Asem Ahmed Ghalwash

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.

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