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Canuto R.,Federal University of Rio Grande do Sul | Garcez A.S.,University of the Rio dos Sinos Valley | Olinto M.T.A.,University of the Rio dos Sinos Valley | Olinto M.T.A.,Federal University of Health Sciences, Porto Alegre
Sleep Medicine Reviews | Year: 2013

The aim of this systematic review was to examine the association between shift work and metabolic syndrome (MetS) as well as the potential confounders investigated. A systematic search was conducted with the aim of finding original articles on the association between shift work and MetS. The included articles were chosen based on established inclusion criteria; their methodological quality was assessed using a validated quality checklist. A total of 10 articles were included in this review. The majority of the studies were classified as having a low risk of bias. The definitions of MetS and shift work varied between studies. Among the ten studies, eight found a positive association between shift work and MetS after controlling for socio-demographic and behavioral factors. Only three studies included sleep duration as a confounder, and these studies presented discordant results. We conclude that there was insufficient evidence regarding the association between shift work and prevalent MetS when the confounders are taken into account. © 2012 Elsevier Ltd.

Berton D.C.,Federal University of Health Sciences, Porto Alegre
Cochrane database of systematic reviews (Online) | Year: 2012

Ventilator-associated pneumonia (VAP) is a common infectious disease in intensive care units (ICUs). The best diagnostic approach to resolve this condition remains uncertain. To evaluate whether quantitative cultures of respiratory secretions are effective in reducing mortality in immunocompetent patients with VAP, compared with qualitative cultures. We also considered changes in antibiotic use, length of ICU stay and mechanical ventilation. We searched The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2011, which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to June Week 4, 2011), EMBASE (1974 to June 2011) and LILACS (1982 to June 2011). Randomised controlled trials (RCTs) comparing respiratory samples processed quantitatively or qualitatively, obtained by invasive or non-invasive methods from immunocompetent patients with VAP and which analysed the impact of these methods on antibiotic use and mortality rates. Two review authors independently reviewed and trials identified in the search results and assessed studies for suitability, methodology and quality. We analysed data using Review Manager software. We pooled the included studies to yield the risk ratio (RR) for mortality and antibiotic change with 95% confidence intervals (CI). Of the 4459 references identified from the electronic databases, five RCTs (1367 patients) met the inclusion criteria. Three studies compared invasive methods using quantitative cultures versus non-invasive methods using qualitative cultures, and were used to answer the main objective of this review. The other two studies compared invasive versus non-invasive methods, both using quantitative cultures. We combined all five studies to compare invasive versus non-invasive interventions for diagnosing VAP. The studies that compared quantitative and qualitative cultures (1240 patients) showed no statistically significant differences in mortality rates (RR 0.91; 95% CI 0.75 to 1.11). The analysis of all five RCTs showed there was no evidence of reduction in mortality in the invasive group versus the non-invasive group (RR 0.93; 95% CI 0.78 to 1.11). There were no significant differences between the interventions with respect to the number of days on mechanical ventilation, length of ICU stay or antibiotic change. There is no evidence that the use of quantitative cultures of respiratory secretions results in reduced mortality, reduced time in ICU and on mechanical ventilation, or higher rates of antibiotic change when compared to qualitative cultures in patients with VAP. Similar results were observed when invasive strategies were compared with non-invasive strategies.

Miura M.S.,Federal University of Health Sciences, Porto Alegre | Mascaro M.,New York University | Rosenfeld R.M.,New York University
Otolaryngology - Head and Neck Surgery | Year: 2012

Objective. To systematically review the association between otitis media and gastroesophageal/laryngopharyngeal reflux in children. Data Sources. Cochrane library, MEDLINE (1966-September 2011), EMBASE (1974-September 2011), proceedings of International Symposia on Recent Advances in Otitis Media, and reference lists of relevant selected articles. Review Methods. Studies with planned data collection, in children with chronic otitis media with effusion/recurrent acute otitis media, assessing gastroesophageal/ laryngopharyngeal reflux, pepsin/pepsinogen in middle ear, or antireflux therapy, were included. Results. Of 242 initial studies, 15 met inclusion criteria. The authors found a mean prevalence of gastroesophageal reflux disease in children with chronic otitis media with effusion of 48.4% (range, 17.6%-64%) and in children with recurrent acute otitis media of 62.9% (range, 61.5%-64.3%). A mean prevalence of laryngopharyngeal reflux of 48.6% (range, 27.3%-70.6%) was found in children with otitis media. Mean pepsin/pepsinogen presence in otitis media was 85.3% (range, 60%-100%) and of enzymatic activity was 34.2% (range, 14.5%-73%). Two randomized trials could not find benefit after antireflux treatment for 3 months, with an absolute rate difference (95% confidence interval) of 0.23 (0.023-0.42) and 0.13 (-0.086 to 0.34), respectively. Reporting of adverse events was limited, or absent, in most studies. Conclusion. The prevalence of gastroesophageal reflux disease in children with chronic otitis media with effusion/recurrent acute otitis media may be higher than the overall prevalence for children. Presence of pepsin/pepsinogen in the middle ear could be related to physiologic reflux. A cause-effect relationship between pepsin/pepsinogen in the middle ear and otitis media is unclear. Antireflux therapy for otitis media cannot be endorsed based on existing research. © American Academy of Otolaryngology - Head and Neck Surgery Foundation 2012.

Damin D.C.,Federal University of Rio Grande do Sul | Ziegelmann P.K.,Federal University of Rio Grande do Sul | Damin A.P.,Federal University of Health Sciences, Porto Alegre
Colorectal Disease | Year: 2013

Aim: Human papillomavirus (HPV) infection is associated with cervical cancer, but whether it is involved in colorectal carcinogenesis is controversial. We conducted a meta-analysis to evaluate the association between HPV and colorectal adenocarcinoma. Method: A search of the MEDLINE database was performed using the MESH terms 'HPV', 'human papillomavirus', and 'colon cancer', 'rectal cancer', 'colorectal cancer'. The prevalence of HPV infection in colorectal cancer was estimated by pooling data from 16 studies (involving 1436 patients) published up to July 2012, taking into consideration methodological heterogeneity between studies. The association of HPV with colorectal cancer risk was estimated from case-control studies. Results: The HPV overall prevalence was 31.9% (95% CI: 19.3-47.9). It was lowest in Europe (14.1%, 95% CI: 4.9-34.1) and highest in South America (60.8%, 95% CI: 42.7-76.4). Eight studies presented the results of HPV typing in 302 HPV-positive colorectal carcinomas. HPV 18 was the virus more frequently found in colorectal cancer cases from Asia (73.34%, 95% CI: 44.9-90.7) and Europe (47.3%, 95% CI: 34.5-60.4). In contrast, HPV 16 was more prevalent in colorectal tumours from South America (58.3%, 95% CI: 45.5-69.9). The analysis of five case-control studies showed an increase in colorectal carcinoma risk with HPV positivity (OR = 10.04; 95% CI: 3.7-27.5). Conclusion: The results provide quantitative evidence for an association between HPV infection and colorectal cancer risk. © 2013 The Association of Coloproctology of Great Britain and Ireland.

Alves de Mattos A.,Federal University of Health Sciences, Porto Alegre
Annals of hepatology : official journal of the Mexican Association of Hepatology | Year: 2010

The treatment of patients with cirrhosis has the following purposes: to prevent the complications of the disease; to allow for the regression of cirrhosis; and to prevent reinfection in the graft in patients undergoing liver transplantation. When the sustained viral response is evaluated in patients with cirrhosis, especially in those with decompensated disease, it is noted to be lower than that of patients with chronic hepatitis, and with a higher possibility of complications of the treatment. Based on a review of the literature, we conclude that we should treat patients with compensated cirrhosis, probably also those with portal hypertension, and patients with decompensated cirrhosis only when included on the transplant list, as long as Child B with HCV genotype 2 (possibly 3) and preferably after clinical compensation.

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