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Scientific literature on the health effects of air pollution is diverse, and broadly acknowledges the importance of human experience and social and economic precarity as modifying factors. Still, the inclusion of the embodied experience of air pollution has been limited. Also, the health effects of pollution are often studied at the group or population level, without adequately considering individual difference. This paper uses a Bio3Science framework, which integrates biology, biography, and biosphere, to explore how air pollution affects residents in Medellín, Colombia. By using qualitative research on individual experiences of air pollution (biography) to probe the intersection of individual health (biology) and environment (biosphere), we illustrate how pollution shapes lived rhythms at multiple scales. Our findings emphasize that air pollution's health impacts extend beyond measurable pollutants to include the complex synergies of smoke, noise, stress, and disruptions to daily life. This comprehensive approach provides a nuanced understanding of how air pollution materially shapes the lives of individuals and communities, advocating for research models that capture the subtle, everyday experiences often overlooked by traditional group or population-level analyses.

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Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. Patients commonly experience neuropathic pain, leading them to seek medical advice. However, other symptoms experienced in patients with CTS, such as paresthesia, dysesthesia and allodynia, classed as positive sensory symptoms (PSS), are often under-reported. In the present study, patients with surgically-managed CTS were observed pre- and post-surgery to evaluate PSS, using the symptoms scale component of the Boston Carpal Tunnel Questionnaire (BCTQ) and the Sensory Frequency of Symptoms Scale. In total, 19 patients were included in the present study, with 79% female patients, and a mean age of 54±10.59 years. In addition, the mean follow-up was 63±29.91 months. The results of the present study revealed a pre-surgery BCTQ score of 3.52±0.63 and a post-surgery BCTQ score of 1.58±0.61. Notably, improvements in pain were observed, at 7.7±2.26 pre-surgery compared with 1.65±2.88 post-surgery. Compared with pre-surgery, post-surgery paresthesia scores were reduced from 2.94±0.82 to 0.47±0.45, dysesthesia scores were reduced from 2.52±0.84 to 0.47±0.39 and allodynia scores were reduced from 0.63±0.75 to 0.26±0.47. In conclusion, the results of the present study demonstrated that median nerve decompression ameliorated CTS symptoms, such as paresthesia and dysesthesia. However, further investigations are required to verify the benefits of surgery in relieving allodynia.

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Background: This report aims to describe the neuromodulation effect on seizure control in a patient with a left hippocampal migrated electrode to the Posterior Sylvian Junction (PSJ) during a follow-up of 17 years. Case Description: We report a case of a female patient with drug-resistant epilepsy who initiated at seven years old and underwent a stereotactic frame-based insertion of a left hippocampal electrode for deep brain stimulation (DBS). Posterior migration of the electrode was identified at PSJ by postoperative magnetic resonance imaging one month after surgery. A consistent seizure reduction (Engel IC) was obtained with 2v-120 uS-145 Hz, contacts 0-3 negative, casing positive DBS parameters and maintained to this day. Patient data were collected from electronic medical records preceded by obtaining an informed consent for research and publication purposes. Stimulation parameter adjustments were confirmed with the digital records of the local device provider (Medtronic). Results: PSJ is a connectivity confluence point of white matter pathways in the posterior quadrant of the hemispheres. White mater DBS could be considered for research as a potential complementary target for neuromodulation of refractory epilepsy.

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BACKGROUND: Rehabilitation following anterior cruciate ligament (ACL) reconstruction surgery is essential to regain functionality and return to previous activity level. Electromyographic biofeedback may be an effective intervention for rehabilitation of patients following ACL surgery. OBJECTIVE: To synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, EMBASE, CENTRAL and Epistemonikos were searched. ELIGIBILITY CRITERIA: Randomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group. DATA EXTRACTION AND DATA SYNTHESIS: Two authors selected articles and performed data extraction. The analysed outcomes were strength, function, pain, knee extension and balance. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. Results were combined through random-effects meta-analysis, reporting mean differences. RESULTS: Eight articles were included in the qualitative analysis, and four articles were included in the quantitative analysis. The interventions lasted between 4 and 12 weeks. Three studies evaluated the effect of biofeedback on quadriceps strength; of these, two studies showed a significant difference in favour of the biofeedback group. In addition, biofeedback was found to improve knee extension [standardized mean difference - 1.3, 95% confidence interval (CI) - 1.74 to -0.86] and balance (one study). There was no significant difference in Lysholm score (mean difference -6.21, 95% CI -17.51 to 5.08; I2 =59%) or pain between the biofeedback group and the control group. CONCLUSION: Electromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery. KEY MESSAGES: SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42020193768).

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Polyamines (Pas) are short molecules that exhibit two or three amine groups that are positively charged at a physiological pH. These small molecules are present in high concentrations in a wide variety of organisms and tissues, suggesting that they play an important role in cellular physiology. Polyamines include spermine, spermidine, and putrescine, which play important roles in age-related diseases that have not been completely elucidated. Aging is a natural process, defined as the time-related deterioration of the physiological functions; it is considered a risk factor for degenerative diseases such as cardiovascular, neurodegenerative, and musculoskeletal diseases; arthritis; and even cancer. In this review, we provide a new perspective on the participation of Pas in the cellular and molecular processes related to age-related diseases, focusing our attention on important degenerative diseases such as Alzheimerߣs disease, Parkinsonߣs disease, osteoarthritis, sarcopenia, and osteoporosis. This new perspective leads us to propose that Pas function as novel biomarkers for age-related diseases, with the main purpose of achieving new molecular alternatives for healthier aging.

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Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.

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The increasing production of primary research and literature reviews in the last decades has made it necessary to develop a new methodological design to synthesize the evidence: the overviews. An overview is a type of evidence synthesis that uses systematic reviews as the unit of analysis, with the aim of extracting and analyzing the results for a new or broader research question, helping the shared decision-making processes. The aim of this article is to introduce the reader to this type of evidence summaries, highlighting the differences between overviews and other types of synthesis, the unique methodological aspects of overviews, and future challenges. This is the twelfth article from a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology.

El aumento de la producción de investigación primaria y de las revisiones de la literatura durante las últimas décadas ha hecho necesario el desarrollo de un nuevo diseño metodológico para sintetizar la evidencia: los overviews. Un overview es un diseño de síntesis de evidencia que toma como unidad de análisis a las revisiones sistemáticas, con el objetivo de extraer y analizar los resultados para una pregunta de interés nueva o más amplia, ayudando así a mejorar los procesos de toma de decisiones informadas. El objetivo de este artículo es introducir al lector a este tipo de resúmenes de evidencia, destacando las diferencias con los otros tipos de síntesis de evidencia, los aspectos metodológicos particulares de los overviews, y los desafíos pendientes. Este artículo es el duodécimo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica.

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El aumento de la producción de investigación primaria y de las revisiones de la literatura durante las últimas décadas ha hecho necesario el desarrollo de un nuevo diseño metodológico para sintetizar la evidencia: los overviews. Un overview es un diseño de síntesis de evidencia que toma como unidad de análisis a las revisiones sistemáticas, con el objetivo de extraer y analizar los resultados para una pregunta de interés nueva o más amplia, ayudando así a mejorar los procesos de toma de decisiones informadas. El objetivo de este artículo es introducir al lector a este tipo de resúmenes de evidencia, destacando las diferencias con los otros tipos de síntesis de evidencia, los aspectos metodológicos particulares de los overviews, y los desafíos pendientes. Este artículo es el duodécimo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica.

The increasing production of primary research and literature reviews in the last decades has made it necessary to develop a new methodological design to synthesize the evidence: the overviews. An overview is a type of evidence synthesis that uses systematic reviews as the unit of analysis, with the aim of extracting and analyzing the results for a new or broader research question, helping the shared decision-making processes. The aim of this article is to introduce the reader to this type of evidence summaries, highlighting the differences between overviews and other types of synthesis, the unique methodological aspects of overviews, and future challenges. This is the twelfth article from a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology.

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La enfermedad de Behçet (EB) es un trastorno inflamatorio, multisistémico, recidivante y remitente de etiología desconocida. Una característica clave de la enfermedad es la ulceración orogenital que provoca una morbilidad considerable con gran impacto en la calidad de vida de los pacientes. Su manejo médico consiste en un esquema con colchicina, esteroides o inmunomoduladores. Comunicamos el caso de una paciente con lesiones genitales quien consultó en múltiples ocasiones, recibiendo manejo antibiótico e incluso quirúrgico, con respuesta refractaria a estas intervenciones. Posteriormente, por las características de las lesiones y el comportamiento clínico se sospechó enfermedad de Behçet y se instauró manejo médico con esteroides orales y curaciones con fitoestimulina. Hubo resolución de las úlceras genitales y posteriormente la paciente fue llevada a cirugía para corrección de las sinequias vulvares.

Behçet's disease (BD) is an inflammatory, multisystemic, relapsing-remitting disorder of unknown etiology. A key feature of the disease is orogenital ulceration that causes considerable morbidity with great impact on patient's quality of life. Its medical management consists of a scheme with colchicine, steroids or immunomodulators. We report the case of a patient with genital lesions who consulted on multiple occasions, receiving antibiotics and even surgical management, with refractory response to these interventions. Subsequently, due to the characteristics of the lesion and clinical behavior, Behçet's disease was suspected and medical management with oral steroids and cures with phytostimulin was initiated. The genital ulcers were resolved, and the patient was subsequently taken to surgery for correction of the vulvar synechiae.

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BACKGROUND: There are no articles that aim to evaluate the specific role of surgical decompression on the recovery of pain and positive sensory symptoms (PSS) in patients with brachial plexus neuropathy (BPN), as well as the relationship between pain and frequency of sensory manifestations. METHODS: A prospective before and after study was performed, considering the pain intensity through the visual analogue scale (VAS), and the frequency of PSS through a proposed new scale: Sensory Frequency of Symptoms Scale (SFSS). To compare the patients before and after the intervention, a paired T-test, a Wilcoxon signed-rank test, and Cohen's D test were made, coupled with a Spearman analysis in order to establish the relationship between pain and PSS. RESULTS: Sixteen patients were included in the study, the clinical evaluation showed changes in pain according with VAS, going from a mean preoperative state of 8.19 to 1.31 after surgery, showing significant changes (84%, p < 0.00006, Δ = 2.776). Within the PSS, a significant decrease was observed in paresthesias (74%, p < 0.0001, Δ = 1.645), dysesthesias (80%, p < 0.002, Δ = 1.453), and allodynia (70%, p = 0.031, Δ = 0.635). Conversely, the preoperative correlation analysis between pain and dysesthesias/allodynia showed a low and non-significant relationship (R < 0.4, p > 0.05). CONCLUSIONS: Surgical decompression is an effective technique for the relief of pain and sensory manifestations in adult patients with BPN of compressive origin. No relationship was observed between pain and dysesthesias/allodynia. Therefore, during clinical evaluation, they should be considered as independent manifestations, highlighting the need to validate new scales.

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El COVID-19 es una nueva enfermedad que requería resultados prontos provenientes de la investigación. Un abordaje para la comprensión de su fisiopatología es conocer el daño a nivel histopatológico que genera en los pulmones de los afectados. Objetivo. Proveer un resumen riguroso de la evidencia disponible sobre los hallazgos histopatológicos pulmonares en pacientes con COVID-19. Se desarrolló una revisión sistemática con metaanálisis de proporciones. Se incluyeron estudios primarios de cualquier diseño que tuvieran datos primarios de hallazgos histopatológicos de pulmones en pacientes COVID-19. Se excluyeron revisiones y guías. Las fuentes de información fueron el repositorio centralizado Living OVerview of Evidence, PubMed/Medline, LitCovid, la base de datos COVID-19 de la Organización Mundial de la Salud, y medRxiv hasta el 3 de abril 2021. La evaluación del riesgo de sesgos se realizó utilizando las herramientas del Instituto Joanna Briggs para series de casos y reportes de casos. Se extrajo cada dato de hallazgo pulmonar histopatológico. Se calcularon las frecuencias encontradas y los datos de los hallazgos más frecuentes fueron resumidas en metaanálisis usando el método de efectos aleatorios de Der Simmonian-Liard. Se midió la heterogeneidad. Los criterios de inclusión fueron cumplidos por 69 artículos sumando 594 sujetos. Presentaron bajo riesgo de sesgos 35 artículos. El metaanálisis de proporciones mostro daño alveolar difuso en 0,62 (IC 95 % 0,51-0,72), I2 59 % (p < 0,01), en su fase temprana (85,14 %). Conclusión. El daño alveolar difuso temprano fue el hallazgo histopatológico más frecuente en muestras pulmonares de pacientes con COVID-19

COVID-19 is a new disease that required prompt results from research. An approach to understanding its pathophysiology is to know the damage at the histopathological level that it generates in the lungs of those affected. Aim. To provide a rigorous summary of the available evidence on pulmonary histopathological findings in patients with COVID-19. A systematic review with meta-analysis of proportions was developed. Primary studies of any design that had primary data on lung histopathology findings in COVID-19 patients were included. Reviews and guidelines were excluded. The sources of information were the Living OVerview of Evidence centralized repository, PubMed/Medline, LitCovid, the World Health Organization COVID-19 database, and medRxiv up to April 3, 2021. The risk of bias assessment was performed using the Joanna Briggs Institute tools for case series and case reports. Each histopathological pulmonary finding data was extracted. The frequencies found were calculated and the data of the most frequent findings were summarized in meta-analyses using the Der Simmonian-Liard random effects method. Heterogeneity was measured. The inclusion criteria were met by 69 articles totaling 594 subjects. Thirty-five articles presented low risk of bias. The meta-analysis of proportions showed diffuse alveolar damage in 0.62 (95% CI 0.51-0.72), I2 59% (p < 0.01), in its early phase (85.14%). Conclution. Early diffuse alveolar damage was the most frequent histopathological finding in lung samples from patients with COVID-19

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Resumen En investigaciones recientes se ha constatado que la empatía y la conectividad con el medioambiente natural son variables predictoras de la conducta proambiental. Sin embargo, no se han realizado trabajos en los que se analicen las relaciones entre estas dimensiones y el ajuste en la escuela, un escenario en el que tienen lugar gran parte de los programas relacionados con la educación ambiental y cuya finalidad es la de promover conductas proambientales. Con el presente trabajo se pretende analizar las relaciones entre el ajuste escolar, la empatía y la conectividad con el medioambiente natural en función del género. La muestra estuvo constituida por 881 estudiantes (47.2 % chicos), escolarizados en centros de educación secundaria (España), con edades comprendidas entre los 12 y los 17 años (M = 13.67 y SD = 1.32). Se administró una batería de instrumentos para medir el ajuste escolar, la empatía y la conectividad con el medioambiente natural. Se realizó un MANOVA para el análisis de los datos. Los resultados obtenidos mostraron que el ajuste escolar, la empatía y la conectividad se relacionan significativamente y que el género desempeña un rol significativo en estas relaciones. También se observó que chicos y chicas con alto ajuste escolar diferían en empatía emocional, pero no en conectividad. Se discuten los resultados obtenidos y se recomienda la incorporación del ajuste escolar en los estudios y programas relacionados con la educación ambiental.

Abstract In recent research it has been observed that empathy and connectedness with the natural environment are relevant predictive variables of pro-environmental behaviour. However, no work has been done in which the relationships between these dimensions and the adjustment in the school are analysed, a context in which most of the programs related to environmental education, whose purpose is to promote pro-environmental behaviours, take place. The general aim of this paper is to analyse the relationships between school adjustment, empathy and connectedness with the natural environment according to gender. School adjustment is defined as the adolescent's ability to adapt to this context and includes aspects such as academic performance, adaptation to school rules, respect for the teacher as an authority figure, the student's attitude towards school and participation in school activities. Empathy is conceptualized as the awareness of the emotions and cognitions of others, and it is important in the school context for the promotion of coexistence and prevention of aggressive behaviors. Like empathy with people, empathy with the natural environment is a social-emotional process. It is a process that focuses on the ability to feel and understand everything related to that medium. In this line, an essential aspect of empathy is its influence on the attitudes and behaviors of people in general and towards the natural environment. An aspect related to empathy is connectedness which refers to the identification of human beings with the natural environment and the relationships they establish with it. In such a way that to study the connection with nature is to try to understand how people build their relationships and identify themselves with it. Connectedness to the natural environment is related in a negative sense to selfish beliefs and attitudes and in a positive sense to the development of attitudes towards the natural environment and ecological behavior in general. These aspects are taken into account in this work. The sample was composed of 881 students (47.2 % boys), enrolled in secondary education (Spain), aged between 12 and 17 (M = 13.67 y SD = 1.32). A battery of instruments to measure school adjustment, empathy and connectedness with the natural environment was administered. A MANOVA was used for data analysis. The results showed that the school adjustment, empathy and connectedness were significantly related and that gender had a significant role in these relationships. It was also observed that boys and girls with high school adjustment differed in emotional empathy, but not in connectedness. Results obtained are discussed and the inclusion of the school adjustment in the studies and programs related to environmental education is recommended. These results raise the idea that school adjustment, connectedness and empathy should be the subject of further analysis because their results would help to incorporate new ideas and proposals into education and intervention programs regarding the natural environment. It was expected that environmental connectedness in adolescents had the same sign as their connectedness with school, family, etc. because many studies have observed that girls have greater connectedness in these scenarios than boys; however, this result deserves a greater exploration regarding gender and its relationships with other connectedness It is recommended that the results presented be considered in future environmental education programs, mainly aimed at students and their families. All this will benefit these educational programs and interventions aimed at enhancing respect and awareness of the natural environment. In short, the promotion of pro-environmental behaviors should be defended through environmental education that seeks to ensure the health and well-being of all citizens.

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Temperament is defined as individual behavioral responses to potentially fear-eliciting or challenging situations related to human presence and handling. A total of 190 steers of commercial Zebu Brahman (Bos indicus) were used in this study, selected when they were between 10 and 11 months of age, fattened for 24 months (720 days) and slaughtered between 34 and 35 months of age. Using a temperament index (based on two tests: chute and exit score), animals were classified as calm, restless, or nervous. In general, calm animals had a longer carcass, a higher slaughter and fasting weight, and a normal pH24 (<5.7). However, carcass yield was significantly higher in nervous than in restless animals, but did not differ from that of calm steers. It is important to note that these results were obtained under experimental conditions, therefore, effects could have a greater impact on carcass quality under commercial conditions.

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Introducción: Aunque existen numerosas evidencias científica sobre la pandemia, el impacto de la COVID-19 en los servicios de salud desde la perspectiva del personal asistencial ha sido poco explorado. Objetivo: Explorar las experiencias en los servicios de salud de epidemiólogos en formación durante la pandemia COVID-19. Métodos: Estudio exploratorio, cualitativo-descriptivo, con herramientas de investigación etnográfica para la toma de datos como la observación, diario de campo y entrevista grupal; así como teoría fundamentada para la construcción de categorías que permitieron comprender el fenómeno de estudio. Para la conformación del grupo focal, participaron siete epidemiólogos en formación de una universidad colombiana, previo consentimiento informado. Se realizó la introducción de la temática, con la posterior aplicación de los instrumentos guía de grupo focal, carteles de consenso, hojas de respuesta y guía de observación. Resultados: Se generó colapso hospitalario y reestructuración emergente de servicios de salud, promoviendo otras estrategias de atención como la telemedicina. Los participantes del estudio experimentaron temor atendiendo pacientes en jornadas estresantes, con desabastecimiento de insumos y medicamentos; fueron estigmatizados, lo que les generó ansiedad y estrés laboral. Sin embargo, aprendieron a clasificar mejor los casos y con el aumento de los pacientes pudieron percibir inequidades que representaron un desafío profesional y humano. Conclusiones: La pandemia de COVID-19 ha sido válida como proceso de aprendizaje con nuevas perspectivas de formación para poder actuar ante eventos sanitarios de interés mundial, con la necesaria aplicación y manejo de protocolos, lo cual puede cambiar el enfoque de la atención en salud y permitir que la epidemiología avance hacia la educación, promoción y prevención(AU)

Introduction: Although there is ample scientific evidence on the pandemic, the impact of COVID-19 on health services from the perspective of healthcare personnel has been little explored. Objective: To explore the experiences in health services of epidemiologists in training during the COVID-19 pandemic. Methods: Exploratory, qualitative-descriptive study, with ethnographic research tools for data collection such as observation, field diary and group interview; as well as grounded theory for the construction of categories that allowed to understand the studied phenomenon. For the formation of the focus group, seven epidemiologists in training from a Colombian university participated, with prior informed consent. The topic was introduced, with the subsequent application of the focus group guide tools, consensus posters, response sheets and an observation guide. Results: Hospital collapse and emerging restructuring of health services were generated, promoting other care strategies such as telemedicine. Study participants experienced fear attending patients on stressful days, with shortages of supplies and medicines; they were stigmatized, which generated anxiety and work stress. However, they learned to better classify cases and with the increase in patients they were able to perceive inequities that represented a professional and human challenge. Conclusions: The COVID-19 pandemic has been valid as a learning process with new training perspectives to be able to act in the face of health events of global interest, with the necessary application and management of protocols, which can change the focus of health care and allow epidemiology to move towards education, promotion and prevention(AU)

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RESUMEN La preeclampsia es una patología con múltiples implicaciones y causa de morbimortalidad materno perinatal. Aunque su frecuencia es baja, la ascitis es un signo clínico a tener en cuenta. Reportamos el caso de un embarazo de 33,1 semanas con preeclampsia severa, en quien durante la cesárea se observó ascitis que evolucionó a ascitis masiva al segundo día postoperatorio, y requirió manejo invasivo (drenaje por pig tail) y traslado a UCI por 6 días. Necesitó nitroprusiato durante 2 días por persistencia de la crisis hipertensiva, con mejoría progresiva y egreso de la clínica a los 12 días.

ABSTRACT Preeclampsia is a pathology with multiple implications and a cause of maternal and perinatal morbidity and mortality. Although its frequency is low, ascites is a clinical sign to be taken into account. We report the case of a 33.1-week pregnant woman with severe preeclampsia, in whom ascites was observed during cesarean section and evolved to massive ascites on the second postoperative day, requiring invasive management (pig tail drainage) and transfer to the ICU for 6 days. She needed nitroprusside for 2 days due to persistent hypertensive crisis, with progressive improvement and discharge from the clinic after 12 days.

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Resumen La Tuberculosis (TB) es una de las diez causas principales de muerte en el mundo, y la principal causa por un solo agente infeccioso. La detección precoz del Complejo Mycobacterium tuberculosis (CMT) y de mutaciones que confieren resistencia a los principales fármacos empleados en la terapia antituberculosa, contribuye a la disminución de la transmisión de la infección y consecuentemente a la expansión de la TB resistente. La prueba GeneXpertMTB/RIF, mediante ensayos de PCR en tiempo real identifica de manera simultánea el CMT y detecta las mutaciones más frecuentemente asociadas con resistencia a rifampicina. El objetivo de este estudio es comparar el rendimiento del método GeneXpertMTB/RIF en lavado broncoalveolar (BAL) frente al lavado bronquial (LB) en pacientes inmunocompetentes con sospecha clínica de TB pulmonar, sin documentación microbiológica previa. Materiales y Métodos: Se incorporaron prospectivamente pacientes con infiltrados radiológicos pulmonares compatibles con TB activa o residual sin tratamiento previo, con baciloscopia directa negativa o tos improductiva, para valoración de enfermedad activa. Se identificó el segmento más afectado mediante tomografía axial computada realizándose broncoscopia con BAL en dicho segmento, seguido de LB en todo el lóbulo afectado. Se consideró significativa una recuperación del BAL >40%. Las muestras obtenidas fueron procesadas para baciloscopia, cultivo y GeneXpertMTB/RIF. Se analizó la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) tomando como referencia el cultivo en medio sólido para el diagnóstico del CMT. Resultados: Se incorporaron 20 pacientes, se excluyeron 3 por no obtener una muestra representativa de BAL. Se estudiaron 17 pacientes (11 mujeres, 65%), edad 37.2 ± 16.3 años. Se identificó al CMT con métodos convencionales en 10 pacientes: 10 con cultivo positivo en LB y 9 en BAL. Comparando con métodos convencionales, 6 de 17 muestras obtenidas mediante BAL fueron positivas con GeneXpertMTB/RIF: S = 60.0% (IC 31%-83%), E = 100% (IC 65%-100%), VPP = 100% (IC 61%-100%) y VPN = 64% (IC 35.4%-84.8%). Con LB, 9 de 17 fueron Xpert MTB/RIF positivas: S = 90.0% (IC 60%-98%), E = 100% (IC 65%-100%), VPP = 100% (IC 70%-100%) y VPN = 88% (IC 53%-98%). Todos los casos identificados con GeneXpertMTB/RIF fueron verdaderos positivos en relación con los cultivos convencionales. Conclusión: Considerando al cultivo sólido como método de referencia, el LB resultó más sensible que el BAL para el diagnóstico de infección tuberculosa por el método de GeneXpertMTB/RIF en los pacientes con sospecha de TB sin documentación microbiológica previa.

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Abstract Tuberculosis (TB) is one of the ten leading causes of death worldwide, and the main cause from a single infectious agent. Early detection of the Mycobacterium tuberculosis complex (MTC) and of mutations conferring resistance to the main drugs used in antituberculous treatment contributes to reducing the transmission of the infection, and consequently the spread of resistant TB. The GeneXpert MTB/ RIF test identifies the MTC and simultaneously detects mutations most frequently associated with rifampicin resistance, through real-time PCR testing. The purpose of this study was to compare the performance of the GeneXpert MTB/RIF method in bronchoalveolar lavage (BAL) with bronchial lavage (LB) in immunocompetent patients with clinical suspicion of pulmonary TB without any previous microbiological documentation. Materials and Methods: We prospectively enrolled patients with radiologic pulmonary infiltrates compatible with active or residual TB without previous treatment, with negative direct bacilloscopy or nonproductive cough, for the assessment of active disease. We identified the most affected segment through computed axial tomography and bronchoscopy with BAL in said segment, followed by BL of the affected lobe. A BAL recovery > 40% was considered significant. The samples obtained were processed for bacilloscopy, culture and GeneXpert MTB/RIF. We analyzed sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV), taking the solid culture medium as reference for the diagnosis of MTC. Results: We included 20 patients; 3 were excluded because they didn't have a representative BAL sample. 17 patients were evaluated (11 women, 65%), age 37.2 ± 16.3. The MTC was identified through conventional methods in 10 patients: 10 with positive culture in BL and 9 in BAL. In comparison with the conventional methods, 6 out of 17 samples obtained through BAL had a positive result for GeneXpert MTB/ RIF: S = 60.0% (CI 31%-83%), SP = 100% (CI 65%-100%), PPV = 100% (CI 61%-100%) and NPV = 64% (CI 35.4%-84.8%). With BL, 9 out of 17 had a positive result for Xpert MTB/RIF: S = 90.0% (CI 60%-98%), SP = 100% (CI 65%-100%), PPV = 100% (CI 70%-100%) and NPV = 88% (CI 53%-98%). All the cases identified with GeneXpert MTB/RIF were true positives in relation to conventional cultures. Conclusion: Considering the solid culture as reference method, the BL was more sensitive than the BAL for the diagnosis of tubercu lous infection through the GeneXpert MTB/RIF method in patients with suspected TB without previous microbiological documentation.

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This article belongs to a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology. The goal is to present basics concepts concerning the systematics reviews of multiple treatments comparisons with network meta-analysis. For clinical ques-tions with several therapeutic alternatives to be compared, the central question is how to classify or rank their effectiveness (benefit and harm) to choose the best option. The network meta-analysis aims to answer questions related to the effectiveness and safety of comparing multiple treatments by the simultaneous analysis of results raised from direct and indirect comparisons. The network geometry is the general graphical representation of the network meta-analysis and allows to understand and assess the strength of comparisons. The network meta-analysis should check several assumptions to be valid, especially the transitivity assumption, which allows assuming that there are no systematic differences among the included comparisons, except their compared interventions. Thus, it is possible to know the relative therapeutic effectiveness of each pair of interventions included in the network meta-analysis and their ranking in terms of categorization. It has been proposed to use a modified Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach considering the distinctive features of network meta-analysis to assess the certainty of the evidence for each comparison and the ranking of interventions.

Este artículo forma parte de una serie metodológica colaborativa de revisiones narrativas sobre bioestadística y epidemiología clínica. El objetivo de este trabajo es presentar conceptos básicos respecto de las revisiones sistemáticas de intervenciones múltiples con metanálisis en red. Para las preguntas clínicas en las que hay muchas alternativas terapéuticas que compiten (o se comparan) entre sí. La pregunta central es cómo clasificar u ordenar jerárquicamente su efecto (beneficio y/o daño) para escoger la mejor opción. Los metanálisis en red buscan responder a preguntas relacionadas con la efectividad o seguridad de múltiples tratamientos comparados entre sí, mediante el análisis simultáneo de resultados surgidos tanto de comparaciones directas como de comparaciones indirectas. La geometría de la red (network geometry) es la representación gráfica general de los metanálisis en red y permite comprender e incluso evaluar la fuerza de las comparaciones. Para que un metanálisis de comparaciones múltiples sea válido debe cumplir una serie de supuestos, destacándose el supuesto de transitividad que permite asumir que no hay diferencias sistemáticas entre las comparaciones disponibles, a excepción de las intervenciones comparadas. Así, es posible conocer la efectividad terapéutica relativa entre cualquier par de intervenciones del metanálisis en red y el orden de las intervenciones en términos de su categorización. Se ha propuesto utilizar el modelo Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) modificado en cuanto a las particularidades de los metanálisis en red para valorar la certeza de la evidencia, tanto para cada comparación como para la jerarquización de intervenciones.

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OBJECTIVE: This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. DESIGN: This is the protocol of a living systematic review. DATA SOURCES: We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. ETHICS AND DISSEMINATION: No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

OBJETIVO: Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de la rehabilitación pulmonar en el tratamiento de los pacientes con COVID-19. DISEÑO: Es el protocolo de una revisión sistemática viva. FUENTE DE DATOS: Realizaremos búsquedas en la plataforma L·OVE (Living OVerview of Evidence) para COVID-19, un sistema que mapea los componentes de las preguntas de investigación (PICO) en un repositorio mantenido a través de búsquedas regulares en bases de datos electrónicas, servidores de pre-impresión, registros de ensayos y otros recursos relevantes para COVID-19. No se aplicarán restricciones de fecha ni de idioma. CRITERIOS DE ELEGIBILIDAD PARA LA SELECCIÓN DE ESTUDIOS Y MÉTODOS: Se adaptó un protocolo común ya publicado para revisiones sistemáticas paralelas múltiples a las especificidades de la pregunta. Se incluirán ensayos aleatorios que evalúen el efecto de la rehabilitación pulmonar como monoterapia o en combinación con otras intervenciones frente a un tratamiento simulado o ningún tratamiento en pacientes con COVID-19. Dos revisores examinarán de forma independiente cada estudio para determinar su elegibilidad, extraerán los datos y evaluarán el riesgo de sesgo. Se agruparán los resultados mediante un metaanálisis y se aplicará el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la certeza de las pruebas para cada resultado. ÉTICA Y DIFUSIÓN: No se considera necesaria la aprobación ética. Los resultados de esta revisión se difundirán ampliamente a través de publicaciones revisadas por pares, redes sociales y medios de comunicación tradicionales.

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Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

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