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World Journal of Pediatrics : WJP Sep 2022Neonatal hyperbilirubinemia is observed in most newborns, and 5-15% of neonates require phototherapy. Phototherapy is effective but often prolongs hospitalization and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Neonatal hyperbilirubinemia is observed in most newborns, and 5-15% of neonates require phototherapy. Phototherapy is effective but often prolongs hospitalization and has both short-term and potential long-term harms. The aim of this systematic review and meta-analysis was to evaluate the role of ursodeoxycholic acid (UDCA) combined with phototherapy in neonatal hyperbilirubinemia.
METHODS
A literature search was conducted on September 1, 2021; 590 studies were screened, and 17 full texts were assessed by two authors. We included randomized controlled trials with or without placebo intervention. Primary outcomes were changes in total bilirubin levels at 24 hours and phototherapy duration. We calculated mean differences with 95% confidence intervals (CI).
RESULTS
Six studies with 880 neonates were included. Of these studies, only two used a placebo-controlled double-blinded design. The overall risk of bias was high in one and moderate in four of the included studies. The mean decrease in the total bilirubin level during the first 24 hours was 2.06 mg/dL (95% CI 0.82-3.30; six studies) greater in the UDCA treatment group. The phototherapy duration was 19.7 hours (95% CI 10.4-29.1; five studies) shorter in the UDCA treatment group.
CONCLUSIONS
We found low-quality evidence that UDCA as an adjuvant to phototherapy seems to decrease total bilirubin faster and shorten phototherapy duration compared to standard treatment. Further studies are needed to confirm the efficacy, acute and long-term outcomes, and safety before implementing UDCA as an adjuvant to phototherapy in neonatal hyperbilirubinemia.
Topics: Bilirubin; Combined Modality Therapy; Humans; Hyperbilirubinemia; Hyperbilirubinemia, Neonatal; Infant, Newborn; Jaundice, Neonatal; Phototherapy; Ursodeoxycholic Acid
PubMed: 35689782
DOI: 10.1007/s12519-022-00563-z -
Journal of Optometry 2023To analyse the scientific evidence about the efficacy of Syntonic phototherapy for producing changes in visual function. (Review)
Review
PURPOSE
To analyse the scientific evidence about the efficacy of Syntonic phototherapy for producing changes in visual function.
MATERIAL AND METHODS
A systematic review was performed to obtain studies on the effects of Syntonic phototherapy on vision. A search in health science databases (Medline, Scopus, Web of Science and PsycINFO) for studies published between 1980 and 2022 was conducted in accordance with the principles of Cochrane approach. The search identified 197 articles. Only clinical studies which used the Syntonic phototherapy as a vision therapy for any visual condition were included. Clinical cases and case series were excluded. Following the inclusion criteria, 8 clinical studies met inclusion, 5 of them being pseudo-experimental studies with an equivalent control group and 3 pre-post pseudo-experimental studies. GRADE tool was used to assess the certainty of the evidence of the studies. The GRADE evidence profile for the studies through the Soft table was made to analyse data.
RESULTS
The studies analysed seven outcomes: visual symptoms, functional visual fields, visual acuity, contrast sensitivity, deviation (phoria/tropia), stereopsis and reading abilities. Finding table about results (Soft Table) showed that for all outcomes reviewed, all studies yielded very low certainty of evidence. Results revealed a lack of scientific evidence of the efficacy of Syntonic optometric phototherapy to produce changes in the visual function.
CONCLUSION
This systematic review found no consistent evidence for the efficacy of Syntonic phototherapy to cause changes in visual function. There is no scientific evidence to support its clinical use for treating any type of visual anomalies.
Topics: Humans; Phototherapy; Visual Acuity; Vision Disorders; Contrast Sensitivity; Vision, Low
PubMed: 37230932
DOI: 10.1016/j.optom.2023.03.002 -
International Journal of Molecular... Oct 2023Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local... (Review)
Review
Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.
Topics: Humans; Thumb; Prospective Studies; Quality of Life; Arthritis; Pain; Platelet-Rich Plasma
PubMed: 37834357
DOI: 10.3390/ijms241914909 -
Psoriasis (Auckland, N.Z.) 2023Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about... (Review)
Review
Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease's development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports, but further investigations with larger cohorts are needed.
PubMed: 37772169
DOI: 10.2147/PTT.S400402 -
BMJ Clinical Evidence Mar 2011Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The extent and distribution... (Review)
Review
INTRODUCTION
Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The extent and distribution of vitiligo often changes during the course of a person's lifetime and its progression is unpredictable.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of medical treatments, and of ultraviolet light treatments, for vitiligo in adults and in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 25 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids (oral and topical), oral levamisole, topical immunomodulators, topical vitamin D analogues, ultraviolet A plus psoralen (PUVA [oral or topical]), and ultraviolet B (narrowband).
Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Child; Humans; Melanocytes; Ultraviolet Therapy; Vitiligo
PubMed: 21439099
DOI: No ID Found -
BMC Complementary and Alternative... Jul 2018Neonatal jaundice affects at least 481,000 newborns every year. Phototherapy is recommended but it's effects are limited and adverse reactions can occur. In China,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Neonatal jaundice affects at least 481,000 newborns every year. Phototherapy is recommended but it's effects are limited and adverse reactions can occur. In China, phototherapy combined with Yinzhihuang oral liquid is also used for this condition. This systematic review evaluated the effectiveness and safety of combination therapy with Yinzhihuang oral liquid and phototherapy compared to phototherapy alone for treating neonatal jaundice.
METHOD
A comprehensive literature search was performed in four Chinese databases, two English language databases and two trial registries from inception to June 2017. Two authors independently screened the citations and retrieved full publications for randomized trials on Yinzhihuang oral liquid combined with phototherapy for neonatal jaundice. The methodological quality of the trials was assessed according to the Cochrane Collaboration's tool for assessing risk of bias. Data were analyzed using RevMan 5.3.
RESULT
Totally 17 trials (involving 2561 neonates) were included in this review. Fourteen of them had a high risk of bias. Significant differences were detected between combination therapy and phototherapy alone for serum bilirubin level (MD - 50.25 μmol/L, 95% CI -64.01 to - 36.50, I = 98%; 7 trials, post-hoc decision choosing random effects model), failure of jaundice resolution (RR 0.21, 95% CI 0.14 to 0.32, I = 0%; 11 trials, fixed effects model), and time to jaundice resolution (MD - 2.17 days, 95%CI -2.96 to - 1.38, I = 98%; 6 trials, random effects model). Adverse events were reported in eight trials but none were serious. Trial sequential analysis for serum bilirubin level suggested that the cumulative Z-curve (which represents 1478 participants) reached the required information size (DARIS = 1301 participants).
CONCLUSION
Based on trials with low methodological quality, Yinzhihuang oral liquid combined with phototherapy seemed to be safe and superior to phototherapy alone for reducing serum bilirubin in neonatal jaundice. These potential benefits need to be confirmed in future trials using rigorous methodology.
TRIAL REGISTRATION
Systematic review registration: [PROSPERO registration: CRD42016037691 ].
Topics: Drugs, Chinese Herbal; Humans; Infant, Newborn; Jaundice, Neonatal; Phototherapy; Randomized Controlled Trials as Topic
PubMed: 30055615
DOI: 10.1186/s12906-018-2290-x -
Neonatology 2016Transcutaneous bilirubin (TcB) devices are commonly used for screening of hyperbilirubinemia in term and near-term infants not exposed to phototherapy. However, the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transcutaneous bilirubin (TcB) devices are commonly used for screening of hyperbilirubinemia in term and near-term infants not exposed to phototherapy. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear.
OBJECTIVES
To conduct a systematic review of studies comparing TcB devices with total serum bilirubin (TSB) in infants receiving phototherapy or in the postphototherapy phase.
METHODS
MEDLINE, EMBASE, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. Additional citations were identified from the bibliography of selected articles and from the abstracts of conference proceedings. The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. Risk of bias was assessed using the QUADAS-2 tool.
RESULTS
Fourteen studies were identified. The pooled estimates of correlation coefficients (r) during phototherapy were: covered sites 0.71 (95% CI 0.64-0.77, 11 studies), uncovered sites 0.65 (95% CI 0.55-0.74), 8 studies), forehead 0.70 (95% CI 0.64-0.75, 12 studies) and sternum 0.64 (95% CI 0.43-0.77, 5 studies). Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 µmol/l, respectively). The correlation coefficient improved marginally in the postphototherapy phase (r = 0.72, 95% CI 0.64-0.78, 4 studies).
CONCLUSION
We found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the postphototherapy phase. Further research is needed before the use of TcB devices can be recommended for these settings.
Topics: Bilirubin; Equipment and Supplies; Humans; Hyperbilirubinemia, Neonatal; Infant, Newborn; Infant, Premature; Jaundice, Neonatal; Neonatal Screening; Phototherapy; Premature Birth; Reproducibility of Results; Skin; Term Birth
PubMed: 26789390
DOI: 10.1159/000442195 -
Actas Dermo-sifiliograficas Jun 2015Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. (Review)
Review
BACKGROUND
Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines.
OBJECTIVE
To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis.
MATERIAL AND METHODS
We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform.
RESULTS
Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results.
CONCLUSIONS
There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time.
Topics: Adolescent; Adult; Child; Controlled Clinical Trials as Topic; Dermatitis, Atopic; Humans; PUVA Therapy; Phototherapy; Randomized Controlled Trials as Topic; Treatment Outcome; Ultraviolet Therapy
PubMed: 25728564
DOI: 10.1016/j.ad.2014.12.017 -
Journal of the European Academy of... Jun 2022Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of... (Review)
Review
Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of intervention. Many clinicians are not aware of the unique opportunity these lasers offer to improve the outcomes of vitiligo treatment. To date, no clear overview exists of the use of lasers in vitiligo treatment. Thus, the aim of this review is to discuss the various types of lasers and provide an overview of the evidence for their efficacy. We found good evidence from a systematic review that the excimer laser is effective, induces repigmentation rates comparable to NB-UVB and has improved outcomes when combined with calcineurin inhibitors. Ablative lasers are commonly used for tissue graft or melanocyte-keratinocyte cell graft transplantation. They provide safe, fast and uniform denudation of the epidermis with propitious repigmentation outcomes. We found conflicting evidence from two systematic reviews regarding the efficacy of fractional ablative lasers for improving outcomes of NB-UVB therapy, a systematic review including only fractional ablative lasers provided evidence for efficacy. Q-switched nanosecond lasers have shown to be safe and effective for inducing depigmentation, although recurrence is common, and most studies were small and retrospective. Despite proven efficacy and safety, laser treatments are relatively expensive and suited for limited body surface areas and selected cases. Each type of laser has benefits and risks associated and should, therefore, be individually chosen based on location, extent, activity and type of vitiligo.
Topics: Combined Modality Therapy; Humans; Lasers, Excimer; Retrospective Studies; Treatment Outcome; Ultraviolet Therapy; Vitiligo
PubMed: 35176186
DOI: 10.1111/jdv.18005 -
The Cochrane Database of Systematic... Mar 2021This review has been withdrawn because it has been split into the following reviews: 'Pharmaceutical interventions for Barrett's oesophagus' and 'Endoscopic... (Meta-Analysis)
Meta-Analysis
This review has been withdrawn because it has been split into the following reviews: 'Pharmaceutical interventions for Barrett's oesophagus' and 'Endoscopic interventions for Barrett's oesophagus'.
Topics: Adenocarcinoma; Barrett Esophagus; Catheter Ablation; Esophageal Neoplasms; Gastroesophageal Reflux; Humans; Laser Coagulation; Photochemotherapy; Precancerous Conditions; Randomized Controlled Trials as Topic
PubMed: 33661543
DOI: 10.1002/14651858.CD004060.pub3