Background Dry eye disease (DED) is a disease caused by a reduced volume or deficient quality of tears and is treated mainly with tear supplementation. There is emerging evidence that nicotinic nasal sprays are effective for DED. Our systematic review and meta-analysis assessed the efficacy and safety of varenicline nasal spray (OC-01) for DED treatment utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Methods Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Only randomized controlled trials (RCTs) that evaluated the efficacy of OC-01 versus placebo were included. The mean change in the Schirmer test score from baseline on day 28 was the efficacy endpoint. Serious adverse events (SAEs), nonserious adverse events (NSAEs), and the rate of mortality were the safety endpoints. The standardized mean difference (SMD) was used for continuous outcomes, while the risk ratio (RR) was used to demonstrate dichotomous variables. Data pooling was performed using the inverse variance weighting technique. The certainty of evidence was rated using the GRADE approach. The risk of bias assessment was conducted using the Revised Cochrane risk of bias tool for randomized trials. Results Three RCTs (n = 1063) met the eligibility criteria. All RCTs had a low risk of bias. Meta-analysis found a statistically significant increase in the mean STS change from baseline on day 28 (SMD = 5.70, 95% CI 3.40 − 7.99 P < 0.00001, I2 = 99%). The pooled analysis found no significant difference between OC-01 and placebo in the frequency of SAEs (RR = 0.99, 95% CI 0.49–2.00, P = 0.98, I2 = 8%) or mortality (RR = 1.05, 95% CI 0.16–7.16, P = 0.96, I2 = 0%). However, OC-01 had a significant effect on developing NSAEs (RR = 1.88, 95% CI 1.51–2.34, P < 0.00001, I2 = 75%). Conclusion OC-01 had a highly significant increase in the efficacy endpoints but caused an increased frequency of NSAEs. OC-01 did not correlate with either SAEs or mortality. The RCTs included in our study had a low risk of bias assessment. Nevertheless, they were downgraded in multiple domains upon GRADE assessment.
Background: Intraparenchymal meningioma is a rare entity of one of the most common brain tumors. It is challenging to diagnose preoperatively due to the vague clinical presentation and absence of stereotypical radiological features. These atypical features might mislead the differential to favor high-grade gliomas or brain metastasis. Case presentation: We describe a case of a 46-year-old male who presented with vertigo, right-sided sensorineural hearing loss, and bilateral blurred vision. Contrast-enhanced magnetic resonance imaging (MRI) of the brain revealed a large parieto-occipital contrast-enhanced mass with a multi-loculated cystic component and diffusion restriction but without dural attachment. A gross total reaction was achieved, and the histopathological results yielded a WHO grade I meningioma diagnosis. The patient exhibited no signs of recurrence after two years of follow-up. Conclusion: Intraparenchymal meningiomas are difficult to identify without histopathological assessment. We emphasize the importance of considering this diagnosis when outlining an initial differential as it may direct management planning. Total surgical resection is the best treatment modality for such cases; however, radiotherapy is a valuable option. The prognosis of intraparenchymal meningiomas is generally favorable.
BackgroundCranioplasty (CP) is a common cranial reconstructive procedure. It is performed after craniectomy due to various causes such as relieving increased intracranial pressure, infection, and tumor infiltration. Although CP is an easy procedure, it is associated with a high rate of complications. We aimed to retrospectively investigate the outcomes of CP at the King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah (KAMC-J). MethodsThis is a retrospective observational study that included all patients who had CP (first time or redo) at KAMC-J from 1st January 2010 to 31st December 2020. Patients with congenital cranial malformation were excluded. ResultA total of 68 patients underwent CP. Of those, 23 (34%) had complications. The most common complication was infection (10.3%). Twelve of the 23 patients had major complications that necessitated reoperation. Of those 12, six underwent redo CP; three out of these six patients had further complications which were also managed surgically. On bivariate analysis, cranial defects over 50 cm² were associated with a higher rate of both infection and hydrocephalus (p=0.018) while the frontal site was associated with a higher rate of infection (p=0.014). Moreover, traumatic brain injury as an etiology was exclusively associated with postcranioplasty hydrocephalus (p=0.03). ConclusionPatients undergoing CP after craniectomy are prone to a considerably high rate of adverse outcomes. The overall rate of complications in this study was 34%, with an infection rate of 10.3% and a 1.5% mortality rate. Consistent with other studies, larger cranial defects as well as frontal sites have a higher rate of infection.
Background: Intraparenchymal meningioma is a rare entity of one of the most common brain tumors. It is challenging to diagnose preoperatively due to the vague clinical presentation and absence of stereotypical radiological features. These atypical features might mislead the differential to favor high-grade gliomas or brain metastasis. Case Description: We describe a case of a 46-year-old male who presented with vertigo, right-sided sensorineural hearing loss, and bilateral blurred vision. Contrast-enhanced magnetic resonance imaging of the brain revealed a large parieto-occipital contrast-enhanced mass with a multi-loculated cystic component and diffusion restriction but without dural attachment. A gross total reaction was achieved, and the histopathological results yielded a World Health Organization Grade I meningioma diagnosis. The patient exhibited no signs of recurrence after 2 years of follow-up. Conclusion: Intraparenchymal meningiomas are difficult to identify without histopathological assessment. We emphasize the importance of considering this diagnosis when outlining an initial differential as it may direct management planning. Total surgical resection is the best treatment modality for such cases; however, radiotherapy is a valuable option. The prognosis of intraparenchymal meningiomas is generally favorable.
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