-
Dermatologic Surgery : Official... Jul 2024Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating... (Review)
Review
BACKGROUND
Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma.
OBJECTIVE
To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma.
METHODS
A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data.
RESULT
The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma.
CONCLUSION
Chemical peels were found to be safe and effective in the management of melasma.
Topics: Melanosis; Humans; Chemexfoliation; Glycolates; Treatment Outcome; Keratolytic Agents
PubMed: 38530985
DOI: 10.1097/DSS.0000000000004167 -
British Journal of Clinical Pharmacology Sep 2022Linezolid is often used for the infections caused by drug-resistant Gram-positive bacteria. Recent studies suggest that large between-subject variability (BSV) and... (Review)
Review
AIMS
Linezolid is often used for the infections caused by drug-resistant Gram-positive bacteria. Recent studies suggest that large between-subject variability (BSV) and within-subject variability could alter drug pharmacokinetics (PK) during linezolid therapy due to pathophysiological changes. This review synthesized information on linezolid population PK studies and summarized the significant covariates that influence linezolid PK.
METHODS
A literature search was performed using PubMed, Web of Science and Embase from their inception to 30 September 2021. Published studies were included if they contained data analysing linezolid PK parameters in humans using a population approach with a nonlinear mixed-effects model.
RESULTS
Twenty-five studies conducted in adults and five in paediatrics were included. One- and two-compartment models were the commonly used structural models for linezolid. Body size (weight, lean body weight and body surface area), creatinine clearance (CLcr) and age significantly influenced linezolid PK. The median clearance (CL) values (ranges) in infants (0.128 L/h/kg [0.121-0.135]] and children (0.107 L/h/kg [0.088-0.151]] were higher than in adults (0.098 L/h/kg [0.044-0.237]]. For patients with severe renal impairment (CLcr ≤ 30 mL/min), the CL was 37.2% (15.2-55.3%) lower than in patients with normal renal function.
CONCLUSION
The optimal linezolid dosage should be adjusted based on the patient's body size, renal function and age. More studies are needed to explore the exact mechanism of linezolid elimination and evaluate the PK characteristics in paediatric patients.
Topics: Adult; Anti-Bacterial Agents; Child; Humans; Linezolid; Models, Biological; Nonlinear Dynamics; Renal Insufficiency
PubMed: 35484096
DOI: 10.1111/bcp.15368 -
Brain and Behavior Nov 2022To compare the efficacy and safety of Levetiracetam (LEV) and Oxcarbazepine (OXC) as monotherapy for the treatment of newly diagnosed focal epilepsy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the efficacy and safety of Levetiracetam (LEV) and Oxcarbazepine (OXC) as monotherapy for the treatment of newly diagnosed focal epilepsy.
METHODS
We searched PubMed, Cochrane Library, EMBASE, and Google Scholar from January 1, 2000 to May 11, 2022, with no language restrictions along with The ClinicalTrials.gov website and the WHO International Controlled Trials Registry platforms. We pooled the risk ratio (RR) and corresponding 95% confidence interval (95% CI) for the efficacy and safety outcomes. The quality of included trials was assessed using the Cochrane Collaboration's tool.
RESULTS
Two RCTs included a total of 574 newly diagnosed focal epilepsy patients (the LEV group [282 patients] and the OXC group [292 patients]). LEV group when compared with the OXC group had no significant difference in the pooled estimate of seizure freedom at week 24. (RR: 0.81; 95% CI: 0.62-1.05, p = .11). Similarly, there was no significant difference in the pooled estimate of withdrawal due to adverse events (AEs) (RR: 0.87; 95% CI: 0.34-2.23, p = .77). The commonly reported AEs in both trials were dizziness, headache, rash, somnolence, and nasopharyngitis with zero medication-related death and few serious AEs.
CONCLUSIONS
LEV is noninferior to OXC in terms of seizure freedom at week 24 and treatment withdrawal rate due to AEs among adults but long-term treatment data is still missing. Future multicentric double-blinded RCTs and real-world studies are of great need.
Topics: Adult; Humans; Oxcarbazepine; Levetiracetam; Anticonvulsants; Epilepsies, Partial
PubMed: 36184821
DOI: 10.1002/brb3.2779 -
Gynecologic Oncology Reports Aug 2019Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and... (Review)
Review
Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a priority for the Tanzanian government. In this systematic review of 39 peer-reviewed publications that appeared in the PubMed/MEDLINE (NCBI) database from 2013 to 2018, we synthesize the growing body of literature to capture current trends in Tanzania's evolving cervical cancer landscape. Six domains were identified, including risk factors, primary prevention, barriers to screening, treatment, healthcare worker education, and sustainability. In addition to traditional risk factors associated with sexual behavior, acetowhite changes observed during visual inspection of the cervix with acetic acid, lower education, rural setting, and HIV positivity also have a noteworthy clinical impact.
PubMed: 31309135
DOI: 10.1016/j.gore.2019.05.008 -
Asian Pacific Journal of Cancer... Feb 2022Despite being a cheap, easy, and commonly used technique for screening early development of cervical cancer, collective evidence on the effect of visual inspection with... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Despite being a cheap, easy, and commonly used technique for screening early development of cervical cancer, collective evidence on the effect of visual inspection with acetic acid (VIA) for reducing cervical cancer mortality and incidence are conflicting. We conducted a systematic review and meta-analysis to determine the effectiveness of VIA screening on cervical cancer mortality and incidence.
METHODS
We searched PubMed, Embase, Cochrane library (Cochrane Database of Systematic Reviews & Cochrane Central Register of Controlled Trials), World Health Organization's (WHO) International Clinical Trials Registry Platform, and Google Scholar to identify studies conducted among women with no history of cervical cancer that assessed effectiveness of VIA on the cervical cancer mortality and incidence. Random effects model was used to estimate incident rate ratio and sensitivity analysis was conducted using Bayesian methods.
RESULTS
Of the included 4 studies, three were cluster randomized trials from India and one was quasi-experimental study done in Thailand. Duration of follow-up ranged from 7 to 12 years. Based on 3 trials, pooled rate-ratio for cervical cancer mortality and all-cause mortality was 0.68 (95% CI: 0.56-0.81, I2=0%) and 0.91 (0.85-0.97, I2=57%), respectively. Pooled rate-ratio of invasive cervical cancer was 0.94 (95% CI: 0.67 - 1.30, I2=84%). Likewise, there was non-significant reduction in incidence of stage IB, >=stage II, and unknown stage cervical cancer.
CONCLUSIONS
VIA screening may lead to reduction in cervical cancer and all-cause mortality in long run. However, the effectiveness of VIA in preventing invasive cervical cancer is inconclusive.
Topics: Acetic Acid; Adult; Bayes Theorem; Cervix Uteri; Early Detection of Cancer; Female; Humans; Incidence; India; Middle Aged; Non-Randomized Controlled Trials as Topic; Physical Examination; Randomized Controlled Trials as Topic; Thailand; Uterine Cervical Neoplasms
PubMed: 35225450
DOI: 10.31557/APJCP.2022.23.2.399 -
Gastro Hep Advances 2023Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder that may complicate conditions such as obstructive airway disease. Our group has...
BACKGROUND AND AIMS
Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder that may complicate conditions such as obstructive airway disease. Our group has identified predictive biomarkers of GERD in particulate exposed first responders with obstructive airway disease. In addition, GERD diagnosis and treatment is costly and invasive. In light of these clinical concerns, we aimed to systematically review studies identifying noninvasive, multiOmic, and multicompartmental biomarkers of GERD.
METHODS
A systematic review of PubMed and Embase was performed using keywords focusing on reflux disease and biomarkers and registered with PROSPERO. We included original human studies in English, articles focusing on noninvasive biomarkers of GERD published after December 31, 2009. GERD subtypes (non-erosive reflux disease and erosive esophagitis) and related conditions (Barrett's Esophagus [BE] and Esophageal Adenocarcinoma). Predictive measures were synthesized and risk of bias assessed (Newcastle-Ottawa Scale).
RESULTS
Initial search identified n = 238 studies andn 13 articles remained after applying inclusion/exclusion criteria. Salivary pepsin was the most studied biomarker with significant sensitivity and specificity for GERD. Serum assessment showed elevated levels of Tumor Necrosis Factor-alpha in both GERD and Barrett's. Exhaled breath volatile sulfur compounds and acetic acid were associated with GERD. Oral Microbiome: Models with , , and showed the greatest discrimination between BE and controls vs ; ROC 0.94 (95% confidence interval; 0.85-1.00).
CONCLUSION
Prior studies identified significant multiOmic, multicompartmental noninvasive biomarker risks for GERD and BE. However, studies have a high risk of bias and the reliability and accuracy of the biomarkers identified are greatly limited, which further highlights the need to discover and validate clinically relevant noninvasive biomarkers of GERD.
PubMed: 38009162
DOI: 10.1016/j.gastha.2023.01.014 -
Neurology Jan 2023Early life epilepsies are common and often debilitating, but no evidence-based management guidelines exist outside of those for infantile spasms. We conducted a...
BACKGROUND AND OBJECTIVES
Early life epilepsies are common and often debilitating, but no evidence-based management guidelines exist outside of those for infantile spasms. We conducted a systematic review of the effectiveness and harms of pharmacologic and dietary treatments for epilepsy in children aged 1-36 months without infantile spasms.
METHODS
We searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from January 1, 1999, to August 19, 2021. Using prespecified criteria, we identified studies reporting data on children aged 1-36 months receiving pharmacologic or dietary treatments for epilepsy. We did not require that studies report etiology-specific data. We excluded studies of neonates, infantile spasms, and status epilepticus. We included studies administering 1 of 29 pharmacologic treatments and/or 1 of 5 dietary treatments reporting effectiveness outcomes at ≥ 12 weeks. We reviewed the full text to find any subgroup analyses of children aged 1-36 months.
RESULTS
Twenty-three studies met inclusion criteria (6 randomized studies, 2 nonrandomized comparative studies, and 15 prestudies/poststudies). All conclusions were rated low strength of evidence. Levetiracetam leads to seizure freedom in some infants (32% and 66% in studies reporting seizure freedom), but data on 6 other medications were insufficient to permit conclusions about effectiveness (topiramate, lamotrigine, phenytoin, vigabatrin, rufinamide, and stiripentol). Three medications (levetiracetam, topiramate, and lamotrigine) were rarely discontinued because of adverse effects, and severe events were rare. For diets, the ketogenic diet leads to seizure freedom in some infants (rates 12%-37%), and both the ketogenic diet and modified Atkins diet reduce average seizure frequency, but reductions are greater with the ketogenic diet (1 RCT reported a 71% frequency reduction at 6 months for ketogenic diet vs only a 28% reduction for the modified Atkins diet). Dietary harms were not well-reported.
DISCUSSION
Little high-quality evidence exists on pharmacologic and dietary treatments for early life epilepsies. Future research should isolate how treatments contribute to outcomes, conduct etiology-specific analyses, and report patient-centered outcomes such as hospitalization, neurodevelopment, functional performance, sleep quality, and patient and caregiver quality of life.
TRIAL REGISTRATION INFORMATION
This systematic review was registered in PROSPERO (CRD42021220352) on March 5, 2021.
Topics: Infant; Infant, Newborn; Child; Humans; Lamotrigine; Levetiracetam; Topiramate; Spasms, Infantile; Quality of Life; Epilepsy; Anticonvulsants; Diet, Ketogenic
PubMed: 36270899
DOI: 10.1212/WNL.0000000000201026 -
BMC Medicine Oct 2022The beneficial role of gut microbiota and bacterial metabolites, including short-chain fatty acids (SCFAs), is well recognized, although the available literature around... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The beneficial role of gut microbiota and bacterial metabolites, including short-chain fatty acids (SCFAs), is well recognized, although the available literature around their role in colorectal cancer (CRC) has been inconsistent.
METHODS
We performed a systematic review and meta-analysis to examine the associations of fecal SCFA concentrations to the incidence and risk of CRC. Data extraction through Medline, Embase, and Web of Science was carried out from database conception to June 29, 2022. Predefined inclusion/exclusion criteria led to the selection of 17 case-control and six cross-sectional studies for quality assessment and analyses. Studies were categorized for CRC risk or incidence, and RevMan 5.4 was used to perform the meta-analyses. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Studies lacking quantitation were included in qualitative analyses.
RESULTS
Combined analysis of acetic, propionic, and butyric acid revealed significantly lower concentrations of these SCFAs in individuals with a high-risk of CRC (SMD = 2.02, 95% CI 0.31 to 3.74, P = 0.02). Additionally, CRC incidence was higher in individuals with lower levels of SCFAs (SMD = 0.45, 95% CI 0.19 to 0.72, P = 0.0009), compared to healthy individuals. Qualitative analyses identified 70.4% of studies reporting significantly lower concentrations of fecal acetic, propionic, butyric acid, or total SCFAs in those at higher risk of CRC, while 66.7% reported significantly lower concentrations of fecal acetic and butyric acid in CRC patients compared to healthy controls.
CONCLUSIONS
Overall, lower fecal concentrations of the three major SCFAs are associated with higher risk of CRC and incidence of CRC.
Topics: Butyrates; Colorectal Neoplasms; Cross-Sectional Studies; Fatty Acids, Volatile; Feces; Humans; Incidence
PubMed: 36184594
DOI: 10.1186/s12916-022-02529-4 -
Microbiology (Reading, England) Jul 2023, a combination of honey and vinegar, has been used as a remedy for wounds and infections in historical and traditional medical settings. While honey is now clinically...
, a combination of honey and vinegar, has been used as a remedy for wounds and infections in historical and traditional medical settings. While honey is now clinically used to treat infected wounds, this use of a complex, raw natural product (NP) mixture is unusual in modern western medicine. Research into the antimicrobial activity of NPs more usually focuses on finding a single active compound. The acetic acid in vinegar is known to have antibacterial activity at low concentrations and is in clinical use to treat burn wound infections. Here, we investigated the potential for synergistic activity of different compounds present in a complex ingredient used in historical medicine (vinegar) and in an ingredient mixture (). We conducted a systematic review to investigate published evidence for antimicrobial effects of vinegars against human pathogenic bacteria and fungi. No published studies have explicitly compared the activity of vinegar with that of a comparable concentration of acetic acid. We then characterized selected vinegars by HPLC and assessed the antibacterial and antibiofilm activity of the vinegars and acetic acid, alone and in combination with medical-grade honeys, against and . We found that some vinegars have antibacterial activity that exceeds that predicted by their acetic acid content alone, but that this depends on the bacterial species being investigated and the growth conditions (media type, planktonic vs. biofilm). Pomegranate vinegars may be particularly interesting candidates for further study. We also conclude that there is potential for acetic acid, and some vinegars, to show synergistic antibiofilm activity with manuka honey.
Topics: Humans; Acetic Acid; Honey; Anti-Bacterial Agents; Biofilms; Biological Products
PubMed: 37435775
DOI: 10.1099/mic.0.001351 -
Sleep Medicine Apr 2024Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking.
OBJECTIVE
This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population.
DATA SOURCES
PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA.
STUDY SELECTION
Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children.
DATA EXTRACTION AND SYNTHESIS
Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839).
MAIN OUTCOME(S) AND MEASURE(S)
The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2).
RESULTS
17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %).
CONCLUSIONS AND RELEVANCE
The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.
Topics: Child; Humans; Network Meta-Analysis; Acetates; Sleep Apnea, Obstructive; Mometasone Furoate; Cyclopropanes; Quinolines; Sulfides
PubMed: 38460418
DOI: 10.1016/j.sleep.2024.01.030