Systematic review of case reports concerning adults suffering from neutropenic enterocolitis.

INTRODUCTION: Neutropenic enterocolitis (NEC) is a well recognised clinical-pathological and life-threatening complication in patients suffering from several conditions, including solid and haematological malignancies or aplastic anaemia. OBJECTIVE: This review was aimed at evaluating overall NEC mortality rate, describing clinical diagnostic findings and therapeutical interventions reported in the literature and generating a hypothesis regarding factors influencing mortality and surgical intervention. MATERIALS AND METHODS: An advanced search was made in Medline, Embase, Lilacs and Google. Additional strategies included manual search of specific journals. Reports were considered if they described case definition, inclusion and exclusion criteria. RESULTS: 275 cases were selected; 109 were from individual data and 40 from grouped data. Comparing data between case reports and case series revealed no significant differences related to mortality, surgical intervention, sex or age. Higher mortality (chi2 = 7.51 p = 0.006) was found in women (50%) compared to men (28%). No significant difference was found between antibiotic combinations and mortality (chi(2) = 12.85 df 13 p = 0.45). Mortality (chi2 = 3.89 df 1, p = 0.049), surgical intervention (chi2 = 7.64 df 1, p = 0.006) and duration of diarrhoea (chi2 = 4.71 df 1, p = 0.043) were significantly different in 26.4% of individuals using antifungal agents; death occurred in 81% of patients! who did not receive such medication compared to 19% individuals reported as being treated with antifungal agents. CONCLUSION: The current evidence suggests that antifungal agents should be used early in patients suffering from NEC. However, this hypothesis must be evaluated in multi-centric, randomised controlled trials.

Systematic review of case reports concerning adults suffering from neutropenic enterocolitis

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Introduction. Neutropenic enterocolitis (NEC) is awell recognised clinical-pathological and life-threateningcomplication in patients suffering from severalconditions, including solid and haematologicalmalignancies or aplastic anaemia.Objective. This review was aimed at evaluatingoverall NEC mortality rate, describing clinical diagnosticfindings and therapeutical interventions reportedin the literature and generating a hypothesisregarding factors influencing mortality and surgicalintervention.Materials and methods. An advanced search wasmade in Medline, Embase, Lilacs and Google. Additionalstrategies included manual search of specificjournals. Reports were considered if they describedcase definition, inclusion and exclusion criteria.Results. 275 cases were selected; 109 were from individualdata and 40 from grouped data. Comparingdata between case reports and case series revealedno significant differences related to mortality, surgicalintervention, sex or age. Higher mortality (÷2 =7.51 p = 0.006) was found in women (50%) comparedto men (28%). No significant difference wasfound between antibiotic combinations and mortality(÷2 = 12.85 df 13 p = 0.45).Mortality (÷2 = 3.89 df 1, p = 0.049), surgical intervention(÷2 = 7.64 df 1, p = 0.006) and duration of diarrhoea(÷2 = 4.71 df 1, p = 0.043) were significantly differentin 26.4% of individuals using antifungal agents;death occurred in 81% of patients! who did not receivesuch medication compared to 19% individualsreported as being treated with antifungal agents.Conclusion. The current evidence suggests that antifungalagents should be used early in patients sufferingfrom NEC. However, this hypothesis must beevaluated in multi-centric, randomised controlledtrials

[The use of bibliographic databases by Spanish-speaking Latin American biomedical researchers: a cross-sectional study]. / Uso de bases de datos bibliográficas por investigadores biomédicos latinoamericanos hispanoparlantes: estudio transversal.

OBJECTIVE: To describe how Spanish-speaking biomedical professionals in Latin America access and utilize bibliographic databases. METHODS: Based on a MEDLINE search, 2 515 articles published between August 2002 and August 2003 were identified that dealt with and/or had authors from 16 countries: Argentina, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. The search was limited to references to basic science, clinical science, or social medicine. A survey was sent by e-mail to researchers who lived in 15 of the 16 countries (the exception being Nicaragua). The survey asked about the researcher's area of work (basic science, clinical science, or public health), the level of skill in using databases, the frequency and type of access to the databases most utilized, the impact from not having access to the full text of articles when preparing a manuscript, and how the respondent usually obtained the full-text version of articles. RESULTS: A total of 586 e-mail messages with the survey were sent out, and 185 responses were received (32%). The databases most utilized to obtain biomedical information were MEDLINE (34.1%), general search engines (Google, Yahoo!, and AltaVista) (15.9%), on-line journals (9.8%), BIREME-LILACS (6.0%), BioMedNet (5.4%), the databases of the Centers for Disease Control and Prevention of the United States of America (5.2%), and the Cochrane Library (4.9%). Of the respondents, 64% said they had average or advanced abilities in using MEDLINE. However, 71% of the respondents did not use or were not aware of the MEDLINE Medical Subject Headings (MeSH), a controlled vocabulary established by the National Library of Medicine of the United States of America for indexing articles. The frequency of accessing the databases was similar in all the countries studied, without significant differences in terms of the type of access (authorized access to commercial databases, unauthorized access to those databases, or access to databases available for free) or the level of abilities. Of the respondents, 87% said they had not included important references in the articles that they had published because they had not had access to the full text of those items, and 56% said they had cited articles that they had not read in full. In addition, 7.6% of the respondents admitted to unauthorized use of limited-access databases, such as through borrowed passwords or copied disks. More than two-thirds of the respondents said they obtained the full text of articles through photocopies or directly from the authors. CONCLUSIONS: In order to encourage scientific output by Latin American researchers, more of them need to be trained in the use of the most frequently used databases, especially MEDLINE. Those researchers also need to have expanded access to the biomedical literature.

Eficacia de la flunarizina en la profilaxis de migraña: revision metaanalitica de la literatura / Effectiveness of flunarizine in the prophylaxis of migraine: a meta-analytical review of literature

Introducción. La migraña es una enfermedad de alta prevalencia en la población general. En su profilaxis se ha utilizado la flunarizina por más de dos décadas. Objetivo. Determinar la eficacia y seguridad de la flunarizina comparada con placebo en la profilaxis de migraña en adultos y valorar la mejor evidencia encontrada en una revisión sistemática de la bibliografía. Material y métodos. Se realizaron búsquedas electrónicas exhaustivas en MEDLINE, EMBASEy el CCTR de Cochrane, entre otros, demás de búsquedas manuales para la identificación de ensayos clínicos aleatorizados, dobleciegos, que compararan flunarizina con placebo para la profilaxis de migraña en adultos. La principal medida de desenlace file la. frecuencia de las crisis; se calculó la diferencia de medias antes y durante la intervención en cada brazo de tratamiento, y entre los dos grupos. Para evaluar la seguridad se tuvieron en cuenta estudios incluidos, excluidos y abiertos. Resultados. IM búsqueda permitió seleccionar nueve artículos, pero únicamente cuatro estudios cumplieron con los criterios de elegibilidad. El modelo de efectos fijos comunicó una mayor reducción en la frecuencia de migraña en el grupo de flunarizina. respecto al grupo de placebo, con una diferencia mensual en el número de crisis de 0,5 5 (IC 95 por ciento = 0,215-0,895; p= 0,002). El evento secundario más frecuente para la totalidad de los sujetos (n= 1.987) fue somnolencia en un 20,5 por ciento. Conclusiones. Se encontró que la flunarizina en dosis de 10 mg al día tiene un leve efecto en la disminución de la frecuencia de las crisis de migraña.

Cáncer e internet. Une studio descriptivo de los ensayos clínicos sobre cáncer encontrados en MEDLINE y CANCERLIT a través de Internet / Neoplasm and internet. A epidemiology descriptive

Internet y las bases de datos médicos son recursos que se encuentran en expansión. Actualmente, algunos registros como MEDLINE, CANCERLIT o la librería Cochrane permiten el acceso a un gran número de artículos médicos. Dentro de los objetivos esta describir y evaluar las características de los ensayos clínicos sobre cáncer encontrados en las bases de datos MEDLINE y CANCERLIT a partir de una muestra representativa de artículos. Materiales y métodos: Empleando la plataforma OVID se realizaron búsquedas estructuradas en las bases de datos MEDLINE y CANCERLIT usando el filtro diseñado para ensayos clínicos según la metodología propuesta por Dickersin y limitando la búsqueda a estudios publicados entre 1980 y 2002 que fueran indentificables utilizando las palabras clave cáncer, tumor, carcinoma y neoplasia. Los datos obtenidos se analizaron por categorías. Resultados: Se encontraron un total de 80.032 y 91.085 referencias en MEDLINE y CANCERLIT respectivamente. El 92.5 por ciento y el 95 por ciento de los artículos encontrados dentro de la muestra seleccionada estaban relacionados con cáncer; un 59 por ciento de las citas bibliográficas de MEDLINE y un 35,7 por ciento de las de CANCERLIT correspondieron a ensayos clínicos en los que el tipo de neoplasia más frecuente fue la hematológica y la fase II, la más relevante. Conclusiones:Este estudio muestra que la estrategia de búsqueda avanzada tiene un potencial limitado para identificar ensayos clínicos relacionados con cáncer en bases de datos generales como MEDLINE. Esta información revela las grandes restricciones de los motores de búsqueda de literatura médica debido a que cubren parcialmente el número de referencias indizadas. Proponemos desarrollar registros más especializados, como CANCERLIT, que permitan incrementar la especificidad de las búsquedas avanzadas.