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Chemosphere Dec 2017It has been suggested that the plasticizer di(2-ethylhexyl) phthalate (DEHP) exerts obesogenic effects after pre- or perinatal exposure. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It has been suggested that the plasticizer di(2-ethylhexyl) phthalate (DEHP) exerts obesogenic effects after pre- or perinatal exposure.
OBJECTIVE
A systematic review with meta-analyses was conducted of early life exposure to DEHP, or its biologically active metabolite mono(2-ethylhexyl) phthalate (MEHP), on the obesity related outcome measures body weight, fat (pad) weight, triglycerides, free fatty acids and leptin in experimental rodent studies.
METHODS
The applied methodology was pre-specified in a rigorous protocol. Relevant articles were identified using PubMed and EMBASE and meta-analyses were performed using mean differences (MD) and random effects model when at least five studies could be included per outcome measure. Risk of bias and the quality of evidence was assessed using established methodologies.
RESULTS
Overall, 31 studies could be included and meta-analyses could be performed for body weight and fat weight. Early life exposure to DEHP was significantly associated with increased fat weight (MD = 0.02; 95% CI: 0.00, 0.03), while a non-significant association was estimated for body weight (MD = -0.14; 95% CI: -0.32, 0.04). There was substantial heterogeneity across studies and the information was insufficient to assess the risk of bias for most studies. No meta-analyses could be conducted for other outcome measures, because too few studies were available.
CONCLUSIONS
The results of this systematic review indicate that early life exposure to DEHP is potentially associated with increased adiposity in rodents. More data is needed to strengthen the evidence base.
Topics: Adipose Tissue; Aging; Animals; Body Weight; Diethylhexyl Phthalate; Environmental Pollutants; Humans; Obesity; Plasticizers; Rodentia; Triglycerides
PubMed: 28886551
DOI: 10.1016/j.chemosphere.2017.08.165 -
Sexual Medicine Reviews Oct 2022Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic... (Review)
Review
INTRODUCTION
Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on the market for purchase.
OBJECTIVES
We conducted a systematic literature review to find information to guide clinical recommendations to pelvic radiotherapy patients on potential differences regarding the use of plastic vs silicone dilators with regard to efficacy, cost, and patient preferences.
METHODS
A systematic literature review was conducted in Embase, MEDLINE, and PubMed using Emtree terms. To be included in the review, papers needed to: focus on female patients undergoing radiation therapy, assess a vaginal dilator, measure any dilator intervention outcome, and specifically compare plastic vs silicone dilators for any measured outcome (either qualitative or quantitative).
RESULTS
The initial search yielded 195 articles. Two area experts, with a third expert for arbitration, read each article and found that none met all review inclusion criteria. No studies were found that compared silicone to plastic dilators with regard to efficacy in treating vaginal stenosis due to radiation therapy, no studies were found that compared cost or cost-effectiveness of the 2 dilator types, and no studies were found comparing patient preferences or experiences (eg, comfort, adherence, ease of use) between the 2 dilator types.
CONCLUSION
The materials used to create dilators have never been rigorously compared in the context of radiotherapy-related vaginal stenosis. Institutions and patients have no data to guide their choice. Significantly more research at the patient and institutional level is needed to explore the potential long-term quality of life and cost benefits of improved adherence with silicone dilator use, and to guide shared decision-making regarding dilator choice. Morgan O, Lopez MD, Martinez AJC, et al. Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap. Sex Med Rev 2022;10:513-519.
Topics: Constriction, Pathologic; Female; Humans; Plastics; Quality of Life; Silicones; Vagina
PubMed: 36030181
DOI: 10.1016/j.sxmr.2022.06.008 -
Knee Surgery, Sports Traumatology,... Sep 2022Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly... (Meta-Analysis)
Meta-Analysis Review
Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials.
PURPOSE
Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA.
METHODS
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool.
RESULTS
Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05).
CONCLUSIONS
There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA.
LEVEL OF EVIDENCE
II.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Osteolysis; Polyethylene; Polyethylenes; Prosthesis Design; Prosthesis Failure; Randomized Controlled Trials as Topic
PubMed: 35182171
DOI: 10.1007/s00167-022-06879-7 -
Journal of Dentistry Sep 2021(i) To undertake a comprehensive scoping review of the literature that addresses the research question 'What is the current state of environmental sustainability in... (Review)
Review
OBJECTIVES
(i) To undertake a comprehensive scoping review of the literature that addresses the research question 'What is the current state of environmental sustainability in general dental practice?' (ii) To provide an effective baseline of data that will consider general awareness, barriers and challenges for the implementation of sustainable practice.
DATA & SOURCES
The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews) was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n = 39); Research (n = 60); Literature reviews (n = 25); Reports [Policy and legislation] (n = 4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this first paper focusing on awareness of the problem and barriers or challenges to the implementation of sustainable care.
CONCLUSIONS
Eight diverse but closely interlinked themes that influence the sustainability of oral health provision were identified: Environmental impacts (COe, air and water); Reduce, reuse, recycle and rethink; Policy and guidelines; Biomedical waste management; Plastics (SUPs); Procurement; Research & Education; Materials. Barriers to implementation were identified as: Lack of professional and public awareness; carbon emissions arising from patient and staff commute; challenges associated with the recovery and recycling of biomedical waste with a focus on SUPs; lack of knowledge and education into sustainable healthcare provision and; the challenges from the manufacturing, use and disposal of dental materials.
Topics: Delivery of Health Care; Dentistry; Humans; Oral Health; Research Design; Research Report
PubMed: 34182058
DOI: 10.1016/j.jdent.2021.103735 -
World Journal of Plastic Surgery Jul 2022We aimed to provide a single, viable and user-friendly operative protocol for preoperative antibiotic prophylaxis that meets the needs of all plastic surgery... (Review)
Review
BACKGROUND
We aimed to provide a single, viable and user-friendly operative protocol for preoperative antibiotic prophylaxis that meets the needs of all plastic surgery practitioners.
METHODS
The research was conducted through the abstract and citation databases of peer-reviewed literature Pubmed® (National Center for Biotechnology Information), Medscape® (General Surgery) and Scopus® (Elsevier), comparing existing data from 2010 to 2020. A separated and dedicated research was accomplished for each of 8 macroareas such as: skin and soft tissue, hand, breast, aesthetics, head and neck, trauma, burns and miscellaneous.
RESULTS
The findings for each macroareas included the choice of the antibiotic, the route and timing of administration and the clinical applications. Finally, the review has been condensed in an operative algorithm for antibiotic use to apply in each field of plastic surgery.
CONCLUSION
We could provide plastic surgeon an effective, easy-to-use operative protocol for antibiotic prophylaxis in daily activity.
PubMed: 36117892
DOI: 10.52547/wjps.11.2.24 -
BMC Infectious Diseases Oct 2023COVID-19 has been a public health emergency of international concern (PHEIC) for a lengthy period of time. The novel coronavirus is primarily spread via aerosols at a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
COVID-19 has been a public health emergency of international concern (PHEIC) for a lengthy period of time. The novel coronavirus is primarily spread via aerosols at a short distance, with infected individuals releasing large amounts of aerosols when speaking and coughing. However, there is an open question regarding whether mouthwash could effectively reduce virus transmission during the COVID-19 pandemic and support the prevention of infection among medical workers.
METHODS
Cochrane Library, PubMed, Web of Science, and Embase databases were systematically searched from the inception of each database to January 12, 2023 for currently available randomized clinical trials (RCTs) on the effect of mouthwash on novel coronavirus load in the oral cavity in COVID-19 patients. The treatment group received mouthwash for rinsing the mouth, while the control group received a placebo or distilled water for COVID-19 patients. The primary outcomes were CT value and viral load. Odds ratios (ORs) were estimated using a random-effects model. Subgroup and sensitivity analyses were performed to minimize the bias and the impact of heterogeneity.
RESULTS
Thirteen RCTs were included. Seven studies reported the intervention effect of mouthwash on the CT value of novel coronavirus. The analysis results showed that the mouthwash group had a positive impact on the CT value of novel coronavirus [ SMD = 0.35, 95% CI (0.21, 0.50)] compared with the control group. In addition, subgroup analysis showed a significant positive effect of mouthwash on CT values in the treatment group compared with the control group, with chlorhexidine (CHX) [SMD = 0.33, 95% CI (0.10, 0.56)], povidone-iodine (PVP-I) [SMD = 0.61, 95% CI (0.23, 0.99)], or hydrogen peroxide (HP) [SMD = 1.04, 95% CI (0.30, 1.78)] as an ingredient of the mouthwash. Six studies reported the intervention effect of mouthwash on the viral load, 263 cases in the treatment group and 164 cases in the control group. The analysis results showed that there was no statistical difference between the mouthwash group and the control group in the viral load of novel coronavirus [SMD = -0.06, 95% CI (-0.18, 0.05)]. In the subgroup analysis by measurement time, there were statistically significant differences between the mouthwash and control groups for CT values [SMD = 0.52, 95% CI (0.31, 0.72)] and viral load [SMD = - 0.32, 95% CI (- 0.56, - 0.07)] within 30 min of gargling.
CONCLUSIONS
In summary, mouthwash has some efficacy in reducing the viral load of novel coronavirus, especially within 30 min after rinsing the mouth. Mouthwash containing CHX, PVP-I and HP all had significant positive effects on CT values, and PVP-I-containing mouthwash may be a promising option to control novel coronavirus infections and relieve virus-related symptoms. However, studies on the dose and frequency of use of mouthwash for infection control are still lacking, which may limit the clinical application of mouthwash.
TRIAL REGISTRATION
Protocol registration: The protocol was registered at PROSPERO (CRD42023401961).
Topics: Humans; Mouthwashes; SARS-CoV-2; COVID-19; Povidone-Iodine; Viral Load; Respiratory Aerosols and Droplets; Chlorhexidine; Hydrogen Peroxide
PubMed: 37821800
DOI: 10.1186/s12879-023-08669-z -
Journal of Cutaneous and Aesthetic... 2019The incidence of melanoma and nonmelanoma skin cancers is increasing in the United Kingdom. Surgical excision carries the highest cure rates for all skin cancers and is... (Review)
Review
BACKGROUND
The incidence of melanoma and nonmelanoma skin cancers is increasing in the United Kingdom. Surgical excision carries the highest cure rates for all skin cancers and is the first-line treatment for melanomas and high-risk nonmelanoma cancers. This is most commonly performed by general practitioners (GPs), dermatologists, and plastic surgeons.
OBJECTIVE
The aim of this study was to identify which health-care professionals achieve the best outcomes following surgical excision of skin cancer lesions.
MATERIALS AND METHODS
A comprehensive search of the Cochrane Library and PubMed databases was conducted. PRISMA guidelines were adhered to throughout.
RESULTS
Six studies were identified and reviewed. Dermatologists were most likely to excise lesions adequately, and GPs were the least likely. Dermatologists displayed the greatest diagnostic accuracy, and excisions led by them had the highest overall and disease-free survival rates. Plastic surgeons were most likely to excise complex lesions on difficult-to-treat areas.
CONCLUSION
Dermatologists can excise many skin lesions adequately, but plastic surgeons should continue to take an active role in complex or anatomically challenging lesions. There is a need for more validated training for GPs in the management of skin cancers. Further studies incorporating a randomized control protocol are needed to definitely assess who is best placed to surgically excise these lesions.
PubMed: 31619886
DOI: 10.4103/JCAS.JCAS_174_18 -
Perioperative Medicine (London, England) Jun 2024Tranexamic acid has been widely used in plastic surgery. However, its efficacy has yet to be fully established. This meta-analysis aimed to determine its effectiveness... (Review)
Review
INTRODUCTION
Tranexamic acid has been widely used in plastic surgery. However, its efficacy has yet to be fully established. This meta-analysis aimed to determine its effectiveness in aesthetic plastic surgery.
METHODS
Following PRISMA guidelines, we conducted a meta-analysis of prospective randomised clinical trials that compared the effects of topical or systematic administration of tranexamic acid versus the control group in aesthetic plastic surgeries. The study was registered on the International Register of Systematic Reviews (PROSPERO) and is available online ( www.crd.york.uk/prospero , CRD42023492585).
RESULTS
Eleven studies encompassing 960 patients were included for the synthesis after critical evaluation. Systematic (MD - 18.05, 95% Cl, - 22.01, - 14.09, p < 0.00001) and topical (MD - 74.93, 95% Cl, - 88.79, - 61.07, p < 0.00001) administration of tranexamic acid reduced total blood loss. Topical tranexamic acid reduced drainage output (p < 0.0006).
CONCLUSION
Tranexamic acid reduced blood loss in aesthetic plastic surgery. More strictly defined RCTs, using high-quality methodology, are needed to evaluate the advantages and disadvantages of tranexamic acid in aesthetic plastic surgery.
PubMed: 38831387
DOI: 10.1186/s13741-024-00406-7 -
Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials.Hand (New York, N.Y.) Sep 2022Osteoarthritis of the first carpometacarpal joint is a common condition. Various management options and surgical procedures have been described to treat symptomatic...
BACKGROUND
Osteoarthritis of the first carpometacarpal joint is a common condition. Various management options and surgical procedures have been described to treat symptomatic cases. Many systematic reviews examine aspects of thumb carpometacarpal joint osteoarthritis treatment, although none solely examines the outcomes of trapezial partial resection and interposition arthroplasty in stage II to III patients in detail, yet this technique is of growing interest as surgeons seek more nuanced, tailored approaches for osteoarthritis of the first carpometacarpal joint.
METHODS
A systematic review of the thumb carpometacarpal joint hemiresection and interposition arthroplasty was performed with pain assessment as a primary outcome measure and patient-reported outcome measures (PROMs) and reoperation rate as secondary outcome measures. A search was performed between 2004 and 2019 using MEDLINE, Embase, and PubMed. Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines were used.
RESULTS
Twenty-nine articles met the inclusion criteria and were included in the final review. Pain relief and improved PROMs were described in all the articles using this technique with all the interposition materials. Materials such as polyurethane urea matrix and poly-l/d-lactide scaffold had higher complication rates. Revision rates varied and were highest with the polyurethane urea matrix.
CONCLUSIONS
This review shows that hemiresection interposition arthroplasty is a useful technique and provides symptomatic benefit in patients with Eaton-Littler stage II and III osteoarthritis. Revision surgery rates due to persistent pain and instability were higher with the use of implants. Larger and long-term studies of this technique using autologous or more bioinert materials and implants are required to assess duration of symptomatic benefit.
Topics: Arthroplasty; Carpometacarpal Joints; Humans; Osteoarthritis; Pain; Polyurethanes; Thumb; Urea
PubMed: 33307813
DOI: 10.1177/1558944720974124 -
The Cochrane Database of Systematic... Mar 2022Viruses cause about 80% of all cases of acute conjunctivitis. Human adenoviruses are believed to account for 65% to 90% of cases of viral conjunctivitis, or 20% to 75%... (Review)
Review
BACKGROUND
Viruses cause about 80% of all cases of acute conjunctivitis. Human adenoviruses are believed to account for 65% to 90% of cases of viral conjunctivitis, or 20% to 75% of all causes of infectious keratoconjunctivitis worldwide. Epidemic keratoconjunctivitis (EKC) is a highly contagious subset of adenoviral conjunctivitis that has been associated with large outbreaks at military installations and at medical facilities. It is accompanied by severe conjunctival inflammation, watery discharge, and light sensitivity, and can lead to chronic complications such as corneal and conjunctival scarring with discomfort and poor quality of vision. Due to a lack of consensus on the efficacy of any pharmacotherapy to alter the clinical course of EKC, no standard of care exists, therefore many clinicians offer only supportive care.
OBJECTIVES
To assess the efficacy and safety of topical pharmacological therapies versus placebo, an active control, or no treatment for adults with EKC.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 4); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), with no restrictions on language or year of publication. The date of the last search was 27 April 2021.
SELECTION CRITERIA
We included randomized controlled trials in which antiseptic agents, virustatic agents, or topical immune-modulating therapy was compared with placebo, an active control, or no treatment.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodology.
MAIN RESULTS
We identified 10 studies conducted in Asia, Europe, the Middle East, and North Africa with a total of 892 participants who were treated for 7 days to 6 months and followed for 7 days up to 1.5 years. Study characteristics and risk of bias In most studies participants were predominantly men (range: 44% to 90%), with an age range from 9 to 82 years. Three studies reported information on trial registration, but we found no published study protocol. The majority of trials had small sample sizes, ranging from 18 to 90 participants enrolled per study; the only exception was a trial that enrolled 350 participants. We judged most studies to be at high or unclear risk of bias across risk of bias domains. Findings We included 10 studies of 892 EKC participants and estimated combined intervention effects in analyses stratified by steroid-containing control treatment or artificial tears. Six trials contributed to the comparisons of topical interventions (povidone-iodine [PVP-I], trifluridine, ganciclovir, dexamethasone plus neomycin) with artificial tears (or saline). Very low certainty evidence from two trials comparing trifluridine or ganciclovir with artificial tears showed inconsistent effects on shortening the mean duration of cardinal symptoms or signs of EKC. Low certainty evidence based on two studies (409 participants) indicated that participants treated with PVP-I alone more often experienced resolution of symptoms (risk ratio (RR) 1.15, 95% confidence interval (CI) 1.07 to 1.24) and signs (RR 3.19, 95% CI 2.29 to 4.45) during the first week of treatment compared with those treated with artificial tears. Very low certainty evidence from two studies (77 participants) suggested that PVP-I or ganciclovir prevented the development of subepithelial infiltrates (SEI) when compared with artificial tears within 30 days of treatment (RR 0.24, 95% CI 0.10 to 0.56). Four studies compared topical interventions (tacrolimus, cyclosporin A [CsA], trifluridine, PVP-I + dexamethasone) with topical steroids, and one trial compared fluorometholone (FML) plus polyvinyl alcohol iodine (PVA-I) with FML plus levofloxacin. Evidence from one trial showed that more eyes receiving PVP-I 1.0% plus dexamethasone 0.1% had symptoms resolved by day seven compared with those receiving dexamethasone alone (RR 9.00, 95% CI 1.23 to 66.05; 52 eyes). In two trials, fewer eyes treated with PVP-I or PVA-I plus steroid developed SEI within 15 days of treatment compared with steroid alone or steroid plus levofloxacin (RR 0.08, 95% CI 0.01 to 0.55; 69 eyes). One study found that CsA was no more effective than steroid for resolving SEI within four weeks of treatment (RR 0.84, 95% CI 0.67 to 1.06; N = 88). The evidence from trials comparing topical interventions with steroids was overall of very low level certainty. Adverse effects Antiviral or antimicrobial agents plus steroid did not differ from artificial tears in terms of ocular discomfort upon instillation (RR 9.23, 95% CI 0.61 to 140.67; N = 19). CsA and tacrolimus eye drops were associated with more cases of severe ocular discomfort, and sometimes intolerance, when compared with steroids (RR 4.64, 95% CI 1.15 to 18.71; 2 studies; N = 141). Compared with steroids, tacrolimus did not increase the risk of elevated intraocular pressure (RR 0.07, 95% CI 0 to 1.13; 1 study; N = 80), while trifluridine conferred no additional risk compared to tear substitute (RR 5.50, 95% CI 0.31 to 96.49; 1 study; N = 97). Overall, bacterial superinfection was rare (one in 23 CsA users) and not associated with use of the intervention steroid (RR 3.63, 95% CI 0.15 to 84.98; N = 51). The evidence for all estimates was of low or very low certainty.
AUTHORS' CONCLUSIONS
The evidence for the seven specified outcomes was of low or very low certainty due to imprecision and high risk of bias. The evidence that antiviral agents shorten the duration of symptoms or signs when compared with artificial tears was inconclusive. Low certainty evidence suggests that PVP-I alone resolves signs and symptoms by seven days relative to artificial tears. PVP-I or PVA-I, alone or with steroid, is associated with lower risks of SEI development than artificial tears or steroid (very low certainty evidence). The currently available evidence is insufficient to determine whether any of the evaluated interventions confers an advantage over steroids or artificial tears with respect to virus eradication or its spread to initially uninvolved fellow eyes. Future updates of this review should provide evidence of high-level certainty from trials with larger sample sizes, enrollment of participants with similar durations of signs and symptoms, and validated methods to assess short- and long-term outcomes.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Conjunctivitis; Conjunctivitis, Viral; Cyclosporine; Dexamethasone; Female; Fluorometholone; Ganciclovir; Humans; Keratoconjunctivitis; Levofloxacin; Lubricant Eye Drops; Male; Middle Aged; Povidone-Iodine; Tacrolimus; Trifluridine; Young Adult
PubMed: 35238405
DOI: 10.1002/14651858.CD013520.pub2