The Use of Lasers in Enhancing the Bond Strength of Orthodontic Brackets.

Background: The use of lasers in orthodontics has garnered interest for its potential to enhance the bond strength between orthodontic brackets and tooth surfaces, a crucial factor for successful orthodontic treatment. This study aims to investigate the effect of laser irradiation on the bond strength of orthodontic brackets in a sample of 30 patients. Materials and Methods: Thirty patients undergoing orthodontic treatment were divided into two groups. In Group A, brackets were bonded using conventional methods, while in Group B, brackets were bonded after laser irradiation. A diode laser operating at 810 nm was used, with an energy setting of 2.5 W for 20 s. After bonding, a universal testing machine measured the bond strength in megapascals (MPa). The adhesive remnant index (ARI) was also recorded to determine the mode of bond failure. Statistical analyses were conducted to compare the results between the groups. Results: The mean bond strength in Group B (laser irradiation) was significantly higher (P < 0.05) than in Group A (conventional bonding). Group B exhibited a mean bond strength of 9.72 MPa, whereas Group A showed a mean bond strength of 7.41 MPa. The ARI scores indicated that Group B had more adhesive remaining on the tooth surface, suggesting a stronger bond. Conclusion: Laser irradiation prior to orthodontic bracket bonding resulted in significantly enhanced bond strength compared to conventional bonding methods. The increased bond strength and greater adhesive remnant on the tooth surface indicate that laser irradiation improves the adhesion between brackets and tooth enamel. Integrating lasers into orthodontic procedures has the potential to elevate treatment outcomes by ensuring durable bracket adhesion.

Antifungal and Antiproliferative Activity of Pistagremic Acid and Flavonoids Extracted from the Galls of Pistacia chinensis subsp. integerrima.

Pistacia chinensis subsp. integerrima (J.L. Stewart) Rech. f. is a plant known for its therapeutic applications in traditional medicine, which are related to its antimicrobial, anticancer, antioxidant, anti-inflammatory, analgesic, antidiarrheal, and muscle relaxant properties. The galls of P. chinensis are rich in triterpenes and flavonoids, and we here report the extraction of pistagremic acid (1), apigenin (2) and sakuranetin (3) from this source. The isolated compounds were tested against Aspergillus flavus, Candida albicans, Candida glabrata, Fusarium solani, Microsporum canis and Trichoderma longibrachiatum. The results highlighted the antimicrobial activity of flavonoids 2 and 3, suggesting that this class of molecules may be responsible for the effect related to the traditional use. On the other hand, when the compounds and the extract were tested for their antiproliferative activity on a panel of 4 human cancer cell lines, the triterpene pistagremic acid (1) showed a higher potential, thus demonstrating a different bioactivity profile. Structure-based docking and molecular dynamics simulations were used to help the interpretation of experimental results. Taken together, the here reported findings pave the way for the rationalization of the use of P. chinensis extracts, highlighting the contributions of the different components of galls to the observed bioactivity.

Physician Attitude toward Their Attires and Laundering Habit Changes during the COVID-19: A Cross-Sectional Survey in a Tertiary Care Center.

Background Patient safety is of utmost importance and every effort is to be made to reduce the risk of hospital-acquired infection. Contaminated attire is proposed as a mode of hospital infections spread. This study aims to assess the laundering habits, the perception of healthcare workers toward the contamination of their attire, and the effect of coronavirus disease 2019 (COVID-19) pandemic on their cleaning practices in non-operative settings. Methods This is a cross-sectional study conducted using a self-administered questionnaire which was distributed among physicians at King Abdul-Aziz Medical city, Riyadh. The questionnaire queried the physicians about their laundering habits, knowledge toward their attire, and the difference in cleaning practices after the emergence of COVID-19. Results Out of 220 questionnaires distributed, 192 physicians responded. Majority of physicians were male (54%) and were in the 20 to 30 age group. Female gender was significantly associated with the frequency of uniform washing ( p- value < 0.0001) and place of cleaning (home vs. outside home) ( p- value <0.0001). Physicians in intensive care were more likely to take off their uniforms daily before leaving the hospital compared to others ( p- value of 0.018). Most physicians did not prefer to use the hospital laundry system for cleaning their uniforms but consultants were the most to use it. COVID-19 pandemic led to changes in washing habits in 108 physicians (60%). Conclusion Majority of physicians accepted washing their uniforms multiple times per week and their washing habits increased during the COVID-19 pandemic. Female gender and younger physician both were associated with increasing washing habits.

A Clot in Transit: A Cause of Death or a Bystander?

Introduction: The clot in transit is a rare manifestation of thromboembolic disease occurring usually in the setting of PE and frequently associated with poor outcomes. The best therapeutic option is not well established. We describe a series of 35 patients diagnosed with clots in transit including their therapeutic interventions and outcome between the period January 2016 to December 2020. Methods: a retrospective chart review of all patients with an Echocardiogram showing thrombi in the right heart chambers including patients with thrombus in the presence of central lines or other devices. We exclude patients where masses were described as tumors or vegetation and masses in the presence of bacteremia. Results: There were 35 patients with echocardiographic evidence of a thrombus in the right heart chambers. In 12 of those patients, the thrombus was related to an intracardiac catheter. 37.1% of CT chest was done along with Echocardiogram and showed a concomitant PE in 77%. On echocardiogram, 66% of the thrombi were mobile. RV strain was present in 17% while abnormal RVSP (>30 mmHg) was present in 74%. Respiratory support was required in 37.1% and only 17% required inotropic support. There was a total or partial resolution in 80% those who had repeated echocardiogram after four weeks of therapy. Heparin was started in the majority of patients (74%). Warfarin was the most frequently used follow-up anti-coagulant in 51.4%. The mortality rate was significantly higher in those patients with RVSP >50, UFH group, O2 or inotropic support. 26% of patients died within the first 28 days after the diagnosis, while first 7 days mortality was 6% only. Conclusion: a clot in transit in our study was not directly associated with poor outcomes in the first week of therapy, UFH is still the most frequently used initial method to treat clots in transit. However, only 26% had a total resolution of clot within 4 weeks of treatment.

Post-mortem computed tomography differentiation of putrefactive gas and air embolism: A case of traumatic carotid-jugular arteriovenous fistula.

INTRODUCTION: PMCT is superior to autopsy for identification of intravascular or extravascular gas pockets and their distribution. However, differentiation between air embolism and putrefactive gas can prove challenging due to overlapping imaging findings. CASE REPORT: We report a case of a healthy young man who was involved in a fight, sustained a slash wound to the right side of his head by a kitchen knife and died at the scene. Pre-autopsy PMCT demonstrated complex fractures of the right mastoid bone extending to the right petrous apex and jugular bulb, exposing the right sigmoid sinus. There was also asymmetric intravascular air distribution suspicious of air embolism with ancillary findings of traumatic carotid-jugular pseudoaneurysm and arteriovenous fistulous formation. Post-mortem examination revealed a slash wound measuring 12x2 cm at the right side of the head, cutting through the scalp, right temporal bone, right temporal meninges, right sigmoid venous sinus and part of the right occipital lobe. No intracranial haemorrhage was found on both PMCT and autopsy. DISCUSSION: PMCT findings of air embolism versus putrefactive air on PMCT are discussed in this case. Detailed history on mechanism, circumstances, time of death and careful analysis of intravascular and extravascular air distribution patterns on PMCT are essential in guiding differentiation of true fatal air embolism and "normal" post-mortem putrefactive air. Needless to say, it is recommended that PMCT be performed as early as possible after death to reduce the chances and presence of artifactual decomposition changes.

Insight into Oncogenic Viral Pathways as Drivers of Viral Cancers: Implication for Effective Therapy.

As per a recent study conducted by the WHO, 15.4% of all cancers are caused by infectious agents of various categories, and more than 10% of them are attributed to viruses. The emergence of COVID-19 has once again diverted the scientific community's attention toward viral diseases. Some researchers have postulated that SARS-CoV-2 will add its name to the growing list of oncogenic viruses in the long run. However, owing to the complexities in carcinogenesis of viral origin, researchers across the world are struggling to identify the common thread that runs across different oncogenic viruses. Classical pathways of viral oncogenesis have identified oncogenic mediators in oncogenic viruses, but these mediators have been reported to act on diverse cellular and multiple omics pathways. In addition to viral mediators of carcinogenesis, researchers have identified various host factors responsible for viral carcinogenesis. Henceforth owing to viral and host complexities in viral carcinogenesis, a singular mechanistic pathway remains yet to be established; hence there is an urgent need to integrate concepts from system biology, cancer microenvironment, evolutionary perspective, and thermodynamics to understand the role of viruses as drivers of cancer. In the present manuscript, we provide a holistic view of the pathogenic pathways involved in viral oncogenesis with special emphasis on alteration in the tumor microenvironment, genomic alteration, biological entropy, evolutionary selection, and host determinants involved in the pathogenesis of viral tumor genesis. These concepts can provide important insight into viral cancers, which can have an important implication for developing novel, effective, and personalized therapeutic options for treating viral cancers.

Efficacy of Biomarkers in Predicting Anastomotic Leakage After Gastrointestinal Resection: A Systematic Review and Meta-Analysis.

Our systematic review and meta-analysis were designed to evaluate the published literature from 2016 to 2019 on which the role of biomarkers in predicting the anastomotic leakage (AL) in gastroesophageal cancer surgery was investigated. This extensive literature search was conducted on the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Excerpta Medica dataBASE (EMBASE) were used to gather the relevant information. No restrictions were made on the type of biomarkers. Wald or likelihood ratio (LRT) fixed effect tests were used to estimate the pooled prevalence to generate the proportions with 95% confidence intervals (CI) and model-fitted weights. For analyzing heterogeneity, the Cochran Q test and I square test were used. The Egger regression asymmetry test and funnel plot were used for publication. In this meta-analysis, a total of 15 studies were recruited with 1892 patients undergoing the resection. The pooled elevated C-reactive protein (CRP) was observed as 13.9% ranging from 11.6% to 16.1%. The pooled prevalence of other biomarkers with AL was observed as 4.4%. Significant heterogeneity was observed between studies that reported CRP and other biomarkers (92% each with chi-squared values of 78.80 and 122.78, respectively). However, no significant publication was observed between studies (p=0.61 and p=0.11, respectively). We concluded our study on this note that different biomarkers are involved in the diagnosis of AL. However, all these biomarkers are poor predictors with insufficient predictive value and sensitivity.

Diagnostic Test Accuracy of Genetic Tests in Diagnosing Psoriasis: A Systematic Review.

The pathogenesis of psoriasis involves the interaction of several environmental and genetic factors. Predicting the disease risk cannot depend on individual genetic alleles. Consequently, some studies have evaluated the use of genetic risk scores that combine several psoriasis susceptibility loci to increase the accuracy of predicting/diagnosing the disease. This meta-analysis summarizes the evidence regarding using genetic risk scores (GRS) in the diagnosis or prediction of psoriasis. A search of MEDLINE/PubMed, the Latin American Caribbean Health Sciences Literature (LILACS) database, Cochrane Library, Scopus, Web of Science, and ProQuest was conducted in July 2022. The primary objective was to record the area under the curve (AUC) for GRS of psoriasis. Secondary objectives included characteristics of studies and patients. The risk of bias (ROB) was assessed using the PROBAST tool. Five studies fulfilled the eligibility criteria of this review. None of the studies described the clinical criteria (reference standard) that were employed to diagnose psoriasis. The AUCs of the 11 GRS models ranged from 0.6029-0.8583 (median: 0.75). Marked heterogeneity was detected (Cochran Q: 1250.051, p < 0.001, and I2 index: 99.2%). So, pooling of the results of the included studies was not performed. The ROB was high for all studies and clinical application was not described. Genetic risk scores are promising tools for the prediction of psoriasis with fair to good accuracy. However, further research is required to identify the most accurate combination of loci and to validate the scores in variable ethnicities.

Experimental and theoretical studies of linear and non-linear optical properties of novel fused-triazine derivatives for advanced technological applications.

Controlling photophysical properties is critical for the continued development of electroluminescent devices and luminescent materials. The preparation and study of novel molecules suitable as luminescent for the development of optoelectrical devices have recently received a lot of attention. Even though the as-triazine unit is a good building block for organic active substances, it is rarely used in this context. We created here novel bis-triazine derivative dyes in the far UV-Vis range by alkylation of triazine-thione derivatives with appropriate dibromo compounds. At the B3LYP/6-311**G(d,p) basis set, their optimal molecular structures were obtained. DFT technique confirmed that the new triazine derivatives are in noncoplanar with one of the two phenyl rings and the triazine plane rotating out by 102.09. Also, depending on the energy gap difference between HOMO and LUMO, some important parameters including chemical potential (π), electronegativity (χ), and chemical hardness (η) were calculated. The compounds may be readily polarized and have significant NLO characteristics, as seen by the tiny HOMO-LUMO energy gap. The calculated values for the polarizability (α) of the two new triazine derivatives have the range 6.09-10.75 × 10-24 (esu). The emission peaks seemed to move to the long-wavelength (redshift), with a rise in the fluorescence band, suggesting that the singlet excited state is more polar than the ground state. The influence of solvent polarity and the intermolecular charge transfer (ICT) processes are reflected in the photophysical properties of new fused triazine derivatives. These properties such as extinction coefficient, absorption and emission cross-sections, fluorescence quantum yield, fluorescence lifetime, oscillator strength, the dipole moment, radiative decay rate constant, the energy yield of fluorescence, and the attenuation length were assessed and discussed.

Comparison of effectiveness of oral hygiene instruction methods in improving plaque scores among 8-9-year children: a randomized controlled trial.

PURPOSE: The relative effectiveness of different methods used for delivery of information regarding oral health in children has not been widely raised in the literature. This study aimed at evaluating the effect of verbal oral hygiene instruction (OHI) against the verbal instruction supplemented by three different methods (written, teeth teaching model, and videotape) on the mean plaque scores and to determine factors that may influence the effectiveness of methods used. METHODS: Prospective-comparative randomized controlled trial carried out on 120 children aged 8-9 years. Participants were randomly divided into four groups (verbal, verbal and written, verbal and teeth teaching model, and verbal and video). Plaque Control Index was evaluated at baseline and 4 weeks after OHI. ANOVA and post hoc, t test, and ANCOVA were used for statistical analysis. RESULTS: A statistically significant decrease of the mean percentage of plaque scores was found indicating the effectiveness of different methods of delivery of OHI (p < 0.01, 0.001). Verbal supported by teaching model was the most statistically effective method (p < 0.001) followed by the verbal (p < 0.001). There was a significant difference in the improvement in plaque score (p < 0.001) between the four methods of OHI after controlling for age, gender, monthly income, mother's and father's educational levels and plaque index before delivery of OHI. CONCLUSIONS: Regardless of the method used, a gradient of effectiveness was observed in improving plaque scores. Verbal instruction supplemented by teaching model was the most effective. Effectiveness was influenced by monthly income, mother's and father's educational levels and plaque index before OHI.

Synthesis of core-shell copper-graphite submicronic particles and carbon nano-onions by spark discharges in liquid hydrocarbons.

Spark discharge in hydrocarbon liquids is considered a promising method for the synthesis of various nanomaterials, including nanocomposites. In this study, copper-carbon particles were synthesized by generating spark discharges between two Cu electrodes immersed in heptane, cyclohexane, or toluene. The synthesized particles were characterized using scanning electron microscopy, high-resolution transmission electron microscopy, and selected area electron diffraction. Overall, two families of particles were observed: Cu particles (diameter < 10 nm) embedded in a carbon matrix and submicrometric Cu particles encapsulated in a carbon shell. The obtained results indicate that the size distribution of the Cu nanoparticles and the degree of graphitization of the carbon matrix depend on the liquid. Indeed, discharges in heptane lead to Cu particles with diameters of 2-6 nm embedded in a carbon matrix of low graphitization degree, while discharges in toluene result in particles with diameters of 2-14 nm embedded in carbon matrix of high graphitization degree. Based on the obtained experimental results, it is proposed that the Cu nanoparticles are produced in the plasma core where Cu (evaporated from the electrode surface) and carbonaceous species (decomposition of the liquid) are present. When the plasma hits the electrode surface, hot (thousands of Kelvin) Cu particles are ejected from the electrode, and they propagate in the liquid. The propagation of the hot particles in the liquid results in the local evaporation of this liquid, which leads to the formation of a C-shell around each Cu particle. In few cases where the shape of the Cu particle is not spherical, carbon nanoonions are detected between the C-shell and the Cu core. These nanoonions are supposedly formed under the effect of the fluid vortices generated close to the particle surfaces when these latter are ejected into the liquid.

Spectroscopic and Photo-Physical Properties of Near-IR Laser Dye in Novel Benign Green Solvents.

IR-792 as near IR (NIR) laser dye was dissolved with different concentrations in two types of ionic liquids (ILs) of different anion and cation, 1-Ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl) imide (EMIM TFSI) & 1-Butyl-3-methylimidazolium tetrafluoroborate (BMIM BF4), as the benign green solvent and in methanol (MeOH) as a standard solvent. The behavior of fluorescence of IR-792 dye was studied. The fluorescence of IR-792 dissolved in the ILs was heavily compared to organic solvent. Some photo-physical parameters of IR-792 were calculated. Mainly, IR-792 had a very low quantum yield of fluorescence with high intersystem crossing rate & fluorescence lifetime in picosecond range. Optical absorption and behavior of fluorescence for the rigorously the purified imidazolium ILs in the neat condition and effect of IR-792 on their fluorescence have been examined. The emission behavior of IR-792 in green solvents was independent upon the wavelength of excitation, while the emission behavior of green solvents dependent upon the wavelength of excitation whether in pure state or with NIR laser dye. At most, the intensity of fluorescence of ILs is dependent upon dye concentration.

Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma.

OBJECTIVES: To report on the efficacy and adverse effects of interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma. METHODS: A retrospective chart review was conducted of eight patients with vocal process granuloma resistant to anti-reflux therapy who underwent interarytenoid botulinum toxin A injection. The mean dosage of botulinum toxin A injected was 6.56 U. RESULTS: Fifty per cent of patients had complete regression of the lesion and 50 per cent had partial regression. The main side effects were breathiness (n = 4), voice breaks (n = 1) and aspiration (n = 1). CONCLUSION: Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma is an effective mode of therapy, with transient vocal and swallowing side effects.

Genotyping of avian infectious bronchitis virus in Afghanistan (2016-2017): the first report.

BACKGROUND: Avian infectious bronchitis (IB) is a highly contagious viral disease which affects the poultry industry. The virus exists in a wide variety of genotypes, and phylogenetic analysis has been used to classify infectious bronchitis virus (IBV) strains. AIMS: The object of the study is a molecular characterization of circulating IBV in Afghanistan as a first study. METHODS: The tracheal tissue specimens from 100 different commercial broiler flocks with respiratory distress in Afghanistan were collected during 2016-2017. After real-time reverse transcriptase-polymerase chain reaction (RRT-PCR), IBV-positive samples were further characterized. A 390 bp hypervariable spike glycoprotein gene segment was amplified using Nested PCR, sequenced, and analyzed. RESULTS: The results of real-time RT-PCR showed that 45/100 of the mentioned flocks were IBV positive. Phylogenetic analysis of all positive samples revealed that IBV strains were clustered into two distinct genotypes: LX4 (GI-19) (9/45) and IS-1494 like (GI-23) (34/45). Also, 2 of the 45 samples remained uncharacterized. CONCLUSION: It is the first study focusing on the molecular epidemiology of IBV in Afghanistan, extending our understanding of IB in the region. These results showed the high rate of IB infection in Afghanistan broiler farms and confirm the continuing monitoring of IBVs to modify the vaccination program.

Prevalence of dysphagia in patients with muscle tension dysphonia.

BACKGROUND: It is hypothesised that patients with muscle tension dysphonia have a high prevalence of dysphagia in comparison to normative values reported in the literature. METHODS: This prospective study included 44 subjects diagnosed with muscle tension dysphonia, based on symptoms and laryngoscopic findings, and 25 control subjects with no history of dysphonia and normal laryngeal examination findings. Demographic data included age, gender and smoking history. The aetiology of muscle tension dysphonia was classified as primary or secondary. Evaluation involved the Eating Assessment Tool ('EAT-10') questionnaire. RESULTS: Patients' mean age was 45.93 ± 14.95 years, with a female to male ratio of 1.2:1. Fourteen patients had primary muscle tension dysphonia, while 30 had secondary muscle tension dysphonia. Among patients with secondary muscle tension dysphonia, Reinke's oedema was the most common aetiology. There was a significant difference in the prevalence of dysphagia between the study group and the control group (40.9 per cent vs 8 per cent respectively, p < 0.05). CONCLUSION: This study demonstrates a higher prevalence of dysphagia in patients with the presenting symptom of dysphonia and diagnosed with muscle tension dysphonia in comparison to subjects with no dysphonia.

Screening of nematophagous-fungi from fresh faeces of grazing animals and soils.

An investigation was undertaken for screening and isolating nematophagous-fungi from the faecal samples of various grazing animals and soils in Malaysia. Total of 111 faeces and 50 soil samples were collected and the samples were cultured on 2% water agar plates. The growth of nematophagous-fungi was stimulated by sprinkling-baiting technique. The conidia of suspected nematophagous-fungi were inoculated on 2% water agar plates. All isolated were maintained on 2% cornmeal agar plates. Verticillium spp., Fusarium spp. and Arthrobotrys spp. were identified from the faecal and soil samples. 62.5% of the faecal samples and 100% of the soil samples were shown to be positive with nematophagous-fungi. This study highlights the present of nematophagous-fungi population in faecal and soil samples. Much study remains to be done to better understanding some fungi especially their mode of action and their predatory behaviour against parasitic nematodes.

Screening of nematophagous-fungi from fresh faeces of grazing animals and soils

@#An investigation was undertaken for screening and isolating nematophagous-fungi from the faecal samples of various grazing animals and soils in Malaysia. Total of 111 faeces and 50 soil samples were collected and the samples were cultured on 2% water agar plates. The growth of nematophagous-fungi was stimulated by sprinkling-baiting technique. The conidia of suspected nematophagous-fungi were inoculated on 2% water agar plates. All isolated were maintained on 2% cornmeal agar plates. Verticillium spp., Fusarium spp. and Arthrobotrys spp. were identified from the faecal and soil samples. 62.5% of the faecal samples and 100% of the soil samples were shown to be positive with nematophagous-fungi. This study highlights the present of nematophagous-fungi population in faecal and soil samples. Much study remains to be done to better understanding some fungi especially their mode of action and their predatory behaviour against parasitic nematodes.

Spectroscopic Study of Solvent Polarity on the Optical and Photo-Physical Properties of Novel 9,10-bis(coumarinyl)anthracene.

Novel 7,7'-((anthracene-9,10-diylbis(methylene))bis(oxy))bis(4-methyl-2H-chromen-2-one) (BisCA) was prepared as fluorescent probe. The chemical structure of the novel BisCA was confirmed by spectroscopic data as well as elemental analyses. The solvatochromic characteristics of the new proble and its precursors were investigated in different solvents including, ethanol, DMF and toluene as protic polar, aprotic polar and non-polar solvents, respectively. Photo-physical parameters of probes, such as fluorescence quantum yields, fluorescence lifetime of excited state, radiative and non-radiative decay, were assessed in different media. The intermolecular H-bond effect on absorption and excitation spectra of the novel probe was reported in different solvents. Also, Onsager cavity radius and dipole moment of ground state and excited state of the probe were calculated as described by Bakhshiev and Reichardt methods.

The development of new clinical instruments in laryngopharyngeal reflux disease: The international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.

INTRODUCTION: To analyze the epidemiological characteristics of placebo controlled randomized trials (RCTs) that evaluated the effectiveness of medical treatments over placebo in laryngopharyngeal reflux (LPR). MATERIAL AND METHODS: PubMed, Cochrane database, and Scopus were assessed for subject headings using the PRISMA recommendations. Placebo RCTs published between 1990 and 2018 describing clinical evolution throughout LPR treatment were extracted and analyzed for evidence-based level, number of patients, inclusion and exclusion criteria, gender, age, symptoms and signs used as therapeutic outcomes, and treatment schemes. RESULTS: The database search identified 15 placebo RCTs with a total of 763 patients. The mean age of patients was 48.59 years and 52.68% of patients were female. Among the 15 placebo RCTs, 9 have demonstrated a partial or total superiority of a medical treatment over placebo. Most of authors based the LPR diagnosis on symptoms and signs without additional examination. Our analysis reveals an important heterogeneity between studies with regard to the diagnosis criteria, treatment schemes and signs and symptoms used as therapeutic outcomes. Many commonly reported signs and symptoms related to LPR were not used as therapeutic outcomes. Half of the authors did not prescribe diet and behavioral changes along the treatment. CONCLUSION: The controversy in the RCTs about the superiority of medical treatment over placebo in LPR disease is probably due to discrepancies in the diagnosis method, exclusion criteria, therapeutic schemes and the lack of comprehensive tools for the assessment of signs and symptoms. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies developed two new instruments to precisely assess signs and symptoms throughout the treatment. These two instruments could be used in future trials comparing medical treatment over placebo in LPR disease.