Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Abstract Introduction: The increasing use of biologic agents in rheumatoid arthritis marks a pivotal shift in disease management, necessitating rigorous evaluation of their efficacy and safety. Given their high cost, variable patient response, and potential for serious adverse effects, a systematic synthesis of randomized controlled trials is essential. Such analysis informs evidence-based clinical decisions, supports personalized treatment strategies, and ensures optimal resource allocation in the evolving landscape of RA therapy.

Material and methods: This systematic review rigorously identified and analyzed randomized controlled trials evaluating biologic agents in adult rheumatoid arthritis patients. Comprehensive database searches and strict eligibility criteria ensured inclusion of high-quality studies reporting on efficacy and safety outcomes. Independent data extraction and bias assessment using standardized tools minimized error and enhanced validity. Statistical and clinical heterogeneity were carefully evaluated, with subgroup and sensitivity analyses conducted to ensure robust, reliable conclusions on biologic therapy effectiveness and safety.

Results: A systematic search identified 278 records, with 257 remaining after duplicate removal. Screening titles and abstracts excluded 202 records. Of the 55 full-text articles assessed, 49 were excluded for reasons including not meeting inclusion criteria, non-randomized design, or insufficient endpoints. Ultimately, six high-quality randomized controlled trials on biologic agents in rheumatoid arthritis were included, ensuring robust and relevant evidence for this review.

Conclusion: A thorough systematic search identified 278 records, with 257 unique studies screened after duplicate removal. Title and abstract screening excluded 202 records, and full-text review of 55 articles led to exclusion of 49 for methodological or relevance issues.

Abstract Introduction: The comparative evaluation of 2% lidocaine with epinephrine for epistaxis management holds significant clinical importance, as it directly influences both the efficacy and safety of acute hemostasis strategies.

Material and methods: This prospective, randomized clinical trial at Imam Reza Hospital enrolled adults with acute anterior epistaxis to compare the efficacy and safety of local 2% lidocaine injection versus topical epinephrine application. Eligible patients were randomized using concealed allocation, with outcome assessors and statisticians blinded. Primary and secondary outcomes included time to hemostasis, pain, adverse events, and satisfaction.

Results: The baseline characteristics were well-matched between the Lidocaine 2% and Epinephrine groups. Clinically, the Epinephrine group showed a significantly higher outcome score compared to Lidocaine (p = 0.005). However, side effects were more frequent in the Epinephrine group, with a significantly higher total number of adverse events and systemic scores (p = 0.014 and p = 0.023, respectively), indicating a greater risk of systemic reactions with epinephrine use.

Conclusion: Based on the study findings, both 2% lidocaine and topical epinephrine were effective for acute anterior epistaxis, with well-matched baseline characteristics. Epinephrine demonstrated superior clinical efficacy but was associated with a significantly higher rate of side effects and systemic reactions. These results suggest that while epinephrine is more effective for hemostasis, its use should be weighed carefully against the increased risk of adverse events, especially in susceptible patients.

Abstract Introduction: The use of tranexamic acid in hepatic resection holds significant clinical importance due to its potential to reduce intraoperative blood loss and minimize reliance on allogeneic transfusions, which are associated with increased morbidity, mortality, and oncologic risk. Given the liver’s complex vascular anatomy and fragile hemostatic balance, optimizing bleeding control while preserving safety is critical. A clearer understanding of TXA’s efficacy and risks can directly impact surgical outcomes and perioperative care standards.

Material and methods: This systematic review, following PRISMA guidelines, evaluated the impact of tranexamic acid on intraoperative bleeding and transfusion needs in hepatic resection. Eligible studies included RCTs and observational research involving adult patients. Comprehensive database searches, independent data extraction, and validated risk of bias assessments were conducted. Meta-analyses were performed where appropriate, with heterogeneity explored through subgroup and sensitivity analyses, providing a robust evidence base on the perioperative efficacy of tranexamic acid in liver surgery.

Results: This systematic review included six comparative studies evaluating tranexamic acid (TXA) in hepatic resection. TXA significantly reduced intraoperative blood loss and perioperative transfusion requirements compared to control or placebo. Both transfusion incidence and PRBC volumes were consistently lower in the TXA groups. These findings support the efficacy of intravenous TXA in minimizing bleeding and transfusion burden, indicating a beneficial role.

Conclusion: Tranexamic acid administration during hepatic resection significantly reduces intraoperative blood loss and decreases the need for perioperative blood transfusions. Consistently lower transfusion volumes and reduced transfusion incidence were observed across diverse patient populations and dosing regimens.

Abstract Introduction: The effective management of postoperative pain following laparoscopic cholecystectomy is essential to enhance recovery, minimize complications, and reduce opioid dependence. Given the global urgency to limit opioid-related adverse effects, ketorolac—a potent NSAID with proven analgesic efficacy—offers a valuable alternative.

Material and methods: This systematic review, conducted per PRISMA guidelines, evaluated the efficacy and safety of ketorolac for postoperative pain management in adults undergoing laparoscopic cholecystectomy. Eligible studies included RCTs, cohort, and comparative clinical studies reporting on pain, opioid use, and adverse events. Comprehensive database searches, standardized data extraction, and risk of bias assessments were performed. Heterogeneity was analyzed using I² statistics, with appropriate meta-analytic models applied based on its degree.

Results: This systematic review included seven studies evaluating the efficacy and safety of ketorolac in postoperative pain management following laparoscopic cholecystectomy. The findings demonstrated that ketorolac significantly reduced pain scores and opioid consumption within the first 24 hours postoperatively. Additionally, ketorolac did not increase the incidence of adverse events such as nausea, vomiting, or bleeding, supporting its favorable safety profile and potential as an effective opioid-sparing analgesic in this surgical context.

Conclusion: Based on the systematic review, ketorolac demonstrates effective postoperative analgesia following laparoscopic cholecystectomy, with significantly reduced pain scores and opioid consumption within the first 24 hours. Its analgesic benefits were consistent across diverse populations and study designs, without a significant increase in adverse events. These findings support ketorolac as a safe, opioid-sparing alternative for pain management in this surgical setting.