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European Journal of Pharmacology Nov 2023Intestinal ischemia/reperfusion injury (IRI) is a multifactorial, complex pathophysiological process in clinical settings. In recent years, intestinal IRI has received... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intestinal ischemia/reperfusion injury (IRI) is a multifactorial, complex pathophysiological process in clinical settings. In recent years, intestinal IRI has received increasing attention due to increased morbidity and mortality. To date, there are no effective treatments. Dexmedetomidine (DEX), a highly selective α-adrenergic receptor agonist, has been demonstrated to be effective against intestinal IRI. In this systematic review and meta-analysis, we evaluated the efficacy and potential mechanisms of DEX as a treatment for intestinal IRI in animal models.
METHODS
Five databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were searched until March 15, 2023. Using the SYRCLE risk bias tool, we assessed methodological quality. Statistical analysis was conducted using STATA 12 and R 4.2.2. We analyzed the related outcomes (mucosa damage-related indicators; inflammation-relevant markers, oxidative stress markers) relied on the fixed or random-effects models.
RESULTS
There were 15 articles including 18 studies included, and 309 animals were involved in the studies. Compared to the model groups, DEX improved intestinal IRI. DEX decreased Chiu's score and serum diamine oxidase (DAO) level. DEX reduced the level of inflammation-relevant markers (interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α). DEX also improved oxidative stress (decreased malondialdehyde (MDA), increased superoxide dismutase (SOD)).
CONCLUSIONS
DEX's effectiveness in ameliorating intestinal IRI has been demonstrated in animal models. Antioxidation, anti-inflammation, anti-apoptotic, anti-pyroptosis, anti-ferroptosis, enhancing mitophagy, reshaping the gut microbiota, and gut barrier protection are possible mechanisms. However, in light of the heterogeneity and methodological quality of these studies, further well-designed preclinical studies are warranted before clinical implication.
Topics: Rats; Animals; Dexmedetomidine; Rats, Sprague-Dawley; Adrenergic alpha-2 Receptor Agonists; Reperfusion Injury; Inflammation; Ischemia
PubMed: 37778612
DOI: 10.1016/j.ejphar.2023.176090 -
Clinical and Experimental Dental... Apr 2023The objective of this review is to assess the available literature systematically related to the effect of silver diamine fluoride (SDF) for the management of occlusal...
OBJECTIVES
The objective of this review is to assess the available literature systematically related to the effect of silver diamine fluoride (SDF) for the management of occlusal and root carious lesions in permanent teeth regardless of age. MATERIALS AND METHODS: This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses statement. A literature search was performed using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ, and Open Gray with no language restrictions up to December 2022. Three reviewers critically assessed the studies for eligibility. Any disputes between the reviewers were handled by a fourth independent reviewer. The quality assessment and data extraction of the studies were performed.
RESULTS
A total of 2176 studies were screened. The titles and abstracts of the studies were then reviewed (n = 346), and 52 studies met the search criteria. Following the full-text review, 11 studies investigated the effect of SDF against other treatments such as chlorhexidine, sodium fluoride, ammonium bifluoride, tricalcium silicate paste, casein phosphopeptide amorphous calcium phosphate, glass ionomer cement (GIC) combined with fluoride varnish, resin-modified GIC, and atraumatic restorative treatment were assessed.
CONCLUSIONS
Within the limitations of this review, the use of SDF is promising with high preventative fractions in permanent teeth of children and older populations when compared to other topical applications such as dental varnish containing sodium fluoride.
Topics: Child; Humans; Dental Atraumatic Restorative Treatment; Dental Caries; Fluorides, Topical; Sodium Fluoride
PubMed: 36823765
DOI: 10.1002/cre2.716 -
Children (Basel, Switzerland) Dec 2022Apart from the major drawback of black staining once lesion is arrested, few studies have indicated that dental personnel's perception and attitude towards silver... (Review)
Review
Apart from the major drawback of black staining once lesion is arrested, few studies have indicated that dental personnel's perception and attitude towards silver diamine fluoride (SDF) influences its usage. This report aims to provide a systematic review presenting dental personnel's knowledge, attitudes, and perceptions, (KAPs) regarding SDF. A search of multiple electronic literature databases and a manual search were performed. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. A comprehensive search yielded 719 publications and 14 cross-sectional studies matching the inclusion criteria. Awareness of SDF among respondents ranged from 29.6% to 87.8%, whereas awareness of its use in dentistry ranged from 14.4% to 94.5%. Regarding attitude towards SDF, the mean score ranged from 3.39 to 14.35. An increase in knowledge of and attitude towards SDF is significantly associated with the usage of SDF and may increase the usage of SDF. This review provides vital information on dental personnel's KAPs regarding SDF. It is anticipated that the adaptation of SDF usage will be more widespread in the future, especially among children. Findings from the review may assist intervention programs to change misperceptions and to enhance awareness regarding SDF among dental personnel.
PubMed: 36553379
DOI: 10.3390/children9121936 -
European Review For Medical and... Nov 2023Early childhood caries is a common condition that poses a serious risk to children's health because it can progress quickly, resulting in pain, abscesses, and a general...
OBJECTIVE
Early childhood caries is a common condition that poses a serious risk to children's health because it can progress quickly, resulting in pain, abscesses, and a general decline in health. As a result, invasive therapies are needed, which call for highly skilled personnel. This systematic review of the literature aims to identify the most recent and widely applied early childhood caries (ECC) prevention and treatment approaches. Only substances that act topically and minimally invasive interventions were considered.
MATERIALS AND METHODS
The database search was restricted to randomized clinical trials completed within the last five years, specifically those that examined the following procedures: sodium fluoride (NaF) varnish, alternative restorative technique (ART), nano-silver fluoride, silver diamine fluoride, and silver modified atraumatic restorative treatment sealants (SMART).
RESULTS
A total of 815 articles were found. After removing duplicates, 584 articles were included, and 567 of them were excluded due to not meeting the predefined inclusion criteria.
CONCLUSIONS
Every method considered has been proven to be successful in halting the progression of ECC and is well-liked by patients, even those who are unwilling to cooperate, as well as by parents. The most common unfavorable effect of SDF is irreversible black discoloration in treated tooth surfaces, but this is typically not a problem. They are all low-cost, minimally invasive techniques that might also be widely used in large communities and low socioeconomic settings.
Topics: Child; Humans; Child, Preschool; Cariostatic Agents; Dental Atraumatic Restorative Treatment; Dental Caries Susceptibility; Sodium Fluoride
PubMed: 38039039
DOI: 10.26355/eurrev_202311_34477 -
Neurological Sciences : Official... Oct 2023Neurological deterioration, soon after anti-copper treatment initiation, is problematic in the management of Wilson's disease (WD) and yet reports in the literature are... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Neurological deterioration, soon after anti-copper treatment initiation, is problematic in the management of Wilson's disease (WD) and yet reports in the literature are limited. The aim of our study was to systematically assess the data according to early neurological deteriorations in WD, its outcome and risk factors.
METHODS
Using PRISMA guidelines, a systematic review of available data on early neurological deteriorations was performed by searching the PubMed database and reference lists. Random effects meta-analytic models summarized cases of neurological deterioration by disease phenotype.
RESULTS
Across the 32 included articles, 217 cases of early neurological deterioration occurred in 1512 WD patients (frequency 14.3%), most commonly in patients with neurological WD (21.8%; 167/763), rarely in hepatic disease (1.3%; 5/377), and with no cases among asymptomatic individuals. Most neurological deterioration occurred in patients treated with d-penicillamine (70.5%; 153/217), trientine (14.2%; 31/217) or zinc salts (6.9%; 15/217); the data did not allow to determine if that reflects how often treatments were chosen as first line therapy or if the risk of deterioration differed with therapy. Symptoms completely resolved in 24.2% of patients (31/128), resolved partially in 27.3% (35/128), did not improve in 39.8% (51/128), with 11 patients lost to follow-up.
CONCLUSIONS
Given its occurrence in up to 21.8% of patients with neurological WD in this meta-analysis of small studies, there is a need for further investigations to distinguish the natural time course of WD from treatment-related early deterioration and to develop a standard definition for treatment-induced effects.
Topics: Humans; Hepatolenticular Degeneration; Penicillamine; Trientine; Copper; Nervous System Diseases
PubMed: 37311952
DOI: 10.1007/s10072-023-06895-6 -
European Journal of Clinical... Oct 2022Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring... (Review)
Review
PURPOSE
Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and systemic corticosteroids), another pharmacological option is represented by ketamine. We performed a systematic review to explore the role of ketamine in refractory SAEs.
METHODS
We performed a systematic search on PubMed and EMBASE up to August 12th, 2021. We selected prospective studies only, and outcomes of interest were oxygenation/respiratory parameters, clinical status, need for invasive ventilation and effects on weaning.
RESULTS
We included a total of seven studies, five being randomized controlled trials (RCTs, population range 44-92 patients). The two small prospective studies (n = 10 and n = 11) did not have a control group. Four studies focused on adults, and three enrolled a pediatric population. We found a large heterogeneity regarding sample size, age and gender distribution, inclusion criteria (different severity scores, if any) and ketamine dosing (bolus and/or continuous infusion). Of the five RCTs, three compared ketamine to placebo, while one used fentanyl and the other aminophylline. The outcomes evaluated by the included studies were highly variable. Despite paucity of data and large heterogeneity, an overview of the included studies suggests absence of clear benefit produced by ketamine in patients with refractory SAE, and some signals towards side effects.
CONCLUSION
Our systematic review does not support the use of ketamine in refractory SAE. A limited number of prospective studies with large heterogeneity was found. Well-designed multicenter RCTs are desirable.
Topics: Adrenal Cortex Hormones; Adult; Aminophylline; Anti-Asthmatic Agents; Asthma; Child; Cholinergic Antagonists; Fentanyl; Humans; Ketamine; Multicenter Studies as Topic; Prospective Studies
PubMed: 36008492
DOI: 10.1007/s00228-022-03374-3 -
JAMA Nov 2023Dental caries is common in children and adolescents aged 5 to 17 years and potentially amenable to primary care screening and prevention. (Meta-Analysis)
Meta-Analysis
Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: A Systematic Review for the US Preventive Services Task Force.
IMPORTANCE
Dental caries is common in children and adolescents aged 5 to 17 years and potentially amenable to primary care screening and prevention.
OBJECTIVE
To systematically review the evidence on primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force.
DATA SOURCES
MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.
STUDY SELECTION
Diagnostic accuracy of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions and systematic reviews of such studies; cohort studies on primary care oral health screening and preventive intervention harms.
DATA EXTRACTION AND SYNTHESIS
One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Random-effects meta-analysis was performed for fluoride supplements and xylitol; for other preventive interventions, pooled estimates were used from good-quality systematic reviews.
MAIN OUTCOMES AND MEASURES
Dental caries, morbidity, functional status, quality of life, harms; diagnostic test accuracy.
RESULTS
Three systematic reviews (total 20 684 participants) and 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study (total 15 026 participants) were included. No study compared screening vs no screening. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) (mean difference, -0.73 [95% CI, -1.30 to -0.19]) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 (95% CI, 0.09-0.27) at outcomes closest to 3 years (4 trials; n = 1525), fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 (95% CI, 0.11-0.76) at 1 to 4.5 years (5 trials; n = 3902), and resin-based sealants were associated with decreased risk of carious first molars (odds ratio, 0.21 [95% CI, 0.16-0.28]) at 48 to 54 months (4 trials; n = 440). No trial evaluated primary care counseling or dental referral. Evidence on screening accuracy, silver diamine fluoride, xylitol, and harms was very limited, although serious harms were not reported.
CONCLUSIONS AND RELEVANCE
Administration of fluoride supplements, fluoride gels, varnish, and sealants in dental or school settings improved caries outcomes. Research is needed on the effectiveness of oral health preventive interventions in primary care settings and to determine the benefits and harms of screening.
Topics: Adolescent; Child; Humans; Counseling; Dental Caries; Fluorides; Gels; Observational Studies as Topic; Oral Health; Quality of Life; Xylitol; Child, Preschool; Mass Screening; Referral and Consultation; Preventive Dentistry; Primary Health Care; Cariostatic Agents
PubMed: 37934216
DOI: 10.1001/jama.2023.20435 -
The European Respiratory Journal Mar 2023Suboptimal exposure to antituberculosis (anti-TB) drugs has been associated with unfavourable treatment outcomes. We aimed to investigate estimates and determinants of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Suboptimal exposure to antituberculosis (anti-TB) drugs has been associated with unfavourable treatment outcomes. We aimed to investigate estimates and determinants of first-line anti-TB drug pharmacokinetics in children and adolescents at a global level.
METHODS
We systematically searched MEDLINE, Embase and Web of Science (1990-2021) for pharmacokinetic studies of first-line anti-TB drugs in children and adolescents. Individual patient data were obtained from authors of eligible studies. Summary estimates of total/extrapolated area under the plasma concentration-time curve from 0 to 24 h post-dose (AUC) and peak plasma concentration ( ) were assessed with random-effects models, normalised with current World Health Organization-recommended paediatric doses. Determinants of AUC and were assessed with linear mixed-effects models.
RESULTS
Of 55 eligible studies, individual patient data were available for 39 (71%), including 1628 participants from 12 countries. Geometric means of steady-state AUC were summarised for isoniazid (18.7 (95% CI 15.5-22.6) h·mg·L), rifampicin (34.4 (95% CI 29.4-40.3) h·mg·L), pyrazinamide (375.0 (95% CI 339.9-413.7) h·mg·L) and ethambutol (8.0 (95% CI 6.4-10.0) h·mg·L). Our multivariate models indicated that younger age (especially <2 years) and HIV-positive status were associated with lower AUC for all first-line anti-TB drugs, while severe malnutrition was associated with lower AUC for isoniazid and pyrazinamide. -acetyltransferase 2 rapid acetylators had lower isoniazid AUC and slow acetylators had higher isoniazid AUC than intermediate acetylators. Determinants of were generally similar to those for AUC.
CONCLUSIONS
This study provides the most comprehensive estimates of plasma exposures to first-line anti-TB drugs in children and adolescents. Key determinants of drug exposures were identified. These may be relevant for population-specific dose adjustment or individualised therapeutic drug monitoring.
Topics: Child; Adolescent; Humans; Child, Preschool; Antitubercular Agents; Isoniazid; Pyrazinamide; Ethambutol; Rifampin
PubMed: 36328357
DOI: 10.1183/13993003.01596-2022 -
BioMed Research International 2022. has been implicated in infections of treated root canals. Current irrigants and intracanal medicaments cannot eliminate completely from the root canal. Silver... (Review)
Review
. has been implicated in infections of treated root canals. Current irrigants and intracanal medicaments cannot eliminate completely from the root canal. Silver diamine fluoride (SDF) prevents caries by promoting remineralization and exerting an antibacterial effect. Studies suggest that SDF may possess antibacterial properties against . The purpose of this review is to systematically and critically analyze the literature, focusing on the use of SDF as an intracanal medicament or irrigant, when compared to other antibacterial agents. . The focused question was "Is the antibacterial effect of SDF against better than other intracanal medicaments and irrigants?" Using the keywords ((silver diamine fluoride) AND ()) AND ((sodium hypochlorite) OR (NaOCl) OR (chlorhexidine) OR (calcium hydroxide) OR (Ca(OH))), an electronic search was conducted on the following databases: PubMed/MEDLINE, ISI Web of Science, Scopus, EMBASE, and Google Scholar. The clinical trial registers ClinicalTrials.gov and CONTROL were also searched using the same keywords. General characteristics and outcomes were extracted, and quality of the studies was assessed using the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) guidelines. . Six articles (five studies and one study) were included in this systematic review. In the majority of the studies, SDF had equal or better antibacterial efficacy against compared to calcium hydroxide, sodium hypochlorite, and chlorhexidine. However, the majority of the studies did not fulfill several items in the PRILE criteria and had numerous sources of bias. . Within the limitations of the systematic review and the studies reviewed, SDF may be effective against and therefore could be used as an intracanal medicament and/or irrigant to prevent reinfections of the root canals and improve the outcomes of endodontic treatment. However, animal and clinical studies should be carried out to determine the efficacy of SDF in endodontics. . The protocol for this review was registered on PROSPERO. Registration number: CRD42021224741.
Topics: Animals; Chlorhexidine; Enterococcus faecalis; Sodium Hypochlorite; Calcium Hydroxide; Anti-Infective Agents; Anti-Bacterial Agents; Dental Pulp Cavity
PubMed: 36567909
DOI: 10.1155/2022/6544292 -
Dermatitis : Contact, Atopic,... 2024Widespread use of oxidative hair dyes during the past decades has raised questions on the potential allergy reactions and their management, as well as prevention... (Review)
Review
Widespread use of oxidative hair dyes during the past decades has raised questions on the potential allergy reactions and their management, as well as prevention measures for both professionals and consumers. Allergic contact dermatitis can be elicited by various hair dye-related allergens, though the main problem remains with -phenylenediamine and related aromatic amines. If allergy is suspected, patch testing identifies the responsible hapten. Individuals sensitized to specific permanent hair dyes substances should avoid the exposure to these chemicals, but also be aware of possible cross-sensitization to other similar compounds. Cross-reactions detected in patch-tested populations indicate that one cannot safely use alternatives, although cross-reactivity is not always clinically relevant. An open application hair dye allergy self-test is recommended by manufacturers for early detection of allergy predisposition in consumers, although the lack of standardized conditions makes the efficacy of this process doubtful. Appropriate use of hand gloves, especially nitrile, is the most efficient prevention measure for professional hand eczema. In this systematic review, we focus on cross-reactions among hair dye-related allergens and make an attempt to answer some, frequently encountered by physicians, questions, while presenting the prevalence of the hair dye-related allergens.
Topics: Humans; Allergens; Hair Dyes; Prevalence; Phenylenediamines; Dermatitis, Allergic Contact; Patch Tests
PubMed: 37352419
DOI: 10.1089/derm.2023.0019