El hipotiroidismo subclínico suele ser identificado como un cuadro que disminuye la capacidad reproductiva de las mujeres y está asociado a un riesgo aumentado de complicaciones perinatales. A partir de un caso clínico real, revisamos la evidencia disponible y encontramos que existen pruebas que contradicen este conocimiento tradicional sobre el pronóstico y la necesidad de tratamiento de este cuadro.

Purpose To assess the effects of Serenoa repens alone or in combination with other phytotherapy compared to placebo in men with LUTS due to benign prostatic enlargement. Materials and Methods Following a registered protocol (CRD42021226655), we searched (December 2020) MEDLINE, CENTRAL, Embase, ClinicalTrials.gov, WHO-ICTRP trials platform and other sources with no restrictions on language, publication date or status. We included randomized controlled trials, and we critically appraised them using the Cochrane Tool for Risk of Bias Assessment (RoB 2). We conducted random-effects meta-analysis when appropriate. The primary outcomes included urinary symptoms score, quality of life, and adverse events. The certainty of the evidence was rated using GRADE. Results We included 27 trials with 4,853 participants. S. repens results in little to no difference in urinary symptoms, quality of life, and adverse events at short- and long-term follow-up. S. repens combined with other phytotherapy may slightly reduce urinary symptoms at short-term follow-up, but the results are uncertain. The results on quality of life and adverse events are also very uncertain. Conclusions S. repens alone may result in no clinical benefits for men with LUTS. There is greater uncertainty in the effects of S. repens in combination with other phytotherapy.

ObjectiveTo translate and culturally adapt the tool ‘Assessing Competency in evidence-based medicine (EBM)’ (ACE) to Spanish and to implement it in a cohort of medical students for the evaluation of the instrument’s psychometric properties.DesignBilingual translators produced a translation and backtranslation of the original instrument, with interim consensus in each stage with oversight and input by a group of experts. We then performed cognitive interviews to adapt the wording of the tool culturally. Finally, we implemented the final version in a cohort of medical students on a virtual general practice course with EBM modules.SettingMedical School in Buenos Aires, Argentina. Due to restrictions to in-person teaching during the COVID-19 pandemic, we conducted this study in the context of virtual learning.ParticipantsWe included 125 fourth and fifth-year medical students.Main outcome measuresWe measured internal consistency with the Kuder-Richardson coefficient (>0.6 as a threshold for reliability) and construct validity through a Pearson’s correlation between the examinations carried out with the translated instrument and the results of the regular examinations of EBM in the same students (expected values of at least 0.3 to 0.7). We also compared the total score of the instrument of fifth-year students to fourth-year students.ResultsAs for measurements for internal consistency, the coefficient Kuder-Richardson resulted in a value of 0.268, below our prespecified threshold. For construct validity, the Pearson correlation between the sum of the items and regular examinations was 0.139, also below our prespecified threshold. However, fifth-year students averaged 0.94 points more than fourth-year students (95% CI 0.24 more to 1.65 more).ConclusionThe translated and cross-culturally adapted version of the ACE tool into Spanish had low reliability and validity in an MBE course taught and evaluated in a virtual environment.Trial registrationNot applicable.

The exponential growth of currently available evidence has made it necessary to collect, filter, critically appraise, and synthesize biomedical information to keep up to date. In this sense, systematic reviews are a helpful tool and can be reliable sources to assist in evidence-based decision-making. Systematic reviews are defined as secondary research or syntheses of evidence focused on a specific question that -- based on a structured methodology -- make it possible to identify, select, critically appraise, and summarize findings from relevant studies. Systematic reviews have several potential advantages, such as minimizing biases or obtaining more accurate results. The reliability of the evidence presented in systematic reviews is determined, amongst other factors, by the quality of their methodology and the included studies. To conduct a systematic review, a series of steps must be followed: the formulation of a research question using the participants, interventions, comparisons, outcomes (PICO) format; an exhaustive literature search; the selection of relevant studies; the critical appraisal of the data obtained from the included studies; the synthesis of results, often using statistical methods (meta-analysis); and finally, estimating the certainty of the evidence for each outcome. In this methodological note, we will define the basic concepts of systematic reviews, their methods, and their limitations.

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