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1.
J Acoust Soc Am ; 148(4): 2322, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33138475

RESUMO

Respiratory droplets emitted during speech can transmit oral bacteria and infectious viruses to others, including COVID-19. Loud speech can generate significantly higher numbers of potentially infectious respiratory droplets. This study assessed the effect of speech volume on respiratory emission of oral bacteria as an indicator of potential pathogen transmission risk. Loud speech (average 83 dBA, peak 94 dBA) caused significantly higher emission of oral bacteria (p = 0.004 compared to no speech) within 1 ft from the speaker. N99 respirators and simple cloth masks both significantly reduced emission of oral bacteria. This study demonstrates that loud speech without face coverings increases emission of respiratory droplets that carry oral bacteria and may also carry other pathogens such as COVID-19.


Assuntos
Microbiologia do Ar , Bactérias/patogenicidade , Infecções Bacterianas/transmissão , Exposição por Inalação , Boca/microbiologia , Respiração , Acústica da Fala , Aerossóis , Infecções Bacterianas/microbiologia , Infecções Bacterianas/prevenção & controle , Humanos , Exposição por Inalação/prevenção & controle , Máscaras , Equipamento de Proteção Individual , Dispositivos de Proteção Respiratória
2.
J Otolaryngol Head Neck Surg ; 49(1): 77, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109269

RESUMO

BACKGROUND: The COVID-19 pandemic has raised concerns of inadvertent SARS-CoV-2 transmission to healthcare workers during routine procedures of the aerodigestive tract in asymptomatic COVID-19 patients. Current efforts to mitigate this risk focus on Personal Protective Equipment, including high-efficiency filtration as well as other measures. Because the reservoir for SARS-CoV-2 shedding is in the nasopharynx and nasal and oral cavities, the application of viricidal agents to these surfaces may reduce virus burden. Numerous studies have confirmed that povidone-iodine inactivates many common respiratory viruses, including SARS-CoV-1. Povidone-iodine also has good profile for mucosal tolerance. Thus, we propose a prophylactic treatment protocol for the application of topical povidone-iodine to the upper aerodigestive tract. CONCLUSION: Such an approach represents a low-cost, low-morbidity measure that may reduce the risks associated with aerosol-generating procedures performed commonly in otorhinolaryngology operating rooms.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Povidona-Iodo/administração & dosagem , Adulto , Aerossóis , Anti-Infecciosos Locais/administração & dosagem , Infecções por Coronavirus/prevenção & controle , Humanos , Boca , Pneumonia Viral/prevenção & controle
3.
Otolaryngol Clin North Am ; 53(6): 1139-1151, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039097

RESUMO

This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic. In particular, the prolonged exposure and manipulation of the nasal and oral cavities portend a high risk of viral transmission. We discuss evidence-based recommendations to mitigate the risk of viral transmission through novel techniques and device implementation as well as increasing conservative management of certain pathologies.


Assuntos
Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Rinoplastia/métodos , Ritidoplastia/métodos , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Boca/virologia , Cavidade Nasal/virologia , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Rinoplastia/efeitos adversos , Ritidoplastia/efeitos adversos , Gestão da Segurança/métodos
4.
Surg Clin North Am ; 100(6): 1183-1192, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128887

RESUMO

Achalasia is a neurodegenerative disorder of the lower esophagus characterized by high lower esophageal pressures and aperistalsis of the esophageal body. It remains a difficult to treat disease with significant burden on patients due to difficulty swallowing leading to malnutrition. Peroral endoscopic myotomy (POEM) is a newer endoscopic treatment of achalasia. It involves dividing the muscular layer of the esophagus through a submucosal tunnel. Ten-year data show POEM is a safe and effective treatment of achalasia. However, postoperative gastroesophageal reflux disease remains an important consideration.


Assuntos
Acalasia Esofágica/cirurgia , Miotomia de Heller/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Acalasia Esofágica/diagnóstico , Esfíncter Esofágico Inferior/cirurgia , Refluxo Gastroesofágico/etiologia , Miotomia de Heller/efeitos adversos , Humanos , Boca , Cirurgia Endoscópica por Orifício Natural/efeitos adversos
6.
J Breath Res ; 14(4): 047105, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021205

RESUMO

The influence of breath sampling on exhaled carbon monoxide (eCO) and related pulmonary gas exchange parameters is investigated in a study with 32 healthy non-smokers. Mid-infrared tunable diode laser absorption spectroscopy and well-controlled online sampling is used to precisely measure mouth- and nose-exhaled CO expirograms at exhalation flow rates (EFRs) of 250, 120 and 60 ml s-1, and for 10 s of breath-holding followed by exhalation at 120 ml s-1. A trumpet model with axial diffusion is employed to fit simulated exhalation profiles to the experimental expirograms, which provides equilibrium airway and alveolar CO concentrations and the average lung diffusing capacity in addition to end-tidal concentrations. For all breathing maneuvers, excellent agreement is found between mouth- and nose-exhaled end-tidal CO (ETCO), and the individual values for ETCO and alveolar diffusing capacity are consistent across maneuvers. The eCO parameters clearly show a dependence on EFR, where the lung diffusing capacity increases with EFR, while ETCO slightly decreases. End-tidal CO is largely independent of ambient air CO and alveolar diffusing capacity. While airway CO is slightly higher than, and correlates strongly with, ambient air CO, and there is a weak correlation with ETCO, the results point to negligible endogenous airway CO production in healthy subjects. An EFR of around 120 ml s-1 can be recommended for clinical eCO measurements. The employed method provides means to measure variations in endogenous CO, which can improve the interpretation of exhaled CO concentrations and the diagnostic value of eCO tests in clinical studies. Clinical trial registration number: 2017/306-31.


Assuntos
Testes Respiratórios/métodos , Monóxido de Carbono/análise , Expiração , Manejo de Espécimes , Adulto , Feminino , Heme/metabolismo , Humanos , Masculino , Boca , Nariz , Reologia
7.
Compend Contin Educ Dent ; 41(9): e10-e11, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001662

RESUMO

Occasionally, a patient may present with an intraoral tattoo, such as the patient in this instance who presented with one on the lower orolabial mucosa. Both extraoral and intraoral tattooing could be considered a potential indicator of risk-taking behaviors and possible increased risk of mental health or sleep disorders in this patient population. This article discusses risks of ornamental tattooing and the role oral healthcare providers can play in early identification of possible systemic diseases.


Assuntos
Boca , Tatuagem , Assistência Odontológica , Humanos , Saúde Mental , Assunção de Riscos
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5900-5904, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019317

RESUMO

In this paper, we propose a novel approach for respiratory monitoring through the direct measurement of oral cavity pressure. To measure the oral cavity pressure, a pressure sensor is placed inside the oral cavity. The intraorally obtained pressure signals are analyzed in the time-domain and validated against the conventional respiration monitoring belt (reference measurement). Tests have been performed on four subjects (four tests on each subject) in stationary and non-stationary conditions to evaluate the usage of the system in real life. Measurement from the proposed system shows that our approach can monitor the respiration rate with an accuracy of 99% when compared to the reference measurement. Moreover, the system can effectively track the respiration pattern and can detect breathing events independent of breathing routes, i.e., the nasal and oral. It has the minimum susceptibility to motion artifacts. Therefore, it has potential to be used as a wearable monitoring system for day to day life.


Assuntos
Artefatos , Respiração , Monitorização Fisiológica , Movimento (Física) , Boca
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4282-4285, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018942

RESUMO

One of the challenges in examining development of newborns is measuring activities which are correlated to their health. Oral feeding is the most important factor in an infant's healthy development. Here, we present a new device that can measure intraoral and expression pressures produced in a newborn's mouth by non-nutritive sucking. We then develop a method to extract time-intervals that a sucking has occurred. To show an application of this device, we use Apgar score as a reference of the general health of newborns, and we evaluate these scores with the non-nutritive sucking patterns demonstrated by the infants. We show that for the pairs of infant with the same background but different Apgar scores, those with lower Apgar scores have lower pressure amplitudes while sucking. Importance of non-nutritive sucking skills in the development of newborns and ease of using our device make it useful for clinical studies of infantile health.


Assuntos
Recém-Nascido Prematuro , Comportamento de Sucção , Índice de Apgar , Desenvolvimento Infantil , Humanos , Lactente , Recém-Nascido , Boca
10.
Wiad Lek ; 73(8): 1641-1649, 2020.
Artigo em Polonês | MEDLINE | ID: mdl-33055326

RESUMO

OBJECTIVE: Introduction: Current information suggests the existence of two main transmission routes for SARS-CoV-2. This is the drip trajectory and contact transmission. The order to cover the mouth and nose in the public space has been introduced as one of the preventive measures to limit the spread of some virus-induced respiratory diseases, including COVID-19. Both medical and non-medical masks have become the most popular tool. Is there any evidence of their effectiveness? What can be the disadvantages of using them? The aim: To analyze social behaviour towards the order to cover the nose and mouth during the SARS-CoV-2 pandemic and to confront them with the results of research on the effectiveness of medical and non-medical masks. PATIENTS AND METHODS: Material and methods: The study involved a group of 2512 respondents from all over Poland. The research tool was an original questionnaire containing 24 questions. RESULTS: Results: 76.1% of the respondents declare that they always obey the current order. 83% use a material mask and 26.9% wear a surgical mask. 35.2% of respondents think that the order to cover their nose and mouth is not justified. CONCLUSION: Conclusions: The authors confronted the results of the questionnaire with the scientific research mentioned above. There is limited evidence to resolve the question - "Masks - protection or danger?" However, it is worth noting the small harmfulness and indirect evidence of benefits, which together have precedence over the lack of clear arguments supporting the use of masks by Polish society in times of epidemics.


Assuntos
Infecções por Coronavirus , Máscaras , Boca , Pandemias , Pneumonia Viral , Atitude , Betacoronavirus , Humanos , Polônia
11.
Anticancer Res ; 40(11): 6375-6379, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109575

RESUMO

BACKGROUND/AIM: Sclerosing microcystic adenocarcinoma (SMA) is a rare oral cavity neoplasia, histologically resembling microcystic adnexal carcinoma (MAC) of the skin. Only nine SMA cases have been reported in the literature, frequently in the context of immunosuppression; SMA has not been recognized in the most recent WHO tumor classification. We sought to identify potential molecular mechanisms of tumorigenesis in a case of SMA relative to those known for MAC. CASE REPORT: A 41-year-old female with psoriatic arthritis undergoing immunosuppression therapy presented with a tongue mass. Biopsy revealed a diagnosis of SMA. Partial glossectomy and neck dissection showed no residual tumor or nodal disease. RESULTS: whole exome sequencing revealed moderate mutational burden and putative loss of function mutations in CDK11B but no overlap with known MAC mutations. CONCLUSION: We characterized the genomic profile of SMA for the first time, identifying both mutational burden and unique somatic variants associated with tumorigenesis.


Assuntos
Adenocarcinoma/genética , Adenoma/genética , Quinases Ciclina-Dependentes/genética , Adenocarcinoma/patologia , Adenoma/patologia , Adulto , Carcinogênese/genética , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Boca/metabolismo , Boca/patologia , Mutação/genética , Neoplasias/genética , Neoplasias/patologia , Sequenciamento Completo do Exoma
12.
Arch Virol ; 165(12): 2847-2856, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33034764

RESUMO

Here, we investigated the fecal, oral, blood, and skin virome of 10 laboratory rabbits using a viral metagenomic method. In the oral samples, we detected a novel polyomavirus (RabPyV), and phylogenetic analysis based on the large T antigen, VP1 and VP2 regions indicated that the novel strain might have undergone a recombination event. Recombination analysis based on related genomes confirmed that RabPyV is a multiple recombinant between rodent-like and avian-like polyomaviruses. In fecal samples, three partial or complete genome sequences of viruses belonging to the families Picobirnaviridae, Parvoviridae, Microviridae and Coronaviridae were characterized, and phylogenetic trees were constructed based on the predicted amino acid sequences of viral proteins. This study increases the amount of genetic information on viruses present in laboratory rabbits.


Assuntos
Metagenoma , Polyomavirus/isolamento & purificação , Coelhos/virologia , Proteínas Virais/genética , Vírus/classificação , Animais , Animais de Laboratório/virologia , Sangue/virologia , Fezes/virologia , Genoma Viral , Boca/virologia , Filogenia , Pele/virologia , Vírus/isolamento & purificação , Sequenciamento Completo do Genoma
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 494-497, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018035

RESUMO

Parkinson's disease (PD) is the second most common age-related neurodegenerative disorder after Alzheimer's disease, associated, among others, with motor symptoms such as resting tremor, rigidity and bradykinesia. At the same time, early diagnosis of PD is hindered by a high misdiagnosis rate and the subjective nature of the diagnosis process itself. Recent developments in mobile and wearable devices, such as smartphones and smartwatches, have allowed the automated detection and objective measurement of PD symptoms. In this paper we investigate the hypothesis that PD motor symptom degradation can be assessed by studying the in-meal behavior and modeling the food intake process. To achieve this, we use the inertial data from a commercial smartwatch to investigate the in-meal eating behavior of healthy controls and PD patients. In addition, we define and provide a methodology for calculating Plate-to-Mouth (PtM), an indicator that relates with the average time that the hand spends transferring food from the plate towards the mouth during the course of a meal. The presented experimental results, using our collected dataset of 28 participants (7 healthy controls and 21 PD patients), support our hypothesis. Results initially point out that PD patients have a higher PtM value than the healthy controls. Finally, using PtM we achieve a precision/recall/F1 of 0.882/0.714/0.789 towards classifying the meals from the PD patients and healthy controls.


Assuntos
Doença de Parkinson , Humanos , Hipocinesia , Refeições , Boca , Movimento
14.
Shanghai Kou Qiang Yi Xue ; 29(3): 281-286, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-33043345

RESUMO

PURPOSE: To investigate the effect of extraction on condylar process position and upper airway in 12-14 years old females with skeletal ClassⅡhigh angle. METHODS: Twenty seven 12-14 years old females with skeletal ClassⅡhigh angle (experimental group) and 30 physical examinees without malocclusion (control group) in Stomatology Hospital Affiliated to Southwest Medical University from January 2016 and June 2017 were enrolled. All patients received cone-beam CT (CBCT) examinations. Mimics 20.0 was used to process the data. The changes of the condylar process position and upper airway were recorded. The data were analyzed using SPSS 20.0 software package. RESULTS: Before treatment, patients in the experimental group had higher Sa as well as lower Sp than those of the control group (P<0.05), but with no difference in Su between 2 groups before treatment (P>0.05). After treatment, Sa was decreased in the experimental group (P<0.05), but no change was observed in Sp and Su(P>0.05). After treatment, the joint space indexes were increased in the experimental group (P<0.05). Before treatment, the V total, V tongue, V mouth, and SMIN in the experimental group were significantly lower than those of the control group (P<0.05). Before treatment, V nose, V palate, V larynx, APTE, APHP and APSP in the experimental group showed no difference with those of the control group (P>0.05). V nose, V larynx, APHP and APTE showed no difference before and after treatment within the experimental group (P>0.05). After treatment, the V total, V tongue, V palate, V mouth, SMIN and APSP in the experimental group were significantly increased (P<0.05). CONCLUSIONS: Extraction treatment can widen the airway, suggesting that there may be a certain correlation between the changes of condyle position and upper airway volume.


Assuntos
Laringe , Má Oclusão de Angle Classe II , Má Oclusão , Adolescente , Criança , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Má Oclusão de Angle Classe II/diagnóstico por imagem , Má Oclusão de Angle Classe II/terapia , Boca
15.
J Spec Oper Med ; 20(3): 114-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969014

RESUMO

This is second of a two-part series on the history and effectiveness of mouthguards (MGs) for protection from orofacial injuries. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue which helps prevent lacerations and bruises. The single study on MG use in military training found that when boil-and-bite MGs were required for four training activities, orofacial injury rates were reduced 56% compared with when MGs were required for just one training activity. A recent systematic review on the effectiveness of MGs for prevention of orofacial injuries included 23 studies involving MG users and nonusers and a wide variety of sports. For cohort studies that directly collected injury data, the risk of an orofacial injury was 2.33 times higher among MG nonusers (95% confidence interval, 1.59-3.44). More well-designed studies are needed on the effectiveness of MGs during military training. Despite some methodological limitations, the current data suggest that MGs can substantially reduce the risk of orofacial injuries in sport activities. MGs should be used in activities where there is a significant risk of orofacial injuries.


Assuntos
Militares , Protetores Bucais , Traumatismos em Atletas/prevenção & controle , Traumatismos Faciais/prevenção & controle , Humanos , Lacerações , Boca/lesões
16.
PLoS One ; 15(9): e0239898, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986784

RESUMO

BACKGROUND: People with special needs have high unmet oral healthcare needs, partly because dentists find it difficult to access their oral cavity. The Oral Accessibility Spatula aims to improve oral accessibility. This prospective multicenter interventional open-label non-randomized patient-self-controlled trial assessed the ability of the spatula to improve the oral accessibility of special-needs patients during dental examinations. METHODS: The cohort was a convenience sample of minor and adult patients with special needs due to physical, intellectual, and/or behavioral disorders who underwent dental check-up/treatment in five French tertiary hospitals/private clinics in 2016-2018 and evinced some (Venham-Score = 2-4) but not complete (Venham-Score = 5) resistance to oral examination. After inclusion, patients underwent oral examination without the spatula and then immediately thereafter oral examination with the spatula. Primary outcome was Oral Accessibility Score (0-12 points; higher scores indicate visualization and probing of the tooth sectors). Secondary outcomes were patient toleration (change in Venham-Score relative to first examination), safety, and Examiner Satisfaction Score (0-10; low scores indicate unsatisfactory examination). RESULTS: The 201 patients were mostly non-elderly adults (18-64 years, 65%) but also included children (21%), adolescents (11%), and aged patients (3%). One-quarter, half, and one-quarter had Venham-Score = 2, 3, and 4 at inclusion, respectively. The spatula significantly improved Oral Accessibility Score (4.8 to 10.8), Venham-Score (3.1 to 2.6), and Examiner Satisfaction Score (3.4 to 7.2) (all p<0.001). There were no severe spatula-related adverse events. CONCLUSION: The spatula significantly improved oral access, was safe and well-tolerated by the patients, and markedly improved oral examination quality.


Assuntos
Assistência Odontológica para Pessoas com Deficiências/instrumentação , Instrumentos Odontológicos/efeitos adversos , Diagnóstico Bucal/instrumentação , Pessoas com Deficiência , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Ansiedade ao Tratamento Odontológico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Boca , Satisfação do Paciente , Estudos Prospectivos , Adulto Jovem
17.
Quintessence Int ; 51(9): 696-709, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32901234

RESUMO

OBJECTIVES: To evaluate masking effects of resin infiltration on labial white spot lesions (WSL), by comparing the latter with a remineralization approach (using hydroxyapatite and fluorides) and conventional oral care (using fluoride-free toothpaste). METHOD AND MATERIALS: Fifteen patients with at least three WSL were enrolled for a within-person randomized controlled trial, thus allowing for intrapersonal comparisons. Each WSL per tooth in every patient was randomly assigned to one of the following groups. Group 1: lesions were resin-infiltrated with Icon (RI; DMG); Group 2: Remin Pro (RP; VOCO) was used as remineralizing agent; and Group 3 (control): affected teeth were brushed with Complete Care toothpaste (CC; Himalaya). RP and CC were applied by means of a polishing brush, using a low-speed handpiece (5 min), and these procedures were repeated chairside thrice daily for 7 consecutive days. Digital photographs were captured before and after lesion treatment under standardized conditions. The CIE L*a*b* color system was used to analyze the optical outcome, and intrapersonal color differences were statistically evaluated. RESULTS: Compared to RP and CC, RI showed prompt and subjectively satisfactory color improvements, and this was primarily driven by L* and b* shifts. Statistical analysis of the objective color differences (ΔE*) between the three groups revealed significant differences for RI vs RP (P = .029), RI vs CC (P < .001), and RP vs CC (P = .001). CONCLUSION: Resin infiltration is considered a time-effective treatment option for esthetically camouflaging WSL, while RP and CC failed to improve lesion appearance and oral health in the current short-term trial.


Assuntos
Cárie Dentária , Saúde Bucal , Esmalte Dentário , Humanos , Boca , Resinas Sintéticas
19.
J Craniomaxillofac Surg ; 48(10): 1004-1008, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32873466

RESUMO

AIM AND OBJECTIVE: This study was aimed to compare the effectiveness of 3-0 knotless barbed suture (polydioxanone) with 4-0 polyglactin 910 (vicryl) in achieving wound closure after impacted mandibular third molar surgery. MATERIALS AND METHODS: Patients with bilateral mandibular third molar impaction of similar difficulty index enrolled in the split mouth study. Wound closure was done using 3-0 knotless suture (30 × 30 cm) for the study group and 4-0 polyglactin 910 (vicryl) for the control group following extraction. Samples were allocated on the basis of simple randomization. The clinical outcome parameters that were measured were (1) time taken to achieve wound closure and hemostasis (2) postoperative mouth opening (3) swelling and (4) Pain. Data analysis involved descriptive statistics and paired t-tests (p < 0.05). IBM SPSS software (v.20.0) was used. RESULT: A total of 25 patients participated in the study (14 males and 11 females) with the mean age of 25.6 years. The mean time taken for wound approximation was 2.45 min and 4.1480 min (p-0.026) for the study and control groups respectively. The difference in mouth opening (p-0.015), VAS score(p-0.24), and swelling (p-0.041) were statistically significant on the first post-operative day in the study group than the control group indicating reduction in pain (p < 0.0001), swelling (p-0.033) and improvement in mouth opening (p < 0.0001) on seventh post-operative day in the study group compared to the control group. CONCLUSION: Knotless suture is an effective alternative to conventional sutures for intra oral wound closure as it reduces suturing time, facilitates effective wound closure and minimises knot related complications.


Assuntos
Dente Serotino/cirurgia , Dente Impactado/cirurgia , Adulto , Edema/etiologia , Edema/prevenção & controle , Feminino , Humanos , Masculino , Boca , Técnicas de Sutura , Suturas
20.
Cochrane Database Syst Rev ; 9: CD013628, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32936947

RESUMO

BACKGROUND: COVID-19 infection poses a serious risk to patients and - due to its contagious nature - to those healthcare workers (HCWs) treating them. The risks of transmission of infection are greater when a patient is undergoing an aerosol-generating procedure (AGP). Not all those with COVID-19 infection are symptomatic, or suspected of harbouring the infection. If a patient who is not known to have or suspected of having COVID-19 infection is to undergo an AGP, it would nonetheless be sensible to minimise the risk to those HCWs treating them. If the mouth and nose of an individual undergoing an AGP are irrigated with antimicrobial solutions, this may be a simple and safe method of reducing the risk of any covert infection being passed to HCWs through droplet transmission or direct contact. Alternatively, the use of antimicrobial solutions by the HCW may decrease the chance of them acquiring COVID-19 infection. However, the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose. OBJECTIVES: To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to HCWs and/or patients when undertaking AGPs on patients without suspected or confirmed COVID-19 infection. SEARCH METHODS: Information Specialists from Cochrane ENT and Cochrane Oral Health searched the Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embase and additional sources for published and unpublished trials. The date of the search was 1 June 2020.  SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies: randomised controlled trials (RCTs); quasi-RCTs; non-randomised controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before-and-after studies. We set no minimum duration for the studies.   We sought studies comparing any antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered to the patient or HCW before and/or after an AGP. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Our primary outcomes were: 1) incidence of symptomatic or test-positive COVID-19 infection in HCWs or patients; 2) significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 3) COVID-19 viral content of aerosol (when present); 4) change in COVID-19 viral load at site(s) of irrigation; 5) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 6) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We found no completed studies to include in this review.   AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review, nor any ongoing studies. The absence of completed studies is not surprising given the relatively recent emergence of COVID-19 infection. However, we are disappointed that this important clinical question is not being addressed by ongoing studies.


Assuntos
Anti-Infecciosos/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Antissépticos Bucais/administração & dosagem , Sprays Nasais , Pneumonia Viral/transmissão , Administração Intranasal , Microbiologia do Ar , Anti-Infecciosos/efeitos adversos , Infecções Assintomáticas/terapia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Boca/virologia , Antissépticos Bucais/efeitos adversos , Nariz/virologia , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia
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