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Karam M, Alsaif A, Al-Naseem A, Almuhanna A, Aldubaikhi A, Hussain F, Alkandari K, Simmons I, Alfreihi S. Diclofenac Versus Corticosteroids Following Strabismus Surgery: Systematic Review and Meta-analysis. J Pediatr Ophthalmol Strabismus 2023; 60:312-322. [PMID: 36441127 DOI: 10.3928/01913913-20221011-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of the current study was to compare outcomes of diclofenac versus corticosteroids following strabismus surgery. A systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed to include comparative studies of diclofenac versus corticosteroids following strabismus surgery. The analysis was based on fixed and random effect models. Primary outcomes included discomfort, chemosis, inflammation, conjunctival gap, intraocular pressure, and conjunctival injection. Secondary outcomes were conjunctival congestion, discharge, and drop intolerance. Eight studies with a sample of 469 eyes were included. At weeks 1 and 4 postoperatively, there were no statistically significant differences between the diclofenac and corticosteroid groups, except for conjunctival injection at week 1 (mean difference [MD] = -0.21, P = .04) favoring diclofenac. Interestingly, all primary outcomes significantly favored diclofenac at week 2: discomfort (MD = -0.34, P = .03), conjunctival chemosis (MD = -0.16, P = .04), conjunctival inflammation (MD = -0.16, P = .02), conjunctival gap (MD = -0.17, P = .002), intraocular pressure (MD = -2.53, P < .00001), and conjunctival injection (MD = -0.30, P = .03). Moreover, conjunctival congestion was significantly improved for dexamethasone, whereas discharge and drop intolerance was not statistically different. Diclofenac is comparable to various corticosteroids when used following strabismus surgery. However, it is important to note that diclofenac yielded significant improvements in discomfort, conjunctival chemosis, inflammation, conjunctival gap, intraocular pressure, and conjunctival injection, mainly at 2 weeks postoperatively. [J Pediatr Ophthalmol Strabismus. 2023;60(5):312-322.].
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Gonnah AR, Masoud O, AbdelWahab M, ElMosalamy A, Al-Naseem A. The Role of High Intensity Focused Ultrasound in the Treatment of Fibroadenomas: A Systematic Review. Breast Care (Basel) 2023; 18:279-288. [PMID: 37900548 PMCID: PMC10601662 DOI: 10.1159/000524738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/21/2022] [Indexed: 10/31/2023] Open
Abstract
Introduction Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging, and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple areolar distortion, scarring, and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option. Methods A literature search was performed on the databases Embase, MEDLINE/PubMed, Google Scholar, and Ovid for English language papers published between January 1, 2000, and March 17, 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were "HIFU", "High Intensity Focused Ultrasound," "Fibroadenoma," "Breast," "Lesion." This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Recently, a thermal ablative technique, high intensity focused ultrasound (HIFU), was found to be a safe, noninvasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients' satisfaction with the cosmetic results and future recommendation of the procedure to other patients. Conclusion Overall, HIFU is a well-tolerated treatment associated, with low risk of complications, that can potentially include erythema, skin discoloration, and bruising with the majority of these self-resolving shortly after the procedure.
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Affiliation(s)
| | - Omar Masoud
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Al-Naseem A, Sallam A, Gonnah A, Masoud O, Abd-El-Barr MM, Aleem IS. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2023; 33:9-20. [PMID: 34842991 DOI: 10.1007/s00590-021-03167-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Robot-assisted pelvic screw fixation is a new technology with promising benefits on intraoperative outcomes for patients with posterior pelvic ring injuries. We aim to compare robot-assisted pelvic screw fixation to the traditional fluoroscopy-assisted technique with regards to intraoperative and postoperative outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used along with a search of electronic information to identify all studies comparing the outcomes of robot-assisted versus conventional screw fixation in patients with posterior pelvic ring injuries. Primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure and intraoperative drilling frequency. Secondary outcome measures included Majeed score, healing time (minutes) and rate (%), postoperative complications, screw positioning, incision length (cm) and guide wire insertion times (minutes). The random effects model was used for analysis. RESULTS Four observational studies including a total of 294 patients were identified. There was a significant difference between robot-assisted and conventional groups in terms of operative duration (MD = - 24.66, p < 0.05), intraoperative bleeding (MD = - 10.37, P < 0.05), fluoroscopy exposure (MD = - 2.15, P < 0.05) and intraoperative drilling frequency (MD = - 2.42, P = < 0.05). For secondary outcomes, no significant difference was seen in Majeed score, healing time and rate and postoperative complications. The robot-assisted group had better screw positioning, smaller incision length, and shorter anaesthesia and guide wire insertion times. CONCLUSIONS Robot-assisted fixation has superior intraoperative outcomes compared to conventional fixation. Further studies are needed to look at postoperative outcomes as there is no significant difference in postoperative prognosis between the techniques.
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Affiliation(s)
| | - Abdelrahman Sallam
- School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Ahmed Gonnah
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Omar Masoud
- School of Medicine, King's College London, London, UK
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University Medical Centre, Durham, USA
| | - Ilyas S Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep 2022; 3:100135. [PMID: 36578464 PMCID: PMC9791175 DOI: 10.1016/j.xagr.2022.100135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is debate on whether uterine gauze packing or intrauterine balloon tamponade is safer and more effective as a surgical management option for treating postpartum hemorrhage. OBJECTIVE This study aimed to compare intra- and postoperative outcomes of intrauterine balloon tamponade and uterine gauze packing in patients with postpartum hemorrhage. STUDY DESIGN A range of databases such as Cochrane and PubMed were searched using terms including "post-partum haemorrhage," "uterine balloon tamponade," and "uterine gauze packing." All observational studies comparing intrauterine balloon tamponade with uterine gauze packing were included. Five studies were identified enrolling 821 adult patients diagnosed with postpartum hemorrhage. Primary outcomes included blood loss volume, success rates, and maternal mortality. Secondary outcomes comprised requiring additional interventions, postoperative hemoglobin levels, and requiring blood transfusions. Fixed and random models were used for analysis. RESULTS Intrauterine balloon tamponade seemed to be a superior option to uterine gauze packing. Intrauterine balloon tamponade was better in reducing intraoperative blood loss, with a statistically significant improvement (P<.0001). Cases managed with intrauterine balloon tamponade seemed to have statistically significant shorter operative time (P=.023) and hospital length of stay (P=.020) in one study. CONCLUSION Intrauterine balloon tamponade remains more effective and safer as a first-line surgical management option for postpartum hemorrhage compared with uterine gauze packing.
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Affiliation(s)
- Ahmad Abul
- School of Medicine, University of Leeds, Leeds, United Kingdom (XX Abul, XX Althuwaini, and XX Al-Muhanna)
| | - Abdulrahman Al-Naseem
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom (XX Al-Naseem)
| | - Abdulwahab Althuwaini
- School of Medicine, University of Leeds, Leeds, United Kingdom (XX Abul, XX Althuwaini, and XX Al-Muhanna)
| | - Abdulredha Al-Muhanna
- School of Medicine, University of Leeds, Leeds, United Kingdom (XX Abul, XX Althuwaini, and XX Al-Muhanna)
| | - Naomi S. Clement
- Faculty of Medicine and Health, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (Dr Clement),Corresponding author: Abdulredha Al-Muhanna, XX
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Karam M, Abul A, Althuwaini A, Almuhanna A, Alenezi T, Aljadi A, Al-Naseem A, Alsaif A, Alwael A. Coblation Versus Bipolar Diathermy Hemostasis in Pediatric Tonsillectomy Patients: Systematic Review and Meta-Analysis. Cureus 2022; 14:e23066. [PMID: 35419233 PMCID: PMC8995054 DOI: 10.7759/cureus.23066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 12/19/2022] Open
Abstract
This study aimed to compare the outcomes of coblation versus bipolar diathermy in pediatric patients undergoing tonsillectomy. A systematic review and meta-analysis were performed per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. An electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Primary outcome measures were intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage, and post-operative pain. Secondary outcome measures included a return to a normal diet, effects on the tonsillar bed, operation time, and administration of analgesia. Fixed and random-effects models were used for the analysis. Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.27, P = 0.005) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. The coblation group improved analgesia administration, diet and tonsillar tissue recovery, and thermal damage for secondary outcomes. No significant difference was reported in terms of operation time. In conclusion, coblation is comparable to a bipolar technique for pediatric patients undergoing tonsillectomy. It improves postoperative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.
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Affiliation(s)
- Mohammad Karam
- Medicine, Farwaniya Hospital, Kuwait City, KWT.,School of Medicine, University of Leeds, Leeds, GBR
| | - Ahmad Abul
- School of Medicine, University of Leeds, Leeds, GBR
| | | | | | | | - Ali Aljadi
- School of Medicine, University of Leeds, Leeds, GBR
| | | | - Abdulmalik Alsaif
- Medicine, Walsall Healthcare NHS Trust, Birmingham, GBR.,School of Medicine, University of Leeds, Leeds, GBR
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Karam M, Alsaif A, Al-Naseem A, Hayre A, Al Jabbouri A, Aldubaikhi A, Kahlar N, Al-Mutairi S. Mycophenolate versus Methotrexate in Non-infectious Ocular Inflammatory Disease: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm 2022; 31:613-620. [PMID: 35201968 DOI: 10.1080/09273948.2022.2034166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the outcomes of mycophenolate mofetil (MMF) versus methotrexate (MTX) in non-infectious ocular inflammatory disease (NIOID). METHODS The study was performed as per the PRISMA Guidelines. A search identified all studies comparing MMF versus MTX in NIOID. Treatment result and side effects were primary outcomes. RESULTS Four studies enrolling 905 patients were identified. There was no significant difference between MMF and MTX groups in overall treatment success (OR = 0.97, P = .96), treatment failure (OR = 0.86, P = .85). MTX showed a significantly improved effect in cases involving posterior uveitis and panuveitis (OR = 0.41, P = .003). In addition, MTX was associated with a faster median time to treatment success and had less side effects when compared to MTX, however this was not significant. For secondary outcomes, no significant difference was found in visual acuity and resolution of macular oedema. CONCLUSION MMF is comparable to MTX in the treatment of NIOID.
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Affiliation(s)
- Mohammad Karam
- Bachelor of Medicine and Bachelor of Surgery (MBChB), School of Medicine, University of Leeds, Leeds, UK.,Farwaniya Hospital, Ministry of Health, State of Kuwait
| | - Abdulmalik Alsaif
- Bachelor of Medicine and Bachelor of Surgery (MBChB), School of Medicine, University of Leeds, Leeds, UK.,West Midlands, West Midlands, UK
| | | | - Amrit Hayre
- Bachelor of Medicine and Bachelor of Surgery (MBChB), School of Medicine, University of Leeds, Leeds, UK.,Whittington Health NHS Trust, London, UK
| | | | - Ahmed Aldubaikhi
- Bachelor of Medicine and Surgery (MBBS), College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Narvair Kahlar
- Bachelor of Medicine and Bachelor of Surgery (MBChB), School of Medicine, University of Leeds, Leeds, UK.,Sandwell and West Birmingham Hospitals NHS Trust, West Midlands, UK
| | - Salem Al-Mutairi
- Senior Consultant Ophthalmic Surgeon (M.D, FRCSC, External Eye Diseases, Cornea, Refractive Surgery and Uveitis), Head of Uveitis Unit, Al-Bahar Eye Center, Ministry of Health of Kuwait, State of Kuwait.,Program Director of Kuwait Board of Ophthalmology, Kuwait Institute of Medical Specialities (KIMS), State of Kuwait
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Alzaid M, Al-Naseem A, Al-Niaimi F, Ali FR. Topical timolol in dermatology: infantile hemangiomas and beyond. Clin Exp Dermatol 2021; 47:819-832. [PMID: 34798680 DOI: 10.1111/ced.15021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022]
Abstract
Timolol, a non-selective β-adrenergic receptor blocker, is well-tolerated and is becoming increasingly popular in dermatology especially after its use in the management of infantile hemangiomas. Its effects are mainly due to vasoconstriction, inhibition of angiogenesis and keratinocyte migration promotion for re-epithelialization and wound healing. We review the evidence behind the use of timolol in several dermatological conditions including infantile hemangiomas, pyogenic granulomas, Kaposi's sarcoma, chronic wound healing, post-surgical wounds, acne vulgaris, rosacea, eczema and red scrotum syndrome.
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Affiliation(s)
- M Alzaid
- University of Manchester Medical School, Manchester, UK
| | - A Al-Naseem
- University of Manchester Medical School, Manchester, UK
| | - F Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - F R Ali
- Mid Cheshire NHS Foundation Trust, Macclesfield, UK.,Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
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Alsaif A, Karam M, Al-Naseem A, Almuhanna A, Aldubaikhi A, Aljebreen M, Alfreihi S. Diclofenac Versus Dexamethasone Following Strabismus Surgery: A Systematic Review and Meta-Analysis. J Ocul Pharmacol Ther 2021; 37:343-353. [PMID: 33944620 DOI: 10.1089/jop.2020.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To compare outcomes of diclofenac versus dexamethasone in patients after strabismus surgery. Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted on MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). All randomized controlled trials (RCTs) comparing the outcomes of diclofenac versus dexamethasone poststrabismus surgery were included. An extraction spreadsheet for data collection and Review Manager 5.3 were used for data analysis based on the fixed and random effects models. Discomfort, inflammation, chemosis, conjunctival gap, and intraocular pressure (IOP) were primary outcome measures. Secondary outcomes included conjunctival congestion and injection, discharge, and drop intolerance. Fixed and random effects models were used for the analysis. Results: Five RCTs enrolling 248 subjects were enrolled. At week 2 postoperatively, there was a significant difference favoring diclofenac over dexamethasone in terms of discomfort (mean difference [MD] = -0.37, P = 0.02), conjunctival inflammation (MD = -0.16, P = 0.02), conjunctival chemosis (MD = -0.16, P = 0.04), and postoperative conjunctival gap (MD = -0.17, P = 0.002). In terms of IOP, there were no significant differences. However, no statistically significant differences were noted at weeks 1 and 4 postoperatively. For secondary outcomes, dexamethasone had significantly improved conjunctival congestion; however, diclofenac had significantly less injection at the site of muscle attachments at week 2. No significant difference was noted in terms of discharge and drop intolerance. Conclusion: Diclofenac is comparable to dexamethasone when used following strabismus surgery. However, a significant difference favoring diclofenac in terms of discomfort, inflammation, conjunctival chemosis, and conjunctival gap was only noted at 2 weeks postoperatively. The authors suggest conducting further studies to support the effectiveness of diclofenac as an alternative to corticosteroids following strabismus surgery.
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Affiliation(s)
| | - Mohammad Karam
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | | | | | - Ahmed Aldubaikhi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Meshaal Aljebreen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shatha Alfreihi
- Department of Pediatric Surgery, King Abdullah Specialist Children's Hospital, Ministry of National Guards, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Alsaif A, Alazemi M, Kahlar N, Karam M, Abul A, Al-Naseem A, Muhanna AA, Aldrees T. Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis. Ear Nose Throat J 2021; 102:NP183-NP191. [PMID: 33719616 DOI: 10.1177/0145561321994995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND AIMS There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. METHODS A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis. RESULTS Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = -0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue. CONCLUSIONS There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.
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Affiliation(s)
| | | | | | | | - Ahmad Abul
- University of Leeds, School of Medicine, Leeds, UK
| | | | | | - Turki Aldrees
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Abstract
Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by clinicians despite its high prevalence, probably because of suboptimal screening recommendations. Diagnosing IDWA relies on a combination of tests, including haemoglobin and ferritin levels, as well as transferrin saturation. Although the causes of iron deficiency may sometimes be obvious, many tend to be overlooked. Iron sufficiency throughout pregnancy is necessary for maternal and foetal health. Preoperative IDWA must be corrected to reduce the risk of transfusion and postoperative anaemia. Oral iron is the first-line treatment for managing IDWA; however, intravenous supplementation should be used in chronic inflammatory conditions and when oral therapy is poorly tolerated or ineffective. This review considers the causes and clinical features of IDWA, calls for greater awareness of the condition, and proposes diagnostic and management algorithms.
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