Mesna 600mg tablets

Otitis media (OM) is a frequent disease with incidence rate of 5300 cases per 100,000 people. Recent studies showed that polymicrobial biofilm formation represents a significant pathogenic mechanism in recurrent and chronic forms of OM. Biofilm enables bacteria to resist antibiotics that would typically be recommended in guidelines, contributing to the ineffectiveness of current antimicrobial strategies. Given the challenges of successfully treating bacterial biofilms, there is an growing interest in identifying novel and effective compounds to overcome antibacterial resistance. The objective of this review was to provide an overview of the novel compounds with antibiofilm effects on bacterial biofilm formed by clinical isolates of OM. The systematic review included studies that evaluated antibiofilm effect of novel natural or synthetic compounds on bacterial biofilm formed from clinical isolates obtained from patients with OM. The eligibility criteria were defined using the PICOS system: (P) Population: all human patients with bacterial OM; (I) Intervention: novel natural or synthetic compound with biofilm effect; (C) Control standard therapeutic antimicrobial agents or untreated biofilms, (O) Outcome: antibiofilm effect (biofilm inhibition, biofilm eradication), (S) Study design. The PRISMA protocol for systematic reviews and meta-analysis was followed. From 3564 potentially eligible studies, 1817 duplicates were removed, and 1705 were excluded according to defined exclusion criteria. A total of 41 studies with available full texts were retrieved by two independent authors. Fifteen articles were selected for inclusion in the systematic review which included 125 patients with OM. A total of 17 different novel compounds were examined, including N-acetyl-L-cysteine (NAC), tea tree oil, xylitol, eugenol, Aloe barbadensis, Zingiber officinale, Curcuma longa, Acacia arabica, antisense peptide nucleic acids, probiotics Streptococcus salivarius and Streptococcus oralis, Sodium 2-mercaptoethanesulfonate (MESNA), bioactive glass, green synthesized copper oxide nanoparticles, radish, silver nanoparticles and acetic acid. Staphylococcus aureus was the most commonly studied pathogen, followed by Pseudomonas aeruginosa and Haemophilus influenzae. Biofilm inhibition only by an examined compound was assessed in six studies; biofilm eradication in four studies, and both biofilm inhibition and biofilm eradication were examined in five studies. This systematic review indicates that some compounds like NAC, prebiotics, nanoparticles and MESNA that have significant effects on biofilm are safe and could be researched more extensively for further clinical use. However, a lack of data about reliable and efficient compounds used in therapy of different types of otitis media still remains in the literature.

Abstract licence: CC BY

Temporomandibular disorders (TMD) are managed with interventions ranging from conservative physiotherapy to minimally invasive procedures, but their comparative effectiveness is unclear. We conducted a systematic review and meta-analysis of randomized trials to quantify treatment effects on pain and function. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we included randomized/quasi-randomized TMD trials reporting pre-/post-procedure and between-group outcomes. Ten trials (~500 participants) were pooled. Pain (Visual Analog Score (VAS) and Numerical Rating Scale (NRS)) was the primary outcome while maximal mouth opening (MMO) was the secondary outcome. Medians, interquartile ranges (IQRs) and standard errors (SEs) were converted to mean/standard deviation (SD) where needed. RevMan 5.4 (inverse-variance, random-effects) was used for statistical analysis. Subgroups contrasted minimally invasive (arthrocentesis/lavage±injectates) versus conservative/physical therapy (manual therapy, low-level laser therapy (LLLT) vs transcutaneous electrical nerve stimulation (TENS), ultrasound vs splints). Small-study effects were explored using funnel plots. Active interventions improved pain more than controls. In conservative care, adding manual therapy enhanced exercise/education, photobiomodulation outperformed TENS, and ultrasound gave modest early benefit. Invasive protocols (arthrocentesis) yielded faster pain relief than non-surgical comparators, with small differences across lavage agents/volumes. Both strategies produced clinically meaningful pooled benefits, with slightly greater effects for minimally invasive care. Heterogeneity was moderate; funnel plot symmetry suggested little publication bias. Excluding the retracted sodium 2-mercaptoethanesulfonate (MESNA) trial did not change the findings. Both conservative and minimally invasive approaches yield meaningful short-term pain reductions in TMD. Benefits are greatest with multimodal conservative programs and arthrocentesis as escalation. Publication bias was limited. Future randomized controlled trials (RCTs) should standardize outcomes and clarify escalation criteria.

Abstract licence: CC BY