Régis B Andriolo

Use of Color Doppler Ultrasonography for the Prediction of Malignancy in Follicular Thyroid Neoplasms Systematic Review and Meta-analysis

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.

Levodopa for idiopathic restless legs syndrome: evidence-based review

Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7 to 5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Systematic review of randomized or quasi‐randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Nine eligible clinical trials were included. The subjective analyses of these studies showed contradictory results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. The short‐term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long‐term treatment and the augmentation phenomenon in RLS. Further long‐term randomized controlled trials using standard follow‐up measurements as the International RLS Study Group Rating Scale are necessary.

A systematic review of the interventions to promote the wearing of hearing protection

CONTEXT AND OBJECTIVE Noise-induced hearing loss can only be prevented by eliminating or lowering noise exposure levels. When the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. The aim here was to summarize the evidence for the effectiveness of interventions to enhance the wearing of hearing protection among workers exposed to noise in the workplace. DATA SOURCE Studies with random assignment were identified by an electronic search of the medical literature up to 2005. Data were double-entered into the Review Manager software, version 4.2.5. DATA SYNTHESIS Two studies were found. A computer-based intervention tailored to individual workers risks and lasting 30 minutes was not found to be more effective than a video providing general information for workers. A second randomized controlled trial evaluated the effect of a four-year school-based hearing loss prevention program among schoolchildren working on their parents farms. The intervention group was twice as likely to wear some kind of hearing protection as was the control group (which received only minimal intervention). REVIEWERS CONCLUSIONS: The limited evidence does not show whether tailored interventions are more or less effective than general interventions among workers, 80% of whom already use hearing protection. Long-lasting school-based interventions may increase the use of hearing protection substantially. Better interventions to enhance the use of hearing protection need to be developed and evaluated in order to increase the prevention of noise-induced hearing loss among workers.

Bevacizumab for ocular neovascular diseases: a systematic review

CONTEXT AND OBJECTIVE Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method. DATA SYNTHESIS A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity.

Metformin treatment before and during in vitro fertilization or intracytoplasmic sperm injection in women with polycystic ovary syndrome: summary of a Cochrane review.

In women with polycystic ovary syndrome, metformin treatment before or during assisted reproductive technology cycles increases clinical pregnancy rates and decreases the risk of ovarian hyperstimulation syndrome. However, there is no conclusive evidence of a benefit in live birth rates.

Dopaminergic antagonists for alcohol dependence

This is a protocol for a review. The objectives are as follows: To evaluate the effectiveness and safety of dopaminergic antagonists for treating alcohol dependence when compared to placebo, other pharmacotherapy, other psychosocial interventions or no intervention.

Complementary therapies for chronic plaque psoriasis

Background: Emerging data suggests that chronic inflammatory disease, such as psoriasis, may be associated to coronary artery disease (CAD). Objective: Analyze the association between psoriasis and subclinical atherosclerosis using coronary calcium score (CAC). Methods: We investigated 221 participants with psoriasis and 718 ageand sex-matched controls without prior known CAD. All participants completed a questionnaire and underwent laboratory tests and a CAC exam. Logistic regression models adjusted for Framingham risk score (FRS) and C-reactive protein (hs-CRP) were built. CAC was included in the models as a binary variable with different cut off values. Results: Body-mass index, race, hypertension, HDL, LDL and hs-CRP were significantly associated with psoriasis presence and severity. Psoriasis severity was significantly associated with CAC (p = 0.04), particularly for very high CAC (>400) (p < 0.01). The OR for severe psoriasis and CAC >400 was 2.45 Tese Doutorado em andamento • Psoríase e Aterosclerose Subclínica avaliada pela Espessura Médio-Intimal nas Artérias Carótidas -IMTc por meio da

15. Levodopa for idiopathic restless legs syndrome: Systematic review

Background: Restless Legs Syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7–5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Method: It was a systematic review of randomized or quasi-randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Results: Nine eligible clinical trials were included. The subjective analyses of these studies showed controversial results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. Conclusions: The short-term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long-term treatment and the augmentation phenomenon in RLS. Further long-term randomized controlled trials using standard follow-up measurements as the International RLS Study Group Rating Scale are necessary.

13. Speech disorders in obstructive sleep apnea syndrome: Systematic review

Background: Obstructive sleep apnea (OSA) is a common disorder, and estimates of prevalence may affect 5–7% in general population. The treatment of OSA is based on Continuous Positive Airway Pressure (CPAP) appliance and Mandibular Advancement Oral Appliances. Phonoaudiologic approach for treatment of patients with Obstructive Sleep Apnoea has been controversial, and the aim of this review was to evaluate the effectiveness of these phonoaudiologic interventions. Method: It was a review of randomized or quasi-randomized, double blind trials on OSA. Outcomes: decrease of apnea/hypopnea index (AHI), daytime somnolence, and snoring measured by a validated scale. Results: Two eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analysis of these studies showed improvement of OSA, and an improvement of snoring by subjective analysis. However the poor methodological quality and the heterogeneity of the results limited us to pool the results. Conclusions: There is no accepted scientific evidence on phonoaudiologic approach for treatment of OSA. Well designed RCTs are needed to assess the efficacy of these interventions. Supported by FAPESP 02/02145-1, 99/08189-6 (L.B.C. Carvalho and G.F. Prado).

14. Second line treatment for idiopathic restless legs syndrome: Systematic review

Background: Obstructive sleep apnea (OSA) is a common disorder, and estimates of prevalence may affect 5–7% in general population. The treatment of OSA is based on Continuous Positive Airway Pressure (CPAP) appliance and Mandibular Advancement Oral Appliances. Phonoaudiologic approach for treatment of patients with Obstructive Sleep Apnoea has been controversial, and the aim of this review was to evaluate the effectiveness of these phonoaudiologic interventions. Method: It was a review of randomized or quasi-randomized, double blind trials on OSA. Outcomes: decrease of apnea/hypopnea index (AHI), daytime somnolence, and snoring measured by a validated scale. Results: Two eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analysis of these studies showed improvement of OSA, and an improvement of snoring by subjective analysis. However the poor methodological quality and the heterogeneity of the results limited us to pool the results. Conclusions: There is no accepted scientific evidence on phonoaudiologic approach for treatment of OSA. Well designed RCTs are needed to assess the efficacy of these interventions. Supported by FAPESP 02/02145-1, 99/08189-6 (L.B.C. Carvalho and G.F. Prado).