BACKGROUND:Abdominal wall hernias are common, largely non-fatal surgical conditions that impose substantial disability when untreated. Contemporary guidelines emphasize standardized evaluation and repair to reduce recurrence and chronic pain and to optimize population health impact. This study aims to assess the burden and trends of hernia in Arabian Gulf Region from 1990 to 2023. METHODS:A comparative, multi-country analysis was conducted for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates using Global Burden of Disease (GBD) 2023 estimates. Outcomes included age-standardized incidence (ASIR), prevalence (ASPR), years lived with disability (YLDs), and disability-adjusted life years (DALYs), reported per 100,000 by year (1990-2023), sex, and age. Temporal trends were evaluated with Joinpoint regression to derive average annual percent change (AAPC). Forecasts to 2033 applied linear regression, Exponential Smoothing (ETS), ARIMA, and Neural Network Autoregression (NNAR) models; the best model for each indicator-country-sex combination was selected using root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE), with 95% prediction intervals. Analyses were performed in R (forecast package) and the NCI Joinpoint program. RESULTS:In 2023, the Gulf Cooperation Council (GCC) recorded approximately 1.1 million prevalent hernia cases. While absolute counts rose 12.4% since 1990, attributable to population aging, age-standardized metrics declined across countries and sexes. YLDs comprised 75%-80% of DALYs, confirming a predominantly non-fatal burden. Male prevalence exceeded female prevalence in all states; Qatar and Bahrain formed a higher-burden cluster, whereas the United Arab Emirates and Saudi Arabia exhibited lower rates. Age-specific analyses showed marked improvements at 60-79 years but persistent or paradoxical increases in ≥ 85 years. Forecasts indicated continued declines in ASIR/ASPR to 2033, with vigilance warranted for very-elderly cohorts. CONCLUSION:The GCC experienced sustained reductions in age-standardized hernia burden since 1990 despite rising absolute numbers from demographic change. Findings support guideline-concordant expansion of elective repair, registry-based quality measurement, and targeted capacity for the oldest adults to further compress disability.
Artificial intelligence (AI) is increasingly recognized as a transformative force in the field of solid organ transplantation. From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosuppressive therapy, AI has the potential to improve both operational efficiency and patient outcomes. Despite these advancements, the perspectives of transplant professionals - those at the forefront of critical decision-making - remain insufficiently explored. To address this gap, this study utilizes a multi-round electronic Delphi approach to gather and analyses insights from global experts involved in organ transplantation. Participants are invited to complete structured surveys capturing demographic data, professional roles, institutional practices, and prior exposure to AI technologies. The survey also explores perceptions of AI's potential benefits. Quantitative responses are analyzed using descriptive statistics, while open-ended qualitative responses undergo thematic analysis. Preliminary findings indicate a generally positive outlook on AI's role in enhancing transplantation processes, particularly in areas such as donor matching and post-operative care. These mixed views reflect both optimism and caution among professionals tasked with integrating new technologies into high-stakes clinical workflows. By capturing a wide range of expert opinions, the findings will inform future policy development, regulatory considerations, and institutional readiness frameworks for the integration of AI into organ transplantation.
Objective To evaluate outcomes and durability of AUS implants after failed male urethral sling surgeries in comparison to primary AUS implantation. Methods A systematic review and meta-analysis of cohort studies was performed. We compared surgical and long-term outcomes for men undergoing AUS after prior urethral sling failure with those receiving a primary AUS. Pooled effects were generated using random-effects models; dichotomous outcomes were summarized as odds ratios (ORs) and time-to-event outcomes as hazard ratios (HRs), each with 95% confidence intervals (CIs). Results Four cohort studies comprising 2194 men were included; 202 patients underwent AUS implantation after failed sling surgery and 1992 underwent primary AUS implants. Across the studies, AUS after prior sling was not associated with a statistically significant increase in revision risk versus primary AUS (OR 1.67, 95% CI 0.78–3.54), although heterogeneity was substantial (I²=67%). Although pooled analysis did not show a statistically significant difference, results were unstable and sensitive to individual study effects, with sensitivity analysis suggesting a potentially significant higher revision risk after prior sling. Continence (≤1 pad/day) was comparable between groups (OR 0.93, 95% CI 0.22–3.91; I²=33%). Rates of erosion or infection did not differ significantly (OR 1.22, 95% CI 0.36–4.16; I²=0%). Prior sling was not significantly associated with device failure in time-to-event analyses (HR 2.31, 95% CI 0.88–6.05; I²=50%). Conclusions In available observational evidence, AUS implantation after failed male sling surgeries demonstrates continence and complication outcomes comparable to primary AUS, while revision risk may be influenced by study-level factors and warrants further high-quality evaluation.
Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. While clinical guidelines strongly recommend lifestyle modifications, including exercise, as a core treatment, they currently lack specific recommendations regarding the optimal timing of its administration. Given the circadian regulation of blood pressure (BP), autonomic tone, and vascular function, the timing of exercise may impact BP control. This systematic review aims to synthesize evidence from randomized clinical trials (RCTs) to compare the effects of morning and evening exercise on BP control in hypertensive patients. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Embase from inception to January 2026. We included RCTs involving adult hypertensive patients that compared morning and evening exercise interventions. Outcomes of interest included systolic BP (SBP), diastolic BP (DBP), mean arterial pressure, 24-hour ambulatory BP, nocturnal BP, and post-exercise hypotension (PEH). Five studies, comprising four trials (two long-term parallel RCTs and two short-term crossover RCTs), were included. Long-term interventions indicated that evening exercise was superior to morning exercise in reducing SBP and mean arterial pressure (MAP) in hypertensive men. Short-term interventions yielded conflicting results. However, limited data suggest that morning exercise may be more beneficial for women in reducing SBP and attenuating stress reactivity. The timing of exercise may influence BP control in hypertensive patients. Evening exercise appears to be the optimal strategy for long-term BP reduction in hypertensive men. Conversely, morning exercise may be preferable for women. These findings suggest that exercise recommendations should be tailored individually to each patient. Future efforts should be directed towards long-term studies to better elucidate the effects of morning and evening exercise on BP control.
