Steroid efficacy in Meralgia Paresthetica: A systematic review and meta-analysis.

Objective: To determine the efficacy of steroid injections for pain relief in patients with meralgia paresthetica (MP). Methods: All the literature published until March 2023 was explored from several databases, including EBSCO, PubMed, EMBASE, Cochrane Library, Google Scholar, and Scopus. Articles investigating the change in pain status of MP patients after steroid injection were included. The primary outcomes were complete pain relief, pain scores at 15 days and one month after intervention. When compared to the baseline, the secondary outcomes for the steroid group included pain scores at the end of treatment and quality of life, which were further evaluated by two factors, namely mental and physical health. Results: The analysis of the studies validated that steroids were significantly successful in providing complete pain relief (p-value = 0.00001), and in reducing the pain score of patients with meralgia paresthetica at 15 days (p-value = 0.02), but not at one month (p-value = 0.79) as compared to the control group. The analysis did not reveal any significant subgroup differences among various steroids (P = 0.52; CI: 0.01 - 0.10; RR: 0.04; I2 = 0%). Mental health (MD = 4.23; 95% CI = 0.42 to 8.03; p = 0.03, I2 = 0%) was significantly improved in the steroid group when compared with baseline. Conclusion: Steroids injections can play an important role in improving symptoms and complications of meralgia paresthetica, especially in the short term.

Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis.

PURPOSE: In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay. METHODS: We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI). RESULTS: The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83-1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50-6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49-2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance. CONCLUSION: The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.

Comparative effectiveness of calfactant and beractant in neonatal respiratory distress syndrome: A systemic review and meta-analysis.

INTRODUCTION: Animal derived surfactants are considered to be the standard treatment for neonatal respiratory distress syndrome (NRDS). However, their comparative effectiveness remains inconclusive given the multiple prior studies with inconsistent results. Therefore, we conducted a systematic review and meta analysis to compare the effectiveness of two animal extract surfactants (calfactant and beractant) for the management of NRDS. METHODS: We searched Pubmed, Scopus, and Google Scholar for studies comparing efficacy of calfactant and beractant for the treatment of NRDS. Mean differences (MD) and risk ratios (RR) with a 95% confidence interval (CI) were calculated using Review Manager. RESULT: We found no significant difference between calfactnat and beractant groups in the primary outcomes: neonatal mortality before the age of 28 days (RR = 1.19, 95% CI = 0.97-1.46, p = 0.09), mortality before the hospital release (RR = 1.12, 95% Cl = 0.94-1.33, p = 0.22), oxygen requirement at 28 days of age (RR = 0.97, 95% CI = 0.90-1.05, p = 0.52), and death or oxygen need at 36 weeks postmenstrual age (RR = 0.99, 95% CI = 0.91-1.08, p = 0.81). The duration of supplementary oxygen was significantly lower in calfactant users (MD = -4.95, 95% CI = -7.60--2.30, p = 0.0002). Calfactant significantly lowered the duration of hospital stay, risk of pneumothorax and air leak syndrome whereas beractant users had lower risk of intraventricular hemorrhage (Grades 3 and 4). CONCLUSION: There is no substantial difference in the efficacy of both surfactants in the prophylaxis and treatment of NRDS.