Oral drugs for hypertensive urgencies: systematic review and meta-analysis

CONTEXTO E OBJETIVO: Urgências hipertensivas são definidas como elevações graves na pressão arterial sem evidência de danos agudos ou progressivos a órgãos-alvo. A necessidade de tratamento é considerada urgente, mas permite um controle gradual, utilizando-se drogas orais ou sublinguais. Se o aumento na pressão arterial não está associado a risco de vida ou danos a órgãos alvo, o controle pressórico deve ser feito lentamente durante 24 horas. em relação às urgências hipertensivas, não é conhecida qual a classe de drogas anti-hipertensivas que promove os melhores resultados e há controvérsia em relação a quando e quais as drogas devem ser utilizadas nestas situações. O objetivo desta revisão foi avaliar a efetividade e a segurança de drogas orais para urgências hipertensivas. METODOS: Esta revisão sistemática da literatura foi desenvolvida no Centro Cochrane do Brasil, e na Disciplina de Medicina de Urgência e Medicina Baseada em Evidências da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (Unifesp-EPM), de acordo com a metodologia da Colaboração Cochrane. RESULTADOS: Os 16 ensaios clínicos aleatórios selecionados incluíram 769 participantes e demonstraram um efeito superior dos inibidores da enzima conversora de angiotensina no tratamento da urgência hipertensiva, avaliada em 223 participantes. Os efeitos adversos mais frequentes para os bloqueadores de canal de cálcio foram cefaleia (35/206), rubor (17/172) e alterações do ritmo cardíaco (14/189); para os inibidores da enzima conversora de angiotensina, o efeito colateral mais frequente foi disgeusia (25/38). CONCLUSÕES: Há evidências importantes a favor do uso de inibidores da enzima conversora da angiotensina para o tratamento de urgências hipertensivas, quando comparados aos bloqueadores dos canais de cálcio, devido a maior efetividade e à menor frequência de efeitos adversos, como cefaléia e rubor facial.

Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies

OBJECTIVETo determine the current status of the literature regarding the clinical efficacy and complication rates of cryoablation vs radiofrequency ablation in the treatment of small renal tumours.METHODSA review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: MEDLINE, EMBASE and LILACS.Inclusion criteria were (i) case series design with more than one case reported, (ii) use of cryoablation or radiofrequency ablation, (iii) patients with renal cell carcinoma and, (iv) outcome reported as clinical efficacy.When available, we also quantified the complication rates from each included study.Proportional meta-analysis was performed on both outcomes with a random-effects model. The 95% confidential intervals were also calculated.RESULTSThirty-one case series (20 cryoablation, 11 radiofrequency ablation) met all inclusion criteria.The pooled proportion of clinical efficacy was 89% in cryoablation therapy from a total of 457 cases. There was a statistically significant heterogeneity between these studies showing the inconsistency of clinical and methodological aspects.The pooled proportion of clinical efficacy was 90% in radiofrequency ablation therapy from a total of 426 cases. There was no statistically significant heterogeneity between these studies.There was no statistically significant difference regarding complications rate between cryoablation and radiofrequency ablation.CONCLUSIONSThis review shows that both ablation therapies have similar efficacy and complication rates.There is urgency for performing clinical trials with long-term data to establish which intervention is most suitable for the treatment of small renal masses.

Meta-análise de parâmetros genéticos relacionados ao consumo alimentar residual e a suas características componentes em bovinos

The objective of this work was to estimate, by meta-analysis, the heritability (h(2)) and the genetic (r(g)) and phenotypic (r(f)) correlations of residual feed intake (RFI), and of its component traits in beef cattle from 19 breeds or genetic groups. Twenty-two scientific papers published from 1963 to 2011, from eight countries, totaling 52,637 cattle of ages from 28 days up to slaughter, were evaluated. The estimates of RFI, dry matter intake (DMI), average daily gain (ADG) and metabolic weight (BW0.75) were weighted by the inverse of sample variance. The variation between studies of h(2) for each trait was analyzed by weighted least squares. The effects of sex, country and breed were significant for h(2) of RFI, explaining 67% of variation between studies. For DMI, country and breed effects were significant and explained 96% of variation. Pooled estimates of h(2) were: 0.255+/-0.008, 0.278+/-0.012, 0.321+/-0.015, and 0.397+/-0.032 for RFI, DMI, ADG and BW0.75, respectively. Pooled estimates of genetic and phenotypic correlations were low between RFI and ADG and between RFI and BW0.75 (from -0.021+/-0.034 to 0.025+/-0.035), and moderate between RFI and DMI (0.636+/-0.035 and 0.698+/-0.041) and between DMI, ADG and BW0.75 (0.441+/-0.062 to 0.688+/-0.032). The trait RFI has lower heritability estimates than its components.

Rural property size drives patterns of upland and riparian forest retention in a tropical deforestation frontier

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A Meta-Analysis of Predation Risk Effects on Pollinator Behaviour

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

GnRH agonist versus GnRH antagonist in poor ovarian responders: A meta-analysis

The aim of this meta-analysis was to compare the efficacy of gonadotrophin antagonist (GnRH-ant) versus GnRH agonist (GnRHa) as coadjuvant therapy for ovarian stimulation in poor ovarian responders in IVF/intracytoplasmic sperm injection cycles. Search strategies included on-line surveys of databases such as MEDLINE, EMBASE and others. A fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Six trials fulfilled the inclusion criteria (randomized controlled trials). There was no difference between GnRH-ant and GnRHa (long and flare-up protocols) with respect to cycle cancellation rate, number of mature oocytes and clinical pregnancy rate per cycle initiated, per oocyte retrieval and per embryo transfer. When the mete-analysis was applied to the two trials that had used GnRH-ant versus long protocols of GnRHa, a significantly higher number of retrieved oocytes was observed in the GnRH-ant protocols [P = 0.018; WMD: 1.12 (0.18, 2.05)]. However, when the meta-analysis was applied to the four trials that had used GnRH-ant versus flare-up protocols, a significantly higher number of retrieved oocytes (P = 0.032; WMD: -0.51, 95% CI -0.99, -0.04) was observed in the GnRHa protocols. Nevertheless, additional randomized controlled trials with better planning are needed to confirm these results.

Recombinant LH supplementation to recombinant FSH during induced ovarian stimulation in the GnRH-antagonist protocol: A meta-analysis

This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration (P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocytes retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further. © 2007 Published by Reproductive Healthcare Ltd.

Heuristics and meta-heuristics for lot sizing and scheduling in the soft drinks industry: A comparison study

This chapter studies a two-level production planning problem where, on each level, a lot sizing and scheduling problem with parallel machines, capacity constraints and sequence-dependent setup costs and times must be solved. The problem can be found in soft drink companies where the production process involves two interdependent levels with decisions concerning raw material storage and soft drink bottling. Models and solution approaches proposed so far are surveyed and conceptually compared. Two different approaches have been selected to perform a series of computational comparisons: an evolutionary technique comprising a genetic algorithm and its memetic version, and a decomposition and relaxation approach. © 2008 Springer-Verlag Berlin Heidelberg.

Meta-heuristic approaches for a soft drink industry problem

The present paper evaluates meta-heuristic approaches to solve a soft drink industry problem. This problem is motivated by a real situation found in soft drink companies, where the lot sizing and scheduling of raw materials in tanks and products in lines must be simultaneously determined. Tabu search, threshold accepting and genetic algorithms are used as procedures to solve the problem at hand. The methods are evaluated with a set of instance already available for this problem. This paper also proposes a new set of complex instances. The computational results comparing these approaches are reported. © 2008 IEEE.

Correlação entre a taxa de fertilização e o fuso meiótico em oócitos humanos: Uma meta-análise

Objective: To investigate the relationship between the presence of meiotic spindle in human oocytes and fertilization rates in ICSI cycles. Methods: Search strategies included online surveys of databases from 1990 to 2008. Nine trials fulfilled the inclusion criteria Results: According to the meta-analysis, the results showed statistically significant higher fertilization rate (p<0.0001) when the meiotic spindle was viewed than when it was not. There was heterogeneity in this comparison. Conclusion: The presence of a birefringent meiotic spindle in human oocytes can predict a higher fertilization rate. This observation has clinical relevance mainly in countries where there is a legal limit on the number of oocytes to be fertilized. Copyright - SBRA - Sociedade Brasileira de Reprodução Assistida.

Progresos en la reducción de la pobreza extrema en América Latina: dimensiones y políticas para el análisis de la primera meta del milenio

Incluye Bibliografía

Practica anticonceptiva requerida para lograr una meta prescrita de natalidad bruta: un macromodelo propuesto (TABRAP) e ilustraciones hipoteticas

Incluye Bibliografía

A meta-analytical study about the relation of blood plasma addition in diets for piglets in the post-weaning and productive performance variables

The meta-analysis was used to evaluate the performance of piglets in post-weaning period, without imposition of sanitary challenge and fed diets containing blood plasma, obtained by spray-dried process (SDBP). Piglets are faced with normal challenges in post-weaning period such as environmental stress and the substitution of the liquid diet to a solid one. References regarding sanitary challenges were disregarded in this study. Only data regarding normal and expected challenges were considered. Data were obtained from indexed journals with information extracted from the material, methods and results sections of pre-selected scientific articles. First, the database was analyzed graphically to observe the distribution of data and presence of outliers. Afterwards correlation analysis and variance-covariance analyses were carried out. The database contained a total of 23 articles. The average initial weight of the piglets was 8.02. kg (4.00-9.28. kg) and the average initial age was 27 days (14-32 days). The average duration of feeding diets containing spray-dried blood plasma (SDBP) was 9 days (6-28 days). SDBP increased the feed conversion by 20.2% (P<0.05) during the initial period. Feed conversion during the total period was 10.2% higher (P<0.05) for animals fed with SDBP. Average daily weight gain and daily feed intake were not affected (P>0.05) during the entire period, but average daily gain was higher (P<0.05) for animals fed with SDBP during the initial period. The initial age of supplementation influenced the average daily weight gain and average daily feed intake of animals fed with SDBP. Better results were obtained than those obtained for animals up to 35 days of age fed diets without added SDBP supplementation. In early post-weaning period for piglets weaned up to 35 days of age, the SDBP supplementation positively influenced the average daily weight gain and feed conversion. © 2013 Elsevier B.V.

Informe del Seminario Regional sobre Sistemas Ambientales y Estrategias para Ampliar la Frontera Agropecuaria en América Latina = Report of the Regional Seminar on Environmental Systems and Strategies for Extending the Agricultural Frontier in Latin America

Contiene los antecedentes y el resumen de los debates del seminario que tuvo como propósito hacer un aporte a la ejecución del proyecto del mismo nombre cuyo objetivo básico es propiciar metodologías viables que tiendan a disminuir el costo ecológico de las transformaciones y a formar silvoagrosistemas sustentables, y que puedan ser utilizados por los planificadores y encargados de proyectos de desarrollo agrícola y regional en áreas de expansión de frontera agropecuaria.