Limited Quality Data Research Articles

NMDA antagonist agents for the treatment of symptoms in autism spectrum disorder: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess the efficacy of NMDA antagonists in ASD (Autism Spectrum Disorder) on the core (communication and social interaction, repetitive behavior) and associated symptoms (irritability) of ASD, as well as their safety. PubMed, CENTRAL, CINHAL, EMBASE, and PsycINFO databases were searched until November 2023. Two authors independently selected the studies and extracted data. Randomized controlled trials assessing the efficacy of NMDA receptor antagonists in participants with ASD aged <18years were included. The quality of the studies was assessed using the Risk of Bias-2 tool. A random-effect meta-analysis model was used to calculate standardized mean differences (SMD) or odds ratios (OR) using meta package in R. This systematic review included ten studies (588 participants). Most studies did not report scales assessing core symptoms of ASD. Meta-analysis of efficacy on ASD core symptoms included three studies (248 participants). NMDA antagonists were not superior to placebo [SMD = 0.29; CI 95% (-1,94; 1.35); I2 = 0%]. NMDA antagonists was not superior to placebo concerning response (four studies, 189 participants) [OR = 2.4; CI 95% (0.69; 8.38); I2 = 35%]. Meta-analysis of efficacy on irritability included three studies (186 participants); NMDA antagonists were not superior to placebo [MD irritability = -1.94; CI 95% (-4.66; 0.77); I2 = 0%]. Compared with placebo, significantly more participants in the NMDA antagonist group reported at least one adverse event (five studies, 310 participants) [OR = 2.04; CI 95% (1.17; 3.57); I2 = 0%]. Current evidence does not support the effectiveness of NMDA antagonists in the treatment of ASD symptoms or irritability. Further research is needed due to the limited and low quality data available. PROSPERO CRD42018110399.

Long-term outcomes of COVID-19 infection in children and young people: a systematic review and meta-analysis

Background Children and young people (CYP) may experience prolonged symptoms following COVID-19, commonly termed ‘Long-COVID’. The characteristics of Long-COVID in CYP are unclear, as are the sequalae of acute COVID-19. We aimed to systematically synthesise evidence of the long-term outcomes of COVID-19 in CYP. Methods 13 electronic databases were searched until January 2022. Inclusion criteria: observational studies reporting outcomes occurring four-weeks or more after COVID-19 in children &lt;18 years old. Exclusion criteria: outcomes of Paediatric Inflammatory Multisystem Syndrome. Title, abstract and full text screening were conducted independently by two reviewers. Data extraction and risk of bias assessment was by one reviewer with independent verification. Critical appraisal tools appropriate for study type were employed. Results were narratively synthesised with meta-analysis to generate summary estimates of risk of prolonged symptoms in CYP. Results 94 studies were included in this systematic review. Of these, 66 studies recruited from hospital settings and 8 studies recruited solely from community settings. Over 100 symptoms were reported, the most common being fatigue, headache and cognitive symptoms. Summary estimates of prevalence of prolonged symptoms were higher for hospital samples (31.2%, 95% CI 20.3% to 43.2%) than for community samples (4.6%, 95% CI 3.4% to 5.8). Reported sequalae of COVID-19 in CYP included stroke, type-1 diabetes, Guillan-Barre syndrome, and persistent radiological or blood test abnormalities. Most studies reporting these sequalae were case reports / case series and the quality of evidence in these studies was low. Conclusions Prolonged symptoms following COVID-19 in children are variable and multi-systemic. Rates of prolonged symptoms in community samples are lower than hospital samples. There is currently limited good quality data on other sequalae in CYP. Heterogeneity in methods of diagnosis of COVID-19, symptom classification, assessment method and duration of follow-up made synthesis less secure.

Delineation of Potential Groundwater Zones and Assessment of Their Vulnerability to Pollution from Cemeteries Using GIS and AHP Approaches Based on the DRASTIC Index and Specific DRASTIC

The risk of aquifer contamination is determined by the interaction between the pollutant load and the vulnerability of an aquifer. Owing to the decomposition of bodies and degradation of artefacts, cemeteries may have a negative impact on groundwater quality and suitability for use due to the leaching of organic compounds (e.g., biodegradable organics, pharmaceuticals, and formaldehyde), inorganic compounds (e.g., nitrate and heavy metals), pathogenic bacteria, and viruses. Factors such as burial and soil type, rainfall amount, and groundwater depth may increase aquifer vulnerability to pollutants generated in cemeteries. The potential for groundwater contamination was investigated in two cemeteries of the Soure region in Portugal (Samuel–UC9 and Vinha da Rainha–UC10), using the classic DRASTIC model, followed by some adjustments, depending on the particularities of the locations, resulting in a Final Classification considered as Specific DRASTIC. By combining Remote Sensing (RS), Geographic Information System (GIS), and Analytical Hierarchy Process (AHP), groundwater potential zones (GWPZs) were identified, and aquifer vulnerability was assessed, which included the elaboration of thematic maps using GIS operation tools. The maps allowed for the identification of areas with different susceptibilities to contamination: from “Low” to “Very high” for the DRASTIC index and from “Very Low” to “Very high” for the Specific DRASTIC index. Although the difference between the UC9 and UC10 cemeteries is negligible, UC10 is more vulnerable because of its proximity to the community and critically important mineral water resources (such as Bicanho Medical Spa). The Specific model seems better-suited for describing vulnerability to cemeteries. Although there is limited groundwater quality data for the area, the development of vulnerability maps can identify areas that can be sensitive spots for groundwater contamination and establish procedures for pollution prevention.

PM2.5 Concentration Prediction Based on LightGBM Optimized by Adaptive Multi-Strategy Enhanced Sparrow Search Algorithm

The atmospheric environment is of great importance to human health. However, its influencing factors are complex and variable. An efficient technique is required to more precisely estimate PM2.5 concentration values. In this paper, an enhanced Sparrow Search Algorithm (LASSA)-optimized Light Gradient Boosting Machine (LightGBM) is proposed for PM2.5 concentration prediction. This approach can provide accurate predictions while also reducing potential losses resulting from unexpected events. LightGBM is regarded as an outstanding machine learning approach; however, it includes hyperparameters that must be optimally mixed in order to achieve the desired results. We update the Sparrow Search Algorithm (SSA) and utilize it to identify the optimal combination of the most crucial parameters, using cross-validation to increase the reliability. Using limited air quality data and meteorological data as inputs, PM2.5 concentration values were predicted. The LASSA-LGB’s output was compared to normal LGB, SSA-LGB and ISSA-LGB. The findings demonstrate that LASSA-LGB outperforms the other models in terms of prediction accuracy. The RMSE and MAPE error indices were lowered from 3% to 16%. The concordance correlation coefficient is not less than 0.91, and the R2 reached 0.96. This indicates that the proposed model has potential advantages in the field of PM2.5 concentration prediction.

Revealing Long-Term Indoor Air Quality Prediction: An Intelligent Informer-Based Approach.

Indoor air pollution is an urgent issue, posing a significant threat to the health of indoor workers and residents. Individuals engaged in indoor occupations typically spend an average of around 21 h per day in enclosed spaces, while residents spend approximately 13 h indoors on average. Accurately predicting indoor air quality is crucial for the well-being of indoor workers and frequent home dwellers. Despite the development of numerous methods for indoor air quality prediction, the task remains challenging, especially under constraints of limited air quality data collection points. To address this issue, we propose a neural network capable of capturing time dependencies and correlations among data indicators, which integrates the informer model with a data-correlation feature extractor based on MLP. In the experiments of this study, we employ the Informer model to predict indoor air quality in an industrial park in Changsha, Hunan Province, China. The model utilizes indoor and outdoor temperature, humidity, and outdoor particulate matter (PM) values to forecast future indoor particle levels. Experimental results demonstrate the superiority of the Informer model over other methods for both long-term and short-term indoor air quality predictions. The model we propose holds significant implications for safeguarding personal health and well-being, as well as advancing indoor air quality management practices.

Assessment of Use and Impact of Chemotherapy in Lymph Node-Negative, T1a Triple-Negative Breast Cancer

BackgroundCurrent treatment guidelines suggest considering adjuvant chemotherapy in high-risk patients with T1a, node-negative triple-negative breast cancer (TNBC); however, limited quality data support this statement. Our population-based study assessed the efficacy of adjuvant chemotherapy and factors associated with its administration in node-negative, T1a TNBC. Materials and MethodsWe obtained data from the Surveillance, Epidemiology, and End Results database for patients with T1aN0 TNBC diagnosed between 2010 and 2019. We utilized the Kaplan-Meier method and Cox regression model to analyze the overall survival (OS) and breast cancer-specific survival (BCSS) in chemotherapy benefit. We performed stratified models to identify differences in OS and BCSS between those who received chemotherapy and those who did not across subgroups. Competing risk analysis was conducted to assess differences in risk of breast cancer death in patients with chemotherapy administration versus no chemotherapy. Additionally, propensity score matching was executed to assess survival analysis in a matched cohort. ResultsWe included 1739 patients with T1a TNBC. Patients who received chemotherapy were younger, had higher histological grade and ductal histology subtype, were more likely to be married and undergo mastectomy. Our study did not show improvement in OS (HR, 0.63; 95% CI, 0.35-1.13; P = .122) or BCSS (HR, 0.95; 95% CI, 0.37-2.43; P = .908) after chemotherapy use. We did not identify any subgroup of patients that may benefit from chemotherapy. Without chemotherapy, 8-year risk of breast cancer death is 2.75% for these patients. ConclusionAdjuvant chemotherapy is not associated with benefit on OS or BCSS in node-negative, T1a TNBC.

Backcasting COVID-19: a physics-informed estimate for early case incidence.

It is widely accepted that the number of reported cases during the first stages of the COVID-19 pandemic severely underestimates the number of actual cases. We leverage delay embedding theorems of Whitney and Takens and use Gaussian process regression to estimate the number of cases during the first 2020 wave based on the second wave of the epidemic in several European countries, South Korea and Brazil. We assume that the second wave was more accurately monitored, even though we acknowledge that behavioural changes occurred during the pandemic and region- (or country-) specific monitoring protocols evolved. We then construct a manifold diffeomorphic to that of the implied original dynamical system, using fatalities or hospitalizations only. Finally, we restrict the diffeomorphism to the reported cases coordinate of the dynamical system. Our main finding is that in the European countries studied, the actual cases are under-reported by as much as 50%. On the other hand, in South Korea-which had a proactive mitigation approach-a far smaller discrepancy between the actual and reported cases is predicted, with an approximately 18% predicted underestimation. We believe that our backcasting framework is applicable to other epidemic outbreaks where (due to limited or poor quality data) there is uncertainty around the actual cases.

Cannabis Use in Patients Seen in an Academic Radiation Oncology Department

Cannabis use rates are increasing throughout the United States along with shifts in state-level policy. Patients with cancer use cannabis for a broad range of indications, but there is limited quality data to support many of these uses. To date, few studies have sought to understand cannabis use in populations of patients served by radiation oncology departments.Standardized electronic medical record prompts were used by clinicians for cannabis history documentation for 1050 adult patients seen for initial consultation or follow-up between 10/2020 and 2/2021 at an academic radiation oncology department. Cannabis use data, including recency/frequency of use, indication, and mode of administration, were later gathered using the Michigan Radiation Oncology Analytics Resource (M-ROAR) under an IRB-approved protocol. Cannabis use characteristics were summarized, and logistic regression was used to explore associations between age and gender and recent cannabis use.In total, 54 (5.1%) of 1050 unique patients declined to answer questions about cannabis use. Of the remaining 996 patients, 106 (10.6%) endorsed recent cannabis use (≤1 month ago), 71 (7.1%) noted remote use (> 1 month ago), and 819 (82.2%) denied history of cannabis use. The median age of those with recent cannabis use was 59.5 (IQR: 49.7-66.4) vs. 65.4 (IQR: 57.1-73.5) in all others. A multivariable logistic regression analysis revealed an association between age (OR 0.96; 95% CI: 0.95-0.97; P < 0.001) but not gender (male OR 1.24; 95% CI: 0.82-1.88; P = 0.310) and recent cannabis use. Patients noted pain (46.2%), anxiety (23.6%), insomnia (17.9%), "for the high" (17.0%), nausea (15.1%), poor appetite (14.2%), "to fight cancer" (4.7%), and depression (1.9%) as indications for use. The most common mode of administration was inhalation via smoking (47.2%), followed by oral (edibles, 36.8%), topical (15.1%), oral (drinks, 4.7%), vaping (3.8%), sublingual (1.0%), and rectal (1.0%). Most patients used cannabis daily (58.5%). Only 4 individuals (3.8%) noted use multiple times daily, while the remainder endorsed weekly (20.8%) or less than weekly (17.0%) use.Approximately 10% of patients seen in a radiation oncology department reported recent cannabis use for a variety of reasons. These findings suggest a need for: 1) collection of cannabis use history in radiation oncology departments, 2) efforts to destigmatize cannabis use to facilitate frank discussions between patients and providers, 3) patient education about the fact that cannabis is not an evidence-based cancer treatment, 4) recommendation against inhaled forms of cannabis, which may carry risk of pulmonary toxicity, and 5) careful application of proven therapies to address symptoms when appropriate to provide alternatives to cannabis. Further research is needed to assess changes in cannabis use patterns over the course of cancer treatment and to evaluate risks and benefits of cannabis use in patients with cancer.

Global Health and Surgical Infection: From Neglect to Emerging Frontier.

Background: In past decades, surgical site infections (SSIs) were neglected and not given much global attention in low- and middle-income countries (LMICs). The risk and incidence of SSIs in LMICs continue to increase. Methods: We reviewed the limited quality data on SSIs and complicated intra-abdominal infections in these settings that have hampered advocacy and infection prevention and control efforts. Results: This review identifies the rising profile of global surgery that has resulted in efforts to scale up access to surgical care as well as increase surgical volumes to address unmet needs. The fallout of these efforts would be increasing SSI rates and a rising volume of laparotomies for intra-abdominal infections. Conclusion: Surgical infections are an emerging frontier in global health and surgery. There is an urgent need for global advocacy and investments in their prevention and control.

Immunogenicity and safety of 4 vs. 3 standard doses of HBV vaccination in HIV-infected adults with isolated anti-HBc antibody

BackgroundPresence of isolated anti-HBc antibody is common in HIV-infected patients in endemic areas and could be caused by prior HBV infection with loss of anti-HBs antibody. The role of vaccination in these patients remains controversial and is based largely on limited and low quality data. We, therefore, conducted this study to determine immunogenicity and safety of 4 vs. 3 standard doses of HBV vaccination in HIV-infected adults with isolated anti-HBc antibody.MethodsAn open-label, randomized controlled trial was conducted among HIV-infected patients visiting HIV clinic of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand between July and September 2017. Inclusion criteria included ≥ 18 years of age, currently on a stable antiretroviral regimen, CD4+ cell count ≥ 200 cells/mm3, plasma HIV-1 RNA < 20 copies/mL, and isolated anti-HBc antibody. The participants were randomized to receive either 3 standard doses (20 µg at month 0, 1, 6) or 4 standard-doses (20 µg at month 0, 1, 2, 6) of IM HBV vaccination, and were evaluated for anamnestic response at week 4 and vaccine response at week 28.ResultsOf the 97 patients screened, 54 (32 male, mean age of 46 years) were enrolled and 27 were allocated to each of the vaccination groups. Anamnestic response occurred in 25.9% vs. 33.3% in 3-dose group vs. 4-dose group, respectively (p = 0.551). The vaccine response rates at week 28 were 85.2% in 3-dose group vs. 88.9% in 4-dose group (p = 1.000); geometric mean titer of anti-HBs antibody at week 28 was 63.8 and 209.8 mIU/mL in 3-dose group and 4-dose group, respectively (p = 0.030). No adverse events were reported.ConclusionsAn anamnestic response occurred in one-third of Thai HIV-infected patients with isolated anti-HBc antibody who received one dose of HBV vaccination; however, the majority were still unprotected. The use of either 3 or 4 standard-doses of vaccination was highly effective and should be recommended in all HIV-infected individuals with isolated anti-HBc antibody.Trial registration ClinicalTrials.gov; NCT03212911. Registered 11 July 2019, https://clinicaltrials.gov/ct2/show/NCT03212911

WITHDRAWN: Interventions for treating obesity in children.

Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood. We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied. We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded. Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information. We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs. While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

Systematic review of quality of life following pleurectomy decortication and extrapleural pneumonectomy for malignant pleural mesothelioma

BackgroundFew studies have focused on quality of life (QoL) after treatment of malignant pleural mesothelioma (MPM). There are still questions as to which surgical procedure, extrapleural pneumonectomy (EPP) or pleurectomy decortication (P/D) is most effective and results in better survival outcomes, involves fewer complications, and results in better QoL. Here we performed a literature review on MPM patients to assess and compare QoL changes after P/D and EPP.MethodsResearch articles concerning QoL after mesothelioma surgery were identified through May 2018 in Medline. For inclusion, studies were 1) cohort or randomized controlled trials (RCT) design, 2) included standardized QoL instruments, 3) reported QoL measurement after surgery, 4) described the type of surgery performed (EPP or P/D), 5) were written in English. Measures of lung function (FEV1, FVC) and measures from the EORTC-C30 were compared 6 months following surgery with preoperative values.ResultsQoL data was extracted from 17 articles (14 datasets), encompassing 659 patients (102 EPP, 432 P/D); the available evidence was of low quality. While two studies directly compared QoL between the two surgical procedures, additional data was available from one arm of two RCTs, as the RCTs were not comparing EPP and P/D. The remaining data was reported from observational studies. While QoL was still compromised 6 months following surgery, from the limited and low quality data available it would appear that P/D patients had better QoL than EPP patients across all measures. Physical function, social function and global health were better at follow-up for P/D than for EPP, while other indicators such as pain and cough were similar. Forced Expiratory Volume (FEV1) and Forced Vital Capacity (FVC) were reported in one study only, and were higher at follow-up for P/D compared to EPP.ConclusionsAlthough the existing evidence is limited and of low quality, it suggests that P/D patients have better QoL than EPP patients following surgery. QoL outcomes should be factored into the choice of surgical procedure for MPM patients, and the possible effects on lung function and QoL should be discussed with patients when presenting surgical treatment options.

Maintenance interventions for overweight or obesity in children: a systematic review and meta-analysis.

Childhood obesity is associated with significant health consequences. Although several intervention programmes for children result in weight loss or stabilization in the short-term, preventing relapse after treatment remains an important challenge. This systematic review summarizes the evidence about maintenance interventions after treatment in childhood obesity. Studies were identified by searching PubMed, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, CINAHL and SocINDEX. The primary outcome measure for this review was body mass index standard deviation score (BMI-Z-score). Data were pooled using quality effect models. Eleven studies (1,532 participants, age 2-18years) were included, covering a wide range of maintenance approaches. Included studies varied widely in methodological quality. Pooled analysis showed that the BMI-Z-score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for 'face-to-face' versus 'on distance' interventions was shown. In summary, this review shows that, although there is limited quality data to recommend one maintenance intervention over another, continued treatment does have a stabilizing effect on BMI-Z-score. Considering the magnitude of the problem of childhood obesity, this is an important finding that highlights the need for further research on weight loss maintenance.

Designing Kenya's 'first generation' revenue allocation among counties formula with imperfect data: an application of response surface methodology

This paper investigates the design of Kenya's 'first generation' formula for sharing of revenue among 47 counties in the face of imperfect data and highly politicised issue of historical injustices in the past fiscal dispensation of a centralised system of government. We show that with limited quality data at subnational level, an innovative loss function in a response surface methodology offers an appropriate platform to generate initial weights of fiscal need factors that not only ensure redistributive justice and equity but are also perceived to be objective and fair by different political interest groups.

Designing Kenya's 'first generation' revenue allocation among counties formula with imperfect data: an application of response surface methodology

This paper investigates the design of Kenya's 'first generation' formula for sharing of revenue among 47 counties in the face of imperfect data and highly politicised issue of historical injustices in the past fiscal dispensation of a centralised system of government. We show that with limited quality data at subnational level, an innovative loss function in a response surface methodology offers an appropriate platform to generate initial weights of fiscal need factors that not only ensure redistributive justice and equity but are also perceived to be objective and fair by different political interest groups.

Poultry and policy in Ghana: Lessons from the periphery of an agricultural policy system

We analyze poultry‐related policy documents from Ghana and ask how the problems identified and the actions proposed have changed over time. The analysis highlights the fact of limited and poor quality data, and associated uncertainty, ambiguity and poor specification of both problems and interventions. It also points to a long‐term commitment to intensive commercial production as the preferred pathway to deliver more animal protein. However, in the face of persistent feed constraints and economic liberalization, imports of frozen chicken have sky‐rocketed since the early 2000s, and a new pathway has come to dominate. We discuss this outcome and what it says more generally about policy around minor crops and livestock species.

The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear

AimFelt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear. MethodsThis study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear. ResultsStatistically significant decreases in peak pressure of 49% and 32% were measured with newly applied felt padding (188.0kPa; p<0.001) and worn felt padding (248kPa; p=0.003) respectively, compared to no padding (367.2kPa). Worn felt offloaded 32% less pressure than new felt however this did not reach statistical significance (p=.069). Corresponding increases in contact area of 18% and 14% occurred with newly applied felt padding (156.9cm2; p<.001) and worn felt padding (150.6cm2; p=0.003) compared to no padding (132.5cm2). Contact time was constant across testing conditions. ConclusionsNew felt padding offloaded on average half the pressure applied to sites of plantar neuropathic ulceration, which reduced to one third after wear. Increased contact area under the foot is a possible mechanism contributing to pressure reduction. Further studies are required to evaluate effectiveness of felt padding directly on ulcer healing.

Corticosteroids as co-analgesics with opioids for cancer pain: a survey of Australian and New Zealand palliative care clinicians.

Corticosteroids are commonly used as co-analgesics with opioids for cancer pain; however limited quality data exist supporting their efficacy for this purpose. Further, little is known about individual prescribing practices. The current study surveyed members of the Australian New Zealand Society of Palliative Medicine about their use of corticosteroids as adjuvant analgesics in cancer pain. It confirmed high rates of utilisation and found variability in starting doses and associated decision-making. Further research is required to determine the efficacy and safety of corticosteroids as co-analgesics in cancer pain management.

Open surgical or endovascular revascularization for acute limb ischemia

Acute limb ischemia (ALI) is one of the most common vascular emergencies, with high risk for limb loss if it is not treated expediently. Endovascular therapy is less invasive and used increasingly because of patient factors that disfavor open surgery despite limited quality data to support its safety and efficacy. This evidence summary reviews literature from 1990 to 2014, comparing contemporary surgical and endovascular revascularization. Systematic review was performed with emphasis on acuity of presentation, study design, revascularization techniques, limb salvage and mortality rates, and complications. There were 2999 articles identified and 563 abstracts reviewed; 68 articles were reviewed fully and 26 critically appraised. Limb salvage, amputation-free survival, overall survival and mortality, and treatment complications were elucidated, including Medicare outcomes data. Risk factors for amputation and mortality were identified. Surgical or endovascular revascularization for ALI is achievable with acceptable limb salvage and amputation rates, which are not markedly different between the two modalities in the short term. Endovascular therapy and surgery are complementary rather than competing strategies for ALI. Further good-quality clinical trial data are needed to define longer term outcomes.

Odontoiatria e disturbi del sonno

ObjectivesThe aim of this study is to describe the aetiopathogenesis, clinical findings and peculiarities of dental and oral diseases associable with sleep disorders and, conversely, to investigate the conditions of sleep impairment which may affect the development of oral diseases. Materials and methodsThe authors reviewed the most updated publications from the international scientific literature concerning the correlation between dentistry and sleep, with a view to summarizing the most useful information for the clinical practice. Results and conclusionsNocturnal bruxism is one of the most frequent sleep disturbances with repercussions on the health of dental tissues. This may result in an obstructive sleep apnea syndrome, which, at slight to mild intensity, can be managed by using mandibular advancement devices. Moreover, recent studies have related oro-facial pain to sleep disorders, although limited and low quality data are available. The dentist plays a primary role in identifying these conditions and in referring the patient to specialists. Last but not least, the clinician should be aware of potential adverse effects on the oral cavity of the most commonly prescribed drugs for insomnia.