RESUMEN
Objective: Nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant contributor to chronic liver disease worldwide. Orlistat blocks intestinal fat absorption, leading to decreased liver fat content. Therefore, it is a viable option for NAFLD management. Methods: We performed a systematic review and metaanalysis using randomized controlled trials (RCTs). We used mean difference (MD) to pool continuous outcomes presented with the corresponding confidence interval (CI). Results: We included four RCTs with a total of 379 patients. Orlistat was effective in reducing liver fat content (MD: -5.02, 95% CI [-7.23, -2.82], P = 0.00001), alanine transferase (MD: -10.03, 95% CI [-17.80, -2.26], P = 0.01), aspartate transferase (MD: -4.29, 95% CI [-7.59, -0.99], P = 0.01), waist circumference (MD: -3.18, 95% CI [-4.25, -2.10], P = 0.00001), body mass index (MD: -1.03, 95% CI [-1.34, -0.73], P = 0.00001), total cholesterol (MD: -3.75, 95% CI [-4.02, -3.49], P = 0.00001), and low-density lipoprotein (MD: -3.83, 95% CI [-4.05, -3.61], P = 0.00001). However, orlistat was associated with increased serum triglycerides (MD: 7.46, 95% CI [6.48, 8.44], P = 0. 00001). Conclusion: Orlistat is a viable option for NAFLD management; however, it increases triglyceride levels. Larger RCTs are required.
RESUMEN
Background: Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques' efficacy and safety. Methods: We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22nd, 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755. Results: We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: -1.78 with 95% CI: -2.50, -1.06, P<0.00001), time to achieve 50% reduction (MD: -2.83 with 95% CI: -3.36, -2.30], P<0.00001) and duration of antibiotic needed (MD: -2.13 with 95% CI: -3.84, -0.42, P=0.01). We found no difference in the duration of hospitalization (MD: -0.72 with 95% CI: -1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days. Conclusions: Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.
RESUMEN
OBJECTIVE: Post-orthopaedic operative pain is a serious concern that often requires the administration of analgesics; however, the optimal time of analgesic administration is still inconclusive. Perioperative analgesia is administrating pre-emptive analgesia before and during the surgery followed by postoperative analgesia to decrease the procedure associated nociceptive response. We aim to assess perioperative meloxicam versus postoperative meloxicam for pain control after orthopaedic operations. METHODS: A systematic review and meta-analysis involving randomized controlled trials from PubMed, Embase, Scopus, WOS, and Cochrane until 28th May 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol in PROSPERO with ID: CRD42022336046. RESULTS: We included five RCTs with 964 patients. All the included trials showed high risk of performance and detection biases because of lack of blinding. Pooled analysis favored perioperative meloxicam in reducing pain score after six hours (MD: -0.42 with 95% CI [-0.63, -0.21], p = .0001), 12 h (MD: -0.54 with 95% CI [-0.69, -0.39], p = .00001), and 24 h (MD: -0.23 with 95% CI [-0.36, -0.10]. Pooled analysis favored perioperative meloxicam in improving patient global assessment scale after 12 h (MD: -0.66 with 95% CI [-0.86, -0.46], p = .00001), 24 h (MD: -0.30 with 95% CI [-0.49, -0.11, p = .002), and 48 h (MD: -0.17 with 95% CI [-0.33, -0.01], p = .04). Pooled analysis favored perioperative meloxicam in reducing patient-controlled analgesia (MD: -4.25 with 95% CI [-5.96, -2.54], p = .00001). CONCLUSION: Short-term pain management after orthopaedic procedures is better accomplished with perioperative meloxicam than postoperative meloxicam. Before recommending perioperative meloxicam for pain control following orthopaedic surgeries, further multicentre trials are still warranted to examine the impact of perioperative meloxicam in different orthopaedic procedures.