Efficacy of miltefosine compared with glucantime for the treatment of cutaneous leishmaniasis: a systematic review and meta-analysis / 한국역학회지

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,” “glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I² index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.

Efficacy of miltefosine compared with glucantime for the treatment of cutaneous leishmaniasis: a systematic review and meta-analysis / 한국역학회지

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,”“glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I² index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.

Efficacy of miltefosine compared with glucantime for the treatment of cutaneous leishmaniasis: a systematic review and meta-analysis / 한국역학회지

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,” “glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I² index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.

Effects of combined prokinetic administration on gastric emptying in critically ill patients

Background and study aims: Combination of prokinetic drugs with different mechanisms of action is frequently used when feeding intolerance is not improved with a single agent. In this study, we evaluated the effect of combined infusion of neostigmine and metoclopramide on gastric passage in critically ill patients in the intensive care unit [ICU]

Patients and methods: This study is a randomized double-blind controlled trial in 90 patients between 20 and 60 years of age who were under mechanical ventilation and had gastric residual volumes [GRVs] >120 mL 3 h after the last lavage. Patients were randomly assigned to one of the following three groups: intravenous neostigmine 2.5 mg, intravenous metoclopramide 20 mg, and combination of both agents at the mentioned doses. Gastric volume aspiration was first performed before starting the study and then at 3, 6, 9, and 12 h after the infusion of study drugs was finished. Increase in gastric lavage was defined as an aspiration volume of >120 mL

Results: In total, 86 cases in the three groups completed the treatment [all 90 patients included in the study were analysed according to an intention-to-treat approach]. There was no significant difference detected at baseline in age, intubation duration, albumin, haemoglobin, haematocrit, total leucocytic count [WBC], Na, K, Mg, and sequential organ failure assessment score between the study groups. In the combination group, 96.7% of patients showed GRV improvement [GRV < 120 cc], whereas in the metoclopramide and neostigmine groups, 50% and 43.3% of the patients, respectively, showed improvement [p < 0.001]. The frequency of overall adverse effects in the metoclopramide, neostigmine, and combination groups were 3.3%, 16.7%, and 10%, respectively [p = 0.28]

Conclusions: The present results suggested that combination therapy with metoclopramide and neostigmine decreases GRV in critically ill patients with a higher efficacy than monotherapies

Comparison of the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea: a randomized clinical trial

Objectives: Dysmenorrhea is a common gynecologic disorder. Although non-steroidal anti-inflammatory drugs are commonly used, due to their side effects and lack of response in some individuals, other approaches such as exercise have been considered. This study compared the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea

Methods: In this randomized clinical trial, 122 female students with moderate to severe dysmenorrheal were assessed and were placed in either the exercise or mefenamic acid group. The exercise program was performed for 15 minutes, three times a week and included a five-minute warm up and six belly and pelvic stretching exercises for 10 minutes. The mefenamic acid group received 250 mg capsules every eight hours from the onset of menstruation until pain relief. Both interventions were performed during two consecutive menstrual cycles. Pain intensity was measured using a 10 cm visual analog scale

Results: The mean pain intensity was significantly higher in the exercise group only in the first cycle [p = 0.058]. In the second cycle, the mean difference in pain reduction in the exercise group was higher than the mefenamic group compared to the start of the study [p = 0.056] and the first cycle [p = 0.007]. There was no significant difference in the severity and duration of pain between the groups [p > 0.050]

Conclusions: Stretching exercises were as effective as mefenamic acid in the treatment of primary dysmenorrhea. Our results suggest that the effect of exercise on relieving menstruation pain increases over time

Use of ginger versus stretching exercises for the treatment of primary dysmenorrhea: a randomized controlled trial / 中西医结合学报

<p><b>BACKGROUND</b>Dysmenorrhea is a common gynecologic problem. In some cases, non-medical treatments are considered to be more effective, with fewer side effects. Ginger and exercise are alternative treatments for dysmenorrhea, but in the present study they were not combined.</p><p><b>OBJECTIVE</b>In this study, the effects of ginger and exercise on primary dysmenorrhea were compared.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>This randomized controlled trial was performed in Mazandaran University of Medical Sciences, Iran. Two groups of female students were recruited by simple random allocation. In each group, 61 students with moderate to severe primary dysmenorrhea with regular menstrual cycles and without a history of regular exercise were assessed. The ginger group received 250 mg ginger capsules from the onset of menstruation. In the exercise group, belly and pelvic stretching exercises were performed for 10 min, 3 times per week.</p><p><b>MAIN OUTCOME MEASURES</b>Intensity of pain was assessed according to a visual analogue scale after the first and the second month.</p><p><b>RESULTS</b>Exercise was significantly more effective than ginger for pain relief (31.57 ± 16.03 vs 38.19 ± 20.47, P = 0.02), severity of dysmenorrhea (63.9% vs 44.3% mild dysmenorrhea, P = 0.02) and decrease in menstrual duration (6.08 ± 1.22 vs 6.67 ± 1.24, P = 0.006), in the second cycle.</p><p><b>CONCLUSION</b>Stretching exercises, as a safe and low-cost treatment, are more effective than ginger for pain relief in primary dysmenorrhea.</p><p><b>TRIAL REGISTRATION</b>The trial was registered in www.IRCT.ir with No. 201203118822N2.</p>

Association between Iron deficiency anemia and febrile convulsion in 3- to 60-month-old children: a systematic review and meta-analysis

Controversy exists regarding the association between Iron Deficiency Anemia [IDA], iron status, and Febrile Convulsion [FC] during childhood. In this article, a systematic review and meta-analysis is conducted in order to determine possible association and the degree of association between these statuses and FC. To identify all studies related to IDA and FC, various references such as MEDLINE [PubMed], Embase [OVID], Web of sciences [Thomson Reuters] and Google scholar were searched [up until 15 January 2013]. Heterogeneity was assessed using the Q statistic, Tau[2], and I[2]. Additionally, subgroup analyses were performed. The outcome of primary interest was the overall Odds Ratio [OR] of FC for IDA and standard mean differences [SMD] of ferritin level. In total, 21 articles were considered to assess the association between IDA and FC. Anemia was more prevalent among the FC patients compared with the controls and the overall OR was 1.52 [95% CI=1.03 to 2.25]. In addition, the pooled OR for 17 studies performed in the populations with low and moderate prevalence of anemia was 2.04 [95% CI=1.46 to 2.85]. Furthermore, 12 studies assessed the association between the ferritin level and FC. The overall SMD was -0.02 with a 95% CI of -0.09 to 0.06. Besides, the pooled SMD of ferritin was -0.57 [95% CI=-0.7 to -0.46] in 6 studies reporting no difference between the FC and the control group with respect to temperature. IDA was associated with a moderate increased risk of FC in children, particularly in the areas with low and moderate prevalence of anemia

Adiponectin is a good marker for metabolic state among type 1 diabetes mellitus patients

Adiponectin is secreted from adipose tissue. This hormone has a fundamental role in pathogenesis of insulin resistance, and has anti-inflammatory and anti-atherogenic effects. The objectives of this study were to compare serum adiponectin level between type 1 diabetics and healthy people and to assess its related factors, and also to determine the relationship between adiponectin and metabolic state. This was a case control study involving 60 diabetics [25 good and 35 poor metabolic controlled] and 28 healthy persons [younger than 18 years old]. The data about demographic [age and sex], clinical and paraclinical characteristics [body mass index [BMI], duration of disease, puberty state, and glycosylated hemoglobin [HbA1c] and adiponectin level in serum] were collected. Determinants of adiponectin were assessed using univariate and multiple linear regression analyses. Mean [ +/- SD] serum adiponectin level in healthy persons, good-controlled and poor-controlled type 1 diabetes mellitus patients were 9.16 [ +/- 4.2] microg/cc, 10.89 [ +/- 4.48[microg/cc, and 15.92 [ +/- 8.26]microg/cc, respectively. Post hoc analysis revealed that differences of adiponectin between poor- and good-controlled type 1 diabetes mellitus patients [P=0.01] and between healthy persons and poor controlled type 1 diabetes mellitus [P<0.0001] were statistically significant. Adiponectin level was associated with puberty state and BMI in healthy persons. It was associated with puberty state and HbA1c in type 1 diabetic persons. Serum level of adiponectin was higher in type 1 diabetics than in healthy persons and it can be used as a good marker for metabolic control state among diabetics

Music can effectively reduce pain perception in women rather than men

Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music [Iranian folkloric and preferred music] on pain tolerance and pain rating in cold pressor test. A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music [F [1,48] =25.44, p=0.0001] and no music [F[1,48]=3.51, p=0.0001] conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females [F[1,48]=5.53, p=0.023]. The results also indicated that pain ratings, regardless of sex, were different in three musical conditions [F[1.7,81.34]=15.37, p=0.0001]. Music distracted attention from pain and Women can be impressed and distracted more easily by music

Success rate of nonsurgical endodontic treatment of nonvital teeth with variable periradicular lesions

Bacterial infection of tooth pulp can progress into periapical diseases. Root canal treatment has been established as the best treatment. In cases of failure, nonsurgical retreatment of teeth is preferred to surgical procedure and extraction. In this historical cohort study, 104 permanent teeth with apical lesion were treated during 2002-2008. All teeth showed radiographic evidence of periapical lesion varying in size from 1 to >10mm. A total of 55 teeth were treated with initial root canal treatment and 49 teeth required retreatment. Patients were recalled up to 7 years. All radiographs were taken by RSV MAC digital imaging set and long cone technique. The presence/absence of signs and symptoms and periapical index scores [PAI] were used for measuring outcome. Teeth were classified as healed [clinical/radiographic absence of signs and symptoms] or diseased [clinical/radiographic presence of signs and symptoms]. The data were statistically analyzed using student t-test and Pearson chi-square or fisher's exact test. The rate of complete healing for teeth with initial treatment was 89.7%, and for retreatment group was 85.7%; there was no significant difference. Size of lesions did not significantly affect the treatment outcomes. Success of tooth treatment did not reveal significant correlation with gender and number of roots. Orthograde endodontic treatment/retreatment demonstrates favorable outcomes. Thus, nonsurgical endodontic treatment/retreatment should be considered as the first choice in teeth with large periapical lesion

comparative study of depth of anesthesia monitored by BIS values in two anesthesia techniques and their cost-effectiveness

Propofol is an intravenous agent used extensively in total venous anesthesia [TIVA], but its acquisition cost is nearly 1 to 3 folds higher than other intravenous or inhalation agents. Thiopental is an ultra short acting barbiturate which can reduce the cost of induction to one seventh of Propofol induction cost. In this study, by BIS monitoring of the depth of anesthesia, we evaluated maintaining anesthesia with Propofol while Thiopental has been used for induction of anesthesia and the aim of study was to find a cost effective method. In a single blind clinical trial, 82 patients with ASA II and I scheduled for cataract surgery were randomized in two groups. In the first group [A], induction of anesthesia was done with Propofol 2 mg/kg and then anesthesia maintained with Propofol 100 micro/kg. In the other group [B], induction was Thiopental 5 mg/kg and anesthesia maintained with Propofol 160 micro/ kg. BIS monitored depth of anesthesia throughout the procedure. We compared the BIS values in each step of the procedure in both groups. After extubation, mean of BIS score were 87.53[ +/- 2.52] and 88.79[ +/- 2.07] for groups A and B respectively. This difference was not clinically significant. Multiple linear regression analysis, identified decreased maintenance dose of Propofol and duration of surgery as independent predictors for BIS span 40-60.[P < 0.000,r[2] =0.558]. Cost effectiveness [acquisition cost/percent of 40-60 BIS span] for groups A and B were 2.95 S and 1.03 S respectively. Minor surgeries like ophthalmic surgery can be conducted with maintenance of Propofol while induction is with Thiopental. Monitoring the depth of anesthesia with BIS showed that if we choose 160 micro/kg Propofol for maintenance then it is not necessary to have a loading dose and induction can be done by Thiopental. Further studies with different type of surgery and different maintenance doses of Propofol must be done

In vitro inhibitory effects of chlorhexidine and Persica mouthwashes on HSV-1 compared with acyclovir

Recurrent intraoral herpes is a common oral disease that causes painful ulcers and viral shedding, resulting in various complications for patients. The antiviral efficacy of oral mouthwashes has not been adequately studied, although they are a readily available and rapid treatment modality for oral ulcers. In this experimental study, viricidal effects of chlorhexidine and Persica mouthwashes on Vero cell lines were examined, before and after HSV-1 infection of the cells, in the presence of various concentrations of mouthwashes at different time intervals by using quantal assays. Then the results were compared with those of acyclovir. The 50% cytotoxic concentrations [CC[50] of the two mouthwashes were determined. Data was analyzed by one-way and two-way ANOVA [alpha = 0.05]. CC[50] of Persica at 5- and 30-minute intervals were 0.2% and 0.14%, respectively. Chlorhexidine was toxic at durations more that 5 minutes. Before inoculation, both mouthwashes showed viricidal effects and Persica showed more viricidal effect than chlorhexidine and acyclovir [p values of 0.0001 and 0.04, respectively]. After virus inoculation antiviral effects of these mouthwashes were only limited to concentrations above 1/4. Acyclovir demonstrated the highest antiviral effect [p value = 0.0001]. Considering the better direct anti-HSV effect of the herbal mouthwash, Persica, and its less side effects compared to chlorhexidine, it can be used to reduce oral fluid contamination caused by viral shedding and reduce infectivity ofintra-oral ulcers

Reliability of fixation preference for detecting amblyopia in strabismic patients

To evaluate the association between fixation preference [FP] and amblyopia in strabismic patients. This study includes 50 patients with horizontal, vertical or mixed strabismus of at least 10 prism diopters. Best-corrected monocular visual acuity [VA] was measured using Snellen E-chart and the presence of amblyopia was determined accordingly; FP was evaluated and graded from 0 to 3. Of 50 patients, including 27 female and 23 male subjects, 29 [58%] patients had FP but 18 [36%] subjects were truly amblyopic. Overall, the sensitivity and specificity of FP for detection of amblyopia was 88.9% and 59.4% respectively. The positive predictive value [PPV] and negative predictive value [NPV] were 55.2% and 90.5% respectively. Sensitivity, PPV and NPV were significantly higher in esotropic as compared to exotropic patients. Strong monocular FP was correlated with more than 3 lines of interocular difference [IOD] in visual acuity [P=0.001]. Although FP is not an ideal method for diagnosis of strabismic amblyopia, it has high sensitivity, PPV and NPV in esotropic patients and in subjects with more than 3 lines of IOD in VA