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Journal of Plastic, Reconstructive &... Sep 2023Rhinoplasty can cause tissue trauma and inflammatory responses. Edema and ecchymosis, especially on the face, accompanied by inflammation are common complications. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rhinoplasty can cause tissue trauma and inflammatory responses. Edema and ecchymosis, especially on the face, accompanied by inflammation are common complications. The anti-inflammatory properties of steroids can reduce postoperative edema and ecchymosis.
OBJECTIVE
This review aims to determine the most effective type of steroids for preventing complications related to rhinoplasty.
METHODS
The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The population of comprised patients who underwent rhinoplasty or septorhinoplasty. Different types of steroids administrated intravenously during the perioperative period were compared. The primary outcome of postoperative edema and other outcomes were evaluated on postoperative day 1, 3, and 7. Random-effects model was performed. The means and standard deviations were extracted.
RESULTS
Eighteen randomized controlled trials were included. The network meta-analysis revealed that dexamethasone and methylprednisolone significantly reduced edema on postoperative day 1 compared with placebo. No significant differences between the effects of any of two types of steroids were noted.
CONCLUSION
At least one dose of intravenous steroid intervention is recommended during the perioperative period of rhinoplasty. However, in terms of reducing edema and ecchymosis, no significant differences were noted among dexamethasone, methylprednisolone, and betamethasone.
Topics: Humans; Ecchymosis; Rhinoplasty; Network Meta-Analysis; Randomized Controlled Trials as Topic; Methylprednisolone; Edema; Dexamethasone; Postoperative Complications
PubMed: 37329745
DOI: 10.1016/j.bjps.2023.04.087 -
Complementary Therapies in Medicine Sep 2020Some studies have investigated the effect of Lavender on pain and the healing of wounds. The aim of this systematic review was to investigate the effect of Lavender on...
INTRODUCTION
Some studies have investigated the effect of Lavender on pain and the healing of wounds. The aim of this systematic review was to investigate the effect of Lavender on pain and wound healing of episiotomy.
METHODS
The Cochrane Library, MEDLINE (PubMed), Scopus, and Web of Science (all databases from inception until February 2020) were searched. Data were extracted from eligible studies by two review authors individually. Our inclusion criteria were full-text interventional studies published in English or any other languages. All data were analyzed using Review Manager 5.3. The protocol of this systematic review was registered in PROSPERO with the reference number CRD42020140623.
RESULTS
Our search found six trials involving 415 participants. The use of Lavender could significantly reduce pain in women with episiotomy (95 % CI: -1.06 - -0.32). The use of Lavender has significantly improved the healing of episiotomy compared to the placebo (95 % CI: -2.13 - -1.34). In all studies, pain and healing of episiotomy were evaluated with Visual Analog Scale (VAS) and Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale respectively.
CONCLUSION
This review showed that the use of Lavender (in any form) in postpartum has a significant effect on pain relief and healing of episiotomy wound. All six studies that were included in this systematic review were from developing countries. A high level of heterogeneity was observed in the effect of Lavender on pain but not the healing of the episiotomy. Therefore, the results should be considered with caution. Using Lavender may be considered for wound healing of episiotomy.
Topics: Episiotomy; Female; Humans; Lavandula; Pain Management; Pain, Postoperative; Pregnancy; Wound Healing
PubMed: 33066851
DOI: 10.1016/j.ctim.2020.102510 -
Journal of Cosmetic Dermatology Feb 2019Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity.
OBJECTIVES
This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran.
MATERIALS AND METHODS
Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model.
RESULTS
We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively.
CONCLUSIONS
his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.
Topics: Ecchymosis; Humans; Iran; Kidney Failure, Chronic; Nail Diseases; Pigmentation Disorders; Prevalence; Pruritus; Renal Dialysis; Skin Diseases
PubMed: 29577562
DOI: 10.1111/jocd.12531 -
Aesthetic Plastic Surgery Aug 2023According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss.
OBJECTIVES
To comprehensively assess the use of local TXA during plastic surgery through a systematic review and meta-analysis of randomized controlled trials addressing these issues.
METHODS
Four electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, were searched until December 12, 2022. Following meta-analyses, the mean difference (MD) or standardized mean difference (SMD) for blood loss volume (BLV), ΔHct, ΔHb and operation time were calculated when appropriate.
RESULTS
Eleven randomized controlled trials were included in the qualitative synthesis, while 8 studies were included in the meta-analysis. Compared with the control group, the local TXA group showed a reduction in blood loss volume of -1.05 (p < 0.00001; 95% CI, -1.72 to -0.38). However, local TXA had a limited effect on reducing ΔHct, ΔHb and operation time. A meta-analysis was not performed because of heterogeneity in other outcomes; however, except for 1 study in which no significant difference was observed on POD 1, all studies showed significantly lower rates of postoperative ecchymosis after surgery, 2 studies showed statistically significant reductions in transfusion risk or volume, and 3 studies reported significantly better surgical field quality in operations with local TXA. In the 2 included studies, the researchers concluded that local treatment does not play a role in relieving postoperative pain.
CONCLUSIONS
Local TXA is associated with less blood loss, less ecchymosis and better surgical field in plastic surgery patients.
LEVEL OF EVIDENCE I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Blood Loss, Surgical; Surgery, Plastic; Ecchymosis; Randomized Controlled Trials as Topic
PubMed: 36810834
DOI: 10.1007/s00266-023-03281-7 -
The Cochrane Database of Systematic... Aug 2013Heparin as an adjunct in assisted reproduction (peri-implantation heparin) is given at or after egg collection or at embryo transfer during assisted reproduction.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Heparin as an adjunct in assisted reproduction (peri-implantation heparin) is given at or after egg collection or at embryo transfer during assisted reproduction. Heparin has been advocated to improve embryo implantation and clinical outcomes. It has been proposed that heparin enhances the intra-uterine environment by improving decidualisation with an associated activation of growth factors and a cytokine expression profile in the endometrium that is favourable to pregnancy.
OBJECTIVES
To investigate whether the administration of heparin around the time of implantation (peri-implantation heparin) improves clinical outcomes in subfertile women undergoing assisted reproduction.
SEARCH METHODS
A comprehensive and exhaustive search strategy was developed in consultation with the Trials Search Co-ordinator of the Cochrane Menstrual Disorders and Subfertility Group (MDSG). The strategy was used in an attempt to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress). Relevant trials were identified from both electronic databases and other resources (last search 6 May 2013).
SELECTION CRITERIA
All randomised controlled trials (RCTs) were included where peri-implantation heparin was given during assisted reproduction. Peri-implantation low molecular weight heparin (LMWH) during IVF/ICSI was given at or after egg collection or at embryo transfer in the included studies. Live birth rate was the primary outcome.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the eligibility and quality of trials and extracted relevant data. The quality of the evidence was evaluated using GRADE methods.
MAIN RESULTS
Three RCTs (involving 386 women) were included in the review.Peri-implantation LMWH administration during assisted reproduction was associated with a significant improvement in live birth rate compared with placebo or no LMWH (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.07 to 2.90, three studies, 386 women, I(2) = 51%, very low quality evidence with high heterogeneity). There was also a significant improvement in the clinical pregnancy rate with use of LMWH (OR 1.61, 95% CI 1.03 to 2.53, three studies, 386 women, I(2) = 29%, very low quality evidence with low heterogeneity).However these findings should be interpreted with extreme caution as they were dependent upon the choice of statistical method: they were no longer statistically significant when a random-effects model was used.Adverse events were poorly reported in all included studies, with no comparative data available. However, LMWH did cause adverse effects including bruising, ecchymosis, bleeding, thrombocytopenia and allergic reactions. It appeared that these adverse effects were increased if heparin therapy was used over a longer duration.
AUTHORS' CONCLUSIONS
The results of this Cochrane review of three randomised controlled trials with a total of 386 women suggested that peri-implantation LMWH in assisted reproduction treatment (ART) cycles may improve the live birth rate in women undergoing assisted reproduction. However, these results were dependent on small low quality studies with substantial heterogeneity, and were sensitive to the choice of statistical model. There were side effects reported with use of heparin, including bruising and bleeding, and no reliable data on long-term effects. The results do not justify this use of heparin outside well-conducted research trials.These findings need to be further investigated with well-designed, adequately powered, double-blind, randomised, placebo-controlled, multicentre trials. Further investigations could also focus on the effects of the local (uterine) and not systemic application of heparin during ART.
Topics: Anticoagulants; Birth Rate; Drug Administration Schedule; Embryo Implantation; Embryo Transfer; Female; Heparin, Low-Molecular-Weight; Humans; Live Birth; Pregnancy; Randomized Controlled Trials as Topic; Reproductive Techniques, Assisted
PubMed: 23955506
DOI: 10.1002/14651858.CD009452.pub2 -
World Journal of Urology Jul 2023False penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea's injury, with or without lesion of... (Meta-Analysis)
Meta-Analysis
PURPOSE
False penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea's injury, with or without lesion of dorsal penile vein. Their presentation is often indistinguishable from true penile fractures (TPF). This overlapping of clinical presentation, and lack of knowledge about FPF, can lead surgeons often to proceed directly to surgical exploration without further examinations. The aim of this study was to define a typical presentation of false penile fractures (FPF) emergency, identifying in absence of "snap" sound, slow detumescence, penile shaft ecchymosis, and penile deviation main clinical signs.
METHODS
We performed a systematic review and meta-analysis based on Medline, Scopus and Cochrane following a protocol designed a priori, to define sensitivity of "snap" sound absence, slow detumescence and penile deviation.
RESULTS
Based on the literature search of 93 articles, 15 were included (73 patients). All patients referred pain, most of them during coitus (n = 57; 78%). Detumescence occurred in 37/73 (51%), and all patients described detumescence occurrence as "slow". The results show that single anamnestic item have a high-moderate sensibility in the diagnosis of FPF, and the highest sensitive item was penile deviation (sensibility = 0.86). However, when more than one item is present, overall sensitivity increases greatly, closing to 100% (95% Confidence Interval 92-100).
CONCLUSION
Surgeons can consciously decide between additional exams, a conservative approach, and rapid intervention using these indicators to detect FPF. Our findings identified symptoms with excellent specificity for FPF diagnosis, giving clinicians more useful tools for making decisions.
Topics: Male; Humans; Rupture; Penile Diseases; Penis; Coitus; Pelvis
PubMed: 37326652
DOI: 10.1007/s00345-023-04456-2 -
Orthopaedics & Traumatology, Surgery &... Oct 2023Botulinum toxin injections for lateral elbow tendinopathy have been used as an alternative therapeutic option. However, few studies have quantitatively summarized the... (Review)
Review
BACKGROUND
Botulinum toxin injections for lateral elbow tendinopathy have been used as an alternative therapeutic option. However, few studies have quantitatively summarized the effect of botulinum toxin as well as its clinical significance. We aimed to evaluate the clinical efficacy (based on pain and grip strength) and adverse events of botulinum toxin on lateral elbow tendinopathy.
PATIENTS AND METHODS
The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until March 2023 for randomized controlled trials reporting the effects of botulinum toxin injections on lateral elbow tendinopathy. A random- or fixed-effects model (depending of inter-study variability) and generic inverse variance method were used to pool quantitative data from outcomes. The risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool.
RESULTS
A total of 8 clinical trials recruiting 438 subjects were included for meta-analysis. Pooled analysis revealed that botulinum toxin significantly reduced pain (mean difference [MD] -0.95, 95% CI [-1.63, -0.26], p=0.007) but it was not clinically relevant. No significant effect was detected for grip strength (MD-0.62kg, 95% CI [-2.25, 1.02], p=0.46) or in the risk for adverse events (odds ratio [OR] 0.41, 95% CI [0.05, 3.56], p=0.42) between botulinum toxin injection and control interventions.
DISCUSSION
The use of botulinum toxin reached greater pain relief than control interventions and normal saline after a period of 12 to 24 weeks. However, changes in pain relief did not reach clinical significance. The studies that had the greatest reduction in pain used higher doses of botulinum toxin (60 U). Additionally, differences in grip strength and adverse events did not reach statistical or clinical importance. A subanalysis indicated that botulinum toxin outperformed corticosteroid injections in terms of improving grip strength. Botulinum toxin only causes local and minimal side effects such as irritation, ecchymosis, and paralysis.
LEVEL OF EVIDENCE
I.
PubMed: 37890524
DOI: 10.1016/j.otsr.2023.103733 -
Aesthetic Plastic Surgery Dec 2023Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore,... (Review)
Review
BACKGROUND/PURPOSE
Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore, management of blood pressure has been shown to promote greater visualization of the surgical field and decrease postoperative complications, such as ecchymosis and edema. While multiple therapies have been utilized to achieve permissive hypotension, it remains unclear how modalities compare in terms of safety and efficacy. The purpose of this study was to conduct a systematic review to better understand the specific modalities and associated outcomes in managing blood pressure during rhinoplasty.
METHODS
A systematic literature review was conducted in order to identify and assess therapeutics utilized in achieving permissive hypotension during rhinoplasty. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes (i.e., intraoperative bleeding, edema, and ecchymosis), adverse events, complications, and satisfaction. Articles were then categorized by the level of evidence as set forth by the American Society of Plastic Surgeons. Any conflicts were resolved through discussion and full-text review among co-authors. Of note, the search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No funding was required to conduct this review of the literature.
RESULTS
Initial review yielded sixty-five articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of ten studies for analysis. Articles discussed multiple therapies for management of blood pressure during rhinoplasty, including dexmedetomidine, dexamethasone, gabapentin, labetalol, nitroglycerine, remifentanil, magnesium sulfate, clonidine, and metoprolol. Overall, intraoperative bleeding, as well as postoperative ecchymosis and edema were reduced when MAP was controlled.
CONCLUSION
Given its intra- and postoperative benefits, permissive hypotension can be leveraged to improve outcomes in rhinoplasty. This study presents an updated comprehensive review of various modalities used to achieve permission hypotension in rhinoplasty. Future studies should explore how comorbidities may impact choice of treatment regimen among patients undergoing rhinoplasty.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Hemorrhage; Hypotension; Rhinoplasty; Treatment Outcome; Postoperative Complications
PubMed: 36877227
DOI: 10.1007/s00266-023-03298-y -
Plastic and Reconstructive Surgery.... Jun 2023Upper eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains...
UNLABELLED
Upper eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains unclear, especially in Asian skin types. We aimed to compare the Colorado needle electrocautery pure cutting mode and the traditional scalpel to determine their efficacy, complications, and cosmetic outcomes.
METHODS
A systematic review was performed to review the outcome with the conventional method (scalpel) and other methods in upper blepharoplasty procedures. Further, a prospective intraindividual randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and the scalpel in upper blepharoplasty. Study outcomes included scar quality at different times until 1-year postoperation, bleeding during incision, and postoperative ecchymosis.
RESULTS
Five articles met the inclusion criteria for this systematic review. The prospective randomized controlled trial study included 30 patients; the average incisional time on the electrocautery side was significantly longer than that on the scalpel side, and the electrocautery side had less blood loss during incision than the scalpel side (2.4 versus 3.27 using average cotton bud sticks, respectively) ( < 0.001). Hypopigmented scarring occurred more frequently on the scalpel side; however, the difference was not statistically significant.
CONCLUSIONS
Colorado needle electrocautery pure cutting mode can be an alternative to traditional scalpel for upper eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery use has hemostatic benefits, leading to a decrease in bleeding that can obscure the incision site. However, the incision time on the electrocautery side was significantly longer than the scalpel side, which may be owing to an adaptation of surgical technique.
PubMed: 37305197
DOI: 10.1097/GOX.0000000000005045 -
International Journal of Surgery... Oct 2017Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been... (Review)
Review
BACKGROUND
Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is therefore to evaluate the complications and side effects of ESWT in order to determine whether ESWT is a safe treatment for PF.
METHODS
For this systematic review the databases PubMed, MEDLINE, Cochrane and Embase were used to search for relevant literature between 1 January 2005 and 1 January 2017. PRISMA guidelines were followed.
RESULTS
Thirty-nine studies were included for this review, representing 2493 patients (2697 heels) who received between 6424 and 6497 ESWT treatment sessions, with an energy flux density between 0.01 mJ/mm and 0.64 mJ/mm and a frequency of 1000-3800 SWs. Average follow-up was 14.7 months (range: 24 h - 6 years). Two complications occurred: precordial pain and a superficial skin infection after regional anaesthesia. Accordingly, 225 patients reported pain during treatment and 247 reported transient red skin after treatment. Transient pain after treatment, dysesthesia, swelling, ecchymosis and/or petechiae, severe headache, bruising and a throbbing sensation were also reported.
CONCLUSION
ESWT is likely a safe treatment for PF. No complications are expected at one-year follow-up. However, according to the current literature long-term complications are unknown. Better descriptions of treatment protocols, patient characteristics and registration of complications and side effects, especially pain during treatment, are recommended.
Topics: Extracorporeal Shockwave Therapy; Fasciitis, Plantar; Humans; Pain
PubMed: 28890412
DOI: 10.1016/j.ijsu.2017.08.587