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Effect of platelet counts and activator in platelet-rich plasma on the treatment of androgenetic alopecia, split-head comparison: A randomised, double-blind study
Singh SK, Singh S
Indian journal of dermatology, venereology and leprology. 2023;:1-9
Abstract
Background Androgenetic alopecia is a common, chronic, non-scarring alopecia. It is characterised by stepwise miniaturisation of the hair follicles, due to alteration in the hair cycle dynamics, leading to the transformation of terminal hair follicles into a vellus ones. Oral finasteride and topical minoxidil are the only approved drugs for treating this condition. Due to a limited number of effective therapies for androgenetic alopecia, platelet-rich plasma may be an effective alternative treatment. Aims To study the effect of activator in platelet-rich plasma and baseline platelet count in platelet-rich plasma on the treatment of androgenetic alopecia. Methods A randomised, double-blind split-head comparative study. The sample size was calculated and randomisation was done. Patients with androgenetic alopecia were allocated into two groups; in the first group, autologous activated platelet-rich plasma was injected in the right half of the affected scalp and autologous non-activated platelet-rich plasma was injected in the left half of the affected scalp and vice versa in the second group. Patients were also categorised on the basis of platelet counts in their platelet-rich plasma in three groups; group A (6-8 lakh/mm3), group B (8.1-10 lakh/mm3) and group C (>10 lakh/mm3). Interventions were done monthly for three months and followed up for the next three months. Effects of interventions were assessed by hair density, hair thickness, patient self-assessment and clinical photography. Results A total of 80 patients were included in the study. Activated platelet-rich plasma produced significant improvement of hair density after four months and hair thickness at 6 months. An increase in platelet count led to a significant increase in hair density and hair thickness after three and four months respectively and a highly significant increase in both parameters at the end of the study. Limitations Long-term follow-up of cases was not done and no measurement of vellus hair count was done. Conclusion There is a significant effect of activator and platelet count of the platelet-rich plasma on hair density as well as hair thickness.
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2.
Evaluation of Arthrocentesis with and Without Platelet-Rich Plasma in the Management of Internal Derangement of Temporomandibular Joint: A Randomized Controlled Trial
Singh AK, Sharma NK, Kumar PGN, Singh S, Mishra N, Bera RN
Journal of maxillofacial and oral surgery. 2021;20(2):252-257
Abstract
PURPOSE The purpose of this study was to compare the efficacy of intra-articular injection of platelet-rich plasma after arthrocentesis versus arthrocentesis alone as a treatment modality in patients with internal derangement of temporomandibular joint. METHODS Twenty-four patients suffering from internal derangement of temporomandibular joint were included in the study. The patients were randomly divided into two groups as follows-twelve patients underwent arthrocentesis followed by intra-articular injection of platelet-rich plasma (study group) and the other twelve were treated by arthrocentesis alone (control group). Pain intensity was recorded on visual analogue scale (VAS); maximum mouth opening and joint sound were measured before and after intervention. The patients were clinically evaluated at the intervals of 1 month, 3 and 6 months subsequently. RESULTS There was no statistically significant difference in all the parameters between the groups. Intra-group analysis showed statistically significant improvement in all the parameters. CONCLUSION In both groups, improvement of pain, maximum mouth opening and TMJ sound were observed at all intervals, but there was no statistically significant improvement in arthrocentesis with PRP group when compared with arthrocentesis alone.
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3.
Comparison of Therapies for Primary Prevention of Esophageal Variceal Bleeding: A Systematic Review and Network Meta-analysis
Sharma M, Singh S, Desai V, Shah VH, Kamath PS, Murad MH, Simonetto DA
Hepatology (Baltimore, Md.). 2018
Abstract
BACKGROUND AND AIMS We performed a systematic review with network meta-analysis (NMA) to compare the efficacy of different approaches in primary prevention of esophageal variceal bleeding and overall survival in cirrhotic patients with large varices. METHODS Thirty-two randomized clinical trials (RCT) with 3362 cirrhotic adults with large esophageal varices and no prior history of bleeding, with minimum 12m follow-up were included. Nonselective beta- blockers (NSBB), isosorbide-mononitrate (ISMN), carvedilol and variceal band ligation (VBL), alone or in combination, were compared to each other or placebo. Primary outcomes were reduction of all-cause mortality, and prevention of esophageal variceal bleeding. Random effects NMA was performed and summary estimates were expressed as odds ratio and 95% confidence intervals (OR; CI). Quality of evidence was critically appraised using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Moderate quality evidence supports NSBB monotherapy (0.70; 0.49-1.00) or in combination with VBL (0.49; 0.23-1.02) or ISMN (0.44; 0.21-0.93) for decreasing mortality in cirrhotic patients with large esophageal varices and no prior history of bleeding. Moderate quality evidence supports carvedilol (0.21; 0.08-0.56) and VBL monotherapy (0.33; 0.19-0.55) or in combination with NSBB (0.34; 0.14-0.86), and low quality evidence supports NSBB monotherapy (0.64; 0.38-1.07) for primary prevention of variceal bleeding. VBL carries a higher risk of serious adverse events compared to NSBB. CONCLUSION NSBB monotherapy may decrease all-cause mortality and the risk of first variceal bleeding in cirrhotic patients with large esophageal varices. Additionally, NSBB carry a lower risk of serious complications compared to VBL. Therefore, NSBB may be the preferred initial approach for primary prophylaxis of esophageal variceal bleeding. This article is protected by copyright. All rights reserved.
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4.
Comparative efficacy of low dose, daily versus alternate day plasma exchange in severe myasthenia gravis: a randomised trial
Trikha I, Singh S, Goyal V, Shukla G, Bhasin R, Behari M
Journal of Neurology. 2007;254((8):):989-95.
Abstract
OBJECTIVE To evaluate the comparative efficacy of low dose daily versus alternate day plasma exchange in patients with severe myasthenia. METHODS Thirty three patients with myasthenia gravis (Osserman's stage II b and III) were randomized to receive alternate day (n = 17) or daily low dose plasma exchange (n = 16). Plasma exchange were carried on each patient, number of exchanges varying subject to their requirements and 20-25 ml/kg plasma was removed during each session. Myasthenia gravis disease scale (MGDS) score was evaluated before and after the procedure. Time to wean off ventilator, removal of nasogastric tube and total duration of hospital stay were also assessed. RESULTS There was no statistically significant difference between daily vs. alternate day group with regards to change in MGDS score, percentage change in MGDS score, and complication rates. A decreased hospital stay was observed in patients on daily plasma exchange which almost reached statistical significance. CONCLUSION We conclude from our study that daily and alternate day plasma exchange are similar in their efficacy and complication rates, however the daily schedule could be a preferred modality due to decreased hospital stay.
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5.
Comparison of oral versus intravenous iron therapy in predialysis patients of chronic renal failure receiving recombinant human erythropoietin
Aggarwal HK, Nand N, Singh S, Singh M, Hemant D, Kaushik G
The Journal of the Association of Physicians of India. 2003;51((2):):170-4.
Abstract
OBJECTIVES To compare oral versus intravenous iron in pre-dialysis patients of chronic renal failure (CRF) receiving recombinant human erythropoietin (rHuEPO). METHODS The study was undertaken in 40 adult patients of chronic renal failure. The patients were randomly divided into two groups A and B of 20 patients each. Group A patients were given oral iron and group B patients were given intravenous iron. All patients in both groups were given recombinant human erythropoietin 2000 IU twice weekly subcutaneously. The study was carried for up to three months. Patients were monitored every month for renal parameters and haematological parameters which included haemoglobin, reticulocyte count and packed cell volume. Ferrokinetic studies were done at baseline and at three months. RESULTS It was observed that haematological parameters showed significant statistical improvement in the intravenous iron group as compared to group A (oral iron group). The ferrokinetic studies revealed that serum iron, serum ferritin and transferrin saturation, decreased significantly in oral iron group, whereas significant increase was seen in group B (intravenous iron group). None of the patients developed any adverse effects because of erythropoietin or iron therapy. CONCLUSIONS Concomitant use of intravenous iron is better than oral iron in CRF patients treated with rHuEPO. The intravenous route of iron administration may be a preferred route along with rHuEPO therapy, more so in the Indian context where prevalence of iron deficiency anaemia is fairly high.
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6.
A prospective randomized study to determine the optimal dose of intravenous vitamin K in reversal of over-warfarinization
Hung A, Singh S, Tait RC
British Journal of Haematology. 2000;109((3):):537-9.
Abstract
The optimal management of asymptomatic overanticoagulated patients remains unknown. We measured international normalized ratio (INR), activated partial thromboplastin time (APTT) and prothrombin fragment 1 + 2 (F1 + 2) over 7 d in 24 asymptomatic or mildly haemorrhagic patients on warfarin with prolonged INR of > 7.0 who were randomized to receive 0.5 mg, 1 mg or 2 mg intravenous vitamin K. Of six severely overanticoagulated patients (INR > 9.5 with APTT ratio > 2), five failed to achieve an INR < or = 4.0 on day 1, irrespective of vitamin K dose given. In the remaining 18 cases, an optimal response (INR 2-4 at day 1) was observed in 67% of those receiving 0.5 mg vitamin K, but only in 33% of those receiving 1 or 2 mg, the majority of whom developed an INR < 2.0. Our results support an optimal dose of 0.5 mg i.v. vitamin K for most overanticoagulated patients, with possibly a repeat dose in the small group of severely overanticoagulated patients.