Role of honey after tonsillectomy: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Honey reduced post-tonsillectomy pain, but its effects on awakening at night, inflammation and healing of the tonsillar fossa were controversial. OBJECTIVES: This systematic review and meta-analysis of randomised controlled trials (RCTs) evaluated the effect of oral honey on pain, consumption of painkillers, awakening at night, healing of tonsillar fossa and adverse effects in children after tonsillectomy. METHODS: A search of MEDLINE, EMBASE, Scopus, CINAHL and Cochrane Collaboration Library databases was performed without any restriction of publication year. The end date of search was 30 June 2016. The search was supplemented by search from Google, hand search of cross-references of selected articles and reviews, and contacting the authors of different studies. The inclusion criteria were RCTs comparing the effect of honey with control on different outcomes, in children after tonsillectomy. RESULTS: Our search generated 64 studies, and eight RCTs met our inclusion criteria. The methodological quality of RCTs was poor. Compared to control, honey significantly decreased postoperative pain from day 1 to day 7 (P = 0.05 to <0.0001); consumption of painkillers from days 1 to 5 (P = 0.03 to 0.003) and on day 10 (P = 0.002); and number of awakening at night due to pain on days 2 and 4 after tonsillectomy (P = 0.0001, 0.004). The healing of tonsillar fossa was significantly greater with honey compared to control on days 3-4 (P = 0.02) and days ≥9 (P = 0.01) after tonsillectomy. The adverse effects were not significantly different between honey and control groups. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) of the evidence for different outcomes varied from 'low' to 'very low'. CONCLUSIONS: Honey improved pain, requirement of painkillers and awakening at night due to pain in children after tonsillectomy. There was little improvement in healing of tonsillar fossa. The GRADE of the evidence varied from 'low' to 'very low'. A good-quality, placebo-controlled RCT of different doses and durations of administration of honey is required to evaluate its clear efficacy and safety in children after tonsillectomy.

The effectiveness and safety of heat/cold therapy in adults with lymphoedema: systematic review.

PURPOSE: The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema. METHODS: A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken. RESULTS: Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema. CONCLUSIONS: Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events.Implications for rehabilitationThis review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema.There was no evidence that controlled localised heat therapy was unsafe.The current evidence-base is at a point where no specific clinical recommendations can be made.The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema.

Bilateral occurrence of dental caries and oral hygiene in preschool children of Riyadh, Saudi Arabia.

The objective of the study was to determine bilateral caries occurrence or caries bilaterality in preschool children of Riyadh. For this purpose, 789 randomly selected preschool children, 379 (48%) boys and 410 (52%) girls, were examined for dental caries utilizing the World Health Organization (WHO) criteria for diagnosis of dental caries. Caries were significantly bilateral (p < .05) in all the teeth. Among the posterior teeth, mandibular second molars showed the highest caries bilaterality (88%) and among the anterior teeth, maxillary central incisors had the highest caries bilaterality (88.9%). Mandibular canines had the lowest caries bilaterality (52.7%). There was more than 50% probability of left side tooth being carious given that right side tooth was carious for all the teeth. Amongst posterior teeth, the conditional probability for bilateral caries occurrence was highest in mandibular second molars (.88) and amongst the anterior teeth, maxillary central incisors had the highest conditional bilaterality (.89). Caries bilaterality was significantly high (p < .05) in children with poor and fair oral hygiene as compared to children with good oral hygiene for all the molars and maxillary central incisors. It can be concluded that bilateral caries occurrence or caries bilaterality is highly prevalent in all the primary teeth; especially in mandibular molars and maxillary incisors.

Predicting impairment of central vision from dimensions of the optic chiasm in patients with pituitary adenoma.

AIM: To study a possible relationship between dimensions of the optic chiasm and extent of visual field impairment in patients with pituitary adenoma. METHODS: Pre-operative magnetic resonance (MR) scans and Goldmann perimetry charts of patients having undergone resection of a pituitary adenoma were retrieved. Area of the chiasm (A (chiasm)), central height of the chiasm (H (chiasm)), and perpendicular height of tumour (H (tumour)) were measured on coronal images using standard software. Visual fields were quantified by subdividing the central 30 degrees of vision into 72 subunits each bounded by 15 degree meridians and 10 degree isoptres. RESULTS: Nineteen patients were included in this study. There was a strong statistically significant linear correlation between H (chiasm) and bitemporal (Pearson's coefficient r = -0.69, p = 0.001), binocular (r = -0.63, p = 0.004) and binasal (r = -0.52, p = 0.01) central field loss. A similar relationship was observed between H (tumour) and bitemporal (r = 0.55, p = 0.015) and binocular (r = 0.46, p = 0.05) central field loss. CONCLUSION: Height of the chiasm and height of the tumour can be used to predict extent of central visual impairment.

The effect of proprioceptive knee bracing on knee stability during three different sport related movement tasks in healthy subjects and the implications to the management of Anterior Cruciate Ligament (ACL) injuries.

INTRODUCTION: Proprioceptive knee braces have been shown to improve knee mechanics, however much of the work to date has focused on tasks such as slow step down tasks rather than more dynamic sporting tasks. OBJECTIVE: This study aimed to explore if such improvements in stability may be seen during faster sports specific tasks as well as slower tasks. METHOD: Twelve subjects performed a slow step down, single leg drop jump and pivot turn jump with and without a silicone web brace. 3D kinematics of the knee were collected using a ten camera Qualisys motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the Calibrated Anatomical Systems Technique. A two way ANOVA with repeated measures was performed with post-hoc pairwise comparison to explore the differences between the two conditions and three tasks. RESULTS: Significant differences were seen in the knee joint angles and angular velocities in the sagittal, coronal and transverse planes between the tasks. The brace showed a reduction in knee valgum and internal rotation across all tasks, with the most notable effect during the single leg drop jump and pivot turn jump. The transverse plane also showed a significant reduction in the external rotation knee angular velocity when wearing the brace. DISCUSSION: The brace influenced the knee joint kinematics in coronal and transverse planes which confirms that such braces can have a significant effect on knee control during dynamic tasks. Further studies are required exploring the efficacy of proprioceptive braces in athletic patient cohort.

Coronary artery fistula after cardiac transplantation.

A cardiac transplant recipient with multiple coronary artery fistulae draining into the right ventricle is described. These fistulae presumably resulted from repeated endomyocardial biopsies. The diagnosis of coronary artery fistulae was made at the annual coronary arteriography. The magnitude of the shunt remained small over eight years of follow-up.

Chronic stable angina pectoris. Strategies for effective drug therapy.

In most patients with stable angina pectoris, severe eccentric atherosclerotic narrowing of coronary arteries is responsible for chest pain and myocardial ischemia. If myocardial infarction or death occurs, it is usually the consequence of a ruptured plaque. About 10% to 20% of patients with stable angina have normal coronary arteries, and their long-term prognosis is excellent. In patients with angina secondary to atherosclerotic lesions, the annual mortality rate is 1.6% to 3.2%; prognosis is determined by systolic left ventricular function and the extent of coronary artery disease. Patients can be stratified into low- and high-risk groups by medical history, left ventricular function at rest, and results of physical examination and stress testing. Coronary angiography should be reserved for high-risk patients. Risk-factor modification and appropriate use of antianginal drugs are successful in most patients, but those who fail to respond should be considered for angioplasty or coronary bypass surgery; patients with left main coronary artery disease or three-vessel disease and poor left ventricular function should be considered for coronary artery bypass surgery.

Placement and replacement of dental restorations.

OBJECTIVE: To determine the types of various dental restorative materials used, and the reasons for the placement and replacement of dental restorations in 10 randomly selected polyclinics in Riyadh, Saudi Arabia. DESIGN: A cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Ten selected polyclinics in Riyadh metropolitan area, Saudi Arabia during a period of two weeks in January 2003. PATIENTS AND METHODS: Information was collected by using a specially-designed form that was distributed to one dentist in each selected polyclinic. The dentists were asked to record specific details for all restorations placed in adult patients. Chi-square tests were used to analyze the data. RESULTS: Data were collected for 326 restorations. Amalgam (52.5%) was the most commonly used restorative material followed by resin composite (31.3%) and temporary restorations (14.4%), with a minimal use of glass ionomer cement (1.8%, p<0.001). Most of the restorations (69.9%) were initial placements, while 30.1% were replacement restorations, (p<0.05). Caries was the major reason for the initial placement (92.1%), and for the subsequent replacement (96.9%) of restorations. CONCLUSION: Amalgam and resin composite were the most commonly used restorative materials. Caries was the major reason for the initial restoration placements and subsequent replacements.

Feeding and dietary practices of nursing caries children in Riyadh, Saudi Arabia.

The aim of the study was to determine the feeding and dietary practices of Saudi nursing caries children in Riyadh. A sample of nursing caries children attending the dental clinics of three health care facilities in Riyadh was selected for the study. The information about the feeding and dietary practices was obtained through a self-administered questionnaire. A total of 74 nursing caries children, 34 (45.9%) male and 40 (54.1%) female with a mean age of 55.0 (SD 20.0) months participated in the study and, their mothers completed the questionnaire. About two-thirds of the children (65.0%) were breast-fed before sleep and a similar percentage (60.8%) was breast-fed during sleep. More than two-thirds (68.9%) were bottle-fed with liquids such as fresh fruit juices (51.4%), packed juices (43.2%) and soft drinks (81.1%). The mean age of starting to drink in a cup was 25.1 (SD 10.4) months. The most popular (71.6%) drinks in a cup were fruit juices. More than two-thirds (71.6%) of the children were taking soft drinks directly from a container and, about two-thirds (60.0%) of the children started drinking directly from a container at or before the age of 24 months. Almost all the children (93.2%) were taking sweets; about half (45.9%) of them taking sweets twice or more daily. It was concluded that the study children have feeding and dietary characteristics (typical of nursing caries) such as breast-feeding before/during sleep, nocturnal/nap-time bottle-feeding, excessive consumption of fruit juices/soft drinks from a container and a high frequency of sweet intake.

Age and sexwise child mortality and the influencing socio-economic factors in a rural and tribal population in western India.

PIP: The study was a part of the survey conducted under the USAID-assisted Integrated Child Development Services impact evaluation project in Panchmahals district of Gujarat State, western India, where data of the same population were collected during 1985-86 for the baseline and during 1989-90 for the final evaluation. A minimum of 3 and a maximum of 7 villages were randomly selected from all the 11 blocks of Panchmahals. The entire child population of the selected villages was surveyed. Data were collected by means of a questionnaire by interviewing the head of the family. The families were categorized as below or above poverty line. The mothers were categorized as illiterate or literate. The children were weighed to the nearest 0.1 Kg. The association between age/sex and child deaths that occurred over the 5-year period demonstrated that the number of deaths were highest (70/1000 children) among children who were in the age category of 0-6 months at the baseline evaluation and lowest (8/1000 children) among those in the age category of over 37 months. More male than female children had died in the 7-12 months age group and more females than males had died in the 13-24 months age group. Deaths were 4-fold among the children under 3 as compared to those over 3 years of age. The number of deaths were higher among children of illiterate mothers. Male deaths were higher than female deaths when the birth order was over 4. Among children over 3 years of age birth order seemed to be positively related to male as well as female deaths. More children died when their birth interval was less than 24 months, particularly those under 3 years old. Deaths were higher among children with poor nutritional status ( 70% weight/age, NCHS median) especially among females. A significantly higher number of deaths occurred in females over 36 months of age who had poor nutritional status.^ieng