Citations

Objective Inflammatory bowel disease (IBD) is increasingly recognised in the Middle East, but limited regional data hinder a clear understanding of its burden. We aimed to examine trends in IBD diagnoses, disease phenotypes and predictors of poor outcomes at a major tertiary referral centre in the United Arab Emirates (UAE). Methods In this retrospective observational study, we evaluated diagnostic trends in a cohort of 600 Arab patients between 2002 and June 2025 and analysed detailed phenotypes in a subcohort of 414 patients diagnosed since 2012. Results We observed a nearly 13-fold increase in new IBD diagnoses among Arab patients at our centre between 2002 and 2024. This cohort (median age at diagnosis 25 years; 65% Crohn’s disease (CD; n=269), 35% ulcerative colitis (UC; n=145)) demonstrated a sharper rise in CD compared with UC, with CD being diagnosed at a significantly younger age (median 25 years vs 30 years, p=0.001). A substantial proportion of patients with CD presented with complicated disease defined as stricturing (B2; 22%, n=59), penetrating (B3; 17%, n=46) and perianal (34%, n=92) disease. Ileocolonic (L3) disease was a significant predictor for presenting with a complicated phenotype (OR 3.89). Penetrating (OR 13.9), stricturing (OR 3.38) and perianal (OR 2.22) disease were significant predictors for requiring surgery. 84% of patients with CD and 62% of patients with UC were exposed to advanced therapy. A diagnosis of CD and younger age at diagnosis were associated with a higher likelihood of needing advanced therapy. Conclusions This study provides the most comprehensive data set on IBD diagnoses and phenotypes in the UAE to date, highlighting a pronounced rise in IBD overall and of aggressive disease presentations in CD in particular.

Key Points Among US preemptively waitlisted patients with CKD, deceased donor transplants increased for Black and Hispanic patients, comparable with White patients. Dialysis initiation was higher for waitlisted Asian, Black, and Hispanic patients compared with White patients, mirroring lower living donor transplants. Organ Procurement and Transplantation Network wait time credit and Increasing Organ Transplant Access metric could expand preemptive transplantation. Background Preemptive kidney transplantation (before dialysis initiation) is the optimal therapy for most transplant-eligible advanced patients with CKD. Although prior research has documented racial and ethnic disparities in preemptive referrals, less is known about distinct outcomes after preemptive waitlisting. This study examines the association between race and ethnicity and outcomes for preemptively waitlisted patients. Methods We conducted a secondary analysis of a prospectively maintained US cohort using data from the Scientific Registry of Transplant Recipients. The study population included 98,863 adult first-time kidney transplant candidates who were preemptively waitlisted from January 1, 2009, to December 31, 2020, and followed through December 31, 2024. The exposure of interest was race and ethnicity. The primary outcome was 3-year preemptive deceased donor kidney transplantation, living donor kidney transplantation, or dialysis initiation. We used competing risk models to estimate adjusted subdistribution hazard ratios (aSHRs). Data were stratified into 3-year intervals (2009–2011, 2012–2014, 2015–2017, and 2018–2020). Results Black and Hispanic patients received preemptive deceased donor kidney transplants as often as White patients (era 2018–2020, aSHRs [95% confidence interval (CI)]: 0.99 [95% CI, 0.92 to 1.07] and 1.02 [95% CI, 0.93 to 1.12], respectively), while Asian patients had lower rates (0.78 [95% CI, 0.69 to 0.88]). However, Asian, Black, and Hispanic patients were more likely to initiate dialysis (aSHRs: 1.50 [95% CI, 1.39 to 1.61]; 1.41 [95% CI, 1.34 to 1.49]; and 1.21 [95% CI, 1.14 to 1.29], respectively) and were less likely to receive preemptive living donor kidney transplants than White patients (era 2018–2020, aSHRs: 0.49 [95% CI, 0.44 to 0.54]; 0.31 [95% CI, 0.29 to 0.34]; and 0.61 [95% CI, 0.56 to 0.66], respectively). Conclusions Among waitlisted patients with CKD in the United States between 2009 and 2020, rates of preemptive deceased donor kidney transplantation improved for Black and Hispanic patients and became comparable with White patients. However, Asian, Black, and Hispanic patients experienced higher rates of dialysis initiation and lower rates of preemptive living donor kidney transplantation.

Summary Bariatric surgery and glucagon-like peptide-1 receptor agonist medications (GLP-1RAs) are common and effective methods for treating obesity. Since bariatric surgery is associated with an increased risk of malnutrition, there are extensive post-operative dietary recommendations and nutritional monitoring guidelines. There is, however, less evidence regarding the risk of malnutrition with GLP-1RAs and little research on the use of GLP-1RAs in patients post-bariatric surgery. We present a clinical case in which a 39-year-old male on semaglutide therapy presented with severe weakness and inability to ambulate. His symptoms had developed over the prior 3 months following transoral outlet reduction surgery and worsened with an increase of his semaglutide dose to 1.7 mg/week. Physical examination demonstrated severe distal-predominant bilateral lower extremity weakness, loss of lower extremity reflexes, and impaired sensation distal to the T4 dermatome. Laboratory serum testing revealed thiamine and vitamin E deficiencies. Lumbar magnetic resonance imaging demonstrated mild homogeneous enhancement of the cauda equina nerve roots, neural foraminal narrowing, and disc protrusions without significant spinal canal stenosis. Given the absence of structural abnormalities, he was diagnosed with lumbosacral polyradiculopathy due to micronutrient deficiencies. Treatment included discontinuation of semaglutide and initiation of thiamine and vitamin E supplementation. He was admitted for inpatient rehabilitation therapy and demonstrated improvement of motor and sensory symptoms over the next month. With the increasing use of GLP-1RAs, it is crucial for clinicians, dietitians, and pharmacists to understand the risk and pathophysiologic processes of these medications when used in combination with other weight-loss therapies such as bariatric surgery. Learning points While there are robust pre- and post-operative micronutrient screening guidelines for patients undergoing bariatric surgery, nutritional monitoring guidelines are limited for patients on GLP-1 receptor agonist therapy or for patients with a history of bariatric surgery who are on GLP-1 receptor agonist therapy. The use of multiple weight-loss therapies that suppress appetite and nutrient intake may increase the risk of micronutrient deficiencies. Micronutrient deficiencies can have severe neurological manifestations, which may be correctable with nutritional supplementation. Avoid initiating GLP-1 receptor agonist therapy in close proximity to bariatric surgery. Further research is needed focusing on patients using multiple weight-loss therapies. This may contribute to the development of specific nutritional and micronutrient monitoring guidelines for this population. Endocrinologists, bariatric surgeons, and primary care providers must work together to care for patients undergoing weight-loss interventions.

ABSTRACT Background Right bundle branch block (RBBB) has a high prevalence among heart transplant recipients and could influence outcomes. Crucially, the predictors of RBBB development after heart transplantation are not well‐established. Our study aims to evaluate the preoperative predictors and outcomes of RBBB following heart transplantation. Methods PubMed, Scopus, Web of Science, and Cochrane Library were searched up to November 15, 2024, to identify studies comparing heart transplant recipients with RBBB and without RBBB. Random‐effects models were used to estimate the pooled mean difference (MD) and risk ratios (RRs) with 95% confidence intervals (95% CIs). Results Nine studies incorporating 1507 patients were included. Patients who developed RBBB had higher graft ischemia time [MD: 10.0; 95% CI: 2.00–17.91; p = 0.01] and pulmonary vascular resistance (PVR) (MD: 0.44; 95% CI: 0.21–0.68; p < 0.001). There was no significant difference between RBBB and non‐RBBB patients in terms of pulmonary artery pressure (MD: 1.83; 95% CI: ‐0.86–4.53; p = 0.18) or donor age (MD: 1.51; 95% CI: ‐0.30– 3.31; p = 0.10). There was no significant difference in the prognosis of RBBB patients in terms of acute rejection (RR: 1.06; 95% CI: 0.70–1.61; p = 0.78), chronic rejection (RR: 0.92; 95% CI: 0.60–1.41; p = 0.70), or mortality (RR: 1.87; 95% CI: 0.81–4.31; p = 0.14). Conclusion Despite the association of RBBB with graft ischemia time and PVR, post‐transplant RBBB had no significant impact on mortality or graft rejection. Further research focusing on the identification period and applied definition of RBBB is recommended.

BACKGROUND AND OBJECTIVES: The therapeutic approach for small- and medium-sized vestibular schwannoma (VS) with normal hearing function remains controversial, with limited comparative data regarding hearing outcomes after stereotactic radiosurgery (SRS) or observation (OBS). We evaluated the serviceable hearing preservation, loss of American Academy of Otolaryngology-Head and Neck Surgery class A hearing, and tumor control (TC) across individuals with Koos grade I and II VSs and normal hearing at presentation who underwent SRS or OBS. METHODS: In this multicenter international study, we retrospectively analyzed the hearing, radiological, and neurological outcomes of patients who underwent SRS (SRS group) or OBS (OBS group). The cohorts were matched using propensity scores based on age, sex, tumor volume, pure-tone average, and speech discrimination score at a 1:1 ratio without replacement. RESULTS: After matching, each group comprised 57 patients. The median follow-up was 49 and 37 months for the SRS and the OBS groups, respectively ( P = .3). The 5- and 9-year serviceable hearing preservation rates in the SRS group were 76.2% and 42.4% vs 56.1% and 16.8% in the OBS group ( P = .17). Class A preservation occurred in 57.9% (33/57) of the SRS and 52.6% (30/57) of the OBS cohorts ( P = .70). Regarding the TC rates, SRS was associated with significantly higher TC rates ( P < .0001). CONCLUSION: We found that SRS is significantly superior regarding TC and provided noninferior hearing outcomes compared with OBS in VS patients with American Academy of Otolaryngology-Head and Neck Surgery class A hearing at presentation. Therefore, we suggest performing SRS in individuals with VS and normal hearing function.

BACKGROUND AND OBJECTIVES: Surgery in NF2-related schwannomatosis (NF2-SWN) vestibular schwannoma (VS) carries a higher risk of facial nerve damage, hearing loss, and partial resection, than in sporadic cases. Radiosurgery is also associated with higher failure compared with sporadic schwannomas. Nowadays, bevacizumab (BEV) is frequently considered in the NF2-SWN population. However, some patients experience progression despite treatment. Among other surgical risks, in BEV-treated patients, hemorrhage and impaired healing are specific considerations. These concerns have led manufacturers to recommend stopping BEV 6 to 8 weeks preoperatively. The aim of our multicentric study was to assess the perioperative bleeding risk and postoperative outcomes in NF2-SWN patients undergoing VS surgery after preoperative BEV treatment. METHODS: Our retrospective analysis included medical and surgical records along with imaging reviews from 4 high-volume tertiary academic referral centers for NF2-SWN and VS. RESULTS: A total of 21 patients met the inclusion criteria. VS had a mean volume of 13.2 ±7.6 cm 3 corresponding to 1 KOOS III and 20 KOOS IV. BEV was stopped at a mean of 5.8 ± 4.0 months before surgery with a total mean treatment duration of 33.7 ± 20.7 months and a monthly dose of 10.2 ± 4.1 mg/kg. Intraoperatively, the tumor was assessed to be bloody by the operating surgeons in 7 patients. Late BEV discontinuation and high cumulative dose independently predicted perioperative bleeding and longer surgery duration. No other complication such as wound dehiscence was reported. CONCLUSION: Our findings suggest that a higher cumulative BEV dose (∼600 mg/kg) and a longer interval between BEV discontinuation and surgery (∼8 months) are associated with a modest but statistically significant increase in intraoperative bleeding risk. Based on these observations, a BEV-free window between 6 weeks and 6 months (depending on the clinical scenario) before tumor resection seems optimal, particularly for patients with high cumulative exposure.

Background: Pneumocystis jirovecii pneumonia (PJP) is life-threatening for immunocompromised patients. No consensus exists on PJP prophylaxis for immunosuppressed patients without HIV, transplant, or cancer. Methods: We retrospectively reviewed the electronic health records of adult immunosuppressed patients with PJP diagnosed between 1990 and 2020 at Mayo Clinic. Patients with HIV, solid organ transplants, or cancer were excluded. Demographic data, treatments, and outcomes were manually abstracted. Results: The most common indications for immunosuppression were rheumatoid arthritis (19.7%), vasculitis (18.1%), and interstitial lung disease (ILD) not related to connective tissue disease (17.6%). Despite having high risk of PJP, 86.0% of patients did not receive PJP prophylaxis. Corticosteroids were the most common immunosuppressive agent used (84.5%), with 64.4% of patients receiving high-dose treatment. Nonbiologic disease-modifying antirheumatic drugs were used for 49.7%, including methotrexate (51.0%), azathioprine (22.9%), and hydroxychloroquine (11.5%). Biologics were prescribed for 25.4%, primarily rituximab (59.2%) and infliximab (22.4%). Hospitalization occurred for 76.7% of patients; 70.3% required intensive care unit (ICU) admission, and 46.6% received mechanical ventilation. The in-hospital mortality rate was 30.4% overall and 53.6% for patients on ventilation. Predictors of death included ILD [odds ratio (OR), 4.61; 95% CI, 1.75-13.00], ICU admission (OR, 3.60; 95% CI, 1.19-11.08), and ventilator use (OR, 3.46; 95% CI, 1.30-9.79). Biologic use was associated with lower odds of death (OR, 0.34; 95% CI, 0.11-0.89). Conclusions: Most patients in our cohort did not receive PJP prophylaxis, and outcomes were poor with high mortality rates. Standardized risk stratification and prophylaxis protocols are needed to improve outcomes.