Idiopathic short stature (ISS) is a heterogeneous growth disorder characterized by height below − 2 standard deviations from the population mean for age and sex in the absence of identifiable pathological causes. Recombinant human growth hormone (rhGH) has been approved for ISS treatment in several countries; however, region-specific evidence from Gulf Cooperation Council (GCC) countries remains sparse. This systematic review was conducted in accordance with PRISMA 2020 guidelines to evaluate the effectiveness and safety of rhGH therapy in children with ISS across GCC countries. Six information sources were searched for peer-reviewed studies published between January 2015 and July 2025. Study selection, data extraction, and quality appraisal were performed independently by two reviewers. Due to substantial clinical and methodological heterogeneity across the included studies, data were synthesized narratively. Seven observational studies enrolling a combined ISS cohort of 301 children from the UAE, Saudi Arabia, Qatar, and Kuwait were included. All studies reported positive growth responses to rhGH therapy, measured predominantly by change in height standard deviation score (ΔHtSDS). First-year ΔHtSDS ranged from + 0.17 (median, IQR 0.16–0.41) to + 0.58 ± 0.31, with most studies reporting gains of + 0.3 to + 0.5 SDS. Longer treatment duration was associated with greater cumulative gains, with some cohorts exceeding + 1.0 SDS at final adult height (FAH). Reported adverse events were predominantly mild; no serious adverse events were reported, although adverse-event reporting was incomplete. rhGH therapy is associated with consistent, though modest and variable, improvements in linear growth in children with ISS across GCC countries. Growth benefit accumulates with continued therapy. Standardized prospective multicenter studies within the GCC region are required to strengthen the evidence base and improve cross-study comparability.
Accurate staging of liver fibrosis is critical for guiding antifibrotic therapy and predicting disease prognosis. Liver biopsy, the current reference standard, is invasive, costly, and subject to significant sampling error. Although T2-weighted MRI and B-mode ultrasound offer established noninvasive alternatives, existing deep learning approaches are validated on a single imaging modality and lack visual interpretability. This study proposes HybridDenseViT, an explainable framework for multi-stage liver fibrosis classification applying a shared feature extraction backbone across both modalities. HybridDenseViT integrates DenseNet-121 for local texture feature extraction with ViT-B/16 for long-range spatial dependency modelling via a dual-branch parallel architecture. Training and evaluation used five-fold cross-validation: patient-level StratifiedGroupKFold on a 4-class T2W-MRI dataset (6,964 slices; 305 patients; cirrMRI600+; F0–F3) and image-level StratifiedKFold on a 5-class B-mode ultrasound dataset (6,323 images; METAVIR F0–F4). Class imbalance was corrected through an ordinal-aware class-weighted loss. Explainability used LayerCAM on the DenseNet-121 branch and Attention Rollout on the ViT-B/16 branch. On MRI, HybridDenseViT achieved an OOF Quadratic Weighted Kappa (QWK) of 0.9154 (95
Retained primary teeth are primary teeth that stay on the dental alveolus beyond their normal time without eruption of the respective permanent teeth. We present a case of well-preserved bilateral retained primary second molars in an adult following a fortuitous discovery presenting without root resorption nor infraocclusion. The most distal tooth in each tooth group is usually the congenitally absent tooth.
Prehypertension is the initial stage of the risk pathway of CVD, which commonly associates with hidden metabolic derangements such as insulin resistance and dyslipidemia. In the clinical setting, convenient, inexpensive predictors for early screening are required, particularly in underprivileged countries. This study evaluated the discriminatory performance of TyG, TyG-BMI, and lipid-derived indices for identifying cardiometabolic risk among adults with prehypertension. A cross-sectional study was carried out among 110 apparently healthy adults (70 prehypertensive and 40 normotensive) in Owo, Nigeria. Anthropometric measurements, along with biochemical assessments and blood pressure readings, were collected. The TyG index, TyG-BMI, and lipid indices were estimated. Then, comparative grouping was performed, correlation analysis was conducted, logistic regression was applied, and ROC curve analysis was performed. In the prehypertensive group, TyG (p = 0.001) along with TyG-BMI (p < 0.001) was noticeably higher compared with the control group. TyG-BMI demonstrated the strongest correlation with systolic and diastolic blood pressure parameters (p < 0.001), whereas the other measurements were not statistically significant. Looking at the ROC results, TyG-BMI performed best in terms of discriminatory capacity (AUC = 0.861), then TyG (AUC = 0.685). Meanwhile, the lipid-related indices were less convincing, with AUC values staying below 0.50. When the variables were combined, the prediction improved slightly (AUC = 0.870). Even after the adjustments, TyG-BMI remained the main independent predictor for prehypertension (adjusted OR = 4.85, p < 0.001). TyG-BMI showed better discrimination among the evaluated indices, and may serve as a simple surrogate marker of subjects at high cardiometabolic risk. Further validation studies are required before its routine clinical application.
Substance Use Disorder (SUD) is a chronic, relapsing condition that poses a significant public health challenge in Iraq. Evaluating the work system within specialized centers is essential for identifying barriers to effective patient management. This study aimed to explore healthcare providers’ (HCPs) perspectives on factors shaping patient management and treatment acceptance in specialized SUD centers in Baghdad, utilizing the Systems Engineering Initiative for Patient Safety (SEIPS) model. A qualitative study was conducted between December 2023 and July 2024 at two specialized facilities: a social rehabilitation center (Site A) and an addiction treatment hospital (Site B). Semi-structured face-to-face interviews were held with 28 HCPs, including psychiatrists and nurses. Data were analyzed using Braun and Clarke’s thematic analysis framework and organized according to the five SEIPS domains: person, tasks, tools/technology, organization, and environment. Key findings across the SEIPS domains revealed significant systemic barriers. In the Person domain, HCPs highlighted inadequate specialized training and weak patient willpower fueled by the availability of substances. Tasks were characterized by the high effort required for continuous counseling and managing aggressive behavior. In the Tools and Organization domains, severe shortages of specialized staff, lack of electronic health records, and inadequate assessment spaces were reported. Environmentally, overcrowding and the “prison-like” atmosphere of facilities negatively impacted patient motivation. Effective SUD management in Iraq is hindered by structural limitations, workforce shortages, and environmental stressors. Enhancing treatment outcomes requires a multidisciplinary approach, including specialized staff training, infrastructure modernization, and stronger inter-ministerial collaboration to address post-discharge relapse triggers.
