Uso de fibras no tratamento da constipação infantil : revisão sistemática com metanálise

Objective: To gather current evidence on the use of fiber for constipation treatment in pediatric patients. Source of data: Systematic review with meta-analysis of studies identified through Pubmed, Embase, LILACS and Cochrane databases published up to 2016. Inclusion criteria: Randomized controlled trials; patients aged between 1 and 18 years and diagnosed with functional constipation receiving or not drug treatment for constipation; articles published in Portuguese, English, Spanish, French, and German in journals accessible to the researchers. Synthesis of data: A total of 2963 articles were retrieved during the search and, after adequate evaluation, nine articles were considered relevant to the study objective. A total of 680 children were included, of whom 45% were boys. No statistical significance was observed for bowel movement frequency, stool consistency, therapeutic success, fecal incontinence, and abdominal pain with fiber intake in patients with childhood constipation. These results should be interpreted with care due to the high clinical heterogeneity between the studies and the methodological limitation of the articles selected for analysis. Conclusions: There is a scarcity of qualified studies to evaluate fiber supplementation in thetreatment of childhood constipation, generating a low degree of confidence in estimating thereal effect of this intervention on this population. Today, according to the current litera-ture, adequate fiber intake should only be recommended for functional constipation, and fibersupplementation should not be prescribed in the diet of constipated children and adolescents.commetanáliseResumoObjetivo: Reunir evidências atuais sobre o uso de fibras no tratamento da constipac¸ão funcionalem pacientes pediátricos.Fontes dos dados: Revisão sistemática com metanálise de estudos identificados por pesquisanas bases de dados Pubmed, Embase, LILACS e Cochrane publicados até o ano de 2016.Critérios de inclusão: estudos controlados randomizados; pacientes com idade entre 1 a 18 anoscom diagnóstico de constipac¸ão funcional em uso ou não de tratamento medicamentoso paraconstipac¸ão; artigos publicados em língua portuguesa, inglesa, espanhola, francesa e alemã emrevistas acessíveis aos pesquisadores.Síntese dos dados: Foram encontrados 2.963 artigos na busca e, após avaliac¸ão adequada,nove artigos mostraram-se relevantes frente aos objetivos do estudo. Um total de 680crianc¸as foram incluídas, sendo 45% meninos. Não foi demonstrado significância estatística dafrequência evacuatória, da consistência evacuatória, do sucesso terapêutico, da incontinênciafecal e da dor abdominal com o uso de fibras nos pacientes com constipac¸ão infanto-juvenil.Esses resultados devem ser interpretados com atenc¸ão devido à alta heterogeneidade clínicaentre os estudos e à limitac¸ão metodológica dos artigos analisados.Conclusões: Existe uma grande falta de estudos qualificados para avaliar a suplementac¸ão defibras no tratamento da constipac¸ão infanto-juvenil, gerando um baixo grau de confianc¸a para seestimar o efeito real dessa intervenc¸ão na populac¸ão em questão. Até esse momento, conformea literatura atual, deve-se apenas recomendar a ingestão adequada de fibras na constipac¸ãofuncional, não se podendo prescrever a suplementac¸ão de fibras na dieta das crianc¸as e ado-lescentes constipados

Global Strain in Severe Aortic Valve Stenosis:Relation to Clinical Outcome after Aortic Valve Replacement

Background— Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement is unknown. Methods and Results— A total of 125 patients with severe aortic stenosis and ejection fraction &gt;40% scheduled for aortic valve replacement were evaluated preoperatively and divided into 4 groups according to GLS quartiles. Patients were followed up for 4 years. The primary end points were major adverse cardiac events (MACEs) defined as cardiovascular mortality and cardiac hospitalization because of worsening of heart failure; the secondary end point was cardiovascular mortality. MACE and cardiac mortality were significantly increased in patients with lower GLS. Estimated 5-year MACE was increased: first quartile 19% (n=6) / second quartile 20% (n=6) / third quartile 35% (n=11) / fourth quartile 49% (n=15); P =0.04. Patients with increased age, left ventricular hypertrophy, and left atrial dilatation were at increased risk. In Cox regression analysis, after correcting for standard risk factors and ejection fraction, GLS was found to be significantly associated with cardiac morbidity and mortality. In a stepwise Cox model with forward selection, GLS was the sole independent predictor: hazard ratio=1.13 (95% confidence interval, 1.02–1.25), P =0.04. Comparing the overall log likelihood χ 2 of the predictive power of the multivariable model containing GLS was statistically superior to models based on EuroScore, history with ischemic heart disease, and ejection fraction. Conclusions— In patients with symptomatic severe aortic stenosis undergoing aortic valve replacement, reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00294775. </jats:sec

Data on association between QRS duration on prehospital ECG and mortality in patients with confirmed STEMI

Data presented in this article relates to the research article entitled âAssociation between QRS duration on prehospital ECG and mortality in patients with suspected STEMIâ (Hansen et al., in press) [1].Data on the prognostic effect of automatically recoded QRS duration on prehospital ECG and presence of classic left and right bundle branch block in 1777 consecutive patients with confirmed ST segment elevation AMI is presented. Multivariable analysis, suggested that QRS duration >111 ms, left bundle branch block and right bundle branch block were independent predictors of 30 days all-cause mortality. For interpretation and discussion of these data, refer to the research article referenced above