RESUMO
ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS CONCLUSIONS: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.
Assuntos
Humanos , Qualidade de Vida , Inibidores de Hidroximetilglutaril-CoA Redutases , Estenose da Valva Aórtica , HospitalizaçãoRESUMO
BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. SELECTION CRITERIA: Randomised controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. DATA COLLECTION AND ANALYSIS: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalisation for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalisation for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS' CONCLUSIONS: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis.The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.
RESUMO
BACKGROUND:: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES:: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS:: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions.Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS:: We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. AUTHORS CONCLUSIONS:: Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Qualidade de Vida , Estenose da Valva Aórtica , Hospitalização , HumanosRESUMO
CONTEXT AND OBJECTIVE: Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography. DESIGN: Systematic review and meta-analysis. METHOD: The Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations. RESULTS: A total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95% confidence interval, CI = 1.06-1.29; I² = 19%). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected. CONCLUSION: The cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Filme para Raios XRESUMO
CONTEXT AND OBJECTIVE: Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography. DESIGN: Systematic review and meta-analysis. METHOD: The Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations. RESULTS: A total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95 percent confidence interval, CI = 1.06-1.29; I² = 19 percent). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected. CONCLUSION: The cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods.
CONTEXTO E OBJETIVO: A mamografia é o melhor método para rastreamento do câncer de mama, capaz de reduzir a mortalidade. Os estudos que avaliam seu impacto clínico foram realizados com mamografia em filme. A mamografia digital é proposta para substituir a mamografia em filme com benefícios inerentes à tecnologia digital. O objetivo do estudo foi comparar o desempenho da mamografia digital com a mamografia em filme. TIPO DE ESTUDO: Revisão sistemática e metanálise. MÉTODO: Foram pesquisadas as bases Medline, Scopus, Embase e Lilacs, buscando-se por estudos pareados, coortes e ensaios clínicos randomizados comparando a mamografia digital e a mamografia em filme, quanto à taxa de detecção de câncer, de reconvocação e características dos tumores, publicados até 2009. As referências dos estudos incluídos foram verificadas em busca de citações relevantes. RESULTADOS: Foi incluído um total de 11 estudos, somando 190.322 mamografias digitais e 638.348 em filme. A taxa de detecção do câncer pela mamografia digital foi significantemente maior (risco relativo, RR: 1,17 [95 por cento intervalo de confiança, IC = 1,06-1,29 I² = 19 por cento]) do que pela mamografia em filme. A vantagem da mamografia digital parece maior em pacientes entre 50 e 60 anos. Não houve diferenças significantes nas taxas de reconvocação de pacientes e nas características dos tumores encontrados. CONCLUSÃO: A mamografia digital apresenta taxa de detecção de câncer pouco maior que a mamografia em filme. Não há diferenças significantes nas taxas de reconvocação entre a mamografia digital e a em filme. As características dos tumores são semelhantes em pacientes em ambos os métodos.
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama , Mamografia/métodos , Filme para Raios XRESUMO
OBJECTIVE: The purpose of this systematic review was to obtain summary estimates of the diagnostic accuracy of color Doppler ultrasonography (CDU) in predicting malignancy in thyroid follicular neoplasms (FNs). METHODS: We searched Medical Subject Headings together with the search terms "follicular," "thyroid," and "Doppler" in the MEDLINE, Web of Science, and Excerpta Medica databases as well as the Latin American and Caribbean Health Sciences Literature database, after which we performed manual searches of the reference lists to locate additional studies. There were no language restrictions. We included studies that assessed the diagnostic accuracy of CDU in identifying malignancy in thyroid FNs. The assessments of the quality and extraction of data were performed by 3 independent reviewers. RESULTS: We included 4 studies, which collectively evaluated 457 thyroid FNs, 67 of which had been classified as malignant based on the evaluation of surgical biopsy samples. Moderate, rich, predominant, or exclusive internal flow on CDU of thyroid FNs was considered indicative of malignancy. The overall sensitivity of CDU was 85% (95% confidence interval [CI], 74%-93%), with an overall specificity of 86% (95% CI, 82%-89%). The overall prevalence was 14.7%, and the positive and negative predictive values were 51% and 97%, respectively. The positive likelihood ratio was 6.07, and the negative likelihood ratio was 0.18. CONCLUSIONS: Predominant internal flow seen on CDU is associated with malignancy of thyroid FNs. Absence of internal flow or predominantly peripheral flow indicates a low probability of thyroid FN malignancy.
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Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/epidemiologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/epidemiologia , Ultrassonografia Doppler em Cores/estatística & dados numéricos , Humanos , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
As revisões sistemáticas de estudos de acurácia, da mesma forma que revisões sistemáticas de intervenções, são importantes instrumentos para aumentar a precisão dos resultados dos estudos, antecipar resultados significativos, prevenir controvérsias, economizar recursos e orientar políticas de saúde.Há um esforço crescente no sentido de padronizar uma metodologia adequada e aumentar o número de publicações desse tipo de estudo.Alguns aspectos desse tipo de revisão sistemática são particularmente diferentes das revisões de intervenção. Desde a formulação dos objetivos, passando pela estratégia de busca, avaliação da qualidade dos estudos, análise estatística e apresentação dos resultados.Revisões sistemáticas de estudos de acurácia permitem avaliar testes individualmente, ou a comparação de diferentes tipos de teste para uma mesma condição.É importante que os profissionais de saúde e principalmente os desenvolvedores de diretrizes e políticas de saúde adquiram maior familiaridade com esse tipo de trabalho científico, habilitando-se a avaliá-lo criticamente, de forma a fazer melhor uso de suas conclusões.
Assuntos
Confiabilidade dos DadosRESUMO
O hipotiroidismo primário é a disfunção tiroidiana mais freqüente.A tiroidite de Hashimoto é a causa mais comum de hipotiroidismo primário na maior parte do Brasil.Amiodarona e carbonato de lítio podem ser causa de hipotiroidismo.O hipotiroidismo subclínico é caracterizado por T4 (tiroxina) livre normal e TSH (hormônio tireoestimulante) elevado.O TSH (hormônio tireoestimulante) sérico é o melhor exame para diagnosticar e monitorar o hipotireoidismo primário.O monitoramento do hipotireoidismo central ou secundário deve ser feito através da dasogem de T4 (tiroxina) livre e não do TSH (hormônio tireoestimulante).As necessidades de levotiroxina aumentam de 30% a 50% durante o período gestacional nas mulheres com hipotireoidismo.
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Terapêutica , Medicina Baseada em Evidências , HipotireoidismoRESUMO
Este artigo discute os principais aspectos do diagnóstíco e tratamento das dislipidemias. Os autores chamam à atenção para a importância da história clínica e exame físico na identificação dos fatores de risco para doença cardiovascular, hábitos alimentares e pre- sença ou ausência de medicamentos e doenças que podem causar dislipidemias secundárias. Após análise do perfil lipídico do paciente, os autores mostram como estabelecer as metas terapêuticas baseadas nas III Diretrizes do Programa Nacional de Educação em Colesterol, utilizando medidas não farmacológicas e farmacológícas para prevenção da doença aterosclerótica.
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Humanos , Anticolesterolemiantes/farmacologia , Anticolesterolemiantes/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Hiperlipidemias , Estilo de VidaAssuntos
Humanos , Antagonistas Adrenérgicos/efeitos adversos , Antagonistas Adrenérgicos/farmacologia , Coma , Crise Tireóidea/diagnóstico , Crise Tireóidea/etiologia , Crise Tireóidea/fisiopatologia , Crise Tireóidea/terapia , Glucocorticoides , Hormônios Tireóideos/deficiência , Mixedema , Insuficiência RespiratóriaRESUMO
A doença de Graves é a causa mais comum de hipertireoidismo. É uma doença auto-imune caracterizada pela presença de anticorpos contra o receptor de TSH, também chamados de imunoglobulinas estimuladoras da tiróide. Como o tratamento do hipertireoidismo defere, de acordo com a etiologia, o diagnósico correto é imprescindível antes da terapia ser instiuída.(au)