Comparative Analysis Of Efficacy Research Articles

Experimental assessment and comparative analysis of efficacy for modified method of cellular therapy in chronic wounds on background of diabetes mellitus

Objective. Determination of efficacy of the cellular therapy modified method in chronic wounds on background of diabetes mellitus, comparing with standard and new methods of treatment in experiment.
 Materials and methods. Experimental investigations were conducted on 30 adult male rats of a Wistar line, in which diabetes mellitus was experimentally simulated. Full-thickness square wound was used as experimental pattern. In the animals of group A (control) the wounds were processed with 0.05% solution of chlorhexidine bigluconate and the hydrohel bandages put on (standard of treatment). To the group B animals photodynamic therapy was conducted, and processes of regeneration were stimulated with the help of the mesenchymal stem cells application. To the group C animals the wounds bottom and edges were infiltrated with suspension of autologous mesenchymal stem cells for active regeneration after conduction of photodynamic therapy.
 Results. Best healing of the wounds while application of photodynamic therapy and injections of mesenchymal stem cells was noted: on the 5th day from the treatment beginning the wounds square reduction have appeared the most – 71.9%, while application of mesenchymal stem cells this index have constituted 61.6%, and while standard treatment – 36.0%.
 Conclusion. Treatment of chronic wounds on background of diabetes mellitus, using photodynamic therapy and injections of mesenchymal stem cells, have demonstrated essentially better results, than after standard method. Application of mesenchymal stem cells into the wound, the results of which were compared with results of their injectional introduction, may be recommended as alternative, if immediate injections of mesenchymal stem cells into the tissues over the wound are impossible.

A Comparative Analysis of Efficacy of Intralesional Mumps-Measles-Rubella Vaccine Versus 5-Fluorouracil in the Treatment of Palmoplantar Warts.

Background:Palmoplantar warts are quite resistant to treatment, so treating them is a challenge as ablative modalities lead to pain, temporary immobility, secondary infections, and scarring. The treatment of warts using immunotherapeutic methods and cytotoxic methods is being increasingly used to overcome drawbacks in the treatment of warts.Aim:To evaluate the efficacy and safety of intralesional mumps-measles-rubella (MMR) vaccine versus 5-fluorouracil (5-FU) in the treatment of palmoplantar warts.Materials and Methods:A total of 36 patients were divided into two groups of 18 each, MMR and 5-FU groups, respectively. The patients in the MMR group were given 0.1ml - 0.5ml of intralesional MMR vaccine in each lesion depending on the dimensions of the lesion and was repeated at 2 weekly intervals until complete clearance or a maximum of six doses. The patients in the 5-FU group were given 0.1ml - 0.5ml of intralesional injection of a solution containing 4 mL of 250 mg/mL of 5-FU and 1 mL of a mixture of 20 mg/mL (2%) lidocaine and 0.0125 mg/mL of epinephrine, which was given at 2 weekly intervals until complete clearance or maximum six doses.Results:In our study, warts had resolved in all 18 (100%) patients belonging to the MMR group by the 12th week, whereas 11 (61.11%) patients still had warts among the patients belonging to the 5-FU group (i.e., warts had resolved only in 7 (38.89%) patients at the end of 12th week), which was found to be statistically significant (P-value < 0.05).Limitation:Smaller sample size and lack of follow-up to evaluate for possible recurrence.Conclusion:MMR vaccine is a safe and effective treatment modality for palmoplantar warts compared to 5-FU.

Comparative Efficacy Analysis of Intubation Profile in Airtraq Video Laryngoscope Versus Macintosh Laryngoscope in Simulated Difficult Airway Using Cervical Collar

Aim: Comparative efficacy analysis of laryngoscopes -Airtraq vs macintosh - using Intubation Time and Intubationdifficulty score in simulated difficult airway using cervical collar.Methods: Peculiarity is simulated difficult airway by use of cervical collar. A prospective interventionalrandomizedstudy conducted on 60 adult ASA grade-I&amp;II patients scheduled for surgery in tertiary care center.Tracheal Intubation 1. Group(AVL) Airtraq videolaryngoscope (n=30) 2. Group(ML) Macintoshlaryngoscope(n=30). Parameters observed: 1) Intubation Time- seconds 2) Intubation Difficulty Score (IDS) comprised Numbersof-1. intubation attempts 2.operators 3.alternative intubation techniques, 4. Glottic exposure. 5. paramatriccomparison lifting force required during laryngoscopy, Necessity for external laryngeal pressure, Position of thevocal cords.Results: With airtraq laryngoscope intubation discoursed outcomes intubation time is irrelevant with difficultairway where it is highly associated in case of macintosh laryngoscope. Intubation time &amp; difficulty score iscommentating use of Airtraq laryngoscope.Conclusions: The enhanced visual interiors expedite in such a way that intubation time in Airtraq is not dependenton IDS like Macintosh but on neuromuscular reflexes of performer, commentating the superiority of Airtraq overMacintosh

The optimal dosage of rituximab for ABO-incompatible kidney transplantation: comparative analysis of efficacy and safety

The optimal dosage of rituximab for ABO-incompatible kidney transplantation: comparative analysis of efficacy and safety

Comparative analysis of efficacy and tolerability of tramadol versus diclofenac in treatment of knee osteoarthritis

Background: Present study was conducted on patients of osteoarthritis (OA) treated with the traditional drug diclofenac sodium and compares it with tramadol, with the primary objective for determining effectiveness and tolerability based on WOMAC scores.Methods: The study was conducted as a randomized clinical study of the effectiveness and tolerability of tramadol versus diclofenac in the treatment of knee OA, at Tertiary care institute of Gujarat in the department of orthopedics. Consecutive patients were allotted serially in two groups; tramadol group (n=75) One tablet orally twice daily for 8 weeks. Diclofenac group (n75) patients received 75 mg oral dose of diclofenac 2 times daily for a period of 8 weeks. Overall improvement was evaluated through various parameters.Results: About 33% decrease in the scoring of stiffness domain of the WOMAC OA index questionnaire in the tramadol group and a 21% decline in the diclofenac group was observed. There was a 65% decrease in the scoring of knee joint tenderness questionnaire in the tramadol group and a 44% reduction in the diclofenac group. Tramadol was found to be more effective in improving the WOMAC OA index. WOMAC score (overall) and knee joint tenderness scores were also improved by tramadol than diclofenac.Conclusions: There was a significant improvement in the standard of life in patients suffering from knee OA when treated with tramadol. Tolerability was better with tramadol than diclofenac.

25030 Comparative efficacy of treatments for moderate-to-severe plaque psoriasis: An updated network meta-analysis (NMA)

Background: The clinical benefits of biologic treatments for moderate-to-severe plaque psoriasis (PsO) are well-established, but efficacy outcomes can vary across different therapies. Comparative efficacy analysis can be highly informative in clinical settings where multiple therapeutic options are available.

Immunotherapy in elderly patients

In the recent years the growing life expectancy of the population and increasing cancer burden in elderly patients substantiate the urgent need for the search of optimal cancer treatment strategies. This article provides an overview of the current literature on the efficacy and safety of checkpoint inhibitors in the elderly population. A literature search for published studies using Medline (PubMed) and Elibrary databases was performed. All studies containing data on treatment results including tumor response criteria, treatment response rate, tumor control rate, overall survival were included. Case studies, animal studies and studies containing duplicate results were excluded from the analysis. In elderly patients with cancer there is a substantial number of comorbid conditions and functional disorders, which may decrease the efficacy and modulate the tolerability of immune checkpoint inhibitors (ICI). Besides, different changes associated with immunologic ageing, including thymolysis, increase of the number of memory B-cells and a decrease of hematopoesis intensity are observed. Several studies performed a comparative analysis of efficacy and toxicity of ICIs in elderly and younger patients. In most cases similar results for efficacy and toxicity were demonstrated. To evaluate the toxicity and the influence of treatment on functional status and other important measures in geriatric population further studies of factors, influencing the tolerability and treatment response of newer ICI in elderly cancer patients are needed, including additional adverse events associated with treatment.

AB0556 COMPARING EFFICACY OF GUSELKUMAB VERSUS USTEKINUMAB IN PATIENTS WITH PSORIASIS ARTHRITIS: AN ADJUSTED COMPARISON USING INDIVIDUAL PATIENT DATA FROM DISCOVER 1&amp;2 AND PSUMMIT TRIALS

Background:Guselkumab is an anti-interleukin (IL)-23 monoclonal antibody recently approved for a treatment of Psoriasis arthritis (PsA). In two large Phase III trials of patients with PsA (DISCOVER -1 &amp; -2) guselkumab has shown to be superior versus placebo. In this indication no direct comparison is available between guselkumab and ustekinumab, a monoclonal antibody targeting IL-12 and IL-23. Indirect comparisons based on relative treatment effects versus a common comparator (placebo) only allow for analyses up to week 24 due to cross-over to active arms in available PsA trials.Objectives:To compare indirectly joint and skin efficacy of guselkumab versus ustekinumab up to week 52, using pooled patient-level trial data from DISCOVER 1&amp;2 and PSUMMIT 1&amp;2, adjusting for cross-trial population differences.Methods:Patient level data, including baseline characteristics and outcome data on American College of Rheumatology (ACR) response, Psoriasis Area Severity Index (PASI) response from the guselkumab arms of DISCOVER -1 &amp; -2 were pooled with the data from the ustekinumab trials PSUMMIT -1&amp;-2. Analyses were performed for bio-naïve and bio-experienced populations separately. Differences in patient characteristics across trial populations were adjusted for using multivariate logistic regression, including: gender, age, body mass index, previous TNF use, disease duration, PASI level, number of swollen and tender joints. This method of indirect comparisons allows for analysis of comparative efficacy beyond controlled induction period and odds ratios’ resulting from this model were translated into predicted response rates for ustekinumab, assuming same patient population, as enrolled in the guselkumab trial arms.Results:Majority of baseline characteristics for patients on guselkumab (100mg q8w; 100mg q4w) were comparable to patients on ustekinumab 45/90mg, in both in bio-naïve and bio-experienced group of patients. The probability of reaching a ACR 20 in both the bio-naïve &amp; bio-experienced population was significantly higher for guselkumab vs ustekinumab at weeks 52 for both dosing regimens of guselkumab (bio-naïve ACR 20: q8w OR= 1.88 [1.28;2.76]), q4w (OR= 1.92 [1.29;2.86]; bio experienced ACR20 q8w OR= 2.72[1.17;6.31], q4w OR=4.77 [1.95;11.63]). Similarly guselkumab was superior over ustekinumab on PASI 90 outcome at week 52 in both bio-naïve &amp; bio-experienced patients with BSA ≥3 % at baseline (bio-naïve: q8w OR= 2.59 [1.68;3.99]), q4w OR= 3.19 [2.03;5.00], and bio-experienced q8w OR= 3.96[1.39,11.27], q4w OR=13.10[4.18,41.04]). Figure 1 represents unadjusted pooled DISCOVER 1&amp;2 trial results and estimated proportions of ustekinumab treated patient group achieving ACR 20 in bio-naïve patient group up to week 52 using the method described above.Conclusion:An adjusted comparison using patient level data from pivotal Phase III studies demonstrates both dosages of guselkumab to be significantly more effective versus ustekinumab in both skin and joint outcomes in both bio-naïve &amp; bio experienced patients up to week 52.Disclosure of Interests:Joris Diels Shareholder of: Janssen, Employee of: Janssen, Pushpike Thilakarathne Employee of: Janssen, Agata Schubert Shareholder of: Janssen, Employee of: Janssen, Fareen Hassan Shareholder of: Janssen, Employee of: Janssen, Steve Peterson Shareholder of: Janssen, Employee of: Janssen, Wim Noel Shareholder of: Janssen, Employee of: Janssen.

Comparative Efficacy and Relative Ranking of Biologics and Oral Therapies for Moderate-to-Severe Plaque Psoriasis: A Network Meta-analysis.

IntroductionThe clinical benefits of biologic and oral treatments for moderate-to-severe plaque psoriasis are well-established, but efficacy outcomes can vary across therapies. Comparative efficacy analysis can be highly informative in clinical settings with multiple therapeutic options. This study assessed the short-term and long-term comparative efficacy of biologic and oral treatments for moderate-to-severe psoriasis.MethodsA systematic literature review identified phase 2/3/4 randomized controlled trials (RCTs) through to 1 July 2020 for Food and Drug Administration- or European Medicines Agency-licensed treatments for moderate-to-severe psoriasis. Psoriasis Area and Severity Index (PASI) 75/90/100 response rates at the end of the primary response (short-term: 10–16 weeks from baseline) and maintenance periods (long-term: 48–52 weeks from baseline) were estimated using Bayesian network meta-analysis. Surfaces under the cumulative ranking curves (SUCRA) were estimated to present the relative ranking of treatments.ResultsIn the short term (N = 71 RCTs), the PASI 90 response rates were highest for ixekizumab (72.9%, SUCRA 0.951), risankizumab (72.5%, 0.940), and brodalumab (72.0%, 0.930), which were significantly higher than those for guselkumab (65.0%, 0.795), secukinumab (65.0%, 0.794), infliximab (56.8%, 0.702), certolizumab (400 mg: 49.6%, 0.607; 200 mg: 42.2%, 0.389), ustekinumab (90 mg: 47.9%, 0.568; weight-based: 45.7%, 0.505; 45 mg: 44.6%, 0.460), adalimumab (43.0%, 0.410), tildrakizumab (200 mg: 39.7%, 0.327; 100 mg: 37.2%, 0.268), etanercept (18.0%, 0.171), apremilast (12.4%, 0.090), and dimethyl fumarate (12.2%, 0.092). The PASI 100 response rates were highest for ixekizumab (41.4%), risankizumab (40.8%), and brodalumab (40.3%). In the long term (N = 11 RCTs), the PASI 90 rate was highest for risankizumab (85.3%, SUCRA: 0.998), which were significantly higher than those for brodalumab (78.8%, 0.786), guselkumab (78.1%, 0.760), ixekizumab (72.1%, 0.577), secukinumab (67.0%, 0.450), ustekinumab (weight-based: 55.0%, 0.252), adalimumab (51.6%, 0.176), and etanercept (37.9%, 0.001). Risankizumab had the highest PASI 100 response rate (65.4%), followed by brodalumab (55.7%) and guselkumab (54.8%).ConclusionsIxekizumab, risankizumab, and brodalumab had the highest short-term efficacy, and risankizumab had the highest long-term efficacy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00511-1.

Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta-analyses.

To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses. We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses. We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids. We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.

Ditans vs Gepants: A Systematic Review and Indirect Network Meta-Analysis for Comparative Analysis of Efficacy and Safety.

An acute attack of migraine, incapacitates the migraineurs, and is widely prevalent. And to warden off its symptoms, recently two groups of drugs have been approved and launched. The aim of this systematic review and indirect meta-analysis is to evaluate and summarize the effectiveness of these pharmacological interventions in managing the aforesaid disease. An extensive literature search was done through Cochrane library, Pub Med, clincialtrials.gov, for a period of 5 years (2015-2020), using key words: lasmiditan; ubrogepant; rimegepant; and acute migraine. Randomized double-blind phase III clinical trials, published in English language, were included which explored the efficacy and safety of these drugs. The outcomes of this meta-analysis included proportion of patients' headache, most bothersome symptoms free, and no disability at all at 2 h post-dose, with sustained pain freedom 2-24 h, and experiencing any adverse event. An indirect network meta-analysis was also conducted to determine the comparative effectiveness of these drugs. A total of seven RCTs involving 7266 patients were included. In general, the new drugs demonstrated better result in all the efficacy parameters. The adverse events were observed in treatment group compared to placebo. While in the indirect comparison, lasmiditan emerged to be superior in all the outcomes, except for sustained pain freedom 2-24 h (rimegepant was better). The adverse events were more with lasmiditan. All the newer drugs have shown significant improvement in the outcomes analyzed. Lasmiditan appears to be superior among the newer drugs in efficacy; however it has more adverse effects.

Efficacy of sublingual immunotherapy tablets in dust mite and pollen allergy.

The latest evidence on the mechanisms, efficacy, and safety of sublingual immunotherapy (SLIT) was reviewed. Interleukin (IL) 35 and IL-35-producing regulatory T cells were assessed as new biomarkers for SLIT responsiveness. A detailed analysis of clinical studies, including timothy grass pollen, 5-grass pollen, ragweed, and house-dust mite SLIT tablets, was provided, including a comparative analysis of efficacy and safety of SLIT versus subcutaneous immunotherapy.

Lessons learned from contemporary glioblastoma randomized clinical trials through systematic review and network meta-analysis: part 2 recurrent glioblastoma.

BackgroundThere exists no consensus standard of treatment for patients with recurrent glioblastoma (GB). Here we used a network meta-analysis on treatments from randomized control trials (RCTs) to assess the effect on overall survival (OS) and progression-free survival (PFS) to determine if any consensus treatment can be determined for recurrent GB.MethodsWe included all recurrent GB RCTs with at least 20 patients in each arm, and for whom patients underwent standard of care at the time of their GB initial diagnosis. Our primary outcome was OS, with secondary outcomes including PFS and adverse reactions. Hazard ratio (HR) and its 95% confidence interval (CI) of the comparison of study arms regarding OS and PFS were extracted from each paper. For comparative efficacy analysis, we utilized a frequentist network meta-analysis, an extension of the classic pair-wise meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses.ResultsFifteen studies were included representing 29 separate treatment arms and 2194 patients. In our network meta-analysis, combination treatment with tumor-treating field and Vascular endothelial growth factor (VEGF) inhibitor ranked first in improving OS (P = .80). Concomitant anti-VEGF and Lomustine treatment was superior to Lomustine alone for extending PFS (HR 0.57, 95% CI 0.41–0.79) and ranked first in improving PFS compared to other included treatments (P = .86).ConclusionsOur analysis highlights the numerous studies performed on recurrent GB, with no proven consensus treatment that is superior to the current SOC. Intertrial heterogeneity precludes drawing strong conclusions, and confidence analysis was low to very low. Further confirmation by future trials is recommended for our exploratory results.

Benefit of second-line therapy for advanced esophageal squamous cell carcinoma: a tri-center propensity score analysis.

Background:The level of evidence for palliative second-line therapy in advanced esophageal squamous cell carcinoma (aESCC) is limited. This is the first study that reports efficacy data comparing second-line therapy + active symptom control (ASC) versus ASC alone in aESCC.Methods:We conducted a tri-center retrospective cohort study (n = 166) including patients with aESCC who had experienced disease progression on palliative first-line therapy. A propensity score model using inverse probability of treatment weighting (IPTW) was implemented for comparative efficacy analysis of overall survival (OS) in patients with second-line + ASC (n = 92, 55%) versus ASC alone (n = 74, 45%).Results:The most frequent second-line regimens used were docetaxel (36%) and paclitaxel (18%). In unadjusted primary endpoint analysis, second-line + ASC was associated with significantly longer OS compared with ASC alone [hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.35–0.69, p < 0.0001]. However, patients in the second-line + ASC group were characterized by more favorable baseline features including a better Eastern Cooperative Oncology Group (ECOG) performance status, a longer first-line treatment duration and lower C-reactive protein levels. After rigorous adjusting for baseline confounders by re-weighting the data with the IPTW the favorable association between second-line and longer OS weakened but prevailed. The median OS was 6.1 months in the second-line + ASC group and 3.2 months in the ASC group, respectively (IPTW-adjusted HR = 0.40, 95% CI: 0.24–0.69, p = 0.001). Importantly, the benefit of second-line was consistent across several clinical subgroups, including patients with ECOG performance status ⩾1 and age ⩾65 years. The most common grade 3 or 4 adverse events associated with palliative second-line therapy were hematological toxicities.Conclusion:This real-world study supports the concept that systemic second-line therapy prolongs survival in patients with aESCC.

Comparative efficacy analysis of photodynamic therapy for involution skin changes in monotherapy and in combination with photosensitizing agents based on chlorine E6

Comparative efficacy analysis of photodynamic therapy for involution skin changes in monotherapy and in combination with photosensitizing agents based on chlorine E6

Comparative analysis of efficacy and safety of Bilastine 20 mg and Levocetirizine 5 mg in the treatment of Allergic Rhinoconjunctivitis

Objective: The present study was conducted to assess the efficacy and safety of bilastine 20 mgand compare the results with that of levocetirizine 5 mg in the treatment of allergicrhinoconjunctivitis. Material and Methods: It was a prospective study conducted in theDepartment of Ophthalmology and Department of Otorhinolaryngology at a tertiary institute ofsouthern Rajasthan, India during the period of 6 months from September 2019 to February 2020.100 patients of chronic allergic rhinoconjunctivitis were included in the study, of which 50 weretreated with Bilastine 20 mg, and the rest 50 patients were treated with levocetirizine 5 mg. Theprimary assessment was done by calculating the total symptom score (TSS) before and after the 7thand 14th post-treatment day. Results: The age of the patients ranges from 10 years to 65 yearswith a mean age of 32±5.2 years. The primary efficacy parameter for assessment was a reduction intotal symptom score (TSS). Both bilastine 20 mg and levocetirizine 5 mg significantly reduced theTSS on the 7th and 14th post-treatment days (p-value&lt; 0.001). There was no significant differencebetween TSS of bilastine and levocetirizine after 7 days (p-value= 0.41) and after 14 days treatment(p-value= 0.68). Adverse events were reported by 10% of patients in the bilastine group and by38% of patients in the levocetirizine group. Conclusion: Bilastine is a selective H1 antihistaminewith good efficacy and excellent safety profile and it is highly recommended to use it as a first-linetreatment for allergic rhinoconjunctivitis.

Comparative Analysis of Efficacy of Lactic Acid with Ferulic Peel (Combination Peel) Vs Ferulic Peel Alone as a Monotherapy for Photoaging.

Chemical peels are used to treat fine lines, photoaging, skin discoloration and scars. The objective of this study is to do a comparative analysis of lactic acid 30% with ferulic peel 12% (combination peel) versus ferulic peel 12% alone as a monotherapy for photoaging. This is a prospective study from Feb 2016 to 2020 in which a total of 60 female patients with ages between 25 and 36 years were treated. Randomization of patients was done for both groups with 30 patients enrolled in each group. The first group of 30 patients was treated with ferulic peel 12% (hydroalcohol base) with L-ascorbic acid 15% as a sealer alone (i.e., Group A). In the second group, 30 patients were treated with lactic acid 30 % with ferulic peel 12% (hydroalcohol base) with L-ascorbic acid 15% as a sealer (combination peel) (i.e., Group B). Inclusion and exclusion criteria have been defined for the study. Two scales have been used for assessing the results, Allergan Skin Roughness Scale (ASRS) and Allergan Fine Line Scale (AFLS). ASRS and AFLS scores were assessed at pre-treatment (pre) and post-treatment (post 1 month after last peel session) and compared using Student's paired t test and independent t test. The results showed significant and higher improvement of 27% and 42%, respectively, in ASRS (1.37 ± 0.49 vs. 1.87 ± 0.51, diff = 0.50, 95% CI = 0.24 to 0.76, p < 0.001) and AFLS (1.20 ± 0.41 vs. 2.07 ± 0.58, diff = 0.87, 95% CI = 0.61-1.13, p < 0.001) scores in patients treated with lactic acid and ferulic peel as compared to patients treated with ferulic peel alone. No complications were observed in our study. The study found the combination of lactic acid and ferulic peel significantly more effective than ferulic peel alone in the management of fine lines, photoaging and skin discoloration. The findings of this study may need to be further validated on a larger sample size and multicentric analysis. Initial results of our 4-year study have yielded promising results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

1% ivermectin in combination therapy regimens for rosacea

Introduction. The article provides latest data on modern methods of treating rosacea. The results of own clinical observations of patients with moderate to severe papulopustular rosacea receiving combination treatment and a comparative analysis of the efficacy of various therapy regimens are presented.Objective of the study. The aim of the study was to conduct a comparative analysis of the therapeutic efficacy of combination therapy using the ivermectin 1% topical drug combined with systemic therapy drugs (doxycycline, minocycline, isotretinoin).Materials and methods. We observed 37 patients with moderate to severe papulo-pustular rosacea subtype. The patients were divided into 4 groups (A, B, C, D). Patients in the control group received monotherapy with 1% ivemectin topical drug, patients in the other groups received combination therapy (1% ivermectin combined with low-dose doxycycline, minocycline and isotretinoin). The efficacy of the therapy was evaluated by measuring rosacea severity on the Scale for Diagnostic Assessment of Rosacea (SDAR), clinical manifestations according to the IGA (Investigator Global Assessment) criteria, and by assessing the patients' quality of life using the DLQI (Dermatology Life Quality Index) questionnaire before and after 3-month treatment.Results. The comparative analysis of changes in severity indicators of the skin process and quality of life in patients with moderate to severe papulopustular rosacea after topical and combination therapy showed that the results of the treatment in patients receiving combination therapy were more significant than those in the group receiving monotherapy.Conclusion. The concomitant use of 1% ivermectin and systemic drugs is most effective in patients with severe papulopustular rosacea subtype. The combination treatment tailored to the clinical forms and severity of rosacea allows to optimize the clinical results of the therapy, which significantly affects the patients' quality of life and opens up potential for an individual approach in the algorithms for the treatment of rosacea.

Comparative analysis of efficacy and safety of transurethral and vesicoscopic surgery of primary vesicoureteral reflux in children

Introduction. Research interest in vesicoureteral reflux (VUR) is determined by continued dissatisfaction with the treatment results, which do not exclude the development of renal failure and hypertension. The management tactics of such patients currently range from the dynamic follow-up to various surgical correction options, which determines the relevance of developing a personalized approach when choosing a surgical treatment technique. Purpose of the study. The study was aimed at a comparative analysis of the efficacy and safety of transurethral administration of a polyacrylate polyalcohol copolymer (PPC) and vesicoscopic transregional ureterovesical anastomosis (VUVA) according to Cohen. Materials and methods. The study is based on a retrospective analysis of the results of treatment of 214 patients with primary VUR, who underwent surgery from 2012 to 2018. The average age was 61.7 ± 47.9 months. Girls — 133 (62.1%), boys — 81 (37.6%). Indication for surgery in 150 (70%) children was recurrent urinary tract infection, in 64 (30%) — progressive reflux nephropathy. Bilateral process was observed in 92 (43%) patients, left-sided — in 69 (32%), right-sided — in 53 (25%). Patients were divided into two groups. Group I — 119 (55.6%) patients (179 renal units (RU)), who underwent endoscopic treatment (ET) using PPC. Group II — 95 (44.4%) children (127 RU) who underwent VUVA. Each of the groups was divided into subgroups, including RU with a low grade of (I-III) VUR and RU with a high grade of (IV-V) VUR. Complications were graded using the Clavien-Dindo classification. Statistical analysis and processing of the obtained data were performed using Microsoft Excel and STATISTICA10 software. Results. When comparing the gender structure of the groups, differences were not detected (p >0.05). The average age in Group I was 53.5 ± 44.4 months, in Group II — 72.0 ± 50.4 months. (p 0.05). In Subgroup I (IV-V) after the first ET, reflux was eliminated in 76.3%, after the second ET the overall efficiency was 81.4%. In Subgroup II (IV-V deg), VUR was eliminated in 100% of cases (p 0.05). In Subgroup I (IV-V), a predominance of the III-grade complications (p <0.01) was revealed. Conclusion. A comparative analysis of the efficacy and safety of surgical treatment of VUR using transurethral and vesicoscopic approaches revealed that ET is preferred for patients with low reflux grades (I-III). Vesicoscopic approach provides higher efficacy and safety in patients with high VUR grades (IV-V) compared with ET.

Comparative analysis of efficacy of US and CT in diagnosis of acute abdomen

Background: Acute abdominal pain is a common chief complaint in patients examined in the emergency department (ED) and can be related to a myriad of diagnoses. Of all patients who present to the ED, 4%–5% have acute abdominal pain. The causes of acute abdominal pain range from life-threatening to benign self-limiting disorders. Acute appendicitis, diverticulitis, cholecystitis, and bowel obstruction are common causes of acute abdominal pain. Other important but less frequent conditions that may cause acute abdominal pain include perforated viscous and bowel ischemia. A confident and accurate diagnosis can be made solely on the basis of medical history, physical examination, and laboratory test findings in only a small proportion of patients. The clinical manifestations of the various causes of acute abdominal pain usually are not straightforward. Aim of the study: To compare the efficacy of US and CT in diagnosis of acute abdomen. Materials and methods: The present study was conducted in the Department of Radio-Diagnosis, Rajindra Hospital, Patiala. The ethical clearance for the study was approved from the ethical committee of the hospital. US was performed with Philips Envisor or GE Logiq α-200 with a 3.5mhz sector or curvilinear probes. CT scan was performed with Siemens- Somatom Emotion 6 slice third generation spiral CT. In our study, we consider 60 patients referred to Department of Radio-Diagnosis, Rajindra Hospital, Patiala with clinical suspicion of acute abdomen. All patients were subjected to ultrasound abdomen. Before doing CT, a detailed history was taken and a thorough clinical examination was performed and findings recorded. Results: Age distribution in our series ranged from 3-83 years. Maximum number of patients were in 41-60 years age group (50.00%). Second highest incidence was in 21-40 years age group (20.00%) followed by 61-80 years age group (16.67%). There were 33 males and 27 females with M:F ratio 1.2:1. Mean age in our study was 45 years. Median was 47 and Mode was 50. 60 (Maximum number) patients presented with abdominal pain (100%). Second most common symptom was vomiting which was seen in 34 patients (56.67%) followed by non-passage of stools in6 patients (10.00%) and abdominal distension in 5 patients (8.33%). MDCT has accuracy of 100% in mesenteric ischaemia, malrotation of gut, GB perforation, Pancreatitis and pseudomembranous colitis. MDCT has accuracy of approximately 98% in diagnosing other mentioned conditions. USG has accuracy of 100% in diagnosing G.B perforation and small bowel obstruction. USG has less efficacy in diagnosing other acute abdominal conditions. Conclusion: From our study, it can be concluded that MDCT is an effective imaging modality with results that have a positive effect on the management of many patients with acute abdominal pain. CT may then be reserved for patients with non-diagnostic US results. At present, MDCT can be considered the primary imaging technique for patients with acute abdominal pain.