Use of second-generation antipsychotics in autism spectrum disorder: a systematic review and meta-analysis protocol.

INTRODUCTION: Atypical antipsychotics have been studied to treat autism spectrum disorder (ASD). However, like little is known about whether these drugs are effective and safe when compared in controlled and non-controlled settings. This study aims to assess the efficacy and safety of second-generation antipsychotics in ASD in randomised controlled trials (RCT) and observational studies. METHODS AND ANALYSIS: This systematic review will include RCT and prospective cohorts evaluating second-generation antipsychotics in people 5 years and older diagnosed with ASD. Searches will be conducted in Medline, Embase, Cochrane Library, Epistemonikos, Lilacs, CINAHL, PsycINFO, trial registries and grey literature databases without restriction on publication status, year of publication and language. The primary outcomes will be symptoms of aggressive behaviour, quality of life for the individual or their careers, and discontinuation or dropouts/withdrawals of antipsychotics due to adverse events. The secondary outcomes are other not serious adverse events and adherence to pharmacotherapy. Selection, data extraction, and quality assessment will be performed by pairs of reviewers, independently. The Risk of Bias 2 (RoB 2) and Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tools will be used to assess the risk of bias in the included studies. If appropriate, a meta-analysis and network meta-analysis will be conducted to synthesise the results. The overall quality of the evidence for each outcome will be determined by the Recommendation, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: This study will systematically summarise the existing evidence evaluating the use of second-generation antipsychotics for treating ASD, in controlled and uncontrolled studies. The results of this review will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42022353795.

Antimicrobial resistance of microorganisms present in periodontal diseases: A systematic review and meta-analysis.

Objective: The aim of this study was to estimate the antimicrobial resistance in microorganisms present in periodontal diseases. Methods: A systematic review was conducted according to the PRISMA statement. The MEDLINE (PubMed/Ovid), EMBASE, BVS, CINAHL, and Web of Science databases were searched from January 2011 to December 2021 for observational studies which evaluated the antimicrobial resistance in periodontal diseases in permanent dentition. Studies that allowed the antimicrobial consumption until the time of sample collection, studies that used laboratory acquired strains, studies that only characterized the microbial strain present, assessment of cellular morphological changes, sequencing system validation, and time series were excluded. Six reviewers, working in pairs and independently, selected titles, abstracts, and full texts extracting data from all studies that met the eligibility criteria: characteristics of patients, diagnosis of infection, microbial species assessed, antimicrobial assessed, identification of resistance genes, and virulence factors. "The Joanna Briggs Institute" critical appraisal for case series was adapted to assess the risk of bias in the included studies. Results: Twenty-four studies (N = 2.039 patients) were included. Prevotella and Porphyromonas species were the most cited microorganisms in the included studies, and the virulence factors were related to Staphylococcus aureus. The antimicrobial reported with the highest frequency of resistance in the included studies was ampicillin (39.5%) and ciprofloxacin showed the lowest frequency of resistance (3.4%). The most cited genes were related to macrolides. The quality of the included studies was considered critically low. Conclusion: No evidence was found regarding the profile of antimicrobial resistance in periodontal diseases, requiring further research that should focus on regional population studies to address this issue in the era of increasing antimicrobial resistance. Clinical relevance: The knowledge about the present microorganism in periodontal diseases and their respective antimicrobial resistance profiles should guide dentists in prescribing complementary therapy for these infections. Systematic review registration: [http://dx.doi.org/10.1097/MD.0000000000013158], identifier [CRD42018077810].

Time-trend in excess weight in Brazilian adults: A systematic review and meta-analysis.

BACKGROUND: This review aimed to estimate the time-trend prevalence of excess weight, overweight and obesity in the Brazilian adult population, from the 1970s-2020, through systematic review and meta-analysis (Protocol: CRD42018091002). METHODS: A search for articles was conducted in the databases MEDLINE, EMBASE, Scopus, and LILACS up to June 2021. Studies that assessed excess weight, overweight and obesity in the adult population were eligible. Two authors selected studies, collected data and assessed the methodological quality of the studies. The primary outcomes were the prevalence of excess weight, overweight, and obesity by sex and period of years. Pooled prevalence and 95% confidence intervals (CIs) were calculated in the meta-analysis of the random effects model. Heterogeneity (I2) was investigated by meta-regression and publication bias was investigated by Egger's test. RESULTS: A total of 7,938 references were identified in the search strategies, of which eighty-nine studies and nine national surveys, conducted from 1974-2020, were included in the meta-analysis. The pooled prevalence of excess weight in Brazilian adults increased from 33.5% (95% CI: 25.0; 42.6%) in 1974-1990 to 52.5% (95% CI: 47.6; 57.3%) in 2011-2020. The pooled prevalence of overweight in Brazilian adults was 24.6% (95% CI: 18.8; 31.0%) from 1974-1990 and 40.5% (95% CI: 37.0; 43.9%) from 2011-2020. The pooled prevalence of obesity in Brazilian adults increased by 15.0% from 1974-1990 to 2011-2020. The increases were observed for both men and women in almost all periods. The prevalence of excess weight and obesity remained higher among women in all periods. CONCLUSIONS: A continuous increase in the prevalence of excess weight, overweight and obesity were observed over the years. The prevalence of excess weight affected half of Brazilian adults in the period from 2011-2020 and both sexes.

Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis.

Evidence on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticoids for rheumatoid arthritis (RA) is inconclusive and is not up to date. This systematic review assessed the effectiveness and safety of these anti-inflammatories (AI) in the treatment of RA. COCHRANE (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science and Virtual Health Library were searched to identify randomized controlled trials (RCT) with adults which used AI (dose represented in mg/day) compared with placebo or active controls and was carried out up to December of 2019. Reviewers, in pairs and independently, selected studies, performed the data extraction and assessed the risk of bias. The quality of the evidence was assessed by GRADE. Network meta-analyses were performed using the Stata v.14.2. Twenty-six articles were selected (NSAIDs = 21 and corticoids = 5). Naproxen 1,000 improved physical function, reduced pain and the number of painful joints compared to placebo. Etoricoxib 90 reduced the number of painful joints compared to placebo. Naproxen 750 reduced the number of swollen joints, except for etoricoxib 90. Naproxen 1,000, etoricoxib 90 and diclofenac 150 were better than placebo regarding patient assessment. Assessment physician showed that NSAIDs were better than placebo. Meta-analyses were not performed for prednisolone and prednisone. Naproxen 1,000 was the most effective drug and celecoxib 200 showed fewer adverse events. However, the low quality of the evidence observed for the outcomes with NSAIDs, the absence of meta-analyses to assess the outcomes with corticoids, as well as the risk of bias observed, indicate that future RCT can confirm such findings.

Resistance profile to antimicrobial agents in the main circulating bacteria isolated from acute periodontal and endodontic infections in Latin America (MICROBE- DENT): A systematic review protocol.

BACKGROUND: Antimicrobial resistance is currently considered the main risk to global health. A variety of microbial species have been isolated from endodontic and periodontal infections. However, clinical endodontic and periodontics bacterial isolates have not been sufficiently characterized with regard to their capacity for antibiotic resistance. We aim to assess the existing evidence to estimate the prevalence of the main antimicrobial resistance and multidrug resistant organisms in endodontics and periodontics and to describe their geographic distribution in Latin America. METHODS: All types of designs and will be restricted to Latin American studies will be included in this systematic review. MEDLINE, Embase, CINAHL, BVS (LILACS, BBO - bvsalud.org), IBECS (bases.bireme.br), Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Science databases will be searched from 2013 to December 31, 2018 for all types of study designs that report microbial infection in endodontics and periodontics and their resistance and that define the microbiological methods used to identify microorganisms. The selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. The Cochrane and ROBINS-I risk of bias assessment tools will be used to assess the methodological quality of randomized control trials. The Newcastle-Ottawa scale will be used to assess the quality of methodology in observational studies. The overall quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) using the same principles and domains applied in the quality assessment of prognostic studies. The heterogeneity of the findings will be assessed using both the χ test and the I statistic. Sensitivity analysis will be performed by subgroup analyses and meta-regression to investigate the effect of study-level characteristics, such as age, gender, and methodological quality score, whenever possible. Publication bias across studies will be evaluated by visual inspection of the funnel plots and Begg's test for the results covered in 10 or more studies. RESULTS: The evidence derived by this study will inform best practices for patients with endodontic and periodontal problems receiving antimicrobial agents. CONCLUSION: Successful completion will significantly impact clinical practice and contribute to improved prescribing competency. PROTOCOL REGISTRATION: PROSPERO-CRD42018077810.

Efficiency and effectiveness evaluation of three glass fiber post removal techniques using dental structure wear assessment method.

AIM: This study evaluated the efficiency and effectiveness of three glass fiber post removal techniques. MATERIALS AND METHODS: Forty-five extracted maxillary teeth were endodontically treated and cross-sectioned in thirds. Presence of cementing agent and dental structure wear were assessed by analyzing images taken before luting of glass fiber post and after removal procedure. Teeth were divided into 3 groups: Group 1 - diamond bur + Largo reamer; Group 2 - ultrasonic insert; Group 3 - carbide bur + ultrasonic insert. Time spent on removal procedures, dental structure wear and amount of remaining cement agent were recorded and results submitted to ANOVA, Kruskal Wallis and Tukey-Kramer tests. RESULTS: Group 1 - 16'46", 33.33% and 6.99%; Group 2 - 12'31", 40% and 7.86%; and Group 3 - 10'24", 80% and 8.14%. Group 3 presented the most effective removal of glass fiber posts. CONCLUSION: There was no significant difference in efficiency among the evaluated techniques.

Analysis of the preparation obtained by three techniques of root canal instrumentation using computed tomography / Análise do preparo obtido por três técnicas de instrumentação do canal radicular através de tomografia computadorizada

Objective: Use computed tomography to compare three methods of root canal instrumentation. Methods: Thirty mandibular molar mesiobuccal canals were divided in three groups according to instrumentation technique: Group 1 - hand instrumentation with balanced force technique; Group 2 - Protaper Universal rotary system following manufacturer's instructions; and Group 3 - Protaper Universal rotary system and Gates-Glidden drills. Teeth were evaluated by computed tomography before and after preparation at three axial cuts: 3mm, 5mm, and 7mm from the root apex. Data were subjected to statistical analysis using the F, Chi-Square, Likelihood Ratio Chi-Square, and Mantel-Haenszel Chi-Square tests. Results: Group 3 showed significantly greater dentin removal with no tendency towards mesial or distal canal transportation, compared with Groups 1 and 2. Also, Group 3 required the least amount of time for instrumentation. Conclusion: Association of rotary instrumentation and Gates-Glidden drills is a safe and effective technique for root canal preparation.

Objetivo: Comparar o preparo de canais radiculares através de tomografia computadorizada. Métodos: Trinta canais mésio-vestibulares de molares inferiores foram divididos em 3 grupos, de acordo com a técnica de instrumentação a ser utilizada: Grupo 1 - instrumentação manual, utilizando-se de movimentos de forças balanceadas; Grupo 2 - Sistema Protaper Universal de instrumentação rotatória, conforme protocolo do fabricante; Grupo 3 - Sistema Protaper Universal de instrumentação rotatória associada a brocas de Gates- Glidden para pré-alargamento cervical. Os dentes foram submetidos à tomografia computadorizada antes e após o preparo, e a análise das imagens foi feita através de cortes axiais a 3mm, 5mm e 7mm do ápice radicular. Os dados foram submetidos a análise estatística utilizando testes paramétricos (para as variáveis tempo e desgaste de dentina) e não-paramétricos (para a variável sentido do desvio). Resultados: Os resultados mostraram uma tendência significativa do grupo 3 a desgastar mais dentina quando comparado aos grupos 1 e 2. O grupo 1 desgastou significantemente mais dentina para o sentido distal e o grupo 2 desgastou significantemente mais para o sentido mesial. O grupo 3 não apresentou tendência de sentido de desgaste. O tempo despendido foi menor no grupo 3, seguido pelo grupo 1 e 2. Conclusão: Pôde-se concluir que a associação das brocas de Gates-Glidden ao Sistema Protaper Universal promoveu um preparo adequado de maneira segura e, a tomografia computadorizada foi um método adequado para a análise do preparo de canais radiculares.

Comparison of the effectiveness of the protaper system versus hand instrumentation in endodontic retreatment: a scanning electron microscopy study

Introduction: Several rotary systems have been evaluated for removal of endodontic filling materials from the canal. Moreover, studies focusing on the comparison of the effectiveness of rotary systems versus hand instrumentation have yielded mixed results in terms of the efficacy and amount of time required by each technique. Objective: To compare the effectiveness of a nickel-titanium rotary system and of hand instrumentation using stainless steel files and Gates-Glidden burs in the removal of gutta-percha from root canals, as well as the time required to complete the procedure by each method. Material and methods: Forty single-rooted teeth were prepared and obturated then divided in two groups, according to the method employed for removal of the gutta-percha: ProTaper Universal rotary retreatment system (rotary instrumentation) and stainless steel hand files with Gates-Glidden burs (hand instrumentation). The time required to remove gutta-percha by each method was recorded. Roots were then sectioned lengthwise and the apical, middle, and coronal thirds were analyzed by SEM under two magnifications: x400 and x1,000. Results: Rotary instrumentation promoted better cleansing compared with hand instrumentation. The apical third was less clean than the coronal and middle thirds (Kruskal-Wallis p < 0.05). Rotary instrumentation was faster than hand instrumentation (Tukey p < 0.05). Conclusion: Although none of the methods promoted complete cleanliness of the canal walls, ProTaper Universal system showed better results and was faster than hand instrumentation.

Persistent infection in root-filled tooth: an SEM morphological analysis after apical microsurgery

Introduction and Objective: Endodontic failure can be associated to well-conducted treatments due to microbial factors characterized by intra or extraradicular infections not eliminated during endodontic treatment. Case report: This report describes a case of persistent apical periodontitis of an asymptomatic maxillary lateral incisor endodontically retreated and subsequently subject to apical surgery. Conclusion: After SEM morphological analysis of the apical fragment, areas of cementum-dentin resorption that were probably responsible for the perpetuation of the disease process were observed.

Treatment of inflammatory external root resorption resulting from dental avulsion and pulp necrosis: clinical case report.

The aim of this case report was to present a treatment for severe inflammatory external root resorption. The condition developed due to the patient's neglect to seek adequate treatment following replantation of an avulsed maxillary left central incisor. Following diagnosis, treatment consisted of conventional endodontic therapy with calcium hydroxide dressings and definitive filling of the root canal after the resorption was controlled radiographically. A 24-month follow-up showed that the resorption process had stabilized and the patient was free of symptoms. Successful tooth replantation requires following the indicated therapy effectively. Nevertheless, when an inflammatory external root resorption occurs, adequate endodontic treatment to remove the necrotic content and bacteria is required, as is the use of calcium hydroxide dressings.