Percorrer por autor "Pontarolo, R."
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- Mapping the characteristics of network meta-analyses on antithrombotic therapies: an overview and critical appraisalPublication . Sousa, P. G.; Tonin, Fernanda; Mainka, F.; Pontarolo, R.Objectives: A large number of network meta-analyses (NMAs) in the field of cardiac disease are available, yet the scientific literature lacks an updated straightforward synthesis of this evidence to ground the decision-making process. We aimed to map and critically appraise NMAs on antithrombotic therapies used as treatment or prophylaxis of cardiac diseases and cardiac surgical procedures. Methods: A systematic review of systematic reviews with meta-analysis was conducted following Cochrane Collaboration and Joanna Briggs recommendations (PROSPERO-CRD2020166468). Searches to identify NMAs meeting the eligibility criteria of this study were performed in PubMed and Scopus (Jan-2022). NMAs characteristics including metadata, statistical models’ description, and main pooled results were collected. The methodological quality of NMAs was evaluated using the PRISMA-NMA checklist and AMSTAR-2 tools. Descriptive statistical analyses with categorical variables reported as frequencies and continuous variables as the median and interquartile range (IQR) were performed (SPSS-Statistics v.25.0). Results: Overall, n=88 NMAs published between 2007-2022 were identified. The most evaluated clinical condition was atrial fibrillation (n=57; 64.7%); around one-third of the studies (38.6%) assessed cardiac surgical procedures. Only 28.4% NMAs had a registered study protocol. Fifty NMAs (56.8%) were published by authors from one single country China the most frequently. A median of 14 primary studies (IQR 5-20.75) (mostly randomized clinical trials) were included per NMA. A median of 40 (IQR 24-84.25) indirect meta-analyses per study were found. At least one network diagram for a given outcome was provided by 68 (77.2%) studies, yet only 22 (25.6%) performed treatment ranking analyses. Conflict of interest declarations and study funding were informed by 34 (38.6%) and 38 (43.2%) NMAs, respectively. Conclusions: Although there is a widespread of NMA-type studies assessing different antithrombotic agents for different cardiac conditions, the lack of standardized conduction and reporting of NMAs (poor-moderate methodological quality) may limit their comparison and results implementation into clinical practice.
- Systematic review and evidence gap mapping of biomarkers associated with neurological manifestations in patients with COVID-19Publication . Domingues, K. Z.; Cobre, A. F.; Lazo, R. E.; Amaral, L. S.; Ferreira, L. M.; Tonin, Fernanda; Pontarolo, R.Objective: This study aimed to synthesize the existing evidence on biomarkers related to coronavirus disease 2019 (COVID-19) patients who presented neurological events. Methods: A systematic review of observational studies (any design) following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Collaboration recommendations was performed (PROSPERO: CRD42021266995). Searches were conducted in PubMed and Scopus (updated April 2023). The methodological quality of nonrandomized studies was assessed using the Newcastle‒Ottawa Scale (NOS). An evidence gap map was built considering the reported biomarkers and NOS results. Results: Nine specific markers of glial activation and neuronal injury were mapped from 35 studies published between 2020 and 2023. A total of 2,237 adult patients were evaluated in the included studies, especially during the acute phase of COVID-19. Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) biomarkers were the most frequently assessed (n = 27 studies, 77%, and n = 14 studies, 40%, respectively). Although these biomarkers were found to be correlated with disease severity and worse outcomes in the acute phase in several studies (p < 0.05), they were not necessarily associated with neurological events. Overall, 12 studies (34%) were judged as having low methodological quality, 9 (26%) had moderate quality, and 9 (26%) had high quality. Conclusions: Different neurological biomarkers in neurosymptomatic COVID-19 patients were identified in observational studies. Although the evidence is still scarce and conflicting for some biomarkers, well-designed longitudinal studies should further explore the pathophysiological role of NfL, GFAP, and tau protein and their potential use for COVID-19 diagnosis and management.