Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. We included data for 29,234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70-0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41-0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37-0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18-1·28]; p<0·0001 for the increasing HR with each day's delay). We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection. F Hoffmann-La Roche.

Objective: Gastric cancer is one of the leading causes of death worldwide, with many influences contributing to thedisease. The aim of this study was to identify the most important risk factors. Methods: This study was conducted in2017 with a structured overview in the Science Directe, Scopus, PubMed, Cochrane, Web of Science (ISI) databases.In the first step, articles were extracted based on their titles and abstracts; the quality of 43 articles was evaluatedusing the STORBE tool. Inclusion criteria were studies carried out on human, English language (first step), year ofthe study and the study type (second step). Results: Finally, 1,381 articles were found, of which 1,269 were excludedin primary and secondary screening. In reviewing the references of the remaining 44 papers, 4 studies were added.Finally, 43 articles were selected for the quality assessment process. A total of 52 risk factors for gastric cancer wereidentified and classified into nine important categories: diet, lifestyle, genetic predisposition, family history, treatmentand medical conditions, infections, demographic characteristics, occupational exposures and ionizing radiation’.Conclusion: Several environmental and genetic factors are involved in the development of gastric cancer. Regardingthe role of changes in ‘diet and lifestyle’, considering appropriate nutrition and improving the level of education andawareness of people is vital for early diagnosis and timely treatment of this disease, especially in people with a familyhistory and genetic predisposition.

Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis, not only affect the intestinal tract but also have an extraintestinal involvement within the oral cavity. These oral manifestations may assist in the diagnosis and the monitoring of disease activity, whilst ignoring them may lead to an inaccurate diagnosis and useless and expensive workups. Indurated tag-like lesions, cobblestoning, and mucogingivitis are the most common specific oral findings encountered in CD cases. Aphthous stomatitis and pyostomatitis vegetans are among non-specific oral manifestations of IBD. In differential diagnosis, side effects of drugs, infections, nutritional deficiencies, and other inflammatory conditions should also be considered. Treatment usually involves managing the underlying intestinal disease. In severe cases with local symptoms, topical and/or systemic steroids and immunosuppressive drugs might be used.

Background: Among several potential transmission sources in the spreading of the COVID-19, dental services have received a high volume of attention. Several reports, papers, guidelines, and suggestions have been released on how this infection could be transmitted through dental services and what should be done. This study aimed to review the guidelines in order to develop a practical feasibility protocol for the re-opening of dental clinics and the reorientation of dental services. Methods: This study systematically reviewed the published literature and the guidelines of international health care institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms. The recommendations identified were tested with a convenience sample of experienced practitioners, and a practical step-by-step protocol is presented in this paper. Results: To the date this paper was drafted, 38 articles were found, of which 9 satisfied our inclusion criteria. As all the nine studies were proposed in a general consensus, any elective non-emergency dental care for patients with suspected or known COVID-19 should be postponed for at least 2 weeks during the COVID-19 pandemic. Only urgent treatment of dental diseases can be performed during the COVID-19 outbreak taking into consideration pharmacological management as the first line and contagion-reduced minimally invasive emergency treatment as the secondary and final management. Conclusions: While the currently available evidence has not demonstrated a clear and direct relationship between dental treatment or surgery and the possibility of the transmission of COVID-19, there is clearly the potential for transmission. Therefore, following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting.

Background: Twenty four hour oesophageal pH monitoring is frequently used to quantify the association between a patient’s symptom and gastro-oesophageal reflux. Three indices (symptom association probability (SAP), symptom index (SI), and symptom sensitivity index (SSI)) are used to quantify and establish this relation. Aims: The aim of the present study was to compare these indices against the omeprazole test (OT) as an objective indicator of reflux induced symptoms. Methods: Fifty two patients with a predominant symptom of heartburn were enrolled from gastroenterology and primary care clinics. Baseline symptom score was calculated at the fist visit. All patients underwent 24 hour oesophageal pH monitoring, and symptom-reflux association indices were calculated. All patients were placed on high dose omeprazole (40 mg in the morning, 20 mg at night) after completion of pH monitoring and symptom score was recorded again after one week. Results: Thirty eight patients completed the study. All three indices were significantly related to each other (p<0.001). SAP and SSI (with a new cut off of 1.3, but not with the commonly used 5%) had statistically significant relations with OT (p<0.05 for both). SSI had the highest positive and negative predictive values and sensitivity. The specificity of SSI and SAP was equal and lower than SI. Areas under the receiver operating characteristic (ROC) curve for the three indices were not significantly different from each other or from a hypothetical non-discriminating test. Per cent time pH <4, sex, and age had no relation to OT and no effect on its correlation with association indices. No cut off point could be found at which the results of SI could be related significantly to the OT results. Conclusion: SAP and SSI are significantly related to symptomatic response to high dose omeprazole; however, they are far from perfect, with a significant number of discordant cases as well as relatively small areas under the ROC curves. We suggest that the new cut off of 1.3 be used for SSI in the future. Further research is needed to identify possible methods to improve the discrimination power of these indices or to identify possible patient characteristics that may affect this relation.