VICTOR FIGUEIREDO LEITE
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- Viscosupplementation for Hip Osteoarthritis: A Systematic Review and Meta-Analysis of the Efficacy on Pain and Disability, and the Occurrence of Adverse Events(2018) LEITE, Victor Figueiredo; AMADERA, Joao Eduardo Daud; BUEHLER, Anna MariaObjective: To assess the efficacy of viscosupplementation (hyaluronic acid [HA]) on the pain and disability caused by hip osteoarthritis, and to determine the occurrence of adverse events. Data Sources: PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov database, and specific journals up to March 2017. Study Selection: Randomized controlled trials (RCTs) comparing HA with any other intra-articular injection. Data Extraction: Performed according to Cochrane/Grades of Recommendation, Assessment, Development, and Evaluation criteria. Two authors extracted data and assessed the risk of bias and quality of evidence. A random-effects meta-analysis was conducted. Data Synthesis: Eight RCTs were retrieved (n = 807): 4 comparing HA to placebo; 3 to platelet-rich plasma (PRP); 3 to methylprednisolone; and 1 to mepivacaine. Some RCTs had 3 arms. There is very low evidence that HA is not superior to placebo for pain at 3 months (standardized mean difference [SMD]= -.06; 95% CI, -.38 to .25; P = .69), and high evidence that it is not superior in adverse events (risk ratio [RR] = 1.21; 95% CI, .79-1.86; P = .38). There is low evidence that HA is not superior to PRP for pain at I month. There is very low evidence that HA is not superior to PRP for pain at 6 and 12 months (mean difference in visual analog scale [in cm]: -.05 [95% CI, -.81 to .71], 1.0 [95% CI, -1.5 to 3.50], and .81 [95% CI, -1.11 to 2.73], respectively). There is high evidence that HA is no different from methylprednisolone for pain at 1 month (SMD = .02; 95% CI, -.18 to .22; P = .85). There is low evidence that HA is no different from methylprednisolone for Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International Responders Index at 1 month (RR = .44; 95% CI, .10-1.95; P = .28). There is high evidence that HA is no different from methylprednisolone for adverse events (RR = 1.21; 95% CI, .79-1.87; P = .38). Conclusions: We do not recommend viscosupplementation for hip osteoarthritis. Compared with placebo, data show scarce evidence of its efficacy up to 3 months, and suggest no difference at 6 months. However, future RCTs could present HA as an alternative to methylprednisolone for short-term symptom relief. (C) 2017 by the American Congress of Rehabilitation Medicine
- Rehabilitation Interventions for Head and Neck Cancer-Associated Lymphedema A Systematic Review(2023) CHENG, Jessica T.; LEITE, Victor F.; TENNISON, Jegy M.; GUTIERREZ, Carolina; KLINE-QUIROZ, Cristina; CAPOZZI, Lauren C.; YU, Shui; KRAUSE, Kate J.; LANGELIER, David; PARKE, Sara C.IMPORTANCE Head and neck cancer-associated lymphedema (HNCaL) affects up to 90% of survivors of head and neck cancer and is a substantial contributor to disability following head and neck cancer treatment. Despite the prevalence and morbidity associated with HNCaL, rehabilitation interventions are not well studied.OBJECTIVE To identify and appraise the current evidence for rehabilitation interventions in HNCaL.EVIDENCE REVIEW Five electronic databases were searched systematically from inception to January 3, 2023, for studies on HNCaL rehabilitation interventions. Study screening, data extraction, quality rating, and risk of bias assessment were performed by 2 independent reviewers.FINDINGS Of 1642 citations identified, 23 studies (1.4%; n = 2147 patients) were eligible for inclusion. Six studies (26.1%) were randomized clinical trials (RCTs) and 17 (73.9%) were observational studies. Five of the 6 RCTs were published during 2020 to 2022. Most studies had fewer than 50 participants (5 of 6 RCTs; 13 of 17 observational studies). Studies were categorized by intervention type, including standard lymphedema therapy (11 studies [47.8%]) and adjunct therapy (12 studies [52.2%]). Lymphedema therapy interventions included standard complete decongestive therapy (CDT) (2 RCTs, 5 observational studies), modified CDT (3 observational studies), therapy setting (1 RCT, 2 observational studies), adherence (2 observational studies), early manual lymphatic drainage (1 RCT), and inclusion of focused exercise (1 RCT). Adjunct therapy interventions included advanced pneumatic compression devices (APCDs) (1 RCT, 5 observational studies), kinesio taping (1 RCT), photobiomodulation (1 observational study), acupuncture/moxibustion (1 observational study), and sodium selenite (1 RCT, 2 observational studies). Serious adverse events were either not found (9 [39.1%]) or not reported (14 [60.9%]). Low-quality evidence suggested the benefit of standard lymphedema therapy, particularly in the outpatient setting and with at least partial adherence. High-quality evidence was found for adjunct therapy with kinesio taping. Low-quality evidence also suggested that APCDs may be beneficial.CONCLUSIONS AND RELEVANCE The results of this systematic review suggest that rehabilitation interventions for HNCaL, including standard lymphedema therapy with kinesio taping and APCDs, appear to be safe and beneficial. However, more prospective, controlled, and adequately powered studies are needed to clarify the ideal type, timing, duration, and intensity of lymphedema therapy components before treatment guidelines can be established.
article 44 Citação(ões) na Scopus Anti-Nerve Growth Factor in the Treatment of Low Back Pain and Radiculopathy: A Systematic Review and a Meta-Analysis(2014) LEITE, Victor F.; BUEHLER, Anna M.; ABD, Omar El; BENYAMIN, Ramsin M.; PIMENTEL, Daniel C.; CHEN, Janini; HSING, Wu Tu; MAZLOOMDOOST, Danesh; AMADERA, Joao E. D.Background: Low back pain with or without radiculopathy is an important cause of disability and economic expenditure. However, many patients are not meeting optimal pain control through existing treatments. Recent studies have linked nerve growth factor (NGF) and the pathophysiology of persistent pain. Anti-NGF could be an alternative drug treatment for low back pain. Objective: Systematically review the efficacy and safety of anti-NGF in the treatment of low back pain. Methods: A systematic review of the literature with no language, date or publication status restriction, using Medline, EMBASE, Cochrane Library, and the clinicaltrials. gov database. Additional literature was retrieved by conferring with experts in the field or reviewing bibliographies and annals of meetings and congresses. Search terms included ""monoclonal antibodies,"" "" nerve growth factor,"" ""anti-ngf,"" ""fulranumab,"" ""tanezumab,"" "" sciatica,"" "" back pain,"" and ""spine."" Study Design: Inclusion criteria were observational studies with safety as an outcome and randomized or nonrandomized controlled trials studying the efficacy and/or the safety of anti-NGF drugs on low back pain. Exclusion criteria included patients with autoimmune conditions or osteoporosis. Studies were assessed independently by 2 authors regarding inclusion/exclusion criteria, risk of bias, clinical relevance, and quality of evidence (GRADE approach). Results: 1,168 studies were retrieved. After excluding duplicates and applying the inclusion/exclusion criteria, 4 RCTs remained (n = 2,109): 2 for tanezumab, one for REGN475, and one for fulranumab. Only the tanezumab studies showed any significant difference over placebo (n = 1,563) for both pain relief and functional improvement. Conclusions: There is very low evidence that systemically administered anti-NGF therapy has a small positive effect compared to placebo for both pain relief (standarized mean difference [SMD] = -0.29, 95% confidence interval [CI] -0.58 to 0.00) and functional improvement (SMD = -0.21, 95% CI -0.37 to -0.05) of low back pain. There was low evidence of adverse effects (AEs) compared to placebo and low evidence of neurological AEs than placebo (relative risk = 1.93, 95% CI 1.41 to 2.64). Tanezumab, as a specific anti-NGF treatment, showed low evidence of a small to moderate effect for pain relief of low back pain (SMD = -0.44, 95% CI -0.81 to -0.07); and low evidence of a small effect for functional improvement (SMD = -0.26, 95% CI -0.40 to -0.12) with systemic administration, although not clinically significant. Tanezumab and anti-NGFs overall had, respectively, moderate and low evidence of overall AEs and serious AEs and a higher risk of developing neurological AEs when compared with placebo. Although anti-NGF, specifically tanezumab, showed a low-to-moderate effect on pain relief and functional improvement, it cannot be recommended for low back pain treatment. Without more research on the pathophysiology of anti-NGFs and adverse effects, its use is not safe in the overall population. However, as corroborated by the US Food and Drug Administration, this meta-analysis underscores a role for greater insight into anti-NGF therapy for painful conditions that are refractory to current drugs, such as oncologic pain, chronic pancreatitis, and phantom-limb pain. Given the pathophysiology of axial pain involving inflammatory mediators and the adverse effects of systemic anti-NGF use, consideration of local therapies may warrant further exploration.- Antagonistas muscarínicos de longa duração vs. β2-agonistas de longa duração em exacerbações da DPOC: revisão sistemática e meta-análise(2017) MAIA, Israel Silva; PINCELLII, Mariangela Pimentel; LEITE, Victor Figueiredo; AMADERA, Joao; BUEHLER, Anna MariaObjetivo: Determinar se long-acting muscarinic antagonists (LAMAs, antagonistas muscarínicos de longa duração) são superiores a long-acting β 2 agonists (LABAs, β2agonistas de longa duração) na prevenção de exacerbações da DPOC. Métodos: Revisão sistemática e meta-análise de ensaios clínicos controlados aleatórios com pacientes com DPOC estável, de moderada a grave, conforme os critérios da Global Initiative for Chronic Obstructive Lung Disease , tratados com LAMA (brometo de tiotrópio, aclidínio ou glicopirrônio), acompanhados durante pelo menos 12 semanas e comparados a controles que usaram LABA isoladamente ou com um corticosteroide. Resultados: Foram analisados 2.622 estudos para possível inclusão com base em seu título e resumo; 9 estudos (17.120 participantes) foram incluídos na análise. Em comparação com LABAs, LAMAs resultaram em maior diminuição da razão da taxa de exacerbações [risco relativo (RR) = 0,88; IC95%: 0,84-0,93]; menor proporção de pacientes que apresentaram pelo menos uma exacerbação (RR = 0,90; IC95%: 0,87-0,94; p < 0,00001); menor risco de hospitalizações em virtude de exacerbação da doença (RR = 0,78; IC95%: 0,69-0,87; p < 0,0001) e menor número de eventos adversos sérios (RR = 0,81; IC95%: 0,67-0,96; p = 0,0002). A qualidade geral das evidências foi moderada para todos os desfechos. Conclusões: O principal achado desta revisão sistemática e meta-análise foi que LAMAs reduziram significativamente a taxa de exacerbações (episódios de exacerbação/ano), os episódios de exacerbação, as hospitalizações e os eventos adversos sérios.
article 30 Citação(ões) na Scopus Anti-Tumor Necrosis Factor Antagonists in the Treatment of Low Back Pain and Radiculopathy: A Systematic Review and Meta-analysis(2014) PIMENTEL, Daniel C.; ABD, Omar El; BENYAMIN, Ramsin M.; BUEHLER, Anna M.; LEITE, Victor F.; MAZLOOMDOOST, Danesh; CHEN, Janini; HSING, Wu Tu; AMADERA, Joao E. D.Background: Low back pain, with or without radiculopathy, is an important cause of disability and economic expenditure. However, many patients are not achieving optimal pain control with existing medications. Tumor necrosis factor antagonists (anti-TNF alpha) could be an alternative drug treatment. Objectives: Systematic review the efficacy and safety of anti-TNF alpha in the treatment of low back pain with or without radiculopathy. Study Design: Inclusion criteria were observational studies with safety as an outcome, and randomized or nonrandomized controlled trial (RCT) studies on efficacy and/or safety of anti-TNF alpha drugs on low back pain. Exclusion criteria included patients with auto-immune conditions or osteoporosis. Results: Studies were assessed independently by 2 authors regarding inclusion/exclusion criteria, risk of bias, clinical relevance, quality, and strength of evidence (GRADE approach). Of the 1,179 studies retreived, all duplicates were excluded and then the inclusion/exclusion criteria was applied. One observational study (n = 143) and 11 RCTs remained (n = 539): 8 for etanercept (n = 304), one for adalimumab (n = 61), one for adalimumab and etanercept (n = 60), one for infliximab (n = 40) and one for REN-1654 (n = 74). Only 3 etanercept and 2 adalimumab studies showed statistically significant pain relief when compared to placebo. There was no difference in the overall incidence of adverse effects when comparing anti-TNF-alpha and placebo. Limitations: Despite the statistically significant effect, this meta-analysis has important limitations, such as high heterogeneity and high use of outcome imputation. Conclusions: There is low evidence that epidural etanercept has a low-to-moderate effect size when compared to placebo for pain due to discogenic lumbar radiculopathy (5 studies, n=185), with a standardized mean difference = -0.43 (95% confidence interval [CI] -0.84 to -0.02). There is moderate evidence that epidural etanercept does not have a higher adverse effects incidence rate when compared to placebo for discogenic lumbar radiculopathy (5 studies, n = 185) with a relative risk (RR) = 0.84 (95% CI 0.53 to 1.34). There is moderate evidence that anti-TNF alpha does not have a higher adverse effects incidence rate when compared to placebo for low back pain (10 studies, n= 343) with an RR = 0.93 (95% CI 0.56 to 1.55). We strongly suggest that anti-TNF alpha continue to be studied in experimental settings for the treatment of low back pain. We cannot currently recommend this therapy in clinical practice. New research could shed some light on the efficacy of anti-TNF alpha and change this recommendation in the future.- Current Status of Cancer Rehabilitation in Latin America(2024) VILLALOBOS, Vanessa Ucles; SILVA, Ana Carolina Mendez; BELMONTE, Gema Herrera; RUIZ, Judith del Rosario Bermudez; MOJICA, Yudi Milena Rodriguez; BRITO, Christina May Moran de; FIGUEIREDO, Victor; MERIDA, Patricia Rosales; SANTANDER, Blanca Irene Acuna; FLORES, Jonathan Ortiz; LUCIANI, Monica; SIERRA, Leonardo; TAGLE, Maritza Martinez; MONCHEZ, Georgina Granados; MARTINEZ, Licellot; JIMENEZ, Merly Monica Rivero; FLORES, Every Nataly Casas; SATO, Koyi; LEON, Erika Lissette Perez De; GOMEZ, Juan Carlos Leal; SINCAL, Edin Geovanny Xicay; PONCE, Flor de Maria Perez; QUAN, Martha Lolany Perez Ramirez de; DUARTE, Claudia Morales; RAMIREZ, Jose Emilio Albizures; CHAVEZ, Sigrid Yerena LemusPurpose of ReviewThis article provides an overview of access, advancements, and obstacles in the field of cancer rehabilitation in Latin America.Recent FindingsSince cancer rehabilitation is a relatively new service for Latin American countries, there is a noticeable lack of economic, human, and other resources available to carry out the optimal program. This study aims to highlight the current state in order to find solutions to the identified challenges.SummaryCancer and its treatment contribute to significant patient morbidity and mortality with physical and mental late effects. Cancer rehabilitation provides care and interventions to mitigate these functional impairments and improve quality of life. There are significant increases in global cancer incidence and number of survivors, which necessitates an increase in cancer rehabilitation services. Currently, in our countries, there are substantial political, economic, and educational challenges that are barriers to growth in these services.
- Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort(2019) LEITE, Victor F.; SOUZA, Daniel R. de; IMAMURA, Marta; BATTISTELLA, Linamara R.Study design Retrospective cohort. Objective To evaluate the survival outcomes in patients with traumatic spinal cord injury (TSCI). Setting A teaching hospital in Brazil. Methods A total of 434 patients diagnosed with TSCI (2004-2014) were included. Overall survival, standardized mortality ratios (SMR), and causes of death were assessed by Student's t-test, chi(2) test, Kaplan-Meier analysis, and Cox proportional-hazards regression. Results The mean follow-up was 4.8 years (+/- 3.3 years). Individuals with tetraplegia had a median survival of 11 years, with participants in the paraplegia group not reaching median survival. The overall mortality rate was 37 per 1000 person-years. Age-adjusted SMR was 28.8 (95% CI: 22.8-36). There were 77 deaths with 56 defined causes, of which pneumonia was the most frequent (35.7%). Combined infectious etiologies caused 55.3% of deaths. Multivariate analysis revealed higher mortality among individuals with tetraplegia vs. paraplegia in the first 2 years post injury (HR = 8.28, 95% CI: 2.76-24.80), after 2 years post injury (HR = 2.35, 95% CI: 1.31-4.24), and in all years combined (HR = 3.36, 95% CI: 2.04-5.52). Conclusion Mortality among patients with TSCI was 28.8 times higher than in the reference population. In more than half of the cases, the cause of death was linked to infectious diseases. Pneumonia caused two times more deaths in individuals with tetraplegia than in individuals with paraplegia, with a higher impact in the first 2 years post injury. Reported findings indicate the need for a surveillance and prevention program with emphasis on vaccination and respiratory rehabilitation.
- Establishing a Cancer Rehabilitation Service in a Middle-Income Country: an Experience from Brazil(2022) LEITE, Victor F.; CECATTO, Rebeca Boltes; BATTISTELLA, Linamara Rizzo; BRITO, Christina May Moran dePurpose of Review Our aim is to provide a historical review of the implementation of a cancer rehabilitation center in Brazil, active since 2008. We expect this data to support the implementation of other centers both in Brazil and worldwide. Recent Findings Cancer rehabilitation delivery is fragmented and punctuated in most cases, and cancer rehabilitation centers are rare. Data on how to establish rehabilitation centers could facilitate the implementation of new centers. We provide data on what was our strategy for hiring, establishing treatment protocols, barriers, and facilitators. We also provide figures on the number of each rehabilitation specialist, as well as the general standard operating procedures of our rehabilitation center, among other features. Establishing cancer rehabilitation centers in a middle-income country is feasible. We expect that our experience may facilitate the establishment of new cancer rehabilitation services and the improvement of current ones.
article 8 Citação(ões) na Scopus Use of pulse pressure variation to estimate changes in preload during experimental acute normovolemic hemodilution(2012) SANT'ANA, A. J.; OTSUKI, D. A.; NOEL-MORGAN, J.; LEITE, V. F.; FANTONI, D. T.; HAJJAR, L. Abrahao; GALAS, F. R. Barbosa Gomes; ALMEIDA, J. Pinheiro De; FUKUSHIMA, J.; AULER JR., J. O. CostaBackground. Acute normovolemic hemodilution (ANH) is an alternative to blood transfusion in surgeries involving blood loss. This experimental study was designed to evaluate whether pulse pressure variation (PPV) would be an adequate tool for monitoring changes in preload during ANH, as assessed by transesophageal echocardiography. Methods. Twenty-one anesthetized and mechanically ventilated pigs were randomized into three groups: CTL (control), HES (hemodilution with 6% hydroxyethyl starch at a 1:1 ratio) or NS (hemodilution with saline 0.9% at a 3:1 ratio). Hemodilution was performed in animals of groups NS and HES in two stages, with target hematocrits 22% and 15%, achieved at 30-minute intervals. After two hours, 50% of the blood volume withdrawn was transfused and animals were monitored for another hour. Statistical analysis was based on ANOVA for repeated measures followed by multiple comparison test (P<0.05). Pearson's correlations were performed between changes in left ventricular end-diastolic volume (LVEDV) and PPV, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP). Results. Group NS received a significantly greater amount of fluids during ANH (NS, 900 +/- 168 mL vs. HES, 200 +/- 50 mL, P<0.05) and presented greater urine output (NS, 2643 +/- 1097mL vs. HES, 641 +/- 338mL, P<0.001). Significant decreases in LVEDV were observed in group NS from completion of ANH until transfusion. In group HES, only increases in LVEDV were observed, at the end of ANH and at transfusion. Such changes in LVEDV (Delta LVEDV) were better reflected by changes in PPV (Delta PPV, R=-0.62) than changes in CVP (Delta CVP R=0.32) or in PAOP (Delta PAOP, R=0.42, respectively). Conclusion. Changes in preload during ANH were detected by changes in PPV. Delta PPV was superior to Delta PAOP and Delta CVP to this end. (Minerva Anestesiol 2012;78:426-33)- Rehabilitation Interventions in Head and Neck Cancer(2024) CHENG, Jessica T.; EMOS, Marc Ramos; LEITE, Victor; CAPOZZI, Lauren; WOODROW, Lindsey E.; GUTIERREZ, Carolina; NGO-HUANG, An; KRAUSE, Kate J.; PARKE, Sara C.; LANGELIER, David MichaelObjective: The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer. Design: A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type. Results: Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9). Conclusions: Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.