Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis.

AIMS: This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. METHODS: PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: "drug interactions," "clinically relevant," and "hospital." In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. RESULTS: From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0-19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose. CONCLUSIONS: This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.

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

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Myofibroma of the oral cavity. A rare spindle cell neoplasm

Myofibroma is an un common spindle cell neoplasm rarely found in oral cavity. Typically, this lesion is seen inneonates and infants with few cases reported in adults patients. In the oral cavity, myofibroma occurs within the submucosal or intramuscular tissue and has a predilection by the tongue, buccal mucosa and lips. Microscopically, a typical biphasic pattern can be observed. Misdiagnosis included benign and malignant spindle cell lesions of nerve tissue or smooth muscle origin, such as neurofibroma, leiomyoma and sarcomas. Thus, immunohistochemical staining is a useful tool to identify the nature of neoplastic cells and to reach an accurate diagnosis. An immunohistochemical panel consisting of antibodies to vimentin, SMA, HHF-35, S-100p and desmin must be achieved.In most cases, positivity for vimentin, SMA and HHF-25 can be observed. Our report describes a solitary myofibroma of the tongue of a 23-year-old man with emphasis in clinical, histopathological and immunohistochemical features of this lesion (AU)

Tratamento cirúrgico de mucoceleutilizando a técnica de Shira: relatode caso / Surgical treatment of mucoceleusing Shira?s technique: casereport

Introdução: O termo mucocele é empregado, clinicamente,como um termo genérico para se referir aos fenômenos de retenção eextravasamento de muco, diferenciados somente após a análise histopatológica.Atinge, com maior freqüência, o lábio inferior, principalmentepelo fato de esse sítio ter maior tendência a sofrer injúrias. Objetivo:O tratamento ideal para qualquer forma de mucocele é a sua completaremoção cirúrgica juntamente com as glândulas acessórias que nutrem alesão. Material e método: Algumas técnicas têm sido preconizadas parafacilitar sua remoção e evitar recidivas, dentre elas uma que utiliza materialde moldagem (Técnica de Shira). Resultados: O estudo do casoclínico de mucocele em lábio inferior descrito neste trabalho foi realizadocom auxílio do alginato como parte da técnica para excisão da lesão. Conclusão:Independentemente do tipo de tratamento cirúrgico escolhido, ospacientes devem ser orientados quanto aos fatores etiológicos envolvidos,pois sua permanência fatalmente acarretará recidiva das lesões.

Introduction: The term mucoceleis used clinically as general term which refersto phenomenon of retention and extravasationof mucus, deferring just after histopathologicalanalyze. The inferior lip is most frequentlyachieved, primarily by the fact of this site hasmore tendency to suffer injury. Objective: Theideal treatment to any form of mucocele iscomplete surgical removal with accessory glandsthat nourish the lesion. Material and methods:Some techniques have been proposal to facilitate itremoval and avoid relapses, among them one thatuse casting material (Shira?s Technique). Results:This article show a mucocele?s case in inferior lip,in that alginate was used as part of the techniqueto excision of the lesion. Conclusion: Despiteof the chirurgical technique, the patient must beinformed about the etiological factors involved,because the high frequency of relapse from thislesions.