The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. Evidence Acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. Evidence Synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. Patient Summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

O efeito da cafeína no desempenho de ciclistas sob condçoes de alto risco térmico / Effect of caffeine in the performance of cyclists under high thermal risk

PURPOSE: To verify the effect of caffeine on yield time, the tympanic temperature and body weight with the administration of 5 and 9 mg/kg doses of caffeine and placebo, in cycling races under high thermal risk conditions. METHODS: Eight highly-trained cyclists were studied in 3 races of 45 km using the experimental model and double-blind with intra-subjects randomized. RESULTS: Air temperature ranged from 28.,5 and 32 degrees C and humidity between 71 e 78% with an index of WBGT varying between 24.5 degrees and 27 degrees C, figures that indicate high thermal risk. No significant differences were observed between variables assessed, yet yield time was lower with doses of 5 and 9 mg/kg caffeine than with placebo. CONCLUSION: These data indicate that heat and humidity conditions may be sufficient to mask the ergogenic benefit of caffeine in cycling races of prolonged duration. Therefore, isn't justifiable it's utilization in high thermal risk conditions.