Antiplatelet therapy and exodontia: far away from a definite conclusion

Dear Editor;We read a review article about antiplatelet therapy and dental management in your journal (1). Kumar concluded that patients taking dual antiplatelet therapy has an increased risk for post-operative bleeding complications.The focus question of this article contains many other smeller questions. We recently answered one of these questions in our study; one tooth extraction is safe in patients taking aspirin and clopidogrel during one year after percutaneous coronary intervention (PCI) with stenting (2). But many questions remained without answer. Is two teeth extraction safe in these patients? What about more than two teeth extraction or in patients taking other antiplatelet drugs for other indications? What about other dental interventions? For answering each of these specific questions we need to design a prospective original study, with enough sample size, and comparing the results with a matched control group.Also there are many confounders for bleeding after exodontia (e.g. dentist's skill, type of antiplatelet drug and its manufacturing company, indication and duration of taking antiplatelet therapy, number and kind of extracted teeth, and dentist's skill) (2, 3). Controlling these confounders needs prospective studies focusing on specific group of patients. For example, patients taking unique dose and type of antiplatelet drug for a unique indication and duration, undergoing unique dental intervention by unique dentist. Then this result could be compared with a group of healthy subjects undergoing same dental intervention by the same dentist. So we do not have enough evidences to make a definite conclusion about what we should do in case of dental intervention for patients taking antiplatelet therapy.Â

Student Research Committee as a Model for Development of Medical Research Projects.

peer reviewedStudent Research Committee (SRC) has been developed a subset of each university's Vice chancellor for research in purpose of research training for motivated students and conducting their research interests. In this paper, we evaluated effect of SRCs on Iran's research through Scopus database and showed that SRCs has a remarkable impact on Iran's publication performance

Prevalence of occult HCV infection in hemodialysis and kidney-transplanted patients: A systematic review

peer reviewedAim: We performed a systematic review for determining the prevalence rate of occult HCV infection (OCI) among hemodialysis and kidney-transplanted (KT) patients. Methods: Electronic databases were searched with appropriate search strategies. We considered positive result for tests of HCV-RNA in peripheral blood mononuclear cell, ultracentrifuged serum or hepatocytes in the absence of HCV-RNA and anti-HCV antibody in patients' sera as the definition of OCI. Results: Two studies reported OCI prevalence rate of 0 and 2% among KT patients. Results of OCI prevalence rates among hemodialysis patients varied between 0 and 45% in ten different included studies showing a great heterogeneity. Conclusion: Although we still need more evidence to support our results, they suggest that checking OCI in hemodialysis or KT patients with unexplained signs of liver diseases may have some benefit

Cessation or Continuation of Aspirin in Patients Undergoing 20-gauge Pars Plana Vitrectomy due to Diabetic Retinopathy

peer reviewe

Sofosbuvir and ribavirin with or without pegylated-interferon in hepatitis C virus genotype-2 or -3 infections: A systematic review and meta-analysis

peer reviewedBackground: Direct-acting antiviral agents (DAAs) have changed the treatment landscape of hepatitis C virus (HCV) infection. Sofosbuvir (SOF), as a DAA inhibiting HCV NS5B polymerase, has found a remarkable contribution to the treatment regimens of HCV genotype-2 (HCV-2) and -3 infections. Objectives: In this meta-analysis, we aimed to evaluate the efficacy of the combination of SOF and Ribavirin (RBV) with or without pegylated-interferon (PegIFN) in the treatment of HCV-2 and -3 infections. Methods: In this meta-analysis, we searched electronic databases including PubMed, Scopus, ScienceDirect, andWeb of Science using appropriate and relevant keywords. Based on the results of the heterogeneity test (chi-squared and I-squared), fixed- or randomeffects models were used to calculate the pooled sustained virological response (SVR) rates. Results: After removing duplicates and screening of 1408 articles, 16 studies were included in the quantitative synthesis. The pooled SVR rates calculated for the treatment of patients suffering HCV-2 infection were 92% (95% CI: 87% - 96%) using the SOF + RBV regimen for 12 weeks and 95% (95% CI: 85% - 100%) using the SOF + RBV + PegIFN regimen for 12 weeks. The pooled SVR calculated for the treatment of patients suffering HCV-3 infection was 55% (95% CI: 44% - 66%) using the SOF + RBV regimen for 12 weeks, 81% (95% CI: 72% - 88%) using the SOF + RBV regimen for 24 weeks, and 93% (95% CI: 85% - 99%) using the SOF + RBV + PegIFN regimen for 12 weeks. Conclusions: The combination of SOF and RBV with or without PegIFN for 12 weeks is highly efficacious (> 90%) for the treatment of patients with HCV-2 infection. However, for the treatment of patients with HCV-3 infection only 12 weeks of SOF + PegIFN + RBV would result in > 90% treatment success

Effect of Cytomegalovirus Exposure on the Atherosclerotic Events Among Kidney-Transplanted Patients, A Systematic Review and Meta-Analysis

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Combination of Ledipasvir and Sofosbuvir for Treatment of Hepatitis C Virus Genotype 1 Infection: Systematic Review and Meta-Analysis

Background and aim. The combination of Sofosbuvir (SOF) and Ledipasvir (LDV) has been lead to considerable enhancement of treatment of hepatitis C virus (HCV) genotype 1 infection. A meta-analysis of the currently available studies was undertaken with the aim to evaluate the antiviral efficacy of SOF/LDV therapy for 12 or 24 weeks with or without Ribavirin (RBV) in patients with HCV genotype 1 infection.Material and methods. In this meta-analysis, we searched databases including PubMed, Scopus, Science Direct and Web of Science using appropriate keywords. All papers which evaluated the efficacy of combination therapy of SOF/LDV with or without RBV for 12 or 24 weeks among patients with HCV genotype 1 infection were included.Results. The 20 published articles were assessed for eligibility and finally 10 articles pooling 2248 participants were included in this meta-analysis. Pooled SVR12 for four SOF/LDV regimens were 95% (95%CI = 93%-97%) for 12 weeks of treatment with SOF/LDV, 97% (95%CI = 95%-98%) for 24 weeks of treatment with SOF/LDV, 96% (95%CI = 94%-97%) for 12 weeks of treatment with SOF/ LDV/RBV and 98% (95%CI = 97%-99%) for 24 weeks of treatment with SOF/LDV/RBV. Only in treatment regimen of SOF/LDV for 12 weeks, cirrhosis had a significant effect on the SVR12 (OR = 0.21, 95%CI = 0.07-0.66). Furthermore, NS5A resistance-associated substitutions at baseline were associated with decrease in the rate of SVR (OR = 0.31, 95%CI = 0.2-0.5).Conclusions. The Interferon-free regimen of SOF/LDV for 12 or 24 weeks with or without RBV is highly effective for treatment of patients with HCV genotype 1 infection

Infectious and coronary artery disease

BACKGROUND:&lrm; Atherosclerotic event is one of the most causes of death in the world. Coronary artery disease (CAD) is one manifestation of atherosclerosis. It is well-known that several risk factors, such as diabetes mellitus (DM), smoking, hypertension (HTN), have effects on it. It is proposed that infection can lead to atherosclerosis or even make its process faster. Here, we discuss about the effect of some of infectious agents on the atherosclerosis and CAD. METHODS: In this study, first we did a comprehensive search in PubMed, Scopus, and Science Direct using some related keywords such as atherosclerosis, CAD, myocardial infarction (MI), infection, and name of viruses and bacteria. After finding the related papers, we reviewed the correlation between some microbial agents and risk of CAD. RESULTS: Literature has reported several infectious agents (viruses, bacteria, and parasites) that can be associated with risk of CAD. This association for some of them like Helicobacter pylori (H. pylori), Chlamydia pneumonia (C. pneumoniae), and Cytomegalovirus (CMV) is a very strong. On the other hand, there are some other agents like influenza that still need to be more investigated through original studies. Furthermore, different mechanisms (general and special) have been reported for the association of each agent with CAD. CONCLUSIIN: Based on the studies in databases and our literature review, it is so clear that some microbes and infectious agents can be involved in the process of atherosclerosis. Therefore, controlling each type of infections especially among people with a traditional risk factor for atherosclerosis should be taken into account for reducing the risk of CAD and atherosclerosis.&nbsp;</p