Rehabilitation Treatment in Pediatric Patients with Molar Incisor Hypomineralization: A Scoping Review

Objective: To identify the available evidence on the different treatment types for the rehabilitation of MIH-affected teeth in children. Material and Methods: A search was carried out in Pubmed, Cochrane Library, Epistemonikos, Lilacs and Google Scholar. Observational studies published until June 2022 were included. Two reviewers independently screened studies and extracted data. Results: 1593 studies were screened and a total of 38 articles were included, which were mainly case reports published in Brazil. Most included studies concluded that the evaluated treatment was "beneficial" or "probably beneficial". Reported treatments included: glass ionomer cements (GIC), composite resin restorations, preformed metal crowns, laboratory fabricated crowns, microabrasion management of incisors and resin infiltration. Conclusion: Successful treatment options have been identified, such as GIC as a provisional restoration for severe cases and for uncooperative children; restorations with composite, indirect restorations, or preformed metal crowns also seem suitable treatment options for young patients diagnosed with MIH. There is still little evidence to support an approach for anterior teeth affected by MIH

Comparison of the effectiveness and safety between autologous bone grafts and xenografts for the treatment of alveolar bone defects: Overview of systematic reviews using FRISBEE methodology

Introduction: Due to the extensive number of studies developed on periodontal pathologies and the clinical need generated to correct bonvze defects, we have carried out an Overview of systematic reviews using the FRISBEE methodology. Material and Methods: Through this study we expect to bridge the knowledge gap generated regarding the clinical question on the effectiveness of autologous bone substitutes and xenografts in maxillary and mandibular bone defects. Results: For this study, we carried out a systematic search in Epistemonikos and PubMed, we included 3 systematic reviews and 5 primary studies included in these reviews to extract their data. We analyzed data using RevMan 5.4. and GRADEpro. Assessed outcomes included: bone gain [MD 0.06 mm lower (0.26 lower to 0.14 higher)] and bone resorption [MD 0.03 mm higher (0.12 lower to 0.18 higher)], where no significant differences were found between the study groups. The certainty of the evidence was moderate for both outcomes. Bone length and bone density outcomes were not measured or reported in the included studies. Conclusion: We concluded that there are no significant clinical differences between the application of autologous bone grafts and xenografts for bone defects correction for the assessed outcomes, therefore, these biomaterials should be applied at the discretion of the clinician and according to the needs and preferences of patients

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: Overview of reviews (FRISBEE review)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone

Vaccines for the common cold.

BACKGROUND The common cold is a spontaneously remitting infection of the upper respiratory tract, characterised by a runny nose, nasal congestion, sneezing, cough, malaise, sore throat, and fever (usually < 37.8 ºC). Whilst the common cold is generally not harmful, it is a cause of economic burden due to school and work absenteeism. In the United States, economic loss due to the common cold is estimated at more than USD 40 billion per year, including an estimate of 70 million workdays missed by employees, 189 million school days missed by children, and 126 million workdays missed by parents caring for children with a cold. Additionally, data from Europe show that the total cost per episode may be up to EUR 1102. There is also a large expenditure due to inappropriate antimicrobial prescription. Vaccine development for the common cold has been difficult due to antigenic variability of the common cold viruses; even bacteria can act as infective agents. Uncertainty remains regarding the efficacy and safety of interventions for preventing the common cold in healthy people, thus we performed an update of this Cochrane Review, which was first published in 2011 and updated in 2013 and 2017. OBJECTIVES To assess the clinical effectiveness and safety of vaccines for preventing the common cold in healthy people. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (April 2022), MEDLINE (1948 to April 2022), Embase (1974 to April 2022), CINAHL (1981 to April 2022), and LILACS (1982 to April 2022). We also searched three trials registers for ongoing studies, and four websites for additional trials (April 2022). We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) of any virus vaccine compared with placebo to prevent the common cold in healthy people. DATA COLLECTION AND ANALYSIS We used Cochrane's Screen4Me workflow to assess the initial search results. Four review authors independently performed title and abstract screening to identify potentially relevant studies. We retrieved the full-text articles for those studies deemed potentially relevant, and the review authors independently screened the full-text reports for inclusion in the review, recording reasons for exclusion of the excluded studies. Any disagreements were resolved by discussion or by consulting a third review author when needed. Two review authors independently collected data on a data extraction form, resolving any disagreements by consensus or by involving a third review author. We double-checked data transferred into Review Manager 5 software. Three review authors independently assessed risk of bias using RoB 1 tool as outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We carried out statistical analysis using Review Manager 5. We did not conduct a meta-analysis, and we did not assess publication bias. We used GRADEpro GDT software to assess the certainty of the evidence and to create a summary of findings table.  MAIN RESULTS: We did not identify any new RCTs for inclusion in this update. This review includes one RCT conducted in 1965 with an overall high risk of bias. The RCT included 2307 healthy young men in a military facility, all of whom were included in the analyses, and compared the effect of three adenovirus vaccines (live, inactivated type 4, and inactivated type 4 and 7) against a placebo (injection of physiological saline or gelatin capsule). There were 13 (1.14%) events in 1139 participants in the vaccine group, and 14 (1.19%) events in 1168 participants in the placebo group. Overall, we do not know if there is a difference between the adenovirus vaccine and placebo in reducing the incidence of the common cold (risk ratio 0.95, 95% confidence interval 0.45 to 2.02; very low-certainty evidence). Furthermore, no difference in adverse events when comparing live vaccine preparation with placebo was reported. We downgraded the certainty of the evidence to very low due to unclear risk of bias, indirectness because the population of this study was only young men, and imprecision because confidence intervals were wide and the number of events was low. The included study did not assess vaccine-related or all-cause mortality.  AUTHORS' CONCLUSIONS: This Cochrane Review was based on one study with very low-certainty evidence, which showed that there may be no difference between the adenovirus vaccine and placebo in reducing the incidence of the common cold. We identified a need for well-designed, adequately powered RCTs to investigate vaccines for the common cold in healthy people. Future trials on interventions for preventing the common cold should assess a variety of virus vaccines for this condition, and should measure such outcomes as common cold incidence, vaccine safety, and mortality (all-cause and related to the vaccine)

Expected accuracy of proximal and distal temperature estimated by wireless sensors, in relation to their number and position on the skin

A popular method to estimate proximal/distal temperature (TPROX and TDIST) consists in calculating a weighted average of nine wireless sensors placed on pre-defined skin locations. Specifically, TPROX is derived from five sensors placed on the infra-clavicular and mid-thigh area (left and right) and abdomen, and TDIST from four sensors located on the hands and feet. In clinical practice, the loss/removal of one or more sensors is a common occurrence, but limited information is available on how this affects the accuracy of temperature estimates. The aim of this study was to determine the accuracy of temperature estimates in relation to number/position of sensors removed. Thirteen healthy subjects wore all nine sensors for 24 hours and reference TPROX and TDIST time-courses were calculated using all sensors. Then, all possible combinations of reduced subsets of sensors were simulated and suitable weights for each sensor calculated. The accuracy of TPROX and TDIST estimates resulting from the reduced subsets of sensors, compared to reference values, was assessed by the mean squared error, the mean absolute error (MAE), the cross-validation error and the 25th and 75th percentiles of the reconstruction error. Tables of the accuracy and sensor weights for all possible combinations of sensors are provided. For instance, in relation to TPROX, a subset of three sensors placed in any combination of three non-homologous areas (abdominal, right or left infra-clavicular, right or left mid-thigh) produced an error of 0.13°C MAE, while the loss/removal of the abdominal sensor resulted in an error of 0.25°C MAE, with the greater impact on the quality of the reconstruction. This information may help researchers/clinicians: i) evaluate the expected goodness of their TPROX and TDIST estimates based on the number of available sensors; ii) select the most appropriate subset of sensors, depending on goals and operational constraints

Evidence to decision frameworks enabled structured and explicit development of healthcare recommendations

Altres ajuts: Universidad Santo Tomás, Bogotá, Colombia (FODEIN project code: 2115005).Objective: The aim of this study is to identify and describe the processes suggested for the formulation of healthcare recommendations in healthcare guidelines available in guidance documents. Methods: We searched international databases in May 2020 to retrieve guidance documents published by organizations dedicated to guideline development. Pairs of researchers independently selected and extracted data about the characteristics of the guidance document, including explicit or implicit recommendation-related criteria and processes considered, as well as the use of evidence to decision (EtD) frameworks. Results: We included 68 guidance documents. Most organizations reported a system for grading the strength of recommendations (88%), half of them being the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Two out of three guidance documents (66%) proposed the use of a framework to guide the EtD process. The GRADE-EtD framework was the most often reported framework (19 organizations, 42%), whereas 20 organizations (44%) proposed their own multicriteria frameworks. Using any EtD framework was related with a more comprehensive set of recommendation-related criteria compared to no framework, especially for criteria like values, equity, and acceptability. Conclusion: Although limited, the use of EtD frameworks was associated with the inclusion of relevant recommendation criteria. Among the EtD structured frameworks, the GRADE-EtD framework offers the most comprehensive perspective for evidence-informed decision-making processes

COVID-19 Vaccine Safety Monitoring Studies in Low- and Middle-Income Countries (LMICs)-A Systematic Review of Study Designs and Methods

BACKGROUND: Post-marketing vaccine safety surveillance aims to monitor and quantify adverse events following immunization in a population, but little is known about their implementation in low- and middle-income countries (LMICs). We aimed to synthesize methodological approaches used to assess adverse events following COVID-19 vaccination in LMICs. METHODS: For this systematic review, we searched articles published from 1 December 2019 to 18 February 2022 in main databases, including MEDLINE and Embase. We included all peer-reviewed observational COVID-19 vaccine safety monitoring studies. We excluded randomized controlled trials and case reports. We extracted data using a standardized extraction form. Two authors assessed study quality using the modified Newcastle-Ottawa Quality Assessment Scale. All findings were summarized narratively using frequency tables and figures. RESULTS: Our search found 4254 studies, of which 58 were eligible for analysis. Many of the studies included in this review were conducted in middle-income countries, with 26 studies (45%) in lower-middle-income and 28 (48%) in upper-middle-income countries. More specifically, 14 studies were conducted in the Middle East region, 16 in South Asia, 8 in Latin America, 8 in Europe and Central Asia, and 4 in Africa. Only 3% scored 7-8 points (good quality) on the Newcastle-Ottawa Scale methodological quality assessment, while 10% got 5-6 points (medium). About 15 studies (25.9%) used a cohort study design and the rest were cross-sectional. In half of them (50%), vaccination data were gathered from the participants' self-reporting methods. Seventeen studies (29.3%) used multivariable binary logistic regression and three (5.2%) used survival analyses. Only 12 studies (20.7%) performed model diagnostics and validity checks (e.g., the goodness of fit, identification of outliers, and co-linearity). CONCLUSIONS: Published studies on COVID-19 vaccine safety surveillance in LMICs are limited in number and the methods used do not often address potential confounders. Active surveillance of vaccines in LMICs are needed to advocate vaccination programs. Implementing training programs in pharmacoepidemiology in LMICs is essential

Reflexiones sobre bioética y la atención primaria de la salud en el Ecuador

The right to health is a fundamental right that should be guaranteed through the application of several strategies, such as Primary Health Care (PHC). This strategy has been emphasized globally in the Declarations of Alma Ata and Astana and locally in the Ecuadorian Constitution and in several public policies such as the new Model of Comprehensive Health Care - Family, Community and Intercultural (MAIS - FCI). The objective of this article is to analyze, from a bioethical point of view, the right to health in Ecuador and its compliance through public policies focused on PHC.El derecho a la salud es un derecho fundamental que debería garantizarse mediante la aplicación de varias estrategias, como la Atención Primaria de la Salud (APS). Esta estrategia ha sido enfatizada globalmente en las Declaraciones de Alma Ata y Astaná y localmente en la Constitución ecuatoriana y en varias políticas públicas como el nuevo Modelo de Atención Integral de Salud – Familiar, Comunitario e Intercultural (MAIS - FCI). El objetivo de ese artículo es analizar desde un punto de vista bioético, el derecho a la salud en el Ecuador y su cumplimiento mediante políticas públicas enfocadas en la APS

Relación entre la estructura urbana y la transmisión de enfermedades infecciosas

The rate of urbanization tends to accelerate as countriesindustrialize. It is estimated that by 2030, 60 % of theworld’s population will live in urban areas, where socialfactors such as poverty, inequality, migration, illegalhuman settlements and environmental degradation areconcentrated, hindering a sustainable development andcontributing to an increased transmission of infectiousdiseases. Throughout this article, we will discuss theimportance of urban planning and the developmentof policies for the control of infectious diseases, suchas dengue, leishmaniasis and COVID-19, diseasesthat have mainly affected those who live in unplannedurban areas or informal settlements. Through anextensive review of the literature, we will demonstratethat urban planning and policies play an important rolein disease prevention and on the creation of healthyliving environments, but the lack of them can amplifythe risks to people’s health. The experiences of Braziland the epidemiological data in Ecuador regardingdengue and leishmaniasis demonstrate the impactthat unplanned urbanization and unresolved inequitiescan have on public health. It should be noted thathealth has an essential place in the interrelationshipof sustainable cities and communities, it is essentialto have an interdisciplinary team that involves urbanplanners, architects, builders and public healthprofessionals to work throughout the process thatinvolves urban planning; to create spaces that haveadequate health conditions and to improve the qualityof life of the populations that live in those places.A medida que los países se industrializan, la tasa de urbanización tiende a acelerarse. Se estima que para el año 2030, el 60 % de la población mundial vivirá en áreas urbanas, lugares donde se concentran factores sociales como la pobreza, la desigualdad, la migración, asentamientos humanos ilegales y la degradación ambiental, los cuales obstaculizan el desarrollo sostenible y contribuyen a una mayor transmisión de enfermedades infecciosas. A lo largo de este artículo, discutiremos la relevancia de una planificación y la implementación de políticas urbanas adecuadas para el control de enfermedades infecciosas, como el dengue, la leishmaniasis y el COVID-19, las que han afectado especialmente a aquellas personas que habitan en asentamientos informales o en zonas urbanas no planificadas. Mediante una extensa revisión de literatura demostraremos que la planificación y las políticas urbanas desempeñan un papel importante en la prevención de enfermedades y en la creación de entornos de vida saludable, mientras que la falta de estas puede ampliar los riesgos para la salud de las personas. Las experiencias de Brasil y los datos epidemiológicos en Ecuador en cuanto al dengue y la leishmaniasis demuestran el impacto que la urbanización no planificada y las inequidades no resueltas pueden tener en la salud pública. Cabe destacar que la salud ocupa un lugar imprescindible en las interrelaciones de las ciudades y comunidades sostenibles. Por ello es esencial contar con un equipo interdisciplinario que involucre a urbanistas, arquitectos, constructores y profesionales en la salud pública para trabajar en ..

Sintomatología, factores de riesgo y seroprevalencia en la poblacion pediátrica dignosticada con COVID-19

The diagnosis of COVID-19 in children is a clinical challenge, especially for general practitioners, since its prevalence is lower in childhood, the symptoms are diverse and vary according to age. Children can be asymptomatic, present mild symptoms or even have serious conditions such as Multisystemic Inflammatory Syndrome. The purpose of this review article is to present the most important scientific information on seroprevalence, clinical symptoms and risk factors associated with this infectious disease in childhood in order to contribute to the timely diagnosis and management.El diagnóstico de COVID-19 en niños es un reto clínico especialmente para los médicos generales pues su prevalencia es menor en la infancia, la sintomatología es diversa y varía según la edad. Los niños pueden ser asintomáticos, presentar sintomatología leve o incluso llegar a tener cuadros graves como el Síndrome Inflamatorio Multisistémico. El propósito de este artículo de revisión es presentar la información científica más importante sobre seroprevalencia, cuadro clínico y factores de riesgo asociados a esta enfermedad infecciosa en la infancia con el fin de aportar al diagnóstico y manejo oportunos