Safety and efficacy of daridorexant in the treatment of insomnia: a systematic review and meta-analysis of randomized controlled trials.

Daridorexant is a novel dual orexin receptor antagonist used in treating insomnia disorder. Daridorexant improves sleep quality without impairing daytime functioning. We assess the safety and efficacy of this novel drug in the treatment of insomnia. We performed a systematic search for electronic databases in SCOPUS, PubMed, Web of Science and the Cochrane library. Seven randomized controlled trials were included in this review, with 2425 participants enrolled. Daridorexant was superior to placebo in reducing wake time after sleep onset (MD = -13.26; 95% CI, -15.48 to -11.03; P < 0.00001), latency to persistent sleep (MD = -7.23; 95% CI, -9.60 to -4.85; P < 0.00001), with increasing the total sleep time (MD = 14.80; 95% CI, 11.18-18.42; P < 0.00001) and subjective total sleep time (MD = 14.80; 95% CI, 11.18-18.42], P < 0.00001). The 25 mg and 50 mg were the most officious doses. Treatment with daridorexant has resulted in a slightly higher incidence of adverse events [risk ratio (RR) = 1.19; 95% CI, 1.05-1.35;, P = 0.005], specifically somnolence (RR = 1.19; 95% CI, 1.13-3.23; P = 0.005) and fatigue (RR = 2.01; 95% CI, 1.21-3.36; P = 0.007). Daridorexant is superior to placebo in improving sleep quality. However, the drug resulted in a slightly higher incidence of adverse events, including somnolence and fatigue.

Mini-laparotomy for cholecystectomy in resourced limited settings: a 10-year retrospective hospital-based study.

Cholecystectomy is a commonly performed abdominal procedure, the gold standard currently is the laparoscopic approach and, however, the facilities and expertise for laparoscopy are not available widely, especially in developing countries. A Mini-laparotomy cholecystectomy is an additional approach that is performed through an incision that is less than 5 cm thus minimizing the complications of the traditional open cholecystectomy and the postoperative hospital stay. The study aims to evaluate the outcome of mini-laparotomy cholecystectomy in terms of operative duration, complications, and hospital stay in a rural hospital. This is a retrospective study conducted in El-Dwaim Teaching Hospital, Sudan. All cases of mini-laparotomy cholecystectomy conducted from March 2009 to December 2020 were included and retrospectively studied. Descriptive statistics were applied using SPSS version 25. A total of 512 mini-laparotomy cases were involved in the study, of those 442 aged more than 40 years. The operation lasted less than 60 minutes for 486 of the participants, and the most frequent cholecystitis complication observed intraoperatively was mucocele, occurring in 70 (13.6%) participants. Intraoperative complications due to mini-laparotomy occurred in 4 (0.8%) cases, in the form of bleeding and none of the observed cases converted into open cholecystectomy. Postoperative complications occurred in the form of wound infection in 7 participants, biliary leak in 1 participant, and fistula formation in 1 participant. Post-operative hospital stay was 24 hours for 458 participants. Mini-laparotomy cholecystectomy is a safe minimally invasive approach with low rates of complications and short postoperative hospital stay, making it an optimum approach in facility-deprived countries.