COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF CLINICAL DATA COLLECTION THROUGH ONLINE AND PHYSICAL ELECTRONIC QUESTIONNAIRE IN ORTHOPEDIC PATIENTS.

The collection of clinical data is an essential step for the development of any scientific research. Online digital data collection can optimize this step. Objective: To compare the response rate and the accuracy of the clinical data collection date through the online and physical digital questionnaire in orthopedic patients. Methods: Comparative study, level III of evidence, with forty patients who had ankle sprains were evaluated, followed up for a period of 12 weeks with the application of physical and digital Visual Analogue Scale, Foot Function Index and Cumberland Ankle Instability Tool questionnaires, and data were collected about the moment of collection of each questionnaire. Results: We obtained a response rate of 83.3% in the digital collection group and 60% in the physical collection group (p < 0.05), and the response rate in the digital collection group was higher at all times of collection (3, 6 and 12 weeks). Analysis of the time of collection shows greater variability in the larger physical collection group at all times of the study (2.8 vs 1.5; 4.0 vs 2.4; 8.6 vs 1.5). Conclusion: Digital data collection is effective for obtaining clinical data in patients with ankle sprains. Level of Evidence III, Comparative, Prospective, Longitudinal Study in Parallel Groups.

A coleta de dados clínicos é etapa essencial para o desenvolvimento de qualquer pesquisa científica, e a coleta de dados digital online pode otimizá-la. Objetivo: Comparar o índice de resposta e a precisão da data de coleta de dados clínicos por meio de aplicação de questionário digital online e físico a pacientes ortopédicos. Métodos: Estudo comparativo realizado com 40 pacientes que apresentaram entorse de tornozelo, acompanhados pelo período de 12 semanas, com aplicação dos questionários escala visual analógica, foot function index e Cumberland ankle instability tool físicos e digitais. Além disso, foram recolhidos dados sobre o momento da coleta dos questionários. Resultados: Obtivemos índice de resposta de 83,3% no grupo de coleta digital e 60% no grupo de coleta física (p < 0,05), sendo que o índice de resposta no grupo de coleta digital foi maior em todos os momentos de coleta (3, 6 e 12 semanas). A análise do momento da coleta apresenta maior variabilidade no grupo de coleta física em todos os momentos do estudo (2,8 vs 1,5; 4,0 vs 2,4; 8,6 vs 1,5). Conclusão: A coleta de dados digital é efetiva para a obtenção dos dados clínicos de pacientes que apresentam entorse do tornozelo. Nível de Evidência III, Estudo Comparativo, Prospectivo, Longitudinal em Grupos Paralelos.

Comparative analysis of the effectiveness of clinical data collection through online and physical electronic questionnaire in orthopedic patients / Análise comparativa da efetividade da coleta de dados clínicos por meio de questionários eletrônicos online e físicos em pacientes ortopédicos

ABSTRACT The collection of clinical data is an essential step for the development of any scientific research. Online digital data collection can optimize this step. Objective: To compare the response rate and the accuracy of the clinical data collection date through the online and physical digital questionnaire in orthopedic patients. Methods: Comparative study, level III of evidence, with forty patients who had ankle sprains were evaluated, followed up for a period of 12 weeks with the application of physical and digital Visual Analogue Scale, Foot Function Index and Cumberland Ankle Instability Tool questionnaires, and data were collected about the moment of collection of each questionnaire. Results: We obtained a response rate of 83.3% in the digital collection group and 60% in the physical collection group (p < 0.05), and the response rate in the digital collection group was higher at all times of collection (3, 6 and 12 weeks). Analysis of the time of collection shows greater variability in the larger physical collection group at all times of the study (2.8 vs 1.5; 4.0 vs 2.4; 8.6 vs 1.5). Conclusion: Digital data collection is effective for obtaining clinical data in patients with ankle sprains. Level of Evidence III, Comparative, Prospective, Longitudinal Study in Parallel Groups.

RESUMO A coleta de dados clínicos é etapa essencial para o desenvolvimento de qualquer pesquisa científica, e a coleta de dados digital online pode otimizá-la. Objetivo: Comparar o índice de resposta e a precisão da data de coleta de dados clínicos por meio de aplicação de questionário digital online e físico a pacientes ortopédicos. Métodos: Estudo comparativo realizado com 40 pacientes que apresentaram entorse de tornozelo, acompanhados pelo período de 12 semanas, com aplicação dos questionários escala visual analógica, foot function index e Cumberland ankle instability tool físicos e digitais. Além disso, foram recolhidos dados sobre o momento da coleta dos questionários. Resultados: Obtivemos índice de resposta de 83,3% no grupo de coleta digital e 60% no grupo de coleta física (p < 0,05), sendo que o índice de resposta no grupo de coleta digital foi maior em todos os momentos de coleta (3, 6 e 12 semanas). A análise do momento da coleta apresenta maior variabilidade no grupo de coleta física em todos os momentos do estudo (2,8 vs 1,5; 4,0 vs 2,4; 8,6 vs 1,5). Conclusão: A coleta de dados digital é efetiva para a obtenção dos dados clínicos de pacientes que apresentam entorse do tornozelo. Nível de Evidência III, Estudo Comparativo, Prospectivo, Longitudinal em Grupos Paralelos.

Corin ankle arthroplasty: Case-series.

BACKGROUND: Total Ankle Arthroplasty (TAA) is complex and can bring a wide variety of complications. Implant revision rates can vary from 4% to 8% in 5 years. Recent publications have shown good results in the short and intermediate follow-up and high patient satisfaction. The pre- and postoperative evaluation of these patients should include physical examination and objective radiographic measurements, which may have predictive value for implant failures and survivorship. In this paper we will present the results obtained with 29 patients treated with the Zennith (Corin Group, UK) total ankle prosthesis in Brazil. METHODS: This paper presents the results obtained with 29 patients treated with the Corin-Zennith prosthesis in three tertiary hospitals in Brazil, with an average follow-up of 5 years. The patients were submitted to clinical and radiographic evaluation. There were seventeen women and twelve men, ranging in age from 35 to 76 years, who were submitted to surgical treatment between January 16, 2013 and May 5, 2017. RESULTS: Seven patients (24%) presented cysts, being 4 (13.7%) tibial cysts and 3 (10.3%) tibial and talar cysts. Six patients (20.6%) presented talar subsidence and 3 (10.3%) presented tibial subsidence. Three patients (10.3%) presented component wear. VAS reduced and AOFAS and ROM increased in the post-operative period. The development of Cysts was associated with the theta angle and the difference in LTS (between the post and preoperative period) was associated with tibial subsidence. The complications rate was 44.8%, the revision rate was 6.9% and the survivorship rate was 93.1%. CONCLUSION: The Corin-Zennith prosthesis demonstrated to be a safe implant for improving functional parameters. Functional outcomes were not influenced for most commonly measured radiographic parameters. Further studies are needed to better understand these associations.

Elongated Styloid Process in Panoramic Radiographs / Processo Estilóide Alongado nas Radiografias Panorâmicas

The aim of this study is to evaluate the prevalence of the elongated styloid process in panoramic radiographic exams, in a subpopulation of northern Brazil in relation to age, sex and side. Panoramic radiographs were selected, and the apparent size of the styloid process was measured from the point where the styloid leaves the tympanic plate to the tip of the process. The data were analyzed using chi-square tests and variance analysis with a 5% significance level. Approximately 30% of the elongated styloid process was observed in patients between 18 to 35 years. Of the styloid processes that measured more than 30 mm (elongated), 764 styloid processes (81%) showed Type I elongation pattern, 97 styloid processes (10%) showed Type II calcification patterns, and 85 styloid processes (9%) showed Type III calcification patterns. The prevalence of the elongated styloid process was high, and no statistically significant correlation was found between the presence of the elongated styloid process and the variables studied. (AU)

O objetivo deste estudo é avaliar a prevalência do processo estilóide alongado em exames radiográficos panorâmicos, em uma subpopulação do norte do Brasil em relação à idade, sexo e lado. Radiografias panorâmicas foram selecionadas, e tamanho aparente do processo estilóide foi medido a partir do ponto em que o estilóide deixa a placa timpânica até a ponta do processo. Os dados foram analisados por meio de testes qui-quadrado e análise de variância com nível de significância de 5%. Aproximadamente 73% do processo estilóide alongado foi observado em pacientes entre 18 e 53 anos (p <0,05). Dos processos estilóides que mediram mais de 30 mm (alongados), 543 processos estiloide (82,9%) mostraram padrão de alongamento do Tipo I, 33 processos estiloide (5,03%) mostraram padrões de calcificação do Tipo II, e 79 processos estilóide (12,06%) mostraram padrões de calcificação do Tipo III. A prevalência do processo estilóide alongado foi alta e não foi encontrada correlação estatisticamente significante entre a presença do processo estilóide alongado e as variáveis estudadas. (AU)

Deltoid ligament arthroscopic repair in ankle fractures: Case series.

INTRODUCTION: Diagnosis and treatment of ankle medial ligament lesions in malleolar fractures has always been a matter of controversy. Even when deltoid involvement is clear, the direct repair of this structure is not a consensus. Recently, deltoid repair through an arthroscopic technique was described aiming to potentialize better clinical results and minimize complications. OBJECTIVE: Demonstrate safety and functional results on patients with ankle fractures submitted to open reduction and internal fixation and arthroscopic deltoid repair. METHODS: This is a retrospective study in patients diagnosed with ankle fractures associated with acute deltoid injuries submitted to open malleolar fixation and deltoid arthroscopic repair between June 2016 and January 2020. All patients were evaluated for pain and functionality according to the Visual Analogue Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) at a minimum of 6 months follow-up. RESULTS: From January 2016 to January 2020, 20 ankles with fractures or dislocations were operated and the deltoid ligament rupture was repaired arthroscopically. A mean follow-up of 14.45 months (6-48) was observed, and patients presented an average AOFAS of 93.5 (SD 7.25) and a VAS of 0.75 (SD 1.05). Three minor complications were noticed and no signs of medial chronic instability, loss of reduction or osteoarthritis were observed. DISCUSSION: The repair of the deltoid complex and the low morbidity of the arthroscopic technique used may improve the clinical outcomes of these patients. Additional studies, with a prospective and comparative methodology are required to sustain this proposal. DESIGN: Level IV. Retrospective case series.

Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability.

BACKGROUND: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability. METHODS: This is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study. RESULTS: The AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%). CONCLUSION: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients. LEVEL OF EVIDENCE: Level IV, retrospective case series.

ATR-MIR spectroscopy as a tool to assist 'Tempranillo' clonal selection process: Geographical origin and year of harvest discrimination and oenological parameters prediction.

The present study evaluated the ability of Attenuated Total Reflectance - Mid-Infrared (ATR-MIR) spectroscopy combined with Partial Least Squares Discriminant Analysis (PLS-DA) to discriminate the origin and harvest year of 'Tempranillo' grape clones and with Partial Least Squares (PLS) regressions to predict its contents in soluble solids (SS), pH and titratable acidity (TA). Normalized spectra of grape homogenates and normalized plus 1st Derivative spectra of grape skins allowed an overall percentage of correct classifications of 99.6% and 96.7% in validation, according to origin, and 98.3% and 90.0% in validation, according to harvest year, respectively. The normalized spectra of grape homogenates allowed a calibration and validation determination coefficients (R2) of 0.92 and 0.90 for SS, 0.90 and 0.84 for pH, 0.88 and 0.84 for TA, respectively. The ATR-MIR combined with multivariate analysis showed to be an appropriate tool to assist the clonal selection process of 'Tempranillo'.

Brazilian Total Ankle Replacement Experience.

Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early total ankle replacement generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience with Brazilian surgeons unable to participate in the development of the technique and implant designs during these years. This article discusses the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.

First MTP joint instability - Expanding the concept of "Turf-toe" injuries.

BACKGROUND: Although the classic definition of the Turf-toe injury refers to a very specific clinical and pathological picture, we think that the concept can be broadened to encompass a wide variety of traumatic lesions of the first metatarsophalangeal joint (MTP1). These are lesions typically difficult to diagnose, with a large variation of outcomes and a potential to impair patients' functional performance on a definitive and perennial basis. The objective of this study is to present the result obtained by treating 24 cases of traumatic injuries to the MTP1 joint in a midterm follow-up time. METHODS: In the period from 1999 to 2016, 24 patients were treated with MTP1 joint instability - "Expanded Turf-toe" - diagnosis. All patients were performing sports activities when they were injured: soccer (33%); martial arts (17%); running (13%); tennis (8%); olympic gymnastics (8%) and others (basketball, slalom, motorcycling, surfing, and ballet) (21%). Injuries were classified as Grade I (2 patients - 8%), Grade II (8 patients - 33%) and Grade III (14 patients - 59%) lesions. All patients with grades I and II were treated conservatively whereas those classified as grade III were treated surgically. RESULTS: After an average follow-up of 4.5 years we observed an improvement in the AOFAS hallux score from 42 to 82 points after treatment (p<0.001). The most frequent cause was axial load with various direction of stress at the first MTP. The mechanism of lesion varied among extension with hallux varism (42%), pure hyperextension (25%), extension with hallux valgism (21%), pure hyperflexion (8%) and hyperflexion with hallux valgism (4%). A separate analysis of each group showed a significant improvement in AOFAS Hallux scores after treatment: 51-84 (p<0.001) and 36-81 (p<0.001) for conservative and surgical groups, respectively. Four patients with GIII injuries (29%) and two with GII injuries (20%) did not resume their previous activities. Although pre-treatment AOFAS hallux scores were significantly different between groups, post-treatment scores were similar (p=0.615). CONCLUSIONS: Turf-toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. Mechanism of lesion might be varied generating a wide range of lesions that fit into the expanded concept of the Turf-toe injury. Both forms of treatment lead to satisfactory results if well conducted. The correct identification, classification, and grading of first metatarsophalangeal joint (MTP) instability helps in decision making and selection of the adequate treatment. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series.

OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.

Combined Spring and Deltoid Ligament Repair in Adult-Acquired Flatfoot.

BACKGROUND: Adult-acquired flatfoot deformity (AAFD) is usually due to a combination of mechanical failure of the osteoligamentous complex that maintains the medial longitudinal arch of the foot and attenuation or complete tear of the posterior tibial tendon. Magnetic resonance imaging studies in patients with flatfoot deformities have reported the posterior tibial tendon to be pathologic in up to 100% of patients, the spring ligament in up to 87%, and the deltoid ligament in 33%. Many studies in the literature describe reconstruction of the spring ligament or the deltoid ligament associated with AAFD, but there is no study in which both (spring and deltoid) ligaments are reconstructed at the same time. We describe a novel technique to reconstruct the deltoid ligament and the spring ligament at the same time. METHODS: We described the technique and evaluated 10 consecutive patients with AAFD and insufficient ankle and midfoot ligaments. RESULTS: We found no postoperative complications, stiffness, or loss of correction. CONCLUSION: We present a novel technique to reconstruct the failed deltoid and spring ligament during flatfoot correction. It is unique in that it uses internal brace augmentation with FiberTape® to help and protect the soft tissue healing. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Efficacy and safety of tiotropium bromide in chronic obstructive pulmonary disease: a systematic review of randomized clinical trials / Eficácia e segurança do brometo de tiotrópio na doença pulmonar obstrutiva crônica. Revisão sistemática de ensaios clínicos randomizados

Chronic obstructive pulmonary disease (COPD) is among the most prevalent pulmonary diseases. This study aimed at assessing the efficacy and safety of anticholinergic tiotropium bromide (TB) in Chronic obstructive pulmonary disease patients. This is a systematic review of randomized clinical trials performed in the Brazilian Cochrane Center. Electronic database searched: Cochrane library, Medline, LILACS, Pubmed. There were no language, date or other restrictions. Participants: Patients with Chronic obstructive pulmonary disease. Intervention: tiotropium bromide. Comparison: Other bronchodilators or placebo. Outcomes: Mortality, Chronic obstructive pulmonary disease exacerbation, hospitalizations, adverse effects. Results: 14 studies were included in this systematic review. Mortality was lower in the tiotropium bromide group when compared with the salmeterol group [statistical significance: relative risk (RR) 0.16, confidence interval 95% (CI) 0.03 to 0.89, number needed to treat (NNT) of 100]. There was not a statistical difference in the mortality outcome in the comparison between tiotropium bromide and placebo groups (RR 0.88, CI 0.74 to 1.06). Chronic obstructive pulmonary disease exacerbation decreases significantly in the tiotropium bromide group when compared to placebo (statistical significance: RR 0.85, CI 0.77 to 0.93, NNT 25), but in comparison to the salmeterol group there was no statistical difference (RR 0.93, CI 0.80 to 1.08). The number of hospitalizations was lower in the tiotropium bromide group than in the placebo group (statistical significance:RR 0.77, CI 0.59 to 0.99, NNT 50). The results indicate that tiotropium bromide is an effective once-daily bronchodilator. Tiotropium bromide was associated with consistent health benefits, including reduced chronic obstructive pulmonary disease exacerbations, hospitalizations and even mortality when compared with salmeterol.(AU)

A doença pulmonar obstrutiva crônica está entre as doenças pulmonares mais prevalentes. O objetivo deste estudo foi verificar a eficácia e segurança do brometo de tiotrópio em pacientes com doença pulmonar obstrutiva crônica. Trata-se de revisão sistemática de ensaios clínicos randomizados realizada no Centro Cochrane do Brasil. A estratégia de busca eletrônica foi realizada nos nas bases LILACS, MEDLINE, Biblioteca Cochrane, PubMed. Não houve restrições à linguagem e nem à data. Participaram pacientes com doença pulmonar obstrutiva crônica. A intervenção foi o uso de brometo de tiotrópio comparado a outros broncodilatadores ou placebo. Os desfechos analisados foram mortalidade, exacerbações da doença pulmonar obstrutiva crônica, hospitalização e efeitos adversos. A mortalidade foi menor no grupo brometo de tiotrópio quando comparado com o grupo salmeterol (significância estatística: risco relativo de 0,16; intervalo de confiança de 95% de 0,03-0,89, número necessário para tratar de 100). Não houve diferença estatística no desfecho mortalidade na comparação entre os grupos brometo de tiotrópio e placebo (risco relativo de 0,88; intervalo de confiança de 95% de 0,74-1,06). As exacerbações da doença pulmonar obstrutiva crônica diminuíram significantemente no grupo brometo de tiotrópio quando comparado ao placebo (significância estatística: risco relativo de 0,85; intervalo de confiança de 95% de 0,77-0,93; número necessário para tratar de 25), porém, quando comparado ao salmeterol não obteve significância estatística (risco relativo de 0,93; intervalo de confiança de 95% 0,80-1,08). O número de hospitalizações foi menor no grupo brometo de tiotrópio do que no grupo placebo (significância estatística: risco relativo de 0,77; intervalo de confiança de 95% 0,59-0,99; número necessário para tratar de 50). Os resultados indicam que o brometo de tiotrópio é um broncodilatador eficaz em dose única diária. O brometo de tiotrópio traz benefícios à saúde com resultados consistentes, incluindo redução de exacerbações da doença pulmonar obstrutiva crônica, internações e até mesmo a mortalidade quando comparados com salmeterol.(AU)

Is cone beam computed tomography accurate for postoperative evaluation of implants? An in vitro study.

OBJECTIVE: The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT) for evaluation of the bone-implant interface in comparison with periapical radiography. STUDY DESIGN: Titanium implants were inserted in 74 bovine rib blocks in intimate contact with bone walls and with a gap of 0.125 mm (simulating failure in the osseointegration process). Periapical radiographs were taken with conventional film, and CBCT scans were acquired with i-CAT (0.2 mm and 0.125 mm voxel) and Kodak (0.2 mm and 0.076 mm voxel) units. Three examiners evaluated the images using a 5-point scale. Diagnostic accuracy was analyzed through sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) with 95% confidence intervals (CIs). Intra- and interexaminer agreements were analyzed through Kendall's concordance test. RESULTS: Intra- and interexaminer agreements showed satisfactory results. The greatest accuracy was observed with conventional radiography (AUC = 0.963; CI 95% = 0.891-0.993). I-CAT 0.125-mm images showed good accuracy (AUC = 0.885; CI 95% = 0.790-0.947), with no significant difference compared with conventional radiography. Kodak images had high specificity and low sensitivity, presenting more false-negative results. CONCLUSIONS: Conventional radiography showed the highest accuracy for assessment of the bone-implant interface. However, CBCT (i-CAT; 0.125-mm voxel), if available or if performed for preoperative assessment of another implant site, may provide similar accuracy.

Smartphone application for emergency signal detection.

Currently, a number of studies focus on the study and design of new healthcare technologies to improve elderly health and quality of life. Taking advantage of the popularity, portability, and inherent technology of smartphones, we present an emergency application for smartphones, designated as knock-to-panic (KTP). This innovative and novel system enables users to simply hit their devices in order to send an alarm signal to an emergency service. This application is a complete and autonomous emergency system, and can provide an economic, reliable, and unobtrusive method for elderly monitoring or safety protection. Moreover, the simple and fast activation of KTP makes it a viable and potentially superior alternative to traditional ambient assisted living emergency calls. Furthermore, KTP can be further extended to the general population as well and not just be limited for elderly persons. The proposed method is a threshold-based algorithm and is designed to require a low battery power consumption. The evaluation of the performance of the algorithm in collected data indicates that both sensitivity and specificity are above 90%.

Efetividade e segurança do vegetal Cissus sicyoides (?insulina vegetal?) como fitoterápico hipoglicemiante / Effectiveness and safety of the plant Cissus sicyoides (?plant insulin?) as a hypoglycemic herbal medicine

Introdução: Em algumas regiões do Brasil, a infusão de folhas da planta Cissus sicyoides (conhecida popularmente como ?insulina vegetal?) é utilizada como agente hipoglicemiante em diabéticos. Objetivo: Verificar a efetividade desse fitoterápico no tratamento do diabetes em seres humanos. Métodos: Revisão sistematizada da literatura realizada no Centro Cochrane do Brasil. Resultados: Um estudo feito em coelhos mostrou redução significativa de 60% da glicemia. Dois estudos feitos em ratos foram controversos, um mostrando redução de 25% na glicemia e outro mostrando resultados insignificantes. Um estudo feito em humanos mostrou resultados não satisfatórios para a efetividade do Cissus sicyoides. Conclusão: Não existem evidências científicas que indiquem a planta Cissus sicyoides, conhecida popularmente como insulina vegetal, no tratamento do diabetes mellitus em humanos.

Efetividade e segurança dos probióticos nas doenças intestinais / Effectiveness and safety of probiotics in intestinal diseases

Introdução e objetivo: Os probióticos são microrganismos vivos ditos protetores da microflora intestinal. O objetivo é verificar sua efetividade e segurança nas doenças intestinais. Metodologia: Revisão sistematizada da literatura. Resultados: Na doença de Crohn, os resultados foram insignificantes (odds ratio (OR) 0,80, intervalo de confiança (IC) de 0,04-17,20) e em outro estudo verificou-se que os pacientes conseguiam se manter sem atividade da doença. A Escherichia coli Nissle não reduziu o risco de recidiva em comparação com placebo (risco relativo (RR) 0.43, IC de 0,15-1,20), nem o lactobacillus GG pôde induzir remissão (RR 0.83, IC de 0,25-2,80). Na comparação com a terapia com aminosalicilatos ou azatioprina versus probióticos, não houve significância estatística em reduzir o risco de recidiva (RR 0,67, IC de 0,13-3,30). Os probióticos reduziram duração da diarreia significativamente (diferença média (DM) de 24,76 horas, IC de 15,9-33; DM 4,02 dias, IC de 4,61-3,43 dias) diarreia com duração ≥ 4 dias (RR 0,41; IC de 0,32-0,53) e frequência de evacuações no dia 2 (DM de 0,80, IC de 0,45-1,14). Os probióticos não reduzem a atividade da retocolite ulcerativa leve a moderada. Em crianças, os probióticos em altas doses reduzem a diarreia desencadeada por antibióticos (IC de 6-10). Os probióticos reduzem significativamente a incidência de enterocolite necrotizante (ECN) grave (RR 0.35, IC de 0,24-0,52) e mortalidade (RR 0,40, IC de 0,27-0,60), mas sem evidência significativa na sepse nosocomial (RR 0,90, IC de 0,76-1,07). Houve redução significativa no eczema infantil (RR 0.82, IC de 0,70, 0,95), mas não no eczema atópico (RR 0,80, IC 0,62-1,02). Conclusão: Na doença de Crohn, não há evidências suficientes sobre a eficácia dos probióticos. Os probióticos encurtam a duração e reduzem a frequência de evacuações da diarreia infecciosa aguda. Em crianças, o uso de probióticos em altas doses tem efetividade na diarreia. Os probióticos diminuem ECN grave e mortalidade por qualquer causa em prematuros.

Aveia / oatmeal

A aveia pode reduzir o risco de doenças vasculares através da redução do colesterol total e do LDL-colesterol.Objetivo: Verificar evidências do uso da aveia na prevenção de doenças vasculares.Métodos: Busca sistematizada da literatura, por meio de busca eletrônica, de artigos que avaliem o uso da aveia na terapêutica médica.Resultados: Encontramos uma revisão sistemática com oito estudos com aveia. Esse estudo evidenciou diminuição significativa do colesterol total e do LDL-colesterol. Encontramos três ensaios clínicos randomizados nos quais houve demonstração da diminuição do colesterol total e do LDL-colesterol.Conclusão: O uso regular de aveia em suas diversas formas é um coadjuvante importante no tratamento das dislipidemias em pacientes com fatores de risco para doenças vasculares e hiperlipêmicos...

Influence of sibutramine on heart rate in obese patients: systematic review / Influência da sibutramina na frequência cardíaca de pacientes obesos: revisão sistemática

Cardiovascular alterations are part of the obesity-related metabolic syndrome. The objective of this study was to verify the effect of sibutramine on obese patients heart rate. Systematic review of randomized clinical trials performed in the Brazilian Cochrane center, in obese patients, on use of sibutramine or placebo. Outcome: change in heart rate. Electronic database searched: Cochrane library, Medline, LILACS, Pubmed. There were no language, date, or other restrictions. Two reviewers made data collection and extraction, who independently obtained full articles of all eligible papers. Four studies provided dichotomous data for a meta-analysis, the outcome of which was favorable to placebo: relative risk (RR) 3.73, confidence interval (CI) 2.07 to 6.73, risk difference (RD) of 0.13, number needed to harm (NNH) of 7. Ten studies presented continuous data for a meta-analysis, the result of which was favorable to placebo: mean difference (MD) of 7.24, CI of 6.22-8.26. The use of sibutramine in obese patients significantly affects the heart rate.

Alterações cardiovasculares são parte da síndrome metabólica relacionada à obesidade. O objetivo deste estudo foi verificar a influência da sibutramina sobre a frequência cardíaca em pacientes obesos.Revisão sistemática de ensaios clínicos randomizados realizados no centro Cochrane do Brasil em pacientes obesos em uso de sibutramina ou placebo. Desfecho: alteração da frequência cardíaca. Banco de dados eletrônico pesquisados: Cochrane Library, Medline, LILACS, Pubmed. Não houve restrições quanto a idioma, data, ou outras restrições. Coleta de dados e extração foi realizada por dois revisores, que de forma independente obteve artigos na íntegra de todos os estudos elegíveis. Quatro estudos forneceram dados dicotômicos para uma meta-análise, cujo resultado foi favorável ao placebo:risco relativo (RR) 3,73, intervalo de confiança (IC) 2,07-6,73, diferença de risco (DR) de 0.13, número necessário para causar lesão (NNL) de 7. Dez estudos apresentaram dados contínuos para uma metanálise, cujo resultado foi favorável ao placebo: diferença média (DM) de 7,24, IC de 6,22-8,26. O uso da sibutramina em pacientes obesos afeta significativamente a frequência cardíaca.