PICO Methodology Research Articles

Influence of genetic polymorphism on sports talent performance versus non-athletes: a systematic review and meta-analysis

BackgroundTalented athletes exhibit remarkable skills and performance in their respective sports, setting them apart from their peers. It has been observed that genetic polymorphisms can influence variations in sports performance, leading to numerous studies aimed at validating genetic markers for identifying sports talents. This study aims to evaluate the potential contribution of genetic factors associated with athletic performance predisposition in identifying sports talents.MethodsA systematic review was conducted following the PRISMA framework, utilizing the PICO methodology to develop the research question. The search was limited to case-control studies published between 2003 and June 2024, and databases such as Medline, LILACS, WPRIM, IBECS, CUMED, VETINDEX, Web of Science, Science Direct, Scopus and Scielo were utilized. The STREGA tool was employed to assess the quality of the selected studies.ResultsA total of 1,132 articles were initially identified, of which 119 studies were included in the review. Within these studies, 50 genes and 94 polymorphisms were identified, showing associations with sports talent characteristics such as endurance, strength, power, and speed. The most frequently mentioned genes were ACTN3 (27.0%) and ACE (11.3%).ConclusionThe ACE I/D and ACTN3 R577X polymorphisms are frequently discussed in the literature. Although athletic performance may be influenced by different genetic polymorphisms, limitations exist in associating them with athletic performance across certain genotypes and phenotypes. Future research is suggested to investigate the influence of polymorphisms in elite athletes from diverse backgrounds and sports disciplines.

Integration of Artificial Intelligence and Robotic Process Automation: Literature Review and Proposal for a Sustainable Model

This article investigates the growing integration between Artificial Intelligence (AI) and Robotic Process Automation (RPA), proposing an innovative model aimed at optimizing the operational efficiency of organizations balancing the social and environmental impacts arising from the use of these technologies. The research identifies a significant gap in the literature through a systematic review, revealing the need for greater attention to the social and environmental impacts of the implementation of AI and RPA. Employing an approach based on the PICO methodology (Population, Intervention, Comparison, Outcome), this study justifies the formulation of hypotheses and the choice of methodology, ensuring scientific rigor. The proposed model considers ethical issues such as privacy and cybersecurity and explores the challenges associated with the adoption of these innovations. The discussion includes the readiness of organizations to integrate these technologies, highlighting technical and cultural limitations that may influence the model’s effectiveness. The theoretical results suggest that careful implementation can optimize resource utilization, promoting a balance between operational efficiency and social and environmental responsibility. Furthermore, the article presents an analysis of the positive impacts, such as improved efficiency, and negative impacts, such as the fear of job displacement associated with the integration of AI and RPA, reinforcing the need for responsible adoption that fosters social and environmental sustainability in the digital age.

ATUAÇÃO FISIOTERAPÊUTICA NA PREVENÇÃO DE LESÃO MENISCAL EM JOGADORES DE FUTEBOL: UMA REVISÃO BIBLIOGRÁFICA INTEGRATIVA

Meniscal injuries are common among football players due to the high physical demands and repetitive movements required by the sport. Given the importance of preventing and treating these injuries, this study aims to explore physiotherapeutic treatment in football, as the role of physiotherapists has been gradually expanding in sports, seeking more effective approaches to prevent these injuries. The objective was to analyze the role of physiotherapy in preventing meniscal injuries in professional football players of both sexes. An integrative literature review was conducted using the PICO methodology, covering studies published in the last five years. The results indicate that 193 articles were initially identified, of which 5 randomized clinical trials were selected after applying inclusion criteria. Physical therapy, through muscle strengthening exercises, proprioception, and other techniques, can be as effective as surgery in the recovery of athletes. In addition to helping prevent new injuries, physical therapy can, in some cases, replace the need for surgical interventions. It is concluded that physiotherapy is a viable strategy for preventing and treating meniscal injuries, although more research is needed to understand its long-term effects.

Corruption in Public Administration: Evaluation of its Impact on Government Efficiency

Corruption in public administration is a serious problem that negatively affects society and the functioning of the State. It is essential to address this issue effectively to promote transparency, integrity and trust in government institutions. This research aims to review the existing literature on the evaluation of corruption and its effects on the effectiveness of public administration. Three research questions were posed following the PICO methodology (1) What is the effect of corruption on the population's trust in government institutions?, (2) What mechanisms to prevent and combat corruption in public administration have been implemented in different countries?, (3) What is the impact of corruption on government efficiency? The investigations were carried out using the Scopus database and Web of Science for which inclusion and exclusion criteria were applied to identification, screening and including 40 relevant articles. The results elucidate citizens' perception of corruption in public administration, as well as the sources that cause this scourge. In addition, the key findings of the review are presented, including the mechanisms to prevent and combat corruption implemented in different contexts. It is concluded that to combat corruption requires a joint effort from society, the government and entities in order to promote transparency and strengthen institutions, which in turn will contribute to building a more just and trustworthy society.

Dry Needling and Acupuncture for Scars-A Systematic Review.

Objectives: This research aims to synthesize existing data on the evidence gap in scar treatment and evaluate the effectiveness of acupuncture and dry needling in treating scars and related symptoms. Methods: The article adhered to the PRISMA 2020 statement for recommended reporting elements in systematic reviews. The inclusion criteria followed the PICO methodology. The literature search was conducted using databases including PubMed, Cochrane Library, Semantic Scholar, Europe PubMed Central, and Google Scholar. Studies on acupuncture and dry needling for scar treatment were included. Because of the diversity of the studies' results and methodologies, a systematic review was conducted to organize and describe the findings without attempting a numerical synthesis. Results: Nineteen studies relevant to the article's theme were identified, with eleven selected for detailed review. The studies included two case reports on dry needling, one case series on dry needling, five case reports on acupuncture, two randomized controlled trials on acupuncture, and one case report on Fu's subcutaneous needling. A quality assessment was conducted using the JBI CAT and PEDro scales. Four case reports scored 7 points, one case scored 8 points, three cases were rated 6 points or lower, the case series was rated 6 points, and the randomized controlled trials scored 8 and 5 points. Most studies demonstrated a desired therapeutic effect in scar treatment with acupuncture and dry needling, but the level of evidence varied across studies. The analysis does not conclusively support the use of acupuncture and dry needling to improve scar conditions. Conclusions: Although dry-needling and acupuncture techniques are popular in physiotherapy, adequate scientific evidence is currently not available to support their effectiveness in scar treatment. There are gaps in the research methodology, a lack of randomized trials, and significant heterogeneity in the assessment of effects.

Preferred Imaging for Target Volume Delineation for Radiotherapy of Recurrent Glioblastoma: A Literature Review of the Available Evidence.

Recurrence in glioblastoma lacks a standardized treatment, prompting an exploration of re-irradiation's efficacy. A comprehensive systematic review from January 2005 to May 2023 assessed the role of MRI sequences in recurrent glioblastoma re-irradiation. The search criteria, employing MeSH terms, targeted English-language, peer-reviewed articles. The inclusion criteria comprised both retrospective and prospective studies, excluding certain types and populations for specificity. The PICO methodology guided data extraction, and the statistical analysis employed Chi-squared tests via MedCalc v22.009. Out of the 355 identified studies, 81 met the criteria, involving 3280 patients across 65 retrospective and 16 prospective studies. The key findings indicate diverse treatment modalities, with linac-based photons predominating. The median age at re-irradiation was 54 years, and the median time interval between radiation courses was 15.5 months. Contrast-enhanced T1-weighted sequences were favored for target delineation, with PET-imaging used in fewer studies. Re-irradiation was generally well tolerated (median G3 adverse events: 3.5%). The clinical outcomes varied, with a median 1-year local control rate of 61% and a median overall survival of 11 months. No significant differences were noted in the G3 toxicity and clinical outcomes based on the MRI sequence preference or PET-based delineation. In the setting of recurrent glioblastoma, contrast-enhanced T1-weighted sequences were preferred for target delineation, allowing clinicians to deliver a safe and effective therapeutic option; amino acid PET imaging may represent a useful device to discriminate radionecrosis from recurrent disease. Future investigations, including the ongoing GLIAA, NOA-10, ARO 2013/1 trial, will aim to refine approaches and standardize methodologies for improved outcomes in recurrent glioblastoma re-irradiation.

THE IMPACT OF NURSE–LED EDUCATION, ON QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE DURING CARDIAC REHABILITATION: A REVIEW OF THE LITERATURE

Abstract Introduction The complex mosaic of cardiac rehabilitation (CR) in heart failure (HF) is composed of several "pieces": adherence to the rehabilitation program (Mazza & Paneroni, 2019), therapeutic education, improvement of perceived QoL and self–care (Deek et al., 2017). To improve the patient‘s QoL, however, it is imperative to position them at the focal point of the care process. Several studies, have documented the favorable impact of CR on QoL in HF patients (Conway et al., 2015). Although variations in therapeutic and rehabilitative treatment plans vary according to each stage of the disease, adopting lifestyle changes is a recommended strategy regardless of the stage of HF from which the person is affected (ACC/AHA 2005; Yancy et al., 2005). However, despite the evidence–based benefits of post–discharge interventions combined with patient education in HF patients, the specific impact and benefits of nurse–led patient education alone, independent of the broader health care system, remain still unclear. Objective This review aims to investigate the influence of the nurse‘s educational role on the quality of life of patients with HF in the setting of cardiac rehabilitation. Materials and Methods A comprehensive literature review was conducted using databases such as PubMed, Scopus, CIHNAL Complete and EMBASE. The review followed the PICO methodology, with the formulation of a research question. MeSH terms and keywords were combined using Boolean operators and inclusion criteria. The primary outcome of interest was improved QoL. Relevant articles were subjected to preliminary analysis on the Rayyan platform. They were first evaluated by title and abstract, then selected for full–text reading, and finally subjected to "quality appraisal". Results, Discussion and Conclusions Individuals with HF experience a decline in QoL and are at increased risk of poor prognosis, characterized by exacerbation episodes leading to frequent re–hospitalizations and increased mortality rates (Heo et al., 2009; Rechenberg et al., 2020; Freedland et al., 2021). Therefore, improving QoL in patients with HF is a priority from both care and organizational perspectives (Ades et al., 2013; Darkins et al., 2015). Notably, a tailored CR educational program helps to improve self–care management and, consequently, improve QoL. That highlights the importance of nurse–led CR for HF patients in improving health behaviors and adherence to therapeutic practices.

Technological assistance in highly competitive sports for referee decision making: A systematic literature review.

Introduction: During the last decade, it has become evident that the impact of a referee's decision in professional sports turns out to be a turning point in the outcome of a competition, often generating discomfort among fans and competitors. It is for this reason that technological assistants were implemented in sports to help in referee decision making.Objective: Review and analyze those technological solutions based on the use of artificial intelligence techniques capable of serving as technological assistants in support of referee decision-making in highly competitive professional sports.Method: The PICO methodology was used for the selection process of scientific publications of the PRISMA declaration. Finding 21 scientific publications extracted from the SCOPUS database that comply with the proposed guidelines, which were reviewed and analyzed to obtain information with added value.Results: It was found that the proposed technological assistants reached a level of precision greater than 90% in certain sports. Likewise, those limitations were found that reduce the operational quality of these solutions. As found those algorithms, models, methods and approaches of artificial intelligence most used and recommended for future research studies.Conclusions: In conclusion, the implementation of technological assistants based on artificial intelligence in referee decision making in professional sports has proven to be an effective tool, achieving significant levels of precision.

Electronic medical record and its impact on health care and management. A systematic review between the years 2013 – 2023

The adoption of Electronic Health Records (EHR) has revolutionized the landscape of healthcare and healthcare management in recent decades. These technological systems have been the subject of extensive interest and study to understand their impact on improving patient care and efficiency in health management. For this reason, this study proposes to evaluate the impact of the use of electronic medical records on health care and management. In addition, the study includes a systematic review of the literature of research carried out between 2013 and 2023 on the use of the Electronic Health Record (EHR) focused on patient care and health management. The PICO methodology was used to formulate the search equation in the Scopus database. To select the studies, the PRISMA methodology was used through 3 stages: identification, screening, and inclusion, obtaining a total of 17 articles for review, according to inclusion and exclusion eligibility criteria. At the beginning of the systematic search, 56400 studies were found, 5220 were related to health care, 244 researchers work carried out between 2013 and 2023 focused on health management. Also, 17 studies obtained at the end of the third search stage, 42,11 % indicated that the EHR facilitates medical care, 21,05 % indicated that it provides better safety and greater patient satisfaction. On the other hand, 36,36 % and 45,45 % mentioned that with the EHR there is a good quality of care and better clinical management, respectively, compared to the use of paper medical records. In conclusion, the EHR offers benefits in medical care and facilitates decision making at the health management level. Its interoperability means that clinical management is integrated with all other medical systems to provide quality care, despite certain limitations that persist in the health field.

A Systematic Review of Factors Influencing Signage Salience in Indoor Environments

Wayfinding signage is an intermediary public facility that coordinates the relationship between space and people, and it is crucial to help people find their way in complex indoor environments. In people’s cognitive behaviour towards wayfinding signs, the visual salience of the signs is the prerequisite and key to ensuring their effective operation. This paper aims to review published research articles on the effect of indoor environments on the saliency of wayfinding signs. The literature review was conducted by PICO methodology to formulate the research question and develop search strategies. Relevant research articles were identified by systematically searching electronic databases, including Web of Science, ScienceDirect, ProQuest, and EBSCO. This paper summarises two categories of factors influencing signage salience: (1) floor plan factors and (2) environmental factors. This study examined and condensed the attributes of wayfinding signage and their impact on how pedestrians perceive visuals while navigating. Exploring the elements that influence the visual prominence of indoor signs enhances our comprehension of how pedestrians engage with visually guided information indoors. Furthermore, this offers a theoretical foundation for the realm of indoor wayfinding.

Systematic Review on Stress, Insomnia and Burnout Syndrome in Secondary School Teachers

The purpose of this systemic review article was to analyze the symptoms of stress and insomnia and burnout syndrome in secondary school teachers. The PICO methodology was adapted for the research question and the PRISMA methodology for the article review and selection process. As a result, it was obtained that professional stress occurs when there is dissatisfaction or restrictions in the environment where it is exercised, the preparation of the person has ceased before an elaboration of organizations, as well as the deterioration of the teacher's vitality because of the stress produced. Burnout syndrome, which is a response to chronic professional stress, the amplitudes that stand out in burnout syndrome are related to stress levels and insomnia. As a conclusion, it was obtained that Burnout syndrome tends to be more evident in teachers, since they have direct contact with people and also current economic and political factors directly influence the development of their daily activity, in this way, when all these factors come together, it is possible to suffer from Burnout

Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy

To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request. The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021identified 508references, of which 79were selected and analyzed with the GRADE grid. Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1% of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5%, and less than 2% describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3months post-vasectomy and after 30ejaculations. If there are still a few non-motile spermatozoa at 3months, it is recommended that a check-up be performed at 6months post-vasectomy. In case of motile spermatozoa or more than 100,000immobile spermatozoa/mL at 6months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.

Ultrasound versus physical examination in predicting disease flare in children with juvenile idiopathic arthritis: a systematic literature review and qualitative synthesis.

In this systematic review we analyzed the published articles related to the predictive value for flare of subclinical synovitis assessed by ultrasound (US) in juvenile idiopathic arthritis(JIA). Medline, Embase and Cochrane databases were searched from 1990 to 2020 by two authors, using PICO methodology. The study is built and reported according to PRISMA guidelines. Searches identified four articles comprising a total of 187 JIA patients in clinical remission from at least 3 months. Two of the articles found US subclinical signs of synovitis to be predictive for flare, with a five times higher risk (with Power Doppler signal as an important feature), while in the other two baseline US abnormalities did not predict a clinical flare. The articles differed for protocols, definitions, and length of follow-up. US has an expanding role in pediatric rheumatology, with interest-ing applications especially during the follow-up, potentially identifying subclinical inflammatory signs predictive of flare. However, the few studies available do not allow definite conclusions at this time.

Recomendaciones para la realización de broncoscopia en pacientes pediátricos en la pandemia COVID-19

Introduction: a bronchoscopy is a fundamental tool in respiratory clinical conditions, but it can be a source of transmission of infectious agents such as SARS-COV-2. Therefore, it is urgent to adopt international recommendations for our environment. In this study, we need indications, contraindications, and biosafety measures to perform bronchoscopy in patients with SARS-COV-2 infection.Methods: the first phase consists of an analysis of the state of scientific research with a source of exploration on an academic basis. Subsequently, the elaboration of questions with the PICO methodology, using the PRISMA strategy. These were voted on by 18 Pediatric Bronchoscopist Pulmonologists who answered a survey and defined the agreement strength as strong, moderate and weak, based on expert agreement.Results: the indications with the highest level of an agreement are suspicion of foreign body aspiration and massive hemoptysis. The contraindications with the highest level of an agreement are non-urgent conditions, thermoplasty, stent placement. The general recommendations with the highest degree of agreement are a notification to the anesthesiologist and surgical team. The recommendations during and after the procedure are to use personal protective equipment, proper removal of it, and disinfection of equipment with 75% alcohol.Conclusions: bronchoscopy is a procedure inherent to critical care areas, the high training of the personnel assigned to these tasks is a fundamental principle for the success of its execution. Our project reaches a high level of agreement among the participating experts, which allows the elaboration of the Mexican Bronchoscopy Consensus.

¿Cómo evaluar los resultados en salud en el dolor crónico no oncológico? Investigación cualitativa

Introduction and objectivesThere is a lack of indicators that evaluate the health results of the non-cancer chronic pain (NCCP). The objective of this study was to agree on how to evaluate health outcomes in NCCP in Spain, as well as to propose lines of action to have an optimal evaluation framework not only for patients, but for healthcare professionals and managers as well. Material and methodsThis was a qualitative research study through directed group interviews which followed a script based on structured questions using the PICO methodology. ResultsMore than the intensity of pain, the main points to be measured are pain-free time, improved rest/sleep, improved mood, recovery of daily activities and adherence to treatment, in addition to —in the scope of management— resource consumption. The therapeutic objective must be defined individually, based on the adjustment of expectations between the healthcare professional and the patients, taking into account their preferences and involving them in the therapeutic process. Patients and caregivers must be informed and trained with special emphasis on the psycho-emotional sphere of pain. ConclusionsIt is necessary to evaluate the health outcomes in NCCP in Spain. Lines of action are proposed that might provide an adequate assessment framework for the patient, the healthcare professionals and the health managers.

AROMATIC PLANTS AND ESSENTIAL OILS USED DURING LABOR WITH NOCICEPTIVE AND ANXIOLYTIC POTENTIAL

Aromatherapy is a practice applied in different sectors such as post-operative care, pain treatment and anxiety reduction. However, in Brazil, the legislation allows the use of aromatherapy by nurses since 2018, but the use of essential oils during labor is not regulated. The aim of the study was to analyze the records of the benefits of using aromatherapy during labor and the chemical components of aromatic plants that contribute to the reducing pain, duration of contractions, anxiety and stress effects resulting from childbirth. The integrative review carried out in the Scopus, MEDLINE / PubMed and Science Direct databases specified between 2010 and 2020, in Portuguese, English and Spanish. The PICo methodology (Population, Interest and Context) was used to construct the research question and select controlled and uncontrolled descriptors, which were combined with the Boolean operators "AND", "OR" and "NOT". 17 articles were selected using aromatherapy during labor, individually or in conjunction with other therapies. The most used essential oil was Lavandula officinalis (53%), and the effects were related to the decrease in the pain of contractions and childbirth, followed by Rosa x damascena oil (23.5%), although the effect of the plant is more related to the reduction in the parturient’s anxiety and stress. Aromatherapy acts both on the physiological aspects of women in labor and on their subjectivity. Chemical evidence supports the relationship between the major compounds present in the essential oils of the aromatic plants used in the study and the beneficial effects of aromatherapy in labor.

Role of Regulatory T Cells in Skeletal Muscle Regeneration: A Systematic Review.

Muscle injuries are frequent in individuals with genetic myopathies and in athletes. Skeletal muscle regeneration depends on the activation and differentiation of satellite cells present in the basal lamina of muscle fibers. The skeletal muscle environment is critical for repair, metabolic and homeostatic function. Regulatory T cells (Treg) residing within skeletal muscle comprise a distinct and special cell population that modifies the inflammatory environment by secreting cytokines and amphiregulin, an epidermal growth factor receptor (EGFR) ligand that acts directly upon satellite cells, promoting tissue regeneration. This systematic review summarizes the current knowledge regarding the role of Treg in muscle repair and discusses their therapeutic potential in skeletal muscle injuries. A bibliographic search was carried out using the terms Treg and muscle regeneration and repair, covering all articles up to April 2021 indexed in the PubMed and EMBASE databases. The search included only published original research in human and experimental animal models, with further data analysis based on the PICO methodology, following PRISMA definitions and Cochrane guidelines.

Micro-RNAs Predict Response to Systemic Treatments in Metastatic Renal Cell Carcinoma Patients: Results from a Systematic Review of the Literature.

Locally advanced or metastatic renal cell carcinomas (mRCCs) account for up to 15% of all kidney cancer diagnoses. Systemic therapies (with or without surgery) represent gold standard treatments, mostly based on tyrosine kinase inhibitors in association with immunotherapy. We provide an overview of the current knowledge of miRNAs as predictors of treatment resistance. A systematic review of the literature was carried out in January 2022 following the PICO methodology. Overall, we included seven studies—four testing plasmatic miRNAs, two exosomal miRNAs, and one urinary miRNA. A total of 789 patients were included (354 for plasmatic miRNAs, 366 for urinary miRNAs, and 69 for exosomal miRNAs). Several miRNAs were tested within the included studies, but six plasmatic (miR9-5-p¸ miR-192, miR193-3p, miR-501-3p¸ miR-221, miR-376b-3p) one urinary (miR-30a-5p), and three exosomal (miR-35-5p, miR-301a-3p, miR-1293) were associated with resistance to systemic treatments or treatment failure in mRCC patients. Results showed a fair accuracy of these biomarkers in predicting treatment resistance and overall survival. However, to date, the biomarkers tested have not been validated and their clinical uses are not recommended. Nevertheless, the literature results are encouraging; future large clinical trials are warranted to validate the effectiveness of these tools in clinical decision-making.

Sociodemographic predictors associated with the spectrum of non-opportunist neuroretinal disease of non-infectious etiology in patients with HIV/AIDS: A scoping review.

Non-infectious retinal disease, even in the HAART era, continues to be one of the most common diagnoses in patients with HIV, with prevalences of up to 27% of cases. This study aims to characterize the association between demographic variables and their role. As a risk factor for the development of non-opportunistic non-infectious retinal disease in patients with HIV/AIDS. An integrative review of the literature was carried out according to Arksey O'Malley's approach, based on the PICO methodology and following the PRISMA recommendations; An exhaustive search was carried out in databases of articles that were filtered using established criteria, with their extraction and analysis carried out qualitatively. Ocular manifestations from any cause develop from 35 years of age in patients with HIV/AIDS, with the highest risk for age-related macular degeneration over the fourth decade of life and for the development of neuroretinal disorder on the fifth decade of life; some studies report a slight tendency to diagnose macular degeneration in women and those who acquired AIDS through sexual contact; data contrasted with increased risk for diagnosing neuroretinal disorder in homosexual men who also use intravenous drugs, possibly due to oversampling in studies; non-Hispanic whites and African Americans were the races most commonly affected by neuroretinal disease; the means between the 11.3-14.5 years elapsed since the HIV diagnosis were more frequently associated with cognitive impairment and both in those with high or low CD4 counts, and in patients with high or low viral loads, neuroretinal disease without Statistically significant differences. Adherence and early initiation of HAART had a modest impact on the development of neuroretinal disease. Even in the HAART era, non-infectious neuroretinal disease and cytomegalovirus retinitis remain the most frequent ocular diagnoses, however, different studies argue an increase in age-related non-infectious retinal diseases in patients with HIV, theories that are may explain by the increase in life expectancy, the metabolic effects of HAART itself or the generalized pro-inflammatory state in this group of patients, it is essential to recognize this new diagnostic challenge in order to direct preventive efforts through the use of cost-effective sociodemographic risk predictors towards that technological tools for diagnosis and treatment can be targeted. HIV/AIDS patients who present at the ophthalmological consultation with the suggested sociodemographic predictors have a high risk of visual impairment due to non-infectious retinopathy, therefore prevention, diagnosis and treatment efforts directed at these diseases should be increased.

Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

Pediatric supracondylar humerus fractures occur frequently. Often, the decision has to be made whether to operate immediately, e.g., during after-hours, or to postpone until office hours. However, the effect of timing of surgery on radiological and clinical outcomes is unclear. This literature review with the PICO methodology found six relevant articles that compared the results of office-hours and after-hours surgery for pediatric supracondylar humerus fractures. The surgical outcomes of both groups in these studies were assessed. One of the articles found a significantly higher “poor fixation rate” in the after-hours group, compared with office hours. Another article found more malunions in the “night” subgroup vs. the “all groups but night” group. A third article found a higher risk of postoperative paresthesia in the “late night” subgroup vs. the “day” group. Lastly, one article reported increased consultant attendance and decreased operative time when postponing to office hours more often. No differences were reported for functional outcomes in any of the articles. Consequently, no strong risks or benefits from surgical treatment during office hours vs. after-hours were found. It appears safe to postpone surgery to office hours if circumstances are not optimal for acute surgery, and if there is no medical contraindication. However, research with a higher level-of-evidence is needed make more definite recommendations.