Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis.

This study compares the effectiveness of pharmacological treatments to develop guidelines for the management of acute pain after tooth extraction. We searched Medline, EMBASE, CENTRAL, and US Clinical Trials registry on November 21, 2020. We included randomized clinical trials (RCTs) of participants undergoing dental extractions comparing 10 interventions, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations to placebo. After duplicate screening and data abstraction, we conducted a frequentist network meta-analysis for each outcome at 6 h (i.e., pain relief, total pain relief [TOTPAR], summed pain intensity difference [SPID], global efficacy rating, rescue analgesia, and adverse effects). We assessed the risk of bias using a modified Cochrane RoB 2.0 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We implemented the analyses in RStudio version 3.5.3 and classified interventions from most to least beneficial or harmful. We included 82 RCTs. Fifty-six RCTs enrolling 9,095 participants found moderate- and high-certainty evidence that ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg (mean difference compared to placebo [MDp], 1.68; 95% confidence interval [CI], 1.06-2.31), acetaminophen 650 mg plus oxycodone 10 mg (MDp, 1.19; 95% CI, 0.85-1.54), ibuprofen 400 mg (MDp, 1.31; 95% CI, 1.17-1.45), and naproxen 400-440 mg (MDp, 1.44; 95% CI, 1.07-1.80) were most effective for pain relief on a 0 to 4 scale. Oxycodone 5 mg, codeine 60 mg, and tramadol 37.5 mg plus acetaminophen 325 mg were no better than placebo. The results for TOTPAR, SPID, global efficacy rating, and rescue analgesia were similar. Based on low- and very low-certainty evidence, most interventions were classified as no more harmful than placebo for most adverse effects. Based on moderate- and high-certainty evidence, NSAIDs with or without acetaminophen result in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo.

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2016 revision

BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines. METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America.

OBJECTIVE: To evaluate the prevalence of and the associated factors for metabolic syndrome (MS) among Latin American HIV-infected patients receiving antiretroviral therapy (ART) using baseline data from the RAPID II study. METHODS: A longitudinal study to evaluate the metabolic profile, cardiovascular disease (CVD) risk and associated treatment practices to reduce this risk has been conducted in seven Latin American countries (the RAPID II study). Adult HIV patients with at least six months of RT were enrolled. MS was defined following ATP-III criteria. Demographic and anthropometric data, serum biochemical and clinical parameters were compared in patients with and without MS using bivariate and multivariate analysis. RESULTS: A total of 4,010 patients were enrolled, 2,963 (74%) were males. Mean age (SD) was 41.9 (10.0) years. The prevalence of MS was 20.2%. Females had higher prevalence of MS than males (22.7% vs. 19.4%, p = 0.02). MS was driven by high triglycerides, low HDL-cholesterol and high blood pressure (HBP). Patients with MS had higher 10 year CVD risk: 22.2% vs. 7.4%, p < 0.001. Age (OR: 1.05 per year), female gender (OR: 1.29), family history of CVD (OR: 1.28), CD4 cell count (OR: 1.09 per 100 cell increase), and protease inhibitor based-ART (OR: 1.33) correlated with MS in the multivariate analysis. CONCLUSIONS: Prevalence of MS in this setting was similar to that reported from developed countries. MS was driven by high triglycerides, low-HDL and HBP, and it was associated with higher risk of CVD. Traditional risk factors, female gender, immune reconstitution, and protease inhibitor based-ART correlated with MS.

Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America

OBJECTIVE: To evaluate the prevalence of and the associated factors for metabolic syndrome (MS) among Latin American HIV-infected patients receiving antiretroviral therapy (ART) using baseline data from the RAPID II study. METHODS: A longitudinal study to evaluate the metabolic profile, cardiovascular disease (CVD) risk and associated treatment practices to reduce this risk has been conducted in seven Latin American countries (the RAPID II study). Adult HIV patients with at least six months of RT were enrolled. MS was defined following ATP-III criteria. Demographic and anthropometric data, serum biochemical and clinical parameters were compared in patients with and without MS using bivariate and multivariate analysis. RESULTS: A total of 4,010 patients were enrolled, 2,963 (74 percent) were males. Mean age (SD) was 41.9 (10.0) years. The prevalence of MS was 20.2 percent. Females had higher prevalence of MS than males (22.7 percent vs. 19.4 percent, p = 0.02). MS was driven by high triglycerides, low HDL-cholesterol and high blood pressure (HBP). Patients with MS had higher 10year CVD risk: 22.2 percent vs. 7.4 percent, p < 0.001. Age (OR: 1.05 per year), female gender (OR: 1.29), family history of CVD (OR: 1.28), CD4 cell count (OR: 1.09 per 100 cell increase), and protease inhibitor based-ART (OR: 1.33) correlated with MS in the multivariate analysis. CONCLUSIONS: Prevalence of MS in this setting was similar to that reported from developed countries. MS was driven by high triglycerides, low-HDL and HBP, and it was associated with higher risk of CVD. Traditional risk factors, female gender, immune reconstitution, and protease inhibitor based-ART correlated with MS.

Frecuencia de cryptosporidium en pacientes adultos con síndrome de inmunodeficiencia adquirida (sida) y diarrea: Caracas Venezuela 1997/1999 / Cryptosporidium frequency in adult patients with adquired immunodeficiency syndrome (aids) and diarrhea: Caracas Venezuela 1997/1999

Se reporta la frecuencia de Cryptosporidium como enteroparásito importante productor de diarreas, en una población adulta inmunocomprometida por la infección con el virus de la inmunodefiencia humana (VIH/SIDA). Se realiza estudio prospectivo durante 30 meses (1997/1999) en Caracas, Venezuela. Se estudiaron 124 muestras de heces mediante la coloración de Kinyoun, buscando estructuras ácido-alcohol-resistentes, compatibles con ooquistes de Cryptosporidium. De los pacientes incluidos, 11,80 por ciento eran mujeres y 88,20 por ciento hombres; la mayor concentración de pacientes (77,30 por ciento) estuvo en los grupos de edad entre 25 y 44 años. El 58,40 por ciento de los pacientes resultaron con heces positivas, y las muestras positivas, para la presencia de ooquistes de Cryptosporidium fue del 60,50 por ciento. La diferencia entre el número de pacientes y el número de muestras de heces estudiadas se debe a que algunos de los pacientes aportaron más de una muestra, por presentar nuevos episodios diarréicos. Se identificaron otros enteropatógenos asociados a Cryptosporidium en el 16,90 por ciento de los pacientes. Durante el período del estudio se registraron 32 pacientes fallecidos (31,70 por ciento). Al comparar nuestros resultados con los de otros grupos, concluímos que se corresponden con los hallazgos reportados en trabajos realizados en países subdesarrollados, donde las condiciones sanitarias son deficientes y los pacientes con infección por VIH/SIDA no reciben tratamiento anti-retroviral efectivo, como ocurría en Venezuela para el período en que se desarrolló el estudio

In vitro susceptibility of 137 Candida sp. isolates from HIV positive patients to several antifungal drugs.

Oropharyngeal candidiasis caused by various species of Candida is one of the most common infections in HIV seropositive or AIDS patients. Drug resistance among these yeasts is an increasing problem. We studied the frequency of resistance profile to fluconazole, itraconazole, ketoconazole, amphotericin B and terbinafine of 137 isolates of Candida sp. From HIV positive or AIDS patients with oropharyngeal candidiasis at Instituto de Inmunología, U.C.V. and the Hospital "Jose Ignacio Baldó", Caracas Venezuela, using the well diffusion susceptibility test (Magaldi et al.). We found that nearly 10% of C. albicans isolates were primarily fluconazole resistant, 45% of C. albicans isolates from patients with previous treatment were resistant to fluconazole, of which 93% showed cross-resistance to itraconazole, and even about 30% of C. tropicalis (n = 13) were resistant to fluconazole and/or itraconazole. To this respect, several recent reports have been described antifungal cross-resistance among azoles. Therefore, we consider that C. tropicalis should be added to the growing list of yeast in which antifungal drug resistance is common. This report could be useful for therapeutic aspect in AIDS patients with oral candidiasis.

Erysipelas and tinea pedis.

During a 2-year period 30 adults were selected out of a group of patients diagnosed with erysipelas, who, except for tinea pedis, were apparently otherwise healthy patients. Clinical and epidemiological studies were performed to establish how tinea pedis and erysipelas are related. Thirteen of 30 patients with a diagnosis of erysipelas were found to have tinea pedis due to Trichophyton mentagrophytes and Trichophyton rubrum. In seven of the patients (23%) tinea pedis was found to be the unique predisposing factor for erysipelas. Tinea pedis may be a risk factor for streptococcal infections such as erysipelas, mainly in tropical countries, where tinea pedis is a frequent disease.

Resistencia de pseudomonas aeruginosa a la gentamicina, tobramicina y amikacina en Venezuela / Resistance of pseudomonas aeruginosa at the gentamicen, tobramycin and amikacina in Venezuela

Se realizó una revisión de la resistencia de 20.030 cepas de pseudomonas aeruginosa a la gentamicina (GM), tobramicina (NN) y amikacina (AN), mediante el método de difusión en agar, siguiendo las normas de eficiencia de la NCCLS, obtenidas del Proyecto de Vigilancia de la Resistencia a los Antimicrobianos en Venezuela durante los años 1988-1998. En 1988, el menor porcentaje de resistencia correspondió AN (19 por ciento), seguido de NN (23 por ciento) y GM (27 por ciento). En 1992 se aprecia una disminución en los porcentajes de resistencia, siendo el más bajo para NN (12 por ciento). Para los años 1996 y 1997, se refleja un aumento en los porcentajes de resistencia y para el año 1998 éstos vuelven a disminuir, manteniendo los porcentajes de resistencia similares a los del año 1988. La elevada resistencia de pseudomonas aeruginosa a estos aminoglicosidos es parecida a la encontrada en estudios realizados en otros países

Diagnóstico de pneumocystis carinii: estudio comparativo entre la inmunofluorescencia directa y la coloración histológica de gomori-grocott / Pneumocystis carinii diagnostic: comparative study between directed immunofluorescence and histological staining of gomori-grocott

Se compararon las técnicas de inmunofluorescencia directa (IFD) y de Gomori-Grocott (G-G) para el diagnóstico de pneumocystis carinii en pacientes inmunocomprometidos con infección respiratoria baja. Se analizaron 30 muestras de esputo; a cada muestra se le practicó IFD y G-G. Se obtuvo el 12/30 (40 por ciento) de positividad, correspondiéndole 9 (30 por ciento) a la IFD, 2 (7 por ciento) al G-G y 1 (3 por ciento) para ambas. Este resultado fue estadísticamente significativo (p<0,05), concluyéndose que la IFD es la prueba más idónea para diagnósticar P. carinii en muestras de esputo