Uterine artery embolization versus myomectomy: a systematic review and meta-analysis.

Introduction: Uterine fibroids are the commonest benign tumors of the reproductive tract in women of childbearing age. They are usually asymptomatic but can cause menorrhagia. Treatments include myomectomy and uterine artery embolization (UAE). The latter is a relatively new procedure, therefore of special interest. Objectives: We conducted a systematic review and meta-analysis of all published studies to provide a comprehensive outlook on the effectiveness of UAE by comparing its outcomes to those of myomectomy. Electronic databases (PubMed and Cochrane Central) were systematically searched from January 2000 to March 2022 for published randomized control trials, observational studies, and meta-analyses that compared UAE to myomectomy for at least one of the pre-specified outcomes, namely re-intervention rates, length of hospital stay, and complications. Methods: We shortlisted nine studies for the final analysis. For continuous outcomes, results from random-effects meta-analysis were presented as mean differences (MDs) and corresponding 95% confidence intervals (CIs). Risk ratios (RRs) for dichotomous outcomes were pooled using a random-effects model. Results: The final analysis consisted of nine studies. Factors like re-intervention, hospitalization, and complications, each with its unique follow-up duration were assessed. Pooled analysis demonstrated significant results for greater re-intervention rates with UAE as compared to myomectomy (RR: 2.16, 95% CI: (1.27-3.66), p-value 0.004, heterogeneity I2 = 85%). UAE holds a greater but statistically insignificant risk for major complications (RR: 0.62, 95% CI: (0.29-1.33), p-value 0.22, heterogeneity I2 = 0%) and myomectomy shows a statistically insignificant greater risk for minor complications (RR: 1.72, 95% CI: (0.92-3.22), p-value 0.09, heterogeneity I2 = 0%). UAE had a shorter but statistically insignificant duration of hospital stay (MD: -1.12, 95% CI: (-2.50 to 0.27), p-value 0.11, heterogeneity I2 = 96%) (p-value for subgroup differences = 0.005). Conclusion: Our meta-analysis of approximately 196,595 patients demonstrates that myomectomy results in a significant reduction in re-intervention rate compared to UAE.

1,3-di-4-piperidylpropane derivatives as potential acetyl cholinesterase antagonists: Molecular docking, synthesis, and biological evaluation.

Acetylcholine esterase (AChE) is a key biological target responsible for the management of cholinergic transmission, and its inhibitors are used for the therapy of Alzheimer's disease. In the present study, a small library of molecules with 1,3-di-4-piperidylpropane nucleus were docked on AChE. The selected compounds were synthesized and evaluated for their enzyme inhibition. P25 and P17 expressed significantly higher AChE inhibition than standards with IC50 values of 0.591µM and 0.625µM, respectively. Binding mode of derivatives in the active site of AChE revealed dual binding of molecules in peripheral anionic site (PAS) and catalytic anionic site (CAS) of enzyme cavity.

Which is the best antibiotic prophylaxis protocol to prevent early implant failures?

Selection criteria The inclusion criteria of this systematic review were patients undergoing dental implant placement. Only randomised clinical trials (RCTs) that compared placebo, no antibiotic and/or any type of antibiotics, administered pre-operatively, intra-operatively, post-operatively or combinations of these, at any dose and for any duration were considered eligible. Included RCTs were required to have a follow up period of at least three months with at least 20 patients per treatment arm. No restrictions on date of publication or language were applied.Key study factor Four electronic databases (MEDLINE, SCOPUS, CENTRAL and Web of Knowledge) in addition to six related journals (Journal of Clinical Periodontology, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, Journal of Periodontology, European Journal of Oral Implantology, International Journal of Oral & Maxillofacial Implants) were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through hand-searching of reference lists, and through grey literature databases. Two independent reviewers screened the titles and abstracts . Data extraction and risk of bias assessment was performed simultaneously by two reviewers independently and in duplicate using the Cochrane tool for risk of bias assessment. A Network Meta-analysis (NMA) was conducted by integrating direct and indirect comparisons and the probability that each protocol was optimal was estimated. Subgroup and sensitivity analyses were planned to test the effect of risk of bias and of different variables on the results, but were not conducted due to the limited number of included studies.Main outcome measure Outcomes analysed were adverse events and early implant failures, defined as removal of mobile or stable implants with progressive marginal bone loss or infection in the first year after placement.Main results A total of 2248 RCTs were identified after removing duplicates, nine of which were finally included. Different protocols of antibiotic prophylaxis were compared with a total number of 1,693 participants. Seven of the included trials compared the use of one or more protocols of antibiotic prophylaxis with no prophylaxis or prophylaxis with a placebo, and two trials compared the use of different protocols, without the use of a no prophylaxis/placebo group. Amoxicillin was the only type used in all studies. Doses and timing varied among studies, although most of them used a single dose taken just before the implant placement. For the investigated outcomes, two trials were considered at low risk of bias and seven at high risk of bias.All protocols were more effective in reducing implant failures compared to placebo/no antibiotic (mean OR 0.08 to 0.45). Meta-analysis of direct comparison was only possible for the four trials comparing 2 g amoxicillin one hour preoperatively (B) to no antibiotic or placebo (A), indicating B as more effective (pulled OR = 0.40; 95% CI: 0.19-0.88; heterogeneity chi-squared 1.40, P = 0.706). These results were consistent with NMA effect estimates (mean OR = 0.45; 95% CI: 0.0210.93). A single dose of 3 g of amoxicillin administered one hour pre-operatively (C) was statistically more effective in reducing implant failures if compared to no prophylaxis/placebo (OR = 0.41, 95% CI = 0.180.91) and was considered as the most effective protocol. The single dose of 2 g of amoxicillin administered one hour pre-operatively was less effective than protocol C. Adverse events could not be studied in a meta-analysis due to an insufficient number of trials reporting it.Conlusions Implant patients are likely to benefit from antibiotis being administered one hour preoperatively in a dose of 3 g orally. The use of post-operative antibiotics does not seem, however, to be justified.

Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: A multicenter pilot intervention study.

OBJECTIVE: To measure the impact of an antimicrobial stewardship (AMS) program on the use of antibiotics for surgical prophylaxis at acute care hospitals in Egypt. METHODS: This was a before-and-after intervention study conducted in 5 tertiary, acute-care surgical hospitals. The baseline, intervention, and follow-up periods were 3, 6, and 3 months, respectively. The impact of the intervention was measured by preintervention and postintervention surveys for surgical patients with clean and clean-contaminated wounds. Information was collected on demographic characteristics and antibiotic use. The intervention focused mainly on educating surgical staff on the optimal timing and duration of antibiotics used for surgical prophylaxis. Only 3 hospitals identified a surgeon to audit antibiotic surgical prescriptions. The primary outcome measures were the percentages of surgical patients receiving optimal timing and duration of surgical prophylaxis. RESULTS: Data were collected for 745 patients before the intervention and for 558 patients after the intervention. The optimal timing of the first dose improved significantly in 3 hospitals, increasing from 6.7% to 38.7% (P < .01), from 2.6% to 15.2% (P < .01), and from 0% to 11% (P < .01). All hospitals showed a significant rise in the optimal duration of surgical prophylaxis, with an overall increase of 3%-28% (P < .01). Days of therapy per 1000 patient-days were decreased significantly in hospitals A, B, C, and D, with no change in hospital E. CONCLUSIONS: An AMS program focusing on education supported by auditing and feedback can have a significant impact on optimizing antibiotic use in surgical prophylaxis practices.