Centro Cochrane do Brasil: 15º aniversário

Universidade Federal de São Paulo (UNIFESP) Program on Internal Medicine and TherapeuticsBrazilian Cochrane CenterDivision of Emergency and Evidence-Based MedicineUNIFESP, Program on Internal Medicine and TherapeuticsSciEL

Eficácia e segurança dos antipsicóticos atípicos (quetiapina, risperidona, aripiprazol, paliperidona) em comparação com um placebo ou medicamentos antipsicóticos típicos no tratamento da esquizofrenia refratária: overview de revisão sistemática

CONTEXT AND OBJECTIVE: According to some cohort studies, the prevalence of refractory schizophrenia (RS) is 20-40%. Our aim was to evaluate the effectiveness and safety of aripiprazole, paliperidone, quetiapine and risperidone for treating RS. METHODS: This was a critical appraisal of Cochrane reviews published in the Cochrane Library, supplemented with reference to more recent randomized controlled trials (RCTs) on RS. The following databases were searched: Medical Literature Analysis and Retrieval System Online (Medline) (1966-2009), Controlled Trials of the Cochrane Collaboration (2009, Issue 2), Embase (Excerpta Medica) (1980-2009), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) (1982-2009). There was no language restriction. Randomized controlled trials, systematic reviews and meta-analyses evaluating atypical antipsychotics for treating RS were included. RESULTS: Seven Cochrane systematic reviews and 10 additional RCTs were included in this review. The data generally showed minor differences between the atypical antipsychotics evaluated and typical antipsychotics, regarding improvement in disease symptoms, despite better adherence to treatment with atypical antipsychotics. Risperidone was specifically evaluated in patients with RS in one of the systematic reviews included, with favorable outcomes, but without definitive superiority compared with other drugs of proven efficacy, like amisulpride, clozapine and olanzapine. CONCLUSIONS: The findings underscore the difficulty in treating these patients, with high dropout rates and treatment patterns of modest improvement in assessments of effectiveness. Atypical antipsychotics have advantages over typical antipsychotics mainly through their better safety profile, which leads to better adherence to treatment. A combination of antipsychotics may also be an option for some refractory patients.CONTEXTO E OBJETIVO: De acordo com alguns estudos de coorte, a prevalência da esquizofrenia refratária (ER) está entre 20-40%. Nosso objetivo foi avaliar a efetividade e segurança de aripiprazol, paliperidona, quetiapina e risperidona no tratamento da esquizofrenia refratária. MÉTODOS: Avaliação crítica das revisões Cochrane publicadas na Biblioteca Cochrane e complementação com referências de ensaios clínicos randomizados (ECRs) mais atualizados sobre ER. As seguintes bases de dados foram pesquisadas: Medline (Medical Literature Analysis and Retrieval System Online) (1966-2009), Ensaios Controlados da Colaboração Cochrane (2009, edição 2), Embase (Excerpta Database) (1980-2009), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) (1982-2009). Não houve restrição a idiomas. Ensaios clínicos randomizados, revisões sistemáticas e metanálises que avaliaram antipsicóticos atípicos no tratamento da esquizofrenia refratária foram incluídos. RESULTADOS: Sete revisões sistemáticas Cochrane e 10 ECRs complementares foram incluídos nessa revisão. No geral os dados demonstram pequenas diferenças entre os antipsicóticos atípicos avaliados e os típicos na melhora dos sintomas da doença, apesar da melhor adesão ao tratamento com os atípicos. A risperidona foi avaliada especificamente em pacientes com esquizofrenia refratária em uma das revisões sistemáticas incluídas, a qual demonstrou desfechos favoráveis, porém não definitivos quando comparada a drogas também com eficácia comprovada como amisulprida, clozapina e olanzapina. CONCLUSÕES: Os dados reforçam a dificuldade de tratar esses pacientes, com elevadas taxas de desistência do tratamento e padrões de melhora modestos nas avaliações de eficácia. Os antipsicóticos atípicos têm vantagens sobre os típicos principalmente pelo melhor perfil de segurança, o que leva a melhor adesão ao tratamento. A associação de antipsicóticos também pode ser uma opção em alguns pacientes refratários ao tratamento.Universidade Federal de São Paulo (UNIFESP) Brazilian Cochrane CenterUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Brazilian Cochrane CenterUNIFESP, Brazilian Cochrane CenterUNIFESP, EPM, Brazilian Cochrane CenterSciEL

Relato de Experiência Docente: A Primeira Disciplina no Brasil sobre a Prática da Psicologia Baseada em Evidências Ministrada no Instituto de Psicologia da Universidade de São Paulo

This article reports the experience of teaching the first course in Brazil on the Evidence-Based Practice in Psychology (EBPP), offered by the Institute of Psychology of the University of São Paulo. The course instructed students on the concepts of EBPP, primary and secondary sources of evidence, adequacy of the research question to the experimental design, single-subject design, observational studies, randomized controlled trials and implementation of systematic reviews with or without meta-analysis. It is noteworthy that the development of the discipline allowed reflections on the importance of EBPP in clinical, academic, institutional and public policy management on mental health. It is recommended the inclusion of EBPP course in the curriculum of undergraduate and graduate students in Psychology.  Este artigo relata a experiência de ensino da primeira disciplina no Brasil sobre a Prática da Psicologia Baseada em Evidências (PPBE), oferecida pelo Instituto de Psicologia da Universidade de São Paulo. O curso instruiu os alunos sobre os conceitos da PPBE, fontes de evidências primárias e secundárias, adequação da pergunta de pesquisa ao delineamento, delineamento experimental de caso único, estudos observacionais, ensaios clínicos randomizados e sobre a execução de revisões sistemáticas, com ou sem metanálise. É importante destacar que o desenvolvimento da disciplina oportunizou a reflexão sobre a importância da PPBE no âmbito clínico, acadêmico, institucional e na gestão de políticas públicas na saúde mental. Recomenda-se a inserção da disciplina na grade curricular dos cursos de graduação e pós-graduação na área da Psicologia

The Relation Between the Surface Brightness and the Diameter for Galactic Supernova Remnants

In this work, we have constructed a relation between the surface brightness ($\Sigma$) and diameter (D) of Galactic C- and S-type supernova remnants (SNRs). In order to calibrate the $\Sigma$-D dependence, we have carefully examined some intrinsic (e.g. explosion energy) and extrinsic (e.g. density of the ambient medium) properties of the remnants and, taking into account also the distance values given in the literature, we have adopted distances for some of the SNRs which have relatively more reliable distance values. These calibrator SNRs are all C- and S-type SNRs, i.e. F-type SNRs (and S-type SNR Cas A which has an exceptionally high surface brightness) are excluded. The Sigma-D relation has 2 slopes with a turning point at D=36.5 pc: $\Sigma$(at 1 GHz)=8.4$^{+19.5}_{-6.3}$$\times10^{-12}$ D$^{{-5.99}^{+0.38}_{-0.33}}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ (for $\Sigma$$\le3.7\times10^{-21}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ and D$\ge$36.5 pc) and $\Sigma$(at 1 GHz)=2.7$^{+2.1}_{-1.4}$$\times$ 10$^{-17}$ D$^{{-2.47}^{+0.20}_{-0.16}}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ (for $\Sigma$$>3.7\times10^{-21}$ Wm$^{-2}$Hz$^{-1}$ster$^{-1}$ and D$<$36.5 pc). We discussed the theoretical basis for the $\Sigma$-D dependence and particularly the reasons for the change in slope of the relation were stated. Added to this, we have shown the dependence between the radio luminosity and the diameter which seems to have a slope close to zero up to about D=36.5 pc. We have also adopted distance and diameter values for all of the observed Galactic SNRs by examining all the available distance values presented in the literature together with the distances found from our $\Sigma$-D relation.Comment: 45 pages, 2 figures, accepted for publication in Astronomical and Astrophysical Transaction

Controlled drug delivery systems for perivascular application and intimal hyperplasia prevention

Intimal hyperplasia (IH) is a pathophysiological process developing in venous grafts, commonly used to bypass circulation blocked by atherosclerosis. IH causes graft failure with life-threatening consequences. IH occurs in three stages: hyper-acute, acute, and chronic over 6 to 8 weeks. The aim of the present thesis was to develop a perivascular drug delivery system for localized prevention of IH with atorvastatin. To increase the residence time at the injury sites, hyaluronic acid was derivatized with dopamine, and a novel cross-linking mechanism was suggested. To optimize drug release profile, atorvastatin was encapsulated into biodegradable polymer by spray-drying. The microspheres showed activity towards synthetic vascular smooth muscle cells in vitro. The device showed a burst release phase to target IH in the hyper-acute stage, followed by a sustained release to supply the drug continuously over several weeks, and demonstrated biocompatibility in vivo