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Pereira RO, Correia LA, Farah D, Komoni G, Farah V, Fiorino P. Wistar rat as an animal model to study high-fat induced kidney damage: a systematic review. Arch Physiol Biochem 2024; 130:205-214. [PMID: 34915796 DOI: 10.1080/13813455.2021.2017462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/08/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
The effects of high-fat-associated kidney damage in humans are not completely elucidated. Animal experiments are essential to understanding the mechanisms underlying human diseases. This systematic review aimed to compile evidence of the role of a high-fat diet during the development of renal lipotoxicity and fibrosis of Wistar rats to understand whether this is a satisfactory model for the study of high fat-induced kidney damage. We conducted systematic searches in PUBMED, EMBASE, Lilacs, and Web of Science databases from inception until May 2021. The risk of bias was assessed using SYRCLE toll. Two reviewers independently screened abstracts and reviewed full-text articles. A total of 11 studies were included. The damage varied depending on the age and sex of the animals, time of protocol, and amount of fat in the diet. In conclusion, the Wistar rat is an adequate animal model to assess the effects of a high-fat diet on the kidneys.HighlightsA high-fat diet may promote kidney damage in Wistar rats.Wistar rat is efficient as an animal model to study high-fat-induced kidney damage.The effect of the diet depends on the fat amount, consumption time, and animal age.
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Affiliation(s)
- Renata O Pereira
- Translational Medicine Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Renal, Cardiovascular and Metabolic Physiopharmacology Laboratory, Health and Biological Science Center, Mackenzie University, São Paulo, Brazil
| | - Luana A Correia
- Renal, Cardiovascular and Metabolic Physiopharmacology Laboratory, Health and Biological Science Center, Mackenzie University, São Paulo, Brazil
| | - Daniela Farah
- Women's Health Technology Assessment Center, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Geovana Komoni
- Translational Medicine Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Renal, Cardiovascular and Metabolic Physiopharmacology Laboratory, Health and Biological Science Center, Mackenzie University, São Paulo, Brazil
| | - Vera Farah
- Translational Medicine Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Renal, Cardiovascular and Metabolic Physiopharmacology Laboratory, Health and Biological Science Center, Mackenzie University, São Paulo, Brazil
| | - Patricia Fiorino
- Renal, Cardiovascular and Metabolic Physiopharmacology Laboratory, Health and Biological Science Center, Mackenzie University, São Paulo, Brazil
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Cervantes GV, Ribeiro PAAG, Tomasi MC, Farah D, Ribeiro HSAA. Sexual Function of Patients with Deep Endometriosis after Surgical Treatment: A Systematic Review. Rev Bras Ginecol Obstet 2023; 45:e729-e744. [PMID: 38029775 PMCID: PMC10686762 DOI: 10.1055/s-0043-1772596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/11/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To review the current state of knowledge on the impact of the surgical treatment on the sexual function and dyspareunia of deep endometriosis patients. DATA SOURCE A systematic review was conducted in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted systematic searches in the PubMed, EMBASE, LILACS, and Web of Science databases from inception until December 2022. The eligibility criteria were studies including: preoperative and postoperative comparative analyses; patients with a diagnosis of deep endometriosis; and questionnaires to measure sexual quality of life. STUDY SELECTION Two reviewers screened and reviewed 1,100 full-text articles to analyze sexual function after the surgical treatment for deep endometriosis. The risk of bias was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Collaboration's tool for randomized controlled trials. The present study was registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration CRD42021289742). DATA COLLECTION General variables about the studies, the surgical technique, complementary treatments, and questionnaires were inserted in an Microsoft Excel 2010 (Microsoft Corp., Redmond, WA, United States) spreadsheet. SYNTHESIS OF DATA We included 20 studies in which the videolaparoscopy technique was used for the excision of deep infiltrating endometriosis. A meta-analysis could not be performed due to the substantial heterogeneity among the studies. Classes III and IV of the revised American Fertility Society classification were predominant and multiple surgical techniques for the treatment of endometriosis were performed. Standardized and validated questionnaires were applied to evaluate sexual function. CONCLUSION Laparoscopic surgery is a complex procedure that involves multiple organs, and it has been proved to be effective in improving sexual function and dyspareunia in women with deep infiltrating endometriosis.
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Affiliation(s)
- Graziele Vidoto Cervantes
- Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paulo Augusto Ayroza Galvão Ribeiro
- Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Mariana Carpenedo Tomasi
- Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Daniela Farah
- Department of Gynecology, Women's Health Technology Assessment Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Quintairos RDA, Oliveira Brito LG, Farah D, Ayroza Ribeiro HSA, Galvão Ribeiro PAA. Author's Reply: Letter to the Editor About Systematic Review on Treatment for Deep Infiltrating Endometriosis and Bowel Function. J Minim Invasive Gynecol 2023; 30:679-680. [PMID: 37257773 DOI: 10.1016/j.jmig.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
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Sartori LGF, Nunes BM, Farah D, Oliveira LMD, Novoa CCT, Sartori MGF, Fonseca MCM. Mirabegron and Anticholinergics in the Treatment of Overactive Bladder Syndrome: A Meta-analysis. Rev Bras Ginecol Obstet 2023; 45:337-346. [PMID: 37494577 PMCID: PMC10371066 DOI: 10.1055/s-0043-1770093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB). DATA SOURCE Systematic searches were conducted in EMBASE, PUBMED, Cochrane, and LILACS databases from inception to September 2021. We included RCTs, women with clinically proven OB symptoms, studies that compared mirabegron to antimuscarinic drugs, and that evaluated the efficacy, safety or adherence. DATA COLLECTION RevMan 5.4 was used to combine results across studies. We derived risk ratios (RRs) and mean differences with 95% CIs using a random-effects meta-analytic model. Cochrane Collaboration Tool and GRADE was applied for risk of bias and quality of the evidence. DATA SYNTHESIS We included 14 studies with a total of 10,774 patients. Fewer total adverse events was reported in mirabegron group than in antimuscarinics group [RR 0.93 (0.89-0.98)]. The risk of gastrointestinal tract disorders and dry mouth were lower with mirabegron [RR 0,58 (0.48-0.68); 9375 patients; RR 0.44 (0.35-0.56), 9375 patients, respectively]. No difference was reported between mirabegron and antimuscarinics drugs for efficacy. The adherence to treatment was 87.7% in both groups [RR 0.99 (0.98-1.00)]. CONCLUSION Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.
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Affiliation(s)
| | | | - Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leticia Maria de Oliveira
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Marcelo Cunio Machado Fonseca
- Department of Gynecology, Health Technologies Assessment Center, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Tomasi MC, Ribeiro PAA, Farah D, Vidoto Cervantes G, Nicola ALD, Abdalla-Ribeiro HS. Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1294-1302. [PMID: 36252916 DOI: 10.1016/j.jmig.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This systematic review aimed to review all the available evidence regarding bladder endometriosis (BE) surgical techniques, resolution of symptoms, and nodule size. DATA SOURCES We conducted systematic searches in PubMed MEDLINE, Embase, Latin American and Caribbean Centre on Health Sciences Information, Cochrane Library, and Web of Science databases from inception to December 2021. METHODS OF STUDY SELECTION Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search yielded 1279 articles. Two reviewers independently screened abstracts and reviewed full-text articles to meet the eligibility criteria: women diagnosed as having BE, treated surgically to remove the BE nodule, and reported of the nodule size and/or symptoms after the surgery. We included 28 studies, which mainly were case reports and case series. TABULATION, INTEGRATION, AND RESULTS The following information was extracted from the included studies: author, country, publication year, study design, number of patients, age, surgery performed, follow-up time, operation time, nodule location, nodule size, and postsurgical symptoms. Patients' ages range from 26 to 44 years and most women were nulliparous. The BE nodule size ranged from 0.7 to 5.5 cm, and the most frequent location (63.57%) was the posterior wall. Dysuria was reported by 27.18% of women and generic lower urinary tract symptoms were reported by 27.95%. After surgery, the recurrence rate of urinary symptoms was 7.34%. Most studies performed a partial cystectomy to remove the nodule, showing that the disease affects the bladder mucosa frequently. CONCLUSION Surgical treatment with complete excision of BE lesion was shown to improve complaints of urinary symptoms in patients with BE. Given that most of the studies evaluated were descriptive, additional studies with a large sample population and a better level of evidence for this condition are needed.
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Affiliation(s)
- Mariana Carpenedo Tomasi
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro).
| | - Paulo Augusto Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, Sao Paulo, Brazil (Drs. Farah)
| | - Graziele Vidoto Cervantes
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Ana Luiza De Nicola
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Helizabet Salomão Abdalla-Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
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Quintairos RDA, Brito LGO, Farah D, Ribeiro HSAA, Ribeiro PAAG. Conservative versus Radical Surgery for Women with Deep Infiltrating Endometriosis: Systematic Review and Meta-analysis of Bowel Function. J Minim Invasive Gynecol 2022; 29:1231-1240. [PMID: 36184064 DOI: 10.1016/j.jmig.2022.09.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess bowel function in women with deep infiltrating endometriosis according to surgical approach (radical vs conservative). DATA SOURCES Five databases were searched from 1970 to September 2021 to retrieve studies comparing radical (colorectal segmental resection) and conservative (shaving or discoid excision) surgery for bowel function in women with deep infiltrating endometriosis. METHODS OF STUDY SELECTION No language restriction was applied. Two reviewers extracted and combined data from the included studies, applying a meta-analytic model with random effects in all calculations. Results are expressed in risk ratio (RR) with 95% confidence interval (CI). Assessment of risk of bias and quality of evidence was performed by the Newcastle-Ottawa and Grading of Recommendations, Assessment, Development and Evaluation, respectively. TABULATION, INTEGRATION, AND RESULTS We included 13 studies in our meta-analysis, and most of them were of nonrandomized design. Conservative surgery had fewer events of constipation and frequent bowel movements when compared with radical surgery (RR, 2.31; 95% CI, 1.21-4.43; I2 = 0%; 3 studies; RR, 2.80; 95% CI 1.17-6.75; I2 = 0%; 2 studies, respectively). Defecation pain, anal incontinence loss, minor and major lower anterior resection syndrome, and Clavien-Dindo complications grade I to IV showed no statistically significant difference between surgeries. Grading of Recommendations, Assessment, Development and Evaluation assessment was low to very low for all outcomes. CONCLUSION Conservative surgery (shaving or discoid excision) presented fewer events of constipation and frequent bowel movements than colorectal segmental resection. There was a very low quality of evidence to provide recommendations regarding bowel function.
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Affiliation(s)
- Ricardo de Almeida Quintairos
- From the Center of Endometriosis, Belem, Para (Dr. Quintairos); Division of Gynecology Endoscopy and Endometriosis (Drs. Quintairos and Ribeiro), Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
| | | | - Daniela Farah
- Women's Health Technology Assessment Center (Dr. Farah), Gynecology Department, Federal University of Sao Paulo
| | - Helizabet Salomao Abdalla Ayroza Ribeiro
- Division of Gynecology Endoscopy and Endometriosis (Drs. Quintairos and Ribeiro), Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Paulo Augusto Ayroza Galvao Ribeiro
- Division of Gynecology Endoscopy and Endometriosis (Drs. Quintairos and Ribeiro), Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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da Silva PSL, Reis ME, Farah D, Andrade TRM, Fonseca MCM. Care bundles to reduce unplanned extubation in critically ill children: a systematic review, critical appraisal and meta-analysis. Arch Dis Child 2022; 107:271-276. [PMID: 34284999 DOI: 10.1136/archdischild-2021-321996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/05/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the current evidence for the efficacy of care bundles in reducing unplanned extubations (UEs) in critically ill children. DESIGN Systematic review according to the Cochrane guidelines and meta-analysis using random-effects modelling. METHODS We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Cochrane and SciELO databases from inception until April 2021. We conducted a quality appraisal for each study using the Newcastle-Ottawa Scale and Standards for Quality Improvement Reporting Excellence (SQUIRE) V.2.0 checklist. MAIN OUTCOME The primary outcome measure was UE rates per 100 intubation days. RESULTS We screened 10 091 records and finally included 11 studies. Six studies were pre/post-intervention studies, and five were interrupted time-series studies. The methodological quality was 'good' in 70%, and the remaining as 'fair' (30%). The most frequently used implementation strategies were staff education (100%), root cause analysis (100%), and audit and feedback (82%). Key bundle care components comprised identification of high-risk patients, endotracheal tube care and sedation protocol. Not all studies fully completed the SQUIRE V.2.0 checklist. Meta-analysis revealed a reduction in UE rate following the introduction of care bundles (rate ratio: 0.40 (95% CI: 0.19 to 0.84); p=0.02), which equates to a 60% reduction in UE rates. CONCLUSIONS We found that identifying high-risk patients, endotracheal tube care and protocol-directed sedation are core elements in care bundles for preventing UEs. However, there are several methodological gaps in the literature, including poor evaluation of adherence to bundle components. Future studies should address these gaps to strengthen their validity.
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Affiliation(s)
| | - Maria Eunice Reis
- Division of Neonatology, Santa Joana Hospital and Maternity, Sao Paulo, Brazil
| | - Daniela Farah
- Health Technologies Assessment Center, Federal University of Sao Paulo Paulista School of Medicine, Sao Paulo, Brazil
| | - Teresa Raquel M Andrade
- Health Technologies Assessment Center, Federal University of Sao Paulo Paulista School of Medicine, Sao Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Health Technologies Assessment Center, Federal University of Sao Paulo Paulista School of Medicine, Sao Paulo, Brazil
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Farah D, de Moraes Andrade TR, Sansone D, Batista Castello Girão MJ, Fonseca MCM. A Cost Effectiveness Model of Long-Acting Reversible Contraceptive Methods in the Brazilian National Health System. Am J Prev Med 2022; 62:114-121. [PMID: 34922650 DOI: 10.1016/j.amepre.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of long-acting reversible contraceptives is low among adolescents owing to the high up-front cost. In this study, a 5-year cost-effectiveness model and budget impact analysis were used to compare the use of long-acting reversible contraceptives with the use of combined oral contraceptives among Brazilian adolescents. METHODS A Markov model was developed to mirror the clinical and economic effects of long-acting reversible contraceptives among sexually active Brazilian adolescents in the public health system for a 5-year duration, starting from 2018. The costs were expressed in U.S.$, and a 5% discount rate was applied for both costs and benefits. Model inputs included costs of the contraceptive methods, contraceptive discontinuation and adherence rates, abortion, and birth costs associated with unintended pregnancies. The model outcomes were avoided pregnancies, abortions, and births. Univariate and probabilistic sensitivity analyses were conducted. RESULTS Copper intrauterine device use was dominant 100% of the time for all outcomes, and a budget impact analysis revealed a cost savings of $422,431,269.10 in the 5-year period. Levonorgestrel intrauterine system and subdermal implant use were cost effective for all outcomes. The budget impact analyses revealed costs of $65,645,417.54 for levonorgestrel intrauterine system and $302,852,972.12 for subdermal implant use during the 5-year study period. CONCLUSIONS According to this Brazilian model, copper intrauterine device use is dominant, and levonorgestrel intrauterine systems and subdermal implants are more cost effective than combined oral contraceptives.
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Affiliation(s)
- Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Dayan Sansone
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manoel João Batista Castello Girão
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
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Fonseca MCM, de Araújo GTB, Scorza FA, da Silva PSL, Andrade TRDM, Farah D, Sansone D. Who is going to turn on the ventilators? Einstein (Sao Paulo) 2021; 19:eAO6211. [PMID: 34705947 PMCID: PMC8522706 DOI: 10.31744/einstein_journal/2021ao6211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To analyze the COVID-19 pandemic in Brazil, a continental-sized country, considered as an emerging economy but with several regional nuances, focusing on the availability of human resources, especially for intensive care units. METHODS The database of the National Registry of Health Facilities was accessed. Healthcare professionals in the care of COVID-19 were georeferenced. We correlated the number of professionals with the parameters used by the World Health Organization. According to the Brazilian Intensive Care Medicine Association, we correlated the data for adult intensive care unit beds in each state with the number of professionals for each ten intensive care unit beds. The number of professionals, beds, and cases were then organized by state. RESULTS The number of physicians per 100 thousand inhabitants followed the World Health Organization recommendations; however, the number of nurses did not. The number of intensivists, registered nurses, nurse technicians specialized in intensive care, and respiratory therapists, necessary for every ten intensive care beds, was not enough for any of these professional categories. A complete team of critical care specialists was available for 10% of intensive care unit beds in Brazil. CONCLUSION There is a shortage of professionals for intensive care unit, as we demonstrated for Brazil. Intensive care physical resources to be efficiently used require extremely specialized human resources; therefore, planning human resources is just as crucial as planning physical and structural resources.
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Affiliation(s)
- Marcelo Cunio Machado Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Gabriela Tannus Branco de Araújo
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Fulvio Alexandre Scorza
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Paulo Sérgio Lucas da Silva
- Hospital do Servidor Público Municipal de São PauloSão PauloSPBrazilHospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil.
| | - Teresa Raquel de Moraes Andrade
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Daniela Farah
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Dayan Sansone
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Farah D, Girão MJBC, Fonseca MCM. Willingness to pay for short- and long-acting contraceptives among female adolescents and their parents in Brazil:a pilot study. Einstein (Sao Paulo) 2021; 19:eAO6376. [PMID: 34644746 PMCID: PMC8483636 DOI: 10.31744/einstein_journal/2021ao6376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/26/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate willingness to pay for short- and long-acting reversible contraceptive methods among female Brazilian adolescents and their parents, as well as their perspective on using such methods. Methods This is a cross-sectional study of female adolescents aged 13 to 19 years and their parents. We surveyed to estimate their willingness to pay for contraceptive methods. The values are expressed as mean±standard deviation in Brazilian reals (R$). Spearman correlation was employed for socioeconomic status of parents, age of adolescents and their standpoints. The methods types and adolescent and parent perspectives were analyzed by the test χ2. To determine an agreement between pairs and their willingness to pay, we used the Bland-Altman plot. Results A total of 165 surveys were collected. Short-acting method was significantly more acceptable to pay than the long-action method, by both parents and their daughters. Parents and their daughters are willing to pay out-of-pocket R$ 52,25±22,48 and R$ 51,63±21,24 for short-acting reversible contraception method, and R$ 176,83±130,34 and R$ 174,83±143,64, for long-acting method, respectively. Bland-Altman analysis indicated an agreement on both perspectives and the price they are willing to pay for each contraceptive method. Conclusion Parents and adolescent daughters are more willing to pay for short-acting methods. We showed an agreement between the parent and the daughter for the values paid for each method.
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Affiliation(s)
- Daniela Farah
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Farah D, Andrade TRDM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis. EUR J CONTRACEP REPR 2021; 27:127-135. [PMID: 34431421 DOI: 10.1080/13625187.2021.1964467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. METHODS Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence. RESULTS Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%). CONCLUSION Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.
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Affiliation(s)
- Daniela Farah
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | - Manoel João Batista Castello Girão
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
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12
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Farah D, Andrade TRM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis. EUR J CONTRACEP REPR 2021; 25:492-501. [PMID: 33140990 DOI: 10.1080/13625187.2020.1833187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER CRD42017055452.
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Affiliation(s)
- Daniela Farah
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa Raquel Moraes Andrade
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Manoel João Batista Castello Girão
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
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13
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Andrade TR, Salluh JIF, Garcia R, Farah D, Silva PSLD, Bastos DF, Fonseca MCM. A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit. Rev Bras Ter Intensiva 2021; 33:428-433. [PMID: 35107554 PMCID: PMC8555397 DOI: 10.5935/0103-507x.20210068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objetivo Construir um modelo de custo-efetividade para comparar o uso de propofol com
o de midazolam em pacientes críticos adultos sob uso de
ventilação mecânica. Métodos Foi construído um modelo de árvore decisória para
pacientes críticos submetidos à ventilação
mecânica, o qual foi analisado sob a perspectiva do sistema privado
de saúde no Brasil. O horizonte temporal foi o da
internação na unidade de terapia intensiva. Os desfechos foram
custo-efetividade por hora de permanência na unidade de terapia
intensiva evitada e custo-efetividade por hora de ventilação
mecânica evitada. Foram obtidos os dados do modelo a partir de
metanálise prévia. Assumiu-se que o custo da
medicação estava incluído nos custos da unidade de
terapia intensiva. Conduziram-se análises univariada e de
sensibilidade probabilística. Resultados Pacientes mecanicamente ventilados em uso de propofol tiveram
diminuição de sua permanência na unidade de terapia
intensiva e na duração da ventilação
mecânica, respectivamente, em 47,97 horas e 21,65 horas. Com o uso de
propofol, ocorreu redução média do custo de U$2.998,971
em comparação ao uso do midazolam. A custo-efetividade por
hora de permanência na unidade de terapia intensiva evitada e por
hora de ventilação mecânica evitada foi dominante,
respectivamente, em 94,40% e 80,8% do tempo. Conclusão Ocorreu diminuição significante do custo associado ao uso de
propofol, no que se refere à permanência na unidade de terapia
intensiva e à duração da ventilação
mecânica para pacientes críticos adultos.
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Affiliation(s)
| | | | - Raphaela Garcia
- AxiaBio Life Sciences International Ltda. - São Paulo (SP), Brasil
| | - Daniela Farah
- AxiaBio Life Sciences International Ltda. - São Paulo (SP), Brasil
| | - Paulo Sérgio Lucas da Silva
- Unidade de Terapia Intensiva Pediátrica, Departamento de Pediatria, Hospital do Servidor Público Municipal - São Paulo (SP), Brasil
| | | | - Marcelo Cunio Machado Fonseca
- Departamento de Ginecologia, Núcleo de Avaliação de Tecnologias em Saúde, Universidade Federal de São Paulo - São Paulo (SP), Brasil
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14
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Garcia R, Salluh JIF, Andrade TR, Farah D, da Silva PSL, Bastos DF, Fonseca MCM. A systematic review and meta-analysis of propofol versus midazolam sedation in adult intensive care (ICU) patients. J Crit Care 2021; 64:91-99. [PMID: 33838522 DOI: 10.1016/j.jcrc.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Compare outcomes of adult patients admitted to ICU- length of ICU stay, length of mechanical ventilation (MV), and time until extubation- according to the use of propofol versus midazolam. METHODS We searched MEDLINE, EMBASE, LILACS, and Cochrane databases to retrieve RCTs that compared propofol and midazolam used as sedatives in adult ICU patients. We applied a random-effects, meta-analytic model in all calculations. We applied the Cochrane collaboration tool and GRADE. We separated patients into two groups: acute surgical patients (hospitalization up to 24 h) and critically-ill patients (hospitalization over 24 h and whose articles mostly mix surgical, medical and trauma patients). RESULTS Globally, propofol was associated with a reduced MV time of 4.46 h (MD: -4.46 [95% CI -7.51 to -1.42] p = 0.004, I2 = 63%, 6 studies) and extubation time of 7.95 h (MD: -7.95 [95% CI -9.86 to -6.03] p < 0.00001, I2 = 98%, 16 studies). Acute surgical patients sedation with propofol compared to midazolam was associated with a reduced ICU stay of 5.07 h (MD: -5.07 [95% CI -8.68 to -1.45] p = 0.006, I2 = 41%, 5 studies), MV time of 4.28 h (MD: -4.28; [95% CI -4.62 to -3.94] p < 0.0001, I2 = 0%, 3 studies), extubation time of 1.92 h (MD: -1.92; [95% CI -2.71 to -1.13] p = 0.00001, I2 = 89%, 9 studies). In critically-ill patients sedation with propofol compared to midazolam was associated with a reduced extubation time of 32.68 h (MD: -32.68 [95% CI -48.37 to -16.98] p = 0.0001, I2 = 97%, 9 studies). GRADE was very low for all outcomes. CONCLUSIONS Sedation with propofol compared to midazolam is associated with improved clinical outcomes in ICU, with reduced ICU stay MV time and extubation time in acute surgical patients and reduced extubation time in critically-ill patients.
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Affiliation(s)
- Raphaela Garcia
- AxiaBio Life Sciences International ltda, São Paulo, Brazil; Health Technologies Assessment Center - Department of Gynecology, Escola Paulista de Medicina - Federal University of Sao Paulo, Brazil
| | | | - Teresa Raquel Andrade
- AxiaBio Life Sciences International ltda, São Paulo, Brazil; Health Technologies Assessment Center - Department of Gynecology, Escola Paulista de Medicina - Federal University of Sao Paulo, Brazil
| | - Daniela Farah
- AxiaBio Life Sciences International ltda, São Paulo, Brazil; Health Technologies Assessment Center - Department of Gynecology, Escola Paulista de Medicina - Federal University of Sao Paulo, Brazil
| | - Paulo S L da Silva
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil
| | | | - Marcelo C M Fonseca
- AxiaBio Life Sciences International ltda, São Paulo, Brazil; Health Technologies Assessment Center - Department of Gynecology, Escola Paulista de Medicina - Federal University of Sao Paulo, Brazil.
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15
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Toulson Davisson Correia MI, Castro M, Oliveira Toledo D, Farah D, Sansone D, Morais Andrade TR, Tannus Branco de Araújo G, Fonseca MCM. Nutrition Therapy Cost‐Effectiveness Model Indicating How Nutrition May Contribute to the Efficiency and Financial Sustainability of the Health Systems. JPEN J Parenter Enteral Nutr 2020; 45:1542-1550. [PMID: 33241592 PMCID: PMC8697995 DOI: 10.1002/jpen.2052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Background Method Results Conclusion
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Affiliation(s)
| | | | | | - Daniela Farah
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Dayan Sansone
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Tereza Raquel Morais Andrade
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Gabriela Tannus Branco de Araújo
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Marcelo Cunio Machado Fonseca
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
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16
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Moreira NJD, Dos Santos F, Moreira ED, Farah D, de Souza LE, da Silva MB, Moraes-Silva IC, Lincevicius GS, Caldini EG, Irigoyen MCC. Acute renal denervation normalizes aortic function and decreases blood pressure in spontaneously hypertensive rats. Sci Rep 2020; 10:21826. [PMID: 33311525 PMCID: PMC7733454 DOI: 10.1038/s41598-020-78674-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022] Open
Abstract
Mechanisms involved in the acute responses to renal denervation (RDN) have yet to be fully understood. We assessed urinary volume, autonomic control and aorta vascular reactivity after acute RDN. Male normotensive Wistar rats and spontaneously hypertensive rats (SHR) were divided into normotensive + RDN (ND) or sham surgery (NS), and hypertensive + RDN (HD) or sham surgery (HS). Metabolic parameters and hemodynamic measurements were recorded 72h and 4 days after intervention, respectively. Aortic rings were studied 7 days post RDN in an isometric myograph. Concentration–response curves to phenylephrine, sodium nitroprusside and acetylcholine (10–10–10−5 M) were performed. Two-way ANOVA was used for group comparisons and differences reported when p < 0.05. Results are presented as mean ± SEM. Urinary volume was 112% higher in HD vs. HS (HS = 14.94 ± 2.5 mL; HD = 31.69 ± 2.2 mL) and remained unchanged in normotensive rats. Systolic BP was lower in HD rats (HS = 201 ± 12 vs. HD = 172 ± 3 mmHg) without changes in normotensive group. HD group showed increased HF and LF modulation (HS = 5.8 ± 0.7 ms2vs. HD = 13.4 ± 1.4 ms2; HS = 3.5 ± 0.7 ms2vs. HD = 10.5 ± 1.7 ms2, respectively). RDN normalized vascular reactivity in HD rats and increased phenylephrine response in ND rats. Acute fall in BP induced by RDN is associated with increased urinary volume, which in turn may also have contributed to functional changes of the aorta.
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Affiliation(s)
- Nathalia Juocys Dias Moreira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil.,Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM - UNIFESP), São Paulo, Brazil
| | - Fernando Dos Santos
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil
| | - Edson Dias Moreira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil
| | - Daniela Farah
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil.,Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM - UNIFESP), São Paulo, Brazil
| | - Leandro Eziquiel de Souza
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil
| | - Maikon Barbosa da Silva
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil
| | - Ivana Cinthya Moraes-Silva
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil
| | - Gisele Silvério Lincevicius
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, Brazil.,Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM - UNIFESP), São Paulo, Brazil
| | - Elia Garcia Caldini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
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17
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Ishihara BP, Farah D, Fonseca MCM, Nazário ACP. Abstract P5-08-19: The risk of breast, ovarian and endometrial cancer in obese women submitted to bariatric surgery: A meta-analysis. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-08-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Obesity is related to major risk factors for a number of noncommunicable diseases including cancer. There is a high incidence of breast and endometrial cancer in obese women. Thus, we performed a systematic review followed by meta-analysis to evaluate the relationship between bariatric surgery, a method widely used to treat obesity, and the risk of developing breast, ovarian and endometrial cancer in obese women.
Methods: MEDLINE, EMBASE, LILACS and Cochrane databases were searched from inception until January 2019 which retrieve studies to assessed the risk of breast, ovarian and endometrial cancer in obese women submitted to bariatric surgery. There was no language restriction. We extracted and combined data from studies in order to assess the risk ratio (RR) of developing these cancers. A random-effects, meta-analytic model was applied in all calculations. The New Castle Ottawa and GRADE were used to assess quality and bias of the included studies. Trial registered in PROSPERO (CRD42019112927).
Results: We found 188 articles and only seven of those were included in our meta-analysis, which incorporated a total of 150,528 patients in the bariatric surgery arm and 1,461,938 women in the control arm. The total risk of developing breast, ovarian and endometrial cancer was 0.37 (95%CI [0.28 to 0.48]; I2=87%; 7 studies). The risk of breast cancer was reduced by 61% [RR: 0.39 (95%CI [0.24 to 0.64]; I2= 90%; 6 studies). The risk of ovarian cancer was reduced by 53% [RR: 0.47 (95%CI [0.27 to 0.81]; I2= 0%; 3 studies). The risk of endometrial cancer was reduced by 67% [RR: 0.33 (95%CI [0.21 to 0.51]; I2= 88%; 7 studies).
Conclusion: Bariatric surgery may have a protective effect by reducing the risk of developing breast, ovarian and endometrial cancer in obese women. However, high heterogeneity was found and not explained by our subgroup analysis. Although we couldn’t separate the types of surgeries performed, we hypothesized that the high heterogeneity might be due to the types of surgery. Therefore, we suggest more research with appropriate report of the type of the surgery by group.
Citation Format: Beatriz Pércia Ishihara, Daniela Farah, Marcelo Cunio Machado Fonseca, Afonso Celso Pinto Nazário. The risk of breast, ovarian and endometrial cancer in obese women submitted to bariatric surgery: A meta-analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-19.
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18
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Farah D, Fonseca MCM. Short-term Evidence in Adults of Anorexigenic Drugs Acting in the Central Nervous System: A Meta-Analysis. Clin Ther 2019; 41:1798-1815. [DOI: 10.1016/j.clinthera.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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19
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Farah D, Leme GM, Eliaschewitz FG, Fonseca MCM. A safety and tolerability profile comparison between dipeptidyl peptidase-4 inhibitors and sulfonylureas in diabetic patients: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 149:47-63. [PMID: 30710655 DOI: 10.1016/j.diabres.2019.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/14/2018] [Accepted: 01/21/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND The first treatment approach for type 2 diabetes mellitus is lifestyle change and metformin, but it is usually not sufficient. For some time, the anti-hyperglycemic classes of sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors were considered second-line of treatment, since they show similar efficacy effect. However, the recent ADA-EASD consensus gives the preference to DPP-4 inhibitors compared to sulfonylureas, except if cost is a major problem. We performed a meta-analysis for safety and tolerability profile to comprehend which treatment has less adverse events. METHODS PUBMED and EMBASE databases were searched from inception until July 2017 to retrieve RCT studies comparing DPP-4 inhibitors and sulfonylureas treatments in adult type 2 diabetes patients. There was no language restriction. We extracted and combined data from studies comparison that reported safety profile and weight change. A random effect, meta-analytic model was applied to all calculations. Cochrane collaboration tool was used to assess quality and bias of the included studies. Trial registered with PROSPERO (CRD42017075823). FINDINGS Out of 1472 articles identified in our search and screened for eligibility, 36 studies comparing DPP-4 inhibitors and sulfonylureas were identified. DPP-4 inhibitors in combination with metformin had less overall adverse events (RR: 0·90; 95% CI, 0·86-0·94; p < 0·0001; I2 = 83%; 17 studies), cardiovascular events (RR: 0·54; 95% CI, 0·37-0·79; p = 0·002; I2 = 0%; 6 studies), hypoglycemia (RR: 0·17; 95% CI, 0·13-0·22; p < 0·00001; I2 = 76%; 17 studies) and severe hypoglycemic events (RR: 0·10; 95% CI, 0·05-0·19; p < 0·00001; I2 = 0%; 12 studies). The mean difference of the weight change was 1·92 kg in favor of DPP-4 inhibitors in combination with metformin in relation to sulfonylureas in combination with metformin. Monotherapy with DPP-4 inhibitors also had less rates of hypoglycemia (RR: 0·31; 95% CI, 0·24-0·41; p < 0·00001; I2 = 0%; 8 studies) and severe hypoglycemic events (RR: 0·26; 95% CI, 0·10-0·66; p = 0·004; I2 = 0%; 8 studies) and patients did not gain 1·19 kg. INTERPRETATION These results suggest better safety profile for DPP-4 inhibitors than sulfonylureas for both comparisons, and it is more notable when the treatment regimen includes metformin. FUNDING This study was funded by Takeda Pharmaceuticals, Brazil.
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Affiliation(s)
- Daniela Farah
- Women's Health Technology Assessment Center, Federal University of Sao Paulo (Universidade Federal de São Paulo), Sao Paulo, Brazil
| | | | | | - Marcelo Cunio Machado Fonseca
- Women's Health Technology Assessment Center, Federal University of Sao Paulo (Universidade Federal de São Paulo), Sao Paulo, Brazil; AxiaBio Life Sciences, Sao Paulo, Brazil.
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Philip Rajan D, Siti Sabzah MH, Zulkiflee S, Tengku Mohamed I, Kumareysh Vijay V, Iskandar H, Sobani D, Valuyeetham KA, Shahrul A, Mas D, Azyani N, Farah D, Azmawanie A, Noormala A, Norhana A, Shahrom A, Amirudin M. Surgical and functional outcomes of cochlear implantation in post-lingual and cross-over patients: First 5-year review of the National Ministry of Health Malaysia cochlear implant programme. Med J Malaysia 2018; 73:393-396. [PMID: 30647210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION There has been a paradigm shift in the management of acquired sensory neural deafness in the past 30years. This is due to the emergence of implantable hearing devices such as the cochlear implant. The objective of this study is to identify surgical and functional outcomes of post-lingual and cross-over patients implanted with a cochlear implant under the National Ministry of Heath Cochlear Implant (CI) Program between 2009-2013. MATERIALS AND METHODS We retrospectively reviewed all postlingual and cross-over recipients of cochlear implants under the National Ministry of Heath CI Programme from 2009 to 2013. The outcomes measured were surgical complications and functional outcome. Surgical complications were divided into major and minor complications. Functional outcomes were measured using Categorical Auditory Performances (CAP) scale. RESULTS A total of 41 post-lingual and 15 cross-over patients were implanted between 2009 and 2013. The age of implantees ranged from 3.6 years to 63.2 years old. There were two major complications (3.6%), one is a case of electrode migration at three months post implantation, and six months post second implantation. Another was a case of device failure at about one-year post implantation. Both patients were reimplanted in the same ear. There was no minor complication. The CAP score for both groups (overall) showed significant improvement with 96.4% achieved CAP score of five and above at 24 months after implantation (p<0.001). The CAP score showed marked improvement at the first 6 months post implantation and continued to improve with time in both groups. CONCLUSION The Malaysian National Ministry of Health Cochlear implant (CI) Program between 2009-2013 has been a successful programme with good surgical and functional outcomes among the post lingual and cross-over patients.
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Affiliation(s)
- D Philip Rajan
- Hospital Raja Permaisuri Bainun, Department of Otorhinolaryngology, Ipoh, Perak, Malaysia.
| | - M H Siti Sabzah
- Hospital Sultanah Bahiyah, Department of Otolaryngology, Alor Setar, Kedah, Malaysia
| | - S Zulkiflee
- Hospital Raja Perempuan Zainab II, Department of Otolaryngology, Kota Bharu, Malaysia
| | - I Tengku Mohamed
- Hospital Sultan Ismail, Department of Otolaryngology, Johor Bharu, Malaysia
| | - V Kumareysh Vijay
- Hospital Raja Permaisuri Bainun, Department of Otorhinolaryngology, Ipoh, Perak, Malaysia
| | - H Iskandar
- Hospital Kuala Lumpur, Department of Otolaryngology, Kuala Lumpur, Malaysia
| | - D Sobani
- Hospital Sungai Buloh, Department of Otolaryngology, Selangor, Malaysia
| | - K A Valuyeetham
- Hospital Tuanku Jaafar, Department of Otolaryngology, Seremban, Malaysia
| | - A Shahrul
- Hospital Sultanah Bahiyah, Clinical Research Centre, Alor Setar, Kedah, Malaysia
| | - D Mas
- Hospital Kuala Lumpur, Department of Otolaryngology, Kuala Lumpur, Malaysia
| | - N Azyani
- Hospital Sungai Buloh, Department of Otolaryngology, Selangor, Malaysia
| | - D Farah
- Hospital Sultanah Bahiyah, Department of Otolaryngology, Alor Setar, Kedah, Malaysia
| | - A Azmawanie
- Hospital Raja Perempuan Zainab II, Department of Otolaryngology, Kota Bharu, Malaysia
| | - A Noormala
- Hospital Sungai Buloh, Department of Otolaryngology, Selangor, Malaysia
| | - A Norhana
- Hospital Sultanah Bahiyah, Department of Otolaryngology, Alor Setar, Kedah, Malaysia
| | - A Shahrom
- Hospital Raja Perempuan Zainab II, Department of Otolaryngology, Kota Bharu, Malaysia
| | - M Amirudin
- Hospital Sultan Ismail, Department of Otolaryngology, Johor Bharu, Malaysia
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21
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Moreira N, Dos Santos F, Moreira E, Farah D, De Souza L, Da Silva M, Irigoyen M. P758Acute vascular and autonomic responses of renal denervation in spontaneously hypertensive rats. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Farah D, Nunes J, Sartori M, Dias DDS, Sirvente R, Silva MB, Fiorino P, Morris M, Llesuy S, Farah V, Irigoyen MC, De Angelis K. Exercise Training Prevents Cardiovascular Derangements Induced by Fructose Overload in Developing Rats. PLoS One 2016; 11:e0167291. [PMID: 27930685 PMCID: PMC5145255 DOI: 10.1371/journal.pone.0167291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/11/2016] [Indexed: 12/21/2022] Open
Abstract
The risks of chronic diseases associated with the increasing consumption of fructose-laden foods are amplified by the lack of regular physical activity and have become a serious public health issue worldwide. Moreover, childhood eating habits are strongly related to metabolic syndrome in adults. Thus, we aimed to investigate the preventive role of exercise training undertaken concurrently with a high fructose diet on cardiac function, hemodynamics, cardiovascular autonomic modulation and oxidative stress in male rats after weaning. Male Wistar rats were divided into 4 groups (n = 8/group): Sedentary control (SC), Trained control (TC), Sedentary Fructose (SF) and Trained Fructose (TF). Training was performed on a treadmill (8 weeks, 40–60% of maximum exercise test). Evaluations of cardiac function, hemodynamics, cardiovascular autonomic modulation and oxidative stress in plasma and in left ventricle (LV) were performed. Chronic fructose overload induced glucose intolerance and an increase in white adipose tissue (WAT) weight, in myocardial performance index (MPI) (SF:0.42±0.04 vs. SC:0.24±0.05) and in arterial pressure (SF:122±3 vs. SC:113±1 mmHg) associated with increased cardiac and vascular sympathetic modulation. Fructose also induced unfavorable changes in oxidative stress profile (plasmatic protein oxidation- SF:3.30±0.09 vs. SC:1.45±0.08 nmol/mg prot; and LV total antioxidant capacity (TRAP)- SF: 2.5±0.5 vs. SC:12.7±1.7 uM trolox). The TF group showed reduced WAT, glucose intolerance, MPI (0.35±0.04), arterial pressure (118±2mmHg), sympathetic modulation, plasmatic protein oxidation and increased TRAP when compared to SF group. Therefore, our findings indicate that cardiometabolic dysfunctions induced by fructose overload early in life may be prevented by moderate aerobic exercise training.
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Affiliation(s)
- Daniela Farah
- Laboratory of Metabolic Cardiovascular and Renal Physiopharmacology, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
- Laboratory Experimental Hypertension, Heart Institute (INCOR), School of Medicine, Sao Paulo University (FMUSP), Sao Paulo, Brazil
| | - Jonas Nunes
- Laboratory of Metabolic Cardiovascular and Renal Physiopharmacology, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
| | - Michelle Sartori
- Laboratory Experimental Hypertension, Heart Institute (INCOR), School of Medicine, Sao Paulo University (FMUSP), Sao Paulo, Brazil
- Laboratory of Translational Physiology, Universidade Nove de Julho, Sao Paulo, Brazil
| | | | - Raquel Sirvente
- Laboratory Experimental Hypertension, Heart Institute (INCOR), School of Medicine, Sao Paulo University (FMUSP), Sao Paulo, Brazil
| | - Maikon B. Silva
- Laboratory Experimental Hypertension, Heart Institute (INCOR), School of Medicine, Sao Paulo University (FMUSP), Sao Paulo, Brazil
| | - Patrícia Fiorino
- Laboratory of Metabolic Cardiovascular and Renal Physiopharmacology, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
| | - Mariana Morris
- Institute Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, United States of America
| | - Susana Llesuy
- Department of General and Inorganic Chemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Vera Farah
- Laboratory of Metabolic Cardiovascular and Renal Physiopharmacology, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
| | - Maria-Cláudia Irigoyen
- Laboratory Experimental Hypertension, Heart Institute (INCOR), School of Medicine, Sao Paulo University (FMUSP), Sao Paulo, Brazil
| | - Kátia De Angelis
- Laboratory of Translational Physiology, Universidade Nove de Julho, Sao Paulo, Brazil
- * E-mail:
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Farah H, Farah D, Nunes J, Ogihara C, Cafarchio E, Giannoco G, Angelis K, Irigoyen M, Farah V, Sato M. Exercise training (ET) in treadmill running reduces oxidative stress and inflammatory signaling of the commissural nucleus of the solitary tract (commNTS) and rostral ventrolateral medulla in rats. Auton Neurosci 2015. [DOI: 10.1016/j.autneu.2015.07.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Farah H, Farah D, Nunes J, Ogihara C, Cafarchio E, Giannoco G, Angelis K, Irigoyen M, Farah V, Sato M. Exercise training (ET) in treadmill running reduces oxidative stress and inflammatory signaling of the commissural nucleus of the solitary tract (commNTS) and rostral ventrolateral medulla in rats. Auton Neurosci 2015. [DOI: 10.1016/j.autneu.2015.07.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Elayeh E, Akour A, Yousef A, Farah D, Hamaly M, Basheti I. Osteoporosis Amongst Jordanians: Effect of Pharmacist- Directed Brochure Education on People’s Knowledge. TROP J PHARM RES 2015. [DOI: 10.4314/tjpr.v13i12.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Farah D, Nunes JP, Bechara ACC, Yokota R, Sartori M, Irigoyen MC, De Angelis K, Fiorino P, Farah V. Effects of physical exercise and high fructose diet on cardiac autonomic control in rats. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1138.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Rodrigo Yokota
- NephrologyFederal University of Sao PauloSao PauloBrazil
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Morrison H, Baigel R, Farah D, Ravichandran D. Factors Affecting the Length of Hospital Stay after Breast Cancer Surgery: A Prospective Study. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Farah D. Papers show U.S. role in Guatemalan abuses. In declassified documents, diplomats describe massacres, CIA ties to Army. Int J Health Serv 2000; 29:897-9. [PMID: 10615580 DOI: 10.2190/kue2-pgfg-h4bf-hw8g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently declassified U.S. intelligence documents reveal the close ties between the United States and the Guatemalan military and security forces during Guatemala's 36-year civil war, even though U.S. officials were aware of the government's and army's massive human rights abuses.
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Ali AKA, Farah D. Some mechanical factors affecting machine milking characteristics under semi-arid condition. Asian Australas J Anim Sci 1992. [DOI: 10.5713/ajas.1992.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hall MJ, Downs L, Ene MD, Farah D. Effect of reduced phytate wheat bran on zinc absorption. Eur J Clin Nutr 1989; 43:431-40. [PMID: 2545437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The rise in plasma zinc after the ingestion of 765 mumol (50 mg) elemental zinc was measured over 6 h in three groups of healthy subjects who, in a second test, also consumed a standard wheat bran, a reduced phytate, high fibre processed bran or rice-based, low phytate, low fibre breakfast cereal (Rice Krispies). Standard bran, reduced phytate bran and Rice Krispies all significantly decreased the area under the plasma zinc time curve (AUC) compared to the zinc alone test. The AUC obtained with standard bran was significantly lower than that after reduced phytate bran (mean +/- s.e.: -5.9 +/- 2.7 vs 18.5 +/- 4.2 mumol.h/l, P less than 0.001). The percentage reductions in AUC produced by the test meals were: standard bran 106.4 +/- 2.4, reduced phytate bran 75.9 +/- 4.8, Rice Krispies 46.3 +/- 10.4 per cent, P less than 0.01). Histidine, taken with standard bran in a small subgroup of subjects, tended to improve zinc absorption but the difference was not statistically significant.
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Affiliation(s)
- M J Hall
- University Department of Medicine, Bristol Royal Informary, UK
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Abstract
In a study of patients attending a rheumatology clinic 230 unselected patients, 185 with rheumatoid arthritis (RA) and 45 with other rheumatic disorders (non-RA), were examined by endoscopy and a detailed history of symptoms referable to the gastrointestinal tract was taken. A peptic ulcer was found in 67 (36%) of the patients and in 13 (29%) of the non-RA group. Gastric ulceration was more common in the group with RA (32 patients (17%) compared with three patients (7%) in the non-RA group); 17/32 (53%) patients with RA and gastric ulcer were asymptomatic. In the group with RA, of those with gastric ulcer 20/32 (63%) were smokers, compared with only 40/118 (34%) of the non-ulcer group. There was no difference in the duration of rheumatic disease or non-steroidal anti-inflammatory drug (NSAID) treatment between the ulcer and non-ulcer groups. Treatment with H2 receptor antagonist and maintenance of NSAID treatment resulted in healing in 26 out of 29 (90%) patients with gastric ulcer and 23 out of 27 (85%) patients with duodenal ulcer.
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Affiliation(s)
- D Farah
- Department of Gastroenterology, Royal Infirmary, Glasgow
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