Vitamin C Levels in Pregnant Women and the Efficacy of Vitamin C Supplements in Preventing Premature Rupture of Membranes: A Systematic Review and Meta-Analysis.

Background: Premature rupture of membranes (PROM) is defined as the leakage of amniotic fluid before the onset of labor and delivery contractions. Some studies found that women who experienced PROM had significantly lower vitamin C blood levels than those who did not, while others found no significant differences. Previous systematic reviews and meta-analyses on the efficacy of vitamin C in the prevention of PROM had conflicting results. Aims: We aimed to conduct a systematic review and meta-analysis to determine if there was a significant difference in vitamin C blood levels in women who had PROM versus the control group who did not and to determine if vitamin C supplements could help prevent it. Study Design: Systematic review and meta-analysis. Methods: We registered our protocol with PROSPERO (CRD42022371644). We searched PubMed/MEDLINE, Web of Science, and Scopus through February 15, 2024. Additionally, backward and forward citation searches were conducted. Studies were selected based on predetermined inclusion and exclusion criteria. Meta-Essentials: Workbooks for Meta-Analysis (Version 1.5) was used for analysis. Results: Twenty-five studies (26 reports) met all eligibility criteria, with 18 studies (18 reports) assessing vitamin C levels and seven studies (eight reports) evaluating efficacy. Women with PROM, whether preterm or term, had significantly lower vitamin C levels [Hedges' g, -1.48; 95% confidence interval (CI): -2.82, -0.14; p = 0.020; I2 = 94.08%) and specifically preterm PROM after removing the outlying study [Hedges' g, -1.29; 95% CI: -1.85, -0.73; p < 0.001; I2 = 87.35%). Vitamin C supplementation significantly reduced the risk of preterm or term PROM [risk ratio (RR), 0.57; 95% CI: 0.39, 0.81; p < 0.001; I2 = 12.17%), particularly for preterm PROM (RR, 0.67; 95% CI: 0.45, 0.99; p = 0.001; I2 = 0.00%). There were no significant differences in vitamin C levels between women with term PROM and controls, and there were no differences in the risk of developing term PROM between women taking vitamin C supplements and controls. Results were not robust in all sensitivity analyses. Conclusion: Women with PROM, particularly those who developed it preterm, appear to have significantly lower vitamin C levels, and vitamin C supplementation appears to be effective in reducing the risk of PROM, particularly preterm PROM. More high-quality studies with low risk of bias, more homogenous, and larger samples are needed to confirm these findings.

Outcomes of long-acting injectable antipsychotics use in pregnancy: A literature review.

BACKGROUND: Women with a history of serious psychotic disorders are at increased risk of disease relapse during pregnancy. Long-acting injectable (LAI) antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders, but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during pregnancy. AIM: To summarize relevant data on maternal, pregnancy, neonatal, and developmental outcomes from published cases of LAI antipsychotic use in pregnancy. METHODS: A literature search was performed through November 11, 2023, using three online databases: PubMed/MEDLINE, Scopus, and Web of Science. Case reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy, with available full texts, were included. Descriptive statistics, narrative summation, and tabulation of the extracted data were performed. RESULTS: A total of 19 publications satisfied the inclusion criteria: 3 case series, 15 case reports, and 1 conference abstract. They reported the outcomes of LAI antipsychotic use in 74 women and 77 pregnancies. The use of second-generation LAI antipsychotics was reported in the majority (n = 47; 61.0%) of pregnancies. First-generation LAI antipsychotics were administered during 30 pregnancies (39.0%). Most of the women (approximately 64%) had either satisfactory control of symptoms or no information about relapse, while approximately 12% of them had developed gestational diabetes mellitus. A minority of cases reported adverse outcomes such as stillbirth, spontaneous abortion, preterm birth, low birth weight, congenital anomalies, and neurological manifestations in newborns. However, there were no reports of negative long-term developmental outcomes. CONCLUSION: Currently available data seem reassuring, but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

Priapism associated with anti-seizure medications: a pharmacovigilance study and a review of published cases.

BACKGROUND: Recently, case reports of priapism associated with the use of some anti-seizure medications began to emerge in the literature. We aimed to investigate if there is a potential safety signal of priapism among individual anti-seizure medications and to search the literature for relevant published cases. RESEARCH DESIGN AND METHODS: We conducted a disproportionality analysis using OpenVigil 2.1 to query the United States Food and Drug Administration's Adverse Event Reporting System (FAERS) database. Literature search was conducted in PubMed/MEDLINE, Scopus and Web of Science up to 12 July 2023. RESULTS: We identified positive signal of priapism for valproic acid and its derivatives (n = 23, chi-squared = 59.943, PRR = 4.566), gabapentin (n = 20, chi-squared = 9.790, PRR = 2.060), lamotrigine (n = 16, chi-squared = 8.318, PRR = 2.120), levetiracetam (n = 16, chi-squared = 10.766, PRR = 2.329), topiramate (n = 14, chi-squared = 28.067, PRR = 3.972) and carbamazepine (n = 8, chi-squared = 6.147, PRR = 2.568), as well as published cases of priapism associated with these drugs. We also found published cases of priapism for pregabalin and phenytoin in the literature and FAERS, and at least one reported adverse event of priapism in FAERS for clonazepam, lacosamide, ethosuximide, oxcarbazepine, and vigabatrin in which they were considered primary suspect. CONCLUSIONS: Our study identified signals for priapism for several anti-seizure medications, but these results need to be confirmed in well-designed pharmacoepidemiological studies.

Factors associated with gastrointestinal dysmotility in critically ill patients.

Critical illness may disrupt nutritional, protective, immune, and endocrine functions of the gastrointestinal tract, leading to a state of gastrointestinal dysmotility. We aimed to identify factors associated with the occurrence of gastrointestinal dysmotility in critically ill patients. A cross-sectional retrospective study was conducted, using patient files as a source of data. The study included 185 critically ill patients treated in the intensive care unit of the University Clinical Center, Kragujevac, Serbia, from January 1, 2016, to January 1, 2022. Significant risk factors associated with some form of gastrointestinal dysmotility were acute kidney injury (with paralytic ileus, nausea, vomiting, and constipation), recent abdominal surgery (with ileus, nausea, vomiting, and constipation), mechanical ventilation (with ileus, and nausea), age (with ileus and constipation), and use of certain medication such as opioids (with ileus, gastro-esophageal reflux, nausea, vomiting, and constipation), antidepressants (with ileus, nausea, and vomiting), and antidiabetics (with ileus). On the other hand, Charlson comorbidity index had divergent effects, depending on the form of gastrointestinal dysmotility: it increased the risk of gastro-esophageal reflux but protected against ileus, nausea, and vomiting. In clonclusion, recognition of factors associated with gastrointestinal dysmotility should initiate preventative measures and, thus, accelerate the recovery of critically ill.

Comparative analysis of antigen-presenting cells in gingival tissues in healthy and periodontitis patients.

AIMS: Microbial flora of dental plaque trigger innate and adaptive immune responses. The function of antigen-presenting cells (APCs) is to bridge the innate and adaptive immune systems. The human immune system contains three main types of APCs: dendritic cells (DC) (Langerhans cells (LCs) and interstitial DCs, IDCs), macrophages and B lymphocytes. In this study, the distribution and density of all APCs in healthy and inflamed human gingival tissue were comparatively analysed. METHODS: Research was conducted on gingival biopsy specimens obtained from 55 patients and classified in three groups: healthy gingiva (control group, n=10), moderate periodontal disease (PD) (n=21) and severe PD (n=24). For APCs' identification antibodies raised against CD1a (for LCs), S100 protein (for iDCs), CD68 (for macrophages) and CD20 (for B lymphocytes) were used. RESULTS: Increased density of IDCs, macrophages and B lymphocytes in lamina propria and reduced density of LCs in the gingival epithelium were found in patients with periodontitis. Simultaneously, it was noticed an increased concentration of macrophages and B cells in the gingival epithelium in patients with PD. No statistically significant difference in the distribution and density of APC was found among patients with moderate and advanced periodontitis. CONCLUSIONS: It was hypothesised that in the periodontitis the role of antigen presentation was largely taken from LCs by the DCs, macrophages and B cells. These APCs are thought to have less protective and tolerogenic potential than LCs and this is a significant reason for alveolar bone destruction in periodontitis.

Brixia Chest X-ray Score, Laboratory Parameters and Vaccination Status for Prediction of Mortality in COVID-19 Hospitalized Patients.

Chest X-ray has verified its role as a crucial tool in COVID-19 assessment due to its practicability, especially in emergency units, and Brixia score has proven as a useful tool for COVID-19 pneumonia grading. The aim of our study was to investigate correlations between main laboratory parameters, vaccination status, and Brixia score, as well as to confirm if Brixia score is a significant independent predictor of unfavorable outcome (death) in COVID-19 patients. The study was designed as a cross-sectional multicentric study. It included patients with a diagnosed COVID-19 infection who were hospitalized. This study included a total of 279 patients with a median age of 62 years. The only significant predictor of unfavorable outcome (death) was Brixia score (adjusted odds ratio 1.148, p = 0.022). In addition, the results of the multiple linear regression analysis (R2 = 0.334, F = 19.424, p < 0.001) have shown that male gender (B = 0.903, p = 0.046), severe COVID-19 (B = 1.970, p < 0.001), and lactate dehydrogenase (B = 0.002, p < 0.001) were significant positive predictors, while albumin level (B = -0.211, p < 0.001) was a significant negative predictor of Brixia score. Our results provide important information about factors influencing Brixia score and its usefulness in predicting the unfavorable outcome (death) of COVID-19 patients. These findings have clinical relevance, especially in epidemic circumstances.

Potential Novel RNA-Targeting Agents for Effective Lipoprotein(a) Lowering: A Systematic Assessment of the Evidence From Completed and Ongoing Developmental Clinical Trials.

ABSTRACT: An increase in blood lipoprotein (a) [Lp(a)] levels, mostly genetically determined, has been identified as an independent risk factor of atherosclerotic cardiovascular disease. No drug has yet been approved that markedly lowers Lp(a) and thereby reduces residual cardiovascular risk. The aim of this article was to critically review the evidence from clinical development studies to date on the efficacy and safety of new RNA-based therapeutics for targeted lowering of Lp(a). PubMed/MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov were searched without any language or date restriction up to November 5, 2022, and a total of 12 publications and 22 trial records were included. Several drugs were found that are currently in various stages of clinical development, such as the antisense oligonucleotide pelacarsen and the small interfering RNA molecule olpasiran and drugs coded as SLN360 and LY3819469. Among them, pelacarsen has progressed the most, currently reaching phase 3. All these drugs have so far shown satisfactory pharmacokinetic properties, consistently high and stable, dose-dependent efficacy in lowering Lp(a) even by more than 90%, with an acceptable safety profile in subjects with highly elevated Lp(a). In addition, reports of early clinical trials with pelacarsen imply a promising suppressive effect on key mechanisms of atherogenesis. Future research should focus on confirming these beneficial clinical effects in patients with lower average Lp(a) levels and clearly demonstrating the association between lowering Lp(a) and reducing adverse cardiovascular outcomes.

Kounis Syndrome Associated With the Use of Diclofenac.

BACKGROUND: Diclofenac is a widely used analgesic, anti-inflammatory, antipyretic drug. In several case reports, its use was associated with the occurrence of Kounis syndrome. The aim of this review was to investigate and summarize published cases of Kounis syndrome suspected to be associated with the use of diclofenac. METHODS: Electronic searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Serbian Citation Index. RESULTS: Twenty publications describing the 20 patients who met inclusion criteria were included in the systematic review. Specified patient ages ranged from 34 to 81 years. Eighteen (90.0%) patients were male. Five patients (25.0%) reported a previous reaction to diclofenac. Reported time from the used dose of diclofenac to onset of the first reaction symptoms ranged from immediately to 5 hours. Diclofenac caused both type I and type II Kounis syndrome, with the presence of various cardiovascular, gastrointestinal, dermatologic, and respiratory signs and symptoms. Most patients experienced hypotension (n = 15 [75.0%]) and chest pain (n = 12 [60.0%]). The most frequently reported finding on electrocardiogram was ST-segment elevations (n = 17 [85.0%]). Coronary angiogram showed normal coronary vessels in 9 patients (45.0%), with some pathologic findings in 8 patients (40.0%). CONCLUSION: Clinicians should be aware that Kounis syndrome may be an adverse effect of diclofenac. Prompt recognition and withdrawal of the drug, with treatment of both allergic and cardiac symptoms simultaneously, is important.

Mirtazapine-induced Acute Pancreatitis in Patients With Depression: A Systematic Review.

OBJECTIVE: Antidepressant-induced pancreatitis is a rare, albeit serious, adverse effect, with a frequency of occurrence that is not equally distributed among antidepressant drugs. The goal of this study was to investigate the association and causal relationship between mirtazapine treatment of patients with depression and pancreatitis. METHODS: The study was designed as a systematic review of the literature, accompanied by the description of a new case of mirtazapine-associated acute pancreatitis. RESULTS: Nine cases of mirtazapine-associated pancreatitis have been reported, involving 7 female patients and 2 male patients with a mean age of 46.4 years (range: 26 to 83 y of age). All of the patients were hospitalized, with an average length of stay of 16.2 days (range: 3 to 34 d). In 6 cases, "de-challenge" followed by improvement was reported. The patients for whom the outcome was reported (7 of 9) recovered completely. CONCLUSION: Although a rare adverse effect, mirtazapine-induced pancreatitis should be considered when patients taking mirtazapine report abdominal discomfort.

Amoxicillin-associated Stevens-Johnson syndrome or toxic epidermal necrolysis: systematic review.

Our aim was to explore and summarize available cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) suspected to be associated with amoxicillin reported in the literature. Electronic searches were conducted in several databases. Fifty-one publications describing a total of 64 patients who satisfied inclusion criteria were included in the review. The age of the patients ranged from 1.5-80 years (median: 24.5 years). TEN, SJS and SJS/TEN overlap were diagnosed in 30 (46.9%), 28 (43.8%) and 1 (1.6%) patients, respectively. SJS/TEN may occur promptly after administration of amoxicillin, but it could also be a delayed adverse effect. The total length of hospital stay ranged from 3-70 days (median: 16 days). Amoxicillin-induced SJS/TEN is accompanied by frequent occurrence of serious complications, long-term ocular and skin sequelae and high mortality rate. Clinicians should be aware that amoxicillin alone or combined with clavulanic acid can cause SJS/TEN in patients of all ages.

Testing of new instrument for measuring quality and diversity of nutrition in pregnancy.

OBJECTIVES: Our aim was construction and development of a new questionnaire for assessing the quality and diversity of nutrition of pregnant women. MATERIAL AND METHODS: This was a cross-sectional study. The novel questionnaire was developed through eight steps according with internationally accepted guidelines for questionnaire development. The questionnaire with 18 questions and answers according to the Likert's scale was created and called Balkan Food Quality and Diversity in Pregnancy Questionnaire-18 (BFQDPQ-18). Reliability testing and factor analysis of BFQDPQ-18 were carried out on a sample of 382 women in the third trimester of pregnancy whose pregnancy control and monitoring were performed at the Clinic for Gynecology and Obstetrics of the Clinical Center in Kragujevac, Serbia. RESULTS: The first test of reliability indicated high levels of internal consistency, with the Cronbach's alpha of 0.85 of the BFQDPQ-18. After dividing the BFQDPQ-18 into two parts of nine questions each by split-half method, the Cronbach's alphas were 0.799 and 0.716. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was 0.878, and the Bartlett's test of sphericity: 1,892.206, p < 0.000. Factor analysis revealed four factors explained in total 51.99% of the variance: mean meal and snack, foods with a low degree of industrial processing, subjective assessment of dietary quality and starchy foods. CONCLUSIONS: The final version of the BFQDPQ-18 showed high reliability and good psychometric properties, so we believe it could be useful instrument for assessing the quality of nutrition of pregnant women.

Meta-analysis of peripheral insulin-like growth factor 1 levels in schizophrenia.

OBJECTIVE: We aimed to investigate if there is a significant difference in peripheral insulin-like growth factor 1 (IGF-1) levels between schizophrenia patients and healthy controls and to determine whether a difference exists before and after initiation of antipsychotics. METHODS: PubMed/MEDLINE, Scopus, and Web of Science were searched up to March 27, 2022. Original clinical studies of any type that reported peripheral blood, serum or plasma IGF-1 levels measured after fasting in schizophrenia patients and/or healthy control group were selected based on inclusion and exclusion criteria. Data were analyzed using Meta-Essentials: Workbooks for meta-analysis and pooled through random-effects meta-analyses. RESULTS: Twelve publications met eligibility criteria. Schizophrenia patients under antipsychotic treatment had significantly lower peripheral IGF-1 levels compared to healthy controls (n = 632, Hedges' g -0.42, 95% CI from -0.79 to -0.04, p = .006, I2  = 70.38%), while no significant difference was found between schizophrenia patients regardless of the antipsychotic treatment status and healthy controls, as well as between antipsychotic naïve or free schizophrenia patients and healthy controls, and before and after initiation of antipsychotic treatment. However, high heterogeneity was observed and its potential sources in some of the subgroup analyses included sample type and region. CONCLUSIONS: Schizophrenia patients under antipsychotic treatment seem to have lower peripheral IGF-1 levels compared to healthy controls. Additional studies with larger and more homogenous samples are needed to confirm these findings.

Tooth loss and periodontal status in patients with cardiovascular disease in the Serbian population: A randomized prospective study.

OBJECTIVES: Chronic periodontal infections may predispose to cardiovascular disease. Since tooth loss may be due to periodontitis it is assumed that tooth loss can also predisposes cardiovascular disease. The aim was to investigate the possible relationship between the severity of the clinical picture of periodontitis and the occurrence of cardiovascular disease. METHODS: We evaluated the association between clinical periodontal parameters, tooth loss and cardiovascular incident. A total of 100 subjects (50 subjects diagnosed with cardiovascular disease and 50 in control group without cardiovascular disease) underwent a dental examination. Tooth loss in all participants was caused only as a consequence of periodontitis. In addition to periodontal status, conventional risk factors for cardiovascular diseases (hypertension, smoking, obesity, hypercholesterolemia, diabetes) were measured, too. RESULTS: Periodontal status was worse in patients in the group with cardiovascular disease compared to the group without cardiovascular disease. A significant association was observed between tooth loss levels and cardiovascular disease. In the group of patients who had cardiovascular disease, tooth loss was more than 50%. In the group of patients without cardiovascular disease, tooth loss was about 20% of the total number of teeth. A significant association was observed between tooth loss levels and cardiovascular disease prevalence. CONCLUSION: This study presents relationship between number of teeth and cardiovascular disease, indicating a link between oral health and cardiovascular disease.

Factors associated with fetal growth restriction and small for gestational age newborns.

OBJECTIVES: To identify risk factors that contribute to the occurrence of fetal growth restriction (FGR) and small for gestational age (SGA) and quantify the strength of their impact. MATERIAL AND METHODS: This study was designed as a retrospective-prospective observational cohort study conducted on pregnant women at the Clinic for Gynecology and Obstetrics at the University Clinical Centre Kragujevac, Serbia. We measured the intrauterine degree of fetal development through the estimated fetal weight (EFW) on ultrasound examination, which was calculated using Hadlock's formula 3. Fetuses whose EFW was below the 10th percentile on the World Health Organization (WHO) fetal growth charts adjusted for gender and gestational age were classified as FGR fetuses, while newborns weighing less than the 10th percentile were considered SGA. RESULTS: The study included 320 pregnant women with an average age of 30.3 ± 5.5 years who gave birth to 332 newborns. The results of univariate and multivariate stepwise backward conditional binary logistic regression showed that the occurrence of FGR during the second trimester was more likely in pregnant women with lower body height and proteinuria. The risk factors for the occurrence of FGR during the third trimester were lower body height and proteinuria, while iron supplementation had a protective effect. SGA newborns were more common in pregnant women who were shorter, had proteinuria, used corticosteroids, or smoked during pregnancy. CONCLUSIONS: Clinicians should pay special attention to pregnant women with lower body height, proteinuria, who smoke and use corticosteroids in order to prevent FGR and SGA.

Validation of the fear of COVID-19 scale in a central Balkan country - Serbia.

Validation of the fear of introduction: High levels of fear of COVID-19 may be associated with increased levels of stress, anxiety, and depression, as well as decreased resilience and life expectancy. Objective: This study aimed to translate and confirm the Serbian version of the Fear of COVID-19 scale as well as to investigate its psychometric properties. Methods: The translation and intercultural adaptation of the Fear of COVID-19 scale was performed by the leading standard of the International Society for Pharmacoeconomics and Outcome Research. When the distribution was normal, the Kolmogorov-Smirnov test was used. The reliability of the Serbian version of FCV-19S was tested by measuring the internal consistency through the value of Cronbach's alpha. Results: The original version of the Fear of COVID-19 scale was tested on a sample of 256 subjects with a mean age of 25.38 ± 12.47. The Cronbach's alpha value was 0.864. We divided the scale by the split-half method (Spearman-Brown), and the value of the coefficient for the questionnaire as a whole was 0.882. Divergent criterion validity was tested through the non-parametric correlation between the scores of the Fear of COVID-19 scale and the Fear of Hospitalization scale. A score of the Fear of COVID-19 scale was calculated as the sum of each question for each of the respondents. Convergent criterion validity was tested through the non-parametric correlation between the scores of the Fear of COVID-19 scale and the Emotional Regulation Questionnaire. Conclusion: The validated version of the scale in Serbia complements versions available in other cultures and other languages and facilitates global studies related to mental health during the COVID-19 pandemic.

Polymeric nanotechnologies for the treatment of periodontitis: A chronological review.

Periodontitis is a chronic infectious and inflammatory disease of periodontal tissues estimated to affect 70-80 % of all adults. At the same time, periodontium, the site of periodontal pathologies, is an extraordinarily complex plexus of soft and hard tissues, the regeneration of which using even the most advanced forms of tissue engineering continues to be a challenge. Nanotechnologies, meanwhile, have provided exquisite tools for producing biomaterials and pharmaceutical formulations capable of elevating the efficacies of standard pharmacotherapies and surgical approaches to whole new levels. A bibliographic analysis provided here demonstrates a continuously increasing research output of studies on the use of nanotechnologies in the management of periodontal disease, even when they are normalized to the total output of studies on periodontitis. The great majority of biomaterials used to tackle periodontitis, including those that pioneered this interesting field, have been polymeric. In this article, a chronological review of polymeric nanotechnologies for the treatment of periodontitis is provided, focusing on the major conceptual innovations since the late 1990s, when the first nanostructures for the treatment of periodontal diseases were fabricated. In the opening sections, the etiology and pathogenesis of periodontitis and the anatomical and histological characteristics of the periodontium are being described, along with the general clinical manifestations of the disease and the standard means of its therapy. The most prospective chemistries in the design of polymers for these applications are also elaborated. It is concluded that the amount of innovation in this field is on the rise, despite the fact that most studies are focused on the refinement of already established paradigms in tissue engineering rather than on the development of revolutionary new concepts.

Alopecia associated with the use of selective serotonin reuptake inhibitors: Systematic review.

We aimed to systematically review published cases of alopecia (hair loss) associated with selective serotonin reuptake inhibitors (SSRIs). Four electronic databases were searched up to November 16, 2021. Thirty-eight publications describing 71 patients with a total of 81 episodes of alopecia met inclusion criteria. Patients' age ranged from 7 to 85 years and 80.3% were female. Alopecia most commonly affected scalp (98.6%). Reported time to onset ranged from 3 days to 5 years (median: 8.6 weeks). Discontinuation of the suspected SSRI led to recovery in 63.0% of episodes. Clinicians should be aware of this possible adverse effect of SSRIs.

Effect of the local probiotics in the therapy of periodontitis A randomized prospective study.

OBJECTIVES: The use of local probiotics in the therapy of periodontitis is reflected in their ability to antagonize periodontopathogens and modulates the immune response of the host to the presence of pathogenic microorganisms. The aim of this study was to investigate the use of local probiotics in the treatment of periodontitis as an adjunctive therapy to scaling and root planning (SRP). METHODS: The study involved 80 patients diagnosed with periodontitis. All participants underwent SRP therapy. Semi-solid probiotic was then locally applied to the periodontal pocket in randomly selected patients for the test group (40 of them). The other 40 patients were in the control group. Clinical parameters including periodontal pocket depth (PPD), bleeding on probing (BOP) and plaque index (PI) were measured at baseline, and at 7 and 30 days after treatment. RESULTS: Seven days after the applied therapy in the test and control group, there was a significant decrease in the values or BOP (p < .001), while the values of other parameters did not show a statistically significant difference (p < .05). One month after the therapy in both groups, there was a statistically significant difference in the values of all clinical parameters (p < .001). CONCLUSIONS: Based on the results of this pilot study, it can be said that, during periodontal treatment, topical application of probiotics in combination with SRP increases the effectiveness of conventional non-surgical therapy of periodontitis.

Delirium associated with the use of macrolide antibiotics: a review.

OBJECTIVE: This review aimed to explore and summarise available cases of delirium suspected to be associated with the use of macrolide antibiotics reported in the literature and the United States Food and Drug Administration's Adverse Event Reporting System (FAERS) database. METHODS: Electronic searches of the literature were conducted in four online databases: PubMed/MEDLINE, Scopus, Web of Science and Serbian Citation Index (SCIndeks). A search of FAERS database was also conducted to supplement the findings of the literature search. Descriptive statistics, narrative summation and tabulation of the extracted data were made. RESULTS: Cases of delirium which satisfied inclusion criteria were found for clarithromycin, azithromycin, erythromycin and telithromycin. Delirium was described in patients of various age groups, including children. Drug-drug interactions may have contributed to its occurrence in some of the cases. Average time to onset of delirium was 2.5 days for azithromycin and 3.3 days for clarithromycin. CONCLUSIONS: Considering that these drugs may be a possible cause of delirium, clinicians should be aware that timely recognition of this possible side effect can lead to earlier discontinuation of the culprit drug, reduce time spent in a delirious state and improve patients' outcomes.KEY POINTSCases of delirium which satisfied inclusion criteria were found for clarithromycin, azithromycin, erythromycin and telithromycin.Cases of delirium were described in patients of various age groups, including children.Drug-drug interactions may have contributed to the occurrence of delirium in some of the cases.Time to onset of delirium ranged from 2 to 3.5 days (mean: 2.5 days) for azithromycin and from 1 to 7 days (mean: 3.3 days) for clarithromycin.Cessation of the macrolide antibiotic seems to be the best management strategy, although some of the patients may, in addition, require antipsychotics.

Acute Hydroxychloroquine Overdose: A Review of Published Pediatric Cases With Confirmed Hydroxychloroquine Exposure.

OBJECTIVES: This review aimed to explore and summarize information from available cases of pediatric acute hydroxychloroquine overdose with confirmed hydroxychloroquine exposure to give the clinicians a helpful perspective for its better recognition and management. METHODS: Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, EBSCO and Serbian Citation Index. The abstracts from 2 toxicology conferences were manually checked for additional relevant publications, as well as reference lists of the retrieved publications. Descriptive statistics, narrative summation, and tabulation of the extracted data were made. RESULTS: Nine publications and a total of 9 patients were included in the review. Reported age of the patients varied from 2.5 to 16 years (median, 16 years). There were more female patients (77.8%). Estimated total ingested hydroxychloroquine dose was reported in 7 cases (77.8%), and it ranged from 4.0 to 20.0 g (median: 12.0 g). Four patients (44.4%) ingested hydroxychloroquine with a coingestant. Altered mental status (100.0%), cardiotoxicity (88.9%), hypotension (77.8%), and hypokalemia (55.6%) were the most commonly reported clinical manifestations. The majority of the patients were hospitalized (88.9%). More than half of the patients (55.6%) were reported to be treated in the intensive care unit. Most frequently reported therapeutic measures were the following: administration of intravenous fluids/infusions (77.8%), vasopressors (77.8%), bicarbonate therapy-sodium bicarbonate (66.7%), potassium replacement (55.6%), and intubation/ventilation (55.6%). Three patients (33.3%) died. CONCLUSIONS: Management of acute hydroxychloroquine overdose in children should be symptomatic and tailored to observed clinical manifestations. There is a need for additional investigations to better understand the impact and effectiveness of various treatment options.