Efficacy of low-level laser therapy and low-intensity pulsed ultrasound in alleviating pain caused by orthodontic separation

A recent study found that both the low-level laser therapy (LLLT) and the low-intensity pulsed ultrasound (LIPUS) are successful in decreasing separation pain when administered in numerous doses, with no distinguishable variations between the two methods. This study’s results were published in the journal, BMC Oral Health.

150 patients were divided into three groups: the LLLT group, the LIPUS group, and the control group. The first dose of either laser or ultrasound was administered 5 minutes after the separators were placed. The second dose was administered 24 hours later, followed by the third dose 48 hours later, for both the maxillary and mandibular first molars. The laser exposure lasted for 20 seconds at each point, using an 810-nm aluminum-gallium-arsenide (AlGaAs) diode laser in continuous mode. The laser spot diameter was 7 mm, the output power was adjusted to 150 mW and the energy density was measured at 4 J/cm². On the other hand, the ultrasonic toothbrush had a frequency of 1.6 MHz and an average output intensity of 0.2 W/cm². The application time was 20 minutes, with 5 minutes on each first molar. The control group only received the separators without any additional intervention. Pain intensity was assessed using a Visual Analog Scale (VAS 100 mm) at various time intervals during the first 4 days after the separators were placed.

In total, 145 patients were evaluated. After a duration of 5 minutes, a significant difference in pain perception was observed among the three groups (P = .002). The highest level of pain was documented 24 hours later. Both the laser group and the ultrasound group exhibited a significant reduction in pain scores compared to the control group across all assessment timeframes (P < .001). No difference was observed in the pain score reduction between the laser group and the ultrasound group (P > .05).

It can be concluded that the application of multiple doses of LLLT and LIPUS is effective in diminishing separation pain. There are no notable differences between these two methods.

The role of intranasal antihistamines and corticosteroids in the management of allergic rhinitis

According to recent study, most intranasal medications have proven effective in mitigating rhinitis symptoms and enhancing quality of life. The findings of this research have been published in The Journal of Allergy and Clinical Immunology.

Four electronic bibliographic databases and three clinical trials databases were systematically searched for randomized controlled trials that (1) focused on adult patients with seasonal or perennial allergic rhinitis (AR) and (2) compared the effects of intranasal antihistamines or corticosteroids with those of a placebo. The outcomes assessed included the Total Ocular Symptom Score, the Total Nasal Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. The mean differences for each medication and outcome were determined using random-effects meta-analyses. The certainty of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework.

In this review, 151 primary studies were evaluated, primarily focusing on patients diagnosed with seasonal allergic rhinitis, with many of these studies showing either unclear or high levels of bias risk. In both perennial and seasonal AR cases, the majority of evaluated treatments proved to be more effective than placebo. For seasonal AR, fluticasone furoate, azelastine-fluticasone, and fluticasone propionate were identified as the medications with the highest likelihood of achieving moderate to significant improvements in the Rhinoconjunctivitis Quality-of-Life Questionnaire and the Total Nasal Symptom Score. Azelastine-fluticasone, in particular, showed the highest probability of leading to moderate or substantial improvements in the Total Ocular Symptom Score. The overall certainty of evidence was classified as "high" in 6 of the 46 analyses, "moderate" in 23 of the 46 analyses, and "low" or "very low" in 17 of the 46 analyses.

The above study highlighted the effectiveness of intranasal medications in reducing rhinitis symptoms and improving quality of life. However, it is important to note that there are relevant differences in the associated evidence of certainty with these treatments.

Comparison of tadalafil and tamsulosin with 5-alpha reductase inhibitors for benign prostatic hyperplasia

A recent study found that both the combinations of tamsulosin/finasteride and tadalafil/finasteride are comparably effective in enhancing lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) within 3 months. Tamsulosin/finasteride demonstrated a significantly better maximum urinary flow rate (Qmax) only during the fourth week. Tadalafil/finasteride improved sexual performance compared to the alternative combination. This study’s results were published in the World Journal of Urology.

In this study, the selection criteria included prostate volume greater than 40 ml and IPSS scores exceeding 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were not included in the study. The patients were randomly assigned to two groups: tamsulosin/finasteride (Group I) and tadalafil/finasteride (Group II). The primary endpoint of the study included the changes in urinary and sexual function within each group, as measured by IPSS, urinary flow rates, IPSS-quality of life, and IIEF domains. The secondary endpoint involved comparing the treatment-induced changes between the two groups.

The number of patients in each group was 131 and 127 at the 4th and 12th weeks, respectively. Significant improvement in LUTS was observed in both groups, with IPSS changes of - 4.9 ± 2.7 and - 4.3 ± 2.9 at the 4th week, and - 6.1 ± 3 and - 5.4 ± 2.8 points at the 12th week in both groups, respectively. Group I showed improved average flow rates during both follow-up sessions. At the 12th week, maximum flow rates were comparable in both groups (13.5 ± 3.9 vs 12.6 ± 3.7). In group I, all IIEF domains showed a significant decrease at both visits. During the 4th and 12th weeks, Group II displayed a significant improvement in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2, respectively). However, there was a temporary reduction in IIEF-orgasm and sexual desire, which was only observed at the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively).

The above study demonstrated that within a span of 3 months, both the tamsulosin/finasteride and tadalafil/finasteride combinations have demonstrated equal effectiveness in enhancing LUTS associated with BPH. During the fourth week, tamsulosin/finasteride exhibited a significantly better Qmax. The combination of tadalafil/finasteride showed a positive impact on sexual performance when compared to the alternative combination.

Dentin hypersensitivity and toothache in individuals with Molar-Incisor Hypomineralization

A recent study found that the prevalence of dentin hypersensitivity (DH)/toothache was 22% per tooth and 45% per patient globally. The prevalence estimates differed depending on the diagnostic methods utilized. Individuals with Molar-Incisor Hypomineralization (MIH) were more prone to presenting proxy reports of DH or toothache compared to the controls. This study’s results were published in the Journal of Dentistry.

The studies that were included in the evaluation focused on DH/toothache in patients with MIH, while those that centered on other enamel defects were excluded. In January 2024, a comprehensive search was conducted across eight databases, including grey literature. The Joanna Briggs Institute checklist for Cross-sectional studies was used to assess the methodological quality of the studies. Meta-analyses on proportion and association, subgrouped by diagnostic methods, were performed. The GRADE approach was utilized for the assessment of the certainty of the evidence.

In the qualitative analysis, fifteen studies were included, and fourteen were included in the meta-analyses. Two studies met all the criteria in the methodological quality checklist. The overall prevalence of DH/toothache among individuals with MIH was 45%. Prevalence rates of 47%, 30%, and 55% were estimated based on self-reports, proxy reports, and air stimulation, respectively. The overall prevalence of DH/toothache per tooth was 22%, with a range from 16% to 29% depending on the diagnostic method utilized. Individuals with MIH were more likely to present proxy reports of DH/toothache when compared to individuals without MIH (OR: 1.51; 95% confidence interval (1.23-1.85); P < 0.01; I²: 0%). Due to the low methodological quality of the studies included and high inconsistency, the certainty of evidence was very low.

Thus, it can be concluded that the prevalence of dental hypersensitivity/ toothache was 22% per tooth and 45% per patient worldwide and the prevalence estimates differed based on the diagnostic techniques used. Individuals with MIH were more likely to present proxy reports of DH or toothache compared to the controls.

Recent medical technologies in the management of cough

Recent research indicated that Eladis® exhibited overall effectiveness and a statistically significant superiority compared to the placebo. The data from this study were presented in the journal Terapevticheskii arkhiv.

This phase III clinical trial enrolled 250 individuals aged 18 to 65 years suffering from acute respiratory viral infections with acute bronchitis or upper respiratory tract involvement. Participants were randomly assigned into two groups of 125: one group received Eladis® (40 mg tablets), while the other group received a placebo. The study drugs were administered as one tablet twice daily for a duration of seven to fourteen days. Following the treatment, patients were followed up (on day 7±2) to evaluate the therapy effects on the frequency and intensity of daytime and nighttime cough, the frequency of coughing episodes, the severity of cough, the duration until clinical resolution of cough, and the effect on the severity of the main symptoms associated with acute respiratory viral infections.

Significant differences were observed among the study groups in the percentage of patients who achieved a reduction in coughing attack frequency by 50% or more by day five (p value <0.0001). Additionally, the Eladis® group demonstrated clinical resolution of cough two days earlier, with a median time of six days compared to eight days in the placebo group. By day five of treatment, there was a substantial decrease in both the frequency and severity of cough attacks, exceeding 3.5 points. All these effects were correlated with the drug's high safety profile.

Therefore, Eladis® demonstrated overall efficacy and a statistically significant benefit in comparison to the placebo.

Impact of focal zone size on treatment outcomes and renal injury subsequent to extracorporeal shockwave lithotripsy for renal calculi

A recent study showed that the standard narrow focal zone (FZ) demonstrates similar safety and superior treatment efficacy when compared to the extended FZ during extracorporeal shockwave lithotripsy (SWL) for renal stones. This study’s findings were published in Journal of Endourology.

In this prospective randomized study, 276 patients diagnosed with renal stones were assigned to receive SWL using either standard or extended FZ. The treatment was administered using a Modulith SLX-F2 lithotripter, delivering a maximum of 3000 shocks at a frequency of 1.5 Hz. The primary outcome of the study assessed the success of the treatment 12 weeks after a single SWL session, which was determined by the absence of a stone or stone fragment smaller than 4 mm on computed tomography. Secondary outcomes included the incidence of the stone-free rate (SFR), perinephric hematoma, and changes in the levels of acute renal injury markers in the urine.

Similar baseline parameters were observed in both groups. The standard FZ group achieved a significantly higher treatment success rate (74.3%) than the extended FZ group (59.3%). Additionally, standard FZ exhibited a significantly better SFR (Grade-A, 36.8% vs. 23.0%,) and lower post-treatment pain levels. Both groups had comparable rates of perinephric hematoma formation, changes in urinary acute renal injury markers, and unplanned hospital admissions.

The above results demonstrated that the standard narrow FZ shows comparable safety and improved treatment efficacy in comparison to the extended FZ in extracorporeal SWL for renal stones.

Evaluation of Pollinex Quattro (PQ) Grass allergen-specific immunotherapy induced immunomodulatory mechanisms for treating seasonal allergic rhinitis

A recent study found that Pollinex Quattro (PQ) Grass exhibited a superior extended regimen with a mechanistic efficacy profile compared to the conventional PQ regimen. This study was published in the journal, Clinical and Experimental Allergy.

This study included 119 subjects suffering from grass pollen seasonal allergic rhinitis (SAR) who were randomized in a 2:2:1:1 ratio. These patients received a cumulative dose of PQ Grass either as an extended pre-seasonal or conventional regimen, placebo, or placebo with MicroCrystalline Tyrosine. An exploratory endpoint, gene expression analysis, was assessed in a subgroup of 30 individuals chosen at random from each of the four treatment arms. Baseline samples and those obtained before the start and end of the grass pollen season were analyzed.

At the end of the study, transcriptome analysis showed most significant changes in the gene expression for the main Th1 candidate molecules (IL-12A, IFNγ) upregulated as well as the Th2 signature cytokines downregulated (IL-4, IL-13, IL-9). Based on the absolute value of the activation z-score, the canonical pathways analysis showed that Th1, Th2, Th17, and IL-17 were the most significantly enriched pathways. Pronounced inhibition of pro-inflammatory allergic molecules, IgE, IL-17A, IL-17F, IL-25 and activation of pro-tolerogenic molecules, IL-12A, IL-27, IL-35 was shown by upstream regulator analysis.

Based on the above results, it can be concluded that peripheral blood mononuclear cells showed an inhibition of pro-inflammatory allergic responses (Th2, Th17) while exhibiting an immune deviation towards Th1 responses. Thus, PQ Grass extended regimen may show a superior mechanistic efficacy profile compared to the conventional PQ regimen.

Risk factors for thromboembolic events in individuals with dialysis-dependent chronic kidney disease

A recent study has shown that it is reasonable to avoid sudden fluctuations in hemoglobin levels and maintain transferrin saturation (TSAT) levels at or above 30%, rather than escalating the dosage of roxadustat. The findings of the study were published in the journal Advances in Therapy.

Thromboembolic events in patients receiving roxadustat were investigated through a combined analysis of four phase 3 trials, including PYRENEES, HIMALAYAS, SIERRAS, and ROCKIES, both prior to and following the twelfth week. Cox regression analyses were used to explore the baseline risk factors for thromboembolic events. The association between thromboembolic events and laboratory parameters that were last known before the event was explored through nested case-control studies using matched case-control pairs.

Among the 2354 patients studied, 1026 thromboembolic events were observed in 568 patients. Baseline risk factors identified included hemodialysis versus peritoneal dialysis, race, high high-sensitivity C-reactive protein, advanced age ≥ 65 years, a history of thromboembolism, cardiovascular disease, or diabetes. Univariate case-control analyses indicated that a high hemoglobin rate of rise (≥ 0.5 g/dL/week; OR 2.09; 95% CI 0.98-4.46) showed a potential increase in the risk of thromboembolic events before week twelve, while a high rate of hemoglobin decline was linked to events after week 12 (< - 0.5 g/dL/week; OR 3.73; 95% CI 1.68-8.27) in comparison to steady levels of hemoglobin (ranging from ≥ - 0.1– < 0.1 g/dL/week).

Multivariate case-control analyses demonstrated that a low last known hemoglobin level (< 10 g/dL: adjusted OR 1.91; 95% CI 1.04-3.50; versus ≥ 12 g/dL) and low last known transferrin saturation (TSAT < 10%: adjusted OR 3.78; 95% CI 1.71-8.39; versus ≥ 30%) before event onset were associated with events after week twelve. An increased dose of roxadustat was correlated with thromboembolic events in patients whose last known transferrin saturation was less than 30%, while no correlation was observed in patients with transferrin saturation of 30% or higher.

The above study demonstrated that among several risk factors associated with thromboembolic events, it is suitable to avoid abrupt changes in hemoglobin levels and keep TSAT levels at or above 30% instead of increasing the dosage of roxadustat.