Standard of care for COVID-19 in randomized clinical trials registered in trial registries and published in preprint servers and scholarly journals: a cross-sectional study

Background

The concept of standard of care (SoC) treatment is commonly utilized in clinical trials. However, in a setting of an emergent disease, such as COVID-19, where there is no established effective treatment, it is unclear what the investigators considered as the SoC in early clinical trials. The aim of this study was to analyze and classify SoC reported in randomized controlled trial (RCT) registrations and RCTs published in scholarly journals and on preprint servers about treatment interventions for COVID-19.

Methods

We conducted a cross-sectional study. We included RCTs registered in a trial registry, and/or published in a scholarly journal, and/or published on preprint servers medRxiv and bioRxiv (any phase; any recruitment status; any language) that aim to compare treatment interventions related to COVID-19 and SoC, available from January 1, 2020, to October 8, 2020. Studies using „standard“ treatment were eligible for inclusion if they reported they used standard, usual, conventional, or routine treatment. When we found such multiple reports of an RCT, we treated those multiple sources as one unit of analysis.

Results

Among 737 unique trials included in the analysis, 152 (21%) reported that SoC was proposed by the institutional or national authority. There were 129 (18%) trials that reported component(s) of SoC; the remaining trials simply reported that they used SoC, with no further detail. Among those 129 trials, the number of components of SoC ranged from 1 to 10. The most commonly used groups of interventions in the SoC were antiparasitics (62% of the trials), antivirals (57%), antibiotics (31%), oxygen (17%), antithrombotics/anticoagulants (14%), vitamins (13%), immunomodulatory agents (13%), corticosteroids (12%), analgesics/antipyretics (12%). Various combinations of those interventions were used in the SoC, with up to 7 different types of interventions combined. Posology, timing, and method of administration were frequently not reported for SoC components.

Conclusion

Most RCTs (82%) about treatment for COVID-19 that were registered or published in the first 9 months of the pandemic did not describe the “standard of care” they used. Many of those interventions have, by now, been shown as ineffective or even detrimental.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01646-1.

Research methodology and characteristics of journal articles with original data, preprint articles and registered clinical trial protocols about COVID-19

BACKGROUND

The research community reacted rapidly to the emergence of COVID-19. We aimed to assess characteristics of journal articles, preprint articles, and registered trial protocols about COVID-19 and its causal agent SARS-CoV-2.

METHODS

We analyzed characteristics of journal articles with original data indexed by March 19, 2020, in World Health Organization (WHO) COVID-19 collection, articles published on preprint servers medRxiv and bioRxiv by April 3, 2010. Additionally, we assessed characteristics of clinical trials indexed in the WHO International Clinical Trials Registry Platform (WHO ICTRP) by April 7, 2020.

RESULTS

Among the first 2118 articles on COVID-19 published in scholarly journals, 533 (25%) contained original data. The majority was published by authors from China (75%) and funded by Chinese sponsors (75%); a quarter was published in the Chinese language. Among 312 articles that self-reported study design, the most frequent were retrospective studies (N = 88; 28%) and case reports (N = 86; 28%), analyzing patients' characteristics (38%). Median Journal Impact Factor of journals where articles were published was 5.099. Among 1088 analyzed preprint articles, the majority came from authors affiliated in China (51%) and were funded by sources in China (46%). Less than half reported study design; the majority were modeling studies (62%), and analyzed transmission/risk/prevalence (43%). Of the 927 analyzed registered trials, the majority were interventional (58%). Half were already recruiting participants. The location for the conduct of the trial in the majority was China (N = 522; 63%). The median number of planned participants was 140 (range: 1 to 15,000,000). Registered intervention trials used highly heterogeneous primary outcomes and tested highly heterogeneous interventions; the most frequently studied interventions were hydroxychloroquine (N = 39; 7.2%) and chloroquine (N = 16; 3%).

CONCLUSIONS

Early articles on COVID-19 were predominantly retrospective case reports and modeling studies. The diversity of outcomes used in intervention trial protocols indicates the urgent need for defining a core outcome set for COVID-19 research. Chinese scholars had a head start in reporting about the new disease, but publishing articles in Chinese may limit their global reach. Mapping publications with original data can help finding gaps that will help us respond better to the new public health emergency.

Comparing the Arch Forms between Mongoloid Race and Dravidian Race in 11-14-year-old Children

Aim and objective

To compare arch forms between Mongoloid race and Dravidian race in 11–14-year-old children.

Materials and methods

Total 10 subjects from each study group were selected. Impression of both maxillary and mandibular arches were taken of all the subjects. Dental casts were poured. Intercanine measurement can be termed as the distance across two canine cusp tips, and intermolar measurement can be termed as the distance across two mesiobuccal cusp tips. This distance was recorded for maxillary and mandibular casts by making use of digital Vernier caliper. Data were tabulated.

Statistical analysis

To note the statistical impact, a Chi-square test was applied.

Results

The difference across the two groups was found to be statistically significantly noteworthy (independent t test p < 0.001).

Conclusion

Group I (Mongoloid race) showed significantly larger intercanine to intermolar width compared to Dravidian race with wide flaring arches.

Clinical significance

The size and forms of dental arches exhibit considerable variability within and among human groups. This research demonstrated that while considering Mongoloid patients, we must make use of prior formed orthodontic wires for ovoid shaped arches in a trivial fraction of patients.

How to cite this article

Smitha S, Nagar P, Abinaya R, et al. Comparing the Arch Forms between Mongoloid Race and Dravidian Race in 11–14-year-old Children. Int J Clin Pediatr Dent 2020;13(S-1):S26–S28.

Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study

Aim

This study aims to compare the caries removal efficacy of three minimally invasive techniques and to analyze qualitatively under stereomicroscopy and quantitatively using Vickers hardness test.

Materials and methods

Thirty non-carious anterior primary teeth were selected and subjected to demineralization and the same was confirmed using RadioVisioGraphy (RVG). Samples were divided into three groups: Bromelain gel, smart bur, and atraumatic restorative technique (ART). Caries removal was carried out for a time period of 2 minutes. The remaining demineralized dentin was measured using stereomicroscopy. Random dentin blocks were prepared and a microhardness test was conducted.

Statistical analysis

Data were subjected to statistical analysis by one-way analysis of variance (ANOVA) test.

Results

Stereomicroscopic analysis revealed bromelain gel and smart burs to be superior to ART. Bromelain gel was found to have comparable microhardness levels as healthy dentin. Statistically significant (p < 0.001) results were obtained.

Conclusion

In terms of caries removal and microhardness, bromelain gel was highly efficient when compared to other groups.

Clinical significance

Fear and anxiety of children and parents about conventional drills led to the emerging trends of minimally invasive restorative dentistry. This research indicated the use of bromelain gel and smart bur in the process of caries removal and that bromelain was more efficient when compared to other groups.

How to cite this article

Abinaya R, Nagar P, Urs Pallavi, et al. Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(6):585–589.

Comparative Evaluation of Cleaning Efficacy using Four Novel Nickel-titanium Rotary Instruments: An in vitro Scanning Electron Microscope Study

AIM

The aim of the study was to compare the cleaning efficacy (debris and smear layer removal) of two multifile rotary systems (MTwo and Silk) and two single-file rotary systems (F6 Skytaper and NeoNiTi).

MATERIALS AND METHODS

Eighty mesial canals of mandibular first molars were cleaned and shaped using four nickel-titanium (NiTi) rotary instruments to size # 25 and 3% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA). Samples were randomly divided into four equal groups (n = 20) according to instrumentation: Group I, Mtwo; group II, Silk; group III, F6 Skytaper; group IV, NeoNiTi. Samples were split longitudinally and examined under scanning electron microscope (SEM) for debris and smear layer removal in coronal, middle, and apical thirds of each root canal.

RESULTS

F6 skytaper and Mtwo groups showed significantly higher debris removal than Silk and NeoNiTi groups in apical third of root canal as well as when compared with NeoNiTi group in middle third. F6 Skytaper group showed significantly higher debris and smear layer removal than Silk group in coronal third. There was statistically significant difference among all thirds of root canal in terms of debris removal in Silk and NeoNiTi groups. There was statistically significant difference among all thirds of root canal in F6 Skytaper and NeoNiTi groups in terms of smear layer removal.

CONCLUSION

F6 Skytaper single-file rotary instrumentation showed the maximum cleaning efficacy followed by Mtwo multifile rotary instrumentation in all thirds of root canal.

CLINICAL SIGNIFICANCE

F6 Skytaper rotary instrument is most efficient followed by Mtwo rotary instrument among all rotary instruments.

Preperitoneal surgery using a self-adhesive mesh for inguinal hernia repair

Background and Objectives:

Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh.

Methods:

This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed.

Results:

Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m². Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome.

Conclusion:

The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction.