Recent randomized trials showed neutral results for distal medium vessel occlusion (DMVO) thrombectomy, but real-world effectiveness across diverse healthcare settings remains unknown. We evaluated DMVO thrombectomy outcomes in the Middle East and North Africa (MENA) region. The MEMENTO registry retrospectively analyzed consecutive DMVO thrombectomy patients (M2, M3, A2-3, P2-3 segments) across 15 centers (2022–2024). DMVOs were classified as primary, baseline secondary, or iatrogenic secondary. Primary outcome was 90-day functional independence (mRS 0–2). Secondary outcomes included successful recanalization (TICI ≥ 2b), mortality, and symptomatic hemorrhage. Among 164 patients (median age 72, NIHSS 10), subtypes included primary (25
BACKGROUND Autologous bone grafts are commonly associated with higher complication rates than alloplastic materials in cranioplasty. While previous systematic reviews have shown favorable outcomes with alloplastic grafts, there is limited comparative data on the performance of different alloplastic materials. This systematic review and network meta-analysis aims to assess the efficacy of alloplastic materials used in cranioplasty, focusing on complications, re-surgery, and implant exposure. MATERIAL AND METHODS Following PRISMA and PRISMA for network meta-analyses (NMA), we searched PubMed/MEDLINE, Embase, Scopus, and Web of Science (January 2015-January 2025). Eligibility criteria were adult cranioplasty cohorts comparing 2 or more alloplastic materials and reporting at least 1 pre-specified outcome: infection, overall complications, implant exposure, or re-surgery. Data extracted a priori included study design, indication, implant material (polyetheretherketone, titanium, hydroxyapatite, polymethylmethacrylate [porous and hard], ultra-high-molecular-weight polyethylene), follow-up, and event counts per outcome. Random-effects models estimated pooled effects; NMA generated P-scores/SUCRA ranks. Heterogeneity (I²), transitivity, and incoherence were assessed. Risk of bias was measured with the Newcastle-Ottawa Scale. RESULTS From 1025 studies, 24 studies met the inclusion criteria. The highest complication rates were reported for polymethylmethacrylate, hydroxyapatite, and titanium, although differences were not statistically significant. SUCRA rankings suggested the lowest infection rates with polyetheretherketone and titanium. Meta-regression indicated that polymethylmethacrylate was associated with higher incidence of infection. Network analysis showed titanium had maximum implant exposure. Polymethylmethacrylate (P-score=0.79) and hydroxyapatite (P-score=0.73) carried the highest re-surgery risks. CONCLUSIONS Polymethylmethacrylate and hydroxyapatite were associated with higher infection and re-surgery rates, while titanium showed greater implant exposure.
BACKGROUND:Accurate fetal weight estimation is crucial in prenatal care to prevent complications related to low birth weight or macrosomia. Conventional methods such as the Hadlock formula, based on biometric parameters, may lack accuracy, especially at weight extremes. Mid-thigh soft tissue thickness (MTSTT) has emerged as a promising, reproducible parameter for improved fetal weight estimation. This study aimed to compare the accuracy of mid-thigh soft tissue thickness (MTSTT) and the Hadlock formula in fetal weight estimation during the third trimester of pregnancy. METHODS:A prospective cross-sectional study was conducted on 300 term singleton pregnancies at Hospital (2023-2025). Standard fetal biometric parameters were measured using ultrasound, and estimated fetal weight (EFW) was calculated via both Hadlock and MTSTT-based formulas. Actual birth weight was recorded post-delivery. Correlations, error analysis, and ROC curves were used to compare predictive accuracy. RESULTS:EFW using the MTSTT model showed a stronger correlation with Actual birth weight (r = 0.956, r2 = 0.914) compared to the Hadlock method (r = 0.778, r2 = 0.610). MTSTT-based estimation demonstrated higher accuracy, with 74 % of values within 5 % of Actual birth weight and an AUC of 0.992 for predicting macrosomia. Superior diagnostic performance was consistent across all birth weight categories. CONCLUSION:MTSTT is a highly accurate and clinically feasible tool for fetal weight estimation. It outperforms the Hadlock formula, especially in extreme weight categories, and offers a reproducible alternative for routine obstetric practice.
BACKGROUND:Stroke remains a leading cause of mortality and long-term disability in the Middle East and North Africa (MENA) region. The substantial burden of stroke in low- and middle-income countries, where 75% of stroke-related deaths and 81% of disability-adjusted life years occur, underscores the critical need for region-specific adaptations of acute stroke care guidelines to address critical regional challenges while maintaining evidence-based core principles of care. METHODS:We adapted evidence from multiple international guidelines (AHA/ASA 2019-2023, ESO 2021-2023, NICE 2019-2022, Chinese Stroke Association 2022) and recent meta-analyses using MENA-SINO's systematic seven-step framework including comprehensive evidence review, multidisciplinary expert panel input from 45 experts across 22 MENA countries, regional implementation barrier assessment, and formal modified Delphi consensus procedures achieving > 85% agreement. Recommendations employ modified Class of Recommendation, Level of Evidence, Resource-Limited designations, and Expert Opinion statements following AGREE II standards. KEY RECOMMENDATIONS:Our regional roadmap emphasizes ten cornerstone concepts: (1) tiered stroke care systems with telemedicine networks; (2) rapid reperfusion protocols for IV thrombolysis within 4.5 hours and mechanical thrombectomy within 6-24 hours based on imaging; (3) resource-stratified care; (4) culturally sensitive decision-making frameworks; (5) aggressive secondary prevention targeting regional risk factor patterns; (6) standardized quality metrics across diverse systems; (7) comprehensive workforce development programs; (8) appropriate technology integration; (9) region-specific emergency response systems;and (10) sustainable phased implementation strategies. CONCLUSION:These guidelines provide the first comprehensive, resource-stratified framework for acute ischemic stroke management across the MENA region, with practical adaptations addressing diverse healthcare settings while preserving essential evidence-based care components.
Candida auris, a multidrug-resistant yeast, has recently been recognized as an important global health concern. Challenges in identification, treatment, and cleaning and disinfection have contributed to its spread within healthcare facilities and have been associated with outbreaks of invasive healthcare-associated infections worldwide. Objective: This study aimed to identify the clinical and epidemiological characteristics of C. auris cases, and to highlight the significance of strict infection control interventions for prevention of in-hospital C. auris transmission. Methods: We implemented infection control mitigation interventions including early identification, active screening, stringent infection control measures, patient skin hygiene, effective instrument and environmental disinfection. In addition, weekly screening and environmental cultures were implemented to detect potential sources of ongoing transmission. Results: This study investigated reported C. auris cases at KAMC between November 2020 and December 2021. During the study period, a total of 44 positive cultures were identified among 1,408 ICU admissions. Of these, 27.27
