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Montolío-Marzo S, Rodríguez-Iranzo G, Peris-Martínez C. Severe Descemetocele after EDTA Chelation for Band Keratopathy. Ophthalmology 2024; 131:395. [PMID: 37422756 DOI: 10.1016/j.ophtha.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 07/10/2023] Open
Affiliation(s)
| | | | - Cristina Peris-Martínez
- Fundación Oftalmología Médica, Valencia, Spain; Ophthalmology Department, University of Valencia, School of Medicine, Valencia, Spain
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Fahim SZ, Ghali RM, Hashem AA, Farid MM. The efficacy of 2780 nm Er,Cr;YSGG and 940 nm Diode Laser in root canal disinfection: A randomized clinical trial. Clin Oral Investig 2024; 28:175. [PMID: 38403667 PMCID: PMC10894764 DOI: 10.1007/s00784-024-05563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Effective disinfection of the root canals is the cornerstone of successful endodontic treatment. Diminishing the microbial load within the root canal system is crucial for healing in endodontically treated teeth. The aim of this study was to evaluate the effect of 2780 nm Er,Cr:YSGG and 940 nm diode lasers on the eradication of microorganisms from single-rooted teeth with asymptomatic apical periodontitis. MATERIALS AND METHODS Thirty participants conforming to the inclusion criteria were randomly divided into 3 groups according to the disinfection protocol used; Conventional group: 2.5% Sodium Hypochlorite (NaOCl) and 17% EDTA solution NaOCl/EDTA, Dual laser group: 2780 nm Erbium, chromium: yttrium scandium-gallium-garnet (Er,Cr:YSGG) laser and 940 nm diode laser Er,CrYSGG/Diode, and Combined group: 17% EDTA and 940 nm diode laser EDTA/Diode. Bacterial samples were collected before and after intervention. The collected data were statistically analyzed using Friedman's test and Kruskal-Wallis test (P ≤ 0.05). RESULTS The results of the study showed that both dual laser Er,CrYSGG/Diode and combined laser EDTA/Diode groups showed significantly less mean Log10 CFU/ml of aerobic and anaerobic bacterial counts than the conventional NaOCl/EDTA group. CONCLUSIONS In this study we evaluated in vivo the bactericidal efficacy of three disinfection protocols for endodontic treatment of single-rooted teeth with apical periodontitis. The results indicated that both dual laser Er,CrYSGG/Diode and combined laser EDTA/Diode groups provide superior bactericidal effect compared to the conventional NaOCl/EDTA group. CLINICAL RELEVANCE The integration of lasers into root canal disinfection protocols has demonstrated significant bacterial reduction which might promote healing and long-term success.
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Affiliation(s)
- Sara Zakaria Fahim
- Faculty of Dentistry, Department of Oral Medicine, Periodontology, Diagnosis and Radiology, Future University, Cairo, Egypt.
| | - Rami Maher Ghali
- Faculty of Dentistry, Department of Prosthodontics, Ain Shams University, Cairo, Egypt
| | - Ahmed A Hashem
- Ain Shams University, Faculty of Dentistry, Endodontic Department, Cairo, Egypt
- Cleveland Dental Institute, Cleveland, OH, USA
| | - Mary Medhat Farid
- Faculty of Dentistry, Department of Oral and Maxillofacial, Radiology, Ain Shams University, Cairo, Egypt
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Singh DK, Raj BSH, Soans CR, Elango A, Kamath DG, Nasyam FA, Mishra D. Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study. J Contemp Dent Pract 2024; 25:156-159. [PMID: 38514413 DOI: 10.5005/jp-journals-10024-3618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM The purpose of the present study was to evaluate the smear layer removal efficacy of three various agents on periodontally compromised tooth. MATERIALS AND METHODS The current study included 75 molar teeth that were extracted due to periodontal disease. After that, 25 samples were randomly assigned using a simple random technique to the three different agent groups, group A: Scaling and root planing (SRP) and application of SofScale agent, group B: SRP and application of QMix agent, group C: SRP and application of MTAD agent. Using a diamond circular saw, the treated portions were divided into horizontal and vertical halves. All samples were viewed under Scanning Electron Microscope. Every tooth was focused at the coronal third, middle third, and apical third portion with a magnification of 1000×. Data were recorded and statistically analyzed. RESULTS The smear layer removal efficacy was more in the QMix agent (3.06 ± 0.04) group followed by MTAD agent (3.28 ± 0.09) and SofScale agent (4.14 ± 0.10) group on the root surface. On intra group comparison, there was a statistically significant difference found in all the intra group agents with all the three levels. On inter group evaluation, at coronal third, there was no significant difference found between the different agents. There was a significant difference found between the different agents at middle and coronal third. CONCLUSION On conclusion, the current investigation found that, the root surfaces treated with QMix shown a greater ability to remove smear layers compared to tooth surfaces treated with MTAD and SofScale agent. CLINICAL SIGNIFICANCE Conventional therapies such as SRP effectively eliminate calculus, plaque, and necrosed cementum; nevertheless, they leave behind a smear layer that could impede normal healing. In an effort to overcome this, root conditioning agents were applied on the root surface to remove the smear layer. The traditional root conditioning agents such as citric acid have certain disadvantages, though, such as an acidic pH that could harm the root surface. As a result, researchers have been looking for biocompatible root conditioning treatments that are more effective. How to cite this article: Singh DK, BS Raj H, Soans CR, et al. Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study. J Contemp Dent Pract 2024;25(2):156-159.
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Affiliation(s)
- Dhirendra Kumar Singh
- Department of Periodontology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - B S Harsha Raj
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India, Phone: +91 9845004120, e-mail:
| | - Crystal Runa Soans
- Department of Orthodontics and Dentofacial Orthopaedics, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), NITTE (Deemed to be University), Mangaluru, Karnataka, India
| | - Akshitha Elango
- Department of Public Health Dentistry, Nandha Dental College & Hospital, Erode, Tamil Nadu, India
| | - Dinesh G Kamath
- Department of Conservative Dentistry and Endodontics, Indira Gandhi Institute of Dental Sciences, Ernakulam, Kerala, India
| | - Fazil A Nasyam
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, Saudi Arabia
| | - Debasish Mishra
- Department of Periodontology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
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İlhan H, Cakici EB, Cakici F. The comparative of chitosan and chitosan nanoparticle versus ethylenediaminetetraacetic acid on the smear layer removal: A systematic review and meta-analysis of in vitro study. Microsc Res Tech 2024; 87:181-190. [PMID: 37732467 DOI: 10.1002/jemt.24423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/20/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
The purpose of this systematic review of meta-analysis was to compare the effectiveness of removing the smearing layer using EDTA versus Chitosan (Ch) and Chitosan nanoparticles (Ch-NPs). A search was performed in four electronic databases (Web of Science, PubMed, Scopus, and Cochrane). The included studies were assessed by two reviewers using Joanna Briggs Institute's critical appraisal checklist for the quasi-experimental studies. Outcomes obtained by scanning electron microscopy (SEM) and conventional methods were presented as standardized mean differences alongside 95% confidence intervals. Seven investigations employed 212 single-root teeth. In the apical section (p = .317, 95% CI = -0.820 to 0.266, Tau2 = 0.387), middle segment (p = .914, 95% CI = -1.019 to 0.912, Tau2 = 1.027), and coronal segment (p = .277, 95% CI = -1.008 to 0.289, Tau2 = 0.378). This meta-analysis found no difference between Ch, Ch-NPs, and EDTA in removing the smear layer in the three segments. This systematic review is designed to show evidence related to the PICO question, in which our outcome is smear layer removal and not the clinical success of such a treatment. RESEARCH HIGHLIGHTS: The study aimed to compare the effectiveness of chitosan and chitosan nanoparticles with ethylenediaminetetraacetic acid (EDTA) in removing the smear layer, a layer of debris and organic material on the tooth surface, through a systematic review and meta-analysis. The removal of the smear layer is crucial for successful dental treatments, as it enhances the adhesion of restorative materials and improves the penetration of antimicrobial agents into dentinal tubules. The researchers conducted a systematic review and meta-analysis, searching various databases of electron microscopy results for relevant in vitro studies comparing the effects of chitosan or chitosan nanoparticles with EDTA on smear layer removal. The results encourage further exploration of chitosan and chitosan nanoparticles for clinical use in dentistry, while considering their specific applications and long-term effects.
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Affiliation(s)
- Hasan İlhan
- Department of Chemistry, Faculty of Art and Science, Ordu University, Ordu, Turkey
| | - Elif Bahar Cakici
- Department of Endodontics, Faculty of Dentistry, Ordu University, Ordu, Turkey
| | - Fatih Cakici
- Department of Endodontics, Faculty of Dentistry, Ordu University, Ordu, Turkey
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Idowu D, Gray Z, Stanton M, Rushton W, Gummin D. A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage. J Med Toxicol 2024; 20:49-53. [PMID: 37843802 PMCID: PMC10774239 DOI: 10.1007/s13181-023-00970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa2EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa2EDTA was unavailable. CASE REPORT A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa2EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits. DISCUSSION The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.
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Affiliation(s)
- Damilola Idowu
- Division of Medical Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
- Wisconsin Poison Center, PO Box 1997, Suite C660, Milwaukee, WI, 53226, USA.
| | - Zachary Gray
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Matthew Stanton
- Division of Medical Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Wisconsin Poison Center, PO Box 1997, Suite C660, Milwaukee, WI, 53226, USA
| | - William Rushton
- Alabama Poison Information Center, 1600 7th Ave South, Birmingham, AL, 35233, USA
| | - David Gummin
- Division of Medical Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Wisconsin Poison Center, PO Box 1997, Suite C660, Milwaukee, WI, 53226, USA
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Gattini D, Yan H, Belza C, Avitzur Y, Wales PW. Cost-utility analysis of 4% tetrasodium ethylenediaminetetraacetic acid, taurolidine, and heparin lock to prevent central line-associated bloodstream infections in children with intestinal failure. JPEN J Parenter Enteral Nutr 2024; 48:47-56. [PMID: 37465871 DOI: 10.1002/jpen.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) are a serious complication in children with intestinal failure. This study assessed the incremental costs of 4% tetrasodium ethylenediaminetetraacetic acid (EDTA) compared with taurolidine lock and heparin lock per quality-adjusted life-year (QALY) gained in children with intestinal failure from the healthcare payer and societal perspective. METHODS A Markov cohort model of a 1-year-old child with intestinal failure was simulated until the age of 17 years (time horizon), with a cycle length of 1 month. The health outcome measure was QALYs, with results expressed in terms of incremental costs and QALYs. Model parameters were obtained from published literature and institutional data. Deterministic, probabilistic, and scenario sensitivity analyses were performed. RESULTS 4% Tetrasodium EDTA was dominant (more effective and less expensive) compared with taurolidine and heparin, yielding an additional 0.17 QALYs with savings of CAD$88,277 compared with heparin, and an additional 0.06 QALYs with savings of CAD$52,120 compared with taurolidine lock from the healthcare payer perspective. From the societal perspective, 4% tetrasodium EDTA resulted in savings of CAD$90,696 compared with heparin and savings of CAD$36,973 compared with taurolidine lock. CONCLUSIONS This model-based analysis indicates that 4% tetrasodium EDTA can be considered the optimal strategy compared with taurolidine and heparin in terms of cost-effectiveness. The decision uncertainty can be reduced by conducting further research on the model input parameters. An expected value of perfect information analysis can identify what model input parameters would be most valuable to focus on.
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Affiliation(s)
- Daniela Gattini
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology & Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment, Transplant and Regenerative Medicine Centre, Toronto, Ontario, Canada
| | - Han Yan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christina Belza
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment, Transplant and Regenerative Medicine Centre, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology & Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Group for Improvement of Intestinal Function and Treatment, Transplant and Regenerative Medicine Centre, Toronto, Ontario, Canada
| | - Paul W Wales
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Toronto, Cincinnati, Ohio, United States
- Cincinnati Center of Excellence for Intestinal Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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Guo Z, Henry RK, Dastjerdi MH. Comparative Analysis of Alternative Calcium Chelators for the Treatment of Calcific Band Keratopathy. Cornea 2023; 42:1551-1554. [PMID: 37603695 DOI: 10.1097/ico.0000000000003370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/16/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE In this study, we compared clinically relevant biochemical properties of each chelator for pH, osmolarity, and calcium chelation potential. METHODS In total, 0.2 M K 2 EDTA and K 3 EDTA (BD vacutainer tubes by Becton, Dickinson and Company) and Na 2 EDTA (Sigma Aldrich) solutions were made. The pH of each solution was measured (Mettler Toledo pH meter), and the theoretical osmolarity was calculated. Next, we determined the calcium chelation potential of each EDTA salt by titrating it with 10 μmol of calcium hydroxyapatite or CaCl 2 containing Patton-Reeder colorimetric indicator. Statistical significance was analyzed using analysis of variance. RESULTS The 0.2 M solutions of Na 2 EDTA, K 2 EDTA, and K 3 EDTA have pH values of 4.43, 5.71, and 9.191 and theoretical osmolarities of 600, 600, and 800 mOsm/L, respectively. Calcium chelation ability was similar among all 3 solutions: 0.94 to 0.98 mol of EDTA was needed to fully chelate 1 mol calcium ions of CaCl 2 ( P = 0.296), 0.100 to 0.108 mol of EDTA for 1 mol calcium ions of the hydroxyapatite aqueous suspension ( P = 0.296), and 0.992 to 0.996 mol for 1 mol calcium ions of hydroxyapatite in acidic solution ( P = 0.178). Compared with the clinical standard of 3% (30 mg/mL) Na 2 EDTA, approximately 3.3% (33 mg/mL) K 2 EDTA and 3.6% (36 mg/mL) K 3 EDTA are needed to chelate an equivalent amount of calcium. CONCLUSIONS In this article, we provide clinically relevant biochemical properties of 2 alternatives to Na 2 EDTA and demonstrate comparable calcium chelation ability among all 3 solutions. In situations where sterile sources of Na 2 EDTA are unavailable, potassium EDTA may provide a convenient and equally effective method of treatment for band keratopathy.
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Affiliation(s)
- Zhuojun Guo
- Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Rutgers University, Newark, NJ
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Tartari T, Wilchenski BS, de Souza Lima LA, Vivan RR, Ballal V, Duarte MAH. The use of sodium hypochlorite mixed with etidronic acid during canal preparation increases debris extrusion. AUST ENDOD J 2023; 49:584-591. [PMID: 37571801 DOI: 10.1111/aej.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023]
Abstract
The purpose of this study was to compare the impact of different irrigation protocols on debris extrusion. Single-rooted teeth were distributed into groups based on the irrigation protocols (n = 40): 2.5% NaOCl (biomechanical preparation: 20 mL and final irrigation: 5 mL); 2.5% NaOCl (biomechanical preparation: 20 mL) + 17% EDTA (final irrigation: 2 mL) + 2.5% NaOCl (final irrigation: 3 mL); and a mixture of 5% NaOCl +18% HEDP (biomechanical preparation: 20 mL and final irrigation: 5 mL). The canals were prepared using a reciprocating instrument size 40/0.06. For final irrigation, the groups were reassigned based on the agitation methods (n = 10): (a) no agitation; (b) ultrasonic; (c) sonic; and (d) continuous rotation. The control group (n = 10) received saline solution without agitation. The amount of debris extruded was measured by weight and analysed using One-way ANOVA (α < 0.05). The subgroups treated with NaOCl + HEDP mixture showed a significantly higher amount of extruded debris (p < 0.05), while there was no difference among agitation methods in all groups (p > 0.05).
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Affiliation(s)
- Talita Tartari
- Department of Restorative Dentistry, Piracicaba School of Dentistry, State University of Campinas, Piracicaba, Brazil
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Brenda Stefhany Wilchenski
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Luana Arantes de Souza Lima
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Vasudev Ballal
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Abdelazim MH, Mandour Z, Abdelazim AH, Ismaiel WF, Gamal M, Abourehab MA, Alghamdi S, Alghamdi MA, Alrugi RR, Alharthi RR. Intra Nasal Use of Ethylene Diamine Tetra Acetic Acid for Improving Olfactory Dysfunction Post COVID-19. Am J Rhinol Allergy 2023; 37:630-637. [PMID: 37786364 PMCID: PMC10293862 DOI: 10.1177/19458924231184055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND COVID-19 has been associated with olfactory dysfunction in many infected patients. The rise of calcium levels in the nasal secretions plays an essential role in the olfaction process with a desensitization effect on the olfactory receptor neurons and a negative impact on the olfaction transmission. Ethylene diamine tetra acetic acid (EDTA) is a chelating agent that can bind free calcium in the nasal secretions, thereby reducing the adverse effects of calcium on olfactory function. OBJECTIVES The objective of this work is to demonstrate the effect of intranasal EDTA on improving olfactory dysfunction following COVID-19. METHODS Fifty patients with a history of COVID-19 and olfactory dysfunction that persisted for more than 6 months were enrolled in the current prospective randomized clinical trial. Participants were randomized into 2 equal groups. Twenty-five patients were treated with olfactory training only, while the remaining 25 patients received treatment with olfactory training and a topical nasal spray of ethylene diamine tetra acetic acid. The olfactory function was assessed before treatment and 3 months later using the Sniffin' Sticks test. Additionally, the determination of calcium level in the nasal secretions was performed using an ion-selective electrode before treatment and 3 months later. RESULTS Eighty-eight percent of the patients treated with olfactory training in addition to EDTA exhibited clinical improvement, while 60% showed improvement in patients treated with olfactory training only. Furthermore, a significant decrease in the measured calcium level in the nasal secretions was demonstrated after the use of ethylene diamine tetra compared to patients treated with olfactory training only. CONCLUSION Ethylene diamine tetra acetic acid may be associated with an improvement of the olfactory function post-COVID-19.
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Affiliation(s)
- Mohamed H. Abdelazim
- Department of Otolaryngology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Zeyad Mandour
- Department of Otolaryngology, Alexandria University, Alexandria, Egypt
| | - Ahmed H. Abdelazim
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Wael F. Ismaiel
- Department of Otolaryngology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohammed Gamal
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohammed A.S. Abourehab
- Department of Pharmaceutics, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Minia University, Minia, Egypt
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha, Saudi Arabia
| | - Mohamed A. Alghamdi
- Department of Surgery, Division of Otolaryngology, Faculty of Medicine, Al Baha University, Al Baha City, Saudi Arabia
| | - Rehab R. Alrugi
- Pharm D student, College of Pharmacy, Shaqra University, Shaqra, Saudi Arabia
| | - Rawan R. Alharthi
- Department of Pharmacy, Dawadmi General Hospital, Dawadmi, Saudi Arabia
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Twardy SM, Hanson SM, Jursa T, Gaitens JM, Kalinich JM, McDiarmid MA, Smith DR. Succimer chelation does not produce lasting reductions of blood lead levels in a rodent model of retained lead fragments. Environ Toxicol Pharmacol 2023; 104:104283. [PMID: 37775076 DOI: 10.1016/j.etap.2023.104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
Retained lead fragments from nonfatal firearm injuries pose a risk of lead poisoning. While chelation is well-established as a lead poisoning treatment, it remains unclear whether chelation mobilizes lead from embedded lead fragments. Here, we tested whether 1) DMSA/succimer or CaNa2EDTA increases mobilization of lead from fragments in vitro, and 2) succimer is efficacious in chelating fragment lead in vivo, using stable lead isotope tracer methods in a rodent model of embedded fragments. DMSA was > 10-times more effective than CaNa2EDTA in mobilizing fragment lead in vitro. In the rodent model, succimer chelation on day 1 produced the greatest blood lead reductions, and fragment lead was not mobilized into blood. However, with continued chelation and over 3-weeks post-chelation, blood lead levels rebounded with mobilization of lead from the fragments. These findings suggest prolonged chelation will increase fragment lead mobilization post-chelation, supporting the need for long-term surveillance in patients with retained fragments.
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Affiliation(s)
- Shannon M Twardy
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Sarah M Hanson
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Thomas Jursa
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Joanna M Gaitens
- Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John M Kalinich
- Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa A McDiarmid
- Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Don R Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA.
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11
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Rossi-Fedele G, Rödig T. Effectiveness of root canal irrigation and dressing for the treatment of apical periodontitis: A systematic review and meta-analysis of clinical trials. Int Endod J 2023; 56 Suppl 3:422-435. [PMID: 35579074 DOI: 10.1111/iej.13777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH)2 ) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient-related outcomes requires further understanding. OBJECTIVES To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP). METHODS A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta-analyses were performed using the fixed-effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta-analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS The search identified 1357 records of which six fulfilled the inclusion criteria, providing data for 'irrigation' from 212 teeth and for 'dressings' from 438 teeth. Two studies reported no significant difference regarding the outcome 'pain at 7 days' using 2% chlorhexidine vs. 5.25% NaOCl and EDTA or after using different concentrations of NaOCl (1% vs. 5%). No significant difference was detected between different NaOCl concentrations regarding the reduction of AP. A meta-analysis was possible for the comparison of single-visit (SV) versus multiple-visits including the use of Ca(OH)2 demonstrating a significant effect in favour of SV (RR: 1.10; 95% CI: 1.03-1.19; p = .007; I2 = 0). RoB of included studies was moderate to low. DISCUSSION The use of Ca(OH)2 for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings. CONCLUSIONS There is moderate certainty that SV treatment is associated with better radiographic evidence of normal periodontal ligament space (strict criteria) compared with the use of Ca(OH)2. Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar. REGISTRATION PROSPERO database CRD42021260271.
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Affiliation(s)
| | - Tina Rödig
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
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Sharif F, Junaid A, Ashraf K, Ijaz M, Saeed M, Farhat T, Rehman N, Rehman MU. Evaluation of sodium citrate anticoagulant for the Resolution of edta-dependent pseudo Thrombocytopenia. J Ayub Med Coll Abbottabad 2023; 35:544-548. [PMID: 38406932 DOI: 10.55519/jamc-04-12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND EDTA-dependent pseudo thrombocytopenia (EDTA-PTCP) refers to a falsely low platelet count occurring in the presence of ethylene diamine tetra-acetic acid (EDTA) anticoagulant during blood sample collection, which results in the formation of platelet clumps in vitro. This phenomenon has significant clinical implications, including unnecessary administration of platelets. Our study aims to evaluate the efficacy of sodium citrate anticoagulant for the resolution of EDTAPTCP. METHODS This retrospective study was conducted in the haematology laboratory of Shifa International Hospital (SIH), Pakistan. Patients with pseudo thrombocytopenia (i.e. platelet count less than 150,000/ul with platelet clumps seen on peripheral smear) were included in this study if they had blood samples drawn in both EDTA and sodium citrate tubes less than 48 hours apart. Data was analyzed using IBM® SPSS Software Version 22. RESULTS A total of 151 study participants were included in this study. The mean age was 48.95±20.69 years and the majority were female (52.3%). Wilcoxon signed-rank test showed that there was a statistically significant difference in platelet count measured in both tubes (Z = -3.223, p=0.001). Overall, blood samples processed in sodium citrate tubes showed lower platelet count than EDTA samples. Sodium citrate anticoagulant was able to correct EDTA-PTCP in 47 (31.1%) of the cases. CONCLUSIONS Sodium citrate anticoagulant was only able to resolve one-third of our EDTA-PTCP cases. Our findings do not support the use of sodium citrate as a suitable alternative for correction of EDTA-PTCP.
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Affiliation(s)
- Fatima Sharif
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Ayesha Junaid
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Khadija Ashraf
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Maira Ijaz
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Maria Saeed
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Tuba Farhat
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Noor Rehman
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
| | - Mujeeb Ur Rehman
- Department of Haematology, Shifa International Hospital, Islamabad, Pakistan
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13
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Arora A, Sahu SK, Muni I, Sharma A. Use of Ethylenediaminetetraacetic Acid in Chronic Calcium-Based Chemical Injury. Cornea 2023; 42:1034-1036. [PMID: 36729674 DOI: 10.1097/ico.0000000000003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE This study presents the successful management of a patient with chronic chemical-based injury using ethylenediaminetetraacetic acid (EDTA) chelation. METHODS This is a case report of a 59-year-old man who presented to us 2 months after a bilateral, accidental, ocular injury with lime particles at his workplace. RESULTS The patient was initially managed with extensive debridement and amniotic membrane grafting for both eyes. At 4-month follow-up, the left eye appeared to have extensive calcium-based plaques. 0.02N EDTA chelation was performed for his left eye. Postchelation, the visual acuity improved to 20/800. At 1-week follow-up, a repeat EDTA chelation was performed. The corneal clarity improved further, and the patient recovered a visual acuity of 20/200. CONCLUSIONS EDTA chelation in the setting of calcium deposition in the chronic phase of chemical injuries can be reasonably effective.
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Affiliation(s)
- Anchal Arora
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, India
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14
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Pratabsingha J, Noppawong S, Thamsoonthorn C, Vichathai W, Saikaew P. Bonding Protocols to Reverse the Bond Strength of a Universal Adhesive to Hemostatic Agent-contaminated Dentin. Oper Dent 2023; 48:447-456. [PMID: 37326305 DOI: 10.2341/22-091-l] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the effect of different bonding protocols on the microtensile bond strength (μTBS) of a universal adhesive to dentin contaminated with a hemostatic agent. METHODS AND MATERIALS Ninety-five extracted premolars were used in this study. For the μTBS test, 80 teeth were cut to expose mid-coronal dentin and randomly divided into two groups (uncontaminated dentin and hemostatic agent-contaminated dentin). Each group was further divided into five subgroups (n=8/group): 1) SE: no additional treatment, 2) ER: etching with 32% phosphoric acid, 3) CHX: rinsing with 0.2% chlorhexidine, 4) EDTA: rinsing with 17% EDTA, and 5) T40: application of universal adhesive for 40 seconds. A universal adhesive was applied followed by resin composite build-up. μTBS test was performed after 24 hours of water storage. Two-way analysis of variance (ANOVA) was calculated followed by the Duncan testing (α=0.05). The failure mode was analyzed using light microscopy. Additional teeth were prepared for energy-dispersive X-ray (EDX) analysis (n=1/group) and resin-dentin interface observation (n=2/group) using scanning electron microscopy. RESULTS Adverse effects of hemostatic agent contamination on the bonding performance of a universal adhesive was found in the SE, CHX, and T40 groups (p<0.05). Fewer and shorter resin tags were observed in the SE, CHX, and T40 groups. A higher percentage of adhesive failure and mixed failure was found in contaminated dentin. All bonding protocols revealed lower amounts of Al and Cl after dentin contamination, except for the SE group. CONCLUSIONS Hemostatic agent contamination adversely affected dentin bond strength. However, this bond strength could be reversed using the etch-and-rinse technique or rinsing with EDTA prior to adhesive application.
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Affiliation(s)
- J Pratabsingha
- Jaikaew Pratabsingha, DDS, Institute of Dentistry, Department of Medical Services, Nonthaburi, Thailand
| | - S Noppawong
- Sawaphon Noppawong, DDS, Institute of Dentistry, Department of Medical Services, Nonthaburi, Thailand
| | - C Thamsoonthorn
- Chanida Thamsoonthorn, DDS, MSD, Grad Dip in Clin Sc, Institute of Dentistry, Department of Medical Services, Nonthaburi, Thailand
| | - W Vichathai
- Weeranun Vichathai, DDS, Grad Dip in Clin Sc, Dip Thai Board of General Dentistry, Institute of Dentistry, Department of Medical Services, Nonthaburi, Thailand
| | - P Saikaew
- *Pipop Saikaew, DDS, MSc, PhD, assistant professor, Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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15
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Dorsey MJ, Rubinstein A, Lehman H, Fausnight T, Wiley JM, Haddad E. PEGylated Recombinant Adenosine Deaminase Maintains Detoxification and Lymphocyte Counts in Patients with ADA-SCID. J Clin Immunol 2023; 43:951-964. [PMID: 36840835 PMCID: PMC10276086 DOI: 10.1007/s10875-022-01426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/22/2022] [Indexed: 02/26/2023]
Abstract
PURPOSE Metabolic detoxification with enzyme replacement therapy (ERT) promotes immune recovery in patients with adenosine deaminase (ADA)-deficient severe combined immunodeficiency (ADA-SCID). Elapegademase is a PEGylated recombinant bovine ADA ERT developed to replace the now-discontinued bovine-derived pegademase. This study was a 1-way crossover from pegademase to elapegademase in 7 patients with ADA-SCID to assess efficacy and safety outcomes for elapegademase. METHODS After once-weekly pegademase dosage was adjusted to achieve therapeutic metabolic detoxification and trough ADA activity, patients transitioned to a bioequivalent dose of elapegademase. Maintenance of metabolic detoxification and adequate ADA activity were evaluated periodically. RESULTS One patient withdrew after 2 doses of an early elapegademase formulation due to injection-site pain caused by EDTA. The 6 remaining patients completed 71-216 weeks of elapegademase therapy with a formulation that did not contain EDTA. In these patients, elapegademase improved ADA activity compared with pegademase and maintained metabolic detoxification. Total lymphocyte counts increased for all completer patients from between 1.2- and 2.1-fold at the end of study compared with baseline. Elapegademase had a comparable safety profile to pegademase; no patient developed a severe infectious complication. Three patients had transient, non-neutralizing antibodies to pegademase, elapegademase, and/or polyethylene glycol ≤ 47 weeks of treatment without effect on trough plasma ADA activity or trough erythrocyte deoxyadenosine nucleotide levels. CONCLUSION Elapegademase was safe, well tolerated, achieved stable trough plasma ADA activity with weekly dosing, was effective in maintaining metabolic detoxification, and was associated with maintenance or improvements in lymphocyte counts compared with pegademase therapy in patients with ADA-SCID.
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Affiliation(s)
- Morna J Dorsey
- Pediatric Immunology and Allergy Center, University of California San Francisco Medical School, San Francisco, CA, USA.
| | - Arye Rubinstein
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Heather Lehman
- Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Tracy Fausnight
- Department of Pediatrics, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Joseph M Wiley
- Medical Affairs, Leadiant Biosciences, Inc, Gaithersburg, MD, USA
| | - Elie Haddad
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
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16
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Hassan R, Roshdy NN. Effect of continuous chelation on the dentinal tubule penetration of a calcium silicate-based root canal sealer: a confocal laser microscopy study. BMC Oral Health 2023; 23:377. [PMID: 37296374 PMCID: PMC10257323 DOI: 10.1186/s12903-023-02995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of various irrigation protocols on the penetration depth of a calcium silicate-based sealer into dentinal tubules using confocal laser scanning microscopy (CLSM). METHODS Twenty single-rooted mandibular premolars were endodontically prepared and divided into the following two groups according to the irrigation protocol used (n = 10): Group I: NaOCl + EDTA and Group II: continuous chelation (NaOCl/Dual Rinse). Obturation was performed with the warm vertical compaction technique using TotalFill HiFlow bioceramic sealer mixed with a fluorophore dye. Samples were observed using CLSM at 10× to measure the percentage of sealer penetration and its maximum depth into the dentinal tubules. Data were analysed using one-way ANOVA followed by Tukey's post-hoc test. The significance level was set at p < 0.05 within all tests. RESULTS Comparing the overall results of all sections tested, no statistically significant differences existed between the groups regarding the percentage of sealer penetration (p = 0.612) and maximum depth of penetration (p > 0.05). CONCLUSIONS With both types of irrigation used, dentinal tubule penetration was higher in the coronal section than in the apical section. Continuous chelation using NaOCl/Dual Rinse HEDP performed better in the coronal segments, while irrigation using NaOCl + EDTA promoted a higher percentage of sealer penetration in the apical segment.
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Affiliation(s)
- Reham Hassan
- Egyptian Russian University, Badr city, Egypt.
- Faculty of Dentistry, Minia University, Minia, Egypt.
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17
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Yen TH, Yen JS. Chelation trial in patients with cardiovascular disease. Am Heart J 2023; 256:1. [PMID: 36336079 DOI: 10.1016/j.ahj.2022.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ju-Shao Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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18
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Lamas GA, Anstrom KJ, Navas-Acien A, Boineau R, Kim H, Rosenberg Y, Stylianou M, Jones TLZ, Joubert BR, Santella RM, Escolar E, Aude YW, Fonseca V, Elliott T, Lewis EF, Farkouh ME, Nathan DM, Mon AC, Gosnell L, Newman JD, Mark DB. The trial to assess chelation therapy 2 (TACT2): Rationale and design. Am Heart J 2022; 252:1-11. [PMID: 35598636 PMCID: PMC9434822 DOI: 10.1016/j.ahj.2022.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Intravenous edetate disodium-based infusions reduced cardiovascular events in a prior clinical trial. The Trial to Assess Chelation Therapy 2 (TACT2) will replicate the initial study design. METHODS TACT2 is an NIH-sponsored, randomized, 2x2 factorial, double masked, placebo-controlled, multicenter clinical trial testing 40 weekly infusions of a multi-component edetate disodium (disodium ethylenediamine tetra-acetic acid, or Na2EDTA)-based chelation solution and twice daily oral, high-dose multivitamin and mineral supplements in patients with diabetes and a prior myocardial infarction (MI). TACT2 completed enrollment of 1000 subjects in December 2020, and infusions in December 2021. Subjects are followed for 2.5 to 5 years. The primary endpoint is time to first occurrence of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina. The trial has >;85% power to detect a 30% relative reduction in the primary endpoint. TACT2 also includes a Trace Metals and Biorepository Core Lab, to test whether benefits of treatment, if present, are due to chelation of lead and cadmium from patients. Design features of TACT2 were chosen to replicate selected features of the first TACT, which demonstrated a significant reduction in cardiovascular outcomes in the EDTA chelation arm compared with placebo among patients with a prior MI, with the largest effect in patients with diabetes. RESULTS Results are expected in 2024. CONCLUSION TACT2 may provide definitive evidence of the benefit of edetate disodiumbased chelation on cardiovascular outcomes, as well as the clinical importance of longitudinal changes in toxic metal levels of participants.
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Affiliation(s)
- Gervasio A Lamas
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Kevin J Anstrom
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ana Navas-Acien
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robin Boineau
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Hwasoon Kim
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Yves Rosenberg
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mario Stylianou
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Teresa L Z Jones
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Bonnie R Joubert
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Regina M Santella
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Esteban Escolar
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Y Wady Aude
- Heart and Vascular Specialists of South Texas, McAllen, TX, USA
| | - Vivian Fonseca
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Eldrin F Lewis
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - David M Nathan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana C Mon
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Leigh Gosnell
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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19
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Basir L, Abdi R, Hashemi E. Cleaning efficacy of various root canal irrigants in primary teeth: a scanning electron microscopic study. Gen Dent 2022; 70:29-33. [PMID: 35993930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Root canal irrigation plays an important role in debridement and disinfection of the root canal system. The present study aimed to evaluate the efficacy of 17% ethylenediaminetetraacetic acid (EDTA), 2% iodine-potassium iodide (IKI), and 1% and 3% concentrations of sodium hypochlorite (NaOCl) for root canal irrigation in the anterior primary teeth. A total of 60 anterior primary teeth were selected and assigned to 1 of 4 irrigation groups (n = 15): 1, 17% EDTA; 2, 3% NaOCl; 3, 2% IKI; and 4, 1% NaOCl. The root canals in all groups were subsequently irrigated with normal saline following a 30-minute incubation period. The prepared specimens were cut longitudinally and imaged using scanning electron microscopy to evaluate the cleaning efficacy in the coronal, middle, and apical thirds. Data were analyzed using descriptive statistics as well as nonparametric Kruskal-Wallis and Mann-Whitney U tests. Group 2 (3% NaOCl) showed the greatest efficacy for cleaning the entire root canal (P < 0.01). Analysis of the different parts of the root canal revealed that group 2 also demonstrated the greatest efficacy in achieving a clean apical portion (P < 0.01). According to the results of the present study, 3% NaOCl offered a better performance in irrigating the root canals of primary teeth.
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20
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Aakerøy R, Stokes CL, Tomić M, Hegstad S, Kristoffersen AH, Ellekjær H, Schjøtt J, Spigset O, Helland A. Serum or Plasma for Quantification of Direct Oral Anticoagulants? Ther Drug Monit 2022; 44:578-584. [PMID: 35051972 PMCID: PMC9275836 DOI: 10.1097/ftd.0000000000000956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Direct oral anticoagulants are increasingly replacing vitamin K antagonists for prevention of stroke in patients with atrial fibrillation, partly owing to the lack of a need for routine monitoring. Therapeutic drug monitoring may still be warranted under certain circumstances. It is generally assumed that serum and plasma can be interchangeably used for this purpose. The aim of this study was to investigate possible differences between the serum, citrate-plasma, and ethylenediaminetetraacetic acid (EDTA)-plasma concentrations of apixaban and rivaroxaban in a larger patient group and their relation to factor X measurements. METHODS Plasma and serum samples were drawn during the same venipuncture from patients treated with apixaban or rivaroxaban. Drug levels were measured using ultrahigh-performance liquid chromatography combined with tandem mass spectrometry. Three sample matrices were obtained from 8 healthy volunteers for measurement of factor X antigen and activity. RESULTS Mean concentrations of apixaban and rivaroxaban were 16.8% and 36.6% higher in serum than in citrate-plasma, respectively (both P < 0.001). The corresponding differences in serum versus EDTA-plasma were 4.5% for apixaban and 13.1% for rivaroxaban (both P < 0.001). Factor X antigen measurements in citrate-plasma, EDTA-plasma, serum with clot activator, and serum without additives yielded comparable results, and factor X activity was significantly higher in serum than in plasma. CONCLUSIONS Apixaban and rivaroxaban concentrations were significantly higher in serum than in plasma. The difference was more pronounced with rivaroxaban and was larger between serum and citrate-plasma than between serum and EDTA-plasma. Higher factor X activity in serum may explain the observed concentration differences. The choice of matrix is, thus, important when interpreting therapeutic drug monitoring results and in research involving analyses of direct oral anticoagulants. The authors recommend citrate-plasma as the preferred matrix.
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Affiliation(s)
- Rachel Aakerøy
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte L. Stokes
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Marija Tomić
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Solfrid Hegstad
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; and
- Stroke Unit, Department of Internal Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Helland
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Giliberti A, Curcio A, Marchitto N, Di Lullo L, Paolozzi F, Nano F, Pironti M, Raimondi G. Comparison of Ferric Sodium EDTA in Combination with Vitamin C, Folic Acid, Copper Gluconate, Zinc Gluconate, and Selenomethionine as Therapeutic Option for Chronic Kidney Disease Patients with Improvement in Inflammatory Status. Nutrients 2022; 14:nu14102116. [PMID: 35631257 PMCID: PMC9145680 DOI: 10.3390/nu14102116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 01/23/2023] Open
Abstract
Anemia is one of the most frequent and earliest complications of chronic kidney disease (CKD), which impacts a patient’s quality of life and increases the risk of adverse clinical outcomes. Patients’ inflammatory status is strictly related to the occurrence of functional iron deficiency anemia (IDA) because this causes an increase in hepcidin levels with the consequent inhibition of iron absorption and release from cellular stores into blood circulation. The aim of this study was to evaluate the use of the new oral formulation based on ferric sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate, and selenomethionine (Ferachel Forte®) in patients with moderate CKD and functional IDA, analyzing the inflammatory status in addition to iron blood parameters, in comparison with oral ferrous sulfate and liposomal iron therapies. Sixty-two elderly patients were randomly allocated to one of the following oral treatments for 6 months: ferrous sulfate (Group 1; N = 20), ferric sodium EDTA in combination (Group 2; N = 22), and ferric liposomal formulation (Group 3; N = 20). The evaluated parameters included iron profile parameters of hemoglobin (Hb), sideremia, ferritin, transferrin saturation, C-reactive protein (CRP), and hepcidin. The results showed that in Group 1, there were no improvements. In Group 2, there were statistically significant (p < 0.001) improvements in all evaluated parameters. Finally, in Group 3, there were significant improvements in all evaluated parameters except for hepcidin, which was less than that of Group 2 patients. In conclusion, the findings showed the superior efficacy of the formulation based on ferric sodium EDTA over the other oral iron sources, and that this formulation can contribute to reducing the systemic inflammatory status in patients with CKD.
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Affiliation(s)
- Antonella Giliberti
- Department of Nephrology and Dialysis, “Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Naples, Italy;
| | - Annalisa Curcio
- Medical Department, Aqma Italia S.p.A., 80138 Naples, Italy; (F.N.); (M.P.)
- Correspondence: ; Tel.: +39-3482322796
| | - Nicola Marchitto
- Department of Internal Medicine, “San Giovanni di Dio” Hospital, 04022 Fondi, Italy;
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, “L. Parodi-Delfino” Hospital, 00034 Colleferro, Italy;
| | - Fulvia Paolozzi
- Department of Pharmacy, Pellegrini Hospital, 80134 Naples, Italy;
| | - Fabiana Nano
- Medical Department, Aqma Italia S.p.A., 80138 Naples, Italy; (F.N.); (M.P.)
| | - Michele Pironti
- Medical Department, Aqma Italia S.p.A., 80138 Naples, Italy; (F.N.); (M.P.)
| | - Gianfranco Raimondi
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Internal Medicine, “Sapienza” University of Rome, 04100 Latina, Italy;
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22
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Li M, Bao Q, Guo J, Xie R, Shen C, Wei Q, Hu P, Qin H, Shi J. Low Colorectal Tumor Removal by E-Cadherin Destruction-Enabled Tumor Cell Dissociation. Nano Lett 2022; 22:2769-2779. [PMID: 35333538 DOI: 10.1021/acs.nanolett.1c04797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Treatments for low colorectal cancer (CRC) remain a great challenge due to the heavy physical and psychological burdens of colostomy, strong drug toxicity in chemotherapy, and myelosuppression-/chemoradiation-related gastrointestinal symptoms. In this study, a highly biosafe and effective tumor cell dissociation-based low CRC treatment modality has been verified on both PDOs in vitro and colorectal tumor models in vivo. Notably, controllable EDTA release at the tumor sites was achieved by the LDH degradation in response to a slightly acidic microenvironment of low CRC tumors. Resultantly, the intratumoral E-cadherin for intercellular junctions of low CRC tumors was effectively destroyed via Ca2+ depletion by released EDTA from the interlayers, initiating remarkable tumor cell dissociation and resultant tumor disaggregation/removal via defecation. Dissociated tumor cells were prevailingly enveloped by LDH/EDTA, which prevented them from readhering to adjacent tissues, providing an unprecedented, efficient and safe therapeutic modality for low CRC, which will benefit patients suffering low CRC.
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Affiliation(s)
- Man Li
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- Department of Pathology, Shanghai Tenth People's Hospital, 301 Yan-chang Road, Shanghai 200072, P. R. China
| | - Qunqun Bao
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
| | - Jing Guo
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- Department of Pathology, Shanghai Tenth People's Hospital, 301 Yan-chang Road, Shanghai 200072, P. R. China
| | - Ruting Xie
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- Department of Pathology, Shanghai Tenth People's Hospital, 301 Yan-chang Road, Shanghai 200072, P. R. China
| | - Chao Shen
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
| | - Qing Wei
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- Department of Pathology, Shanghai Tenth People's Hospital, 301 Yan-chang Road, Shanghai 200072, P. R. China
| | - Ping Hu
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics Chinese Academy of Sciences, Shanghai 200050, P.R. China
- Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease, Chinese Academy of Medical Sciences (2021RU012), Shanghai 200050, P.R. China
| | - Huanlong Qin
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- Department of GI Surgey, Shanghai Tenth People's Hospital, 301 Yan-chang Road, Shanghai 200072, P.R. China
| | - Jianlin Shi
- Shanghai Tenth People's Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, 200072, P.R. China
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics Chinese Academy of Sciences, Shanghai 200050, P.R. China
- Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease, Chinese Academy of Medical Sciences (2021RU012), Shanghai 200050, P.R. China
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23
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Ravalli F, Vela Parada X, Ujueta F, Pinotti R, Anstrom KJ, Lamas GA, Navas‐Acien A. Chelation Therapy in Patients With Cardiovascular Disease: A Systematic Review. J Am Heart Assoc 2022; 11:e024648. [PMID: 35229619 PMCID: PMC9075296 DOI: 10.1161/jaha.121.024648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
Background EDTA is an intravenous chelating agent with high affinity to divalent cations (lead, cadmium, and calcium) that may be beneficial in the treatment of cardiovascular disease (CVD). Although a large randomized clinical trial showed benefit, smaller studies were inconsistent. We conducted a systematic review of published studies to examine the effect of repeated EDTA on clinical outcomes in adults with CVD. Methods and Results We searched 3 databases (MEDLINE, Embase, and Cochrane) from database inception to October 2021 to identify all studies involving EDTA treatment in patients with CVD. Predetermined outcomes included mortality, disease severity, plasma biomarkers of disease chronicity, and quality of life. Twenty-four studies (4 randomized clinical trials, 15 prospective before/after studies, and 5 retrospective case series) assessed the use of repeated EDTA chelation treatment in patients with preexistent CVD. Of these, 17 studies (1 randomized clinical trial) found improvement in their respective outcomes following EDTA treatment. The largest improvements were observed in studies with high prevalence of participants with diabetes and/or severe occlusive arterial disease. A meta-analysis conducted with 4 studies reporting ankle-brachial index indicated an improvement of 0.08 (95% CI, 0.06-0.09) from baseline. Conclusions Overall, 17 studies suggested improved outcomes, 5 reported no statistically significant effect of treatment, and 2 reported no qualitative benefit. Repeated EDTA for CVD treatment may provide more benefit to patients with diabetes and severe peripheral arterial disease. Differences across infusion regimens, including dosage, solution components, and number of infusions, limit comparisons across studies. Additional research is necessary to confirm these findings and to evaluate the potential mediating role of metals. Registration URL: https://www.crd.york.ac.uk/; Unique identifier: CRD42020166505.
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Affiliation(s)
- Filippo Ravalli
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNY
| | | | - Francisco Ujueta
- Department of Medicine at Mount Sinai Medical CenterMiami BeachFL
| | - Rachel Pinotti
- Levy LibraryIcahn School of Medicine at Mount SinaiNew YorkNY
| | | | - Gervasio A. Lamas
- Department of Medicine at Mount Sinai Medical CenterMiami BeachFL
- Columbia University Division of Cardiology at Mount Sinai Medical CenterMiami BeachFL
| | - Ana Navas‐Acien
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNY
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24
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Kristian P, Cholevík D. CHELATION OF BAND KERATOPATHY IN LONG-TERM MONITORING. Cesk Slov Oftalmol 2022; 78:250-256. [PMID: 36220365 DOI: 10.31348/2022/26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM To report the clinical results of chelation of band keratopathy in long-term follow-up. MATERIAL AND METHODS The long-term results of 5 patients (5 eyes) with symptomatic band keratopathy with a follow-up period of at least 6 months, in whom 2% EDTA was chelated on the affected eye in the study period from April 2018 to March 2021, were retrospectively evaluated. The follow-up period was 9-37 months. RESULTS In all patients, there was a significant improvement in the local findings and an increase in the transparency of the cornea. The effect of therapy was verified on a color photograph of the anterior segment and on AS-OCT by the disappearance of subepithelial hyperreflective foci and accompanying optical shadows. Postoperatively, this enabled a more detailed visualization of the deeper layers of the cornea and other structures of the anterior segment. In a patient with the potential to improve vision, it was also possible to significantly improve visual functions. In the other three patients with pain in the affected eye, the pain subsided, and they also benefited cosmetically from the operation. CONCLUSION Based on our experience and previously published reports, EDTA corneal chelation is able to causally resolve the pathology and improve vision in eyes with visual potential. At the same time, it reduces discomfort and has an analgesic effect in long-term irritated eyes. The operation is also suitable for amaurotic, cosmetically unsightly bulbs, as a successful intervention preserving the eye and improving the appearance of such eyes leads to satisfaction and a subjective increase in the quality of life of the patients.
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25
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Narvaez J, Chang M, Ing J, De Chance D, Narvaez JJ. Simplified, Readily Available Method for the Treatment of Band Keratopathy With Ethylenediaminetetraacetic Acid. Cornea 2021; 40:1360-1362. [PMID: 34481414 PMCID: PMC8423137 DOI: 10.1097/ico.0000000000002635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare 3 methods for creating ethylenediaminetetraacetic acid (EDTA) solution using readily available Vacutainer tubes for the treatment of band keratopathy. METHODS All 3 protocols used commercially available Vacutainer blood collection tubes coated with K2EDTA. An osmometer was used to measure and compare the concentration of EDTA created using 3 different protocols. The time required for preparation of the solution was measured and compared to evaluate its efficiency for everyday clinical use. In addition, volume of EDTA solution obtained was measured for method 1. The most promising protocol for clinical use was then used for treatment of a series of patients. RESULTS Average osmolarity was 532, 285, and 422 for methods 1, 2, and 3, respectively (ANOVA P < 0.01, all Tukey honestly significant difference P < 0.01). For the respective mixtures, average concentration was 65, 35, and 52 mg/mL, and average time to create solution was 189, 38, and 83 seconds (ANOVA P < 0.01, all Tukey honestly significant difference P < 0.01). The most promising, method 3, was found to be safe and effective in removing calcium from the corneal stroma in a series of 5 patients with 6 eyes treated. It also yielded 25% more solution for clinical use than method 1. CONCLUSIONS Method 3 using a single 10-mL Vacutainer tube with 18 mg of K2-EDTA had the best balance of effective concentration of EDTA, time to preparation, and simplicity of methodology, when compared with previously published methods 1 and 2. It also yielded a greater final volume of solution.
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Affiliation(s)
- Julio Narvaez
- Delta Eye Medical Group, Stockton, Lodi, and Tracy, CA
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA
| | - Matthew Chang
- Loma Linda University School of Medicine, Loma Linda, CA; and
| | - Jeffrey Ing
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA
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Górski B, Szerszeń M, Kaczyński T. Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial. Clin Oral Investig 2021; 26:1761-1772. [PMID: 34431001 PMCID: PMC8816759 DOI: 10.1007/s00784-021-04151-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. RESULTS Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. CONCLUSIONS Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland.
| | - Marcin Szerszeń
- Department of Dental Prosthetics, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Tomasz Kaczyński
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
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Dakal TC. SARS-CoV-2 attachment to host cells is possibly mediated via RGD-integrin interaction in a calcium-dependent manner and suggests pulmonary EDTA chelation therapy as a novel treatment for COVID 19. Immunobiology 2021; 226:152021. [PMID: 33232865 PMCID: PMC7642744 DOI: 10.1016/j.imbio.2020.152021] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/18/2020] [Indexed: 12/15/2022]
Abstract
SARS-CoV-2 is a highly contagious virus that has caused serious health crisis world-wide resulting into a pandemic situation. As per the literature, the SARS-CoV-2 is known to exploit humanACE2 receptors (similar toprevious SARS-CoV-1) for gaining entry into the host cell for invasion, infection, multiplication and pathogenesis. However, considering the higher infectivity of SARS-CoV-2 along with the complex etiology and pathophysiological outcomes seen in COVID-19 patients, it seems that there may be an alternate receptor for SARS-CoV-2. I performed comparative protein sequence analysis, database based gene expression profiling, bioinformatics based molecular docking using authentic tools and techniques for unveiling the molecular basis of high infectivity of SARS-CoV-2 as compared to previous known coronaviruses. My study revealed that SARS-CoV-2 (previously known as 2019-nCoV) harbors a RGD motif in its receptor binding domain (RBD) and the motif is absent in all other previously known SARS-CoVs. The RGD motif is well known for its role in cell-attachment and cell-adhesion. My hypothesis is that the SARS-CoV-2 may be (via RGD) exploiting integrins, that have high expression in lungs and all other vital organs, for invading host cells. However, an experimental verification is required. The expression of ACE2, which is a known receptor for SARS-CoV-2, was found to be negligible in lungs. I assume that higher infectivity of SARS-CoV-2 could be due to this RGD-integrin mediated acquired cell-adhesive property. Gene expression profiling revealed that expression of integrins is significantly high in lung cells, in particular αvβ6, α5β1, αvβ8 and an ECM protein, ICAM1. The molecular docking experiment showed the RBD of spike protein binds with integrins precisely at RGD motif in a similar manner as a synthetic RGD peptide binds to integrins as found by other researchers. SARS-CoV-2 spike protein has a number of phosphorylation sites that can induce cAMP, PKC, Tyr signaling pathways. These pathways either activate calcium ion channels or get activated by calcium. In fact, integrins have calcium & metal binding sites that were predicted around and in vicinity of RGD-integrin docking site in our analysis which suggests that RGD-integrins interaction possibly occurs in calcium-dependent manner. The higher expression of integrins in lungs along with their previously known high binding affinity (~KD = 4.0 nM) for virus RGD motif could serve as a possible explanation for high infectivity of SARS-CoV-2. On the contrary, human ACE2 has lower expression in lungs and its high binding affinity (~KD = 15 nM) for spike RBD alone could not manifest significant virus-host attachment. This suggests that besides human ACE2, an additional or alternate receptor for SARS-CoV-2 is likely to exist. A highly relevant evidence never reported earlier which corroborate in favor of RGD-integrins mediated virus-host attachment is an unleashed cytokine storm which causes due to activation of TNF-α and IL-6 activation; and integrins role in their activation is also well established. Altogether, the current study has highlighted possible role of calcium and other divalent ions in RGD-integrins interaction for virus invasion into host cells and suggested that lowering divalent ion in lungs could avert virus-host cells attachment.
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Affiliation(s)
- Tikam Chand Dakal
- Genome and Computational Biology Lab, Department of Biotechnology, Mohanlal Sukhadia University, Udaipur 313001, Rajasthan, India.
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Song T, Zhang D. Evaluation on curative effects of ethylene diamine tetra-acetic acid chelation therapy in treating with atherosclerotic cardiovascular disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23346. [PMID: 33350725 PMCID: PMC7769341 DOI: 10.1097/md.0000000000023346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ethylene diamine tetra-acetic acid (EDTA) is a chelating agent which attach to metals such as calcium and enables their elimination. In particular, some researchers suggest chelation with EDTA to treat cardiovascular disease with the hypothesis of moderating calcium to decrease atherosclerotic calcification of arteries. However, chelation with EDTA therapeutic effects in atherosclerotic cardiovascular disease is still unclear. Therefore, we propose to undertake a meta-analysis to assess the curative effects of EDTA chelation therapy in patients with atherosclerotic cardiovascular disease. METHODS In the current study, we set to perform a systematic literature search using the electronic databases of 4 most commonly used English databases (EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov trials register), as well as 3 most commonly employed Chinese databases (China Nation Knowledge Infrastructure, Wan Fang, and VIP), from the date of database inception until September 30, 2020 to identify relevant randomized controlled studies of the evaluation on curative effects of EDTA chelation therapy in patients with atherosclerotic cardiovascular disease. In the study, 2 authors worked independently to screen search results, chose studies for inclusion, then they extracted pertinent data to evaluate and study quality based on Cochrane Risk of Bias Tool V.2.0. Additionally, we will address discrepancies by consultation with a third author. We also intend to use pooled risk ratio (RR) and pooled mean difference (MD) or pooled standardized mean difference (SMD) with 95% confidence intervals (CI) to approximate the relative strength of curative effects of EDTA chelation therapy in patients with atherosclerotic cardiovascular disease. RESULTS The results of the current study will systematically assess curative effects of EDTA chelation therapy in patients with atherosclerotic cardiovascular disease. CONCLUSION The study will infer the currently published evidence to evaluate curative effects of EDTA chelation therapy in patients with atherosclerotic cardiovascular disease, which might be beneficial to these patients. ETHICS AND DISSEMINATION The present study is a systematic review, hence the pooled results are founded upon the published evidence. Therefore, ethical approval is not necessary for the study. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER October 20, 2020.osf.io/tvmk8. (https://osf.io/tvmk8/).
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Affiliation(s)
- Tao Song
- Department of Cardiology, People's Hospital of Lanling County, Linyi, Shandong
| | - Daimin Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Dash S, Ismail PM, Singh J, Agwan MA, Ravikumar K, Annadurai T. Assessment of Effectiveness of Erbium:Yttrium-Aluminum-Garnet Laser, GentleWave Irradiation, Photodynamic Therapy, and Sodium Hypochlorite in Smear Layer Removal. J Contemp Dent Pract 2020; 21:1266-1269. [PMID: 33850073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM AND OBJECTIVE To compare the effectiveness of erbium:yttrium-aluminum-garnet laser, GentleWave irradiation, photodynamic therapy (PDT), and sodium hypochlorite in smear layer removal and dentin permeability with a scanning electron microscope (SEM). MATERIALS AND METHODS Seventy-five recently extracted single-rooted teeth (maxillary second premolars) were randomly divided into 5 groups of 15 each. Group I teeth was the control group in which conventional root canal preparation (RCP) [17% ethylenediaminetetraacetic acid (EDTA)] was done without laser irradiation, group II teeth underwent RCP and GentleWave™ treatment, group III teeth were subjected to Er:YAG laser irradiation, group IV uses low-level 660 nm (PDT), and group V samples were irrigated with 5.25% NaOCl. All samples were viewed under the SEM. Images at the coronal, middle, and apical part of the root canal were obtained at ×1000. A scoring system for smear layer removal and debris removal scoring was used for analysis. RESULTS Smear layer removal was significantly higher at different points (coronal, middle, and apical area) in group I, followed by V, IV, II, and group III in declining order (p < 0.05). Intercomparison between the groups at different points indicates a significant difference in smear layer removal score between group I and group V at coronal, middle, and apical third. The result was not significant at coronal third and middle third, between group I and V, II and III, II and IV. The result was not significant at apical third between I and V, II and III, and II and IV (p < 0.05). Ethylenediaminetetraacetic acid and sodium hypochlorite are effective in smear layer removal followed by the Er-YAG laser technique. CONCLUSION Ethylenediaminetetraacetic acid and NaOCl are effective in smear layer removal. Er:YAG laser-activated RCP was comparatively efficient in cleaning the smear layer and opening dentinal tubules. CLINICAL SIGNIFICANCE Er:YAG laser-activated RCP was comparatively efficient in cleaning the smear layer and it can be used for effective removal of smear layer for clinical usage.
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Affiliation(s)
- Sumit Dash
- Department of Conservative Dentistry and Endodontics, Institute of Dental Science, Siksha O' Anusandhan, Deemed to be University, Bhubaneswar, Orissa, India
| | - Prabu Ms Ismail
- Department of Restorative Dentistry, College of Dentistry, AR Rass Qassim University, Kingdom of Saudi Arabia
| | - Jyotirmay Singh
- Department of Orthodontics and Dentofacial Orthopedics, Patna Dental College and Hospital, Patna, Bihar, India, Phone: +91 9334115000, e-mail:
| | - Muhammad As Agwan
- Department of Restorative Dentistry, College of Dentistry, AR Rass Qassim University, Kingdom of Saudi Arabia
| | - Kaarunya Ravikumar
- Department of Conservative Dentistry and Endodontic, Vinayaka Mission's Sankarachariyar Dental College (Deemed to be University), Salem, Tamil Nadu, India
| | - Thendral Annadurai
- Private Practitioner, Endodontist and Faculty of Conservative Dentistry, Tamil Nadu, India
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Ghosh R, Dubey S, Chatterjee S, Ghosh M, Ray BK, Benito-León J. Hypermanganesemia Induced Chorea and Cognitive Decline in a Tea Seller. Tremor Other Hyperkinet Mov (N Y) 2020; 10:45. [PMID: 33178484 PMCID: PMC7597573 DOI: 10.5334/tohm.537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 01/02/2023] Open
Abstract
Background Manganese associated neurotoxicity and neurodegeneration is quite rare yet established neurological disorder. This neurotoxic element has predilection for depositing in basal ganglia structures, manifesting mainly as parkinsonian and dystonic movement disorders with behavioral abnormalities. Case report We report a 40-year-old man who presented with a subacute onset bilateral, asymmetric hyperkinetic movement disorder (predominantly left sided chorea) with multi-domain cognitive impairment, dysarthria, and generalized rigidity. Clinical history and examination yielded multiple differential diagnoses including deposition and metabolic disorders, autoimmune and paraneoplastic encephalitis involving basal ganglia, and neurodegenerative disorders with chorea and cognitive impairment. However, magnetic resonance imaging was suggestive of paramagnetic substance deposition, which came out to be manganese after laboratory investigations. History, clinical examinations, and investigation results pointed towards a diagnosis of acquired hypermanganesemia due to over-ingestion of manganese containing substance (i.e., black tea). He was treated symptomatically and with chelation therapy (calcium disodium edetate). At the sixth month of follow-up, complete resolution of chorea, dysarthria and partial amelioration of rigidity were observed. His cognitive decline and behavioral abnormalities improved. Discussion This is probably the first reported case of acquired hypermanganesemia that presented as a combination of asymmetric chorea and cognitive dysfunction with atypical imaging characteristics. The clinical picture mimicked that of Huntington's disease. We highlight the potential deleterious effects of an apparently "benign" non-alcoholic beverage (i.e., black tea) on cerebral metabolism.
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Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, IN
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, IN
| | - Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, IN
| | - Mrinalkanti Ghosh
- Department of Radiology, Burdwan Medical College, Burdwan, West Bengal, IN
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, IN
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, ES
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, ES
- Department of Medicine, Complutense University, Madrid, ES
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Escolar E, Ujueta F, Kim H, Mark DB, Boineau R, Nahin RL, Goertz C, Lee KL, Anstrom KJ, Lamas GA. Possible differential benefits of edetate disodium in post-myocardial infarction patients with diabetes treated with different hypoglycemic strategies in the Trial to Assess Chelation Therapy (TACT). J Diabetes Complications 2020; 34:107616. [PMID: 32446881 PMCID: PMC9434823 DOI: 10.1016/j.jdiacomp.2020.107616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The NIH-funded Trial to Assess Chelation Therapy (TACT) randomized 1708 stable patients age ≥50 who were ≥6 months post myocardial infarction to 40 infusions of an edetate disodium-based regimen or placebo. In 633 patients with diabetes, edetate disodium significantly reduced the primary composite endpoint of mortality, recurrent myocardial infarction, stroke, coronary revascularization, or hospitalization for angina (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.44-0.79, p < 0.001). The principal secondary endpoint of a composite of cardiovascular death, myocardial infarction, or stroke was also reduced (HR 0.60, 95% CI 0.39-0.91, p = 0.017). It is unknown if the treatment effect differs by diabetes therapy. METHODS We grouped the subset of 633 patients with diabetes according to glucose-lowering therapy at time of randomization. The log-rank test was used to compare active therapy versus placebo. All treatment comparisons were performed using 2-sided significance tests at the significance level of 0.05 and were as randomized. Relative risks were expressed as HR with associated 95% CI, calculated using the Cox proportional hazards model. RESULTS There were 162 (25.7%) patients treated with insulin; 301 (47.5%) with oral hypoglycemics only; and 170 (26.8%) receiving no pharmacologic treatment for diabetes. Patients on insulin reached the primary endpoint more frequently than patients on no pharmacologic treatment [61 (38%) vs 49 (29%) (HR 1.56, 95% CI 1.07-2.27, p = 0.022)] or oral hypoglycemics [61 (38%) vs 87 (29%) (HR 1.46, 1.05-2.03, p = 0.024)]. The primary endpoint occurred less frequently with edetate disodium based therapy versus placebo in patients on insulin [19 (26%) vs 42 (48%) (HR 0.42, 95% CI 0.25-0.74, log-rank p = 0.002)], marginally in patients on oral hypoglycemics [38 (25%) vs 49 (34%) (HR 0.66, 95% CI 0.43-1.01, log-rank p = 0.041)], and no significant difference in patients not treated with a pharmacologic therapy [23 (25%) vs 26 (34%) (HR 0.69, 95% CI 0.39-1.20, log-rank p = 0.225)]. The interaction between randomized intravenous treatment and type of diabetes therapy was not statistically significant (p = 0.203). CONCLUSIONS Edetate disodium treatment in stable, post-myocardial infarction patients with diabetes suggests that patients on insulin therapy at baseline may accrue the greatest benefit. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: http://clinicaltrials.gov/ct2/show/NCT00044213?term=TACT&rank=7 identifier Trial to Assess Chelation Therapy (TACT), NCT00044213.
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Affiliation(s)
- Esteban Escolar
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami, FL, United States of America
| | - Francisco Ujueta
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami, FL, United States of America
| | - Hwasoon Kim
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Robin Boineau
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Richard L Nahin
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Christine Goertz
- Duke Department of Orthopaedic Surgery, Duke University, Durham, NC, United States of America
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Gervasio A Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami, FL, United States of America.
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Salamone AB, Salamone JC, McMahon RE, Poleon S, Bionda N, D'Arpa P. Synergistic Effect and Antibiofilm Activity of a Skin and Wound Cleanser. Wounds 2020; 32:208-216. [PMID: 32804659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Biofilm in chronic wounds impedes the wound healing process. Each biofilm has differing characteristics requiring a multifaceted approach for removal while maintaining a surrounding environment conducive to wound healing. OBJECTIVE In this study, 3 of the components in a wound cleanser are tested to determine synergy in eradicating biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in vitro. MATERIALS AND METHODS The 3 components assessed for synergy were ethylenediamine tetraacetic acid sodium salts (EDTA), vicinal diols (VD; ethylhexylglycerin and octane-1,2-diol), and polyhexamethylene biguanide (PHMB). Each component was assessed individually and in combination while dissolved in a base solution. The Calgary assay method was used for biofilm growth and treatment. Kull Equation analysis for synergy was conducted using viable count results. RESULTS Synergy is defined as the interaction of components to produce a combined effect greater than the sum of their separate effects. The base solution containing all 3 components (EDTA, VD, and PHMB) reduced biofilm viability by more than 5 logs, demonstrating statistically significant synergy. The 3 components tested individually in the base solution resulted in the following: EDTA did not reduce bacteria viability; VD reduced viability by about 1 log; and PHMB reduced P aeruginosa viability by about 2.5 logs and MRSA viability by about 4 logs. Of importance, the MRSA biofilm failed to regrow in the recovery plates after combined treatment, indicating complete elimination of the biofilm bacteria. CONCLUSIONS The experimental and calculated results indicate the 3 components (VD, EDTA, and PHMB) when used together act synergistically to eradicate MRSA and P aeruginosa biofilms in vitro.
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Affiliation(s)
| | | | | | - Suprena Poleon
- University of North Texas Health Science Center, Fort Worth, TX
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Abstract
BACKGROUND Chelation therapy is promoted and practiced around the world as a form of alternative medicine in the treatment of atherosclerotic cardiovascular disease. It has been suggested as a safe, relatively inexpensive, non-surgical method of restoring blood flow in atherosclerotic vessels. However, there is currently limited high-quality, adequately-powered research informing evidence-based medicine on the topic, specifically regarding clinical outcomes. Due to this limited evidence, the benefit of chelation therapy remains controversial at present. This is an update of a review first published in 2002. OBJECTIVES To assess the effects of ethylene diamine tetra-acetic acid (EDTA) chelation therapy versus placebo or no treatment on clinical outcomes among people with atherosclerotic cardiovascular disease. SEARCH METHODS For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 6 August 2019. We searched the bibliographies of the studies retrieved by the literature searches for further trials. SELECTION CRITERIA We included studies if they were randomised controlled trials of EDTA chelation therapy versus placebo or no treatment in participants with atherosclerotic cardiovascular disease. The main outcome measures we considered include all-cause or cause-specific mortality, non-fatal cardiovascular events, direct or indirect measurement of disease severity, and subjective measures of improvement or adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality using standard Cochrane procedures. A third author considered any unresolved issues, and we discussed any discrepancies until a consensus was reached. We contacted study authors for additional information. MAIN RESULTS We included five studies with a total of 1993 randomised participants. Three studies enrolled participants with peripheral vascular disease and two studies included participants with coronary artery disease, one of which specifically recruited people who had had a myocardial infarction. The number of participants in each study varied widely (from 10 to 1708 participants), but all studies compared EDTA chelation to a placebo. Risk of bias for the included studies was generally moderate to low, but one study had high risk of bias because the study investigators broke their randomisation code halfway through the study and rolled the placebo participants over to active treatment. Certainty of the evidence, as assessed by GRADE, was generally low to very low, which was mostly due to a paucity of data in each outcome's meta-analysis. This limited our ability to draw any strong conclusions. We also had concerns about one study's risk of bias regarding blinding and outcome assessment that may have biased the results. Two studies with coronary artery disease participants reported no evidence of a difference in all-cause mortality between chelation therapy and placebo (risk ratio (RR) 0.97, 95% CI 0.73 to 1.28; 1792 participants; low-certainty). One study with coronary artery disease participants reported no evidence of a difference in coronary heart disease deaths between chelation therapy and placebo (RR 1.02, 95% CI 0.70 to 1.48; 1708 participants; very low-certainty). Two studies with coronary artery disease participants reported no evidence of a difference in myocardial infarction (RR 0.81, 95% CI 0.57 to 1.14; 1792 participants; moderate-certainty), angina (RR 0.95, 95% CI 0.55 to 1.67; 1792 participants; very low-certainty), and coronary revascularisation (RR 0.46, 95% CI 0.07 to 3.25; 1792 participants). Two studies (one with coronary artery disease participants and one with peripheral vascular disease participants) reported no evidence of a difference in stroke (RR 0.88, 95% CI 0.40 to 1.92; 1867 participants; low-certainty). Ankle-brachial pressure index (ABPI; also known as ankle brachial index) was measured in three studies, all including participants with peripheral vascular disease; two studies found no evidence of a difference in the treatment groups after three months after treatment (mean difference (MD) 0.02, 95% CI -0.03 to 0.06; 181 participants; low-certainty). A third study reported an improvement in ABPI in the EDTA chelation group, but this study was at high risk of bias. Meta-analysis of maximum and pain-free walking distances three months after treatment included participants with peripheral vascular disease and showed no evidence of a difference between the treatment groups (MD -31.46, 95% CI -87.63 to 24.71; 165 participants; 2 studies; low-certainty). Quality of life outcomes were reported by two studies that included participants with coronary artery disease, but we were unable to pool the data due to different methods of reporting and varied criteria. However, there did not appear to be any major differences between the treatment groups. None of the included studies reported on vascular deaths. Overall, there was no evidence of major or minor adverse events associated with EDTA chelation treatment. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of people with atherosclerotic cardiovascular disease. More high-quality, randomised controlled trials are needed that assess the effects of chelation therapy on longevity and quality of life among people with atherosclerotic cardiovascular disease.
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Affiliation(s)
| | | | - Antonio L Dans
- Section of Adult Medicine, College of Medicine, University of the Philippines, Ermita, Philippines
| | - Flordeliza N Tan
- Emergency Department, Montefiore Westchester Square Campus, New York, USA
| | - Dennis V Sulit
- Department of Internal Medicine, Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines
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Maisetta G, Grassi L, Esin S, Kaya E, Morelli A, Puppi D, Piras M, Chiellini F, Pifferi M, Batoni G. Targeting Pseudomonas aeruginosa in the Sputum of Primary Ciliary Dyskinesia Patients with a Combinatorial Strategy Having Antibacterial and Anti-Virulence Potential. Int J Mol Sci 2019; 21:ijms21010069. [PMID: 31861859 PMCID: PMC6981532 DOI: 10.3390/ijms21010069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
In primary ciliary dyskinesia (PCD) patients, Pseudomonas aeruginosa is a major opportunistic pathogen, frequently involved in chronic infections of the lower airways. Infections by this bacterial species correlates with a worsening clinical prognosis and recalcitrance to currently available therapeutics. The antimicrobial peptide, lin-SB056-1, in combination with the cation chelator ethylenediaminetetraacetic acid (EDTA), was previously demonstrated to be bactericidal against P. aeruginosa in an artificial sputum medium. The purpose of this study was to validate the anti-P. aeruginosa activity of such a combination in PCD sputum and to evaluate the in vitro anti-virulence effects of EDTA. In combination with EDTA, lin-SB056-1 was able to significantly reduce the load of endogenous P. aeruginosa ex vivo in the sputum of PCD patients. In addition, EDTA markedly reduced the production of relevant bacterial virulence factors (e.g., pyocyanin, proteases, LasA) in vitro by two representative mucoid strains of P. aeruginosa isolated from the sputum of PCD patients. These results indicate that the lin-SB056-1/EDTA combination may exert a dual antimicrobial and anti-virulence action against P. aeruginosa, suggesting a therapeutic potential against chronic airway infections sustained by this bacterium.
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Affiliation(s)
- Giuseppantonio Maisetta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy; (L.G.); (S.E.); (E.K.); (G.B.)
- Correspondence: ; Tel.: +39-050-2213692; Fax: +39-050-2213711
| | - Lucia Grassi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy; (L.G.); (S.E.); (E.K.); (G.B.)
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy; (L.G.); (S.E.); (E.K.); (G.B.)
| | - Esingül Kaya
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy; (L.G.); (S.E.); (E.K.); (G.B.)
| | - Andrea Morelli
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy; (A.M.); (D.P.); (F.C.)
| | - Dario Puppi
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy; (A.M.); (D.P.); (F.C.)
| | - Martina Piras
- Section of Pneumology and Allergology, Unit of Pediatrics, Pisa University Hospital, 56126 Pisa, Italy; (M.P.); (M.P.)
| | - Federica Chiellini
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy; (A.M.); (D.P.); (F.C.)
| | - Massimo Pifferi
- Section of Pneumology and Allergology, Unit of Pediatrics, Pisa University Hospital, 56126 Pisa, Italy; (M.P.); (M.P.)
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56123 Pisa, Italy; (L.G.); (S.E.); (E.K.); (G.B.)
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Abstract
A 1.5-year-old Polish hen was presented with a history of watery droppings and poor vent tone. Results of diagnostic tests revealed blood lead at levels considered to be toxic. Chelation therapy was started with calcium ethylenediaminetetraacetate. The hen was laying eggs before, during, and after chelation therapy. Eggs were tested for the presence of lead by combining yolk and albumen together. Before chelation therapy, the level of lead in the egg tested was 14 μg. Two days after the end of chelation therapy, results of a second blood lead test revealed a drop to nontoxic levels. No lead was detected in the combined yolks and albumen of eggs collected 7-11 days after the end of chelation therapy. Four weeks after the end of chelation therapy, no lead was identified in the shells of tested eggs.
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Ujueta F, Arenas IA, Escolar E, Diaz D, Boineau R, Mark DB, Golden P, Lindblad L, Kim H, Lee KL, Lamas GA. The effect of EDTA-based chelation on patients with diabetes and peripheral artery disease in the Trial to Assess Chelation Therapy (TACT). J Diabetes Complications 2019; 33:490-494. [PMID: 31101487 PMCID: PMC6557676 DOI: 10.1016/j.jdiacomp.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/05/2019] [Accepted: 04/07/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Approximately 1 in 7 US adults have diabetes; and over 60% of deaths in patients with diabetes have cardiac disease as a principal or contributing cause. Both coronary and peripheral artery disease (PAD) identify high-risk cohorts among patients with diabetes. We have previously demonstrated improved cardiovascular outcomes with edetate disodium-based chelation in post-MI patients with diabetes, enrolled in the Trial to Assess Chelation Therapy (TACT). In these analyses we further studied the effect size of patients with diabetes and severe disease in 2 vascular beds; coronaries, and lower extremity arteries. We questioned whether greater atherosclerotic burden would attenuate the observed beneficial effect of edetate disodium infusions. RESEARCH DESIGN AND METHODS The multicenter TACT used a double blind, placebo controlled, 2 × 2 factorial design with 1708 participants, randomly assigned to receive edetate disodium-based chelation, or placebo and high dose oral vitamins or placebo. There were 162 (9.5% of 1708) post-MI patients with a diagnosis of diabetes mellitus and PAD for this post hoc analysis. Patients received up to 40 double-blind intravenous infusions of edetate disodium-based chelation, or placebo. The composite primary endpoint of TACT consisted of death from any cause, myocardial infarction, stroke, coronary revascularization and hospitalization for angina. RESULTS The median age was 66 years, 15% female, 5% non-Caucasian, and BMI was 31. Insulin was used by 32% of patients. Active infusions significantly reduced the primary endpoint compared with placebo infusions (HR, 0.52; 95% CI, 0.30-0.92; P = 0.0069), with a 30% absolute risk reduction in the primary endpoint. There was a marked reduction in total mortality from 24% to 11%, although of borderline significance (P = 0.052). CONCLUSION Atherosclerotic disease in multiple vascular beds did not attenuate the beneficial effect of edetate disodium infusions in post MI patients with diabetes. Studies now in progress will prospectively test this post hoc finding.
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Affiliation(s)
- Francisco Ujueta
- Department of Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA
| | - Ivan A Arenas
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA
| | - Esteban Escolar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA
| | - Denisse Diaz
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA
| | - Robin Boineau
- National Center of Complementary and Integrative Health (NCCIH), Bethesda, MD, USA
| | | | - Patrick Golden
- The Golden Center for Integrative Medicine, Fresno, CA, USA
| | | | - Hwasoon Kim
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kerry L Lee
- Duke Clinical Research Institute, Durham, NC, USA
| | - Gervasio A Lamas
- Department of Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA; Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA.
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Calderon Moreno R, Navas-Acien A, Escolar E, Nathan DM, Newman J, Schmedtje JF, Diaz D, Lamas GA, Fonseca V. Potential Role of Metal Chelation to Prevent the Cardiovascular Complications of Diabetes. J Clin Endocrinol Metab 2019; 104:2931-2941. [PMID: 30869793 PMCID: PMC9136707 DOI: 10.1210/jc.2018-01484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/07/2019] [Indexed: 02/12/2023]
Abstract
CONTEXT For decades, there has been epidemiologic evidence linking chronic toxic metal exposure with cardiovascular disease, suggesting a therapeutic role for metal chelation. Given the lack of compelling scientific evidence, however, the indications for metal chelation were never clearly defined. To determine the safety and efficacy of chelation therapy, the National Institutes of Health funded the Trial to Assess Chelation Therapy (TACT). TACT was the first double-blind, randomized, controlled trial to demonstrate an improvement in cardiovascular outcomes with edetate disodium therapy in patients with prior myocardial infarction. The therapeutic benefit was striking among the prespecified subgroup of patients with diabetes. DESIGN We review the published literature focusing on the atherogenic nature of diabetes, as well as available evidence from clinical trials, complete and in progress, of metal chelation with edetate disodium therapy in patients with diabetes. RESULTS The TACT results support the concept that ubiquitous toxic metals such as lead and cadmium may be modifiable risk factors for cardiovascular disease, particularly in patients with diabetes. CONCLUSIONS The purpose of this review is to discuss the potential mechanisms unifying the pathogenesis of atherogenic factors in diabetes with toxic metal exposure, and the potential role of metal chelation.
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Affiliation(s)
| | - Ana Navas-Acien
- Columbia University Mailman School of Public Health, New York, New York
| | - Esteban Escolar
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
| | - David M Nathan
- Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jonathan Newman
- Department of Medicine, New York University School of Medicine, New York, New York
| | | | - Denisse Diaz
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
- Correspondence and Reprint Requests: Denisse Diaz, MD, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, Florida 33140. E-mail:
| | - Gervasio A Lamas
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Dumit S, Avtandilashvili M, McComish SL, Strom DJ, Tabatadze G, Tolmachev SY. Validation of a system of models for plutonium decorporation therapy. Radiat Environ Biophys 2019; 58:227-235. [PMID: 30627772 DOI: 10.1007/s00411-018-00773-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
A recently proposed system of models for plutonium decorporation (SPD) was developed using data from an individual occupationally exposed to plutonium via a wound [from United States Transuranium and Uranium Registries (USTUR) Case 0212]. The present study evaluated the SPD using chelation treatment data, urine measurements, and post-mortem plutonium activities in the skeleton and liver from USTUR Case 0269. This individual was occupationally exposed to moderately soluble plutonium via inhalation and extensively treated with chelating agents. The SPD was linked to the International Commission on Radiological Protection (ICRP) Publication 66 Human Respiratory Tract Model (HRTM) and the ICRP Publication 30 Gastrointestinal Tract model to evaluate the goodness-of-fit to the urinary excretion data and the predictions of post-mortem plutonium retention in the skeleton and liver. The goodness-of-fit was also evaluated when the SPD was linked to the ICRP Publication 130 HRTM and the ICRP Publication 100 Human Alimentary Tract Model. The present study showed that the proposed SPD was useful for fitting the entire, chelation-affected and non-affected, urine bioassay data, and for predicting the post-mortem plutonium retention in the skeleton and liver at time of death, 38.5 years after the accident. The results of this work are consistent with the conclusion that Ca-EDTA is less effective than Ca-DTPA for enhancing urinary excretion of plutonium.
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Affiliation(s)
- Sara Dumit
- U.S. Transuranium and Uranium Registries, Washington State University, 1845 Terminal Drive, Suite 201, Richland, WA, 99354, USA.
- Los Alamos National Laboratory, Mail Stop G761, Los Alamos, NM, 87545, USA.
| | - Maia Avtandilashvili
- U.S. Transuranium and Uranium Registries, Washington State University, 1845 Terminal Drive, Suite 201, Richland, WA, 99354, USA
| | - Stacey L McComish
- U.S. Transuranium and Uranium Registries, Washington State University, 1845 Terminal Drive, Suite 201, Richland, WA, 99354, USA
| | - Daniel J Strom
- U.S. Transuranium and Uranium Registries, Washington State University, 1845 Terminal Drive, Suite 201, Richland, WA, 99354, USA
| | - George Tabatadze
- U.S. Transuranium and Uranium Registries, Washington State University, 1845 Terminal Drive, Suite 201, Richland, WA, 99354, USA
| | - Sergei Y Tolmachev
- U.S. Transuranium and Uranium Registries, Washington State University, 1845 Terminal Drive, Suite 201, Richland, WA, 99354, USA
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Abstract
Neurotoxicity can be caused by numerous direct agents, of which toxic metals, organophosphorus pesticides, air pollution, radiation and electromagnetic fields, neurotoxins, chemotherapeutic and anesthetic drugs, and pathogens are the most important. Other indirect causes of neurotoxicity are cytokine and/or reactive oxygen species production and adoptive immunotherapy. The development of neurodegenerative diseases has been associated with neurotoxicity. Which arms are useful to prevent or eliminate neurotoxicity? The chelating agent calcium disodium ethylenediaminetetraacetic acid (EDTA)-previously used to treat cardiovascular diseases-is known to be useful for the treatment of neurodegenerative diseases. This review describes how EDTA functions as a therapeutic agent for these diseases. Some case studies are reported to confirm our findings.
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Affiliation(s)
- Alessandro Fulgenzi
- Department of Biomedical Sciences for Health, University of the Study of Milan, 20133 Milan, Italy.
| | - Maria Elena Ferrero
- Department of Biomedical Sciences for Health, University of the Study of Milan, 20133 Milan, Italy.
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Ata SA, Abu-Dari KI, Tutunji MF, Mubarak MS. Reversing the adverse biochemical effects in lead-intoxicated rats by N,N`- bis[(1,2-didehydro-1-hydroxy-2-thioxopyrid-4-yl)-carbonyl]- L-lysine. J Trace Elem Med Biol 2018; 50:93-99. [PMID: 30262322 DOI: 10.1016/j.jtemb.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 02/08/2023]
Abstract
N,N`-Bis[(1,2-didehydro-1-hydroxy-2-thioxopyrid-4-yl)-carbonyl]- L-lysine (HTPL) is a novel newly synthesized compound intended to be used for the chelation of lead in intoxicated animals. Subchronic lead intoxication experiments were carried out on Wistar male rats; these rats were intoxicated with lead and then treated with HTPL. Results were compared with those obtained with known compounds used for lead chelation therapy, such as disodium ethylnediaminetetraacetic acid (CaNa2EDTA) and meso-2,3-dimercaptosuccininc acid (DMSA), using different routes of administration. Biological samples of whole blood and urine were collected and analyzed for urinary proporphyrins, δ-aminolevulinic acid dehydratase, and zinc protoporphyrin. Results revealed that HTPL can remarkably reverse the toxic effects of lead intoxication at biochemical levels. Additionally, results showed that this agent is as good or even more potent than calcium disodium ethylnediaminetetraacetic acid (CaNa2EDTA) and meso-2,3-dimercaptosuccininc acid (DMSA) in reversing the toxic effect of lead. More importantly, HTPL was found effective when administrated intraperitoneally and orally.
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Affiliation(s)
- Samah A Ata
- Pharmacy Department, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman-Jordan, 130 Amman 11733, Jordan
| | - Kamal I Abu-Dari
- Department of Chemistry, Faculty of Science, The University of Jordan, Amman 11942, Jordan.
| | - Maha F Tutunji
- Department of Chemistry, Faculty of Science, The University of Jordan, Amman 11942, Jordan
| | - Mohammad S Mubarak
- Department of Chemistry, Faculty of Science, The University of Jordan, Amman 11942, Jordan.
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Rousseau E, Lau J, Kuo HT, Zhang Z, Merkens H, Hundal-Jabal N, Colpo N, Lin KS, Bénard F. Monosodium Glutamate Reduces 68Ga-PSMA-11 Uptake in Salivary Glands and Kidneys in a Preclinical Prostate Cancer Model. J Nucl Med 2018; 59:1865-1868. [PMID: 30097503 PMCID: PMC6278899 DOI: 10.2967/jnumed.118.215350] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 01/28/2023] Open
Abstract
We evaluated the ability of monosodium glutamate (MSG) to reduce salivary and kidney uptake of a prostate-specific membrane antigen (PSMA) radioligand without affecting tumor uptake. Methods: LNCaP tumor-bearing mice were intraperitoneally injected with MSG (657, 329, or 164 mg/kg) or phosphate-buffered saline (PBS). Fifteen minutes later, the mice were intravenously administered 68Ga-PSMA-11. PET/CT imaging and biodistribution studies were performed 1 h after administration. Results: Tumor uptake (percentage injected dose per gram [%ID]) was not statistically different between groups, at 8.42 ± 1.40 %ID in the 657 mg/kg group, 7.19 ± 0.86 %ID in the 329 mg/kg group, 8.20 ± 2.44 %ID in the 164 mg/kg group, and 8.67 ± 1.97 %ID in the PBS group. Kidney uptake was significantly lower in the 657 mg/kg group (85.8 ± 24.2 %ID) than in the 329 mg/kg (159 ± 26.2 %ID), 164 mg/kg (211 ± 27.4 %ID), and PBS groups (182 ± 33.5 %ID) (P < 0.001). Salivary gland uptake was lower in the 657 mg/kg (3.72 ± 2.12 %ID) and 329 mg/kg (5.74 ± 0.62 %ID) groups than in the PBS group (10.04 ± 2.52 %ID) (P < 0.01). Conclusion: MSG decreased salivary and kidney uptake of 68Ga-PSMA-11 in a dose-dependent manner, whereas tumor uptake was unaffected.
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Affiliation(s)
- Etienne Rousseau
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Joseph Lau
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Hsiou-Ting Kuo
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Zhengxing Zhang
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Helen Merkens
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Navjit Hundal-Jabal
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Nadine Colpo
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - François Bénard
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW For over 60 years, chelation therapy with disodium ethylene diamine tetraacetic acid (EDTA, edetate) had been used for the treatment of cardiovascular disease (CVD) despite lack of scientific evidence for efficacy and safety. The Trial to Assess Chelation Therapy (TACT) was developed and received funding from the National Institutes of Health (NIH) to ascertain the safety and efficacy of chelation therapy in patients with CVD. RECENT FINDINGS This pivotal trial demonstrated an improvement in outcomes in postmyocardial infarction (MI) patients. Interestingly, it also showed a particularly large reduction in CVD events and all-cause mortality in the prespecified subgroup of patients with diabetes. The TACT results may support the concept of metal chelation to reduce metal-catalyzed oxidation reactions that promote the formation of advanced glycation end products, a precursor of diabetic atherosclerosis. SUMMARY In this review, we summarize the epidemiological and basic evidence linking toxic metal accumulation and diabetes-related CVD, supported by the salutary effects of chelation in TACT. If the ongoing NIH-funded TACT2, in diabetic post-MI patients, proves positive, this unique therapy will enter the armamentarium of endocrinologists and cardiologists seeking to reduce the atherosclerotic risk of their diabetic patients.
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Affiliation(s)
- Denisse Diaz
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Yamil W. Aude
- University of Texas Rio Grande Valley Doctors Hospital at Renaissance, Edinburg, Texas, USA
| | - Gervasio A. Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL
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Oliveira LV, Maia TS, Zancopé K, Menezes MDS, Soares CJ, Moura CCG. Can intra-radicular cleaning protocols increase the retention of fiberglass posts? A systematic review. Braz Oral Res 2018; 32:e16. [PMID: 29561949 DOI: 10.1590/1807-3107bor-2018.vol32.0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/30/2018] [Indexed: 11/22/2022] Open
Abstract
The presence of residues within the root canal after post-space preparation can influence the bond strength between resin cement and root dentin when using fiberglass posts (FGPs). Currently, there is no consensus in the literature regarding what is the best solution for the removal of debris after post-space preparation. This systematic review involved "in vitro" studies to investigate if cleaning methods of the root canal after post-space preparation can increase the retention of FGPs evaluated by the push-out test. Searches were carried out in PubMed (MEDLINE) and Scopus databases up to July2017. English language studies published from 2007 to July 2017 were selected. 475 studies were found, and 9 were included in this review. Information from the 9 studies were collected regarding the number of samples, storage method after extraction, root canal preparation, method of post-space preparation, endodontic sealer, resin cement, cleaning methods after post-space and presence of irrigant activation. Five studies presented the best results for the association of sodium hypochlorite (NaOCl) and ethylenediamine tetra-acetic acid (EDTA), while in the other 4 studies, the solutions that showed improved retention of FGPs were photon-induced photoacoustic streaming (PIPS), Qmix, Sikko and EDTA. The results showed heterogeneity in all comparisons due to a high variety of information about cleaning methods, different concentrations, application time, type of adhesive system and resin cements used. In conclusion, this review suggests that the use of NaOCl/EDTA results in the retention of FGPs and may thus be recommended as a post-space cleaning method influencing the luting procedure.
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Affiliation(s)
- Lilian Vieira Oliveira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Endodontics, Uberlândia, MG, Brazil
| | - Thais Souza Maia
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlândia, MG, Brazil
| | - Karla Zancopé
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Occlusion, Fixed Prostheses, and Dental Materials, Uberlândia, MG, Brazil
| | - Murilo de Souza Menezes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlândia, MG, Brazil
| | - Carlos José Soares
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlândia, MG, Brazil
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Abstract
PURPOSE The surgical treatment of band keratopathy usually consists of abrasion of the corneal epithelium followed by removal of the subepithelial calcium deposits by means of an ethylenediamine-tetraacetic acid (EDTA) solution. In order to reduce the discomfort and pain that occur after corneal abrasion, the authors developed a modified technique that avoids the abrasion of the epithelium. METHODS In three patients (four eyes) with long-standing band keratopathy, the epithelium was detached with a 19% ethanol solution and placed gently toward the limbus, a method also used in laser-assisted subepithelial keratectomy (LASEK). After clearing the anterior stroma with EDTA solution, the epithelial flap is unrolled and a bandage contact lens applied. RESULTS Postoperative pain was greatly reduced and after removal of the contact lens no pain was reported. CONCLUSIONS This modified epithelium-sparing treatment of band keratopathy shows good results while reducing postoperative pain.
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Affiliation(s)
- D de Ortueta
- Eye Centre Recklinghausen, Erbruch 34-46, 45657 Recklinghausen, Germany.
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45
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Abstract
In March 2014, a 39-year-old Korean male presented with a 6-month history of various nonspecific symptoms including dizziness, fatigue, asthenia, irritability, elevated blood pressure, palpitation, eyestrain, and tinnitus. His occupational history revealed that he had been working as an indoor firing range manager for 13 months; therefore, he was subjected to a blood lead level (BLL) test. The test results showed a BLL of 64 μg/dL; hence, he was diagnosed with lead poisoning and immediately withdrawn from work. As evident from the workplace environmental monitoring, the level of lead exposure in the air exceeded its limit (0.015-0.387 mg/m³). He received chelation treatment with calcium-disodium ethylenediaminetetraacetic acid (1 g/day) for 5 days without any adverse effects. In the follow-up results after 2 months, the BLL had decreased to 9.7 μg/dL and the symptoms resolved. This report represents the first occupational case of lead poisoning in firing ranges in Korea, and this necessitates institutional management to prevent the recurrence of poisoning through this route. Workplace environmental monitoring should be implemented for indoor firing ranges, and the workers should undergo regularly scheduled special health examinations. In clinical practice, it is essential to question the patient about his occupational history.
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Affiliation(s)
- Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
- Department of Neurology, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Korea
| | - Won Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Department of Occupational and Environmental Medicine, Aerospace Medical Research Center, Republic of Korea Air Force, Cheongju, Korea.
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Li L, Guo L, Chen X. The changes of lead exposed workers' ECG and blood pressure by testing the effect of CaNa2EDTA on blood lead. Pak J Pharm Sci 2017; 30:1837-1842. [PMID: 29084655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The role of lead pollution in the induction of hypertension and electrocardiogram (ECG) changes has not been sufficiently recognized. The present study is aimed to calculate the association between lead exposure and blood pressure (BP) and ECG findings. A group of 147 lead-exposed workers from a battery plant and 104 controls were examined for blood lead levels (PbB), BP, and ECG. The exposed workers were followed annually from 2008 to 2010. Furthermore, lead in air dust and fumes were also detected in the breathing zone of the workplace. The PbB of lead-exposed workers were correlated with air lead in worksites from 2008 to 2010. A linear regression of repeated measurement analysis showed that diastolic blood pressure (DBP) in exposed workers decreased consecutively from 2008 to 2010 (p<0.01) with reduced lead exposure; however, this value was not correlated with the incidence of hypertension (p=0.138). Abnormal ECG rates were 35.37%, 38.78%, and 44.90% in 2008, 2009, and 2010, respectively, demonstrating an annual increase (p=0.024). Our study showed that lead exposure was crucial factor in causing ECG abnormalities. No correlation was identified between lead exposure and hypertension, and further study is needed. EDTA for the treatment of blood lead object on lead poisoning (PbB) level, abnormal electrocardiogram and blood pressure increases curative effect, and the better effect of the longer range.
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Affiliation(s)
- Li Li
- The department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Li Guo
- The department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xingjie Chen
- The department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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Solakoglu Ö, Filippi A. Transreplantation:
An alternative for periodontally hopeless teeth. Quintessence Int 2017; 48:287-293. [PMID: 28338103 DOI: 10.3290/j.qi.a37806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The periodontal therapy of severely damaged teeth that have advanced bone loss, a significant degree of mobility, and often tooth migration and elongation, frequently exposes the dental clinician to difficult decisions regarding the appropriate therapy for the patient. Extensive rehabilitation, with the replacement of periodontally hopeless teeth, has biologic, prognostic, and financial limitations. A possible alternative in such cases is the transreplantation of periodontally hopeless teeth. Ankylosis of the tooth is induced by appropriate extraoral pretreatment and thus the mobility disappears and the alveolar bone is reformed. This little-known technique is described step by step, with reference to a clinical case.
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Srivastava PK, Nagpal A, Setya G, Kumar S, Chaudhary A, Dhanker K. Assessment of Coronal Leakage of Temporary Restorations in Root Canal-treated Teeth: An in vitro Study. J Contemp Dent Pract 2017; 18:126-130. [PMID: 28174365 DOI: 10.5005/jp-journals-10024-2002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Coronal leakage is one of the constant concerns in routine dental practice. It is one of the factors responsible for the failure of root canal therapy. Permanent restorations should be given as soon as possible after the completion of root canal therapy. If unavoidable, provisional restoration should be given in such a way that it maximally reduced the leakage of microorganisms and fluids from the external environment into the canal space. Hence, we evaluated the effect of saliva on the coronal leakage of temporary restorations. MATERIALS AND METHODS Biomechanical preparation of the root canals of 204 fresh mandibular first premolar teeth was done using endodontic files with intermittent irrigation of sodium hypochlorite solution and ethylenediaminetetraacetic acid. Alternate irrigation with normal saline was done periodically. After preparation, drying of the canals was done using paper points followed by sealing of the apical foramen. For the assessment of the microleakage, Siqueira et al apparatus and method was used. All the specimens were divided into four groups based on the provisional restorative material used. All the groups were further divided into three subgroups based on the presence and absence of intracanal medicaments. Verissimo et al's criteria were used to check the turbidity at 1-, 2-, 3-, and 4-week interval respectively. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Chi-square test was used to measure the level of significance, and p < 0.05 was considered to be significant. RESULTS In group I, all the subgroups' specimens showed significant difference at 1 week's time. Only the subgroup with no intracanal medicaments in Cavit-containing provisional restoration showed nonsignificant alterations. Statistically significant alterations were seen at 1, 2, and 3 weeks' interval in all the subgroups except for one with intracanal medicaments. CONCLUSION All the temporary restorative materials were not able to prevent microleakage after 1 week's time, with worst bacterial resistance shown by Ketac Molar and ionomer restorative material. Future studies are advocated for better prognosis of root canal therapy.
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Affiliation(s)
- Pankaj K Srivastava
- Department of Dentistry, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
| | - Ajay Nagpal
- Department of Conservative Dentistry and Endodontics, K.D. Dental College & Hospital, Mathura, Uttar Pradesh, India
| | - Gaurav Setya
- Department of Conservative Dentistry and Endodontics Sri Gobind Tricentenary Dental College, Hospital & Research Institute, Gurugram, Haryana, India, Phone: +919501544877, e-mail:
| | - Sunil Kumar
- Department of Conservative Dentistry and Endodontics, K.D. Dental College & Hospital, Mathura, Uttar Pradesh, India
| | - Alankrita Chaudhary
- Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Kuldeep Dhanker
- Department of Public Health Dentistry, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
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Liu X, Mao M, Ma T. The effect of EDTA root conditioning on periodontal surgery outcome: A meta-analysis. Quintessence Int 2016; 47:833-841. [PMID: 27458614 DOI: 10.3290/j.qi.a36571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chemical root conditioning is a procedure to remove the smear layer, which influences periodontal healing. The purpose of this study was to determine the effect of using ethylenediaminetetraacetic acid (EDTA) as a root conditioning agent on periodontal surgery outcomes. METHOD AND MATERIALS The databases searched from their earliest records to February 2015 included Pubmed, Embase, the Cochrane library, and ISI Web of Science. Quality assessment of the methodologies of all the included studies and data was performed with Review Manager software. Probing depth (PD) and clinical attachment level (CAL) were analyzed using inverse variance. RESULTS The evaluation of the three articles that met the inclusion criteria showed that the differences between the EDTA groups and the control groups were not statistically significant (6 months PD: mean difference [MD] = -0.15 mm, Z = 1.09, P = .27; CAL: MD = 0.15 mm, Z = 0.89, P = .37). CONCLUSION EDTA was not able to significantly improve the PD and CAL. A positive outcome of using EDTA as a root conditioning agent was not evident. Thus, future research should focus on EDTA in combination with other drugs or a better alternative drug to EDTA.
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50
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Abstract
BACKGROUND Lead is a toxic element of the environment which leads to major complications once it enters the blood stream, affecting multiple organs and systems of the body. METHODS We present the case of a 16-year-old girl, diagnosed with lead poisoning after occupational exposure due to the fact that the girl was actively involved in the family's pottery business.History revealed that the girl participated in the process of pottery, her father was also diagnosed with lead poisoning 2 years before. The patient's personal history underlined that approximately 1 year ago she presented with severe abdominal pain, being diagnosed with acute appendicitis and she underwent appendectomy, but the pain persisted, thus due to family history of lead poisoning, the suspicion of saturnine colic rose, and she was diagnosed with lead poisoning. The main symptoms and signs were severe abdominal pain, vomiting, and arterial hypertension. The clinical evolution was favorable under symptomatic treatment and chelation therapy. RESULTS Lead toxicity is a life-threatening condition because of its severe acute and chronic complications. In children, there is no safe blood lead level, prevention methods are, therefore, very important in order to avoid toxic multiorganic effects of this metal. CONCLUSION Even though the diagnosis of lead poisoning remains difficult in children, it must also be taken into consideration by the clinician facing a child with gastrointestinal or neurological involvement.
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Affiliation(s)
| | - Lorena Elena Meliţ
- Department of Pediatrics I
- Correspondence: Lorena Elena Meliţ, Department of Pediatrics I, University of Medicine and Pharmacy Tîrgu Mureş, 38 Gh. Marinescu St., 540139 Tîrgu Mureş, Romania (e-mail: )
| | - Horaţiu Moldovan
- Department of Occupational Health, University of Medicine and Pharmacy, Tîrgu Mureş
| | - Vasile Valeriu Lupu
- Department of Pediatrics, University of Medicine and Pharmacy, Gr. T. Popa Iaşi, Romania
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