Fibrin tissue adhesive versus nasal packing in endoscopic nasal surgery: a systematic review and meta-analysis.

BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

Prognostic factors in patients with metastatic spinal cord compression secondary to melanoma: a systematic review.

Melanoma is one of the most common primary tumours associated with metastatic spinal cord compression (MSCC). The aim of this review is to identify prognostic factors specifically for MSCC secondary to melanoma. A systematic search of literature was performed in MEDLINE, Embase and the Cochrane Library to identify studies reporting prognostic factors for patients with MSCC secondary to melanoma. Two studies, involving a total of 39 patients, fulfilled the inclusion criteria. The variables associated with increased survival were receiving postoperative radiotherapy, receiving chemotherapy, perioperative lactate dehydrogenase level less than or equal to 8.0 µkat/l, preoperative haemoglobin level more than 11.5 mg/dl, an interval of 4 or more years between melanoma diagnosis and skeletal metastasis, absence of further skeletal metastases, absence of visceral metastases, Eastern Cooperative Oncology Group Performance Status of 2 or less, two or fewer involved vertebrae, being ambulatory preradiotherapy and an interval of more than 7 days between developing motor deficits and radiotherapy. The variables associated with good functional outcome were slow development of motor dysfunction, good performance status and being ambulatory before radiotherapy. The most important prognostic factors for survival are Eastern Cooperative Oncology Group Performance Status of 2 or less and absence of visceral metastases. There is a lack of studies looking specifically at prognostic factors for patients with MSCC secondary to melanoma, and the number of patients involved in the existing studies is small.

Shisha waterpipe use and awareness of health risks among young adults in a semi-rural underprivileged community in North West England.

INTRODUCTION: Waterpipe smoking has become increasingly popular among young adults across the globe. Evidence suggests waterpipes have overtaken cigarettes in popularity among university students in the UK. This survey aimed to measure the prevalence of use, awareness of the tobacco content and associated health risks of waterpipes among young adults in a non-university semi-rural underprivileged community in England. METHODS: A self-completed questionnaire was distributed by six schools and colleges to young adults aged 16-25 in Tameside, North West England. RESULTS: A total of 210 young adults completed the survey, of these 12% smoked cigarettes and 16% smoked waterpipes. Of those that smoked waterpipes, 45% smoked at home and 88% smoked in shisha bars. Of the respondents, 62% did not know that shisha waterpipes contained tobacco and 18% believed that waterpipes were less harmful than smoking cigarettes. There was no difference in knowledge of tobacco content, or of the associated health risks, between those who smoked waterpipes and those that did not. The majority of respondents (81%) stated that if they wanted to know more about how shisha tobacco could affect their health they would access information via the internet. Social networking websites was by far the most popular route for communication for messages about the health risks associated with smoking shisha waterpipes. CONCLUSIONS: These results suggest that waterpipes may have overtaken cigarettes as the method of choice for smoking tobacco among the young adult population in the UK.

Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review.

INTRODUCTION: Childhood obesity is now a global epidemic and the incidence continues to increase. Dietary interventions and nutritional education are possible options to manage childhood obesity. However, restrictive diets can result in negative outcomes, and therefore it may be more apt to encourage children to consume more fruit and vegetables and thereby develop a healthier positive attitude towards food. METHOD: A systematic review of literature of interventions to increase fruit and/or vegetable consumption in overweight or obese children and adolescents was conducted, applying a free-text strategy with a set of search terms. RESULTS: A total of five studies describing seven interventions published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. All five studies examined family-focused interventions to increase daily fruit and vegetable consumption measured either by child self-report or parent report. Only one intervention reported a lasting statistically significant increased consumption of fruit and vegetables. CONCLUSIONS: This review highlights that in order to tackle obesity narrow interventions focusing on single aspects of behaviour are unlikely to achieve long-term change. Successful public health interventions tackling childhood obesity will need to take a holistic approach and target behaviour change in multiple aspects of children's lifestyles and their surroundings, including nutritional education, parental support and physical activity.