Medical Subheadings Research Articles

Spatial navigation metrics differentiating preclinical and prodromal Alzheimer’s disease: a systematic review

AbstractBackgroundIncreasing evidence suggests that impairments of spatial navigation, orientation and memory may represent one of the earliest features Alzheimer’s disease (AD), preceding deficits in other cognitive domains. This is consistent with early pathological tau and amyloid deposition in temporal and parietal brain regions implicated in spatial processing. However, it remains unclear which metrics and spatial behaviours can i) differentiate high‐risk, preclinical or prodromal AD individuals, and ii) may be captured with digital devices suitable for future deployment at scale in clinical practice. We addressed this knowledge gap with a systematic review.MethodTwo databases (PubMed/Web of Science) were searched following PRISMA guidelines. Medical subheading keywords for different dementia types were combined with prodromal, preclinical and genetic or disorder risk factor terms. We included studies published until October 2022 that collected digital or physical objective measures of egocentric or allocentric processing (wayfinding, orientation, reference frame translation, route learning or path integration). We excluded diagnoses of other conditions or dementia, cross‐sectional MCI studies without biomarkers, young adults, case studies, interventional studies or studies without appropriate controls.Result25 articles were included from 316 identified abstracts. None investigated non‐AD dementias. 131 metrics were extracted from 38 different tasks, of which 31 where digital (81%). 82 metrics showed differentiation of predementia AD groups (63%). We harmonised these into 21 distinct summary metrics covering four domains of active or passively tracked spatial behaviours. Across all domains, metrics capturing decreased navigation efficiency (i.e. distance or time required to find goals) and accuracy (i.e. distance or angle from goal) were most frequently reported, but egocentric better differentiated prodromal than preclinical groups. Metrics for path integration and passive tracking of everyday GPS data were promising but relatively under‐explored.ConclusionFor future clinical use, spatial tests will require standardisation and validation against established markers of disease. These review data will inform the selection of digital tools to assess spatial behaviours in at‐risk, preclinical and prodromal AD populations as part of the EDoN Initiative.

Clinical Manifestations.

Increasing evidence suggests that impairments of spatial navigation, orientation and memory may represent one of the earliest features Alzheimer's disease (AD), preceding deficits in other cognitive domains. This is consistent with early pathological tau and amyloid deposition in temporal and parietal brain regions implicated in spatial processing. However, it remains unclear which metrics and spatial behaviours can i) differentiate high-risk, preclinical or prodromal AD individuals, and ii) may be captured with digital devices suitable for future deployment at scale in clinical practice. We addressed this knowledge gap with a systematic review. Two databases (PubMed/Web of Science) were searched following PRISMA guidelines. Medical subheading keywords for different dementia types were combined with prodromal, preclinical and genetic or disorder risk factor terms. We included studies published until October 2022 that collected digital or physical objective measures of egocentric or allocentric processing (wayfinding, orientation, reference frame translation, route learning or path integration). We excluded diagnoses of other conditions or dementia, cross-sectional MCI studies without biomarkers, young adults, case studies, interventional studies or studies without appropriate controls. 25 articles were included from 316 identified abstracts. None investigated non-AD dementias. 131 metrics were extracted from 38 different tasks, of which 31 where digital (81%). 82 metrics showed differentiation of predementia AD groups (63%). We harmonised these into 21 distinct summary metrics covering four domains of active or passively tracked spatial behaviours. Across all domains, metrics capturing decreased navigation efficiency (i.e. distance or time required to find goals) and accuracy (i.e. distance or angle from goal) were most frequently reported, but egocentric better differentiated prodromal than preclinical groups. Metrics for path integration and passive tracking of everyday GPS data were promising but relatively under-explored. For future clinical use, spatial tests will require standardisation and validation against established markers of disease. These review data will inform the selection of digital tools to assess spatial behaviours in at-risk, preclinical and prodromal AD populations as part of the EDoN Initiative.

Direct Effect of Iron Deficiency Independent of Anemia on Adverse Perinatal Outcomes- a Scoping Review

Introduction Iron is required throughout pregnancy by both the pregnant individual and the fetus. Iron stores can be depleted during pregnancy resulting in iron deficiency (ID), which is the most common cause of anemia in pregnancy. Iron deficiency anemia (IDA) is associated with an approximately two-fold increase in adverse perinatal outcomes (APO) such as low birth weight (LBW), preterm delivery, and stillbirth. It is uncertain whether depleted iron store in a non-anemic pregnant individual affects fetal growth and well-being. The effect of ID per se on these outcomes, independent of anemia, is the central focus of this scoping review. If an independent association between iron deficiency without anemia (IDWA) and these APO is established and given the potential for non-anemic iron deficiency to progress to IDA, early screening, and intervention before the development of IDA may be important in preventing these morbidities and mortality. Our objective is to determine the current state of existing knowledge concerning IDWA and APO. The specific aims are to determine the prevalence of IDWA in pregnant individuals, assess predictors and determine types of APO associated with IDWA. Methods We performed a comprehensive systematic scoping review of the independent effect of IDWA on APO. The search for relevant studies involved Ovid Medline, Cochrane Database of Systematic Reviews, Cochrane Control Register of Controlled Trials, and hand search of citations of relevant articles for cohort and cross-sectional studies, randomized controlled trials, systematic reviews, and meta-analyses, scoping and narrative reviews from the inception of the databases. We used all relevant Medical Subject Headings terms and subheadings with no language restrictions. Two reviewers independently screened titles, abstracts, and full text based on the outlined inclusion and exclusion criteria. The inclusion criteria include relevant studies reporting on IDWA in pregnancy and APO. Exclusion criteria include studies not reporting IDWA and APO, and the presence of medical conditions such as hemoglobinopathies, polycythemia, iron overload, autoimmune and inflammatory conditions. Discrepancies were resolved through discussion and consensus. Covidence ® systematic review software was used for screening, automatically eliminating duplicates and data extraction. PRISMA for Scoping Reviews reporting guidelines was used. The selection process and results of included and excluded studies were presented with a PRISMA flow chart. A narrative summary was conducted to descriptively summarize the findings. Results A total of 4389 articles were identified from the searched databases after all duplicates were removed. Two studies conducted between 2005-2008 and 2017-2018 respectively met the inclusion criteria and were eligible for data extraction. A total of 5684 participants made up of 5479 Danish and 205 Spanish cohorts were included. The prevalence of IDWA in Denmark was 14.2% based on serum ferritin of <30μg/L and hemoglobin ≥110g/L and 20% in Spain using thresholds of SF <12μg/L and Hb≥110g/L. The mean (standard deviation, SD) age of participants was 31.8 ± 5.0 years in Denmark, and the mean (95% CI) was 31.0 (29.4-32.6) years in Spain. In the Danish study, the babies had a mean (SD) birth weight of 3508±523g and were on average 192g smaller (p=0.028). The mean (SD) gestational age (GA) at delivery was 39.8±1.7 weeks, adjusted odds ratio (95%CI) of LBW was 0.6 (0.4-1.0), stillbirth 4.0(1.0-14.3) and gestational diabetes mellitus 1.1 (0.7-1.7) in the IDWA group. The Spanish study reported a mean (95% CI) infant birth weight (IBW) of 3140 (3067-3213) g, reduction in adjusted IBW of -192.4 (-363.6, -21.2)g, p=0.028, R 2c.100 = 35.4, F 194,11 =9.3, p<0.001 in IDWA. Both studies reported the covariates and predictors of APO including parity, race, body mass index, and socioeconomic status. Conclusion Overall, there is limited research on this important obstetric hematology topic. The few available studies identified higher odds of non-causal association between IDWA, stillbirth, and smaller birth weight. Similarly, there was a non-significant causal association with most predictors and maternal medical complications of pregnancy. These findings will motivate further research work by our team. The study will involve the use of large population-based data to establish a potential causal association between IDWA and APO.

Reproductive outcomes of water pipe smoking: A scoping review

Objective: To present an overview of the adverse effects of water pipe smoking on various aspects of reproduction and perinatal complications, covering all the most relevant studies, from descriptive findings to clinical trials. Methods: We reviewed the literature and included full publications in English provided by international biomedical databases, including PubMed, Science Direct, EBSCO, Scopus, and Google Scholar, and Cochrane Library over the last 38 years (May 1985 to June 2023). Search terms (Water pipe, Narghile, Shisha, Dokha, etc., and Reproduction, Fertility, etc.) were adopted from Medical Subheading (MeSH) and Boolean operators were utilized to improve sensitivity. Results: 133 Papers were identified in the initial search, of which 29 were excluded due to duplication. Eliminating search overlap and irrelevant records by reviewing titles and abstracts reduced 42 papers. 62 Full-publication articles met the inclusion criteria. We summarized the effects of waterpipe smoke exposure on reproductive health based on three main categories: male and female fertility, fetal and neonatal outcomes, and pregnancy complications. Conclusions: Water pipe smoking has potential adverse effects on different aspects of human reproductive health, including semen parameters, male and female fertility, and fetal and neonatal health, and contributes to many maternal complications and morbidities.

Physical Therapy Interventions in Children With Cerebral Palsy: A Systematic Review.

Cerebral palsy is a group of disorders affecting individuals already from birth. It enormously impacts an individual's physical and emotional life and can bring many challenges to the individual, caregivers, and families. Therefore, it is crucial to investigate interventions that could improve various symptoms in children with cerebral palsy. Our systematic review intends to assess the effect of different exercise and physical therapy interventions in children with cerebral palsy. We used three databases for our article search: PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and PubMed Central (PMC). The combined number of papers found in all databases was 65,412. We then applied our inclusion and exclusion criteria, filters, key terms, and Medical Subheadings (MeSH). After applying our quality assessment tools, we included nine papers in our systematic review. The studies included in our review used various interventions to assess for improvement in symptoms in individuals with cerebral palsy. Interventions included stretching and resistance exercises, horse riding, biking, core stability exercises, slackline training, a home exercise program using an online tool, sit-to-stand exercise program, and functional training. Many studies have shown that interventions improved symptoms like balance, coordination, gait, and cardiovascular endurance in cerebral palsy. This review suggests that some of the included interventions have great potential to improve the symptoms of cerebral palsy and, therefore, can be a great addition to existing training and rehabilitation programs. Given that studies included a relatively small number of participants and were conducted over a short time, more research with a more significant number of participants over a longer time is necessary.

Effects of Continuous Positive Airway Pressure on Nonalcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea: A Systematic Review

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the first-line therapy for OSA. However, the effect of CPAP on NAFLD in patients with concomitant OSA is still unclear. This study aims to identify the use of CPAP on NAFLD in patients with OSA. Method: A systematic literature search was performed using particular keywords and medical subheadings in three journal databases: Cochrane, PubMed, and EBSCOhost. The results were screened and assessed using inclusion and exclusion criteria by three independent authors. The Randomized controlled trial (RCT) quality was evaluated with Jadad scale and the cohort studies quality was assessed with Newcastle-Ottawa quality assessment scale.Results: Two RCTs and three cohort studies were eligible to fulfil the inclusion criteria, consisting of 620 total patients. Two RCTs showed no statistically significant improvement after CPAP treatment in NAFLD based on intrahepatic triglyceride (measured by proton magnetic resonance spectroscopy), liver stiffness measurement, serum cytokeratin-18 fragment, and liver function blood test parameters. Meanwhile, 2 cohort studies in adults and 1 cohort study in children showed significant improvement in ALT, AST, and APRI. However, one cohort study showed no significant improvement in serum fibrosis markers and transient elastography measurement after CPAP treatment.Conclusion: CPAP might be beneficial in some patients with OSA to improve NAFLD, but further research that includes many subjects and longer duration of CPAP therapy is needed to confirm this result.

A Systematic Review of Cystic Fibrosis in Children: Can Non-Medical Therapy Options Lead to a Better Mental Health Outcome?

Cystic fibrosis (CF) is a chronic disorder that begins at an early age, so it is crucial to be aware of the physical and emotional burden placed on individuals suffering from it and their families. It significantly impacts an individual's life; therefore, it is essential to acknowledge the effects of the disease on physical and mental health. Our systematic review aims to highlight the areas of life affected by cystic fibrosis and evaluate various non-medical treatment options that may support the mental health of CF patients. We selected PubMed, Google Scholar, and MEDLINE (Medical Literature Analysis and Retrieval System Online) as our databases. We initially found 146,095 articles and narrowed the number of articles down using filters, exclusion and inclusion criteria, and various combinations of Medical Subheadings (MeSH) and key terms. We decided to use a final count of nine articles for our systematic review. The studies we included highlighted the negative impact of cystic fibrosis on mental health, like depression and anxiety, as well as on sleep, physical health, and overall quality of life. Several non-medical interventions, such as logotherapy, psychological interventions, complementary and alternative medicine, and many more, have been shown to enhance the mental health of many participants. Studies suggested that such therapy options may greatly benefit individuals with cystic fibrosis and their current treatment plan. This review indicates that non-medical therapy options can enhance the mental health of individuals suffering from cystic fibrosis and that it is crucial to bring more attention to preventing and treating mental health issues in cystic fibrosis patients. However, as current data is limited, more research with a larger number of participants over an extended period of time is necessary to better evaluate the efficacy of non-medical interventions on mental health.

A Systematic Review of Yoga and Meditation for Attention-Deficit/Hyperactivity Disorder in Children.

With attention-deficit/hyperactivity disorder (ADHD) being a prevalent disorder in childhood, it is essential to acknowledge the different adverse effects the disorder can have on the quality of life in children. Therefore, this systematic review focuses mainly on children. Medical therapy, especially stimulants, can have many side effects. Our systematic review aims to evaluate the potential of other non-medical treatment options for ADHD, such as yoga or meditation. We used PubMed and Google Scholar as databases for this systematic review. Using different combinations of medical subheadings (MeSH) and key terms, followed by the application of several inclusion/exclusion criteria and filters to narrow down our search. From an initial 51,675 articles, we selected 10 papers that passed our screening process and quality check to analyze in depth. Yoga and meditation positively affect various symptoms in children with ADHD, including attention, hyperactivity, and impulsive behavior. If done in family group sessions, it also benefited the parents and family dynamics, suggesting a potential option for family therapy. Furthermore, other psychological symptoms, such as anxiety or low self-esteem, appeared to be positively impacted by these interventions. Although yoga and meditation positively influenced children with ADHD, a more in-depth research is necessary with a more significant number of participants and over a more extended period of time. The results of the included studies suggest a substantial benefit. Nonetheless, as the number of studies is limited, at present yoga and meditation could be beneficial as supplemental therapy rather than being used alone as a therapy for ADHD.

Safety and Effectiveness of Evolocumab During Acute and Sub-acute Phases of Acute Coronary Syndrome (ACS): A Systematic Review and Meta-analysis.

Coronary artery disease (CAD), manifested mainly as acute coronary syndrome (ACS), continues to be a major cause of mortality globally and a significant contributing factor to the global disease burden. Elevation of low-density lipoprotein cholesterol levels attributed to proprotein convertase subtilisin/Kexin type-9 (PCSK9) during and following ACS puts patients at high risk of subsequent adverse events. Evolocumab is a PCSK9 inhibitor that is associated with a significant reduction in low-density lipoprotein cholesterol (LDL-C) levels through PCSK9 inhibition in comparison to traditional statin therapy. We conducted a systematic review and meta-analysis of literature addressing the efficacy and safety of evolocumab compared to other lipid-lowering therapies or placebo. An extensive internet-based literature search using pre-determined key phrases supported by medical sub-headings and Boolean operators was performed in October 2022 to identify literature pertinent to the research topic. The search was primarily based on the National Library of Medicine (PubMed and Clinical Trials), MEDLINE, Cochrane, and the Science direct literature databases. Subsequently, the researchers devised PICOs-based screening criteria which had to be met by each identified study for inclusion in the review and meta-analysis. Two independent reviewers conducted data stratification and quality assessment of identified studies. Statistical analysis of the primary and secondary outcomes was conducted on the Cochrane REVMAN 5.4 statistical softwarefor randomized trials. Two thousand five hundred and seventy-six potential studies were identified for inclusion in the systematic review. Data stratification, screening, and quality assessment of these studies based on the eligibility criteria led to the exclusion of two thousand five hundred and sixty-seven studies as they did not meet the standards set. Nine randomized controlled trials progressed to numerical analysis for validity and reliability. Eight studies were included in the meta-analysis. Meta-analytical results showed a significant decrease in LDL-C changes from initiation of evolocumab therapy to 8 weeks following ACS compared to placebo. Similar results were derived in the sub-acute phase of ACS [SMD -1.95 (95% CI -2.29, -1.62)].The meta-analysis revealed no statistically significant relationship between the risk of adverse effects, serious adverse effects, and major adverse cardiovascular events (MACE) from treatment using evolocumab in comparison to placebo [(relative risk, RR 1.04 (95% CI 0.99, 1.08) (Z = 1.53; p=0.12)]. Early evolocumab therapy initiation was associated with a significant decrease in LDL-C levels and was not associated with an increased risk of adverse effects in comparison to placebo.

Application of Artificial Intelligence for managing Diabetes Mellitus patients during the Covid-19 pandemic

The Covid-19 quarantine policy and mobility restriction were carried out to break coronavirus transmission. These were implemented for several months to affect the quality of life, especially in patients with diabetes mellitus. To overcome this, technology such as applications with artificial intelligence can be used. This literature aims to identify the use of Artificial Intelligence systems in managing diabetes mellitus during pandemics. This review conducted a narrative review method. Articles were searched using databases, such as PubMed, Science Direct, and EBSCO. The keywords were based on the medical subheading (MeSH) term and combined using a boolean operator. Articles were selected using inclusion criteria, namely the year of publication between 2016-2021, articles in English, full text, and open access. The articles that were duplicated and articles that did not fit the research topic were excluded. We found that six articles met the criteria. These discussed four programs, namely diabetes retinopathy screening, blood glucose monitoring, lifestyle management programs, and insulin therapy guidelines. The four programs can be used in the home care services for diabetes mellitus patients during the Covid-19 pandemic

Mapping the research hotspots and theme trends of simulation in nursing education: A bibliometric analysis from 2005 to 2019

BackgroundSimulation-based nursing training has been used incorporated into nursing education for decades, however, there is limited information related to simulation research hotspots and theme trends over time. ObjectivesTo investigate the research hotspots and theme trends of simulation in nursing education through bibliometric analysis. MethodsRelevant articles on simulation in nursing education published between 2005 and 2019 were retrieved from PubMed. The Bibliographic Item Co-occurrence Matrix Builder (BICOMB) was used to extract and quantitatively analyze the Medical Subject Headings (MeSH) terms and subheadings. The biclustering analysis was conducted using gCluto1.0 to identify the research hotspots. A strategic diagram was employed to reveal the development trend of the theme. ResultsA total of 4102 publications were retrieved from PubMed showing an overall increasing trend. Based on the results, the United States was the most productive country (2868,55.7 %), the journal Nurse Education Today journal was the top journal concerning this field, and Cooper SJ and Holtschneider ME were authors with the highest number of publications on this topic. Quantitative and co-word biclustering analyses were used in this study. The research hotspots in recent 5 years were focused on: (1) interprofessional simulation in patient-care teams; (2) patient simulation in psychiatric nursing education; (3) virtual reality simulation (VRS) in midwifery and nursing education; (4) simulation in critical care nurses' continuing education/training, and (5) simulation in pediatric resuscitation education. The strategic diagram showed that the VRS in midwifery and nursing education might have a significant potential to become an emerging hotspot soon. ConclusionThe research literature production of simulation in nursing education was increasing over the past 15 years. Through co-word biclustering analysis, five research hotspots were identified. Among them, simulation in psychiatric education and critical care continuing education had a central priority that researchers should pay further attention to, and VRS could be the major trend for future study. Furthermore, this study described the overall range of research interests and provided ideas for innovative and efficient research projects.

Multiple Sclerosis: Therapeutic Strategies on the Horizon.

Multiple sclerosis (MS) is a chronic disease affecting the brain and the spinal cord. It is a chronic inflammatory demyelinating disease of the central nervous system. It is the leading cause of non-traumatic disability in young adults. The clinical course of the disease is quite variable, ranging from stable chronic disease to rapidly evolving debilitating disease. The pathogenesis of MS is not fully understood. Still, there has been a rapid shift in understanding the immune pathology of MS away from pure T cell-mediated disease to B cells and microglia/astrocytes having a vital role in the pathogenesis of MS. This has helped in the emergence of new therapies for management. Effective treatment of MS requires a multidisciplinary approach to manage acute attacks, prevent relapses and disease progression and treat the disabling symptoms associated with the disease. In this review, we discuss the pathogenesis of MS, management of acute relapses, disease-modifying therapies in MS, new drugs and drugs currently in trial for MS and the symptomatic treatment of MS. All language search was conducted on Google Scholar, PubMed, MEDLINE, and Embase till February 2022. The following search strings and medical subheadings (MeSH) were used: "Multiple Sclerosis", "Pathogenesis of MS", and "Disease-modifying therapies in MS". We explored literature on the pathogenic mechanisms behind MS, management of acute relapses, disease-modifying therapies in MS and symptomatic management.

17 EFFECTS OF WHOLE-BODY VIBRATION TRAINING ON BLOOD PRESSURE IN POSTMENOPAUSAL WOMEN WITH HYPERTENSION: A SYSTEMATIC REVIEW

Background: Menopause is considered an important determinant of hypertension in women, with 41% of postmenopausal women are hypertensive. Increased blood pressure (BP) in postmenopausal women can be caused by arterial stiffness, renin-angiotensin system activation, endothelial dysfunction, lack of estrogens, sympathetic activation, anxiety, and depression. Hence, they should be given special treatment, such as exercise therapy, to improve the quality of their hypertensive therapy. Whole-body vibration training (WBVT) is a resistance training known for its ability to improve arterial stiffness. However, its ability to decrease BP is still controversial. Objective: This study aims to identify the effects of WBVT on blood pressure in postmenopausal women with hypertension. Method: A systematic literature search was performed using particular keywords with medical subheading (MeSH) terms on three journal databases, including Pubmed, Proquest, and Cochrane. The search results were screened and assessed using inclusion and exclusion criteria, double article, and full text availability by three independent authors. The quality of the randomized control trial (RCT) was evaluated using the Jadad scale. Result: Four Randomized controlled trials (RCTs) consisting of 114 total patients were eligible to fulfil the criteria. All studies showed that WBVT significantly decreased systolic (10-12 mmHg) and diastolic (5-6 mmHg) BP compared with the control group. One study also showed a reduction of mean arterial pressure (9 mmHg). Conclusion: WBVT might be beneficial as an adjuvant therapy to reduce blood pressure in postmenopausal women with hypertension, but further research that includes more subjects is needed to confirm this result.

Connections and Biases in Health Equity and Culture Research: A Semantic Network Analysis.

Health equity is a rather complex issue. Social context and economical disparities, are known to be determining factors. Cultural and educational constrains however, are also important contributors to the establishment and development of health inequities. As an important starting point for a comprehensive discussion, a detailed analysis of the literature corpus is thus desirable: we need to recognize what has been done, under what circumstances, even what possible sources of bias exist in our current discussion on this relevant issue. By finding these trends and biases we will be better equipped to modulate them and find avenues that may lead us to a more integrated view of health inequity, potentially enhancing our capabilities to intervene to ameliorate it. In this study, we characterized at a large scale, the social and cultural determinants most frequently reported in current global research of health inequity and the interrelationships among them in different populations under diverse contexts. We used a data/literature mining approach to the current literature followed by a semantic network analysis of the interrelationships discovered. The analyzed structured corpus consisted in circa 950 articles categorized by means of the Medical Subheadings (MeSH) content-descriptor from 2014 to 2021. Further analyses involved systematic searches in the LILACS and DOAJ databases, as additional sources. The use of data analytics techniques allowed us to find a number of non-trivial connections, pointed out to existing biases and under-represented issues and let us discuss what are the most relevant concepts that are (and are not) being discussed in the context of Health Equity and Culture.

Efficacy of Chitosan and Chlorhexidine Mouthwash on Dental Plaque and Gingival Inflammation: A Systematic Review.

Mouthwash is the effective chemical plaque control mechanism being practiced globally. Teeth and tongue discoloration, a temporary change in taste perception, an increase in calculus deposits, a burning sensation, and genotoxicity of buccal epithelial cells are all possible side effects. This review evaluates the efficacy of chitosan mouthwash in comparison to chlorhexidine mouthwash in combating plaque accumulation and gingival inflammation. Electronic databases such as Medline, Cochrane, LILACS, TRIP, Google scholar, and clinical trial registries (CTRI) for ongoing trials were searched with appropriate medical subheadings (MeSH) and search terms. Randomized clinical trials comparing the efficacy of chitosan mouthwash and chlorhexidine mouthwash on dental plaque accumulation and gingivitis were included. The outcome variables of interest were plaque index, gingival index, gingival bleeding index, and colony-forming unit (CFU/ml). All data from the included studies were extracted in a customized extraction sheet. The risk of bias across the studies was assessed using the Cochrane tool for intervention (ROB-2), which consisted of six domains. Of the included three studies, we found one study with an overall low risk of bias and two studies with an overall high risk of bias across the domains. Though there was a significant reduction in plaque accumulation, gingival inflammation, and colony-forming units on the use of chitosan mouthwash and chlorhexidine mouthwash separately, all three included studies reported that a combination of both be more effective.

Necrozoospermia: The tree that hides the forest.

Necrozoospermia is a condition found in 0.2%-0.4% of male infertility cases. The causes of necrozoospermia are multiple: they can be related to testicular and/or post-testicular damage. Additionally, these causes most often involve the production of reactive oxygen species (ROS) and/or sperm DNA fragmentation (SDF) which can reduce the chances of spontaneous pregnancy or affect the outcome of assisted reproductive technologies. To focus on potential etiologies of necrozoospermia, its diagnosis and its therapeutic management especially before the employment of ICSI. Authors searched PubMed/Medline, Web of Science, Cochrane Library, Google and Institutional websites for medical subheading terms and free text words referred to "necrozoospermia", "sperm vitality", "sperm viability", SDF and "ICSI". We identified 12 main etiologies of necrozoospermia responsible for either a decrease of sperm vitality, a mild, a moderate or a severe necrozoospermia. In case of a confirmed decreased vitality, a thorough check-up should be conducted and if available, etiological treatment should be proposed. Therapeutic management could also include repeated ejaculations, drug treatments, the use of ICSI with ejaculated or surgically extracted spermatozoa in case of a non-treatable necrozoospermia. The potential causes of necrozoospermia should be investigated because many of them could be corrected, thus avoiding the use of ICSI. Moreover, if ICSI procedure remains necessary, the therapeutic management of necrozoospermia could also improve the chances of success by reducing oxidative stress and/or SDF.

Frequency of Adverse Events in the Placebo Arms of COVID-19 Vaccine Trials

Adverse events (AEs) after placebo treatment are common in randomized clinical drug trials. Systematic evidence regarding these nocebo responses in vaccine trials is important for COVID-19 vaccination worldwide especially because concern about AEs is reported to be a reason for vaccination hesitancy. To compare the frequencies of AEs reported in the placebo groups of COVID-19 vaccine trials with those reported in the vaccine groups. For this systematic review and meta-analysis, the Medline (PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched systematically using medical subheading terms and free-text keywords for trials of COVID-19 vaccines published up to July 14, 2021. Randomized clinical trials of COVID-19 vaccines that investigated adults aged 16 years or older were selected if they assessed solicited AEs within 7 days of injection, included an inert placebo arm, and provided AE reports for both the vaccine and placebo groups separately. Full texts were reviewed for eligibility by 2 independent reviewers. Data extraction and quality assessment were performed independently by 2 reviewers, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and using the Cochrane risk-of-bias tool. Meta-analyses were based on random-effects models. The primary outcomes were the proportions of placebo recipients reporting overall, systemic, and local (injection-site) AEs as well as logarithmic odds ratios (ORs) to evaluate group differences. Outcomes were tested for significance using z tests with 95% CIs. Twelve articles with AE reports for 45 380 participants (22 578 placebo recipients and 22 802 vaccine recipients) were analyzed. After the first dose, 35.2% (95% CI, 26.7%-43.7%) of placebo recipients experienced systemic AEs, with headache (19.3%; 95% CI, 13.6%-25.1%) and fatigue (16.7%; 95% CI, 9.8%-23.6%) being most common. After the second dose, 31.8% (95% CI, 28.7%-35.0%) of placebo recipients reported systemic AEs. The ratio between placebo and vaccine arms showed that nocebo responses accounted for 76.0% of systemic AEs after the first COVID-19 vaccine dose and for 51.8% after the second dose. Significantly more vaccine recipients reported AEs, but the group difference for systemic AEs was small after the first dose (OR, -0.47; 95% CI, -0.54 to -0.40; P < .001; standardized mean difference, -0.26; 95% CI, -0.30 to -0.22) and large after the second dose (OR, -1.36; 95% CI, -1.86 to -0.86; P < .001; standardized mean difference, -0.75; 95% CI, -1.03 to -0.47). In this systematic review and meta-analysis, significantly more AEs were reported in vaccine groups compared with placebo groups, but the rates of reported AEs in the placebo arms were still substantial. Public vaccination programs should consider these high rates of AEs in placebo arms.

Efficacy and Safety of Stem Cell Therapy in Diabetic Retinopathy: A Scoping Review

Background: Diabetic Retinopathy (DR) is a microvascular disorder that arises due to chronic hyperglycemia, which, if left untreated, would ultimately cause loss of vision. Although there are some established treatments for DR, those treatments failed to show a capability to induce cellular regeneration. Stem cells are unspecialized cells of the human body that would be able to differentiate and have the ability to self-regeneration and recently emerged as a potential treatment for DR. Aim: The aim of this review is to evaluate the ability of stem cells as a treatment for DR by promoting cellular regeneration and evaluate the safety of stem cell treatment. Method: We identified relevant articles from three established databases and did an advanced search using a combination of Medical SubHeading Terms (MeSH Terms) keywords and boolean operators such as: (“Diabetic Retinopathy” [MeSH Terms]) AND stem cells [MeSH Terms]”. Result: In this scoping review, the authors identified thirteen studies that meet the inclusion criteria. Of the twelve pre-clinical studies, eleven studies evaluated cellular regeneration, and five studies evaluated neurotrophic factors. Only two studies reported side effects of stem cell therapy in pre-clinical studies. Only one clinical study was identified that evaluated the cellular regeneration of stem cell therapy in DR. Conclusion: Several types of stem cells have been researched as a new therapeutic modality for Diabetic Retinopathy. Most studies showed successful application as noted on its ability to promote and preserve cell regeneration as well as increase neurotrophic factors of the retina with no serious adverse effects are reported.

Role of Essential Oil-Based Mouthwashes in Controlling Gingivitis in Patients Undergoing Fixed Orthodontic Treatment. A Review of Clinical Trials.

Essential oil (EO)-based mouthwashes have been used for oral health maintenance due to their antimicrobial and anti-inflammatory properties. The aim was to review clinical trials that assessed the role of EO-based mouthwashes in controlling gingivitis in patients undergoing fixed orthodontic treatment (OT). The Patients, Interventions, Control and Outcome (PICO) format was based on the following: (a) P: Patients undergoing fixed OT (b) Intervention: EO-based mouth-wash; Control: Mouthwashes that did not contain EOs or no mouthwash (d) Outcome: Control of gingivitis measured by clinical indices. Databases were searched manually and electronically up to and including May 2021 using different medical subject subheadings. Data screening and extraction were performed. The risk of bias within randomized controlled trials was assessed using the revised Cochrane Collaboration’s risk of bias tool (RoB 2). The Risk of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool was used for non-randomized controlled trials. Disagreements related to literature search and RoB evaluations were resolved via discussion. Six clinical studies were included. Four studies showed that Listerine® is effective in controlling gingivitis in patients undergoing fixed OT. One study reported that the use of 5% Fructus mume mouthwash resulted in a significant reduction in gingival bleeding. Two mouthwashes that contained 1% Matricaria chamomilla L. and 0.5% Zingiber officinale were also found to be efficient in controlling gingival bleeding. Four, one and one studies had a low, moderate and high RoB, respectively. In conclusion, EO-based mouthwashes seem to be effective for the management of gingivitis among patients undergoing fixed OT. Further well-designed and power-adjusted clinical trials are needed.

Self-concept and body image of people living with lupus: A systematic review.

To summarize existing evidence regarding body image in patients with systemic lupus erythematosus, with the following considerations: (a) the perceptions patients have of their body changes; (b) how patients cope with changes in their body; (c) and what their perceptions are of body changes. A systematic review of literature integrating quantitative and qualitative studies. We searched databases (PubMed, CINAHL, Embase, SCOPUS, the Web of Science, Medline, Medline Complete, and Academic Search Premier) and publications from 2010 to 2020 with "Systemic Lupus Erythematosus" AND "Self-Concept" OR "Body Image" AND "Woman" as medical subheading terms. The studies included were subjected to a thematic content analysis, which allowed subjective interpretation of data through a systematic classification process for coding themes or patterns. We identified 647 studies, of which 22 were analyzed in this study. Our results indicate that changes in the body image of people with lupus and their perception are issues that must be treated as characteristics of the disease; therefore, they need to receive the same attention as is given to physical disabilities and pain. The analysis identified 3 thematic categories: (a) depression and anxiety associated with body changes (hair loss, weight gain); (b) body image reflecting the disease; and (c) confrontations and interventions to promote acceptance and adaptation to the new image. The dimensions of self-concept and body image are essential for assessing the quality of life of individuals with lupus. The formation of a adjusted self-concept can be managed by health professionals supporting these people.