Trip Database Research Articles

Adaptation Frameworks for Clinical Guidelines and Proposing a Framework for Iran: A Review and Comparative Study.

Background: Clinical Practice Guidelines (CPGs) can be adapted to local conditions to prevent any resources from being wasted. Adaptation of CPGs implies a systematic view of developed guidelines through maintaining evidence-based principles in order to find the ones most relevant with patients' conditions and its integration with the cultural and regional requirements of the target population and health system facilities. The main purpose of the study was to describe, interpret and compare different frameworks for adaptation of clinical guidelines and proposing a comprehensive framework for Iran. Methods: This study was based on a review and comparative analysis of adaptation frameworks of CPGs. Initially, all adaptation frameworks were collected by systematic search in the literature. We searched the following electronic databases: PubMed, Scopus, Trip Database, Science Direct, and Google Scholar. Then, based on the stages of the comparative study, frameworks were described, interpreted, juxtaposed, and compared. Finally, a comprehensive framework for the adaptation of clinical guidelines was proposed by consulting a panel of experts. Results: Our literature search resulted in 26 frameworks, of which 18 were potentially relevant. Based on inclusion/exclusion criteria, nine frameworks were included in the study and have been described, interpreted, and compared. The proposed comprehensive framework for the adaptation of clinical guidelines consists of ten main steps. Conclusion: The proposed comprehensive framework is an appropriate tool for the adaptation of clinical guidelines in Iran that can be used in other countries. However, further validation of the framework requires case studies and expert consultation to determine its application to the adaptation of clinical guidelines.

PROTEOMIC PROFILE OF ECHINOCOCCUS GRANULOSUS: A SYSTEMATIC REVIEW.

Cystic echinococcosis is a zoonotic disease caused by the larval stage of Echinococcus granulosus. This affliction is an endemic worldwide condition that represents a neglected parasitic disease with important socioeconomic repercussions. Proteomic characterization of larval and adult stages of E. granulosus, as well as the association between expression profiles and host interactions, is relevant for a better understanding of parasite biology, and eventually for drug design and vaccine development. This study aimed to develop a synthesis of the evidence available related to proteomics of E. granulosus. A systematic review was carried out to collect data concerning the proteomics of E. granulosus, without language or host restriction, published between 1980 and 2019. A systematic search was carried out in the Trip Database, BIREME-BVS, SciELO, Web of Science, PubMed, EMBASE, SCOPUS, EBSCO host, and LILACS, using MeSH terms, free words, and Boolean connectors, and adapting strategies to each source of information. Additionally, a manual cross-reference search was performed. Variables studied were the year of publication, geographic origin of the study, number of samples, hosts, parasitic organs, proteomic techniques, and parasite proteins verified. Nine-hundred and thirty-six related articles were identified: 17 fulfilled selection criteria, including slightly more than 188 samples. Most articles were published between 2014 and 2019 (64.7%) and were from Brazil and China (35.3% each). In reference to confirmed hosts in the primary articles, cattle (41.2%) and humans (23.5%) were the most frequently reported. Concerning proteomic techniques applied in the primary articles, LC-MS/MS was the most used (41.1%), and 890 proteins were reported by the primary articles. As the results of our search suggest, the information related to E. granulosus proteomics is scarce, heterogeneous, and scattered throughout several articles that include a diversity of tissues, samples, intermediate hosts, and proteomic techniques. Consequently, the level of evidence generated by our search is type 4.

Priapism, a symptoms of claudication of the cauda equina in spinal stenosis

Keywords: Priapism, Cauda Equina Syndrome, Spinal Stenosis Purpose: This paper was written following the authors clinical management of a patient whom had features of incomplete CES in combination with the symptom priapism. The literature regarding this phenomenon appeared sparse therefore the authors sought to improve their own understanding and share their findings. The aim was to discuss the relationship between spinal stenosis, cauda equina syndrome and priapism using available literature. The objective was to contribute to the evidence base and raise awareness of this rare clinical finding. Methods: A narrative review was completed with a structured search by a clinical librarian. A structured search of Medline, Embase and CINAHL was undertaken by a clinical librarian. In addition, the following resources were searched; BMJ Case Reports, UpToDate, BMJ Best Practice, TRIP Database, NHS Evidence and Google Advanced Search. The following search terms were utilised; cauda equine, cauda equina syndrome, spin* stenosis, lumbar stenosis, priapism and erection. For quality assurance, the authors used the revised SANRA tool. Results: This revealed 40 cases of intermittent priapism reported in the English literature. There appears to be an association with lumbar spine stenosis and priapism but there is a paucity of literature documenting cases of priapism as a feature of CES. Priapism can be an atypical presentation of lumbar spine stenosis/transient cauda equina compression. Increased intrathecal pressure secondary to direct compression and/or local nerve root ischemia at a stenotic level of the sacral cauda equina, this may lead to parasympathetic hyperactivity and subsequent priapism. Albeit transient, the manifestation of priapism suggests that the patient is experiencing sexual dysfunction from cauda equina compression and patients should be appropriately safety netted and managed depending upon their overall clinical picture. The literature appears to demonstrate decompressive surgery is a viable treatment option. Conclusion(s): Cases of priapism secondary to transient ischemia of the cauda equina nerve roots exist. Greater awareness of this clinical finding may help clinicians in their contextual reasoning in patients with suspected CES particularly in patients with suspected spinal stenosis. There is a paucity of literature on sexual dysfunction in patients with acute CES. It could also be beneficial for further research looking at the correlation between imaging and sexual dysfunction and priapism. Impact: This project may raise awareness of patients with priapism may have subcritical compression of the cauda equina; and that the increased mechanical pressure on the cauda equina induced by walking in patients with spinal stenosis may contribute to priapism as a transient autonomic disorder. These patients should be appropriately safety netted and managed according to their overall clinical picture. Funding acknowledgements: This work was not funded.

Exosomes and Cystic Echinococcosis. Systematic Review

Exosomes are small and single-membrane secreted organelles, up to 200 nm in diameter that have the same topology as the cell, but are enriched in proteins, nucleic acids, lipids, and glycoconjugates. It can be found in any type of body fluids such as plasma, urine, saliva, sperm, bile, etc. On the other hand, cystic Echinococcosis (CE) has been studied from different points of view, among others, from genomics and proteomics, and the presence of CE exosomes in humans and other intermediate hosts has been reported in very few articles. The aim of this review was to report the evidence available regarding exosomes and CE. Systematic review. Data sources: Trip Database, SciELO, WoS, MEDLINE, EMBASE and SCOPUS. Eligibility criteria: Studies related to CEin any type of host and state of the parasite, without language restriction, published between 1966-2021. Variables: Year of publication, geographical origin, species isolated, location of exosomes. Forty-two studies were initially identified. After scrutinizing titles and abstracts, checking duplications and in-depth analysis of the studies selected, 12 articles including human, bovine, sheep, dog samples were also included. All were case reports or case series. The highest proportion of articles was published between 2019 and 2021 (58.3 %). Publications were predominantly from China (58.3 %). Evidence about exosomes and CE is scarce and reduced range of articles and cases.

Accuracy of Prenatal Ultrasound Scans for Screening Cleft Lip and Palate: A Systematic Review.

Children born with clefts encounter various postnatal issues which have a negative impact and long-term psychological effects on both the parents and themselves. This systematic review aims to find the accuracy of two-dimensional (2D)/3D scans for screening cleft lip and palate which would help the parents to be mentally and psychologically prepared to plan for future surgeries. To identify relevant literature, an electronic search was performed using PubMed, Trip database, Cochrane, and Google Scholar database. The search yielded 927 articles, of which 10 fulfilled the eligibility criteria and were included in this systematic review. These studies showed that the combination of 2D and 3D ultrasound scans has increased the specificity and sensitivity in detecting orofacial clefts, as they aid in improved visualization of the fetal face. However, in future, the visualization of the palate can be improved by inventing other modified views as cleft palate diagnosis is more prone to error.

Pharmacoeconomic considerations for acute myeloid leukemia pharmacotherapy

Introduction Acute myeloid leukemia (AML) is a rare blood cancer with a poor prognosis. Recently, targeted drugs have improved survival both in the elderly and in fit patients. However, as monthly costs of targeted agents are high, regulatory bodies often impose restrictions on their use. Areas Covered The authors review the value-for-cost of targeted drugs such as gemtuzumab ozogamycin, CPX-351, midostaurin, gilteritinib, glasdegib, venetoclax, oral azacytidine and enasidenib used to treat adult AML. EMBASE and TRIP databases, together with authority web sites were searched for technology assessments. Add-on drugs, namely midostaurin and gemtuzumab ozogamycin, have been reported to have the best pharmacoeconomic profile for newly diagnosed fit patients with FLT3 mutation or favorable/intermediate cytogenetics, since allogeneic transplant rates were stable or reduced. Most of the other drugs, on the other hand, did not achieve highly favorable cost-for-benefit, due to a poor absolute survival gain and/or increased transplant rates. Expert opinion The cost of most targeted therapies for AML in unfit patients seems unfair in comparison to the absolute survival advantage provided in fit patients. Point of cure and transplant outcomes should be standardized to allow comparability among the models.

Neurocognitive effects of acupuncture in dementia: A brief literature review

AbstractBackgroundDementia, including Alzheimer’s disease, is one of the biggest global public health challenges that stretches through generations. Given the limitations of current pharmacologic interventions, acupuncture has been proposed as a potential alternative to dementia therapy. We review the literature to find studies that illustrate the effects of acupuncture on mild cognitive impairment (MCI), post stroke cognitive impairment (PSCI), Vascular dementia (VD), and Alzheimer’s disease (AD).MethodFive databases, including PubMed, Cochrane database, Google Scholar, CINAHL, and Trip database were searched for Keywords: acupuncture OR acupuncture treatment OR acupuncture therapy and mild cognitive impairment OR dementia OR vascular dementia OR poststroke dementia. Articles’ titles and abstracts were reviewed and selected according to their relevance for this review. Most of the selected papers were systematic reviews (SR) and meta‐analysis dated to 2020 publication. Only randomized controlled trials (RCTs) that are not included in the selected systematic reviews are selected for this review.ResultOf the selected articles, two studies found acupuncture could offer an alternative to conventional treatment of MCI. Three studies showed some cognitive benefits including, improving functional communication and language function in PSCI. One study found that acupuncture might stimulate neurogenesis after a stroke. One RCT revealed acupuncture with routine care may improve cognitive status and activities of daily living (ADLs) but has limited effects on quality of life in those with VD. Four studied showed mixed results of acupuncture in AD. No major adverse reactions from acupuncture were reported.ConclusionAcupuncture may improve cognitive function in those with MCI and PSCI. For VD and AD, the evidence is still lacking. More well‐structured, large scale double blinded RCTs are needed with more focus on the different stages of AD.

Factors affecting the successful implementation of the referral system: A scoping review.

An effective referral system ensures that there is a close relationship among all levels of health care, and individuals can receive the best possible care. The main purpose of the present study was to summarize studies that have addressed factors affecting the successful implementation of the referral system. A scoping review was performed to identify English and Farsi papers that were indexed in PubMed, Scopus, Science Direct, Trip Database, Cochrane Library, Embase, Google Scholar, SID, and Magiran until November 2020. Data was collected from the included studies by a reviewer and was checked by a second reviewer the collected data was analyzed using narrative methods. About 1245 relevant studies were identified in the first stage. After checking titles and abstracts, 63 studies were included. The factors that affected the referral system were classified in 4 themes and fourteen subthemes including technology (electronic referral, coordination, response and feedback), processes (effectiveness, efficiency), organizational (management, policy and planning, rules and regulations), patient centered individual (insurance coverage, social capital, transportation, awareness, attitude, satisfaction, and social influence). Therefore, a wide range of factors are affecting the performance of referral systems. For implementing an effective referral system, it is necessary to consider these factors.

Safety and effectiveness of enhanced external counterpulsation (EECP) in refractory angina patients: A systematic reviews and meta-analysis.

Enhanced external counterpulsation (EECP) is believed to be a non-invasive treatment for coronary artery disease and angina. The aim of this study was to determine the safety and effectiveness of EECP in refractory angina patients through a systematic reviews and meta-analysis. We conducted a comprehensive search of the literature published on PubMed, Cochrane library, Scopus, ScienceDirect, Trip Database and Google Scholar databases using appropriate keywords and specific strategy with no time limit. Having selected and screened the studies based on the defined inclusion and exclusion criteria and evaluating their quality based on the Cochrane checklist. For the meta-analysis,the Mantel-Haenszel method or the generic Inverse Variance was used. Analyses were done with Review Manager 5.2 software. A number of 299 studies were initially reviewed and finally, seventeen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Also, thirteen outcomes were analyzed and the results of meta-analysis in twelve outcomes including (Systolic Blood Pressure (7 studies), Diastolic Blood Pressure (7 studies), Pulse Pressure (4 studies), Mean Arterial Pressures (4 studies), Heart Rate (6 studies), Angina episodes (7 studies), Walking distance (2 studies),Canadian Cardiovascular Society classification (6 studies), Flow-Mediated Dilation (3 studies), Daily Nitrate Usage (4 studies), Exercise Treadmill Test-Time (2 studies), ST-segment depression (2 studies)demonstrated a significant clinical advantage in the EECP treatment effectiveness in patients with angina. No significant difference was observed regarding EECP usefulness (P = 0.18) in the outcome of brachial artery diameter (2 studies). Based on the meta-analysis, the results indicate the safety and effectiveness of EECP in patients with angina pectoris and indicate the usefulness of this treatment in these patients. In general, the authors believe that the general conclusion in this regard requires some studies with a large sample size and a control group assignment.

PROBABILITY ASSESSMENT OF CROSSING SITUATION IN SUNDA STRAIT

The new routeing measures in Sunda Strait, that consists of traffic separation scheme (TSS), precautionary area (PA), and inshore traffic zones (ITZ), have been implemented since July 2020. The Automatic Identification System (AIS) data is utilized to understand the traffic pattern in this area. One dataset before and one dataset after the implementation of TSS is then converted into a vessel trip database. Eight vessel courses, two positions, and seven crossing zones are determined from the density plot to categorise the vessel trips. This study introduced a different perspective to assess the crossing situation by using three point-of-views to calculate the probability, namely crossing zone basis, course basis, and vessel type basis. The analysis result shows that the crossing situation is mostly occurred in the precautionary area of the new routeing measure.

A Trip Generation Model for a Petrol Station with a Convenience Store and a Fast-Food Restaurant

A trip generation manual and database are important for transportation planners and engineers to forecast new trip generation for any new development. Nowadays, many petrol stations have fast-food restaurant outlets. However, this land use category has yet to be included in the Malaysian Trip Generation Manual. Therefore, this study attempted to develop a new trip generation model for the new category of “petrol station with convenience store and fast-food restaurant”. Significant factors influencing the trip generation were also determined. Manual vehicle counts at the selected sites were conducted for 3 h during morning, afternoon and evening peak hours. Regression analysis was used in this study to develop the model. A simple trip generation model based on the independent variable number of restaurant seats showed a greater value for the coefficient of determination, R2, compared with the independent variables gross floor area in thousand square feet and number of pumps. The multivariable trip generation model using three independent variables generated the highest R2 among all of the models but was still below a satisfactory level. Further study is needed to improve the model for this new land use category. We must ensure more accuracy in trip generation estimation for future planning and development.

The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis

Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I2 test statistics and Egger’s significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0–15.1, I2 = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0–43.7, I2 = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9–6.8, I2 = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8–18.3, p < 0.001, I2 = 96.3%) and Asia had the lowest prevalence (10.7, 95% CI 8.5–13.5, p < 0.001, I2 = 98.7%), however no continental differences were found. Sample size and year of publication were slight contributing factors to the heterogeneity in the analysis. Overall, these results were classified with a SORT A recommendation.

Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review.

Background: Lesbian, gay, bisexual, and transgender (LGBT) people present poorer mental and physical health results compared to the heterosexual and cisgender population. There are barriers in the healthcare system that increase these health inequities. Objective: To synthesise the available evidence on how nurses can intervene in reducing health inequities in LGBT people, identifying their specific health needs and describing their experiences and perceptions of the barriers they face in the healthcare system. Methods: Systematic review. Between March and April 2021, a bibliographic search was carried out in the Cuiden, LILACS, PubMed, Dialnet, SciELO, Trip Database, and Web of Science databases and metasearch engines. Inclusion criteria: Articles published in the last 5 years that address the specific health needs of LGBT people, their experiences and perceptions, or interventions in this group in which nurses may engage. Results: A total of 16 articles were selected. Health disparities were detected in the LGBT community, which exhibited higher rates of mental health problems, substance abuse, risky sexual behaviours, self-harm, and suicide. These inequalities were related to minority stress, and each of them differently impacted individual populations within the broader LGBT community depending on their sexual orientations and gender identities. The impact of these factors was, in turn, modified by the intersections of race/ethnicity, geographic region, and socioeconomic factors. LGBT people described discriminatory experiences by health professionals, as well as their distrust and fear in this setting. Nurses can carry out interventions such as inclusive education about sex and sexual and gender diversity and bullying and suicide prevention programmes, and can provide gender-affirming and family-centred care. Conclusions: LGBT people experience health inequities and discrimination in the healthcare system. Nurses can implement diverse interventions to reduce these problems and, moreover, these health professionals are obliged to acquire cultural competence regarding LGBT health.

Systematic review and meta-analysis of the safety of chloroquine and hydroxychloroquine from randomized controlled trials on malarial and non-malarial conditions

BackgroundDespite the expectations regarding the effectiveness of chloroquine (CQ) and hydroxychloroquine (HCQ) for coronavirus disease (COVID-19) management, concerns about their adverse events have remained.ObjectivesThe objective of this systematic review was to evaluate the safety of CQ and HCQ from malarial and non-malarial randomized clinical trials (RCTs).MethodsThe primary outcomes were the frequencies of serious adverse events (SAEs), retinopathy, and cardiac complications. Search strategies were applied to MEDLINE, EMBASE, LILACS, CENTRAL, Scopus, and Trip databases. We used a random-effects model to pool results across studies and Peto’s one-step odds ratio (OR) for event rates below 1%. Both-armed zero-event studies were excluded from the meta-analyses. We used the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the certainty of evidence.ResultsOne hundred and six RCTs were included. We found no significant difference between CQ/HCQ and control (placebo or non-CQ/HCQ) in the frequency of SAEs (OR: 0.98, 95% confidence interval [CI]: 0.76–1.26, 33 trials, 15,942 participants, moderate certainty of evidence). However, there was a moderate certainty of evidence that CQ/HCQ increases the incidence of cardiac complications (RR: 1.62, 95% CI: 1.10–2.38, 16 trials, 9908 participants). No clear relationship was observed between CQ/HCQ and retinopathy (OR: 1.63, 95% CI: − 0.4–6.57, 5 trials, 344 participants, very low certainty of evidence).ConclusionsCQ and HCQ probably do not increase SAEs, with low frequency of these adverse events on malarial and non-malarial conditions. However, they may increase cardiac complications especially in patients with COVID-19. No clear effect of their use on the incidence of retinopathy was observed.Systematic review registrationPROSPERO CRD42020177818

Effectiveness of teacher-based nutrition interventions in addressing malnutrition among sub-Saharan children

Introduction: To address the high malnutrition rates in Sub Saharan Africa, most programs addressing malnutrition have continuously been streamlined through the health system, yet this has not yielded results as expected. On the other hand, the education sector has shown an immense capacity to address some challenges, such as eliminating short-term hunger through School feeding programs. Yet, little attention has been given to teachers as far as implementing health and nutrition interventions. With an increased school enrolment rate in Sub Saharan Africa, teachers present huge potential as change agents.Objectives: To consolidate evidence about the effectiveness of teacher-based interventions in addressing malnutrition in Sub- Saharan Africa.Methods: A search strategy through online databases including EBSCO, PubMed, BASE, Cochrane, Google Scholar, LILACS, Project MUSE, TRIP Database, and Emerald Insight gave rise to 95,734 studies. These were identified and taken through a series of screening stages such that the most eligible were included to answer the review question.Results: Three studies fulfilled the inclusion criteria. Results showed that teacher-based interventions such as school lunch, deworming, vitamin A supplementation, and nutrition education positively affect the nutrition status of primary school children, school attendances, are sustainable and reach many children.Conclusion: There is a need to actively involve teachers in the primordial and primary prevention stages of malnutrition through strengthening nutrition education, supplementary programs and school gardening. Teachers have an essential role to play in the fight against Malnutrition in Sub Saharan Africa. Â

EP.TH.670Antibiotic Prophylaxis Use In Paediatric Robotic-Assisted Laparoscopic Pyeloplasty: A Systematic Review

Abstract Aim A systematic review was conducted to evaluate the current evidence for prophylactic antibiotic use in paediatric robotic-assisted laparoscopic pyeloplasty (RALP). As pyeloplasties are ‘clean contaminated’ procedures, prophylactic antibiotics are recommended, however, recent evidence suggests that antibiotics may be unnecessary. Prophylactic antibiotics are often either under or over prescribed in paediatric surgery, which increases the risk of developing antibiotic resistance. In general, minimally invasive surgery is associated with less postoperative infections, however, it is not yet clear how RALP compares with other approaches. Recent reviews have indicated prophylactic antibiotics may not decrease postoperative infections, however, there are no clear guidelines. Methods A systematic review was conducted of the following electronic databases: Pubmed, Medline Ovid, The Cochrane Library, TRIP Database, NICE Evidence Search, and EMBASE. The search terms used were: paediatric, pyeloplasty, robotic, antibiotic and were used as keywords as well as in combination as MeSH terms. Results Forty-one articles were retrieved, and after screening for relevance and redundancy, 2 articles remained including a total of 315 pyeloplasties. Prophylactic antibiotics did not reduce the incidence of postoperative UTIs in RALP. Conclusion Prophylactic antibiotics for RALP is not associated with lower rates of UTIs and therefore, may be reserved for patients with risk factors. However, due to the limited data and confounding factors, further research is required to optimise antibiotic stewardship and infection prevention.

Clinical utility of liquid biopsy in breast cancer: A systematic review.

Advancements in genetic sequencing techniques along with the identification of specific mutations and structural changes in multiple cancer genes, make it possible to identify circulating tumor cells and cell free nucleic acids as blood-based biomarkers, serving as a liquid biopsy (LB) with great utility for the diagnosis, treatment and follow-up of patients with neoplasms. This systematic review focuses on the clinical utility of LB in patients with breast cancer (BC). Articles published between 1990 and 2021 were included. Databases searched: Trip Database, WoS, EMBASE, PubMed, SCOPUS, and Clinical Keys. Variables studied: Publication year, country, number of cases, primary study design, LB detection methods, genes found, overall survival, disease-free survival, stage, response to treatment, clinical utility, BC molecular type, systemic treatment and methodological quality of primary studies. Of 2619 articles, 74 were retained representing 12 658 patients, mainly cohort studies (66.2%), the majority were from China (15%) and Japan (12.2%). All primary studies described clinical stage and type of systemic treatment used. Most used biomarker detection method: DNA (52.7%) and type of analysis: quantification of total cfDNA (35.1%). PIK3CA mutation was most frequent (62.9%). Evidence suggests clinically useful applications of BC. Though heterogeneous, publications suggest that LB will constitute part of the standard diagnostic-therapeutic process of BC.

Mental health during pregnancy and early childhood: recommendations from evidence-based guidelines

Abstract Background Mental health problems are common during pregnancy and after birth and are therefore often addressed in the context of antenatal and postnatal care. The project is an update of previous work and aimed at identifying and summarising screening and counselling recommendations from evidence-based guidelines. Mental health was defined broadly and included topics such as substance use and domestic violence. Methods Relevant guidelines were identified by searching 2 databases (G-I-N, TRIP Database) and websites of relevant institutions and professional societies. Guidelines, that were published or updated within the last 5 years and fulfilled methodological quality criteria, were included. Results A total of 52 guidelines from 16 different institutions fulfilled the inclusion criteria. The guidelines (predominantly) advocate the following mental health screenings: Interviewing about psychosocial stress factors and support needs during pregnancy and after birth; screening for postpartum depression and anxiety disorders; interviewing pregnant women about substance use (smoking, alcohol, drugs) and appropriate counselling. With regard to domestic violence and child welfare risks, some guidelines recommend routine screening and some recommend increased awareness of signs and symptoms by health workers. Routine screening for specific mental and behavioural disorders in children is not recommended by included guidelines; however, if there are indications and symptoms, clarification should take place and attention should be paid to signs and symptoms during preventive examinations. Conclusions The included guidelines recommend screening and/or counselling for the majority of the topics addressed. The results of the report can be used as a basis for decision-making for updating national antenatal care and screening programmes. Key messages The majority of the included evidence-based guidelines strongly recommend addressing mental health issues during pregnancy and after birth by offering screening and/or counselling. The recommendations from evidence-based guidelines can serve as a decision support for developing national antenatal and postnatal care programmes.

Pharmacotherapy of Cytokine Release Syndrome in Severe COVID-19 Patients: A Systematic Review

The coronavirus pandemic which spread from Wuhan China toward the latter part of 2019 has resulted in 216,303,376 confirmed cases and 4,498,451deaths deaths to date. The novelty and lack of a definitive treatment protocol for the virus and the acute respiratory distress syndrome it produces has resulted in patients being placed on artificial ventilation and most often never recovering therefrom. Very little is known about the pathophysiology of the virus and the biological mechanisms in which it disrupts to bring about the now identified wide array of clinical features which are not solely isolated to the respiratory tract. It is now an established fact however, that one of the major pathways implicated and on which often results in the death and or severe complications in COVID-19 patients is the cytokine storm. The use of new drugs to combat such a cytokine storm is thus important considering the current global COVID-19 situation so as to stop the further progression of the disease in patients and decrease both morbidity and mortality by crippling a major mechanism which hastens death in the hosts. It is, therefore, vital that a systematic analysis and review of the various therapeutic agents are undertaken to select the best drug for the treatment of patients with cytokine storm. This research aims to relate the best therapeutic regimens currently available precisely and concisely to physicians so as to ensure the best possible treatment modality is selected for each patient. An extensive review of the literature was done on the following databases: Google scholar, Trip database, EMBASE, PubMed, and PubMed Central. The keywords and the Boolean operators used for searches were “COVID-19” OR “SARS-CoV-2” AND “Therapeutics” OR “drug therapy” AND “Cytokine Release Syndrome.” The discovery and the use of such drugs, namely, Tocilizumab and potent corticosteroids such as dexamethasone and methylprednisolone in the maximum daily doses of 6 mg and 250 mg, respectively, have shown positive outcome to combat cytokine storm in severe COVID-19 patients. The rationale behind the use of these drugs being to suppress the immune system and thus decrease the detrimental cytokine cascade induced in severely ill COVID-19 patients will be instrumental in the treatment and prevention of severe complication. It is vital for the various drugs under trial and implemented in emergency use to be compared and studied so as to best select the drug which can be incorporated into a treatment regimen which is both effective and has diminished adverse effects.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic.

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.