Análise do índice de mortalidade das principais neoplasias malignas no Brasil e seus respectivos cenários internacionais: um estudo comparativo / Analysis of the mortality rate of the main malignant neoplasms in Brazil and their respective international scenarios: a comparative study

Segundo o Ministério da Saúde brasileiro, o câncer já é um dos principais problemas de saúde pública mundial, sendo uma das quatro principais causas de morte prematura, caracterizada pela morte antes dos 70 anos, em todo o mundo. Entre os mais incidentes estão o câncer de pulmão, mama, cólon e reto e próstata. Alguns desses são amplamente divulgados por campanhas nacionais, logo são mais conhecidos pela população. Entretanto, neoplasias como a de cólon e reto, uma das mais incidentes, e como as de estômago e pele (não melanoma), que estão entre as mais incidentes em homens, por não possuírem uma divulgação tão ampla, não são tão conhecidas pela população como as citadas anteriormente, mesmo sendo tão preocupantes quanto aquelas. O objetivo deste trabalho foi identificar as 10 neoplasias de maior taxa de mortalidade no Brasil em 2019, conforme registrado no Departamento de Informática do Sistema Único de Saúde (DATASUS) e, a partir desses dados, estabelecer uma comparação com dados a respeito da mortalidade pelas mesmas neoplasias em escala mundial, utilizando as bases de dados “Medline”, “Scielo” e “International Agency for Research On Câncer” para a obtenção de tais dados. Trata-se de um estudo descritivo, de abordagem quantitativa, cuja fonte de dados é o Departamento de Informática do Sistema Único de Saúde (DATASUS), além das bases “Medline”, “Scielo”, “International Agency for Research On Câncer” e GLOBOCAN para obtenção dos dados internacionais. No ano de 2019, foram registrados 235.301 casos referentes a neoplasia. Dentre elas, as neoplasias malignas com maior número de óbitos foi, nos indivíduos do sexo masculino, a de Brônquios e Pulmões, com 16.661 mortes registradas de janeiro a dezembro de 2019, conforme o DATASUS. Já no sexo feminino, temos a neoplasia de Mama como principal em número de mortos, com 18068 casos registrados no mesmo período. O Brasil segue o padrão mundial apresentado para a análise proposta, mantendo localizações de neoplasias, bem como suas respectivas taxas de mortalidade, semelhantes ao padrão mundial observado. Entretanto, observam-se grandes diferenças entre o cenário brasileiro e os cenários apresentados pelos Estados Unidos da América e pela Inglaterra

Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis

Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87–0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40–0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60–0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD − 19.44 mg/dL; 95% CI − 21.49 to − 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD − 0,13%; IC 95% − 0.16 to − 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents

Rituximab Effectiveness and Safety for Treating Primary Sjögren’s Syndrome (pSS): Systematic Review and Meta-Analysis

<div><p>Background</p><p>Primary Sjögren’s Syndrome (pSS) is a systemic autoimmune disease that involves the exocrine glands and internal organs. pSS leads to destruction and loss of secretory function due to intense lymphoplasmacytic infiltration. Therapeutic options include mainly symptomatic and supportive measures, and traditional immunosuppressant drugs have shown no effectiveness in randomized trials. Rituximab (RTX) is a chimeric antibody anti-CD20 that leads to B cell depletion by diverse mechanisms. There is evidence that this drug may be effective for treating pSS. The objective of this systematic review was to evaluate Rituximab effectiveness and safety for treating pSS.</p><p>Methods and Findings</p><p>We conducted a systematic review of RCTs published until December 2015, with no language restriction. We registered a protocol on <i>Plataforma Brasil</i> (40654814.6.0000.5505) and developed search strategies for the following scientific databases: MEDLINE, EMBASE, CENTRAL and LILACS. We included adults with established pSS diagnosis and considered the use of Rituximab as intervention and the use of other drugs or placebo as control. Four studies met our eligibility criteria: three with low risk of bias and one with uncertain risk of bias. The total number of participants was 276 (145 RTX, 131 placebo). We assessed the risk of bias of each included study and evaluated the following as primary outcomes: lacrimal gland function, salivary gland function, fatigue improvement and adverse events. We found no significant differences between the groups in the Schirmer test at week 24 meta-analysis (MD 3.59, 95% CI -2.89 to 10.07). Only one study evaluated the lissamine green test and reported a statistically significant difference between the groups at week 24 (MD -2.00, 95% CI -3.52 to -0.48). There was a significant difference between the groups regarding salivary flow rate (MD 0.09, 95% CI 0.02 to 0.16) and improvement in fatigue VAS at weeks 6 (RR 3.98, 95% CI 1.61 to 9.82) and week 16 (RR 3.08, 95% CI 1.21 to 7.80).</p><p>Conclusions</p><p>According to moderate quality evidence, the treatment with a single RTX course in patients with SSp presents discrete effect for improving lacrimal gland function. Low-quality evidence indicates the potential of this drug for improving salivary flow. According to low quality evidence, no differences were observed in the evaluation after 24 weeks regarding fatigue reduction (30% VAS), serious adverse events occurrence, quality of life improvement and disease activity. With a very low level of evidence, there was no improvement in oral dryness VAS evaluation.</p></div

Prevalence of orofacial injuries in sports with non-motorized wheeled vehicles players: a systematic review and meta-analysis

Nowadays, facial injury is a public health problem that its most frequent forms are in automobile accidents, violence and sports practice. Among the sports-related injuries, orofacial injuries are very common and constitute serious health problems in athletes of different competition levels, with short, medium and long term consequences. However, the prevalence of injuries in different types of sports may vary depending on modalities, competition level and epidemiological characteristics of athletes and equipment allowed. Considering the equipment, sports with vehicles are considered the most likely to cause injury. Among these, studies are more common with athletes of sports with non-motorized wheeled vehicles, as cycling, skateboarding and skating

Rituximab X Placebo.

<p>Meta-analysis of the outcome disease activity assessed through the ESSDAI at week 24.</p

Risk of bias assessment of included studies.

<p>Risk of bias assessment of included studies.</p

Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis

Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87–0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40–0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60–0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD − 19.44 mg/dL; 95% CI − 21.49 to − 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD − 0,13%; IC 95% − 0.16 to − 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c

A diferença na qualidade de vida de pacientes com doença venosa crônica leve e grave Differences in the quality of life of patients with mild and severe chronic venous disease

CONTEXTO: A doença venosa crônica atinge os indivíduos em sua fase mais produtiva da vida, acarretando dor, perda de mobilidade e afastamento de atividades, podendo interferir diretamente na qualidade de vida. Seus sintomas clínicos decorrem de um estado de hipertensão venosa, causada por refluxo e/ou obstrução venosa. OBJETIVO: Determinar a diferença na qualidade de vida de pacientes com doença venosa crônica leve e grave. MÉTODOS: Foi realizado estudo transversal analítico comparativo na unidade de saúde durante 8 meses. A amostra foi calculada em 88 pacientes e dividida em dois grupos: Grupo A (CEAP clínico 1, 2 e 3) e Grupo B (CEAP clínico 4, 5 e 6). Foi usado o questionário genérico Medical Outcomes Study - 36-Item Short-Form Health Survey (SF-36). A análise estatística para verificar se havia diferença foi através do teste t de Student, com intervalo de confiança de 95% e p < 0,05. RESULTADOS: Foram analisados 88 indivíduos, sendo 47 no grupo A e 41 no grupo B. Do total, 87,5% (77) eram mulheres. Com relação à idade, 34% (30) tinham entre 30 e 40 anos. As alterações subcutâneas (CEAP clínico 4) foram os sintomas mais presentes, em 28,4%. Com exceção do domínio estado geral da saúde, todos os outros mostraram que o grupo B apresentava escores inferiores quando comparado ao grupo A. CONCLUSÕES: A qualidade de vida dos pacientes com doença venosa crônica leve e grave é diferente, apresentando-se mais afetada de acordo com a gravidade.<br>BACKGROUND: Chronic venous disease afflicts individuals in their most productive years, resulting in pain and loss of mobility and independence in performing routine daily activities, which may directly interfere with the patient's quality of life. Clinical symptoms result from venous hypertension caused by reflux and/or venous blockage. OBJECTIVE: To determine differences in the quality of life of patients with mild and severe chronic venous disease. METHODS: A cross-sectional comparative study was conducted in a health care facility during an 8-month period. The sample was composed of 88 patients divided into two groups: group A (clinical CEAP class 1, 2 and 3) and group B (clinical CEAP class 4, 5 and 6). The Medical Outcomes Study - 36-Item Short-Form Health Survey (SF-36) questionnaire was used. Statistical analysis was conducted using the Student t test, with a 95% confidence interval and a level of significance set at p < 0.05. RESULTS: We analyzed 88 subjects, 47 in group A and 41 in group B. Of the total, 87.5% (77) were women and 34% (30) were aged 30 to 40 years. Subcutaneous changes (CEAP class 4) were the most common symptoms, observed in 28.4% of the individuals. Except for the general health perceptions domain, group B showed lower scores than group A in all other domains. CONCLUSIONS: The quality of life of patients with mild and severe chronic venous disease proved to be different according to disease severity