Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis.

BACKGROUND: Lower urinary tract symptoms (LUTSs) are common in patients with multiple sclerosis (MS). Percutaneous posterior tibial nerve stimulation (PTNS) is a minimally invasive treatment which is considered to be effective for patients who suffer from LUTS symptoms. In previous studies, the endpoints of treatment reported differently. So, we designed this systematic review and meta-analysis to estimate pooled efficacy of PTNS based on different assessment methods. METHODS: We systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. We also searched the gray literature including references of the included studies, and conference abstracts which were published up to May 2021. The search strategy included the MeSH and text words as (((Tibial Nerves) OR Posterior Tibial Nerve) OR (Posterior Tibial Nerves) OR (Medial Plantar Nerves) OR (Medial Plantar Nerve) OR (tibial Nerve Stimulation) OR (Trans-Cutaneous Tibial Nerve Stimulation) OR (Percutaneous Tibial Nerve Stimulation) OR (Cutaneous Tibial Nerve Stimulation) AND ((Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).Two independent researchers independently evaluated the articles. RESULTS: We found 2430 articles by literature search, after deleting duplicates 2027 remained. Eight articles remained for meta-analysis The pooled SMD of post voiding residual (PVR) (post-treatment - pre-treatment) was -0.75 (95%CI:-0.93, -0.56)(I2=0, p = 0.67). The pooled SMD of voiding volume (post-treatment - pre-treatment) was 1.21 (95% CI:0.94-1.49) (I2:0%, p = 0.4). The pooled SMD of nocturia (post-treatment - pre-treatment) was -1.10 (95% CI:-1.33, -0.87) (I2:86.4%, p<0.001). The pooled SMD of leakage per day (post-treatment - pre-treatment) was -0.69 (95% CI:-0.93, -0.45) (I2:84.3%, p<0.001). The pooled frequency of responders was 66%(95% CI:59%-73%)(I2:0). CONCLUSION: The results of this systematic review and meta-analysis show that PTNS in effective in treating LUTS in patients with MS.

Effect of Vitamin D Supplements on Relapse Rate and Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory disease while there are controversies regarding the role of vitamin D supplements in controlling relapse and disability improvement during treatment. OBJECTIVE: The goal of this systematic review and meta-analysis was to evaluate the effect of vitamin D supplements on MS-related relapse and the Expanded Disability Status Scale (EDSS). METHODS: We searched databases to include randomized clinical trials (RCTs) which were published up to October 2018. We included RCTs, being single-blinded or double-blinded or open-label trials in which one of the main outcomes was EDSS and/or relapse after vitamin D supplementation. All statistical analyses were performed using RevMan 5.3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for relapse between treatment arms. The mean difference was calculated for EDSS comparisons. RESULTS: Nine articles were included for analysis. Of these nine studies, five compared vitamin D supplement groups with placebo (group 1 studies), and four compared high- and low-dose vitamin D groups. A total of 561 patients were analyzed. Being treated with vitamin D instead of placebo showed no effect on relapse rate (OR = 0.66, 95% CI = 0.28-1.54) as well as EDSS (mean difference = 0.06, 95%CI [-0.31, 0.42]). The results of studies comparing high- vs. low-dose vitamin D interventions showed no significant effect on relapse rate (OR = 1.08, 95%CI [0.29-4.08] as well as final EDSS (mean difference = 0.17, 95% CI = -0.73, 1.07). CONCLUSIONS: Our findings show that vitamin D supplements (high or low dose) have no significant effect on relapse rate and disability during treatment in MS patients.

Effect of Two Different Doses of Vitamin D Supplementation on Uterine Myoma on South East Iranian Population: A Clinical Trial.

Objective: Uterine myoma is the most common benign tumor however with significant distress and reduced quality of life in affected women. Besides, vitamin D deficiency may be a risk factor for uterine myoma. This study aimed to evaluate the effect of vitamin D supplements on the size of myoma in women with vitamin D insufficiency or deficiency. Materials and methods: This clinical trial was conducted in a teaching hospital from 2019 to 2020. According to baseline vitamin D level, participants were assigned into two interventional equal groups (vitamin D deficiency or insufficiency) to receive either 1000 IU daily or 50000 IU weekly vitamin D for 12 weeks. The size and location of the uterine myoma were compared before and after the intervention. Results: Totally, 137 women with uterine myoma were enrolled. Based on baseline vitamin D level, 52 cases had vitamin D insufficiency and 85 cases had vitamin D deficiency. No significant difference was observed in age and BMI in both groups. The location of the subserosal and intramural myoma did not differ, otherwise, the percent of the submucosal myomas were increased significantly (p=0.020) after the intervention. In both groups decreased myoma size otherwise not significant was seen after the intervention (p=0.148 and p=0.664 respectively). Conclusion: Vitamin D supplementation may not be effective in women with vitamin D insufficiency or deficiency in the short term to reduce myoma size.

The Effect of Vitamin D Supplements on Clinical and Para-Clinical Outcomes in Patients With Multiple Sclerosis: Protocol for a Systematic Review.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory disease, which has a wide range of effects on patients. There are controversies regarding the role of vitamin D in clinical and laboratory improvements in MS patients. OBJECTIVE: The aim of this systematic review protocol is to evaluate the efficacy of vitamin D supplements on relapse rate, gadolinium-enhancing lesions of magnetic resonance imaging (MRI), and cytokine profiles. METHODS: We will search PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, ProQuest, American College of Physicians Journal Club database, Health Technology Assessment Database (The Cochrane Collaboration), and National Health System Economic Evaluation Database (The Cochrane Collaboration) and gray literature including reference of included studies and conference abstracts. Clinical trials reporting the effect of any doses of vitamin D on relapse rate, gadolinium-enhancing lesions of MRI, and cytokine profiles will be included. In total, 2 independent researchers will independently assess the studies, extract data, and evaluate the quality of primary studies. RESULTS: This systematic review was started in September 2017 and the process is continuing. The included articles are evaluated and researchers are going to extract the data. CONCLUSIONS: To our knowledge, this will be the first comprehensive systematic review aiming to assess the effect of vitamin D supplements on clinical and para-clinical outcomes in patients with multiple sclerosis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12045.

Effects of Vitamin D Supplements on IL-10 and INFγ Levels in Patients with Multiple Sclerosis: a Systematic Review and Meta-Analysis.

Background:Vitamin D is one of the considerable environmental factors exhibiting immunomodulatory and anti-inflammatory effects. Objective: To conduct a systematic review and meta-analysis to estimate the effect of vitamin D supplements on IL-10 and INFγ levels in patients with multiple sclerosis. Methods: We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, The Cochrane Library and gray literature, including references of selected studies, conference abstracts which were published up to May 2019. We included single- or double-blinded RCTs or open-label trials in which one of the main outcomes was INFγ and/ or IL-10 levels after vitamin D supplementation. Only articles that had been published in English were included. Results: The literature search yielded 369 articles, that were monitored by us. After eliminating duplicates, 128 studies remained; from these, we excluded observational studies, reviews, case reports and non-randomized trials, and 33 studies remained. Finally, only three articles were included. The mean difference for INFγ was 268.4 and 95 % CI 200.6-336.1. There was no significant heterogeneity (I ² = 0 %, Chi ² = 0.1, p = 0.7). The mean difference for IL-10 was 398.3 and 95% CI -528.05-1324.8). There was significant heterogeneity (I2 = 94 %, Chi2 = 31.1 p < 0.001). Conclusion: The results of this systematic review were not satisfactory. More clinical trials are further needed to evaluate the effects of vitamin D supplements on IL-10 and INFγ levels in patients with multiple sclerosis.

Comparison of one and two-day bowel preparation with polyethylene glycol in pediatric colonoscopy.

BACKGROUND/AIMS: Proper colon preparation in children has been a challenge for many years. Different regimens have been used for this purpose, but the best regimen is not determined. The aim of this study was to evaluate successful colon preparation before colonoscopy in children who were treated with one- or two-day regimen with polyethylene glycol (PEG) plus bisacodyl and clear liquids. MATERIALS AND METHODS: In this randomized clinical trial, 100 children (2-14 years old) who were candidates for colonoscopy were enrolled and divided into two groups. The children in group one were started on 2 g/kg PEG powder (17 g in 240 mL water or another beverage) and 5 mg bisacodyl suppository (BD) the day before colonoscopy, whereas those in the other group were started on 1.5 g/kg PEG with fruit juices for two days and 5 mg bisacodyl suppository (BD) for two days before colonoscopy. RESULTS: Compliance rates, regimens, adverse effects, and complete colonoscopy were not significantly different between the two groups. The Boston score was excellent and good in 70% of group one and 72% of group two children, respectively. Compliance rate, adverse effects, and need for enema were similar in both groups. The rate of compliance and non-requirement of enema were significantly higher in children with satisfactory colon preparation. CONCLUSION: The one-day PEG plus bisacodyl regimen for bowel preparation is as effective as the two-day regimen in children; furthermore, it is well tolerated and has low adverse effects.

Posterior tibial nerve stimulation for treating neurologic bladder in women: a randomized clinical trial.

Overactive bladder (OAB) is a disabling disorder. Treatment of cases with OAB includes behavioral, pharmacological, surgical interventions and peripheral electrical stimulation. The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder (OAB). Fifty women were randomly assigned to PTNS (posterior tibial nerve stimulation) plus tolterodine or tolterodine alone treatment. Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks. Two in PTNS group and 8 in the control group withdrew from the study. Age, education level, and occupation status were not significantly different between two groups. Mean total FSFI and its subscales were not significantly different before and after treatment between two groups. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient's control became significantly different after treatment between two groups. Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder.