The effects of NAD+ precursor (nicotinic acid and nicotinamide) supplementation on weight loss and related hormones: a systematic review and meta-regression analysis of randomized controlled trials.

Background: Despite the fact that obesity and overweight are serious major health problems worldwide, fighting against them is also considered a challenging issue. Several interventional studies have evaluated the potential weight-reduction effect of nicotinamide adenine dinucleotide (NAD+) precursor. In order to obtain a better viewpoint from them, this study aimed to comprehensively investigate the effects of NAD+ precursor supplementation on weight loss, adiponectin, and leptin. Methods: Scopus, PubMed/Medline, Web of Science, Cochrane, and Embase databases were searched using standard keywords to identify all controlled trials investigating the weight loss and related hormones effects of NAD+ precursor. Pooled weighted mean difference and 95% confidence intervals were achieved by random-effects model analysis for the best estimation of outcomes. Results: Twenty two treatment arms with 5,144 participants' were included in this systematic review and meta-regression analysis. The pooled findings showed that NAD+ precursor supplementation has an effect on lowering BMI (weighted mean difference (WMD): -0.19 kg/m2, 95% confidence interval (CI): -0.29 to -0.09, p < 0.001) and increasing adiponectin (WMD: 1.59 µg/mL, 95% CI: 0.49 to 2.68, p = 0.004) in humans compared with control groups. However, no significant effect was observed on body weight and leptin. There was a significant relationship between doses of intervention with changes in BMI. In addition, subgroup analysis showed that BMI reduction was greater when receiving nicotinic acid (NA) supplementation than nicotinamide (NE) supplementation. Conclusion: NAD+ precursor had significant effects on weight management with the reduction of BMI and increasing adiponectin.

Quality management tools applied to drug dispensing in hospital pharmacy: A scoping review.

BACKGROUND: The process of drug dispensing in hospital pharmacies (HPs) is one of the essential steps in health care, but presents high complexity due to the diversity of professionals and clinical conditions of patients. Therefore, the use of quality management tools may be an important strategy to improve patient safety and to achieve institutional goals, including user satisfaction and reduction of costs. OBJECTIVE: This scoping review sought to describe quality management tools applied to drug dispensing in HPs; quality indicators used and results obtained. METHODS: This scoping review was developed according to the Cochrane methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA), being registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/KP3AJ). The searches were performed in electronic databases Medline, Cochrane Library, Embase, CINAHL and Lilacs, with no limit of date or language. Studies on quality management tools applied to drug dispensing in HPs were assessed for eligibility, extracted and compiled in a narrative form. RESULTS: From the 1318 studies identified, 11 were eligible for this review. The quality management tools more frequently reported were those related to the definition of root cause (n = 4; 36%), e.g. DMAIC (Define, Measure, Analyze, Improve and Control) and the cause and effect diagram; tools for risk management, such as FMEA (Failure Mode and Effect Analysis) and its variations (n = 4; 36%); and tools related to the LSS (LEAN Six Sigma) principles (n = 3; 27%). The quality indicators used to monitor the results were, mainly, work team satisfaction, time spent performing activities and reduction of errors and costs. CONCLUSIONS: The use of quality management tools showed a tendency to improve the indicators of the drug dispensing process in HPs, such as increase in work team satisfaction, reduction of time spent performing activities, errors and costs, improving the quality of services.

Factors associated with nonadherence to the use of coumarin derivatives or direct oral anticoagulants: A systematic review of observational studies.

Nonadherence to thromboprophylaxis treatment with oral anticoagulants (OAC) is a public health problem and may be associated with high mortality rates. We sought to synthesize the factors associated with nonadherence to therapy with coumarin derivatives or direct oral anticoagulants. A systematic review was performed at electronic databases Medline, Embase, CINAHL, Lilacs and grey literature (Google Scholar, MedNar, OpenGray, ProQuest Dissertations and Theses, and hand search). This study was conducted according to Cochrane's method and PRISMA. The registration on PROSPERO is CRD42020223555. Overall, 1270 studies were identified and nine studies were selected for this review. In hand searching, 77 studies were found, but none included. The associated factors with nonadherence were heterogeneous, and some factors were described as both risk and protection for nonadherence, with few variables showing consistent results among the studies. Variables reported only as risk factors were "male sex", "hospitalization", "Charlson score" and "bleeding", while "white race", CHA2 DS2 VASc (score range 2-9)" and "polypharmacy" were reported only as protective factors. Most studies did not present details in the description of concepts and methods to assess nonadherence. In clinical practice, the knowledge on factors associated with nonadherence is helpful to identifying patients at higher risk of complications that would benefit from individualized interventions.

The COVID-19 Vaccination Strategy in Brazil-A Case Study.

Brazil is among the countries which have faced two devastating infection waves of COVID-19 in the past year. Despite the fact the country has one of the world's leading immunization programs, Brazil only slowly established a national COVID-19 vaccination strategy and campaign. This case study is based on an integrative review of primary and secondary literature sources. Different search strategies on Medline and Google Scholar were performed for the case presentation, for the management and outcome of the COVID-19 outbreak and for the state of the COVID-19 vaccination program. Official documents from the Brazilian Ministry of Health, the website of the World Health Organization and pharmaceutical companies were also reviewed. Searches were limited to English, French, German, Portuguese and Spanish. This article describes the Brazilian COVID-19 vaccination campaign and the drivers and barriers to its implementation; and evaluates further investigations needed to have a conclusive overview over the constantly evolving situation. Healthcare inequalities, which were widened during the pandemic, a lack of coordination at the federal level, the absence of federal government support for scientific research and the lack of endorsement and commitment to the mitigation of the COVID-19 pandemic set the country's COVID-19 vaccination campaign off to a challenging start. However, Brazil had a well-developed primary care system and national vaccination program prior to the pandemic, which are both important facilitators. At the time of writing, six vaccines are currently available in the country, and the program is advancing. The scientific community needs to continue to investigate the country's vaccination strategy and its implementation to make sure that maximum effort is undertaken for the health of the Brazilian population.

Serological tests using Sporothrix species antigens for the accurate diagnosis of sporotrichosis: a meta-analysis.

Some species of the fungus Sporothrix cause a chronic granulomatous infection in humans and animals called sporotrichosis. In the last decades, some research into serological tests has been carried out by different groups for the rapid detection of this infection. We performed a systematic review of the literature with meta-analysis to evaluate studies using Sporothrix spp. antigens and to evaluate their accuracy for sporotrichosis diagnostic. We searched Scopus, MEDLINE, Web of Science, GALE, Technology Research Database, DOA, Elsevier, SciELO, and Google Scholar Databases. The united results of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio with their corresponding 95% confidence intervals (CI) were assessed. A total of 15 assays from 8 studies using 7 different serological methods and 8 different antigens were analyzed. The studies were performed in the USA, Brazil, and Venezuela from 1973 until 2015 and presented good quality. A high heterogeneity for sensitivity [I2 = 90.7%; 87% CI = (84-89), P < 0.001] and specificity [I2 = 89.2%; 93% CI = (92-95), P < 0.001] was observed. The performance of diagnostic tests was 0.93. Enzyme-linked immunosorbent assay was the main tool used, and the ConA-binding fraction antigen of the strain 1099-18 appears as a promising diagnostic biomarker candidate.

Acute kidney injury biomarkers in the critically ill.

Acute kidney injury (AKI) is a highly common complication in intensive care units (ICUs). Novel biomarkers might accelerate the detection and management of AKI. We performed a systematic review aiming to evaluate the performance of biomarkers for early AKI diagnosis in ICUs. MEDLINE, BVS, CINAHL, COCHRANE and EMBASE were searched for studies (2006-2019) on the use of biomarkers for AKI diagnosis. Preselected biomarkers were cystatin C, chitinase-3-like protein-1 (UCHI3L1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1) and interferon-gamma-inducible protein 10 (IP-10/CXCL-10), measured in plasma or urine. Eleven articles with total of 2,289 patients were included. The most cited biomarker was NGAL (n = 7 studies; 63.6%). Biomarkers with the highest sensitivity (se) and specificity (sp) were urinary heat shock protein (HSP-72) (se = 100%; sp = 90%) and urinary IL-18 (se = 92%; sp = 100%). All biomarkers' performance was influenced by the presence of comorbidities or AKI etiology. Although some biomarkers showed good performance, there was no externally validated biomarker for early AKI diagnosis. Thus, from this review, we did not indicate a novel biomarker to be promptly used in clinical practice. Prospective studies with a large number of patients are needed to expand knowledge in this field. PROSPERO registration number CRD42016037325.

Diagnostic accuracy of tests using recombinant protein antigens of Mycobacterium leprae for leprosy: A systematic review.

The aim of this systematic review was to investigate the studies that evaluated the sensitivity and specificity of serologic tests using recombinant protein antigens from Mycobacterium leprae for leprosy diagnosis. We included 13 studies that were available in PubMed, Brazilian Virtual Library of Health, Web of Science, ScienceDirect and Scopus. From these studies, we found that the recombinant serine-rich 45-kDa protein of M. leprae (ML0411) demonstrated high performance for multibacillary (MB) also to paucibacillary (PB) patients, although this study was tested only for Indian population. Despite that, studies using the ND-O-LID antigen have been able to more accurately identify new cases of leprosy among people living in endemic or non-endemic areas and household contacts in Brazil, Colombia, and the Philippines, especially when combined with other biomarkers. Finally, low sensitivity values for PB patients' antibodies response remain challenging for tests intended to diagnose clinical forms that comprise this classification in leprosy.

Distúrbios nutricionais e metabólicos provocados pela utilização da terapia antirretroviral e abordagem nutricional: uma revisão narrativa / Nutritional and metabolic disorders caused by antiretroviral therapy and nutritional approach: a narrative review

O uso da terapia antirretroviral (TARV) tem aumentado à sobrevida das pessoas vivendo com HIV/AIDS (PVHA) alterando consideravelmente a história natural da infecção. Entretanto, em alguns casos, o uso destes medicamentos tem sido associado à distúrbios nutricionais e metabólicos. O objetivo deste estudo foi descrever os distúrbios nutricionais e metabólicos ocasionados pelo uso da TARV e o respectivo papel terapêutico da abordagem nutricional em PVHA. Trata-se de uma revisão narrativa, realizada durante o segundo semestre do ano de 2012, utilizando os seguintes descritores: AIDS, HIV, PVHA, TARV, estado nutricional, acompanhamento nutricional. O principal distúrbio nutricional encontrado nesta revisão, relacionado ao uso de TARV, foi a síndrome lipodistrófica associada à dislipidemias e hiperglicemias, bem como, alterações ósseas e aumento de gordura corporal. Neste sentido, o acompanhamento nutricional é extremamente importante para a melhora da qualidade de vida e prevenção de demais complicações metabólicas em PVHA (AU)

The use of antiretroviral therapy has increased the survival of people living with HIV/AIDS considerably altering the natural history of infection. However, in some cases, the use of these drugs have been associated with nutritional and metabolic disorders. The objective of this study was to describe the nutritional and metabolic disorders caused by antiretroviral therapy and their therapeutic role of nutritional approach for people living with HIV/AIDS. This is a narrative review, conducted during the second half of 2012, using the following descriptors: AIDS, HIV, people living with HIV/AIDS, antiretroviral therapy, nutritional status, nutritional counseling. The main nutritional disorder found in this review, related to the use of antiretroviral therapy was the lipodystrophy syndrome associated with dyslipidemia and hyperglycemia, as well as bone changes and increase in body fat. In this sense, the nutritional monitoring is extremely important to improve the quality of life and prevention of other metabolic complications in people living with HIV/AIDS (AU)