Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study.

OBJECTIVE: To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit. METHODS: A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aß (1-42)], Aß (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge. RESULTS: Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder. CONCLUSION: Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.

Omega-3 as an adjuvant in the treatment eating and psychological symptoms in patients with anorexia nervosa: a systematic review and meta-analyses.

BACKGROUND: This study was carried out to assess the effects of omega-3 supplementation as an adjunct treatment for eating and psychological symptoms in patients with anorexia nervosa. METHODS: We conducted a systematic review of the literature using the terms 'anorexia nervosa' AND 'Fatty Acids, Omega-3'. Five randomised controlled trials with a total of 144 participants, published between 2003 and 2022, were included. RESULTS: The effects of supplementation of omega-3 on anxiety were standardised mean difference (SMD) 0.79, 95% confidence interval (CI) -0.08 to 1.66; p = 0.08; I² = 3%; two studies, 33 participants; moderate quality of evidence. For depression, the supplementation of omega-3 was SMD: 0.22, 95% CI: -0.50 to 0.93; p = 0.18; I² = 45%; two studies, 33 participants; moderate quality of evidence. For obsessive-compulsive disorder, the supplementation of omega-3 was SMD: -0.22, 95% CI: -0.70 to 2.25; p = 0.36; I² = 0%; three studies, 32 participants; low quality of evidence. CONCLUSION: This research showed that regardless of dose, time or, if associated with other components, the use of omega-3 supplementations as an adjuvant treatment showed no evidence of effect in eating and psychological symptoms in patients with anorexia nervosa.

Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study / Biomarcadores de disfunção neuropsiquiátrica em sobreviventes de unidades de terapia intensiva: um estudo de coorte prospectivo

ABSTRACT Objective: To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit. Methods: A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge. Results: Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder. Conclusion: Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.

RESUMO Objetivo: Avaliar os fatores associados aos desfechos neuropsiquiátricos de longo prazo, incluindo biomarcadores, medidos após a alta da unidade de terapia intensiva. Métodos: Foi realizado um estudo de coorte prospectivo com 65 sobreviventes de unidades de terapia intensiva. A avaliação cognitiva foi realizada por meio do Miniexame do Estado Mental; os sintomas de ansiedade e depressão foram avaliados por meio da Escala Hospitalar de Ansiedade e Depressão, e o transtorno de estresse pós-traumático foi avaliado pela Escala de Impacto do Evento-6. Os níveis plasmáticos de beta amiloide (1-42), beta amiloide (1-40), interleucina 10, interleucina 6, interleucina 33, interleucina 4, interleucina 5, fator de necrose tumoral alfa, proteína C-reativa e fator neurotrófico derivado do cérebro foram medidos na alta da unidade de terapia intensiva. Resultados: Das variáveis associadas à terapia intensiva, apenas o delirium foi relacionado de forma independente à ocorrência de comprometimento cognitivo de longo prazo. Além disso, níveis mais altos de interleucina 10 e interleucina 6 foram associados à disfunção cognitiva. Apenas a interleucina 6 foi associada de forma independente à depressão. A ventilação mecânica, os níveis de interleucina 33 e os níveis de proteína C-reativa foram associados de forma independente à ansiedade. Nenhuma variável foi associada de forma independente ao transtorno de estresse pós-traumático. Conclusão: A disfunção cognitiva, bem como os sintomas de depressão, ansiedade e transtorno de estresse pós-traumático, estão presentes em pacientes que sobrevivem a uma doença grave, e alguns desses desfechos estão associados aos níveis de biomarcadores inflamatórios medidos na alta da unidade de terapia intensiva.

Mental health interventions for suicide prevention among indigenous adolescents: a systematic review

ABSTRACT BACKGROUND: The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES: To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING: Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS: The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS: Two studies were identified: one on adolescents in the remote Yup'ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS: The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS: The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.

Vitamin D supplementation during pregnancy to prevent vitamin D deficiency in newborns: a systematic review and meta-analysis / Suplementação de vitamina D durante a gravidez para a prevenção da deficiência de vitamina D em recém-nascidos: uma revisão sistemática e meta-análise

Abstract Objectives: to assess the effects of vitamin D supplementation during pregnancy on the outcomes of vitamin D concentration in newborns, length at birth, overall health (Apgar), birth weight and maternal vitamin D concentration after childbirth. Methods: this research was conducted in the electronic databases of MEDLINE, LILACS, EMBASE and Cochrane Library until December 2020, using the terms "vitamin D", "pregnancy", "vitamin D deficiency", "infant", "newborn" and their synonyms. Randomized controlled trials were searched by evaluating the effects of maternal vitamin D supplementation in neonates. The data was analyzed on RevMan 5.4 software and the quality of evidence on GRADE. Results: the newborn's overall health condition was presented as Apgar, with a mean difference (MD) of 0.15 (CI95%=0.06-0.25; p=0.002; I2=0%, two studies, 648 participants, moderate quality evidence) at the first minute and 0.11 (CI95%=0.04-0.17; p=0.001; I2=0%, two studies, 648 participants, moderate quality evidence) at the fifth minute. Significant effects were also presented at the length at birth considering any supplemented dose (MD=0.19; CI95%=0.08-0.30; p=0.0010; I2=0%, 1452 participants, low quality evidence) and birth weight in doses higher than 4000IU/day (MD=257.05 (CI95%=137.81-376.29; p<0.0001; I2=14%, 176 participants, moderate quality evidence). Conclusion: vitamin D supplementation during pregnancy improves serum 25 (OH) D concentration and suggests positive effects on overall health condition, length at birth and birth weight. PROSPERO CRD42017073292.

Resumo Objetivos: avaliar os efeitos da suplementação materna de vitamina D durante a gravidez nos desfechos concentração de vitamina D no recém-nascido, comprimento ao nascer, estado geral de saúde (Apgar), peso ao nascer e concentração de vitamina D materna após o nascimento. Métodos: a pesquisa foi conduzida nas bases de dados eletrônicas MEDLINE, LILACS, EMBASE e Cochrane Library até dezembro de 2020, utilizando os termos "vitamin D", "pregnancy", "vitamin D deficiency", "infant", "newborn" e seus sinônimos. Pesquisou-se por ensaios clínicos randomizados avaliando os efeitos da suplementação materna de vitamina D no neonato. Os dados foram analisados pelo software RevMan 5.4 e a avaliação da qualidade das evidências pelo GRADE. Resultados: o estado geral de saúde do recém-nascido foi apresentado como Apgar, com uma diferença de média (DM) de 0,15 (IC95%=0,06-0,25; p=0,002; I2=0%, dois estudos, 648 participantes, evidência de qualidade moderada) para o teste no primeiro minuto e 0,11 (IC95%=0,04-0,17; p=0,001; I2=0%, dois estudos, 648 participantes, evidência de qualidade moderada) para quinto minuto. Efeitos significativos também foram apresentados para o comprimento ao nascer em qualquer dose suplementada (DM=0,19 (IC95%=0,08-0,30; p=0,0010; I2=0%, 1452 participantes, evidência de baixa qualidade) e peso ao nascer em doses maiores que 4000UI/dia (DM=257,05 (IC95%=137,81-376,29; p<0,0001; I2=14%, 176 participantes, evidência de qualidade moderada). Conclusão: a suplementação de vitamina D durante a gravidez melhora a concentração sérica de 25 (OH)D e sugere apresentar efeitos positivos no estado geral de saúde, comprimento ao nascer e peso ao nascer. PROSPERO CRD42017073292.

Mental health interventions for suicide prevention among indigenous adolescents: a systematic review.

BACKGROUND: The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES: To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING: Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS: The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS: Two studies were identified: one on adolescents in the remote Yup'ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS: The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS: The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.

Nutritional Interventions in Children with Brain Injuries: A Systematic Review.

BACKGROUND: Brain injury has several consequences throughout life, its increased incidence has caused great public concern. The aim was identifying the main nutritional therapies recommended for children with brain injuries. METHODS: A systematic review was carried out using the terms in the search strategy: "Brain Injuries", "Nutrition Therapy", and "Child" and their synonyms, from database inception up to August 2020. The search was conducted in the following databases: MEDLINE, EMBASE, Scopus, Cochrane library, LILACS, and grey literature. Two reviewers independently selected the included studies, according to the eligibility criteria and extracted data from the included articles. RESULTS: A total of 1196 studies resulted from electronic searches, and out of these, 27 studies were read in full and eight studies were included. For early enteral nutritional support (<48 h), results suggest benefit in increasing survival rates. Type of dietary protein seems to be related to decreasing gastric emptying by 40%. The use of fibers seems to reduce gastrointestinal discomfort and increase stool frequency. CONCLUSIONS: The evidence mapped was extracted from small studies analyzing different outcomes, so any decision making should be analyzed considering the context. We present the direction of the effect, but the magnitude is still unclear.

Undergraduate Medical Students Perception about the Progress Testing / Percepção dos Acadêmicos de Medicina sobre o Teste de Progresso

Abstract: Introduction: The Progress Test was created to address the necessity of measuring the level of knowledge consolidation along the years of Medical school. The test is administered periodically to all students in a curriculum, assessing the student's cognitive growth throughout their journey at undergraduate level. In addition to assessing the student individually, the test evaluates the institution, showing in which areas its curriculum base should be improved. The aim is to assess the Universidade do Extremo Sul Catarinense student's perception of the Progress Test. Methods: A cross-sectional study was performed. Data was collected through questionnaires created by the researchers and applied to medical students - the ones who took the Progress Test at least once - from October 15th to November 30th, 2018. The statistical analysis was performed with a 95% confidence interval. Results: A response rate of 70.41% was obtained, with a total of 424 questionnaires being included in the research. Demographic data showed a predominance of female gender (60,4%) and white ethnicity (96,2%) in the population and a mean age of 23 years. In all semesters (early, intermediate and final ones) the participants knew the goal of the progress test, and most students consider it important. It was also observed that the majority of the students considered clinical surgery and collective health as their worst performance in the test. In clinical medicine, pediatrics, and gynecology-obstetrics, the students of the intermediate and final semesters were satisfied with their level of knowledge. "To evaluate the student's progress/performance" was highlighted as the most positive point. Among the negative ones "decrease the number of questions so the test is not as extensive" was emphasized. Conclusion: The students of the sample consider the Progress Test important and know about its purpose. The final third of the Medical School is the one who feels most prepared to face the test. The main fields to which the students attributed their worst performance were clinical surgery and collective health. Regarding clinical medicine, pediatrics, gynecology, and obstetrics the students were satisfied with their knowledge.

Resumo: Introdução: O Teste de Progresso serve para medir a consolidação do conhecimento ao longo da formação acadêmica médica. O teste é administrado periodicamente a todos os alunos de um currículo, com o propósito de avaliar o crescimento cognitivo deles na graduação. Além de avaliar o estudante de forma individual, o teste avalia a instituição, de modo a mostrar em quais áreas a sua base curricular deve ser melhorada. O objetivo deste estudo foi avaliar a percepção de acadêmicos de Medicina da Universidade do Extremo Sul Catarinense em relação ao Teste de Progresso. Método: Realizou-se um estudo transversal, em que se coletaram dados por meio de questionários elaborados pelos pesquisadores, aplicados aos alunos do curso de Medicina - que fizeram o Teste de Progresso em algum momento do curso - no período de 15 de outubro a 30 de novembro de 2018. A análise estatística foi realizada com um nível de confiança de 95%. Resultados: Obteve-se uma taxa de resposta de 70,41%, com um número de 424 questionários incluídos na pesquisa. Os dados demográficos revelam uma população de predominância feminina (60,4%), branca (96,2%), com uma média de 23 anos de idade. Nas fases iniciais, intermediárias e finais da pesquisa, os participantes sabiam o objetivo do Teste de Progresso, bem como a maioria dos estudantes, em todas as fases, considerou-o importante. Observou-se também que a maioria dos estudantes considera clínica cirúrgica e saúde coletiva como seu pior desempenho no Teste de Progresso. Já nas áreas de clínica médica, pediatria e ginecologia obstetrícia, os estudantes das fases intermediárias e finais se consideram satisfeitos com seu nível de conhecimento. "Avaliar a evolução/o desempenho do acadêmico" foi o ponto positivo mais citado. Já entre os negativos, destacou-se "diminuir o número de questões para que a prova não fique tão extensa". Conclus ões: Os estudantes da amostra consideram o Teste de Progresso importante e conhecem o objetivo dele. Reconheceram que se sentiram mais preparados nas fases finais. As principais áreas a que os estudantes atribuíram seu pior desempenho foram: clínica cirúrgica e saúde coletiva. Já nas áreas de clínica médica, pediatria e ginecologia obstetrícia, eles se mostraram satisfeitos com o próprio nível de conhecimento.

Metodologia para realizar e interpretar uma revisão sistemática e metanálise individual de dados de participantes / Methodology to perform and interpret a systematic review and individual meta-analysis of participants' data

Metanálise é o método estatístico utilizado na revisão sistemática para integrar os resultados dos estudos incluídos e aumentar o poder estatístico da pesquisa primária.Estudos de metanálise, decorrentes de uma revisão sistemática, envolvem a combinação e a análise de evidências, que são utilizadas para produzir resultados baseados em conjunto de pesquisas prévias. Métodos tradicionais de metanálise sintetizam os dados agregados obtidos de publicações de estudo, como estimativa de efeito de tratamento (odds ratio, risco relativo) e sua incerteza associada (erro padrão ou intervalo de confiança). Uma abordagem alternativa é a metanálise individual de dados de participantes ou de pacientes, nos quais os dados de nível individual bruto para cada estudo são obtidos e utilizados para síntese. O objetivo deste artigo é apresentar, de forma metodológica, como realizar e interpretar uma revisão sistemática e uma metanálise individual de dados de participantes. (AU)

A meta-analysisis the statistical method used in the systematic review to integrate the result sof includeds tudies, and to increase the statistical power of primary research. Meta-analysis studies, stemming from a systematic review, involve the combination and analysis of evidence that are used to produce results based on a set of previous research. Traditional meta-analysis methods synthesize aggreg ate data obtained from study publications, such as anestimate of treatment effect (odds ratio, relative risk) and the ir associated uncertainty (standard error or confidence interval). An alternative approach isthe individual meta-analysis of participants' or patients' data, in whichgross individual-level data for eachstudy are obtained and used for synthesis. The objective of this articleis to present a method o logical way of performing and in ter preting a systematic review and individual meta-analysisof the participants' data. (AU)

INCREASED OXIDATIVE STRESS IN THE BLOOD OF OSTOMY PATIENTS.

BACKGROUND: Ostomy is a surgical procedure that creates a stoma that aims to construct a new path for the output of feces or urine. The relationship of oxidative stress (OxS) markers in patients with ostomy is still poorly described. OBJECTIVE: The present study was aimed at investigating the changes in oxidative stress parameters in peripheral blood collected from ostomy patients when compared with a healthy control group. METHODS: It was evaluated 29 ostomy patients and 30 healthy control patients. The oxidative stress parameters evaluated were: lipid peroxidation [lipid hydroperoxide (LPO), 8-isoprostane (8-ISO) and 4-hydroxynonenal (4-HNE)], protein oxidation and nitration [carbonyl and 3-nitrotyrosine (3-NT)] and DNA oxidation [8-hydroxy-2'-deoxyguanosine (8-OHDG)] in serum from ostomy patients compared to health controls. RESULTS: The data showed an increase of LPO, 8-ISO, 4-HNE, 3-NT and 8-OHDG in serum collected from ostomy patients when compared to healthy controls. CONCLUSION: The findings support the hypothesis that ostomy triggers the oxidative stress observed in the blood collected from these patients.

Depressive symptoms and neurotrophin levels in ostomy patients / Sintomas depressivos e níveis de neurotrofina em pacientes com ostomia

ABSTRACT Objective: The aim of the present study was to investigate the depressive symptoms and changes in neurotrophins (BDNF, NGF, NT-3), and cortisol levels in serum of peripheral blood from ostomy patients compared to healthy control group. Methods: We evaluated ostomy (n = 29) and healthy control (n = 30) patients. The neurotrophin (BDNF, NGF, NT-3), and cortisol levels were assessed by ELISA in serum of peripheral blood. Depressive symptoms were defined based on the Hamilton Depression Rating Scale (HDRS), and major depression disorder was based on clinical interviews and was confirmed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Results: The results showed a significant decrease in BDNF levels and, a significant increase in NT-3 levels in serum of peripheral blood from ostomy patients when compared to healthy controls. The levels of NGF and cortisol showed no significant differences between groups. The depressive symptom evaluations by HDRS demonstrated a significant increase in ostomy patients when compared to healthy controls. The major depression disorder diagnosis by SCID-I showed no significant difference between groups. Conclusion: Our results suggest ostomy triggers significant depressive symptoms and alterations in neurotrophins levels in serum of peripheral blood samples collected from these patients.

RESUMO Objetivo: O objetivo do presente estudo foi investigar os sintomas depressivos e alterações nos níveis de neurotrofinas (BDNF, NGF, NT-3) e cortisol em soro de sangue periférico de pacientes ostomizados em comparação com grupo controle saudável. Métodos: Foram avaliados pacientes ostomizados (n = 29) e controles saudáveis (n = 30). Os níveis de neurotrofinas (BDNF, NGF, NT-3) e cortisol foram avaliados por kit ELISA em soro de sangue periférico. Os sintomas depressivos foram definidos com base na Hamilton Depression Rating Scale (HDRS), e o transtorno depressivo maior foi baseado em entrevistas clínicas e confirmado pela Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Resultados: Os resultados mostraram diminuição significativa nos níveis de BDNF e aumento significativo nos níveis de NT-3 no soro de sangue periférico de pacientes ostomizados quando comparados com controles saudáveis. Os níveis de NGF e cortisol não apresentaram diferenças significativas entre os grupos. As avaliações dos sintomas depressivos pela HDRS demonstraram aumento significativo em pacientes ostomizados quando comparados com controles saudáveis. O diagnóstico de transtorno depressivo maior pela SCID-I não mostrou diferença significativa entre os grupos. Conclusão: Nossos resultados sugerem que a ostomia desencadeia sintomas depressivos significativos e alterações nos níveis de neurotrofinas no soro de sangue periférico coletadas desses pacientes

Aumento de estresse oxidativo no sangue de pacientes com ostomia / Increased oxidative stress in the blood of ostomy patients

ABSTRACT BACKGROUND: Ostomy is a surgical procedure that creates a stoma that aims to construct a new path for the output of feces or urine. The relationship of oxidative stress (OxS) markers in patients with ostomy is still poorly described. OBJECTIVE: The present study was aimed at investigating the changes in oxidative stress parameters in peripheral blood collected from ostomy patients when compared with a healthy control group. METHODS: It was evaluated 29 ostomy patients and 30 healthy control patients. The oxidative stress parameters evaluated were: lipid peroxidation [lipid hydroperoxide (LPO), 8-isoprostane (8-ISO) and 4-hydroxynonenal (4-HNE)], protein oxidation and nitration [carbonyl and 3-nitrotyrosine (3-NT)] and DNA oxidation [8-hydroxy-2'-deoxyguanosine (8-OHDG)] in serum from ostomy patients compared to health controls. RESULTS: The data showed an increase of LPO, 8-ISO, 4-HNE, 3-NT and 8-OHDG in serum collected from ostomy patients when compared to healthy controls. CONCLUSION: The findings support the hypothesis that ostomy triggers the oxidative stress observed in the blood collected from these patients.

RESUMO CONTEXTO: Ostomia é um procedimento cirúrgico que cria um estoma com objetivo de construir um novo caminho para a saída das fezes ou urina. A relação dos marcadores de estresse oxidativo em pacientes ostomizados ainda é pouco descrita. OBJETIVO: O presente estudo tem como objetivo investigar as alterações dos parâmetros de estresse oxidativo em sangue de pacientes ostomizados comparados a controles saudáveis. MÉTODOS: Foram avaliados 29 pacientes ostomizados e 30 controles saudáveis. Os parâmetros de estresse oxidativo avaliados foram: peroxidação lipídica [hidroperóxido de lipídio (LPO), 8-isoprostano (8-ISO) e 4-hidroxinonenal (4-HNE)], oxidação e nitração de proteínas [carbonila e 3-nitrotirosina (3-NT)] e oxidação do DNA [8-hidroxi-2'-desoxiguanosina (8-OHDG)] em soro de pacientes ostomizados comparados a controles saudáveis. RESULTADOS: Os dados mostraram um aumento de LPO, 8-ISO, 4-HNE, 3-NT e 8-OHDG em soro de pacientes ostomizados em comparação a controles saudáveis. CONCLUSÃO: Os achados sustentam a hipótese de que a ostomia desencadeia o estresse oxidativo observado no sangue coletado destes pacientes.

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators.

Epicardial adipose tissue and metabolic syndrome An update protocol for systematic review and meta-analysis

BACKGROUND: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia, and an increased risk of cardiovascular events. However, there are no systematic analyses, or well conducted meta-analyses to evaluate the relationship between epicardial adipose tissue (EAT) and (MetS). The aim of this study is to examine this association of EAT with MetS in different ages and sex. METHODS: The update systematic review, and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that firstly, examined the association between EAT and MetS, secondly, focus on cohort, case-control, and cross-sectional studies, thirdly, were conducted among in adults aged between 40 and 70 years, fourth, provided sufficient data for calculating ORs or relative risk with a 95% CI, fifth, were published as original articles written in English or other languages, and sixth, have been published until January year 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. RESULTS: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. This study will provide a high quality synthesis on the association of EAT and MetS. CONCLUSION: This systematic review will provide evidence to assess whether there is a strong association of EAT and MetS, and its components.

Epicardial adipose tissue and carotid artery disease Protocol for systematic review and meta-analysis

BACKGROUND: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Epicardial adipose tissue (EAT) is a metabolically active fat depot, abundant in proinflammatory cytokines, and has been correlated with the extent and severity of carotid artery disease (CD). The locations most frequently affected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between EAT and CD. The aim of this study is to examine this association of EAT with CD in different ages and sex. METHODS: This systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that (1) examined the association between EAT and CD, (2) focus on cohort, case-control and cross-sectional studies, (3) will conducted among in adults aged 40 to 70 years, (4) provided sufficient data for calculating ORs or relative risk with a 95% CI, (5) will published as original articles written in English or other languages, and (6) have been published until January 2018 will be included. Study selection, data collection, quality assessment and statistical syntheses will be conducted based on discussions among investigators. Results: We propose the current protocol to evaluate the evaluation of EAT with ED. CONCLUSION: This systematic review will not need ethical approval, because it does not involve human beings. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal.

Pilates for breast cancer: A systematic review and meta-analysis / Pilates para mulheres com câncer de mama: revisão sistemática e metanálise

Summary Introduction: Breast cancer is the leading type of cancer causing death in women worldwide. The incidence of the disease is expected to grow worldwide due to the aging of the population and risk factors related to lifestyle behaviors. Considering the lifestyle of women with breast cancer before or after surgery, pilates exercise may be a complementary intervention additionally to standard treatment. Objective: To analyze the efficacy of pilates compared to other exercises and to no exercise for women with breast cancer diagnosis. Method: We searched Medline via Pubmed, Embase via Ovid, Amed via EBSCO, Biosis via Ovid, Lilacs and the Cochrane Library for relevant publications until March 2017. The keywords used were pilates and "breast cancer," and only randomized controlled trials were included. Critical appraisal was done using Risk of Bias Tool and GRADE score for assessing the quality of evidence. Results: A total of five studies were included in our review. Our results demonstrate that pilates or home-based exercises are better than no exercise in each individual study. We observed significant improvements in the pilates groups compared to home-based exercises. Additionally, in the individual studies, we observed improvements in range of motion, pain and fatigue. Conclusion: The evidence shows that pilates or home-based exercise should be encouraged to women with breast cancer.

Resumo Introdução: O câncer de mama é o principal tipo de câncer que causa morte em mulheres em todo o mundo. Estima-se que a doença cresça em razão do envelhecimento da população e dos fatores de risco relacionados ao comportamento e estilo de vida. Considerando o estilo de vida das mulheres com câncer de mama antes ou após a cirurgia, o exercício de pilates pode ser uma intervenção complementar, além do tratamento padrão. Objetivo: Analisar a eficácia do pilates em relação a outros exercícios e a nenhum exercício para mulheres com diagnóstico de câncer de mama. Método: Buscamos em Medline via Pubmed, Embase via Ovid, Amed via EBSCO, Biosis via Ovid, Lilacs e Cochrane Library publicações relevantes até março de 2017. As palavras-chave utilizadas foram pilates e "câncer de mama"; apenas ensaios clínicos randomizados foram incluídos. A avaliação crítica foi feita com a ferramenta Risk of Bias e escore GRADE para avaliar a qualidade da evidência. Resultados: Um total de cinco estudos foi incluído nesta revisão. Nossos resultados demonstram que pilates ou exercícios feitos em casa são melhores do que a ausência de exercícios em cada estudo individual. Observamos melhorias significativas no grupo de pilates em comparação com exercícios em casa. Adicionalmente, nos estudos individuais observamos melhorias na amplitude de movimento, dor e fadiga. Conclusão: A evidência mostra que pilates ou exercícios em casa devem ser encorajados a mulheres com câncer de mama.

Urinary EN-2 to predict prostate cancer: Systematic review and meta-analysis.

INTRODUCTION: Prostate cancer is the second type of cancer diagnosed and the fifth cause of death in men worldwide. Early diagnosis helps to control disease progression. Currently, prostate specific antigen is the standard biomarker, as it has a broad scope of identification and, thus, new and more specific biomarkers must be studied. OBJECTIVE: To evaluate the accuracy of engrailed-2 protein (EN2) in urine as a prostate cancer biomarker. METHOD: A comprehensive search was conducted in the period from January 2005 to July 2016 using the following electronic databases: Medline (PubMed), Embase, Cochrane Library and Lilacs. The keywords used in the databases were: "engrailed-2," "EN2," "prostatic neoplasms." The search was limited to humans and there was no language restriction. Critical appraisal of the included studies was performed according to Quadas-2. Statistical analysis was performed using Meta-DiSc® and RevMan 5.3 softwares. RESULTS: A total of 248 studies were identified. After title and abstract screening, 231 studies were removed. A total of 17 studies were read in full and two studies were included in the meta-analysis. The pooled sensitivity was 66% (95CI 0.56-0.75) and specificity was 89% (95CI 0.86-0.92). The DOR was 15.08 (95CI 8.43-26.97). CONCLUSION: The EN2 test showed high specificity (89%) and low sensitivity (66%).

Urinary EN-2 to predict prostate cancer: Systematic review and meta-analysis / Proteína EN2 urinária no diagnóstico do câncer de próstata: revisão sistemática e metanálise

Summary Introduction: Prostate cancer is the second type of cancer diagnosed and the fifth cause of death in men worldwide. Early diagnosis helps to control disease progression. Currently, prostate specific antigen is the standard biomarker, as it has a broad scope of identification and, thus, new and more specific biomarkers must be studied. Objective: To evaluate the accuracy of engrailed-2 protein (EN2) in urine as a prostate cancer biomarker. Method: A comprehensive search was conducted in the period from January 2005 to July 2016 using the following electronic databases: Medline (PubMed), Embase, Cochrane Library and Lilacs. The keywords used in the databases were: "engrailed-2," "EN2," "prostatic neoplasms." The search was limited to humans and there was no language restriction. Critical appraisal of the included studies was performed according to Quadas-2. Statistical analysis was performed using Meta-DiSc® and RevMan 5.3 softwares. Results: A total of 248 studies were identified. After title and abstract screening, 231 studies were removed. A total of 17 studies were read in full and two studies were included in the meta-analysis. The pooled sensitivity was 66% (95CI 0.56-0.75) and specificity was 89% (95CI 0.86-0.92). The DOR was 15.08 (95CI 8.43-26.97). Conclusion: The EN2 test showed high specificity (89%) and low sensitivity (66%).

Resumo Introdução: O câncer de próstata é o segundo tipo de câncer diagnosticado e a quinta causa de morte em homens em todo o mundo. O diagnóstico precoce é fundamental para o prognóstico da doença. Atualmente, o antígeno específico da próstata (PSA) é o biomarcador mais utilizado; porém, biomarcadores mais específicos devem ser estudados. Objetivo: Avaliar a acurácia da proteína engrenada-2 (EN2) na urina como biomarcador de câncer de próstata. Método: Foi realizada uma busca abrangente no período de janeiro de 2005 a julho de 2016, utilizando as seguintes bases de dados eletrônicas: Medline (PubMed), Embase, Cochrane Library e Lilacs. As palavras-chave utilizadas foram: "engrailed-2", "EN2", "prostatic neoplasms". A busca foi limitada a humanos e não houve restrição de idioma. A avaliação da qualidade dos estudos incluídos foi realizada de acordo com Quadas-2. A análise estatística foi realizada usando o software Meta-DiSc® e RevMan 5.3. Resultados: Foram identificados 248 estudos. Após a triagem dos títulos e resumos, foram excluídos 231. Um total de 17 foram lidos na íntegra e dois, incluídos na metanálise. A sensibilidade combinada foi de 66% (IC95% 0,56-0,75). A especificidade foi de 89% (IC95% 0,86-0,92). O DOR foi de 15,08 (IC95% 8,43-26,97). Conclusão: O teste EN2 mostrou alta especificidade (89%) e baixa sensibilidade (66%).

O Teste de Progresso como Indicador para Melhorias em Curso de Graduação em Medicina / Progress Testing as an Indicator for Improvements in a Medical School

RESUMO Introdução O Núcleo de Apoio Pedagógico Interinstitucional Sul II (Napisul II) foi estabelecido em agosto de 2010 com o apoio da Associação Brasileira de Educação Médica (Abem), tendo o propósito específico de formulação, implementação e análise do teste de progresso. Objetivo Verificar se os resultados do teste de progresso podem ser usados como indicador para melhorar a qualidade do curso de Medicina. Métodos Foram realizados três estudos transversais institucionais durante os três anos da aplicação deste teste no curso de Medicina da Universidade do Extremo Sul Catarinense (Unesc), localizada na Região Sul do Brasil. Todos os participantes do estudo eram estudantes de graduação em Medicina na Unesc e haviam feito o teste de progresso em 2011, 2012 e 2013. A análise estatística foi realizada com um nível de confiança de 95%. Resultados A adesão média ao longo dos três anos variou de 91,8% a 100%. Em 2011, o curso de Medicina da Unesc obteve classificação igual ou superior à média dos oito cursos que compõem o Napisul II até a oitava fase e ficou abaixo da média na quinta e sexta fases. Em 2012, a Unesc novamente foi classificada com desempenho mediano até a sétima fase. Na oitava fase, a classificação da Unesc foi significativamente maior do que a média global, e assim, na quinta fase, o curso não diferiu da média do grupo. No entanto, na sexta fase, a classificação do curso foi significativamente inferior à média. Em 2013, a Unesc foi novamente classificada com desempenho mediano até a oitava fase, e nas últimas três fases o curso foi classificado acima da média. Conclusão: O teste de progresso é um excelente indicador para os gestores, pois pode ser usado para desenvolver intervenções para melhorar a qualidade dos cursos. Após a aplicação do primeiro teste foram realizadas mudanças no curso de Medicina da universidade. Testes posteriores demonstraram a eficácia dessas mudanças.

ABSTRACT Introduction The Núcleo de Apoio Pedagógico Interinstitucional Sul II (Napisul II) was established in August 2010 with the support of the Brazilian Association of Medical Education (Abem) with the specific purpose of formulating, implementing and analyzing the progress test. Objective To verify whether the results of the progress test can be used as an indicator to improve the degree course in medicine. Methods We performed three cross-sectional studies of institutional households during the three years of the application of the test in the medical school at the University of Extremo Sul Catarinense (Unesc), South Brazil. All participants in the study were undergraduate students in medicine at the Unesc who had taken the progress test in 2011, 2012, and 2013. Statistical analysis was performed with a 95% confidence level. Results Mean adherence over the three years ranged from 91.8% to 100%. In 2011, the medical program at the Unesc ranked equal to or above the average for the eight Napisul II schools until the eighth stage and ranked below average in the fifth and sixth years. In 2012, the Unesc again was ranked in the average range until the seventh stage. In the eighth stage, the Unesc’s ranking was significantly higher than the overall average, and thus, in the fifth year, the school was on par with the group average. However, in the sixth year, the school’s ranking was significantly below average. In 2013, Unesc was again ranked in the middle of the group until the eighth phase, and in the last three phases, the school was ranked above average. Conclusion The progress test is an excellent indicator for managers, as it can be used to develop interventions to improve the quality of the courses. After the first test was administered and changes in the school’s courses were implemented, subsequent tests demonstrated the effectiveness of the changes.

Effects of whey protein supplement in the elderly submitted to resistance training: systematic review and meta-analysis.

AIM: We performed a systematic review to map the evidence and analyze the effect of whey protein supplementation in the elderly submitted to resistance training. METHODS: A comprehensive search on Medline, LILACS, EMBASE, and the Cochrane Library for relevant publications was conducted until August 2015. The terms used in the search were: "Resistance training"; "Whey protein"; "Elderly". RESULTS: A total of 632 studies were screened. Five studies were included composing a sample of 391 patients. The supplement whey protein was associated with higher total protein ingestion 9.40 (95% CI: 4.03-14.78), and with an average change in plasma leucine concentration. The supplementation was also associated with increased mixed muscle protein synthesis 1.26 (95% CI: 0.46-2.07) compared to the control group. CONCLUSION: We observed an increase in total protein intake, resulting in increased concentration of leucine and mixed muscle protein fractional synthesis rate.