Navegando por Palavras-chave "Meta-Analysis"

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    Agonistas dopaminérgicos no tratamento da dependência a cocaína
    (Universidade Federal de São Paulo (UNIFESP), 2003) Soares, Bernardo Garcia de Oliveira [UNIFESP]; Lima, Maurício Silva de [UNIFESP]
    OBJETIVOS: a dependencia a cocaina e um importante problema de Saúde publica, sendo diversas as abordagens terapeuticas utilizadas. Muitas vezes a farmacoterapia e relacionada como a intervencao de melhor custo-efetividade porem os resultados das pesquisas disponiveis sao bastante heterogeneos. Os agonistas dopaminergicos sao medicacoes usadas em varias estrategias de tratamento da dependencia a cocaina e esta revisao sistematica objetiva esclarecer o papel dessas drogas nessa situacao. METODOS: Revisao sistematica da literatura e metanaiise de ensaios clinicos randomizados (ECR). Foi realizada uma ampla busca por estudos relevantes em bases de dados eletronicas (Cochrane Library, EMBASE, MEDLINE, LILACS, PsycLIT, Biological Abstracts), atraves da verificacao manual de referencias e do contato com autores. Os resultados foram analisados em intencao por tratar, sendo que para dados dicotomicos o risco relativo (RR) com 95 por cento de intervalo de confianca (IC) foi calculado usando-se o modelo randomico. RESULTADOS: 17 ECR foram incluidos, num total de 1224 individuos. Amantadina, bromocriptina e pergolide foram as medicacoes estudadas, sendo a maioria dos ECR controlados com placebo. Considerando-se 'presenca de metabolitos de cocaina na urina' como principal medida de eficacia, nao encontrou-se diferencas entre as drogas e mesmo em comparacao com placebo (RR 0,97; IC 0,80 a 1,18; n=188, N=5). As taxas de perdas foram altas e similares para ambas intervencoes. Nao houve diferenca quanto aos efeitos colaterais. CONCLUSOES: A evidencia atual a partir de ECR nao suporta o uso de agonistas dopaminergicos no tratamento da dependencia a cocaina. Todavia os resultados dos estudos primarios sao controversos e estudos com maior amostragem seriam importantes
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    Anastomose biliar com ou sem tubo em t durante transplante hepático em adultos: revisão sistemática e metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2021) Oliveira Filho, Jose Jeova de [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Universidade Federal de São Paulo
    Introduction: In liver transplantation, biliary complications, especially leaks/fistulas and stenosis, remain the main causes of surgical morbidity (5% to 35%) and mortality (10% to 60%). The end-to-end choledochocholedocostomy is the most commonly adopted biliary anastomosis technique, be it associated or not with the use of a T-tube. There is no consensus regarding the use of the T-tube as a drainage technique during biliary reconstruction. Objectives: Analyzing the results of biliary anastomosis, with or without the use of a T-tube in adults undergone liver transplantation. Methods: Systematic review of randomized clinical trials. The research was conducted on the Cochrane Hepato-Biliary Group Controlled Trials Register (Cochrane Hepato-Biliary Group Module) databases, Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE Ovid, Embase Ovid, Latin American and Caribbean Health Sciences Database (LILACS; Virtual Health Library - BVS), Science Citation Index Expanded (Web of Science), Conference Proceedings Citation Index - Science (Web of Science) (Royle 2003), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), ClinicalTrial.gov (clinicaltrials.gov/), and WHO International Clinical Trial Registry Platform (www.who.int/ictrp). There were no restrictions on language and publication date. Randomized clinical trials comparing choledochocholedocostomy with or without the use of a T-tube were included. The primary outcomes studied were mortality, serious adverse events (anastomotic and non-anastomotic stenosis, anastomotic and non-anastomotic biliary leakage, complications related to the T-tube, retransplantation and non- biliary complications) and quality of life. Secondary outcomes were non-serious adverse events (systemic and other biliary complications) and pain. We used the standard methodological procedures expected by Cochrane and Cochrane Hepato-Biliary Group Module and performed the analyzes using Review Manager 5.4. We used a random-effects model meta-analysis and presented the results of the review incorporating the methodological quality of the studies using GRADE. In our review, we used dichotomous results and expressed the results as hazard ratio (HR) with a 95% confidence interval (CI). Results: The review included seven randomized controlled trials, with a total of 881 adult participants, averaged 50.4 years old and with an average follow-up period from 8 to 35 months. Has been demonstrated the occurrence of a greater number of anastomotic stenosis in the control group (without T-tube) just as it was observed greater number of complications related to the T-tube and greater overall risk of serious adverse events in this same group, being these differences were statistically significant. There was no evidence of an overall significant difference between T-tube and non-T-tube groups, regarding the other outcomes. Heterogeneity between studies was variable. All studies presented a high risk of biases and we classified the evidence from low-quality to very low-quality. Conclusions: There was low-quality to very low-quality evidence showing that biliary anastomosis without a T-tube may be associated with an increased risk of anastomotic stenosis and that biliary anastomosis with a T-tube may be associated with an increased risk of complications related to its use, such as leakage and cholangitis and the increased overall risk of serious adverse events. We suggest more randomized controlled trials, especially with a longer observation period and better evidence quality.
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    Anestesia neuroaxial comparada à anestesia geral para procedimentos na metade inferior do corpo: revisão sistemática de revisões sistemáticas
    (Sociedade Brasileira de Anestesiologia, 2012-04-01) Barbosa, Fabiano Timbó; Castro, Aldemar Araujo [UNIFESP]; Miranda, Cláudio Torres de [UNIFESP]; Universidade Federal de Alagoas; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Ciências da Saúde de Alagoas
    BACKGROUND AND OBJECTIVES: Systematic reviews organize literature data by combining results from published studies in order to resolve conflicts in the area of medical knowledge describing the interventions. The inadequate reporting of systematic reviews can damage the credibility and interfere in the results' quality. The objective of this study was to determine the frequency of good quality systematic reviews comparing neuraxial anesthesia with general anesthesia for procedures on the lower half of the body. METHODS: Systematic review of systematic reviews. Primary variable: The frequency of good quality systematic reviews. The information was analyzed from the following databases: LILACS (January 1982 to December 2010); PubMed (January 1950 to December 2010); The Cochrane Database of Systematic Review and Database of Abstracts of Reviews of Effects (volume 10, 2010); and SciELO (December 2010). The quality of systematic reviews was determined by the Overview Quality Assessment Questionnaire. The sample size calculation showed that it was necessary to analyze eight systematic reviews, taking into account that the frequency of good quality systematic reviews was 5%, an absolute precision of 15%, and a significance level of 5%. RESULTS: Were identified 1,995 articles. The selection process eliminated 1,968 articles. Twenty-seven articles of systematic reviews were read in full, 9 were excluded due to incompatibility with the inclusion criteria, and 8 were duplicate publications. Ten systematic reviews were assessed for their quality. The frequency of good quality systematic reviews was 40% (4/10; 95% CI 9.6 to 70.4%). CONCLUSION: The frequency of good quality systematic reviews was 40%.
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    Avaliação da segurança, eficácia e custo-efetividade dos métodos contraceptivos de longa duração em comparação aos métodos convencionais em adolescentes
    (Universidade Federal de São Paulo (UNIFESP), 2020-11-27) Farah, Daniela De Moura Azevedo Tuma [UNIFESP]; Fonseca, Marcelo Cunio Machado [UNIFESP]; Universidade Federal de São Paulo
    Adolescent pregnancy is a worldwide concern, affecting not only the teenager's life but also the community. The unmet need for acceptable and effective contraceptive methods in this population contributes to high adolescent pregnancy rates. Our objective was to assess the safety and efficacy of long-term reversible contraceptives (LARC) for adolescent girls and estimate these methods' cost-effectiveness compared to non-LARC methods. Within this scope, we consider the willingness to pay for contraceptive methods of adolescent girls and their parents. Thus, we conducted a meta-analysis to assess the efficacy, safety, adherence, and preference of choice of contraception LARC and SARC methods in young women. We performed an incidence meta-analysis to estimate the average rates of continuation and pregnancy of four contraceptive methods. We carry out systematic searches in the PUBMED, EMBASE, LILACS, and Cochrane databases. There was no restriction on the language. We included observational studies or RCTs. Two authors independently selected abstracts and reviewed full-text articles, and extracted data. We used RevMan 5.3 software in the first meta- analysis to combine the results of the studies. The data were derived in risk ratios (RR) and mean differences with 95% CI using a meta-analytic model of random effects. For the meta- analysis of incidence, we used the Metafor and Meta packages in RStudio software (version 1.1.4). We collected the pregnancy and continuation rates for each contraceptive method, used the inverse of variance in all calculations, and applied the LOGIT transformation. We used the random-effects meta-analytical model. The Cochrane collaboration tool and New Castle- Ottawa were used to assess all included ECR and observational studies' quality and bias, respectively. We assessed the quality of the evidence using the GRADE criteria. Concerning cost-effectiveness, we developed a Markov model to mirror the clinical and economic impact of adopting LARC methods compared to combined oral contraceptives in sexually active Brazilian adolescent girls from the perspective of the public health system and with a time horizon of five years. Costs are expressed in 2018 US dollars (US $), and we applied a 5% discount rate to clinical outcomes and costs. The model's inputs included the costs of contraceptive methods, the rate of discontinuation and compliance of the contraceptives, abortion rates, and the costs of childbirth and neonatal care associated with pregnancies. The model's outcomes were the number of pregnancies, abortions, and the number of preterm and term births avoided. We conducted univariate and probabilistic sensitivity analyzes. Finally, we conducted a study of willingness to pay for contraceptive methods. The willingness to pay was assessed by a cross-sectional study using a questionnaire applied to Brazilian adolescents aged 13 to 19 and their parents. Values are expressed as mean ± SD in reais (R $). Spearman's correlation was performed for the socioeconomic status of the parents and the age of adolescents. Chi-square analyzes were carried out between the types of methods and the adolescents 'and parents' perspectives. We performed the Bland-Altman chart to determine an agreement between the pairs and their willingness to pay. The first meta-analysis included 25 studies, of which eight compared the non-LARC and LARC methods, and 17 studies performed comparisons between the LARC methods. There was greater adherence favoring LARC methods in 12 months than non-LARC methods [RR 1.60 (95% CI 1.21–2.12) I2 = 88%; 1,606 young women]. However, young women still opt for non-LARC methods [RR 0.37 (95% CI 0.17–0.80) I2 = 99%; 2,835 young women]. Pregnancies in LARC methods were rare, with xii very few events. In the incidence meta-analysis, we showed that the oral contraceptive pill's continuation rate was estimated at 51%. At the same time, for the copper IUD, LNG-IUS, and implant, it was 77%, 84%, and 86%, respectively. The oral contraceptive pill's combined pregnancy rate was 11%, while for the copper IUD, LNG-IUS, and implant, it was 5%, 1.7%, and 1.8%, respectively. Our cost-effectiveness model showed that the copper IUD was dominant 100% of the time for all outcomes and a five-year budgetary impact of - $ 422,431,269.10. The LNG-IUS and the subdermal implant were cost-effective for all outcomes. However, in the budgetary impact analysis of the subdermal implant, it represented a savings of - US $ 851,686,904.96 in five years. A total of 165 pairs of questionnaires were answered. The non-LARC method was significantly more acceptable to pay out of pocket than the LARC method for adolescents and parents. Parents and their daughters are willing to pay R $ 52.25 ± 22.48 and R $ 51.63 ± 21.24 out of their pocket by the non-LARC method, while by the LARC method, when they are subsidized, they are willing to pay R $ 176.83 ± 130.34 and R $ 174.83 ± 143.64, respectively. The Bland-Altman analysis indicated agreement between peers and the price they are willing to pay for each contraceptive method. The LARC methods are more effective in preventing pregnancy in adolescent girls, being more cost-effective than the birth control pill. However, non-LARC methods are still more willing to pay for parents and their daughters.
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    Características De Revisões Sistemáticas Cochrane Versus Revisões Sistemáticas Publicadas Em Revistas De Alto Fator De Impacto
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-20) Porfirio, Gustavo Jose Martiniano [UNIFESP]; Riera, Rachel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The systematic review consists of the application of strategies that limit the risk of bias in the gathering, critical evaluation and synthesis of all relevant studies on a subject. It is considered as the best source of evidence for informed decision and has, as main aspects, clear eligibility criteria; explicit and reproducible methods; high sensitivity search looking for all relevant studies on the subject; critical appraisal of included studies; and systematic synthesis of the results of included studies. Despite the recent appreciation of systematic reviews and a significant increase in the number of publications with this design, there are several doubts about the quality of these publications in a global way. Although the limitations of using the impact factor for journal metrics, it is thought that the higher citation numbers of high impact factor journals identify that these reviews are as well executed as the Cochrane systematic reviews. Objective: To evaluate the characteristics of systematic reviews published in high impact factor journals compared to the reviews published in the Cochrane Database of Systematic Reviews regarding the presence of adequate content for critical appraisal of the publication. The hypothesis of this study was that the characteristics would be similar. Study design: A cross-sectional study. Sample: We included systematic reviews of the literature published in 2015 in journals of high impact factor or published by the Cochrane Collaboration. Outcomes: The primary outcomes were the characteristics of the systematic reviews based on PRISMA Statement and other complementary information. Statistical methods: No sample size calculation was performed. We analyzed all the systematic reviews published in high impact factor journals published in the year 2015 and their number was the criterion for defining the sample size of the other reviews (Cochrane reviews) included in the research. Results: Of the 134 studies included in the analyzes two groups studied (67 Cochrane and 67 journals of high impact factor), the following characteristics presented a significantly higher frequency in Cochrane reviews: a) provide at least one search strategy; b) does not restrict the search and / or selection of studies by language; c) do not use restriction of the search by year of publication; d) conduct the search for non-indexed studies; e) conducting the search in databases of clinical trials records; f) description duplicity for selection and extraction of data; g) description of method to resolve disagreements; h) description of the criteria for meta-analysis; and i) description of criteria for sensitivity or subgroup analysis; j) information on characteristics of excluded studies; l) information about ongoing studies; m) presentation of bias risk per study; n) indication of registration of the revision or of the existence of a previous protocol; o) presentation of a summary table of the findings; p) use of the GRADE approach; q) refer to the assessment of the quality of the evidence at the conclusion. Conclusion: Significant differences were observed between systematic reviews published by Cochrane and journals of high impact factor in relation to key items related to the quality of publications. The Cochrane publications presented a greater detail of the description of critical items in relation to the others, despite the lower number of gross citations observed in the sample and the lower impact factor in relation to the periodicals analyzed
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    Efetividade da terapia de laser de baixa potência na implantodontia dentária: revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2021) Horvath Neto, Pedro [UNIFESP]; Macedo, Cristiane Rufino De [UNIFESP]; Universidade Federal de São Paulo
    Introduction: The loss of teeth causes impairment in the functions of chewing, swallowing, digestion, phonation, aesthetics and breathing. Dental implants are used to replace teeth and their functions. Low Power Laser Therapy is used to assist in the osseointegration process. Objective: To evaluate the effectiveness of low-level laser therapy (LLLT) in dental implantodontics. Methods: Systematic review of randomized clinical trials (RCTs). The electronic databases searched included MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and LILACS, BVS. The ClinicalTrials.gov and WHO-ICTRP clinical trial record bases were also searched. There was no language restriction or publication date. The searches were carried out in February 2021. The quality of evidence and methodological studies were assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and by the risk of Cochrane bias, respectively, independently and by two authors. The effect size estimate, the mean difference (DM) was calculated with a 95% confidence interval (95% CI). Results: Five ECR studies were included, which evaluated LLLT in the red (Laser V) to infrared (Laser IV) range. A total of 76 participants and 285 implants that compared different wavelengths (637 nm, 810 nm, 830 nm and 940 nm ) and LLLT energy dosage versus non-treatment (Non-Laser) or placebo (Sham). Most RCTs were considered to be at uncertain risk of bias. The outcomes assessed were: pain measured by the visual analogue-VAS scale and immediate implant locking measured by the implant stability coefficient using the ISQ method (Osstell resonance frequency analyzer) and the PTV method (Periotest Device). The stability of the ISQ-implant was verified in 4 RCTs: Laser IV of 637 nm (1 RCT); Laser V of 830 nm (2 ECR) and Laser V of 940 nm (1 ECR) versus Non Laser or Placebo. The meta-analysis of this comparison found a trend in favor of the laser, but without significant differences with DM = 0.92; 95% CI [-1.07 to 2.91]; N = 199 implants; 4 RCT; I2 = 62% with very low quality of evidence. Another RCT also evaluated the stability of the implant, but by PTV (Periotest Device), to compare Laser IV of 810 nm versus Non-Laser, without significant differences DM = 5.22; 95% CI [- 6.10 to 1.57]; N = 24 implants; 1 RCT; with very low quality of evidence. There was only 1 RCT that assessed pain and found no significant differences between the 830 nm Laser IV versus Non Laser groups with DM = 0.00; 95% CI [-1.13 to 1.13] N = 50 implants; 1 RCT with very low quality of evidence. Only one study reported that no adverse events were recorded. The other RCTs did not measure this outcome, nor did quality of life and mediate fixation. Conclusions: Evidence is very uncertain about the effect of low-power laser used in dental implants for pain and immediate implant locking compared to placebo or no treatment. Using a low-power laser may have little or no effect on results; however, there is much uncertainty about these results. New searched RCTs should be aimed at determining the size of the laser effect on the implant osseointegration process.
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    Exercícios para tratamento da tendinopatia patelar: revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2020-10-29) Teixeira, Kamila Pinho [UNIFESP]; Riera, Rachel [UNIFESP]; Universidade Federal de São Paulo
    Objective: To evaluate the effects (benefits and harms) of physical exercises in the treatment of individuals with patellar tendinopathy (PT). Methods: Systematic review including randomized clinical trials (RCTs) that have compared physical exercise with non-surgical interventions (or different types of exercises) for PT. Primary outcomes included pain, function, and adverse events. Secondary endpoints included quality of life, patient satisfaction and return to sports or routine physical activities. Searches were performed in the Cochrane Library, CINAHL, EMBASE, LILACS, MEDLINE, PEDro and SPORTDiscus databases. Additional searches were performed on Opengrey, WHO International Clinical Trials Registry Platform and Clinical Trials.gov, and manual search on the reference lists of relevant studies. There were no restrictions on language or date of publication. The process of study selection, data extraction, and bias risk assessment was conducted by two independent reviewers. The certainty in the final set of evidence was evaluated following the recommendations of the Grading of Recommendations Assessment, Development and Evaluation (GRADE). To estimate the effect size for dichotomous variables, the relative risk (RR) was used and for the continuous variables, the mean difference (DM) with 95% confidence interval was used. Results: 16 RCTs were included (total of 372 participants, aged between 15 and 50 years), overall classified as presenting high risk of bias due, among other factors, to the impossibility of personnel and participants blinding. The ECRs evaluated ten different comparisons and, due to the clinical heterogeneity, the quantitative synthesis of the results was not possible for any of the outcomes. For all comparisons, the certainty in the set of evidence was very low or could not be evaluated due to lack of data. Conclusions: Considering that the evidence on the effects of all evaluated exercise modalities in this review is of very low certainty, the implications for practice are extremely limited and future studies may most likely alter the estimates that exist at the time. Thus, any recommendation for current clinical practice for patellar tendinopathy is underpinned by many uncertainties. Considering the lack of evidence, both a shared decision and an individualized decision-making may be adopted until future studies can robustly support the recommendations.
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    Fios laterais comparados aos cruzados para o tratamento cirúrgico das fraturas supracondilianas do úmero em crianças. Revisão sistemática.
    (Universidade Federal de São Paulo (UNIFESP), 2019-07-31) Carrazzone, Oreste Lemos [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Matsunaga, Fábio Teruo [UNIFESP]; Belloti, João Carlos [UNIFESP]; Faloppa, Flavio [UNIFESP]; http://lattes.cnpq.br/6528908852030714; http://lattes.cnpq.br/0981211406387862; http://lattes.cnpq.br/3695111273396745; http://lattes.cnpq.br/5982439031327655; http://lattes.cnpq.br/0887456536451884; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Closed reduction and percutaneous fixation with crossed or lateral wire configuration are the most acceptable treatment for displaced supracondylar humerus fractures in children. Nevertheless, there is still no consensus about the effectiveness of these treatment methods. Objective: The aim of this study was to assess the effectiveness of both wire configurations for the treatment of these fractures. Methods: A systematic review of randomized controlled trials or quasi-randomized controlled trials was performed in order to compare crossed to two lateral wires treatment techniques. The search was carried out using MEDLINE, LILACS, EMBASE, Cochrane Library and ongoing clinical trials database until February 2019. The main outcomes were function, measurement by Flynn criteria, complications (neurologic lesion, infection, loss of reduction, and residual deformity) and failure. Loss of movement and variation of Baumann’s angle and carrying angle were also assessed. Risk relative analysis was performed for dichotomous variable, difference of means for continuous, and confidence interval of 95% were stablished for all analysis. Results: Twelve randomized or quasi-randomized controlled trials with a total of 930 patients were included. Both groups presented satisfactory funcional results with no difference between them (RR=0.99; p=0.44). The lateral configuration group was superior, considering iatrogenic ulnar nerve lesion (p=0.03; RR 0.40). However, with regard to the loss of reduction, the crossed group was superior to lateral group (p=0.03; RR 1.39). Conclusion: There is evidence of very low quality that the fixation with lateral wires is safer when iatrogenic nerve lesion was considered, on the other hand, the crossed wires showed to be more effective to maintain the fracture reduction.
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    Inguinotomia transversa versus longitudinal para abordagem da artéria femoral
    (Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Camara, Marcus Vinicius Canteras Raposo Da [UNIFESP]; Cacione, Daniel Guimaraes [UNIFESP]; Universidade Federal de São Paulo
    Background: Access to the femoral vessels is necessary for a wide range of vascular procedures, including treatment of thromboembolic disease, arterial grafts, endovascular repair of abdominal aortic aneurysm, thoracic endovascular aneurysm repair and transcatheter aortic valve implantation. The surgical technique used to access the femoral artery may be a factor in the occurrence of postoperative complications; this will be the focus of our review. We will compare the transverse surgical technique—a cut made parallel to the groin crease—versus the vertical groin incision surgical technique—classic technique: a surgical cut made across the groin crease—to access the femoral artery, in an attempt to determine which technique has the lower rate of complications, is safer and is more effective. Objectives: To evaluate the efficacy and safety of transverse groin incision compared with vertical groin incision for accessing the femoral artery in endovascular surgical procedures and open surgery. Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases, and the World Health Organization (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to 17 February 2020. The review authors searched the IBECS database to 26 March 2020 and reference lists of relevant studies/papers. Selection criteria: We included randomized controlled trials and quasi-randomized trials that compare transverse and vertical groin incision, during either endovascular or open surgery procedures. Data collection and analysis: Two review authors independently selected the studies, assessed risk of bias, extracted data, performed data analysis and graded the certainty of evidence according to GRADE. Main results: We included one Randomized Controlled Trial and one randomized controlled trials and quasi-randomized in this review. These two studies had a combined total of 237 participants (283 groins). Infection of the surgical wound was the only outcome that was similar in both studies, and that could therefore be submitted to a combined analysis. Meta-analysis of the two studies showed low-certainty evidence that transverse groin incision resulted in a lower risk of surgical wound infection in the 10- to 28-day period following surgery (risk ratio [RR] 0.25, 95% confidence interval [CI] 0.08 to 0.76; 2 studies; 283 groin incisions). There was low heterogeneity between the studies. We downgraded the certainty of the evidence for surgical wound infection by one level due to serious limitations in the design (there was a high risk of bias in critical domains). The confidence interval for surgical wound infection is relatively wide, further indicating that the certainty of the effect estimate is low. This is likely due to the small number of studies and participants. We observed no evidence of a difference between the two surgical techniques for the other evaluated primary outcome 'lymphatic complications': lymphocele (RR 0.46, 95% CI 0.20 to 1.02; one study; 116 groins); and lymphorrhea (RR 2.77, 95% CI 0.92 to 8.34; one study; 116 groins). We downgraded the certainty of evidence for lymphatic complications by one level due to serious limitations in the design (there was a high risk of bias in critical domains); and by two further levels because of imprecision (small number of participants and only one study included). High-quality studies are needed to enable a comparison of the two surgical techniques with respect to other outcomes, such as infection of the vascular graft (endoprosthesis/prosthesis), prolonged hospitalization, reoperative surgery, death, neurological deficit (e.g. paresthesia), amputation, graft patency, and postoperative pain. Conclusion: In this systematic review, we found low-certainty evidence that performing transverse groin incision to access the femoral artery resulted in fewer surgical wound infections compared with performing vertical groin incision. We observed no evidence of a difference between the two surgical techniques for the other evaluated outcomes (lymphocele and lymphorrhea). Other outcomes were not evaluated in these studies. Limitations of this systematic review are, however, the small sample size, short clinical follow-up period and high risk of bias in critical domains. For this reason, the applicability of the results is limited.
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    Intervenções psicossociais no tratamento do alcoolismo
    (Universidade Federal de São Paulo (UNIFESP), 2007) Soares, Bernardo Garcia de Oliveira [UNIFESP]; Lima, Maurício Silva de [UNIFESP]
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    N-acetilcisteína como terapia adjuvante para erradicação de Helicobacter pylori. Revisão sistemática Cochrane
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Fontes, Luis Eduardo Santos [UNIFESP]; Riera, Rachel [UNIFESP]; http://lattes.cnpq.br/0591884301805680; http://lattes.cnpq.br/7387849617501693; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To assess the efficacy and safety of N-acetylcysteine as an adjuvant therapy to antibiotics for Helicobacter pylori eradication. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to present), Embase (1988 to present), CINAHL (1982 to present), and LILACS (1982 to present). The last search date was April 2018. We handsearched the reference lists of relevant studies. We screened 726 articles. Of these articles, we assessed 22 for eligibility. We included randomised controlled trials (RCTs) comparing NAC plus any antibiotic regimen with a control consisting of the same antibiotic regimen with or without placebo, in adult people infected with H pylori. Outcomes of interest were eradication rates, gastrointestinal, toxic, and allergic adverse events. Reporting of the primary outcomes listed here was not an inclusion criterion for the review. Two review authors independently reviewed and extracted data and completed the risk of bias assessment. A third review author independently confirmed the risk of bias assessment. We used Review Manager 5 software for data analysis. We contacted study authors if there was missing information. Results: The review included eight RCTs (n = 559). Studies have recruited outpatient adults between 17 and 76 years who were referred to endoscopy centres in several different countries. The certainty of evidence was reduced for most outcomes due to the poor methodological quality of included studies (mainly related to the generation of allocation sequence, allocation concealment, and blinding - this last one domain specifically for adverse outcomes). The small sample size of each single study that contributed for comparisons can be associated with an increased risk of type 2 error. We are uncertain whether the addition of NAC to antibiotics improves H pylori eradication rates, compared with the addition of placebo or no NAC (38.8% versus 49.1%, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.51 to 1.08; participants = 559; studies = eight; very low-certainty evidence). A post-hoc sensitivity analysis, in which we removed studies that tested antibiotic regimens no longer recommended in clinical practice, showed that the addition of NAC may improve eradication rates compared to control (27.2% versus 37.6%, RR 0.71, 95% CI 0.53 to 0.94; participants = 397; published studies = five). We are uncertain whether NAC is associated with a higher risk of gastrointestinal adverse events compared to control (23.9% versus 18.9%, RR 1.25, 95% CI 0.85 to 1.85; participants = 336; studies = five; very low-certainty evidence), or allergic adverse events (2% versus 0%, RR 2.98, 95% CI 0.32 to 27.74; participants = 336; studies = five; very low-certainty evidence). There were no reports of toxic adverse events amongst included studies.Conclusion: We are uncertain whether the addition of NAC to antibiotics improves H pylori eradication rates compared with the addition of placebo or no NAC. Due to the clinical, statistical and methodological heterogeneity found in included studies, and the uncertainty observed when analyzing therapy subgroups, any possible beneficial effect of NAC should be regarded cautiously. We are uncertain whether NAC is associated with a higher risk of gastrointestinal or allergic adverse events compared with placebo or no NAC. There were no reports of toxic adverse events amongst the included studies. Further large, well-designed, randomised clinical studies should be conducted, with good reporting standards and appropriate collection of efficacy and safety outcomes, especially for current recommended antibiotic regimens.
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    Níveis de cortisol salivar e sérico e Transtorno de Estresse Pós-Traumático em crianças e jovens: uma revisão sistemática e metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2021) Canasiro, Soraya [UNIFESP]; Mello, Marcelo Feijo De [UNIFESP]; Universidade Federal de São Paulo
    Background: There is inconsistency in the literature regarding the relationship between cortisol levels and child and adolescent (C&A) posttraumatic stress disorder (PTSD) since previous studies have reported high, low and normal cortisol levels. Method: We performed a systematic review and a meta-analysis aimed to investigate hypothalamic-pituitary-adrenal (HPA) axis functionality via plasma and salivary profiles of basal cortisol in children/young people with PTSD and a control group with healthy subjects. Results: Out of the 1,293 articles reviewed, only six met all inclusion criteria. Our sample included 184 patients with PTSD and 149 controls. The meta-analysis did not show any statistically significant difference between the PTSD and control groups (SMD= -0.15, 95% CI -0.45 to 0.14, p=0.12), with moderate heterogeneity among the results of the respective studies (I= 42%). We subsequently performed exploratory subgroup analyses. Conclusions: We found lack of evidence regarding basal cortisol levels in the PTSD group and controls in the overall analysis. The subgroup analysis found high heterogeneity only in studies including salivary cortisol. It is difficult to draw conclusions about the patterns of cortisol levels and the data has to be carefully interpreted.
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    Optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature Database (LILACS)
    (Associação Paulista de Medicina - APM, 1997-06-01) Castro, Aldemar Araujo [UNIFESP]; Clark, Otávio Augusto Câmara [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Brazilian Cochrane Center
    OBJECTIVE: To define and disseminate the optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature (LILACS). This strategy was elaborated based on the optimal search strategy for MEDLINE recommended by Cochrane Collaboration for the identification of clinical trials in electronic databases. DESIGN: Technical information. SETTING: Clinical Trials and Meta-Analysis Unit, Federal University of São Paulo, in conjunction with the Brazilian Cochrane Center, São Paulo, Brazil. (http://www.epm.br/cochrane). DATA: LILACS/CD-ROM (Latin American and Caribbean Health Science Information Database), 27th edition, January 1997, edited by BIREME (Latin American and Caribbean Health Science Information Center). LILACS Indexes 670 journals in the region, with abstracts in English, Portuguese or Spanish; only 41 overlap in the MEDLINE-EMBASE. Of the 168.902 citations since 1982, 104,016 are in human trials, and 38,261 citations are potentiality clinical trials. Search strategy was elaborated combining headings with text word in three languages, adapting the interface of the LILACS. We will be working by locating clinical trials in LILACS for Cochrane Controlled Trials Database. This effort is being coordinated by the Brazilian Cochrane Center.
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    Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis
    (Univ Federal Estado Rio De Janeiro, Programa Pos-Graduacao & Enfermagem, 2016) Blay, Sergio Luis [UNIFESP]; Augusto Aguiar, Joao Vicente; Passos, Ives Cavalcante
    Background: The association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. Methods: PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive-compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. Results: Six studies were included in the meta-analysis
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    Ressecção distal da clavícula associada ao reparo do manguito rotador versus reparo isolado do manguito rotador em pacientes com osteoartrose acromioclavicular associada a lesão do manguito rotador. Revisão sistemática.
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-18) Lima, Geraldo Kalif [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Rotator cuff injuries are an important source of shoulder pain and dysfunction and may be associated with acromioclavicular joint osteoarthrosis. Distal clavicle resection is an additional option for patients undergoing rotator cuff surgical repair. However, there is no consensus on the effectiveness of these associated techniques. Objective: To evaluate the effectiveness of distal clavicle resection in patient with rotator cuff tears associated with acromioclavicular osteoarthritis. Method: A systematic review of randomized or quasi-randomized controlled trials was performed to compare rotator cuff repair associated with distal clavicle resection and isolated rotator cuff repair. The search was carried out using MEDLINE, LILACS, EMBASE, Cochrane Library and ongoing clinical trials database until February 2019. Outcomes were performed by function, ASES, Constant-Murley, and range of motion (ROM) measurements, pain assessed by visual analogue scale (VAS) and as complications and failures. Dichotomous data were applied by relative risk and continuous data by media difference, with 95% CI. Results: Three RCTs or quasi-randomized totalizing 208 patients were included. There was no difference between groups regarding ASES score (MD=0.14;p=0.95), Constant-Murley (MD=0.69;p=0.55) and ROM. When evaluating VAS, no difference was detected between the methods (MD=0.25;p=0.25). Regarding secondary outcomes, residual pain (RR=1.76;p=0.29), rerupture (RR = 0.78; p = 0.59) e reoperation (RR, 0,86; p=0,88) were evaluated and no difference between groups was also found. Conclusion: Routine distal clavicle resection in patients undergoing rotator cuff repair showed no benefits regarding shoulder function, pain, and complications compared to isolated rotator cuff repair.
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    Revisão sistemática sobre o uso de psicoterapia e medicação no tratamento do transtorno da compulsão alimentar periódica (TCAP)
    (Universidade Federal de São Paulo (UNIFESP), 2006) Stefano, Sergio Carlos [UNIFESP]; Blay, Sergio Luis [UNIFESP]
    Objetivo: Avaliar, através de uma revisão sistemática da literatura, intervenções utilizando psicoterapia e medicação no tratamento do Transtorno da Compulsão Alimentar Periódica, testadas em ensaios clínicos controlados randomizados, comparados à lista de espera, placebo ou qualquer outro tipo de grupo controle. Métodos: Foram realizadas buscas nas bases eletrônicas de dados: MEDLlNE, EMBASE, PsycINFO, LlLACS, "The Cochrane Collaboration Controlled Trials Register" e "The Cochrane Depression, Anxiety and Neurosis Group Database of Trials", e uma busca manual no "International Journal of Eating Disorders" abrangendo o período de Janeiro/94 a Maio/2006. Resultados: Identificamos 5.403 artigos através da estratégia de busca. Efetuamos uma varredura através dos títulos destes no sentido de excluir artigos que não se enquadravam nos objetivos desta revisão. Um mil oitocentos e oito resumos foram avaliados mais detalhadamente. Por fim, 102 artigos completos foram analisados. Trinta e um estudos preencheram os critérios de inclusão desta revisão. Conclusões: Este trabalho revelou que os Tratamentos de Auto-Ajuda e a Terapia Cognitivo-Comportamental apresentam diferenças significantes em termos de remissão dos episódios de compulsão alimentar quando comparados à lista de espera; bem como o uso de antidepressivos quando comparados a placebo também apresentam resultados similares no curto prazo. Quando as comparações são feitas entre duas modalidades psicoterápicas não encontramos diferenças favorecendo alguma das intervenções com relação ao padrão de remissão. Quanto à mudança na freqüência dos episódios de compulsão alimentar, encontramos diferença apenas na comparação Terapia Cognitivo-Comportamental versus lista de espera. Em termos de mudança no peso ou taxa de abandono do tratamento não encontramos diferenças entre as intervenções. Novos estudos com antidepressivos, bem como com novos agentes farmacológicos como Orlistat, Sibutramina e Topiramato, com período de seguimento superior ao de 16 semanas para avaliar a manutenção dos efeitos destes agentes são indicados. A realização de estudos comparando Terapia Cognitivo-Comportamental com outras psicoterapias tais como Tratamentos de Auto-Ajuda e Terapia Interpessoal também é indicada. Estes deverão ser multicêntricos, incluir um número maior de pacientes com critérios de inclusão e avaliação dos pacientes bem padronizados.
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    Screening for group B Streptococcus in pregnant women: a systematic review and meta-analysis
    (Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2011-12-01) Taminato, Mônica [UNIFESP]; Fram, Dayana; Torloni, Maria Regina [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Saconato, Humberto; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Infection with Group B Streptococcus (GBS) is considered an important public health problem. It is associated with: Neonatal sepsis, meningitis, pneumonia, neonatal death, septic abortion, chorioamnionitis, endometritis and other perinatal infections. The aim of this study was to determine the best screening strategy for GBS in pregnant women. For this a systematic review and meta-analysis were carried out in the Nursing Department of the Federal University of São Paulo, Cochrane Center, Brazil. Sources used were, EMBASE, LILACS, Medline, list of references, personal communication and the Cochrane library. The criterion for the selection of the studies was; studies which analyze some type of screening for GBS in pregnant women. Independent of the comparator, all analyses were in favor of a universal screening program for reducing the incidence of neonatal sepsis. The evidence obtained in this study suggests that the strategy of universal screening of pregnant women associated with the use of prophylactic antibiotics is safe and effective.
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    Segurança E Efetividade Das Estratégias Ventilatórias Para Pacientes Obesos Submetidos À Cirurgia Bariátrica: Revisão Sistemática E Metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-20) Souza, George Marcio Da Costa E [UNIFESP]; Melnik, Tamara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction. Obesity is a global epidemic. Whilst affecting the quality of life of obese patients, it also has a significant economic impact. Bariatric surgery stands out as an effective treatment. It is widely known that BMI is associated with changes in the mechanics of the respiratory system and that it leads to atelectasis and decreased oxygenation during surgery. Hence, the choice of ventilation strategy to be used is of utmost importance. Objective. To assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery under general anesthesia. Type of study. A systematic review of randomized clinical trials that were aimed at evaluating different ventilation strategies for obese patients undergoing bariatric surgery. Types of participants. Obese patients whose BMI had been greater than 35 kg/m2 and who had gone through bariatric surgery under general anesthesia. Intervention. Different ventilation strategies such as: VCV, PCV, alveolar recruitment maneuvers, and the use of different levels of PEEP. Outcomes. Primary: In-hospital mortality, gas exchange, and respiration mechanics. Secondary: number of intra and postoperative complications, cardiovascular response, need for admittance into the intensive care unit, and length of stay at the post-anesthesia care unit. Method. An online search strategy was employed by looking into MEDLINE, Embase, Clinical Trials, WHO data banks, and grey literature, as well as manual search and personal communication. The last search was carried out on March 20, 2017. Two independent reviewers analyzed the studies that had been found according to the eligibility criteria for this SR. Results. Fourteen clinical trials with 574 participants were included. Eight of these assessed RM x PEEP, showing that RM caused better oxygenation p = 0.03, (MD 79.93, 95% CI 8.83 to 151.04; participants = 121; studies = 5; I2 = 80%. low-quality evidence), higher plateau pressure p < 0.00001, (MD 7.30, 95% CI 4.47 to 10.13; participants = 31; studies = 1; I2 = 0%. low-quality evidence), higher mean airway pressure p<0.00001 (MD 6.61, 95% CI 4.83 to 8.39; participants = 68; studies = 3; I2 = 40%. low-quality evidence), and higher compliance p < 0.00001 (MD 21.00, 95% CI 12.92 to 29.08; participants = 20; studies = 1; I2 = 0%. low-quality evidence); when comparing PCV x VCV, just two studies were included, of which only one demonstrated that the PCV mode led to better oxygenation p = 0.007, (MD 82.00, 95% CI 21.90 to 142.10; participants = 36; studies = 1; I2 = 0%. low-quality evidence); RM + ZEEP x RM + PEEP 5 or 10 cmH2O, two studies carried out such comparison, but only one evaluated gas exchange showing that RM associated with PEEP brought on higher oxygenation p = 0.001, (MD 167.00, 95% CI 82.40 to 251.60; participants = 20; studies = 1; I2 = 0%. low-quality evidence); CPAP 40 cmH2O + PEEP 10 cmH2O x CPAP 40 cmH2O + PEEP 15 cmH2O, one study assessed this comparison showing that CPAP 40 + PEEP 15 led to better gas exchange p = 0.003, (MD 36.00, 95% CI 12.10 to 59.90; participants = 38; studies = 1; I2 = 0%. low-quality evidence) and compliance p = 0.0003, (MD 3.00, 95% CI 1.38 to 4.62; participants = 38; studies = 1; I2 = 0%. low-quality evidence); RM + PEEP 5 cmH2O x RM + PEEP 10 cmH2O, one study examined this comparison and showed that RM + PEEP 5 led to fewer cases of lamellar atelectasis p = 0.05, (RR 2.61, 95% CI 1.00 to 6.80; participants = 39; studies = 1; I2 = 0%. low-quality evidence) and higher mean arterial pressure p= 0.02, (MD -10.56, 95% CI -19.62 to -1.50; participants = 39; studies = 1; I2 = 0%. low-quality evidence); RM + PEEP 10, 15, and 20 cmH2O x CPAP 30 cmH2O, one study examined this comparison and showed that RM + PEEP 10, 15, and 20 cmH2O lowered mean airway pressure p = 0.0003, (MD -7.40, 95% CI -11.45 to -3.35; participants = 33; studies = 1; I2 = 0%. very low-quality evidence); PEEP 10 cmH2O x PEEP 5 cmH2O, one study assessed this comparison looking only into the length of stay in the post-anesthesia care unit and showing that there was no difference p = 0.21, (MD 36.00, 95% CI -20.16 to 92.16; participants = 30; studies = 1; I2 = 0%. very low-quality evidence), and finally the ratio I:E 1:1 x ratio I:E 1:2, one study examined this comparison and showed that the ratio I:E 1:1 brought on higher compliance p = 0.01, (MD 4.67, 95% CI 1.06 to 8.28; participants = 30; studies = 1; I2 = 0%. very low-quality evidence). None of the studies reported mortality or the need for admittance to an ICU. Conclusion. There is low-quality and very low-quality evidence to support the notion that alveolar recruitment maneuvers associated with PEEP lead to better oxygenation. We did identify large clinical heterogeneity in the fourteen studies that were included due to the great variety of interventions and outcomes assessed. There were no reports of mortality or of the need for intensive care unit admissions, thus showing that the interventions appear to be safe
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    Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise
    (Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2012-01-01) Taminato, Mônica [UNIFESP]; Fram, Dayana Souza [UNIFESP]; Grothe, Cibele [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate the impact of the use of topical Mupirocin on the insertion of central venous catheter for hemodialysis. METHODS: This was a systematic review with meta-analysis. RESULTS: After a careful and extensive search, we included three clinical trials that compared the use of Mupirocin versus other intervention in central venous catheter for hemodialysis. CONCLUSION: The study found that the use of topical Mupirocin is effective in reducing episodes of infection among hemodialysis patients, increasing duration time for catheter, and significantly reducing S aureus infections, which are the most prevalent in this population.
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    Vacinas contra a Leishmaniose tegumentar americana: revisão sistemática da literatura e metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2020-09-24) Martins, Keilla Machado [UNIFESP]; Silva, Edina Mariko Koga Da [UNIFESP]; Universidade Federal de São Paulo
    Background: The management of American Cutaneous Leishmaniasis (ACL) has been hindered by the current treatments, related adverse effects, high cost for the patient and the health system, and rates of clinical cure that are less than ideal. The usage of vaccines for treatment of ACL had been reported as a promising treatment and technology for prevention of ACL, although its results are conflicting. We aimed to investigate the efficacy and safety of vaccines used for the prevention and treatment of ACL. Methods: We performed a systematic review with meta-analyses of randomized controlled clinical trials. We searched Embase, MEDLINE, and the Cochrane Library among other databases up to April, 2020. Two authors independently selected studies, extracted the data, and assessed the risk of bias of studies. Meta-analyses of random effects were employed to calculate the relative risk (RR) and 95% of confidence interval (CI) of incidence, cure and immunogenicity of ACL. Heterogeneity was estimated by I2 and investigated by subgroup analysis. Findings: Vaccine associated with pentavalent antimonial in low dosage for treating ACL performed similarly to placebo (RR=0.98; 95%CI: 0.92, 1.04; I2 = 0%, moderate certainty of evidence). Adverse events were significantly lower in vaccines than pentavalent antimonial (RR=0.10; 95%CI: 0.05 to 0.20; I2 = 0%, high certainty of evidence). Prophylaxis outcomes were not summarizable. Conclusion: Vaccine did not prevent ACL in population under risk; the cure rates regarding the vaccine group in patients with ACL were similar to the control group, with the advantage of significantly lower levels of adverse events.