Artigos e Materiais de Revistas Científicas - HC/Outros

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Single Peroneus Longus Tendon Graft
(2024) SILVA, Andre Giardino Moreira da; MACEDO, Rodrigo Sousa; SOUZA, Michel Oliveira; GIGLIO, Pedro Nogueira; VIDEIRA, Livia Dau; GOBBI, Riccardo Gomes; SANTOS, Alexandre Leme Godoy dos; HELITO, Camilo Partezani
The peroneus longus tendon seems a viable graft option for knee ligament reconstructions, with adequate biomechanical properties and low morbidity after harvesting. The objective of this article is to describe a combined anterior cruciate ligament and anterolateral ligament reconstruction technique using a single peroneus longus tendon graft harvested from the infra malleolar region to ensure sufficient length.
End-of-life experiences in the dying process: scoping and mixed-methods systematic review
(2023) SILVA, Tais Oliveira; RIBEIRO, Henrique Goncalves; MOREIRA-ALMEIDA, Alexander
ObjectivesTo identify the current state of understanding about end-of-life experiences (ELEs) and examine evidence concerning prevalence, the impact on the process of dying and the perceptions/explanations of patients, relatives and healthcare professionals (HCPs) with regard to ELEs. MethodsScoping review and mixed-methods systematic review (ScR and MMSR). Nine academic databases were searched for a screening of the available scientific literature (ScR). Articles reporting qualitative, quantitative or mixed-methods studies were selected (MMSR), the quality of which was assessed using the Joanna Briggs Institute (JBI) standardised critical appraisal tools. The quantitative data were synthesised in narrative form while a meta-aggregation approach was adopted for the qualitative results. ResultsThe ScR identified 115 reports, with 70.4% published after 2010, 55.6% from the USA and the most common terminology for ELE was deathbed visions (29%). The MMSR included 36 papers, describing 35 studies in various settings. The combination of quantitative and qualitative evidence indicated a greater prevalence of ELEs in samples of patients and HCPs compared with relatives. The most common ELEs were visions and dreams of the presence of deceased relatives/friends with references to making ready for a journey. The impact of ELEs was mainly positive, and there was a tendency to interpret them as spiritual experiences inherent to the process of dying. ConclusionsELEs are often reported by patients, relatives and HCPs and have a significant, generally positive impact on the process of dying. Guidelines for the furtherance of studies and clinical applications are discussed.
Epidemiological and Clinical Characteristics of Young Patients With Breast Cancer in Brazil: A Retrospective Study
(2023) CORREA, Daniela B.; ARAUJO, Guilhermino C.; ALVARENGA, Bruno H.; RODRIGUES, Angelica N.
PURPOSE Understanding the epidemiological profile of young patients with breast cancer (BC) is crucial for devising effective control strategies. However, data on Brazilian patients with BC, particularly concerning the association with pathogenic germline mutations, are limited. This retrospective cross-sectional study seeks to shed light on the epidemiological and genetic profiles of young patients with BC in Brazil, with a specific focus on the correlation between germline mutations and clinical outcomes. METHODS We analyzed medical records from two institutions in Minas Gerais, Brazil, focusing on young patients with BC diagnosed from January 2012 to December 2020. The collected variables included sociodemographic profile, tumor characteristics, mutational status, follow-up duration, and time from diagnosis to death. RESULTS The findings highlight high rates of genetic mutations, more aggressive tumor characteristics, and the necessity for more radical surgical interventions in patients with mutations. CONCLUSION In general, young patients with BC in Brazil present an unfavorable prognosis, emphasizing the need for early diagnosis and personalized treatment strategies.
Photobiomodulation Associated With Conservative Treatment for Achilles Tendon Rupture: A Double-Blind, Superiority, Randomized Controlled Trial
(2022) OLIVEIRA, P. R. de; ARREBOLA, L. S.; STéFANI, K. C.; PINFILDI, C. E.
Objective: To investigate the effects of photobiomodulation on Achilles tendon rupture (ATR) treated conservatively. Design: Prospective, patient- and assessor-blinded, parallel, randomized controlled trial. Setting: Patients with acute ATR treated conservatively. Participants: Thirty-four male individuals with acute unilateral ATR treated conservatively (N=34), equally divided in 2 groups: photobiomodulation group (PBMG) and sham group, with mean age of 45.5±9.47 and 48.7±8.38 years, respectively. Intervention: All participants underwent through an immobilization period, followed by rehabilitation sessions (2 d/wk for 12 weeks) comprising strengthening, range of motion, and balance/weightbearing exercises. In PBMG, the tendon was irradiated with a photobiomodulation cluster (1 904 nm/50 mW infrared laser, 4 858 nm/50 mW infrared diodes, and 4 658 nm/40 mW red diodes; power density of 105 mW/cm2 per cluster area) during the immobilization period (2 d/wk for 8 weeks) and the sham group received a simulation of the procedure with no irradiation. Outcomes were assessed at the removal of the immobilization 12 and 16 weeks after tendon rupture. Main Outcome Measures: Primary outcome was the Achilles Tendon Rupture Score. Secondary outcomes included Numerical Pain Rating Scale at rest and during effort, plantar flexor strength, and ankle range of motion. Results: Both groups demonstrated an increase in the Achilles Tendon Rupture Score and improvements in range of motion, plantar flexor strength, and pain. There were no significant differences in outcomes between the 2 groups (P>.05) except in pain during walking, which was significantly lower in the PBMG in week 12 (P<.01, effect size=0.56) and week 16 (P<.01, effect size=0.55). Conclusion: Photobiomodulation associated with conservative treatment is not superior to conservative treatment alone for improving function in patients with acute ATR.
Use of anticoagulants in patients with COVID-19: an update of a living systematic review and meta-analysis
(2023) BATISTA, Diane R.; FLORIANO, Idevaldo; SILVINATO, Antonio; BACHA, Helio A.; BARBOSA, Alexandre Naime; TANNI, Suzana E.; BERNARDO, Wanderley M.
Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis
(2023) FLORIANO, Idevaldo; SILYINATO, Antonio; BACHA, Helio Arthur; BARBOSA, Alexandre Naime; TANNI, Suzana; BERNARDO, Wanderley Marques
Objective: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. Methods: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials. gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. Results: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I-2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I-2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I-2 = 0%; p = 0.00001], both with low quality of evidence. Conclusions: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.
Relationship between chronic pain , depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty
(2023) BORIM, Flavia Silva Arbex; ASSUMPCAO, Daniela de; YASSUDA, Monica Sanches; COSTA, Henrique Trajano de Moraes; BATISTONI, Samila Sathler Tavares; NERI, Anita Liberalesso; VOSHAAR, Richard C. Oude; APRAHAMIAN, Ivan
Objective: To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Methods: Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Results: Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3 +/- 4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. Conclusion: The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.
Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows
(2016) NOBRE, Fernando; MION JUNIOR, Decio
Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review.
A novel mortality risk score for emphysematous pyelonephritis: A multicenter study of the Global Research in the Emphysematous Pyelonephritis group
(2024) TRUJILLO-SANTAMARIA, Hegel; ROBLES-TORRES, Jose Ivan; TEOH, Jeremy Yuen-Chun; TANIDIR, Yiloren; CAMPOS-SALCEDO, Jose Gadu; BRAVO-CASTRO, Edgar Ivan; WROCLAWSKI, Marcelo Langer; YEOH, W. S.; KUMAR, Santosh; SANCHEZ-NUNEZ, Juan Eduardo; ESPINOZA-AZNAR, Jose Enrique; RAGOORI, Deepak; HAMRI, Saeed Bin; AIK, Ong Teng; TAROT-CHOCOOJ, Cecil Paul; SHRESTHA, Anil; LAKMICHI, Mohamed Amine; COSENTINO-BELLOTE, Mateus; VAZQUEZ-LAVISTA, Luis Gabriel; KABRE, Boukary; TIONG, Ho Yee; ARRAMBIDE-HERRERA, Jose Gustavo; GOMEZ-GUERRA, Lauro Salvador; KUTUKOGLU, Umut; ALVES-BARBOSA, Joao Arthur Brunhara; JASPERSEN, Jorge; ACEVEDO, Christian; VIRGEN-GUTIERREZ, Francisco; AGRAWAL, Sumit; DUARTE-SANTOS, Hugo Octaviano; ANN, Chai Chu; CASTELLANI, Daniele; GAHUAR, Vineet
Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality. We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission.Materials and methods: Patients diagnosed with EPN between 2013 and 2020 were retrospectively included. Data from 15 centers (70%) were used to develop the scoring system, and data from 7 centers (30%) were used to validate it. Univariable and multivariable logistic regression analyses were performed to identify independent factors related to mortality. Receiver operating characteristic curve analysis was performed to construct the scoring system and calculate the risk of mortality. A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points. The area under the curve was used to quantify the scoring system performance. An 8-point scoring system for the mortality risk was created (range, 0-7).Results: In total, 570 patients were included (400 in the test group and 170 in the validation group). Independent predictors of mortality in the multivariable logistic regression were included in the scoring system: quick Sepsis-related Organ Failure Assessment score >= 2 (2 points), anemia, paranephric gas extension, leukocyte count >22,000/mu L, thrombocytopenia, and hyperglycemia (1 point each). The mortality rate was <5% for scores <= 3, 83.3% for scores 6, and 100% for scores 7. The area under the curve was 0.90 (95% confidence interval, 0.84-0.95) for test and 0.91 (95% confidence interval, 0.84-0.97) for the validation group.Conclusions: Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.
Sulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report
(2023) SILVA, Ana Flávia Garcia; MELRO, Lívia Maria Garcia; BESEN, Bruno Adler Maccagnan Pinheiro; MENDES, Pedro Vitale; PARK, Marcelo
The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials
(2023) YVAMOTO, Erika Yuki; MOURA, Diogo Turiani Hourneaux de; PROENCA, Igor Mendonca; MONTE JUNIOR, Epifanio Silvino do; RIBEIRO, Igor Braga; RIBAS, Pedro Henrique Boraschi Vieira; HEMERLY, Matheus Candido; OLIVEIRA, Victor Lira de; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
Introduction The duodenal-jejunal bypass liner (DJBL) is a less-invasive treatment of obesity and type 2 diabetes mellitus (T2DM). Methods This is a systematic review and meta-analysis including randomized clinical trials (RCTs) comparing DJBL versus sham or pharmacotherapies aiming to evaluate the effectiveness and safety of DJBL. Results Ten RCTs (681 patients) were included. The DJBL group showed superior excess weight loss (+ 11.4% [+ 7.75 to + 15.03%], p < 0.00001) and higher decrease in HbA1c compared to the control group (- 2.73 +/- 0.5 vs. - 1.73 +/- 0.4, p = 0.0001). Severe adverse events (SAEs) occurred in 19.7%. Conclusion The DJBL did not reach the ASGE/ASMBS thresholds for the treatment of obesity. However, it is important to state that many SAEs were not really severe. Therefore, we believe this therapy plays an important role in the management obesity and T2DM.
The efficacy of cryotherapy in reducing edema and ecchymosis in patients who underwent rhinoplasty: A narrative review
(2023) JARDAK, Mira Nawfal; SAAD, Elio Assaad; JALLOUL, Rawan; EMMANUEL, Nancy; NICOLAS, Gregory; MENENDEZ, Juan Pablo
Objective: The aim of this article was to showcase current literature on the efficacy of different postoperative and intraoperative cryotherapy techniques in reducing edema, ecchymosis, and pain in patients who have undergone rhinoplasty. Background: Rhinoplasty has some unfavorable postoperative temporary side effects, such as edema, ecchymosis, and pain, which hinder the patients' daily activities. Several interventions have been proposed in the literature, including cryotherapy, which refers to cold application to the desired facial area in patients who have undergone rhinoplasty. Methods: Specific keywords were used, and PubMed, Scopus, and Embase databases were searched. Two extensive selection rounds were performed to finally include 27 articles; the first round was based on the title and abstract, while the second was based on the full article. Discussion: The articles were split into postoperative and intraoperative categories based on the time cryotherapy was administered during the surgery. They were then subdivided depending on the specific cryotherapy technique used, and a detailed description of the method of application and improvement in patients' edema, ecchymosis, and pain was noted. Articles that compared different cryotherapy techniques were also compared with articles that discussed previously used techniques. Conclusion: Cryotherapy has shown promising outcomes in reducing edema, ecchymosis, and pain after rhinoplasty and bleeding. It is crucial to build further studies upon these outcomes and develop guidelines for surgeons to effectively use these cryotherapy techniques in their practice. & COPY; 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Lateral exposure of the proximal and distal peroneal artery without bone resection
(2023) BRITO-QUEIROZ, Andre; MOTA, Rodrigo de Sousa; BARROS, Bruno Rodrigues; MORAES, Tayrine Mazotti de; MULATTI, Grace Carvajal; ARAUJO FILHO, Jose Siqueira de
Surgical revascularization with distal bypass surgery is associated with good outcomes for chronic limb-threatening ischemia. The peroneal artery, the most-often preserved outflow vessel, is commonly reached through a lateral approach involving resection of the fibula. We present two different techniques for a lateral approach to the peroneal artery: the first by proximal exposure and the second by exposing the distal segment of the peroneal artery. Both techniques are performed without bone resection. (J Vasc Surg Cases Innov Tech 2023;9:101144.)
Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)
(2023) BARBOSA, Alexandre Naime; CHEBABO, Alberto; STARLING, Carlos; PEREZ, Clevy; CUNHA, Clovis Arns; LUNA, David de; NUNES, Estevao Portela; ZAMBRANO, Gabriela; FERREIRA, Juliana Carvalho; CRODA, Julio; FALAVIGNA, Maicon; GOMES-DA-SILVA, Monica Maria; THORMANN, Monica; CIMERMAN, Sergio; PARAHIBA, Suena Medeiros; TANNI, Suzana; BERNARDO, Wanderley Marques; RODRIGUEZ-MORALES, Alfonso J.
BackgroundSince the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population.MethodsFifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system.ResultsNine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged.ConclusionThis guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.
The effects of gratitude interventions: a systematic review and meta-analysis
(2023) DINIZ, Geyze; KORKES, Ligia; TRISTAO, Luca Schiliro; PELEGRINI, Rosangela; BELLODI, Patricia Lacerda; BERNARDO, Wanderley Marques
Introduction: Gratitude has several implications. Over time, a logical relationship has been established between gratitude and well-being. In addition, researchers aimed to establish associations between gratitude and other factors of positive feelings using scientific methods. We conducted a systematic review and meta-analysis of interventions to develop gratitude and its benefits to human beings. Objective: This study aimed to evaluate and quantify the available scientific evidence on interventions to acquire knowledge on gratitude as a quantifiable causal factor of benefit to human beings. Methods: A systematic literature search was conducted to identify studies that investigated the effects of gratitude interventions. MEDLINE, Embase, and Central Cochrane databases were searched in addition to gray (Google Scholar) and manual search. Two authors independently evaluated the titles and abstracts, and selected the studies that met the inclusion criteria. The searches were conducted between January and July 2022. Results: Sixty-four randomized clinical trials were included. The meta-analysis demonstrated that patients who underwent gratitude interventions experienced greater feelings of gratitude, better mental health, and fewer symptoms of anxiety and depression. Moreover, they experienced other benefits such as a more positive mood and emotions. Conclusion: The results demonstrate that acts of gratitude can be used as a therapeutic complement for treating anxiety and depression and can increase positive feelings and emotions in the general population.Prospero database registration: (www.crd.york.ac.uk/prospero) under the number CRD42021250799.
Impacto da monitoria de Cirurgia Plástica no conhecimento teórico e nas habilidades práticas em estudantes de medicina
(2015) PEDROSO, JUAN CARLOS MONTANO; PAZINI, RODRIGO NGAN; BILÓ, JOÃO PEDRO ROCHA; SALLUM, NATASHA; NOVO, NEIL FERREIRA; BRANDOLI, PRISCILA DO AMARAL; FERREIRA, LYDIA MASAKO
ABSTRACT Introduction: To assess the impact of extracurricular activities in plastic surgery on the knowledge and practical skills of medical students at the Federal University of São Paulo. Methods: Six students participating in extracurricular activities and eight students who did not participate were randomly selected and evaluated before and after the program by using multiple-choice tests and a Surgical Skills Assessment (SSA) instrument to assess their practical skills. Results: The study group obtained higher scores in the theoretical tests, when the scores before starting the program (average, 15.8; standard deviation, 2.7) were compared with those received after their participation in extracurricular activities (average, 21.8; standard deviation, 1.3) (p = 0.02). Similar results were obtained with the SSA instrument for the period before the start of (average, 9.8; standard deviation, 1.4) and after (average, 13.5; standard deviation, 1.6) (p = 0.02) the program. The control group did not show significant changes in the scores received for theoretical tests when the period from August 2010 (average, 14.0; standard deviation, 4.1) to June 2011 (average, 13.8; standard deviation, 2.6) (p = 0.40) was evaluated. Similar results were obtained with the SSA instrument for the evaluation period between August 2010 (average, 8.5; standard deviation, 2.2) and June 2011 (average, 9.6; standard deviation, 1.7) (p = 0.18). Conclusion: The students participating in extracurricular activities in plastic surgery at the Federal University of São Paulo improved their knowledge and acquired better practical skills compared with students who did not participate.
Eltrombopag for Adults and Children with Immune-Refractory Thrombocytopenic Purpura: A Systematic Review
(2023) TORELLI, Danielle Francisco Honorato de Barros; OLIVEIRA, Crystian Bitencourt Soares; NAI, Gisele Alborghetti; TRINDADE, Evelinda Marramon; PRESTES-CARNEIRO, Luiz Euribel
Eltrombopag is an agonist that binds to the membrane-bound domain of the thrombopoietin receptor used in immune thrombocytopenic purpura (ITP). We conducted a meta-analysis of randomized controlled trials to assess the efficacy and safety of eltrombopag in adults and children with refractory ITP. Adults who received eltrombopag had a significantly better platelet response (relative risk [RR], 3.65; 95% confidence interval [CI], 2.39-5.55), but there were no differences in the incidence of bleeding (RR, 0.8; 95% CI, 0.52-1.22) and adverse effects (RR, 0.99; 95% CI, 0.55-1.78) compared with the placebo. In children, there was no difference between eltrombopag and placebo for a platelet response >50,000/mm(3) (RR, 3.93; 95% CI, 0.56-27.79) and the number of adverse events (RR, 0.99; 95% CI, 0.25-1.49); however, a lower incidence of bleeding was observed (RR, 0.47; 95% CI, 0.27-0.83). Treatment with eltrombopag protected adults and children from severe disease and death.
The use of esketamine in the treatment of patients with oral antidepressant-resistant depression: systematic review and meta-analysis
(2023) FLORIANO, Idevaldo; SILVINATO, Antonio; BERNARDO, Wanderley Marques
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field to standardize how to conduct, and to assist in the reasoning and decision-making of doctors. The information provided by this project must be critically evaluated by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical condition of each patient. Guideline conclusion: April 2023. Societies: Brazilian Medical Association.
Omentectomy vs omentum preservation for advanced gastric cancer: A systematic review and meta-analysis
(2023) TRISTAO, Luca Schiliro; RIVA, Wagner Jose; SANTOS, Clara Lucato dos; BERNARDO, Wanderley Marques
Currently, gastric cancer is the sixth most prevalent cancer in the world. The recommended treatment for advanced disease is gastrectomy with D2 lymphadenectomy. However, there is no consensus regarding the performance of an omentectomy as part of the treatment. The procedure is considered by some authors to be essential for the elimination of a micrometastasis since cells in the peritoneum prefer growing in milky spots in the omentum. On the other hand, retrospective studies demonstrated that there is the possibility that omentum preservation may not impact patients' overall survival. Therefore, the objective of this review was to quantify the effect of performing an omentectomy to determine whether it is necessary. Medline (PubMed), Embase, Cochrane, ClinicalTrials.gov and LILACS were searched up to September 2022. Selection was restricted to comparative studies in patients with advanced GC (& GE;T2). The certainty of evidence was assessed with GRADEPro and the risk of bias with ROBINS-I and RoB 2.0. Five cohort studies, and one randomized controlled trial (RCT) were included. The meta-analysis found that there were no significant differences between the procedures for overall survival, relapse-free survival, and peritoneal recurrence. Furthermore, in perioperative outcomes, a significant difference was only found in intraoperative bleeding, which was lower in patients who had their omentum preserved. Therefore, omentum preservation in patients with advanced gastric cancer has been shown to have no inferior results than resection in long-term outcomes.
How to Advance Palliative Care Research in South America? Findings From a Delphi Study
(2023) PAIVA, Carlos Eduardo; BONILLA-SIERRA, Patricia; TRIPODORO, Vilma Adriana; RODRIGUEZ-NUNEZ, Alfredo; SIMONE, Gustavo De; RODRIGUEZ, Liliana Haydee; VIDAL, Edison Iglesias de Oliveira; RIOS, Miriam Riveros; CRISPIM, Douglas Henrique; PERREZ-CRUZ, Pedro; NASCIMENTO, Maria Salete de Angelis; OSPINA, Paola Marcela Ruiz; LIMA, Liliana de; PASTRANA, Tania; ZIMMERMAN, Camilla; HUI, David; BRUERA, Eduardo; PAIVA, Bianca Sakamoto Ribeiro
Context. Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved.Objectives. To develop a set of recommendations to advance PC research in SA.Methods. Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of >= 75%. Results. 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public poli-cies, education and prognosis were defined as the most relevant.Conclusion. Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resour-ces and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region. J Pain Symptom Manage 2023;65:193-202. (c) 2022 The Authors.

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