric particles constitutively produced by Gram-negative bacteria (GNB) under different environmental conditions. OMVs are biologically active; they are loaded with selected lipids, polysaccharides, proteins, and even different types of nucleic acids. OMVs from pathogenic oral bacteria play key roles in pathogen-host interactions, constituting a possible link between oral health and systemic disease. OMVs participate in adhesion, invasion, and damage to cells, as well as in modulating the host's immune response, biofilm formation, and promotion of virulence. The objective of this systematic review was to collect, analyze and synthesize the knowledge available on literature reviews on OMVs of the most studied pathogenic oral anaerobic GNB. This information was classified into the following categories: induction of vesiculation and biogenesis, its liberation from the parental cell, content, internalization by another host cell, and the interaction with the host cell. It was found that the most studied OMVs are those of Porphyromonas gingivalis and Bacteroides spp. and, to a lesser extent, Aggregatibacter spp., and Treponema spp. This systematic review provides a synthesis of the current knowledge regarding OMVs, with emphasis on the information available for periodontopathogens.
Resumen Las vesículas extracelulares (EV) son estructuras esféricas delimitadas por membranas y producidas por varios tipos de células. En particular, las vesículas de membrana externa (OMV) son partículas nanométricas producidas constitutivamente por bacterias Gram negativas (GNB) en diferentes condiciones ambientales. Las OMV son biológicamente activas; están cargadas de lípidos, polisacáridos, proteínas e incluso diferentes tipos de ácidos nucleicos. Las OMV de bacterias orales patógenas desempeñan papeles clave en las interacciones patógeno-hospedero, constituyendo un posible vínculo entre la salud oral y las enfermedades sistémicas. Las OMV participan en la adhesión, la invasión y el daño celular, así como en la modulación de la respuesta inmunitaria del hospedero, la formación de biopelículas y la promoción de la virulencia. El objetivo de esta revisión sistemática era recopilar, analizar y sintetizar los conocimientos disponibles sobre las OMV de las GNB anaerobias orales patógenas más estudiadas. Esta información se clasificó en las siguientes categorías: inducción de la vesiculación y biogénesis, su liberación de la célula parental, contenido, internalización por otra célula hospedadora e interacción con la célula hospedadora. Se observó que las OMV más estudiadas son las de Porphyromonas gingivalis y Bacteroides spp. y, en menor medida, Aggregatibacter spp. y Treponema spp. Esta revisión sistemática ofrece una síntesis de los conocimientos actuales sobre las OMV, haciendo hincapié en la información disponible para los periodontopatógenos.
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RESUMEN Bajo el término neuropatía periférica se agrupan condiciones muy variadas y complejas que presentan dificultades para su abordaje diagnóstico y terapéutico. Uno de los factores que se encuentran en la base de esas entidades es el déficit de las vitaminas neurotróficas B1, B6 y B12. Dado los extremos oscuros o mal conocidos de este asunto y el empirismo con el que se han utilizado los recursos terapéuticos, se ha realizado una búsqueda exhaustiva de la literatura intentando ordenar y basar en evidencia científica las ideas y puntos conflictivos que han presidido la aproximación al tema por parte de los profesionales concernidos por él. Este estudio sirve de base a un intento de consenso de expertos que promueva una serie de recomendaciones que racionalicen y faciliten el manejo del tema en la práctica clínica.
ABSTRACT The term peripheral neuropathy includes very varied and complex conditions that present difficulties in their diagnostic and therapeutic approach. One of the factors underlying these entities is the deficiency of neurotrophic vitamins B1, B6 and B12. Given the uncertainity and poorly known extremes of this subject and the empirical approach when using the therapeutic resources, a systematic search of the literature has been carried out trying to organize and base on scientific evidence the ideas and conflicting points that have presided over the approach to the issue by the professionals concerned by it. This study serves as the basis for an attempt at expert consensus that promotes a series of recommendations that rationalize and facilitate the management of the issue in clinical practice.
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Objetivo: Analisar as evidências sobre o efeito dos agentes tópicos empregados para a prevenção da radiodermatite em pacientes com câncer. Método: Revisão sistemática de estudos clínicos randomizados duplos-cegos construída conforme recomendações do Joanna Briggs Institute e busca nas bases de dados MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase, Scopus, além da literatura cinzenta. Utilizaram-se a ferramenta de avaliação crítica do JBI para ensaios clínicos randomizados para avaliar a possibilidade de viés, o Grading of Recommendations, Assessment, Development and Evaluation para a qualidade das evidências e o Gradepro® para recomendá-las. Resultados: Selecionaram-se 13 estudos que avaliaram diferentes agentes tópicos para prevenir a radiodermatite, a saber: corticosteroides, de ação antioxidante e fitoterápicos. A qualidade metodológica de cada estudo foi apropriada, mas a qualidade da evidência gerada pela reunião deles foi baixa, independentemente do tipo de agente tópico empregado, sugerindo que a confiança no seu efeito é limitada e tornando a força de recomendação fraca. Conclusão: Alguns agentes tópicos mostraram-se promissores para a prevenção de radiodermatite, mas as evidências aqui reunidas sobre a eficácia deles não permitem indicar seu uso para a prevenção de radiodermatite em pacientes com câncer. (AU)
Objective: To analyze the evidence on the effect of topical agents to prevent radiodermatitis in cancer patients. Methods: Systematic review of double-blind randomized clinical studies built according to JBI recommendations and search in the databases MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase and Scopus, in addition to the Gray Literature. The JBI critical assessment tool for randomized clinical trials was used to assess the possibility of bias, GRADE for the quality of evidence, and Gradepro® to recommend them. Results: Thirteen studies were selected that evaluated different topical agents to prevent radiodermatitis, namely: corticosteroids, with antioxidant action and herbal medicines. The methodological quality of each study was appropriate. Still, the quality of evidence generated by pooling them was low, regardless of the type of topical agent employed, suggesting that confidence in its effect is limited and weakening the strength of the recommendation. Conclusions: Some topical agents have shown promise for the prevention of radiodermatitis, but the evidence gathered here about their effectiveness does not indicate their use for the prevention of radiodermatitis in cancer patients. (AU)
Objetivo: Analizar la evidencia sobre el efecto de los agentes tópicos utilizados para la prevención de la radiodermatitis en pacientes con cáncer. Método: Revisión sistemática de estudios clínicos aleatorizados, doble ciego, elaborados según las recomendaciones del JBI y buscados en MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase y Scopus, además de literatura gris. Se utilizó la herramienta de evaluación crítica JBI para ensayos clínicos aleatorios para evaluar la posibilidad de sesgo, GRADE para la calidad de la evidencia y Gradepro® para recomendarla. Resultados: Se seleccionaron trece estudios que evaluaron diferentes agentes tópicos para prevenir la radiodermatitis, a saber: corticosteroides, con acción antioxidante y fitoterapia. La calidad metodológica de cada estudio fue apropiada, pero la calidad de la evidencia generada al combinarlos fue baja, independientemente del tipo de agente tópico empleado, lo que sugiere que la confianza en su efecto es limitada y debilita la fuerza de la recomendación. Conclusión: Algunos agentes tópicos se han mostrado prometedores para la prevención de la radiodermatitis, pero la evidencia aquí reunida sobre su eficacia no nos permite indicar su uso para la prevención de la radiodermatitis en pacientes con cáncer. (AU)
Subject(s)
Humans , Male , Female , Radiodermatitis/prevention & control , Radiotherapy , Enterostomal TherapyABSTRACT
Intravascular Optical Coherence Tomography (OCT) has emerged advanced imaging modality in cardiology, offering high-resolution visualization of coronary artery structures. Since its inception in the late 1990s, OCT has undergone significant advancements, transitioning from time-domain to frequency-domain systems, thereby enhancing its clinical viability and diagnostic efficacy. We aimed to comprehensively assess the clinical applications and diagnostic efficacy of intravascular OCT in cardiology, particularly in guiding percutaneous coronary interventions (PCI) and evaluating coronary artery diseases. In methodology, A systematic search was conducted in PubMed and Google Scholar databases for studies published between 2013 and 2023, comparing OCT with intravascular ultrasound (IVUS) and conventional angiography (C.A.) in guiding PCI procedures. Studies were selected based on predefined inclusion and exclusion criteria, focusing on major adverse cardiovascular events (MACE), cardiac death, and revascularizations as outcomes. In results we included 28 studies from databased and 3 manuals, highlighting OCT's superior resolution in identifying thin-capped fibroatheromas (TCFAs), optimizing stent placement, and assessing plaque composition. Comparative analyses revealed no significant differences in clinical efficacy between OCT and IVUS, with both modalities showing superiority over C.A. in reducing cardiovascular events. The OCTIVUS trial further confirmed the non-inferiority of OCT-guided PCI compared to IVUS-guided PCI, with lower procedural complications reported in the OCT group. In conclusion, Intravascular OCT has revolutionized the diagnostic and interventional landscape in cardiology, offering unparalleled insights into coronary artery pathology. Its high-resolution imaging capabilities facilitate accurate plaque characterization, stent optimization, and real-time intervention guidance, thereby improving clinical outcomes in PCI procedures. Future research should focus on expanding OCT's applications and further validating its efficacy in diverse clinical settings.
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Acute complicated diverticulitis presents a more severe form of diverticular illness frequently needing urgent medical intervention and possibly surgical therapy. The aim of this review is to gather conclusive evidence from the literature comparing laparoscopic techniques to open and conservative ones in order to determine the most effective treatment plan for complicated diverticulitis. Online databases like PubMed, Google Scholar, Cochrane, Elsevier and many others were systematically searched according to an inclusion criterion to obtain a total of 13 studies to be included in the review. 8/13 studies presented short term outcomes while 5/13 studies concluded with long term outcomes following index surgeries. Based on the end results, it can be concluded that laparoscopic surgery, in particular laparoscopic colon resection is superior to other techniques in treating complicated diverticulitis in terms of fewer short-term complications, low mortality rate better quality of life with few recurrence rates. However, other approaches have their own advantages and can be given priority based on the unique presentation of each case. The clinicians are advised to make informed decisions keeping in view all the patient and disease associated aspects.
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La investigación del proceso de cambio en psicoterapia es el estudio de los procesos por los cuales ocurre el cambio en psicoterapia. Siendo la depresión una problemática con altas prevalencias y diversas complicaciones, es una tarea ineludible de los clínicos poder entender cómo ocurre el proceso de cambio en pacientes con este diagnóstico. Por ello, este estudio tiene como objetivo realizar una revisión sistemática de la literatura, para explorar y analizar la investigación empírica del proceso de cambio en psicoterapia individual en la adultez en pacientes con depresión, en los últimos diez años. La revisión se realizó en las bases de datos Web of Science, APA PsycNet, PubMed y EBSCO, siguiendo los lineamientos que señala la metodología PRISMA. Luego del proceso de tamizaje y revisión, se seleccionaron y analizaron 39 artículos. Se aprecia una clara tendencia a la utilización de metodologías mixtas de investigación, es decir, cualitativas y cuantitativas, con diseños longitudinales en casi la totalidad de estudios y una amplia gama de instrumentos para la recolección de datos. Los resultados sugieren que el proceso de cambio suele seguir un desarrollo no lineal, originando comúnmente cambios positivos profundos en áreas diversas y con trayectorias que tienden a patrones comunes.
Change process research in psychotherapy is the study of the processes by which change occurs in psychotherapy. Since depression is a problem with high prevalence and various complications, it is an unavoidable task for clinicians to be able to understand how the process of change occurs in patients with this diagnosis. Therefore, this study aims to carry out a systematic review of the literature, to explore and analyze the empirical investigation of the process of change in individual psychotherapy in adulthood in patients with depression, in the last ten years. The review was carried out in the Web of Science, APA PsycNet, PubMed and EBSCO databases, following the guidelines indicated by the PRISMA methodology. After the screening and review process, 39 articles were selected and analyzed. There is a clear tendency to use mixed research methodologies, that is, qualitative and quantitative, with longitudinal designs in almost all the studies and a wide range of instruments for data collection. The results suggest that the change process tends to follow a non-linear development, commonly causing deep positive changes in diverse areas and with trajectories that tend to common patterns.
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Objective. To determinate the educational interventions for reducing the stigma caused by HIV worldwide. Methods. This scoping review study analyzed all papers published from early 2000 to the end of 2022 by searching all the scientific databases, Scopus, Web of Science, PubMed, Cochrane, Embase and CINHAL. The quality assessment of the papers was done using the ROBIS tool checklist. Results. 31papers were admitted to the scoping review process. Stigma reduction intervention was founded on three parts: Society, health and therapeutic services providers, and the patients who had HIV and their families. The interventions included education on the reduction of fear, and shame, observation of protective standards, conducting tests and treatment at the above levels, as well as the support provided by the society, policymakers, religious leaders and families of patients in economic, psychological and cultural terms, together with the establishment of social centres and organization of campaigns. Conclusion. The stigma associated with HIV is a significant obstacle before treatment, life expectancy and living quality of patients. Therefore, the stigma associated with this disease can be reduced, and the living quality of patients can be raised using approaches such as education of healthcare service providers and afflicted people, as well as economic, social, cultural, and psychological support.
Objetivo. Determinar las intervenciones educativas para reducir el estigma causado por el VIH en todo el mundo. Métodos. Revisión de alcance en el que se analizaron los artículos publicados desde 2000 a 2022 recuperados en las bases de datos científicas Scopus, Web of Science, PubMed, Cochrane, Embase y CINHAL. La evaluación de la calidad de los artículos se realizó mediante la lista de comprobación de la herramienta ROBIS. Resultados. Se admitieron 31 artículos. Las intervenciones para la reducción del estigma se basaron principalmente en tres componentes: La sociedad, los proveedores de los servicios de salud, y los pacientes con VIH y sus familias. Las intervenciones incluyeron la educación sobre la reducción del miedo y la vergüenza, la observación de las normas de protección, la realización de pruebas y el tratamiento en los niveles de atención, así como el apoyo prestado por la sociedad, los responsables políticos, los líderes religiosos y las familias de los pacientes en términos económicos, psicológicos y culturales, junto con la creación de centros sociales y la organización de campañas. Conclusión. El estigma asociado al VIH es un obstáculo importante ante el tratamiento, la esperanza y la calidad de vida de los pacientes. Por lo tanto, es posible reducir el estigma asociado a esta enfermedad y elevar la calidad de vida de los pacientes mediante enfoques como la educación de los proveedores de servicios sanitarios y de las personas afectadas; así como el apoyo económico, social, cultural y sicológico.
Objetivo. Analisar as intervenções educacionais implementadas para reduzir o estigma relacionado ao HIV. Métodos. A revisão de escopo analisou artigos publicados de 2000 a 2022 recuperados dos bancos de dados científicos Scopus, Web of Science, PubMed, Cochrane, Embase e CINHAL. A avaliação da qualidade dos artigos foi realizada usando a lista de verificação da ferramenta ROBIS. Resultados.31 artigos foram admitidos. As intervenções para redução do estigma baseavam-se principalmente em três componentes: Sociedade, prestadores de serviços de saúde e pacientes com HIV e suas famílias. As intervenções incluíram educação sobre a redução do medo e da vergonha, adesão a normas de proteção, testagem e tratamento nos níveis de atendimento, bem como apoio fornecido pela sociedade, formuladores de políticas, líderes religiosos e familiares dos pacientes em termos econômicos, psicológicos e culturais, juntamente com a criação de centros sociais e a organização de campanhas. Conclusão. O estigma associado ao HIV é um grande obstáculo ao tratamento, à esperança e à qualidade de vida dos pacientes. Portanto, é importante reduzir o estigma associado a esta doença e aumentar a qualidade de vida dos pacientes através de abordagens como a educação dos prestadores de cuidados de saúde e das pessoas afetadas; bem como apoio económico, social, cultural e psicológico.
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Humans , Health Education , HIV , Social Stigma , Systematic ReviewABSTRACT
Resumo Fundamento A obesidade está associada ao desenvolvimento de doenças cardiovasculares e constitui um grave problema de saúde pública. Em modelos animais, a alimentação com uma dieta hiperlipídica (DH) compromete a estrutura e a função cardíaca e promove estresse oxidativo e apoptose. O treinamento resistido (TR), entretanto, tem sido recomendado como coadjuvante no tratamento de doenças cardiometabólicas, incluindo a obesidade, porque aumenta o gasto energético e estimula a lipólise. Objetivo Na presente revisão sistemática, nosso objetivo foi avaliar os benefícios do TR no coração de ratos e camundongos alimentados com DH. Métodos Foram identificados estudos originais por meio de busca nas bases de dados PubMed, Scopus e Embase de dezembro de 2007 a dezembro de 2022. O presente estudo foi conduzido de acordo com os critérios estabelecidos pelo PRISMA e registrado no PROSPERO (CRD42022369217). O risco de viés e a qualidade metodológica foram avaliados pelo SYRCLE e CAMARADES, respectivamente. Os estudos elegíveis incluíram artigos originais publicados em inglês que avaliaram desfechos cardíacos em roedores submetidos a mais de 4 semanas de TR e controlados por um grupo controle sedentário alimentado com DH (n = 5). Resultados Os resultados mostraram que o TR atenua o estresse oxidativo cardíaco, a inflamação e o estresse do retículo endoplasmático. Também modifica a atividade de marcadores de remodelamento estrutural, apesar de não alterar parâmetros biométricos, parâmetros histomorfométricos ou a função contrátil dos cardiomiócitos. Conclusão Nossos resultados indicam que o TR parcialmente neutraliza o remodelamento cardíaco adverso induzido pela DH, aumentando a atividade dos marcadores de remodelamento estrutural; elevando a biogênese mitocondrial; reduzindo o estresse oxidativo, marcadores inflamatórios e estresse do retículo endoplasmático; e melhorando os parâmetros hemodinâmicos, antropométricos e metabólicos.
Abstract Background Obesity is associated with the development of cardiovascular diseases and is a serious public health problem. In animal models, high-fat diet (HFD) feeding impairs cardiac structure and function and promotes oxidative stress and apoptosis. Resistance exercise training (RT), however, has been recommended as coadjutant in the treatment of cardiometabolic diseases, including obesity, because it increases energy expenditure and stimulates lipolysis. Objective In this systematic review, we aimed to assess the benefits of RT on the heart of rats and mice fed HFD. Methods Original studies were identified by searching PubMed, Scopus, and Embase databases from December 2007 to December 2022. This study was conducted in accordance with the criteria established by PRISMA and registered in PROSPERO (CRD42022369217). The risk of bias and methodological quality was evaluated by SYRCLE and CAMARADES, respectively. Eligible studies included original articles published in English that evaluated cardiac outcomes in rodents submitted to over 4 weeks of RT and controlled by a sedentary, HFD-fed control group (n = 5). Results The results showed that RT mitigates cardiac oxidative stress, inflammation, and endoplasmic reticulum stress. It also modifies the activity of structural remodeling markers, although it does not alter biometric parameters, histomorphometric parameters, or the contractile function of cardiomyocytes. Conclusion Our results indicate that RT partially counteracts the HFD-induced adverse cardiac remodeling by increasing the activity of structural remodeling markers; elevating mitochondrial biogenesis; reducing oxidative stress, inflammatory markers, and endoplasmic reticulum stress; and improving hemodynamic, anthropometric, and metabolic parameters.
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ABSTRACT Background: Parasacral Transcutaneous Electrical Nerve Stimulation (PTENS) is a treatment used in enuresis refractory to first-line treatment. This review aimed to evaluate the effectiveness of PTENS in treating monosymptomatic enuresis (MNE) in children and adolescents. Methods: The study followed the Preferred Reporting Items for Systematic (PRISMA) guidelines. The search was carried out in the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Central Cochrane Library and Physiotherapy Evidence Database (PEDro). The selected studies were randomized clinical trials (RCTs). The "Risk of Bias tool for randomized trials" and the "Risk of Bias VISualization" were used to analyze the risk of bias. Results: Of the 624 studies selected, four RCTs were eligible. Three included 146 children and adolescents aged between six and 16.3 years and used similar PTENS protocols with a frequency of 10 Hz, pulse duration of 700 µs and 20 minutes three times/week. One study enrolled 52 patients aged seven to 14 years used PTENS at home, with a pulse duration of 200 µs and 20 to 60 minutes twice/day. Risk of bias was observed in three studies due to results' randomization and measurement. Two studies showed a partial response with a reduction in wet nights, one a complete response in 27% of patients, and one showed no improvement. Conclusion: PTENS reduces wet nights' frequency but does not cure them, except in 27% of patients in one study. Limited RCTs and data heterogeneity are limitations.
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Introduction: Systemic arterial hypertension (SAH) is a significant cause of morbidity and mortality worldwide. Despite the difficulty in diagnosing SAH in the early stages, the rapid detection and management of SAH are essential in preventing the development of target organ injuries. Newer technologies such as metabolomics have been revealed as promising alternatives for SAH diagnoses. Objectives: The purpose of this study is to evaluate, through a systematic review, the metabolomic profile of individuals with and without SAH. Methods: This review followed the PRISMA guidelines on reporting items. It analyses articles selected from the EMBASE and MEDLINE databases that compares metabolites in a hypertensive group with a non-hypertensive group. Results: The differences that reached statistical significance were a higher prevalence of lipids and lactic acid in the hypertensive group, as well as a reduction in methionine. Conclusion: Future research should be conducted to establish a possible clinical implication to this metabolite alteration, by linking it to a potential target organ injury for SAH, such as atherosclerosis, renal failure, retinopathy our ventricular hypertrophy.
Introdução: a hipertensão arterial sistêmica (HAS) é uma causa significativa de morbidade e mortalidade em todo o mundo. Apesar da dificuldade de diagnóstico da HAS em estágios iniciais, a rápida detecção e manejo da HAS são essenciais na prevenção do desenvolvimento de lesões em órgãos-alvo. Tecnologias mais recentes, como a metabolômica, têm se revelado alternativas promissoras para o diagnóstico de HAS. Objetivos: o objetivo deste estudo é avaliar, por meio de uma revisão sistemática, o perfil metabolômico de pacientes com e sem HAS. Método: esta revisão seguiu as diretrizes PRISMA. Foram analisados artigos, selecionados nas bases de dados EMBASE e MEDLINE, que comparavam metabólitos entre um grupo de pacientes hipertensos e um grupo não hipertenso. Resultados: as diferenças dos metabólitos que alcançaram significância estatística foram: a maior prevalência de lipídios e ácido lático no grupo hipertenso, bem como a redução de metionina neste mesmo grupo. Conclusão: novas pesquisas devem ser realizadas para estabelecer qual a implicação clínica desta alteração metabólica, relacionando-a uma potencial lesão de órgão-alvo como a aterosclerose, a insuficiência renal, a retinopatia ou a hipertrofia ventricular.
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Unintentional weight loss in older adults is linked to multiple factors, being most often associated with comorbidities such as cancer, dementia syndromes, chronic obstructive pulmonary disease, and chronic kidney disease. Difficulty in managing this condition can quickly lead to malnutrition and, consequently, a state of cachexia. There is a dearth of studies in the literature regarding pharmacotherapeutic interventions for this population, with megestrol acetate (MA) being the most commonly studied medication. In this systematic review, we evaluated the use of MA to improve appetite and treat unintentional weight loss and/or the anorexia-cachexia syndrome in older adults. Randomized studies published up to December 2023 in three languages (Portuguese, Spanish, or English) were retrieved from five databases. We included 25 studies, most of which addressed the use of MA for treatment of patients diagnosed with cancer and the anorexia-cachexia syndrome. We used the PEDro scale to assess methodological quality of the included studies and calculated measures of heterogeneity, such as the tau-squared (τ2), I-squared (I2), and Q test, to assess consistency across studies. Although the studies selected for the systematic review suggest that patients with the anorexia-cachexia syndrome secondary to cancer may benefit from MA therapy, a meta-analysis of 8 selected studies (total n = 592) did not confirm this effect (p = 0.104). The indication of MA for treatment of patients with weight loss required further studies with better methodological designs to evaluate the efficacy and safety profile of this medication in older adults. PROSPERO registry number CDR42024497640. (AU)
A perda de peso não intencional em pessoas idosas está ligada a múltiplos fatores, sendo comumente associada a comorbidades como câncer, síndromes demenciais, doença pulmonar obstrutiva crônica e doença renal crônica. A dificuldade no manejo deste quadro pode levar rapidamente à desnutrição e, consequentemente, a um estado de caquexia. Há na literatura uma escassez de estudos de intervenção farmacológica nessa população, sendo o acetato de megestrol (AM) a medicação mais comumente estudada. Nessa revisão sistemática, avaliamos o uso do AM para melhora do apetite e no tratamento da perda de peso não intencional e/ou síndrome anorexia-caquexia em idosos. Foram avaliados estudos randomizados, disponíveis em cinco bases de dados, até dezembro de 2023 e em três idiomas (português, espanhol e inglês). Foram incluídos 25 estudos que abordaram em sua maioria o uso do AM para o tratamento de pacientes com diagnóstico de câncer e síndrome anorexia-caquexia. A qualidade metodológica dos estudos incluídos foi avaliada utilizando a escala PEDro; e medidas de heterogeneidade, como tau-quadrado (τ2), I-quadrado (I2) e o teste de heterogeneidade Q, foram fornecidas para avaliar a consistência entre os estudos. Apesar de os estudos selecionados na revisão sistemática apontarem que pacientes com síndrome anorexiacaquexia secundária ao câncer podem se beneficiar do uso do AM, o resultado da metanálise de 8 estudos selecionados (total de 592 pacientes) não confirmou esse efeito (p = 0,104). A indicação desta medicação para tratamento de pacientes com perda de peso carece de estudos com melhor delineamento metodológico para avaliar a eficácia e o perfil de segurança do AM em idosos. Registro PROSPERO número CDR42024497640. (AU)
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Humans , Aged , Aged, 80 and over , Aged , Cachexia , Megestrol Acetate , Anorexia , Meta-Analysis , Appetite Stimulants , Systematic ReviewABSTRACT
O objetivo deste estudo foi revisar sistematicamente a contribuição da família e da escolano desenvolvimento de habilidades para a vida(HV)no contexto de formação esportiva. As buscas foram conduzidas em sete bases de dado se por meio da pesquisa de referências. Foram seguidas as descrições do Prisma, identificando 51 estudos. Os resultados demonstraram uma predominância de investigações no Canadá e nos Estados Unidos. Os autores dos estudos têm utilizado diferentes instrumentos, variáveis e modelos teóricos para verificar a contribuição da escola e/ou da família no desenvolvimento de habilidades para a vida. Conclui-se que o envolvimento escolar e o familiar no esporte podem contribuir com a aquisição, refinamento e transferência de características que podem ser aplicadas na vida dos indivíduos. Por fim, existe a necessidade de construir instrumentos quantitativos específicos que avaliem em conjunto a contribuição da escola e da família neste processo (AU).
The aim of this study was to systematically review the contribution of family and school in the development of life skills(LS)in the context of sports training. The searches were conducted in sevendatabases and through the reference searches.Prisma descriptions were followed, identifying 51 studies. The results showed a predominance of investigations in Canada and the United States. The authors of the studies have used different instruments, variables and theoretical models to verify the contribution of the school and/or the family in the development of skills for life. It is concluded that school and family involvement in sport can contribute to the acquisition, refinement and transfer of characteristics that can be applied in the lives of individuals. Finally,there is a need to build specific quantitative instruments that jointly assess the contribution of the school and the family in this process (AU).
El objetivo de este estudio fue revisar sistemáticamente la contribución de la familia y la escuela en el desarrollo de habilidades para la vida(HV)en el contexto del entrenamiento deportivo. Las búsquedas se realizaron en siete bases de datos y mediante la búsqueda de referencias.Se siguieron las descripciones de Prisma, identificando 51 estudios. Los resultados mostraron un predominio de investigaciones en Canadá y Estados Unidos. Los autores de los estudios han utilizado diferentes instrumentos, variables y modelos teóricos paraverificar la contribución de la escuela y/o la familia en el desarrollo de habilidades para la vida. Se concluye que la implicación escolar y familiar en el deporte puede contribuir a la adquisición, perfeccionamiento y transferencia de características que pueden ser aplicadas en la vida de los individuos. Finalmente,existe la necesidad de construir instrumentos cuantitativos específicos que evalúen de manera conjunta la contribución de la escuela y la familia en este proceso (AU).