Efficacy and safety of nitazoxanide in treating SARS-CoV-2 infection: a systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials.

PURPOSE: Nitazoxanide is a broad-spectrum antiparasitic that has been tested for COVID-19 due to its anti-inflammatory effects and in vitro antiviral activity. This study synthesized the best evidence on the efficacy and safety of nitazoxanide in COVID-19. METHODS: Searches for studies were performed in peer-reviewed and grey-literature from January 1, 2020 to May 23, 2022. The following elements were used to define eligibility criteria: (1) Population: individuals with COVID-19; (2) Intervention: nitazoxanide; (3) Comparison: placebo; (4) Outcomes: primary outcome was death, and secondary outcomes were viral load, positive RT-PCR status, serum biomarkers of inflammation, composite measure of disease progression (ICU admission or invasive mechanical ventilation), and any adverse events; (5) Study type: blinded, placebo-controlled, randomized clinical trials (RCTs). Treatment effects were reported as relative risk (RR) for dichotomous variables and standardized mean difference (SMD) for continuous variables with 95% confidence intervals (CI). RESULTS: Five blinded, placebo-controlled RCTs were included and enrolled individuals with mild or moderate SARS-CoV-2 infection. We found no difference between nitazoxanide and placebo in reducing viral load (SMD = - 0.16; 95% CI - 0.38 to 0.05) and the frequency of positive RTP-PCR results (RR = 0.92; 95% CI 0.81 to 1.06). In addition, there was no decreased risk for disease progression (RR = 0.63; 95% CI 0.38 to 1.04) and death (RR = 0.81; 95% CI 0.36 to 1.78) among patients receiving nitazoxanide. Patients with COVID-19 treated with nitazoxanide had decreased levels of white blood cells (SMD = - 0.15; 95% - 0.29 to - 0.02), lactate dehydrogenase (LDH) (SMD - 0.32; 95% - 0.52 to - 0.13), and D-dimer (SMD - 0.49; 95% CI - 0.68 to - 0.31) compared to placebo, but the magnitude of effect was considered small to moderate. CONCLUSION: This systematic review showed no evidence of clinical benefits of the use of nitazoxanide to treat patients with mild or moderate COVID-19. In addition, we found a reduction in WBC, LDH, and D-dimer levels among nitazoxanide-treated patients, but the effect size was considered small to moderate.

Recommendations for a safety dental care management during SARS-CoV-2 pandemic.

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly through droplets, sneezes and aerosols, there is a high risk of transmission during dental procedures. This report describes measures that can be adopted by oral healthcare personnel to minimize the risk of cross-contamination in clinical practice during the current SARS-CoV-2 pandemic.

Dado que el SARS-CoV-2, causante de síndrome respiratorio agudo severo, se transmite principalmente por medio de gotitas, estornudos y aerosoles, existe un alto riesgo de transmisión durante los procedimientos dentales. En este informe se describen las medidas que puede adoptar el personal de salud bucodental para reducir al mínimo el riesgo de contaminación cruzada en la práctica clínica durante la actual pandemia por SARS-CoV-2.

Como o SARS-CoV-2, que causa síndrome respiratória aguda grave, é transmitido principalmente por gotículas, espirros e aerossóis, há um alto risco de transmissão durante os procedimentos odontológicos. Este relatório descreve os passos que podem ser tomados pelo pessoal de saúde oral para minimizar o risco de contaminação cruzada na prática clínica durante a actual pandemia do SARS-CoV-2.

Recommendations for a safety dental care management during SARS-CoV-2 pandemic

[ABSTRACT]. As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly through droplets, sneezes and aerosols, there is a high risk of transmission during dental procedures. This report describes measures that can be adopted by oral healthcare personnel to minimize the risk of cross-contamination in clinical practice during the current SARS-CoV-2 pandemic.

[RESUMEN]. Dado que el SARS-CoV-2, causante de síndrome respiratorio agudo severo, se transmite principalmente por medio de gotitas, estornudos y aerosoles, existe un alto riesgo de transmisión durante los procedimientos dentales. En este informe se describen las medidas que puede adoptar el personal de salud bucodental para reducir al mínimo el riesgo de contaminación cruzada en la práctica clínica durante la actual pandemia por SARS-CoV-2.

[RESUMO]. Como o SARS-CoV-2, que causa síndrome respiratória aguda grave, é transmitido principalmente por gotículas, espirros e aerossóis, há um alto risco de transmissão durante os procedimentos odontológicos. Este relatório descreve os passos que podem ser tomados pelo pessoal de saúde oral para minimizar o risco de contaminação cruzada na prática clínica durante a actual pandemia do SARS-CoV-2.

Cryotherapy in reducing pain, trismus, and facial swelling after third-molar surgery: Systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate the efficacy of cryotherapy in reducing pain, trismus, and facial swelling in patients undergoing third-molar surgery. TYPES OF STUDIES REVIEWED: The authors searched for randomized clinical trials in PubMed, Web of Science, SCOPUS, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, and OpenThesis. Eligibility criteria were population: patients submitted to removal of impacted third molars; intervention and comparison: postoperative cryotherapy versus no cold therapy; and outcomes: primary outcome was postoperative pain, and secondary outcomes were facial swelling and trismus. Eligible studies must have reported at least 1 of the outcomes of interest. After extracting data and assessing quality, the authors performed the meta-analyses. RESULTS: The authors included 6 studies in the quantitative synthesis analysis. Differences in pain intensity were found on postoperative day 2 (weighted mean difference, -0.72; 95% confidence interval, -1.45 to 0.01; P = .05) and postoperative day 3 (weighted mean difference, -0.36; 95% confidence interval, -0.59 to -0.13; P = .002). No evidence was found that cryotherapy was effective in reducing trismus and facial swelling. The quality of evidence was graded as low. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Evidence suggests that cryotherapy may have a small benefit in reducing pain after third-molar surgery, but it is not effective on facial swelling and trismus. Owing to the lack of standardization of cold application, effective evidence-based treatment protocols for cryotherapy after third-molar surgery still need to be established.

Efficacy of proteolytic enzyme bromelain on health outcomes after third molar surgery. Systematic review and meta-analysis of randomized clinical trials

Background: Bromelain is a cysteine protease isolated from pineapple with a range of biological properties including platelet aggregation inhibition and anti-inflammatory effects. Recent studies have evaluated the clinical implications of bromelain in reducing postoperative inflammatory complications after third molar surgery, but the results are contrasting. This systematic review and meta-analysis evaluated the effects of bromelain on health outcomes in patients submitted to third molar surgery. Material and methods: The study was conducted following the PRISMA statement. Searches were conducted in six electronic databases and Google Scholar from inception to May 2018. The following elements were used to define eligibility criteria: (1) population: patients undergoing third molar surgery; (2) intervention and controls: bromelain vs placebo or no-treatment control group; (3) outcomes: quality of life, postoperative pain, rescue analgesic consumption, facial swelling, and trismus; and (4) study type: randomized clinical trials (RCTs). Treatment effects were defined as weighted (WMD) or standardized mean difference (SMD) and 95%CIs. Results: Six RCTs were included in the meta-analysis. There was large effect size of bromelain on improving physical appearance (SMD -0.77, CI% 95 -1.11 to -0.42), social isolation (SMD -0.97, CI% 95 -1.74 to -0.21), and sleep quality (SMD -1.19, CI% 95 -1.97 to -0.40) during the first postoperative week. Differences in pain intensity were found during the first 24h (SMD -0.49, CI 95% -0.82 to -0.17) and 7 days after surgery (SMD -0.52, CI 95% -0.79 to -0.24). No evidence was found that bromelain was effective in reducing trismus and facial swelling. Conclusions: The currently available evidence suggests that bromelain has a beneficial effect in reducing pain and has a positive impact on patient quality of life after third molar surgery. However, therapeutic advances for the use of bromelain need a high level of evidence and further head-to-head RCTs are needed to inform clinical choices

No disponible

Femicide trends in Brazil: relationship between public interest and mortality rates.

In this information epidemiology (infodemiology) study, we describe the online public interest about the issue of femicide in Brazil and analyze the relationship between search queries and femicide trends from 2004 to 2015. We showed that information-seeking behavior for femicide in the Brazilian states has been strongly influenced by female homicide rates. Educational and policy-related interventions are needed to improve the population's knowledge and attitude toward femicide.