Zayed Military Hospital

BackgroundThe clinical learning environment for hospital trainees needs evaluation for patient safety and healthcare quality to acquire theoretical knowledge, clinical skills, and problem-solving abilities.ObjectiveWe evaluated participants from three residency programs at a teaching hospital as per the PHEEM questionnaire domains to understand the learning environment and areas of improvement in the program.MethodsAfter study approval, a cross-sectional study was conducted from December 2023 to March 2024 with a validated questionnaire, which was piloted and administered online to 51 participants with slight modifications for cultural inclusivity and relevance and also checked for reliability and validity. The response rate was 100% for all questions. Data analysis was conducted using SPSS Statistics Version 22.0 at p < 0.05.ResultsA total of 51 participants completed the questionnaire, and the majority of the trainees were males and emergency medicine residents. Perceptions of role autonomy and perception of teaching had a mean score of 38.7 (out of 52) and 45.9 (out of 60), respectively, indicating a generally positive outlook, while perception of social support had a mean score of 33.0 (out of 44). The total mean study score was 117.7 out of 156. The mean scores for all items ranged from 2.51±1.03 to 3.31±0.58. Areas for improvement included collaborating with other doctors who are in the same year. The results revealed no significant variations in the scores across different strata. There was a slightly higher perception of social support among female students.ConclusionThis study revealed a positive perception and outlook toward various domains. There is a need to provide counseling services for a better interpersonal environment at work.

All-epiphyseal reconstruction of the anterior cruciate ligament (ACL) has gained traction as a way to stabilise the knees of children and adolescents, without violating their open physes. Nevertheless, evidence is still mixed regarding its clinical benefits and complication profile. This systematic review and meta-analysis, therefore, set out to determine the procedure’s effectiveness and safety in paediatric patients with open growth plates.PubMed, Scopus, Web of Science, and Google Scholar were systematically searched up to July 2025 for studies reporting outcomes of all-epiphyseal ACL reconstruction in skeletally immature patients. Eligible studies reported at least one clinical or radiological outcome. Meta-analyses were performed using standardised mean differences (SMDs) and odds ratios (ORs).Six studies (n = 150 patients) were included. Meta-analysis showed a significant improvement in Lysholm knee function scores after all-epiphyseal ACL reconstruction (SMD = -2.54; 95% CI: -2.90 to -2.17; p < 0.00001), and a marked reduction in the odds of a positive Lachman test indicating instability (OR = 1026.65; 95% CI: 142.49 to 7397.31; p < 0.00001). Most patients (up to 96%) returned to sport within 8-14 months. The risk of clinically significant growth disturbance was low (<2%), and graft failure rates ranged from 4% to 17%. Mild limb overgrowth was reported, but it is rarely clinically relevant.All-epiphyseal ACL reconstruction provides excellent knee function and stability, with a low risk of growth disturbance in skeletally immature patients. Careful technique and long-term follow-up are recommended to minimise complications.

Refractive errors (REs) remain a leading cause of visual impairment worldwide. Medical students frequently report a high burden of REs, possibly attributable to genetic influences and lifestyle factors like extended near-work activities and limited outdoor exposure. Limited data exist on the prevalence and determinants of REs among medical students in the United Arab Emirates (UAE). This study aimed to determine the prevalence of REs in this population and to identify the key potential risk factors associated with them. A cross-sectional survey was conducted among medical students at the United Arab Emirates University. A validated 14-item questionnaire assessed the presence and type of REs, demographic and physical characteristics, educational level, family history, electronic device usage, and sunlight exposure. The survey was disseminated electronically between November 2023 and February 2024. Proper statistical analysis was employed to determine key predictors of REs. Among 328 participants, the overall prevalence of refractive errors was 61.3%, with myopia (with or without astigmatism) accounting for 84.1% of these cases. Female students exhibited more than three-fold higher risk of having REs than males (p = 0.01), and students with a first-degree relative affected had a 7.6-fold greater likelihood of having REs (p < 0.001). Most students with REs (77.1%) used spectacles for correction, and only 11 had laser refractive surgery. Finally, body weight significantly modulated RE type, favoring hyperopia among heavier participants (p < 0.05). This study reveals a high prevalence of REs among medical students in UAE, with myopia being the predominant type. The key risk factors associated with this high prevalence were female sex and positive family history. These findings underscore the need for targeted preventative and corrective strategies.

Abstract Background: Mycotic aneurysms (MAs) are rare, life-threatening vascular complications of systemic infections that are most commonly associated with endocarditis. While the majority of research has focused on ruptured MAs, the role of endovascular treatment (EVT) in managing unruptured cases remains unclear. Given the limited availability of data specific to unruptured MAs, we conducted a systematic review and meta-analysis to evaluate the outcomes of EVT in this subgroup, with a focus on technical success, follow-up occlusion, complications, functional outcomes, and mortality. Methods: A comprehensive literature search was conducted in PubMed, EMBASE, and Web of Science to identify studies reporting outcomes of EVT in unruptured MAs. Screening and full-text review were performed via Rayyan AI, and data extraction was conducted via Microsoft Excel. We included studies that explicitly reported outcomes for unruptured cases, and a proportional meta-analysis was performed via a random-effects model in R 4.4.2, with publication bias assessed via a funnel plot. Results: A total of eight studies with 43 unruptured mycotic aneurysms met the inclusion criteria. EVT demonstrated excellent procedural success, whereas endovascular procedures achieved universal technical success and complete occlusion at follow-up (both 100%; 95% CI: 95–100%). Complications were rare, occurring in only 4% of the patients (95% CI: 0–17%). The functional outcomes were favorable, with 90% of patients achieving mRS 0 or GOS 5 at follow-up (95% CI: 74–100%), indicating a high likelihood of preserved neurological function posttreatment. No mortality was reported among the unruptured patients (0%, 95% CI: 0–13%), further supporting the safety profile of EVT in this patient population. Conclusion: EVT appears to be a safe and effective treatment for unruptured mycotic aneurysms, with high technical and angiographic success rates, low complication rates, and favorable functional outcomes. However, data on unruptured cases remain scarce, as most of the available literature has focused primarily on ruptured MAs. This underscores the need for larger studies and prospective data collection to better define the role of EVT in managing these rare lesions.

Risk stratification in pulmonary arterial hypertension is critical in determining therapeutic strategies for patients. Patients are stratified into low-, intermediate-, and high-risk groups based on determinants of prognosis like clinical assessment, exercise tests, biochemical markers, echocardiography, and haemodynamic tests. The primary objective of treatment is to shift each of the component tests into a low-risk zone either by treatment escalation alone, as in the case of intermediate-risk patients, or by a combination of treatment escalation and repeat evaluation by right heart catheterisation in high-risk patients. Low-risk patients should be clinically assessed at least every 3 months, but follow-up is more frequent for intermediate- and high-risk patients. Apart from improving survival rates, health-related quality of life is also assessed at baseline and followup visits, which may predict the prognosis. Additionally, therapeutic drug monitoring is also essential during visits due to the risk of major side effects during treatment initiation or dose escalation. Initial and follow-up risk stratification can prevent delays in the intensification of therapy, but insurance denials act as a barrier to this approach. Therefore, a dedicated insurance team is required for approval of testing and therapies and a fasttrack process to communicate with the pulmonary hypertension expert centre. It can be concluded that risk stratification improves the treatment approach and helps make individualised treatment decisions. It also helps healthcare professionals better allocate treatment resources in cases of scarcity.

Pulmonary arterial hypertension (PAH) is a frequent complication of connective tissue diseases (CTDs), such as systemic sclerosis (SSc), mixed connective tissue disease, systemic lupus erythematosus (SLE), and, to a lesser extent, dermatomyositis, rheumatoid arthritis, and Sjögren syndrome. Connective tissue disease-associated PAH (CTD-PAH) is the second most common cause of PAH, following the idiopathic form of PAH. Nearly 15%–30% of patients with SSc develop PAH and have a very poor prognosis and survival rates compared to idiopathic PAH. Also, the majority of these patients present with substantial functional impairment and severe hemodynamics at diagnosis. Therefore, an early diagnosis of CTD-PAH through annual systematic screening and appropriate treatment is crucial in order to achieve optimal clinical outcomes and has been strongly recommended with the highest level of evidence in rheumatology, cardiology, and pulmonary guidelines since 2014. Unfortunately, annual screening in at-risk CTD-PAH patients is not being performed in the majority of patients, leading to substantial delays in therapy.