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Drug and Alcohol Review Nov 2022Policy enforcement is crucial to achieve impacts on alcohol-related harm. It is not clear what level of enforcement intensity or 'dosage' is necessary for addressing... (Review)
Review
ISSUES
Policy enforcement is crucial to achieve impacts on alcohol-related harm. It is not clear what level of enforcement intensity or 'dosage' is necessary for addressing drink driving and related harms. Given competing enforcement demands and agencies' resource constraints, understanding how much enforcement is sufficient to deter drink driving is critical.
APPROACH
This systematic literature review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines to examine research about dosage effects of enforcement and related visibility on drink-driving outcomes, including motor vehicle crashes and fatalities. Risk of bias was assessed using the Cochrane Collaboration Effective Practice and Organization of Care tool and the JBI checklist.
KEY FINDINGS
The 21 studies that met the inclusion criteria for this review differed in measures of enforcement dosage and outcomes, making it difficult to synthesise results across studies and draw conclusions about a threshold or optimal level of enforcement. Although most included studies found that sustained enforcement was associated with reductions in drink driving or related harms, only two studies tested an optimal dosage. Due to study design limitations, a substantial percentage of these studies must be considered with caution.
IMPLICATIONS
Additional research with rigorous study designs with appropriate controls is needed to determine an optimal high visibility enforcement dosage level to help law enforcement agencies make realistic decisions about allocating enforcement resources to address drink driving.
CONCLUSION
Consistent evidence about a drink-driving enforcement dosage threshold is lacking, partly due to an insufficient number of well-designed studies. Addressing challenges of conducting rigorous studies in community settings is crucial.
Topics: Humans; Accidents, Traffic; Alcohol Drinking; Automobile Driving; Driving Under the Influence; Law Enforcement
PubMed: 35894270
DOI: 10.1111/dar.13519 -
Drug and Alcohol Dependence May 2023Methadone maintenance therapy is a leading treatment strategy for stabilizing and rehabilitating patients with opioid dependence; however, findings related to the risk... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Methadone maintenance therapy is a leading treatment strategy for stabilizing and rehabilitating patients with opioid dependence; however, findings related to the risk of motor vehicle collisions after methadone use have been conflicting. In the present study, we compiled the available evidence on the risk of motor vehicle collisions after methadone use.
METHODS
We completed a systematic review and meta-analysis of studies identified on six databases. Two reviewers independently screened the identified epidemiological studies, extracted data, and used the Newcastle-Ottawa Scale to assess the quality of the studies. Risk ratios were retrieved for analysis, conducted using random-effects model. Sensitivity analyses, subgroup analyses, and tests for publication bias were conducted.
RESULTS
Among 1446 identified relevant studies, a total of 7 epidemiological studies enrolling 33226142 participants met the inclusion criteria. Overall, study participants with methadone use had a higher risk of motor vehicle collisions than did those without methadone use (pooled relative risk 1.92, 95% CI 1.25-2.95; number needed to harm 11.3, 95% CI 5.3-41.6); the I statistic was 95.1%, indicating substantial heterogeneity. Subgroup analyses revealed that database type explained 95.36% of the between-study variance (p = 0.008). Egger's (p = 0.376) and Begg's (p = 0.293) tests revealed no evidence of publication bias. Sensitivity analyses indicated that the pooled results were robust.
CONCLUSION
The present review revealed that methadone use is significantly associated with a nearly doubled risk of motor vehicle collisions. Therefore, clinicians should exercise caution in implementing methadone maintenance therapy for drivers.
Topics: Humans; Methadone; Opioid-Related Disorders; Opiate Substitution Treatment; Accidents, Traffic; Motor Vehicles
PubMed: 36933540
DOI: 10.1016/j.drugalcdep.2023.109832 -
The Journal of Allergy and Clinical... Aug 2022Aquagenic urticaria (AquaU) is a rare variant of chronic inducible urticaria where wheals occur after skin contact with water. Information on clinical manifestations and...
BACKGROUND
Aquagenic urticaria (AquaU) is a rare variant of chronic inducible urticaria where wheals occur after skin contact with water. Information on clinical manifestations and treatment outcomes is limited, which makes the management of AquaU challenging.
OBJECTIVE
To systematically review disease features and relevant triggers of AquaU and patients' response to treatment.
METHODS
Related articles were searched by use of the terms "aquagenic urticaria" and "aquagenic angioedema" until June 2021 and reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations.
RESULTS
A total of 77 patients with AquaU were investigated in 59 studies including 47 case reports and 12 case series. AquaU predominantly presented in women (47 patients, 61%), and the mean age of onset of the disease was 19.6 ± 10.8 years (range: 0-54 years). Wheals commonly occurred in localized areas and regardless of the water temperature. Based on the reviewed evidence, AquaU can be classified as familial AquaU (FAquaU, 18.2%) and acquired AquaU (AAquaU, 81.8%). Although many treatments were used in both subtypes of AquaU, the use of second-generation H antihistamines (2AH) was reported most often to achieve marked improvement in both subtypes. The use of topical therapies in AquaU, which most commonly use hydrophobic vehicles, is poorly documented and of controversial efficiency.
CONCLUSIONS
AquaU is proposed to be classified into 2 subtypes, FAquaU and the more common AAquaU. Treatment with a 2AH is recommended as the first-line treatment for both types of AquaU. Further studies are required to fill knowledge gaps.
Topics: Adolescent; Adult; Child; Child, Preschool; Chronic Disease; Female; Histamine Antagonists; Humans; Infant; Infant, Newborn; Middle Aged; Temperature; Urticaria; Water; Young Adult; Chronic Inducible Urticaria
PubMed: 35533998
DOI: 10.1016/j.jaip.2022.04.033 -
Drug Development and Industrial Pharmacy May 2024TheDES are formed by mixing a Hydrogen Bond Donor (HBD) and a Hydrogen Bond Acceptor (HBA) in appropriate molar ratios. These solvents have been shown to enhance drug... (Review)
Review
OBJECTIVE
TheDES are formed by mixing a Hydrogen Bond Donor (HBD) and a Hydrogen Bond Acceptor (HBA) in appropriate molar ratios. These solvents have been shown to enhance drug solubility, permeability, and delivery. The main objective of the present article is to review these advantages of TheDES.
SIGNIFICANCE
TheDES show unique properties, such as low toxicity, biodegradability, improved bioavailability and enhanced drug delivery of poorly soluble active pharmaceutical ingredients. They are also biocompatible in nature which makes them a promising candidate for various therapeutic applications, including drug formulations, drug delivery and other biomedical uses. The development and utilization of TheDES shows significant advancement in pharmaceutical research, providing new opportunities for improving drug delivery.
METHODS
The current study was carried out by conducting a systematic literature review that identified relevant papers from indexed databases. Numerous studies and research are cited and quoted in this article to demonstrate the effectiveness of TheDES in enhancing drug solubility, permeability, and delivery. All chosen articles were selected considering their significance, quality, and approach to addressing issues.
RESULT
As a result, various TheDES were identified that can be formulated in different ways: one component can act as a vehicle for an API, either HBD or HBA can be an API, both HBD and HBA can be APIs, or the individual components of DES are not therapeutically active but the resulting DES possesses therapeutic activity. Additionally, TheDES were also recognized to enhance drug delivery and solubility for different APIs, including NSAIDs, anesthetic drugs, antifungals, and others.
Topics: Solubility; Deep Eutectic Solvents; Drug Delivery Systems; Permeability; Humans; Drug Compounding; Hydrogen Bonding; Chemistry, Pharmaceutical; Biological Availability; Pharmaceutical Preparations; Solvents
PubMed: 38634708
DOI: 10.1080/03639045.2024.2345131 -
Pediatric Dermatology 2023Molluscum contagiosum (MC) is a contagious infection that, although benign, can become an aesthetic burden and lead to other opportunistic infections, secondary... (Meta-Analysis)
Meta-Analysis
Safety and efficacy of topical nitric oxide-releasing berdazimer gel for molluscum contagiosum clearance: A systematic review and meta-analysis of randomized controlled trials.
Molluscum contagiosum (MC) is a contagious infection that, although benign, can become an aesthetic burden and lead to other opportunistic infections, secondary dermatitis, and self-isolation. Currently, several treatment options are available for MC, including the newly investigated nitric oxide-releasing berdazimer gel, leading this review to evaluate randomized controlled trials (RCT) comparing berdazimer gel with a vehicle for treating MC. The meta-analysis included three reports and four RCT involving 1854 patients, with 1106 (59.6%) randomized to receive berdazimer. Our findings suggest that berdazimer is effective in the management of MC lesions, but the increased clearance of lesions and reduction of scarring must be weighed against the potential for topical adverse effects, particularly when considering the use of this therapy in pediatric patients.
Topics: Child; Humans; Molluscum Contagiosum; Nitric Oxide; Treatment Outcome; Randomized Controlled Trials as Topic; Gels
PubMed: 37721050
DOI: 10.1111/pde.15419 -
The Cochrane Database of Systematic... Jan 2020Onychomycosis refers to fungal infections of the nail apparatus that may cause pain, discomfort, and disfigurement. This is an update of a Cochrane Review published in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Onychomycosis refers to fungal infections of the nail apparatus that may cause pain, discomfort, and disfigurement. This is an update of a Cochrane Review published in 2007; a substantial amount of new research warrants a review exclusively on toenails.
OBJECTIVES
To assess the clinical and mycological effects of topical drugs and device-based therapies for toenail onychomycosis.
SEARCH METHODS
We searched the following databases up to May 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase and LILACS. We also searched five trials registers, and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials.
SELECTION CRITERIA
Randomised controlled trials of topical and device-based therapies for onychomycosis in participants with toenail onychomycosis, confirmed by positive cultures, direct microscopy, or histological nail examination. Eligible comparators were placebo, vehicle, no treatment, or an active topical or device-based treatment.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Primary outcomes were complete cure rate (normal-looking nail plus fungus elimination, determined with laboratory methods) and number of participants reporting treatment-related adverse events.
MAIN RESULTS
We included 56 studies (12,501 participants, average age: 27 to 68 years), with mainly mild-to-moderate onychomycosis without matrix involvement (where reported). Participants had more than one toenail affected. Most studies lasted 48 to 52 weeks; 23% reported disease duration (variable). Thirty-five studies specifically examined dermatophyte-caused onychomycosis. Forty-three studies were carried out in outpatient settings. Most studies assessed topical treatments, 9% devices, and 11% both. We rated three studies at low risk of bias across all domains. The most common high-risk domain was performance bias. We present results for key comparisons, where treatment duration was 36 or 48 weeks, and clinical outcomes were measured at 40 to 52 weeks. Based on two studies (460 participants), compared with vehicle, ciclopirox 8% lacquer may be more effective in achieving complete cure (risk ratio (RR) 9.29, 95% confidence interval (CI) 1.72 to 50.14; low-quality evidence) and is probably more effective in achieving mycological cure (RR 3.15, 95% CI 1.93 to 5.12; moderate-quality evidence). Ciclopirox lacquer may lead to increased adverse events, commonly application reactions, rashes, and nail alteration (e.g. colour, shape). However, the 95% CI indicates that ciclopirox lacquer may actually make little or no difference (RR 1.61, 95% CI 0.89 to 2.92; low-quality evidence). Efinaconazole 10% solution is more effective than vehicle in achieving complete cure (RR 3.54, 95% CI 2.24 to 5.60; 3 studies, 1716 participants) and clinical cure (RR 3.07, 95% CI 2.08 to 4.53; 2 studies, 1655 participants) (both high-quality evidence) and is probably more effective in achieving mycological cure (RR 2.31, 95% CI 1.08 to 4.94; 3 studies, 1716 participants; moderate-quality evidence). Risk of adverse events (such as dermatitis and vesicles) was slightly higher with efinaconazole (RR 1.10, 95% CI 1.01 to 1.20; 3 studies, 1701 participants; high-quality evidence). No other key comparison measured clinical cure. Based on two studies, compared with vehicle, tavaborole 5% solution is probably more effective in achieving complete cure (RR 7.40, 95% CI 2.71 to 20.24; 1198 participants), but probably has a higher risk of adverse events (application site reactions were most commonly reported) (RR 3.82, 95% CI 1.65 to 8.85; 1186 participants (both moderate-quality evidence)). Tavaborole improves mycological cure (RR 3.40, 95% CI 2.34 to 4.93; 1198 participants; high-quality evidence). Moderate-quality evidence from two studies (490 participants) indicates that P-3051 (ciclopirox 8% hydrolacquer) is probably more effective than the comparators ciclopirox 8% lacquer or amorolfine 5% in achieving complete cure (RR 2.43, 95% CI 1.32 to 4.48), but there is probably little or no difference between the treatments in achieving mycological cure (RR 1.08, 95% CI 0.85 to 1.37). We found no difference in the risk of adverse events (RR 0.60, 95% CI 0.19 to 1.92; 2 studies, 487 participants; low-quality evidence). The most common events were erythema, rash, and burning. Three studies (112 participants) compared 1064-nm Nd:YAG laser to no treatment or sham treatment. We are uncertain if there is a difference in adverse events (very low-quality evidence) (two studies; 85 participants). There may be little or no difference in mycological cure at 52 weeks (RR 1.04, 95% CI 0.59 to 1.85; 2 studies, 85 participants; low-quality evidence). Complete cure was not measured. One study (293 participants) compared luliconazole 5% solution to vehicle. We are uncertain whether luliconazole leads to higher rates of complete cure (very low-quality evidence). Low-quality evidence indicates there may be little or no difference in adverse events (RR 1.02, 95% CI 0.90 to 1.16) and there may be increased mycological cure with luliconazole; however, the 95% CI indicates that luliconazole may make little or no difference to mycological cure (RR 1.39, 95% CI 0.98 to 1.97). Commonly-reported adverse events were dry skin, paronychia, eczema, and hyperkeratosis, which improved or resolved post-treatment.
AUTHORS' CONCLUSIONS
Assessing complete cure, high-quality evidence supports the effectiveness of efinaconazole, moderate-quality evidence supports P-3051 (ciclopirox 8% hydrolacquer) and tavaborole, and low-quality evidence supports ciclopirox 8% lacquer. We are uncertain whether luliconazole 5% solution leads to complete cure (very low-quality evidence); this outcome was not measured by the 1064-nm Nd:YAG laser comparison. Although evidence supports topical treatments, complete cure rates with topical treatments are relatively low. We are uncertain if 1064-nm Nd:YAG laser increases adverse events compared with no treatment or sham treatment (very low-quality evidence). Low-quality evidence indicates that there is no difference in adverse events between P-3051 (ciclopirox hydrolacquer), luliconazole 5% solution, and their comparators. Ciclopirox 8% lacquer may increase adverse events (low-quality evidence). High- to moderate-quality evidence suggests increased adverse events with efinaconazole 10% solution or tavaborole 5% solution. We downgraded evidence for heterogeneity, lack of blinding, and small sample sizes. There is uncertainty about the effectiveness of device-based treatments, which were under-represented; 80% of studies assessed topical treatments, but we were unable to evaluate all of the currently relevant topical treatments. Future studies of topical and device-based therapies should be blinded, with patient-centred outcomes and an adequate sample size. They should specify the causative organism and directly compare treatments.
Topics: Administration, Topical; Adult; Aged; Antifungal Agents; Female; Humans; Male; Middle Aged; Onychomycosis; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31978269
DOI: 10.1002/14651858.CD012093.pub2 -
Forensic Science International Nov 2021Past research on cannabis has been limited in scope to THC potencies lower than legally available and efforts to integrate the effects into models of driving performance... (Review)
Review
Past research on cannabis has been limited in scope to THC potencies lower than legally available and efforts to integrate the effects into models of driving performance have not been attempted to date. The purpose of this systematic review is to understand the implications for modeling driving performance and describe future research needs. The risk of motor vehicle crashes increases 2-fold after smoking marijuana. Driving during acute cannabis intoxication impairs concentration, reaction time, along with a variety of other necessary driving-related skills. Changes to legislation in North America and abroad have led to an increase in cannabis' popularity. This has given rise to more potent strains, with higher THC concentrations than ever before. There is also rising usage of novel ingestion methods other than smoking, such as oral cannabis products (e.g., brownies, infused drinks, candies), vaping, and topicals. The PRISMA guidelines were followed to perform a systematic search of the PubMed database for peer-reviewed literature. Search terms were combined with keywords for driving performance: driving, performance, impairment. Grey literature was also reviewed, including congressional reports, committee reports, and roadside surveys. There is a large discrepancy between the types of cannabis products sold and what is researched. Almost all studies that used inhalation as the mode of ingestion with cannabis that is around 6% THC. This pales in comparison to the more potent strains being sold today which can exceed 20%. Which is to say nothing of extracts, which can contain 60% or more THC. Experimental protocol is another gap in research that needs to be filled. Methodologies that involve naturalistic (real world) driving environments, smoked rather than vaporized cannabis, and non-lab certified products introduce uncontrollable variables. When considering the available literature and the implications of modeling the impacts of cannabis on driving performance, two critical areas emerge that require additional research: The first is the role of cannabis potency. Second is the route of administration. Does the lower peak THC level result in smaller impacts on performance? How long does potential impairment last along the longer time-course associated with different pharmacokinetic profiles. It is critical for modeling efforts to understand the answers to these questions, accurately model the effects on driver performance, and by extension understand the risk to the public.
Topics: Analgesics; Automobile Driving; Cannabinoid Receptor Agonists; Cannabis; Dronabinol; Hallucinogens; Marijuana Smoking; Psychomotor Performance
PubMed: 34634690
DOI: 10.1016/j.forsciint.2021.110902 -
Journal of Drugs in Dermatology : JDD May 2023Allergic contact dermatitis (ACD) may occur secondary to topical corticosteroids. This may be due to topical corticosteroids containing potential allergens in their...
BACKGROUND
Allergic contact dermatitis (ACD) may occur secondary to topical corticosteroids. This may be due to topical corticosteroids containing potential allergens in their vehicles. Variation of allergenic ingredients among various brands of a product has not been well characterized.
OBJECTIVE
This study aimed to assess the frequency of allergenic ingredients in various brands and manufacturers of clobetasol propionate.
METHODS
Common brands of clobetasol propionate were identified online on GoodRx website. Then, ingredient lists for these products were obtained from the US Food & Drug Administration’s Online Label Repository via a proprietary name search. A systematic literature review was performed using the ingredient name on Medline (PubMed) database to find reports of ACD confirmed by patch testing.
CONCLUSIONS
Forty-nine different ingredients were identified among all 18 products included, with an average of 8.4 ingredients per product; 19 of these ingredients have allergenic potential, while one has protective effects. Two branded foam formulations contained the greatest number of potential allergens (5), while a shampoo formulation contained no potential allergens. Knowing which allergens are present in different products may be helpful when treating a patient with an allergy or suspected allergy to one of these ingredients. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.4651.
Topics: Humans; Allergens; Clobetasol; Dermatitis, Allergic Contact; Glucocorticoids; Pharmaceutical Vehicles
PubMed: 37133477
DOI: 10.36849/JDD.4651 -
The International Journal on Drug Policy Mar 2022Children are often exposed to increased rates of secondary harm such as physical harm, motor vehicle incidents, maltreatment, and neglect because of others' or their own... (Review)
Review
BACKGROUND
Children are often exposed to increased rates of secondary harm such as physical harm, motor vehicle incidents, maltreatment, and neglect because of others' or their own alcohol consumption. Alcohol supply reduction, or alcohol control policies, are often enacted to mitigate alcohol harms within the community. The current systematic narrative review aims to synthesise recent literature that examines how alcohol supply reduction policies impact the physical health, mental health, and offending behaviour of children and adolescents.
METHODS
Eight databases and grey literature sources were systematically searched, and results were synthesised by policy under evaluation. Twenty-one peer reviewed articles and ten grey literature articles were included after screening of 7,135 original articles. Included articles examined the alcohol control policies of the minimum legal drinking age, price control, and trading restrictions, with the most common outcomes under evaluation being related to the physical health or offending behaviour of adolescents.
RESULTS
Overall, the current review identified that the impact of alcohol policy on children and adolescents varied depending on the policy type, policy environment and assessed outcome. Common limitations within the literature include inability to control for covariates, use of alcohol related outcomes unsuitable to children and adolescents, and use of cross-sectional data and regression-discontinuity analysis in lieu of actual policy changes.
CONCLUSIONS
The current review highlights the need to further evaluate the impact of actual alcohol-related policy changes on children and adolescents.
Topics: Adolescent; Alcohol Drinking; Child; Cross-Sectional Studies; Humans; Public Policy; Underage Drinking
PubMed: 35065451
DOI: 10.1016/j.drugpo.2022.103581 -
Addiction Biology Jan 2024Driving is a critical everyday task necessitating the rapid and seamless integration of dynamic visually derived information to guide neurobehaviour. Biological markers... (Review)
Review
Driving is a critical everyday task necessitating the rapid and seamless integration of dynamic visually derived information to guide neurobehaviour. Biological markers are frequently employed to detect Δ9-tetrahydrocannabinol (THC) consumption among drivers during roadside tests, despite not necessarily indicating impairment. Characterising THC-specific alterations to oculomotor behaviour may offer a more sensitive measure for indexing drug-related impairment, necessitating discrimination between acute THC effects, chronic use and potential tolerance effects. The present review aims to synthesise current evidence on the acute and chronic effects of THC on driving-relevant oculomotor behaviour. The review was prospectively registered (10.17605/OSF.IO/A4H9W), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines informed reporting standards. Overall, 20 included articles comprising 12 experimental acute dosing trials, 5 cross-sectional chronic use studies and 3 roadside epidemiological studies examined the effects of cannabis/THC on oculomotor parameters including saccadic activity gaze behaviour, nystagmus, smooth pursuit and eyelid/blink characteristics. Acute THC consumption selectively impacts oculomotor control, notably increasing saccadic latency and inaccuracy and impairing inhibitory control. Chronic cannabis users, especially those with early age of use onset, display enduring oculomotor deficits that affect visual scanning efficiency. The presence of eyelid tremors appears to be a reliable indicator of cannabis consumption while remaining distinct from direct impairment associated with visual attention and motor control. Cannabis selectively influences oculomotor activity relevant to driving, highlighting the role of cannabinoid systems in these processes. Defining cannabis/THC-specific changes in oculomotor control may enhance the precision of roadside impairment assessments and vehicle safety systems to detect drug-related impairment and assess driving fitness.
Topics: Cannabis; Dronabinol; Cross-Sectional Studies; Cannabinoids; Cannabinoid Receptor Agonists
PubMed: 38221807
DOI: 10.1111/adb.13359