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Androgenetic alopecia is a widespread condition that is the most common type of hair loss affecting approximately 58% and 40% of men and women by the age of 50, respectively. Patients have been known to experience severe distress due to androgenetic alopecia, including anxiety, low self-esteem, and depression. The objective of this study was to conduct a systematic review and meta-analysis to determine the efficacy of combination therapy using topical minoxidil and microneedling compared to topical minoxidil alone. This systematic review of randomized controlled trials was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023391164). The literature search was performed using Scopus, Cochrane, Embase, and the National Institutes of Health's United States National Library of Medicine from inception through January 20, 2022. Randomized controlled trials examining the efficacy of combinational therapy and monotherapy using microneedling and minoxidil on patients with clinically diagnosed androgenetic alopecia were included after screening titles, abstracts, and full texts. Two independent reviewers selected studies, extracted data, and appraised the risk of bias using the Cochrane risk of bias assessment tool. Ten randomized controlled trials, including ­­­466 patients,­ were selected for this review and eight studies were ultimately included in the meta-analysis. All eight studies displayed a statistically significant increase in total hair count (standard mean difference [SMD], 1.76; 95% CI, 1.26-2.26; P<0.00001); however, the evidence did not support a statistically significant increase in hair diameter (SMD, 0.82; 95% CI, -0.01–1.65; P=0.05). No scarring nor serious adverse events were reported in any of the studies. The findings of this meta-analysis strongly support the utilization of a multimodal therapeutic approach of minoxidil and microneedling for hair growth in patients with androgenetic alopecia. However, variations in factors such as rating scale measurements, microneedling methods, and areas of treatment may have resulted in confounding. Further randomized controlled, large-sample trials employing rigorous methodologies are needed to gain a more comprehensive understanding regarding treatment efficacy, namely the impact of combinational therapy on hair diameter.

Review question / Objective: To test the effectiveness of multimodality therapy using minoxidil and micmroneedling, in comparison to minoxodil alone for the treatment of alopecia. In terms of the PICO framework: Population: Includes patients with any form of clinically diagnosed alopecia. Intervention: Includes using combination therapy with microneedling and minoxidil in the treatment of alopecia. Comparison: Includes comparison to minoxidil alone as control group. Outcome: Primary outcome: Increased hair density. Secondary outcome: Increased hair diameter. Condition being studied: Alopecia (hair loss) is a condition that is frequently seen in dermatology. When a thorough examination is made, the root of the issue is frequently revealed, allowing for an explanation and the most suitable treatments. Nevertheless, hair loss can occasionally be the first indicator of a serious underlying medical problem, be observed in conjunction with other conditions, or be a side effect of treatment. Furthermore, alopecia may result in distressingly noticeable symptoms, cause significant patient distress, and cause alopecia with lifelong scars and irreversible hair loss. Therefore, with these illnesses, a precise diagnosis and quick therapy are essential for the most beneficial outcomes.

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In this article, we extend previous work showing that DiffServ can provide some QoS guarantees to both realtime and non real-time traffic in the event of the failure of an optical component. Even though DiffServ cannot totally replace optical protection in a network, it might be able to do so to some degree. In this paper, we study a 4-node linear topology which can be protected by DiffServ, DiffProtect or even a combination of both (MixProtect). We evaluate the performance of all protection combinations which enables us to study the extent to which we could replace optical protection by DiffServ in a particular network. Results have shown that replacing optical protection by DiffServ cannot be done randomly, the number and positions of DiffServ protected links versus DiffProtect's must be carefully chosen in order to guarantee maximum performance to all traffic types.

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