Systematic reviews on leptospirosis

OBJECTIVES: To find the existing clinical evidence on interventions for leptospirosis. The objective is to evaluate the effectiveness and safety of any intervention on leptospirosis through systematic reviews of randomized controlled trials (RCTs).DATA SOURCE: The sources of studies used (where there were no limitations concerning language, date, or other restrictions) were: EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and the Cochrane Hepato-Biliary Group Randomized Trials register.SELECTION OF STUDIES: Type of Study: All systematic reviews of randomized controlled trials. Participants: patients with clinical and/or laboratorial diagnosis of leptospirosis, and subjects potencially exposed to leptospirosis as defined by the authors Interventions: any intervention for leptospirosis (as antibiotics or vaccines for prevention or treatment).DATA COLLECTION: The assessment will be independently made by the reviewers and cross-checked. The external validity was assessed by analysis of: studies, interventions, and outcomes.DATA SYNTHESIS: Located 163 studies using the search strategy described above, at the electronic databases above. Only 2 hits were selected, which are protocols of systematic reviews of Cochrane Collaboration, and not full reviews. One of the protocols evaluates antibiotics for treatment, and the other evaluates antibiotics for prevention of leptospirosis.CONCLUSIONS: There were not complete systematic reviews on interventions for leptospirosis. Any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.Federal University of São PauloUNIFESPSciEL

Optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature Database (LILACS database): update

Universidade Federal de São Paulo (UNIFESP)Universidade Estadual de CampinasUNIFESPSciEL

Effect of theophylline associated with short-acting or long-acting inhaled beta2-agonists in patients with stable chronic obstructive pulmonary disease: a systematic review

OBJECTIVES: To determine whether, in stable patients with chronic obstructive pulmonary disease, administration of theophylline in combination with short-acting or long-acting inhaled beta2-agonists is more efficacious than is a placebo or each of these drugs used in isolation. METHODS: A systematic review and meta-analysis were carried out. All randomized and double-blind clinical trials found in the literature were selected. RESULTS: A total of eight studies were included. In comparing the effect of theophylline combined with beta2-agonists to that of a placebo, we found a statistically significant improvement in mean FEV1 (0.27 L; 95%CI: 0.11 to 0.43) and mean dyspnea (-0.78; 95%CI: -1.26 to -0.29). None of the meta-analyses performed detected any difference between the results obtained using theophylline combined with beta2-agonists and those obtained using beta2-agonists alone. When the administration of theophylline combined with beta2-agonists was compared to that of theophylline alone, there was a statistically significant improvement in mean dyspnea (-0.19; 95%CI: -0.34 to 0.04). CONCLUSION: In patients with stable chronic obstructive pulmonary disease, theophylline combined with beta2 agonists is more efficacious than is a placebo in terms of improving FEV1 and dyspnea. In addition, theophylline combined with beta2 agonists is more efficacious than is theophylline in improving dyspnea. Furthermore, administration of theophylline combined with beta2 agonists is no more efficacious, for any of the variables studied, than is the use of beta2-agonists in isolation.OBJETIVOS: Avaliar se o tratamento com teofilina associada ao beta2-agonista inalatório de curta ou longa duração é mais eficaz que o placebo e que o uso isolado de cada um dos fármacos, para os pacientes com doença pulmonar obstrutiva crônica estável. MÉTODOS: Realizou-se uma revisão sistemática com metanálise, sendo selecionados todos os ensaios clínicos aleatórios e duplo-cegos encontrados na literatura. RESULTADOS: Foram incluídos oito estudos. Teofilina associada ao beta2-agonista vs. placebo: houve melhora estatisticamente significante para o VEF1 (L), com média 0,27 (IC95% 0,11 a 0,43); e para a dispnéia, com média -0,78 (IC95% -1,26 a -0,29). Teofilina associada ao beta2-agonista vs. beta2-agonista isolado: nenhuma das metanálises realizadas detectou diferença entre os grupos. Teofilina associada ao beta2-agonista vs. teofilina isolada: houve melhora estatisticamente significante para a dispnéia, com média -0,19 (IC95% -0,34 a -0,04). CONCLUSÕES: Em pacientes com doença pulmonar obstrutiva crônica estável: 1) teofilina associada ao beta2-agonista é mais eficaz que o placebo, em relação ao VEF1 e dispnéia; 2a) teofilina associada ao beta2-agonista é mais eficaz que a teofilina isolada, em relação à dispnéia; e 2b) teofilina associada ao beta2-agonista não é mais eficaz que o beta2-agonista isolado, para quaisquer das variáveis estudadas.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Research

O texto traz uma reflexão sobre os principais momentos da execução experimental, e aborda seqüencialmente: a) o que é a pesquisa?, b) por que fazer pesquisa?, c) como a pesquisa pode ser útil posteriormente?, d) quais são as etapas da pesquisa?, e) quem serão os autores da pesquisa? Finaliza citando a importância da análise de resultados e sua inserção no contexto da coletividade.This text presents a reflection on the chief steps involved in experimental execution, and approaches sequentially the following aspects: a) what is research?, b) why carry out a research?, c) how can a research be useful in the future?, d) what are the stages involved in a research?, and e) who should be considered authors of a research? Finally, this article mentions the importance of results analysis and the relevance of the obtained results to the community

O RPG (roleplaying game) como ferramenta de ensino do suporte básico da vida

Objetivo. Determinar a diferença de proporção de desempenhos satisfatórios nas avaliações de habilidades em Suporte Básico da Vida (SBV) em estudantes de medicina depois de utilizar o RPG (role-playing game) como ferramenta de ensino comparado com antes do RPG. A hipótese é que a diferença de proporção é de 10% a mais após o uso do RPG. Métodos. Tipo de estudo: antes-depois. Amostra: estudantes do curso de graduação em medicina, do primeiro ao último ano, estratificados por ano em uma amostra por conveniência. Procedimentos: Foram realizadas sessões de RPG simulando diferentes situações da parada cardiorrespiratória, com avaliação dos participantes imediatamente antes e depois destas sessões. Variável: a diferença de proporção de desempenhos satisfatórios nas avaliações de habilidades em SBV depois de utilizar o RPG como ferramenta de ensino comparado com antes. Foi utilizado um formulário padronizado para avaliar as habilidades e os conhecimentos. Método estatístico: o tamanho da amostra foi estimado em 77 participantes. A análise estatística foi realizada com o teste de McNemar, e foi calculado o intervalo de confiança de 95%. Resultados. A diferença de proporção de desempenhos satisfatórios nas avaliações de habilidades em SBV depois de utilizar o RPG como ferramenta de ensino comparado com antes foi de 58% (IC95% 45 a 71, P < 0,0001). A diferença de proporção de desempenhos satisfatórios nas avaliações de conhecimentos sobre SBV depois de utilizar o RPG comparado com antes foi de 36% (IC95% 24 a 48, P < 0,0001). Conclusões. O uso do RPG no ensino do SBV pode melhorar a aquisição de habilidades e conhecimentos em SBV.Background. Determining the satisfactory performances ratio difference in the abilities evaluations in Basic Life Support (BLS) in medicine students after using the RPG (role-playing game) as a teaching tool compared to before the RPG. The hypothesis is that the ratio difference is 10% higher after using the RPG. Methods. Design: before and after study. Sample: undergraduate students of the medicine course, from the first to the last year, stratified by year in a convenience sample. Procedures: RPG sessions were held to simulate different cardiorespiratory arrest situations, with the evaluation of the participants immediately before and after these sessions. Variable: satisfactory performances ratio difference in the abilities evaluations in Basic Life Support after using the RPG compared to before. A standardized formulary was used to evaluate the abilities and the knowledge. Statistical method: the size of the sample was estimated in 77 individuals. The statistical analysis was done with the McNemar’s test; it was calculated a confidence interval of 95% for each estimated point. Results. The satisfactory performances ratio difference in the abilities evaluations in Basic Life Support in medicine students after using the RPG as a teaching tool compared to before was equal to 58% (CI95% 45 a 71, P < 0,0001). The satisfactory performances ratio difference in the knowledge evaluations in Basic Life Support in medicine students after using the RPG as a teaching tool compared to before was equal to 36% (CI95% 24 a 48, P < 0,0001). Conclusions. Using the RPG in the BLS teaching can improve the acquisition of abilities and knowledge in BLS

Assessment of calf muscle pump in patients with primary varicose veins of the lower limbs by air plethysmography

OBJECTIVE: This article aims at assessing the influence of calf muscle vein reflux (suraland genicular veins) on calf muscle pump function in patients with primary varicose veins of the lower limbs. METHODS: Cross-sectional and prospective study assessing 120 patients divided into two groups (60 subjects each) by physical examination, duplex scan and air plethysmography. The first group showed calf muscle venous reflux, whereas the second group presented absence of reflux. Both groups were examined by air plethysmography to verify calf pump function through measurement of ejection fraction, residual volume fraction, ejected volume and venous filling index in both limbs. RESULTS: In the group of patients with reflux, ejection fraction indexes lower than 60% (p < 0.001) were found in 82.3% (left leg) and 74.6% (right leg) of cases. Levels of residual volume fraction greater than 60% were identified in 62.5% (left leg, p= 0.015) and in 86.7% (right leg, p = 0.014) of assessed cases. There was no statistically significant variation concerning the venous filling index between groups with or without reflux, with p= 0.140 in both legs. Of all patients, 63.6% had calf vein reflux (left leg) and 61.8% (right leg) had ejection volume greater than 150 mL (p = 0.001). CONCLUSIONS: The calf pump function decreased in both lower limbs, due to presence of calf muscle vein reflux (genicular and sural veins).OBJETIVO:Avaliar a influência do refluxo das veias musculares da panturrilha (surais e geniculares) na função da bomba muscular da panturrilha em pacientes com varizes primárias nos membros inferiores. MÉTODOS: Estudo transversal prospectivo, no qual os pacientes foram avaliados por meio de exame físico, mapeamento dúplexe pletismografia a ar. Foram selecionados 120 pacientes divididos em dois grupos (60 indivíduos em cada). O primeiro grupo apresentava refluxo das veias musculares da panturrilha e o segundo grupo apresentava ausência de refluxo. Cada grupo foi analisado com pletismografia a ar para estudo da função da bomba da panturrilha. As variáveis estudadas foram fração de ejeção, fração do volume residual, volume ejetado e índice de enchimento venoso para membro inferior direito e esquerdo. RESULTADOS: No grupo com refluxo, índices de fração de ejeção abaixo de 60% (com p < 0,001) foram encontrados em 82,3% (em perna esquerda) e em 74,6% (em perna direita) dos casos. Índices de fração do volume residual acima de 60% foram identificados em 62,5% (em perna esquerda, p = 0,015) e em 86,7% (em perna direita, p = 0,014) dos casos avaliados. Não houve variação estatisticamente significativa para o índice de enchimento venoso entre os grupos com e sem refluxo, com p = 0,140 e p = 0,140 para pernas esquerda e direita, respectivamente. Foram encontrados 63,6% dos pacientes com refluxo das veias da panturrilha (em perna esquerda), e 61,8% (em perna direita) com volume ejetado acima de 150 mL (p = 0,001). CONCLUSÕES: Houve alteração da bomba muscular da panturrilha, levando a uma diminuição de sua função, em ambos os membros inferiores por conseqüência da presença do refluxo das veias musculares da panturrilha (geniculares e surais).Universidade Federal de Campina Grande Universidade Federal de Campina GrandeUniversidade Estadual de Ciências da Saúde de Alagoas Escola de Ciências Médicas de Alagoas Departamento de Medicina SocialUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review

Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL