Pathogen Reduction Technology: A Novel Possibility for Inactivation of Blood Products Used in Oral and Periodontal Surgeries
Journal of International Society of Preventive & Community Dentistry. 2020;10(6):713-718
Emergency surgical treatment has been challenging and the risk of blood contamination has been high, which is a concern among the medical and dental fraternity. The risk outweighs the benefits in these unprecedented times if proper screening and inactivation of blood products are not performed. Pathogen reduction technologies incorporate various modalities for the inactivation of blood products mainly related to blood transfusion. Oral surgical procedures and periodontal surgeries use platelet-rich fibrin for various regenerative procedures that amplify the prognosis positively. The use of blood products for various treatments could result in contamination, a factor which should be significant attention. The objective of this study was to review the role of pathogen reduction technology in inactivating pathogens in blood products and its use in oral and periodontal surgical procedures. The literature presented in the study is from original studies from a period of 2000 to 2020 which was sourced from Medline, PubMed, and Cochrane central databases. Relevant published papers and in-press papers that provided information were identified and selected. The studies presented have shown data related to implementation of pathogen reduction technologies in relation to the severe acute respiratory syndrome, Middle East respiratory syndrome, and its possible implementation in coronavirus disease-2019 (COVID-19). The paper reviews the various technologies offered and the possibility to eradicate pathogens found in routine blood products, used in oral and periodontal surgical procedures. In all probability, the use of pathogen reduction technology might offer a ray of light to contain the spread among dental treatment procedures.
Comparison of Therapies for Primary Prevention of Esophageal Variceal Bleeding: A Systematic Review and Network Meta-analysis
Hepatology (Baltimore, Md.). 2018
BACKGROUND AND AIMS We performed a systematic review with network meta-analysis (NMA) to compare the efficacy of different approaches in primary prevention of esophageal variceal bleeding and overall survival in cirrhotic patients with large varices. METHODS Thirty-two randomized clinical trials (RCT) with 3362 cirrhotic adults with large esophageal varices and no prior history of bleeding, with minimum 12m follow-up were included. Nonselective beta- blockers (NSBB), isosorbide-mononitrate (ISMN), carvedilol and variceal band ligation (VBL), alone or in combination, were compared to each other or placebo. Primary outcomes were reduction of all-cause mortality, and prevention of esophageal variceal bleeding. Random effects NMA was performed and summary estimates were expressed as odds ratio and 95% confidence intervals (OR; CI). Quality of evidence was critically appraised using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Moderate quality evidence supports NSBB monotherapy (0.70; 0.49-1.00) or in combination with VBL (0.49; 0.23-1.02) or ISMN (0.44; 0.21-0.93) for decreasing mortality in cirrhotic patients with large esophageal varices and no prior history of bleeding. Moderate quality evidence supports carvedilol (0.21; 0.08-0.56) and VBL monotherapy (0.33; 0.19-0.55) or in combination with NSBB (0.34; 0.14-0.86), and low quality evidence supports NSBB monotherapy (0.64; 0.38-1.07) for primary prevention of variceal bleeding. VBL carries a higher risk of serious adverse events compared to NSBB. CONCLUSION NSBB monotherapy may decrease all-cause mortality and the risk of first variceal bleeding in cirrhotic patients with large esophageal varices. Additionally, NSBB carry a lower risk of serious complications compared to VBL. Therefore, NSBB may be the preferred initial approach for primary prophylaxis of esophageal variceal bleeding. This article is protected by copyright. All rights reserved.