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RESUMEN Introducción: La revisión sistemática es la evaluación comprehensiva, reproducible, crítica y explícita de la mejor evidencia disponible en respuesta a una pregunta de investigación específica. Para conseguir ello las revisiones sistemáticas deben cubrir como mínimo los siguientes siete pasos: i) una pregunta de investigación específica y estructurada usando la técnica PICO; ii) criterios de elegibilidad de las evidencias; iii) una estrategia de búsqueda clara y reproducible; iv) selección de las evidencias y extracción de datos; v) análisis de sesgos; vi) síntesis de resultados; y, vii) publicación. Si los datos son suficientes y homogéneos es factible incluir en las síntesis de resultados el metanálisis de los mismos. De esta manera las revisiones sistemáticas y metanálisis pueden generar conocimiento nuevo y fundamental para la toma de decisiones en el área clínica y en otras áreas

ABSTRACT Introduction: The systematic review is the comprehensive, reproducible, critical, and detailed evaluation of the best available evidence in response to a specific research question. To achieve this, systematic reviews should cover at least the following seven steps: i) a detailed and structured research question using the PICO technique; ii) evidence eligibility criteria; iii) a precise and reproducible search strategy; iv) selection of evidence and data extraction; v) analysis of biases; vi) synthesis of results; and vii) publication. If the data are sufficient and homogeneous, it is feasible to include their meta-analysis to synthesize results. In this way, systematic reviews and meta-analyzes can generate new and fundamental knowledge for decision-making in the clinical and other areas.

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BACKGROUND: The prognostic role of intratumoral programmed cell death ligand 1 (PD-L1) expression in hepatocellular carcinoma (HCC) has been investigated by several meta-analyses. However, the prognostic value of pretreatment peripheral PD-L1 (PPPD-L1) level in HCC remains undetermined. Thus, this systemic review aimed to establish PPPD-L1 as a new prognostic marker in HCC according to available evidence. METHODS: Case-control studies investigating the prognostic role of PPPD-L1 in HCC were systemically sought in the database of PubMed and Web of Science until March 25th, 2020. Our main concern is survival results, including overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS). The combined results were summarized in narrative form according to data extracted from each included study. RESULTS: Finally, nine studies published from 2011 to 2019, were incorporated into this systemic review. Among these, six studies evaluated the PD-L1 expression by enzyme-linked immunosorbent assay (ELISA) from blood serum, and three studies evaluated the PD-L1 expression by flow cytometric analysis from peripheral blood mononuclear cells (PBMC). According to the extracted evidence, high PPPD-L1 expression, measured in either blood serum or PBMC, is associated with poor OS, poor DFS, and poor PFS. Meanwhile, PPPD-L1 was also correlated with enlarged tumor size and more likely with advanced tumor stage as well as vascular invasion. CONCLUSION: High PPPD-L1 level is associated with increased mortality rate and increased recurrence rate in HCC. As a convenient serum marker, PPPD-L1 could be a promising marker of prognosis in HCC patients.

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Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.

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AIMS: To systematically review the management of lower urinary tract symptoms (LUTS) in patients with dementia and associated disorders. METHODS: This systematic review was performed according to the PRISMA statement. Studies were identified by electronic search of Embase and Medline databases (last search August 2015) and by screening of reference lists and reviews. RESULTS: Of 1,426 abstracts that were screened, 102 full-text articles were identified and assessed for eligibility. Seventy-six articles were then included in the quantitative synthesis. Urinary incontinence (UI) prevalence rates in dementia patients have varied considerably, ranging from 11 to 93%. In Alzheimer's disease patients, UI usually correlates with disease progression (late-stage dementia). In contrast, LUTS usually precede severe mental failure in Lewy body disease and in vascular dementia. Behavioral therapy, including toilet training and prompted voiding, may be especially useful in patients with unawareness UI. High-quality data to guide the choice of treatment strategies in this population are lacking. Current evidence suggests that antimuscarinics, especially oxybutynin, can be associated with cognitive worsening, due to the blockade of M1 receptors. Thus, the use of antimuscarinics that do not easily cross the blood-brain barrier or are more M2/M3 selective should be considered. No data are available for beta-3 agonists so far. CONCLUSION: Different types of dementia cause different LUTS at varying time points during the disease process and need singular therapeutic approaches. Treatment of LUTS should be tailored to individual patient needs and disease status, considering factors like mobility, cognitive function, and general medical condition. Neurourol. Urodynam. 36:245-252, 2017. © 2015 Wiley Periodicals, Inc.

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ANTECEDENTES: La identificación de factores que pudieran afectar la reserva ovárica permitiría predecir el resultado a la hiperestimulación ovárica en las técnicas de reproducción asistida, y en forma independiente a la edad, el éxito de estos procedimientos. Se ha propuesto que la presencia de menarquia precoz, definido como su aparición antes de los 12 años, sería uno de los factores predictivos de baja reserva ovárica. OBJETIVO: Determinar si existe asociación entre menarquia precoz y disminución de la reserva ovárica futura. MÉTODO: Se realizó una revisión sistemática de la literatura en las bases de datos MEDLINE y EMBASE entre los años 2000 y 2013 con los conceptos "premature menarchae" y "ovarian reserve". Sólo 3 artículos cumplieron los criterios de selección, con un total de 2.470 pacientes. RESULTADO: El meta-análisis mostró una asociación significativa entre menarquia temprana y disminución de la reserva ovárica en la vida adulta (OR 1,89; IC95% 1,52-2,35; p=0,001). CONCLUSIÓN: De confirmarse la relación entre disminución de reserva ovárica en pacientes que presentaron menarquia precoz, será fundamental que ésta información sea debidamente registrada y evaluada dentro de la consejería preconcepcional.

BACKGROUND: The identification of predictors of controlled ovarian hyperstimulation could predict the outcome of assisted reproductive technologies procedures, and independently of age, predict the success of said procedures. It has been suggested that premature menarchae, i.e. below 12 years of age, predicts diminished ovarian reserve. OBJECTIVE: To determine if there is an association between premature menarche and diminished ovarian reserve. METHODS: We performed a systematic review in MEDLINE and EMBASE, for articles published between 2000 and 2013, with key words "premature menarchae" and "ovarian reserve". Three articles fulfilled the inclusion criteria, including a total of 2,470 patients. RESULTS: The meta-analysis of the results demonstrated an association between premature menarchae and diminished ovarian reserve (OR 1.89; 95%CI 1.52-2.35; p=0.001). CONCLUSION: If our findings are confirmed, it would be fundamental to include this information in any routine gynecological visit.

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Introducción: la corriente denominada hoy «medicina basada en la evidencia¼ aporta una especie de marco conceptual o paradigma novedoso para la solución de los problemas clínicos. Esta forma de practicar la medicina pretende acercar más los resultados provenientes de la investigación clínica a la práctica médica. Se necesitan para esto entonces soluciones ante el exceso actual de información proveniente de la investigación médica. Objetivo: realizar una aproximación al tema de las revisiones sistemáticas y metánalisis como método eficaz para resumir la mejor evidencia científica disponible.Desarrollo: ambos términos no son necesariamente equivalentes si bien están estrechamente relacionados. El metaanálisis es una síntesis cuantitativa de información que debe basarse en una revisión sistemática de la literatura para eliminar posibles sesgos de selección. Una revisión sistemática puede o no ir acompañada de un metaanálisis. Conclusiones: las revisiones sistemáticas acompañadas de metaanálisis proporcionan estimaciones más precisas sobre los efectos de la atención sanitaria, que aquellas derivadas de los estudios individuales y constituyen por tanto un instrumento metodológico para la evaluación del efecto de un factor de riesgo o la eficacia de una medida terapéutica. Esto nos permite ampliar el conocimiento científico a partir de elementos verdaderamente confiables, para así a brindar a nuestros pacientes el mejor y más seguro servicio(AU)

Introduction: there is a current named "evidence-based medicine" and it brings a kind of novel conceptual framework or paradigm for solving clinical problems. This way of practicing medicine aims to bring more results from the clinical research to the medical practice. It is required then solutions to face the present excess of information from the clinical research. Objective: to carry out an approach to systemic reviews and meta-analysis as an efficient method to summarize the best available scientific evidence. Development: both terms are not necessarily equivalent though they are closely related. Meta-analysis is a quantitative synthesis of information that should be based on a literature systemic review to eliminate possible selection biases. A systemic review may or may not be accompanied of a meta-analysis. Conclusions: the systemic reviews with meta-analysis provide more precise estimates of the effects of health care than those derived from the individual studies and, therefore, they constitute a methodological tool for evaluating the effect of a risk factor or the effectiveness of a therapeutic measure. This allows us to broaden the scientific knowledge departing from truly reliable elements, in order to give our patients the best and safest service(AU)

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Introducción: la corriente denominada hoy «medicina basada en la evidencia¼ aporta una especie de marco conceptual o paradigma novedoso para la solución de los problemas clínicos. Esta forma de practicar la medicina pretende acercar más los resultados provenientes de la investigación clínica a la práctica médica. Se necesitan para esto entonces soluciones ante el exceso actual de información proveniente de la investigación médica. Objetivo: realizar una aproximación al tema de las revisiones sistemáticas y metánalisis como método eficaz para resumir la mejor evidencia científica disponible. Desarrollo: ambos términos no son necesariamente equivalentes si bien están estrechamente relacionados. El metaanálisis es una síntesis cuantitativa de información que debe basarse en una revisión sistemática de la literatura para eliminar posibles sesgos de selección. Una revisión sistemática puede o no ir acompañada de un metaanálisis. Conclusiones: las revisiones sistemáticas acompañadas de metaanálisis proporcionan estimaciones más precisas sobre los efectos de la atención sanitaria, que aquellas derivadas de los estudios individuales y constituyen por tanto un instrumento metodológico para la evaluación del efecto de un factor de riesgo o la eficacia de una medida terapéutica. Esto nos permite ampliar el conocimiento científico a partir de elementos verdaderamente confiables, para así a brindar a nuestros pacientes el mejor y más seguro servicio.

Introduction: there is a current named "evidence-based medicine" and it brings a kind of novel conceptual framework or paradigm for solving clinical problems. This way of practicing medicine aims to bring more results from the clinical research to the medical practice. It is required then solutions to face the present excess of information from the clinical research. Objective: to carry out an approach to systemic reviews and meta-analysis as an efficient method to summarize the best available scientific evidence. Development: both terms are not necessarily equivalent though they are closely related. Meta-analysis is a quantitative synthesis of information that should be based on a literature systemic review to eliminate possible selection biases. A systemic review may or may not be accompanied of a meta-analysis. Conclusions: the systemic reviews with meta-analysis provide more precise estimates of the effects of health care than those derived from the individual studies and, therefore, they constitute a methodological tool for evaluating the effect of a risk factor or the effectiveness of a therapeutic measure. This allows us to broaden the scientific knowledge departing from truly reliable elements, in order to give our patients the best and safest service.