Uso do laser de baixa potência para o tratamento de parestesia: uma revisão de literatura / Use of low-level laser to treat paresthesia: a literature review

Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

Efficacy of High-intensity laser therapy in patients with temporomandibular joint disorders: A systematic review and meta-analysis.

This study aimed to assess the effects of High-intensity laser therapy (HILT) on individuals suffering from temporomandibular joint disorders (TMDs). A search was conducted across six electronic databases for randomized controlled trials (RCTs) focusing on HILT for TMDs: PubMed, Scopus, Web of Science, ScienceDirect, EBSCOhost, Cochrane Library, the PEDro database and Google Scholar (last updated on July 18, 2024). Eligible studies were chosen by independent reviewers, and their quality was assessed with the Cochrane risk of bias tool (RoB). The main outcome was pain intensity (VAS), with secondary outcomes including mouth opening (mm), disability (JFLS-20), and quality of life (OHIP-14). A meta-analysis was conducted to assess the pooled effect by calculating mean differences (MD) for these variables (95% confidence level). The heterogeneity of the meta-analyses was explored using the I2 statistic. Three studies met the selection criteria and were included in the meta-analysis. The main RoB was the blinding of participant and treaters. Statistically significant differences (p < 0.05) in favor of HILT were observed for VAS and maximum mouth opening. The pooled effect showed an MD of -14.8 mm (95% CI:-27.1,-2.5) for pain intensity and 3.7 mm (95% CI:0.9,6.5) for mouth opening, changes that were assessed as clinically important. According to GRADE, the evidence was rated as important, and the certainty was moderate due to the heterogeneity between studies. A sensitivity analysis was not performed to address heterogeneity, primarily due to the limited availability of RCTs. HILT has been found effective in short-term pain relief and improvement of jaw opening in TMDs, potentially enhancing quality of life by facilitating activities such as chewing, jaw mobility, and communication. However, further research is needed to confirm its long-term effectiveness. Combining HILT with interventions such as occlusal splints or therapeutic exercises could potentially enhance its effects, leveraging the existing evidence supporting these treatments. It is important to note that the high RoB associated with the lack of blinding of participants and treaters may influence data collection, compromising the internal validity of findings in some studies.

A new technique to implant intracorneal ring-segments from the perilimbal region: one-year prospective pilot study report.

BACKGROUND: Recently a new surgical technique for intracorneal ring-segments (ICRS) assisted by femtosecond laser (FSL) called ByLimB was developed, involving the creation of the incision from a paralimbic region. This study aims to evaluate the safety and efficacy of the ByLimb technique following one year of follow-up. METHODS: A prospective, single-center study was conducted at the Zaldivar Institute in Buenos Aires, Argentina. Keratoconus patients with indication for ICRS-FSL assisted procedure, operated with the ByLimb technique were included. By using the ByLimb technique, the ICRS are placed without affecting the tunnel's roof, and the end of the ICRS is always away from the incision area. Visual acuity, topographic astigmatism, and the occurrence of complications were evaluated. Safety index was the main outcome and efficacy indes was a complimentary outcome. RESULTS: A total of 17 eyes completed the 12-month follow-up period. The safety index was 1.10 (mean postoperative corrected distance visual acuity (CDVA) in decimal: 0.76/preoperative CDVA: 0.69), while the efficacy index was 0.89 (mean postoperative uncorrected distance visual acuity UDVA in decimal: 0.62/preoperative CDVA: 0.69). Mean preoperative astigmatism was 5.3 ± 2.3, decreasing twelve months after surgery at 2.1 ± 1.2 (p < 0.001). No eye loss lines of vision and no intraoperative complications were observed. During the first month after surgery, an improper positioning of the ICRS based on topographic assessment was detected in five cases. A second procedure was performed, which consisted of opening the incision and introducing a Sinsky hook, through which the ICRS was mobilized and placed in its correct position. No incisional alterations, signs of infection, anterior segment anomalies, or fundus alterations were observed. CONCLUSION: FSL-assisted ICRS implantation through the perilimbal region has demonstrated an adequate safety index one year post-surgery. Additionally, this technique has facilitated accurate realignment of ICRS during secondary surgical interventions within one-month post-surgery. While the current findings are promising, continued follow-up of these cases is warranted.

Rejuvenecimiento facial y láser de dióxido de carbono / Facial rejuvenation and carbon dioxide laser

El envejecimiento facial es multifactorial, la piel muestra el paso del tiempo a través de manchas, poros dilatados, arrugas, fl acidez y otras alteraciones. Si al momento de realizar un rejuvenecimiento facial no se rejuvenece también la piel, el resultado nunca será armónico o coherente. Actualmente la mejor herramienta para el rejuvenecimiento facial integral es el láser de dióxido de carbono. Si lo combinamos con el uso de microagujas y la aplicación de plasma rico en plaquetas, potenciaremos aún más los resultados

Facial aging is multifactorial, the skin shows prevents aging through spots, pores, wrinkles, gas, fl accidity and other situations. If at the time of perform facial rejuvenation we do not rejuvenate the skin, the result will never be harmonious or coherent. To this day, the best tool for refacial rejuvenation is the carbon dioxide laserand if we associate it with the use of microneedles and applications of rich plasma we are going to enhance the result

Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease.

Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 "minimal energy pilonidotomies (MELPi)" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain.

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

Comparison between contact diode laser with 980 nm and 1470 nm wavelengths for posterior laryngofissure in pigs.

To compare two different wavelengths of the surgical contact diode laser (CDL) for producing a posterior laryngofissure in in-vivo pigs. Anesthetized pigs underwent a tracheostomy and an anterior laryngofissure through a cervicotomy. They were randomly selected for the CDL wavelength and Power, according to the peak of Power set at device (980nm wavelength: Ppeak power of 10 W, 15 W, and 20 W, or 1470 nm wavelength: Ppeak 3 W, 5 W, 7 W, 10 W). At the end of the experiment, the laryngotracheal specimen was extracted and sent for histology and morphometry measurements (incision size, depth, area, and lateral thermal damage). Hemodynamic data and arterial blood gases were recorded during the incisions. Statistical analysis of the comparisons between the parameters and groups had a level of significance of p < 0.05. Twenty-six pigs were divided into CDL 980 nm (n = 11) and 1470 nm (n = 15). There was a greater incision area at the thyroid level in the 980 nm CDL and a wider incision at the trachea level, with a larger distance between mucosa borders. There were no significant differences in the area of lateral thermal damage between the two groups and neither difference among the power levels tested. Both wavelengths tested showed similar results in the various combinations of power levels without significant differences in the lateral thermal damage. The posterior laryngofissure incision can be performed by either of the wavelengths at low and medium power levels without great difference on lateral thermal damage.

Effectiveness of Laser Acupuncture for Reducing Pain and Increasing Mouth Opening Range in Individuals with Temporomandibular Disorder: A Systematic Review and Network Meta-Analysis.

PURPOSE OF REVIEW: Laser acupuncture (LA) demonstrates promising results in the treatment of musculoskeletal disorders. However, its effects on temporomandibular disorder (TMD) are not yet fully understood. Thus, the aim of this systematic review and network meta-analysis was to assess the effectiveness of LA on pain intensity and maximum mouth opening range (MMO) related to TMD. A search was carried out in 11 electronic databases and references of included studies to locate randomized clinical trials (RCTs) that evaluated LA as a primary treatment for TMD. The risk of bias was assessed using the RoB 2 tool. Network meta-analysis was conducted on the MetaInsight platform, considering the pain intensity and counseling (C) as the outcome of reference. The GRADE system was used to assess the certainty of the evidence. RECENT FINDINGS: Five studies evaluated pain intensity, four with a high risk of bias and one with a low risk. Two studies evaluated pain intensity on palpation (one with high and one with low risk of bias), and one study with high risk of bias evaluated MMO. Laser parameters were: 690-810 nm, 40-150 mW, and 7.5-112.5 J/cm2. Occlusal splint (OS) [- 2.47; CI 95% - 3.64, - 1.30] and Physiotherapy (PT) [-2.64; CI 95% - 3.94, - 1.34] reduced pain intensity compared to C. The ranking of treatments in order of effectiveness was PT > OS > LA > C > CR (craniopuncture). The certainty of the evidence was very low or low. The data do not support the indication of LA for the treatment of TMDs and new placebo-controlled RCTs must be conducted to demonstrate its effectiveness more precisely.

Histological evaluation of the surgical margins of oral soft tissue incisions using a dual-wavelength diode laser and an Er, Cr:YSGG laser; an ex vivo study.

OBJECTIVE: This study compared a dual-wavelength diode laser and an Er, Cr:YSGG laser in oral soft tissue incisions to determine the most effective and safest laser system at the histopathological level. METHODOLOGY: The (810 and 980 nm) dual-wavelength diode laser was used at 1.5 W and 2.5 W (CW) power settings, and the (2780 nm) Er, Cr:YSGG laser was used at 2.5 W and 3.5 W (PW) power settings. Both laser systems were used to incise the tissues of freshly dissected sheep tongue pieces to obtain the following histopathological criteria: epithelial tissue changes, connective tissue changes, and lateral thermal damage extent by optical microscopy. RESULTS: The epithelial and connective tissue damage scores were significantly higher in the dual-wavelength diode laser groups than in the Er, Cr:YSGG laser groups (P<0.001), and there was a significant difference between some groups. The extent of lateral thermal damage was also significantly higher in the diode laser groups than in the Er, Cr: YSGG laser groups (P<0.001), and there was a significant difference between groups. Group 2 (2.5 W) of the diode laser was the highest for all three criteria, while group 3 (2.5 W) of the Er, Cr:YSGG laser was the lowest. CONCLUSION: The Er, Cr:YSGG laser with an output power of 2.5 W is, histologically, the most effective and safest laser for oral soft tissue incision. The dual-wavelength diode laser causes more damage than the Er, Cr:YSGG laser, but it can be used with a low output power and 1 mm safety distance in excisional biopsy.

Spatially modulated ablation driven by chaotic attractors in human lung epithelial cancer cells.

A significant modification in photoinduced energy transfer in cancer cells is reported by the assistance of a dynamic modulation of the beam size of laser irradiation. Human lung epithelial cancer cells in monolayer form were studied. In contrast to the quantum and thermal ablation effect promoted by a standard focused Gaussian beam, a spatially modulated beam can caused around 15% of decrease in the ablation threshold and formation of a ring-shaped distribution of the photothermal transfer effect. Optical irradiation was conducted in A549 cells by a 532 nm single-beam emerging from a Nd:YVO4 system. Ablation effects derived from spatially modulated convergent waves were controlled by an electrically focus-tunable lens. The proposed chaotic behavior of the spatial modulation followed an Arneodo chaotic oscillator. Fractional dynamic thermal transport was analyzed in order to describe photoenergy in propagation through the samples. Immediate applications of chaos theory for developing phototechnology devices driving biological functions or phototherapy treatments can be considered.

Proactive esophageal cooling during laser cardiac ablation: A computer modeling study.

BACKGROUND AND OBJECTIVES: Laser ablation is increasingly used to treat atrial fibrillation (AF). However, atrioesophageal injury remains a potentially serious complication. While proactive esophageal cooling (PEC) reduces esophageal injury during radiofrequency ablation, the effects of PEC during laser ablation have not previously been determined. We aimed to evaluate the protective effects of PEC during laser ablation of AF by means of a theoretical study based on computer modeling. METHODS: Three-dimensional mathematical models were built for 20 different cases including a fragment of atrial wall (myocardium), epicardial fat (adipose tissue), connective tissue, and esophageal wall. The esophagus was considered with and without PEC. Laser-tissue interaction was modeled using Beer-Lambert's law, Pennes' Bioheat equation was used to compute the resultant heating, and the Arrhenius equation was used to estimate the fraction of tissue damage (FOD), assuming a threshold of 63% to assess induced necrosis. We modeled laser irradiation power of 8.5 W over 20 s. Thermal simulations extended up to 250 s to account for thermal latency. RESULTS: PEC significantly altered the temperature distribution around the cooling device, resulting in lower temperatures (around 22°C less in the esophagus and 9°C in the atrial wall) compared to the case without PEC. This thermal reduction translated into the absence of transmural lesions in the esophagus. The esophagus was thermally damaged only in the cases without PEC and with a distance equal to or shorter than 3.5 mm between the esophagus and endocardium (inner boundary of the atrial wall). Furthermore, PEC demonstrated minimal impact on the lesion created across the atrial wall, either in terms of maximum temperature or FOD. CONCLUSIONS: PEC reduces the potential for esophageal injury without degrading the intended cardiac lesions for a variety of different tissue thicknesses. Thermal latency may influence lesion formation during laser ablation and may play a part in any collateral damage.

Long-term functional outcomes and surgical retreatment after thulium laser enucleation of the prostate: A 10-year follow-up study.

BACKGROUND: To evaluate the 10-year functional outcomes (primary) and frequency and predictors of BPH surgical retreatment (secondary) after ThuLEP. MATERIALS AND METHODS: A single-center retrospective analysis of consecutive patients undergoing ThuLEP between 2010 and 2013 was performed. Inclusion criteria were: age ≥ 40 years, prostate volume (PV) ≥ 80 mL, International Prostate Symptom Score (IPSS)-Total score ≥ 8 points. IPSS-Total score was the primary outcome, and BPH surgical retreatment rate was the secondary outcome. Paired t-test, McNemar test, and Wilcoxon signed-rank test were used to compare variables. Logistic regression analysis was performed to evaluate predictors of surgical retreatment. RESULTS: A total of 410 patients with a mean ±SD age of 63.9 ± 9.7 years and a PV of 115.6 ± 28.6 mL were included. Mean ±SD follow-up was 108.2 ± 29.6 months. IPSS-Total score was significantly improved at 1 year compared to baseline (23.3 ± 4.7 vs. 10.3 ± 3.8; p<0.001). It was similar after 5 years (10.5 ± 3.6 vs. 10.7 ± 5.0; p=0.161), with a significant worsening at 10 years (10.3 ±4.8 vs. 13.8 ±4.5; p=0.042) but remaining statistically and clinically better than baseline (13.8 ±4.5 vs. 22.1 ±4.3; p<0.001). After 10 years, 21 (5.9%) patients had undergone BPH reoperation. Baseline PV (adjusted OR 1.27, 95% CI 1.09-1.41; p<0.001) and time from BPH surgery (adjusted OR 1.32, 95% CI 1.15-1.43; p<0.001) were predictors of BPH surgical retreatment. CONCLUSIONS: ThuLEP is associated with optimal functional outcomes and a low frequency of BPH surgical retreatment in the long-term. Baseline PV and time from surgery were predictors of BPH reoperation.

New approaches to second-degree burn healing: Polyvinyl alcohol membrane loaded to arnica combined to laser therapy.

Second-degree burns require greater care, as the damage is more extensive and worrisome and the use of a biomaterial can help in the cell repair process, with better planning, low cost, and better accessibility. Arnica has anti-inflammatory and analgesic properties in skin lesions treatments and laser therapy is another therapeutic alternative for burns. Evaluate the effects of arnica incorporated into PVA associated or not with low intensity laser on burns in rats. PVA and PVA with arnica (PVA+A) were obtained and characterized physicochemically. Through in vivo studies, the effects of PVA and PVA+A with or without the application of laser on the lesions allowed histological and immunohistochemical analyzes. PVA+A was biocompatible and with sustained release of the active, being a promising pharmacological tool and confirmed that laser therapy was effective in accelerating the healing process, due to its potential biomodulator, improving inflammatory aspects, promoting rapid healing in skin lesions.

Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminumgarnet laser posterior capsulotomy.

Capsulotomy with neodymium-doped yttriumaluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Rejuvenecimiento periorbitario fisiológico / Physiological periorbital rejuvenation

Pivoting Brow Lift es una nueva opción terapéutica cuyas ventajas son tres mínimas incisiones, prácticamente imperceptibles, bien aceptadas por pacientes de todas las edades, sexo y incluso pacientes calvos. Una incisión se realiza en la región temporal y otra dentro del cuero cabelludo en la región medio frontal o en una arruga en pacientes calvos. La disección en región frontal es sub-perióstica, muchas veces llega a la punta nasal para reposicionarla. La disección en la región temporal se realiza entre las hojas superficiales y profundas extendiéndose hasta el tarso y canto externo del ojo; en la región palpebral la disección se realiza entre la piel y el musculo. La fijación son dos puntos externos en el cuero cabelludo y unos papeles adherentes. Los puntos del cuero cabelludo se retiran a los 14 días. Evita las complejas fijaciones que se realizan actualmente con tornillos, puntos internos o Endotime. La sencillez del procedimiento hace que este se pueda realizar entre 30 y 45 minutos, con anestesia local y sedación; esto permite lograr una mayor seguridad operatoria. Se han documentado pacientes tratados hace 9 años donde se demuestra la duración en el tiempo. El bajo índice de complicaciones y la alta satisfacción de los pacientes documentadas en encuestas hace que este procedimiento pueda ser considerado como una nueva opción terapéutica.

Treatment of women with vaginal laxity: systematic review with meta-analysis.

BACKGROUND: Despite several treatments that have been used for women reporting vaginal laxity (VL), to our knowledge no systematic review is available on the topic so far. AIM: In this study, we sought to summarize the best available evidence about the efficacy and safety of interventions for treating VL, whether conservative or surgical. METHODS: A comprehensive search strategy was performed in Medline, Embase, Scopus, Web of Science, and Cochrane Library for reports of clinical trials published from database inception to September 2022. Studies selected for inclusion were in the English language and were performed to investigate any type of treatment for VL, with or without a comparator, whether nonrandomized studies or randomized controlled trials (RCTs). Case reports and studies without a clear definition of VL were excluded. OUTCOMES: The outcomes were interventions (laser, radiofrequency, surgery, and topical treatment), adverse effects, sexual function, pelvic floor muscle (PFM) strength, and improvement of VL by the VL questionnaire (VLQ). RESULTS: From 816 records, 38 studies remained in the final analysis. Laser and radiofrequency (RF) were the energy-based treatment devices most frequently studied. Pooled data from eight observational studies have shown improved sexual function assessed by a Female Sexual Function Index score mean difference (MD) of 6.51 (95% CI, 5.61-7.42; i2 = 85%, P < .01) before and after intervention, whether by RF (MD, 6.00; 95% CI, 4.26-7.73; i2 = 80%; P < .001) or laser (MD, 6.83; 95% CI, 5.01-8.65; i2 = 92%; P < .01). However, this finding was not shown when only 3 RCTs were included, even when separated by type of intervention (RF or laser). When RF treatment was compared to sham controls, VLQ scores did not improve (MD, 1.01; 95% CI, -0.38 to 2.40; i2 = 94%; P < .001). Patient PFM strength improved after interventions were performed (MD, 4.22; 95% CI, 1.02-7.42; i2 = 77%; P < .001). The ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions) tool classified all non-RCTs at serious risk of bias, except for 1 study, and the risk of bias-1 analysis found a low and unclear risk of bias for all RCTs. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of the evidence was moderate for sexual function and the VLQ questionnaire and low for PFM strength. CLINICAL IMPLICATIONS: Sexual function in women with VL who underwent RF and laser treatment improved in observational studies but not in RCTs. Improvement in PFM strength was observed in women with VL after the intervention. STRENGTHS AND LIMITATIONS: Crucial issues were raised for the understanding of VL, such as lack of standardization of the definition and for the development of future prospective studies. A limitation of the study was that the heterogeneity of the interventions and different follow-up periods did not make it possible to pool all available data. CONCLUSIONS: Vaginal tightening did not improve sensation in women with VL after intervention, whereas RF and laser improved sexual function in women with VL according to data from observational studies, but not from RCTs. PFM strength was improved after intervention in women with VL.

Comparison of the clinical effectiveness of Class IV Laser therapy and therapeutic ultrasound in patients with chronic neck pain: a randomized controlled trial / Comparação da eficácia clínica da terapia a laser Classe IV e do ultrassom terapêutico em pacientes com dor cervical crônica: um estudo controlado e randomizado

INTRODUCTION: Chronic neck pain (CNP) is a common musculoskeletal problem that affects a large proportion of the population and lasts longer than three months. It has a high cost in terms of life, disability, and healthcare. Several modalities have effectively provided immediate and long-term relief for CNP; however, the comparative clinical effectiveness of these modalities is limited. OBJECTIVES: The study aimed to determine the clinical effectiveness of Class IV Laser therapy and Therapeutic Ultrasound (TUS) in patients with CNP. METHODS AND MATERIALS: Forty-four patients with CNP of both genders were recruited from an age range of 20­45 years from the Department of Musculoskeletal Physiotherapy of Maharishi Markandeshwar Institute of Physiotherapy, MM(DU), Ambala, India. They were divided into two groups at random: the LASER group A (n = 22) and the TUS group B (n = 22). The intervention duration was 2 weeks with 6 treatment sessions. Pre- and post-treatment outcome measures were assessed with the Visual Analog Scale (VAS), Algometer, Goniometer, and Neck Disability Index (NDI) questionnaires at baseline and after 2 weeks of intervention. The LASER group received a target dose of 10 joules per cm2 at a power of 10 watts, with a continuous dosage frequency. The TUS group underwent a continuous mode ultrasound (3 MHz, 1 W/cm2) for 6 minutes. The Shapiro-Wilk test was used to assess the normality of the data. For parametric and non-parametric data analysis within the group, the paired t-test and Wilcoxon signed rank were used. The independente t-test and Mann-U Whitney test were used for the group comparison of parametric and non-parametric data, respectively. RESULTS: In both groups, there was a significant improvement in all the outcome measures (p<0.001). There was a statistically significant difference between the two interventions in VAS, Pain Pressure Threshold (PPT), and NDI (p<0.05). CONCLUSION: Class IV Laser therapy is clinically more effective than therapeutic ultrasound in treating patients with chronic neck pain.

INTRODUÇÃO: A dor cervical crônica (DCC) é um problema musculoesquelético comum que afeta uma grande proporção da população e dura mais de três meses. Ela tem um alto custo em termos de vida, incapacidade e assistência médica. Várias modalidades têm proporcionado alívio imediato e de longo prazo para a dor cervical crônica; entretanto, a eficácia clínica comparativa dessas modalidades é limitada. OBJETIVOS: O objetivo do estudo foi determinar a eficácia clínica da terapia a laser de classe IV e do ultrassom terapêutico (UST) em pacientes com DCC. MÉTODOS E MATERIAIS: Quarenta e quatro pacientes com DCC de ambos os sexos, em uma faixa etária de 20 a 45 anos, foram recrutados do Departamento de fisioterapia musculoesquelética do Instituto de Fisioterapia Maharishi Markandeshwar, MM (DU), Ambala, Índia. Eles foram divididos em dois grupos de forma aleatória: o grupo LASER A (n = 22) e o grupo UST B (n = 22). A duração da intervenção foi de 2 semanas com 6 sessões de tratamento. As medidas de resultado pré e pós-tratamento foram avaliadas com os questionários Escala Visual Analógica (EVA), Algometer, Goniometer e Índice de Incapacidade do Pescoço (IIP) na linha de base e após 2 semanas de intervenção. O grupo LASER recebeu dose alvo de 10 joules por cm2 na potência de 10 watts, com frequência de dosagem contínua. O grupo UST foi submetido a ultrassom em modo contínuo (3 MHz, 1 W/cm2) por 6 minutos. O teste de Shapiro-Wilk foi utilizado para avaliar a normalidade dos dados. Para análise dos dados paramétricos e não paramétricos dentro do grupo, foram utilizados o teste t pareado e o posto sinalizado de Wilcoxon. O teste t independente e o teste Mann-U Whitney foram utilizados para comparação de grupos para dados paramétricos e não paramétricos, respectivamente. RESULTADOS: Em ambos os grupos, houve uma melhora significativa em todas as medidas de resultado (p<0,001). Houve uma diferença estatisticamente significativa entre as duas intervenções na EVA, Limiar de pressão de dor (PPT) e IIP (p<0,05). CONCLUSÕES: A terapia a laser de classe IV é clinicamente mais eficaz do que o ultrassom terapêutico no tratamento de pacientes com dor cervical crônica.

Accelerating Healing and Relieving Pain: High-Intensity Laser Therapy for Paraneoplastic Cutaneous Vasculitis Associated with Multiple Myeloma.

BACKGROUND Leukocytoclastic vasculitis (LCV) is an atypical form of cutaneous paraneoplastic manifestation. Its association with multiple myeloma (MM) is even rarer and is associated with poor prognosis and short survival, regardless of the therapy instituted. Different treatment approaches are necessary. We present a case in which LCV was the first manifestation of MM, and high-intensity laser therapy (HILT) was used as an option to accelerate healing and control pain. CASE REPORT A 76-year-old woman presented with pain and paresthesia in her lower limbs, associated with palpable purpura. The clinical diagnosis was small-vessel vasculitis. Laboratory tests showed an elevated gamma globulin monoclonal peak on protein electrophoresis. The immunophenotypic study of bone marrow aspirates led to the diagnosis of MM. Due to pain refractory to conventional analgesics, and the progressive evolution of the lesions, despite corticosteroid therapy, we performed photo-biomodulation with a neodymium-doped yttrium aluminum garnet laser (Nd: YAG), wavelength 1064 nanometers, using a 7-mm probe and energy density 6 J/cm². After the first session, the patient was referred for pain management, and after 5 weeks, we observed complete healing in ulcerated lesions and involution of bullous lesions. CONCLUSIONS This case report shows the positive effects of the Nd: YAG laser in modulating healing and reducing pain. HILT is an innovative, non-invasive, and effective treatment and should be considered a promising technique to accelerate healing and controlling pain.