Przeglądanie według Autor "Kumar, Suresh"

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Comparative efficacy of topical microbicides in the prevention of HIV transmission – results from a systematic review and network meta-analysis
(Rzeszów University Press, 2025-03) Lee, E Lyn; Shanmugham, Suresh; Kumar, Suresh; Smales, Frederick Charles; Noreen, Nabeela; Veettil, Sajesh K.
Introduction and aim. Preventing new HIV infections is crucial, particularly for women and girls at high risk. Vaginal microbi cides offer a female-controlled HIV prevention method. This systematic review evaluated the comparative efficacy of topical microbicides in preventing HIV transmission. Material and methods. Electronic databases were searched up to May 2024 for randomized controlled trials (RCTs) comparing topical microbicides versus placebo/no treatment in sexually active women. The primary outcome was the incidence of HIV. A random effects network meta-analysis (NMA) was employed. Relative ranking was assessed using surface under the cumula tive ranking curve (SUCRA) probabilities. Analysis of literature. Thirteen RCTs were included in the review comparing the dapivirine ring, the tenofovir gel, BufferGel, PRO 2000, Carraguard, cellulose sulfate, or SAVVY against placebos. Compared to placebo, only dapivirine significantly reduced HIV incidence (risk ratio (RR) 0.71 [95% CI 0.56 to 0.91]). Dapivirine was superior to BufferGel (RR 0.61 [95% CI 0.39 to 0.94]) and SAVVY (RR 0.52 [95% CI 0.28 to 0.97]). Dapivirine ranked highest in efficacy (SUCRA=0.93), followed by tenofovir (SUCRA=0.76). In general, consistent network results with some small study effects. Conclusion. This study supports the use of the vaginal dapivirine ring for HIV prevention over SAVVY or BufferGel. More high-quality trials are needed to validate the efficacy of tenofovir gel.
Probiotics for the prevention of antibiotic-associated diarrhea – an umbrella review of meta-analyses of randomized controlled trials
(Rzeszów University Press, 2025-03) Lee, E Lyn; Sidhick, Sulfath Thekkumcheril; Maharajan, Mari Kannan; Shanmugham, Suresh; Ingle, Pravinkumar Vishwanath; Kumar, Suresh; Ching, Siew Mooi; Lee, Yeong Yeh; Veettil, Sajesh K.
Introduction and aim. Antibiotic therapies induce diarrhea by disrupting the intestinal microbiota, prompting research into probiotics to prevent antibiotic-associated diarrhea (AAD). The aim of this study was to systematically identify and summarize meta-analyses of randomized controlled trials (RCT) on probiotics for AAD prevention. Material and methods. Databases including PubMed, EMBASE, Epistemonikos, and the Cochrane Database were searched up to December 11, 2023. Systematic reviews and meta-analyses of RCTs on probiotics for AAD prevention in any age group were included. Meta-analyses were re-performed to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Evidence quality was assessed using GRADE criteria. Analysis of the literature. The review included 16 articles with 39 unique meta-analyses. Probiotics reduced AAD risk across various groups: adults (RR 0.47, 95% CI 0.40–0.56), all ages (RR 0.58, 95% CI 0.50–0.68), and outpatients (RR 0.49, 95% CI 0.36 0.66) with a moderate level of evidence. For the use of any probiotics in pediatrics, the initial high-quality evidence (RR 0.48, 95% CI 0.44–0.63) was downgraded to moderate after a sensitivity analysis excluding small studies. Conclusion. Probiotics are beneficial in preventing AAD, but evidence quality varies from low to moderate. High-quality trials are needed to identify the most effective probiotic species and strains, dosages, and target patient populations.
Randomized, open-label, controlled, comparative clinical study to evaluate the safety and efficacy of Pilex Forte tablets in combination with Pilex Ointment application for the effective management of common ano-rectal conditions
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Kumar, Suresh; Selvarajan, Sandhiya; Lakshmi, Prasanna; Paramesh, Rangesh; Kumawat, Rajesh; Palaniyamma, D; Srikrishna, HA
Introduction. Haemorrhoids and anal fissures are considered as the most common anorectal conditions. Aim. To evaluate the safety and efficacy of Pilex Forte tablets in combination with Pilex Ointment as compared to the Standard of Care in common anorectal conditions Material and methods. Randomized, open-label, controlled comparative clinical study conducted on 162 patients of either sex, aged between 18-50 years, confirmed with common anorectal conditions. As per randomization, patients received either standard of care or Pilex Forte tablet along with Pilex Ointment at a recommended dose of two tablets twice daily and twice daily local application (anal) for a period of 4 weeks. Clinical safety and efficacy assessments were carried out at study specific scheduled visits. Laboratory assessments were carried out only at screening and at the end of the study. Results. Patients who completed the study were considered for statistical analysis. Significant clinical improvement was observed in patients with anorectal conditions who received Pilex Forte tablet and Pilex Ointment than to those who received standards of care. No abnormal lab values were recorded and there were no adverse events reported during the study period. Conclusion. Pilex Forte tablet along with Pilex Ointment at recommended dose is safe and effective in the management of anorectal conditions like haemorrhoids and fissure-in-ano.
The use of topical metronidazole in the management of seborrheic dermatitis – a systematic review and meta-analysis of randomized controlled trials
(Publishing Office of the University of Rzeszow, 2024-12) Lee, E. Lyn; Shanmugham, Suresh; Kumar, Suresh; Smales, Frederick Charles; Ching, Siew Mooi; Veettil, Sajesh K.
Introduction and aim. Topical metronidazole, with its well-known anti-inflammatory and antibacterial properties, could be beneficial for managing seborrheic dermatitis (SD), but studies report conflicting results. The aim was to evaluate the efficacy and safety of topical metronidazole in the treatment of SD. Material and methods. A systematic search of Medline, Embase, and CENTRAL was conducted from inception to April 2024. Randomized controlled trials (RCTs) comparing metronidazole to any comparator for SD were included in this study. Data were pooled using random-effects models. Analysis of the literature. Seven RCTs were included. Overall, topical metronidazole did not significantly reduce SD symptom severity when compared to any comparator/treatment. However, it significantly reduced symptom severity compared to placebo after 4 to 8 weeks (standardized mean difference (SMD) -3.00, 95% CI, -5.21 to -0.78). Specifically for facial SD, metronidazole showed significant symptom reduction (SMD -0.85, 95% CI, -1.41 to -0.29). No significant differences were found in the proportion of patients with clinical improvement or side effect frequency. Most studies had a high risk of bias and lacked information on missing data and assessor masking. Conclusion. Topical metronidazole demonstrates potential for managing SD, but current trials lack quality. Larger, high-quality trials are needed to confirm its efficacy and compare it with other treatments for SD.