The Cleveland Clinic Abu Dhabi (كليفلاند كلينك أبو ظبي, known as CCAD) is a multi specialty hospital located in Abu Dhabi, United Arab Emirates. The 364 bed luxury hospital, part of Cleveland Clinic Foundation, USA, has been open to the public since May 2015.
Background: Epilepsy affects over 50 million people worldwide, and approximately one third of patients develop drug-resistant epilepsy (DRE), a major driver of morbidity, mortality, and healthcare costs. Vagus nerve stimulation (VNS) is an established neuromodulatory treatment option for DRE, but local guidance on its use in the United Arab Emirates (UAE) remains limited. This study aimed to establish an expert consensus to define best practices for the effective and efficient use of the VNS in the UAE setting. Methods: A multidisciplinary Task Force conducted a literature review and developed 25 evidence- and experience-informed statements, which were refined during an in-person expert meeting to ensure clinical relevance for the UAE context. Statements were rated through a single-round modified Delphi process involving UAE neurologists and neurosurgeons. Participants rated their agreement with each statement using a 7-point Likert scale. Consensus was predefined as >= 70% agreement, corresponding to ratings of 6-7. Statements with 60-69% agreement were classified as moderate agreement but were not considered to have reached consensus. Results: Fifty-six experts completed the Delphi round, corresponding to a 75.7% response rate. Item-level denominators varied across statements. Eighteen of 25 statements reached consensus, six demonstrated moderate agreement, and one did not reach consensus. Strong agreement was observed for patient selection, safety, structured parameter optimization, and multidisciplinary care pathways. Moderate agreement emerged for presurgical evaluation, timing of implantation, and selected clinical scenarios. Conclusion: Building on existing international guidance and previous Delphi work in other settings, this study provides a UAE-specific description of expert agreement and variability on the clinical and organizational use of VNS for DRE. The findings may inform future local pathway development and identify areas requiring clearer definitions, prospective data collection, and further evidence generation. Plain Language Summary. This study asked expert clinicians in the United Arab Emirates to rate 25 statements on the clinical and organizational use of vagus nerve stimulation for drug-resistant epilepsy. Vagus nerve stimulation is an adjunctive treatment that aims to reduce seizure burden and improve patient-centred outcomes; it should not be interpreted primarily as a treatment intended to achieve complete seizure freedom. Eighteen statements reached the prespecified consensus threshold, while six showed moderate agreement and one did not reach consensus. Experts showed agreement on several areas, including multidisciplinary care, safety considerations, MRI compatibility, structured follow-up, and individualized programming. However, agreement was more limited for some topics, including expected responder rates after one year, timing of implantation, selected programming criteria, and quality-of-life effects independent of seizure reduction. These findings identify areas where expert views are aligned and areas where practice remains variable. They may support the development of more consistent local care pathways, while highlighting topics that require further clinical evidence and local guidance.
In 2024, a comprehensive framework for the screening, diagnosis, and management of metabolic dysfunction–associated steatotic liver disease (MASLD) was incorporated in the EASL-EASD-EASO clinical practice guidelines. However, physicians often face barriers applying these recommendations in routine clinical care, especially in the Southeastern Europe, Middle East, and Africa (SEEMEA) region. As a multidisciplinary group of physicians involved in MASLD and metabolic dysfunction-associated steatohepatitis (MASH) management, our objective is to provide a practice-oriented roadmap including practical and educational considerations beyond the hepatology field that could improve patient care and support implementation of clinical guidance within the SEEMEA region. This work is informed by a narrative review and expert input obtained through structured discussions, to examine the status quo and identify key gaps in the MASLD/MASH management, unravelling the patient journey from screening and diagnosis to treatment and follow-up. Furthermore, we advise on priorities on screening triggers and, considering the limited availability of vibration-controlled transient elastography (VCTE), discuss alternative approaches to achieve accurate and timely diagnosis. Finally, following the approval of resmetirom and semaglutide 2.4 mg for MASH treatment, we review the evolving pharmacotherapy landscape and propose a “blueprint” for a specialised MASLD clinic, suggesting mandatory and optional facilities for optimised care.
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA2LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Gastrojejunal (GJ) anastomotic strictures are a challenging complication following Roux-en-Y gastric bypass (RYGB) and may be refractory to conventional balloon dilation. Lumen-apposing metal stents (LAMS) provide anchored, wide-caliber support that may treat strictures, yet long-term outcomes remain variable, and stent migration is a concern. This study evaluates the clinical effectiveness and safety of LAMS with or without concurrent endoscopic stricturoplasty in patients with GJ strictures. We conducted a single-center retrospective cohort study of patients with GJ strictures who underwent LAMS placement between January 2020 and May 2025. Patients were stratified by whether concurrent endoscopic stricturoplasty was performed at the time of stent placement. Clinical success was defined as symptom resolution without need for reintervention. The primary outcome was long-term clinical success (> 90 days). Secondary outcomes included short-term clinical success (≤ 30 days), stent dwell time, procedure duration, stent migration, and adverse events. Twenty-five patients were included (mean age 46.8 ± 12.9 years; 76
To quantify serial central subfield thickness (CSFT) changes after slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) for glaucoma, estimate the incidence of OCT-confirmed cystoid macular edema (CME), and explore baseline factors associated with CME, including diabetes and prior diabetic macular edema. Retrospective cohort of 31 eyes undergoing SC-TSCPC for glaucoma with OCT imaging preoperatively and postoperatively at 1, 3, 6, 9, and 12 months and at last follow-up (range 9–30 months). OCT-confirmed CME was defined as cystoid intraretinal changes on OCT; increased CSFT alone was not classified as CME. Changes over time were assessed with non-parametric repeated-measures testing, and subgroup comparisons were exploratory and univariate because of the small sample size. Mean baseline CSFT was 279 ± 25 um and peaked at 355 ± 153 um at 1 month, then declined to 293 ± 25 um at 12 months (p < 0.001 across visits). Mean CSFT at last follow-up remained higher than baseline (294 ± 25 vs. 279 ± 25 um; p < 0.001). OCT-confirmed CME developed in 8/31 eyes (25.8
