Objectives There is increasing interest regarding the relationship between serum levels of free triiodothyronine (fT3) and outcomes of COronaVIrus Disease-19 (COVID-19) patients. As several recent reports have described a worse prognosis in patients with low fT3 levels, we performed a meta-analysis to assess the prognostic role of fT3 serum levels in patients with COVID-19 as this information could be clinically relevant for the management of these patients. Methods The methodology was registered in the International prospective register of systematic reviews (PROSPERO) database under the protocol number CRD42021260952. A systematic search was carried out on PubMed, Embase, Web of Science, and Scopus from May to June 2021 without time and language restrictions. The literature search strategy was based on the following keywords: (T3 OR fT3 OR triiodothyronine) AND (COVID-19) AND (prognosis OR survival). Results The literature search identified 163 studies. Seven retrospective studies met the inclusion and exclusion criteria and were included in the meta-analysis. The included studies had a total of 1,183 patients. From the analysis of the included studies, lower fT3 serum levels were consistently observed in intensive care unit (ICU) than in non-ICU patients and in non-survivors than survivors, respectively. Conclusions Serum fT3 concentrations are significantly lower in patients with severe COVID-19 than in non-severely ill patients and predict all-cause mortality of patients with severe COVID-19. Accordingly, fT3 may become a simple tool for stratified management of patients with severe COVID-19.

BackgroundEx vivo and in vitro studies have demonstrated the effectiveness of some irrigation protocols in reducing the bacterial load in the root canal system. However, standardized protocols have not yet been defined for the real clinical context due to many irrigation procedures available.ObjectiveTo evaluate the clinical endodontic protocols and limitations of irrigating solutions in the disinfection of the root canal system in patients with apical periodontitis.MethodsPubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched for randomized controlled trials (RCT) published until January 2021. Hand searching was also performed. Studies focused on evaluating the effectiveness of irrigating solutions and/or irrigation activation methods in reducing the bacterial load in the root canal system were considered. The Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess the quality of the studies.ResultsFour hundred and twenty eight published articles were identified. After removing the duplicate studies and analyzing full texts, seven RCTs were selected. Two studies compared pure NaOCl with some combination of NaOCl with HEDP and MTAD. Two studies analyzed the antibacterial efficacy of NaOCl and chlorhexidine (CHX). Three studies compared conventional needle irrigation with different irrigation activation methods (PUI, XP-endo finisher, F-file activator, EndoVac activator). The review attained a satisfactory methodology. The main results of each included study were described.DiscussionActivation methods provide significantly higher biofilm reduction than conventional needle irrigation methods. Combinations of NaOCl with different chelating agents were ineffective in terms of antimicrobial, but it could potentially increase the risk of irrigant extrusion. However, the irrigating protocols were not carefully detailed, especially those regarding the irrigants application time or total volume. The existing literature lacks high-quality studies. The level of evidence is moderate.ConclusionsThe available data is too heterogeneous to compare and identify the superiority of specific valuable irrigation protocols in each clinical context. Application time, volume, and activation methods should be standardized to determine the optimal irrigating procedures to reduce the bacterial load and ensure higher predictability of the endodontic treatment.Systematic Review Registration(https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218555), PROSPERO registration: CRD42020218555.

Aim To determine the knowledge of final year undergraduate students attending Italian universities on the appropriate use of systemic antibiotics for endodontic infections. Methodology Final year dental students from twenty Italian universities completed a one‐page questionnaire on antibiotic use for the treatment of endodontic infections. Data were analysed using descriptive statistics and chi‐square tests. Results A total of three hundred and three students completed the questionnaire. The average duration of antibiotic prescription proposed by respondents was 5.48 ± 1.06 days. Amoxicillin with clavulanic acid was the first‐choice antibiotic (85.2%) followed by amoxicillin alone (13.5%), azithromycin (1.0%) and clarithromycin (0.3%), for patients not allergic to penicillin. Clarithromycin was the first‐choice drug for patients with a penicillin allergy (56.1%), followed from azithromycin (31.7%), clindamycin (11.9%) and levofloxacin (0.3%). Alveolar abscess with systemic manifestations was reported as the principal reason to prescribe antibiotics (97.7%) followed by the same condition without systemic manifestations (85.5%). For the scenario of irreversible pulpitis, 5% of students considered antibiotics necessary. Almost 52% of students would prescribe antibiotics for apical acute periodontitis; 29.7% would prescribe antibiotics for chronic apical periodontitis with sinus tract, and 13.5% indicated these drugs for chronic apical periodontitis without sinus tract. Conclusions The results demonstrate that it is necessary to improve the knowledge of Italian students on antibiotics and indications for their use in endodontics.

Objective This study aimed to determine the procalcitonin (ProCT) diagnostic accuracy in prediction and treatment monitoring of medullary thyroid carcinoma (MTC). Data Sources Electronic databases were searched for observational studies published until May 2021 without language or time restrictions. Study Selection Studies comparing ProCT and calcitonin accuracy were included. After removing duplicates and exclusion of not-eligible articles, relevant articles were screened independently by two reviewers. Eleven studies (4.5% of the identified studies) met the selection criteria. Data Extraction Two reviewers independently extracted data and assessed data quality and validity through QUADAS-2. Data Synthesis A meta-analysis was performed on sufficiently clinically and statistically homogeneous eleven studies (n = 5817 patients, 335 MTC patients). HSROC and bivariate methods were applied. Serum ProCT was found to be a highly accurate test for MTC diagnosis and monitoring. The pooled sensitivity, specificity, positive and negative likelihood ratios, AUC, and positive and negative predictive values for ProCT were 0.90 (95%CI: 0.71-0.97), 1.00 (95%CI: 0.85-1.00), 288 (95%CI: 5.6-14929.3), 0.10 (95%CI: 0.03-0.33), 0.97 (95%CI: 0.95-0.98), 99% and 2%. Conclusions The high accuracy, compounded with favorable analytical characteristics, give ProCT great potential to replace calcitonin as a new standard of care in the management of MTC.

Introduction: On March 9, 2020, the Italian government imposed a nationwide lockdown to contain the spread of coronavirus disease 2019. Oral health services were limited to only essential services. Nonurgent treatments were postponed. This study described the management of urgent dental care in northern Italy during the lockdown, with a particular focus on the province of Brescia. Methods: A cross-sectional survey was administered to Italian dentists at the end of the lockdown (May 3, 2020). A total of 1407 dentists answered the survey. Results: A total of 1205 dentists were included. Most of the respondents were dental owners (73.6%). About 79.7% of the dentists handled urgencies during the lockdown. The number of urgencies treated weekly was lower than that generally handled before the coronavirus disease 2019 outbreak (P , .001). Many dentists (81.2%) provided telephone consultations to evaluate symptoms. Pulpitis and abscesses were the most common urgencies (44.7% and 40.2%, respectively). Furthermore, 95% of dentists wore masks, protective eyewear, and surgical gloves while delivering nonpostponable treatments. The filtering facepiece 2 mask was used by 41.8% and 41.7% of owners and dental assistants, respectively. Financial concerns, risk of contagion, and personal protective equipment supply were indicated as the main current concerns. Conclusions: Our survey showed that Italian dentists took protective measures during the lockdown, thus minimizing the risk of contagion for dental health care personnel and patients. Many precautionary guidelines are now available, but a high uncertainty persists about dental health delivery during the pandemic.