CES University

Introduction This systematic review and meta-analysis aimed to assess the safety and efficacy of oral microbiome therapy (OMT) for the treatment of recurrent Clostridioides difficile infection (CDI). Methods A comprehensive search was performed in PubMed, Cochrane library, Scopus and Embase. All randomized controlled trials (RCTs) meeting predefined inclusion criteria were included. Statistical analysis was performed using R software. Results Three RCTs comprising 469 patients were analyzed, of whom 250 (53%) received OMT and 219 (47%) received placebo. OMT significantly reduced CDI recurrence at week 8 compared to placebo (risk ratio [RR] 0.57; 95% confidence interval [CI] 0.33–0.99; p = 0.04). In exploratory efficacy analyses, no significant differences in recurrence were observed between groups when stratified by prior fidaxomicin use (RR 0.36; 95% CI 0.03–4.01; p = 0.40) or vancomycin use (RR 0.68; 95% CI 0.30–1.55; p = 0.35). Similarly, Firmicutes engraftment at week 1 (mean difference [MD] 41.78; 95% CI −10.55 to 94.11; p = 0.12) and week 8 (MD 34.06; 95% CI −2.49 to 70.61; p = 0.07) did not show statistically significant between-group differences. Safety outcomes and adverse events were comparable between OMT and placebo. Conclusion OMT seems to reduce CDI recurrence at week 8 compared with placebo while demonstrating a comparable safety profile, supporting its role as an effective, well-tolerated therapy for recurrent CDI. New studies are necessary to confirm these findings. Registration The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251022230.

Biodegradable polymer drug-eluting stents (BP-DES) are currently used in percutaneous coronary intervention (PCI). Polymer-free drug-eluting stents (PF-DES) have the potential to mitigate any risk associated with BP-DES; however, the relative efficacy and safety of these interventions remain to be fully elucidated. A systematic search of PubMed, Embase, and Cochrane Central was performed from inception to January 2025 to identify randomized controlled trials and observational studies comparing PF-DES with BP-DES in patients undergoing PCI. Heterogeneity was assessed using the I ² statistic. A two-sided P value less than 0.05 was considered statistically significant. Prespecified subgroup analyses were conducted based on follow-up duration. A total of seven randomized controlled trials (RCTs) and four observational studies comprising 11 954 patients were included, of whom 5947 (49.7%) received PF-DES. In the pooled analysis, no statistically significant differences were observed between PF-DES and BP-DES in terms of cardiac death [risk ratio: 1.12, 95% confidence interval (CI): 0.96-1.31, P = 0.15], target lesion failure (risk ratio: 1.09, 95% CI: 0.81-1.46, P = 0.58), stent thrombosis (risk ratio: 0.90, 95% CI: 0.58-1.41, P = 0.64), target lesion revascularization (risk ratio: 1.28, 95% CI: 0.81-2.02, P = 0.28), or target vessel revascularization (risk ratio: 1.05, 95% CI: 0.70-1.58, P = 0.79). Likewise, no significant subgroup effect was observed regarding longer-term follow-up outcomes. This meta-analysis found comparable safety and efficacy outcomes between PF-DES and BP-DES in patients undergoing PCI; however, further RCTs are needed to evaluate long-term outcomes and newer-generation stent models.

Background: Previous studies have reported disparities in maternal cardiovascular health across different U.S. regions; however, the impact of geographic variation on outcomes in peripartum cardiomyopathy (PPCM) remains poorly understood. Objective: To evaluate geographic variations in outcomes of PPCM across U.S. census regions, focusing on sociodemographic and clinical risk factors. Methods: This retrospective study analyzed 2008–2022 data from the National Inpatient Sample (NIS), encompassing 66,368 weighted PPCM hospitalizations. Baseline characteristics across geographical regions were analyzed using descriptive statistics and chi-square tests. Multivariable logistic regression evaluated associations between geographical regions and in-hospital mortality outcomes, adjusting for race, income, and comorbidities. Results: Among 66,368 weighted PPCM hospitalizations, the South accounted for 48.3% of PPCM cases, followed by the Midwest (22.0%), West (15.8%), and Northeast (13.9%; p<0.001). Black patients comprised 51% of Southern cases vs. 37% in non-Southern regions (p<0.001). Southern cases were disproportionately from the lowest income quartile (47% vs 36%; p<0.001). Southern populations demonstrated statistically significant comorbidity burdens, including hypertension (45.9% vs 37.7%, p<0.001), obesity (26.0% vs 23.6%, p<0.001), and chronic kidney disease (6.1% vs 5.2%, p=0.02). Geographical analysis of PPCM mortality revealed significant disparities, with Southern residence associated with 40% higher adjusted odds of mortality compared to other regions (aOR=1.40, 95% CI=1.04–1.87, p=0.025) after controlling for race, income, and comorbidities. Black race (aOR=1.83, 95% CI=1.26–2.65, p=0.001) and chronic kidney disease (aOR=3.81, 95% CI=2.53–5.73, p<0.001) were key predictors. Interestingly, hypertension was associated with lower odds of mortality (aOR=0.53, 95% CI= 0.37–0.75, p<0.001). Conclusion: Geographical disparities in in-hospital mortality of PPCM persist after adjustment for socioeconomic and clinical factors, with the Southern U.S. demonstrating a significantly elevated burden. Addressing systemic drivers of regional inequities is critical to improving maternal cardiovascular outcomes.

ObjectiveThis scoping review aimed to map the knowledge, perceptions, and attitudes of dental professionals and students regarding MIH.Materials and MethodsA systematic search was conducted in the electronic databases MEDLINE/PubMed, Scopus, Web of Science, and Embase up to May 2023. A search in the OpenGrey database for grey literature was also performed. The reference lists of potentially eligible studies were checked to ensure that all relevant studies were analyzed. Scientific papers were considered eligible if they met the specified inclusion criteria: (1) focused on MIH; (2) assessed the knowledge/perception/attitudes of oral health professionals. Scientific papers were deemed ineligible if they met any of the following exclusion criteria: (1) lacking data on the knowledge/perception/attitudes regarding MIH among dental health professionals and students; (2) being a literature review/expert opinion/systematic review/case report.Results207 potentially eligible studies were identified, and 35 studies were included. A clear distinction emerged between qualified dental professionals and students regarding knowledge, attitudes, and management of MIH. Globally, variability was evident: Australia/New Zealand demonstrated strong protocols, China/Chile reported substantial gaps, and the UK showed mixed performance. Treatment preferences differed, with Saudi Arabia favoring stainless steel crowns/composite resin and Malaysia using glass ionomer cement/composite resin.ConclusionKnowledge, attitudes, and management of MIH differ significantly across professional levels and countries. Specialists and general dentists show greater confidence in diagnosing and treating MIH than students, though variations exist within both groups. The systematic review protocol was registered in OSF platform (doi: 10.17605/OSF.IO/NHMV2).

We read with great interest the article by Erdem et al .[1][1] on the efficacy of the erector spinae plane (ESP) block in lumbar disc herniation surgery for reducing postoperative nausea and vomiting (PONV). We acknowledge the rigorous methodological approach; however, we would like to highlight

ABSTRACT Background Neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and vascular and frontotemporal dementia (FTD), are characterized by progressive cognitive and motor decline. So, timely detection, especially early in the disease process, is crucial. Positron Emission Tomography (PET), Functional Magnetic Resonance Imaging (fMRI), and Diffusion Tensor Imaging (DTI) are advanced neuroimaging techniques that have shown promise for early diagnosis. Objective This review evaluates the diagnostic accuracy and clinical utility of PET, fMRI, and DTI in the early detection of neurodegenerative diseases. Methods A systematic search was conducted using PubMed, Google Scholar, and Cochrane Library for studies published between 2014 and 2024. Inclusion criteria focused on phase 2 and 3 clinical trials involving adult patients with AD, PD, and FTD. Studies were assessed for diagnostic accuracy, sensitivity, specificity, and identification of early biomarkers using PET, fMRI, and DTI. Data were extracted and analyzed from 14 selected studies. Results PET imaging with tracers like 18F‐flortaucipir provided visualization of amyloid and tau aggregates in AD and dopaminergic changes in PD. PET showed a strong association with amyloid and tau pathology in AD, with up to 95% diagnostic performance. Another useful technique in identifying early changes in the brain networks was resting‐state fMRI (rs‐fMRI), with a diagnostic accuracy of 80%–95%. DTI offered essential data on white matter connectivity and showed microstructural alterations that pointed to early neurodegenerative processes. Integrating these neuroimaging modalities with machine learning models further enhanced diagnostic accuracy. Conclusion PET, fMRI, and DTI are valuable tools for the early diagnosis of neurodegenerative diseases. These techniques can identify structural and functional changes in the brain before the onset of clinical signs. Integrating these imaging techniques with machine learning improves diagnostic outcomes. Further large‐scale studies with standardized methodologies are needed to validate these findings and implement these techniques in clinical practice.

Resumo Objetivo Determinar o motivo da alta importância dada pelos alunos para as habilidades psicomotoras e a sua percepção do conceito de habilidade é extremamente importante para melhoria do conteúdo da educação. Não foi encontrado nenhum estudo qualitativo que analisasse as razões pelas quais os alunos atribuem mais importância às habilidades psicomotoras do que às comportamentais, e as suas percepções em profundidade sobre as habilidades comportamentais. O objetivo deste estudo é examinar em profundidade as percepções dos alunos de enfermagem em relação ao conceito de habilidade e suas percepções sobre a aquisição de habilidades comportamentais. Métodos Este é um estudo qualitativo descritivo. A amostra consistiu em um total de 19 alunos recrutados aleatoriamente de cada classe. Entrevistas semiestruturadas foram conduzidas por meio de três discussões de grupo focal em 2021-2022. Os dados foram analisados por meio de análise temática. Resultados Os dois temas que surgiram neste estudo foram; significado da enfermagem e adequação. O primeiro tema descreve competência, habilidades psicomotoras e comportamentais. O segundo tema descreve o conteúdo do curso, o ambiente de sala de aula e o ambiente clínico. Conclusão Os alunos não compreenderam adequadamente a importância das habilidades comportamentais, especialmente nos primeiros anos de sua vida educacional, e perceberam sua importância durante o estágio hospitalar. O desenvolvimento de métodos interativos facilitadores do ensino de habilidades comportamentais pode capacitar os alunos para compreensão da importância das práticas não técnicas.

This web-based survey, conducted across multiple countries, sought to explore the factors that impact the decision-making of clinicians when it comes to managing defective direct restorations. A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations. Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision-making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries. This study underscores the complexity of the decision-making process and the need for evidence-based guidelines to inform clinicians' decisions regarding restoration management. Patient-level factors predominantly influence decision-making, emphasizing the need for individualized approaches. The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth-level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians' decisions, often favoring replacement over repair. These findings underscore the necessity for evidence-based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

This study aims to evaluate the five-yearexperience of a single centerregarding the total colpocleisis procedure. This is a retrospective review of 24 women who underwent total colpocleisis at the study center between January 2017 and January 2023. Every participant was informed about this study, and written consent was obtained from each participant who then took Pelvic Floor Distress Inventory-20 (PFDI-20), Body Appreciation Scale-2 (BAS-2) and Decision Regret Scale (DRS) questionnaires consecutively. Eight patients (33.3%) underwent total colpocleisis, whereas 16 patients (66.7%) had concomitant colpocleisis and vaginal hysterectomy. The number of total colpocleisis cases did not change significantly with respect to the past years (p=0.117). The patients who underwent total colpocleisis and the patients who had concurrent colpocleisis and hysterectomy were statistically similar with respect to age, gravidity, chronic disease, blood group, American Society of Anesthesiologists classification, anesthesia type, surgery timing and preoperative and postoperative hemoglobin values (p>0.05 for all). Operative time was significantly shorter in patients who had colpocleisis alone (p=0.001). Both patient groups were also statistically similar in aspects of blood loss, transfusion need, hospital stay, postoperative complications and follow-up time as well as PFDI-20, BAS-2 and DRS scores (p>0.05 for all). Endometrial atrophy (56.3%), endometrial hyperplasia (18.8%) and adenomyosis (12.5%) were the most common histopathological findings detected in vaginal hysterectomy specimens. The combination of vaginal hysterectomy and total colpocleisis appears as a safe and efficient approach which does not contribute to the surgery-related morbidity despite the significantly longer operative time.