Telemedicine for Diabetes Mellitus Management in Older Adults: A Systematic Review.

BACKGROUND: Diabetes mellitus affects almost 20% of the world's population between 65 and 99 years old. The care for this disease urges a complex, multidisciplinary, and stepwise approach. Telemedicine has been evaluated, and clinical trials as well as systematic reviews have been performed, and most have shown the benefits of its use in DM management. However, as the prevalence of diabetes mellitus increases, as well as the population ages, considerations regarding access and compliance of older patients to such technologies arise. OBJECTIVE: The study aimed to determine the efficacy of telemedicine medical consultations in comparison to standard face-to-face consultations. METHODS: A systematic literature search to identify trials investigating the effect of telemedicine medical consultations in clinical-laboratory aspects of DM management was conducted. The search was carried out in electronic databases: Medline, EMBASE, LILACS, ClinicalTrials.gov, and the CENTRAL Cochrane. Two authors independently assessed the included studies using the proper bias assessment tool for each study design. RESULTS: In agreement with the eligibility criteria, three studies were included. In terms of the main outcome, HbA1c, only one out of three articles showed a significant difference between the groups, favoring patients in the telemedicine group. With respect to blood pressure, Sood A reported that the usual care group exhibited a greater improvement in systolic blood pressure with statistical differences. All other results displayed no significant statistical difference between the groups. Also, no statistical difference was found in most of the lipid profile results. CONCLUSION: Our review shows that teleconsultations do not provide a clear benefit to elderly people with diabetes, but they may be non-inferior.

Telementored ultrasonography: a narrative review.

BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Diphallia: a case report of a rare anomaly evaluated by magnetic resonance imaging.

BACKGROUND: Diphallus, also known as penile duplication, is a rare malformation, seen once in every 5 to 6 million births. Newborns showing this condition present higher mortality rates due to malformations and infections. The underlying etiology of this malformation is uncertain, but it is thought to be associated with trauma, drug use, or infections that may affect fetal the mesoderm between the 23rd and 25th day of pregnancy. Our objective is to describe this rare malformation - diphallus - through magnetic resonance imaging, as well as additional findings. CASE: A Three-month-old male patient with a 33-week ultrasound demonstrating genital malformation presented to our clinic. At birth, the physical examination revealed diphallia and imperforated anus. Surgical procedures were carried out right after birth to correct the anus malformation. The child did not present any alteration in skin color, and no signs of pain were shown in the abdomen, pelvis, and penises palpations. Urination was observed only through the right penis. Magnetic resonance imaging (MRI) showed two penile structures, each one presenting developed with corpus cavernosum. The penis located on the right showed a complete urethral path in the corpus spongiosum to the vesical floor while the penis located on the left was bigger and did not present a urethral path. CONCLUSIONS: Penile duplication is a rare condition that is often, associated with other malformations, especially anorectal. To fully understand the extension of congenital anomalies and to determine the optimal surgical approach, MRI yields detailed imaging of the entire pelvic region, providing a thorough anatomical frame of reference, and should be routinely incorporated into presurgical evaluation.

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis.

BACKGROUND: Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. OBJECTIVE: To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. DESIGN AND SETTING: Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. RESULTS: The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CONCLUSION: CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. REGISTRATION NUMBER: CRD42019148491 at the PROSPERO database.

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

BACKGROUND: Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. OBJECTIVE: To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. DESIGN AND SETTING: Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. RESULTS: The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CONCLUSION: CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. REGISTRATION NUMBER: CRD42019148491 at the PROSPERO database.

Congenital Adrenal Hyperplasia Due to 17-α-hydroxylase Deficiency: A Case Report.

Congenital adrenal hyperplasia, an innate error in adrenal steroid biosynthesis, triggers a wide range of consequences based on the level of enzyme blockade. Due to the various forms of enzyme deficiency and degree of penetration, the clinical features are very variable. In this case report, we present a form of congenital adrenal hyperplasia due to an enzymatic defect of CYP17A1, with a late diagnosis. The recognition of this pathology should occur as early as possible to avoid sequelae, both metabolic and psychological.

Dipeptidyl Peptidase IV Inhibitors for Nonalcoholic Fatty Liver Disease - Systematic Review and Metanalysis.

INTRODUCTION: Hepatic steatosis is a frequent condition that afflicts, especially, obese and insulin-resistant patients. Diagnosis is usually made through imaging tests. Despite the high prevalence and risk of complications, there is no specific treatment approved, though a vast number of medications have been tested. OBJECTIVE: This study aimed to determine the efficacy of dipeptidyl peptidase IV inhibitors (i DPP- IV) in the treatment of NAFLD. METHODS: We searched the electronic databases of the Cochrane Library, MEDLINE, EMBASE, and LILACS, as well as reference lists of the included studies and grey literature; 9 studies were selected for inclusion. RESULTS: 7 studies were used for metanalysis for 3 outcomes. i DPP-IV showed an ALT-reducing power of MD -10.83 (95% CI 35.23 to 13.57) at 3 months and MD -9.27 (95% CI 10.92 to -7.62) at 6 months of intervention, as well as a reduction of hepatic steatosis via MRI of SMD 0.10 (95% CI 0.31 to 0.50); the overall incidence of adverse events was very low. The studies were considered of low and very low quality by the GRADE evaluation. CONCLUSION: Because of the overall poor quality of the studies and heterogeneity of the population analyzed, i DPP-IV did not show efficacy on inflammatory markers or fibrosis in patients with NAFLD.

Ultrasound versus electromyography for the detection of fasciculation in amyotrophic lateral sclerosis: systematic review and meta-analysis.

The objective of this study was to determine the diagnostic accuracy of ultrasound and electromyography for the detection of fasciculation in patients with amyotrophic lateral sclerosis and to compare detection rates between the two methods. By searching the Cochrane Library, MEDLINE, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, we identified studies evaluating the diagnostic accuracy and fasciculation detection rates of ultrasound and electromyography. The Quality Assessment of Diagnostic Accuracy Studies, version 2, and RTI item bank tools were used for the evaluation of methodological quality. Ultrasound, for 10 s or 30 s, had a higher detection rate than did electromyography in all muscles evaluated. The overall detection rate (in patients) did not differ significantly between ultrasound for 10 s and ultrasound for 30 s. The accuracy of ultrasound for 10 s was 70% in muscles and 85% in patients. The accuracy of ultrasound for 30 s was 82% in patients. Ultrasound provided detection rates superior to those achieved with electromyography, independent of the examination time and muscles evaluated.

O objetivo deste estudo foi determinar a acurácia diagnóstica da ultrassonografia e da eletroneuromiografia para o diagnóstico da fasciculação e comparar suas taxas de detecção. Foram realizadas buscas nas bases de dados eletrônicas Cochrane Library, MEDLINE, Embase e Lilacs, para estudos que avaliam a acurácia diagnóstica e as taxas de detecção da ultrassonografia e eletroneuromiografia. As ferramentas Quality Assessment of Diagnostic Accuracy Studies, versão 2, e RTI item bank foram utilizadas para avaliação da qualidade do método. A ultrassonografia, tanto de 10 s quanto de 30 s, apresentou taxa de detecção superior à eletroneuromiografia em todos os músculos avaliados. A avaliação da taxa de detecção por pacientes não apresentou diferença significativa entre a ultrassonografia de 10 s e 30 s. A acurácia da ultrassonografia de 10 s nos músculos foi de 70%, enquanto nos pacientes foi de 85%. Já na ultrassonografia de 30 s, a acurácia nos pacientes foi de 82%. A ultrassonografia apresentou taxas de detecção superiores à eletroneuromiografia, independentemente do tempo de sua avaliação e dos músculos avaliados.