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

Abstract Background: Facial volume loss is a hallmark of facial aging and has led to increasing demand for minimally invasive aesthetic interventions. Hyaluronic acid (HA) and poly-L-lactic acid (PLLA) are among the most widely used injectable fillers for facial volume restoration; however, their comparative effectiveness and safety profiles remain debated.

Objective: This systematic review and meta-analysis aimed to compare the clinical effectiveness, longevity of outcomes, patient satisfaction, and safety of HA versus PLLA in facial volume restoration.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases from inception to 2024. Randomized controlled trials, prospective cohort studies, and comparative observational studies evaluating HA and PLLA for facial volumization were included. Primary outcomes were volume improvement and durability of effect, while secondary outcomes included patient satisfaction and incidence of adverse events. Meta-analyses were performed using random-effects models.

Results: A total of 77 studies encompassing over 6,400 patients met the inclusion criteria. Both HA and PLLA demonstrated significant improvements in facial volume compared with baseline. HA provided rapid and predictable volumization with high short-term patient satisfaction, whereas PLLA showed superior longevity of results, particularly beyond 12 months. The pooled analysis indicated no statistically significant difference in overall adverse event rates between the two fillers. However, HA was more frequently associated with transient edema and bruising, while PLLA had a higher incidence of delayed-onset nodules when improper injection techniques were used.

Conclusion: Both HA and PLLA are effective and generally safe options for facial volume restoration. HA is preferable for patients seeking immediate results and reversibility, while PLLA may be better suited for long-term volumization. Individual patient characteristics, aesthetic goals, and practitioner expertise should guide filler selection.

Abstract Facial filler injections have become increasingly popular for aesthetic enhancement, yet they are associated with a spectrum of adverse events ranging from mild to severe. This systematic review and meta-analysis aimed to evaluate the incidence, type, and risk factors of complications following facial filler procedures. A comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted up to 2024, including studies reporting adverse outcomes in patients receiving injectable fillers. Data were extracted on patient demographics, filler type, injection sites, and reported complications, which were subsequently pooled for meta-analysis. Among the included studies, the overall incidence of adverse events was estimated at 8.3% (95% CI: 6.1–10.9%), with mild reactions such as swelling, erythema, and bruising representing the majority. Moderate complications included nodule formation and infection, whereas rare but severe events such as vascular occlusion and vision loss were reported in 0.05% of cases. Hyaluronic acid-based fillers were most frequently implicated, although permanent fillers demonstrated a higher risk of prolonged or severe outcomes. Meta-regression identified practitioner experience and injection technique as significant predictors of complication rates. The findings underscore the importance of pre-procedural patient assessment, meticulous injection techniques, and awareness of anatomical risk zones. Early recognition and prompt management of adverse events are critical to prevent permanent sequelae. This review highlights the need for standardized reporting of filler-related complications to facilitate evidence-based practice and improve patient safety. Future research should focus on long-term safety profiles, comparative studies of different filler types, and the development of guidelines for prevention and management of rare but serious events. Overall, while facial fillers are generally safe, clinicians must remain vigilant to minimize risks and ensure optimal outcomes.

Abstract Introduction: Acute appendicitis remains a frequent surgical emergency in which timely diagnosis and early prediction of complications are critical. The neutrophil to lymphocyte ratio has emerged as a simple, cost effective inflammatory biomarker that reflects disease severity. Growing evidence suggests that NLR may enhance diagnostic accuracy and help identify patients at higher risk of complicated appendicitis, supporting its integration into clinical decision making.

Material and methods: This study evaluated the diagnostic and prognostic value of the neutrophil to lymphocyte ratio in patients undergoing appendectomy for suspected acute appendicitis. Analysis of 340 cases demonstrated that elevated NLR was associated with complicated disease, including suppurative, gangrenous, and perforated appendicitis. These findings support NLR as an accessible, cost effective marker for risk stratification and early clinical decision making in acute appendicitis.

Results: In this study, patients with complicated acute appendicitis demonstrated significantly higher inflammatory markers than those with uncomplicated disease, particularly a markedly elevated neutrophil‑to‑lymphocyte ratio (NLR). Higher NLR values were strongly associated with advanced disease severity and complication status (p < 0.001), highlighting NLR as a simple, reliable, and clinically useful biomarker for early risk stratification in acute appendicitis.

Conclusion: In conclusion, the present findings support the concept that complicated acute appendicitis is characterized by a distinct inflammatory profile marked by neutrophil predominance, lymphocyte suppression, and significantly elevated NLR.

Abstract Granulomatous mastitis is a rare chronic inflammatory breast disease that often mimics malignancy and presents diagnostic and therapeutic challenges. Its unclear etiology, variable clinical course, and lack of standardized management have led to diverse treatment approaches. A comprehensive evaluation of current evidence is essential to optimize diagnosis, guide therapy, and improve patient outcomes. This systematic review synthesizes current evidence on the diagnosis and management of granulomatous mastitis, aiming to clarify clinical approaches and inform evidence based decision making in practice. Granulomatous mastitis is a benign but clinically challenging breast disease characterized by diagnostic ambiguity, heterogeneous pathogenesis, and variable treatment responses. Its frequent clinical and radiologic overlap with breast malignancy and infection contributes to delayed diagnosis and inconsistent management. The immune mediated and multifactorial nature of the disease explains its chronic course and risk of recurrence, particularly when inflammation is insufficiently controlled. Variability in therapeutic strategies largely reflects the absence of standardized guidelines and high quality evidence. These factors collectively result in diverse clinical outcomes and highlight the need for individualized, evidence based management supported by robust prospective research.

Abstract Introduction: Serial radiography remains a widely used tool in the long‑term follow‑up of patients after total knee arthroplasty, aiming to detect implant‑related complications, alignment changes, and periprosthetic bone alterations over time. However, the clinical value and cost‑effectiveness of routine radiographic surveillance, particularly in asymptomatic patients, remain controversial and warrant careful evidence‑based evaluation.

Material and methods: A systematic review was conducted through comprehensive searches of major electronic databases using predefined keywords and Boolean operators, without temporal restrictions, to identify relevant studies on serial radiography after total knee arthroplasty.

Results: Serial radiographic follow‑up after total knee arthroplasty frequently identifies structural abnormalities; however, most findings occur in asymptomatic patients and show limited correlation with clinical deterioration or revision. A clear radiographic–clinical discordance was observed, indicating that routine long‑term imaging provides minimal incremental value in stable patients and should be guided primarily by symptoms and functional status rather than radiographic changes alone.

Conclusion: This study demonstrates that radiographic abnormalities after total knee arthroplasty are common but often clinically inconsequential, with a substantial disconnect between imaging findings and patient experience.

Abstract Facial fillers have become a cornerstone in aesthetic dermatology, offering minimally invasive solutions for facial rejuvenation and contouring. Despite their widespread use, there remains considerable variability in clinical outcomes, often influenced by the depth of filler injection. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of different injection depths for commonly used facial fillers, including hyaluronic acid (HA), poly-L-lactic acid (PLLA), and calcium hydroxylapatite (CaHA). A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases, covering studies published between 2010 and 2025. Eligible studies included randomized controlled trials, cohort studies, and comparative clinical trials reporting clinical outcomes related to injection depth, such as aesthetic improvement, patient satisfaction, longevity of effect, and adverse events.

From an initial pool of 1,243 articles, 66 studies met inclusion criteria and were analyzed. Meta-analytic synthesis revealed that deep subcutaneous and supraperiosteal injections generally provided superior volumization and longer-lasting results compared to superficial injections, particularly for midface augmentation and nasolabial fold correction. Conversely, superficial injections were associated with higher rates of irregularities and visible filler deposits but demonstrated better outcomes in fine-line correction and periorbital rejuvenation. Adverse events, including edema, ecchymosis, and nodule formation, were more frequently reported with superficial injections, although these events were mostly transient. Heterogeneity among studies was moderate to high, attributed to variations in filler type, injection technique, and assessment methods.

In conclusion, injection depth significantly influences the clinical effectiveness and safety profile of facial fillers. While deep injections are preferable for structural augmentation, superficial injections remain valuable for fine-tuning and surface-level corrections. Standardized protocols and further high-quality comparative trials are recommended to optimize treatment outcomes and minimize complications.

Abstract Introduction: Re‑expansion pulmonary edema is a rare but serious complication following rapid lung re‑expansion in patients with massive pleural effusion. Chest tube insertion and video‑assisted thoracoscopic surgery are commonly used interventions, yet their relative risks for this condition remain unclear. Understanding incidence patterns and contributory factors is essential for optimizing procedural choice and improving patient safety.

Material and methods: This prospective clinical study enrolled adult patients with massive pleural effusion who were allocated to four intervention groups based on drainage volume and technique. Pleural fluid was evacuated via thoracoscopy or chest tube insertion under general anesthesia. Postoperative hypoxemia was evaluated using arterial blood gas analysis and chest radiography to identify re‑expansion pulmonary edema, with outcomes systematically recorded and analyzed.

Results: Baseline characteristics were comparable between groups. Video assisted thoracoscopic surgery was associated with a significantly lower incidence of re expansion pulmonary edema, improved post procedural oxygenation, fewer ICU admissions, and shorter hospital stay compared with chest tube drainage (all P ≤ 0.02), particularly in patients with massive pleural effusion, indicating superior early clinical outcomes with thoracoscopic management.

Conclusion: The results primarily reflect early postoperative outcomes and may not capture long term respiratory or functional differences between interventions. Additionally, procedural expertise and institutional experience with thoracoscopic surgery may influence outcomes and limit generalizability to settings with limited thoracoscopic resources.

Abstract Introduction: Nasal fractures are among the most frequent facial injuries in adults and often require surgical management to restore function and aesthetics. Despite generally favorable outcomes, postoperative complications remain clinically relevant and may affect nasal airflow, appearance, and patient satisfaction. Evaluating the incidence and pattern of these complications is essential for improving surgical planning, patient counseling, and overall postoperative care.

Material and methods: This study evaluated postoperative complications following nasal fracture surgery in adult patients. Using an observational design, clinical outcomes were assessed in a representative cohort to identify functional, aesthetic, and early surgical complications. Understanding the incidence and pattern of these adverse outcomes may support improved surgical decision‑making, optimize perioperative management, and enhance patient counseling in adult nasal fracture care.

Results: In this cohort of adults undergoing nasal fracture surgery, postoperative complications were common, with functional impairments such as nasal obstruction and septal deviation predominating. Structural and cosmetic sequelae were also frequent, while infectious and hemorrhagic events occurred less often. Although revision surgery was required in a minority of cases, these findings highlight the persistent clinical burden of nasal fracture repair.

Conclusion: the findings of this study reinforce that nasal fracture surgery in adults, despite its routine nature, carries a meaningful risk of persistent postoperative morbidity. Functional impairment, structural deformity, and aesthetic dissatisfaction remain common, even with timely and minimally invasive intervention.