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Annals of Anatomy = Anatomischer... Feb 2023A higher prevalence of oral problems has been observed in the elderly population. One of the treatment options for some of these pathologies is the administration of...
INTRODUCTION
A higher prevalence of oral problems has been observed in the elderly population. One of the treatment options for some of these pathologies is the administration of mouthwashes combined with mechanical removal techniques. Besides, each type of oral rinse treats certain oral diseases, and it should be selected for each specific situation.
OBJECTIVE
To determine the use and efficacy of mouthwashes in the elderly as a treatment for various pathologies, to indicate the most common kinds of mouth-rinses used, the diseases treated with them, their efficacy in each treatment, and their effectiveness when they are combined with other treatments.
MATERIAL AND METHODS
The review has been carried out following the PRISMA 2020 Statement. Individualized bibliographic searches were performed in five databases. Randomized clinical trials are included in patients over 60 years old where mouthwashes were administered to treat or prevent specific diseases. The PICO question aimed to assess what type of mouthwashes elderly patients use, what they use them for, and their efficacy. Study selection, data extraction, and quality analysis were achieved using the RoB-2 guide.
RESULTS
Thirteen articles were chosen to perform the qualitative analysis. The bibliometric analysis was carried out. We have eleven randomized controlled clinical trials and two uncontrolled. The mouthwash more used was chlorhexidine, followed by essential oils and fluorides. The most studied pathologies were a periodontal disease, caries, candidiasis, denture stomatitis, and xerostomia. Chlorhexidine used weekly is effective as antiplaque and antigingivitis. Fluorides effectively prevent and reverse caries; nystatin and essential oils to treat candidiasis; and pilocarpine rinse to manage xerostomia.
CONCLUSIONS
The included studies show that mouthwashes are widely extended in the elderly population, and each sort is specifically designed for treating a particular condition.
Topics: Aged; Humans; Middle Aged; Chlorhexidine; Fluorides; Mouthwashes; Oils, Volatile; Randomized Controlled Trials as Topic; Xerostomia
PubMed: 36402239
DOI: 10.1016/j.aanat.2022.152026 -
Journal of Inflammation Research 2024Interleukin-10 (IL-10) is a cytokine that plays an important role in the progression of diabetes mellitus (DM). Oral diseases were more common in diabetics than in... (Review)
Review
AIM
Interleukin-10 (IL-10) is a cytokine that plays an important role in the progression of diabetes mellitus (DM). Oral diseases were more common in diabetics than in non-diabetics. The aim of this review is to identify IL-10 levels in diabetic patients with and without oral diseases.
METHODS
A systematic review was conducted based on the PRISMA guidelines. Three databases (PubMed, Cochrane Library, and Science Direct) were used to search for articles up to November 2023 for studies on the measurement of IL-10 in diabetics with and without oral disease. The criteria were limited to human studies and full-text in English only. The outcome was the value of IL-10. The study was quality-graded using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS).
RESULTS
There were eleven articles that met the eligibility criteria for analysis. Four articles discovered higher IL-10 levels, while seven articles discovered lower IL-10 levels in diabetes patients with oral diseases compared with each control group.
CONCLUSION
Most studies showed lower IL-10 levels in diabetic patients with oral diseases compared with the control group.
PubMed: 38313209
DOI: 10.2147/JIR.S449546 -
Clinical Immunology (Orlando, Fla.) Mar 2022This systematic review and meta-analysis was performed to determine the safety of long-term use of ICS in patients with asthma. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis was performed to determine the safety of long-term use of ICS in patients with asthma.
METHODS
A systematic search was made of PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of asthma with ICS, compared with non-ICS treatment (placebo or other active drugs), were reviewed.
RESULTS
Eighty-six RCTs (enrolling 51,538 participants) met the inclusion criteria. Oral or oropharyngeal candidiasis (RR 2.58, 95% CI 2.00 to 3.33), and dysphonia/hoarseness (RR 1.56, 95% CI 1.31 to 1.85) were less frequent in the control group. There was no statistically significant difference in the risk of upper respiratory tract infection, lower respiratory tract infection, influenza, decline in bone mineral density, and fractures between the two groups.
CONCLUSION
In addition to the mild local adverse events, the long-term use of ICS was safe in patients with asthma.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Anti-Asthmatic Agents; Asthma; Humans; Respiratory Tract Infections
PubMed: 35218965
DOI: 10.1016/j.clim.2022.108960 -
Photodiagnosis and Photodynamic Therapy Sep 2020The goal of this study was to update the information about aPDT when using methylene blue (MB) for the treatment of human clinical infections of different etiologies,... (Review)
Review
BACKGROUND
The goal of this study was to update the information about aPDT when using methylene blue (MB) for the treatment of human clinical infections of different etiologies, except for dentistry applications, and to also investigate the best parameters of MB to achieve this.
METHODS
This study was a systematic literature review performed according to the PRISMA guidelines. A literature search was performed for studies with adult human patients (>18 years-old) published in the English, French, Spanish, Portuguese, and Italian languages when using the electronic databases of MEDLINE, Embase, OpenGrey, and LILACS.
RESULTS
1260 relevant articles were found. After a reading of the titles and the abstracts, only 85 articles were selected for a complete reading. After the complete reading, only 05 studies were selected for data extraction, where the treatments were onychomycosis, oral candidiasis, and infectious diabetic foot ulcers. As for the MB concentrations, 0.0003 to 0.06 molar were used. Pre-irradiation times ranged from 1 to 5 min, while the irradiation times ranged from 8 s to 10 min. As for the light sources, lasers, LED, and lamps were used, with irradiances ranging from 50 to 750 mW/cm and radiant exposures from 6 to 18 J/cm.
CONCLUSIONS
For the field of clinical applications of aPDT to develop, studies with a higher level of evidence are needed. For example, future reports should aim at comparing aPDT directly with standard techniques and a placebo aPDT, together with larger samples, and with more objective clinical evaluation methods, in order to provide useful data for the clinically relevant aPDT protocols.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Humans; Methylene Blue; Photochemotherapy; Photosensitizing Agents
PubMed: 32473398
DOI: 10.1016/j.pdpdt.2020.101828 -
International Journal of Dermatology Feb 2024Hidradenitis suppurativa (HS) is a painful skin condition that significantly affects patients' quality of life. Biologic agents, including anti-TNF agents and IL-17... (Meta-Analysis)
Meta-Analysis Review
Hidradenitis suppurativa (HS) is a painful skin condition that significantly affects patients' quality of life. Biologic agents, including anti-TNF agents and IL-17 inhibitors, have shown promise as treatment options for HS. However, there is concern about the increased risk of infections associated with these therapies. We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. We searched PubMed and Embase until February 1, 2023. The primary outcome of interest was the incidence of any infectious complications. Secondary outcomes included serious and opportunistic infections in HS patients treated with biologics or other immunomodulators. Twenty-four studies met our inclusion criteria, comprising 1,696 patients. The pooled incidence rate for any infection was 24.2%, primarily consisting of mild respiratory and skin infections. Subgroup analysis based on the mechanism of action (MOA) showed a pooled incidence of 7.77% for anti-IL1, 14.24% for anti-PDE4, and 21.96% for anti-TNF. Notably, patients receiving anti-IL17 had the highest incidence rate of infection at 33.6%, but the relative risk compared to placebo was not significantly elevated (0.99, 95% CI: 0.86-1.14). Serious infections were rare, with pooled incidences of 0.39% for anti-IL17 and 0.03% for anti-TNF. Opportunistic infections were infrequent, with 10 reported cases, including eight oral candidiasis, one cryptosporidiosis, and one Blastocystis hominis infection. The use of biologic therapies in HS patients does not significantly increase the risk of infectious complications. Additionally, the occurrence of serious or opportunistic infections in HS patients treated with biologics appears to be minimal.
Topics: Humans; Hidradenitis Suppurativa; Biological Products; Quality of Life; Tumor Necrosis Factor Inhibitors; Opportunistic Infections; Immunologic Factors
PubMed: 37888493
DOI: 10.1111/ijd.16885 -
Revista Da Associacao Medica Brasileira... Feb 2022
Meta-Analysis
Topics: Administration, Oral; Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Recurrence; Vagina
PubMed: 35239893
DOI: 10.1590/1806-9282.20210916 -
Microbial Pathogenesis Dec 2020Candida albicans is the main causative agent of oral lesions in HIV-infected patients and its oral colonization is a potential source of systemic dissemination. Although... (Meta-Analysis)
Meta-Analysis Review
Candida albicans is the main causative agent of oral lesions in HIV-infected patients and its oral colonization is a potential source of systemic dissemination. Although the high prevalence of lesions in HIV patients can be explained by the immunosuppressive condition, several studies have reported that natural selection can make C. albicans more virulent in this group of patients. Comparisons of the activity of exoenzymes (phospholipase, proteinase and hemolysin) in C. albicans isolated from HIV-infected and uninfected patients have yielded conflicting results. This study aimed, through a systematic review and meta-analysis, to answer the question: "Is the hydrolytic enzymatic activity of C. albicans, isolated from the oral cavity, different in individuals infected and not infected with HIV?" The question was addressed using the PECO framework: P (Population): children and adults, E (Exposure): HIV infection, C (Comparator): non-HIV-infected patients; O (Outcomes): exoenzymes activity i.e. phospholipase, proteinase and hemolysin. We conducted a systematic search on Pubmed, Embase, Scopus, Livivo, Lilacs, Web of Science, and Science Direct databases, and Google Scholar. The MAStARI tool was used to evaluate the risk of bias in the selected studies. From 2259 studies, 19 were included in this review and 11 comprised the meta-analysis. The activity of phospholipase (M-H = 0.15; Z = 2,76; p = 0.0006) and hemolysin exoenzymes (M-H = 0.07; z = 1,94; p = 0.05) was higher in C. albicans isolated from the oral cavity of HIV-infected patients, whereas the levels of protease activity were not different compared with non-HIV-infected individuals. This study showed a higher phospholipase and hemolysin activity in C. albicans isolates from the oral cavity of HIV-infected patients.
Topics: Adult; Candida albicans; Candidiasis, Oral; Child; HIV Infections; Humans; Phospholipases
PubMed: 32920148
DOI: 10.1016/j.micpath.2020.104477 -
Journal of Fungi (Basel, Switzerland) Feb 2021The Fungal Infections Definitions in Intensive Care Unit (ICU) patients (FUNDICU) project aims to provide standard sets of definitions for invasive fungal diseases...
Performance of Existing Definitions and Tests for the Diagnosis of Invasive Fungal Diseases other than Invasive Candidiasis and Invasive Aspergillosis in Critically Ill, Adult Patients: A Systematic Review with Qualitative Evidence Synthesis.
The Fungal Infections Definitions in Intensive Care Unit (ICU) patients (FUNDICU) project aims to provide standard sets of definitions for invasive fungal diseases (IFDs) in critically ill, adult patients, including invasive aspergillosis (IA), invasive candidiasis (IC), pneumonia (PJP), and other non-IA, non-IC IFDs. The first step of the project was the conduction of separated systematic reviews of the characteristics and applicability to critically ill, adult patients outside classical populations at risk (hematology patients, solid organ transplant recipients) of available definitions and diagnostic tests for IFDs. We report here the results of two systematic reviews exploring the performance of available definitions and tests, for PJP and for other non-IA, non-IC IFDs. Starting from 2585 and 4584 records for PJP and other IFDs, respectively, 89 and 61 studies were deemed as eligible for full-text evaluation. However, only two studies for PJP and no studies for other IFDs met the FUNDICU protocol criteria for inclusion in qualitative synthesis. Currently, there is no sufficient solid data for directly evaluating the performance of existing definitions and laboratory tests for the diagnosis of PJP and other non-IA, non-IC IFDs in critically ill adult patients outside classical populations at risk.
PubMed: 33670864
DOI: 10.3390/jof7030176 -
The Cochrane Database of Systematic... Sep 2020Staphylococcus aureus causes pulmonary infection in young children with cystic fibrosis. Prophylactic antibiotics are prescribed hoping to prevent such infection and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Staphylococcus aureus causes pulmonary infection in young children with cystic fibrosis. Prophylactic antibiotics are prescribed hoping to prevent such infection and lung damage. Antibiotics have adverse effects and long-term use might lead to infection with Pseudomonas aeruginosa. This is an update of a previously published review.
OBJECTIVES
To assess continuous oral antibiotic prophylaxis to prevent the acquisition of Staphylococcus aureus versus no prophylaxis in people with cystic fibrosis, we tested the following hypotheses to investigate whether prophylaxis: 1. improves clinical status, lung function and survival; 2. leads to fewer isolates of Staphylococcus aureus; 3. causes adverse effects (e.g. diarrhoea, skin rash, candidiasis); 4. leads to fewer isolates of other common pathogens from respiratory secretions; 5. leads to the emergence of antibiotic resistance and colonisation of the respiratory tract with Pseudomonas aeruginosa.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Companies manufacturing anti-staphylococcal antibiotics were contacted. Most recent search of the Group's Register: 27 February 2020. Online trials registries were also searched. Most recent search of online trials registries: 15 September 2020.
SELECTION CRITERIA
Randomised trials of continuous oral prophylactic antibiotics (given for at least one year) compared to intermittent antibiotics given 'as required', in people with cystic fibrosis of any disease severity.
DATA COLLECTION AND ANALYSIS
The authors assessed studies for eligibility and methodological quality and extracted data. The quality of the evidence was assessed using the GRADE criteria. The review's primary outcomes of interest were lung function by spirometry (forced expiratory volume in one second (FEV)) and the number of people with one or more isolates of Staphylococcus aureus (sensitive strains).
MAIN RESULTS
We included four studies, with a total of 401 randomised participants aged zero to seven years on enrolment; one study is ongoing. The two older included studies generally had a higher risk of bias across all domains, but in particular due to a lack of blinding and incomplete outcome data, than the two more recent studies. We only regarded the most recent study as being generally free of bias, although even here we were not certain of the effect of the per protocol analysis on the study results. Evidence quality was judged to be low for all outcomes assessed after being downgraded based on GRADE assessments. Downgrading decisions were due to limitations in study design (all outcomes), for imprecision and for inconsistency . Prophylactic anti-staphylococcal antibiotics probably make little or no difference to lung function measured as FEV % predicted after six years (mean difference (MD) -2.30, 95% confidence interval (CI) -13.59 to 8.99, one study, n = 119, low-quality evidence); but may reduce the number of children having one or more isolates of Staphylococcus aureus at two years (odds ratio (OR) 0.21, 95% CI 0.13 to 0.35, three studies, n = 315, low-quality evidence). At the same time point, there may be little or no effect on nutrition as reported using weight z score (MD 0.06, 95% CI -0.33 to 0.45, two studies, n = 140, low-quality evidence), additional courses of antibiotics (OR 0.18, 95% CI 0.01 to 3.60, one study, n = 119, low-quality evidence) or adverse effects (low-quality evidence). There was no difference in the number of isolates of Pseudomonas aeruginosa between groups at two years (OR 0.74, 95% CI 0.45 to 1.23, three studies, n = 312, low-quality evidence), though there was a trend towards a lower cumulative isolation rate of Pseudomonas aeruginosa in the prophylaxis group at two and three years and towards a higher rate from four to six years. As the studies reviewed lasted six years or less, conclusions cannot be drawn about the long-term effects of prophylaxis.
AUTHORS' CONCLUSIONS
Anti-staphylococcal antibiotic prophylaxis may lead to fewer children having isolates of Staphylococcus aureus, when commenced early in infancy and continued up to six years of age. The clinical importance of this finding is uncertain. Further research may establish whether the trend towards more children with CF with Pseudomonas aeruginosa, after four to six years of prophylaxis, is a chance finding and whether choice of antibiotic or duration of treatment might influence this.
Topics: Antibiotic Prophylaxis; Bias; Child; Child, Preschool; Cystic Fibrosis; Drug Resistance, Bacterial; Forced Expiratory Volume; Growth; Humans; Infant; Infant, Newborn; Pseudomonas aeruginosa; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Staphylococcal Infections; Staphylococcus aureus
PubMed: 32997797
DOI: 10.1002/14651858.CD001912.pub5 -
BMJ Paediatrics Open May 2024To develop evidence-based guidance for topical steroid use in paediatric eosinophilic oesophagitis (pEoE) in the UK for both induction and maintenance treatment. (Review)
Review
OBJECTIVE
To develop evidence-based guidance for topical steroid use in paediatric eosinophilic oesophagitis (pEoE) in the UK for both induction and maintenance treatment.
METHODS
A systematic literature review using Cochrane guidance was carried out by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Eosinophilic Oesophagitis (EoE) Working Group (WG) and research leads to determine the evidence base for preparation, dosing and duration of use of swallowed topical steroid (STS) formulations in EoE. Seven themes relating to pEoE were reviewed by the WG, alongside the Cochrane review this formed the evidence base for consensus recommendations for pEoE in the UK. We provide an overview of practical considerations including treatment regimen and dosing. Oral viscous budesonide (OVB) and, if agreed by local regulatory committees, orodispersible budesonide (budesonide 1 mg tablets) were selected for ease of use and with most improvement in histology. A practical 'how to prepare and use' OVB appendix is included. Side effects identified included candidiasis and adrenal gland suppression. The use of oral systemic steroids in strictures is discussed briefly.
RESULTS
2638 citations were identified and 18 randomised controlled trials were included. Evidence exists for the use of STS for induction and maintenance therapy in EoE, especially regarding histological improvement. Using the Appraisal of Guidelines, Research and Evaluation criteria, dosing of steroids by age (0.5 mg two times per day <10 years and 1 mg two times per day ≥10 years) for induction of at least 3 months was suggested based on evidence and practical consideration. Once histological remission is achieved, maintenance dosing of steroids appears to reduce the frequency and severity of relapse, as such a maintenance weaning regimen is proposed.
CONCLUSION
A practical, evidence-based flow chart and guidance recommendations with consensus from the EoE WG and education and research representatives of BSPGHAN were developed with detailed practical considerations for use in the UK.
Topics: Humans; Eosinophilic Esophagitis; Child; Budesonide; Administration, Topical; Evidence-Based Medicine; Glucocorticoids; United Kingdom; Administration, Oral
PubMed: 38782481
DOI: 10.1136/bmjpo-2023-002467