Diagnostic test accuracy of novel biomarkers for lupus nephritis-An overview of systematic reviews.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiorgan inflammatory involvement and a mortality rate that is 2.6-fold higher than individuals of the same age and sex in the general population. Approximately 50% of patients with SLE develop renal impairment (lupus nephritis). Delayed diagnosis of lupus nephritis is associated with a higher risk of progression to end-stage renal disease, the need for replacement therapy, and mortality. The initial clinical manifestations of lupus nephritis are often discrete or absent and are usually detected through complementary tests. Although widely used in clinical practice, their accuracy is limited. A great scientific effort has been exerted towards searching for new, more sensitive, and specific biomarkers in recent years. Some systematic reviews have individually evaluated new serum and urinary biomarkers tested in patients with lupus nephritis. This overview aimed to summarize systematic reviews on the accuracy of novel serum and urinary biomarkers for diagnosing lupus nephritis in patients with SLE, discussing how our results can guide the clinical management of the disease and the direction of research in this area. METHODS: The research question is "What is the accuracy of the new serum and urinary biomarkers studied for the diagnosis of LN in patients with SLE?". We searched for systematic reviews of observational studies evaluating the diagnostic accuracy of new serum or urinary biomarkers of lupus nephritis. The following databases were included: PubMed, EMBASE, BIREME/LILACS, Scopus, Web of Science, and Cochrane, including gray literature found via Google Scholar and PROQUEST. Two authors assessed the reviews for inclusion, data extraction, and assessment of the risk of bias (ROBIS tool). RESULTS: Ten SRs on the diagnostic accuracy of new serum and urinary BMs in LN were selected. The SRs evaluated 7 distinct BMs: (a) antibodies (anti-Sm, anti-RNP, and anti-C1q), (b) cytokines (TWEAK and MCP-1), (c) a chemokine (IP-10), and (d) an acute phase glycoprotein (NGAL), in a total of 20 review arms (9 that analyzed serum BMs, and 12 that analyzed BMs in urine). The population evaluated in the primary studies was predominantly adults. Two SRs included strictly adults, 5 reviews also included studies in the paediatric population, and 4 did not report the age groups. The results of the evaluation with the ROBIS tool showed that most of the reviews had a low overall risk of bias. CONCLUSIONS: There are 10 SRs of evidence relating to the diagnostic accuracy of serum and urinary biomarkers for lupus nephritis. Among the BMs evaluated, anti-C1q, urinary MCP-1, TWEAK, and NGAL stood out, highlighting the need for additional research, especially on LN diagnostic panels, and attempting to address methodological issues within diagnostic accuracy research. This would allow for a better understanding of their usefulness and possibly validate their clinical use in the future. REGISTRATION: This project is registered on the International Prospective Registry of Systematic Reviews (PROSPERO) database (CRD42020196693).

Influence of the presence of mannose-binding lectin polymorphisms on the occurrence of leishmaniasis: a systematic review and meta-analysis.

BACKGROUND: Leishmaniasis is caused by an intracellular protozoan of the Leishmania genus. Mannose-binding lectin (MBL) is a serum complement protein and recognizes lipoprotein antigens in protozoa and the bacterial plasma membrane. Nucleotide variants in the promoter region and exon 1 of the MBL gene can influence its expression or change its molecular structure. OBJECTIVE: To evaluate, through a systematic review, case-control studies of the genetic association of variants in the MBL2 gene and the risk of developing leishmaniasis. METHODS: This review carried out a search in PubMed, Science Direct, Cochrane Library, Scopus and Lilacs databases for case-control publications with six polymorphisms in the mannose-binding Lectin gene. The following strategy was used: P = Patients at risk of leishmaniasis; I = Presence of polymorphisms; C = Absence of polymorphisms; O = Occurrence of leishmaniasis. Four case/control studies consisting of 791 patients with leishmaniasis and 967 healthy subjects (Control) are included in this meta-analysis. The association of variants in the mannose-binding Lectin gene and leishmaniasis under the allelic genetic model, -550 (Hvs. L), -221 (X vs. Y), +4 (Q vs. P), CD52 (A vs. D), CD54 (A vs. B), CD57 (A vs. C) and A/O genotype (A vs. O) was evaluated. International Prospective Register of Systematic Reviews (PROSPERO): CRD42020201755. RESULTS: The meta-analysis results for any allelic genetic model showed no significant association for the variants within the promoter, the untranslated region, and exon 1, as well as for the wild-type A allele and mutant allele O with leishmaniasis. STUDY LIMITATIONS: Caution should be exercised when interpreting these results, as they are based on a few studies, which show divergent results when analyzed separately. CONCLUSIONS: This meta-analysis showed a non-significant association between the rs11003125, rs7096206, rs7095891, rs5030737, rs1800450, and rs1800451 polymorphisms of the Mannose-binding Lectin gene and leishmaniasis in any allelic and heterogeneous evaluation.

Influence of the presence of mannose-binding lectin polymorphisms on the occurrence of leishmaniasis: a systematic review and meta-analysis

Abstract Background Leishmaniasis is caused by an intracellular protozoan of the Leishmania genus. Mannose-binding lectin (MBL) is a serum complement protein and recognizes lipoprotein antigens in protozoa and the bacterial plasma membrane. Nucleotide variants in the promoter region and exon 1 of the MBL gene can influence its expression or change its molecular structure. Objective To evaluate, through a systematic review, case-control studies of the genetic association of variants in the MBL2 gene and the risk of developing leishmaniasis. Methods This review carried out a search in PubMed, Science Direct, Cochrane Library, Scopus and Lilacs databases for case-control publications with six polymorphisms in the mannose-binding Lectin gene. The following strategy was used: P = Patients at risk of leishmaniasis; I = Presence of polymorphisms; C = Absence of polymorphisms; O = Occurrence of leishmaniasis. Four case/control studies consisting of 791 patients with leishmaniasis and 967 healthy subjects (Control) are included in this meta-analysis. The association of variants in the mannose-binding Lectin gene and leishmaniasis under the allelic genetic model, -550 (Hvs. L), -221 (X vs. Y), +4 (Q vs. P), CD52 (A vs. D), CD54 (A vs. B), CD57 (A vs. C) and A/O genotype (A vs. O) was evaluated. International Prospective Register of Systematic Reviews (PROSPERO): CRD42020201755. Results The meta-analysis results for any allelic genetic model showed no significant association for the variants within the promoter, the untranslated region, and exon 1, as well as for the wild-type A allele and mutant allele O with leishmaniasis. Study limitations Caution should be exercised when interpreting these results, as they are based on a few studies, which show divergent results when analyzed separately. Conclusions This meta-analysis showed a non-significant association between the rs11003125, rs7096206, rs7095891, rs5030737, rs1800450, and rs1800451 polymorphisms of the Mannose-binding Lectin gene and leishmaniasis in any allelic and heterogeneous evaluation.

Attenuation of adjuvant-induced arthritis in rats by phonophoresis with an aqueous gel of the Amazonian plant Elaeoluma nuda (Sapotaceae).

BACKGROUND: Various species of the genus Pouteria (Elaeoluma) are used by the native population of Brazil because of, among other factors, their anti-inflammatory properties. The anti-inflammatory properties of the extract of the Amazonian plant Elaeoluma nuda were recently identified in prospective pharmacological studies. OBJECTIVES: The objective of this study was to assess the anti-inflammatory effect of phonophoresis with aqueous gel extract of E. nuda in rat adjuvant-induced arthritis. METHODOLOGY: Arthritis was induced in Lewis rats with an adjuvant. Phonophoresis with E. nuda gel was then administered daily and the results compared with those obtained with phonophoresis of diclofenac diethylammonium gel and ultrasound therapy without phonophoresis. Arthritis in the different groups was evaluated by plethysmometry. Proinflammatory cytokines TNF-α and IL-1α were quantified by cytometric bead array (CBA). RESULTS: The effect of phonophoresis of aqueous gel with E. nuda extract on arthritis in rats' paws (a 33% reduction compared with the controls) was the same as that produced by phonophoresis with diclofenac diethylammonium. Ultrasound therapy without phonophoresis produced no significant effect on the 21st day of therapy. There was a significant reduction in TNF-α and IL-1α levels in the group treated with phonophoresis with E. nuda gel (p=0.0042; p=0.0003, respectively). CONCLUSION: Our results demonstrate the anti-inflammatory effect of phonophoresis with E. nuda gel on cytokines TNF-α, IL-1α and adjuvant-induced arthritis.

Mapeamento das evidências do grupo de odontologia da Colaboração Cochrane pra condutas em saúde / Mapping the evidence of the Cochrane Collaboration dental group to conduct in health

A Colaboração Cochrane (CC) é uma organização internacional que tem como objetivo ajudar profissionais da área da saúde a tomar decisões clínicas bem informadas através da preparação, manutenção e promoção da acessibilidade às revisões sistemáticas sobre os efeitos das intervenções, sensibilidade e especificidade de testes diagnósticos em saúde e associação de fatores de risco e ocorrência de determinada doença. Entretanto, alguns estudos apontaram a constante ausência ou insuficiência de evidências nas revisões sistemáticas da Colaboração Cochrane para a tomada de decisão clínica. Verificar a proporção de revisões sistemáticas completas do grupo de Odontologia da Colaboração Cochrane que permitem ou não a aplicação prática dos resultados, cujos autores consideram reunir evidências suficientes para recomendá-las ou desestimulá-las. Estudo sistemático de revisões da Biblioteca Cochrane, edição 8, 2013. Foram incluídas todas as revisões sistemáticas completas do grupo de Odontologia que preencheram os critérios de inclusão deste trabalho.143 revisões sistemáticas foram analisadas, o que correspondeu a 100% da totalidade disponível na Biblioteca pertinente ao grupo de Odontologia da Colaboração Cochrane. Evidências que apoiam a intervenção 22,38% (95% IC 16 - 29); evidências contra a intervenção 6,29% (95% IC 3 - 10); ausência de evidências 71,33% (95% IC 64 - 78). O total de revisões sistemáticas que recomendam a realização de mais estudos foi de 140 (97,90 %) (95% IC, 96 – 100). A média do número de estudos incluídos foi de 13 e o total de meta-análises incluído nas revisões sistemáticas avaliadas foi de 161...

The Cochrane Collaboration (CC) is an international organization that aims to help health care professionals to making clinical decisions well informed by preparing, supporting and promoting the accessibility of systematic reviews about the intervention effects, sensibility and specificity of diagnostic health tests and association of risk factors and occurrence of a particular disease. However, some studies indicated the constant absence or insufficient evidences in systematic reviews from the Cochrane Collaboration to making clinical decision. To determine the proportion of complete systematic reviews of the Cochrane Collaboration Dentistry Group which allow or not the practical application of the results, which author consider bring enough evidence to recommend or discourage them. Systematic study of the reviews from Cochrane Library, Issue 8, 2013. Was included all the complete systematic reviews of the Dentistry Group who met inclusion criteria for this study. 143 systematic reviews were analyzed, corresponding to 100% of all available of the Library pertinent to the Cochrane Collaboration dentistry Group. Evidences supporting intervention 22,38% (95% IC 16 – 29); evidence against intervention 6,29% (95% IC 3 - 10); absence of evidence 71,33% (95% IC 64 - 78). The total of systematic reviews that recommend further studies was 140 (97,90 %) (95% IC, 96 – 100). The mean of included studies was 13 and the total of meta-analyzes included in systematic reviews evaluated was 161. Only 28,67 of the complete systematic reviews of the the Cochrane Collaboration Dentistry Group showed sufficient evidence to recommend or discourage the treatment of interest and also suggested further studies, or be, none of them showed consistent results...