Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis.

BACKGROUND: Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma. OBJECTIVE: To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma. METHODS: This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded. RESULTS: Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported. LIMITATIONS: Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling. CONCLUSION: Microneedling is useful adjuvant to topical therapies for the treatment of melasma.

Socioeconomic Status and Melanoma in Canada: A Systematic Review.

As melanoma is one of the leading cancers in average years of life lost per death from disease, screening and early diagnosis are imperative to decrease morbidity and mortality. Socioeconomic status (SES) has been shown to be associated with melanoma incidence. However, it is unclear if this association holds true in universal healthcare systems where screening, diagnostic, and treatment services are available to all patients. The objective of this systematic review was to evaluate the evidence on the association of SES and melanoma incidence in Canada. A comprehensive search of PubMed and EMBASE yielded 7 studies reporting on melanoma incidence or outcomes with respect to SES in Canada. High SES was associated with increased melanoma incidence across all studies, which encompassed all Canadian provinces, and time periods spanning from 1979 to 2012. Studies also reported an increasing incidence of melanoma over time. There were substantial discrepancies in melanoma incidence across Canadian provinces, after controlling for SES and demographic characteristics. Populations of lower SES and living within certain healthcare regions had increased risks of advanced melanoma at diagnosis. This review highlights the potential for inequities in access to care even within a universal healthcare system. Future research is needed to characterize specific risk factors within different patient groups and within the universal health system context in order to implement targeted strategies to lower melanoma incidence, morbidity, and mortality.

Intraoperative balloon occlusion of the aorta for blood management in sacral and pelvic tumor resection: A systematic review and meta-analysis.

BACKGROUND: Neoplasms of the sacrum and pelvis are challenging to manage due to their complex vascularity and size and are at high risk of bleeding during resection. Intra-aortic balloon occlusion (IABO) has been used in trauma to control massive blood loss, but its efficacy and safety in oncologic sacral and pelvic surgery are unknown. The primary objective of this systematic review and meta-analysis was to assess the effectiveness of IABO in providing hemorrhage control during resection of sacral and pelvic tumors. METHODS: This PROSPERO pre-registered study meta-analyzed all studies reporting on the use of IABO in the setting of pelvic and sacral tumour resection, in accordance with the PRISMA guidelines. The primary outcome of the meta-analysis was intraoperative blood loss, with secondary outcomes consisting of transfusion volume, post-operative blood loss, operative time, complication rate, and mortality. RESULTS: Across studies, IABO was associated with a large, significant reduction in intraoperative blood loss (SMD -0.81, 95% CI -1.01 to -0.60, P < 0.0001) and transfused red blood cell volume (SMD 0.92, 95% CI -1.30 to -0.53, P < 0.0001). Two studies reported that complication rates were comparable between patients receiving IABO and patient receiving conventional surgery (Odds ratio = 1.29, 95% CI: 0.59 to 2.83, P = 0.52). All studies descriptively reported improved visualization of the operative field with IABO. CONCLUSIONS: Our findings demonstrated that IABO is an effective technique to decrease blood loss and transfusion requirements during sacral and pelvic tumor surgery. Future clinical trials should be conducted to establish the safety of this method and explore potential contraindications.

The roles of stakeholder experience and organizational learning in declining mass drug administration coverage for lymphatic filariasis in Port-au-Prince, Haiti: A case study.

The World Health Organization (WHO) defines an effective round of mass drug administration (MDA) for lymphatic filariasis (LF) as one that reaches at least 65% of the target population. In its first round of MDA in 2011-2012, the National Program to Eliminate LF in Haiti achieved a 79% epidemiological coverage in urban Port-au-Prince. In 2013, coverage dropped below the WHO threshold and has declined year-over-year to a low of 41% in 2017. We conducted a retrospective qualitative case study to identify key factors behind the decline in coverage in Port-au-Prince and ways to address them. Our findings suggest that the main contributors to the decline in MDA coverage appear to be the absence of effective documentation of practices, reporting, analysis, and program quality improvement-i.e., learning mechanisms-within the program's MDA design and implementation strategy. In addition to their contribution to the program's failure to meet its coverage targets, these deficits have resulted in a high cost for the MDA campaign in both lost momentum and depleted morale. Through a proposed operating logic model, we explore how the pathway from program inputs to outcomes is influenced by a wide array of mediating factors, which shape potential participants' experience of MDA and, in turn, influence their reasoning and decisions to take, or not take, the pills. Our model suggests that the decisions and behavior of individuals are a reflection of their overall experience of the program itself, mediated through a host of contextual factors, and not simply the expression of a fixed choice or preference. This holistic approach offers a novel and potentially valuable framing for the planning and evaluation of MDA strategies for LF and other diseases, and may be applicable in a variety of global health programs.

Exact comprehensive equations for the photon management properties of silicon nanowire.

Unique photon management (PM) properties of silicon nanowire (SiNW) make it an attractive building block for a host of nanowire photonic devices including photodetectors, chemical and gas sensors, waveguides, optical switches, solar cells, and lasers. However, the lack of efficient equations for the quantitative estimation of the SiNW's PM properties limits the rational design of such devices. Herein, we establish comprehensive equations to evaluate several important performance features for the PM properties of SiNW, based on theoretical simulations. Firstly, the relationships between the resonant wavelengths (RW), where SiNW can harvest light most effectively, and the size of SiNW are formulized. Then, equations for the light-harvesting efficiency at RW, which determines the single-frequency performance limit of SiNW-based photonic devices, are established. Finally, equations for the light-harvesting efficiency of SiNW in full-spectrum, which are of great significance in photovoltaics, are established. Furthermore, using these equations, we have derived four extra formulas to estimate the optimal size of SiNW in light-harvesting. These equations can reproduce majority of the reported experimental and theoretical results with only ~5% error deviations. Our study fills up a gap in quantitatively predicting the SiNW's PM properties, which will contribute significantly to its practical applications.

Vitamin d deficiency among psychiatric inpatients.

OBJECTIVE: Previous studies in northern Europe and Australia have indicated that vitamin D deficiency is common in psychiatric patients. This study aimed to determine the prevalence of vitamin D deficiency among psychiatric inpatients in a large North American city. The association of vitamin D status with clinical characteristics was also explored, and subgroups of patients that are more vulnerable to vitamin D deficiency were identified. METHOD: This descriptive study looked at 107 unselected consecutive admissions to a psychiatric inpatient service in New York City between September and early December 2010. All patients were aged 18 years and older. Psychiatric diagnoses were established by attending psychiatrists as part of the routine assessment using criteria from the DSM-IV. Serum levels of 25-hydroxyvitamin D were measured by high-performance liquid chromatography, tandem mass spectrometry. A vitamin D-deficient state was defined as serum 25-hydroxyvitamin D level ≤ 20 ng/mL. RESULTS: Fifty-six (52.3%) patients were classified as deficient in vitamin D. Age and 25-hydroxyvitamin D level were significantly correlated (P = .001). Seventy-one percent of patients from age 18 to 34 years were deficient in vitamin D; this rate was significantly higher than the rate of deficiency in older patients (P = .017). No significant relationships were found between 25-hydroxyvitamin D level and gender, race/ethnicity, glycosylated hemoglobin, body mass index, and major psychiatric diagnostic categories. CONCLUSIONS: A high percentage of psychiatric inpatients are deficient in vitamin D. Younger patients were more at risk for deficiency. Screening for vitamin D deficiency should be part of the health assessment of patients with major psychiatric illnesses.

Comparative effectiveness of second-generation antipsychotics and haloperidol in acute schizophrenia.

BACKGROUND: There is little information on the comparative effectiveness of second-generation antipsychotic agents. AIMS: To determine if any of five second-generation antipsychotics or haloperidol is more effective in treating acutely ill patients with schizophrenia, schizoaffective disorder or schizophreniform disorder. METHOD: A sample of 327 newly admitted patients were randomised to open-label treatment with aripiprazole, haloperidol, olanzapine, quetiapine, risperidone or ziprasidone for a minimum of 3 weeks. Measures of effectiveness were improvement in mental status so that the patient no longer required acute in-patient care, and changes in Brief Psychiatric Rating Scale (BPRS) scores. RESULTS: By the first measure, haloperidol (89%), olanzapine (92%) and risperidone (88%) were significantly more effective than aripiprazole (64%), quetiapine (64%) and ziprasidone (64%). Changes in BPRS ratings were not significant among treatments. CONCLUSIONS: Haloperidol, olanzapine and risperidone are superior to aripiprazole, quetiapine and ziprasidone for the acute treatment of psychosis in hospitalised patients with schizophrenia, schizoaffective disorder or schizophreniform disorder.