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Background: In cosmetic dermatology, lasers and lights treat a variety of hair and skin conditions, including some that disproportionately affect people of color. Aims: Our systematic review aims to understand the representation of participants with skin phototypes 4–6 in cosmetic dermatologic trials studying laser and light devices. Methods: A systematic literature search was conducted using search terms "laser," "light," and multiple laser and light subtypes in the PubMed and Web of Science databases. All randomized controlled trials (RCTs) published between January 1, 2010 and October 14, 2021 that studied laser or light devices for cosmetic dermatologic conditions were eligible for inclusion. Results: Our systematic review included 461 RCTs representing 14 763 participants. Of 345 studies that reported skin phototype, 81.7% (n = 282) included participants of skin phototypes 4–6, but only 27.5% (n = 95) included participants of skin phototypes 5 or 6. This trend of excluding darker skin phototypes persisted when results were stratified by condition, laser of study, study location, journal type, and funding source. Conclusions: Trials studying lasers and lights for the treatment of cosmetic dermatologic conditions need better representation of skin phototypes 5 and 6. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was to evaluate the robustness of randomized controlled trials (RCTs) on anal fistula management using the news tools of Fragility Index (FI), Reverse Fragility Index (RFI) and their corresponding fragility quotients. Method: A systematic search was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines which utilized MEDLINE, EMBASE, Cochrane Library and Web of Science databases. Inclusion criteria included RCTs related to the management of anal fistula published from 2000 to 2022 with dichotomous outcomes measures and 1:1 allocation. Calculation of FI and RFI was performed by creating 2 × 2 contingency tables by successively changing one nonevent to an event for each outcome measure until the result was made nonsignificant or significant, respectively. The Fragility Quotients were calculated by dividing the FI or RFI by the total sample size. Fragile results were defined as those with a FI or RFI equal to or less than the number of patients lost to follow‐up. Additionally, those with a FI or RFI less than 3 were also considered fragile. Studies were considered extremely fragile if FI was ≤1 or FQ was ≤0.01. Results: There were 36 RCTs that met our criteria, with 3223 patients. Among these, 19 (53%) were positive RCTs (p < 0.005) and 17 (47%) were negative RCTs (p > 0.05). The median FI was 2 (0–5). The analysis by categorical subgroup showed a strong correlation between FI and the p‐value (p = 0.000) and the number of events (p = 0.011). The median RFI was 5 (3.5–9.5) and the subgroup analysis showed a strong correlation between RFI and the p‐value (p = 0.000), sample size (0.021) and number needed to treat/number needed to harm (0.000). We considered 63.2% of positive RCTs to be fragile and 35.3% of negative RCTs. Conclusions: In the present study we demonstrated the lack of robustness of study findings in published RCTs in the field of anal fistula. [ABSTRACT FROM AUTHOR]

Objectives: To examine the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Design: Systematic review and meta‐analysis of randomised controlled trials (RCTs). Setting: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18 March 2022. Participants: Patients undergoing FESS. Main outcome measures: Primary efficacy endpoints comprised intraoperative blood loss, visual clarity, and operation time. Secondary endpoints comprised side effects. The efficacy endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results: Five RCTs comprising 380 patients (desmopressin = 191 patients and placebo = 189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n = 5 RCTs, MD = –37.97 ml, 95% CI [−56.97, −18.96], p <.001), 5‐point Boezaart scores (n = 2 RCTs, MD = –.97, 95% CI [−1.21, −.74], p <.001), and 10‐point Boezaart scores (n = 2 RCTs, MD = −3.00, 95% CI [−3.61, −2.40], p <.001) were significantly reduced in favour of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n = 5 RCTs, MD = –3.73 min, 95% CI [−14.65, 7.18], p =.50). No patient in both groups developed symptomatic hyponatremia (n = 3 RCTs, 194 patients) or thromboembolic events (n = 2 RCTs, 150 patients). Conclusions: Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihaemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS. Key points: Intraoperative bleeding is a common complication during functional endoscopic sinus surgery (FESS) which can be progressively severe and subsequently culminate in an unfavourable wet surgical field.Desmopressin is an artificial derivative of vasopressin that plays crucial roles in haemostasis, and is widely employed in various operations to reduce perioperative blood loss and requirement for blood transfusion.So far, no meta‐analysis of randomised controlled trials has been carried out to systematically aggregate evidence on the efficacy of prophylactic pre‐operative desmopressin during FESS.This investigation showed that among patients undergoing FESS, prophylactic desmopressin does not correlate with significant clinical benefits.Data on safety is limited. [ABSTRACT FROM AUTHOR]

Summary: Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school‐based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school‐based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school‐based setting, weight‐based outcomes (e.g., BMI, BMI z‐score), weight‐based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z‐score, decrease in BMI z‐score ≥0.10, and decrease in BMI z‐score ≥0.20. Few school‐based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked. [ABSTRACT FROM AUTHOR]

Background: Patients with severe hypertriglyceridaemia (sHTG) are often refractory to lipid‐lowering therapy. Apolipoprotein (Apo) CIII inhibition could be promising to treat subjects with sHTG. The antisense oligonucleotide against APOC3 mRNA volanesorsen was recently introduced to treat sHTG. We performed a systematic review and meta‐analysis of RCTs on the efficacy and safety of volanesorsen as compared to placebo treatment in patients with severe HTG. Methods: Studies were systematically searched in the PubMed, Web of Science and Scopus databases according to PRISMA guidelines. The last search was performed on 7 February 2022. Results: Four studies showed significant reduction in TG after 3 months of treatment with volanesorsen as compared with placebo (MD: −73.9%; 95%CI: −93.5%, −54.2; p <.001 I2 = 89.05%; p <.001); VLDL‐C level (MD: −71.0%; 95%CI: −76.6%, −65.4%; p <.001 I2 = 94.1%; p <.001); Apo‐B48 level (MD: −69.03%; 95%CI: −98.59.4%, −39.47%; p <.001, I2 = 93.51%; p <.001) and Apo‐CIII level (MD: −80.0%; 95%CI: −97.5%, −62.5; p <.001 I2 = 94.1%; p <.001) with an increase in HDL‐C level (MD: +45.92%, 95%CI: +37.24%, +54.60%; p <.001 I2 = 94.34%; p <.001) and in LDL‐C level (MD: +68.6%, 95%CI: +7.0%, +130.1%; p <.001 I2 = 96.18%; p <.001) without a significant elevation of Apo‐B100 level (MD: +4.58%, 95%CI: −5.64%, +14.79%; p =.380 I2 = 95.09%; p <.001) in 139 volanesorsen patients as compared to 100 placebo‐treated controls. Most of adverse events were mild and related to local injection site reactions. Conclusions: In patients with severe HTG, volanesorsen is associated with a significant reduction in TG, VLDL‐C, Apo‐B48 and non‐HDL‐C and increment of HDL‐C as compared to placebo. Documented efficacy is accompanied by an acceptable safety profile. [ABSTRACT FROM AUTHOR]

Introduction: The overall effects of Carboxytherapy, defined as the administration of carbon dioxide, have been studied for many years. It has been suggested that by improving oxygenation, interacting with the tissue perfusion regulators, and disrupting the adipose cell membranes, the method can lead to notable improvements in different esthetic and pathological conditions. Therefore, we aimed to systematically review the available studies evaluating the potential benefits of carboxytherapy in dermatological conditions and how it objectively stands against scientific scrutiny. Methods: We searched the PubMed, Scopus, Embase, and Web of Science databases, including the studies exploring the method's efficacy in managing any dermatological condition. Results: A total 27 of studies were identified (with a pooled sample of over 700 cases), most of which were clinical trials. Facial wrinkles, periorbital hyperpigmentation, skin laxity deficiency, scars, striae distensae, localized lipolysis and cellulite, alopecia, chronic diabetic wounds, and psoriatic plaques comprised the package of the dermatological conditions that were studied. Except for a few studies, the method mainly demonstrated significant improvements on all of the mentioned conditions. The inter‐ and post‐operational adverse events were mild and transient, including erythema, pain, crepitus, and ecchymoses. Discussion: Carboxytherapy can provide those practicing in the field with sustainably favorable results. However, the numbers of cases on whom the fat‐reducing capabilities of the method were studied and experienced varying degrees of recurrence caught our eye. In addition, we observed a notable disparity between the outcome measures utilized in the studies. The modest sample size in each condition also added to the injury, as the conditions on which the method was evaluated are pretty common in the general population. Therefore, for a definite conclusion, more randomized controlled trials with the shortcomings mentioned well addressed need to be conducted. [ABSTRACT FROM AUTHOR]