Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis / El cuidado bucal de rutina con clorhexidina reduce la incidencia de neumonía asociada al ventilador en pacientes de la UCI? Una revisión sistemática y metanálisis

Objective This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP). Design A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Settings The data were obtained from Pubmed, Cochrane Library, and EMBASE. Patients or participants Only mechanically ventilated patients for at least 48h were included. Interventions Randomized clinical trials applying any dosage form of chlorhexidine were eligible. Main variables of interest The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. Results Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). Conclusions CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome (AU)

Objetivo Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV). Diseño se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ámbito Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE. Pacientes o participantes solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas. Intervenciones Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina. Variables de interés principales Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI). Resultados Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32]. Conclusiones CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado (AU)

Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis.

OBJECTIVE: This study aimed to investigate chlorhexidine's efficacy in preventing ventilator-associated pneumonia (VAP). DESIGN: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. SETTINGS: The data were obtained from Pubmed, Cochrane Library, and EMBASE. PATIENTS OR PARTICIPANTS: Only mechanically ventilated patients for at least 48h were included. INTERVENTIONS: Randomized clinical trials applying any dosage form of chlorhexidine were eligible. MAIN VARIABLES OF INTEREST: The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. RESULTS: Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). CONCLUSIONS: CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.

The influence of acetylsalicylic acid on bone regeneration: systematic review and meta-analysis.

Acetylsalicylic acid (ASA) is commonly used as a non-steroidal anti-inflammatory drug that interferes with multiple biological pathways. ASA acts by stimulating osteogenesis and inhibiting osteoclastogenesis. Thus, the objective of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness of the use of ASA in the bone regeneration in animal models. This review was structured based on the PRISMA Statement and registered on PROSPERO database according to protocol number #CDR42018111403. The quality of evidence was assessed by using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). With the development of search strategies, we identified studies on the use of ASA from the following databases: 1- Medline (via PubMed); 2 - Web of Science; 3 - Scopus; and 4 - EMBASE. A total of 296 articles were identified and after screening the title, abstract, and full text, only 18 studies were selected for qualitative analysis and 12 were selected for performance of the quantitative analysis (meta-analysis). A meta-analysis of the amount of bone tissue formed showed a significant advantage when ASA was locally used, revealing a mean difference (MD) of 22.75% (95% CI: 15.39-30.12) p < 0.00001. Within the limitations of the available data, the results were promising and showed that ASA can be effective in bone formation in animal models.

Survival of dental implants placed in HIV-positive patients: a systematic review.

No consensus has been reached on the use of dental implants in human immunodeficiency virus (HIV)-positive patients. This systematic review evaluated dental implants in HIV-positive patients in terms of implant survival and success rates, marginal bone loss, and complications. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until October 2017. Six studies were selected for review. In total, 821 implants were placed: 493 in 169 HIV-positive patients, and 328 in 135 HIV-negative patients. The mean duration of follow-up was 47.9 months. Weighted mean survival rate, success rate, and marginal bone loss values were calculated for the HIV-positive patients. Mean survival and success rates at the patient level (according to the number of patients) were 94.76% and 93.81%, respectively; when calculated at the implant level (according to the number of implants), these rates were 94.53% and 90.37%, respectively. Mean marginal bone loss was 0.83mm at the patient level and 0.99mm at the implant level. Thus, dental implants are suitable for the rehabilitation of HIV-positive patients with controlled risk factors and normal CD4+ cell counts.

Bilateral balanced occlusion compared to other occlusal schemes in complete dentures: A systematic review.

No consensus has been reached regarding the best occlusal scheme for making complete dentures. Thus, the purpose of this systematic review was to compare bilateral balanced occlusion (BBO) with other occlusal schemes (canine guidance, lingualised occlusion and zero degree) in complete dentures. The schemes were compared in terms of quality of life/satisfaction and masticatory performance. Two independent reviewers performed a comprehensive search of studies published in or before October 2017 using the PubMed/MEDLINE, Scopus and Cochrane Library databases. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The focused question was: "In conventional complete denture, is BBO better than lingualised occlusion, canine guidance and zero degree in terms of quality of life, patient satisfaction and masticatory performance/muscle activity?" Seventeen studies were selected for analysis. In total, there were 492 patients with a mean age of 64.78 years and a mean follow-up duration of 2.96 months (range: 1-6 months). All studies compared BBO with the other occlusal schemes. Eleven studies evaluated the influence of the occlusal scheme designs on quality of life and satisfaction, and 8 studies evaluated masticatory performance and muscle activity between BBO and the other occlusion schemes. The present systematic review indicated that BBO does not confer better quality of life/satisfaction or masticatory performance and muscle activity. Thus, lingualised occlusion can be considered a predictable occlusal scheme for complete dentures in terms of quality of life/satisfaction and masticatory performance, while canine guidance can be used to reduce muscular activity.

Dental implants in patients with osteoporosis: a systematic review with meta-analysis.

There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk (RR) of implant failure and mean marginal bone loss were analyzed within a 95% confidence interval (CI). Fifteen studies involving 8859 patients and 29,798 implants were included. The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93-2.08; P=0.11) or at the patient level (RR 0.98, 95% CI 0.50-1.89; P=0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18mm, 95% CI 0.05-0.30, P=0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group. Randomized and controlled clinical studies should be conducted to analyze possible biases.

Treatments for intrusive luxation in permanent teeth: a systematic review and meta-analysis.

Intrusive luxation is a severe form of dental trauma and there is no consensus regarding its management for permanent teeth. A systematic review and meta-analysis was performed to identify the appropriate treatment for teeth with intrusive luxation. The PubMed/MEDLINE, Embase, US Clinical Trials, and ISRCTN Registry electronic databases were used to search for articles in English and unpublished studies without a date limit. Eligible studies evaluated periodontal results (root resorption as the primary outcome; marginal bone defects and/or pulpal changes as secondary outcomes) after spontaneous re-eruption (SRE), orthodontic repositioning (ORP), or surgical repositioning (SRP) for patients with one or more traumatically intruded permanent teeth. Risk ratios with 95% confidence intervals were used to compare treatments. The meta-analysis revealed no significant difference (P>0.05) between SRP and SRE for root resorption. For secondary outcomes, SRE was significantly better than SRP and ORP (P<0.05). Subgroup analyses showed no significant differences among treatments in teeth with completely formed roots (P>0.05) and a better prognosis when SRE was performed in teeth with incompletely formed roots (P<0.05). The available evidence does not allow us to conclude on the best treatment for traumatically intruded teeth. More reliable evidence is needed.