Intraoperative Hemostasis Using WALANT Versus Tourniquet; A Focused Review on Carpal Tunnel Syndrome and Trigger Finger Release.

Maintaining intraoperative haemostasis is crucial when conducting wide-awake hand surgeries, this is particularly to improve visibility which will improve patient's outcome. There are various methods that could achieve the aforementioned, some of which is wide awake local anaesthesia without tourniquet (WALANT) or Tourniquet alongside sedation. Each method has its own benefits and drawbacks. This study primarily focuses on Carpal Tunnel Syndrome and Trigger Finger release. A comprehensive literature review was conducted through PUBMED, Scopus, google scholar, and web of science. A total of 45 articles were included in the study. We aimed to assess whether the literature supports the use of a tourniquet alongside sedation, or only local anesthesia and epinephrine in wide awake hand surgeries. Moreover, we aimed to highlight the benefits and drawbacks of using a tourniquet, and determine the patient population most likely to benefit from tourniquet application.

Factors Influencing the Choice of Glucose-Lowering Medications Among Physicians Treating Patients With Type 2 Diabetes.

Background The factors considered by physicians when prescribing a glucose-lowering agent to patients with type 2 diabetes (T2D) in real-world settings are not necessarily consistent with those recommended by clinical practice guidelines. Here, we identify the major factors that drive physicians' selection of glucose-lowering agents in the real world and how these factors may differ by physician's specialty.  Methods A web-based survey was conducted among 135 physicians who manage patients with T2D in Saudi Arabia. Physicians were categorized according to their specialty into "specialists" (endocrinologists and/or diabetologists) and "generalists" (internists, family physicians, and primary care physicians). Physicians were asked about the type of glucose-lowering medication that they would typically prescribe in certain clinical scenarios and what factors drive such a selection. Results Sulfonylurea remains the most frequently prescribed second-line agent, as an add-on to metformin, according to 50% of the physicians surveyed. Most physicians (89%) reported prescribing glucagon-like peptide 1 receptor agonists (GLP-1RA) to less than half of their patients with T2D and ischemic heart disease; over two-thirds reported prescribing sodium-glucose cotransporter 2 inhibitors (SGLT-2i) to less than half of their patients with T2D and heart failure. When prescribing GLP-1RAs, the cost was a "major consideration" by 75% and 65% of the specialists and generalists, respectively. Likewise, when prescribing SGLT-2i, the cost was a major consideration by 57% and 71% of the specialists and generalists, respectively. Several other factors differed between the generalists and specialists when prescribing thiazolidinedione (TZD), sulfonylurea, dipeptidyl peptidase 4 (DPP-4) inhibitors, GLP-1RAs, and SLGT-2i, but not insulin.  Conclusion Our findings highlight several challenges faced by physicians in the real world that may prevent them from adopting the latest evidence-based guidelines when managing patients with T2D. Health policies to increase accessibility to novel glucose-lowering agents, particularly for patients with T2D and cardiovascular/renal diseases, are needed.

Factors and barriers influencing the decision to undergo body contouring surgery after bariatric surgery: A cross-sectional study.

OBJECTIVES: To identify the factors and predictors that play a role in shaping the decision-making process of post-bariatric patients when considering aesthetic surgery. METHODS: This cross-sectional study was carried out at the Specialized Medical Center Hospital in Riyadh, Saudi Arabia. Data collection for the study occurred between January and March 2023. To gather the necessary data, a self-administered questionnaire was distributed to participants through the messaging platform WhatsApp. RESULTS: Among the 445 responses analyzed, 71.2% reported having excess skin folds. A total of 62 (13.9%) participants underwent body contouring surgery, most of which was carried out in the trunk region (67.7%). Being female was associated with statistically significantly higher rates of body contouring surgery (82.3%, p=0.002), as was achieving one's best weight after 2 years (37.1%, p=0.003) or more than 2 years (14.5%, p=0.003). Among those who did not consider body contouring surgery, the most important reason reported was the belief that such surgeries were not needed, accounting for 41.1% of responses. CONCLUSION: This study found that female gender, achieving optimum weight within 2 or more years post-bariatric surgery, and a smaller median change in body mass index were significant predictors of future body contouring surgery. These findings are important for advising and educating post-bariatric patients regarding their options for body-contouring procedures.

Advancing Surgical Education: A Comprehensive Systematic Review with Meta-Analysis and Novel Approach to Training Models for Local Skin Advancement Flaps.

Performing local skin flaps is a challenging task that requires cognitive and technical skills to design flaps with proper orientation to avoid distorting normal anatomy. Junior trainees need adequate exposure to gain confidence and expertise in such procedures. This article systematically reviews the literature's different local skin advancement flap training models and describes a new, easy-to-use training model. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Web of Science, and Google Scholar databases were searched from their inception until August 2022 for articles about local skin advancement flap training models. The meta-analysis results were pooled across the studies using a random-effects model and presented as a weighted mean difference with a 95% confidence interval (95% CI). Out of 773 reviewed articles, 18 were included in the systematic review, and four reported enough data to be included in the meta-analysis. Rhomboid and Z-plasty flaps were the most commonly taught flaps by training models. The most commonly used training models were synthetic-based, followed by animal-based models. The training models significantly increased the trainees' confidence and expertise regarding local skin flap procedures (p<0.00001) for both domains. Training models, per our reported data, significantly improve the trainees' confidence and expertise in performing local skin advancement flap procedures; continuous efforts in developing and establishing new, simple-to-use, and effective training models are strongly encouraged to further improvement of surgical education and enhance the trainees' surgical skills.

Blood Group and Response to Bariatric Surgery in Morbidly Obese Patients: A Retrospective Study in Saudi Arabia.

OBJECTIVES: To explore the relationship between the blood group of patients and their response to bariatric surgery and to identify predictors of better outcomes. METHODS: This was a retrospective cross-sectional analysis of patients who underwent laparoscopic sleeve gastrectomy for morbid obesity between 2014 and 2020 at King Saud University Medical City in Riyadh, Saudi Arabia. RESULTS: This study included 1434 individuals. The mean change in BMI (pre- versus post-BMI) differed statistically significantly between blood groups (p ≤ 0.01). The greatest drop in body weight was seen in individuals with the AB-negative blood type (56.0 (21.4) kg), which corresponds to the greatest percentage of reduction from baseline (47.7% (14.8)). The mean BMI of the patients decreased by 34.7% (9.2) from a mean pre-operation BMI of 45.5 (8.4) kg/m2 to 29.7 (6.1) kg/m2 (p ≤ 0.001). After laparoscopic sleeve gastrectomy, male patients and those with the B-negative blood type are more likely to see a greater BMI reduction (pre-operation compared to post-operation) (p ≤ 0.05). CONCLUSIONS: For morbidly obese patients, laparoscopic sleeve gastrectomy demonstrated promising weight loss outcomes. Blood groups may be able to predict the success rate of bariatric surgery in morbidly obese patients.