Amgad Mohamed Elshoeibi

Study Design: Case report. Objective: To describe the surgical strategy and clinical outcome of a single-session 270-degree decompression, fixation, and realignment procedure for a neglected subaxial cervical facet dislocation. Summary of Background Data: Neglected cervical facet dislocations are rare but challenging injuries that often present with chronic pain, neurological deficit, and fixed kyphotic deformity. Delayed management is complicated by facet fusion, spinal cord compression, and loss of reduction potential, frequently necessitating complex circumferential reconstruction strategies. Methods: A 22-year-old male presented 1 year after a road traffic accident with persistent neck pain, radiculopathy, bilateral upper limb weakness, and gait imbalance. Computed tomography and magnetic resonance imaging demonstrated C3–C4 anterolisthesis with right-sided facet fusion, a locked facet on the left, and severe canal stenosis with cord compression and cord signal changes. Under neurophysiological monitoring, a single-session circumferential “270 degrees” procedure was performed: posterior partial facetectomy and unilateral lateral mass screw fixation, followed by anterior C4 corpectomy, decompression, cage insertion with plating, and completion of posterior rod fixation for definitive stabilization and realignment. Results: The patient tolerated the procedure without intraoperative complications. Postoperatively, he experienced marked improvement in radicular pain, handgrip strength, and gait stability. Follow-up radiographs confirmed restoration of cervical alignment and correction of lordosis, and he continued to demonstrate neurological recovery with a structured rehabilitation program. At 3-year follow-up, the patient remained neurologically intact with mild intermittent neck pain and stable radiographic alignment. Conclusions: A carefully planned single-stage 270-degree decompression and fusion strategy can provide effective neural decompression, correction of deformity, and restoration of mechanical stability in neglected cervical facet dislocations, enabling meaningful neurological recovery. Early recognition and careful preoperative planning of circumferential surgery are particularly important in settings where delayed presentation is common.

Body Dysmorphic Disorder (BDD) is a condition characterised by intrusive thoughts of ugliness and deformity. The efficacy of cognitive behavioural therapy (CBT) in treating BDD remains debatable despite results from several randomised controlled trials (RCTs). This study evaluated the current evidence on the efficacy of CBT compared to placebo or other interventions for treating BDD. We conducted a systematic review and meta‐analysis of RCTs. Following a database search, the quality effects (QE) model was used to synthesise standardised mean differences and 95% confidence intervals for outcomes including BDD symptoms, insight, depression, body image, anxiety, global functioning and quality of life. Stratified analyses were based on outcome scale, CBT delivery mode and modality, control group type and country. Heterogeneity was assessed using the I ² statistic and publication bias using funnel and Doi plots and the LFK (Luis Furuya‐Kanamori) index and the trim‐and‐fill analysis. Evidence quality was evaluated using the GRADE framework. The meta‐analysis included 19 RCTs (978 participants), demonstrating that CBT significantly improved BDD symptoms (SMD = −1.17, CI: −1.92, −0.43, I ² = 93.3%), body image (SMD = −1.90, CI: −4.22, −0.42, I ² = 97.2%) and global functioning (SMD = 0.63, CI: 0.28, 0.98, I ² = 65.0%). CBT showed non‐significant effects on insight (SMD = −0.93, CI: −2.09, 0.22, I ² = 96.7%), depression (SMD = −0.73, CI: −1.56, 0.10, I ² = 94.8%) and quality of life (SMD = 0.87, CI: −0.35, 2.09, I ² = 94.4%). In conclusion, CBT was efficacious in alleviating BDD symptoms, anxiety, body image concerns and improving global functioning. Face‐to‐face, online and non‐specialised CBT for BDD were also efficacious; however, further investigation is needed to explore the sources of the observed heterogeneity.

Transfusion requirements as a surrogate marker of mortality and morbidity in adults with severe burns: A retrospective cohort study - Turkish Journal of Surgery

Perioperative airway events in pediatric patients with obesity undergoing bariatric surgery: A retrospective cohort - Turkish Journal of Surgery

Background/Objective: This study aimed to determine the clinicopathological findings and prognostic value of chemokine receptor 7 (CCR7) expression in patients with breast cancer (BC). Methods: Up to the 25th of March 2025, a search was conducted using five databases: PubMed, Embase, Scopus, Medline, and Web of Science. The methodological standards for the epidemiological research scale were used to assess the quality of the included articles, and Stata software (Stata 19) was used to synthesize the meta-analysis. Results: We considered 12 of 853 studies that included 3119 patients with BC. High CCR7 expression was not associated with age (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66–1.03); clinicopathological findings, including tumor size (OR 1.062, 95% CI 0.630–1.791); clinical stage (OR 1.753, 95% CI 0.231–13.304); nodal metastasis (OR 1.252, 95% CI 0.571–2.741); or histological differentiation (OR 1.167, 95% CI 0.939–1.450). CCR7 expression did not affect overall survival (hazard ratio 0.996, 95% CI 0.659–1.505). Conclusions: Our quantitative analysis did not reveal an association between CCR7 expression and poor clinicopathological or prognostic features in BC patients. Because of the high heterogeneity and potential publication bias, large high-quality studies are required to further confirm these findings.

Background: Obesity poses significant challenges by altering upper airway anatomy and making mask ventilation and tracheal intubation difficult. In 2023, 46.1% women and 35.9% men > 18 years were classified as obese in Qatar, yet intubation complications in this group have not been extensively studied. The aim of this study was to evaluate the frequency and types of intubation complications in adults with severe obesity undergoing bariatric surgery and to identify incidence of difficult intubation and associated risk factors. Methods: In this retrospective cohort study, 2421 patients (1664 females and 746 males) were analyzed. All patients with severe obesity aged over 18 years with a BMI of 40 kg/m² or higher, who underwent bariatric surgery from January 2014 to January 2024, were included. Difficult intubation was defined as the need for video laryngoscopy, cricothyrotomy, intubation via a supraglottic airway device, use of a stylet or bougie, more than one intubation attempt, or desaturation during intubation. Results: None of the patients experienced any complications of interest. Video laryngoscope was used in 85 patients (3.5%), first-attempt intubation success rate was 95.4%, with more than one attempt required in 4.6% of cases. Logistic regression revealed that the odds of complicated intubation were 1.5 times higher in patients with a BMI > 60, 8.9 times higher in those with Cormack-Lehane class IV, and 5.1 times higher in patients with Mallampati score of IV. Comorbidities increased the odds by 1.3 times, with asthmatic patients having 2.1-fold higher odds. Conclusion: This study highlights the challenges of tracheal intubation in patients with severe obesity undergoing bariatric surgery and the need for tailored strategies to manage these difficulties.

Background: Humeral shaft fractures account for 1–3% of all bone fractures. Conservative treatment often leads to complications such as non-union and shoulder stiffness. Surgical fixation with a dynamic compression plate (DCP) has been the gold standard treatment. Intramedullary nailing (IMN) has recently gained popularity due to its minimally invasive approach and reduced risk of radial nerve injury. This study aims to compare the outcomes of IMN and plate fixation for humeral shaft fractures. Methods: This retrospective study included patients with humeral shaft fractures treated with either IMN or DCP fixation at Hamad General Hospital between April 2015 and October 2018. Patient demographics, fracture characteristics, surgical outcomes, and complications were collected. Descriptive statistics were used to summarize patient information, and univariate analysis was conducted to compare both groups. A Cox proportional hazards model, adjusted for age, gender, and polytrauma status was applied to compare time to union between IMN and DCP groups. Results: Sixty five patients (25 IMN, 40 plate fixation) were included. Non-union rates were higher in the DCP group than in the IMN group (13% vs. 4%). Reoperation rates were also higher in the DCP group (20% vs. 4%). Postoperative neuropathy rates were 4% for IMN and 10% for DCP, with neuropathy resolution significantly higher in the IMN group (92% vs. 68%). Shoulder range of motion (ROM) and pain favored the DCP group, with 98% unaffected ROM in the plate group compared to 76% in the IMN group ( p = 0.007), and a lower incidence of shoulder pain (28% vs. 98%, p < 0.001). Time to union was comparable between both groups, with an adjusted hazard ratio of 1.08 (95% CI 0.62–1.90; p = 0.776). Conclusion: IMN and plate fixation effectively achieved fracture union; however, plate fixation was associated with better shoulder function, reduced pain, and higher reoperation rates. IMN was linked to a lower risk of nerve injury but compromised shoulder ROM and resulted in more postoperative pain.

Background and Objective: Estimates of the prevalence of the autism spectrum disorder (ASD) in the Middle East and North Africa (MENA) region are not readily available, amid a lack of recent evidence. In this study, we estimated the prevalence of ASD in the MENA region by synthesising evidence from published studies in the region. Methods: In this systematic review and meta-analysis, we searched PubMed, EMBASE, Scopus, and CINAHL databases for studies which assessed ASD prevalence in the MENA region. Risk of bias was assessed using the Newcastle Ottawa scale. A bias-adjusted inverse variance heterogeneity meta-analysis model was used to pool prevalence estimates from included studies. Cochran’s Q statistic and the I ² statistic were used to assess heterogeneity, and publication bias assessed using funnel and Doi plots. Results: A total of 3075 studies were identified, 16 studies of which met the inclusion criteria and involved 3,727,731 individuals. The studies were published during the period 2007-2022, and included individuals from Iran, Oman, Libya, Egypt, Kingdom of Saudi Arabia (KSA), Lebanon, United Arab Emirates (UAE), Bahrain and Qatar. Estimates of ASD prevalence ranged from 0.01% in Oman during the period June 2009-December 2009, to a high of 2.51% in the Kingdom of Saudi Arabia during the period December 2017-March 2018. The pooled prevalence of ASD was 0.13% (95% CI: 0.01% – 0.33%), with significant heterogeneity (I ² = 99.8%). For Iran, the only country with multiple analysable studies, an overall prevalence of 0.06% (95% CI: 0.00 – 0.19, I2=97.5%, n= 6 studies) was found. A review of data from countries with repeated studies suggested that the prevalence of ASD is increasing. Conclusion: Estimates of the prevalence of ASD vary widely across the MENA region, from 0.01% in Oman to 2.51% in Saudi, with an overall prevalence of 0.13%. Existing data suggests a trend towards increasing prevalence in the region. More and better-quality research is needed to provide up to date ASD prevalence estimates. Registration: The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42024499837.

Background and Objectives: The etiology of autism spectrum disorder (ASD) is poorly understood, with sparse data from the Middle East and North Africa (MENA) region, which has a unique climate and socio-epidemiological setting. This research investigated the developmental (early life) risk factors associated with ASD in the MENA region. Methods: In this systematic review and meta-analysis, we searched for observational studies, which carried out adjusted analyses for ASD risk factors in the MENA region, in PubMed, Embase, Scopus, and CINAHL databases. We analyzed associations between ASD and factors related to conception, inheritance, maternal morbidity during pregnancy and adverse pregnancy outcomes. After study quality assessment, meta-analyses for each risk factor were carried out using the bias-adjusted inverse variance heterogeneity model. Heterogeneity was assessed using I ² and publication bias using Doi and funnel plots. Results: The systematic review included 19 case control studies from eight countries within the MENA region. In overall synthesis, male sex (OR=3.27, 95% CI: 2.39-4.48, I2 = 40.9%), family history of ASD (OR=2.98, 95% CI: 0.51-17.31, I2 = 85.0%), and consanguinity (OR= 1.77, 95% CI: 1.38-2.28, I2 = 57.1%) were associated with ASD. Although with limited studies, a review of the literature showed some possible associations between ASD and gestational diabetes, gestational hypertension, macrosomia, NICU admission, respiratory distress syndrome, cesarean delivery, gestational age, and older maternal age. Conclusion: These findings confirm the association between male sex, family history of ASD and consanguinity with ASD, potentially suggesting some inherited mechanism in the etiology of ASD in the MENA region. Some maternal co-morbidities during pregnancy and adverse pregnancy outcomes may contribute to ASD risk in the MENA region, although more studies are needed in the region. Registration: The protocol for this systematic review and meta-analysis is registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42024499837.