Efficacy and safety of stem cell transplantation for multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Multiple sclerosis (MS) is a common autoimmune neurological disease affecting patients' motor, sensory, and visual performance. Stem Cell Transplantation (SCT) is a medical intervention where a patient is infused with healthy stem cells with the purpose of resetting their immune system. SCT shows remyelinating and immunomodulatory functions in MS patients, representing a potential therapeutic option. We conducted this systematic review and meta-analysis that included randomized control trials (RCTs) of SCT in MS patients to investigate its clinical efficacy and safety, excluding observational and non-English studies. After systematically searching PubMed, Web of Science, Scopus, and Cochrane Library until January 7, 2024, nine RCTs, including 422 patients, were eligible. We assessed the risk of bias (ROB) in these RCTs using Cochrane ROB Tool 1. Data were synthesized using Review Manager version 5.4 and OpenMeta Analyst software. We also conducted subgroup and sensitivity analyses. SCT significantly improved patients expanded disability status scale after 2 months (N = 39, MD = - 0.57, 95% CI [- 1.08, - 0.06], p = 0.03). SCT also reduced brain lesion volume (N = 136, MD = - 7.05, 95% CI [- 10.69, - 3.4], p = 0.0002). The effect on EDSS at 6 and 12 months, timed 25-foot walk (T25-FW), and brain lesions number was nonsignificant. Significant adverse events (AEs) included local reactions at MSCs infusion site (N = 25, RR = 2.55, 95% CI [1.08, 6.03], p = 0.034) and hematological disorders in patients received immunosuppression and autologous hematopoietic SCT (AHSCT) (N = 16, RR = 2.33, 95% CI [1.23, 4.39], p = 0.009). SCT can improve the disability of MS patients and reduce their brain lesion volume. The transplantation was generally safe and tolerated, with no mortality or significant serious AEs, except for infusion site reactions after mesenchymal SCT and hematological AEs after AHSCT. However, generalizing our results is limited by the sparse number of RCTs conducted on AHSCT. Our protocol was registered on PROSPERO with a registration number: CRD42022324141.

Comparative evaluation of nasolabial flap and buccal fat pad flap in the surgical management of oral submucous fibrosis: a systematic review and meta-analysis.

PURPOSE: Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting any part of the oral cavity and is prevalent in Southeast Asia and the Indian subcontinent. The aim of this study is to compare the efficacy of buccal fat pad flap with the nasolabial flap in the management of OSMF. METHODS: We systematically compared two commonly used constructive techniques in the management of OSMF: the buccal pad of fat flap and the nasolabial flap. We performed a comprehensive search in four databases for all articles published between 1982 and November 2021. We assessed the risk of bias using the Cochrane Handbook and Newcastle-Ottawa Scale. We used the mean difference (MD) for pooling the data with 95% confidence intervals (CIs) and evaluated the heterogeneity between pooled studies using χ2 and I2 tests. RESULTS: Out of 917 studies, six were included in this review. The meta-analysis significantly favored conventional nasolabial flap over buccal fat pad flap in improving the maximal mouth opening (MD, - 2.52; 95% CI, - 4.44 to - 0.60; P = 0.01; I2 = 0%) after OSMF reconstructive surgery. Conversely, when it comes to esthetic outcomes, these studies favored buccal fat pad flap. CONCLUSION: Our meta-analysis found that nasolabial flap was better than buccal fat pad flap in terms of mouth opening restoration after OSMF reconstructive surgery. Also, the included studies found better results, favoring nasolabial flap over buccal fat pad flap in terms of oral commissural width restoration. Also, these studies reported better outcomes in terms of esthetics, favoring buccal fat pad flap. Further studies with larger sample sizes and different populations/races are needed to confirm our findings.

Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction: A network meta-analysis of randomized clinical trials.

BACKGROUND: The aim of this network meta-analysis was to assess the comparative effects of different dexamethasone (DXM) routes and doses on reducing postoperative sequelae (pain, swelling, trismus) after surgical extraction of impacted mandibular third molars. METHODS: Five databases were searched on September 22, 2021, for randomized controlled trials. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Study heterogeneity, publication bias, and quality of evidence were investigated. Network meta-analyses were conducted (P < .05), and the P-score was used to rank comparisons of DXM doses and routes. RESULTS: Thirty-four eligible studies were included. Eight studies had low ROB, 21 had some concerns, and 5 had high ROB. The certainty of evidence evaluated by the Confidence in Network Meta-Analysis tool indicated low to very low certainty in most comparisons. The results showed that most DXM route and dose combinations were superior to a placebo in reducing the postoperative sequelae 1 day after surgical extraction. The results also showed that a 4-mg DXM submucosal injection substantially reduces pain 3 days after extraction compared with a 4-mg twin-mix or 8-mg intramuscular injection. Overall, it appears that 4 mg DXM submucosal injection or admixed with local anesthetic is effective in reducing postoperative sequelae after surgical extraction. CONCLUSIONS: Within the limitations of this study, the administration of DXM appears to be effective in reducing the postoperative sequelae, especially in the submucosal route. However, no noteworthy differences were found between the investigated DXM route and dose comparisons. PRACTICAL IMPLICATIONS: Submucosal DXM injection effectively reduce postoperative sequelae of third-molar extractions.

The Association of Dental Pulp Stones to Cardiovascular and Renal Diseases: A Systematic Review and Meta-Analysis.

BACKGROUND: Pulp stone (PS) is a dystrophic calcification in the tooth's pulp chamber and was suggested in the literature to be associated with other calcifications in the body. This study aimed to investigate the association of PS to cardiovascular diseases (CVD) and renal stones (RS). METHODS: Three databases were searched until June 2021 in addition to manual searching of Google Scholar and grey literature. Original studies were only included and critically appraised using an adapted version of the Newcastle-Ottawa scale. The odds ratio (OR) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to investigate the association of PS with CVD and or RS (P value ˂ .05). RESULTS: The database search identified 4933 studies, and 19 studies were finally included. The risk of bias was low in 13 studies, moderate in 4 studies, and high in 2 studies. The meta-analysis of the moderate and low risk of bias studies revealed a significant association between PS and CVD (OR, 3.35; 95% CI, 1.91-5.89; P < .001, I2 = 65%), but no association was found between PS and RS. The results also revealed an association between PS and CVD in patients older than 40 (OR, 8.78; 95% CI, 3.64-21.17; P < .001, I2 = 0%). CONCLUSIONS: The current study results showed an association between PS and CVD, but no association was found between PS and RS. PS in patients older than 40 years, compared with younger patients (<40 years), was associated with CVD.

The Efficacy and Safety of Pridopidine on Treatment of Patients with Huntington's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Pridopidine is a novel drug that helps stabilize psychomotor function in patients with Huntington's disease (HD) by activating the cortical glutamate pathway. It promises to achieve the unmet needs of current therapies of HD without worsening other symptoms. OBJECTIVE: To review the literature discussing the efficacy of pridopidine in alleviating motor symptoms and its safety in patients with HD. METHODS: We searched Scopus, Web of Science, the Cochrane Library, Wiley, and PubMed for randomized controlled trials (RCTs) of pridopidine on HD. Data from eligible studies were extracted and pooled as mean differences for efficacy and risk ratios (RRs) for safety using RevMan software version 5.3. RESULTS: A total of 4 relevant RCTs with 1130 patients were selected (816 in the pridopidine group and 314 in the placebo group). The pooled effect size favored pridopidine over placebo insignificantly in the Unified Huntington's Disease Rating Scale Total Motor Score (mean difference [MD], -0.93; 95% confidence interval [CI], -2.01 to 0.14; P = 0.09), whereas the effect size of 3 studies significantly favored pridopidine over placebo in the Unified Huntington's Disease Rating Scale Modified Motor Score (MD, -0.81; 95% CI, -1.48 to -0.13; P = 0.02). Pridopidine generally was well tolerated. None of the adverse effects were considerably higher in the case of pridopidine compared with placebo in overall adverse events (RR, 1.03; 95% CI, 0.94-1.13; P = 0.49) and serious adverse events (RR, 1.62; 95% CI, 0.88-2.99; P = 0.12). CONCLUSION: The effects of pridopidine on motor functions (especially voluntary movements) in patients with HD are encouraging and provide a good safety profile that motivates further clinical trials on patients to confirm its effectiveness and safety.

Automated versus manual oxygen control in preterm infants receiving respiratory support: a systematic review and meta-analysis.

BACKGROUND: Ventilated preterm infants are exposed to deviations from the intended arterial oxygen saturation range. Therefore, an automated control system was developed to rapidly modulate the fraction of inspired oxygen. The aim of this review is to compare the efficacy and safety of automated versus manual oxygen delivery control. METHODS: In December 2020, we systematically searched four electronic databases; PubMed, Cochrane Library, Scopus, and Web of Science for eligible randomized controlled trials. We extracted and pooled data as mean difference and 95% confidence interval in an inverse variance method using RevMan software. RESULTS: Thirteen trials were included in this systematic review and meta-analysis, enrolling 343 preterm infants on respiratory support. Automated oxygen control increased the time spent within the target arterial oxygen saturation range of 85-96% (MD = 8.96; 95% CI [6.26, 11.67], p<.00001), and 90-95% (MD = 18.25; 95% CI [4.58, 31.65], p = .008). In addition, it reduced the time of hypoxia (<80%); (MD = -1.24; 95% CI [-2.05, -0.43], p = .003), (MD = -0.82; 95% CI [-1.23, -0.41], p<.0001) with predetermined ranges of 85-96% and 90-95%, respectively. Automated control system reduced as well the time of hyperoxia (>98%) (MD = -0.99; 95% CI [-1.74, -0.25], p = .009) at intended range of 90-95%, and number of manual inspired oxygen fraction adjustments (MD = -2.82; 95% CI [-4.56, -1.08], p = .002). CONCLUSIONS: Automated oxygen delivery is rapid and effective in controlling infants' oxygen saturation. It can be used to reduce the load over the nurses, but not to substitute the clinical supervision. Further long-term trials of large-scale are required to evaluate the prolonged clinical outcomes.