Hatem Eldeeb

Introduction and importance: Intussusception is the most frequent cause of bowel obstruction in infants. Most cases are managed nonsurgically with liquid or enema reduction. Our study aims to evaluate the efficacy and safety of air versus liquid enema reduction for the treatment of intussusception in pediatric patients. Materials and methods: A literature search was conducted on electronic databases, and the references of all included studies were searched to identify additional relevant studies meeting our inclusion criteria. Our meta-analysis included studies that compared the use of air and liquid enemas in pediatric patients with intussusception. The primary outcomes assessed were reduction success, perforation, and recurrence rates. Secondary outcomes included hospital stay duration, reduction time, reduction pressure, and fluoroscopy time. Meta-analysis was performed using RevMan 5.4. Results: Twenty-nine studies were included in the analysis, encompassing 9281 patients. The pneumatic reduction was significantly associated with a higher success rate (risk ratio: 1.22, 95% confidence interval [CI]: {1.12, 1.34}) and a shorter reduction time (mean difference [MD]: −2.64, 95% CI: [−4.73, −0.55]). No significant difference was found between the two procedures in terms of perforation rate, recurrence rate, length of hospital stays, reduction pressure, and fluoroscopy. Subgroup analysis revealed that pneumatic reduction had higher success rates in both RCTs and cohort studies and was superior to liquid reduction before the year 2011. After 2011, both techniques had similar success rates. Pneumatic reduction also showed higher success rates in both children’s and non-children’s hospitals and among the general radiologists’ subgroup, though pediatric radiologists achieved similar success rates with both techniques. Conclusions: Pneumatic enema reduction offers higher success and faster treatment for pediatric intussusception, with comparable safety to hydrostatic methods, supporting its use as the preferred nonsurgical approach. Further comparative studies are recommended to examine radiation dose and fluoroscopy time.

Introduction: Upadacitinib, a selective JAK1 inhibitor, has demonstrated promising results in the treatment of axial Spondyloarthritis (AxSpA). AxSpA management remains challenging since there is a gap in knowledge regarding the potential effect of upadacitinib in axSpA patients. Exploring novel therapeutic options is crucial. Therefore, we performed this systematic review and meta-analysis to summarize and synthesize results collected from available randomized-- controlled trials (RCTs) about the efficacy and safety of upadacitinib for patients with axSpA. Methods: A systematic literature search of Medline via PubMed, Web of Science, Scopus, EBSCO, and Cochrane Central was conducted in October 2023. Relevant RCTs were selected, and their data were extracted and analyzed using the RevMan 5.4 software. The main outcomes were assessment in Spondylarthritis International Society (ASAS) 20, ASAS40, SPARCC MRI sacroiliac joint, and Bath Ankylosing Spondylitis disease activity index (BASDAI) 50. Results: Three RCTs with a total of 920 participants were included in this study. Upadacitinib showed significant improvement in the ASAS40 response, ASAS20 response, BASDAI50 response, and SPARCC MRI Sacroiliac Joint change from baseline compared to placebo at 14-week duration (RR 2.19, 95% CI (1.79 to 2.68), P < 0.00001), (RR 1.62, 95% CI [1.42 to 1.84), P < 0.00001), (RR 2.16, 95% CI (1.75 to 2.67), P < 0.00001), and (MD -3.32 points, 95% CI (-3.96 to -2.68), P < 0.00001) respectively. However, this efficacy decreased after the 52-week duration in terms of ASAS40 RR 2.19 vs. 1.02, ASAS20 RR 1.62 vs. 0.98, BASDAI 50 RR 2.16 vs. 1.05, and ASAS Partial Remission RR 3.82 vs. 1.07. Conclusion: Upadacitinib 15 mg showed satisfactory and promising efficacy in the treatment of AxSpA, with no difference in safety profile compared to the placebo.

Carpal Tunnel Syndrome (CTS) is a common peripheral nerve entrapment disorder with a high global burden. Various surgical techniques have been developed to optimize symptom relief and minimize postoperative morbidity. This network meta-analysis (NMA) aimed to compare the relative efficacy and safety of different carpal tunnel release (CTR) procedures. We conducted a systematic review and NMA of randomized controlled trials (RCTs) comparing surgical CTR techniques. Outcomes included symptom severity, pain scores, functional status, patient-reported outcomes, operative time, and adverse events. Data were synthesized using the frequentist approach with the netmeta package in R. Confidence in network estimates was evaluated using the CINeMA framework. Thirty-two RCTs comprising 2,916 patients were included. One-port and two-port endoscopic CTR (ECTR) techniques demonstrated superior symptom relief compared to conventional open CTR (COCTR), particularly at three months (two-port ECTR: SMD = –4.47; 95% CI: –5.67 to –3.26). One-port ECTR consistently showed better functional outcomes across all timepoints, including improved grip (SMD = 1.37; 95% CI: 0.35 to 2.39) and pinch strength. Pain was significantly reduced with two-port ECTR at one and three months. Ultrasound-guided CTR (CTR-US) showed the highest patient satisfaction (OR = 6.89; 95% CI: 1.87 to 25.43) and a significantly shorter return-to-work duration. The double tunnels technique (DTT) had the lowest risk of adverse events (OR = 0.05; 95% CI: 0.01 to 0.42). Operational time and scar tenderness were comparable across all techniques. Heterogeneity was generally low to moderate across outcomes, and CINeMA assessments indicated moderate to low confidence in several comparisons. Endoscopic techniques, particularly one- and two-port ECTR, offer superior outcomes in symptom severity and functional recovery compared to COCTR. CTR-US appears to maximize patient satisfaction and early return to work, while DTT is associated with the fewest complications. These findings can guide individualized, evidence-based treatment decisions in CTS surgery.

Midline laparotomy incision is mostly used in emergent surgery, especially in hemodynamic instability patients. We aim to compare the Modified Smead–Jones (MSJ) and Smead–Jones (SJ) sutures against conventional continuous suture in midline laparotomy closure. PubMed, Scopus, Web of Science, and Ovoid were searched. We utilized Revman 5.4.1 for statistical analysis. Five studies involving 403 patients were included. Compared to continuous sutures, MSJ showed a significant reduction in wound dehiscence, wound infection, and hospital stay (RR = 0.29, 95% CI [0.14–0.59], p = 0.0006), (RR = 0.41, 95% CI [0.26–0.65], p = 0.0002), and (MD = – 4.50, 95% CI [– 5.43 to – 3.57], p = 0.00001). Conversely, the SJ subgroup showed no statistically significant difference in wound dehiscence, wound infection, and hospital stay. Also, both techniques, MSJ and SJ, showed no significant difference in incisional hernia risk (RR = 0.17, 95% CI [0.02–1.33], p = 0.09) and (RR = 5.16, 95% CI [0. 26–103.27], p = 0.28), respectively. MSJ follows the same far-near-near-far pattern as SJ but is applied continuously rather than interrupted. The MSJ suture technique might be promising in reducing wound dehiscence, infection, and hospital stay compared to conventional continuous closure. However, future large-scale RCTs with standardized methodologies and extended follow-up are essential to determine whether MSJ should be established as the preferred technique for midline laparotomy closure.

Background Various rejuvenation surgeries, including hyaluronic acid (HA) fillers, aim to address mid-face volume loss. However, literature on the comparative efficacy and safety of different HA fillers for the zygomatic area remains limited. Methods: This systematic review and network meta-analysis (NMA), adhering to NMA PRISMA 2020 and Cochrane guidelines. Searches were conducted on different bases. Eligible studies included patients with mid-face volume loss undergoing HA interventions. The primary outcome was the Global Aesthetic Improvement Scale (GAIS) at different time points and the incidence of adverse events. Results: Among 1742 articles, six randomized controlled trials (RCTs) met the inclusion criteria with a total of 579 patients. The studies evaluated Giselleligne, VYC-20, Neuramis Lidocaine and ART-Filler. Results showed that Giselleligne demonstrated superior safety compared to VYC-20, ART-Filler and Neuramis-Lidocaine (Risk Ratios (RR) = 0.27, 95% Confidence interval (CI) [0.14; 0.54]), (RR = 0.36, 95% CI [0.17; 0.75], & RR = 0.22, 95% CI [0.07; 0.67]) respectively However, there were no significant differences in the Global Aesthetic Improvement Scale Assessment (GAIS) scores between HA fillers at 1, 3, and 6 months. Conclusion: While no significant differences were observed in efficacy among HA fillers, Giselleligne emerged as a potentially safer option for the cheeks volume restoration. The study emphasizes the need for further well-designed RCTs to explore the long-term safety and durability of HA fillers. These findings contribute valuable insights for clinicians and patients in making evidence-based decisions regarding mid-face rejuvenation options.

Ultrasound‐guided thermal ablation (TA) is a minimally invasive intervention for treating benign thyroid nodules (BTNs). This meta‐analysis aims to systematically compare the safety and efficacy of ultrasound‐guided TA with surgery in treating BTNs. Relevant studies were identified through searching electronic databases. Included studies focused on comparing TA for BTNs with surgical resection. Primary endpoints encompassed length of hospital stay, procedure time, symptom improvement, cosmetic score, and excellent cosmetic results. Other outcomes include all complications (hypothyroidism, hoarseness, hematoma, blood loss, wound infection, parathyroid injury, chocking, or cough), recurrence, postoperative pain, visual analog scale (VAS) score, scar length, thyroid hormone levels, and finally stress response outcomes. Twenty‐six studies (7 randomized controlled trials and 19 cohort studies) were included. Our findings revealed that TA was associated with shorter hospital stays (MD = −3.30, 95% CI [−3.82, −2.79], P < .00001), reduced procedure time (MD = −47.75, 95% CI [−54.89, −40.61] P < .00001), superior cosmetic outcomes (RR = 1.11, 95% CI [1.00, 1.22], P = .04), lower postoperative pain levels, and lower VAS score. Additionally, surgical resection was linked to a higher incidence of hoarseness, hypothyroidism, parathyroid injury, and blood loss. However, no significant differences were observed in rates of wound infection, hematoma, or recurrence between the two treatment modalities. Our meta‐analysis suggests that ultrasound‐guided TA represents a viable alternative to surgery for treating BTNs, especially for patients unwilling or unable to undergo surgical intervention. This technique was found to be safe and effective. However, future evidence is mandatory to establish TA to a specific type of nodule, to preserve patients from second interventions.

Purpose: Transarterial radioembolization (TARE) is a minimally invasive therapy combining embolization and radiation for cancer treatment. This meta-analysis compares radiation exposure, quality of life, and safety of the transradial (TRA) versus transfemoral (TFA) approaches in TARE for liver tumors. Materials and Methods: We searched PubMed, SCOPUS, Cochrane, EMBASE, and Web of Science for studies comparing TRA versus TFA in TARE for liver tumors. Our primary outcomes focused on various measures of patient radiation exposure, including procedure time, fluoroscopy time, air kerma, and dose-area product (DAP). For secondary outcomes, we evaluated safety parameters, such as overall pain experienced during the procedure, pain in the recovery room post-procedure, the incidence of adverse events, and the impact on quality of life. Study quality was assessed using Cochrane’s ROB 2 tool for RCTs and the Newcastle–Ottawa scale for observational studies. Data analysis was conducted with REVMAN 5.4.1 software. Results: Six studies, comprising one RCT and five cohort studies with 1,209 patients, underwent comprehensive analysis. The aggregated findings revealed a significant reduction in procedure duration associated with TRA (MD =− 6.30, 95% CI [− 9.88, − 2.73], P = 0.005). However, no statistically significant differences were found between TRA and TFA groups concerning fluoroscopy time, recovery time, air kerma, DAP, pain in the recovery room, overall pain during the procedure, quality of life measuring mental health and physical function or adverse events. Conclusion: TRA and TFA showed comparable results in TARE for liver tumors, but TRA offered a shorter procedure time. Further RCTs with larger samples are needed to confirm these findings. Future studies should assess long-term efficacy for a more complete evaluation. Graphical

Background: Adverse childhood experiences (ACEs) refer to distressing events before age 18 that can lead to potential mental and physical health consequences. This systematic review and meta-analysis aimed to examine the association between ACEs and the risk of dementia in elderly adults who experienced ACEs during childhood, addressing the existing inconsistencies and methodological variations. Methods: A comprehensive search strategy was employed across key databases (PubMed, Web of Science, Scopus, and Embase) to identify relevant articles. Our primary outcome was ACEs-dementia risk, and our secondary outcome was mild cognitive impairment risk. A quality assessment was conducted using the Newcastle–Ottawa Quality Assessment Scale and GRADE. A random-effects model was utilized to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses were performed to explore potential sources of heterogeneity and assess the reliability of the results. Results: Out of 1,376 screened papers, nine studies were included. The studies consisted of two case-control, one prospective cohort, and six retrospective cohort studies conducted in the UK, France, USA, China, and Spain. Five studies were of good methodological quality according to the NOS. according to the GRADE, all outcomes were classified as very low or low quality of evidence. A significant association was observed between ACEs and dementia risk (OR = 1.35; 95% CI 1.20, 1.52; P = 0.00001) and mild cognitive impairment risk (OR = 1.28; 95% CI 0.63, 2.62; P = 0.49). A meta-analysis by type of adversity revealed significant results for the maltreatment subgroup(OR = 1.30; 95% CI 0.07-1.58; P = 0.007; I² = 0%). Subgroup analysis based on the dementia definition revealed no between-subgroup difference (P = 0.71) between tool-based and register/criteria-based subgroups. No possibility of Publication bias was observed upon inspection of the funnel plot. Conclusion: Adverse childhood experiences may be associated with an increased risk of dementia. However, caution is warranted in interpreting these results due to the limited number of studies. Larger high-quality studies investigating the association between ACEs and dementia risk are needed to confirm the reliability of our results.

Purpose As a therapeutic intervention for several musculoskeletal illnesses, the benefits and effectiveness of Kinesio taping (KT) are currently unclear. This systematic review and meta-analysis's (MA) goal is to evaluate the effectiveness of KT for anterior cruciate ligament (ACL) reconstruction and its impact on clinical outcomes. Methods A comprehensive search of online databases was done to discover relevant studies. Inclusion criteria included controlled or randomized clinical trials that were published in English. Changes in pain, flexion strength, and extension strength were among the outcomes of interest. RevMan 5.4 was used to extract and analyze data. Results After satisfying the inclusion requirements, five studies were included in the MA. Pooled analysis showed that, in comparison with the intervention group, the control group had a statistically significant improvement in flexion strength (Standardized mean difference (SMD) = 0.44, 95% Confidence interval (CI) [0.01, 0.87], p = 0.04). Extension strength and pain, however, did not significantly differ between the intervention and control groups (SMD = 30, 95% CI [− 0.12, 0.72], p = 0.16), (SMD = 0.26, 95% CI [− 0.14, 0.66], p = 0.20), respectively. Conclusions This analysis suggests limited to no benefits of KA post-ACL reconstruction. While the control group surprisingly showed better improvement in flexion strength, no significant differences were found in extension strength and pain. Further rigorous trials are needed to confirm its utility in rehabilitation.

Background: Trigger finger (also known as stenosing tenosynovitis) is a chronic inflammatory disorder that affects the fingers and causes discomfort and functional impairment. It is estimated to affect 2–3.6% of the population and is more common in manual laborers and individuals engaged in repetitive hand activities. This study comprehensively compares the efficacy of ultrasound‐guided release versus traditional open surgery in treating trigger fingers.Materials: We systematically searched PubMed, Scopus, EMBASE, and the Cochrane Library to identify relevant studies. Inclusion criteria were studies evaluating ultrasound‐guided release of trigger finger (grade 2 and higher) compared with open surgical release. A meta‐analysis was performed by Revman software 5.4.1 to assess efficacy, utilizing appropriate statistical methods to address heterogeneity. Primary outcome measures included “Quick Disability of Arm, Shoulder, and Hand” (QDASH) scores, Grip strength, and the Visual Analogue Scale (VAS). Secondary outcome measures included Days of stopping analgesia, full‐digit flexion and extension, days to return to normal activities, pinch strength, Quinnell grading score, and bow strengthening.Results: Out of the initial pool of 820 studies, five met the inclusion criteria, including 275 patients with 283 trigger digits. The analysis revealed significant differences favoring the ultrasound‐guided release group over the surgical group for improvement in Quick Disability of Arm, Shoulder, and Hand score in the first month (MD −0.48, 95% CI: 0.75 to −0.2, P = .0007, I² = 20%). The difference was not statistically significant in the 3‐month follow‐up period (MD −2.25, 95% CI: −0.54 to 0.05, P = .1, I² = 0%). Additionally, there is a significant difference in the days required for return to normal activities in favor of the ultrasound release approach (MD −13.78, 95% CI: −16.68 to 10.89, P = .00001, I² = 68%). The data displayed heterogeneity, which was resolved through sensitivity analysis that also favored the ultrasound‐guided group. In terms of grip strength, full‐digit flexion and extension, VAS, and days of stopping analgesia no significant differences were observed.Conclusions: Ultrasound‐guided release showed advantages over open surgical release, resulting in improved QDASH score and quicker return to normal activities. This offers a minimally invasive, successful alternative to open surgery, reducing associated risks. Further studies with long‐term follow‐up are recommended.