BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous press... more BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H 2 O 2 , and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks.
Although substantial increases in the numbers of elderly people are now foreseen in all countries... more Although substantial increases in the numbers of elderly people are now foreseen in all countries, greater growth is expected in developing regions such as Brazil, where the proportions are expected to become 18.8% in 2020 and 29.3% in 2050. 1,2 Primary care is considered to be the front line for healthcare for the elderly and can provide regular contacts focused on preventing disabilities resulting from chronic health conditions, such as classification of cognitive impairment in this age group. 3 Healthcare professionals are faced with the challenge of evaluating the limit of normality among elderly people's cognitive alterations. Within the concept of senescence, they need to differentiate the expected changes for this age group from the pathological conditions of aging that constitute senility. If such conditions are seen at the prodromal stage, reversal or mitigation may still be possible. 4,5 Development of dementia in elderly people is a measurable risk. Thus, the pathological transition to this, from a mild stage of cognitive impairment, forms a "gray zone" between normality and initial dementia. 4 Screening for cognitive impairment among elderly people can be achieved through instruments that have already been translated and validated for application in Brazil. 6 Bustamante et al. 7 suggested that cognitive tests and functional scales should be used in combination, in populations with educational heterogeneity. This would improve the accuracy of cognitive screening among mild to moderate cases of dementia because, when used together, they
Para garantir uma ciencia confiavel, ela deve ser produzida por meio de processos transparentes e... more Para garantir uma ciencia confiavel, ela deve ser produzida por meio de processos transparentes e robustos e atualmente como um elemento central para o a transparencia dos processos consiste na integridade cientifica. A integridade cientifica consiste na adesao de estrategias que permitam a promocao e o desenvolvimento de padroes cientificos eticos e honestos que garantam a objetividade, clareza, reprodutibilidade, abertura e acessibilidade, o dever de cuidar, justica em fornecer referencias e dar credito e responsabilidade para os cientista e pesquisadores futuros. Diante dessa perspectiva, o Portal de Revistas Cientificas da UNIFESP foi construido. Lancado em 2019, um dos compromissos e alcancar e manter os mais altos padroes de integridade cientifica.
O magnésio é o quarto mineral mais abundante no organismo humano e o segundo no meio intracelular... more O magnésio é o quarto mineral mais abundante no organismo humano e o segundo no meio intracelular.1 É relevante como cofator enzimático em cerca de 300 reações, incluindo síntese proteica, transmissão nervosa, condução neuromuscular, controle da glicose no sangue e regulação da pressão sanguínea. É também fundamental para o metabolismo de adenosina trifosfato (ATP) e síntese de DNA (ácido desoxirribonucleico) e RNA (ácido ribonucleico).2 De todo o magnésio consumido na dieta, entre 24% e 76% são absorvidos pelo intestino delgado por meio de mecanismo
Contexto: A COVID-19 e uma doenca causada por um coronavirus recentemente descrita e associada a ... more Contexto: A COVID-19 e uma doenca causada por um coronavirus recentemente descrita e associada a sindrome da angustia respiratoria severa (SARS) Atualmente tem impacto grave na saude da populacao e na economia global Esforcos tem ocorrido na tentativa de um tratamento eficaz, sendo a cloroquina uma opcao em foco Objetivo: Avaliar as evidencias na literatura relativas ao uso de cloroquina/hidroxicloroquina, associada ou nao a azitromicina, para tratamento de casos graves de COVID-19 Desenho de estudo: Trata-se de sinopse de evidencias Metodos: Procedeu-se a busca em cinco bases eletronicas de dados: Cochrane Central Register of Controlled Trials (2020), PubMed (1966-2020), EMBASE (1974-2020), Scopus (2020) e Web of Science (2020), alem do megabuscador de evidencias Turning Research Into Practice (TRIP) database (2020) e pesquisa livre na internet Nao houve restricao geografica e de idioma, sendo utilizados descritores e termos do DeCS (Descritores em Ciencias da Saude) O metodo de si...
Introduction: The effectiveness of tinnitus treatment represents a huge gap in the medical scienc... more Introduction: The effectiveness of tinnitus treatment represents a huge gap in the medical science. Acamprosate is a glutamatergic antagonist drug and GABA-agonist that could be used to control tinnitus due to its action on peripheral and central neurotransmission. Purpose: To assess the effectiveness of acamprosate in the treatment of tinnitus. Material and Methods: This is a systematic review and we searched for randomized clinical trials linking acamprosate to tinnitus in six databases: Cochrane - Central Register of Controlled Trials - CENTRAL (2021), PUBMED (1966-2021), EMBASE (1974-2021), IBECS (1982-2021), QINSIGHT (2021) and SCOPUS (2021). Two researchers independently extracted the data and assessed the quality of the studies. Results: Two trials involving 121 patients were included. The methodological quality of these studies was low. Both studies evaluated as primary outcome the efficacy of acamprosate in improving tinnitus. The meta-analysis by random model resulted in n...
Objective: To synthesize the available data on the economic burden of Coronavirus Diseases 2019 (... more Objective: To synthesize the available data on the economic burden of Coronavirus Diseases 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Influenza-Like Illness (ILI), Respiratory Syncytial Virus (RSV)-related Acute Respiratory Infection (ARI), and Parainfluenza Virus type III (PIV3)-related ARI in Upper-Middle-Income Countries (UMIC), highlighting its major causes and comparing direct costs among nations. Study design: Systematic review, following the recommendations proposed in the Cochrane Handbook, but with some adaptations from previous economic studies. Review question: Is there any economic cost of viral ARI in UMIC? Types of studies to be included: Partial economic evaluation, such as Cost-of-Illness (COI) studies and burden of illness/diseases, database analysis, observational reports (cross-sectional studies, and prospective and retrospective cohort), and economic modelling studies that discuss one of the viral ARI in UM...
The Cochrane Library represents excellence in the production of systematic reviews, which are con... more The Cochrane Library represents excellence in the production of systematic reviews, which are considered to provide the best evidence for diminishing uncertainties within healthcare. It is among the ten most important medical journals worldwide and is available to Brazilians openly and free of charge. 1-2 Within the Cochrane Library, there is a collection of databases that provides evidence directed towards Cochrane systematic reviews and their protocols (Cochrane review in progress) and towards Cochrane database systematic reviews (CDSR). The Cochrane Library also includes the largest directory of clinical trials in the world (CENTRAL, the Central Register of Controlled Trials) and Cochrane Clinical Answers, which is an integrated search resource that enables searches in external databases, all within the same tool. 3 Cochrane reviews are live publications, given that they are updated every two years. The Cochrane Library offers its users the best two levels of evidence for decision-making within healthcare.
To be included in the "Medicine, General & Internal" category of the Web of Science Journal Citat... more To be included in the "Medicine, General & Internal" category of the Web of Science Journal Citation Report is a distinction for a select group of 165 journals that are considered to be the most influential in this category worldwide. This means standing shoulder-to-shoulder with giants like the New England Journal of Medicine, Lancet, JAMA, BMJ and Annals of Internal Medicine. Here, we wish to highlight the Brazilian presence among these journals.
Since the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, the coronav... more Since the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, the coronavirus disease (COVID-19) has spread worldwide. On March 11, 2020, the World Health Organization declared the outbreak of the COVID-19 disease to be a pandemic event and a Public Health Emergency of International Concern. In the meantime, its epidemiological picture has been constantly changing. Up to July 9, 2020, almost 12 million cases had been confirmed, with 545,481 deaths, in 213 countries and territories around the world, as reported to the World Health Organization (WHO). 1,2 Amidst this pandemic, the world still needs to deal with the burden of various other diseases that present overlapping occurrences. Whether these are communicable or non-communicable, much remains to be learned regarding how to manage them all, so as to simultaneously mitigate issues relating to healthcare system saturation. In particular, countries located in tropical and subtropical regions, where arboviral diseases occur abundantly, are still dealing with these old endemics, which for some countries are epidemic diseases. 3-6 Individuals affected by these various diseases may present clinical features that range from subclinical to severe forms, such as encephalitic or hemorrhagic forms, with very significant fatality rates. 5 It has been estimated that more than two billion people live in environments suitable for arbovirus dissemination. 7 Throughout the world, epidemiologists have been warning of temporal coincidence between endemic peaks and outbreaks relating to arboviruses and COVID-19. 8,9 The constantly evolving knowledge of COVID-19 and its characteristics suggests that it and arboviral diseases share similarities with regard to clinical manifestations and laboratory findings. 4,7 So far, dengue fever
BACKGROUND: Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of i... more BACKGROUND: Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of infection. OBJECTIVE: To assess whether patients undergoing pharmacological treatment for IMID present higher risk of worse outcomes when diagnosed with COVID-19. DESIGN AND SETTING: Rapid systematic review conducted in the medical school of the Federal University of São Paulo (SP), Brazil. METHODS: We searched CENTRAL, MEDLINE, EMBASE, LILACS, SCOPUS, Web of Science, L•OVE, ClinicalTrials.gov and WHO-ICTRP for studies evaluating patients diagnosed with COVID-19 who were undergoing pharmacological treatment for IMID. Two authors selected studies, extracted data and assessed risk of bias and certainty of evidence, following the Cochrane recommendations. RESULTS: We identified 1,498 references, from which one cohort study was included. This compared patients with and without rheumatic diseases (RD) who all had been diagnosed with COVID-19. Those with RD seemed to have higher chances of hospitalization and mortality, but no statistical difference was detected between the groups: hospitalization: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.6 to 2.29; mortality rate: OR 1.53; 95% CI 0.33 to 7.11 (very low certainty of evidence). Patients with RD were three times more likely to require admission to intensive care units (ICUs), with invasive mechanical ventilation (IMV), than those without RD: OR 3.72; 95% CI 1.35 to 10.26 (for both outcomes; very low certainty of evidence). CONCLUSION: Patients undergoing pharmacological treatment for IMID seem to present higher chances of requiring admission to ICUs, with IMV. Additional high-quality studies are needed to analyze the effects of different treatments for IMID.
Homemade cloth face masks as a barrier against respiratory droplets-systematic review Máscaras de... more Homemade cloth face masks as a barrier against respiratory droplets-systematic review Máscaras de tecido na contenção de gotículas respiratórias-revisão sistemática Mascarillas caseras para contener gotas respiratorias: revisión sistemática
BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous press... more BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H 2 O 2 , and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks.
Although substantial increases in the numbers of elderly people are now foreseen in all countries... more Although substantial increases in the numbers of elderly people are now foreseen in all countries, greater growth is expected in developing regions such as Brazil, where the proportions are expected to become 18.8% in 2020 and 29.3% in 2050. 1,2 Primary care is considered to be the front line for healthcare for the elderly and can provide regular contacts focused on preventing disabilities resulting from chronic health conditions, such as classification of cognitive impairment in this age group. 3 Healthcare professionals are faced with the challenge of evaluating the limit of normality among elderly people's cognitive alterations. Within the concept of senescence, they need to differentiate the expected changes for this age group from the pathological conditions of aging that constitute senility. If such conditions are seen at the prodromal stage, reversal or mitigation may still be possible. 4,5 Development of dementia in elderly people is a measurable risk. Thus, the pathological transition to this, from a mild stage of cognitive impairment, forms a "gray zone" between normality and initial dementia. 4 Screening for cognitive impairment among elderly people can be achieved through instruments that have already been translated and validated for application in Brazil. 6 Bustamante et al. 7 suggested that cognitive tests and functional scales should be used in combination, in populations with educational heterogeneity. This would improve the accuracy of cognitive screening among mild to moderate cases of dementia because, when used together, they
Para garantir uma ciencia confiavel, ela deve ser produzida por meio de processos transparentes e... more Para garantir uma ciencia confiavel, ela deve ser produzida por meio de processos transparentes e robustos e atualmente como um elemento central para o a transparencia dos processos consiste na integridade cientifica. A integridade cientifica consiste na adesao de estrategias que permitam a promocao e o desenvolvimento de padroes cientificos eticos e honestos que garantam a objetividade, clareza, reprodutibilidade, abertura e acessibilidade, o dever de cuidar, justica em fornecer referencias e dar credito e responsabilidade para os cientista e pesquisadores futuros. Diante dessa perspectiva, o Portal de Revistas Cientificas da UNIFESP foi construido. Lancado em 2019, um dos compromissos e alcancar e manter os mais altos padroes de integridade cientifica.
O magnésio é o quarto mineral mais abundante no organismo humano e o segundo no meio intracelular... more O magnésio é o quarto mineral mais abundante no organismo humano e o segundo no meio intracelular.1 É relevante como cofator enzimático em cerca de 300 reações, incluindo síntese proteica, transmissão nervosa, condução neuromuscular, controle da glicose no sangue e regulação da pressão sanguínea. É também fundamental para o metabolismo de adenosina trifosfato (ATP) e síntese de DNA (ácido desoxirribonucleico) e RNA (ácido ribonucleico).2 De todo o magnésio consumido na dieta, entre 24% e 76% são absorvidos pelo intestino delgado por meio de mecanismo
Contexto: A COVID-19 e uma doenca causada por um coronavirus recentemente descrita e associada a ... more Contexto: A COVID-19 e uma doenca causada por um coronavirus recentemente descrita e associada a sindrome da angustia respiratoria severa (SARS) Atualmente tem impacto grave na saude da populacao e na economia global Esforcos tem ocorrido na tentativa de um tratamento eficaz, sendo a cloroquina uma opcao em foco Objetivo: Avaliar as evidencias na literatura relativas ao uso de cloroquina/hidroxicloroquina, associada ou nao a azitromicina, para tratamento de casos graves de COVID-19 Desenho de estudo: Trata-se de sinopse de evidencias Metodos: Procedeu-se a busca em cinco bases eletronicas de dados: Cochrane Central Register of Controlled Trials (2020), PubMed (1966-2020), EMBASE (1974-2020), Scopus (2020) e Web of Science (2020), alem do megabuscador de evidencias Turning Research Into Practice (TRIP) database (2020) e pesquisa livre na internet Nao houve restricao geografica e de idioma, sendo utilizados descritores e termos do DeCS (Descritores em Ciencias da Saude) O metodo de si...
Introduction: The effectiveness of tinnitus treatment represents a huge gap in the medical scienc... more Introduction: The effectiveness of tinnitus treatment represents a huge gap in the medical science. Acamprosate is a glutamatergic antagonist drug and GABA-agonist that could be used to control tinnitus due to its action on peripheral and central neurotransmission. Purpose: To assess the effectiveness of acamprosate in the treatment of tinnitus. Material and Methods: This is a systematic review and we searched for randomized clinical trials linking acamprosate to tinnitus in six databases: Cochrane - Central Register of Controlled Trials - CENTRAL (2021), PUBMED (1966-2021), EMBASE (1974-2021), IBECS (1982-2021), QINSIGHT (2021) and SCOPUS (2021). Two researchers independently extracted the data and assessed the quality of the studies. Results: Two trials involving 121 patients were included. The methodological quality of these studies was low. Both studies evaluated as primary outcome the efficacy of acamprosate in improving tinnitus. The meta-analysis by random model resulted in n...
Objective: To synthesize the available data on the economic burden of Coronavirus Diseases 2019 (... more Objective: To synthesize the available data on the economic burden of Coronavirus Diseases 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Influenza-Like Illness (ILI), Respiratory Syncytial Virus (RSV)-related Acute Respiratory Infection (ARI), and Parainfluenza Virus type III (PIV3)-related ARI in Upper-Middle-Income Countries (UMIC), highlighting its major causes and comparing direct costs among nations. Study design: Systematic review, following the recommendations proposed in the Cochrane Handbook, but with some adaptations from previous economic studies. Review question: Is there any economic cost of viral ARI in UMIC? Types of studies to be included: Partial economic evaluation, such as Cost-of-Illness (COI) studies and burden of illness/diseases, database analysis, observational reports (cross-sectional studies, and prospective and retrospective cohort), and economic modelling studies that discuss one of the viral ARI in UM...
The Cochrane Library represents excellence in the production of systematic reviews, which are con... more The Cochrane Library represents excellence in the production of systematic reviews, which are considered to provide the best evidence for diminishing uncertainties within healthcare. It is among the ten most important medical journals worldwide and is available to Brazilians openly and free of charge. 1-2 Within the Cochrane Library, there is a collection of databases that provides evidence directed towards Cochrane systematic reviews and their protocols (Cochrane review in progress) and towards Cochrane database systematic reviews (CDSR). The Cochrane Library also includes the largest directory of clinical trials in the world (CENTRAL, the Central Register of Controlled Trials) and Cochrane Clinical Answers, which is an integrated search resource that enables searches in external databases, all within the same tool. 3 Cochrane reviews are live publications, given that they are updated every two years. The Cochrane Library offers its users the best two levels of evidence for decision-making within healthcare.
To be included in the "Medicine, General & Internal" category of the Web of Science Journal Citat... more To be included in the "Medicine, General & Internal" category of the Web of Science Journal Citation Report is a distinction for a select group of 165 journals that are considered to be the most influential in this category worldwide. This means standing shoulder-to-shoulder with giants like the New England Journal of Medicine, Lancet, JAMA, BMJ and Annals of Internal Medicine. Here, we wish to highlight the Brazilian presence among these journals.
Since the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, the coronav... more Since the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, the coronavirus disease (COVID-19) has spread worldwide. On March 11, 2020, the World Health Organization declared the outbreak of the COVID-19 disease to be a pandemic event and a Public Health Emergency of International Concern. In the meantime, its epidemiological picture has been constantly changing. Up to July 9, 2020, almost 12 million cases had been confirmed, with 545,481 deaths, in 213 countries and territories around the world, as reported to the World Health Organization (WHO). 1,2 Amidst this pandemic, the world still needs to deal with the burden of various other diseases that present overlapping occurrences. Whether these are communicable or non-communicable, much remains to be learned regarding how to manage them all, so as to simultaneously mitigate issues relating to healthcare system saturation. In particular, countries located in tropical and subtropical regions, where arboviral diseases occur abundantly, are still dealing with these old endemics, which for some countries are epidemic diseases. 3-6 Individuals affected by these various diseases may present clinical features that range from subclinical to severe forms, such as encephalitic or hemorrhagic forms, with very significant fatality rates. 5 It has been estimated that more than two billion people live in environments suitable for arbovirus dissemination. 7 Throughout the world, epidemiologists have been warning of temporal coincidence between endemic peaks and outbreaks relating to arboviruses and COVID-19. 8,9 The constantly evolving knowledge of COVID-19 and its characteristics suggests that it and arboviral diseases share similarities with regard to clinical manifestations and laboratory findings. 4,7 So far, dengue fever
BACKGROUND: Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of i... more BACKGROUND: Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of infection. OBJECTIVE: To assess whether patients undergoing pharmacological treatment for IMID present higher risk of worse outcomes when diagnosed with COVID-19. DESIGN AND SETTING: Rapid systematic review conducted in the medical school of the Federal University of São Paulo (SP), Brazil. METHODS: We searched CENTRAL, MEDLINE, EMBASE, LILACS, SCOPUS, Web of Science, L•OVE, ClinicalTrials.gov and WHO-ICTRP for studies evaluating patients diagnosed with COVID-19 who were undergoing pharmacological treatment for IMID. Two authors selected studies, extracted data and assessed risk of bias and certainty of evidence, following the Cochrane recommendations. RESULTS: We identified 1,498 references, from which one cohort study was included. This compared patients with and without rheumatic diseases (RD) who all had been diagnosed with COVID-19. Those with RD seemed to have higher chances of hospitalization and mortality, but no statistical difference was detected between the groups: hospitalization: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.6 to 2.29; mortality rate: OR 1.53; 95% CI 0.33 to 7.11 (very low certainty of evidence). Patients with RD were three times more likely to require admission to intensive care units (ICUs), with invasive mechanical ventilation (IMV), than those without RD: OR 3.72; 95% CI 1.35 to 10.26 (for both outcomes; very low certainty of evidence). CONCLUSION: Patients undergoing pharmacological treatment for IMID seem to present higher chances of requiring admission to ICUs, with IMV. Additional high-quality studies are needed to analyze the effects of different treatments for IMID.
Homemade cloth face masks as a barrier against respiratory droplets-systematic review Máscaras de... more Homemade cloth face masks as a barrier against respiratory droplets-systematic review Máscaras de tecido na contenção de gotículas respiratórias-revisão sistemática Mascarillas caseras para contener gotas respiratorias: revisión sistemática
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