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ResumoA paralisia obstétrica do plexo braquial é uma lesão bastante comum em neonatos, sendo causada pela tração do plexo braquial durante o trabalho de parto. A presente revisão sistemática tem como objetivo explorar o uso de enxertos e transferências de nervo como procedimentos para melhora da flexão do cotovelo em crianças com paralisia obstétrica. A presente revisão sistemática seguiu as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, na sigla em inglês) e foi baseada em pesquisa nos bancos de dados MEDLINE, EMBASE, LILACS, The Cochrane Central Register of Controlled Trials, Web of Science, Wholis e SCOPUS. De acordo com os critérios pré-determinados, os artigos incluídos eram ensaios clínicos, quase-experimentos, e estudos de coortes sobre enxertos e transferências de nervos em crianças (de até 3 anos de idade) com diagnóstico de paralisia obstétrica. A ferramenta de avaliação Risk of Bias in Non-Randomized Studies of Interventions foi usada em estudos não randomizados. Sete estudos utilizaram os dois procedimentos; três deles compararam os procedimentos de enxerto e transferência de nervo, enquanto os outros quatro os combinaram como método reconstrutivo em crianças com paralisia obstétrica. Segundo o sistema de classificação do Medical Research Council, os dois métodos melhoraram a flexão do cotovelo das crianças de maneira similar. De modo geral, nossos resultados mostraram que o enxerto de nervo e a transferência de nervo são opções igualmente boas para a reconstrução nervosa em casos de paralisia obstétrica. Mais estudos sobre as técnicas de reconstrução nervosa na paralisia obstétrica devem ser realizados, de preferência ensaios clínicos randomizados, para validação dos resultados dessa revisão sistemática.

Obstetric brachial plexus palsy is a rather common injury in newborns, caused by traction to the brachial plexus during labor. In this context, with the present systematic review, we aimed to explore the use of nerve graft and nerve transfer as procedures to improve elbow flexion in children with obstetric palsy. For the present review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the MEDLINE, EMBASE, LILACS, The Cochrane Central Register of Controlled Trials, Web of Science, Wholis and SCOPUS databases. Predetermined criteria defined the following requirements for inclusion of a study: Clinical trials, quasi-experiments, and cohort studies that performed nerve graft and nerve transfer in children (≤ 3 years old) with diagnosis of obstetric palsy. The risk of bias in nonrandomized studies of interventions assessment tool was used for nonrandomized studies. Out of seven studies that used both procedures, three of them compared the procedures of nerve graft with nerve transfer, and the other four combined them as a reconstructive method for children with obstetric palsy. According to the Medical Research Council grading system, both methods improved equally elbow flexion in the children. Overall, our results showed that both techniques of nerve graft and nerve transfer are equally good options for nerve reconstruction in cases of obstetric palsy. More studies approaching nerve reconstruction techniques in obstetric palsy should be made, preferably randomized clinical trials, to validate the results of the present systematic review. Resumo A paralisia obstétrica do plexo braquial é uma lesão bastante comum em neonatos, sendo causada pela tração do plexo braquial durante o trabalho de parto. A presente revisão sistemática tem como objetivo exploraro uso de enxertose transferências de nervo como procedimentos para melhora da flexão do cotovelo em crianças com paralisia obstétrica. A presente revisão sistemática seguiu as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, na sigla em inglês) e foi baseada em pesquisa nos bancos de dados MEDLINE, EMBASE, LILACS, The Cochrane Central Register of Controlled Trials, Web of Science, Wholis e SCOPUS. De acordo com os critérios pré-determinados, os artigos incluídos eram ensaios clínicos, quase-experimentos, e estudos de coortes sobre enxertos e transferências de nervos em crianças (de até 3 anos de idade) com diagnóstico de paralisia obstétrica. A ferramenta de avaliação Risk of Bias in Non-Randomized Studies of Interventions foi usada em estudos não randomizados. Sete estudos utilizaram os dois procedimentos; três deles compararam os procedimentos de enxerto e transferência de nervo, enquanto os outros quatro os combinaram como método reconstrutivo em crianças com paralisia obstétrica. Segundo o sistema de classificação do Medical Research Council, os dois métodos melhoraram a flexão do cotovelo das crianças de maneira similar. De modo geral, nossos resultados mostraram que o enxerto de nervo e a transferência de nervo são opções igualmente boas para a reconstrução nervosa em casos de paralisia obstétrica. Mais estudos sobre as técnicas de reconstrução nervosa na paralisia obstétrica devem ser realizados, de preferência ensaios clínicos randomizados, para validação dos resultados dessa revisão sistemática.

To determine the association between mutations in CDKN2A and FGFR3 genes and the diagnosis of bladder carcinoma (BCa). A systematic search strategy was carried out through MEDLINE, EMBASE, LILACS, CENTRAL and unpublished literature. We included RCTs, cohort, case–control and cross-sectional studies that involved patients > 18-year-old assessing the association between CDKN2A and FGFR3 mutated genes and BCa. The primary outcome was bladder cancer defined by histology of the sample. We assessed the risk of bias with QUADAS2 and performed a meta-analysis with Review Manager v5.3. We found 97 records with the search strategies. After duplicates were removed, six studies were included in meta-analysis. Regarding the association between mutated FGFR3 and bladder cancer, we found an OR 31 95% CI (15–64). However, there was no association for CDKN2A and BCa. There is a strong association between FGFR3 mutated gene and the diagnosis of bladder cancer, which has not been observed with CDKN2A. Such a result supports FGFR3 mutated gene as a promissory bladder cancer screening and monitoring biomarker.

Obstetric brachial plexus palsy is a rather common injury in newborns, caused by traction to the brachial plexus during labor. In this context, with the present systematic review, we aimed to explore the use of nerve graft and nerve transfer as procedures to improve elbow flexion in children with obstetric palsy. For the present review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the MEDLINE, EMBASE, LILACS, The Cochrane Central Register of Controlled Trials, Web of Science, Wholis and SCOPUS databases. Predetermined criteria defined the following requirements for inclusion of a study: Clinical trials, quasi-experiments, and cohort studies that performed nerve graft and nerve transfer in children (≤ 3 years old) with diagnosis of obstetric palsy. The risk of bias in nonrandomized studies of interventions assessment tool was used for nonrandomized studies. Out of seven studies that used both procedures, three of them compared the procedures of nerve graft with nerve transfer, and the other four combined them as a reconstructive method for children with obstetric palsy. According to the Medical Research Council grading system, both methods improved equally elbow flexion in the children. Overall, our results showed that both techniques of nerve graft and nerve transfer are equally good options for nerve reconstruction in cases of obstetric palsy. More studies approaching nerve reconstruction techniques in obstetric palsy should be made, preferably randomized clinical trials, to validate the results of the present systematic review.

Objective To determine the efficacy and harms of using tranexamic acid (TXA) versus placebo/no intervention to reduce blood loss and the need for transfusion in children undergoing surgical correction of craniosynostosis. Methods We searched MEDLINE (OVID), EMBASE, LILACS, CENTRAL, and other sources. We included clinical trials, prospective, retrospective observational studies, case-control studies, and cohort studies. The primary outcomes were blood loss and the need for a transfusion, and secondary outcomes were hemoglobin, hematocrit, and adverse effects. We assessed the risk of bias with the Cochrane Collaboration tool. We performed the statistical analysis in R and reported information about the mean difference (MD) with a 95% confidence interval (CI). We evaluated heterogeneity with the I2 test. We produced forest plots to show the amount of evidence available for each outcome and made subgroup analyses. Results We included 11 studies in qualitative and quantitative analysis accounting for 752 patients. In general, the risk of all bias was assessed as low for non-randomized studies, and we found high performance and detection bias in one randomized study. TXA significantly reduced blood loss and need for transfusion compared to placebo/no intervention with an MD of -15.47 (95%CI -23.82, -7.11) and -8.18 (95%CI -12.24, -4.11), respectively. These differences were maintained regardless of the type of study, secondary outcomes also favored TXA, and there was no report of adverse effects. Conclusions TXA reduces blood loss and the need for transfusion when compared to placebo/no intervention. The available studies on this topic suggest its use in these patients and its implementation in surgery protocols.

Background Results from cohort studies evaluating the benefit in prevention of recurrent Venous Thromboembolism in cancer population are heterogeneous and controversial. Objective To determine the effectiveness and harms of vena cava filters alone or combined with anticoagulation to prevent the risk of recurrent venous thromboembolism in patients with cancer-related venous thromboembolism. Materials and Methods A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration’s tool and a modified version for cohort studies. An analysis of fixed effects was conducted. The primary outcome was recurrent venous thromboembolism. The secondary outcomes were overall survival and adverse effects. The measure of the effect was the risk ratio with a 95% confidence interval. Results Seven studies were included in the qualitative and quantitative analysis. 35,333 patients were found among the seven studies. A low risk of bias was shown for most of the study items. The overall risk ratio (RR) for recurrent venous thromboembolism was 2.53 95%CI (1.35–4.75) favoring anticoagulation compared with vena cava filter. Conclusion Vena cava filter did not show benefits for recurrent venous thromboembolism prevention in the cancer-patients population.

AimsTo determine the association between the sleep duration and the risk of all-cause mortality in adults.MethodsA search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. Cohort studies were included without language, time or setting restrictions. The risk of bias was evaluated with a modified Cochrane Collaboration's tool. An analysis of random effects was conducted. The primary outcome was all-cause mortality. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned comparisons were 7–9 h of sleep v. v. >9 h.ResultsThirty-nine studies were included in our qualitative analysis, regarding the quantitative analysis, 19 studies were included in v. 7–9 h analysis, and 18 studies in the >9 v. 7–9 h. A low risk of bias was shown for most of the study items. The overall RD for all-cause mortality was 0.09 (95% CI 0.07–0.11) favouring the >9 h group compared with our reference. In contrast, no differences were found between the ConclusionWe found a probable association of long sleep duration and higher mortality; however, it could reflect an underlying systemic or neurological disease that cause sleep fragmentation, deterioration in quality and micro-awakenings.

Resumen Objetivo Describir la evidencia que existe en la actualidad acerca del uso del antibiótico profiláctico en el manejo conservador del trauma renal. Material y métodos Decidimos realizar una revisión de la literatura para intentar resolver la controversia existente acerca de la efectividad del uso de antibiótico profiláctico en pacientes con trauma renal para prevenir complicaciones infecciosas. Resultados El trauma renal es un problema importante en los servicios de urgencias en el mundo. La mayoría corresponden a traumatismos cerrados y principalmente a accidentes de tránsito, aunque pueden ser secundarios a un trauma penetrante. Los abscesos perirrenales son poco frecuentes, se estima que ocurren en menos del 1% de todos los casos de trauma renal y en aproximadamente 5% de los casos de trauma renal penetrante. Dada la baja incidencia de abscesos perirrenales y las diferentes corrientes existe controversia para el tratamiento antibiótico. El manejo es conservador en la mayoría de los casos, y depende del grado de la lesión, el compromiso vascular y el estado hemodinámico del paciente. Conclusión Aún no existe claridad acerca de la utilización de antibiótico profiláctico en el manejo conservador del paciente con un traumatismo renal, relacionado con el tipo de trauma y el grado de la lesión. Sugerimos el uso de antibiótico profiláctico en pacientes con trauma penetrante grado IV dada la mezcla de ambiente externo, cuerpo extraño y orina, sin embargo, no hay evidencia de alta calidad al respecto.

Purpose To determine the effectiveness and harm of cytoreductive nephrectomy versus no intervention in patients with metastatic renal carcinoma who undergo targeted therapy to improve overall survival. Materials and methods A search strategy was conducted in the MEDLINE, CENTRAL, Embase, HTA, DARE, NHS, and LILACS databases. Searches were also conducted for unpublished literature through references from relevant articles identified through the search, conferences, thesis databases, OpenGrey, Google Scholar, and clinicaltrials.gov, among others. Studies were included without language restrictions. The risk of bias assessment was made by using a modified Cochrane Collaboration tool. A meta-analysis of fixed effects was conducted. The expected outcomes were overall survival, quality of life, adverse effects, mortality, and progression- free survival. The measure of the effect was the hazard ratio (HR) with a 95% confidence interval (CI). The planned comparison was cytoreductive nephrectomy versus no intervention. Results A total of 22,507 patients were found among seven studies. Seven studies were included in the qualitative analysis (eight publications) and five in the quantitative analysis for overall survival. One study reported progression-free survival and one reported targeted therapy toxicities. A low risk of bias was shown for most of the study items. The HR for overall survival was 0.58 (95% CI, 0.50 to 0.65) favoring cytoreductive nephrectomy compared with no intervention. Conclusions Cytoreductive nephrectomy is effective for improving overall survival in patients with metastatic renal carcinoma who undergo targeted therapy compared with no intervention.

Summary Objective To determine the effectiveness and harm of using antibiotic prophylaxis versus placebo or no intervention in patients undergoing breast reduction surgery to prevent surgical site infection. Materials and methods A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE, and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of fixed effects was conducted. The primary outcome was surgical site infection. The secondary outcomes were delayed wound healing and adverse effects. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were antibiotic prophylaxis versus placebo/no intervention. Results Five articles were included in the qualitative and quantitative analysis. A total of 584 patients were included from the five studies. A low risk of bias was shown for most of the study items. The overall RD for surgical site infection was −0.08 (95% CI −0.14–−0.03), favoring antibiotic prophylaxis compared with placebo. Conclusion Antibiotic prophylaxis lowers the incidence of surgical site infection in breast reduction surgery compared with placebo or no intervention.

Acalvaria, also known as acrania, is a rare congenital anomaly which is characterized by a complete or partial defect of the calvarium. Due to the low number of patients reported, there is no a standard for the treatment of this condition; thereby, the objective is to present a new surviving patient with acalvaria and a novel surgical approach to treat it, giving craniofacial surgeons and neurosurgeons more tools to face it. In this article, the authors present a reproducible surgical approach in patients with partial acalvaria, which consist in use the present bone as a graft to cover the defect, giving a temporal but stable coverture. No other calvaria graft has been published along the available literature, since only around 4 patients are acalvaria survivors worldwide. However, the authors need to make a longer follow-up to establish the usefulness of the technique in long term. Other limitation is the future procedures needed to a better function and aesthetic.

Our purpose was to determine the effectiveness and harms of vaccination in patients with any sexual history to prevent the prevalence of papillomavirus infection. A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. The risk of bias was evaluated with the Cochrane Collaboration's tool. Analysis of fixed effects was conducted. The primary outcome was the infection by any and each human papillomavirus (HPV) genotype, serious adverse effects and short-term adverse effects. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were bivalent vaccine/tetravalent/nonavalent vs. placebo/no intervention/other vaccines. We included 29 studies described in 35 publications. Bivalent HPV vaccine offers protection against HPV16 (RD −0.05, 95% CI −0.098 to −0.0032), HPV18 (RD −0.03, 95% CI −0.062 to −0.0004) and HPV16/18 genotypes (RD of −0.1, 95% CI −0.16 to −0.04). On the other side, tetravalent HPV vaccine offered protection against HPV6 (RD of −0.0500, 95% CI −0.0963 to −0.0230), HPV11 (RD −0.0198, 95% CI −0.0310 to −0.0085). Also, against HPV16 (RD of −0.0608, 95% CI −0.1126 to −0.0091) and HPV18 (RD of −0.0200, 95% CI −0.0408 to −0.0123). There was a reduction in the prevalence of HPV16, 18 and 16/18 genotypes when applying the bivalent vaccine, with no increase in adverse effects. Regarding the tetravalent vaccine, we found a reduction in the prevalence of HPV6, 11, 16 and 18 genotypes, with no increase in adverse effects.

Background To assess the effectiveness and harms of music to reduce anxiety and pain in cystoscopy. Methods We searched MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We included clinical trials, involving the assessment of the effect of music in cystoscopy. The primary outcomes were pain and anxiety measured by any scale and the secondary outcomes were length of stay, physiological parameters (blood pressure or heart rate) and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about mean difference (MD) with 95% CI. Heterogeneity was evaluated using the I2 test. Results We included six studies in our qualitative and quantitative analysis. Five studies used a flexible cystoscope and the other one performed the procedure with a rigid cystoscope. Music was played during the procedure in five studies, while the other was before it. All studies compared music vs. no intervention. Almost all items were assessed as low risk of bias; however, the allocation concealment was unclear in all the studies. We found a MD of −1.33 (95% CI −2.45 to −0.21) (I2=97.2%) favoring music for pain and a MD of −8.42 (95% CI −15.02, −1.82) (I2=99.6%) was found, favoring music for anxiety. Conclusions Playing music might be an effective intervention that lowers pain and anxiety in patients who undergo cystoscopy.

To determine the effectiveness and harms of using antibiotic prophylaxis (ABP) versus placebo/no intervention in patients undergoing elective laparoscopic cholecystectomy (eLCC) to prevent surgical site infection (SSI). We searched MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to October 2017. We included clinical trials which involved adults at low risk undergoing eLCC and compared ABP versus placebo/no intervention. The primary outcome was SSI and secondary outcomes were other infections and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about risk difference (RD) with a 95% confidence interval (CI). Heterogeneity was evaluated using the I2 test. We produced network diagrams to show the amount of evidence available for each outcome and the most frequent comparison. We included 18 studies in qualitative and quantitative analysis. The antibiotics most commonly studied were cefazolin and cefuroxime. We found high risk of detection bias in one study and attrition bias in another. Unclear risks of selection, performance, and detection bias were frequent. For SSI, we found no heterogeneity I2 = 0% and no inconsistency p = 0.9780. No significant differences were found when compared ABP versus placebo/no intervention. Cefazolin had a RD of − 0.00 (95% CI − 0.01 to 0.01). We found no differences in regular meta-analysis, with a RD of − 0.00 (95% CI − 0.01 to 0.01) as well as for intra-abdominal and distant infections. Adverse effects were only assessed in one study, without any case reported. This systematic review demonstrated no differences between ABP versus placebo/no intervention when using to prevent SSI and intra-abdominal and distant infections in patients at low risk undergoing eLCC.

Introduction The amount of information and knowledge about pathways and genetic alterations regarding prostate cancer, including the tools available for its study has been recently increasing. Additionally, a variety of molecular signaling pathways control cell proliferation, however, this incompletely understood process is disturbed in cancer cells. Materials and methods A literature review was made using the MEDLINE, Embase and LILACS databases searching for the following keywords: prostate neoplasms, prostate cancer, molecular medicine, genomics, pathways, and cell cycle. Results Different biological mechanisms have been associated with the development of prostate cancer, such as alterations in tumor suppressor genes, oncogenes (TP53, RB1, among others) and CDKIs; DNA methylation; chromosomal alterations and rearrangements; changes in PTEN and PI3K / mTOR; global defects in apoptosis; alterations in the androgen receptor (AR); and epigenetic mechanisms. Conclusions Good clinical practice and a practical approach have to be based on basic knowledge, thus, in this article, the main genetic alterations, mutations and pathways involved in prostate cancer development were reviewed.

Priapism is an involuntary prolonged erection that lasts for more than 4 h. Although several interventions have been proposed to manage the condition, these strategies are based on expert panel opinions, and little evidence exists regarding prognosis and outcomes. To synthetize information about interventions to treat priapism and to make evidence-based recommendations, we performed a literature search of Medline via Ovid, Scopus (including Embase) and Lilacs from 1980 to the current day with the following keywords: ischemic priapism, erectile function, drainage, and shunt. The length of the ischemic priapism is an important variable for the prognosis because of the pathophysiology of this condition. Here, we propose a step-by-step approach based on the time and invasiveness of the intervention. However, it is important to note that we could not find any clinical trial that supports this approach, and more research is needed for the future statements.