Abstract Background: With the aim of reducing the risk of Cerebrovascular Accident (CVA) in patients with Non-Valvular Atrial Fibrillation (NVAF), Left Atrial Appendage Occlusion (LAAO) devices are emerging as an alternative to oral anticoagulants. Objective: To analyze the efficacy and safety of the LAAO procedure in patients with NVAF and contraindications and/or failure for oral anticoagulants. Method: The search for evidence was carried out in the electronic databases Medline and Embase till January 2024. Additional searches were conducted on Google Scholar. The clinical trials registry database was also consulted. Two blinded investigators performed the search, study selection, and data collection, and assessed quality and risk of bias using the Cochrane tool for randomized clinical trials. Meta-analyses of eligible trials were performed using RevMan 5.4.1 software. The random effects model was used for all analyses. Results: Five articles were selected, among which three were non-inferiority randomized clinical trials that analyzed the performance and safety of LAAO devices compared to the use of Vitamin K Antagonists (AVKs) or Novel Oral Anticoagulants (NOACs). No randomized clinical trials were found that analyzed populations with absolute contraindications to oral anticoagulants. Having as primary outcomes analyzed the occurrence of stroke (ischemic or hemorrhagic), cardiovascular or unexplained death and systemic embolism, the non-inferiority of the LAAO procedure compared to the use of oral anticoagulants was verified. Conclusions: For patients with an absolute contraindication to anticoagulation and/or failure to use oral anticoagulants, evidence for the use of LAAO devices is scarce. Background CVA (CVA NonValvular Non Valvular NVAF, , (NVAF) (LAAO Objective andor Method 2024 Scholar consulted selection collection Metaanalyses Meta analyses 541 5 4 1 5.4. software Results selected noninferiority non inferiority AVKs (AVKs NOACs. NOACs . (NOACs) ischemic hemorrhagic, hemorrhagic hemorrhagic) embolism verified Conclusions scarce (NVAF 202 54 5.4 (NOACs 20 5. 2

OBJETIVO: Analisar o perfil dos óbitos entre pacientes com tuberculose, e descrever a co-infecção tuberculose-Aids e a causa básica de morte nas coortes anuais. MÉTODOS: Foi realizado estudo descritivo dos indivíduos residentes na cidade de Campinas, SP, que foram a óbito durante o tratamento para tuberculose e também dos pacientes notificados após o óbito, mesmo sem ter iniciado o tratamento. As informações foram obtidas do Banco de Dados em Tuberculose /Universidade Estadual de Campinas (Unicamp) e do Banco de Óbitos da Secretaria Municipal de Saúde/Unicamp. Para análise estatística utilizou-se o software Epi Info versão 6. Os óbitos foram agrupados em dois períodos (1993-1996 e 1997-2000) e as proporções, comparadas. RESULTADOS: Foram notificados 4.680 pacientes, totalizando 737 óbitos, com coeficiente de letalidade de 18,1%, de 1993 a 1996, e 13,5%, de 1997 a 2000. Em 78 óbitos (10,6%) a notificação foi no post mortem e não chegou a ser instituído tratamento específico. Verificou-se predomínio do sexo masculino (71,3%) nos dois períodos estudados. A comorbidade tuberculose-Aids esteve presente em 55% dos óbitos. O perfil etário diferiu segundo a presença ou não da Aids: em ambos os períodos, a mediana da idade nos óbitos com Aids esteve na faixa de 30 a 39 e entre 50 e 59 naqueles sem Aids. Os pacientes que nunca haviam sido tratados de tuberculose representaram 81,3% CONCLUSÕES: Destaca-se entre os achados a marcante redução do número de óbitos, a partir de 1997, que pode estar relacionada com a utilização da terapia anti-retroviral (HAART) para Aids.

OBJECTIVE: To analyze the profile of deaths among tuberculosis patients in Campinas, Brazil, between 1993 and 2000, describing TB-AIDS co-infection and the underlying cause of death in the annual cohorts grouped in two periods 1993-1996 and 1997-2000. METHODS: A descriptive study of deaths was conducted among patients in Campinas, Brazil, who were being treated for tuberculosis and those reported as having TB after death. Data from the local Tuberculosis Registry and the Mortality Registry were used. Statistical analyses were performed using Epi Info version 6. Deaths were grouped in two periods (1993-1996 and 1997-2000) and then compared. RESULTS: Of a total of 4,680 patients, there were 737 deaths. The fatality rate was 18.1% in the period 1993-1996 and 13.5% in 1997-2000. After death reporting for patients without treatment was seen in 78 deaths (10.6%). In both periods, there was a prevalence of male deaths (71.3%). TB-AIDS co-infection was found in 55% of deaths and their median age was 30-39 years while the median age was 50-59 years in those without AIDS. Those who were never treated for tuberculosis corresponded to 81.9%. CONCLUSIONS: The most important finding was the significant reduction of deaths from 1997 onward that can be related to the introduction of AIDS antiretroviral therapy (HAART).

OBJETIVO: Analisar o perfil dos óbitos entre pacientes com tuberculose, e descrever a co-infecção tuberculose-Aids e a causa básica de morte nas coortes anuais. MÉTODOS: Foi realizado estudo descritivo dos indivíduos residentes na cidade de Campinas, SP, que foram a óbito durante o tratamento para tuberculose e também dos pacientes notificados após o óbito, mesmo sem ter iniciado o tratamento. As informações foram obtidas do Banco de Dados em Tuberculose /Universidade Estadual de Campinas (Unicamp) e do Banco de Óbitos da Secretaria Municipal de Saúde/Unicamp. Para análise estatística utilizou-se o software Epi Info versão 6. Os óbitos foram agrupados em dois períodos (1993-1996 e 1997-2000) e as proporções, comparadas. RESULTADOS: Foram notificados 4.680 pacientes, totalizando 737 óbitos, com coeficiente de letalidade de 18,1%, de 1993 a 1996, e 13,5%, de 1997 a 2000. Em 78 óbitos (10,6%) a notificação foi no post mortem e não chegou a ser instituído tratamento específico. Verificou-se predomínio do sexo masculino (71,3%) nos dois períodos estudados. A comorbidade tuberculose-Aids esteve presente em 55% dos óbitos. O perfil etário diferiu segundo a presença ou não da Aids: em ambos os períodos, a mediana da idade nos óbitos com Aids esteve na faixa de 30 a 39 e entre 50 e 59 naqueles sem Aids. Os pacientes que nunca haviam sido tratados de tuberculose representaram 81,3% CONCLUSÕES: Destaca-se entre os achados a marcante redução do número de óbitos, a partir de 1997, que pode estar relacionada com a utilização da terapia anti-retroviral (HAART) para Aids.

OBJECTIVE: To analyze the profile of deaths among tuberculosis patients in Campinas, Brazil, between 1993 and 2000, describing TB-AIDS co-infection and the underlying cause of death in the annual cohorts grouped in two periods 1993-1996 and 1997-2000. METHODS: A descriptive study of deaths was conducted among patients in Campinas, Brazil, who were being treated for tuberculosis and those reported as having TB after death. Data from the local Tuberculosis Registry and the Mortality Registry were used. Statistical analyses were performed using Epi Info version 6. Deaths were grouped in two periods (1993-1996 and 1997-2000) and then compared. RESULTS: Of a total of 4,680 patients, there were 737 deaths. The fatality rate was 18.1% in the period 1993-1996 and 13.5% in 1997-2000. After death reporting for patients without treatment was seen in 78 deaths (10.6%). In both periods, there was a prevalence of male deaths (71.3%). TB-AIDS co-infection was found in 55% of deaths and their median age was 30-39 years while the median age was 50-59 years in those without AIDS. Those who were never treated for tuberculosis corresponded to 81.9%. CONCLUSIONS: The most important finding was the significant reduction of deaths from 1997 onward that can be related to the introduction of AIDS antiretroviral therapy (HAART).

OBJETIVO: Descrever a situação da tuberculose nas prisões da Cidade de Campinas, Estado de São Paulo, Brasil. MÉTODOS: Realizou-se um estudo retrospectivo dos casos notificados de tuberculose em presidiários no período de 1993 a 2000. Foram avaliados dados de 4 293 detentos dos quatro presídios que constituem o complexo penitenciário da região. Foram utilizadas informações do banco de dados em tuberculose do Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP). RESULTADOS: Observou-se um pico de incidência da tuberculose em 1994 (1 397,62 notificações em 100 000 indivíduos). A menor taxa foi observada em 1999 (559,04). Predominou a faixa etária de 25 a 34 anos (62,6%) e a AIDS como doença associada (49,9%). A forma preponderante de tuberculose foi a pulmonar (91,9%), com baciloscopia de escarro positiva em 70,3%. A maioria dos presidiários não tinha realizado tratamentos prévios (75,4%). O abandono de tratamento chegou a 49%. Houve cura em apenas 20,8% dos casos no período estudado. CONCLUSÕES: A incidência intermediária de tuberculose observada neste estudo pode estar relacionada à subnotificação. A freqüência de falência do tratamento ainda é baixa. No entanto, o abandono, como fator que facilita a propagação de micobactérias resistentes na comunidade, causa preocupação. O controle da tuberculose nas prisões deveria ser parte rotineira das intervenções direcionadas a eliminar a doença na comunidade e a prevenir a resistência às drogas antituberculose.

OBJECTIVE: To describe the incidence of tuberculosis among inmates of the municipal prison system in the city of Campinas, State of São Paulo, Brazil, from 1993 through 2000. METHODS: A retrospective study was carried out of the number of cases of tuberculosis that were notified among inmates over the study period. This involved reviewing data from a total of 4 293 inmates who were held in the four prisons that comprise Campinas' municipal prison system. Data were obtained from the tuberculosis database belonging to the Department of Social and Preventive Medicine of the School of Medical Sciences at the State University of Campinas. RESULTS: The incidence of tuberculosis peaked in 1994 (1 397.62 cases per 100 000) and was lowest in 1999 (559.04 cases per 100 000). Most cases of tuberculosis occurred in inmates in the 25 to 34 year age group (62.6%). Acquired immunodeficiency syndrome (AIDS) was the disease most commonly associated with tuberculosis (49.9%), which was most often pulmonary in type (91.9%), with positive sputum smears in 70.3% of the inmates tested. Most inmates had not received treatment before (75.4%). The treatment dropout rate reached 49%, and a cure was achieved in only 20.8% of the cases notified over the study period. CONCLUSIONS: The incidence of tuberculosis observed in this study was moderate when compared to incidence rates found in other studies of prison inmates, but this could be due to underreporting. The frequency of treatment failure noted was low, since patients who were treated under supervision showed good adherence and were cured in the majority of cases. However, the high treatment dropout rate seen in the study is alarming because it could facilitate the spread of drug resistant strains of Mycobacterium tuberculosis to the community at large. Controlling tuberculosis among prison inmates should be part of routine interventions aimed at eliminating this disease from the community and at preventing resistance to antituberculosis therapy.