MedNEXT Journal of Medical and Health Sciences

Behind bars and under the influence: understanding substance use among prison inmates in Sri Lanka

Malawige Amila Suranga — 2025-01-03

Introduction: Substance use among prison inmates is a challenge for many countries around the world and this problem has imposed great waste of human, financial capital which leads to several health costs and social harm to the general community. Objective of this study is to determine the pattern of substance use among prison inmates in Sri Lanka. Methods: The study design was a descriptive cross-sectional study. This study was conducted in 22 selected prison institutions in Sri Lanka covering the entire country. Multi-stage probability proportionate to size stratified cluster sampling method was used. The total sample used for the study was 1730 prison inmates. A validated interviewer administrated questionnaire was used for the data collection. Results: Among the 1730 prison inmates the response rate was 98.7%. The total study sample (1708) was consisted with 938 (55%) convicted prison inmates and 770 (45%) un-convicted prison inmates. The mean age of the study sample was 39.2 years, with a standard deviation of 13.6 years. The highest educational qualification of the majority (36.9%) of the study sample was passing grade 9-11. More than four fifths (1373, 80.4%) of prison inmates had ever used a substance while 335 (19.6%) prison inmates had never used a substance. Among ever users of substances 760 (55.3%) were convicted prison inmates. The most prevalent (81.6%) substance used by prison inmates before imprisonment (82.3%) as well as after imprisonment (19.2%) was cigarettes. Almost four fifth (79.3%) of prison inmates had used alcohol before imprisonment followed by betel (47.6%) and heroine (35.2%). Usage of all the types of substances have declined after imprisonment. More than one tenth (10.8%) of prison inmates had used heroine after imprisonment followed by betel (10.8%) and cannabis (2.7%). Thirteen prison inmates (0.9%) had used injectable non prescribed drugs following imprisonment. Among study participants 14.9% had newly started substance use after imprisonment. Conclusions: The habits of substance use among prison inmates before imprisonment shows a higher value compared to the general population. Significant number of prison inmates had continued their habits substance use even after being imprisoned considering the restricted environment within the prison institutions. Among prison inmates a significant number has started the use of substances for the first time in their life while they were imprisoned.

Comparative analysis between plate and cannulated screw in fracture of the posterior malleolus: a retrospective observational cross-sectional study

Wallace Marino Saran — 2025-01-03

Introduction: Ankle fractures account for approximately 4% of all fractures, with an annual incidence of 124 in 100,000 people in the United Kingdom. More than a third of these contain involvement of the posterior malleolus. Objective: It was to analyze and compare the anteroposterior screw (PAS) and posterior support plate (PSP) techniques in postoperative results and percentage of complications, comparing radiographic and functional results in the surgical treatment of the posterior malleolus. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 18 patients were included (12 PAS and 6 PSP). For the PAS group, the mean time to fracture healing on radiography was 9.92 weeks, and for the PSP group, it was 11.83 weeks. Using predictive logistic regression analysis, PAS and PSP consolidation times showed a statistically significant difference in data distribution (with p=0.888>0.05), and Haraguchi's classifications for PAS and PSP did not show a statistically significant association, with p>0.05. The two techniques, anteroposterior screw fixation posterior support plate, have advantages and disadvantages inherent to the procedure, as well as the surgeon's aptitude for each technique can be a confusing factor for the study. Little discrepancy was observed in the clinical and radiographic outcomes of the patients analyzed.

Major clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer: a systematic review

Ademilton Couto Nascimento Junior — 2025-01-04

Introduction: In the context of endodontic treatments and cancer, head and neck squamous cell carcinoma is the 6th most common form of cancer in the world, with more than 400,000 deaths annually. The great challenge is endodontic treatment after radiotherapy processes. Furthermore, the promising applications of exosomes in targeted therapy and we propose future directions for the use of exosomes in clinical and endodontic treatment. Objective: The present study developed a systematic review to elucidate the main clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 35 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=89.2%<50%. It was concluded that biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth demonstrated efficacy in reducing endodontic contaminants. Moreover, Ca(OH)₂ as intracanal medication should be performed in irradiated patients with infected root canals. Also, radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to mean values occur after long periods. The probiotic SsK12 significantly reduced the incidence, onset, and duration of severe oral mucositis with a good safety profile. Artificial intelligence has valuable applications in the field of modern endodontics with promising results, especially in endodontic treatments in patients with head and neck cancer.

Major clinical findings on the types of impressions used in implant-supported prostheses: a systematic review

Ygor Souza Martinez — 2025-01-03

Introduction: The key to obtaining perfect prostheses depends on the passive fit between its connector and the implant itself. The compromised fit between the contact surfaces of implant-supported prostheses creates uncontrolled stresses in the components and peri-implant tissues, evoking biological and mechanical complications. Objective: It was to review the scientific literature on the types of impression used in implant prostheses. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 111 articles were found, and 44 articles were evaluated in full, and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 06 studies with a high risk of bias and 31 studies that did not meet GRADE. Minimizing contraction appears to be the most important factor in ensuring an accurate impression for this technique. Digital printing has achieved high patient acceptance, reduces possible impression and master mold errors, reduces time in the chair, provides a three-dimensional image of the preparation, and ease of communication between the clinician and the laboratory. However, there is a dearth of scientific data regarding implant fingerprints and their accuracy. Research on implant fingerprinting has been limited to a few in vitro studies and case reports.

Caudal versus regional block with the use of ultrasound in pediatric analgesia: a systematic review of the main clinical results

Nathalye Stefanny Resende Carrilho — 2024-11-25

Introduction: Regional anesthesia has been gaining prominence in recent decades. A variety of peripheral and central nerve blocks have been developed to ensure that perioperative pain can be effectively controlled. Caudal block is one of the most widely administered techniques of regional anesthesia, and the use of ultrasound has enabled the optimization and precision of the techniques. Objective: This study aimed to analyze the main clinical considerations and outcomes of ultrasound-guided caudal and regional block for pediatric analgesia. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from May to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found. 75 articles were evaluated and 27 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with a high risk of bias and 21 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I² = 18.7% < 50%. All these techniques protect children from perioperative pain and, combined with periprocedural sedation, allow surgical interventions with spontaneous breathing in groups of patients with maximum risk of difficult airways. We consider this specific point the main advantage of regional anesthesia in pediatric patients. Ultrasound-guided caudal epidural, performed under sedation with a non-instrumented airway, is an effective technique in daily clinical routine; however, higher body weight and surgical procedures in the mid-abdomen are risk factors for pain-related block failure. Patients who, regardless of chronological age, were born as extremely premature infants have a higher risk of respiratory events. For bilateral inguinal hernia surgeries, ultrasound-guided caudal epidural block and transversus abdominis plane block showed similar analgesic efficacy in the first six hours postoperatively. Furthermore, ultrasound-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and longer-lasting analgesia compared with ultrasound-guided caudal block for pediatric lower limb surgeries. Ultrasound-guided erector spinae block was safe and effective in pediatric patients undergoing unilateral lower abdominal surgery, as it provided longer-lasting analgesia and fewer analgesic requirements than caudal block and fewer side effects. In children undergoing regional anesthesia, the incidence of infection, hematoma, and local anesthetic toxicity is low.

Major considerations of orthognathic surgery in treating obstructive sleep apnea syndrome: a systematic review

Marcely Fonn Martineli — 2024-11-25

Introduction: In the setting of airway obstruction, obstructive sleep apnea syndrome (OSAS) is associated with several comorbidities. Patient evaluation includes a detailed history, clinical and radiographic examination, endoscopy, and polysomnography. Treatment may be nonsurgical or surgical, and Phase II of the Stanford Protocol for surgical treatment involves maxillomandibular advancement. Objective: It was conducted a systematic review to present the main considerations of orthognathic surgery in treating obstructive sleep apnea syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 92 articles were found. A total of 22 articles were fully evaluated and 17 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 48 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=82.4%>50%. It has been concluded that orthodontists should perform appropriate screening for obstructive sleep apnea. This can be done as part of our health history, our clinical examination, and review of radiographs taken for purposes other than diagnosis and screening for OSA. Orthodontic treatment for obstructive sleep apnea syndrome can be helpful and effective. However, this can only be done after referral to the appropriate medical specialist, as part of a multidisciplinary team, with consideration of the likely efficacy of the treatment, and after all likely and potential negative consequences have been considered and discussed thoroughly with the patient. Orthognathic surgery combined with soft tissue surgery is most effective as a curative treatment for obstructive sleep apnea syndrome.

Major observations of root canal instrument fractures and techniques for treatment and removal of endodontic instrument fragments: a systematic review

Helena Favaro — 2024-11-25

Introduction: In the context of root canal endodontic treatments, fracture of instruments in the root canal during canal shaping is reported as one of the most common reasons for a negative prognosis. Nickel-titanium (Ni-Ti) instruments stand out. However, Ni-Ti instruments can fracture, with a prevalence of approximately 1.6% (0.7-7.4%). Special techniques to retrieve obstructing objects, such as ultrasonic instruments, hollow tubes with cyanoacrylate adhesive, trepanation techniques using an ultrasonic tip or a trepan bur, endo-extractors and welding with neodymium: yttrium-aluminum-perovskite (Nd: YAG) laser, and surgical techniques have been proposed. Objective: It was to develop a systematic review of the endodontic literature to externalize and discuss the main observations of fractures of root canal instruments, as well as to show the main techniques for treatment and removal of fragments of endodontic instruments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 93 articles were found, 34 articles were evaluated and 08 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 32 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X² =89.5% >50%. It was concluded that comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. No consensus has been reached on a safe technique with a high success rate for removing broken instruments. Fracture of nickel-titanium (Ni-Ti) instruments during root canal instrumentation leads to compromised results in endodontic treatments. Thus, irradiation for a clinical procedure involving the use of a Neodymium: Yttrium-Aluminum-Perovskite (Nd: YAP) laser has shown good performance for removing fractured nickel-titanium files. Thus, fractured instruments can be removed by a variety of methods, such as good ultrasonic tips, microtubule devices, and hemostatic pliers/forceps. These techniques require qualified use of the operating microscope. Removing a fractured file is associated with considerable risk, and therefore the fragment must be circumvented. Removing fractured instruments can be expensive in terms of time and equipment. Thus, a cost-benefit analysis of the treatment must be considered before selecting a definitive therapy for the patient.

Major clinical approaches in the treatment of chronic pain through cognitive-behavioral and lifestyle therapy: a systematic review

Jéssica de Mauro Lobato Silva — 2024-11-15

Introduction: It is estimated that millions of people worldwide suffer from chronic pain, which is a condition influenced by biological, psychological, and social factors and optimally managed by treatments that address not only its biological causes but also its psychological and social influences and consequences. Over the past 60 years, parallel advances in the scientific understanding of pain and the development of cognitive and behavioral therapies have led to the widespread application of cognitive-behavioral therapy (CBT) to chronic pain problems. Objective: This was to conduct a systematic review to demonstrate, through randomized clinical trials and meta-analyses, the real impact of treating chronic pain through cognitive-behavioral therapy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 84 articles were found. 21 articles were evaluated and 07 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies presented homogeneity in their results, with X²= 88.7% >50%. It was concluded that the effectiveness of cognitive-behavioral therapy for individuals with chronic pain has been evaluated in randomized clinical trials for more than three decades, mainly in adults with chronic back pain, headaches, orofacial pain, or arthritis-related pain. Cognitive-behavioral therapy is the “gold standard” psychological treatment for individuals with a wide range of pain problems. The effectiveness of cognitive-behavioral therapy in reducing pain, distress, pain interference with activities, and disability has been established in systematic reviews and meta-analyses. Although the average effect sizes are small to moderate across all pain outcomes, CBT does not have the risks associated with chronic pain medications, surgeries, and interventional procedures. Furthermore, CBT may well have benefits for common comorbid conditions such as diabetes and cardiovascular disease. Research is needed to develop CBT interventions that have stronger beneficial effects, with attention to whether tailoring therapy to specific patient subgroups or problems improves outcomes.

Major considerations of maxillary/mandible osteonecrosis caused by bisphosphonates in the dental implant scenario: a systematic review

Nathalia Silva Tamarindo — 2024-11-14

Introduction: The literature has shown that several patients with a history of bisphosphonate treatment appear to be at risk for medication-related osteonecrosis of the jaw (MRONJ) osteonecrosis of the jaw. Objective: It was analyzing the use of BP associated with dentistry. Because it is a possible alternative for the reduction of loss and increase in bone density, as well as for the possibility of osteonecrosis, which requires therapeutic and preventive measures in the involvement of invasive practices such as dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 85 articles were founded, and 54 articles were evaluated and 30 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 24 studies with a high risk of bias and 18 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X² =81.9% >50%. It was concluded that osteoporosis is a metabolic condition that affects alveolar bone density, but does not present problems for the installation of osseointegrated implants, as long as there is sufficient bone mass in the region where the tooth will be implanted. It suggests to the dental surgeons the knowledge of the diagnosis so that it makes a careful evaluation, directing the professional to observe the quality of the bone through routine image examinations. Further, alendronate sodium is used to decrease bone resorption, the drug should be considered as an adjunctive therapeutic agent for the treatment of osteoporosis.

Major approaches and clinical outcomes of gingival correction procedures for improved aesthetic smile: a concise systematic review

Beatriz Nunes Turatti — 2024-11-14

Introduction: Well-being is directly related to health, people with a balanced smile, between health and beauty, tend to smile more and this generates a condition of wellbeing. A small gingival plastic can modify the smile as a whole, also changing the other variables. In gingival correction, process-specific techniques are used for each case, thus individualizing the patient and the proposed treatment. Objective: It was to present a concise systematic review of the main approaches and clinical outcomes of gingival correction procedures to achieve the best aesthetic smile. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 68 articles were found and 20 articles were evaluated in full and 08 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=89.6%>50%. It was concluded that a gummy smile consists of the visualization of more than 3 mm of gum above the maxillary incisors. For the success of an aesthetic correction, one must be aware of the causes of the change in normality, added to the patient's reasons. The ideal planning is when post-surgical effects directly influence cause removal and patient satisfaction, which is in line with our research results. Digitally assisted esthetic crown lengthening helps to shorten the operation time and reduces the possibility of human errors during measurements. This will be useful to help professionals achieve better results.

Major approaches oral cancer and bucomaxillofacial surgical procedures: a concise systematic review

Ricardo Barbosa de Freitas — 2024-11-13

Introduction: In oral neoplasms, squamous cell carcinomas (SCCs) account for more than 90% of cases. SCCs can have several levels of differentiation and often give rise to lymph node metastases. Clinical recognition and evaluation of oral mucosal lesions can detect up to 99% of oral cancers. Objective: It was sought to list the main approaches to treating oral cancer, both in early identification and in bucomaxillofacial surgical procedures. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from July to August 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found. 23 articles were fully evaluated and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies with a high risk of bias and 32 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=88.8%>50%. It was concluded that oral mucosa cancer is one of the most common oral cancers and has a poor prognosis. This can confirm that the planned dental treatment performed during oral cancer treatment produces an improvement in the quality of life of oral cancer patients. The indication for bucomaxillofacial surgery should be meticulously planned. In addition, dentists should consider a patient's ongoing cancer therapy for those patients who come to the dentist while receiving cancer treatment. The use of nomograms in clinical practice should bring significant benefits to patients with oral mucosa cancer.

Major considerations of gingivoplasty: a concise systematic review

Iasmim Milene Evangelista — 2024-11-01

Introduction: In the scenario of gingivoplasty, well-being is directly related to health, people with a balanced smile, between health and beauty, tend to smile more and this generates a condition of well-being. In gingival correction, process-specific techniques are used for each case, thus individualizing the patient and the proposed treatment, correcting not only the aesthetics but also the patient as a whole. Objective: This systematic review study described the techniques used to correct a gummy smile, with the gingivoplasty technique being selected. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 78 articles were found and 15 articles were evaluated in full and 06 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=87.5%>50%. It was concluded that applications of injectable platelet-rich fibrin have shown positive effects on epithelial wound healing after gingivectomy and gingivoplasty operations. A patient with a meso facial profile, compatible with hypertonic lips, improves our favorable prognostic acceptability with a lower risk of relapse and dissatisfaction. Bone-removing gingivoplasty is indicated for cases where removal of the gingival band only reduces the gingival sulcus invading the biological distance and thus needs to remove the bone for soft tissue stability.

Potential use of bio-stimulators and the successful process of cervicofacial liposculpture: a systematic review

Kamila Stellita Teixeira de Camargo — 2024-10-31

Introduction: In the liposculpture scenario, and at the cellular and molecular level, tissue engineering has numerous advantages that meet the needs of the injured tissue or organ for the regeneration process or fillings and contours. Biological microenvironments enable cell recognition and signaling cascades for neovascularization and stabilization of fat grafting. Objective: A systematic review was conducted on the use of potential bio-stimulators (cells and molecules) and the biochemical and physiological mechanisms that can contribute to the successful process of cervicofacial liposculpture, to promote neovascularization and stabilization of fat grafting or fat reduction. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from June to August 2024 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 110 articles were found. A total of 41 articles were fully evaluated and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies at high risk of bias and 28 studies that did not meet the GRADE. The present study showed that the use of potential bio stimulators such as stromal vascular fraction cells and mesenchymal stem cells from adipose tissue, exosomes, microRNA, and PRP, as well as the molecules secreted by these cells, can contribute to the successful process of cervicofacial liposculpture, to promote neovascularization and stabilization of fat grafting or fat reduction. Furthermore, studies have shown that the use of adipose tissue plus PRP led to the presence of more pronounced inflammatory infiltrates and greater vascular reactivity, increased vascular permeability, and certain reactivity of the nervous component, noting that the addition of 20% PRP activated with calcium to adipose tissue grafts can enhance the results of regenerative and aesthetic facial surgeries.

Clinical considerations of implant prosthesis moulding: a systematic review

Karoline Souza de Macedo — 2024-10-30

Introduction: The long-term success of a dental implant depends on the prosthesis. The key to obtaining perfect dentures depends on the passive seating between its connector and the implant itself. The compromised fit between the contact surfaces of implant-supported prostheses creates uncontrolled tensions in the peri-implant components and tissues, evoking biological and mechanical complications. Objective: Considering that choosing the most precise technique and material for each particular case has become a challenging task for professionals, this study aimed to review the literature on the types of impression used in implant prostheses. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 228 articles were found, and 84 articles were evaluated in full, and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 90 studies that did not meet GRADE. The choice of closed tray or open tray impression techniques depends on the number, depth, angulation, and relative parallelism of the implants. The materials of choice for making impressions, following the closed-tray and open-tray printing techniques, were polyether and polyvinylsiloxane. Most studies reported more accurate impressions with the splinting technique than with the non-splitting technique. Acrylic resin was the most frequently used material. Therefore, minimizing contraction appears to be the most important factor in ensuring an accurate impression for this technique. Digital printing has achieved high patient acceptance, reduces possible impression and master mold errors, reduces time in the chair, provides a three-dimensional image of the preparation, and ease of communication between the clinician and the laboratory. However, there is a dearth of scientific data regarding implant fingerprints and their accuracy. Research on implant fingerprinting has been limited to a few in vitro studies and case reports.

The Promise and Challenges of Oral Testosterone Therapy

Julian Yin Vieira Borges — 2024-10-17

In recent years, the landscape of testosterone replacement therapy (TRT) has evolved significantly, offering new hope for hypogonadal men seeking effective and convenient treatment options. The introduction of oral testosterone undecanoate (TU) marks a pivotal advancement in this field, as highlighted in the comprehensive review by Dr. Julian Borges. This editorial aims to explore the implications of these findings and the future of oral TRT in clinical practice.

Major clinical relevance and considerations of zygomatic implants in elderly patients: a systematic review

Gabriella Morais — 2024-10-10

For decades, zygomatic implants (ZI) have been used to rehabilitate atrophic maxillae and reconstruct maxillary defects, demonstrating significant survival rates, and have emerged as an alternative to extensive bone grafting. Despite their efficacy, surgical techniques for ZI placement have consistently been associated with perioperative complications, with additional problems arising later, especially in elderly patients. Objective: The present study developed a systematic review to address the main clinical relevance and considerations of zygomatic implants in elderly patients. Methods: The present study followed a concise systematic review model. The search was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 220 articles were found. In total, 77 articles were fully evaluated and 57 were included and evaluated in this study, and of the total of 57 articles, only 42 articles were developed in the item results of the systematic review. Of the initial total of articles, 108 articles were excluded because they did not meet the GRADE and AMSTAR-2 classification, and 20 were excluded because they presented a risk of bias that could compromise the credibility of the studies. The symmetric funnel plot does not suggest a risk of bias. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=85.6%>50%. It was concluded the ZI has a high rate of survival accumulated in 12 years, with the majority of failures occurring in the early stages of the postoperative period. The main complication observed related to zygomatic implants in elderly patients was sinusitis, which can appear several years after implantation surgery. The presence of increased maxillary sinus pneumatization with advanced resorption of the posterior alveolus may result in insufficient bone to anchor the implant. Bone augmentation is generally necessary under these conditions to allow the placement of a sufficient number and length of implants. Another more serious condition would be defects of maxillectomy, aplasia of the maxillary sinus, and cleft deformities. Zygomatic implants appear to be a consolidated therapeutic option for a significantly atrophic maxilla in elderly patients, offering a promising alternative to costly heavy bone graft techniques, fewer complications, less time for rehabilitation, less required prosthodontic work, and significantly higher survival rates.

Major considerations in neurotic skin excoriations and psychiatric disorders: a systematic review

Natalia Hirt — 2024-10-04

Introduction: Among psychiatric dermatoses, neurotic excoriation is characterized by the patient's confession of causing lesions on the skin itself, without presenting a basic dermatological disease. The theme has been gaining prominence since the incorporation of the diagnosis in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2014). Objective: The present study addressed the main clinical findings in research studies on neurotic excoriation, in addition to valuing the importance of psychological aspects in etiopathogenesis. Methods: The research and development of the work were carried out from June to July 2024 in the Scopus, PubMed, Science Direct, and Scielo databases, using the main scientific articles on nutrigenomics, and following the PRISMA rules. The quality of the studies was based on the GRADE and AMSTAR-2 instruments, and the risk of bias by the Cochrane instrument (Funnel Plot). Results and Conclusion: 18 studies were included out of a total of 115. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=89.5%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2 criteria. it was found that the subject has been scarcely addressed in the literature since not all cases are diagnosed and this pathology has more than one denomination (excoriation disorder, pathological palpation of the skin, neurodermatitis, dermatothilomania, and psychogenic excoriation). Therefore, the present study addressed the main clinical findings in research studies, through a systematic review, on neurotic excoriation, in addition to valuing the importance of psychological aspects in etiopathogenesis.

Use of cannabidiol in the treatment of compulsion eating and obesity: a systematic review

Thuany da Silva Teixeira — 2024-09-17

Introduction: Obesity represents a multifactorial disease that causes serious public health problems. There are more than 2.50 billion overweight and obese people in the world, and Brazil is in fifth place in the world ranking. In this context, a factor associated with eating disorders is anxiety, which affects 33.7% of the general population. In this sense, cannabidiol (CBD) was identified 50 years ago and has effects that can change mood, sensation, perception, tension, appetite, and pain. Also, CBD showed anxiolytic, antipsychotic, neuroprotective, anti-inflammatory, and antiemetic properties. Objective: It was to analyze, through a systematic review, the main considerations and results in animal and human models of the use of cannabidiol in anxiety and obesity. Methods: The model followed for the systematic review was PRISMA. The search strategy was performed in PubMed, Embase, Ovid and Cochrane Library, Web Of Science, Science Direct Journals (Elsevier), Scopus (Elsevier), and OneFile (Gale) databases. Results: In the context of anxiety and binge eating and the consequent increase in the incidence of obese people, the activation of CB1 receptors improves feeding, modulating the activity of hypothalamic neurons and, subsequently, the release of orexigenic and anorexigenic neuropeptides. Thus, in obesity, the endocannabinoid system (ECS) is generally down- regulated in central and peripheral tissues, as indicated by high and/or overexpression of the CB1 receptor. Therefore, CBD is beneficial for anxiety-related disorders. Thus, CBD has been shown to have anxiolytic, antipsychotic, and neuroprotective properties. Conclusion: Growing evidence indicates that CBD acts as an antipsychotic and anxiolytic, and several reports suggest neuroprotective effects. Furthermore, CBD attenuates the harmful effects of trans-Δ9tetrahydrocannabinol, both acutely and chronically, including psychotogenic, anxiogenic, and deleterious cognitive effects. This suggests that CBD may improve the disease trajectory of individuals with early psychosis and cannabis misuse in particular.

Comparison of complications and degree of correction between the extensile lateral and sinus tarsi approaches in the treatment of calcaneus fractures: a cross-sectional observational retrospective study

Vanessa Cavazana Takata — 2024-09-14

Introduction: Calcaneus fractures are a challenge for traumatologists. Their complex anatomy, relative scarcity of surrounding soft tissue, and long learning curve for surgical treatment partly explain the difficulties encountered by surgeons, in addition to contributing to the high rate of complications. Objective: This study aimed to identify the differences in complication rates and degree of correction between extensile lateral access (ELA) and sinus tarsi (STA) approaches by reviewing medical records between 2018 and 2023 of patients who underwent open reduction and internal fixation of calcaneus fractures at a hospital in the interior of São Paulo. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 77 patients were included (52 ELA and 25 STA). It was concluded that no statistical differences were observed after intergroup comparisons (ELA vs. STA). There was also no statistically significant influence of the predictor “age” on the predictors of the responses “Böhler and Gissane angles in degrees” in the final post-procedure phase. In general, STA presented a lower probability of complications with the use of the sinus tarsi route, reaching the same level of joint reduction and control of progression to osteoarthritis. All these results of the present study almost completely confirm the literary findings that appear under discussion.

Major considerations of food insecurity in the family and community medicine scenario: a systematic review

José Joaquim Portilla Ramos — 2024-09-03

Introduction: In the scenario of food insecurity (FI), food is a fundamental human right, and it is up to the State to ensure the permanence of public food policies. AI has worsened in Brazil, and hunger is even more present in the lives of Brazilians in 2022. According to data from the new National Survey on Food Insecurity in the Context of the COVID-19 Pandemic in Brazil, only 4 out of 10 families have full access to food in the country, and hunger already affects 33.1 million people. Objective: It was to highlight the major considerations of food insecurity in the family and community medicine scenario during the COVID-19 pandemic through a systematic literature review. Methods: The present study followed a concise systematic review model, following the systematic review rules (PRISMA). The literary search process was carried out from May to June 2024 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The low quality of evidence was attributed to case reports, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: It was founded 119 studies that were submitted to the eligibility analysis, then, 12 of the 27 total studies were selected for this systematic review. It was concluded that the implementation of actions for income generation and the promotion of adequate and healthy food are imperative, as well as the return of regulatory actions in the face of food inflation, with emphasis on the constitution of food stocks and the stimulus to production from diversified family-based agriculture. Public health-based policies and strategies are needed to identify the most vulnerable subgroups, strengthen and improve access to food assistance programs, and promote awareness of and access to healthy foods and beverages to improve food security, nutrition, and cardiovascular health. Still, food insecurity is associated with depression, diabetes, poor adherence to medication, and worse glycemic control.

The importance of red aesthetics in dental implants: a systematic review

Guilherme José Nóbrega Neri da Silva — 2024-08-29

Introduction: Aesthetics region should be defined as any area to be restored visible in the patient's smile. The charge or immediate function is a prerequisite for the present implant's primary stability in your installation. Thus, to maintain the gingival architecture, understanding biological principles governing is essential to remodeling, as well as alveolar bone soft tissue. The gingival tissues' health, color, and texture are critical to the long-term success and the aesthetic value of treatment. Objective: It was to review the literature and discuss the major factors supporting the red aesthetic excellence before and after the rehabilitation of former regions, and the use of dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion:128 articles were found, 44 articles were evaluated in full and 32 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=81.5%>50%. It was concluded RED aesthetics has become a primary factor in the patient's expectations, and the duty of the surgeon's professional knowledge of the fundamental aspects in achieving this aspect. A correct treatment plan to meet the restorative and surgical protocols appropriate, thus being able to achieve satisfactory results is required.

Major root endodontic treatments: a systematic review

Larissa Mylena Fernandes dos Santos — 2024-08-29

Introduction: In the root canal treatment scenario, irrigation is one of the most important aspects of the biomechanical preparation of the root canal. A condition for successful endodontic retreatment is adequate cleaning of the root canals, therefore, special attention should be paid to the technique used to remove the filling material, the most commonly used being cement, pastes, and gutta-percha cones. Objective: This study aimed to present the main root endodontic treatments to analyze and compare the techniques for removing pulp tissue debris resulting from root preparation and microorganisms from the canals of the root canal system, seeking complete cleaning and asepsis. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 129 articles were found, 39 were evaluated and 21 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 25 studies with a high risk of bias and 27 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =91.5% >50%. It was concluded that the system of root canal instrumentation with rotary files maintains the quality of root preparation and, at the same time, reduces the number of files required to obtain a canal, which would consequently reduce the operative time and also considerably reduce the risk of torsion fracture within the root canal than with files. Irrigation plays a fundamental role in the success of endodontic treatment. Although hypochlorite is the most important irrigant solution, no irrigant can perform all the tasks required by irrigation. A detailed understanding of the mode of action of various solutions is important for optimal irrigation. Within the limitations of this study, the use of the self-adjusting file with the combination of EDTA and NaOCl improved Ca(OH)₂ removal. Passive ultrasonic irrigation and the self-adjusting file were more effective in removing Ca(OH)₂ from the lateral sulci in the apical parts of the root canal than the EndoVac and conventional syringe irrigation systems.

Relationship between the caries-cardiovascular disease axis and immunological aspects: a systematic review

Maria Julia Galban — 2024-08-29

Introduction: According to the World Dental Federation, the hypothesis is that more than 90.0% of the world's population will have any oral disease in their lifetime. In addition, only 60.0% of the population has access to oral hygiene. In childhood and adolescence, caries and periodontal diseases are the most common diseases in the world, and in Brazil, caries is the main oral health problem. Many recent studies have focused on the association between dental caries and systemic diseases such as cardiovascular disease. Objective: It was to systematically analyze the world literature to list the main considerations regarding the relationship between the axis of caries and cardiovascular diseases, highlighting the immunological aspects. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 148 articles were found, 40 studies were evaluated, and 25 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 22 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =92.7% >50%. It was concluded that there is an important network and cascade of defense events between immunological processes and caries disease. Thus, it is necessary to have a healthy immune response to reduce the incidence of cavities. Dental caries was independently associated with the risk of ischemic stroke and death, with the effect being greatest in African-American participants. Regular dental care was associated with a lower chance of cavities, highlighting its relevance in preventing these events. Higher scores of decayed, missing, and filled teeth correlated positively with increased prevalence of cardiovascular disease. Among patients with type 2 diabetes, dental disease, and oral hygiene care are important determinants of the development of heart failure.

Main findings from the use of ozone therapy alone or combined with conventional treatments in root canal treatment: a systematic review

Camila Oliveira Araujo — 2024-08-28

Introduction: The positive effects of ozone on biological properties include antimicrobial, immunostimulating, and biosynthetic impacts used in the treatment and maintenance of good oral hygiene. Ozone results in alteration in the metabolism of cells by raising the partial pressure of oxygen in tissues which improves the transporting capacity of oxygen in the blood. Ozone causes more blood supply to the ischemic zones due to surgical interventions like tooth extractions and implant placement. In this context of decontamination of root and periapical canals, ozone has emerged as an important sanitizer. Objective: It was to develop a systematic review of the literature to list the main findings of the use of ozone therapy alone or combined with conventional treatments in the treatment of root canals. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, 35 articles were evaluated in full and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=88.5%<50%. Results and Conclusion: It is concluded that ultrasonic and sonic ozone activation resulted in less pain in patients undergoing single-session endodontics compared to no ozone treatment. Ozonated olive oil with zinc oxide and olive oil paste with zinc oxide demonstrated good clinical and radiographic success for pulpectomy of primary teeth. Furthermore, low-intensity laser and ozone therapy are useful methods for postoperative pain in vital symptomatic teeth, but they are not superior to each other.

Major clinical outcomes of rapid maxillary expansion in bucomaxillofacial surgery: a systematic review

Luis Carhuaz Villarreal — 2024-08-28

Introduction: The techniques of surgically assisted rapid maxillary expansion (SARME) and non-surgically assisted rapid maxillary expansion (NSARME) are used to correct maxillary development through palatal disjunction. Objective: It was analyzed using a systematic review of the literature on the main considerations of the rapid expansion of the maxilla, evidencing its main indications, contraindications, types of expanders, as well as the main dental and skeletal alterations by them produced. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 110 articles were found, 34 articles were evaluated in full and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=73.8%>50%. It was concluded there is still no consensus on which is the best jaw-breaker, and it is necessary to increase the number of clinical and randomized studies, with eligibility criteria that can homogenize the participants. In addition, the literature has clearly shown that bucomaxillofacial surgeons must have the knowledge and clinical experience to be able to indicate the best procedure for each patient, that is, the rapid expansion of the non-surgical or surgical maxilla.

Major approaches and clinical evidence of oral and maxillofacial regenerative treatments for the process of osteonecrosis associated with the use of bisphosphonates: a systematic review

José Daniel Núñez Mora — 2024-08-28

Introduction: Bone tissue is a specialized connective tissue made up of cells and a mineralized extracellular matrix. To reduce the excessive resorption observed in these pathologies, more rigorous studies have been carried out in pre-clinical and clinical studies to improve antiresorptive medications that allow the treatment or prevention of bone metabolism pathologies. Thus, anti-resorptive agents, such as Bisphosphonates (BFs) and Denosumab (DN), as well as some angiogenesis inhibitors, can induce osteonecrosis of the jaw. Objective: It was to develop a systematic review to specify the main approaches and clinical evidence on the process of osteonecrosis associated with the use of bisphosphonates, as well as the main oral and maxillofacial regenerative treatments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 36 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=77.7%>50%. It was concluded that patients undergoing treatment with BFs should be informed about the potential risk of BRONJ. Furthermore, it would be advisable for providers responsible for BF therapy to refer patients for dental check-ups before starting treatment, allowing for patient monitoring by a multidisciplinary team. Although the morbidity rate of this pathology is not high, prevention should be mandatory, thus avoiding mutilating and painful processes. However, if a surgical procedure is necessary, the use of new adjuvant therapies such as hyperbaric camera, teriparatide, pentoxifylline, and alpha-tocopherol can be proposed.

Major aspects of the use of bisphosphonates and the formation of osteonecrosis in the involvement of dental implants: a systematic review

Ariane Fontoura Custódio — 2024-08-28

Introduction: Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. Dental patients receiving bisphosphonate treatment are at higher risk of bisphosphonate-related osteonecrosis of the jaws (BRONJ), necessitating dentists' awareness of these risks. Objective: It was to highlight the main aspects of the use of bisphosphonates and the formation of osteonecrosis in the involvement of dental implants, as well as possible treatments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found, 40 articles were evaluated in full and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=89.5%>50%. Therefore, the present study suggests that patients undergoing treatment with BFs should be informed about the potential risk of BRONJ. Furthermore, it would be advisable for providers responsible for BF therapy to refer patients for dental check-ups before starting treatment, allowing for patient monitoring by a multidisciplinary team. Although the morbidity rate of this pathology is not high, prevention should be mandatory, thus avoiding mutilating and painful processes. However, if surgery is necessary, the use of these new adjuvant therapies, such as lowlevel laser therapy and magnetotherapy, can be proposed in the treatment of BRONJ. It is essential to increase our caseload and also involve other institutions in the use of these new effective and safe therapies in BRONJ.

Main clinical approaches to the use of silane in restoration repairs with resin: a systematic review

Lailla Aparecida Gonzaga — 2024-08-28

Introduction: The repair in the composite clinical procedure is handy and allows the removal of the damaged portion of the restoration without requiring complete replacement of the same, allowing the preservation of sound tooth structure. Objective: The objective of this study was to review the literature evaluating the use of silane in repairs of composite resin restorations and the procedures to be followed. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, 43 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 07 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=74.5%>50%. In the literature review was noted that the preference for maintaining part of the restoration and repair of the clinical protocol should be thoroughly evaluated and implemented to increase the predictability of the procedure. The restorative material should unite, not only to tooth structure but also already present in the resin preparation. Thus, silanes and resins without charge are traditionally used as coupling agents in repairs. The advantages of this procedure compared with total replacement, and the possibility of obtaining a good integrity and longevity of the restoration involved were discussed. It was concluded that the adhesion between the existing and the new resin increment of resin can be enhanced by employing a silane, associated or not with an adhesive system.

Risk factors for anti-infliximab antibody formation among patients with inflammatory bowel disease

Qusay Abdoh — 2024-07-31

Introduction: Infliximab (IFX) is an effective therapy for inflammatory bowel disease (IBD), but it may be associated with a high rate of primary and secondary failure. Approximately 30% of patients lose their response. One loss of response to anti-drug antibody (ADA) development is the most common cause of this loss. Objective: This study aims to demonstrate the incidence of antibody formation against infliximab when used to treat inflammatory bowel disease (IBD) and risk factors that may be associated with its formation, to find if there are correlations between antibody formation and patient characteristics, other co-medication, infliximab level, doses, duration, etc., and the subsequent correlation of antibody formation to Primary nonresponse, Secondary failure, Maintained response, and finally, to assess the overall clinical impact on the patients. Methods: A retrospective study included 61 participants who were treated with Infliximab (IFX) for inflammatory bowel disease and received follow-up at... Patients were recruited, and relevant demographic, clinical, and laboratory data were recorded from patients’ files, themselves, or the patient's family. as the antibody level was drawn for all patients, and therefore those with positive antibodies who met our criteria entered the exposure group, while the negative patients were in the non-exposure group. Results: There were 61 patients with IBD under infliximab therapy; 82% had Crohn's disease, and the rest had ulcerative colitis. Patient factors significantly associated with lower maintenance infliximab doses include age, smoking, aminosalicylates, and secondary non-response. Those of younger ages were more likely to develop infliximab-anti-drug antibodies (IFX-ADA) (OR, 95% CI; 1.12,1.007-1.25), and those who needed the use of amino-salicylates showed more tendency to develop IFX-ADA (OR, 95% CI; 0.03,0.01-0.74), AS 11.8% of participants with negative antibodies had used amino-salicylates compared to the other group, in which 3.7% of them used this. Higher doses (342.3 ± 94.54 mg) helped to obtain a better outcome by reducing the prevalence of ADA formation. Conclusion: IFX-ADA is significantly influenced by maintenance infliximab dose, age, smoking, aminosalicylates, and secondary non-response. There should be a decreasing IFX dose interval strategy. Aminosalicylates may help reduce the formation of IFX-ADA. Key messages of your article: Infliximab (IFX) is an effective therapy for inflammatory bowel disease (IBD), but it may be associated with a high rate of primary and secondary failure. This study aims to demonstrate the incidence of antibody formation against infliximab when used to treat inflammatory bowel disease (IBD) and the risk factors that may be associated with its formation to assess the overall clinical impact on patients. There should be a decreasing IFX dose interval strategy and Higher starting doses that may improve outcomes for IFX-treated patients with Crohn's disease and ulcerative colitis. Aminosalicylates may help reduce the formation of IFX-ADA.

Association of anxiety and depression with breast implant illness syndrome (BII): a prospective observational cross-sectional study

Maria Eduarda Guelfi Pinto — 2024-07-12

Introduction: Breast Implant Illness syndrome (BII), popularly known as “silicone disease”, has no defined pathophysiology or recognition by the WHO. It consists of systemic symptoms such as joint pain, muscle pain, confusion, memory loss/cognitive problems, chronic fatigue, and immune diseases. In some more recent studies, anxiety and depression have been observed as an incident characteristic of the syndrome. Objective: It was to relate the appearance of anxiety and depression pathologies with the development of Breast Implant Illness syndrome in women with breast implants. Methods: To prepare the following prospective observational cross-sectional study, 132 women who had breast implants were interviewed and answered an online questionnaire with 18 questions about the breast implant that was disseminated through social networks. To obtain the data, questions about pre-operative and post-operative signs and symptoms were crossed, this data was subsequently struck and finally, another cross was carried out with the other unknown, symptoms were diagnosed by doctors. Results: The validation analysis of the questionnaire proposed in this study using Cronbach's alpha (α) statistical technique showed that the reliability rating was high, with alpha (α)=0.82. It was noted that 31% of women who did not have any characteristic signs and symptoms presented after placement and of these 22 women were diagnosed by doctors. And at the other intersection, it was clear that 25% presented depression after the placement of the breast implant and 23 of these women were diagnosed by doctors. Conclusion: It can be stated that anxiety and depression are pathologies associated with Breast Implant Illness syndrome.