Background: Dry needling (DN) has emerged as a potential treatment for mechanical neck pain, but the evidence remains inconclusive. This study aimed to assess the efficacy of DN in improving pain and functionality in patients with chronic mechanical neck pain. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Databases, including PubMed, Cochrane Library, Scopus, and Google Scholar, were searched from December 2013 to January 2024. Studies involving adult participants with chronic mechanical neck pain treated with DN were included in the study. The primary outcomes were pain pressure threshold (PPT), Neck Disability Index (NDI), and cervical range of motion. Statistical analysis used a random-effect model. Results: Nine RCTs with a total of 540 participants were included in the study. DN significantly improved the PPT with an MD of 0.52 (95% confidence interval [CI], 0.39–0.65; P < 0.001). NDI also showed a significant improvement, with an MD of −0.68 (95% CI, −1.32–−0.05; P = 0.04). In terms of cervical range of motion, DN improved flexion (MD 4.07, 95% CI, 0.39–7.75; P = 0.03) and right rotation (MD 8.20, 95% CI, 3.05–13.35; P = 0.002), but no significant differences were observed in extension, left rotation, or lateral flexions (P > 0.05). Conclusion: DN appears effective in short-term pain relief and functional outcomes for patients with mechanical neck pain but shows limited impact on the cervical range of motion.

Background The practice of preoperative hair removal has been debated regarding its role in Surgical Site Infection (SSI) prevention. This study aimed to compare the different hair removing modalities and investigate the effect of preoperative hair removal on SSI rates. Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. Three databases—PubMed, Web of Science, and Cochrane Library—were searched for relevant studies comparing preoperative hair removal to no hair removal. Studies eligible for inclusion were randomized controlled trials (RCTs) and cohort studies reporting SSI rates. Odds ratios, mean differences, and p-values were analyzed using a random effect model. Results Seventeen studies involving 5,407 patients were included. No statistically significant difference in SSI rates was found between the hair removal and no removal groups (OR = 1.066, 95% CI 0.646–1.758, p = 0.803). When comparing clipping to no hair removal, there was no significant difference (OR = 0.967, 95% CI 0.642–1.455, p = 0.870). Razor shaving was associated with higher skin damage and slightly increased SSI risk compared to clipping but not statistically significant (OR = 0.749, 95% CI 0.346–1.623, p = 0.464). Depilatory creams, however, were favored over razor shaving (OR = 3.235, 95% CI 1.543–6.785, p = 0.002), as they were linked to less skin damage and easier application. Conclusion Preoperative hair removal does not significantly impact SSI rates. Clipping appears to be a safer alternative to shaving, while depilatory creams show promise as an effective, less damaging option.

Background: Cerebral venous thrombosis (CVT) is commonly associated with intracranial hypertension (IH), though its neuroimaging markers remain less well-defined. This study aims to systematically review and compare neuroimaging markers of IH in CVT and idiopathic IH (IIH) to better understand their diagnostic implications. Methods: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. From inception to 2024, we searched PubMed, Web of Science, and Scopus for observational studies and randomized controlled trials focusing on neuroimaging findings in primary IH (i.e., IIH) and IH secondary to CVT. Data were extracted on neuroimaging outcomes, including peri-optic cerebrospinal fluid (CSF) pressure, optic nerve head protrusion, and others. Results: Six studies met the eligibility criteria, comprising three cohort studies and three case-control studies, with a combined total of 301 patients. The results indicated that peri-optic CSF pressure (Odds ratio [OR]: 5.85, P = 0.0002), optic nerve head protrusion (OR: 4.1, P = 0.02), sclera flattening (OR: 2.2, P = 0.04), and empty sella (OR: 3.25, P = 0.03) were observed more frequently in patients with IIH than in those with CVT and IH. However, when comparing CVT with IH to controls, optic nerve tortuosity did not show a significant difference (OR: 2.20, P = 0.18). Increased ventricular volume (Mean difference: 1.76, P < 0.00001) and sclera flattening (OR: 6.68, P = 0.002) were more common in CVT with IH patients compared to the control group. Conclusion: Typical neuroimaging characteristics of IH (e.g., empty sella) are more frequently observed in idiopathic cases (i.e., IIH) than in secondary causes, such as IH resulting from CVT. These differences have the potential to enhance diagnostic precision and facilitate the development of improved imaging protocols.

Background The literature indicates a link between HbA1C levels, infections, and postoperative complications across various surgical procedures. However, its specific association with hernioplasty outcomes remains uncertain. This study aims to evaluate the relationship between HbA1C levels and the outcomes of hernia surgery in diabetic patients treated at a tertiary care center. Methods Data were collected from 301 diabetic patients, categorized into controlled (HbA1C < 7%) and uncontrolled (HbA1C ≥ 7%) groups, who underwent hernioplasty at King Abdulaziz Medical City (KAMC) between September 1, 2017, and September 1, 2022. Patient records were analyzed to explore the association between diabetes and hernia surgery outcomes, including complications, infections, and recurrence, as well as to compare the outcomes of different surgical techniques (open and laparoscopic). Results Of the 301 patients, this study included only 140 (46.5%) diabetic individuals who underwent hernia surgery at the Ministry of National Guard Health Affairs (MNGHA) in Riyadh between 2017 and 2022. Preoperative uncontrolled HbA1C levels were not statistically significant for wound infection (p = 0.706) or hernia recurrence (p = 0.075) within a one-year follow-up period. However, a statistically significant difference was observed in the prevalence of hypertension between the controlled and uncontrolled HbA1C groups (p = 0.039). Conclusion This study indicates that HbA1C levels do not significantly influence complications or infections following hernia surgery, particularly regarding wound infections and recurrence. However, HTN was found to be statistically significant and warrants further investigation. Additionally, no statistical significance was identified between elevated BMI (>30 kg/m 2 ) and HbA1C groups (p = 0.081), which may be attributed to the limited sample size of this study.

Background: Carpal tunnel syndrome (CTS) is a common nerve entrapment condition, and there is ongoing debate regarding the superiority of traditional open versus minimally invasive carpal tunnel surgery. Methods: This meta-analysis reviewed six studies involving 478 patients to compare recovery and functional outcomes between the traditional longitudinal technique and the minimally invasive mini-transverse technique. The primary outcomes included the functional status scale (FSS), symptoms severity scale (SSS), pain scores, time to return to work, duration of operation, and incidence of complications. Results: The mini-transverse technique was associated with lower FSS and SSS scores compared to the longitudinal technique, with mean differences (MD) of −0.32 (95% confidence level [CI]: −0.52, −0.12, P = 0.002) and −0.43 (95%CI: −0.6, −0.25, P < 0.00001), respectively. Pain scores were also lower with the mini-transverse technique (MD) of −0.5 (95%:CI: −0.71, −0.3, P < 0.00001). The mini-transverse group had a statistically significant shorter time to return to work (MD) of −8.34 (95%CI: −13.55, −3.13, P = 0.002). No significant differences were found in the duration of surgery (MD) of −6.96 (95%CI: −16.66, 2.74, P = 0.16) or incidence of complications (MD) of 0.46 (95%CI: 0.15, 1.4, P = 0.17). Conclusion: The mini-transverse approach for CTS resulted in better outcomes, including less pain, faster recovery, and improved hand function. There was no significant difference in surgery time or complications compared to the traditional technique, suggesting it may be the preferable option.

Study design: A retrospective comparative study. Background: The length of hospital stay and the setting to which patients are discharged after surgery can vary, impacting both healthcare resource utilization and the patient’s recovery process. Identifying the factors that affect these outcomes is essential for enhancing patient care and efficiently managing resources in elective spinal stenosis surgery. Objectives: This study aims to identify the predictors associated with extended hospital length of stay and 90-day reoperation in elective spinal stenosis surgeries, to optimize patients’ postoperative outcomes. Methods: We conducted a retrospective study at King Abdulaziz Medical City, Riyadh, Saudi Arabia, from January 2016 to January 2024. Statistical analyses, including multivariate analyses and neural networks, were performed using SPSS. Results: A total of 389 patients were included, with a median length of stay of 6 days (interquartile range [IQR] = 3), with 113 patients (≥75th percentile) in the extended hospital length of stay group ( n = 113; 29.3%). Age ≥60 years ( P = 0.021), reoperation within 90 days ( P = 0.027), body mass index (BMI) ≥35 ( P = 0.001), diabetes ( P = 0.004), and American Society of Anesthesiologists (ASA) classification ( P = 0.019) were found to be significant predictors of extended hospital stay. In the multivariate analysis, BMI ≥35 ( P = 0.002) and diabetes ( P = 0.030) remained significant predictors of extended hospital length of stay. ASA classification ( P = 0.001) and prolonged hospital stay ( P = 0.027) were significant predictors of 90-day reoperation risk in the bivariate analysis; however, these associations were not retained in the multivariate analysis. Conclusion: Our study highlights the need for preoperative optimization of comorbidities, BMI, and overall health to improve postoperative outcomes and reduce costs in elective spinal stenosis surgeries.