RESUMO
BACKGROUND: The objective of the study was to verify the accuracy of hyperbilirubinaemia as a marker for acute perforated appendicitis. METHODS: A comprehensive search of the MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts and Grey literature from January 1969 to July 2014. We included cross-sectional and cohort studies, prospective and retrospective, which evaluated hyperbilirubinaemia level in perforated appendicitis and compared them with histological analysis of all appendectomy specimens. RESULTS: Eleven studies were analysed, which included 5395 patients. Pooled sensitivity was 54.6% (95% confidence interval (CI), 42.8-65.8) and specificity was 70.0% (95% CI, 54.7-81.9%) using STATA. The diagnostic odds ratio was 2.82 (95% CI, 1.38-5.72%). Summary receiver operating characteristic curves were constructed. The area under the curve was 0.65. CONCLUSION: This meta-analysis showed that the value of hyperbilirubinaemia alone cannot predict acute perforated appendicitis.
Assuntos
Apendicite/sangue , Hiperbilirrubinemia/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/patologia , Apendicite/cirurgia , Criança , Estudos de Coortes , Estudos Transversais , Humanos , Hiperbilirrubinemia/sangue , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: To investigate the efficacy, compared to placebo, of fluconazole 150 mg weekly, given for six months as prophylaxis against recurrent vulvovaginal candidiasis (RVVC). STUDY DESIGN: A quantitative systematic review was performed, and randomized controlled trials were included. We conducted searches at Medline, EMBASE, Lilacs, Cochrane Library and ICI Web of Science from 1980 to March 2012. We used the odds ratio (OR) with confidence intervals (CI) of 95% using a random effects model of Mantel-Haenszel. The software used was Review Manager version 5.0. RESULTS: Through the search strategies we identified 249 articles, of which only two were part of the meta-analysis. Fluconazole was more effective than placebo in reducing symptomatic episodes of VVC, immediately after treatment (OR 0.10, 95% CI 0.03-0.34), 3 months after treatment (OR 0.23, 95% CI 0.07-0.74) and 6 months after treatment (OR 0.39, 95% CI 0.24-0.64). CONCLUSION: Weekly treatment with fluconazole (150 mg) for six months is effective against RVVC.
Assuntos
Antibioticoprofilaxia , Antifúngicos/administração & dosagem , Candidíase Vulvovaginal/prevenção & controle , Fluconazol/administração & dosagem , Antifúngicos/uso terapêutico , Candidíase Vulvovaginal/tratamento farmacológico , Esquema de Medicação , Feminino , Fluconazol/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção SecundáriaRESUMO
BACKGROUND: This is an updated version of the original Cochrane review published in The Cochrane Library 2009, Issue 3. Most women with early cervical cancer (stages I to IIA) are cured with surgery or radiotherapy, or both. We performed this review originally because it was unclear whether cisplatin-based chemotherapy after surgery, radiotherapy or both, in women with early stage disease with risk factors for recurrence, was associated with additional survival benefits or risks. OBJECTIVES: To evaluate the effectiveness and safety of platinum-based chemotherapy after radical hysterectomy, radiotherapy, or both in the treatment of early stage cervical cancer. SEARCH METHODS: For the original 2009 review, we searched the Cochrane Gynaecological Cancer Group Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2009, Issue 1), MEDLINE, EMBASE, LILACS, BIOLOGICAL ABSTRACTS and CancerLit, the National Research Register and Clinical Trials register, with no language restriction. We handsearched abstracts of scientific meetings and other relevant publications. We extended the database searches to November 2011 for this update. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy (after radical surgery, radiotherapy or both) with no adjuvant chemotherapy, in women with early stage cervical cancer (stage IA2-IIA) with at least one risk factor for recurrence. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. Meta-analysis was performed using a random-effects model, with death and disease progression as outcomes. MAIN RESULTS: For this updated version, we identified three additional ongoing trials but no new studies for inclusion. Three trials including 368 evaluable women with early cervical cancer were included in the meta-analyses. The median follow-up period in these trials ranged from 29 to 42 months. All women had undergone surgery first. Two trials compared chemotherapy combined with radiotherapy to radiotherapy alone; and one trial compared chemotherapy followed by radiotherapy to radiotherapy alone. It was not possible to perform subgroup analyses by stage or tumour size.Compared with adjuvant radiotherapy, chemotherapy combined with radiotherapy significantly reduced the risk of death (two trials, 297 women; hazard ratio (HR) = 0.56, 95% confidence interval (CI): 0.36 to 0.87) and disease progression (two trials, 297 women; HR = 0.47, 95% CI 0.30 to 0.74), with no heterogeneity between trials (I² = 0% for both meta-analyses). Acute grade 4 toxicity occurred significantly more frequently in the chemotherapy plus radiotherapy group than in the radiotherapy group (risk ratio (RR) 5.66, 95% CI 2.14 to 14.98). We considered this evidence to be of a moderate quality due to small numbers and limited follow-up in the included studies. In addition, it was not possible to separate data for bulky early stage disease.In the one small trial that compared adjuvant chemotherapy followed by radiotherapy with adjuvant radiotherapy alone there was no significant difference in disease recurrence between the groups (HR = 1.34; 95% CI 0.24 to 7.66) and OS was not reported. We considered this evidence to be of a low quality.No trials compared adjuvant platinum-based chemotherapy with no adjuvant chemotherapy after surgery for early cervical cancer with risk factors for recurrence. AUTHORS' CONCLUSIONS: The addition of platinum-based chemotherapy to adjuvant radiotherapy (chemoradiation) may improve survival in women with early stage cervical cancer (IA2-IIA) and risk factors for recurrence. Adjuvant chemoradiation is associated with an increased risk of severe acute toxicity, although it is not clear whether this toxicity is significant in the long-term due to a lack of long-term data. This evidence is limited by the small numbers and poor methodological quality of included studies. We await the results of three ongoing trials, that are likely to have an important impact on our confidence in this evidence.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Compostos de Platina/uso terapêutico , Neoplasias do Colo do Útero/tratamento farmacológico , Quimioterapia Adjuvante/métodos , Cisplatino/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Humanos , Histerectomia , Estadiamento de Neoplasias , Radioterapia Adjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVE: To determine the accuracy of telomerase activity in predicting a higher risk for breast cancer. STUDY DESIGN: A quantitative systematic review was performed. Studies that detected telomerase activities in breast tissue were included. RESULTS: Twenty-five primary studies were analyzed, which included 2395 breast lesions. The proportion of breast cancer was 60.8%. Eighty-two percent (1193/1455) of breast cancer cases and 18% (169/940) of benign lesions cases were positive for telomerase activity. For breast cancer vs benign or normal breast tissue, the pooled likelihood ratio for the presence of telomerase activity was 4.5 (95% confidence interval [CI], 3.1-6.5) and the post-test probability was 88% (95% CI, 83-91). For breast cancer vs benign or normal tissue, the area under the summary receiver operating characteristic (SROC) curve was 0.89 with the Q* point value of 0.82. CONCLUSION: Our systematic review showed that telomerase activity was significantly present in breast cancer when compared with normal breast tissue or benign breast lesions.
Assuntos
Neoplasias da Mama/enzimologia , Telomerase/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To estimate the diagnostic accuracy of magnetic resonance in ovarian tumors. STUDY DESIGN: A quantitative systematic review was performed. Studies that compared magnetic resonance and paraffin sections within subjects for diagnosis of ovarian tumors were included. RESULTS: Fifteen primary studies were analyzed, which included 1267 ovarian masses. For borderline or malignant ovarian cancer vs benign ovarian lesions, the pooled likelihood ratio for the occurrence of a positive magnetic resonance result was 6.6 (95% confidence interval, 4.7-9.2) and the posttest probability for borderline or malignant diagnosis was 77% (95% confidence interval, 70-82). Because specificity and likelihood ratio positive were heterogeneous, a random effect model was used and a summary receiver operating characteristic curve was generated. For borderline or malignant ovarian cancer vs benign ovarian lesions, the area under curve was 0.9526. CONCLUSION: Magnetic resonance seems to be a useful preoperative test for predicting the diagnosis of pelvic masses.
Assuntos
Imageamento por Ressonância Magnética/normas , Neoplasias Ovarianas/patologia , Inclusão em Parafina/normas , Intervalos de Confiança , Feminino , Humanos , Funções VerossimilhançaRESUMO
OBJECTIVE: The objective of the study was to identify epidemiological correlates for persistence and clearance of human papillomavirus (HPV) infection. STUDY DESIGN: Cervical smears collected in a prospective cohort study to perform Papanicoloau cytology and HPV deoxyribonucleic acid (DNA) detection at baseline and during the follow-up. Outcomes analyzed were: (1) persistence of HPV DNA; (2) conversion; and (3) clearance of HPV. RESULTS: Among 501 women the incidence of HPV was 12.3%. Thirty-four women were persistently infected with HPV, which was associated with age below 21 years at first intercourse and 4 or more sexual partners during their lifetime. In a median of 19 months, 80.7% of women had clearance of HPV, which was associated with black race, coinfection with Chlamydia trachomatis at baseline, and a history of previous Papanicoloau smear. CONCLUSION: Strategies for sexual orientation may modify the rates of HPV persistence. The association of HPV clearance with a history of previous Papanicolaou smear screening highlights the importance of improving cervical screening programs. Further studies on the association of gynecological infections with HPV clearance are needed.
Assuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Lesões Pré-Cancerosas/virologia , Displasia do Colo do Útero/virologia , Adulto , Distribuição por Idade , Chlamydia trachomatis/isolamento & purificação , Doença Crônica , Sondas de DNA de HPV , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Teste de Papanicolaou , Papillomaviridae/metabolismo , Reação em Cadeia da Polimerase , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Esfregaço Vaginal , Adulto Jovem , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/patologiaRESUMO
A osteoporose é classificada em primária e secundária (quando é uma manifestação de um processo patológico claramente identificado). Dentre as formas secundárias encontra-se a osteoporose induzida pelo álcool. O álcool torna os pacientes mais suscetíveis a fraturas em decorrência de seus efeitos diretos e indiretos sobre o metabolismo ósseo, bem como em razão de outros efeitos adversos do álcool com alterações no equilíbrio e no sistema nervoso periférico, com maior tendência a quedas. Entretanto, estes efeitos maléficos do álcool não estão presentes quando a ingesta é pequena, casos em que pode haver mesmo um efeito protetor de osteopenia. Os efeitos deletérios do álcool sobre o metabolismo ósseo são, pelo menos em parte, reversíveis através da abstinência, consistindo este o único tratamento específico nesta doença. Neste artigo os autores fazem uma revisão sobre os efeitos diretos e indiretos do álcool no metabolismo ósseo, reversibilidade destes efeitos, influência do sexo, idade e raça dos pacientes, bem como efeitos benéficos do álcool na osteoporose