Laser Therapy Research Articles

Efficacy of Laser Therapy in Comparison With Other Methods for the Treatment of Onychomycosis: A Systematic Review and Meta-Analysis

Efficacy of Laser Therapy in Comparison With Other Methods for the Treatment of Onychomycosis: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain.

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

Comparison of Tecar Therapy and Low-Level Laser Therapy Separately and Simultaneously on Clinical Symptoms and Health-Related Quality of Life in Individuals with Type 2 Diabetes: A 3-Month Follow-up Study

Background: Distal peripheral neuropathy (DPN) is a prevalent issue among patients with type 2 diabetes mellitus. Despite the widespread use of low-level laser therapy (LLLT) and limited use of Tecar therapy in physiotherapy for diabetics, the synergistic effect of these two interventions in a long-term follow-up has not yet been determined. Objectives: This study aimed to compare the effects of Tecar therapy and LLLT separately and simultaneously over a 3-month follow-up period on clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN. Methods: In this double-blind, randomized clinical trial, forty-five individuals with type 2 diabetes (30 women and 15 men) with DPN were randomly assigned to three groups of 15 people: Tecar-on + laser-sham, Tecar-on + laser-on, and laser-on + Tecar-sham. The patients received ten treatment sessions and were followed up for 3-months after the last session. Health-related quality of life was assessed using the WHOQOL-BREF Questionnaire, while clinical symptoms, including pain (measured with a Visual Analog Scale), functional balance (evaluated with the timed-up and go test), and neuropathy symptoms (assessed with the Michigan Questionnaire) were also recorded. Results: Inter-group comparison after ten sessions revealed that the Tecar-on + laser-sham and Tecar-on + laser-on groups exhibited significant improvement in neuropathy symptoms compared to the laser-on + Tecar-sham group. Even after the 3-month follow-up, these two groups showed lasting improvement in all variables compared to the laser-on + Tecar-sham group (P &lt; 0.05). The Tecar-on + laser-on group demonstrated a more enduring significant effect on pain scores (P = 0.035) compared to the Tecar-on + laser-sham group after the 3-month follow-up. In intra-group comparison, all three groups showed significant improvement in clinical symptoms and health-related quality of life after ten treatment sessions compared to before treatment (P &lt; 0.05). Moreover, after the 3-month follow-up, both the Tecar-on + laser-sham group and the Tecar-on + laser-on group demonstrated a more lasting significant effect in all variables compared to before treatment (P &lt; 0.05). For the laser-on + Tecar-sham group, a more durable improvement in health-related quality of life (P = 0.000) and neuropathy symptoms (P = 0.011) was reported after the 3-month follow-up compared to before treatment. Conclusions: Although all three groups exhibited significant improvement in clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN after ten treatment sessions, the synergistic use of Tecar therapy and LLLT after a long-term follow-up period could lead to more durable therapeutic effects in improving these outcomes for individuals with diabetes.

Abstract PO2-18-07: Ultrasound – guided Interstitial Laser therapy for Stage I Breast Cancer: a phase 2 trial

Abstract Background: Screening programs are changing the scope of breast cancer, with a growing number of patients diagnosed at a nearly stage. The current standard treatment (breast conservation and radiation therapy) offers an excellent prognosis for these patients. Besides tumor removal, other techniques can be used to destroy a mass in place. A range of minimally invasive techniques holds promise on local breast tumor ablation (i.e. thermotherapy, cryotherapy, and irreversible electroporation). Previous studies with Interstitial laser thermotherapy (ILT) for breast cancer report mean ablation rates between 33% to 87%. Most common cited causes for failure are equivocal tumor size estimation, inadequate technique and the learning curve. Objective: Improve the ILT technique and achieve better ablation rates through the evaluated procedure. Methods: A prospective study with 15 patients with Stage I invasive breast cancer, presented as a unique lesion as inclusion criteria was conducted. MRI and US were used to estimate the primary tumor volume and rule out multicentric/multifocal disease. ILT ablation was performed using an Echolaser unit (Elesta) through percutaneous laser optical fibers with a US-guided insertion in the lesion center. All procedures were performed under local anesthesia and sedation. The post procedure image reevaluation included an immediate US after the ablation and a new MRI about 3 hours after the procedure. The definitive proposed surgical treatment was carried out 8-13 days after the ILT ablation. Results: Eighteen patients were included in the study, of whom 14 (with 15 lesions) completed the protocol. The mean tumor size measured by MRI was 13.7 (4-20) mm. The mean treatment time was 10.1 minutes and all patients went home the same day, reporting only mild (78%) or moderate (22%) pain, controlled with analgesics. The mean ablation index, evaluated by H&amp;E and CK8/18, was 61,5% (0 -93%) and when only tumors under 15 mm were considered the mean ablation index was 75% (30%-93%). The MRI performed after ablation procedure showed a large area of edema around the clip in all cases. The sensitivity and specificity to detect residual tumors were 1.0 and 0.84, respectively, when the residual tumors were larger than 15% of the original tumor size . Conclusions: These preliminary results suggest that laser therapy can eliminate viable neoplastic tissue in vivo. To achieve better results, standardization in patient selection, power and energy applied, should be considered. There are several advantages of ILT for breast cancer treatment, including preserving the structure and function of breast, no bleeding, no scaring and no radiation. More studies refining the technique should be conducted to allow the implementation of ILT as an alternative to surgical treatment in early breast cancer. Citation Format: Danielle Matsumoto, Silvio Bromberg, Marcus Corpa, Rodrigo Garcia, Guilherme Mariotti, Monica Rudner, Angela Waitzberg, Afonso Nazário, Gil Facina. Ultrasound – guided Interstitial Laser therapy for Stage I Breast Cancer: a phase 2 trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-18-07.

Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): five-year outcomes of a randomised trial

Concerns remain over the long-term safety of vascular endothelial growth factor (VEGF) inhibitors to treat retinopathy of prematurity (ROP). RAINBOW is an open label randomised trial comparing intravitreal ranibizumab (in 0.2mg and 0.1mg doses) with laser therapy in very low birthweight infants (<1500g) with ROP. Of 201 infants completing RAINBOW, 180 were enrolled in the RAINBOW Extension Study. At 5 years, children underwent ophthalmic, development and health assessments. The primary outcome was visual acuity in the better-seeing eye. The study is registered with ClinicalTrial.gov, NCT02640664. Between 16-6-2016 and 21-4-2022, 156 children (87%) were evaluated at 5 years. Of 32 children with no acuity test result, 25 had a preferential looking test, for 4 children investigators reported low vision for each eye, and in 3 further children no vision measurement was obtained. 124 children completed the acuity assessment, the least square mean (95% CI) letter score in the better seeing eye was similar in the three trial arms-66.8 (62.9-70.7) following ranibizumab 0.2mg, 64.6 (60.6-68.5) following ranibizumab 0.1mg and 62.1 (57.8-66.4) following laser therapy; differences in means: ranibizumab 0.2mg v laser: 4.7 (95% CI:-1.1, 10.5); 0.1mg v laser: 2.5 (-3.4, 8.3); 0.2mg v 0.1mg: 2.2 (-3.3, 7.8). High myopia (worse than-5 dioptres) in at least one eye occurred in 4/52 (8%) children following ranibizumab 0.2mg, 8/55 (15%) following ranibizumab 0.1mg and 11/45 (24%) following laser therapy (0.2mg versus laser: odds ratio: 3.99 (1.16-13.72)). Ocular and systemic secondary outcomes and adverse events were distributed similarly in each trial arm. 5-year outcomes confirm the findings of the original RAINBOW trial and a planned interim analysis at 2 years, including a reduced frequency of high myopia following ranibizumab treatment. No effects of treatment on non-ocular outcomes were detected. Novartis Pharma AG.

Evaluation of the efficacy and safety of cold laser (Diode 808 nm) therapy in the treatment of localized plaque psoriasis: clinical, dermoscopic and ultrastructural study

Background Psoriasis is a chronic, recurring, and immune-mediated inflammatory skin disease. Throughout the period of the last few decades, phototherapy has become widely used in treating stable psoriatic lesions. For the treatment of psoriasis, several light/laser therapies with distinct modes of action have been developed. Cold laser therapy might be an effective therapeutic choice for localized plaque psoriasis. Objective To assess the safety and efficacy of cold laser therapy clinically and microscopically in localized plaque psoriasis treatment. Patients and methods 40 patients with localized mild plaque psoriasis were selected from the Dermatology and Venereology outpatient clinic–Tanta University Hospitals and enrolled in the clinical trial. They were treated by cold laser 808 nm wavelength (Endolaser 422, Enraf–nonious B.V. Rotterdam, Netherlands) one session for 10 min on each plaque twice weekly separated by 2 days until clinical cure or for a maximum of 8 weeks. Evaluation was done immediately after the last session by taking the average of three blinded dermatologists of the photos, the modified Psoriasis Area and Severity Index [mPASI], dermoscopic examination, patients’ satisfaction scale and histopathological and electron microscopic examination of punch biopsy specimens taken before and after the end of treatment from psoriatic lesions in four patients only. Results There was a statistically significant clinical improvement after the end of treatment compared with before treatment as 16 patients (40%) showed excellent improvement, 8 patients (20%) showed good improvement, 9 patients (22.5%) showed mild improvement, and 7 patients (17.5%) showed poor improvement. As regard mPASI, a statistically significant decrease in mPASI was found after the end of treatment (P&lt;0.001). Regarding dermoscopic examination, a statistically significant reduction in the percentage of patients showing dermoscopic red dots and white scales after the end of treatment (P&lt;0.01). As regard the patients’ satisfaction scale, 82.5% of patients were satisfied from the results. Histopathological and ultrastructural evaluation revealed normalization of the psoriatic microscopic changes with cold laser. Conclusion The use of cold laser therapy for the management of localized mild plaque psoriasis is safe, tolerable, effective, and can be used as an alternative therapy for psoriasis.

Low-Level Laser and TENS Therapy Assessment for the Treatment of Temporomandibular Joint Disorder

ABSTRACT Introduction: The most prevalent conditions in the population are temporomandibular disorders (TMDs), which are linked to a number of morbidities. A number of treatment options have been proposed, and some of the most successful ones include low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) therapy. Objectives: The purpose of this study was to examine the effectiveness of two therapies—TENS treatment and LLLT—in the management of morbidities related to temporomandibular joint (TMJ) disorders. Materials and Methods: Based on inclusion and exclusion criteria, a total of 50 patients who had been sent to the oral medicine outpatient department and had been pre-diagnosed with TMJ disorders were randomly assigned to two groups, with 25 patients in each: Group I received TENS therapy, while Group II received LLLT. The acquired data was assessed statistically. Result: Both groups showed a substantial decrease in discomfort, an increase in mouth opening, and a decrease in muscular tenderness when compared to within groups. LLT was more effective than TENS for TMD treatment. Conclusion: While TENS and LLLT both had good results, LLLT appeared to outperform TENS therapy in terms of muscle tenderness factors.

Fatigue Alleviation by Low-Level Laser Pre-Exposure in Ischemic Neuromuscular Electrical Stimulation.

Despite its susceptibility to muscle fatigue, combined neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) is an effective regimen for managing muscle atrophy when traditional resistance exercises are not feasible. This study investigated the potential of low-level laser therapy (LLLT) in reducing muscle fatigue after the application of combined NMES and BFR. Thirty-six healthy adults were divided into control and LLLT groups. The LLLT group received 60 J of 850 nm wavelength LLLT before a training program of combined NMES and BFR of the non-dominant extensor carpi radialis longus (ECRL). The control group followed the same protocol but received sham laser therapy. Assessments included maximal voluntary contraction (MVC), ECRL mechanical properties, and isometric force-tracking for wrist extension. The LLLT group exhibited a smaller normalized difference in MVC decrement (-4.01 ± 4.88%) than the control group (-23.85 ± 7.12%) (P < .001). The LLLT group demonstrated a smaller decrease in muscle stiffness of the ECRL compared to the control group, characterized by the smaller normalized changes in frequency (P = .002), stiffness (P = .002), and relaxation measures (P = .011) of mechanical oscillation waves. Unlike the control group, the LLLT group exhibited a smaller post-test increase in force fluctuations during force-tracking (P = .014), linked to the predominant recruitment of low-threshold MUs (P < .001) without fatigue-related increases in the discharge variability of high-threshold MUs (P > .05). LLLT pre-exposure reduces fatigue after combined NMES and BFR, preserving force generation, muscle stiffness, and force scaling. The functional benefits are achieved through fatigue-resistant activation strategies of motor unit recruitment and rate coding.

Regenerative Medicine in Urogynecology: Where We Are and Where We Want to Be.

Pelvic floor disorders (PFDs) constitute a major public health issue given their negative effect on quality of life for millions of women worldwide and the associated economic burden. As the prevalence of PFDs continues to increase, novel therapeutic approaches for the effective treatment of these disorders are urgently needed. Regenerative medicine techniques, including cellular therapies, extracellular vesicles, secretomes, platelet-rich plasma, laser therapy, and bioinductive acellular biomaterial scaffolds, are emerging as viable clinical options to counteract urinary and fecal incontinence, as well as pelvic organ prolapse. This brief expert review explores the current state-of-science regarding application of these therapies for the treatment of PFDs. Although regenerative approaches have not been widely deployed in clinical care to date, these innovative techniques show a promising safety profile and potential to positively affect the quality of life of patients with PFDs. Furthermore, investigations focused on regeneration of the main constituents of the pelvic floor and lower urinary tract improve our understanding of the underlying pathophysiology of PFDs. Regenerative medicine techniques have a high potential not only to revolutionize treatment of PFDs but also to prevent these complex conditions.

Intravitreal Aflibercept vs Laser Therapy for Retinopathy of Prematurity

Prospective long-term data after retinopathy of prematurity (ROP) treatment with anti-vascular endothelial growth factor injections vs laser therapy are scarce. The FIREFLEYE (Aflibercept for ROP IVT Injection vs Laser Therapy) next trial is prospectively evaluating the long-term efficacy and safety outcomes following ROP treatment with intravitreal aflibercept vs laser therapy. To evaluate 2-year ophthalmic and safety outcomes after 0.4-mg aflibercept injection or laser therapy in the 24-week randomized (2:1) FIREFLEYE trial (FIREFLEYE outcomes previously reported). This prospective nonrandomized controlled trial performed in 24 countries in Asia, Europe, and South America (2020-2025) follows up participants treated in the FIREFLEYE randomized clinical trial (2019-2021) through 5 years of age. Participants included children born very or extremely preterm (gestational age ≤32 weeks) or with very or extremely low birth weight (≤1500 g) who were previously treated with a 0.4-mg injection of aflibercept compared with laser therapy for severe acute-phase ROP. Data for the present interim analysis were acquired from March 18, 2020, to July 25, 2022. Complications of ROP treated at investigator discretion (no study treatment). Efficacy end points included ROP status, unfavorable structural outcomes, ROP recurrence, treatment for ROP complications, completion of vascularization, and visual function. Safety end points included adverse events and growth and neurodevelopmental outcomes. Overall, 100 children were enrolled (median gestational age, 26 [range, 23-31] weeks; 53 boys and 47 girls). Of these, 21 were Asian, 2 were Black, 75 were White, and 2 were of more than 1 race. At 2 years of age, 61 of 63 children (96.8%) in the aflibercept group vs 30 of 32 (93.8%) in the laser group had no ROP. Through 2 years of age, 62 of 66 (93.9%) in the aflibercept group and 32 of 34 (94.1%) in the laser group had no unfavorable structural outcomes. No new retinal detachment occurred during the study. Four children in the aflibercept group (6.1%) were treated for ROP complications before 1 year of age (2 had preexisting end-stage disease and total retinal detachment; 1 had reactivated plus disease; and 1 had recurrent retinal neovascularization not further specified). Most children were able to fix and follow a 5-cm toy (aflibercept group, 118 of 122 eyes [96.7%] among 63 children; laser group, 62 of 63 eyes [98.4%] among 33 children). High myopia was present in 9 of 115 eyes (7.8%) among 5 children in the aflibercept group and 13 of 60 eyes (21.7%) among 9 children in the laser group. No relevant differences in growth and neurodevelopmental outcomes by Bayley Scales of Infant and Toddler Development, Third Edition and Vineland Adaptive Behavior Scales, Second Edition were identified. In this nonrandomized follow-up of a randomized clinical trial comparing treatment of severe acute-phase ROP with 0.4-mg injection of aflibercept and laser, disease control was stable and visual function was appropriate in children through 2 years of age. No adverse effects on safety, including growth and neurodevelopment, were identified. These findings provide clinically relevant long-term information on intravitreal aflibercept injection therapy for ROP. ClinicalTrials.gov Identifier: NCT04015180.

Pathogenetic strategies for addressing periodontal morphological and functional disorders in plaque-induced gingivitis

Relevance. Plaque-induced gingivitis represents the initial phase of periodontal diseases and a significant medical and social challenge within global healthcare frameworks, particularly prevalent among younger people.Demographics. This prevalence arises from its multifactorial etiology, complex developmental mechanisms, and notable pathogenetic features, most evidently microcirculatory disruptions leading to tissue hypoxia. Addressing these pathological conditions requires the development of novel diagnostic methodologies and therapeutic interventions to prevent further complications.Materials and methods. The study encompassed 54 subjects with an average age of 22.5 ± 1.7 years. The control group included 34 participants (GroupI), and the comparison group 20 participants (Group II). Group II received vacuum laser therapy in conjunction with Mexidol-based dressings, noted for their antihypoxant and antioxidant properties.Results. Evaluations conducted post-treatment indicated enhancements in both arterial and venous capillary functions. Amid the antioxidant and antihypoxant treatment regimen, capillary diameters were reduced to match those observed in the control group.Conclusion. Regimen implemented in this study was clinically and functionally effective in a combined treatment protocol involving vacuum laser therapy on periodontal tissues of plaque-induced gingivitis patients. This regimen is recommendable as a corrective measure for microcirculatory disturbances within the scope of managing inflammatory periodontal diseases.

Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial

BackgroundDiabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage  this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy.ObjectivesTo evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder.MethodsThis is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up.DiscussionThis will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice.Trial Registration: Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.

Micropulse laser therapy in chronic idiopathic central serous chorioretinopathy in right eye of 38-year-old patient – case report

&lt;b&gt;WSTĘP:&lt;/b&gt; Centralna chorioretinopatia surowicza (&lt;i&gt;central serous chorioretinopathy&lt;/i&gt; – CSC) jest schorzeniem charakteryzującym się idiopatycznym surowiczym uniesieniem sensorycznej warstwy siatkówki w okolicy plamki, które najczęściej występuje jednostronnie, głównie u młodych mężczyzn ze zwiększoną podatnością na stres. Definiowanie optymalnego leczenia CSC jest skomplikowane ze względu na szeroki zakres objawów choroby, zmienny przebieg kliniczny, słabo poznaną patofizjologię CSC oraz brak konsensusu co do systemu klasyfikacji. W leczeniu CSC coraz częściej znajduje zastosowanie laser mikropulsowy, który działając selektywnie na nabłonek barwnikowy siatkówki, nie powoduje uszkodzeń fotoreceptorów. Celem pracy była ocena zastosowania terapii laserem mikropulsowym w leczeniu przewlekłego CSC. &lt;b&gt;OPIS I WYNIKI:&lt;/b&gt; Pacjent 38-letni leczony od kilkunastu miesięcy z powodu nawracającego CSC w oku prawym, leczony miejscowo kroplami oraz lekami doustnymi. Ostrość wzroku pacjenta w chwili rozpoznania wynosiła 0,63, ciśnienie wewnątrzgałkowe 19 mmHg. Centralna grubość siatkówki w optycznej koherentnej tomografii (&lt;i&gt;optical coherence tomography&lt;/i&gt; – OCT) wynosiła 530 µm. U pacjenta wykonano angiografię fluoresceinową (&lt;i&gt;fluorescein angiography&lt;/i&gt; – FA) potwierdzającą rozpoznanie oraz zakwalifikowano go do laseroterapii siatkówki z użyciem mikropulsów. Podczas kontroli w badaniu FA uzyskano poprawę stanu klinicznego. Ostrość wzroku pacjenta wynosiła 1,0, ciśnienie wewnątrzgałkowe 17 mmHg. Uzyskano spadek centralnej grubość siatkówki w badaniu OCT do poziomu 299 µm. &lt;b&gt;WNIOSKI:&lt;/b&gt; Zastosowanie lasera mikropulsowego umożliwia uzyskanie trwałego efektu klinicznego u pacjenta z przewlekłym nawracającym CSC.

A Randomized Controlled, Single-Observer Blinded Study on the Safety and Efficacy of a Combination of 678nm Helmet-Type Low-level Laser Therapy and Topical Minoxidil 5% Versus Topical Minoxidil 5% Alone in the Treatment of Male Androgenetic Alopecia

Male pattern androgenetic alopecia is a chronic, progressive condition with significant social and psychological impact. Few preliminary researches have been done on the role of low-level laser therapy as a treatment modality for male pattern hair loss. This is a randomized, controlled, single-observer blinded clinical trial conducted from November 2019 to October 2021 at the East Avenue Medical Center Dermatology Out-Patient Department on the use of low-level laser therapy and topical minoxidil for the treatment of androgenetic alopecia. Twenty-four male adults with Norwood Hamilton Hair Loss Scale of IIa to V were randomly assigned into 2 groups: a control group (monotherapy with topical minoxidil 5%) and a treatment group (678 nm helmet-type low-level laser therapy and topical minoxidil 5%). A statistically significant higher increase in hair density was observed in the treatment group (14.58 and 15.08 for the right and left sides, respectively) compared to the control (5.83 on the right and 5.50 on the left, respectively, p=.000 &lt;.05). In addition, the investigator’s global photographic assessment and patient satisfaction were also significantly higher. Both treatments were well tolerated. The results of this study show that 678 nm helmet-type low-level laser therapy is an effective adjunctive treatment modality to topical minoxidil 5% solution for the treatment of male androgenetic alopecia.

Definition of refractory melasma and its treatment: a review.

Although patients with refractory melasma have been treated using various methods, there is still no precise definition or summary of the therapies. To define refractory melasma and conduct a review of the treatments, we searched for relevant publications in PubMed, Web of Science, and the Cochrane Library, and a total of 35 references were obtained. Refractory melasma can be roughly defined as an ineffective treatment for melasma, including topical bleaching agents, chemical peels, laser therapy, microdermabrasion for more than six months, or chemical peels treated more than six times. Meanwhile, physicians should be careful when treating patients withdarker skin and dermal or mixed types of melasma since these individuals do not respond well to treatment. Lasers combined with other methods, especially different types of lasers or topical agents, are considered more effective than monotherapy. Oral tranexamic acid (TXA) is a prospective cure for refractory melasma. Other methods include a combination of chemical peels, microneedling, or injections with additional therapies. In conclusion, we were able to provide a rough definition of refractory melasma and list the available therapies. According to the literature, the most prevalent treatment is laser combination therapy. However, laser treatment should be considered only after topical agents and chemical peeling have failed. Considering its side effects, efficacy, and safety, oral TXA may be a better option, but more research is needed to make a firm conclusion. Moreover, maintenance therapy is required after treatment.

Low-level laser therapy and laser acupuncture therapy for pain relief after initial archwire placement : Arandomized clinical trial.

Pain is among the most unpleasant experience during fixed orthodontic therapy. This study compared the effectiveness of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in pain reduction after initial archwire placement. This randomized, parallel-group, single-blind clinical trial included 60female patients who required four premolar extractions to relieve crowding. The subjects were randomly designated into four groups of 15. After placement of the initial orthodontic archwire, patients in group1 took ibuprofen (400 mg), whereas those in group2 received LLLT (808 nm, 200 mW, 2 J/cm2) on both buccal and lingual sides of the teeth. In group3 (LAT), the laser (808 nm, 200 mW, 24 J/cm2) was applied bilaterally to acupuncture points (SI18, ST6, LI4, SJ2, and SJ5). Subjects in group4 received placebo laser treatment. Patients were requested to record the intensity of spontaneous pain, pain while biting with anterior teeth, and pain while biting with posterior teeth at different times using avisual analogue scale (VAS). The intensity of spontaneous and biting pain increased up to the first or second days following initial archwire placement and diminished to anegligible value by the seventh day. No significant difference was found between the study groups concerning spontaneous and biting pain at any timepoint of investigation (P > 0.05). With the protocols used in the study, low-level laser therapy and laser acupuncture therapy were as effective as ibuprofen and placebo laser treatment for pain reduction in orthodontic patients. IRCT, IRCT20200622047886N1. Registered 2020-06-29; https://www.irct.ir/trial/49121.

Efficacy of rehabilitative therapies on otologic symptoms in patients with temporomandibular disorders: A systematic review of randomised controlled trials.

The term temporomandibular disorder (TMD) indicates a set of musculoskeletal conditions involving temporomandibular joint (TMJ), masticatory musculature, and related anatomical structures. Pain is the most common clinical manifestation of TMD, and the auditory system might be involved and affected, through tinnitus, dizziness, otalgia and ear fullness sensation. The aim of this systematic review of randomised controlled trails (RCTs) was to evaluate the efficacy of rehabilitative approaches on otologic symptoms in patients with TMD. PubMed, Scopus and Web of Science were systematically searched from the inception until 8th October 2023 to identify RCTs presenting participants with a diagnosis of TMD associated with otologic signs and symptoms, rehabilitative approaches as interventions, and modification of the otological symptoms as outcome. Out of 931 papers suitable for title/abstract screening, 627 articles were assessed for eligibility. Five studies were included reporting the efficacy of occlusal splint therapy, low-level laser therapies, and physical therapy in patients diagnosed whit secondary otalgia or tinnitus associated with TMD. No RCTs evaluating other otologic symptoms, ear fullness, dizziness or vertigo were found. Results of this systematic review suggested that rehabilitative approaches might be effective in improving secondary otalgia and tinnitus in TMD patients. Thus, further RCTs with a higher level of evidence and more representative samples should be conducted to better understand the effects of TMD therapy on otologic complains.

Efficiency of the use of coordination training in the program of medical rehabilitation of patients after reverse shoulder endoprosthesis

The goal of this study. The goal is to evaluate the effectiveness of using upper limb coordination training after reverse shoulder arthroplasty.Material and methods. 30 patients were examined in Federal State Budgetary Institution «National Medical Research Center for Rehabilitation and Balneology» of the Ministry of Health of the Russian Federation. They were examined in a long-term period after reverse shoulder arthroplasty (in 3–4 months) and were divided into two groups: the main and the comparison groups. All patients were similar in terms of gender and age. Their clinical and functional parameters of the shoulder joint were also comparable. The patients in the comparison group were treated with laser therapy, electrotherapy, massage, group exercises to train the upper limb and mechanotherapy. The patients in the main group additionally underwent coordination training with biological feedback to the shoulder joint.The results of the study were evaluated according to the pain syndrome, functional activity of the shoulder joint, shoulder joint flexion angle and values of dynamic strength of the shoulder muscles. After the course of medical rehabilitation, the patients in both groups showed improvement of all clinical and functional parameters of the shoulder joint. There was a statistically significant improvement in the dynamic strength of the shoulder joint and reduction of pain syndrome in the patients in the main group.Conclusions. The inclusion of shoulder coordination training allows to improve the rehabilitation results for the patients who undergo reverse shoulder joint arthroplasty.

Cryotherapy vs Laser for Genital Warts Management: A Systematic Review

The study compared cryotherapy and laser in managing external genital warts (EGW) using various databases. The research involved eleven studies with 92 patients, with follow-up durations ranging from 28 days to 39 months. One study found that CO2 laser therapy was two times more effective than cryotherapy in terms of clearance, recurrence, and complication rates. Six studies showed that laser was the best option for immunocompromised patients and those who did not respond to cryotherapy, with the lowest recurrence rates and complications. Cryotherapy is economical, effective, and safe, but it is painful, deformed, and requires multiple sessions. Current treatment approaches focus on the surface wart rather than the underlying viral infection, making them less successful in long-term effects. There is little evidence to support the idea that a specific therapy is not more successful than others. Future research should focus on extensive comparisons with larger sample sizes.

Conservative medical intervention as a complement to CDT for BCRL therapy: a systematic review and meta-analysis of randomized controlled trials

BackgroundThe effect of first-line complex decongestive therapy (CDT) for breast cancer-related lymphedema (BCRL) depending on various factors forces patients to seek additional treatment. Therefore, this meta-analysis was conducted to evaluate the effect of different conservative medical interventions as a complement to CDT. This is the first meta-analysis that includes various kinds of conservative treatments as adjunctive therapy to get broader knowledge and improve practical application value, which can provide recommendations to further improve BCRL patients’ health status.MethodsRCTs published before 18 December 2023 from PubMed, Embase, Cochrane Library, and Web of Science databases were searched. RCTs that compared the effects of conservative medical intervention were included. A random-effects or fixed-effects model was used based on the heterogeneity findings. Study quality was evaluated using the Cochrane risk of bias tool.ResultsSixteen RCTs with 690 participants were included, comparing laser therapy, intermittent pneumatic compression (IPC), extracorporeal shock wave therapy (ESWT), electrotherapy, ultrasound, diet or diet in combination with synbiotic supplement, traditional Chinese medicine (TCM), continuous passive motion (CPM), and negative pressure massage treatment (NMPT). The results revealed that conservative medical intervention as complement to CDT had benefits in improving lymphedema in volume/circumference of the upper extremity [SMD = −0.30, 95% CI = (−0.45, −0.15), P &amp;lt; 0.05, I2 = 51%], visual analog score (VAS) for pain [SMD = −3.35, 95% CI (−5.37, −1.33), P &amp;lt; 0.05, I2 = 96%], quality of life [SMD = 0.44, 95% CI (0.19, 0.69), P &amp;lt; 0.05, I2 = 0], and DASH/QuickDASH [SMD = −0.42, 95% CI (−0.70, −0.14), P &amp;lt; 0.05, I2 = 10%] compared with the control group. Subgroup analysis revealed that laser therapy and electrotherapy are especially effective (P &amp;lt; 0.05).ConclusionCombining conservative medical interventions with CDT appears to have a positive effect on certain BCRL symptoms, especially laser therapy and electrotherapy. It showed a better effect on patients under 60 years old, and laser therapy of low to moderate intensity (5–24 mW, 1.5–2 J/cm2) and of moderate- to long-term duration (≥36–72 sessions) showed better effects.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354824, identifier CRD42022354824.