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Journal of Periodontology Sep 2014The primary aim of this systematic review is to address the following focused question: Is laser therapy, as a monotherapy or as an adjunctive therapy, an efficacious... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The primary aim of this systematic review is to address the following focused question: Is laser therapy, as a monotherapy or as an adjunctive therapy, an efficacious treatment modality for patients with peri-implantitis?
METHODS
The PubMed database of the U.S. National Library of Medicine and the Cochrane Central Register of Controlled Trials were electronically searched, complemented by manual searches up to June 2013.
RESULTS
The search yielded 137 titles and abstracts. After initial screening, 15 of 137 publications were scrutinized during the second phase of the review. In the second phase, nine articles were excluded from the analysis and six controlled, clinical studies were selected. Narrative synthesis of the results revealed that non-surgical laser treatment with a single application of either an erbium:yttrium-aluminum-garnet (Er:YAG) (2,940-nm) laser or a diode (660-nm) laser in combination with a phenothiazine chloride dye is efficient in controlling inflammation around treated implants for at least 6 months following intervention, whereas it has only a mild effect on reduction in probing depth (PD) and gain in clinical attachment level (CAL). There is limited information regarding the clinical application of the CO2 (10.6-µm) laser in the surgical treatment of peri-implantitis; however, its use may be promising. A meta-analysis could be performed only for the efficacy of Er:YAG laser due to the heterogeneity of the studies and the limited amount of data available. Meta-analysis did not reveal statistically significant evidence for treatment effects in reducing PD and CAL levels in comparison to controls.
CONCLUSIONS
Based on the limited information currently available, any superiority of laser treatment in comparison to conventional treatment of peri-implantitis could not be identified. Considering the high heterogeneity and the low number of included studies, the authors cautiously conclude that non-surgical laser therapy may be investigated as phase I therapy for the treatment of peri-implantitis. Future research should emphasize detailed description of the specific laser characteristics and power settings in clinical studies.
Topics: Humans; Laser Therapy; Lasers; Lasers, Gas; Lasers, Semiconductor; Lasers, Solid-State; Peri-Implantitis; Photochemotherapy
PubMed: 24444398
DOI: 10.1902/jop.2014.130610 -
BMJ Clinical Evidence Mar 2007Menière's disease causes recurrent vertigo, hearing loss, tinnitus, and fullness or pressure in the ear, which mainly affects adults aged 40-60 years. Menière's... (Review)
Review
INTRODUCTION
Menière's disease causes recurrent vertigo, hearing loss, tinnitus, and fullness or pressure in the ear, which mainly affects adults aged 40-60 years. Menière's disease is at first progressive but fluctuating, and episodes can occur in clusters. Vertigo usually resolves but hearing deteriorates, and symptoms other than hearing loss and tinnitus usually improve regardless of treatment.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute attacks of Menière's disease; and of interventions to prevent attacks and delay disease progression of Menière's disease? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: anticholinergics, benzodiazepines, betahistine, cinnarizine, dietary modification, diuretics, phenothiazines, psychological support, trimetazidine, vestibular rehabilitation.
Topics: Acute Disease; Administration, Oral; Betahistine; Hearing Loss; Humans; Incidence; Meniere Disease; Tinnitus; Trimetazidine; Vertigo
PubMed: 19454061
DOI: No ID Found -
Delaware Medical Journal Jul 2011Methemoglobin is the oxidized form of hemoglobin which does not bind to oxygen efficiently. An increased level of methemoglobin can be attributed to congenital enzymatic... (Review)
Review
Methemoglobin is the oxidized form of hemoglobin which does not bind to oxygen efficiently. An increased level of methemoglobin can be attributed to congenital enzymatic defects, alterations in the hemoglobin molecule, or as a result of medications and toxins. The main clinical characteristic of the disease include cyanosis which is unresponsive to oxygen therapy and blood that is chocolate color when drawn. Co-oximetry is the gold standard for diagnosis but arterial blood gas paired with pulse oximetry and serum methemoglobin levels can confirm the diagnosis clinically. Treatment is aimed at removal of the offending agent, if medication induced, and is directed at aggressive oxygen therapy and treatment with the antidote, methylene blue.
Topics: Enzyme Inhibitors; Humans; Methemoglobinemia; Methylene Blue; Monitoring, Physiologic; Oximetry; Oxygen Inhalation Therapy; Treatment Outcome
PubMed: 21954509
DOI: No ID Found -
Gastrointestinal Endoscopy Apr 2016Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to... (Meta-Analysis)
Meta-Analysis Review
ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus.
BACKGROUND AND AIMS
Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to detect dysplasia during endoscopic surveillance of BE. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met.
METHODS
We conducted meta-analyses calculating the pooled sensitivity, negative predictive value (NPV), and specificity for chromoendoscopy by using acetic acid and methylene blue, electronic chromoendoscopy by using narrow-band imaging, and confocal laser endomicroscopy (CLE) for the detection of dysplasia. Random effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics.
RESULTS
The pooled sensitivity, NPV, and specificity for acetic acid chromoendoscopy were 96.6% (95% confidence interval [CI], 95-98), 98.3% (95% CI, 94.8-99.4), and 84.6% (95% CI, 68.5-93.2), respectively. The pooled sensitivity, NPV, and specificity for electronic chromoendoscopy by using narrow-band imaging were 94.2% (95% CI, 82.6-98.2), 97.5% (95% CI, 95.1-98.7), and 94.4% (95% CI, 80.5-98.6), respectively. The pooled sensitivity, NPV, and specificity for endoscope-based CLE were 90.4% (95% CI, 71.9-97.2), 98.3% (95% CI, 94.2-99.5), and 92.7% (95% CI, 87-96), respectively.
CONCLUSIONS
Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging techniques. The ASGE Technology Committee therefore endorses using these advanced imaging modalities to guide targeted biopsies for the detection of dysplasia during surveillance of patients with previously nondysplastic BE, thereby replacing the currently used random biopsy protocols.
Topics: Acetic Acid; Barrett Esophagus; Biopsy; Coloring Agents; Esophagoscopy; Esophagus; Humans; Intravital Microscopy; Methylene Blue; Microscopy, Confocal; Narrow Band Imaging; Predictive Value of Tests; Watchful Waiting
PubMed: 26874597
DOI: 10.1016/j.gie.2016.01.007 -
TheScientificWorldJournal 2014The aim of this study was to perform a systematic review of the literature on the efficacy of antimicrobial photodynamic therapy (PDTa) on cariogenic dental biofilm. (Review)
Review
BACKGROUND
The aim of this study was to perform a systematic review of the literature on the efficacy of antimicrobial photodynamic therapy (PDTa) on cariogenic dental biofilm.
TYPES OF STUDIES REVIEWED
Studies in vivo, in vitro, and in situ were included. Articles that did not address PDTa, those that did not involve cariogenic biofilm, those that used microorganisms in the plankton phase, and reviews were excluded. Data extraction and quality assessments were performed independently by two raters using a scale.
RESULTS
Two hundred forty articles were retrieved; only seventeen of them met the eligibility criteria and were analyzed in the present review. Considerable variability was found regarding the methodologies and application protocols for antimicrobial PDTa. Two articles reported unfavorable results.
PRACTICAL IMPLICATIONS
The present systematic review does not allow drawing any concrete conclusions regarding the efficacy of antimicrobial PDTa, although this method seems to be a promising option.
Topics: Biofilms; Dental Caries; Dental Plaque; Humans; Light; Methylene Blue; Photochemotherapy; Photosensitizing Agents; Streptococcus; Tolonium Chloride
PubMed: 25379545
DOI: 10.1155/2014/824538 -
The Cochrane Database of Systematic... May 2014Pericyazine is a 3-cyano-10 (3-4'-hydroxypiperidinopropyl) phenothiazine. It is overall pharmacologically similar with chlorpromazine, though particularly sedating.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pericyazine is a 3-cyano-10 (3-4'-hydroxypiperidinopropyl) phenothiazine. It is overall pharmacologically similar with chlorpromazine, though particularly sedating. Dopamine receptor subtype analysis has not been performed for pericyazine, but the drug appears to induce greater noradrenergic than dopaminergic blockade. Compared to chlorpromazine, pericyazine reportedly has more potent antiemetic, antiserotonin, and anticholinergic activity.
OBJECTIVES
To evaluate the clinical effects and safety of pericyazine in comparison with placebo, typical and atypical antipsychotic agents and standard care for people with schizophrenia.
SEARCH METHODS
We searched the Cochrane Schizophrenia Group Trials Register (February 2013) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials.
SELECTION CRITERIA
All relevant randomised controlled trials focusing on pericyazine for schizophrenia and other types of schizophrenia-like psychoses (schizophreniform and schizoaffective disorders). We excluded quasi-randomised trials.
DATA COLLECTION AND ANALYSIS
Data were extracted independently from included papers by at least two review authors. Risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data were calculated. We assessed risk of bias for included studies and used GRADE to judge quality of evidence.
MAIN RESULTS
We could only include five studies conducted between 1965 and 1980. Most of the included studies did not report details of randomisation, allocation concealment, details of blinding and we could not assess the impact of attrition due to poor reporting.For the primary outcome of Global state - not improved, the confidence interval was compatible with a small benefit and increased risk of not improving with pericyazine compared with typical antipsychotics (2 RCTs, n = 122, RR 1.24 CI 0.93 to 1.66, very low quality of evidence) or atypical antipsychotics (1 RCT, n = 93, RR 0.97 CI 0.67 to 1.42, very low quality of evidence).When compared with typical antipsychotics relapse was only experienced by one person taking pericyazine (1 RCT, n = 80, RR 2.59 CI 0.11 to 61.75, very low quality of evidence).Pericyazine was associated with more extrapyramidal side effects than typical antipsychotics (3 RCTs, n = 163, RR 0.52 CI 0.34 to 0.80, very low quality of evidence) and atypical antipsychotics (1 RCT, n = 93, RR 2.69 CI 1.35 to 5.36, very low quality of evidence).The estimated risk of leaving the study early for specific reasons was imprecise for the comparisons of pericyazine with typical antipsychotics (2 RCTs, n = 71, RR 0.46 CI 0.11 to 1.90, very low quality of evidence), and with atypical antipsychotics (1 RCT, n = 93, RR 0.13 CI 0.01 to 2.42, very low quality of evidence).
AUTHORS' CONCLUSIONS
On the basis of very low quality evidence we are unable to determine the effects of pericyazine in comparison with typical or atypical antipsychotics for the treatment of schizophrenia. However, there is some evidence that pericyazine may be associated with a higher incidence of extrapyramidal side effects than other antipsychotics, and again this was judged to be very low quality evidence. Large, robust studies are still needed before any firm conclusions can be drawn.
Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Humans; Phenothiazines; Randomized Controlled Trials as Topic; Schizophrenia; Spasm; Tremor
PubMed: 24825770
DOI: 10.1002/14651858.CD007479.pub2 -
American Journal of Obstetrics and... Sep 2017The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy. (Review)
Review
OBJECTIVE
The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy.
DATA SOURCES
Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews.
STUDY ELIGIBILITY
We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy. Comparators were placebo, different doses of the same medication as intervention, or other nonnarcotic or narcotic medication.
STUDY APPRAISAL AND SYNTHESIS METHODS
Study data were extracted by one reviewer and confirmed by a second reviewer. For each outcome we graded the quality of the evidence. Studies were classified by the type of medication used and by outcome type.
RESULTS
Eighty-four trials met eligibility, with 69 included. Among nonnarcotic medications, paracetamol, gabapentin, and rofecoxib combined with gabapentin resulted in improvements in pain assessment compared with placebo and other nonnarcotic medications. Patient satisfaction was higher in patients who were given gabapentin combined with paracetamol compared with gabapentin alone. Use of preemptive paracetamol, gabapentin, bupivacaine, and phenothiazine resulted in less narcotic usage than placebo. All narcotics (ketamine, morphine, fentanyl) resulted in improved pain control compared with placebo. Narcotics had a greater reduction in pain assessment scores compared with nonnarcotics, and their use resulted in lower total narcotic usage.
CONCLUSION
Preemptive nonnarcotic and narcotic medications prior to abdominal hysterectomy decrease total narcotic requirements and improve patient postoperative pain assessment and satisfaction scores.
Topics: Analgesics; Analgesics, Opioid; Drug Therapy, Combination; Drug Utilization; Female; Humans; Hysterectomy; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Practice Guidelines as Topic; Premedication
PubMed: 28351670
DOI: 10.1016/j.ajog.2017.03.013 -
Brazilian Journal of Otorhinolaryngology 2022Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy.
OBJECTIVE
This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions.
METHODS
Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2).
RESULTS
Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692-0.917), 0.429 (95% CI 0.217-0.672), 0.747 (95% CI 0.607-0.849), and 4.061 (95% CI 1.528-10.796; I=9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91).
CONCLUSION
Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.
Topics: Early Detection of Cancer; Humans; Luminescence; Mouth Diseases; Mouth Neoplasms; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Tolonium Chloride
PubMed: 32847738
DOI: 10.1016/j.bjorl.2020.06.011 -
Medicina Oral, Patologia Oral Y Cirugia... May 2016Gold standard for the diagnosis of oral dysplasia (OD) and oral squamous cell carcinoma (OSCC) and malignant lesions is the histological examination. Several adjunctive... (Review)
Review
BACKGROUND
Gold standard for the diagnosis of oral dysplasia (OD) and oral squamous cell carcinoma (OSCC) and malignant lesions is the histological examination. Several adjunctive diagnostic techniques have been proposed in order to increase the sensitivity (SE) and specificity (SP) of conventional oral examination and to improve the diagnostic first level accuracy. The aim of this study is to perform a systematic review on non-invasive tools for diagnosis of OD and early OSCC.
MATERIAL AND METHODS
Medline, Scopus, Web of Knowledge databases were searched, using as entry terms "oral dysplasia AND diagnosis" / "oral cancer AND diagnosis". Data extracted from each study included number of lesions evaluated, histopathological diagnosis, SE, SP, positive and negative predictive values (PPV and NPV), diagnostic accuracy (DA) and the main conclusions.
RESULTS
After title and abstract scanning of 11.080 records, we selected 35 articles for full text evaluation. Most evaluated tools were autofluorescence (AF), chemiluminescence (CL), toluidine blu (TL) and chemiluminescence associated with toluidine blue (CLTB).
CONCLUSIONS
There is a great inhomogeneity of the reported values and there is no significant evidence of superiority of one tool over the other. Further clinical trials with a higher level of evidence are necessary in order to assess the real usefulness visual diagnostic tools.
Topics: Carcinoma, Squamous Cell; Humans; Hyperplasia; Mouth Neoplasms; Sensitivity and Specificity; Tolonium Chloride
PubMed: 26946204
DOI: 10.4317/medoral.20996 -
World Journal of Gastroenterology Dec 2013To assess systematically the safety and efficacy of bile leakage test in liver resection. (Meta-Analysis)
Meta-Analysis Review
AIM
To assess systematically the safety and efficacy of bile leakage test in liver resection.
METHODS
Randomized controlled trials and controlled clinical trials involving the bile leakage test were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate postoperative bile leakage, intraoperative positive bile leakage, and complications. We used either the fixed-effects or random-effects model.
RESULTS
Eight studies involving a total of 1253 patients were included and they all involved the bile leakage test in liver resection. The bile leakage test group was associated with a significant reduction in bile leakage compared with the non-bile leakage test group (RR = 0.39, 95%CI: 0.23-0.67; I (2) = 3%). The white test had superiority for detection of intraoperative bile leakage compared with the saline solution test (RR = 2.38, 95%CI: 1.24-4.56, P = 0.009). No significant intergroup differences were observed in total number of complications, ileus, liver failure, intraperitoneal hemorrhage, pulmonary disorder, abdominal infection, and wound infection.
CONCLUSION
The bile leakage test reduced postoperative bile leakage and did not increase incidence of complications. Fat emulsion is the best choice of solution for the test.
Topics: Anastomotic Leak; Bile Duct Diseases; Chi-Square Distribution; Diagnostic Techniques, Digestive System; Fat Emulsions, Intravenous; Hepatectomy; Humans; Indocyanine Green; Methylene Blue; Odds Ratio; Predictive Value of Tests
PubMed: 24363535
DOI: 10.3748/wjg.v19.i45.8420