Rajani Dube

Background/Objectives: Blood flow restriction (BFR) training is increasingly combined with neuromuscular electrical stimulation (NMES) in musculoskeletal rehabilitation to augment strength and hypertrophy, but whether NMES adds benefit beyond BFR alone remains uncertain. This systematic review and meta-analysis compared combined BFR + NMES with BFR alone for muscle strength, muscle morphology (mass, thickness, cross-sectional area), neuromuscular activation, and functional performance. Methods: Randomized trials comparing simultaneous BFR + NMES with BFR alone were eligible. MEDLINE via PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception through 15 September 2026. Two reviewers independently screened studies and extracted data; risk of bias was assessed with Cochrane RoB 2 and certainty with GRADE. Random-effects meta-analysis was restricted to independent parallel-group comparisons; crossover and limb-randomized results were pooled only when paired effect estimates and variances were available, otherwise synthesized narratively. The protocol was registered in PROSPERO (CRD420251076162). Results: Five randomized trials involving 174 participants were included. The studies represented healthy-participant training, experimental limb disuse, acute physiological responses, and low-load training in football players with knee osteoarthritis. Quantitative synthesis of torque-based strength found no clear difference between BFR + NMES and BFR alone (MD −41.78 Nm, 95% CI −396.68 to 313.12; p = 0.375; 2 trials, 52 participants), with substantial statistical heterogeneity. Cross-sectional area and rectus femoris EMG RMS were each reported by only two trials and were synthesized narratively. Certainty of evidence was very low across all outcomes. Conclusions: Current evidence does not establish a consistent additional benefit of adding NMES to BFR. The pooled torque-based estimate is exploratory because of the small evidence base, substantial statistical heterogeneity, imprecision, and differences in clinical context and outcome measurement. A possible effect on preserving muscle mass during short-term experimental disuse remains preliminary. None of the included trials directly investigated BFR + NMES following anterior cruciate ligament reconstruction (ACLR), and its effectiveness in this population remains undetermined.

Introduction: Impostor syndrome (IS) is characterized by persistent self-doubt and fear of intellectual fraudulence despite objective evidence of competence. Although widely studied in Western academic and medical settings, limited data exists from non-Western institutions, particularly within the Middle East. Medical and health sciences environments may disproportionately foster impostor feelings due to high performance expectations, frequent evaluations, and hierarchical structures. This study aimed to investigate the prevalence of IS and its associated risk factors among faculty and students in academic institutions, with the goal of informing support initiatives and interventions. Methodology: A cross-sectional questionnaire survey was conducted among students and faculty from all constituent colleges at of Ras Al-Khaimah Medical and Health Sciences University over 6 months using the Clance Impostor Phenomenon Scale and coping strategies. Results: A total of 373 participants completed the survey, with a prevalence of 56.8%, of whom 10.1% had intense IS. Females, medical students, and the age group of 20–30 years were at higher risk of IS. Faculty and students, as well as different colleges, have individualized combination of coping strategies for IS. Conclusions: Prevalence of IS is high among both students and faculty in a medical academic environment, with students and female participants experiencing higher severity. Identification of associated risk factors and coping strategies underscores the importance of targeted institutional interventions to support mental well-being and academic success.

Background: Postoperative sepsis and related infectious complications remain major causes of morbidity after abdominal surgery. Artificial intelligence (AI) and machine learning (ML) models may support earlier risk stratification, but their generalizability and clinical readiness remain uncertain. Methods: We systematically searched PubMed, Scopus, and CENTRAL from inception to 10 August 2026 for studies developing, validating, or evaluating AI/ML models for postoperative sepsis, postoperative infection/surgical-site infection (SSI), anastomotic leakage, or postoperative pancreatic fistula (POPF) after major abdominal or general surgery. SSI, anastomotic leakage, and POPF were analyzed as distinct postoperative endpoints and were not treated as proxy definitions of clinical sepsis. Study selection and data extraction were performed independently by two reviewers, and risk of bias and applicability were assessed using PROBAST + AI. Owing to substantial clinical and methodological heterogeneity, results were synthesized narratively. The review was registered in PROSPERO (CRD420261492111). Results: Forty-five studies were included: 11 addressed sepsis-related outcomes, including six studies with a primary sepsis-related modeled endpoint whose definitions ranged from consensus Sepsis-3 criteria to coded or SIRS-based definitions and a qSOFA-based proxy; 19 evaluated postoperative infection/SSI; eight anastomotic leakage; five POPF; and two broader postoperative complications. Performance varied according to outcome, surgical population, prediction timing, predictor availability, and validation strategy. Fifteen of 45 studies provided strict temporal, geographic/external-center, or independent-investigator evaluation of the principal model, with variable preservation of performance outside development settings. More complex ML methods did not reliably outperform conventional regression. Explicit calibration analysis was reported in 9/45 studies, decision-curve or net-benefit analysis in 7/45, and no study prospectively evaluated the impact of model-guided care on clinical outcomes. Certainty of evidence was very low for primary postoperative sepsis/septic-shock prediction, low for postoperative infection/SSI, and very low for anastomotic leakage and POPF. Conclusions: Although several AI/ML models showed promising predictive performance, the available evidence remains insufficient to support routine use of AI/ML prediction models across major abdominal surgical populations. Future studies should prioritize clearly defined clinical use cases, multicenter external validation, calibration, prospective workflow evaluation, and demonstration of actionable clinical benefit before routine implementation.

Handgrip strength is a simple and objective measure of muscle function, increasingly associated with physical and psychological health. However, data regarding its link to anxiety and depression in young adults remain limited. The aim of this study was to assess handgrip strength in healthy university students and examine its association with symptoms of anxiety and depression. This cross‐sectional study included 216 undergraduate students (mean age: 20.6 ± 4.7 years). Handgrip strength of each participant was measured using a digital hand dynamometer. Symptoms of anxiety and depression were assessed using the GAD‐7 (Generalized Anxiety Disorder‐7) and the PHQ‐9 (Patient Health Questionnaire‐9), respectively. Pearson correlations and independent sample t ‐tests were used for statistical analysis. Handgrip strength showed a small but statistically significant negative correlation with PHQ‐9 (left hand: r = −0.148, p = 0.030) and GAD‐7 (left hand: r = −0.185, p = 0.006) scores. These associations were stronger in female participants. Anxiety and depression scores were strongly positively correlated ( r = 0.705, p < 0.001). The results of this study indicate lower handgrip strength was associated with higher anxiety and depression symptoms in healthy university students, especially in female students. However, further longitudinal studies are needed to establish causality.

Background/Objectives: Cell-based therapies have been proposed as a regenerative treatment for female stress urinary incontinence (SUI), but their efficacy, safety, and optimal delivery characteristics remain uncertain. The aim of this review is to systematically evaluate the post-treatment clinical response and safety of cell-based injection therapies for female SUI and explore factors associated with post-treatment response. Methods: PubMed, Scopus, and the Cochrane Library were searched from inception to 15 February 2026, and the search was subsequently updated through 25 April 2026 to identify newly published studies. Randomized controlled trials and prospective single-arm studies evaluating urethral injection of cell-based therapies in adult women with SUI were included. Random-effects meta-analysis was used to pool study-defined post-treatment response proportions. Subgroup analyses examined response definition, cell source, urinary incontinence type, ultrasound guidance, injection approach, and post-treatment physiotherapy. Continuous moderators were explored using univariable meta-regression. Placebo-controlled randomized trials reporting a common 12-month response endpoint were additionally pooled using risk ratios (RR). Results: Twenty-one studies involving 885 women were included. Seventeen studies contributed to the pooled post-treatment response analysis. The overall response proportion was 63.7% (95% confidence interval [CI] 56.7–70.5%), with moderate-to-substantial heterogeneity (I² = 62.6%). Exploratory subgroup analyses showed higher post-treatment response in ultrasound-guided cohorts than non-ultrasound-guided cohorts (78% vs. 57%; p < 0.001), in cohorts restricted to pure SUI compared with those including mixed urinary incontinence (76% vs. 55%; p < 0.001), and in cohorts incorporating post-treatment physiotherapy compared with those without physiotherapy (78% vs. 58%; p < 0.001). Two placebo-controlled randomized trials reporting ≥ 50% reduction in stress incontinence episode frequency at 12 months were included in an exploratory comparative meta-analysis. The analysis showed no significant difference between cell therapy and placebo (RR 1.02, 95% CI 0.85–1.23; p = 0.85). Reported adverse events were predominantly minor and transient, commonly comprising irritative urinary symptoms, urinary tract infection, and biopsy- or injection-site complications. Serious treatment-related adverse events were rare, and no treatment-related deaths were reported. Conclusions: Stem cell-based injection therapy for female SUI is associated with encouraging post-treatment response rates and a generally favorable short- to medium-term safety profile. However, this estimate cannot be interpreted as treatment-specific efficacy. The available placebo-controlled randomized evidence did not demonstrate a higher 12-month response with cell therapy than placebo. Cell-based therapy should therefore remain investigational, pending adequately powered, controlled trials and long-term follow-up.

Background/Objectives: Vaccination is the most important way to prevent infection-related morbidity and mortality, but delays in the acceptance or refusal of vaccines despite the availability of vaccination services can adversely affect health outcomes. Methods: This is a cross-sectional congruent parallel mixed-methods study exploring vaccine-related knowledge, attitudes and practices and factors associated with vaccine acceptance or hesitancy. A validated questionnaire was used to collect responses from pregnant women. Results: A total of 326 women participated in the study. The majority of women were over 30 years old, educated, had higher incomes, and had been pregnant before. Of the participants, 94.7% had adequate knowledge of vaccine services, 64% relied on more than one source of information, and the majority (89%) relied on information from doctors. In total, 93.5% held a positive attitude towards vaccination, and the majority accepted it. A total of 159 (48.7%) self-reported a moderate to strong vaccine hesitancy (VH). Qualitative analysis showed that those who had strong VH expressed mistrust, social media information, safety concerns regarding newer vaccines, and religious beliefs as influencing factors. Factors significantly affecting VH were education, household income, adequate knowledge, and appropriate attitude. Other factors were knowledge gaps, perceived necessity, distrust, and belief in natural immunity. Hesitancy positively correlated with being a homemaker and being parous, but the difference was not statistically significant. Conclusions: This study reveals a population with generally favorable vaccine attitudes and high vaccination intentions, alongside significant underlying hesitancy. Knowledge gaps exist, and healthcare professionals remain the most trusted information source. Addressing the identified barriers through evidence-based, culturally sensitive, and community-engaged strategies will be essential for maintaining high vaccination coverage and preventing future outbreaks.

Post-hemorrhagic hydrocephalus (PHH) is a serious neurological sequela of severe intraventricular hemorrhage (IVH) in premature infants and remains one of the leading indications for ventriculoperitoneal (VP) shunt placement. Evaluating possible VP shunt-related complications can be challenging because clinical manifestations are often nonspecific, neuroimaging may initially appear unchanged, and microbiological cultures may remain negative. We report the case of a 19-month-old male born at 28 weeks’ gestation who developed Grade IV germinal matrix/intraventricular hemorrhage with bilateral intraparenchymal extension, early periventricular cystic leukomalacia, and post-hemorrhagic communicating hydrocephalus requiring multiple cerebrospinal fluid diversion procedures culminating in long-term VP shunt dependence. His medical history was notable for recurrent neonatal meningitis, secondary epilepsy with previous episodes of status epilepticus, secondary adrenal insufficiency, and severe global developmental delay. He presented with fever, recurrent coffee-ground vomiting, abdominal distension, progressive lethargy, reduced responsiveness, and localized erythematous swelling over the cranial VP shunt reservoir, raising concern for possible shunt-related pathology. During hospitalization, he deteriorated with status epilepticus and respiratory failure, with clinical concern for increased intracranial pressure, requiring admission to the Pediatric Intensive Care Unit (PICU). Laboratory investigations demonstrated leukocytosis, elevated C-reactive protein, cerebrospinal fluid pleocytosis, markedly elevated CSF protein, and CSF glucose of 2.0 mmol/L, for which a paired serum glucose value was unavailable, while repeated blood, urine, wound, and CSF cultures remained negative. Initial computed tomography (CT) demonstrated no significant interval change in the chronic hydrocephalus despite progressive neurological deterioration; however, serial neuroimaging later revealed progressive bilateral extra-axial fluid collections with radiological features suggestive of an evolving subacute subdural hemorrhage. The patient was managed with empirical broad-spectrum intravenous antibiotics, aggressive seizure control, stress-dose corticosteroids, respiratory support, and continuous multidisciplinary monitoring. His neurological and respiratory status subsequently improved, and he returned to his pre-admission neurological baseline before discharge with planned further evaluation at a tertiary pediatric neurosurgical center. This case highlights the diagnostic uncertainty surrounding acute neurological deterioration in a child with shunt-dependent PHH. VP shunt-related infection or malfunction remained important but unconfirmed diagnostic considerations, alongside competing or potentially overlapping contributors including status epilepticus, evolving extra-axial collections, respiratory infection, and endocrine or metabolic decompensation. No single etiology was definitively established. The case emphasizes the importance of serial neurological assessment, consideration of alternative diagnoses, repeat neuroimaging, and multidisciplinary evaluation when initial investigations do not establish the cause of deterioration.

Background/Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with ischemic stroke, systemic thromboembolism, heart failure, and mortality. Although oral anticoagulation (OAC) remains the cornerstone of stroke prevention, long-term therapy may be limited by bleeding risk, contraindications, intolerance, nonadherence, or thromboembolic events despite treatment. Left atrial appendage closure (LAAC) has therefore emerged as a non-pharmacological alternative for selected patients with nonvalvular AF. This review aimed to synthesize current evidence on LAAC, focusing on comparative efficacy versus OAC, device evolution, imaging-guided strategies, antithrombotic management, procedural optimization, unresolved challenges, and emerging technologies. Methods: This state-of-the-art narrative review was informed by targeted, non-systematic searches of PubMed and Scopus for publications from January 2009 to June 2026. Evidence was selected purposively to represent clinically relevant guidelines, randomized trials, registries, comparative observational studies, systematic reviews, meta-analyses, imaging studies, device-comparison studies, and reports of emerging technologies. The selected evidence was synthesized narratively; no exhaustive screening process, PRISMA flow diagram, formal risk-of-bias assessment, or quantitative synthesis was performed. Results: Randomized evidence was context dependent. OPTION supported LAAC as an alternative to oral anticoagulation in selected anticoagulation-eligible patients undergoing atrial fibrillation ablation. CHAMPION-AF established noninferiority of Watchman FLX to non–vitamin K antagonist oral anticoagulants for its composite efficacy endpoint in a predominantly moderate-risk, anticoagulation-eligible population and demonstrated less non-procedural bleeding, although ischemic stroke occurred numerically more often after LAAC. In contrast, CLOSURE-AF did not establish noninferiority of LAAC to physician-directed medical therapy in an older population at high risks of both stroke and bleeding. These findings indicate that the comparative value of LAAC depends strongly on patient selection, comparator therapy, endpoint composition, procedural risk, and trial design. Observational, registry, and emerging evidence was considered supportive or hypothesis-generating rather than equivalent to randomized evidence. OPTION enrolled only patients undergoing or recently undergoing AF ablation who were suitable for anticoagulation. CHAMPION-AF included 3000 anticoagulation-eligible patients but had relatively low baseline bleeding risk, while CLOSURE-AF studied 912 substantially older, higher-risk patients and did not meet its noninferiority criterion. Conclusions: LAAC has evolved into a precision-guided intervention integrating patient risk, left atrial appendage anatomy, device choice, imaging, antithrombotic therapy, and structured surveillance. Further studies are needed to optimize patient selection, standardize post-procedural therapy, and clarify its long-term role compared with contemporary direct oral anticoagulant therapy.

Background/Objectives: Kidney transplantation is the most effective treatment for pediatric patients with end-stage renal disease (ESRD), offering superior survival rates and quality of life compared to dialysis. However, long-term graft survival remains a complex clinical and surgical challenge. This systematic review aims to evaluate short- and long-term graft outcomes and comprehensively analyze the primary clinical, immunological, and procedural risk factors driving pediatric graft failure. Methods: A comprehensive search was conducted across the PubMed database, yielding 289 initial records. Following duplicate removal and systematic title and abstract screening, 108 full-text articles were evaluated for eligibility. Ultimately, 35 high-quality studies met the full inclusion criteria and were selected for final data synthesis and analysis. Results: Synthesized data revealed high short-term outcomes, with a 1-year graft survival rate of 94.60%. However, survival experienced a steady decline over time, dropping to 59.50% at the 10-year mark. Acute rejection episodes and delayed graft function (DGF) were identified as the primary immunological primary risk factors. Furthermore, specific donor characteristics, early surgical complications (such as vascular thrombosis), post-transplant infections affecting nearly 45% of patients, and adolescent non-adherence to immunosuppressive regimens were heavily associated with accelerated graft failure. Conclusions: While short-term success in pediatric kidney transplantation is highly encouraging, long-term graft longevity requires targeted clinical interventions. Optimizing outcomes necessitates precise, lifelong management strategies specifically focused on mitigating chronic rejection, preventing post-operative infections, and implementing multidisciplinary support systems to enhance patient adherence to immunosuppressive therapy.

Background: Multisystem inflammatory syndrome in children (MIS-C) was recognized in 2020 as a post-infectious hyperinflammatory condition occurring 2–6 weeks after SARS-CoV-2 infection. While large studies from Europe and North America have described its clinical spectrum and outcomes, evidence from the Middle East remains limited. MIS-C shares features with Kawasaki disease (KD), including persistent fever, mucocutaneous manifestations, and cardiac involvement, but differs in age distribution, gastrointestinal involvement, and patterns of cardiac injury. Objective: To map the reported Middle Eastern evidence on the clinical and laboratory phenotype, Kawasaki-like manifestations, cardiovascular involvement, management, short-term outcomes, and evidence gaps in children with MIS-C. Methods: A scoping review was conducted using the Arksey and O’Malley framework, guided by Joanna Briggs Institute methodology and reported according to PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science, and the WHO COVID-19 database were searched for studies published from 1 December 2020 through 30 September 2025. Two reviewers independently screened records in Rayyan and charted data using standardized forms. Findings were synthesized descriptively; numerical ranges reflect values reported across selected contributing studies and are not pooled regional estimates. Results: Twenty-seven original clinical studies met the eligibility criteria, including case reports, case series, and observational cohorts from the UAE, Saudi Arabia, Qatar, Jordan, and multinational Middle Eastern collaborations. Across the included reports, affected children were generally older than the typical classic Kawasaki disease population. Gastrointestinal symptoms were commonly reported, and myocardial dysfunction was reported more frequently than coronary artery abnormalities. Most patients received intravenous immunoglobulin, often combined with corticosteroids. Short-term outcomes were generally favorable, but the evidence was heterogeneous and follow-up was limited. No meta-analysis was performed. Conclusions: The available Middle Eastern literature suggests that MIS-C commonly presents in school-aged children with gastrointestinal, mucocutaneous, and myocardial involvement. These patterns are descriptive rather than definitive because the evidence is predominantly retrospective, geographically uneven, and methodologically heterogeneous. The principal contribution of this review is to map the regional literature and identify priorities for prospective, standardized, multicenter studies and long-term follow-up.