RESUMO

Diabetic Retinopathy (DR) is one of the most common microvascular complications presenting by patients diagnosticated with diabetic diseases. Uncontrolled hyperglycemia may manifest as visual impairment and blindness. The early detection of DR is essential to minimize the risk and consequence of visual diminishing. The standard gold diagnoses tool relies on different imaging modalities and requires a judgment of expert photographers, which are not available in most of the primary care centers or remote location. In that scenario, an automate or semiautomated DR screening systems can contribute to improving the accuracy of the diagnostic. Thus, we performed a Systematic Review and Meta-Analysis to evaluate the Decision Support Systems (DSS) in diagnosing DR. The overall Diagnostic Odds Ratio was 73.15 (95%CI: 37.54-142.50), sensitivity was 97.70 (95%CI: 97.50-97.90) and specificity was 90.30 (95%CI: 90.00-90.60). Our results corroborate with the concept of usefulness of DSSs in early diagnosis, screening and preliminary evaluation of suspicious images of DR.

Assuntos

RESUMO

Gliomas comprise a group of heterogeneous primary tumors of the central nervous system that originate from glial cells. Malignant gliomas account for the majority of primary malignant CNS tumors and are associated with high morbidity and mortality. Glioblastoma is the most frequent malignant glioma, and despite recent advances in diagnosis and new treatment options, its prognosis remains dismal. New opportunities for the development of effective therapies for malignant gliomas are urgently needed. Magnetohyperthermia consists of heat generation in the region of the tumor through the application of magnetic nanoparticles subjected to an alternating magnetic and has shown positive results in both preclinical and clinical assays. The aim of this review was to assess the relevance of hyperthermia induced by magnetic nanoparticles in treating gliomas and to describe possible variations of the technique and its implication in the effectiveness of treatment. An electronic search in the literature of articles published from January 1990 to November 2009 was performed, in databases ISI Web of Science and PubMed, and after screening according to the inclusion criteria, 11 articles were selected. Animal models showed that magnetohyperthermia was effective in promoting tumor cell death and reducing tumor mass or increasing survival of the animals. One clinical study demonstrated that magnetohyperthermia could be applied safely and with few adverse effects. Some studies suggested that mechanisms of cell death, such as apoptosis, necrosis, and antitumor immune response were triggered by magnetohyperthermia. Based on these data, it was concluded that the technique proved to be effective in most experiments, and improvement of the nanocomposites, as well as of the alternating magnetic equipment, can contribute towards establishing magnetohyperthermia as a promising tool to treat malignant gliomas.

Gliomas compõem um grupo de tumores primários heterogêneos do sistema nervoso central (SNC) derivados de células gliais. Gliomas malignos representam a maioria dos tumores primários malignos do SNC e estão associados a índices altos de morbidade e mortalidade. Glioblastoma é o glioma mais frequente e maligno e, apesar dos avanços recentes no diagnóstico e das novas opções de tratamento, seu prognóstico permanece obscuro. Novas oportunidades para o desenvolvimento de terapias efetivas para gliomas malignos são urgentemente necessárias. A magnetohipertermia, a qual consiste na geração de calor na região do tumor por meio da aplicação de nanopartículas magnéticas submetidas a um campo magnético alternado, tem apresentado resultados positivos em testes pré-clínicos e clínicos. O objetivo desta revisão foi verificar a relevância da hipertermia induzida por nanopartículas magnéticas no tratamento de gliomas e notar as possíveis variações da técnica e sua implicação na efetividade do tratamento. Realizamos uma busca eletrônica na literatura científica de publicações de Janeiro de 1990 a Novembro de 2009, nos bancos de dados ISI Web of Science e PubMed e, após a aplicação do critério de inclusão, obtivemos um total de 11 artigos. Estudos baseados em modelos animais demonstraram que a magnetohipertermia foi efetiva em promover a morte celular tumoral e reduzir a massa do tumor ou aumentar a sobrevida dos animais. Um estudo clínico mostrou que a magnetohipertermia pode ser aplicada seguramente e com poucos efeitos adversos. Alguns estudos sugerem que mecanismos de morte celular, tais como apoptose, necrose e resposta imune antitumoral foram desencadeadas por magnetohipertermia. Com base nesses dados podemos concluir que a magnetohipertermia foi efetiva na maioria dos experimentos e que o aperfeiçoamento dos nanocompostos, assim como dos equipamentos de campo magnético alternado, podem contribuir para o estabelecimento da magnetohipertermia como uma ferramenta promissora no tratamento dos gliomas malignos.

RESUMO

Gliomas comprise a group of heterogeneous primary tumors of the central nervous system that originate from glial cells. Malignant gliomas account for the majority of primary malignant CNS tumors and are associated with high morbidity and mortality. Glioblastoma is the most frequent malignant glioma, and despite recent advances in diagnosis and new treatment options, its prognosis remains dismal. New opportunities for the development of effective therapies for malignant gliomas are urgently needed. Magnetohyperthermia consists of heat generation in the region of the tumor through the application of magnetic nanoparticles subjected to an alternating magnetic field and has shown positive results in both preclinical and clinical assays. The aim of this review was to assess the relevance of hyperthermia induced by magnetic nanoparticles in treating gliomas and to describe possible variations of the technique and its implication in the effectiveness of treatment. An electronic search in the literature of articles published from January 1990 to November 2009 was performed, in databases ISI Web of Science and PubMed, and after screening according to the inclusion criteria, 11 articles were selected. Animal models showed that magnetohyperthermia was effective in promoting tumor cell death and reducing tumor mass or increasing survival of the animals. One clinical study demonstrated that magnetohyperthermia could be applied safely and with few adverse effects. Some studies suggested that mechanisms of cell death, such as apoptosis, necrosis, and antitumor immune response were triggered by magnetohyperthermia. Based on these data, it was concluded that the technique proved to be effective in most experiments, and improvement of the nanocomposites, as well as of the alternating magnetic field equipment, can contribute towards establishing magnetohyperthermia as a promising tool to treat malignant gliomas.