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Epidemiological data on multiple sclerosis (MS) in the Arabian Gulf remain limited. This study determined the incidence and minimum prevalence of MS in Qatar over a nine-year period. This retrospective, population-based study identified incident MS cases from January 2016 through December 2024 using the Hamad Medical Corporation registry, the principal MS care provider and sole dispenser of disease-modifying therapy in Qatar. Diagnoses fulfilled the McDonald criteria. Rates were estimated for the total population and Qatari nationals. Because 2016 was the inaugural year of centralized MS care, incidence estimation was restricted to 2017 through 2024; 2016 cases were retained only for prevalence estimation. A total of 1017 incident cases were identified, 414 (40.7%) among Qatari nationals. The cohort was predominantly female (62.1%), with 92.3% of cases aged 25 to 64 years. From 2017 to 2024, average annual incidence was 3.26 (95% CI 3.03-3.50) per 100,000 in the total population, 10.89 (95% CI 9.68-12.22) in Qatari nationals, and 2.24 (95% CI 2.04-2.46) in non-Qatari residents. The female-to-male incidence rate ratio was 3.79. Minimum prevalence among Qatari nationals in 2024 was 118.29 per 100,000 (95% CI 107.16-130.25). Interrupted time series analysis showed a significant reduction in case ascertainment during the COVID-19 pandemic. Incidence among Qatari nationals is comparable to rates reported from Kuwait, the United Arab Emirates, and Iran, and approaches those of high-incidence regions. The minimum prevalence represents a substantial increase over the previous national estimate, challenging historical assumptions that MS is uncommon in Middle Eastern populations.

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is an increasingly recognized condition in the Middle East and North Africa (MENA) region, yet real-world data on advanced therapies from this population remain scarce. Ustekinumab, a fully human monoclonal antibody targeting the shared p40 subunit of interleukin-12 and interleukin-23, has demonstrated efficacy and safety in pivotal randomized controlled trials for both CD and UC. However, its real-world performance in MENA populations has not been well characterized. This study aimed to evaluate the real-world drug retention, safety profile, and predictors of treatment discontinuation of ustekinumab in patients with IBD at two major referral centers in Qatar.  This was a retrospective, observational cohort study conducted at two IBD referral centers in Qatar (the Ambulatory Care Center and Al Khor Hospital, Hamad Medical Corporation). Adult patients (≥18 years) with a confirmed diagnosis of CD or UC who received at least one induction dose of ustekinumab were included. The primary outcome was drug retention at 6, 12, and 24 months. Secondary outcomes included the safety profile. The study was approved by the Medical Research Committee of Hamad Medical Corporation (MRC-01-25-1395).  A total of 345 episodes were included (216 CD, 129 UC). Overall retention at 6, 12, and 24 months was 92.2%, 83.9%, and 77.8%, respectively. CD exceeded UC at all time points; the difference reached statistical significance at six months (95.4% vs. 86.8%; p = 0.011) but attenuated at 12 months (86.5% vs. 79.5%; p = 0.163) and 24 months (81.0% vs. 72.4%; p = 0.087). Discontinuation occurred in 79 episodes (22.9%); primary non-response (10.7%) and secondary loss of response (10.1%) were the main causes. Adverse events were documented in 14 episodes (4.1%); serious adverse events in 5 (1.4%). No malignancies or deaths were recorded. Shorter pre-treatment disease duration was a consistent predictor of discontinuation across all time points (6 months: p = 0.046; 12 months: p = 0.028; 24 months: p = 0.045). Disease type also met the significance threshold at six months (p = 0.011), with patients with UC demonstrating higher early discontinuation rates than those with CD. In this retrospective cohort study, ustekinumab demonstrated high drug retention and an acceptable safety profile in a predominantly Arab IBD population in Qatar. Shorter disease duration prior to ustekinumab initiation was associated with treatment discontinuation across multiple time points, while patients with CD showed higher retention than those with UC at six months (p = 0.011). These findings suggest that disease type and timing of biologic initiation may be associated with ustekinumab persistence in this population. Further prospective studies are needed to confirm these observations in MENA populations with IBD.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence is increasing in aging populations. It is a leading cause of acute stroke, heart failure, and other cardiovascular morbidities. AF is often asymptomatic and is frequently diagnosed late, typically after a patient presents with acute stroke. Early detection and treatment can prevent such life-threatening events, making AF screening a public health priority. However, diagnosing asymptomatic AF remains challenging. While international guidelines recommend AF screening, Qatar lacks documented prevalence data and formal screening programs. This study aimed to assess the feasibility of an AF screening program for older adults in Qatar. A cross-sectional study was conducted among individuals aged ≥65 years registered with the Primary Health Care Corporation (PHCC)-Qatar, which serves approximately 70% of Qatar's population. A simple random sample of 139 to 385 individuals was determined to ensure a sampling error of 5% to 3%, assuming a 10% AF prevalence. The participants underwent screening via standard ECG tracing that were reviewed independently by both the family physicians and a cardiologist. The prevalence of AF among the study population was 5.4%. Newly diagnosed cases accounted for 2% of the 249 participants screened. All newly detected patients had CHA2DS2-VA scores indicating the need for anticoagulant therapy to reduce stroke risk. Furthermore, compared with cardiologists, the family physicians in primary care successfully identified 75% of AF cases through ECG. If implemented nationally among individuals aged ≥65 years, the screening program could identify 747 undiagnosed AF cases among the 37,371. AF screening for individuals aged ≥75 years appears to provide an effective strategy for reducing the cost and supporting the implementation of a targeted screening strategy in Qatar.

Metabolically-dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in populations with metabolic risk factors, and the liver fibrosis stage is the main determinant of long-term outcomes. The Fibrosis-4 (FIB-4) index is widely recommended as a first-line noninvasive test for fibrosis risk stratification; however, its diagnostic performance may vary across populations. To evaluate the diagnostic performance of the FIB-4 index for detecting advanced liver fibrosis in Qatari residents with MASLD, using liver biopsy as the primary reference standard and FibroScan as a secondary comparator. This retrospective, cross-sectional diagnostic accuracy study included adults with MASLD evaluated at Hamad Medical Corporation in Qatar between January 2023 and December 2024. FIB-4 was calculated from routine laboratory parameters, and fibrosis was staged using the METAVIR (Meta-Analysis of Histological Data in Viral Hepatitis) scoring system. It is a histological scoring system used to grade necroinflammatory activity (A0-A3) and stage liver fibrosis (F0-F4). Advanced fibrosis was defined as METAVIR stage ≥F3. Diagnostic performance metrics and the area under the receiver operating characteristic curve (AUROC) were calculated at established cut-offs. A total of 117 patients were included; 74 patients (63.2%) underwent liver biopsy, and 91 patients (77.7%) underwent FibroScan assessment. Advanced fibrosis was present in 21 patients (17.9%) on biopsy. At a FIB-4 cut-off of 1.3, sensitivity and specificity for detecting advanced fibrosis were 66.7% and 67.9%, respectively, compared with liver biopsy, with an overall accuracy of 67.6% and a negative predictive value of 83.7%. The AUROC for FIB-4 was 0.76. FIB-4 can be used as a first-line, accountable screening tool, followed by another confirmatory tool in high-risk patients.

Large language models (LLMs) have revolutionized biomedical research, yet they remain prone to hallucinations and struggle with the precise, multi-hop reasoning required for biomedical analysis. To bridge this gap between generative capability of AI model and factual rigor, this article introduces GeneGenie, a model-agnostic, multi-agent framework built upon a directed acyclic graph architecture. Unlike static prompting strategies, GeneGenie implements a deterministic five-node pipeline that orchestrates query planning, intelligent retrieval-augmented generation across curated databases (GenCC, HGNC, and UniProt), and the dynamic execution of bioinformatics tools, including NCBI E-Utilities and local BLAST+. We evaluated the system using the updated 16-module GeneTuring benchmark, comprising 1600 question-answer pairs. The experimental design compared six state-of-the-art models-including GPT-4o, Claude Sonnet 4.5, and Gemini 2.5 Pro-operating in a standalone "Direct Mode" versus the agentic "Graph Mode." The results demonstrate that the graph-based architecture consistently outperforms single-model baselines across all metrics. Notably, among the six selected LLM models we explored, Gemini 2.5 Pro achieved the highest performance, correctly answering 1158 questions (72.375% accuracy), compared with the best baseline score of only 15.8%. Furthermore, our evaluation utilized an "LLM-as-Judge" semantic assessment, revealing that the agentic approach significantly enhances not only lexical accuracy but also the completeness and factual grounding of responses. While limitations remain in named entity recognition for protein-coding genes, GeneGenie establishes a robust, reproducible paradigm for future biomedical AI systems, proving that tool-augmented orchestration is superior to reliance on raw model scale alone.

Abdominoplasty, although classified as a clean elective procedure, carries a meaningful risk of surgical site infection (SSI), with reported SSI rates varying depending on patient factors and procedural complexity. To describe SSI incidence and associated risk factors after abdominoplasty at a Qatari tertiary facility, and to assess compliance with prophylaxis practices, antibiotic consumption, and costs. Retrospective cohort of all abdominoplasties at The Cuban Hospital, from January 1, 2022, to July 31, 2025 (N = 323). Data included demographics, comorbidities, perioperative glucose monitoring, procedure characteristics, and antibiotic use (prophylactic and therapeutic). The cohort comprised both simple abdominoplasties and combined procedures performed with additional interventions such as liposuction or hernia repair. SSI rates were analyzed using relative risk, 95% confidence intervals, and statistical tests with significance at P < 0.05. A total of 323 patients underwent abdominoplasty with a mean age of 40.5 years (SD, 9.8; range, 19-63 years). The majority were female (276 patients, 85.4%), and 13.9% (45 patients) had a history of diabetes mellitus. Overall SSI incidence was 5.3% (17/323), highest in 2025 (8/112; 7.1%). Combined abdominoplasty had a higher SSI rate than simple procedures (10.4% [5/48] vs. 4.4% [12/275]; RR, 2.36 [95% CI, 0.88-6.35]). SSI was more frequent with diabetes (11.1% [5/45] vs. 4.3% [12/278]), overweight/obesity (7.3% [12/151]/4.3% [5/112] vs. 0% [0/42]), and higher postoperative glucose (mean: 7.97, standard deviation: 1.99; P = 0.04). Adherence to antibiotic prophylaxis was high for timing/selection/dose, but discontinuation beyond 24 hours and 7-day discharge prescriptions were common. Antibiotic consumption and costs were higher in SSI cases (355.9 vs. 280.5 DDD/100; 2807.6 vs. 2180 QR/100; P = 0.45; P = 0.72). SSI incidence after abdominoplasty was modest but increased with combined procedures and poorer postoperative glycemic control. Strengthening perioperative glucose protocols and enforcing 24-hour prophylaxis limits may reduce SSI and unnecessary antimicrobial use and costs.

Despite recovery from acute COVID-19, many individuals experience post-COVID-19 syndrome (PCS), which can impair health and functional status, particularly affecting cardiovascular and pulmonary function in physically active adults. To assess the severity of physical dysfunction among patients with PCS in Qatar during 2022. An analytic cross-sectional study was conducted among 368 adults with laboratory-confirmed COVID-19 infection between January and July 2022. After providing verbal consent, participants completed structured telephone interviews assessing physical activity, fatigue, and dyspnea. The World Health Organization's standard case definition for PCS was applied, identifying 159 participants with PCS. Among the PCS participants, a notable reduction in moderate (13.2%) and vigorous (5.7%) physical activity was observed following COVID-19 infection. Severe fatigue and dyspnea were highly prevalent in PCS participants (45.9% and 37.8%, respectively) and were strongly interrelated. Multivariable analysis showed severe dyspnea independently associated with severe fatigue (odds ratio [OR] = 3.04 [95% CI, 1.46-6.31]), and severe fatigue independently associated with severe dyspnea (OR = 3.11 [95% CI, 1.49-6.49]). No significant associations were observed with sociodemographic characteristics, social support, obesity, chronic disease, or hospitalization. Fatigue and dyspnea are central, interrelated manifestations of PCS, largely independent of demographic or clinical characteristics. These findings highlight the need for routine screening and the integration of multidisciplinary rehabilitation programs, including pulmonary support and graded physical activity, to address functional impairment in patients with PCS. Longitudinal studies are warranted to clarify the long-term trajectory and underlying mechanisms of PCS.

Dialysis patients suffer from anemia, muscle fatigue and atrophy, decreased aerobic capacity resulting in reduced physical activity, and decreased quality of life (QoL). The end-stage kidney disease patients often experience reduced QoL due to physical and psychological burdens. This study aims to evaluate the effect of intradialytic resistance exercise (IRE) on QoL, dialysis adequacy, muscle cramps, and physical function of dialysis patients. A quasi-experimental study was conducted at Al Khor Dialysis Unit. Participants performed supervised TheraBand exercises during dialysis, including warm-ups, IREs, and stretching. WHO QoL - BREF (World Health Organization Quality of Life- (Brief Version)) questionnaires and physical function tests, including a 10-m walk test and a 30-second sit-stand test, were performed. The exercise was performed within the first 2 hours of the dialysis session for 6 months. Twenty-four patients were followed for a period of 6 months. The mean QoL score at baseline was 67.9 &#xb1; 20.9, which increased to 70.3 &#xb1; 17.2 after 3 months and 74.5 &#xb1; 15.8 after 6 months. There were 71% male and 29% female in the average age group of 59.9 years. No significant correlations were observed between QoL and demographic factors such as gender, education, or income. Additionally, muscle cramps improved slightly from 4% at baseline to 8% post intervention. Kt/V, a measure of dialysis adequacy, remained stable after the intervention. Physical performance improved, with sit-to-stand test repetitions increasing from 7.2 &#xb1; 2.9 to 10.1 &#xb1; 4.5, though the time for the 10-m walk test improved slightly. The resistance exercise intervention demonstrated modest numerical improvements in quality of life and physical function, although these trends should be interpreted cautiously.

Arrhythmias and cerebrovascular disease commonly coexist in older adults and are associated with increased mortality risk. However, population-level trends and demographic disparities in related deaths remain insufficiently characterized, necessitating large-scale analyses to better inform prevention, risk stratification, and healthcare planning. Data from CDC WONDER (1999-2023) identified U.S. mortality rates in adults aged (&#x2265;&#x2009;65&#xa0;years) with arrhythmia (ICD-10: I47-I49) and cerebrovascular disease (ICD-10: I60-I69) among U.S. adults aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, race, urbanization and regions. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Between 1999 and 2023, a total of 733,476 deaths among older adults (&#x2265;&#x2009;65&#xa0;years) were attributed to arrhythmias and cerebrovascular disease. The AAMRs exhibited an upward trend from 72.14 in 1999 to 74.62 in 2023 (AAPC: 0.055, 95% CI -&#x2009;0.62 to 0.74; p 0.87) with a significant rise in AAMR from 65.51 in 2018 to 80.44 in 2021 (APC: 6.65; p 0.01). Men had higher AAMR than women during 1999-2023 with (73.97 to 81.27 vs. 70.22 to 69.2). NH White individuals had the highest AAMR in 2021 (87.43) with a total (631,483 deaths). The South recorded the most deaths (251,478) with a significant decline in AAMR from (70.36) in 2002 to (58.54) in 2008 (APC: -&#x2009;2.89, 95% CI -&#x2009;3.85 to -&#x2009;1.92; p 0.004). Non-metropolitan areas had higher AAMR compared to metropolitan areas (73.62 vs. 64.71). For the place of death, the majority occurred in inpatient medical facilities (38.73%, 284,079 deaths). Mortality related to arrhythmias and cerebrovascular disease has increased in recent years among older adults. While women accounted for more deaths, men consistently had higher AAMRs. Higher mortality burden was also observed among NH White individuals, residents of the South, and urban populations, with most deaths occurring in inpatient medical facilities, highlighting the need for targeted interventions.

Type 1 diabetes mellitus (T1DM) and celiac disease (CD) represent two frequently recognized and interrelated autoimmune disorders. Despite the well-documented coexistence of T1DM and CD, the exact etiology behind this association remains unclear. A retrospective study analyzed handwritten medical files of 109 children and adolescents diagnosed with T1DM documented between the years 2004 and 2022 in the Pediatric Unit of Mustapha Bacha University Hospital, Algiers, Algeria. Data were collected, including age, sex, age at diagnosis of both T1DM and CD, the mean annual Glycated Hemoglobin ( HbA1c) levels, celiac serology, and histopathological results. Comparisons between the CD-negative and CD-positive groups were performed using the Mann-Whitney U test. The mean age was 9.99 &#xb1; 4.05 years, and the age at diagnosis of T1DM was 6.33 &#xb1; 3.45 years. HbA1c was 8.47 &#xb1; 1.42%, equivalent to 69.1 &#xb1; 15.5&#xa0;mmol/mol. Celiac serology was positive in 21 patients (19.3%), including 11 patients with a confirmed CD (57.89%), with a mean age at CD diagnosis of 5.82 &#xb1; 2.82 years. The Mann-Whitney U test revealed a significant difference in the age at diagnosis of T1DM (P = 0.027). Logistic regression analysis showed that age at T1DM diagnosis was significantly associated with the risk of developing CD, with a 21.4% decrease in risk per additional year of age (odds ratio = 0.786 [95% CI, 0.627-0.986]; P = 0.038). In this retrospective cohort, younger age at T1DM diagnosis was associated with a higher risk of CD, supporting intensified screening in children diagnosed at younger ages. Prospective studies are warranted to confirm these clinical implications.

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for treating severe aortic stenosis, but accurately predicting post-operative outcomes remains a challenge. This study employs machine learning (ML) techniques to predict four critical outcomes following TAVI: 30-day complications, mortality, Conduction Abnormalities (CA), and Paravalvular Leak (PVL). Using a dataset of 256 patients from Hamad Medical Corporation Heart Hospital TAVI program, we processed 54 clinical parameters through several preprocessing methods such as multiple imputation for missing values and synthetic data generation using Synthetic Minority Oversampling Technique (SMOTE) to address missing data and class imbalance. Various machine learning models, including Support Vector Machines (SVM), K-Nearest Neighbors (KNN), and Artificial Neural Networks (ANN), were trained and evaluated. The models demonstrated strong predictive performance across all tasks, with SVM and KNN models achieving the highest ROC-AUC scores. SHapley Additive exPlanations (SHAP) analysis revealed key predictors such as diabetes, pacemaker, dyslipidemia and type of valve, providing insights into the factors contributing to each prediction. Our findings suggest that ML, combined with explainability analysis, can effectively identify high-risk patients and potentially improve clinical decision-making in TAVI procedures.

Safe perioperative transfer of patients with potential spinal cord injury (SCI) is essential to prevent secondary neurological damage. Targeted training of operating room nurses (ORNs) is critical for ensuring adherence to best-practice transfer techniques. To determine the effect of a scenario-based training intervention on knowledge and self-reported practices of ORNs regarding safe perioperative transfer of patients with potential SCI. This survey-based pre- and post-intervention study was conducted at Hamad General Hospital, Doha, Qatar, between January and March 2024. A structured self-administered questionnaire was administered to ORNs before and after a targeted training intervention. Variables included preferred transfer device, number of staff required, leadership during transfer, hand positioning, and command sequence. Descriptive statistics and McNemar's test were used for analysis. A total of 138 ORNs participated (mean age, 37.6 &#xb1; 6.2 years; 68% female). Use of plastic boards increased from 88% (n = 122) to 93% (n = 128) post-intervention (P < 0.05). Compliance with the recommended four-person log-roll team improved from 67% (n = 92) to 79% (n = 109). Reliance on anesthetists for transfer leadership increased from 41% to 58%, while inappropriate reliance on other staff decreased from 33% to 28%. A targeted scenario-based training intervention significantly improved ORNs' knowledge and self-reported adherence to safe perioperative transfer practices for patients with potential SCI.

To describe and evaluate the implementation and outcomes of a targeted health professions education (HPE) programme. Aspetar Orthopaedic Sports Medicine Hospital's accredited education programme targets a global health professions audience-those working at the hospital, those employed to provide services at all Qatar's sports clubs and federations and those from the region and globally. A descriptive process evaluation using routinely collected survey data from accredited continuing professional development (CPD) activities in Aspetar between 2017 and 2023. The evaluation was structured by the RE-AIM framework which evaluates a program across the five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance. During the study period, 420 accredited CPD activities were completed and attended by 50&#x2009;772 professionals. A total of 13&#x2009;557 feedback survey responses were collected during the first accreditation cycle of the HPE programme (2017-2023). The HPE programme demonstrated a steady increase in reach over time, received positive effectiveness ratings and demonstrated a steady increase in attendance rate highlighting successful implementation. Applying the RE-AIM framework highlighted key strengths in the reach, effectiveness and implementation of the Aspetar HPE programme. Overall reach was satisfactory; effectiveness was evident through perceived improvement in clinical performance and implementation through continuous learning over time. Although not all framework dimensions were applicable to our study, our findings could inform efforts to further improve the HPE programme, serve as a model for similar education programmes elsewhere and bolster healthcare services and patient outcomes in sports medicine.

Acute Myelogenous Leukemia (AML) is a rapidly progressing blood and bone marrow cancer, prevalent among adults. Very low five-year survival rate, non-specific and ambiguous symptoms, and lack of potent screenings make early detection and prompt treatment crucial, especially for younger patients. The need for multiple tests to confirm AML and possible misdiagnosis often leads to multiple consultations before moving to the next stage of investigations. This can create operational bottlenecks in the hematology department, leading to further delays in the diagnostic pathway. To develop a lightweight artificial intelligence (AI) model using complete blood count (CBC) data for early AML detection and development of a decision support system (DSS) for triage support. The data for this study were retrieved retrospectively from the National Center for Cancer Care and Research (NCCCR), Qatar (2016-2022). We used 510 CBC data records of AML and non-AML individuals. Statistical analysis of CBC features (mean &#xb1; SD) for AML and control patients was performed, followed by principal component analysis (PCA) to assess the predictive ability of CBC alone. Rigorous feature selection and model tuning resulted in a predictive diagnostic Support Vector Machine (SVM) model to alleviate delays in the AML care pathway. Employing a five-fold cross-validation approach, achieved an accuracy of 96.4% (S.D. 0.029) for test set and 80% (S.D. 0.036) for validation set. This 80% accuracy on the validation set, with high sensitivity (100% recall) but lower precision (77.1%), represents an acceptable triage trade-off, although it may increase follow-up referrals and workload. The developed model showed encouraging performance when used to detect AML using CBCs taken up to 1-year prior diagnosis. This study emphasizes that, with routine CBC data, we can enable better patient screening and referral in the initial stages of triage through a cost-effective, AI-based decision support system that provides complementary support to doctors for timely AML detection.

Fungal infections remain a major global health challenge, particularly among immunocompromised patients, with increasing morbidity and mortality driven by invasive candidiasis, aspergillosis, cryptococcosis, and emerging multidrug-resistant pathogens such as Candida auris. Although conventional antifungal classes, including azoles, echinocandins, polyenes, and flucytosine, remain central to antifungal therapy, their clinical utility is limited by toxicity, drug-drug interactions, restricted spectra, variable pharmacokinetics, and the growing emergence of antifungal resistance. These limitations have highlighted the urgent need for novel antifungal agents with improved safety profiles, new mechanisms of action, broader or more targeted activity, and optimized pharmacokinetic properties. This narrative review summarizes the current landscape of emerging antifungal therapies, focusing on ibrexafungerp 1, rezafungin 2, fosmanogepix 3, olorofim 4, opelconazole 5, and oteseconazole 6. Their mechanisms of action, antifungal spectra, resistance profiles, preclinical evidence, clinical development, pharmacokinetic advantages, and safety data are discussed and compared with established antifungal classes. Several of these agents introduce entirely novel antifungal targets, including inhibition of fungal dihydroorotate dehydrogenase and Gwt1-mediated glycosylphosphatidylinositol-anchor biosynthesis, while others optimize existing antifungal strategies through prolonged half-life, improved fungal selectivity, oral bioavailability, or inhaled pulmonary delivery. Collectively, these emerging antifungal agents expand therapeutic options against resistant Candida species, azole-resistant Aspergillus fumigatus (A.fumigatus), and difficult-to-treat molds, while potentially improving tolerability and reducing interaction-related limitations. However, important challenges remain, including limited activity against Mucorales for several agents, the potential emergence of future resistance, and the need for additional comparative clinical data and real-world experience. Overall, the expanding antifungal pipeline represents a major advancement toward more targeted and individualized antifungal therapy and may significantly reshape the future management of invasive and refractory fungal infections.

Trabeculectomy remains the standard surgical treatment for glaucoma, but is associated with postoperative complications. XEN gel stent implantation has emerged as a minimally invasive alternative, though comparative evidence regarding its efficacy and safety remains inconsistent. To compare the efficacy and safety of ab-interno XEN 45 gel stent implantation versus trabeculectomy in patients with glaucoma. Systematic review and meta-analysis. A comprehensive literature search was conducted across PubMed, Embase, Scopus, the Cochrane Library, and Web of Science to identify studies comparing the XEN Gel Stent with trabeculectomy. Random-effects meta-analyses were performed using odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Eleven studies comprising 1260 eyes (645 XEN, 615 trabeculectomy) were included. Trabeculectomy achieved significantly greater intraocular pressure (IOP) reduction (MD: -2.16&#x2009;mmHg (95% CI: -2.88 to -1.44); I 2&#x2004;=&#x2004;43%) and higher qualified (OR: 1.59 (95% CI: 1.18 to 2.14); I 2&#x2004;=&#x2004;0%) and complete surgical success rates (OR: 1.72 (95% CI: 1.16 to 2.56); I 2&#x2004;=&#x2004;43%). No significant difference was observed in the number of antiglaucoma medications (MD: -0.03 (95% CI: -0.23 to 0.18); I 2&#x2004;=&#x2004;53%). Rates of hyphema, choroidal detachment, hypotony, flat anterior chamber, bleb revision, and reoperation showed no statistically significant differences between procedures, although substantial heterogeneity was observed for hyphema (I 2&#x2004;=&#x2004;60%), hypotony (I 2&#x2004;=&#x2004;76%), and reoperation (I 2&#x2004;=&#x2004;53%). XEN demonstrated significantly lower risks of bleb leakage and endophthalmitis but higher rates of bleb needling. Trabeculectomy achieves greater intraocular pressure reduction and higher surgical success rates than ab-interno XEN45 gel stent implantation, whereas XEN is associated with lower rates of selected bleb-related complications. Procedure selection should be individualized according to target intraocular pressure, glaucoma severity, and postoperative management requirements. PROSPERO (CRD420251075034).

Obstructive sleep apnea (OSA) is a highly prevalent yet substantially underdiagnosed sleep-related breathing disorder increasingly recognized as a heterogeneous systemic disease rather than a purely mechanical consequence of recurrent upper-airway collapse. This review provides an updated and integrated overview of OSA, spanning epidemiology, multifactorial pathophysiology, heterogeneous clinical presentation, major cardiometabolic and end-organ consequences, diagnostic principles, and evolving personalized management, while also emphasizing the limitations of conventional severity classification, which is predominantly based on the apnea-hypopnea index. We highlight how intermittent hypoxia-reoxygenation, sleep fragmentation, sympathetic activation, intrathoracic pressure stress, endothelial dysfunction, inflammation, oxidative stress, and metabolic dysregulation interact to drive systemic injury, and why physiologically enriched metrics such as hypoxic burden, T90, event duration, sleep-stage dependency, and endotypic heterogeneity may better capture biological risk than event frequency alone. Within this broader framework, fibrosis-linked structural remodeling emerges as an important yet under-supported dimension of OSA pathobiology. Experimental and clinical evidence suggests that OSA may contribute to remodeling of the lungs, liver, kidneys, and heart, although the strength of the evidence and the degree of causal inference vary across organs. By integrating established knowledge with this emerging fibrosis-oriented perspective, this review defines key mechanistic, diagnostic, and translational priorities for future research and phenotype-aware clinical stratification.

This study examined the association of sleep quality, eating behaviors, physical activity (PA), and financial security with mental health among elite and amateur male and female athletes during the COVID-19 pandemic. A total of 1385 athletes (41.2% women) from 14 countries participated in this global cross-sectional study, with 40.3% identified as elite athletes and 59.7% as amateur athletes. Data on perceived mental health, sleep quality, PA, eating behaviors, and financial security were gathered through an online survey conducted during the second year of the COVID-19 pandemic. Multiple linear regression analysis assessed the association of these variables with depression, anxiety, stress, and global psychological distress across sex and competitive levels. Poorer sleep quality was the most consistent correlate of higher mental health symptom scores across the regression models, although is association was not uniform across all outcoms and subgroups, PA showed a more variable pattern. In the total sample, higher PA was associated with lower depression, anxiety, stress and global distress scores in both women and men. PA was not significantly associated with mental health outcomes among elite women and was only associated with stress among elite men. PA was associated with global distress and anxiety in amateur women, as well as with global distress, depression and stress in amateur men, but not with all outcomes. Eating behaviors showed less consistent associations, emerging mainly among men in the total sample and between amateur men for specific outcomes. Financial security was associated with lower symptom scores in the total sample for both women and men, but subgroup analyses showed a more differentiated pattern, with more consistent associations among elite women and more limited associations among elite men and amateur athletes. During the COVID-19 pandemic, athletes' mental health symptoms were associated with several behavioral and contextual factors, particularly sleep quality, while PA, eating behaviors, and financial security showed more subgroup-specific patterns.

Chemical, biological, radiological, and nuclear (CBRN) incidents present escalating risks across the Middle East and North Africa (MENA) amid geopolitical instability, cross-border threats, and evolving non-state actor capabilities. This policy analysis examines why prevailing case-level and ministry-siloed governance is insufficient for population-level CBRN readiness, weighs alternative coordination models, and outlines an artificial intelligence (AI)-enabled, centrally coordinated public-health strategy adapted to the region's heterogeneity and resource constraints. We propose a National Emergency Management Advisory Council to provide statutory inter-ministerial authority and stewardship for a National CBRN Dashboard that delivers decision support, inventory tracking, simulation, and rapid triage. We situate this within existing backgrounds and analyze legal authority, financing, data governance, and feasibility in low-resource settings. While prototype AI models report high accuracy for antidote optimization, agent classification, and triage, we argue these metrics reflect controlled research, not operational readiness, and require external validation, robustness testing, and cybersecurity safeguards. A phased, evidence-graded roadmap is proposed to move MENA CBRN management from reactive to predictive and adaptive models.