Latin American Health Research Articles

Are Phosphatidylcholine and Lysophosphatidylcholine Body Levels Potentially Reliable Biomarkers in Obesity? A Review of Human Studies.

Phosphatidylcholines (PCs) are the major components of biological membranes in animals and are a class of phospholipids that incorporate choline as a headgroup. Lysophosphatidylcholines (LPCs) are a class of lipid biomolecules derived from the cleavage of PCs, and are the main components of oxidized low-density lipoproteins (oxLDLs) that are involved in the pathogenesis of atherosclerosis. Since obesity is associated with a state of chronic low-grade inflammation, one can anticipate that the lipidomic profile changes in this context and both PCs and LPCs are gaining attention as hypothetically reliable biomarkers of obesity. Thus, a literature search is performed on PubMed, Latin American and Caribbean Health Science Literature (LILACS), and Excerpta Medica DataBASE (Embase) to obtain the findings of population studies to clarify this hypothesis. The search strategy resulted in a total of 2403 reports and 21 studies were included according to the eligibility criteria. Controversial data on the associations of PCs and LPCs with body mass index (BMI) and body fat parameters have been identified. There is an inverse relationship between BMI and most species of PCs, and a majority of studies exhibited negative associations between BMI and LPCs. Other findings regarding the differences between PCs and LPCs in obesity are presented, and the associated uncertainties are discussed in detail.

Interventions for acute non-arteritic central retinal artery occlusion.

Acute non-arteritic central retinal artery occlusion (CRAO) occurs as a sudden interruption of the blood supply to the retina and typically results in severe loss of vision in the affected eye. Although many therapeutic interventions have been proposed, there is no generally agreed upon treatment regimen. To assess the effects of treatments for acute non-arteritic CRAO. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 2); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 15 February 2022. We included randomized controlled trials (RCTs) comparing any interventions with another treatment in participants with acute non-arteritic CRAO in one or both eyes. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology and graded the certainty of the body of evidence for primary (mean change in best-corrected visual acuity [BCVA]) and secondary (quality of life and adverse events) outcomes using the GRADE classification. We included six RCTs with 223 total participants with acute non-arteritic CRAO; the studies ranged in size from 10 to 84 participants. The included studies varied geographically: one in Australia, one in Austria and Germany, two in China, one in Germany, and one in Italy. We were unable to conduct any meta-analyses due to study heterogeneity. None of the included studies compared the same pair of interventions: 1) tissue plasminogen activator (t-PA) versus intravenous saline; 2) t-PA versus isovolemic hemodilution, eyeball massage, intraocular pressure reduction, and anticoagulation; 3) nitroglycerin, methazolamide, mecobalamin tablets, vitamin B1 and B12 injections, puerarin and compound anisodine (also known as 654-2) along with oxygen inhalation, eyeball massage, tube expansion, and anticoagulation compared with and without intravenous recombinant tissue plasminogen activator (rt-PA); 4) transcorneal electrical stimulation (TES) with 0 mA versus with 66% of the participant's individual electrical phosphene threshold (EPT) at 20 Hz (66%) versus with 150% of the participant's individual EPT (150%) at 20 Hz; 5) ophthalmic artery branch retrograde thrombolysis versus superselective ophthalmic artery thrombolysis; and 6) pentoxifylline versus placebo. There was no evidence of an important difference in visual acuity between participants treated with t-PA versus intravenous saline (mean difference [MD] at 1 month -0.15 logMAR, 95% confidence interval [CI] -0.48 to 0.18; 1 study, 16 participants; low certainty evidence); t-PA versus isovolemic hemodilution, eyeball massage, intraocular pressure reduction, and anticoagulation (MD at 1 month -0.00 logMAR, 95% CI -0.24 to 0.23; 1 study, 82 participants; low certainty evidence); and TES with 0 mA versus TES with 66% of EPT at 20 Hz versus TES with 150% of EPT at 20 Hz. Participants treated with t-PA experienced higher rates of serious adverse effects. The other three comparisons did not report statistically significant differences. Other studies reported no data on secondary outcomes (quality of life or adverse events). AUTHORS' CONCLUSIONS: The current research suggests that proposed interventions for acute non-arteritic CRAO may not be better than observation or treatments of any kind such as eyeball massage, oxygen inhalation, tube expansion, and anticoagulation, but the evidence is uncertain. Large, well-designed RCTs are necessary to determine the most effective treatment for acute non-arteritic CRAO.

Quality and credibility of clinical practice guidelines recommendations for the management of neonatal hypoglycemia. A protocol for a systematic review and recommendations' synthesis.

Hypoglycemia is one of the most frequent metabolic conditions in neonates. Clinical practice guidelines (CPGs) influence clinical practice as high-quality CPGs facilitate the use of evidence in practice. This proposed study aims to systematically identify and appraise CPGs and CPG recommendations (CPGRs) for treating neonatal hypoglycemia (NH). We will conduct searches in MEDLINE, EMBASE, CINAHL, Cochrane Library, LILACS (Latin American & Caribbean Health Sciences Literature), and Epistemonikos. Authors will search CPGs-specific databases and grey literature. Two reviewers will independently perform the titles and abstract screening, full-text review, and data extraction. Two appraisers will assess the quality of the CPGs and their recommendations using AGREE II (Appraisal of Guidelines Research and Evaluation) and AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence) instruments. Scores of ≥ 60% in the rigour of development domain will be considered for defining high-quality with AGREE II tool. CPGRs with scores >60% in the three domains will be used to determine high quality with the AGREE REX tool. We will perform a synthesis of the CPGRs to identify the consistency among the CPGRs and the methodological quality of primary studies that support them. The results will help us to identify the methodological and quality gaps in the existing CPGs for the treatment of NH. Our findings will be submitted to peer-review journals and presented at academic conferences. Based on the study design, approval from the institutional ethics board is not required for this project. Systematic Review Registration Number (PROSPERO): CRD 42021239921.

Let’s make the most out of 2023!

Archives of Pediatric Neurosurgery, the official journal of the Brazilian Society of Pediatric Neurosurgery, was established in 2019 and, since then, has had exponential growth!
 From our first indexing at Google Academics to Latin American and Caribbean Health Sciences Literature (LILACS), in which we are in the final validation process, much has been built and worked in our journal.
 Since 2019 we received 117 papers and published 88 articles. In the last year, we had a rejection rate of 19% with 23 days to the first editorial decision.
 In 2022 we successfully experimented with a new formula, publishing two special issues with 10 papers in each: Craniofacial and Arachnoid cyst. 
 Besides that, 2022 was a year of international growth. This year we published many articles from China, Egypt, Malaysia, and Mexico!
 We also evolved in digital technology by inserting the platform in the "Lepidus" administrator and submission by FORMS, which improved the entire system's performance.
 
 On this special occasion, the editorial office would like to extend their greatest appreciation to all editors, and reviewers who have been supportive, and devoted much of their time and effort to nurturing APN. The journal, in particular, would like to thank the authors for submitting their papers to APN. The editorial board thanks you, and the work continues so that we can reach new indexing bases and consolidate as a reference in Word Pediatric neurosurgery. 
 
 Let's grow together!! 
 
 Happy New year and long life for everyone!
 
 Regard to the last 12 months:
 
 -MOST DOWNLOADED PDF ARTICLE: Jucá et al. Prenatal myelomeningocele repair: report of an inaugural case and considerations about the implementation of a new fetal neurosurgery program
 
 -MOST READ ABSTRACT: De Paula et al. Shaken Baby Syndrome: literature review in the last 5 years
 
 -2020-21 Impact factor 0.24

Intake and food sources of sodium in the population residing in urban areas of Ecuador: results from ELANS study

ABSTRACT Background In 2021, WHO notes that globally, 32% of annual deaths worldwide are due to cardiovascular causes, which have been attributed to excessive sodium intake, and therefore recommends a reduction in salt intake to less than 5 g/day. Ecuador does not have data on sodium consumption in the population. Hence, this study sought to determine the association between sodium consumption and sociodemographic variables in subjects living in urban areas of Ecuador. Objectives Determine the main dietary sources of sodium in subjects living in urban areas of the Coast and Highlands of Ecuador, and the association between sodium intake and sociodemographic variables such as: sex, region, marital status, socio-economic and educational level of this population. Methods Sodium intake was studied in 800 subjects of both sexes aged 15 to 65 years living in urban areas in Ecuador, originating from the Latin American Nutrition and Health Study (ELANS) between 2014 and 2015. Data were obtained through two 24-hour recalls, and were accessed according to sex, region, age, marital status, socio-economic and educational levels. Results The mean sodium intake was 4900 mg/day (SD ± 1188.32 mg/day), and both sexes exceeded the recommendations. Adjusting for energy intake, sodium consumption is higher in participants aged 50–65 years, from low socio-economic status and with basic education level. A positive relationship was found between sodium and energy intake. Around 48% of the sodium sources included the spices, condiments and herbs group. Within this group, salt itself constitutes 99% of sodium sources. Conclusions The Ecuadorian population consumes more than double the sodium recommendations, which vary according to gender and age. The first source of sodium is salt itself, which is part of spices and condiments food group. This data is important to formulate public health policies and interventions in Ecuador, especially in the population at risk.

Outcomes of heparinized adult veno-arterial extracorporeal membrane oxygenation patients managed with low and high activated partial thromboplastin time targets: A systematic review and meta-analysis.

There are no randomized controlled trials comparing low and high activated partial thromboplastin time (aPTT) targets in heparinized adult veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) patients. Our systematic review and meta-analysis summarized complication rates in adult VA ECMO patients treated with low and high aPTT targets. Studies published from January 2000 to May 2022 were identified using Pubmed, Embase, Cochrane Library, and LILACS (Latin American and Caribbean Health Sciences Literature). Studies were included if aPTT was primarily used to guide heparin anticoagulation. For the low aPTT group, we included studies where aPTT goal was ≤60seconds and for the high aPTT group, we included studies where aPTT goal was ≥60seconds. Proportional meta-analysis with a random effects model was used to calculate pooled complication rates for patients in the two aPTT groups. Twelve studies met inclusion criteria (5 in the low aPTT group and 7 in the high aPTT group). The pooled bleeding complication incidence for low aPTT studies was 53.6% (95% CI = 37.4%-69.4%, I2 = 60.8%) and for high aPTT studies was 43.8% (95% CI = 21.7%-67.1%, I2 = 91.8%). No studies in the low aPTT group reported overall thrombosis incidence, while three studies in the high aPTT group reported overall thrombosis incidence. The pooled thrombosis incidence for high aPTT studies was 16.1% (95% CI = 9.0%-24.5%, I2 = 13.1%). Adult ECMO patients managed with low and high aPTT goals appeared to have similar bleeding and other complication rates further highlighting the need for a randomized controlled trial.

Dietary calcium intake in Brazilian preschoolers and schoolchhildren: review of the literature.

ABSTRACTObjective:The objective of this study was to map and synthesize evidence on the adequacy of dietary calcium intake and dairy products in Brazilian preschoolers and schoolchildren.Data source:Evidence searches were performed in the MEDLINE (via PubMed) and Latin American and Caribbean Health Sciences Literature (LILACS; via BVS) databases, with no restriction on date or language of publication. Experimental or observational studies that evaluated healthy Brazilian children between 2 and 12 incomplete years old were included.Data synthesis:A total of 18 studies were included. Seven of 11 studies of 11 studies (63.6%) identified mean values of dietary calcium intake below the age recommendation, especially in schoolchildren, with the progression of the age group. Among preschoolers, studies with direct weighing of food showed higher mean values of dietary calcium ingested compared to those with dietary recall. Children attending public daycare centers on a part-time basis tended to have inadequate calcium intake. The consumption of milk and dairy products was lower among older children, especially schoolchildren.Conclusions:Inadequate dietary calcium intake seems to be prevalent in Brazil during childhood, especially among schoolchildren. Therefore, the evaluation of milk and dairy products intake must be considered in order to desgn appropriate corrective actions.

Treatments of palpebral congenital melanocytic nevus: a systematic review.

Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN. We conducted a systematic review following PRISMA guidelines from October 2022 to April 2023. We included all types of study designs that described or compared PCMN treatments and interventions, as well as histology, recurrence, adverse events, patient satisfaction, and malignant transformation. The search strategy was based on specific search words through the following databases: PubMed, Embase, Latin American and Caribbean Health Sciences Literature (Lilacs), Web of Science, and Scopus. Ongoing studies and gray literature studies were included. We analyzed 25 case reports with 148 participants. The effectiveness, success, and satisfaction with various treatments for PCMN depend on the specific treatment method and the individual patient's case. Most of the studies showed that surgical procedures (exeresis) are able to treat PCMN in the eyelid. The variability in outcomes emphasizes the importance of further research to better understand the most effective and safe approaches for treating congenital melanocytic nevi.

A look at vulnerability in the older population in health sciences studies: a systematic review

The objective of this study was to systematically investigate and review studies on the concept of vulnerability associated with the health of the older population. Articles were selected, filtered, and analyzed following the steps recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Screening and data extraction were performed independently by 2 reviewers using templates developed by the authors. Data extracted included specific details about population, interest, and context. Studies were eligible for inclusion if they: 1) were cross-sectional or prospective, 2) involved community-dwellers aged ≥60 years, 3) were published in the last 10 years, and 4) had as a concept vulnerability associated with the health of the older population. A total of 833 studies were identified and screened, 26 of which were included. Most included studies addressed vulnerability in older adults as an individual aspect, whether biological or psychological. The remaining studies reported vulnerability as affecting socio-environmental, health care system, and multifactorial aspects. Therefore, the concept of “vulnerability in older people” was not properly defined in the biomedical scientific community. When we return to the guiding question of this review, we can conclude that the conditions of vulnerability of older people are being treated broadly and diversely, producing different methodological strategies. The systematic review was conducted in the United States National Library of Medicine (PubMed), Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) databases between August and December 2020 and updated in September 2022, with registration number CRD42022361649.

Impacto do uso de produtos de tabaco aquecido (HTP) na qualidade do ar em ambientes fechados

Abstract Introduction: Heated tobacco products (HTP) have gained popularity in recent years. However, questions have been raised about the damage they cause to health, especially the impacts resulting from exposure to their emissions. This study aims to evaluate the impact of the use of HTPs indoors on air quality and/or the health of passively exposed people, through a systematic review of original studies. Methods: A bibliographic search was carried out in the Medical Literature Analysis and Retrieval System (MEDLINE), Excerpta Medica Database (EMBASE), Latin American and Caribbean Health Sciences (LILACS) and SCOPUS databases. Results: 21 studies were selected and included in this review. The results indicate that heated tobacco products are a source of environmental pollution due to the emission of particulate matter. The stages of selection, data extraction and risk of bias assessment of the studies were performed in pairs, independently, and disagreements were resolved by consensus. Conclusion: Heated tobacco products produce emissions that can expose people to toxic substances emitted indoors, just like other tobacco products.

Clinical manifestations of syphilis in the oral cavity — a review

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection.

Restrição da venda de produtos de tabaco apenas em tabacarias: uma medida necessária para o fortalecimento da Política Nacional de Controle do Tabaco

Abstract Objective To investigate and analyze current legislation, existing experiences and scenarios regarding the restriction of the sale of tobacco products only in tobacconists, in order to prepare recommendations for the public authorities, aiming to strengthen the National Tobacco Control Policy. Method Scope review conducted according to the Joanna Briggs Institute methodology, based on the PRISMA Checklist and Explanation framework. The databases used were the Virtual Health Library (BVS), Epistemonikos, Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System (MEDLINE) via Pubmed, SCIELO electronic library, SCOPUS, Web of Science, Digital Library of Theses and Dissertations (BDTD) and Johns Hopkins. Data collected in March 2021, considering studies published from January 2005 to December 2020. Articles and academic research developed in the Brazilian scenario and published between January 1994 and December 2020 were included. Results Low-income neighborhoods generally have a higher density of tobacco outlets and have higher rates of tobacco use, leading to health inequities. Studies indicate that children are more likely to smoke when they live or go to school in neighborhoods with a high density of tobacco retailers. Conclusion This study shows that it is necessary to set up the sale of tobacco products exclusively in tobacconists in Brazil, but such establishments would be subject to a new legal order to be instituted at the national level.

Does displacement of lower pole stones during retrograde intrarenal surgery improves stone-free status? A systematic review and meta-analysis.

Kidney stones are one of the most common urological diseases worldwide. The size and location of the stone are the most important factors in determining the most suitable treatment options. The aim of this review was to evaluate the displacement of lower pole stones. Three studies assessing the efficacy of translocating kidney stones from the lower pole of the kidney to other locations during retrograde intrarenal surgery published in the last 20 years were included. A systematic search was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and Web of Science databases using the following search terms: "Lower pole," "Lithotripsy." Meta-analysis was performed using Review Manager version 5.4. Stone-free rates were improved through displacement (odds ratio - OR = -0.15; 95% confidence interval-95%CI -0.24--0.05; p = 0.002; I2 = 21%), but at the cost of increased surgical duration (mean difference = -12.50; 95%CI -24.06--0.95; p = 0.03; I2 = 94%). Although this represents a potentially negative outcome, the improvement in clearance rates justifies the additional investment of time and effort. Displacement of lower pole kidney stones for subsequent lithotripsy brings significant benefits in terms of stone-free rate, with no difference in laser energy usage. However, it results in increased surgical time. Despite these factors, the benefits to patients undergoing the procedure are substantial.

Use of nanoparticles in animal models for prostate cancer treatment: a systematic review.

To conduct a systematic review of nanoparticles' use in the treatment of prostate cancer in animals. A systematic review was conducted in the databases PubMed, Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, and EMBASE, and the descriptors were chosen based on terms indexed in Health Sciences Descriptors (DeCS)/Medical Subject Headings (MESH), which are: nanoparticles, nanomedicine, and prostate cancer. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42021271008. A total of 3,897 articles was chosen; after reading the inclusion and exclusion criteria, six scientific articles with themes involving nanoparticles carrying medications were reached. Among the nanoparticles found, there were carboxymethylcellulose polymer, micellar casein nanoparticles, liquid crystal nanoparticles, serum albumin nanoparticles, and poly(ethylene glycol)-block-polylactide (mPEG-PLA) conjugated nanoparticles encapsulating cabazitaxel, docetaxel, and flutamide, which were nanoparticles used to treat prostate cancer in animals. Through using nanoparticles to encapsulate medications for treating prostate cancer in animals, studies show a decrease in weight and tumor reduction, with nanoparticles resulting in greater survival time than free medications. The improved permeability and retention effect of nanoparticles in the bloodstream contribute to their effectiveness.

Saúde mental positiva do estudante de graduação em enfermagem: revisão de escopo

Abstract Objective: Aimed to map the constructs used in articles to discuss the mental health of undergraduate nursing students in a positive perspective. Methods: A scoping review was carried out with a search in the electronic databases: Scopus, Latin American and Caribbean Health Sciences Literature and Cumulative Index to Nursing and Allied Health Literature, in April 2020, which allowed retrieval of 286 articles. Data selection and extraction was performed in a double check by the group investigators and were assessed using the continuous data comparison technique. Results: We selected 53 articles that allowed detecting a set of 13 constructs associated with positive mental health that are continuously investigated by this audience. Conclusion: It was found that the mental health of undergraduate nursing students is a supportive set of characteristics conditioned to the inter-retroactive circuit, in which each component retroacts on each part of a set of strengths, fostering a dynamic state of internal balance.

Virtual Reality in Health Science Education: Professors’ Perceptions

Virtual reality (VR) is a simulated experience in a three-dimensional (3D) computer-simulated world. Recent advances in technology position VR as a multipurpose technology in the healthcare sector and as a critical component in achieving Health 4.0. In this article, descriptive and correlationally quantitative research is carried out on the assessments made by Latin American health sciences university professors on the didactic use of virtual reality technologies. The main objective was to analyze the differences in the perceptions expressed by the public or private tenure of the universities where the professors teach. In addition, gender and age gaps were identified in the assessments obtained from each of the types of universities. The results reveal that Latin American health science professors at private universities have a higher selfconcept of their digital skills for the use of virtual reality in the lectures. This greater selfconcept also leads to a reduction in the gender and age gaps in the participating private universities with respect to the public counterparts. It is advisable to increase both faculty training in the didactic use of virtual reality and funding for its use, mainly in public universities.

Laser therapy for retinopathy in sickle cell disease.

Laser therapy for retinopathy in sickle cell disease.

Technological evolution and food allergies: issues of threats or contributions to the consumer?

Objective: To verify through a review of scientific literature, whether industrial and technological developments are directly related to the increase and prevalence of food allergies or whether it has contributed to the quality of life of allergic consumers. Methods: Searches were carried out in the Scielo (Scientific Electronic Library Online), Google Scholar, Lilacs (Latin American and Caribbean Health Sciences Literature) and PubMed (National Library of Medicine) databases. Results: The results obtained in the scientific literature identified that the significant increase in food allergies has accompanied the technological process, due to the greater consumption of food additives in ultra-processed products, but environmental influences such as dietary factors and lifestyle are also involved in the higher incidence of allergies. On the other hand, technological advances have collaborated with alternative food products for this specific population group by offering foods with reduction or exemption of allergenic compounds produced by different processing techniques or supported by biotechnology and other sciences. Final considerations: As claims for products free from allergenic compounds become mandatory, the food industry must make investments aimed at studies and production of safe alternative foods for allergic consumers.

Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis

Atopic dermatitis is a prevalent condition in children and can be effectively managed with medications such as topical calcineurin inhibitors (pimecrolimus or tacrolimus). A key unresolved safety concern is whether use of topical calcineurin inhibitors is associated with cancer. We systematically reviewed the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors. As part of the 2022 American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters atopic dermatitis guidelines, we searched MEDLINE, Embase, the Latin American and Caribbean Health Sciences Literature database, the Índice Bibliográfico Espanhol de Ciências da Saúde database, the Global Resource of Eczema Trials database, WHO's International Clinical Trials Registry Platform, the US Food and Drug Administration database, the European Medicines Agency database, company registers, and relevant citations from inception to June 6, 2022. We included randomised controlled trials and comparative and non-comparative non-randomised studies in any language addressing cancer risk in patients with atopic dermatitis using topical calcineurin inhibitors. We excluded split-body studies and studies with less than 3 weeks of follow-up. Paired reviewers independently screened records, extracted data, and assessed risk of bias in duplicate. We used Bayesian models to estimate the probability for cancer due to topical calcineurin inhibitor exposure and the GRADE approach to determine the certainty of the evidence. Patients, advocacy groups, and care providers set a priori thresholds of important effects. This study is registered with Open Science Framework, https://osf.io/v4bfc. We identified and analysed 110 unique studies (52 randomised controlled trials and 69 non-randomised studies [11 were non-randomised study extensions of randomised controlled trials]) including 3·4 million patients followed up for a mean of 11 months (range 0·7-120). The absolute risk of any cancer with topical calcineurin inhibitor exposure was not different from controls (absolute risk 4·70 per 1000 with topical calcineurin inhibitors vs 4·56 per 1000 without; odds ratio 1·03 [95% credible interval 0·94-1·11]; moderate certainty). For all age groups and using data from observational studies and randomised controlled trials, the use of pimecrolimus (OR 1·05 [95% credible interval 0·94-1·15]) or tacrolimus (0·99 [0·89-1·09]) is likely to have had little to no association with cancer compared with no topical calcineurin inhibitor exposure. For pimecrolimus versus tacrolimus, the finding was similar (0·95 [95% credible interval 0·83-1·07]). Findings were similar in infants, children, and adults, and robust to trial sequential, subgroup, and sensitivity analyses. Among individuals with atopic dermatitis, moderate-certainty evidence shows that topical calcineurin inhibitors do not increase the risk of cancer. These findings support the safe use of topical calcineurin inhibitors in the optimal treatment of patients with atopic dermatitis. American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology via the Joint Task Force on Practice Parameters.

Non-biologic, steroid-sparing therapies for non-infectious intermediate, posterior, and panuveitis in adults.

Non-biologic, steroid-sparing therapies for non-infectious intermediate, posterior, and panuveitis in adults.