Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials.

Purpose: This study aimed to evaluate the efficacy of tranexamic acid (TXA) in treating melasma through a meta-analysis and systematic review of randomized controlled trials (RCTs). The study focused on identifying associated adverse effects and comparing TXA's effectiveness with other melasma treatments.Materials and methods: Following PROSPERO and PRISMA guidelines, an extensive electronic search was conducted across four databases for RCTs on TXA use in melasma. Inclusion criteria encompassed full-text English articles with specific outcome measures, while studies with high bias risk or non-English publications were excluded. Data were extracted from 22 relevant studies and analyzed using the RevMan software, with heterogeneity identified using I² statistics and forest plots.Results: A total of 22 studies with 1280 patients were included. TXA was administered orally, topically, or via injection, with treatment durations ranging from 8 weeks to nearly 2 years. TXA significantly reduced melasma severity, evidenced by reductions in MASI, mMASI, MI, and hemi-MASI scores. Oral TXA showed the most substantial decrease in MASI scores, followed by injections and topical applications. However, studies exhibited high heterogeneity, particularly in combined treatments. Adverse effects included gastrointestinal discomfort, skin irritation, and menstrual irregularities.Conclusions: TXA is effective in treating melasma, either alone or combined with other treatments. Despite significant reductions in melasma severity, further research is necessary to standardize TXA administration methods and address long-term effects. The high heterogeneity observed suggests a need for more consistent treatment protocols.

Parents' Knowledge, Attitude, and Practice Regarding Febrile Convulsion in Children in Riyadh, Saudi Arabia.

Background Fever is a common presentation in pediatric age groups and is the most common reason for healthcare visits. Parents' knowledge is essential for early presentation to healthcare facilities and to prevent possible complications. Studies suggest that febrile convulsions (FCs) often cause stress and anxiety for parents, who often assume it may cause brain damage, future epilepsy attacks, mental retardation, physical injury, and even death. This study aims to assess the knowledge, attitude, and practices of FCs among parents. Methodology This cross-sectional study was conducted among parents living in Riyadh, Saudi Arabia, with children younger than 14 years of age. A self-administered questionnaire was distributed among the selected population using an online survey. The questionnaire included socio-demographic data, family experiences of FC, practice toward a child with FC, and questions assessing knowledge, attitude, and concerns. Results Of the 415 recruited parents, 350 (84.3%) were mothers, and 56.4% were government employees. Regarding monthly income, 172 (41.4%) were earning more than 15,000 SAR per month. The prevalence of parents with having a child with FC was 33%. Overall, 369 (88.9%) had poor knowledge, 41 (9.9%) had moderate knowledge, and only five (1.2%) had good knowledge levels. Regarding attitude, more than one-third (200, 35.2%), had a negative attitude, 205 (49.4%) were neutral, and the rest had positive attitude levels (64, 15.4%). Increased knowledge and attitude toward FC were associated with having a child or siblings of a child with FC. Regarding the practice and the plan of action for future FC occurrence, the most common was to rush the child to a doctor (94, 68.6%), followed by lowering the child's body temperature (78, 56.9%), and placing the child on his/her side (54, 39.4%). Conclusions There was an optimistic attitude toward a child with FC but knowledge was deficient. However, parents who had a child or siblings experiencing FC were more knowledgeable, while parents with higher education and better income tended to exhibit better attitudes when managing a child with FC. Further investigations are needed to establish the level of understanding and perspectives of parents when managing a child with FC.

Comprehensive Analysis of Current Treatment Approaches for Keloids in Pediatrics: A Systematic Review.

Keloids, benign fibrous growths resulting from atypical skin responses to injuries, present a complex challenge in dermatology. These lesions, characterized by excessive collagen production, often lead to physical discomfort and psychological distress. While various treatment methods exist, the lack of a universally effective modality underscores the need for a systematic evaluation of current approaches. This systematic review aims to comprehensively analyze the current available treatment modalities used for the management of keloids in the pediatric population in terms of their effectiveness, safety, and quality of life outcomes. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted on PubMed and Google Scholar databases to identify relevant studies published in English. The review specifically focused on randomized controlled trials involving patients under 18 diagnosed with keloids, assessing different treatment modalities, and reporting validated measures of treatment efficacy, safety outcomes, and quality of life. The risk of bias was assessed using Cochrane's Risk of Bias Tool for randomized studies to ensure the methodological quality of the included trials. Four studies met the inclusion criteria, collectively involving 196 pediatric patients. Treatment interventions included glucocorticosteroid and fusidic acid cream with silicone gel patches, botulinum toxin type A injections, and Scarban silicone gel sheets. Patient-reported outcomes exhibited varying degrees of improvement in scar size, vascularity, and pliability. Complications, such as rash and wound infection, were reported in some cases. Based on our review of the selected studies and due to the incompletely understood pathogenesis of keloids, there is an ongoing lack of universally effective treatment modality for the management of keloids resulting in their persistently high recurrence rate.

Preferences and attitudes of the Saudi population toward receiving medical bad news: A primary study from Riyadh city.

BACKGROUND: Breaking bad news is one of the most stressful and difficult things a physician has to do. Good communication skills are required in order to ensure that bad news is delivered in a humane but effective way. OBJECTIVES: This study was designed to explore the preferences and attitude of the Saudi population toward receiving bad news. Second, it was to identify the associations between preferences, attitudes, and sociodemographic characteristics. MATERIALS AND METHODS: This was a cross-sectional study conducted during the month of April 2009 in Riyadh. Data were collected from 1013 adult Saudis. Stratified random sampling technique was used through a self-administered questionnaire. RESULTS: In this study, 474 (46.8%) were males and 539 (53.2%) were females. Almost two-third of the participants preferred to be the first to receive the bad news. A majority of the participants 695 (68.6%) preferred to be told the bad news at a private place, whereas, 441 (43.5%) preferred to be told by the head of the medical team. Moreover, almost half of the participants would like the one who breaks the bad news to remain with them to give them some more information about the disease. Significant associations were observed between participants' perception and attitude with age, marital status, gender, and education (P < 0.001), respectively. CONCLUSION: Factors such as marital status, age, and gender, and education play significant roles in how bad news is received. Understanding what is important in the process of breaking bad news may help in determining how best to perform this challenging task.