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Antibiotics (Basel, Switzerland) Mar 2021The effectiveness of antimicrobial photodynamic therapy (aPDT) in the treatment of oral yeast infections was examined many times in recent years. The authors of this... (Review)
Review
The effectiveness of antimicrobial photodynamic therapy (aPDT) in the treatment of oral yeast infections was examined many times in recent years. The authors of this review tried to address the question: "Should TBO (toluidine blue ortho)-mediated aPDT be considered a possible alternative treatment for oral candidiasis?". PubMed/Medline and the Cochrane Central Register of Controlled Trials (CEN-TRAL) databases were searched from 1997 up to the 27th of October 2020 using a combination of the following keywords: (Candida OR Candidiasis oral OR Candidosis oral OR denture stomatitis) AND (toluidine blue OR photodynamic therapy OR aPDT OR photodynamic antimicrobial chemotherapy OR PACT OR photodynamic inactivation OR PDI). Animal studies or in vitro studies involving () and/or nonalbicans stain, randomized clinical trials (RCT) involving patients with oral candidiasis or denture stomatitis published solely in English language were included. elimination method in animal, in vitro studies and RCT used was TBO-mediated aPDT. Exactly 393 studies were taken into consideration. Then, after analyzing titles and abstracts of said studies, 361 were excluded. Only 32 studies ended up being selected for in-depth screening, after which 21 of them were included in this study. All studies reported the antifungal effectiveness of aPDT with TBO against and non-. In studies conducted with planktonic cells, only one study showed eradication of . All others showed partial elimination and only one of them was not statistically significant. Experiments on yeast biofilms, in all cases, showed partial, statistically significant cell growth inhibition and weight reduction (a reduction in the number of cells-mainly hyphae) and the mass of extracellular polymeric substance (EPS). In vivo aPDT mediated by TBO exhibits antifungal effects against oral spp.; however, its clinical effectiveness as a potent therapeutic strategy for oral yeast infections requires further investigation.
PubMed: 33806003
DOI: 10.3390/antibiotics10040349 -
Life (Basel, Switzerland) Mar 2022The objective of the study was to compare the efficacy and safety of antifungal agents used in the prevention of oropharyngeal candidiasis among HIV-infected adults. A... (Review)
Review
Comparative Efficacy and Safety of Antifungal Agents in the Prophylaxis of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis.
The objective of the study was to compare the efficacy and safety of antifungal agents used in the prevention of oropharyngeal candidiasis among HIV-infected adults. A systematic search was conducted in four databases (MEDLINE, Scopus, CENTRAL, and Embase) for eligible randomized control trials (RCTs). The network meta-analyses (NMA) were performed using a random-effects model. Interventions were ranked based on the efficacy and safety using the surface under the cumulative ranking curve (SUCRA). The quality of evidence was assessed using the GRADE approach. From a total of 1574 studies screened, 7 RCTs comprising 959 participants were included in NMA. The use of fluconazole as a prophylactic agent was associated with a significant reduction in incidence of OPC compared to placebo (RR, 0.45 (95% CI: 0.27-0.77)) in HIV-infected adults. The overall quality of evidence was graded as moderate. Fluconazole was ranked the best antifungal for efficacy (SUCRA-95.6%) as well as safety (SUCRA-39.3%) in HIV-infected adults. Overall, the quality of evidence was graded as moderate. Fluconazole can be considered as an effective agent with a better safety profile for the prophylaxis of OPC in HIV-infected adults. However, similar to any other antimicrobial agent, the risk of possibility of resistance must be weighed against the benefits.
PubMed: 35455006
DOI: 10.3390/life12040515 -
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 -
Heliyon Feb 2023A meta-analysis was performed to systematically review the clinical efficacy of external traditional Chinese medicine compounds in the treatment of oral candidiasis to...
OBJECTIVE
A meta-analysis was performed to systematically review the clinical efficacy of external traditional Chinese medicine compounds in the treatment of oral candidiasis to provide a reference for the clinical treatment of this disease.
METHODS
We systematically searched relevant Chinese and English databases, including the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, PubMed, Web of Science, the Cochrane Library and Scopus, from inception to September 2022 to identify all clinical randomized controlled studies of oral candidiasis treated with external Chinese medicine compounds. The inclusion criteria were a randomized controlled study of an experimental group with the intervention of an external traditional Chinese medicine compound, and the results of the literature were clear. Duplicate publications, literature on single or proprietary Chinese medicine treatment, literature from which relevant data could not be extracted and studies without rigorous experimental designs were excluded. Two researchers independently screened relevant studies that met the inclusion and exclusion criteria and conducted quality evaluation and data extraction for the included studies. The total effective rate, Candida negative conversion rate and recurrence rate were statistically analysed by RevMan 5.3 software.
RESULTS
This study included 29 studies and 30 studies, involving 2553 patients with oral candidiasis, with 1320 in the experimental group and 1233 in the control group. The total effective rate of the experimental group was better than that of the control group ( = ). The negative rate of Candida in the experimental group was better than that in the control group ( = =. The recurrence rate of the experimental group was lower than that of the control group = =. The difference was statistically significant.
CONCLUSION
Compared with Western medicine alone, external traditional Chinese medicine in the treatment of oral candidiasis has certain advantages in improving the total effective rate, increasing the negative conversion rate of Candida and reducing the recurrence rate. However, larger samples and high-quality clinical studies are needed to obtain further support and verification.
PubMed: 36785820
DOI: 10.1016/j.heliyon.2023.e13253 -
The Cochrane Database of Systematic... Mar 2023The role of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) has been the subject of much uncertainty. COPD clinical guidelines currently... (Review)
Review
BACKGROUND
The role of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) has been the subject of much uncertainty. COPD clinical guidelines currently recommend selective use of ICS. ICS are not recommended as monotherapy for people with COPD, and are only given in combination with long-acting bronchodilators due to greater efficacy of combination therapy. Incorporating and critiquing newly published placebo-controlled trials into the monotherapy evidence base may help to resolve ongoing uncertainties and conflicting findings about their role in this population.
OBJECTIVES
To evaluate the benefits and harms of inhaled corticosteroids, used as monotherapy versus placebo, in people with stable COPD, in terms of objective and subjective outcomes.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was October 2022.
SELECTION CRITERIA
We included randomised trials comparing any dose of any type of ICS, given as monotherapy, with a placebo control in people with stable COPD. We excluded studies of less than 12 weeks' duration and studies of populations with known bronchial hyper-responsiveness (BHR) or bronchodilator reversibility.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our a priori primary outcomes were 1. exacerbations of COPD and 2. quality of life. Our secondary outcomes were 3. all-cause mortality, 4. lung function (rate of decline of forced expiratory volume in one second (FEV)), 5. rescue bronchodilator use, 6. exercise capacity, 7. pneumonia and 8. adverse events including pneumonia. ]. We used GRADE to assess certainty of evidence.
MAIN RESULTS
Thirty-six primary studies with 23,139 participants met the inclusion criteria. Mean age ranged from 52 to 67 years, and females were 0% to 46% of participants. Studies recruited across the severities of COPD. Seventeen studies were of duration longer than three months and up to six months and 19 studies were of duration longer than six months. We judged the overall risk of bias as low. Long-term (more than six months) use of ICS as monotherapy reduced the mean rate of exacerbations in those studies where pooling of data was possible (generic inverse variance analysis: rate ratio 0.88 exacerbations per participant per year, 95% confidence interval (CI) 0.82 to 0.94; I = 48%, 5 studies, 10,097 participants; moderate-certainty evidence; pooled means analysis: mean difference (MD) -0.05 exacerbations per participant per year, 95% CI -0.07 to -0.02; I = 78%, 5 studies, 10,316 participants; moderate-certainty evidence). ICS slowed the rate of decline in quality of life, as measured by the St George's Respiratory Questionnaire (MD -1.22 units/year, 95% CI -1.83 to -0.60; I = 0%; 5 studies, 2507 participants; moderate-certainty evidence; minimal clinically importance difference 4 points). There was no evidence of a difference in all-cause mortality in people with COPD (odds ratio (OR) 0.94, 95% CI 0.84 to 1.07; I = 0%; 10 studies, 16,636 participants; moderate-certainty evidence). Long-term use of ICS reduced the rate of decline in FEV in people with COPD (generic inverse variance analysis: MD 6.31 mL/year benefit, 95% CI 1.76 to 10.85; I = 0%; 6 studies, 9829 participants; moderate-certainty evidence; pooled means analysis: 7.28 mL/year, 95% CI 3.21 to 11.35; I = 0%; 6 studies, 12,502 participants; moderate-certainty evidence).
ADVERSE EVENTS
in the long-term studies, the rate of pneumonia was increased in the ICS group, compared to placebo, in studies that reported pneumonia as an adverse event (OR 1.38, 95% CI 1.02 to 1.88; I = 55%; 9 studies, 14,831 participants; low-certainty evidence). There was an increased risk of oropharyngeal candidiasis (OR 2.66, 95% CI 1.91 to 3.68; 5547 participants) and hoarseness (OR 1.98, 95% CI 1.44 to 2.74; 3523 participants). The long-term studies that measured bone effects generally showed no major effect on fractures or bone mineral density over three years. We downgraded the certainty of evidence to moderate for imprecision and low for imprecision and inconsistency.
AUTHORS' CONCLUSIONS
This systematic review updates the evidence base for ICS monotherapy with newly published trials to aid the ongoing assessment of their role for people with COPD. Use of ICS alone for COPD likely results in a reduction of exacerbation rates of clinical relevance, probably results in a reduction in the rate of decline of FEV of uncertain clinical relevance and likely results in a small improvement in health-related quality of life not meeting the threshold for a minimally clinically important difference. These potential benefits should be weighed up against adverse events (likely to increase local oropharyngeal adverse effects and may increase the risk of pneumonia) and probably no reduction in mortality. Though not recommended as monotherapy, the probable benefits of ICS highlighted in this review support their continued consideration in combination with long-acting bronchodilators. Future research and evidence syntheses should be focused in that area.
Topics: Female; Humans; Middle Aged; Aged; Bronchodilator Agents; Quality of Life; Adrenal Cortex Hormones; Pulmonary Disease, Chronic Obstructive; Pneumonia; Disease Progression
PubMed: 36971693
DOI: 10.1002/14651858.CD002991.pub4 -
Journal of Fungi (Basel, Switzerland) Aug 2021The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in... (Review)
Review
The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in adult patients with HIV. A systematic search was performed on the four major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents in HIV patients with OPC. A network meta-analysis was performed from the data extracted from the selected studies. The agents were ranked according using surface under the cumulative ranking (SUCRA). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence. A total of 15 trials were included in the quantitative analysis involving the data from a total of 2883 participants. Fluconazole was ranked as the most effective antifungal agent to achieve clinical cure (SUCRA = 0.87) in OPC followed by posaconazole and itraconazole. Posaconazole was ranked the most efficacious agent in achieving mycological cure (SUCRA = 0.81), followed by fluconazole. While nystatin was ranked the safest, the effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. Based on the available evidence, fluconazole can be considered as the most effective drug in the treatment of OPC among HIV-infected adults and has a favorable safety profile, followed by posaconazole.
PubMed: 34436176
DOI: 10.3390/jof7080637 -
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 -
Frontiers in Pediatrics 2021In HIV-infected pediatrics, oral candidiasis (OC) is a global issue of concern due to its association with dysphagia, malnutrition, and mortality. The present systematic...
The Prevalence, Etiological Agents, Clinical Features, Treatment, and Diagnosis of HIV-Associated Oral Candidiasis in Pediatrics Across the World: A Systematic Review and Meta-Analysis.
In HIV-infected pediatrics, oral candidiasis (OC) is a global issue of concern due to its association with dysphagia, malnutrition, and mortality. The present systematic review and meta-analysis are the first to determine the prevalence of OC in HIV-infected pediatrics worldwide. We searched international (PubMed, Web of Science, Scopus, and Embase) databases for studies published between January 2000 to May 2020 reporting the epidemiologic features of OC in HIV-infected pediatrics. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA guidelines. The results of the meta-analysis were visualized as a forest plot. Heterogeneity was also analyzed using the , and τ statistics. The publication bias was evaluated using Egger test. The literature search revealed 1926 studies, of which 34 studies met the eligibility criteria, consisting of 4,474 HIV-infected pediatrics from 12 different countries. The overall prevalence of OC among HIV-infected pediatrics was 23.9% (95% CI 17.3-32.0%), and was the most prevalent etiologic agent. Pseudomembranous candidiasis was the predominant clinical manifestation in HIV-infected pediatrics suffering from OC. Thirty articles involving 4,051 individuals provided data on HIV treatment status. Among the 4,051 individuals, 468 (11.53%) did not receive HIV treatment. The data from 11 articles demonstrated that HIV treatment was significantly associated with a reduction in oral colonization or infection. In contrast, others showed the opposite relationship or did not report any statistical data. A high level of ( = 96%, < 0.01) and τ (τ = 1.36, < 0.01) was obtained among studies, which provides evidence of notable heterogeneity between studies. OC is approximately frequent in HIV-positive children. Therefore, efforts should be made to teach dental and non-dental clinicians who care for HIV-infected pediatrics to diagnose and treat this infection.
PubMed: 35004551
DOI: 10.3389/fped.2021.805527 -
BMC Oral Health Jul 2019To systematically review and assess the in vivo effectiveness and safety of probiotics for prophylaxis and treating oral candidiasis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To systematically review and assess the in vivo effectiveness and safety of probiotics for prophylaxis and treating oral candidiasis.
METHODS
A literature search for studies published in English until August 1, 2018 was conducted in the following databases: PubMed, EMBASE, Cochrane Library, and Web of Science. Randomized controlled clinical trials and experimental mouse animal model studies comparing probiotics (at any dosage and in any form) with control groups (placebo, blank control or other agents) and reporting outcomes of the prophylactic and therapeutic effects were considered for inclusion. A descriptive study and, potentially, a meta-analysis were planned.
RESULTS
Six randomized controlled clinical trials and 5 controlled experiments of mouse animal models were included in the systematic review. Four randomized controlled clinical trials comparing a probiotics group with a placebo/blank control group in 480 elderly and denture wearers were included in the meta-analysis. The overall combined odds ratio of the (random effects) meta-analysis was 0.24 (95% CI =0.09-0.63, P < 0.01). The overall combined odds ratio of the (fixed effects) sensitivity analysis was 0.39 (95% CI =0.25-0.60, P < 0.01) by excluding a study with the smallest sample size. These analyses showed that there was a statistically significant difference in the effect of probiotics compared with the control groups in elderly and denture wearers. The remaining 2 studies compared probiotics with other agents in a population aged 18-75 years and children aged 6-14 years respectively, and were analyzed descriptively. Meta-analysis and descriptive analyses indicated that probiotics were potentially effective in reducing morbidity, improving clinical symptoms and reducing oral Candida counts in oral candidiasis. The biases of the included studies were low or uncertain. The relatively common complaints reported were gastrointestinal discomfort and unpleasant taste, and no severe adverse events were reported.
CONCLUSIONS
Probiotics were superior to the placebo and blank control in preventing and treating oral candidiasis in the elderly and denture wearers. Although probiotics showed a favorable effect in treating oral candidiasis, more evidence is required to warrant their effectiveness when compared with conventional antifungal treatments. Moreover, data on the safety of probiotics are still insufficient, and further research is needed.
Topics: Aged; Animals; Antifungal Agents; Candida; Candidiasis, Oral; Child; Humans; Mice; Odds Ratio; Probiotics
PubMed: 31291932
DOI: 10.1186/s12903-019-0841-2 -
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