Safety and efficacy of beta-3 adrenergic agonists in treating neurogenic lower urinary tract dysfunction: A systematic review and meta-analysis.

PURPOSE: To evaluate efficacy and safety of beta-3 adrenergic agonists in adults with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS: According to a protocol (CRD42022350079), we searched multiple data sources for published and unpublished randomized controlled trials (RCTs) up to 2nd August 2022. Two review authors independently screened studies and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence (CoE). RESULTS: We found data to inform two comparisons: beta-3 adrenergic agonists versus placebo (4 RCTs) and anticholinergics (2 RCTs). Only mirabegron was used for intervention in all included studies. Compared to placebo, beta-3 adrenergic agonists may have a clinically unimportant effect on urinary symptoms score (mean difference [MD] -2.50, 95% confidence interval [CI] -4.78 to -0.22; I²=92%; 2 RCTs; 192 participants; low CoE) based on minimal clinically important difference of 3. We are very uncertain of the effects of beta-3 adrenergic agonists on quality of life (MD 10.86, 95% CI 1.21 to 20.50; I²=41%; 2 RCTs; 98 participants; very low CoE). Beta-3 adrenergic agonists may result in little to no difference in major adverse events (cardiovascular adverse events) (risk ratio 0.57, 95% CI 0.14 to 2.37; I²=0%; 4 RCTs; 310 participants; low CoE). Compared to anticholinergics, no study reported urinary symptom scores and quality of life. There were no major adverse events (cardiovascular adverse events) in either study group (1 study; 60 participants; very low CoE). CONCLUSIONS: Compared to placebo, beta-3 adrenergic agonists may have similar effects on urinary symptom scores and major adverse events. There were uncertainties about their effects on quality of life. Compared to anticholinergics, we are either very uncertain or have no evidence about urinary symptom scores, quality of life, and major adverse events.

Glass Microneedles: A Case Study for Regulatory Approval Using a Quality by Design Approach.

In this paper, a roadmap is provided for the regulatory approval of one of the exciting and dynamic drug delivery fields, microneedles, by using a Quality by Design approach to pharmaceutical product development. In this regard, a quality target product profile (QTPP) and the critical quality attributes (CQA) of microneedles are identified. A case study of the recently patented method of fabricating glass microneedles entirely from a therapeutic agent, thus eliminating the requirement for additional excipients is discussed. The glass microneedle, ArrayPatch, is a propriety wearable device with platform potential consisting of an array of sharp, but painless, dissolvable microneedles manufactured with 100% drug. The microneedles penetrate the skin on application and dissolve to deliver a locally effective dose. The in vitro characterization of the microneedle CQAs under WHO-guided stability conditions will be described to assess the manufacturing readiness of ArrayPatch.  A live technical video is also provided, presenting a unique procedure of jugular vein cannulation through the ear vein of a pig animal model to study the in vivo pharmacokinetics of ArrayPatch compared to standard-of-care marketed products.

A Cross-Sectional Study of Temporomandibular Disorders Among Postgraduate Students.

PURPOSE: The aim of this study is to investigate the prevalence of (TMD) as well as their potential risk factors among postgraduate students. MATERIALS AND METHODS: In this cross-sectional and correlation study, 1255 postgraduate students from different universities were recruited to answer Fonseca's anamnestic index (FAI) in addition to collected demographic data and relevant dental history. Fonseca's anamnestic index (FAI) was used to classify their TMD severity. Five hundred ninety-three participants, that had previous clinical/radiographic TMD reports, out of 1255 were included. Chi-square and fisher's exact tests investigated the relation between each predictor and TMD at P≤.05. A logistic binary regression analysis examined the model fit using -2Log likelihood and Pseudo R2 tests at P≤.05. RESULTS: Based on previous clinical/radiographic reports and on FAI, 73.4% of the participants had TMD, of which 57% had mild dysfunction, followed by moderate (31.7%), and severe (11.3%). There was a statistically significant association between sex, depression, lip/object biting and clenching with TMD (P <.001), where females were 2.302 times more likely to develop TMD than males. The combination of lip biting and clenching in a female dramatically increases the risk of TMD (-2 Log Likelihood =385.7, P<.001 and a Cox and Snell value = 0.315 and a Nagelkerke value = 0.395). CONCLUSION: TMD seems to be highly prevalent among postgraduate students in Egypt, whereby female postgraduate students who bite their lips and/or grind their teeth are particularly highly prone to the condition. Object biting and depression could be also considered as risk factors.

INTRAORAL SCANNING AND CONVENTIONAL IMPRESSION MAY HAVE SIMILAR TIME EFFICIENCY FOR COMPLETE COVERAGE CROWNS AND THREE-UNIT FIXED TOOTH-SUPPORTED PROSTHESES.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Bandiaky ON, Le Bars P, Gaudin A, Hardouin JB, Cheraud-Carpentier M, Mbodj EB, Soueidan A. Comparative assessment of complete-coverage, fixed tooth-supported prostheses fabricated from digital scans or conventional impressions: A systematic review and meta-analysis. J Prosthet Dent. 2022 Jan;127(1):71-79. doi: 10.1016/j.prosdent.2020.09.017. Epub 2020 Nov 2. PMID: 33,143,901. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Soft Tissue Dehiscence Associated with a Titanium Patient-Specific Implant: A Prosthetic Solution as an Alternative to Soft Tissue Grafting.

Patients. This clinical report describes the detailed prosthodontic management of a 23-year-old male patient suffering from soft tissue complication following the placement of a 3d-printed titanium patient-specific implant. This implant was implemented simultaneously with the resection of a calcifying cystic odontogenic tumor related to the maxillary arch. Later, soft tissue dehiscence and implant exposure were encountered with subsequent food impaction, infection, and pus discharge. The treatment plan was to fabricate removable partial denture. The prosthesis was planned to be retained by bar and clip attachment on the patient-specific implant side, while on the other side, the removable prosthesis was allowed to engage two abutments with an embrasure clasp assembly in addition to covering the palatal tissues to offer protection for the soft tissue dehiscence against food impaction. Discussion. Soft tissue dehiscence and implant exposure are among the frequently reported complications associated with the patient-specific implant. The resulting infection complicates the prognosis of the implemented implant and necessitates, in some occasions, its removal. The selection of the removable prosthesis to cover soft tissue dehiscence was a conservative alternative to the implant removal as it protects the exposed titanium surface from food impaction while maintaining the implant functionality. Conclusion. Three-year follow-up showed complete resolution of the patient's complaints while fulfilling the patient's aesthetic and functional demands and indicates that the use of detachable overlay prosthesis could be one of the proposed treatment options.

Early prediction of acute kidney injury in patients with acute on chronic liver failure by measuring kidney injury Molecule-1 level in Urine at Zagazig University Hospitals

Background and study aim: Some of patients with decompensated cirrhosis will exhibit newly developed acute liver failure. This condition is called acute-on-chronic liver failure (ACLF). Acute kidney injury (AKI) is common with ACLF. Kidney injury Molecule-1 (KIM-1) is an ideal biomarker of AKI. The aim of this study was to evaluate role of KIM-1 in prediction of AKI in ACLF patients. Patients and Methods: Eighty four patients were included in this study. They were selected from hospitalized patients with acute decompensated cirrhosis. They were allocated into two groups; group I: patients with no acute-on-chronic liver failure (ACLF), group II: patients with ACLF. Results: KIM-1 was significantly higher in the ACLF (group II). KLM-1 median was 2.4 in group I vs 7.35 in group II with p value <0.001. We found that at cut off value of ≥0.5 KLM-1 can predict the presence of AKI with sensitivity of 85.7%, specificity 88.1%, positive predictive value 87.8%, negative predictive value 86%, accuracy 86.9% and AUC= 0.867 p <0.001. Conclusion: KLM-1 rises significantly in patients with ACLF. KLM-1 can be reliable in prediction of the presence of acute kidney injury in decompensated cirrhosis