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Contexto: A COVID-19 é uma doença viral que surgiu recentemente e associada à síndrome da angústia respiratória severa (SARS). Seu potencial de gravidade e impacto na saúde da população e economia global é objeto primordial na busca por uma terapêutica eficaz ea ivermectina tem sido recomendada para prevenção e tratamento da COVID-19. Objetivo: avaliar como evidências na literatura relativa ao uso de ivermectina para prevenção e tratamento de casos de COVID-19. Desenho de estudo: Trata-se de sinopse de evidências. Métodos:Procedeu-se à busca de bases eletrônicas de dados PubMed (1966-2021), EMBASE (1974-2021) e Clinical Trials (2021) e em dois megabuscadores de evidências: Turning Research Into Practice (TRIP) database (2021) e Epstemonikos ( 2021). Não houve restrição geográfica e de idioma, sendo utilizados descritores e termos do DeCS (Descritores em Ciências da Saúde). O método de síntese envolveu uma combinação de estudos semelhantes em uma revisão narrativa. Resultados: Foram identificados 527 citações e 5 estudos foram incluídos. Há poucos ensaios clínicos concluídos todos apresentam pequena. Discussão: A maioria dos estudos disponíveis na literatura respalda-se em respostas terapêuticas in vitroea recomendação para uso em humanos tem-se baseado nos achados desses estudos. A questão não pode ser respondida com os estudos atuais, sendo recomendada a realização de ensaios de qualidade. Conclusões: Não há suporte atualmente na literatura para uso da ivermectina na prevenção ou tratamento COVID-19.

CONTEXT AND OBJECTIVE: Determining prognostic factors in a context of health crises such as the COVID-19 scenario may provide the best possible care for patients and optimize the management and the resource utilization of the health system. Thus, we aim to systematically review the prognostic factors for different outcomes of patients with COVID-19. DESIGN AND SETTING: Protocol for a rapid living systematic review methodology following the recommendations proposed by the Cochrane Handbook. METHODS: We will include cohorts and case‐control studies. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS- LILACS, Scopus and WebofScience to identify studies. No language restrictions will be applied. We will perform the critical appraisal of included studies with the Quality in Prognosis Studies (QUIPS) tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

CONTEXT AND OBJECTIVE: The current health crisis due to COVID-19 is forcing us to profoundly rethink our social organizations and practices in health. While there is no effective treatment for the virus, staying home and social isolation are the control measures recommended by health authorities. The aim of this study is to perform a scoping review in order to summarize the current evidence in telehealth for COVID-19. METHODS: This study is a protocol to describe the rationale, hypothesis and planned methods of our scoping review. We will include randomized controlled trials (RCTs), observational cohort studies, case-control studies, cross-sectional studies, qualitative studies, and/or case series that describe telehealth interventions applied or developed to respond to COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, and Scopus. We will include studies performed since December 2019 with no language restrictions. We will use the Risk of Bias tool and the Newcastle-Ottawa Scale to perform the critical appraisal of included studies. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

CONTEXT AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) has emerged in China in December 2019 and rapidly spread. Although extraordinary efforts have been made on research regarding pharmacological interventions, none have proven effective. This is the protocol for a rapid living systematic review that aims to compare the effectiveness and safety of different pharmacological interventions for the treatment of COVID-19. METHODS: rapid living systematic review methodology with Network Meta-Analysis following the recommendations of Cochrane Handbook. We will include randomized controlled trials (RCT) and quasi-RCTs that evaluate single and/or combined pharmacological interventions at any dose for the treatment of COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebofScience to identify potentially eligible studies. No language restrictions will be used in the selection. We will perform the critical appraisal of included studies with the Risk of Bias tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Inhaled hypertonic saline is used for bronchial challenge and sputum induction in patients with chronic obstructive pulmonary disease (COPD). We studied the effects of saline aerosol inhalation before each exercise session in an 8-week pulmonary rehabilitation program.This was a double-blind randomized parallel controlled trial, conducted at an out-patient clinic. Sixty-eight subjects with COPD (mean age 67 +/- 6.5 y, percent of predicted FEV(1) 47 +/- 21) were randomized to inhale either 3% hypertonic saline (34 subjects) or normal saline (34 subjects) before each exercise session in an 8-week exercise program that had 3 sessions per week. We measured 6-min walk distance, dyspnea, and quality of life (with the Medical Outcomes Study 36-item short-form health survey).After the 8-week exercise program, both groups' mean 6-min walk distance had significantly increased: from 195 +/- 92 m to 251 +/- 97 m (P.001) in the hypertonic-saline group, and from 237 +/- 93 m to 441 +/- 121 m in the normal-saline group (P.001). The normal-saline group had greater improvement than the hypertonic-saline group (P.001). Dyspnea score improved from 3.1 +/- 0.9 to 2.3 +/- 0.8 (P.01) in the hypertonic-saline group, and from 3.5 +/- 0.2 to 2.3 +/- 1.0 (P.01) in the normal-saline group. Quality of life also significantly improved, except for the physical-functioning and social aspect domains in the hypertonic-saline group. Adverse effects (cough or bronchospasm) occurred in 4 patients (12%) in the hypertonic-saline group.The improvement in 6-min walk distance was greater with normal saline than with hypertonic saline. Hypertonic saline was associated with adverse effects. It is unclear whether the only predictor of improved functional exercise capacity was exercise training. (ClinicalTrials.gov number, NCT00639236.).

It would be useful to have a clinical test that increases the suspicion of white coat hypertension (WCH) during the medical consultation.To evaluate the Slow Breathing Test (SBT) when differentiating hypertension from WCH.101 hypertensive patients selected at triage had their medication withdrawn for 2-3 weeks. The blood pressure (BP) was measured before and after the SBT at two consultations at the office. The test consisted in breathing for 1 minute at the frequency of one respiratory cycle every 10 seconds. Two diagnostic criteria were compared: 1--decrease in diastolic BPor = 10% in at least one visit or 2--decrease in BP to normal levels (140/90 mm Hg) in at least one visit. The ambulatory blood pressure monitoring (ABPM) was performed while blinded to the clinical measurements.71 women and 30 men, with a mean age of 51+/-10 years, with mean pre and post-test BP of 152+/-17/ 99+/-11 and 140+/-18/ 91+/-11 mm Hg were assessed. Nine patients had normal clinical and ambulatory measurements. Of the 92 patients, 28 (30%) were classified as having WCH; 15 had a positive test for Criterion 1 and 21 for the Criterion 2. Among 64 (70%) hypertensive individuals, 14 tested positive for Criterion 1 and 12 for Criterion 2. Sensitivity and specificity (95% CI): 0.54 (0.36-0.71) and 0.78 (0.67-0.87) for Criterion 1; 0.75 (0.57-0.87) and 0.81 (0.70-0.89) for Criterion 2.The SBT showed an increase in the clinical suspicion of WCH in two visits when using the BP normalization criterion. This finding suggests that the test can help in the optimization of ABPM requests for suspected cases.

To evaluate whether different quality assessment tools applied to a group of clinical trials could be correlated, and what would be their impact on meta-analysis results.Thirty-eight randomized controlled clinical trials were analyzed. These had been selected for a systematic review of the therapeutic efficacy of alpha interferon for treating chronic hepatitis B. The following tools were utilized: Maastricht (M), Delphi (D), Jadad (J) and the Cochrane Collaboration (CC) method (gold standard). The Spearman correlation coefficient was used to compare the results from the three methods. The Kappa test was used to assess the concordance between the reviewers in applying the tools, and the weighted Kappa test was applied to compare the quality ranking determined by the tools. The outcomes assessed in the meta-analyses were clearance of HBV-DNA and HBeAg.The studies presented regular to low quality. The concordance between reviewers varied according to the instrument utilized: D=0.12; J=0.29; M=0.33; and CC=0.53. The correlation was moderate and homogeneous (D/J=0.51; D/M=0.53; and J/M=0.52). The meta-analysis result relating to HBV-DNA ranged from RR=0.71 (95% CI: 0.66-0.77) to RR=0.67 (95% CI: 0.58-0.79). For HBeAg, the results ranged from RR=0.85 (95% CI: 0.80-0.90) to RR=0.85 ( 95% CI: 0.77-0.93). These results depended on the quality of the studies included.The quality assessment tools presented good correlation. In systematic reviews with the same direction of effect, the quality assessment may not significantly change the results. The Cochrane Collaboration method was the most reproducible method and easiest to apply.

Painful shoulder is considered the most common complication of hemiplegic/parethic (H/P) stroke patients. It is a negative factor for neuromotor recovery.To study the effects of kinesiotherapy treatment on shoulder pain prevention, and as a secondary endpoints, to analyze muscle strength of H/P shoulder looking at basic functional active mobility.Twenty one inpatients (12 men, 9 women) aged 26 to 87 years, with post-stroke H/P were submitted to thirty minutes daily program kinesiotherapy, started at 48 hours post-stroke up to their hospital discharge. Patients were evaluated pre and post treatment according to the presence or absence of shoulder pain, movements and shoulder strength, and for presence or absence of basic functional movements.No patient complaining of shoulder pain at the hospital discharge (p0.001). The muscle strength improved signifcantly for elevation, protusion, abduction and flexion of the shoulder (p0.001). There was improvement also for functional mobility on moving from dorsal to lateral recumb, from lateral recumb to a seated position and in keeping the seated position (p0.001).Kinesiotherapy in acute phase of stroke prevented shoulder pain.

The aim of this research was to perform a Comparative Effectiveness Research (CER) synthesis of two Cochrane systematic reviews on the effects of interventions in treating halitosis and to evaluate the rigour in their conduct and methodological quality using a validated tool that has been developed specifically for the assessment of multiple systematic reviews (AMSTAR). Methods: Electronic databases were searched from their inception to 2005 and further updated to February 2009. These searches retrieved 990 citations, which after assessment for relevance left 20 potentially eligible studies. Independent and duplicate application of the inclusion criteria excluded all but 7 of these reports from further review. The reference lists were handsearched to ensure that no trials had been missed. Results: A total of seven trials were identified. Two provided some weak and unreliable evidence for the use of tongue scraping as a means of controlling halitosis. Reduction of volatile sulphur compounds (VSC) levels in one trial was short lived and the other showed a small amount of tongue trauma induced by 1 week of tongue scraping. Five trials provided data for the mouthrinses: 0.05% chlorhexidine + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse significantly reduced the mean change (standard deviation (SD)) of organoleptic scores from baseline compared to placebo (-1.13 (1.1) P < 0.005 versus -0.2 (0.7)) and also caused a more significant reduction in the mean change (SD) in peak level of VSC (-120 (92) parts per billion (ppb) versus 8 (145) ppb in placebo). Chlorhexidine cetylpyridinium chloride zinc lactate mouthrinse showed significantly more tongue (P < 0.001) and tooth (P < 0.002) staining compared to placebo. Assessment of the methodological quality of the systematic reviews based on the 11-item AMSTAR tool confirmed their high quality. Conclusions: This comparative effectiveness research synthesis has illustrated the short-lived effect of tongue scraping on reducing VSC levels and that the potential for adverse effects with their long-term use should be off set against the possibly limited duration of their benefits in VSC reduction. It also highlighted the diversity in effectiveness of some of the more popular over the counter mouthrinses in treating halitosis. Antibacterial mouthrinses such as chlorhexidine or cetylpyridinium chloride can reduce bacterial levels on the tongue but the effectiveness of chlorine dioxide and zinc containing mouthrinses in neutralisation of odoriferous sulphur compounds should not be underestimated. There would therefore appear to be a place in the management strategy of halitosis for formulations, which include and combine some of these constituents. Following one of the fundamental principles of the Cochrane Systematic Reviews, this work was updated in April 2014 and only one of the chosen studies met the inclusion criteria, but added no new information that would alter the conclusions of this thesis. Further well-constructed randomized controlled trials, which comply with CONSORT, are necessary and future research should explore outcomes that are both relevant and patient-preferred and should aim to provide evidence for people to make informed decisions whether these treatments are effective. Este trabalho foi desenvolvido objetivando uma síntese da pesquisa de efetividade comparada (CER) de duas revisões sistemáticas da Cochrane sobre os efeitos das intervenções no tratamento da halitose, e para avaliar o rigor na sua conduta e qualidade metodológica usando uma ferramenta validada que foi desenvolvida especificamente para a avaliação de várias revisões sistemáticas (AMSTAR). Métodos: bases de dados eletrônicas foram pesquisadas a partir de sua criação até 2005 e atualizadas até fevereiro de 2009. Essas pesquisas recuperaram 990 citações e, após avaliação da pertinência, 20 estudos remanesceram como potencialmente elegíveis. A aplicação independente e em duplicata dos critérios de inclusão excluiu 13 destes, permanecendo 7 para revisão adicional. Listas de referências foram manualmente buscadas para assegurar que nenhum ensaio foi perdido. Resultados: Um total de sete ensaios foram identificados. Dois forneceram algumas evidências fracas e pouco confiáveis para o uso de higienizador de língua como um meio de controlar a halitose. A redução dos níveis de compostos sulfurados voláteis (CSV) em um estudo teve pouca duração e o outro mostrou uma pequena quantidade de trauma da língua induzido após 1 semana de higienização da língua com escova de cerdas macias. Cinco ensaios forneceram dados para a aplicação de enxaguantes bucais: bochechos com (Clorexidina 0,05% + 0,05% de Cloreto de cetilpiridínio + 0,14% de Lactato de zinco) reduziram significativamente a variação média (desvio-padrão (SD)) dos escores organolépticos dos dados iniciais em comparação com uso de placebo (-1,13 (1,1) P < 0,005 versus -0,2 (0,7)) e também causaram uma redução mais significativa na variação média (DP), em nível de pico de compostos sulfurados voláteis (CSV) (-120 (92) partes por bilhão (ppb) versus 8 (145) ppb de placebo). Bochechos com Cloreto de Cetilpiridínio + Clorexidina + Lactato de zinco mancharam mais significativamente a língua (P