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AIDS (London, England) Apr 2017To summarize published evidence on drug interactions between hormonal contraceptives and antiretrovirals. (Review)
Review
OBJECTIVE
To summarize published evidence on drug interactions between hormonal contraceptives and antiretrovirals.
DESIGN
Systematic review of the published literature.
METHODS
We searched PubMed, POPLINE, and EMBASE for peer-reviewed publications of studies (in any language) from inception to 21 September 2015. We included studies of women using hormonal contraceptives and antiretrovirals concurrently. Outcomes of interest were effectiveness of either therapy, toxicity, or pharmacokinetics. We used standard abstraction forms to summarize and assess strengths and weaknesses.
RESULTS
Fifty reports from 46 studies were included. Most antiretrovirals whether used for therapy or prevention, have limited interactions with hormonal contraceptive methods, with the exception of efavirenz. Although depot medroxyprogesterone acetate is not affected, limited data on implants and combined oral contraceptive pills suggest that efavirenz-containing combination antiretroviral therapy may compromise contraceptive effectiveness of these methods. However, implants remain very effective despite such drug interactions. Antiretroviral plasma concentrations and effectiveness are generally not affected by hormonal contraceptives.
CONCLUSION
Women taking antiretrovirals, for treatment or prevention, should not be denied access to the full range of hormonal contraceptive options, but should be counseled on the expected rates of unplanned pregnancy associated with all contraceptive methods, in order to make their own informed choices.
Topics: Anti-Retroviral Agents; Contraceptives, Oral, Hormonal; Drug Interactions; Female; Humans
PubMed: 28060009
DOI: 10.1097/QAD.0000000000001392 -
Journal of ISAKOS : Joint Disorders &... Feb 2024Early periprosthetic joint infection (PJI) represents one of the most fearsome complications of joint replacement. No international consensus has been reached regarding... (Review)
Review
PURPOSE
Early periprosthetic joint infection (PJI) represents one of the most fearsome complications of joint replacement. No international consensus has been reached regarding the best approach for early prosthetic knee and hip infections. The aim of this updated systematic review is to assess whether debridement, antibiotics, and implant retention (DAIR) is an effective choice of treatment in early postoperative and acute hematogenous PJI.
METHODS
This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The diagnostic criteria defining a PJI, the most present pathogen, and the days between the index procedure and the onset of the PJI were extracted from the selected articles. Additionally, the mean follow-up, antibiotic regimen, and success rate of the treatment were also reported.
RESULTS
The articles included provided a cohort of 970 patients. Ten studies specified the joint of their cohort in PJIs regarding either hip prostheses or knee prostheses, resulting in 454 total knees and 460 total hips. The age of the patients ranged from 18 to 92 years old. Success rates for the DAIR treatments in the following cohort ranged from 55.5% up to a maximum of 90% (mean value of 71%).
CONCLUSION
Even though the DAIR procedure is quite limited, it is still considered an effective option for patients developing an early post-operative or acute hematogenous PJI. However, there is a lack of studies, in particular randomized control trials (RCTs), comparing DAIR with one-stage and two-stage revision protocols in the setting of early PJIs, reflecting the necessity to conduct further high-quality studies to face the burden of early PJI.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Debridement; Anti-Bacterial Agents; Retrospective Studies; Treatment Outcome; Prosthesis-Related Infections; Arthroplasty, Replacement, Hip; Arthritis, Infectious
PubMed: 37714518
DOI: 10.1016/j.jisako.2023.09.003 -
The Cochrane Database of Systematic... Jan 2023Uveitis is a term used to describe a group of intraocular inflammatory diseases. Uveitis is the fifth most common cause of vision loss in high-income countries, with the... (Review)
Review
BACKGROUND
Uveitis is a term used to describe a group of intraocular inflammatory diseases. Uveitis is the fifth most common cause of vision loss in high-income countries, with the highest incidence of disease in the working-age population. Corticosteroids are the mainstay of treatment for all subtypes of non-infectious uveitis. They can be administered orally, topically with drops, by periocular (around the eye) or intravitreal (inside the eye) injection, or by surgical implantation.
OBJECTIVES
To determine the efficacy and safety of steroid implants in people with chronic non-infectious posterior uveitis, intermediate uveitis, and panuveitis.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE Ovid, Embase, PubMed, LILACS, and three trials registries to November 2021. SELECTION CRITERIA: We included randomized controlled trials comparing either fluocinolone acetonide (FA) or dexamethasone (DEX) intravitreal implants with standard-of-care therapy or sham procedures, with at least six months of follow-up after treatment. We included studies that enrolled participants of all ages, who had chronic non-infectious posterior uveitis, intermediate uveitis, or panuveitis with vision that was better than hand-motion.
DATA COLLECTION AND ANALYSIS
We applied standard Cochrane methodology.
MAIN RESULTS
We included data from four trials (683 participants, 907 eyes) that compared corticosteroid implants with either sham or standard-of-care therapy. Study characteristics and risk of bias Of the two trials that compared corticosteroid implants with sham procedure, one examined a 0.18 mg FA implant, and the other, a 0.7 mg DEX implant. The other two trials compared a 0.59 mg FA implant with standard-of-care therapy, which included systemic corticosteroids and immunosuppressive medications, if needed. We assessed the four trials to be at either low risk, or with some concerns of risk of bias across all domains. Findings Using sham procedure as control, combined results at the six-month primary time point suggested that corticosteroid implants may decrease the risk of uveitis recurrence by 60% (relative risk [RR] 0.40, 95% confidence interval [CI] 0.30 to 0.54; 2 trials, 282 participants; low-certainty evidence); and lead to a greater improvement in best-corrected visual acuity (BCVA; mean difference [MD] 0.22 logMAR, 95% CI 0.13 to 0.31; 1 trial, 153 participants; low-certainty evidence). Evidence based on a single-study report (146 participants) suggested that steroid implants may have no effects on visual functioning quality of life, measured on the National Eye Institute 25-Item Visual Function Questionnaire (MD 2.85, 95%CI -3.64 to 9.34; 1 trial, 146 participants; moderate-certainty evidence). Using standard-of care therapy as control, combined estimates at the 24-month primary time point suggested that corticosteroid implants were likely to decrease the risk of recurrence of uveitis by 54% (RR 0.46, 95% CI 0.35 to 0.60; 2 trials, 619 eyes). Combined estimates at 24 months also suggested that steroid implants may have little to no effects on BCVA (MD 0.05 logMAR, 95% CI -0.02 to 0.12; 2 trials, 619 eyes; low-certainty evidence). Evidence based on a single-study report (232 participants) suggested that steroid implants may have minimal clinical effects on visual functioning (MD 4.64, 95% CI 0.13 to 9.15; 1 trial, 232 participants; moderate-certainty evidence); physical functioning (SF-36 physical subscale MD 2.95, 95% CI 0.55 to 5.35; 1 trial, 232 participants; moderate-certainty evidence); or mental health (SF-36 mental subscale MD 3.65, 95% CI 0.52 to 6.78; 1 trial, 232 participants; moderate-certainty evidence); but not on EuroQoL (MD 6.17, 95% CI 1.87 to 10.47; 1 trial, 232 participants; moderate-certainty evidence); or EuroQoL-5D scale (MD 0.02, 95% CI -0.04 to 0.08; 1 trial, 232 participants; moderate-certainty evidence). Adverse effects Compared with sham procedures, corticosteroid implants may slightly increase the risk of cataract formation (RR 2.69, 95% CI 1.17 to 6.18; 1 trial, 90 eyes; low-certainty evidence), but not the risk of cataract progression (RR 2.00, 95% CI 0.65 to 6.12; 1 trial, 117 eyes; low-certainty evidence); or the need for surgery (RR 2.98, 95% CI 0.82 to 10.81; 1 trial, 180 eyes; low-certainty evidence), during up to 12 months of follow-up. These implants may increase the risk of elevated intraocular pressure ([IOP] RR 2.81, 95% CI 1.42 to 5.56; 2 trials, 282 participants; moderate-certainty evidence); and the need for IOP-lowering eyedrops (RR 1.85, 95% CI 1.05 to 3.25; 2 trials, 282 participants; moderate-certainty evidence); but not the need for IOP-lowering surgery (RR 0.72, 95% CI 0.13 to 4.17; 2 trials, 282 participants; moderate-certainty evidence). Evidence comparing the 0.59 mg FA implant with standard-of-care suggested that the implant may increase the risk of cataract progression (RR 2.71, 95% CI 2.06 to 3.56; 2 trials, 210 eyes; low-certainty evidence); and the need for surgery (RR 2.98, 95% CI 2.33 to 3.79; 2 trials, 371 eyes; low-certainty evidence); along with the risk of elevated IOP (RR 3.64, 95% CI 2.71 to 4.87; 2 trials, 605 eyes; moderate-certainty evidence); and the need for medical (RR 3.04, 95% CI 2.36 to 3.91; 2 trials, 544 eyes; moderate-certainty evidence); or surgical interventions (RR 5.43, 95% CI 3.12 to 9.45; 2 trials, 599 eyes; moderate-certainty evidence). In either comparison, these implants did not increase the risk for endophthalmitis, retinal tear, or retinal detachment (moderate-certainty evidence). AUTHORS' CONCLUSIONS: Our confidence is limited that local corticosteroid implants are superior to sham therapy or standard-of-care therapy in reducing the risk of uveitis recurrence. We demonstrated different effectiveness on BCVA relative to comparators in people with non-infectious uveitis. Nevertheless, the evidence suggests that these implants may increase the risk of cataract progression and IOP elevation, which will require interventions over time. To better understand the efficacy and safety profiles of corticosteroid implants, we need future trials that examine implants of different doses, used for different durations. The trials should measure core standard outcomes that are universally defined, and measured at comparable follow-up time points.
Topics: Humans; Adrenal Cortex Hormones; Cataract; Glaucoma; Panuveitis; Quality of Life; Steroids; Uveitis; Uveitis, Intermediate; Randomized Controlled Trials as Topic
PubMed: 36645716
DOI: 10.1002/14651858.CD010469.pub3 -
BMC Oral Health Oct 2023Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to... (Meta-Analysis)
Meta-Analysis
Evaluating the effect of mechanical debridement with adjunctive antimicrobial photodynamic therapy in comparison with mechanical debridement alone on the peri-implant parameters in type 2 diabetic mellitus patients with peri-implantitis: a systematic review and meta-analysis.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to evaluate the effect of mechanical debridement (MD) + antimicrobial photodynamic therapy (a-PDT) in patients with peri-implantitis who have T2DM in terms of bleeding on probing (BOP) and probing depth (PD) as primary outcomes and plaque index (PI) and crestal bone loss (CBL) as secondary outcomes.
METHODS
Publications compared outcomes between MD + aPDT and MD alone in T2DM patients with peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. Literature until July 2023 using MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science, and Google Scholar were collected.
RESULTS
Two randomized controlled trials (RCTs, 88 individuals) and one controlled clinical trial (CCT, 67 individuals) with follow-up periods ranged from 3 to 12 months were recruited. All studies used diode laser with wavelengths ranged from 660 to 810 nm. The results demonstrated that the MD + aPDT group showed significant benefits for BOP reduction after 6 months (SMD = -2.15, 95% CI: -3.78 to -0.51, p = 0.01). However, a great amount of heterogeneity was observed (I = 91.52%, p < 0.001). Moreover, there was a significant difference between MD + aPDT and MD alone groups in CBL (SMD = -0.69, 95% CI: -1.07 to -0.30, p < 0.001). In addition, homogeneity assumption was satisfied (I = 22.49%, p = 0.28). Significant differences in PD and PI reduction were not found except for PI reduction after 3 months (SMD = -0.79, 95% CI: -1.24 to -0.33, p < 0.001. Also, no heterogeneity was observed (I = 0.00%, p = 0.47).
CONCLUSION
Given that high heterogeneity in BOP and PD outcome was found in this systematic review, future long-term CTs with MD + aPDT should be examined to arrive at a firm conclusion.
Topics: Humans; Peri-Implantitis; Debridement; Diabetes Mellitus, Type 2; Dental Implants; Photochemotherapy; Anti-Infective Agents
PubMed: 37828479
DOI: 10.1186/s12903-023-03337-9 -
Journal of Taibah University Medical... Oct 2017Bisphosphonates (BPs) are a class of drugs that are used to treat osteoporosis. It has been suggested that BP coatings on dental implants have a positive effect on new... (Review)
Review
OBJECTIVES
Bisphosphonates (BPs) are a class of drugs that are used to treat osteoporosis. It has been suggested that BP coatings on dental implants have a positive effect on new bone formation. The purpose of this review is to analyse the currently available data concerning the clinical and experimental efficacy of BP-releasing titanium implants such that their potential in clinical oral implant dentistry may be ascertained.
METHODS
Based on a literature review, a focused research question was constructed: what is the effect of a BP-releasing coating on the osseointegration of titanium dental implant? The databases of PubMED/MEDLINE; ISI Web of Knowledge; Embase and Google Scholar were searched electronically using the keywords 'dental implant'; 'bisphosphonate' and 'titanium.' The quality; general characteristics and outcomes of each study were summarized and analysed systematically.
RESULTS
A total of eleven articles fulfilled the criteria to be included in this review. Eight studies were experimental; two studies were clinical; and one study was experimental and clinical. In nine studies (82%), BP-coated implants resulted in higher osseointegration, as indicated by higher resonance frequency values, removal torque, bone-implant contact and new bone formation. In two studies (18%), there was no difference between the osseointegration of BP-coated implants and controls.
CONCLUSIONS
Bisphosphonates-loaded implants may have a positive effect on osseointegration. However, more well-designed clinical studies are required to demonstrate their osseoconductive effects.
PubMed: 31435266
DOI: 10.1016/j.jtumed.2017.05.007 -
Periodontology 2000 Oct 2023Bone regeneration is often required concomitant with implant placement to treat a bone fenestration, a dehiscence, and for contouring. This systematic review assessed... (Meta-Analysis)
Meta-Analysis Review
Bone regeneration is often required concomitant with implant placement to treat a bone fenestration, a dehiscence, and for contouring. This systematic review assessed the impact of different biomaterials employed for guided bone regeneration (GBR) simultaneous to implant placement on the stability of radiographic peri-implant bone levels at ≥12 months of follow-up (focused question 1), as well as on bone defect dimension (width/height) changes at re-assessment after ≥4 months (focused question 2). Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared different biomaterials for GBR were considered. A Bayesian network meta-analysis (NMA) was performed using a random-effects model. A ranking probability between treatments was obtained, as well as an estimation of the surface under the cumulative ranking value (SUCRA). Overall, whenever the biological principle of GBR was followed, regeneration occurred in a predictable way, irrespective of the type of biomaterial used. A lower efficacy of GBR treatments was suggested for initially large defects, despite the trend did not reach statistical significance. Regardless of the biomaterial employed, a certain resorption of the augmented bone was observed overtime. While GBR was shown to be a safe and predictable treatment, several complications (including exposure, infection, and soft tissue dehiscence) were reported, which tend to be higher when using cross-linked collagen membranes.
Topics: Humans; Alveolar Ridge Augmentation; Biocompatible Materials; Bone Regeneration; Dental Implantation, Endosseous; Dental Implants; Guided Tissue Regeneration, Periodontal; Network Meta-Analysis
PubMed: 37752820
DOI: 10.1111/prd.12531 -
Dental Materials Journal 2016Biofilm formation on dental implant surfaces is a serious threat. Up to 50% of all implants show signs of irreversible tissue destruction. The aim of the present... (Review)
Review
Biofilm formation on dental implant surfaces is a serious threat. Up to 50% of all implants show signs of irreversible tissue destruction. The aim of the present systematic review was to summarize the state of the art of strategies to functionalize antimicrobial dental implant surfaces. We searched the following electronic database: SCOPUS, MEDLINE and GOOGLE SCHOLAR and identified relevant controlled trials that evaluated the efficiency of new biomaterial strategies to modify dental implant surfaces, in such a way that biofilm formation was inhibited. The search yielded 2,990 potentially relevant publications. A total of 142 publications met the inclusion criteria. Analysis found that it may be concluded that silver-implanted surfaces, drug-loaded surfaces, surfaces with antimicrobial peptides, bioactive and biopassive polymer coatings as well as nanoscale or UV-activatable surfaces enhance antimicrobial activity compared to commercial pure titanium.
Topics: Anti-Infective Agents; Dental Implantation, Endosseous; Dental Implants; Titanium
PubMed: 27477219
DOI: 10.4012/dmj.2015-314 -
Scientific Reports May 2023To better understand the efficacy of intravitreal dexamethasone implant (Ozurdex) versus antivascular endothelial growth factor (anti-VEGF) treatment in patients with... (Meta-Analysis)
Meta-Analysis
Efficacy and safety profile of intravitreal dexamethasone implant versus antivascular endothelial growth factor treatment in diabetic macular edema: a systematic review and meta-analysis.
To better understand the efficacy of intravitreal dexamethasone implant (Ozurdex) versus antivascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). A systematic review and meta-analysis. The study included randomized control trials (RCTs) and non-randomized control trials (Non-RCTs) before December 2021 that compare the efficacy of Ozurdex-related therapyand anti-VEGF therapy. We searched PubMed, Cochrane Library, and EMBASE. The quality of the included studies was assessed carefully. 30 studies were included. Regarding BCVA change, the overall result revealed no significant differences between Ozurdex and anti-VEGF therapies in patients with nonresistant DME, but Ozurdex group had significantly more VA improvement than anti-VEGF therapies in patients with resistant DME (MD 0.12, 95% CI 0.02-0.21). In terms of central retinal thickness (CRT) decrease, there was a significant difference between Ozurdex therapy and anti-VEGF therapy in patients with nonresistant DME (MD 48.10, 95% CI 19.06-77.13) and resistant DME (MD 65.37, 95% CI 3.62-127.13). Overall, Ozurdex therapy resulted in significantly greater VA improvement and CRT decrease than anti-VEGF therapy in resistant DME patients. Ozurdex therapy was not inferior to anti-VEGF therapy in patients with nonresistant DME.
Topics: Humans; Macular Edema; Ranibizumab; Glucocorticoids; Endothelial Growth Factors; Bevacizumab; Vascular Endothelial Growth Factor A; Dexamethasone; Diabetic Retinopathy; Intravitreal Injections; Diabetes Mellitus
PubMed: 37156823
DOI: 10.1038/s41598-023-34673-z -
International Journal of Surgery... Aug 2016Currently there is no consensus on what is the optimal method for monitoring free flaps. Our meta-analysis compared the free flap success and salvage rates of... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
Currently there is no consensus on what is the optimal method for monitoring free flaps. Our meta-analysis compared the free flap success and salvage rates of Cook-Swartz Implantable Doppler monitoring with clinical monitoring to gain insight into the relative benefit of these systems.
METHODS
Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 16, 2016. Search terms included free flap surgery, free flap microsurgery and implantable Doppler. Studies were included if they involved the comparison of Cook-Swartz Doppler and clinical assessment for monitoring free flap function. Studies using free flap monitoring as an outcome measure for drug treatment were also excluded. Sensitivity analysis using the leave-one-out approach was used to assay the reliability of the findings.
RESULTS
Initial search identified 14 studies, of which five studies were included in the meta-analysis. Cook-Swartz Doppler had significantly better rate of free flap success and salvage than clinical monitoring methods (P values ≤ 0.006). Data did not markedly changed when each study was removed in turn, showing reliability of the findings.
DISCUSSION
The Cook-Swartz Doppler as a monitoring method may result in a higher rate of free flap success and salvaging but also a greater frequency of false positives than conventional methods. Our analysis is limited by designs of included studies and by heterogeneity of clinical monitoring techniques.
CONCLUSIONS
More studies are needed to evaluate if Cook-Swartz Doppler can be used alone, or to be better used as an adjunctive technique to complement the clinical method of monitoring.
Topics: Free Tissue Flaps; Humans; Laser-Doppler Flowmetry; Microsurgery; Monitoring, Ambulatory; Postoperative Care; Prostheses and Implants; Reproducibility of Results; Salvage Therapy
PubMed: 27353849
DOI: 10.1016/j.ijsu.2016.06.034 -
The International Journal of Oral &... 2014To systematically appraise whether anti-infective protocols are effective in preventing biologic implant complications and implant loss after a mean observation period... (Review)
Review
PURPOSE
To systematically appraise whether anti-infective protocols are effective in preventing biologic implant complications and implant loss after a mean observation period ≥ 10 years after loading.
MATERIALS AND METHODS
An electronic search of Medline via PubMed and Embase via Ovid databases complemented by manual search was conducted up to October 31, 2012. Studies were included provided that they were published in English, German, French, or Italian, and conducted on ≥ 20 partially and fully edentulous patients with dental implants and regular (≥ 1×/year) supportive periodontal therapy (SPT) over a mean observation period ≥ 10 years. Assessment of the identified studies and data extraction were performed independently by two reviewers. Authors were contacted if required. Collected data were reported by descriptive methods.
RESULTS
The initial electronic search resulted in the identification of 994 titles from Medline via PubMed and 531 titles from Embase via Ovid databases, respectively. After elimination of duplicate titles and exclusion of 60 full-text articles, 143 articles were analyzed, resulting in 15 studies eligible for qualitative analysis. The implant survival rate ranged from 85.7% to 99.2% after a mean observation period ≥ 10 years. One comparative study assessed the effects of regular SPT on the occurrence of biologic complications and implant loss. Overall, regular diagnosis and implementation of anti-infective therapeutic protocols were effective in the management of biological complications and prevention of implant loss. Residual probing depths at the end of active periodontal therapy and development of reinfection during supportive periodontal therapy (SPT) represented a significant risk for the onset of peri-implantitis and implant loss. Comparative studies indicated that implant survival and success rates were lower in periodontally compromised vs noncompromised patients.
CONCLUSIONS
In order to achieve high long-term survival and success rates of dental implants and their restorations, enrollment in regular SPT including anti-infective preventive measures should be implemented. Therapy of peri-implant mucositis should be considered as a preventive measure for the onset of peri-implantitis. Completion of active periodontal therapy should precede implant placement in periodontally compromised patients.
Topics: Anti-Infective Agents; Dental Implants; Dental Restoration Failure; Female; Humans; Jaw, Edentulous; Middle Aged; Mouth, Edentulous; Peri-Implantitis; Periodontitis
PubMed: 24660205
DOI: 10.11607/jomi.2014suppl.g5.1