Role of corticosteroids in Functional Endoscopic Sinus Surgery - a systematic review and meta-analysis

Background: The aim of our study is to systematically review the existing evidence on the role of corticosteroids in patients undergoing functional endoscopic sinus surgery (FESS).  Methodology: Systematic search of MEDLINE (1950- 2014), EMBASE (1980-2014), metaRegister, Cochrane Library and ISI conference proceedings was carried out.  Results: Eighteen randomised controlled trials with 1309 patients were included. Use of local and/or systemic corticosteroids with FESS was reported in four categories; operative, anaesthesia related, post-operative outcomes and risk of recurrence. Metaanalysis for operative outcomes demonstrated that, mean operative time (MD -10.70 minutes; 95% CI -15.86, -5.55; P <0.0001) and mean estimated blood loss (MD -28.32 mls; 95% CI -40.93, -15.72; P <0.0001) was significantly lower; and surgical field quality (MD -0.81; 95% CI -1.32, -0.30; P = 0.002) was significantly better in corticosteroid group. Meta-analysis showed that post-operative endoscopic scores (SMD -0.39; 95% CI -0.60, -0.17; P = 0.0004) were significantly better in corticosteroid group compared to no corticosteroid group. There was no increase in risk of sinusitis (RR 0.64; 95% CI 0.32, 1.30; P = 0.22) between use of corticosteroids and no corticosteroids; There was no significant difference in recurrence risk of chronic rhinosinusitis (CRS) in mixed population studies (RR 0.77; 95% CI 0.35, 1.70; P = 0.52) between the two groups but analysis of studies reporting on chronic rhinosinusitis with nasal polyps (CRSwNP) (RR 0.64;95% CI 0.45,0.91;P=0.01) showed significant difference in favour of the corticosteroid group.  Conclusion: Pre-operative use of local and/or systemic corticosteroids in FESS, results in significantly reduced blood loss, shorter operative time and improved surgical field quality. Studies are limited on the intra-operative use of corticosteroids to reduce postoperative pain. Postoperative corticosteroids improve postoperative endoscopic scores in CRS and recurrence rates in cases of CRSwNP

Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy:systematic review and meta-analysis

Herein is presented a systematic review and meta-analysis of evidence related to operative outcomes associated with robotic-assisted laparoscopic myomectomy (RLM) compared with abdominal myomectomy (AM) and laparoscopic myomectomy (LM). Outcome measures included estimated blood loss (EBL), blood transfusion, operating time, complications, length of hospital stay (LOHS), and costs. Meta-analysis 1 compared RLM vs AM, and meta-analysis 2 compared RLM vs LM. Studies scored moderately well on the Newcastle-Ottawa Quality Assessment Scale. No significant differences were found in age, body mass index, or number, diameter, and weight of myomas. In meta-analysis 1, EBL, blood transfusion, and LOHS were significantly lower; risk of complications was similar; and operating time and costs were significantly higher with RLM. In meta-analysis 2, no significant differences were noted in EBL, operating time, complications, and LOHS with RLM; however, blood transfusion risk and costs were higher. It was concluded that insofar as operative outcomes, RLM has significant short-term benefits compared with AM and no benefits compared with LM. Long-term benefits such as recurrence, fertility, and obstetric outcomes remain uncertain

[In Press] Onion and garlic polysaccharides : a review on extraction, characterization, bioactivity, and modifications

Allium cepa (onion) and Allium sativum (garlic) are important members of the Amaryllidaceae (Alliaceae) family and are being used both as food and medicine for centuries in different parts of the world. Polysaccharides have been extracted from different parts of onion and garlic such as bulb, straw and cell wall. The current literature portrays several studies on the extraction of polysaccharides from onion and garlic, their modification and determination of their structural (molecular weight, monosaccharide unit and their arrangement, type and position of glycosidic bond or linkage, degree of polymerization, chain conformation) and functional properties (emulsifying property, moisture retention, hygroscopicity, thermal stability, foaming ability, fat binding capacity). In this line, this review, summarizes the various extraction techniques used for polysaccharides from onion and garlic, involving methods like solvent extraction method. Furthermore, the antioxidant, antitumor, anticancer, immunomodulatory, antimicrobial, anti-inflammatory, and antidiabetic properties of onion and garlic polysaccharides as reported in in vivo and in vitro studies is also critically assessed in this review. Different studies have proved onion and garlic polysaccharides as potential antioxidant and immunomodulatory agent. Studies have implemented to improve the functionality of onion and garlic polysaccharides through various modification approaches. Further studies are warranted for utilizing onion and garlic polysaccharides in the food, nutraceutical, pharmaceutical and cosmetic industries