Triple Antibiotic Paste Composition and use in Root Canal Treatment

alexandrossfakianakis shared this article with you from Inoreader Triple Antibiotic Paste Composition and use in Root Canal Treatment via Junior Dentist Triple Antibiotic Paste is a type of Intra Canal Medicament which is used in Endodontic Treatment or Root canal Treatment to kill the micro organisms in the periapical region of an infected Root Canal. Triple antibiotic Paste or (TAP) consists of three medicines - Metronidazole, Ciprofloxacin and Minocycline. This combinati on of medicines have been found to be the best regimen to eliminate root canal pathogens. The most common microorganisms found in infected Root Canals are Peptostreptococcus spp, Actinomyces, Staphylococcus Salivarius, S. Sanguis, P. Endodontalis. The micro organisms most commonly infecting Failed or Re-infected root canals are "Enterococcus Faecalis". Triple Antibiotic paste uses: It is used as an Intracanal Medicament and in Regenerative Endodontics (Pulp Capping). It has been found to be very effective against E Feacalis which is a very stubborn bacteria found in Re-infected root canals. Composition of Triple antibiotic Paste: TAP is a combination of three antibiotics - Minocycline + Ciprofloxacin + Metronidazole. A combination of three antibiotics is required as any Infection of the Root Canal consists of multiple microorganisms of different types and to treat all these bacteria any single Antibiotic is sometimes not enough. A Combination of Antibiotics usually helps in treating the diverse flora of the Root Canal. How is Triple Antibiotics Paste prepared: Hoshino et al. first proposed the combination of TPA and mentioned that the three Antibiotics - Metronidazole (500 mg) 30% + Minocycline (100mg) 30% + Ciprofloxacin (200mg) 30% + Propylene Glycol paste 10% should be mixed in a ratio of 1:1:1. These three components should have a carrier Glycol and macrogol ointment in a ratio of 1:1. The combination was later modified by making changes in the Ratios by Takushige et al. who proposed that the ratios should be Metronidazole + Minocycline + Ciprofloxacin - 3:3:1. A new Intra Canal Medicament known as MTAD was found to be useful in eliminating Enterococcus Faecalis strains  in a study published by Newberry et al. The MTAD is a combination of 3% Doxycycline, Citric Acid and a detergent polysorbate 80. MTAD should be used as an irrigation fluid inside the canals. MTAD should be used as the final irrigation rinse after using 1.3% Naocl and Saline. This has been found to remove the smear layer without altering the structure of dentinal tubules. View on Web

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A Nationwide Evaluation of Bevacizumab-based Treatments in Paediatric Low-Grade Glioma in the UK: Safety. Efficacy, Visual Morbidity and Outcomes

alexandrossfakianakis shared this article with you from Inoreader A Nationwide Evaluation of Bevacizumab-based Treatments in Paediatric Low-Grade Glioma in the UK: Safety. Efficacy, Visual Morbidity and Outcomes via Neuro-Oncology Advance Access Abstract Background Bevacizumab is increasingly used in children with Paediatric Low-Grade Glioma (PLGG) despite limited evidence. A nationwide UK service evaluation was conducted to provide larger cohort 'real life' safety and efficacy data including functional visual outcomes. Methods Children receiving Bevacizumab-based treatments (BBT) for PLGG (2009-2020) from 11 centres were included. Standardised neuro-radiological (RANO-LGG) and visual (logMAR visual acuity) criteria were used to assess clinical-radiological correlation, survival outcomes and multivariate prognostic analysis. Results Eighty-eight children with PLGG received BBT either as 3 rd line with Irinotecan (85%) or alongside 1 st/2 nd line chemotherapies (15%). Toxicity was limited and minimal. Partial response (PR, 40%), stable disease (SD, 49%), and progressive disease (PD, 11%) were seen during BBT. However, 65% progressed at 8 months (median) from BBT cessation, leading to a radiology-based 3yr-progression-free survival (PFS) of 29%. Diencephalic syndrome (p= 0.03) was associated with adverse PFS. Pre-existing visual morbidity included unilateral (25%) or bilateral (11%) blindness. Improvement (29%) or stabilisation (49%) of visual acuity were achieved, more often in patients' best eyes. Vision deteriorated during BBT in 14 (22%), with 3-year visual-PFS of 53%; more often in patients' worst eyes. A superior visual outcome (p=0.023) was seen in Neurofibromatosis type 1-associated Optic Pathway Glioma (OPG). Concordance between visual and radiological responses was 36%; optimised to 48% using only best eye responses. Conclusions BBTs provide effective short-term PLGG control and delay further progression, with a better sustained visual (best >worst eye) than radiological response. Further research could optimise the role of BBTs towards a potentially sight-saving strategy in OPG. View on Web

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The Role of Fluorescent Angiography in Free Flap Reconstruction of the Head and Neck

alexandrossfakianakis shared this article with you from Inoreader The Role of Fluorescent Angiography in Free Flap Reconstruction of the Head and Neck via The Laryngoscope A retrospective study of the use of fluorescent angiography in free flap reconstruction of the head and neck shows that although the use of this technology in every free tissue transfer is not justifiable, it can guide the clinical course in challenging scenarios. Objectives Highlight the use of fluorescent angiography in free flap reconstruction of the head and neck. Qualify how fluorescent angiography can be selectively added to management paradigms for head and neck free flap reconstruction. Methods Retrospective chart review of 993 free flaps completed from the time the SPY Elite® system first became available at our institution between September 2013, until August 2020. Cases that used the SPY Elite® system were grouped into three broad categories: evaluation during initial flap harvest while still attached to the donor site, evaluation after anastomosis in the head and neck area, and evaluation post-operatively for questionable flap viability. Results The SPY Elite® system was used in 64 cases. Forty flaps were evaluated intraoperatively during initial harvest and before anastomosis to the head and neck area. Of these, 20 had signs of poor perfusion of the entire skin paddle, 12 had large myogenous or skin flaps with questionable perfusion of the distal aspect, and 8 were evaluated for other reasons. In this group the use of SPY Elite® changed the management of the patient in 20 cases (50%). Ten flaps were evaluated intraoperatively after anastomosis to the head and neck to ascertain adequate flow to the entire flap. In this group management was changed in two (20%). Fourteen flaps were evaluated 3–5 days post operatively due to suspected failure of a component. In five cases (36%), the use of SPY Elite® determined management with either trimming or discarding the flap. Conclusion Assessment of flap perfusion via fluorescent angiography during initial flap harvest or when flap compromise is suspected post-operatively can guide decision making in free flap reconstruction of the head and neck and can be added to existing planning and management paradigms. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Effects of calcium hydroxide intracanal medicament on push‐out bond strength of endodontic sealers: A systematic review and meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader Effects of calcium hydroxide intracanal medicament on push‐out bond strength of endodontic sealers: A systematic review and meta‐analysis via Journal of Esthetic and Restorative Dentistry Abstract Objective To investigate the effect of calcium hydroxide intracanal medicament on the push-out bond strength of resin-based and calcium silicate-based endodontic sealers. Methods A comprehensive search of was conducted for all relevant in-vitro studies. All randomized controlled in-vitro studies that evaluated the effect of calcium hydroxide on the push-out bond strength of resin-based or calcium silicate-based endodontic sealers were assessed. The variables of interest were extracted, and the risk of the included studies was evaluated. The standardized mean difference was calculated and the significance level was set at p value <0.05. Results A total of 26 studies were eligible for analysis. There were 45 independent comparison groups and 1009 recruited teeth. The pooled data showed no significant difference in push-out bond strength between calcium hydroxide and control group in the resin-based group (SMD = 0.03; 95% CI = −0.55, 0.60; p = 0.93), and calcium silicate-based group (SMD = 0.02; 95% CI = −0.31, 0.35; p = 0.90). Most of the studies (21 out of 26) were at medium risk of bias and five studies showed a low risk of bias. Conclusion The available evidence suggests that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of the resin- and calcium silicate-based endodontic sealers. Clinical significance The results of this meta-analysis suggest that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of resin-based and calcium silicate-based endodontic sealers. View on Web

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HBV REPLICATION DURING TENOFOVIR THERAPY IS FREQUENT IN HIV/HBV-COINFECTION

alexandrossfakianakis shared this article with you from Inoreader HBV REPLICATION DURING TENOFOVIR THERAPY IS FREQUENT IN HIV/HBV-COINFECTION via Clinical Infectious Diseases Advance Access ABSTRACT In the Swiss HIV Cohort Study, 61/222 (27%) HIV-suppressed persons with chronic hepatitis B virus (HBV) infection had HBV replication after two years on tenofovir, of whom 77% were suppressed thereafter. Self-reported adherence to therapy and HBV viral load at tenofovir initiation were predictors of persistent replication. View on Web

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Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B

alexandrossfakianakis shared this article with you from Inoreader Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B via Journal of Medical Virology Abstract Background/Aims Nucleos(t)ide analogs (NA) cannot completely suppress the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study aimed to identify the risk factors for HCC development in naïve CHB patients treated with current NA. Methods Patients receiving NA (n = 905) were recruited retrospectively from the 17 hospitals of the Japanese Red Cross Liver Study Group. All treatment-naïve patients had been receiving current NA continuously for more than one year until the end of the follow-up. We analyzed the accuracy of predictive risk score using area under receiver operating characteristic curve. Results The albumin–bilirubin (ALBI) score was significantly improved by NA therapy (−0.171 ± 0.396; p < 0.001 at week 48). A total of 72 (8.0%) patients developed HCC over a median follow-up of 6.2 (1.03–15.7) years. An independent predictive factor of HCC development was older age, cirrhosis, lower pl atelet counts at baseline and ALBI score, and alpha-fetoprotein (AFP) at 1 year after NA therapy according to multivariate analysis. The accuracy was assessed using the PAGE-B, mPAGE-B, aMAP, APA-B, and REAL-B scores that included these factors. Discrimination was generally acceptable for these models. aMAP and REAL-B demonstrated high discrimination with 0.866/0.862 and 0.833/0.859 for 3- and 5- years prediction from the status of one year after NA therapy, respectively. Conclusion Baseline age and platelet count, as well as ALBI and AFP one year after NA, were useful for stratifying carcinogenesis risk. The aMAP and REAL-B scores were validated with high accuracy in Japanese CHB patients. This article is protected by copyright. All rights reserved. View on Web

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The association between human papillomavirus and bladder cancer: evidence from meta‐analysis and two‐sample mendelian randomization

alexandrossfakianakis shared this article with you from Inoreader The association between human papillomavirus and bladder cancer: evidence from meta‐analysis and two‐sample mendelian randomization via Journal of Medical Virology Abstract Introduction Bladder cancer (BCa) is the tenth most common type of cancer worldwide, and human papillomavirus (HPV) is the most common sexually transmitted infection. However, the relationship between HPV infection and the risk of BCa is still controversial and inconclusive. Methods This systematic review and meta-analysis were conducted following the PRISMA 2020 reporting guideline. This study searched four bibliographic databases with no language limitation. The databases included PubMed (Medline), EMBASE, Cochrane Library and Web of Science. Studies evaluating the interaction between HPV infection and the risk of BCa from inception through May 21, 2022 were identified and used in this study. This study estimated the overall and type-specific HPV prevalence and 95% confidence intervals (95% CI) using Random Effects (RE) models and Fixed Effects (FE) models. In addition, this study also calculated the pooled odds ratio (pOR) and pooled risk ratio (pRR) with 95% CI to assess the effect of HPV infection on the risk and prognosis of bladder cancer. Two-sample mendelian randomization (MR) study using genetic variants associated with HPV E7 protein as instrumental variables was also conducted. Results This study retrieved 80 articles from the four bibliographic databases. Of the total, 27 were case-control studies, and 53 were cross-sectional studies. The results showed that the prevalence of HPV was 16% (95% CI, 11%–21%) among the BCa patients, most of which were HPV-16 (5.99% [95% CI, 3.03%–9.69%]) and HPV-18 (3.68% [95% CI, 1.72%–6.16%]) subtypes. However, the study found that the prevalence varied by region, detection method, BCa histological type, and sample source. A significantly increased risk of BCa was shown for the positivity of overall HPV (OR, 3.35 [95%CI, 1.75–6.43]), which was also influenced by study region, detection method, histological type and sample source. In addition, the study found that HPV inf ection was significantly associated with the progression of BCa (RR, 1.73 [95%CI, 1.39–2.15]). The two-sample MR analysis found that both HPV 16 and 18 E7 protein exposure increased the risk of BCa (HPV 16 E7 protein: IVW odds ratio [OR] per unit increase in protein level = 1.0004 [95% CI, 1.0002–1.0006]; P=0.0011; HPV 18 E7 protein: IVW odds ratio [OR] per unit increase in protein level = 1.0003 [95% CI, 1.0001–1.0005]; P=0.0089). Conclusion In conclusion, HPV may play a role in bladder carcinogenesis and contribute to a worse prognosis for patients with BCa. Therefore, it is necessary for people, especially men, to get vaccinated for HPV vaccination to prevent bladder cancer. This article is protected by copyright. All rights reserved. View on Web

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Wastewater Surveillance for Infectious Disease: A Systematic Review

alexandrossfakianakis shared this article with you from Inoreader Wastewater Surveillance for Infectious Disease: A Systematic Review via American Journal of Epidemiology - Advance Access Abstract Wastewater surveillance of SARS-CoV-2 has been shown to be a valuable source of information regarding SARS-CoV-2 transmission and COVID-19 cases. Though the method has been used for several decades to track other infectious diseases, there has not been a comprehensive review outlining all of the pathogens that have been surveilled through wastewater. Herein we identify what infectious diseases have been previously studied via wastewater surveillance prior to the COVID-19 pandemic. Infectious diseases and pathogens were identified in 100 studies of wastewater surveillance across 38 countries, as well as themes of how wastewater surveillance and other measures of disease transmission were linked. Twenty-five separate pathogen families were identified in the included studies, with the majority of studies examining pathogens from the family Picornaviridae, including polio and non-polio enteroviruses. Most studies of wastewater surveillance did not li nk what was found in the wastewater to other measures of disease transmission. Among those studies that did, the value reported varied by study. Wastewater surveillance should be considered as a potential tool for many infectious diseases. Wastewater surveillance studies can be improved by incorporating other measures of disease transmission at the population-level including disease incidence and hospitalizations. View on Web

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Association of Neoadjuvant Pembrolizumab for OCSCC With Adverse Events After Surgery

alexandrossfakianakis shared this article with you from Inoreader Association of Neoadjuvant Pembrolizumab for OCSCC With Adverse Events After Surgery via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cohort study evaluates the incidence of postoperativ e adverse events in treatment-naive patients receiving neoadjuvant pembrolizumab for advanced oral cavity cancer when compared with matched controls. View on Web

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Maternal diet during breastfeeding in correlation to calcium and phosphorus concentrations in human milk

alexandrossfakianakis shared this article with you from Inoreader Maternal diet during breastfeeding in correlation to calcium and phosphorus concentrations in human milk via Journal of Human Nutrition and Dietetics Abstract Background The impact of maternal diet on minerals concentration in human milk (HM) remains unclear. The main aim of this study was to investigate the relationship between maternal dietary intake and calcium and phosphorus concentrations in HM. Furthermore, we aimed to evaluate the intake of both minerals by exclusively breastfed infants. Methodology HM samples were obtained from 30 mothers at 6-8 weeks postpartum. Each mother was asked to express pre- and post-feeding milk four times during 24-h period (6.00-12.00, 12.00-18.00, 18.00-24.00, 24.00-6.00). Maternal dietary assessment was based on food frequency questionnaire and 3-day dietary records. Analyzed minerals were determined by inductively coupled plasma mass spectrometer (NexION 300D ICP Mass Spectrometer, Perkin Elmer SCIEX, USA). Results The mean concentrations of calcium and phosphorus in HM samples were 278.7 ± 61.0 mg/L and 137.1 ± 21.9 mg/L, respectively, maintaining 2:1 ratio b y weight. The concentration of both minerals was correlated with each other (r=0.632, p=<0.001). The infants' mean calcium intake was 149.53 ± 36.41 mg/L and for phosphorus it was 74.62 ± 19.41 mg/L. The risk of insufficient intake of calcium was reported in 60% of infants (n=18). Spearman/Pearson correlation coefficients did not reveal any correlations between HM calcium concentration and maternal diet, contrary to HM phosphorus concentration, which was positively correlated with energy (r=0.369, p=0.045), total protein (r=0.464, p=0.01), calcium (r=385, p=0.036), phosphorus (r=501, p=0.005), niacin (p<0.001) and pyridoxine (r=382, 0.037) intake. However, in multivariable analysis we observed that maternal dietary intake of both minerals had positive influence on their concentration in HM. Conclusion Maternal calcium and phosphorus intake influenced concentration of both minerals in HM, however the relationship was rather weak. Additionally, we observed that c alcium intake by most of the exclusively breastfed infants was insufficient to meet the recommended daily intake. This article is protected by copyright. All rights reserved. View on Web

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