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PloS One 2014HIV viral load (VL) testing is the gold standard for antiretroviral treatment monitoring, but many barriers exist to VL testing in resource-limited settings, including... (Review)
Review
BACKGROUND
HIV viral load (VL) testing is the gold standard for antiretroviral treatment monitoring, but many barriers exist to VL testing in resource-limited settings, including storage and transport limitations for whole blood and plasma. Data from various studies indicate that HIV RNA is stable beyond current recommendations. We conducted a systematic review to assess stability data of HIV RNA in whole blood and plasma across times and temperatures.
METHODS AND FINDINGS
Using a pre-defined protocol, five databases were searched for studies where blood samples from HIV patients were stored at time and temperature points that exceeded manufacturer recommendations. RNA stability, the primary outcome, was measured by the difference in means compared to samples stored within established thresholds. RNA stability was defined as ≤0.5 log degradation. The search identified 10,716 titles, of which nine full-text articles were included for review. HIV RNA maintained stability in EDTA whole blood and plasma at all measured time points up to 168 hours when stored at 4°C, while stability was detected at 72 hours (95% confidence) in whole blood at 25°C, with data points before and beyond 72 hours suggesting stability but not reaching statistical significance. For EDTA plasma stored at 30°C, stability was maintained up to 48 hours (95% confidence), with OLS linear regression estimates up to 127 hours, suggesting stability. Overall, quality of studies was moderate. Limitations included small sample sizes, few studies meeting inclusion criteria, and no studies examining RNA stability in low viremia (<3,000 copies/mL) environments.
CONCLUSIONS
Whole blood and plasma samples in EDTA may remain stable under conditions exceeding current manufacturer recommendations for HIV VL testing. However, given the limited number of studies addressing this question, especially at low levels of viremia, additional evaluations on HIV RNA stability in EDTA tubes and PPT in field conditions are needed.
Topics: Edetic Acid; HIV Infections; HIV-1; Humans; RNA Stability; RNA, Viral; Specimen Handling; Temperature; Viral Load
PubMed: 25437009
DOI: 10.1371/journal.pone.0113813 -
The Cochrane Database of Systematic... Jul 2016There have been a number of studies with conflicting results which have examined the effect of anti-tuberculous therapy in Crohn's disease. A meta-analysis was performed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There have been a number of studies with conflicting results which have examined the effect of anti-tuberculous therapy in Crohn's disease. A meta-analysis was performed to evaluate the use of anti-tuberculous therapy for the maintenance of remission in Crohn's disease.
OBJECTIVES
To evaluate the effects of anti-tuberculous therapy for the maintenance of remission in patients with Crohn's disease.
SEARCH METHODS
We searched MEDLINE, EMBASE, the Cochrane LIbrary, and the Cochrane IBD Group Specialized Register from inception to June 22, 2015.
SELECTION CRITERIA
Randomized controlled trials (RCTs) of anti-tuberculous therapy compared to placebo or another active therapy in patients with quiescent Crohn's disease were considered for inclusion.
DATA COLLECTION AND ANALYSIS
At least two authors independently extracted data and assessed the quality of included studies using the Cochrane risk of bias tool. We calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes.. The primary outcome was relapse. Secondary outcomes included adverse events, withdrawals due to adverse events and serious adverse events. All data were analyzed on an intention-to-treat basis. The overall quality of the evidence supporting the primary and secondary outcomes was evaluated using the GRADE criteria.
MAIN RESULTS
Four placebo-controlled RCTs including 206 participants were included. Three trials included an 8 to 16 week induction phase with tapering corticosteroids (prednisone, prednisolone or methylprednisolone) as induction therapy. Anti-tuberculous therapy included monotherapy with clofazimine, combination therapy with clofazimine, rifampin, ethambutol, and dapsone or combination therapy with clarithromycin, rifabutin and clofazimine. All of the studies were rated as unclear risk of bias for allocation concealment, three were rated as unclear risk of bias for random sequence generation and two were rated as unclear risk of bias for blinding or participants and personnel. There was a statistically significant difference in relapse rates favoring anti-tuberculous therapy over placebo. Thirty-nine per cent (44/112) of patients in the anti-tuberculous therapy group relapsed at 9 months to 2 years compared to 67% (63/94) of placebo patients (RR 0.58, 95% CI 0.45 to 0.75, I(2) = 47%). A GRADE analysis indicates that the overall quality of the evidence supporting this outcome was very low due to unknown risk of bias and sparse data. Adverse events occurred more frequently in the anti-tuberculous therapy group (37/159) compared to the placebo group (14/163) with a pooled RR of 2.57 (95% CI 1.45 to 4.55; N=322; studies=4, I(2)=64%). A GRADE analysis indicates that the overall quality of the evidence supporting this outcome was very low due to unknown risk of bias, unexplained heterogeneity and sparse data. There was no difference in withdrawals due to adverse events. Nine per cent (14/159) of anti-tuberculous therapy patients withdrew due to adverse events compared to 7% (11/163) of placebo patients (RR 1.29, 95% CI 0.60 to 2.77, I(2) = 0%). Common adverse events included increased skin pigmentation and rashes. No serious adverse events were reported in any of the included studies.
AUTHORS' CONCLUSIONS
Anti-tuberculous therapy may provide a benefit over placebo for the prevention of relapse in participants with Crohn's disease in remission. However, this result is very uncertain due to unclear study quality and the small numbers of patients assessed. Further studies are needed to provide better quality evidence for the use of anti-tuberculous therapy for maintaining remission in people with quiescent Crohn's disease.
Topics: Antitubercular Agents; Clarithromycin; Clofazimine; Crohn Disease; Ethambutol; Glucocorticoids; Humans; Maintenance Chemotherapy; Methylprednisolone; Prednisone; Randomized Controlled Trials as Topic; Recurrence; Remission Induction; Rifabutin; Rifampin; Secondary Prevention
PubMed: 27444319
DOI: 10.1002/14651858.CD000299.pub3 -
PloS One 2016Adequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. Recommendations to aim for a target therapeutic range may be... (Review)
Review
BACKGROUND
Adequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma.
METHODS
A systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge and adverse effects.
DATA SOURCES
CENTRAL, CINAHL, MEDLINE and Web of Science. Search performed in March 2016.
ELIGIBILITY CRITERIA
Studies using intravenous aminophylline in children with an acute exacerbation of asthma which reported the dosage and clinical outcomes.
FINDINGS
14 RCTs were included. There is a poor relationship between the dosage administered to children and symptom resolution, length of stay or need for mechanical ventilation. This study is limited due to its use of indirect evidence.
CONCLUSION
The currently recommended dosage regimens may not represent the optimum safety and efficacy of intravenous aminophylline. There is a need to develop the evidence base correlating dosage with patient centered clinical outcomes, to improve prescribing practices.
Topics: Administration, Intravenous; Aminophylline; Asthma; Bronchodilator Agents; Child; Dose-Response Relationship, Drug; Humans; Treatment Outcome
PubMed: 27483163
DOI: 10.1371/journal.pone.0159965 -
Scientific Reports Feb 2019Dental caries can compromise quality of life and is associated with demineralization of tooth structure by organic acids produced by microorganisms. This study... (Comparative Study)
Comparative Study Meta-Analysis
Dental caries can compromise quality of life and is associated with demineralization of tooth structure by organic acids produced by microorganisms. This study systematically reviewed the dentine caries arrest capabilities of silver diamine fluoride (SDF) and sodium fluoride (NaF). A comprehensive search strategy was developed to identify the relevant publications in electronic databases and hand searched journals and reviews (to March 2018). By applying strict inclusion and exclusion criteria, only six papers (two randomized controlled trials, two follow-up articles and two secondary statistical analysis studies) were considered for full text qualitative and quantitative assessment. The included studies were critically appraised and statistically evaluated. Only four articles were considered for meta-analysis, as the other two were secondary analyses of included studies. When comparing the caries arrest lesions of SDF and NaF, SDF was found to be statistically more effective in dentine caries arrest of primary teeth during the 18 and 30 month clinical examinations. The weighted total effect size of the differences between SDF and NaF regarding arrested caries surfaces was calculated and showed nearly double the effectiveness of SDF to NaF at 30 months. Therefore, SDF is a more effective caries management reagent than NaF. Further clinical research is needed to consolidate the findings of this systematic review.
Topics: Cariostatic Agents; Child; Dental Caries; Fluorides, Topical; Humans; Prognosis; Quaternary Ammonium Compounds; Silver Compounds; Sodium Fluoride
PubMed: 30765785
DOI: 10.1038/s41598-019-38569-9 -
Minerva Urologica E Nefrologica = the... Oct 2018Recurrence after primary treatment of prostate cancer is one of the major challenges facing urologists. Biochemical recurrence is not rare and occurs in up to one third... (Review)
Review
INTRODUCTION
Recurrence after primary treatment of prostate cancer is one of the major challenges facing urologists. Biochemical recurrence is not rare and occurs in up to one third of the patients undergoing radical prostatectomy. Management of biochemical recurrence is tailored according to the site and the burden of recurrence. Therefore, developing an imaging technique to early detect recurrent lesions represents an urgent need. Positron emission tomography (PET) of 68Ga-labelled prostate-specific membrane antigen (68Ga-PSMA) is an emerging imaging modality that seems to be a promising tool with capability to localize recurrent prostate cancer. A systematic review of literature was done to evaluate the role of 68Ga-PSMA PET/CT scan in patients with recurrent prostate cancer after primary radical treatment.
EVIDENCE ACQUISITION
A systematic and comprehensive review of literature was performed in September 2017 analyzing the MEDLINE and Cochrane Library following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The following key terms were used for the search "PSMA," "prostate-specific membrane antigen," "positron emission tomography," "PET," "recurrent," "prostate cancer," "prostate neoplasm," "prostate malignancy," and "68Ga." Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
EVIDENCE SYNTHESIS
Thirty-seven articles met our inclusion criteria and were included in the analysis of this systematic review. Of the 37 articles selected for analysis only four studies were prospective. The overall detection rate of 68Ga-PSMA PET scan ranged from 47% up to 96.6%. The main advantage of this imaging technique is its relatively high detection rates at low serum PSA levels below 0.5 ng/mL (ranging from 11.1% to 75%). Higher serum PSA level was strongly associated with increased positivity on 68Ga-PSMA PET scan. 68Ga-PSMA PET scan was found superior to conventional imaging techniques (CT and MRI) in this setting of patients and even it seems to outperform choline-based PET scan. This technique provided significant changes in the therapeutic management of 28.6-87.1% of patients.
CONCLUSIONS
After biochemical recurrence, the primary goal is to locate the recurrent lesions' site. 68Ga-PSMA PET/CT seems to be effective in identifying recurrence localization also for very low levels of PSA (<0.5 ng/mL) thus permitting to choose the best therapeutic strategy as early as possible. However, data available cannot be considered exhaustive and prospective randomized trials are needed.
Topics: Antigens, Surface; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Male; Neoplasm Recurrence, Local; Oligopeptides; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals
PubMed: 29664244
DOI: 10.23736/S0393-2249.18.03081-3 -
BMC Oral Health Aug 2020This systematic review of the literature was carried out to assess parental acceptance for silver diamine fluoride (SDF) application and esthetic outcome on their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review of the literature was carried out to assess parental acceptance for silver diamine fluoride (SDF) application and esthetic outcome on their children primary dentition and evaluate factors that might influence their acceptance.
METHODS
Our research protocol included a search strategy, inclusion/exclusion criteria, and a data extraction plan. The search engines we used were PubMed, Google Scholar, and Science Direct. Reviewers independently reviewed, determined and carried out quality assessment for included studies using CONSORT (for clinical-trials), and STROBE (for Observational studies). In addition, evidence and recommendation's strength was conducted using Shekelle et al. system. Subsequently, a meta-analysis was performed to assess the association between parental acceptance for SDF treatment and teeth type, location and child's cooperation.
RESULTS
Eight studies fulfilled the inclusion criteria. There were statistically significant differences between parental acceptance for SDF usage on posterior teeth compared to anterior teeth (P < 0.001, OR: 0.23 and 95% CI: 0.15-0.34) and for SDF usage on anterior teeth of uncooperative compared to cooperative children (P < 0.001, OR: 0.27 and 95% CI: 0.17-0.44). Additionally, parent's acceptance rate for SDF application increased after follow-up visits and education.
CONCLUSION
Parental acceptance for SDF treatment was significantly related to tooth location, child cooperation and pre-operative instruction.
Topics: Cariostatic Agents; Child; Dental Caries; Esthetics, Dental; Fluorides, Topical; Humans; Parents; Quaternary Ammonium Compounds; Silver Compounds; Tooth, Deciduous
PubMed: 32819333
DOI: 10.1186/s12903-020-01195-3 -
Annals of Work Exposures and Health Jul 2020Diisocyanates are a group of chemicals that are widely used in occupational settings. They are known to induce various health effects, including skin- and respiratory...
Diisocyanates are a group of chemicals that are widely used in occupational settings. They are known to induce various health effects, including skin- and respiratory tract sensitization resulting in allergic dermatitis and asthma. Exposure to diisocyanates has been studied in the past decades by using different types of biomonitoring markers and matrices. The aim of this review as part of the HBM4EU project was to assess: (i) which biomarkers and matrices have been used for biomonitoring diisocyanates and what are their strengths and limitations; (ii) what are (current) biomonitoring levels of the major diisocyanates (and metabolites) in workers; and (iii) to characterize potential research gaps. For this purpose we conducted a systematic literature search for the time period 2000-end 2018, thereby focussing on three types of diisocyanates which account for the vast majority of the total isocyanate market volume: hexamethylene diisocyanate (HDI), toluene diisocyanate (TDI), and 4,4'-methylenediphenyl diisocyanate (MDI). A total of 28 publications were identified which fulfilled the review inclusion criteria. The majority of these studies (93%) investigated the corresponding diamines in either urine or plasma, but adducts have also been investigated by several research groups. Studies on HDI were mostly in the motor vehicle repair industry [with urinary hexamethylene diamine result ranging from 0.03 to 146.5 µmol mol-1 creatinine]. For TDI, there is mostly data on foam production [results for urinary toluene diamine ranging from ~0.01 to 97 µmol mol-1 creatinine] whereas the available MDI data are mainly from the polyurethane industry (results for methylenediphenyl diamine range from 0.01 to 32.7 µmol mol-1 creatinine). About half of the studies published were prior to 2010 hence might not reflect current workplace exposure. There is large variability within and between studies and across sectors which could be potentially explained by several factors including worker or workplace variability, short half-lives of biomarkers, and differences in sampling strategies and analytical techniques. We identified several research gaps which could further be taken into account when studying diisocyanates biomonitoring levels: (i) the development of specific biomarkers is promising (e.g. to study oligomers of HDI which have been largely neglected to date) but needs more research before they can be widely applied, (ii) since analytical methods differ between studies a more uniform approach would make comparisons between studies easier, and (iii) dermal absorption seems a possible exposure route and needs to be further investigated. The use of MDI, TDI, and HDI has been recently proposed to be restricted in the European Union unless specific conditions for workers' training and risk management measures apply. This review has highlighted the need for a harmonized approach to establishing a baseline against which the success of the restriction can be evaluated.
Topics: Biological Monitoring; Humans; Occupational Exposure; Polyurethanes; Toluene 2,4-Diisocyanate; Workplace
PubMed: 32313948
DOI: 10.1093/annweh/wxaa038 -
Human & Experimental Toxicology 2023This systematic review, conducted according to the PRISMA guidelines, focuses on genotoxicity of oxidative hair dye precursors. The search for original papers published...
This systematic review, conducted according to the PRISMA guidelines, focuses on genotoxicity of oxidative hair dye precursors. The search for original papers published from 2000 to 2021 was performed in Medline, Web of Science, Cochrane registry, Scientific Committee on Consumer Safety of the European Commission and German MAK Commission opinions. Nine publications on genotoxicity of -phenylenediamine (PPD) and toluene-2,5-diamine (-toluylenediamine; PTD) were included, reporting results of 17 assays covering main genotoxicity endpoints. PPD and PTD were positive in bacterial mutation assay, and PPD tested positive also for somatic cell mutations in the Rodent assay . Clastogenicity of PPD and PTD was revealed by chromosomal aberration assay. The alkaline comet assay showed DNA damage after PPD exposure, which was not confirmed where PTD exhibited positive results. PPD induced micronucleus formation , and increased micronucleus frequencies in mice erythrocytes following high dose oral exposure . Based on the results of a limited number of data from the classical genotoxicity assay battery, this systematic review indicates genotoxic potential of hair dye precursors PPD and PTD, which may present an important health concern for consumers and in particular for professional hairdressers.
Topics: Animals; Mice; Hair Dyes; DNA Damage; Comet Assay; Mutation; Oxidative Stress
PubMed: 36879522
DOI: 10.1177/09603271231159803 -
Cells Aug 2022This study aimed to identify the role of crosslinking agents in the resin-dentin bond strength (BS) when used as modifiers in adhesives or pretreatments to the dentin... (Meta-Analysis)
Meta-Analysis Review
This study aimed to identify the role of crosslinking agents in the resin-dentin bond strength (BS) when used as modifiers in adhesives or pretreatments to the dentin surface through a systematic review and meta-analysis. This paper was conducted according to the directions of the PRISMA 2020 statement. The research question of this review was: "Would the use of crosslinkers agents improve the BS of resin-based materials to dentin?" The literature search was conducted in the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts that reported the effect on the BS after the use of crosslinking agents were included. The meta-analyses were performed using Review Manager v5.4.1. The comparisons were performed by comparing the standardized mean difference between the BS values obtained using the crosslinker agent or the control group. The subgroup comparisons were performed based on the adhesive strategy used (total-etch or self-etch). The immediate and long-term data were analyzed separately. A total of 50 articles were included in the qualitative analysis, while 45 articles were considered for the quantitative analysis. The meta-analysis suggested that pretreatment with epigallocatechin-3-gallate (EGCG), carbodiimide, ethylenediaminetetraacetic acid (EDTA), glutaraldehyde, and riboflavin crosslinking agents improved the long-term BS of resin composites to dentin ( ≤ 0.02). On the other hand, the use of proanthocyanidins as a pretreatment improved both the immediate and long-term BS values ( ≤ 0.02). When incorporated within the adhesive formulation, only glutaraldehyde, riboflavin, and EGCG improved the long-term BS to dentin. It could be concluded that the application of different crosslinking agents such as carbodiimide, EDTA, glutaraldehyde, riboflavin, and EGCG improved the long-term BS of adhesive systems to dentin. This effect was observed when these crosslinkers were used as a separate step and when incorporated within the formulation of the adhesive system.
Topics: Adhesives; Carbodiimides; Collagen; Dentin; Dentin-Bonding Agents; Edetic Acid; Glutaral; Materials Testing; Resin Cements; Riboflavin
PubMed: 35954261
DOI: 10.3390/cells11152417 -
Journal of Dentistry Mar 2024To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults.
METHODS
Two independent researchers searched the English literature in five databases (Scopus, PubMed, Web of Science, EMBASE and the Cochrane Library) up to 15th July 2023 for clinical trials investigating the desensitising effect of professionally applied SDF to manage dentine hypersensitivity in adults aged 18 or above at any follow-up period. The primary outcome was the change in dentine hypersensitivity between baseline and follow-up visits after SDF application regarding any validated pain outcome measures. The Cochrane guidelines were used for the risk of bias assessment.
RESULTS
Three hundred and thirty-one studies were identified, and four of them were finally included. Three of the included studies were rated as having a 'low risk' of bias. The SDF solution reduced dentine hypersensitivity in adults. The percentage reduction in dentine hypersensitivity ranged from 23 % to 56 % after a single application of SDF solution. Moreover, the SDF solution was more effective than potassium nitrate, potassium oxalate and glutaraldehyde plus hydroxyethyl methacrylate in reducing dentine hypersensitivity. Meta-analysis indicated a more significant reduction in visual analogue scales (1-10) by 1.35 (95 % CI:0.9-1.8; p<0.00001) after receiving the SDF application than controls.
CONCLUSION
The included clinical trials showed that SDF solution reduced dentine hypersensitivity in adults. However, clinical trials are few, and their protocol varied from one another. Further well-designed clinical trials should be conducted to provide more evidence on its use to manage dentine hypersensitivity.
CLINICAL SIGNIFICANCE
SDF is cleared as desensitizing agents by the US Food and Drug Administration to manage dentine hypersensitivity, which induces pain, limits food choice, and impacts the quality of life. Evidence from this systematic review informs clinicians and provides researchers insight for future research on SDF use for dentine hypersensitivity. THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42023462613.
Topics: Humans; Cariostatic Agents; Dental Caries; Dentin Sensitivity; Fluorides, Topical; Pain; Quality of Life; Quaternary Ammonium Compounds; Silver Compounds
PubMed: 38301767
DOI: 10.1016/j.jdent.2024.104868