Magnetic nanocomposite of maize offal biomass for effective sequestration of Congo red and methyl orange dyes from contaminated water: modeling, kinetics and reusability.

The current study aims to use a facile and novel method to remove Congo red (CR) and Methyl Orange (MO) dyes from contaminated water with Maize offal biomass (MOB) and its nanocomposite with magnetic nanoparticles (MOB/MNPs). The MOB and MOB/MNPs were characterized with Fourier-transform infrared (FTIR), scanning electron microscopy (SEM), BET, XRD and point of zero charge (pHPZC). The influence of initial CR and MO levels (20-320 mg/L), adsorbent dosage (1-3 g/L), pH (3-9), co-exiting ions, temperature (25-45 °C) and time (15-180 min) was estimated. The findings demonstrated that MOB/MNPs exhibited excellent adsorption of 114.75 and 29.0 mg/g for CR and MO dyes, respectively while MOB exhibited 81.35 and 23.02 mg/g adsorption for CR and MO dyes, respectively at optimum pH-5, and dose 2 g/L. Initially, there was rapid dye removal which slowed down until equilibrium was reached. The interfering/competing ions in contaminated water and elevated temperature favored the dyes sequestration. The MOB/MNPs exhibited tremendous reusability and stability. The dyes adsorption was spontaneous, and exothermic with enhanced randomness. The adsorption effects were well explained with Freundlich model, pseudo second order and Elovich models. It is concluded that MOB/MNPs showed excellent, eco-friendly, and cost-effective potential to decontaminate the water.

Nanocomposite of Maize offal biomass demonstrated higher dyes removal.FTIR, SEM, BET, XRD and pH_PZC provided vital evidence for dyes adsorption.MOB/MNPs displayed excellent stability and reusability for dyes adsorption.Groundwater samples exposed a higher dyes removal.Results were validated with equilibrium and kinetic adsorption models.

Food waste: causes and economic losses estimation at household level in Pakistan.

Food waste is one of the major sustainability issues that need to be addressed due to its negative impacts on the economy, environment, and food security. To develop food waste reduction policies on regional and global level, it is mandatory to have a clear understanding of the various factors prompting food waste at household level and the extent of the economic losses incurred by food waste. Reducing food waste can decrease household expenditure on food, freeing resources for health, education, and well-being. The current study was aimed to (1) examine the food waste behavior of the respondents and to (2) determine the level of monetary losses from food waste. To address these objectives, a questionnaire survey and sample of food waste generated during 24 h were collected from 51 households in Tehsil Kahror Pakka, District Lodhran, Punjab, Pakistan. The survey focus was on levels of food waste and respondents' knowledge and behaviors about food waste. Economic estimation of food waste was also done. In the survey, respondents from both high- and low-income households revealed that their fruit and vegetables (31%; 32%) and peel and scrap (53%; 48%) losses were higher while egg losses (4%; 4%) were lower among various food waste categories. Wanting to eat fresh food and having no time to save food were the reasons for food waste. Monetary losses from food waste (US$ 12.8/Rs. 3677.01 per capita per annum) were higher in high-income households compared to low-income households.

Alcohol-Containing Versus Aqueous-Based Solutions for Skin Preparation in Abdominal Surgery: A Systematic Review and Meta-analysis.

INTRODUCTION: The use of optimal skin antiseptic agents for the prevention of surgical site infection (SSI) is of critical importance, especially during abdominal surgical procedures. Alcohol-based chlorhexidine gluconate (CHG) and aqueous-based povidone-iodine (PVI) are the two most common skin antiseptics used nowadays. The objective of this article is to evaluate the effectiveness of alcohol-based CHG versus aqueous-based PVI used for skin preparation before abdominal surgery to reduce SSIs. METHODS: Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomized, controlled trials comparing alcohol-based CHG skin preparation versus aqueous-based PVI in patients undergoing abdominal surgery. The combined outcomes of SSIs were calculated using odds ratio with 95% confidence intervals. All data were analyzed using Review Manager Software 5.4, and the meta-analysis was performed with a random effect model analysis. RESULTS: A total of 11 studies, all randomized, controlled trials, were included (n = 12,072 participants), recruiting adult patients undergoing abdominal surgery. In the random effect model analysis, the use of alcohol-based CHG in patients undergoing abdominal surgery was associated with a reduced risk of SSI compared to aqueous-based PVI (odds ratio: 0.84; 95% confidence interval [0.74, 0.96], z = 2.61, P = 0.009). CONCLUSIONS: Alcohol-based CHG may be more effective for preventing the risk of SSI compared to aqueous-based PVI agents in abdominal surgery. The conclusion of this meta-analysis may add a guiding value to reinforce current clinical practice guidelines.

Biowaste-based sorbents for arsenic removal from aqueous medium and risk assessment.

Water contamination by arsenic (As) is widespread and is posing serious health threats globally. Hence, As removal techniques/adsorbents need to be explored to minimize potentials hazards of drinking As-contaminated waters. A column scale sorption experiment was performed to assess the potential of three biosorbents (tea waste, wheat straw and peanut shells) to remove As (50, 100, 200 and 400 µg L-1) from aqueous medium at a pH range of 5-8. The efficiency of agricultural biosorbents to remove As varies greatly regarding their type, initial As concentration in water and solution pH. It was observed that all of the biosorbents efficiently removed As from water samples. The maximum As removal (up to 92%) was observed for 400 µg L-1 initial As concentration. Noticeably, at high initial As concentrations (200 and 400 µg L-1), low pH (5 and 6) facilitates As removal. Among the three biosorbents, tea waste biosorbent showed substantial ability to minimize health risks by removing As (up to 92%) compared to peanut shells (89%) and wheat straw (88%). Likewise, the values of evaluated risk parameters (carcinogenic and non-carcinogenic risk) were significantly decreased (7-92%: average 66%) after biosorption experiment. The scanning electron microscopy, Fourier transform infrared spectroscopy, energy-dispersive X-ray and X-ray diffraction analyses confirmed the potential of biosorbents to remediate As via successful loading of As on their surfaces. Hence, it can be concluded that synthesized biosorbents exhibit efficient and ecofriendly potential for As removal from contaminated water to minimize human health risk.

Relationship Between Mass Loss and Fruit Quality of Sweet Orange at Two Different Storage Conditions.

Mass loss from fresh produce is linked to a reduction of its aesthetic value. However, a relationship between mass loss and biochemical quality parameters at different storage conditions has not been widely explored. Therefore, the current study is designed with the objectives to determine the behavior of fruit quality parameters and a relationship between fruit mass loss and fruit quality at two different storage conditions. Sweet orange fruit stored in a zero energy cool chamber (ZECC) had greater shelf-life of more than 15 days, fruit size (62.40 mm) and peel (35.15%) and lower mass loss (4.94%), juice (32.19%) and electrical conductivity (EC) (2.06 S/m) as compared to ambient conditions in laboratory during 25 days of storage. In ZECC, only EC was positively correlated (r = 0.57) with mass loss, whereas at room temperature EC (r = 0.76), total soluble solids (TSS) (r = 0.60) and fruit internal temperature (r = 0.64) were positively and peel (%) (r = -0.52) and fruit diameter (r = -0.49) were negatively correlated with mass loss. Correlation of combined storage conditions revealed that EC (r = 0.47) and TSS (r = 0.50) were positively and peel (%) (r = -0.77) and fruit diameter (r = -0.55) were negatively correlated with mass loss (%). The principal component analysis (PCA) revealed that the scores of room temperature were strongly associated with TSS, pH, EC, mass loss (%), juice (%) and internal temperature (°C), whereas scores of ZECC were strongly associated with pulp (%), ascorbic acid (mg 100 mL-1), acidity (%), and fruit diameter (mm).

Meta-Analysis of Randomized Controlled Trials Comparing the Efficacy of Radioactive Iodine Monotherapy versus Radioactive Iodine Therapy and Adjunctive Lithium for the Treatment of Hyperthyroidism.

Background: The objective of this article is to evaluate the outcomes in patients undergoing radioactive iodine (RAI) with adjunctive lithium (Li) therapy versus (vs.) RAI therapy alone for the treatment of hyperthyroidism.Methods: A systematic review of the literature was undertaken to analyze clinical trials comparing RAI with adjunctive Li therapy vs. RAI therapy alone for the treatment of hyperthyroidism.Results: Six randomized-controlled trials (RCT) involving 755 patients were analyzed. RAI with adjunctive Li was associated with a significantly higher cure rate for hyperthyroidism when compared to RAI alone. Furthermore, a significantly higher cure rate for hyperthyroidism at 12 months was achieved with RAI and adjunctive Li. Adjuvant Li with RAI for ≤ 7 days showed significantly higher cure rate compared to RAI alone, whereas > 7 days of adjuvant Li with RAI did not show any difference in cure rate compared to RAI alone. RAI with adjunctive Li was associated with a significantly higher cure rate for patients with Graves' disease compared to RAI alone. There was no significant difference between RAI with adjunctive Li and RAI alone for toxic nodular thyroid disorder (toxic nodule and toxic multinodular goiter) and thyroid volume >40 grams and ≤40 grams.Conclusions: RAI with adjunctive Li therapy demonstrated superiority over RAI therapy alone with regards to both curing hyperthyroidism and, reduced time till cure, with a limited side effect profile. A large multicenter RCT is required, and if this confirms the data from these smaller trials, then this could change current practice.

Cadmium Partitioning, Physiological and Oxidative Stress Responses in Marigold (Calendula calypso) Grown on Contaminated Soil: Implications for Phytoremediation.

Marigold (Calendula calypso) is a multipurpose ornamental plant, but its cadmium (Cd) tolerance and phytoremediation potential is unknown. The proposed study was carried out to unravel Cd partitioning, physiological and oxidative stress responses of C. calypso grown under Cd stress. Plants were grown for four months in pots having different soil Cd levels: 0, 25, 50, 75, and 100 mg kg-1 soil. Plant growth, biomass, photosynthetic pigments, leaf water contents, stomatal conductance, and membrane stability index were not decreased at 25 mg kg-1 Cd. At higher levels of Cd stress, activities of antioxidant enzymes (SOD, APX, CAT, POD) increased to mitigate H2O2 and lipid peroxidation. Cadmium uptake in plants increased with increasing soil Cd levels, and roots accumulated a greater portion of Cd, followed by shoots and flowers, respectively. On the basis of Cd accumulation and its tolerance, it was determined that C. calypso can be successfully grown for phytostabilization of Cd contaminated soils.

Role of laparoscopic cholecystectomy in the management of chronic right upper quadrant pain due to biliary dyskinesia: a systematic review and meta-analysis.

BACKGROUND: The objective of this study was to evaluate the surgical outcomes and feasibility of performing laparoscopic cholecystectomy (LC) in patients with longstanding right upper quadrant pain secondary to biliary dyskinesia. METHODS: A systematic review of the literature including published randomized, controlled trials, non-randomized trials and comparative trials of any type, reporting outcomes of LC in the management of chronic right upper quadrant pain in patients with biliary dyskinesia, using the principles of meta-analysis on RevMan 5.3 statistical software, was undertaken. RESULTS: Thirteen studies including 740 patients evaluating the symptomatic improvement following LC in patients with biliary dyskinesia presenting as chronic right upper quadrant pain were included. There were 542 patients in LC group and 198 patients in Non-LC group. Successful complete resolution of symptoms was more likely to be achieved in LC group [risk ratio (RR), 0.21; 95% confidence interval (CI), 0.09-0.50, P=0.00001]. In addition, the risk of failure to resolve symptoms (risk ratio, 0.15; 95% CI, 0.05-0.39, P=0.00001) was lower in LC group. CONCLUSIONS: LC may be considered as an acceptable surgical intervention in patients with biliary dyskinesia presenting with chronic right upper quadrant pain. Currently there is insufficient evidence to recommend the routine use of LC in every patient with biliary dyskinesia. Paucity of high power randomised, controlled trials is the major reason for this lack of evidence which should be addressed soon and until then current study may be used to provide the basis for offering LC in selected group of patients.

Synergistic effects of bismuth coupling on the reactivity and reusability of zerovalent iron nanoparticles for the removal of cadmium from aqueous solution.

Removal of cadmium (Cd2+), a highly toxic heavy metal, from aqueous solutions was investigated using nano zerovalent iron (Fe0). Cadmium was efficiently removed by Fe0, although reactivity and reusability of Fe0 was significantly promoted by coupling with bismuth (Bi). At a reaction time of 20 min, 85% and 96% Cd2+ was removed by Fe0 and Bi/Fe0, respectively, at first cycle using [Cd2+]0 = 10 mg/L and [Fe0]0 = [Bi/Fe0]0 = 1.0 g/L. However, Cd2+ removal efficiency was reduced to 12% and 80% at sixth cycle by Fe0 and Bi/Fe0, respectively. The X-Ray diffraction and energy dispersive X-Ray spectroscopy analysis proved successful formation of Fe0 by the chemical reduction method and also confirmed coupling of Bi with Fe0 to form bimetallic Bi/Fe0. The oxidation of Fe0 and Bi/Fe0 yielded electron that played significant role in the conversion of toxic Cd2+ into non-toxic Cd0. The reactivity of electron with Cd2+ was calculated to be 4.3 × 109 M-1 s-1. The pH of solution showed pronounced effects on the reactivity of both Fe0 and Bi/Fe0. Removal of Cd2+ by both Fe0 and Bi/Fe0 followed pseudo-first-order kinetic model. The conversion of Cd2+ into non-toxic Cd0 proved Fe0 and Bi/Fe0 to be highly efficient and rewarding in detoxification of Cd2+ and other toxic metals in aqueous environments.

Greener synthesis of zinc oxide nanoparticles using Trianthema portulacastrum extract and evaluation of its photocatalytic and biological applications.

Synthesis of nanoparticles (NPs) through "green" chemistry is an exciting area of research with wide applications. Trianthema portulacastrum's extract containing greater amount of reducing agents has been explored first time for the synthesis of ZnO-NPs that characterized with UV/Vis, XRD, FT-IR, SEM,EDX, HR-TEM and XPS. The particles of ZnO-NPs are crystalline and having the size in the range of 25-90 nm. The cell viability of ZnO-NPs was studied using Mouse pre-osteoblast cell line MC3T3-E1 sub-clone 14 cells which confirmed its biocompatibility that render for biomedical applications. The antibacterial properties were evaluated against Staphylococcus aureus and Escherichia coli which showed high potency of synthesized ZnO-NPs against these species. The antifungal activities of ZnO-NPs were screened against Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus of fungal species. The antioxidant activity of the as-synthesized NPs was also studied using DPPH (2, 2-diphenyl-1-picrylhydrazyl) substrate. The ZnO-NPs were evaluated for catalytic activity through degradation of Synozol Navy Blue-KBF textile dye using solar irradiation that causes 91% degradation of the dye in 159 min. Mechanistic pathways for the degradation of Synozol Navy Blue-KBF dye using ZnO-NPs were also proposed from the pattern of the degradation of the dye and the resulting by-products. The results concluded that the ZnO-NPs synthesized by green method have high biological and photocatalytic applications.

Meta-analysis of randomized controlled trials only exploring the role of single incision laparoscopic surgery versus conventional multiport laparoscopic surgery for colorectal resections.

BACKGROUND: The objective of this article is to evaluate the surgical outcomes in patients undergoing single incision laparoscopic surgery (SILS) versus conventional multi-incision laparoscopic surgery (MILS) for colorectal resections. METHODS: The data retrieved from the published randomized controlled trials (RCTs) reporting the surgical outcomes in patients undergoing SILS versus MILS for colorectal resections was analysed using the principles of meta-analysis. The combined outcome of dichotomous data was represented as risk ratio (RR) and continuous data was shown as standardized mean difference (SMD). RESULTS: Five RCTs on 525 patients reported the colorectal resections by SILS versus MILS technique. In the random effects model analysis using the statistical software Review Manager 5.3, the operation time (SMD, 0.20; 95% CI, -0.11 to 0.52; z=1.28; P=0.20), length of in-patient stay (SMD, -0.18; 95% CI, -0.51 to 0.14; z=1.10; P=0.27) and lymph node harvesting (SMD, 0.09; 95% CI, -0.14 to 0.33; z=0.76; P=0.45) were comparable between both techniques. Furthermore, post-operative complications (RR, 1.00; 95% CI, 0.65-1.54; z=0.02; P=0.99), post-operative mortality, surgical site infection rate (RR, 3.00; 95% CI, 0.13-70.92; z=0.68; P=0.50), anastomotic leak rate (RR, 0.43; 95% CI, 0.11-1.63; z=1.24; P=0.21), conversion rate (P=0.13) and re-operation rate (P=0.43) were also statistically similar following SILS and MILS. CONCLUSIONS: SILS failed to demonstrate any superiority over MILS for colorectal resections in all post-operative surgical outcomes.

Improving the mucosal visualization at gastroscopy: a systematic review and meta-analysis of randomized, controlled trials reporting the role of Simethicone ± N-acetylcysteine.

BACKGROUND: The objective of this article is to study the role of Simethicone ± N-acetylcysteine in improving the mucosal visualization during oesophago-gastro-duodenoscopy (OGD). METHODS: The data retrieved from the published randomized controlled trials (RCTs) reporting the role of Simethicone ± N-acetylcysteine during OGD was analysed using the principles of meta-analysis. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR). RESULTS: Three RCTs on 654 patients reported OGD with and without pre-procedure oral administration of Simethicone ± N-acetylcysteine evaluating visibility as good or excellent in number during the procedure. In the random effects model analysis using the statistical software Review Manager 5.3, the use of Simethicone ± N-acetylcysteine was associated with improved (OR, 0.43; 95% CI, 0.28, 0.68; z=3.65; P=0.0003) mucosal visibility. Four RCTs on 364 patients reported OGD with and without pre-procedure oral administration of Simethicone ± N-acetylcysteine evaluating visibility score in study group. In the random effects model analysis using the statistical software Review Manager 5.3, the use of Simethicone ± N-acetylcysteine was associated with improved (SMD, -1.66; 95% CI, -1.93, -1.40; z=12.25; P=0.00001) mucosal visibility score compared to no-Simethicone group. CONCLUSIONS: The findings of current study on 1,099 patients successfully demonstrate that the pre-procedure oral administration of Simethicone ± N-acetylcysteine improves mucosal visualization and mucosal visualization score during OGD.

Quantification of capsaicinoids in chillies by solid-phase extraction coupled with voltammetry.

Capsaicinoids were extracted from a range of spices and chillies using methanol, prior to concentrating the compounds using solid-phase extraction cartridges and water/methanol (50:50% v/v) as the solvent, followed by elution with acetonitrile. The primary extraction procedure, involving only sonication of the spices in methanol, gave results comparable to a procedure that used a combination of sonication, stirring and centrifuging. The voltammetric quantification of the capsaicinoids, at approximately +0.5 V vs. ferrocene0/+ that were transferred from methanol/water into acetonitrile/water via solid phase extraction, was carried out in microcentrifuge tubes. Linear calibration curves for voltammetry measurements were obtained from low ppm up to at least 1400 ppm of capsaicinoids, with concentrations being detected in the different source extracts (paprika, tabasco sauce, cayenne pepper, and fresh chillies) from approximately 17 to 430 ppm, which corresponded to values of between approximately 130 and 4000 ppm, respectively, present in the original samples.

Determining the efficacy of guppies and pyriproxyfen (Sumilarv® 2MR) combined with community engagement on dengue vectors in Cambodia: study protocol for a randomized controlled trial.

BACKGROUND: Evidence on the effectiveness of low-cost, sustainable, biological vector-control tools for the Aedes mosquitoes is limited. Therefore, the purpose of this trial is to estimate the impact of guppy fish (guppies), in combination with the use of the larvicide pyriproxyfen (Sumilarv® 2MR), and Communication for Behavioral Impact (COMBI) activities to reduce entomological indices in Cambodia. METHODS/DESIGN: In this cluster randomized controlled, superiority trial, 30 clusters comprising one or more villages each (with approximately 170 households) will be allocated, in a 1:1:1 ratio, to receive either (1) three interventions (guppies, Sumilarv® 2MR, and COMBI activities), (2) two interventions (guppies and COMBI activities), or (3) control (standard vector control). Households will be invited to participate, and entomology surveys among 40 randomly selected households per cluster will be carried out quarterly. The primary outcome will be the population density of adult female Aedes mosquitoes (i.e., number per house) trapped using adult resting collections. Secondary outcome measures will include the House Index, Container Index, Breteau Index, Pupae Per House, Pupae Per Person, mosquito infection rate, guppy fish coverage, Sumilarv® 2MR coverage, and percentage of respondents with knowledge about Aedes mosquitoes causing dengue. In the primary analysis, adult female Aedes density and mosquito infection rates will be aggregated over follow-up time points to give a single rate per cluster. This will be analyzed by negative binomial regression, yielding density ratios. DISCUSSION: This trial is expected to provide robust estimates of the intervention effect. A rigorous evaluation of these vector-control interventions is vital to developing an evidence-based dengue control strategy and to help direct government resources. TRIAL REGISTRATION: Current Controlled Trials, ID: ISRCTN85307778 . Registered on 25 October 2015.

Minimally invasive surgery for gastric cancer in UK: current status and future perspectives.

The aim of this study is to review the literature and report the various minimally invasive methods used to treat gastric cancer in the UK and compare it with worldwide practice. Published randomised studies, non-randomised studies and case series reporting the use of minimal invasive approach to treat gastric cancer were retrieved from the search of standard medical electronic databases and their outcomes were highlighted suggesting their effectiveness. Several randomised, controlled trials and meta-analyses have proven the clinical and oncological safety of the laparoscopic gastrectomy for gastric cancer. Similarly, robot-assisted gastrectomy, EMR (endoscopic mucosal resection) and ESD (endoscopic sub-mucosal dissection) have also been proven feasible and safe to treat gastric cancer of various stages in prospective and retrospective comparative studies. However, UK based studies on minimally invasive surgery to treat gastric cancer is scarce and the paucity of trials led to uncertain outcomes. Laparoscopic gastrectomy, robot-assisted gastrectomy, EMR and ESD are feasible procedures in terms of clinical and oncological safety but mainly being practiced in Asian countries with high prevalence of stomach cancer. The UK based practice is still small and limited but the introduction of MIGOCS and STOMACH trial might help to widen the application of this technique.

A critical appraisal of the cost effectiveness of laparoscopic colorectal surgery for oncological and non-oncological resections.

The aim of this study was to critically appraise the cost effectiveness of the laparoscopic colorectal (LCRS) surgery using published randomised, control trials (RCTs). Published RCTs comparing the cost effectiveness of LCRS with conventional open surgery were selected from the search of standard electronic databases and the extracted data were analysed using the statistical software RevMan 5.3. Seven RCTs on 2197 patients reported the cost effectiveness of the LCRS. There was significant heterogeneity (τ 2 = 161,772.25, χ 2 = 166.69, df = 6, p = 0.00001, I 2 = 96%) among included randomised, controlled trials. In the random effects model analysis (MD 320.37, 95% CI -38.21, 678.95, z = 1.75, p < 0.08), the LCRS was costing £320.37 more than open colorectal resection but it failed to reach the statistical significance indicating that LCRS is as much cost effective as the open approach. LCRS is a cost effective intervention and should be offered routinely to all patients requiring colorectal resections provided the resources and expertise are available.

A systematic review of clinical effectiveness of wound edge protector devices in reducing surgical site infections in patients undergoing abdominal surgery.

This article highlights the clinical effectiveness of wound edge protector devices (WEPD) in preventing the post-operative surgical site infections (SSI) in patients undergoing abdominal surgery. Using the principles of meta-analysis and systematic review as recommended by the Cochrane Collaboration, the data from selected randomized, controlled trials (RCTs) were analysed to generate summated outcome and presented in the form of odds ratio (OR). Eighteen RCTs on 3808 reported the effectiveness of WEPD in patients undergoing abdominal surgery. The use of WEPD was associated with the reduced incidence of overall SSI (OR 0.59; 95% CI 0.43-0.81; z = 3.30; p < 0.001) and superficial SSI (OR 0.42; 95% CI 0.18-0.95; z = 2.09; p < 0.04). In addition, WEPD also successfully reduced the risk of SSI in clean-contaminated wounds (OR 0.67; 95% CI 0.46-0.98; z = 2.06; p < 0.04) as well as in contaminated wounds (OR 0.24; 95% CI 0.12-0.49; z = 3.96; p < 0.0001). WEPD seems to be an effective intervention to reduce the risk of post-operative SSI in patients undergoing abdominal surgery.

Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials.

OBJECTIVE: The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD). METHODS: RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference. RESULTS: Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups. CONCLUSION: CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing.

Improving the view during flexible sigmoidoscopy: a systematic review of published randomized, controlled trials comparing the use of oral bowel preparation versus enema bowel preparation.

To systematically analyse the published randomized, controlled trials (RCTs) comparing the use of oral bowel preparation (OBP) versus enema bowel preparation (EBP) for diagnostic or screening flexible sigmoidoscopy. Published RCTs, comparing the use of OBP versus EBP, were analysed using RevMan(®), and the combined outcomes were expressed as odds ratios (OR). Eight RCTs evaluating 2457 patients were retrieved from the standard electronic databases. There was significant heterogeneity among included trials. The compliance of the patients (p = 0.32) and the acceptability of both bowel preparation regimens (OR, 1.42; 95% CI, 0.67, 2.99; z = 0.92; p = 0.36) were similar in both groups. In addition, the incidence of adverse reactions (OR, 0.87; 95% CI, 0.54, 1.41; z = 0.57; p = 0.57), the risk of incomplete procedure due to poor bowel preparation (p = 0.18) and the incidence of poor bowel preparation (OR, 1.21; 95% CI, 0.63, 2.33; z = 0.59; p = 0.56) were also similar in both groups. EBP and OBP were equally effective for bowel preparation in patients undergoing flexible sigmoidoscopy. Although this study failed to demonstrate the superiority of EBP, at least equivalent efficacy for bowel cleansing may be extrapolated.