There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy. We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4. Five RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95
Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disorder affecting the central nervous system, often misdiagnosed as multiple sclerosis. The identification of aquaporin-4–IgG (AQP4-IgG) has improved diagnostic precision and enabled targeted therapies. Given the unique regional challenges in healthcare delivery across the Middle East and North Africa (MENA) region, the Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) convened an expert panel to develop evidence-based, region-specific consensus recommendations for diagnosis and management. These guidelines endorse the 2015 International Panel for NMO Diagnosis (IPND) criteria, emphasizing AQP4-IgG testing via cell-based assays. Differential diagnosis should consider multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and acute disseminated encephalomyelitis (ADEM). For acute treatment: initiate high-dose intravenous methylprednisolone promptly and use plasma exchange early for severe or steroid-refractory attacks. For long-term immunotherapy, monoclonal antibodies (rituximab, inebilizumab, eculizumab, ravulizumab, satralizumab, or tocilizumab) are recommended according to availability and patient factors; conventional immunosuppressants remain alternatives when biologics are inaccessible. Guidance is provided for pediatric patients and for pregnancy and breastfeeding, including planning after ≥ 12 months of disease stability and early postpartum treatment resumption. These MENACTRIMS guidelines aim to improve NMOSD outcomes across the region by promoting accurate diagnosis and timely, effective therapy.
Background:Carotid body tumors (CBTs) are clinically important in head and neck surgery. In this multicenter retrospective study, we aimed to examine the characteristics, diagnosis, and management of patients diagnosed with CBTs at three institutions. Materials and methods:Patient demographics, clinical symptoms, investigative modalities, therapeutic interventions, pathological findings, and clinical outcomes were assessed. Overall, 12 patients, with a median age of 51.5 years, were evaluated. Results:The most common symptom was a painless neck mass (83.3%). Tumors were located on the right side in eight patients (66.6%). No bilateral cases were recorded. One patient had a synchronous small glomus vagale tumor. Contrast-enhanced computed tomography was used as the primary imaging modality in 11 patients. Multiple imaging modalities were used in 66.6% of patients. The median tumor size was 4.6 cm. Of these, 33.3% were Shamblin Class I, 50% Class II, and 16.6% Class III. Seven patients underwent surgery, whereas five opted for non-surgical treatment. Complications, including hoarseness and dysphagia, occurred in three patients. Preoperative embolization was performed in two patients. All operated cases were histopathologically confirmed to be paragangliomas. Conclusions:Our results revealed that, although CBTs are rare and challenging to treat, positive outcomes are possible with careful planning and precise surgery. Active surveillance may be a suitable initial approach in selected patients. Future studies should focus on creating individualized risk plans to guide treatment decisions and follow-ups.
Despite the recent surge in the use of telerehabilitation (TR) for neurological disorders, there is a lack of TR programs tailored to persons with Parkinson’s disease (PwPD), particularly in low-resource settings. To address this gap, we aimed to develop a tele-assisted home exercise program for improving balance and functional mobility in PwPD (TELEPORT-PD). An e-Delphi process was conducted with an international, interprofessional team of experts involved in rehabilitation of PwPD. A comprehensive pool of exercises was compiled and evaluated across three rounds of e-Delphi process. Out of 473 exercises pooled from literature and experts, 99 exercises entered the e-Delphi process after deduplication and were categorized under six domains. After consensus, the final program included 42 exercises along with dosage, progression, and safety considerations. The TELEPORT-PD protocol developed through an international, e-Delphi consensus could be adapted for its use in low-resource settings worldwide.
Background:The therapeutic landscape for inflammatory bowel disease (IBD) has expanded rapidly beyond anti-tumor necrosis factor (anti-TNF) agents. We characterized the evolution of advanced therapy utilization, persistence, and outcomes in a United Arab Emirates (UAE) cohort during 2015-2025. Methods:This prospective registry study from a tertiary IBD facility in the UAE included 508 patients (333 Crohn's disease [CD], 175 ulcerative colitis [UC]). Advanced therapies were grouped by mechanism of action. We compared prescribing patterns between "Pre-2023" and "2023 and Beyond" eras. Treatment persistence was analyzed using Kaplan-Meier methods and Cox proportional hazards models. Results:Of 508 patients, 380 (74.8%) received advanced therapy. In CD, first-line anti-TNF use fell from 76% (pre-2023) to 42% (2023+), with anti-IL-23 agents emerging as a major first-line option (32%). Median time to first advanced therapy decreased dramatically: CD from 23.0 to 2.0 months (P < .0001) and UC from 37.0 to 3.0 months (P < .0001). Anti-IL-23 agents demonstrated significantly superior persistence in CD first-line therapy (P = .011 vs. anti-TNF). In multivariable analysis, anti-IL-23 therapy was associated with significantly lower discontinuation risk (HR: 0.35, 95% CI: 0.19-0.64, P = .0008). Infliximab persistence appeared to improve over time, with significantly better 1-year persistence in 2024+ versus 2018-2019 (pairwise P = .020; overall trend P = .05). A shift in UC second-line prescribing was also observed (P = .048). Early surgery rates were low across both eras (CD: 6.5% vs. 3.9%; UC: 2.5% vs. 1.9%) with no significant difference in 35-month surgery-free survival, though this analysis was underpowered. Conclusions:IBD management in the UAE has undergone a rapid paradigm shift since 2023, characterized by earlier therapy initiation and diversification away from anti-TNF dominance, particularly in CD. Superior persistence of anti-IL-23 agents in our cohort is consistent with this evolution in clinical practice and supports their further evaluation.
