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As drogas utilizadas para prevenção de convulsões podem impactar na movimentação dentária durante o tratamento ortodôntico. O objetivo deste estudo foi avaliar a influência de drogas anticonvulsivantes no tratamento ortodôntico. O desenho deste estudo é uma revisão narrativa da literatura onde uma busca eletrônica foi realizada sem restrição de idioma e data em três bases de dados (PubMed via MEDLINE, SCOPUS e BVS). Foram utilizados os seguintes termos para o PubMed e BVS: anticonvulsants drugs AND orthodontic movement e para o SCOPUS: anticonvulsants AND drugs AND orthodontic AND movement. Uma pesquisa complementar foi realizada nas referências bibliográficas dos estudos incluídos. Os artigos indicaram que o uso de medicação anticonvulsivante favorece o desenvolvimento de hiperplasias gengivais, xerostomia e alterações no metabolismo ósseo que modulam a taxa de movimentação ortodôntica. Dentro das limitações desta revisão, concluiu-se que não há contraindicações para tratamento ortodôntico em pacientes utilizando anticonvulsivantes, no entanto os ortodontistas devem estar cientes dos potenciais efeitos adversos advindos do uso desses medicamentos para que possam adotar medidas para mitigar esses riscos.

Drugs used to prevent seizures can have an impact on tooth movement during orthodontic treatment. This study aimed to evaluate the influence of anticonvulsant medications on orthodontic treatment. The design of this study is a narrative literature review in which an electronic search was carried out without language or date restriction in three databases (PubMed/MEDLINE, SCOPUS, and BVS). The following terms were used for PubMed and BVS: anticonvulsants drugs AND orthodontic movement and SCOPUS: anticonvulsants AND drugs AND orthodontic AND movement. A complementary search was carried out on the bibliographical references of the included studies. The articles indicated that using anticonvulsant medication favors the development of gingival hyperplasia, xerostomia, and alterations in bone metabolism that modulate the rate of orthodontic movement. Within the limitations of this review, it was concluded that there is no contraindication for orthodontic treatment in patients using anticonvulsants. However, orthodontists should be aware of the potential adverse effects arising from the use of these drugs so that they can adopt measures to minimize these risks.

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BACKGROUND: The efficacy of adding ezetimibe to statin therapy for event reduction in patients with acute coronary syndromes (ACS) remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ezetimibe plus statin versus statin monotherapy in patients with ACS. We searched PubMed, Embase, and Cochrane for eligible trials. The random-effects model was used to calculate the risk ratios with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3 (RStudio, PBC). RESULTS: Six RCTs comprising 20 574 patients with ACS were included, of whom 10 259 (49.9%) were prescribed ezetimibe plus statin. The patient population had an average age of 63.8 years, and 75.1% were male. Compared with statin monotherapy, ezetimibe plus statin significantly reduced major adverse cardiovascular events (MACE) (risk ratio 0.93; 95% CI 0.90-0.97; P < 0.01) and nonfatal myocardial infarction (risk ratio 0.88; 95% CI 0.81-0.95; P < 0.01). There was no significant difference between groups for revascularization (risk ratio 0.94; 95% CI 0.90-1.00; P = 0.03), all-cause mortality (risk ratio 0.87; 95% CI 0.63-1.21; P = 0.42), or unstable angina (risk ratio 1.05; 95% CI 0.86-1.27; P = 0.64). CONCLUSION: In this meta-analysis of patients with ACS, the combination of ezetimibe plus statin was associated with a reduction in MACE and nonfatal myocardial infarction, compared with statin monotherapy.

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Introdução: A fitoterapia se baseia na utilização de plantas medicinais, através de diferentes formulações farmacêuticas com fins terapêuticos. Na Odontologia, os fitoterápicos têm sido alvo de estudos, devido suas propriedades benéficas, além de apresentarem biocompatibilidade, baixo custo e fácil acesso. Objetivo: Realizar um levantamento na literatura científica sobre a utilização da fitoterapia na Odontologia, com vistas aos efeitos antimicrobiano, anti-inflamatório e reparador. Material e Métodos: A busca ocorreu entre fevereiro a julho/2023, nas bases PubMed e LILACS, além de livre busca, cruzando-se os descritores "Phytotherapy", "Dentistry", "Anti-inflamatory Agents", "Anti-Infective Agents", "Wound Healing", "Fitoterapia", "Odontologia", "Anti-inflamatório", "Antimicrobiano" e "Cicatrização". Após leitura inicial, seguida da análise crítica com aplicação dos critérios estabelecidos, foram selecionadas 50 referências. Desenvolvimento: Diversas plantas são empregadas sob a forma de fitoterapia, como Aloe vera (babosa), Matricaria recutita (camomila), Copaifera (copaíba), Punica granatum (romã), Uncaria tomentosa (unha-de-gato), Malva sylvestris (malva), Althaea officinalis (malvaísco), Myracrodruon urundeuva (Aroeira), Lippia sidoides (Alecrim pimenta) e Glycyrrhiza glabra (Alcaçuz). Na Odontologia, pesquisas evidenciaram resultados satisfatórios para o tratamento de afecções da cavidade oral, especialmente com caráter inflamatório e infeccioso, além de aclerar a cicatrização. Esses achados apontam que a fitoterapia é um tratamento eficaz, acessível e com mínimos efeitos colaterais. Considerações finais: Com base na literatura revisada, a fitoterapia parece ser uma alternativa promissora no tratamento de afecções orais, devido aos seus notáveis efeitos cicatrizantes, antimicrobianos e anti-inflamatórios. Contudo, mais pesquisas com metodologias adequadas são necessárias para que se estabeleçam protocolos clínicos seguros e eficazes.

Introduction: Phytotherapy is based on the use of medicinal plants through different pharmaceutical formulations for therapeutic purposes. In Dentistry, phytotherapeutics have been the subject of studies due to their beneficial properties, as well as their biocompatibility, low cost, and easy accessibility. Objective: To conduct a literature review on the use of phytotherapy in Dentistry, focusing on antimicrobial, anti-inflammatory, and reparative effects. Materials and Methods: The search took place between February and July 2023, using PubMed and LILACS databases, in addition to a free search, crossing the descriptors "Phytotherapy," "Dentistry," "Anti-inflammatory Agents," "Anti-Infective Agents," "Wound Healing," "Fitoterapia," "Odontologia," "Anti-inflammatory," "Antimicrobial," and "Cicatrização." After an initial reading, followed by critical analysis with the application of established criteria, 50 references were selected. Development: Various plants are employed in phytotherapy, such as Aloe vera (aloe), Matricaria recutita (chamomile), Copaifera (copaiba), Punica granatum (pomegranate), Uncaria tomentosa (cat's claw), Malva sylvestris (mallow), Althaea officinalis (marshmallow), Myracrodruon urundeuva (Brazilian copaiba), Lippia sidoides (rosemary pepper), and Glycyrrhiza glabra (licorice). In Dentistry, research has shown satisfactory results for the treatment of oral cavity conditions, especially those with inflammatory and infectious characteristics, as well as accelerating healing. These findings suggest that phytotherapy is an effective, accessible treatment with minimal side effects. Final considerations: Based on the reviewed literature, phytotherapy appears to be a promising alternative in the treatment of oral conditions due to its notable healing, antimicrobial, and anti-inflammatory effects. However, more research with appropriate methodologies is necessary to establish safe and effective clinical protocols.

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A osteonecrose dos maxilares induzida por medicamentos (MRONJ) caracteriza-se por exposição óssea ou osso que pode ser sondado através de fístula intra ou extraoral, em região maxilofacial, e que não cicatriza dentro de oito semanas. A MRONJ é uma condição rara e debilitante que pode causar dor, disfagia e odor desagradável na cavidade oral, afetando pacientes com histórico ou sob uso contínuo de terapia antirreabsortiva, isolada ou associada a imunomoduladores ou drogas antiangiogênicas, mas sem histórico de radioterapia nos maxilares. O objetivo desta revisão narrativa de literatura é compilar os principais aspectos sobre a etiopatogenia da MRONJ e as opções terapêuticas disponíveis. A etiologia da MRONJ é multifatorial, complexa, e não está totalmente compreendida, não havendo um tratamento definitivo, mas diversas modalidades terapêuticas que visam o controle da dor e da progressão da osteonecrose. Conclui-se com essa revisão que o entendimento da etiopatogenia da MRONJ pelo cirurgião-dentista lhe permite adotar medidas preventivas, bem como o conhecimento das modalidades terapêuticas disponíveis lhe possibilita oferecer o manejo adequado para seu paciente, conforme o estágio da doença.

Medication-related osteonecrosis of the jaw (MRONJ) is characterized by exposed bone or bone that can be probed through an intra or extraoral fistula, in the maxillofacial region, which does not heal within eight weeks. MRONJ is a rare and debilitating condition that can cause pain, dysphagia and unpleasant odor in the oral cavity, affecting patients with a history or continuous use of antiresorptive therapy, alone or associated with immunomodulators or antiangiogenic drugs, but without a history of radiotherapy to the jaws. The aim of this narrative literature review is to compile the main aspects about the etiopathogenesis of MRONJ and the available therapeutic options. The etiology of MRONJ is multifactorial, complex, and is not fully understood, with no definitive treatment, but several therapeutic modalities that aim to control pain and the progression of osteonecrosis. It is concluded from this review that the understanding of the etiopathogenesis of MRONJ by the dental surgeon allows him to adopt preventive measures, as well as the knowledge of the therapeutic modalities available allows him to offer the appropriate management for his patient, depending on the stage of the disease.

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Contextualização: O resfriado comum é uma infecção do trato respiratório superior com remissão espontânea, caracterizada por coriza, congestão nasal, espirros, tosse, mal-estar, dor de garganta e febre baixa. Embora não esteja associado, em geral, a quadros graves, gera custos à economia e prejuízos à sociedade, como absentismo escolar e no trabalho. Objetivos: Sumarizar as evidências de revisões sistemáticas da Cochrane, referentes à efetividade das intervenções para tratamento e prevenção do resfriado comum. Métodos: Trata-se de overview de revisões sistemáticas Cochrane. Procedeu-se à busca na Cochrane Library (2024), sendo utilizado o descritor "COMMON COLD". Todas as revisões sistemáticas de ensaios clínicos foram incluídas. O desfecho primário de análise foi a melhora clínica, a redução dos sintomas ou a prevenção da doença. Resultados: Quatorze estudos foram incluídos, totalizando 175 ensaios clínicos e 39.844 participantes. Discussão: Os ensaios clínicos avaliados mostram grande heterogeneidade, sendo baixa a qualidade da maioria dos estudos, o que demanda baixo potencial de evidência positiva. Ainda assim, é possível que os anti-histamínicos sejam eficazes no curto prazo e os anti-inflamatórios auxiliem a melhora global dos sintomas do resfriado comum. A vitamina C parece ter eficácia na redução do tempo total de sintomas. Conclusão: Não há suporte com bom nível de evidência atualmente para a maioria das intervenções visando prevenção ou tratamento do resfriado comum, sendo recomendada e realização de estudos prospectivos para melhor robustez dos achados desses estudos.

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Introducción: El aumento significativo de especies micobacterianas descritas como agentes patógenos implicó la necesidad de implementar métodos de identificación más avanzados que permitan acortar el tiempo diagnóstico. Desde el punto de vista clínico, es importante diferenciar el complejo Mycobacterium tuberculosis (MTBC) del resto de las especies micobacterianas no tuberculosas (MNT), con el fin de aplicar tratamiento específico. Objetivo: Identificar aislados micobacterianos procedentes de muestras clínicas pulmonares y extrapulmonares por las técnicas diagnósticas SD BIOLINE TB Ag MPT64 y Genotype Mycobacterium CM/AS. Material y métodos: Se recibieron 3.604 muestras clínicas procedentes de pacientes sintomáticos durante el período comprendido entre enero 2018­enero 2024. Estas fueron procesadas en el Laboratorio Nacional de Referencia e Investigaciones de Tuberculosis, Lepra y Micobacterias del Instituto de Medicina Tropical "Pedro Kourí" (IPK). Para la identificación de MTBC, se utilizó el test inmunocromatográfico SD TB Ag MPT64; para la identificación de MNT, las técnicas diagnósticas moleculares Genotype Mycobacterium CM/AS. Resultados: Del total de muestras procesadas, se obtuvieron 325 aislados micobac - terianos; 252 (77,53%) identificados como MTBC y 73 (22,45%) especies micobacte- rianas no tuberculosas. De estas, la de mayor frecuencia de aislamiento fue: Myco- bacterium fortuitum 19 (26,02%), Mycobacterium avium 17 (23,80%) y Mycobacterium intracellulare 13 (17,80%). Conclusiones: Los resultados obtenidos reafirman que los métodos de identificación utilizados son adecuados, ambas técnicas logran el acortamiento del tiempo diagnós- tico, lo que permite la implementación temprana del tratamiento adecuado, y así evitar la diseminación de la infección, sobre todo en pacientes con algún tipo de deterioro en su barrera inmunológica.

Introduction: The significant increase in mycobacterial species described as pathoge - nic agents implied the need to implement more advanced identification methods that would shorten the diagnostic time. From a clinical point of view, it is important to diffe- rentiate Mycobacterium tuberculosis complex (MTBC) from the rest of the nontubercu- lous mycobacterial species (NTM), in order to apply specific treatment. Objective: Identify mycobacterial isolates from pulmonary and extrapulmonary clinical samples using the SD BIOLINE TB Ag MPT64 and Genotype Mycobacterium CM/AS diagnostic techniques. Materials and methods: 3,604 clinical samples were received from symptomatic patients during the period between January 2018­January 2024. These were processed at the National Reference and Research Laboratory for Tuberculosis, Leprosy and Mycobacteria of the "Pedro Kourí" Institute of Tropical Medicine (IPK). For the identification of MTBC, the SD TB Ag MPT64 immunochromatographic test was used, and for the iden- tification of NTM, the Genotype Mycobacterium CM/AS molecular diagnostic techniques were used. Results: Of the total samples processed, 325 mycobacterial isolates were obtained; 252 (77.53%) identified as MTBC and 73 (22.45%) nontuberculous mycobacterial species, of which the highest frequency of isolation was: Mycobacterium fortuitum 19 (26.02%), Mycobacterium avium 17 (23. 80%) and Mycobacterium intracellulare 13 (17.80%). Conclusions: The results obtained reaffirm that the diagnostic methods used are adequate, both techniques achieve a shortening of the diagnostic time, which allows the early implementation of the appropriate treatment, thus avoiding the spread of the infection, especially in patients with some type of deterioration in their barrier immuno - logical.

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Introducción: Un Comité de Tumores de Oncología Torácica (CTOT) es un equipo mul- tidisciplinario que revisa casos de pacientes, discute enfoques terapéuticos y desarro- lla planes personalizados, considerando el tipo de cáncer, estadio, condición general y preferencias del paciente individual. Objetivos: Actualizar la evidencia y ofrecer pautas para la implementación o mejora de los CTOT, analizando factores clave como la preparación, estructura, registro de datos y medición de resultados. Resultados: La revisión narrativa destaca que el CTOT se conforma de un núcleo básico de especialidades (oncológica torácica, neumonología, cirugía torácica, oncología radiante, radiología intervencionista, diagnóstico por imágenes, medicina nuclear y anatomía patológica) y un equipo extendido que puede eventualmente ser citado a de- manda (ej: trabajadora social, médicos de cabecera, paliativos). La frecuencia de las reuniones es generalmente semanal, en función del volumen de casos, con opciones presenciales, virtuales y/o híbridas. Una infraestructura adecuada es crucial para el funcionamiento correcto y eficiente, incluyendo protocolos para la selección y la presentación de casos, normas claras para la dinámica de reuniones, un proceso de toma de decisiones basado en respeto y comunicación, y un sistema de documentación que garantice la confidencialidad. Además, se subraya la importancia de medir los resultados mediante indicadores de calidad. Conclusión: Un sistema eficiente en los CTOT permite la recopilación de datos y su uso en investigación y auditorías internas, lo que asegura un mejor manejo de los pacientes.

Introduction: A Thoracic Oncology Tumor Committee (CTOT) is a multidisciplinary team that reviews patient cases, discusses therapeutic approaches and develops personali- zed plans, considering the type of cancer, stage, general condition, and individual pa- tient preferences. Objectives: To update the evidence and provide guidelines for implementing or enhan- cing CTOTs, analyzing key factors including preparation, structure, data management and outcome evaluation. Results: The narrative review highlights that the CTOT is made up of a core group of specialties (thoracic oncology, pulmonology, thoracic surgery, radiation oncology, inter- ventional radiology, diagnostic imaging, nuclear medicine, and pathology) and an ex- tended team that may be called upon request (e.g., social worker, primary care physi- cians, palliative care). The frequency of meetings is generally weekly, depending on the volume of cases, with in-person, virtual, and/or hybrid options. An adequate infrastructure is crucial for proper and efficient functioning, including pro- tocols for case selection and presentation, clear rules for meeting dynamics, a deci- sion-making process based on respect and communication, and a documentation sys- tem that guarantees confidentiality. In addition, the importance of measuring results through quality indicators is stressed. Conclusion: An efficient system in CTOTs allows data collection and its use in research and internal audits, ensuring better patient management.

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O estresse oxidativo (EO), fenômeno decorrente do desequilíbrio entre a geração de espécies reativas de oxigênio (ERO) e/ou depleção antioxidante (AO), está envolvido na patogênese de diversas doenças e desordens, incluindo o diabetes mellitus tipo 2 (DM2) e a doença periodontal. Uma das conseqüências da geração excessiva das ERO é a destruição tecidual promovida pela peroxidação lipídica, e para combater estes efeitos deletérios, o organismo desenvolveu mecanismos de defesa, como os AO e peroxidases. Objetivos: Avaliar o comportamento dos marcadores de EO na saliva total (SALT) de pacientes com ou sem DM2, portadores ou não de periodontite crônica generalizada (PCG); e verificar e comparar o efeito do tratamento periodontal não-cirúrgico (TPNC) sobre esses marcadores entre os pacientes. Materiais e Métodos: 121 pacientes participaram deste estudo e foram alocados em 4 grupos: diabéticos com PCG (DMPC), diabéticos sem PCG (DM), pacientes sistemicamente saudáveis com PCG (PC) e pacientes sistemicamente saudáveis e sem periodontite (C). Os índices de Placa (IP), nível clínico de inserção (NCI), profundidade clínica de sondagem (PCS) e sangramento à sondagem (SS) foram coletados para a avaliação dos parâmetros clínicos periodontais. Foram também coletadas amostras de sangue periférico e SALT para analisar respectivamente a hemoglobina glicada (HbA1c) e os marcadores de EO, superóxido dismutase (SOD), estado total de antioxidante (TAS) e substâncias reativas do ácido tiobarbitúrico (TBARS) e peroxidase salivar (SPO). As coletas foram realizadas no baseline e após 30 dias do tratamento, previamente à avaliação e reavaliação clínica. Os pacientes DMCP e PC passaram por TPNC, e os DM e C, receberam apenas orientação de higiene oral e profilaxia. Resultados: No baseline, os grupos DMPC e PC apresentaram valores significativamente maiores dos parâmetros clínicos PCS, SS, IP e NCI quando comparados aos grupos DM e C (p<0.05). Após o TPNC, todos esses parâmetros mostraram melhoras significativas (p<0,05). A HbA1c foi significativamente maior no grupo DMPC quando comparado com DM no baseline (p<0,05), no entanto, o TPNC não promoveu melhora significativa após 1 e 3 meses de acompanhamento glicêmico, ainda que, a redução percentual (0,4%) observada possa ser considerada importante. Quanto aos marcadores, no grupo DMPC os valores de TBARS foram significativamente menores comparados aos grupos DM, PC e C (p<0.05), e os de SPO foi significativamente maior em relação aos grupos PC e C (p<0.05), com correlação negativa entre TBARS e SPO (r=-0.35; p=0.002), enquanto que os valores de TAS e SOD não mostraram diferenças significativas entre os grupos estudados (p>0.05). Após o TPNC, os níveis de TBARS aumentaram significativamente, e os de SPO diminuíram significativamente apenas no grupo DMPC (p<0.05 e p<0.05), ao passo que os valores de SOD e TAS permaneceram inalterados nos dois grupos. Conclusão: No baseline, os valores de TBARS e de SPO estiveram alterados nos pacientes DMPC com resultados que mostram correlação inversa entre TBARS/SPO, e após o TPNC houve nova alteração. O comportamento dos marcadores de EO na saliva mostrou a busca pelo ponto de equilíbrio por diversas vias e que este pode ser alterado pelo uso de medicamentos, como a metformina.

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INTRODUCTION: Renal denervation has been associated with substantial and sustained blood pressure reduction and is considered to serve as an alternative treatment for patients with resistant hypertension. However, the first published SHAM-controlled trial assessing RDN safety and efficacy showed no difference between groups. AIM: We aimed to perform a meta-analysis quantifying the magnitude of blood pressure decrease secondary to renal denervation in patients with resistant hypertension. METHODS: Databases were searched for RCTs that compared RDN therapy to SHAM procedure and reported the outcomes of (1) 24-hour ambulatory blood pressure; (2) Office systolic blood pressure; (3) Daytime systolic blood pressure; and (4) Night-time systolic blood pressure. Mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I² statistics. P values of < 0.05 were considered statistically significant. Statistical analyses were performed using RStudio 4.2.3. RESULTS: Nine studies and 1622 patients were included. The AMBP [MD -3.72 95%CI -5.44, -2.00 p < 0.001; I²=34%] and DSBP [MD -4.10 95%CI -5.84, -2.37 p < 0.001; I²=0%] were significantly reduced in the RDN arm. ODBP [MD -6.04 95%CI -11.31, -0.78 p = 0.024; I²=90%] and NSBP [MD -1.81 95%CI -3.90, 0.27 p = 0.08; I²=0%] did not reach a statistically significant difference between groups. CONCLUSION: Renal denervation demonstrates greater efficacy in reducing 24-hour ambulatory and daytime systolic blood pressure in patients diagnosed with resistant hypertension.

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BACKGROUND: Bevacizumab is a monoclonal antibody medication used as standard treatment for different types of cancers, one of them is glioblastoma, which is the most common primary brain tumor. PURPOSE: We aimed to assess bevacizumab and its effects on inducing hypertension in patients with glioblastoma. METHODS: PubMed, Embase and Cochrane databases were searched until February 13th, 2024 for randomized control trials (RCTs) comparing bevacizumab alone with control or bevacizumab in combination with other chemotherapies in patients with glioblastoma. Data was examined using the Mantel-Haenszel method and we computed risk ratio (RRs) for binary endpoints and 95% confidence intervals (Cls). Heterogeneity was assessed using I² statistics. Meta-regression analysis was conducted to evaluate a possible link between the occurrence of hypertension and mortality or progression-free survival. R software version 4.2.3 was used for statistical analysis. RESULTS: 5 RCTs and 1 non-randomized study were included with a total of 1402 patients, of whom 608 (43,36%) were assigned to the bevacizumab and 794(56,64%) composed the control group. Compared with bevacizumab, the control achieved statistically significant lower rates of hypertension occurrence (RR 6,31; CI: 2,13 - 18,65; p=0.000872; I²=54%). Subgroup analysis of bevacizumab alone versus bevacizumab in combination with other chemotherapies tended towards the combination group(RR 2,24; CI: 1,19 - 4,21; p= 0.012497; I² = 68%). Mortality was significantly higher in the bevacizumab group (OR 1,60; CI: 1,02 - 2,52; p=0,040443; I²= 0%). Progression-free survival did not reach a statistically significant difference between groups (OR 1,07; CI: 0,33 - 3,43; p= 0,907923; I²= 45%) and meta-regression analysis showed no significant link between hypertension and mortality or progression-free survival. CONCLUSION: Concerning the treatment of glioblastoma, our results showed that induced hypertension is more likely to happen in patients treated with bevacizumab. Significant statistical difference in the mortality was observed between the use of bevacizumab and control. However, the current data is insufficient to determine a link between hypertension and prognostic value through meta-regression analysis.

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BACKGROUND: The ideal blood pressure target level for preventing cognitive decline or dementia in patients with systemic arterial hypertension (SAH) remains unclear. PURPOSE: This study aims to investigate whether intensive blood pressure reduction compared to standard treatment is associated with a reduced risk of cognitive decline or dementia in adults with SAH. METHODS: PubMed, Scopus and Cochrane databases were searched for randomized clinical trials (RCTs) comparing intensive treatment versus standard treatment for blood pressure reduction in patients with SAH. A random-effects model was used for analyzing the results, which were presented as relative risk (RR) with a 95% confidence interval (CI). Heterogeneity was examined using the I² statistic. Statistical analysis was performed using R software version 4.2.3. RESULTS: A total of 5 RCTs and 46,658 patients were included, of whom 23,726 (50,85%) underwent intensive therapy for SAH treatment. The mean age of participants ranged from 62.8 to 80.9 years in the intensive treatment group while it ranged from 63.3 to 80.3 years in the standard treatment group. Occurrence of dementia or probable dementia was significantly lower in the intensive treatment group (3.8% vs. 4,3%; RR 0.88; 95% CI: 0.80 - 0.96; p= 0.0049; I²=0%). Dementia or Cognitive decline (16.4% vs. 18.8%; RR 0.87; 95% CI 0.83 - 0.90; p < 0.000001; I²=0%), and cognitive decline (13.2% vs. 15.2%; RR 0.88; 95% CI 0.80 - 0.98; p= 0.014; I²=53%) also tended towards the intensive treatment group. Additionally, no significant association was found in mortality (6.4% vs. 7.3%; RR 0.87; 95% CI 0.75 - 1.02; p= 0.09; I²=28%) and serious adverse effects (34.4% vs. 35.5%; RR 0.99; 95% CI 0.92 - 1.06; p=0.73; I²=63%). CONCLUSION: Our study shows that intensive blood pressure treatment is associated with a fewer occurrence of dementia, probable dementia and cognitive decline in comparison to the standard blood pressure target.

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BACKGROUND/INTRODUCTION: Renal denervation (RDN) is an innovative procedure designed to regulate the renal sympathetic nervous system for the control of arterial hypertension (HTN). RDN emerges as an alternative for patients with resistant arterial hypertension. Despite this, the clinical efficacy of RDN is still not fully understood. PURPOSE: Therefore, we aimed to compare the use of renal denervation versus sham procedure or pharmacological treatment in patients with resistant HTN. METHODS: We performed a systematic search of PubMed, Embase, Cochrane databases for randomized controlled trials (RCTs) comparing the use of renal denervation procedures and sham procedure or pharmacological treatment in patients with resistant HTN. Statistical analyses were performed using R Studio 4.3.2. Heterogeneity was examined with the Cochran Q test I² statistics. Mean difference (MD) with 95% CI were pooled across trials. P values of < 0.05 were considered statistically significant. The primary continuous outcomes of interest were change from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP) and serum creatinine. RESULTS: Twenty-one RCTs reporting data on 3345 patients were included in this meta-analysis. Among them, 2004 (59,91%) received renal denervation and 1341 (40,09%) received pharmacological treament or sham procedure. Follow-up ranged from 2 to 48 months. The mean age of patients between studies ranged from 50.7 to 65 years. Compared to control group, RDN significantly reduced Systolic Blood Pressure (SBP) (MD -3.53 mmHg; 95% CI -5.94 to -1.12; I2 = 74%) and Diastolic Blood Pressure (DBP) (MD -1.48 mmHg; 95% CI -2.56 to -0.40; I2 = 51%). Regarding serum creatinine (MD -2.51; 95% CI -7.90 to 2.87; I2 = 40%) there was no significant difference between RDN and control groups. CONCLUSION: In this meta-analysis of RCTs of patients with resistant HTN, RDN was associated with a reduction in SBP and DBP compared to sham procedure or pharmacological treatment.

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BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD), affects approximately 18.6 million individuals worldwide, poses an important healthcare challenge. Despite the established efficacy of both high-intensity statin monotherapy (HIS) and moderate-intensity statin plus ezetimibe (MIS+EZT) in ASCVD management, the optimal treatment strategy remains unclear. PURPOSE: This meta-analysis seeks to assess the impact of moderate-intensity statin plus ezetimibe (MIS+EZT) versus high-intensity statin monotherapy (HIS) on LDL < 70mg/dl; Total Cholesterol; LDL; High Density Cholesterol (HDL) and triglycerides levels. Our goal is to synthesize the existing evidence and pinpoint areas that warrant further investigation. METHODS: A thorough literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane databases, focusing on studies that compared the effects of moderate-intensity statins plus ezetimibe with high-intensity statin monotherapy in ASCVD patients. RESULTS: In the 13 included studies, involving 8,592 patients, of which 4,525 (52.67%) received moderate-intensity statin plus ezetimibe treatment. The follow-up period ranged from 12 to 219 weeks, with participant ages varying from 66 to 76.5 years in the MIS+EZT group and from 67 to 75.9 years in the HIS group. Analysis revealed significant MIS+EZT-associated with greater percentages in Low Density Lipoprotein (LDL) < 70 (Odds Ratio (OR) 1.76; 95% CI [1.26; 2.45]; p=0.001; I²=73%), LDL reduction (Mean Difference (MD) -5.05 mg/dL; 95% CI [-9.02;-1.07]; p< 0.013; I²=56%;); Total Cholesterol reduction (MD -7.91 mg/ dL; 95% CI [-14.90; -0.91]; p< 0.027; I²=60%); Triglycerides reduction (MD -8.20 mg/ dL; 95% CI [-13.05; -3.35]; p< 0.001; I²=2%;); There was no statistical difference between groups in Drug Adverse reaction (Risk Ratio (RR) 1.19; 95% CI [0.79; 1.78]; p=0.404; I²=0%); and Drug intolerance (RR 0.78 ; 95% CI [0.32; 1.92]; p=0.584; I²=35%). CONCLUSIONS: This meta-analysis underscores the effectiveness of MIS+EZT in enhancing significant clinical outcomes for ASCVD patients, as evidenced by improvements in a greater percentage of patients achieved the LDL < 70 target, LDL, Total Cholesterol and Triglycerides levels . Importantly, there were no significant differences in the occurrence of overall adverse events and adverse drug reactions between the two groups.

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INTRODUCTION: In patients with ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) should be conducted within 12 hours of symptom onset. The potential benefits attributable to late reperfusion in STEMI fall under the "open artery hypothesis" where the stunned peri-infarction zone after revascularization would restore blood supply and contractility. PURPOSE: To estimate the differences on the LV ejection fraction (LVEF), indexed LV end-systolic volume (iLVESV) and scar in patients with STEMI without viabilitity randomized to optimal medical therapy (OMT) alone or OMT and a late percutaneous coronary intervention (PCI) performed between 24 hours and 30 days after the event. METHODS: Patients with non-reperfused STEMI were evaluated from September 2021 to June 2022 at a tertiary cardiology hospital. The patients underwent Cardiac Magnetic Resonance (CMR) to assess myocardial viability and were classified as non-viable if they had only 1 wall segment with less than fifty percent thickness of the affected wall with late gadolinium enhancement. The patients were randomized to PCI or OMT alone. CMR was repeated at 6 months to evaluate LVEF, iLVESV and fibrosis. This summary presents a planned partial analysis of the 6-month results (N=51). Descriptive statistics analysis included central and dispersion estimators, or absolute and relative frequencies. To explore the differences between groups and time, Mann-Whitney and Wilcoxon tests were run, and results were given as point-estimates and confidence intervals at 95% (95% CI). A significance level of 5% was adopted for inferential analysis. RESULTS: 51 patients (60±11 years, 71% male) were included in the analysis. Of this total, 24 were randomized to PCI + OMT, and 27 to isolated OMT. The groups showed balanced distribution regarding clinical characteristics and initial CMR parameters (LVEF, iLVESV, and fibrosis). The difference in LVEF at the end of 6 months between the OMT and PCI groups was 2.07%, favoring the OMT group; however, this difference was not significant (p= 0.677, 95% CI: -5 to 10). Between the groups, the difference at the end of 6 months in iLVESV was -6.82 ml/m², also without statistical significance (p= 0.858, 95% CI: -19 to 11). There was a significant reduction in the amount of fibrosis in both PCI group with -14.68g (p= 0.011) and in the OMT group with -12.57g (p= 0.009). Detailed results are presented in Table 1. CONCLUSION: Despite a significant reduction in fibrosis in both groups, there was no superiority observed in late PCI compared to isolated OMT in reducing reverse remodeling and fibrosis in patients with non-viable STEMI when compared to isolated OMT.

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INTRODUCTION: Transthyretin amyloidosis (ATTR) is a multisystem disease caused by the deposition of fibrillar protein in organs and tissues. ATTR genotypes and phenotypes are highly heterogeneous. PURPOSE: We designed the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo (REACT-SP), aiming to describe the demographic, genetic, clinical, and diagnostic test results and treatment of patients with ATTR. METHODS: We present data on physical signs and symptoms, cardiac and neurological assessments, and genetics in patients enrolled in the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo, Brazil. RESULTS: Six hundred-forty-four patients were enrolled, 505 with the variant form (ATTRv) and 139 with wild-type (ATTRwt). Sixteen different mutations were detected, the most common being Val50Met (48.3%) and V142Ile (40.8%). Overall, more than half of the patients presented cardiological involvement, and the difference in this proportion between the ATTRv and ATTRwt groups was significant (43.9 vs. 89.9%; p<0.001). The neurological phenotype also differed between ATTRv and ATTRwt (56.8 vs. 31.7%; p<0.001). The mixed phenotype was found in 25.6% of the population, without a significant difference between the forms of amyloidosis. A group of patients remained asymptomatic (10.4%), with a lower proportion of asymptomatic ATTRwt patients. The median time between the onset of symptoms and diagnosis was 1,853 (IQR 1277­2997) days, which was longer in ATTRv patients than in ATTRwt patients (p<0.001). Sinus rhythm was reported in 74.2%, atrial fibrillation in 17.0%, low voltage in 28.6%, repolarization abnormalities in 39.8%, and pseudo infarction in 27.4%. Echocardiography showed median Left Ventricular Ejection Fraction (LVEF) was 60%, Interventricular Septum (IVS) 14 mm, Posterior Wall Thickness (PWT) 13 mm, Left Atrium (LA) 41 mm, Left Ventricular Diastolic Diameter (LVDD) 45 mm, Left Ventricular Systolic Diameter (LVSD) 30 mm, basal Right Ventricular Diastolic Diameter (RVDD) 35 mm and Left Ventricle (LV) longitudinal strain 9.1%. There was some degree of LV diastolic dysfunction in 38.4%, apical sparing in 31.3%, and thrombus or masses in 1.0%. Late Gadolinium Enhancement (LGE) was absent in 29% and was subendocardial in 35.5%, transmural in 13.7%, mesocardial in 13.7%, and epicardial in 8.2%. CONCLUSIONS: This study details the clinical and genetic spectrum of patients with ATTR in São Paulo, Brazil. This preliminary analysis highlights the considerable phenotypic heterogeneity of neurological and cardiac manifestations in patients with variant and wild-type ATTR.

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BACKGROUND Inspiron is a third-generation drug-eluting stent with abluminal-only biodegradable polymeric coating designed for fast and homogeneous reendothelialization, possibly improving clinical outcomes. This study aimed to evaluate the safety and clinical performance of the Inspiron sirolimus-eluting stent (SES) in the real world. METHODS We pooled patient-level databases derived from the Inspiron Real Life II and Latitude prospective studies. A total of 25 Brazilian tertiary centers included consecutive patients treated with percutaneous coronary intervention (PCI) for native coronary artery lesions with the study stent only. The primary endpoint was the rate of major adverse cardiac events (MACE) including the combination of cardiac death, myocardial infarction, and target lesion revasculariza- tion at 12 and 24-month follow-ups. RESULTS From June 2017 to January 2022, 2,803 patients were enrolled, with a mean age of 62.8 ± 10.8 years and a higher prevalence of male patients (64.6%), and diabetes in 36.5%. The clinical presen tation was stable angina in 45.2% (n = 1, 268) and acute coronary syndrome (ACS) in 54.7% ( n = 509[18.296] STEMI, n = 747[26.796] NSTEMI, and n = 279[10%] angina). The mean number of implanted stents was 1.38 ± 0.96 and the mean stent diameter and length were 3.0 ± 0.5 and 21.0 ± 10.4 mm, respectively. Mean follow- up duration was 571.5 ± 196.2 days, and 2,305 patients reached the 2- year follow-up. The MACE rates at 12 and 24 months were 3.8% and 6.7%, respectively. The global rates of target lesion revascularization (TLR), target vessel revascularization (TVR), definite or probable stent thrombosis (ST), and cardiac death at 24 months were 0.9%, 1.1%, 0.6%, and 2.3%, respectively. Stepwise regression analysis revealed that age (P = 0.03 * 4) left main or 3-vessel disease (P=0.024), and clinical presentation as ACS (P < 0.001) were independent predictors of MACE at 12 and 24 months. CONCLUSIONS Inspiron SES demonstrated favorable safety and effectiveness in all-comers real world patients up to 2-year follow-up. Worse clinical outcomes were determined by older age, multivessel disease and ACS at presentation. These findings are consistent with previous results available for current third generation DES.

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INTRODUÇÃO: A ablação por cateter de Taquicardia Ventricular (TV) em pacientes com Cardiomiopatia Chagásica Dilatada (CCD) pode ser desafiadora devido à complexidade do substrato. Afinalidade do procedimento é a redução do número de TVs e de terapias dos cardiodesfibriladores implantáveis, resultando em melhor qualidade de vida, redução da dose de antiarrítmicos e de seus efeitos colaterais. Ainda não há dados do impacto sobre aumento de sobrevida devido à realização de ablação. OBJETIVO: Determinar a mortalidade em 30 dias pós procedimento de pacientes com Cardiomiopatia Chagásica com fração de ejeção menor que 35% submetidos à ablação de TV. MÉTODOS: Análise retrospectiva de 22 pacientes consecutivos com CCD submetidos à ablação de TV cicatricial em nossa instituição entre outubro de 2020 e junho de 2024 e refratários a, pelo menos, duas drogas antiarrítmicas, incluindo amiodarona. RESULTADOS: A idade média foi de 62 anos, sendo 63,6% (14) do sexo masculino. A fração de ejeção média do ventrículo esquerdo foi de 27,5%. Tempestade elétrica foi o motivo de indicação do procedimento em 50% (11) dos casos. A ablação por radiofrequência era guiada pelo mapeamento eletroanatômico de ativação das TVs bem toleradas, visando potenciais mesodiastólicos, e por mapas funcionais (ILAM). Em 76,2% (16) dos casos foram realizadas abordagens endocárdica e epicárdica. Não foi realizado mapeamento epicárdico em 4 casos devido a: aderências em pericárdio (2) e status clínico do paciente (2). A mortalidade relacionada ao procedimento ocorreu em 4,5% (1) devido a perfuração de ventrículo direito após punção epicárdica. Amortalidade em até 30 dias após procedimento foi de 14,2% (3) devido a choque séptico foco pulmonar e choque cardiogênico. CONCLUSÃO: Em nosso estudo, a taxa de mortalidade precoce em 30 dias após ablação foi considerável, possivelmente influenciada pela cardiomiopatia avançada e altas taxas de tempestade elétrica.

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INTRODUCTION: Brugada syndrome (BrS) is a genetic heart disease that predisposes individuals to malignant ventricular arrhythmias and sudden cardiac death (SCD). Although implantable cardioverter-defibrillators (ICDs) and quinidine are primary treatments, recurrent BrS-triggered cardiac ventricular arrhythmias necessitating ICD therapies can persist. In this setting, epicardial substrate ablation has emerged as a promising alternative for high-risk symptomatic patients. OBJECTIVE:Evaluate the effectiveness and safety of epicardial substrate ablation in patients with BrS. METHODS: In this systematic review and single-arm meta-analysis, we systematically searched PubMed, Embase, and Cochrane databases following PRISMA guidelines for studies including BrS patients who had epicardial substrate ablation. Data was extracted and statistical analysis was performed using random-effects modeling for proportional meta-analysis. Heterogeneity was examined with I² statistics. RESULTS: Seventeen observational cohort studies comprising 695 BrS patients were included. The mean patient age at enrollment was 40.4 ± 14.2 years, 89.9% were males and 77.6% exhibited spontaneous type 1 Brugada ECG pattern. Pooled analysis demonstrated resolution of the type 1 pattern in 89% of cases (95% CI 74-98%; I²=91%) and elimination of abnormal electrograms in 93% (95% CI 84-99%, I²=71%). Post-procedure VF/VT inducibility was 8% (95% CI 1-18%; I²=83%). The overall complication rate was 3% (95% CI 0-8%, I²=78%) with pericarditis being the most common. Rates of recurrent VT/VF and appropriate ICD therapies during post-ablation follow-up were 13% (95% CI 5-23%; I²=87%) and 10% (95% CI 3-21%; I²=87%), respectively. CONCLUSIONS: Epicardial substrate ablation shows promise for BrS patients experiencing recurrent BrS-triggered ventricular arrhythmias, offering demonstrable therapeutic efficacy in eliminating arrhythmogenic substrates with an acceptable safety profile. However, high heterogeneity among studies highlights the need for further research and standardized protocols in this field.

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Breast Cancer (BC) is one of the most common cancers diagnosed in population femmale and it has several subtypes, one of them being theexpressing human epidermal growth factor receptor 2 positive (HER2 +), one of the treatments for HER2+ breast cancer consists of chemotherapy plus trastuzumab deruxtecan. Several clinical trials have shown the effectiveness and safety of trastuzumabe deruxtecano in cancer patients, however, several Adverse Events (AEs) have been described and the decrease in left ventricular ejection has been singled out for more prominent analysis. Objective: We conducted a systematic review and meta-analysis to investigate the cardiovascular effects of Trastuzumab Deruxtecano and whether it can influence the appearance of reduced left ventricular ejection fraction.. METHODS: We performed a systematic search in Embase, PubMed and Cochrane databases for randomized controlled trials (RCTs) showed a decrease in left ventricular ejection fraction in patients using trastuzumab deruxtecan against Her-2-positive breast cancer compared to patients to used another's treatments against this disease. Mean difference (MD) with 95% confidence intervals (CI) were calculated using a random effects model. The heterogeneity was examined in the I2 statistic. P-values > 0.05 were considered statistically significant. The statistical analysis was carried out using R software version 4.2.3. RESULTS: A total of 3 RCTs were included, with a total of 1656 patients evaluated, 928 patients randomized to the use of Trastuzumab Deruxtecan and 728 patients to the use of other treatments according to medical choice, follow-up ranged from 10 to 38 months. There was a visible in the decrease in left ventricular ejection fraction, with a higher incidence in the group that used trastuzumab compared to the placebo group (RR: 5.73%; 95% CI 1.51 - 21.78; I2 33% ; P= 0.010466). Another important point is the discontinuation of treatment due to grade 2 adverse events, classified as reduced LVEF, where a higher incidence is seen in the group that used Trastuzumab Deruxtecan compared to the placebo group (RR 2.11%; 95% CI 1.54 - 2.89; P = 0.000003),7. CONCLUSION: In this meta-analysis, Trastuzumab Deruxtecan showed a relationship with a decrease in left ventricular ejection fraction, displaying the need for more studies to evaluate the cardiotoxicity of trastuzumab and its effects as a whole on the cardiovascular system.

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AIMS: This study aimed to compare the effects of the combination of rivaroxaban and aspirin with aspirin alone on health-related quality of life in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial. METHODS and results: Health-related quality of life assessed using the EQ-5D-3L. The treatment effects on health utility and EQ visual analogue scale (EQ VAS) scores were compared between rivaroxaban plus aspirin and aspirin alone in terms of adjusted mean difference in change from baseline and odds ratio of having deterioration events. Nine thousand forty-nine (98.9%) and 6916 (75.5%) completed the EQ-5D-3L at baseline and at final visit, respectively. Nine thousand twenty-eight (98.9%) and 6887 (76.3%) completed the EQ-5D-3L at baseline and final visit, respectively. Mean (standard deviation) health utility and EQ VAS scores at baseline were 0.871 (0.141) and 76.0 (15.3), respectively, for the rivaroxaban plus aspirin group, compared with 0.873 (0.139) and 75.8 (15.1) for the aspirin group. Adjusted mean difference in change from baseline utility was -0.002 [95% confidence interval (CI), -0.006, 0.002, P = 0.30] between the combination therapy group and the aspirin group. The odds ratio (95% CI) of experiencing deterioration in health utility was 1.01 (95% CI, 0.93, 1.10, P = 0.81) between the two groups. Adjusted mean difference in change from baseline EQ VAS was 0.02 (95% CI, -0.43, 0.47, P = 0.93) between the two groups. CONCLUSION: This analysis of the COMPASS trial demonstrated that the quality of life of patients was similar between the rivaroxaban plus aspirin group and the aspirin alone group. REGISTRATION: Trial registration number: ClinicalTrials.gov number (NCT01776424). Trial protocol and statistical analysis plan: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118#APPNEJMoa1709118PRO.

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