SARS-COV-2 AND ARBOVIRUS INFECTIONS: PROTOCOL FOR A RAPID LIVING SYSTEMATIC REVIEW

Context and objective: While cases of COVID-19 disease increase daily worldwide, outbreaks of arboviral infections have affected health systems of countries in tropical regions. The outcomes for patients and health systems of a possible syndemic are not clarified yet. Thus, we aim to systematically review the literature searching for evidence that describes the clinical presentation, severity and prognostic of SARS-CoV-2 and Arboviral coinfection. Design and setting: Protocol for a rapid living systematic review, that will follow the Cochrane Handbook for Systematic Reviews recommendations. We will include prospective and retrospective cohort, case-control studies and case series of patients with confirmed diagnosis of SARS-CoV-2 and Arboviral infection. We will perform the search strategy with no language restrictions on Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebOfScience to identify published, ongoing, and unpublished studies. The selection and extraction will be performed by two authors. We will perform the critical appraisal of included studies with the Newcastle-Ottawa Scale and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).   &nbsp

Telehealth interventions in the context of the COVID-19 pandemic: Protocol for a scoping review

CONTEXT AND OBJECTIVE: The current health crisis due to COVID-19 is forcing us to profoundly rethink our social organizations and practices in health. While there is no effective treatment for the virus, staying home and social isolation are the control measures recommended by health authorities. The aim of this study is to perform a scoping review in order to summarize the current evidence in telehealth for COVID-19. METHODS: This study is a protocol to describe the rationale, hypothesis and planned methods of our scoping review. We will include randomized controlled trials (RCTs), observational cohort studies, case-control studies, cross-sectional studies, qualitative studies, and/or case series that describe telehealth interventions applied or developed to respond to COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, and Scopus. We will include studies performed since December 2019 with no language restrictions. We will use the Risk of Bias tool and the Newcastle-Ottawa Scale to perform the critical appraisal of included studies. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)

Pharmacological interventions for COVID-19: Protocol for a Rapid Living Systematic Review with network meta-analysis

CONTEXT AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) has emerged in China in December 2019 and rapidly spread. Although extraordinary efforts have been made on research regarding pharmacological interventions, none have proven effective. This is the protocol for a rapid living systematic review that aims to compare the effectiveness and safety of different pharmacological interventions for the treatment of COVID-19. METHODS: rapid living systematic review methodology with Network Meta-Analysis following the recommendations of Cochrane Handbook. We will include randomized controlled trials (RCT) and quasi-RCTs that evaluate single and/or combined pharmacological interventions at any dose for the treatment of COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebofScience to identify potentially eligible studies. No language restrictions will be used in the selection. We will perform the critical appraisal of included studies with the Risk of Bias tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)

COVID-19 AND PATIENTS UNDERGOING PHARMACOLOGICAL TREATMENTS FOR IMMUNE-MEDIATED INFLAMMATORY DISEASES: PROTOCOL FOR A RAPID LIVING SYSTEMATIC REVIEW

CONTEXT AND OBJECTIVE: We propose to systematically review the available evidence to evaluate if patients with immune mediated or inflammatory diseases under pharmacological treatment with immunosuppressants, immunobiologics, DMARDs or targeted synthetic DMARDs have better or worse outcomes when infected by SARS-CoV-2. This study is a protocol for our rapid living systematic review. METHODS: Protocol for a rapid living systematic review methodology following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidance. To conduct the rapid systematic review, we will employ abbreviated systematic review methods, including: not performing independent screens of abstracts and not searching grey literature. As this will be a living review, it will be continuously updated

Cloroquinas para o tratamento de osteoartrite: revisão sistemática e metanálise

Objectives: To assess the effectiveness and safe of chloroquine salts for the treatment of osteoarthritis. Methods: We searched CENTRAL, MEDLINE, Embase, Lilacs and Ibecs, as well as clinical trials registries platforms (clinicaltrials.gov e apps.who.int/trialsearch) up to January 2021. We also searched reference lists of conference abstracts in rheumatology (EULAR and ACR meetings) and reference lists of included lists, as well as contacting experts in the area and pharmaceutical industry. We included all eligible randomised controlled trials (RCTs) comparing chloroquines (chloroquine di-phosphate or hydroxychloroquine), any dose, to another active pharmacological intervention or placebo in people aging 18 or over, with diagnosis of primary osteoarthritis. Two review authors independently selected trials, assessed trial methodological quality, extracted data, and assessed the certainty of the evidence using standard methodological procedures expected by Cochrane. We also performed qualitative syntheses, and when possible, quantitative syntheses (meta-analyses) of the included studies. Results: We included nine RCTs involving 1087 participants. Eight RCTs compared hydroxychloroquine to placebo (main comparison), one RCT compared hydroxychloroquine to acetaminophen (three-arm trial), and one RCT compared hydroxychloroquine to clodronate. We found no studies comparing chloroquine di-phosphate to another active intervention or placebo. Most trials were multicenter with duration varying from 16 to 52 weeks. Participants were predominantly women with knee or hand osteoarthritis, with a mean age varying from 48 to 64 years and in most cases with moderate to severe disease. The dose of hydroxychloroquine ranged from 200 to 400 mg/day. Low-certainty evidence suggests that hydroxychloroquine had a slight clinically unimportant improvement in pain (WOMAC pain subscale; MD = - 3.6 points; 95% CI - 5.8 to - 1.5; participants = 336; studies = 4) and physical function (WOMAC function subscale; MD = - 9.7 points; 95% CI - 16.6 to - 3.2; participants = 336; studies = 4) compared to placebo in people with knee osteoarthritis. High-certainty evidence suggests that hydroxychloroquine results in little to no difference in pain (NRS; - 0.12 points; 95% CI - 0.6 to 0.33; participants = 656; studies = 4) and physical function (AUSCAN function subscale; MD = - 0.2 points; 95% CI - 1.6 to 1.1; participants = 579; studies = 3) compared to placebo in people with hand osteoarthritis. Low-certainty evidence suggests that hydroxychloroquine may result in little to no difference in patient’s global assessment (MD -0.70; 95% CI -1.53 x to 0.13) and investigator's global assessments (MD -0.30; 95% CI -0.93 to 0.33) compared to placebo (assessed with a scale from 0 to 10). Moderate-certainty evidence suggests that hydroxychloroquine likely results in little to no difference in adverse events compared to placebo (RR 0.83; 95% CI 0.60 to 1.13; participants = 732; studies = 6). Low-certainty evidence suggests that hydroxychloroquine likely results in little to no difference in dropouts or withdrawals compared to placebo (RR 1.24, 95% CI 0.91 to 1.69; participants = 748; studies = 6). Conclusions: Our results indicate that hydroxychloroquine may result in a slight clinically unimportant improvement of pain and function when compared to placebo for knee osteoarthritis, and little to no difference for hand osteoarthritis. In general, we found evidence that hydroxychloroquine results in little to no difference in patient's and investigator's global assessments, adverse events, and dropouts or withdrawals.Objetivos: Avaliar a efetividade e segurança dos sais de cloroquina para o tratamento da osteoartrite. Métodos: Foram pesquisadas as bases de dados CENTRAL, MEDLINE, Embase, Lilacs e Ibecs, e plataformas de registros de ensaios clínicos (clinicaltrials.gov e apps.who.int/trialsearch) até janeiro de 2021. Também foram pesquisados resumos de congressos em reumatologia (EULAR e ACR meetings) e listas de referência de estudos incluídos, assim como contato com especialistas da área e indústria farmacêutica. Foram incluídos todos os ensaios controlados randomizados (ECRs) comparando cloroquinas (difosfato de cloroquina ou hidroxicloroquina), em qualquer dose, a outra intervenção farmacológica ativa ou placebo, em pessoas com idade superior ou igual a 18 anos, com diagnóstico de osteoartrite primária. Dois autores selecionaram de forma independente os ensaios, avaliaram a qualidade metodológica, extraíram dados e avaliaram a certeza das evidências utilizando procedimentos metodológicos recomendados pela Cochrane. Também foram realizadas sínteses qualitativas e, quando possível, sínteses quantitativas (meta-análises) dos estudos incluídos. Resultados: Foram incluídos nove ECRs (1087 participantes). Oito ECRs compararam hidroxicloroquina com placebo (comparação principal), um comparou hidroxicloroquina ao acetaminofeno (ensaio com três braços), e um comparou hidroxicloroquina ao clodronato. Não foram encontrados estudos utilizando difosfato de cloroquina. A maioria dos ensaios foram multicêntricos com duração entre 16 e 52 semanas. Os participantes foram predominantemente mulheres com osteoartrite de joelhos ou mãos, idade média entre 48 e 64 anos, na maioria dos casos com doença moderada a grave, recebendo doses de hidroxicloroquina entre 200 e 400 mg/dia. Evidências de certeza baixa sugerem que a hidroxicloroquina apresenta uma leve melhora clinicamente sem importância na dor (WOMAC dor; DM = - 3,6 pontos; IC 95% - 5,8 a - 1,5; participantes = 336; estudos = 4) e função física (WOMAC função; DM = - 9,7 pontos; IC 95% - 16,6 a - 3,2; participantes = 336; estudos = 4) em comparação com placebo em participantes com osteoartrite de joelhos. Evidências de certeza alta sugerem que a hidroxicloroquina resulta em pouca ou nenhuma diferença na dor (NRS; - 0,12 ponto; IC 95% - 0,6 a 0,33; participantes = 656; estudos = 4) e função física (AUSCAN função; DM = - 0,2 ponto; IC 95% - 1,6 a 1,1; participantes = 579; estudos = 3) em comparação com placebo em participantes com osteoartrite de mãos. Evidências de certeza baixa viii sugerem que a hidroxicloroquina resulta em pouca ou nenhuma diferença na avaliação global pelo paciente (DM -0,70; IC 95% -1,53 a 0,13; participantes = 153; estudos = 1) e avaliação global pelo investigador (DM -0,30; IC 95% -0,93 a 0,33; participantes = 153; estudos = 1) em comparação com placebo (escala = 0 a 10). Evidências de certeza moderada sugerem que a hidroxicloroquina resulta em pouca ou nenhuma diferença em eventos adversos em comparação com o placebo (RR 0,83; IC 95% 0,60 a 1,13; participantes = 732; estudos = 6). Evidências de certeza baixa sugerem que a hidroxicloroquina resulta em pouca ou nenhuma diferença em perdas ou retiradas em comparação com placebo (RR 1,24, IC 95% 0,91 a 1,69; participantes = 748; estudos = 6). Conclusões: A hidroxicloroquina pode resultar em uma leve melhora clinicamente sem importância da dor e da função quando comparada ao placebo para osteoartrite de joelhos, e pouca ou nenhuma diferença para osteoartrite de mãos, com pouca ou nenhuma diferença nas avaliações globais pelo paciente e investigador, eventos adversos e perdas ou retiradas.Dados abertos - Sucupira - Teses e dissertações (2021

Intravenous zoledronate for postmenopausal women with osteopenia and osteoporosis: a systematic review and metanalysis

ABSTRACT BACKGROUND: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures. OBJECTIVES: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis. DESIGN AND SETTINGS A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo. METHODS: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD). RESULTS: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24–0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25–0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80–3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91–1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women. CONCLUSION: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years. PROSPERO REGISTRATION NUMBER: CRD42022309708, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309708