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International Journal of Colorectal... Jan 2012The main purpose of this study was to investigate the efficacy and safety of botulinum toxin in the treatment of anal fissure. An answer was attempted to the following... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The main purpose of this study was to investigate the efficacy and safety of botulinum toxin in the treatment of anal fissure. An answer was attempted to the following research questions: (i) what is the efficacy of botulinum toxin in healing of anal fissure compared to placebo, (ii) what is the efficacy of botulinum toxin in healing of anal fissure compared to other means of chemical sphincterotomy, (iii) what is the efficacy of botulinum toxin in healing of anal fissure compared to surgical sphincterotomy, (iv) what is the short term safety of botulinum toxin injections and (v) what is the long term safety of botulinum toxin injections.
METHODS
Clinical trials investigating the effect of botulinum toxin in the treatment of anal fissure met inclusion criteria. Case reports and case series were also included for the estimation of safety. Meta-analysis was not performed due to clinical heterogeneity.
RESULTS
The comparator could be placebo, nitroglycerin ointment, or lateral internal sphincterotomy, with dosage ranging from 20 IU to 50 IU of botulinum toxin. Fissure healing was the most commonly reported primary endpoint but the time period from botulinum toxin injection to fissure healing ranged from 2 weeks to 4 months. Accordingly, outcome data were also heterogenous.
CONCLUSIONS
Botulinum toxin injections should be considered a minimally invasive therapeutic option for the treatment of chronic anal fissure. However, well designed randomized trials are needed for the valid estimation of the efficacy and safety of botulinum toxin in this therapeutic indication.
Topics: Botulinum Toxins; Dose-Response Relationship, Drug; Fissure in Ano; Humans; Lidocaine; Nitrates; Placebos; Randomized Controlled Trials as Topic; Treatment Outcome; Wound Healing
PubMed: 21822595
DOI: 10.1007/s00384-011-1286-5 -
Medicine Jul 2023Traditional Chinese herbal ointment has significant curative effect and few side effects in the treatment of perianal eczema (PE). Currently, there is no systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Traditional Chinese herbal ointment has significant curative effect and few side effects in the treatment of perianal eczema (PE). Currently, there is no systematic evaluation on the treatment of PE with traditional Chinese medicine ointment. The current aim is to systematically evaluate the efficacy of traditional Chinese medicine ointment in the treatment of PE through meta-analysis.
METHODS
Randomized controlled trials on the treatment of PE with Chinese herbal plaster were included in the meta-analysis, which was searched in Chinese and English databases up to March 1, 2023. The search will be conducted in accordance with the object of PICOS framework. Two research will independently use EndnoteX9 to extract the data and evaluate the quality assessment of included trails. Meta-analysis was performed using Revman5.4.1 provided by Cochrane Collaboration; when the outcome indicator is a dichotomous variable, relative risk (RR) was used as the effect size; when the outcome indicator is a continuous variable, weighted mean difference (MD) was used as the effect size, each effect size should be expressed as 95% confidence interval (CI).
RESULTS
The results of meta-analysis showed that: The total effective rate of PE (RR: 1.22, 95% CI: 1.15, 1.30, P < .01; I2 = 32%, Q = 0.17). The cure rate of PE (RR: 3.37, 95% CI: 2.30, 4.94, P < .01; I2 = 21% Q = 0.26). The recurrence rate of PE (RR: 0.25, 95% CI: 0.13, 0.48, P < .01; I2 = 31%Q = 0.23). Itchy points (MD: 0.04, 95% CI: -0.19, 0.27; I2 = 26%) Skin damage area (MD: -0.37, 95% CI: -0.56, -0.19; I2 = 26%). Skin damage form (MD: -0.59, 95% CI: -0.81. -0.36; I2 = 0%).
CONCLUSION
A total of 11 articles were included in this study for meta-analysis, and the results showed that Chinese medicine ointment is more helpful in improving the skin lesion area and skin damage form, significantly improve the response rate and cure rate, reduce the recurrence rate. Chinese herbal ointment has guiding significance for clinical practice which deserve to use ointments by further experimental and clinical investigation.
Topics: Humans; Ointments; Medicine, Chinese Traditional; Eczema; Drugs, Chinese Herbal
PubMed: 37478223
DOI: 10.1097/MD.0000000000034397 -
International Journal of Colorectal... Jan 2023To evaluate the clinical efficacy and safety of different analgesic interventions in the treatment of pain after open hemorrhoidectomy by systematic review and network... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the clinical efficacy and safety of different analgesic interventions in the treatment of pain after open hemorrhoidectomy by systematic review and network meta-analysis.
METHODS
Randomized controlled trials that met the inclusion criteria in PubMed, Cochrane Library, Embase, Web of Science, Scopus, CNKI, WANFANG DATA, and VIP were searched from the date of database construction to June 28, 2022.
RESULTS
Among the 13 randomized controlled trials (RCTs), 731 patients were included in the network meta-analysis. Most interventions are more effective than placebo in relieving postoperative pain. 24 h postoperative Visual Analogue Scale (VAS): glyceryl trinitrate (GTN) (mean difference (MD) - 4.20, 95% CI - 5.35, - 3.05), diltiazem (MD - 1.97, 95% CI - 2.44, - 1.51), botulinum toxin (BT) (MD - 1.50, 95% CI - 2.25, - 0.75), sucralfate (MD - 1.01, 95% CI - 1.53, - 0.49), and electroacupuncture (EA) (MD - 0.45, 95% CI - 0.87, - 0.04). 48 h postoperative VAS: diltiazem (MD - 2.45, 95% CI - 2.74, - 2.15), BT (MD - 2.18, 95% CI - 2.52, - 1.84), and sucralfate (MD - 1.41, 95% CI - 1.85, - 0.97). 7 d postoperative VAS: diltiazem (MD - 2.49, 95% CI - 3.20, - 1.78) and sucralfate (MD - 1.42, 95% CI - 2.00, - 0.85). The first postoperative defecation VAS: EA (MD - 0.70, 95% CI - 0.95, - 0.46). There are few data on intervention safety, and additional high-quality RCTs are expected to study this topic in the future.
CONCLUSION
Diltiazem ointment may be the most effective medication for pain relief following open hemorrhoidectomy, and it can dramatically reduce pain within one week of surgery. The second and third recommended medications are BT and sucralfate ointment. GTN has a significant advantage in alleviating pain 24 h after open hemorrhoidectomy, but whether it causes headache is debatable; thus, it should be used with caution. EA's analgesic efficacy is still unknown. There was limited evidence on the safety of the intervention in this study, and it was simply presented statistically.
Topics: Humans; Hemorrhoidectomy; Diltiazem; Ointments; Sucralfate; Network Meta-Analysis; Analgesics; Nitroglycerin; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 36609578
DOI: 10.1007/s00384-022-04294-5 -
Cureus Jul 2023Uremic xerosis and chronic kidney disease (CKD)-associated pruritus (CKD-ap) are the most commonly occurring dermatological problems faced by most of the CKD patients on... (Review)
Review
Management of Uremic Xerosis and Chronic Kidney Disease (CKD)-Associated Pruritus (CKD-ap) With Topical Preparations: A Systematic Review and Implications in the Indian Context.
Uremic xerosis and chronic kidney disease (CKD)-associated pruritus (CKD-ap) are the most commonly occurring dermatological problems faced by most of the CKD patients on hemodialysis which are not only annoying and draining to the patients but also have an intense effect on patients' quality of life. The PubMed, Scopus, Google Scholar, and Web of Science databases were searched for the literature with the following search terms: uremic xerosis OR CKD-ap OR uremic pruritus AND topical therapy OR topical ointment OR natural oil from the year 2002 -2022, and finally, 22 articles were chosen to write this review. Out of 22 studies, six used pharmacological preparations and remaining 16 studies used natural oils and components. All the articles were experimental studies (Pre/Quazi/RCT/True experimental) focusing on managing itch and xerosis associated with CKD and hemodialysis by topical application. The topical agents tried in various research studies are effective in managing itch and xerosis associated with CKD. They are safe, easy to use, and without allergic reactions. Natural oils like almond, chia seed, clove, glycerin, paraffin, and virgin coconut oil are readily available in home-care settings and can be used as a nurse-led intervention. Topical preparations for uremic xerosis and pruritus are effective, safe, and easy to apply on large body surface areas without systematic side effects. Natural oil-based topical preparations are cost-effective, safe, and easy to use.
PubMed: 37641756
DOI: 10.7759/cureus.42587 -
American Journal of Clinical Dermatology Feb 2016Cutaneous lichen planus (CLP) is an inflammatory dermatosis. Its chronic relapsing course and frequently spontaneous regression hamper the assessment of treatment... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cutaneous lichen planus (CLP) is an inflammatory dermatosis. Its chronic relapsing course and frequently spontaneous regression hamper the assessment of treatment effectiveness.
OBJECTIVE
To evaluate the efficacy of available treatment modalities for CLP.
DATA SOURCES
PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov registry.
METHODS
We performed a systematic review of the current literature. All randomized controlled trials, nonrandomized case-control studies, and cohort studies with more than one treatment arm were included. The primary outcomes were complete response and time to complete response. The secondary outcomes were partial response, relapse, time to relapse, reduction of itch, the adverse event rate, and withdrawal due to adverse events.
DATA SYNTHESIS
Sixteen studies met the inclusion criteria, of which 11 were randomized controlled trials. Most trials had a small sample size. In the rare studies in which variants other than generalized or classic lichen planus were included, they could not be analyzed separately. Body-of-evidence quality ranged from very low to moderate. Acitretin, sulfasalazine, and griseofulvin were associated with increased overall response rates in comparison with placebo. Narrow-band ultraviolet B radiation (NBUVB) was more effective than 6 weeks' low-dose prednisolone in achieving a complete response, and prednisolone was more effective than enoxaparin. Hydroxychloroquine was more effective than griseofulvin in achieving an overall response. Betamethasone valerate 0.1% ointment had comparable efficacy to calcipotriol ointment. Methotrexate was effective, with a nonsignificant difference in the complete response rate in comparison with oral betamethasone. In nonrandomized controlled trials, oral psoralen plus ultraviolet A photochemotherapy (PUVA) had comparable efficacy to a PUVA bath and NBUVB. Psoralen plus sunlight exposure (PUVASOL) and betamethasone dipropionate 0.05% cream were effective relative to a short course of oral metronidazole.
CONCLUSIONS
Several effective treatment options are available for CLP. Further well-designed studies are warranted to investigate the efficacy of topical glucocorticoids-the current first-line therapy-as well as other treatment modalities, and the treatment of different variants of CLP.
Topics: Acitretin; Administration, Cutaneous; Anti-Inflammatory Agents, Non-Steroidal; Antifungal Agents; Calcitriol; Dermatologic Agents; Enoxaparin; Female; Fibrinolytic Agents; Ficusin; Glucocorticoids; Griseofulvin; Humans; Keratolytic Agents; Lichen Planus; Male; Non-Randomized Controlled Trials as Topic; PUVA Therapy; Photochemotherapy; Photosensitizing Agents; Randomized Controlled Trials as Topic; Sulfasalazine; Treatment Outcome
PubMed: 26507510
DOI: 10.1007/s40257-015-0160-6 -
Sexually Transmitted Infections May 2017Anogenital warts (AGWs, condylomata acuminata) are among the most common STIs and may severely impact quality of life (QoL). Available treatment options are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anogenital warts (AGWs, condylomata acuminata) are among the most common STIs and may severely impact quality of life (QoL). Available treatment options are characterised by a high proportion of non-responders and recurrences.
OBJECTIVE
To systematically review and meta-analyse the available evidence from randomised controlled trials (RCTs) on topical treatments for AGWs considering short-term and long-term efficacy, effects on QoL and adverse events (AE).
METHODS
A comprehensive literature search was performed in Cochrane Central Register of Controlled Trials, Embase and MEDLINE. Included studies were evaluated with the Cochrane Collaboration's risk of bias tool. The confidence in the pooled effect estimates was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and categorised as 'very low', 'low', 'moderate' or 'high'.
RESULTS
Eighteen RCTs met the inclusion criteria. Regarding complete clearance (CC), imiquimod 3.75% and 5% cream, podophyllotoxin 0.5% solution and gel and polyphenon E 10% and 15% ointment were superior to placebo. Although more local AE and pain occurred in the actively treated groups, differences regarding dropouts due to AE were not statistically significant. For podophyllotoxin 0.15% cream, no placebo-controlled trials were available; however, in an active-controlled trial, it was inferior to podophyllotoxin 0.5% solution with respect to CC. No significant differences were detected between imiquimod 5% cream and podophyllotoxin 0.5% solution and between polyphenon E 10% and 15% ointment. No data on the influence on health-related QoL were available.
CONCLUSION
Our confidence in the pooled estimates (GRADE quality of the evidence) ranged from very low to high. Apart from the given results, other aspects such as availability, costs or patient preference have to be considered when making a treatment choice. Due to the limited number of direct comparisons, conclusions on the relative efficacy of the different treatment options are restricted.
Topics: Administration, Topical; Anus Diseases; Condylomata Acuminata; Humans; Immunocompetence; Interferon Inducers; Papillomaviridae; Randomized Controlled Trials as Topic; Recurrence; Self Administration
PubMed: 27803240
DOI: 10.1136/sextrans-2016-052768 -
Ophthalmic Epidemiology Jun 2024Herpes stromal keratitis (HSK) is an immune-mediated corneal inflammation that occurs after a herpes simplex virus infection. This paper aims to systematically identify... (Review)
Review
PURPOSE
Herpes stromal keratitis (HSK) is an immune-mediated corneal inflammation that occurs after a herpes simplex virus infection. This paper aims to systematically identify and compare interventions for treating HSK and their patient outcomes.
METHODS
This systematic review followed the PRISMA methodology. Online databases were searched to obtain all relevant papers. Two independent reviewers screened through 168 records. Seven papers were included and used for data extraction. A qualitative analysis was conducted.
RESULTS
HSK patients receiving prednisolone phosphate and acyclovir showed a higher treatment success rate and significantly longer time to failure compared to patients receiving only acyclovir ( < .001). No difference in resolution time was found between oral and topical acyclovir. Between groups receiving dexamethasone and flurbiprofen, resolution occurred in 93% and 67% of patients, and BCVA (LogMAR) improved from 1.0 to 0.30 and 0.48, respectively. BCVA improved in both cyclosporine-A ( < .001) and its control (prednisolone) groups ( = .002). A tacrolimus treatment group showed greater improvement in BCVA compared to its control (prednisolone) group ( < .001).
CONCLUSION
Corticosteroids and antivirals managed HSK most effectively only when used concurrently. Oral acyclovir showed similar effectiveness to its ointment counterpart, a preferable alternative for easier administration. Corticosteroid use could induce greater therapeutic benefits when tapered in concentration and frequency and administrated for at least 10 weeks. Anti-inflammatory drugs including flurbiprofen, cyclosporine-A, and tacrolimus could be safe and effective for treating HSK. Future long-term follow-up and RCTs could provide insights on the therapeutic benefits of these potential alternatives.
Topics: Humans; Keratitis, Herpetic; Antiviral Agents; Anti-Inflammatory Agents; Glucocorticoids; Acyclovir; Corneal Stroma
PubMed: 37184084
DOI: 10.1080/09286586.2023.2213324 -
Integrative Medicine Research Mar 2022Women experience pain from a number of causes during the postpartum period. Although pharmacological pain relief has shown to be effective, the efficacy of... (Review)
Review
BACKGROUND
Women experience pain from a number of causes during the postpartum period. Although pharmacological pain relief has shown to be effective, the efficacy of non-pharmacological methods of pain relief will be of interest to breastfeeding women. The aim of this systematic review was to examine the efficacy and safety of complementary approaches to manage postpartum pain.
METHODS
A search of English language databases from their inception to 2020 was undertaken for randomised controlled trials and included primiparous and multiparous women who experienced postpartum pain up to two weeks post birth. The primary outcome was pain. The risk of bias was assessed using the Cochrane risk of bias tool.
RESULTS
Thirty trials were included in the review, 25 trials (2,413 women) were included in the meta-analysis. Two trials of massage found a reduction in pain following caesarean birth within the first 24 h post birth (MD -2.64, 95-2.82 to -2.46, 184 women, I 0%), and at seven days postpartum (MD -1.91, 95%CI -2.42 to -1.40, 2 trials, 120 women I 37%). Two trials conducted with women receiving an episiotomy found reduction in perineal pain from herbal ointments within 24 h (MD -1.33, 95% CI -.96 to -0.70, 221 women) and at 14 days postpartum (MD -0.74, 95% CI -1.02 to -0.47, 4 trials). Few trials reported on safety, few trials were at an overall low risk of bias, and overall the quality of evidence was very low.
CONCLUSION
Further high quality trials are needed to determine the safety and effectiveness of herbal ointment and massage during the early postpartum period.
PubMed: 34485073
DOI: 10.1016/j.imr.2021.100758 -
ANZ Journal of Surgery Jan 2023Native skin flap necrosis is a potentially devastating complication following skin-sparing or nipple-sparing mastectomy with a reported incidence of as high as 30%.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Native skin flap necrosis is a potentially devastating complication following skin-sparing or nipple-sparing mastectomy with a reported incidence of as high as 30%. Treatment depends on the depth and extent of tissue necrosis and can range from dressings to surgical debridement and further reconstruction. This can have implications on patient physical and psychological wellbeing as well as cost of treatment. This study aims to identify and appraise cost-effective non-surgical adjuncts for the prevention of native skin flap necrosis.
METHODS
A systematic review was performed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and structured around existing recommended guidelines. A search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov was performed with the medical subject headings 'mastectomy' and 'flap necrosis'. After exclusion, 12 articles were selected for review and analysed.
RESULTS
A total of 8439 mastectomies were performed on 7895 patients. Preventative non-surgical adjuncts that demonstrated statistically significant reduction in mastectomy flap necrosis included topical nitroglycerin ointment (P = 0.000), closed-Incision negative pressure wound therapy (P = 0.000), topical dimethylsulfoxide ointment (P = 0.03), oral cilostazol (P = 0.032), and local heat pre-conditioning (P = 0.047).
CONCLUSIONS
This study identifies multiple adjuncts that may aid in preventing mastectomy skin flap necrosis, especially in high-risk patients. Further studies could aim to define standardized protocols and compare the various adjuncts in different circumstances.
Topics: Humans; Female; Ointments; Surgical Flaps; Mastectomy; Mastectomy, Subcutaneous; Postoperative Complications; Vascular Diseases; Skin Diseases; Necrosis; Mammaplasty; Breast Neoplasms; Retrospective Studies; Nipples
PubMed: 36373495
DOI: 10.1111/ans.18146 -
Pediatric Emergency Care Jul 2013Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC.
METHODS
We searched for published and unpublished studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science, ClinicalTrials.gov, and Google.ca. We included studies for meta-analysis if they were randomized, evaluated an intervention other than ultrasound, and reported on 1 of 3 primary outcome measures: success or failure of PIVC, number of attempts to successful cannulation, and procedure time. Two blinded reviewers assessed studies for eligibility and applied a data extraction form to those included. Study quality was assessed using the Cochrane Risk of Bias Tool.
RESULTS
Seven studies met the inclusion criteria. Randomized controlled trials (RCTs) of 3 different interventions were identified. A meta-analysis of 3 RCTs found that use of a transilluminator was associated with a decreased risk of first-attempt PIVC failure (risk ratio, 0.66; confidence interval, 0.41-1.06). Meta-analysis of 3 other RCTs found that near-infrared light devices do not impact the risk of first-attempt PIVC failure (risk ratio, 0.99; confidence interval, 0.74-1.33).
CONCLUSIONS
Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.
Topics: Catheterization, Peripheral; Child; Equipment Design; Humans; Infusions, Intravenous; Inventions; Meta-Analysis as Topic; Nitroglycerin; Ointments; Randomized Controlled Trials as Topic; Single-Blind Method; Transillumination; Treatment Outcome; Vasodilation; Vasodilator Agents
PubMed: 23823270
DOI: 10.1097/PEC.0b013e3182999bcd