Antibiotics efficacy in clinical and microbiological cure of uncomplicated urinary tract infection: a systematic review and network meta-analysis.

PURPOSE: Fosfomycin has been used more frequently in managing uncomplicated urinary tract infections (UTIs) due to decreased compliance and increased multidrug-resistant bacteria. The aim of this network meta-analysis was to assess the efficacy of Fosfomycin compared to Nitrofurantoin, Trimethoprim-Sulfamethoxazole (TMP-SMX), and Ciprofloxacin in terms of clinical and microbiological cure alongside with other measurements. MATERIALS AND METHODS: We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). We included randomized control trials (RCTs) with uncomplicated UTI patients who received Fosfomycin, Nitrofurantoin, TMP-SMX, or Ciprofloxacin and reported the clinical or microbiological cure. We used Cochrane Risk of Bias Assessment Tool to assess the included studies' quality. R-software was used for all statistical analysis. We ranked all antibiotics using the netrank function which yielded P scores. Frequentist network meta-analysis was used to assess the efficacy of all outcomes. RESULTS: We included 13 RCTs with a total number of 3856 patients that showed Fosfomycin ranked the highest among the other antibiotics with respect to clinical cure (P-score = 0.99) and microbiological cure (P-score = 0.99) while Ciprofloxacin ranked the lowest (P-score = 0.11 and 0.02, respectively). Moreover, Ciprofloxacin yielded the highest relapse rate (P-score = 1), whereas TMP-SMX had the lowest relapse rate (P-score = 0.07). As for the adverse events, Ciprofloxacin demonstrated the highest adverse events as opposed to Fosfomycin (P-score = 0.98 and 0.05, respectively). CONCLUSION: The network meta-analysis demonstrated that Fosfomycin is the most effective antibiotic in treating uncomplicated UTIs with respect to clinical cure, microbiological cure, and adverse events profile.

Preoperative Vitamin D and Calcium Administration in Patients Undergoing Thyroidectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective: This systematic review and meta-analysis aimed to assess whether preoperative administration of calcium and vitamin D prevents postoperative hypocalcemia. Data Sources: A computerized search in Medline, Embase, and CENTRAL databases was performed. Review Methods: Trials comparing preoperative calcium and vitamin D administration with either placebo or nothing were eligible for inclusion. The primary outcomes were the occurrence of laboratory hypocalcemia, mean postoperative calcium level, and symptomatic hypocalcemia. The secondary outcomes were the development of permanent hypoparathyroidism and length of hospitalization. Continuous outcomes were represented as standardized mean difference (SMD), and dichotomous outcomes were represented as risk ratio (RR). Results: Nine trials that enrolled 1079 patients were found eligible. Postoperative laboratory hypocalcemia occurred less in patients who received preoperative calcium and vitamin D, but it was not statistically significant (RR = 0.77, 95% CI: 0.60-1.00; P = .05). Mean postoperative calcium level was significantly higher in the intervention group (SMD = 0.10, 95% CI: 0.07-0.12; P < .00001). The number of patients with symptomatic hypocalcemia was significantly lower in the intervention group (RR = 0.54, 95% CI: 0.38-0.76; P = .0005). There was no significant difference between the 2 groups in cases of permanent hypoparathyroidism and length of hospitalization. Conclusion: Administration of calcium and vitamin D preoperatively achieves lower rates of postthyroidectomy symptomatic hypocalcemia in comparison with no intervention.

Minimally invasive sacroiliac joint fusion using triangular titanium implants versus nonsurgical management for sacroiliac joint dysfunction: a systematic review and meta-analysis.

BACKGROUND: Minimally invasive sacroiliac joint (MISIJ) fusion is a surgical option to relieve SIJ pain. The aim of this systematic review and meta-analysis was to compare MISIJ fusion with triangular titanium implants (TTI) to nonoperative management of SIJ dysfunction. METHODS: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included prospective clinical trials that compared MISIJ fusion to nonoperative management in individuals with chronic low back pain attributed to SIJ dysfunction. We evaluated pain on visual analogue scale, Oswestry Disability Index (ODI) score, health-related quality of life (HRQoL) using the 36-Item Short Form Health Survey (SF-36) physical component (PCS) and mental component summary (MCS) scores, patient satisfaction, and adverse events. RESULTS: A total of 8 articles representing 3 trials that enrolled 423 participants were deemed eligible. There was a significant reduction in pain score with MISIJ fusion compared with nonoperative management (standardized mean difference [SMD] -1.71, 95% confidence interval [CI] -2.03 to -1.39). Similarly, ODI scores (SMD -1.03, 95% CI -1.24 to -0.81), SF-36 PCS scores (SMD 1.01, 95% CI 0.83 to 1.19), SF-36 MCS scores (SMD 0.72, 95% CI 0.54 to 0.9), and patient satisfaction (odds ratio 6.87, 95% CI 3.73 to 12.64) were significantly improved with MISIJ fusion. No significant difference was found between the 2 groups with respect to adverse events (SMD -0.03, 95% CI -0.28 to 0.23). CONCLUSION: Our analysis showed that MISIJ fusion with TTI shows a clinically important and statistically significant improvement in pain, disability score, HRQoL, and patient satisfaction with a similar adverse event profile to nonoperative management in patients with chronic low back pain attributed to SIJ dysfunction.

Comparison of acetaminophen, ketamine, or ketorolac versus morphine in the treatment of acute renal colic: A network meta-analysis.

BACKGROUND: Renal colic is a disease in which a calculus obstructs the urinary tract, resulting in severe pain do ureteric peristaltic movements. Other symptoms, such as hematuria, nausea, and vomiting, may accompany the pain. This network meta-analysis aimed to compare the efficacy and safety of different analgesic agents for the treatment of acute renal colic. METHODS: Medline, Embase, and CENTRAL databases were searched. Randomized controlled trials (RCTs) that compared different analgesic agents, either alone or in combination were included. For the management of acute renal colic, analgesic agents were selected based on the current standard medical practice. The medications included intravenous acetaminophen, ketamine, ketorolac, and morphine. This study sought to evaluate the pain score on the visual analog scale (VAS) at 15, 30, and 60 min; adverse events; and the utilization of rescue therapy. The efficacy of different analgesic agents was explored through a frequentist network meta-analysis using the Netmeta statistical package in R software. All treatments were ranked using the Netrank function, yielding P-scores. RESULTS: Twelve RCTs were deemed eligible. As per the P-scores, acetaminophen was the most effective in reducing pain score at 15 min (P-score = 0.74). Ketorolac was the most effective in reducing the pain score at 30 and 60 min (P-score = 0.84) (P-score = 0.99), whereas morphine was the least effective (P-score = 0.07). Moreover, morphine was correlated with the highest odds of adverse events after treatment (P-score = 0.89). Morphine was the most frequently required rescue therapy in cases of suboptimal pain relief (P-score = 0.96). CONCLUSION: This network meta-analysis demonstrated that ketorolac and acetaminophen were the most effective analgesic agents according to the pain score. Morphine showed the highest adverse event profile and the highest rate at which rescue therapy was required for the management of acute renal colic.

Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials.

PURPOSE: To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. METHODS: Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air-bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS: Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6 weeks to 24 months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12 months (OR = 2.24, 95% CI 1.33-3.78) and 24 months (OR = 2.96, 95% CI 1.18-7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6 weeks to 12 months). CONCLUSIONS: Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.

Operative versus non-operative management of primary patellar dislocation: A systematic review and network meta-analysis.

BACKGROUND: Acute patellar dislocation is a common knee injury in adolescents and adults that is associated with a high incidence of medial patellofemoral ligament (MPFL) injuries. The aim of this network meta-analysis was to compare the different operative and non-operative protocols for the management of primary patellar dislocation (PPD). METHODS: We searched Medline, Embase, and CENTRAL databases. We included randomized controlled trials (RCTs) that compared operative and non-operative protocols for adolescent or adult patients with acute traumatic PPD. We sought to evaluate the clinical and functional outcomes of each management protocol by considering the results of Kujala score, Tegner activity score, redislocation rate, and subluxation rate. The effectiveness of the different management protocols was measured through frequentist network meta-analysis, using the Netmeta statistical package in R software. All treatment protocols were ranked using the netrank function, yielding P scores. RESULTS: A total of 10 RCTs were deemed eligible. As per P-scores, open MPFL repair yielded the highest effectiveness with respect to Kujala score (P=0.81) and lowest odds for redislocation (P=0.14) whereas arthroscopic MPFL repair yielded the highest effectiveness with respect to Tegner activity score (P=0.85) and lowest odds for subluxation (P=0.21). Arthroscopic MPFL repair showed a significant reduction in redislocation and subluxation rate. CONCLUSION: This network meta-analysis demonstrated arthroscopic MPFL repair is the most effective treatment protocol for the management of acute primary patellar dislocation.

External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials.

AIM: Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures. METHODS: Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model. RESULTS: A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). DISCUSSION: The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews. CONCLUSION: This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.

Public awareness about glaucoma, cataract, and diabetic retinopathy in Saudi Arabia: a systematic review and meta-analysis.

PURPOSE: To identify the public level of knowledge about the common ophthalmological conditions in Saudi Arabia. METHODS: We searched Medline, Embase, and CENTRAL for relevant literature. We included questionnaire-based cross-sectional studies performed in Saudi Arabia assessing the public awareness and attitude about general knowledge, causes/risk factors, signs/symptoms, disabilities/consequences, and relieving/management measures of the common ophthalmological conditions including glaucoma, cataract, and diabetic retinopathy (DR). The meta-analysis was performed on outcomes reported in ≥ 2 studies utilizing the random-effects model. Quality assessment was done using the Appraisal tool for Cross-Sectional Studies (AXIS) tool. RESULTS: Twenty-eight studies were deemed eligible for inclusion in this review. A total of 72 questions were reported in ≥ 2 studies and were included in the meta-analysis. The total number of participants was 14,408. The meta-analysis estimated that 57.63% (95% confidence interval (CI) 56.87-60.07%), 69.90% (95% CI 67.02-76.07%), and 68.65% (95% CI 65.94-71.23%) of the Saudi public have you ever heard or read about glaucoma, cataract, and DR, respectively. Of the public surveyed in the included studies, 43.68% (95% CI 41.54-45.85%), 55.43% (95% CI 54.03-56.82%), and 63% (95% CI 60.8-65.1%) believed that glaucoma, cataract, and DR could be treated. CONCLUSION: This systematic review showed that the level of knowledge among the Saudi population about the common ophthalmological conditions was the highest with respect to cataract, followed by DR and glaucoma. The areas of unsatisfactory level of awareness about the common ophthalmological conditions included risk factors, signs/symptoms, complications, and management options. These areas need to be addressed appropriately by future educational interventions.

Public awareness about arthritic diseases in Saudi Arabia: a systematic review and meta-analysis.

PURPOSE: Raising public knowledge and perception would have a discernible impact on providing optimal care and reducing the burden of arthritis in the community. This systematic review aimed to identify the public knowledge about the common arthritic conditions in Saudi Arabia. METHODS: We searched MEDLINE, Embase, and CENTRAL for relevant literature. We included questionnaire-based cross-sectional studies performed in Saudi Arabia assessing the public perception of general knowledge, causes/risk factors, signs/symptoms, and relieving/management measures of the common arthritic conditions including osteoarthritis (OA), rheumatoid arthritis (RA), and gout. The meta-analysis was performed on outcomes reported in ≥ two studies utilizing a random-effects model RESULTS: Ten studies representing 6703 participants were deemed eligible for inclusion in this review. A total of 35 questions were feasible to be included in the meta-analysis. The meta-analysis estimated that 83.51%, 54.51%, and 80.42% have ever hearsd or read about OA, RA, and gout. Joint pain and swelling were perceived to be the main signs/symptoms of OA, RA, and gout. 7.5% think OA is predisposed by genetics while only 33.6% think the same of RA. RA knowledge in general is suboptimum. Only 27.04% think medications can help in the management of gout. CONCLUSION: The Saudi public perception of the general knowledge and causes/risk factors of the most common arthritic conditions was acceptable. The level of knowledge about other aspects of the common arthritic conditions is still limited and needs to be addressed by future educational interventions. TRIAL REGISTRATION: PROSPERO registration number: CRD42022345274.

Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. INTRODUCTION: The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF). PURPOSE OF THE STUDY: To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP. METHODS: We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group. RESULTS: Seven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = -0.48, 95% CI -0.73 to -0.22, P < .001; SMD = -0.69, 95% CI -0.97 to -0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups. CONCLUSION: This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses.

Effect of ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis.

BACKGROUND: Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS. METHODS: We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome. RESULTS: A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection. CONCLUSION: This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.

Botulinum toxin type A for lower limb lengthening and deformity correction: A systematic review and meta-analysis.

BACKGROUND: Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. METHODS: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD = -0.28, 95% CI -0.53 to -0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR = 0.77, 95% CI -0.58 to 1.03). CONCLUSIONS: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events. PROSPERO REGISTRATION NUMBER: CRD42021271580.

Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis.

Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR = 2.56, 95% CI 1.37-4.78 and OR = 3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.

Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background: Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques. Methods: We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes. Results: A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = - 0.21, 95% CI - 0.34 to - 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI - 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI - 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85). Conclusions: Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00718-0.

Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: A systematic review and meta-analysis.

BACKGROUND: Trigeminal neuralgia is characterized by pain at the distribution of one or more of the trigeminal nerve branches and is usually treated with anti-epileptic medication. When first line treatment fails, patients receive other treatment modalities including radiofrequency thermoablation (RFT) of the Gasserian ganglion and peripheral branches of the trigeminal nerve. The aim of this study is to compare RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve in terms of efficacy and rate of complications. METHODS: This was a systematic review and meta-analysis that searched Medline, Cochrane Central Register of Controlled Trials, and Embase using Medical Subject Headings and the references of the enrolled studies with no restriction on date. We included only RCTs that compared the RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve with one of the following outcomes: pain scales, immediate effective rate, recurrence rate, and complications. RESULTS: Five articles were eligible for our review and showed that there was no difference between RFT of the peripheral nerves and the Gasserian ganglion in terms of pain scores. There was a non-significant trend for RFT of the peripheral nerve to have higher immediate effect rates and higher recurrence rates. RFT of the Gasserian ganglion group was associated with masticatory weakness, while the other group was associated with facial swelling and numbness of V2. CONCLUSION: RFT of the peripheral branches is a safe and effective method to treat idiopathic trigeminal neuralgia but leads to a higher recurrence rate when compared with RFT of the Gasserian ganglion.

Non-inferior and more feasible transcutaneous tibial nerve stimulation in treating overactive bladder: A systematic review and meta-analysis.

OBJECTIVES: Overactive bladder (OAB) is identified as a urinary urgency accompanied by frequency and nocturia with or without urgency urinary incontinence in the nonexistence of a urinary tract infection or other evident pathologies. This systematic review and meta-analysis aimed to evaluate the efficacy of the transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) or anticholinergic drugs in reducing symptoms and improving the quality of life for OAB patients. METHODS: We performed a systematic search in Medline, Embase, and CENTRAL, in which we included randomized controlled trials that compared TTNS with anticholinergic drugs or PTNS in treating idiopathic OAB. We evaluated the following outcomes: 3-day voiding diary (voiding frequency/day, daytime micturition frequency/day, nighttime micturition frequency/day, number of urgency episodes/day, number of incontinence episodes/day, and mean voiding volume), symptom bother, health related quality of life (HRQoL), and adverse events. We used 95% as a confidence interval (CI) and p < 0.05. Standardized mean difference (SMD) was used for continuous outcomes, and the risk ratio (RR) was used for dichotomous outcomes. RESULTS: There was no significant difference comparing TTNS with anticholinergic drugs or PTNS regarding voiding frequency/day (SMD = -0.01, 95% CI -0.33 to 0.32), nighttime micturition frequency/day (SMD = -0.28, 95% CI -0.94 to 0.37), number of urgency episodes/day (SMD = -0.05, 95% CI -0.36 to 0.26), number of incontinence episodes/day (SMD = -0.04, 95% CI -0.32 to 0.25), symptom bother (SMD = -0.19, 95% CI -0.55 to 0.16), HRQoL (SMD = 0.27, 95% CI -0.32 to 0.85), and adverse events (RR = 0.07, 95% CI 0.01 to 0.54). CONCLUSION: The current meta-analysis reveals that there is no statistically significant difference between TTNS versus PTNS or anticholinergic drugs for the nonsurgical management of OAB patients.

Influence of perioperative opioid-related patient education: A systematic review and meta-analysis.

OBJECTIVE: To determine the role of perioperative protocolized opioid-specific patient education on opioid consumption for individuals undergoing surgical procedures. METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) that compared protocolized perioperative opioid-specific patient education to the usual care for adult individuals undergoing surgical interventions. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: In total, 15 RCTs that enrolled 2546 participants were deemed eligible. Protocolized opioid-specific patient education showed a significant reduction in postoperative opioid consumption and postoperative pain score compared to usual care (SMD= -0.15, 95% confidence interval [CI]: -0.28 to -0.03 and SMD= -0.17, 95% CI: -0.28 to -0.06, respectively). No significant difference was found between the protocolized opioid-specific patient education and the usual care in terms of the number of refill requests (RR=0.82, 95% CI: 0.50-1.34), patients with opioid leftovers (RR=0.92, 95% CI: 0.78-1.08), and patients taking opioids after hospital discharge. CONCLUSIONS: This meta-analysis demonstrated that protocolized opioid-specific patient education significantly reduces postoperative opioid consumption and pain score but has no influence on the number of opioid refill requests, opioid leftovers, and opioid use after hospital discharge. PRACTICE IMPLICATIONS: Healthcare professionals may offer opioid-related educational sessions for the surgical patients during the perioperative period through a video-based material that emphasizes the role of alternative analgesics to opioids, patients' expectations about the post-operative pain, and the potential side effects of opioid consumptions.

Equiosmolar hypertonic saline and mannitol for brain relaxation in patients undergoing supratentorial tumor surgery: A systematic review and meta-analysis.

Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to reduce intracranial pressure (ICP) and provide a satisfactory brain relaxation. The aim of the study was to perform a systematic review and meta-analysis to compare the efficacy of HS and mannitol on brain relaxation intraoperatively in patient undergoing craniotomies for supra-tentorial brain tumors. Methods: A systematic review and meta-analysis of randomized control trials. We included randomized control trials that compared equiosmolar HS and mannitol in supratentorial tumors craniotomies and reported at least one of the following outcomes: degree of brain relaxation, ICP, central venous pressure, mean arterial pressure, perioperative fluid input, urine output, Na+ levels, and K+ levels. We searched Medline, Cochrane Central Register of Controlled Trials, and Embase using MESH terms and keywords. The bibliographic references of included studies and trial registries were also searched. Results: Seven articles were included. The degree brain of relaxation was comparable across the two groups with slight tendency toward HS (RR = 1.13, 95% CI 0.99-1.29; P = 0.08). Mannitol was associated with significantly higher urine output (standardized mean difference [SMD] = -1.33, 95% CI -1.56--1.10; P < 0.001). Na+ levels were higher in HS group (SMD = 1.47, 95% CI 0.86-2.09; P < 0.001). Mannitol was associated with non-significant decrease in CVP and increase fluid input (SMD = 0.42, 95% CI 0.00-0.85 and SMD = -0.18, 95% CI -0.37-0.02, respectively). Conclusion: Both HS and mannitol are associated with satisfactory brain relaxation with a non-statistically significant tendency for HS to achieve better relaxation scores with mannitol resulting in higher urine output while HS with higher Na+ levels.

Intravitreal Anti-vascular Endothelial Growth Factor Injection for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis.

Background: Laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections constitute the current standard treatment for retinopathy of prematurity (ROP). This systematic review and meta-analysis aimed to assess the efficacy and safety of anti-VEGF monotherapy for ROP treatment using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Methods: We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included randomized controlled trials (RCTs) that compared intravitreal anti-VEGF monotherapy (e.g., bevacizumab, ranibizumab, aflibercept, and pegaptanib) with laser photocoagulation in preterm infants with ROP. We evaluated the rates of recurrence, treatment switching, retreatment, adverse events, and mortality. The risk ratio (RR) was used to represent dichotomous outcomes. Data were pooled using the inverse variance weighting method. The quality of evidence was assessed using the GRADE approach. Risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials. Results: Seven RCTs (n = 579; 1,158 eyes) were deemed eligible. Three RCTs had an overall low risk of bias, three had some concerns, and one had an overall high risk of bias. The pooled effect estimate showed a statistically significant reduction in adverse events in favor of anti-VEGF monotherapy [RR = 0.17, 95% confidence interval (CI) 0.07-0.44]. The pooled analysis showed no significant difference between the anti-VEGF and laser groups in terms of recurrence rate (RR = 1.56, 95% CI 0.23-10.54), treatment switching (RR = 2.92, 95% CI 0.40-21.05), retreatment (RR = 1.56, 95% CI 0.35-6.96), and mortality rate (RR = 1.28, 95% CI 0.48-3.41). Conclusion: Overall, intravitreal anti-VEGF monotherapy was associated with fewer adverse events than laser therapy, rated as high quality of evidence according to the GRADE criteria. Pooled analysis revealed no significant difference between the two arms with respect to the recurrence rate, treatment switching, retreatment, and mortality rate, with quality of evidence ranging from moderate to very low as per the GRADE approach. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42021270077].

Efficacy and safety of apremilast monotherapy in moderate-to-severe plaque psoriasis: A systematic review and meta-analysis.

Psoriasis is a chronic, inflammatory, immune-mediated disease of the skin and joints. Plaque psoriasis is the most common clinical phenotype of psoriasis. Apremilast is an oral phosphodiesterase type 4 inhibitor recently approved by the US Food and Drug Administration (FDA) for the management of plaque psoriasis. The aim of this systematic review was to assess the efficacy and safety of apremilast monotherapy for the treatment of moderate-to-severe plaque psoriasis. This systematic review included randomized controlled trials (RCTs) comparing apremilast 20 mg twice daily (BID) and 30 mg BID with placebo for its efficacy on plaque psoriasis. We searched the Medline, Embase, and CENTRAL databases. We sought to evaluate the following outcomes: psoriasis area and severity index score (PASI)-50, PASI-75, PASI-90, static Physician Global Assessment (sPGA), and adverse events. The risk ratio (RR) was used to represent dichotomous outcomes and adverse events, and the data were pooled using the inverse variance weighting method. Eight RCTs that enrolled 2635 participants were deemed eligible. Apremilast 30 mg BID and 20 mg BID were significantly more efficacious than placebo in achieving PASI-75 over 16 weeks (RR = 4.60, 95% CI 3.29-6.41, and RR = 3.15, 95% CI 1.96-5.07, respectively). Apremilast 30 mg BID showed a significantly higher rate of adverse events than the placebo (RR = 1.24, 95% CI 1.16-1.33), whereas apremilast 20 mg BID did not exhibit any significant difference (RR = 1.13, 95% CI 0.91-1.42). This meta-analysis demonstrated that apremilast monotherapy is an effective therapeutic option for moderate-to-severe plaque psoriasis with acceptable tolerability and safety profile.