Context: Cardiovascular diseases cause 17 million deaths annually worldwide, of which hypertension is responsible for 9.4 million and a 7% burden of disease. High blood pressure is responsible for 45% of deaths from heart disease and 51% of deaths from stroke. Objective: The aim of this systematic review and meta-analysis was to quantify the effect of isometric resistance training on systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP, respectively) values in normotensive adult participants. Data Sources: This study was registered with the PROSPERO database. Eligible studies were identified after performing a systematic search within the following databases: PubMed, Scielo, BioMed Central, Clinical Trials, EMBASE, Cochrane Central Register of Controlled Trials, and EBSCO. Study Selection: Randomized controlled trials that categorized participants as normotensive according to the guidelines of the American Heart Association and the American College of Cardiology were included. Study Design: Systematic review with meta-analysis. Level of Evidence: Level 1. Data Extraction: Data related to participant characteristics, exercise programs, level of evidence, risk of bias, Consensus on Exercise Reporting Template, and outcomes of interest were systematically reviewed independently by 2 authors. Results: A total of 6 randomized controlled trials were included. The following reductions in blood pressure (compared with the control group) were generated by isometric resistance training: SBP (mean difference [MD], −2.83 mm Hg; 95% CI, −3.95 to −1.72; P < 0.00001), DBP (MD, −2.73; 95% CI, −4.23 to −1.24; P = 0.0003), and MAP (MD, −3.07; 95% CI, −5.24 to −0.90; P = 0.005). Conclusion: It appears that isometric resistance training reduces SBP, DBP, and MAP in normotensive young adults in a statistically significant and clinically relevant manner. This type of exercise could be considered effective in preventing arterial hypertension.

Background The objective was to identify the benefits and harms of different physical exercise modalities in the symptomatology of major depressive disorder in adults without usual treatment. Methods We conducted a systematic review and meta-analysis of randomized controlled trials. Medline (via Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycInfo, Web of Science, Clinical Trials repository, gray literature, and manual search were searched from inception to November 2022 for relevant studies without language restriction. The following inclusion criteria were used for studies to determine their eligibility: randomized controlled trials (RCTs) in adults diagnosed with major depressive disorder who did not consume antidepressant medication or attended psychological therapy, with or without the presence of chronic communicable or non-communicable diseases, that compared physical exercise modalities with usual therapy, body-mind exercise or did not exercise. We excluded randomized controlled trials in development with pregnant women and adults with other mental health disorders such as bipolar disorder and anxiety. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias II Tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. The main outcome was depressive symptoms measured using validated depression scales after the intervention. Results The nine RCTs included 678 adults (211 men 31.12% and 467 women 68.88%) between 20 and 72 years old. The pooled standardized mean difference (SMD) of the 7 trials (12 interventions), calculated using the random effects model, was − 0.27 (95% CI [-0.58, 0.04) P = 0.09, indicating a small clinical effect in favor of exercise on the instruments scores that assess depressive symptoms, I2 = 76%. Sensitivity analyzes showed a moderate effect size, compared to primary outcomes, in favor of physical exercise: − 0.58 [-1.15, -0.01]. They even showed statistical significance: (P = 0.05); I² = 85%. Subgroup analyzes demonstrated that the intervention (i.e., < 12 weeks duration, frequency 5 per 150 minutes per week, at high intensity and with supervision) and characteristics (i.e., less than 50 years of age, overweight and obese, and diagnosis of depression) could influence the overall effect of treatment. Discussion We found low- to very low-quality evidence supporting the effect of physical exercise, compared with usual therapy, body mind exercise or doing nothing, on symptoms of major depressive disorder. Physical exercise is safe, although it produces adverse events that can be easily controlled. We downgraded the certainty of the evidence due to methodological limitations, inconsistency and imprecision. These are preliminary results, well-designed and reported randomized controlled trials are required.

Background This overview aims to identify, appraise, and summarize the findings of all relevant systematic reviews about the benefits and harms of different exercise training modalities on blood pressure in normotensive, pre-hypertensive, and high blood pressure adults. Methods This overview of systematic reviews protocol was reported following the PRISMA-P Statement. We will search MEDLINE, EMBASE, and Epistemonikos to identify systematic reviews of randomized controlled trials (RCTs) in adults with or without a diagnosis of high blood pressure that compared exercise training interventions with other or no exercise interventions. Major outcomes will be blood pressure and adverse events. Pairs of reviewers will independently screen the systematic reviews for inclusion, extract data, and appraise the methodological quality. The GRADE approach will be used to evaluate the quality of the evidence. Discussion Findings from this study will contribute to the knowledge base in the area by providing a systematic synthesis of the certainty of the evidence for the effects of the different training modalities on blood pressure. These assessments might also assist in both the development of clinical practice guidelines and to strengthen evidence-informed decision making in healthcare. Finally, this study might serve to inform patients, caregivers, healthcare providers, researchers, and decision-makers about the benefits and adverse events related to different exercise training modalities, as well as the knowledge gaps in the body of evidence. Protocol registration: PROSPERO CRD42021247062

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BackgroundEvidence on the management of pregnant patients with lupus activity is limited. The choice of pharmacological treatment is decisive for an adequate outcome.ObjectivesTo show the experience of management with intravenous immunoglobulin (IVIG) in pregnant patients with severe active lupus.MethodsCase series from January 2020 to November 2022 of pregnant patients being managed with IVIG in a hospital in Bogotá, Colombia.ResultsOut a total of 33 pregnant patients evaluated during the period, three cases of the use of IVIG in pregnant patients with severe lupus were found (Figure 1). The main involvement of lupus was renal (increased proteinuria), hematological (thrombocytopenia) and vascular [Intrauterine growth restriction (IUGR) and threatened abortion]. Average age was 30.3 years. One of the patients was diagnosed de novo with the disease during pregnancy, IVIG was given due to thrombocytopenia with resolution, but she presented fetal loss due to sepsis, in addition she had maternal vascular complications due to polyautoimmunity with antiphospholipid syndrome. The other two patients underwent IVIG at 24 weeks, one of them reached week 30 without considering new immunoglobulin applications, in the second case due to persistent proteinuria she received two additional cycles reaching 33 weeks of gestation. In both cases, a cesarean section was performed by IUGR at 30 and 33 weeks respectively. There were no complications associated with the newborns, with good response to proteinuria and resolution of cytopenias (See Table 1). There were no adverse drug events reported in any case.ConclusionIVIG can be a useful medication for the treatment of severe active lupus in pregnant patients, mainly in those with renal and hematological involvement. It is important to highlight IVIG has high safety and few side effects, on the mothers with lupus and their offspring’s.Table 1.Characteristics of PatientsCharacteristicsCase 1Case 2Case 3Patients Age, years323425Pregnancy weeks at the start IVIG724,124Body weight, kg656866Number of prior miscarriage000Serology ANAS Patern Ro/La SM/RNP APS profile1/640homogeneousNegativeNegativeDouble positive1/1280homogeneous129/130 (+)NegativeNegative1/320speckledNegativeNegativeNegativeIndication IVIGSevere active lupus ThrombocytopeniaSevere active lupus NephritisSevere active lupus NephritisPosology IVIG65 g (1g/kg), Single dose136 g (2 g/kg), Single dose132 g (2 g/kg), monthly (3 doses)Days administration IVIG254Side effects with IVIGNoneNoneNonePlatelets (Before IVIG)2,100112,000153,000Proteinuria, g/24h (Before IVIG)0.1313.224.7OutcomesPlaquettes250,000207,000388,000Proteinuria, g/24h-9 (2 week after IVIG)10.6 (1 week after last IVIG)Gestational age at miscarriage/delivery, weeks7, Septic Miscarriage30, Cesarean for IUGR33, Cesarean for IUGRPregnancy complicationsStroke, Carotid dissectionNo, Healthy premature NewbornNo, Healthy premature NewbornBreastfeeding-Yes, until 3rd month>3 monthsANA: Antinuclear antibodies, APS: antiphospholipid antibody syndrome, IUGR: Intrauterine growth restriction, IVIG: Intravenous Immunoglobulin,Figure 1.Patients’ backgroundsREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.