Introduction: The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis  was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies.Material and Methods: We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women.Results: Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth.Discussion: Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone.Conclusion: Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age.

RESUMOTem-se verificado crescente aumento do uso da revisão sistemática como metodologia de investigação para compilar e analisar grandes conjuntos de dados de estudos existentes. Com este aumento também aumentaram as recomendações para conduzir este tipo de investigação. O objectivo deste artigo é fornecer um guia para compreender e/ou realizar uma revisão sistemática para publicação, indicando todas as etapas do processo de revisão. Ao fazerem uma revisão sistemática da literatura, os autores tornam-se conhecedores do tema e, embora consuma muito tempo, podem desenvolver um conjunto de competências incluindo a de pesquisa da literatura e de redacção científica. A revisão sistemática, comparada com a investigação primária, requer relativamente poucos recursos, permitindo que os clínicos normalmente não envolvidos em investigação produzam artigos clinicamente relevantes e de alta qualidade. Palavras-chave:ABSTRACT There has been an increase in the use of systematic review as a research methodology to compile and analyze large datasets of existing studies. With this increase, the recommendations to conduct this type of research also increased. The aim of this article is to provide a guide for understanding and/or undertaking a systematic review for publication across all stages of the review process. When doing a systematic review of the literature the authors become knowledgeable of the subject and, although time-consuming, they can develop a set of skills including literature research and scientific writing. A systematic review, compared to primary research, requires relatively few resources, allowing clinicians not normally involved in research to produce clinically relevant, high-quality articles.

Objectives To compare the treatments used to treat dentin hypersensitivity (DH), based on its efficacy and effect duration. Methods Medline/PubMed, Cochrane Library, EMBASE and ClinicalTrials were searched for articles published between 1 January 2008 and 14 November 2018, in English, Portuguese or Spanish, reporting clinical trials, completed and with results. This systematic review protocol was registered in PROSPERO, number CRD42019121986. Results Seventy‐four randomised clinical trials were included in the systematic review, reporting patients from 16 to 65 years old, with a clinical diagnosis of DH, that evaluate the efficacy of a desensitising product, compared to pre‐treatment, used the evaporative method stimulation and the visual analogue scale. These studies evaluated 5366 patients and at least 9167 teeth. Seven follow‐up periods were considered corresponding to an immediate, medium or long‐time effect. Sixty‐six studies were included in the quantitative synthesis. Glutaraldehyde with HEMA, glass ionomer cements and Laser present significant immediate (until 7 days) DH reduction. Medium‐term (until 1 month) reduction was observed in stannous fluoride, glutaraldehyde with HEMA, hydroxyapatite, glass ionomer cements and Laser groups. Finally, long‐term significant reduction was seen at potassium nitrate, arginine, glutaraldehyde with HEMA, hydroxyapatite, adhesive systems, glass ionomer cements and LASER. Conclusions All active ingredients show efficacy in DH reduction in different follow‐up times. Only in‐office treatments are effective in immediate DH reduction, maintaining its efficacy over time. For long‐time effects, at‐home treatments can also be used. More standardised evaluation protocols should be implemented to increase the robustly of the results.

BackgroundDespite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective.MethodsWe present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies.ResultsTwenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers.ConclusionsThere is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.

Aims:The aim of this study was to assess the stroke rate after transcatheter mitral valve repair (TMVR) with the MitraClip, comparing it with surgical mitral valve repair (SMVR) and optimal medical treatment (OMT). Methods and results:In December 2018, we systematically searched PubMed, Embase and Cochrane Controlled Register of Trials for studies comparing TMVR with SMVR and/or OMT for the treatment of severe mitral regurgitation. Random-effects and cumulative meta-analysis was performed. Ten studies were included (seven of TMVR versus SMVR and three of TMVR versus OMT), providing a total of 1,881 patients and 61 pooled strokes (16 in TMVR versus SMVR and 45 in TMVR versus OMT). There was no difference in stroke incidence between TMVR and SMVR (pooled OR 0.49 [0.17, 1.42], p=0.19). However, there was a trend towards a lower stroke risk in TMVR. For TMVR versus OMT, no difference in stroke rate was identified (pooled OR 1.09 [0.60, 1.97], p=0.79). Post-procedure de novo atrial fibrillation was more frequent in SMVR when compared with TMVR.Conclusions: Despite both a low number of pooled stroke events and the failure to reach the pre-specified statistical significance, there was a trend for a lower post-procedure stroke rate in TMVR when compared with SMVR and a similar one between TMVR and OMT alone.

Owing to an increased demand for safe and esthetically pleasing dental materials, ceramics have been developed and optimized to rehabilitate anterior and posterior teeth. This evolution in ceramic materials is directly related to the development of sophisticated processing technologies and systems for use in dental medicine, particularly computer-aided design/computer-assisted manufacture (CAD/CAM) technology. This study is a systematic review outlining long-term clinical survival rates of single-tooth restorations fabricated with CAD/CAM technology with a minimum follow-up of 3 years. A bibliographic search up to September 2016 was performed using two databases: MEDLINE (PubMed) and Embase. Selected keywords and well-defined inclusion and exclusion criteria guided the search of relevant results. All articles were first reviewed by title, then by abstract, and subsequently by a full text reading. Data were assessed and extracted through a standardized form. The pooled results were statistically analyzed, and the overall failure rate was calculated by random effects model. Reported failures were analyzed by CAD/CAM system, type of restoration, restorative material, and luting agent. From a total of 2,916 single-tooth restorations with a mean exposure time of 7.0 years and 351 failures, the failure rate was 2.17% per year, estimated per 100 restoration years (95% confidence interval [CI]: 1.35% to 3.51%). The estimated total survival rate after 5 years was 89.7% (95% CI: 88.1% to 91.1%). The overall survival rate of single-tooth ceramic restorations fabricated with CAD/CAM technology was similar to those conventionally manufactured.

In the last two decades, zirconia-based restorations have been increasingly used in Dentistry. Patients tend to choose metal-free restorations, preferring materials with similar properties to the natural teeth and similar characteristics of light scattering, achieving good esthetic results [1]. Polycrystalline ceramics, in which zirconia stands out, are ceramics that do not have glassy components, with a dense and cohesive structure that are very difficult to break and fracture [2]. Given those characteristics, Garvie et al. (1975)[3] entitled zirconia as "ceramic steel". Then, considering that zirconia is the dental ceramic material with the highest strength, it can be used as monolithic material, presenting notable advantages mainly related to the non-occurrence of chipping off a veneering ceramic and its numerous indications of use in single, partial, and full-mouth rehabilitation. Also, it presents high biocompatibility, less wear of the antagonist, easiness to polish, high hardness, low thermal conductivity, and chemical stability [4].The emergence of these new materials like monolithic zirconia (MZ) combined with digital technology allows increasingly biomimetic results. In vitro studies showed superior performance and results regarding mechanical strength of MZ[5,6], allowing its use mainly for cases with unfavorable occlusion, parafunctional habits, previous fractures, and limited space for restorative materials [7].However, clinical evidence of the existing literature on clinical performance and durability of this type of restorations is still scarce. There is a lack of clinical studies with a follow-up longer than five years,

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