Evidence on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticoids for rheumatoid arthritis (RA) is inconclusive and is not up to date. This systematic review assessed the effectiveness and safety of these anti-inflammatories (AI) in the treatment of RA. COCHRANE (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science and Virtual Health Library were searched to identify randomized controlled trials (RCT) with adults which used AI (dose represented in mg/day) compared with placebo or active controls and was carried out up to December of 2019. Reviewers, in pairs and independently, selected studies, performed the data extraction and assessed the risk of bias. The quality of the evidence was assessed by GRADE. Network meta-analyses were performed using the Stata v.14.2. Twenty-six articles were selected (NSAIDs = 21 and corticoids = 5). Naproxen 1,000 improved physical function, reduced pain and the number of painful joints compared to placebo. Etoricoxib 90 reduced the number of painful joints compared to placebo. Naproxen 750 reduced the number of swollen joints, except for etoricoxib 90. Naproxen 1,000, etoricoxib 90 and diclofenac 150 were better than placebo regarding patient assessment. Assessment physician showed that NSAIDs were better than placebo. Meta-analyses were not performed for prednisolone and prednisone. Naproxen 1,000 was the most effective drug and celecoxib 200 showed fewer adverse events. However, the low quality of the evidence observed for the outcomes with NSAIDs, the absence of meta-analyses to assess the outcomes with corticoids, as well as the risk of bias observed, indicate that future RCT can confirm such findings.

RESUMOA compreensão da influência do membro superior na marcha de indivíduos hemiparéticos é de extrema importância. Sendo assim, o trabalho objetivou-se no estudo da importância que o membro superior tem na marcha de pacientes após acidente vascular encefálico (AVE). Foi realizada uma revisão bibliográfica na qual buscou-se artigos científicos nas bases de dados, LILACS, BIREME, SciELO e Cochrane. A pesquisa levou em consideração trabalhos publicados no período de 2002 a 2014. De acordo com os artigos encontrados, concluiu-se que a biomecânica da marcha está diretamente relacionada ao membro superior, sendo assim, qualquer disfunção poderá alterar a marcha de pacientes após AVE. Palavras-chave: marcha; extremidade superior; paresia; acidente vascular cerebral. ABSTRACTThe understanding the influence of the upper limb in the gait of hemiparetic subjects is of utmost importance. Thus, the work aimed to study the importance of the upper limb in the gait of post-encephalic vascular accident (EVA) patients. We conducted a brief literature review of scientific articles in the databases LILACS, BIREME, SciELO, and Cochrane. The research took into account articles published between 2002 and 2014. According to the articles studied, it was concluded that the gait biomechanics is directly related to the upper limb, thus, any dysfunction can change the gait of patients after EVA. Keywords: gait; upper extremity; paresis; stroke. INTRODUÇÃOA biomecânica é o estudo do comportamento de sistemas biológicos, sendo relevantes os conceitos e as leis da mecânica, baseadas nas três leis de Isaac Newton, as quais são bases importantes para locomoção, lei do movimento e da gravidade: a primeira é a Lei da Inércia, a segunda é a Lei do Princípio Fundamental da Dinâmica, e a terceira é a Lei é a da Ação e Reação. Torna-se assim possível analisar e descrever qualquer tipo de movimento realizado pelo corpo humano.O andar é uma das principais habilidades do indivíduo e, apesar de sua complexidade, esse se caracteriza por movimentos suaves, regulares e repetitivos, com surpreendente eficiên-cia do ponto de vista neuro-músculo-esquelético.¹ A marcha é composta de movimentos compassados e alternados dos membros, e também do tronco, que desloca o centro de gravidade do corpo. No desenvolvimento infantil, quando a criança começar a ter os reflexos de proteção, esses reflexos passam a ser integrados e ter funcionalidade. Entre 11 e 12 meses ela começa a se segurar em móveis, passando sozinha por todas as posições, já realiza transferência de peso e permanece em pé, e marcha em blocos com a base alargada. A partir dos 12 meses a marcha se torna uma atividade automática, acontecendo devido à ação de muitas articulações e grupos musculares, descarga de peso, reações de equilíbrio e busca pelo centro de gravidade.Quando um indivíduo realiza o movimento de marcha, há todo um conjunto sequencial de movimentos, que se repetem ao longo do tempo (ciclo da marcha). 2Este trabalho teve como objetivo analisar a biomecâ-nica da marcha normal e patológica, o...

BackgroundObesity and its consequences are worldwide epidemic problem; therefore, studies with strategies and mechanisms that favor weight loss to improve outcomes in health are necessary. Effects of mushrooms on body weight are uncertain. The aim of this systematic review is to determine the efficacy of mushrooms in weight loss in animal preclinical models.MethodThis is a systematic review of preclinical studies of animal models of obesity (any type of non-aquatic mammal), which were exposed to edible and medicinal mushrooms orally in comparison with the control. The following databases will be used: MEDLINE (PubMed), Web of Science, BIOSIS, SCOPUS, and gray literature. There will be no restriction of language, date, or publication status. The primary outcome will be body weight loss. And the secondary outcomes include the total amount of food consumed by the animals, analysis of metabolic parameters, inflammatory mediators, mortality for any causes, and any adverse effect reported. A team of reviewers will select, in pairs and independently, the titles and abstracts, extract data from qualifying studies, and assess bias risk (using SYstematic Review Centre for Laboratory animal Experimentation SYRCLE’s risk of bias tool and the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist). The standardized mean difference (SMD) will be calculated to measure treatment effect, with 95% confidence intervals (95% CI). The heterogeneity between-study will be calculated by I2 inconsistency values and Cochran’s Q statistical test, where I2 > 50% and/or p < 0.10 suggest high heterogeneity meta-analyses of random effects will be conducted as possible.DiscussionAlthough many experimental studies about the effects of mushrooms on obesity have already been published, there is still no consensus in the literature. This study will provide evidences of preclinical research on mushrooms and their relation to body weight loss in animal models of obesity, being non-aquatic mammals. Also, this systematic review will show the limitations and strengths of the studies available in the literature, as well as it will to encourage the financing of new studies by public health managers and governmental entities.Systematic review registrationPROSPERO (CRD42019125299).

Acupuncture is one of the therapeutic resources used for the management of chronic pain. Variability in outcome measurements in randomized clinical trials of non-oncologic chronic pain (RCT-NOCP) generates inconsistencies in determining effects of treatments. The objective of this survey was to assess the adherence to the recommendations made by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) in the measurement of RCT-NOCP of acupuncture. This methodological research made a systematic search for eligible studies from different sources of information. Eligible studies included those with number of patients �100, who randomized and allocated patients with chronic non-oncologic pain to be treated with acupuncture or with "sham" acupuncture, or non-acupuncture. This research included the recommendations for IMMPACT in the measurement of RCT-NOCP: presence of outcomes pain, physical function, emotional state and improvement perception of patient, the source of the outcome information pain and the tools used to measure such domains. From a total of 1,386 studies, 24 were included in this survey. Eleven studies presented low risk of bias. Pain outcome was measured in 23 studies, physical function in 22 studies, emotional state in 14 studies and improvement perception of patient in one study. As for the pain outcome, the patient was the information source in 50% of the studies. The measurement tools recommended for IMMPACT were included in eight studies (35%) that evaluated pain, one study that evaluated the emotional state (7%), and one study that evaluated the improvement perception and satisfaction of patient. It was observed that studies which did not adhere to the recommendations had more favorable results for acupuncture in the outcome pain. This study concludes that randomized clinical trials that used acupuncture to manage chronic pain failed to adhere to IMMPACT recommendations. Clinical societies and IMMPACT do not share the same recommendations. This fact reflects in the diversity of outcomes and instruments adopted in the studies, making it difficult to compare the results.

IntroductionPain is one of the most common and most debilitating complaints among patients. It affects the individual, their relationship with friends and family, their ability to function at work, and their sociability. Acupuncture is one of the therapeutic resources for managing chronic pain. Given the variability of outcome measures in controlled randomised clinical trials on non-oncologicchronic pain (CRCT-NOCP), the Initiative in Methods, Measurements and Pain Assessment in Clinical Trials (IMMPACT) recommends six domains to be covered in evaluating the effectiveness of treatments for chronic pain.ObjectiveTo check whether the methodological quality of outcome reporting in published trials has used IMMPACT recommendations in measuring CRCT-NOCP outcomes when acupuncture was used as a treatment.MethodThis is a methodological study. We will systematically search for eligible studies in specific databases with a defined strategy. We will use the MeSHterms of ‘acupuncture’, ‘chronic pain’ and similar terms, without restrictions on idiom. Eligible studies will include those which are randomised and chose NOCP patients to be treated with acupuncture or control (sham acupuncture or no acupuncture), recruited after September 2004, with ≥100 patients. The measured outcomes are to be the presence of outcome domains recommended by IMMPACT, domains reported by the patient or clinician, tools used to measure such domains, as well as other features of the studies. We shall conduct a regression analysis to explore factors which can be associated with the presence of outcome domains according to IMMPACT recommendations.Ethics and disseminationThis survey will be submitted for presentation at congresses and for publication in a scientific journal. The findings obtained in this study will allow us to measure the quality of the evidence and provide greater transparency in decisions regarding the use of acupuncture as a viable alternative to managing chronic pain.

Background:Urinary incontinence is a common complaint in all parts of the world, cause of distress, as well as significant costs for both individuals and society. The aim of this study will be to evaluate the rigor of the development of clinical practice guidelines and to identify the recommendations of interventions for urinary incontinence in adult women.Methods:In this systematic review, clinical practice guidelines will be identified using a prospective protocol through a systematic search of: MEDLINE (via Ovid); EMBASE (Excerpt Medical Database, via Ovid); Web of Science and Virtual Health Library. Specific databases of guidelines for clinical practice will also be searched (National Institute for Health and Care Excellence, American Urological Association, and others). Reviewers, independently and in duplicate, will assess the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II). The results will be checked for discrepancies. Differences between the scores equal to or greater than 2 will be considered as discrepant and the final result will be decided by consensus. A comparison of the recommendations of interventions and information about the level of evidence, the degree of recommendation, the level of agreement and the level of acceptance will be described. This step will also be done independently and in duplicate, and the result will be decided by consensus. The results will be presented in tables and the descriptive statistics will be calculated for all domains of the AGREE II instrument as mean (standard deviation) and median (interquartile range).Results:The results derived from this study will increase the knowledge about the development of recommendations guidelines for urinary incontinence of high methodological rigor. This study may also identify key areas for future research.Conclusion:This study may guide health professionals, policy makers, and health policy managers in choosing the guidelines for recommendation in clinical practice.Protocol Registration:PROSPERO - CRD42018116517

IntroductionAntiretroviral therapy (ART) for HIV/AIDS is associated with adverse events (AEs). However, little is known about the differences in the risk of AEs between women and men living with HIV/AIDS. This study aims to determine (1) whether there are sex differences in the risk of AEs in people with HIV/AIDS treated with ART and (2) the prevalence of AEs to the reproductive system and bone mineral density in women.Methods and analysisThis systematic review (SR) will include randomised trials evaluating ART in people living with HIV/AIDS with at least 12 weeks of duration follow-up. Searches will be conducted in Medline, Embase, Cochrane Library, Epistemonikos, Lilacs, trial registries and grey literature databases, without restriction on publication status, year of publication and language. The primary outcome will be the risk of ART discontinuation or drop-outs/withdrawals of ART due to AEs and the number of any treatment-emergent AE. The secondary outcomes are the incidence of serious clinic or laboratory (grade 3 and/or 4) treatment-emergent AEs, hospitalisation, death and AEs specific to the reproductive system and bone mineral density (osteoporosis, osteopenia and fractures) of women. Selection, data extraction and quality assessment will be performed by pairs of reviewers. Cochrane collaboration tools will be used to assess the risk of bias. If appropriate, a meta-analysis will be conducted to synthesise results. The overall quality of the evidence for each outcome will be determined by the Grades of Recommendation, Assessment, Development and Evaluation.Ethics and disseminationThe results of this SR will assist the formulation of public policies aimed at the management and monitoring of AEs of ART in people living with HIV/AIDS. A deliberative dialogue will be scheduled with the Department of Chronic Conditions and Sexually Transmitted Infections of Brazil’s Ministry of Health to align the project with policymakers’ interests.PROSPERO registration numberCRD42021251051.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Main objectiveTo assess the effects of policies that regulate drug promotion on drug utilization, coverage or access, healthcare utilization, patient outcomes, adverse events and costs. Secondary objective(s)To assess whether the effects of policies that regulate drug promotion to patients/consumers, healthcare professionals, regulators and third-party payers differ according to drug class, clinical indication, target groups and country (high-, middle-or low-income countries). Pharmaceutical policies: effects of policies regulating drug marketing (Protocol)