Dubai Hospital

Background: Transcatheter mitral valve intervention, including repair (e.g., edge-to-edge repair) and replacement, is now a cornerstone of treatment for severe mitral regurgitation (MR) in high-risk patients, providing a less invasive alternative to surgical treatment. The purpose of this systematic review is to assess the efficacy and safety of different antithrombotic strategies to prevent thromboembolic events and bleeding complications after transcatheter mitral valve repair (TMVR). Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search on PubMed, Embase, Web of Science, Scopus, and Cochrane Library was conducted from January 2015 to January 2025. Eligible studies included adult patients who underwent transcatheter mitral valve intervention (including repair and replacement procedures) and compared different antithrombotic regimens, including direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs), and antiplatelet therapies. Two reviewers independently extracted data and assessed quality. The studies were too heterogeneous, so a narrative synthesis was performed. Results: Fifteen studies involving 20,956 patients were included. DOACs were associated with a lower risk of major bleeding compared to VKAs [hazard ratio (HR): 0.21, p = 0.02, in one large study], with similar rates of stroke. Mortality was lower with DOACs in several analyses (e.g., HR: 0.67). Triple therapy and dual antiplatelet therapy (DAPT) were associated with increased bleeding risk without providing additional thromboembolic protection. Discussion: DOACs have a safer profile in post-TMVR patients, with reduced bleeding risk and lower mortality compared with VKAs. Triple therapy and DAPT should only be used in high-risk patients with specific indications due to their greater risk of bleeding. Optimizing outcomes requires a tailored approach to antithrombotic therapy, considering patient factors and procedural considerations. Definitive standards may still demand further investigation, such as multicenter randomized controlled trials evaluating antithrombotic treatments after TMVR.

This systematic review consolidates current evidence on the efficacy, safety, and tolerability of awake, office-based procedures for chronic rhinosinusitis (CRS). It aims to evaluate whether these minimally invasive interventions performed under local anesthesia are viable alternatives to conventional sinus surgery under general anesthesia. A systematic search of PubMed/MEDLINE, Google Scholar, and Scopus databases was performed through November 2025, following PRISMA guidelines. Studies were selected using the PICOS framework, including adult patients undergoing in-office procedures (e.g., balloon sinus dilation, endoscopic sinus surgery, polypectomy, steroid-eluting implant placement) for CRS. Data were extracted and narratively synthesized due to heterogeneity. Eleven studies involving 1,283 patients were included. The procedures demonstrated significant and sustained improvements in patient-reported (SNOT-22, SNOT-20, NOSE, VAS) and objective (Lund-Mackay, Nasal Polyp Score) outcomes. Complication rates were low, with minor adverse events. Intraoperative pain was generally mild, tolerability was high (82-95%), and patients reported rapid recovery (often within 48h) and high satisfaction (72-95% willing to repeat the procedure). Awake sinus procedures are an effective, safe, and well-tolerated treatment option for selected CRS patients. They offer significant symptom relief, high patient satisfaction, and rapid recovery while avoiding general anesthesia. These techniques represent a transformative, patient-centered, and resource-efficient component of modern rhinology.

Background: Postoperative bleeding is a frequent complication in otolaryngology and head and neck surgery, often leading to readmissions and increased healthcare costs. Objectives: This systematic review evaluates the clinical efficacy, safety, and impact of RADA16, a synthetic self-assembling peptide hydrogel, as a topical haemostatic adjunct in this surgical field. Methods: In adherence with PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted through December 2025. Eligible studies included adult patients undergoing otolaryngological or head and neck surgical procedures where RADA16 (CAS 289042-25-7, PuraBond®/PuraStat®/PuraGel®, ®, 3-D Matrix SAS; Caluire et Cuire, Lyon, France) was applied intraoperatively. Exclusion criteria included non-English publications, reviews, and studies without clinical outcome data. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies. A narrative synthesis was performed due to heterogeneity in outcome reporting. Results: Eight studies involving 1761 patients were included. In oropharyngeal surgery, RADA16 significantly reduced postoperative haemorrhage (6.3% vs. 16.7%, p = 0.016) and was associated with faster resumption of normal diet and lower pain scores (p = 0.016). In nasal surgery, it significantly lowered epistaxis rates (0.4% vs. 2.2%, adjusted OR 0.027, p = 0.026) and reduced the need for nasal packing. In cervical endocrine surgery, the rate of hematoma requiring revision was low (0.84%), with no delayed bleeding beyond 24 h. Surgeons consistently reported high satisfaction and ease of application. No serious device-related adverse events were reported. Discussion: Current evidence suggests RADA16 is a safe and effective haemostatic adjunct that can improve postoperative recovery and reduce readmission rates in specific surgical contexts. Limitations include heterogeneity in study designs, small sample sizes in some domains, and a lack of long-term follow-up. Further large-scale randomized controlled trials are needed to quantify its economic impact and formalize its role in surgical pathways. Funding: This study was funded by 3-D Matrix Medical Technology for article processing charges. The funder had no role in study design, data collection, analysis, interpretation, or writing. Registration: This review was not registered in a systematic review registry.

• Patient-centered communication links ethics with daily clinical practice. • Telehealth, AI and VR can shape patient outcomes and satisfaction. • Simulation-based education builds confidence in ethical communication. • Classical models such as ICE and SPIKES support ethical counselling. • End-of-life care, errors, anger and disasters need team-based dialogue. Clinical ethics deals with ethical issues in clinical practice scoped through the four ethical principles, alongside professional communication, to uphold good medical practice. The aim of this review was to emphasise educational significance of patient-centred healthcare communication in clinical ethics, utilising classical, novel and technology-based approach models. A comprehensive narrative review included recent systematic reviews, randomised controlled trials and other empirical studies identified through searching PubMed and Scopus, from 1 January 2010 to 31 January 2025. Effective healthcare communication incorporates patient centeredness using verbal and non-verbal techniques. Emerging technologies influenced by the pandemic including use of video consultations, chatbots, Artificial Intelligence (AI) and virtual reality in communication, have impacted participants' satisfaction, signifying transformative innovation in medical education. Ethical issues approaches including ICE for counselling, SPIKES for breaking bad news, shared decision making (SDM) for informed consents, DNAR-related communication for medical futility, de-escalation tactics for anger and the combined approach for disasters, are found effective through patient-centred communication. This review emphasizes that ethical issues require implementation of systematic, or technology-based, evidence-based approaches that utilise contextually tailored patient-centred communication, built upon learner-centred health professions education. Therefore, engagement in patient-centred communication education requires institutional support, strengthened through development of innovative simulation-based educational strategies, and further outcome-based studies on telehealth and artificial intelligence are still needed.

Diabetic ketoacidosis (DKA) is a severe diabetes complication managed with fluids, insulin and electrolyte correction. This review evaluates the debated effectiveness of bicarbonate therapy on DKA outcomes. Following PRISMA guidelines, we systematically reviewed studies on bicarbonate therapy in DKA. We searched PubMed, Google Scholar, the Cochrane Library and ClinicalTrials.gov (as of August 2024), including studies on patients with DKA. Meta-analysis was conducted using RevMan. Bias risk was assessed with the Newcastle-Ottawa Scale (NOS) for cohort studies, Cochrane's ROB-2 for RCTs and the Joanna Briggs Institute (JBI) Scale for case series. Prospero ID: CRD42024581810. Eight studies, including 646 patients, met the inclusion criteria. Participants' mean ages spanned from approximately 9.7 years to 45.8 years. Bicarbonate therapy did not significantly improve pH levels (mean difference = -0.02, 95% CI [-0.13, 0.09], p = 0.7), time to resolution of acidosis (mean difference = 0.09 h, 95% CI [-2.6, 2.79], p = 0.95) or potassium levels (mean difference = -0.10, 95% CI [-0.49, 0.29], p = 0.61). Bicarbonate therapy was associated with a marginally longer duration of hospital stay (mean difference = 13.63 h, 95% CI [0.23, 27.03], p = 0.05), although the overall effect size was small. No significant difference was observed in the incidence of hypoglycemia (odds ratio = 2.62, 95% CI [0.59, 11.63], p = 0.20). High heterogeneity was observed across most outcomes, mainly due to variability in study protocols and patient populations. Bicarbonate therapy provided no meaningful clinical benefit in the routine management of DKA and was associated with potential harm, including worsened hyperglycemia. Consistent with current guidelines, its use should be restricted to cases of severe acidemia (pH < 6.9). Further high-quality studies are needed to clarify its role in extreme acidosis and to explore alternative buffering strategies.

This is a summary of the original article "Safety and effectiveness of concomitant iGlarLixi and SGLT-2i use in people with T2D during Ramadan fasting: a SoliRam study sub-analysis." iGlarLixi is a fixed-ratio combination of insulin glargine 100U/ml and glucagon like peptide1 receptor agonist (GLP-1RA) lixisenatide which has demonstrated its effectiveness of improving glycemic parameters and reducing body weight with low risk of hypoglycemia incidence in adults with type2 diabetes (T2D) who were previously sub-optimally controlled with oral antidiabetic drugs (OADs) alone or in combination with basal insulin or GLP-1RA. This sub-analysis of the SoliRam study assessed the safety and effectiveness of concomitant iGlarLixi and sodium/glucose cotransporter2 (SGLT-2i) use with or without other OADs in adults with T2D who fasted during Ramadan. Participants were divided into two groups: SGLT-2i-users and SGLT-2i-non-users. The findings showed low incidence of severe and/or symptomatic documented hypoglycemia, improved glycemic control, and body weight benefits, irrespective of SGLT-2i use. No serious adverse events were reported in either group. The sub-analysis concluded that the concomitant iGlarLixi and SGLT-2i therapy, with or without other OADs, was demonstrated to be a safe treatment for people with T2D during Ramadan fasting.

Eating disorders (EDs) are serious illnesses and a better understanding of initial symptom phases could inform early intervention. This study aims to evaluate duration of untreated eating disorder (DUED) and duration/characteristics of the preceding prodrome period in young people diagnosed with an ED. Fifty-four young people (28 adolescents aged 13-17 and 26 emerging adults aged 18-25) with recent onset EDs (< 3 years) completed a retrospective onset interview and life chart. DUED, prodrome duration and prodrome characteristics (ED-specific and more broad psychiatric symptoms) were compared according to developmental stage and diagnosis. The relationships between DUED and prodrome duration with early outcomes were evaluated. Emerging adults had a longer DUED than adolescents. This group also had a longer prodrome but only when broad psychiatric symptoms (i.e., not ED-specific) were considered. Those with bulimia-type EDs had a longer ED-specific and broad psychiatric prodrome compared to those with anorexia-type EDs. There were no significant developmental stage or diagnosis-related differences in symptom severity during prodrome. In those who were underweight at presentation to services, a shorter broad prodrome duration was associated with greater weight gain after 3 months of treatment. When both ED and broad psychiatric symptoms are considered, DUED and prodromal symptoms of EDs differ according to developmental stage and diagnosis. Duration of prodrome may also impact early outcomes but further research is needed.

This study characterizes the epidemiological trends and resistance profiles of respiratory tract infections (RTIs) in the United Arab Emirates (UAE) from 2010 to 2022, aiming to inform national control strategies. We conducted a retrospective observational study of RTI cases across 345 UAE healthcare settings using data from the national surveillance network. Pathogen identification and resistance profiling were performed using advanced diagnostics and standardized antimicrobial susceptibility testing, in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Lower respiratory tract infections (LRI) comprised most cases (73.1%; n = 100,856), including 6416 due to Mycobacterium tuberculosis, while upper respiratory infections made up 26.9%. LRI incidence was stable until 2014 but rose significantly from 2015 to 2022 (AAPC = 1.58; 95% CI: 1.58-3.87), especially in the Northern Emirates. Carbapenem resistance among Enterobacterales was 22.5% (14.4% in K. pneumoniae), and third-generation cephalosporin resistance 30.1% (62.3% in E. coli). Resistance was highest in A. baumannii (61%) and P. aeruginosa (27.4%). Macrolide and MRSA resistance increased significantly. The majority (85%) of tuberculosis cases were identified among individuals from South Asian and East African regions, with a post-COVID surge, while drug resistance remained below 15%. These findings underscore the urgent need for regionally tailored infection control strategies, enhanced antimicrobial stewardship, and expanded pathogen surveillance to prevent further escalation of AMR.

Ultrasound (US)-guided interventions are a core skill for radiologists and trainees; however, access to affordable, durable, and realistic training models remains limited. Animal tissue phantoms such as chicken breast are messy, perishable, and culturally unacceptable to many learners. Commercial phantoms are expensive and often inaccessible in low-resource regions. We describe the ADIP–Agar (Abu Dhabi Intervention Practice Agar) phantom—a low-cost, reproducible, vegetarian-friendly model prepared from agar–agar. As the agar–agar model was developed, refined, and repeatedly tested over several years in Abu Dhabi, we designated it the ADIP–Agar. Over 6 years of hands-on interventional US workshops in Abu Dhabi, trainees consistently expressed overwhelmingly positive feedback, with 97% preferring agar-based phantoms over chicken breast models. ADIP–Agar enables layered construction, stable embedded targets, realistic echotexture, and excellent durability when refrigerated. Its simplicity, reusability, and trainee endorsement make it a practical training tool for basic and intermediate US-guided procedures.