Júnia Xavier Maia

Telemedicine application in the care of diabetes patients: systematic review and meta-analysis.

Background The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients. Methods Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results. Results Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine. Conclusions Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.

Comparison between pre-thickened and home-thickened formulas in gastroesophageal reflux treatment

OBJECTIVE The purpose of this study was to compare the effectiveness of a pre-thickened infant formula (Nan AR) with a conventional homemade formula in the reduction of regurgitation and vomiting in infants with gastroesophageal reflux.\par METHODS A hundred children, under 12 months, not exclusively breast feeding, were select for the study. Forty-eight were treated with conventional formula with starch and 52 with pre-thickened infant formula.\par RESULTS There was no statistically significant difference between the two groups in the improvement or cure of symptoms, each treatment having been effective.\par CONCLUSION Thickened formulas, pre-thickened or home-thickened, have shown the same efficacy in the management of gastroesophageal reflux in children.Objetivo: o presente estudo foi realizado com o objetivo de comparar a eficacia de uma formula infantil pre-espessada (Nan AR) com formula convencional, de espessamento caseiro, com amido de milho, na reducao de episodios de regurgitacoes e vomitos de lactentes com refluxo gastroesofagico (RGE). Metodos: foram estudadas 100 criancas, menores de 12 meses de idade, que nao faziam uso de leite materno exclusivo. Por sorteio, 48 receberam formula convencional, e 52 receberam formula infantil pre-espessada (Nan AR), com comparacao dos resultados clinicos apos 3 meses. Resultados: nao houve diferenca estatisticamente significativa na melhora ou cura dos sintomas entre os dois grupos, tendo sido ambos os tratamentos eficazes. Conclusoes: o espessamento dietetico, seja com formulas infantis especiais, seja com medidas caseiras, tem eficacia semelhante no tratamento do refluxo gastroesofagico do lactente.