Background: Different scales have attempted to assess various aspects of family dynamics and structures. Good family function seems to allow for better prognoses for basic diseases and appears to be a predictor of depression. The aim of this study was to determine the association between family functionality and depression. Methods: This is a systematic review and meta-analysis including cross-sectional, cohort, and case-control studies using validated instruments such as the Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve) and Family Adaptability and Cohesion Evaluation Scale III. A search strategy was designed for the MEDLINE, Embase, Central, and LILACS databases along with data saturation through a search of unpublished literature from the onset of the databases to the present. The categorical variables are expressed in terms of odds ratios (OR), and the statistical analysis was carried out using Review Manager ver. 5.31 (The Cochrane Collaboration, Oxford, UK) using forest plots with corresponding 95% confidence intervals (CI). A fixed-effect model was used according to the expected heterogeneity, expressed in terms of I 2. The risk of bias was evaluated using the MINORS (methodological index for non-randomized studies) tool. Results: A total of 1,519 studies were found, of which 10 were selected for the qualitative synthesis and four were chosen for the meta-analysis. The result for the association between family dysfunction and depression yielded an OR (95% CI) of 3.72 (2.70 to 5.12) and I 2 of 24%. Conclusion: Family dysfunction and depression are strongly associated.

Regarding the study published by Ramirez-Sevilla et al. (1) in your prestigious journal, we would like to make specific comments:Metabolic syndrome encompasses multiple diseases, such as visceral obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol levels (HDL-C). Multiple epidemiologic studies and meta-analyses demonstrate the association between Lower urinary tract symptoms and metabolic syndrome, according to its pathogenesis: systemic inflammation and oxidative stress.(2) In consequence, metabolic syndrome and all its components are risk factors for developing urinary tract infections, and this is a vital population for having the intention to prevent this deleterious condition. Hence, considering any new tool to prevent UTIs might improve these patients' quality of life. Furthermore, in this study, inclusion criteria are vague and imprecise, and definitions are outdated. (3) Therefore, conclusion might not be applicable nowadays.Accordingly, assessing the effect of healthcare interventions is vital to inform and deciding. Researchers routinely use multiple study designs to evaluate the hypothesis, although a few are internationally accepted for decision-making. Randomized trials (RCT) are considered the "gold standard" of causal inference: large sample size, and randomization, among other characteristics. However, this study might be impractical and unethical in some settings. Consequently, observational studies are an alternative to RCT, ensuring a comparison group and well-documented statistical methods, mimicking the gold standard design. (4) Although Ramirez-Sevilla et al. refer to the study as being comparative, it must not be considered as it since they did not compare the vaccine against any other intervention but presenting one factor or not. In this case, they could have evaluated the effect in smokers or metabolic syndrome patients with a subgroup analysis.

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Introduction: Although the levels of low-density lipoprotein (LDL-C) should ideally be determined by beta quantification or enzymatic methods, there are limitations in developing countries. The goal of this study is to compare LDL-C obtained through three formulae (LDL-Cnf) with LDL-C obtained through the Friedewald formula (LDL-Cf) using LDL-C through enzymatic methods as the most-accepted reference method in clinical practice (LDL-Cr).Methods: A concordance study was carried out in a reference laboratory in Cali, Colombia. The three formulae were (mg/ dl): Men with triglycerides under 400 mg/dl: LDL-C = Total Cholesterol (TC) -triglycerides (TG) /6.5) -45; men with triglycerides equal to or greater than 400 mg/dl: LDL-C = (TC -(TG / 7)) -50 and women: LDL-C = (TC-(TG /6.5)) -70.Results: Three-hundred fifteen values were obtained of which 53% were for women. The mean age and LDL-Cr were 54 years (±15.8) and 112.1 mg/dl (±32.5), respectively. The median (interquartile range, mg/dl) of TC, high-density lipoprotein (HDL-C) and TG were 204 mg/dl (171-229), 51 mg/dl (41-61), and 156 mg/dl (99-237), respectively. There were no differences between mean values of p=0.45). The intraclass correlation coefficient among LDL-Cr and LDL-Cf and LDL-Cnf were high (R=0.93 and 0.92, respectively). The correlation between LDL-Cf and LDL-Cnf was 0.95. There is no difference between the areas under the receiver operating characteristic (ROC) curve with the level of LDL-Cr at 160 mg/dl for LDL-Cnf and LDL-Cf. (0.94 vs. 0.93; p=0.27). Conclusion:There is high concordance between LDL-Cf and LDL-Cnf. These formulae could be an alternative when there are limitations to determine LDL-C because of the lack of enzymatic methods or through Friedewald formula due to the absence of HDL-C.