Ahmed Sermed Al Sakini

Background: Equitable representation in clinical trials (CTs) is essential for the validity, generalizability, and ethical integrity of medical research. However, participation from low- and middle-income countries (LMICs) remains disproportionately low, particularly in the Middle East and North Africa (MENA) region. Iraq, despite a substantial disease burden, has minimal participation in global clinical research, and patient-level determinants of CT engagement remain largely unexplored. Understanding patient perceptions in these settings is essential to enhance recruitment in CTs. Purpose: To assess awareness, willingness, motivators, and concerns regarding CT participation among Iraqi patients, and to identify demographic and perceptual factors associated with willingness to participate. Methods: A multi-center, cross-sectional study was conducted using a validated 16-item interviewer-administered survey among patients attending five major teaching hospitals in Baghdad, Iraq, between October 2023 and February 2024. The survey assessed demographic characteristics, awareness of CTs, prior participation, perceived motivators and barriers, and willingness to participate under different trial scenarios (invasive, non-invasive, digital, and drug safety contexts). If a respondent reported lack of knowledge of the term ‘clinical trial,’ the investigator explained the meaning in simple Arabic to enable the respondent to participate. Descriptive statistics, univariate and multivariate analyses were performed to examine associations between participant characteristics and willingness to participate. Results: A total of 631 patients (mean age 41.7 ± 16.2 years; 60.1% women) with generally low educational attainment (30.1% primary education; 14.4% no formal education) participated. Awareness of CTs was extremely limited, as 90.6% of participants had never heard of CTs and only 1.1% reported prior participation. More than half (51.3%) expressed concerns regarding participation, with safety being the predominant concern (85.9%), followed by family obligations that could limit trial adherence (55.8%), and fears of being experimented upon. Despite these concerns, altruistic motivations were prominent, with advancing medical science (86.4%) and helping other patients (85.4%) cited most frequently. If invited to participate in a CT, 40.1% of respondents indicated willingness, whereas 51.3% would decline and 8.6% were uncertain. Willingness varied substantially by trial characteristics: only 28.8% were willing to participate in trials involving invasive procedures, compared with the 61.2% who would participate in non-invasive studies, including educational interventions, telemedicine, or digital applications. Perceived drug safety was a key determinant, with willingness increasing to 70.8% when investigational drugs had confirmed safety, but declining sharply when safety was uncertain, with 85.9% declining willingness. Overall, educational level, prior awareness of CTs, and safety-related concerns were strongly associated with willingness to participate. In multivariable analysis, higher education (college/postgraduate) was independently associated with greater willingness to participate (OR 2.06, 95% CI 1.15–3.68), whereas having concerns about CTs was associated with reduced willingness (OR 0.42, 95% CI 0.27–0.66). Conclusions: Iraqi patients demonstrate profound gaps in awareness of CTs and substantial safety-related concerns, yet exhibit strong altruistic motivations and openness to non-invasive and digital research models. These findings underscore the need for culturally tailored public education, transparent communication regarding trial safety, and innovative trial designs to enhance participation. Addressing these barriers is critical to improve equitable representation of LMIC populations in general and of the MENA region in particular in global clinical research, and to strengthen the external validity of CT evidence.

Background: Catheter ablation is increasingly used in patients with ventricular tachycardia (VT) and an implantable cardioverter‐defibrillator (ICD) device in situ, but its real‐world safety and effectiveness remain underexplored in this high‐risk population. We aim to evaluate in‐hospital outcomes associated with catheter ablation in VT patients with a history of ICD implantation using a large, nationally representative dataset. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021) to identify adult hospitalizations with VT and prior ICD device insertion. Patients were stratified into ablation and non‐ablation groups. Propensity score matching was used to balance baseline characteristics. Primary outcome was in‐hospital mortality; secondary outcomes included acute heart failure, ST‐elevation myocardial infarction (STEMI), sepsis, major adverse cardiac events (MACE), and procedure‐related complications. Results: Among 395,290 hospitalizations with VT and prior ICD, 4.9% underwent ablation. Catheter ablation remained independently associated with reduced in‐hospital mortality (adjusted odds ratio [aOR] = 0.59; 95% CI: 0.48–0.74), acute heart failure (aOR = 0.59; 95% CI: 0.54–0.64), ST‐elevation MI (aOR = 0.44; 95% CI: 0.36–0.54), and sepsis (aOR = 0.34; 95% CI: 0.26–0.45) (all p < 0.001). The composite MACE outcome also showed a reduced odds ratio for ablation (aOR = 0.76; 95% CI: 0.68–0.85; p < 0.001). However, ablation was also associated with higher odds of cardiac tamponade (aOR = 8.33; 95% CI: 5.92–11.73), cardiogenic shock (aOR = 1.36; 95% CI: 1.19–1.55), need for mechanical circulatory support (aOR = 5.36; 95% CI: 4.63–6.21), and prolonged hospital stay ≥ 7 days (aOR = 1.69; 95% CI: 1.57–1.82) (all p < 0.001). Conclusion: In patients with VT and prior ICD implantation, catheter ablation is associated with improved in‐hospital outcomes but higher procedural risks. These findings support its selective use in experienced centers capable of managing complications.

Right ventricular (RV) dysfunction is a critical predictor of adverse outcomes in cardiac surgery patients. The assessment of right ventricular global long

This study explored the integration of supervised, semi-supervised, and unsupervised learning strategies to classify ophthalmic images under label-scarce conditions. Given the high cost of annotations in medical imaging, the goal was to improve diagnostic performance using minimal labeled data and robust feature representations. A dataset of 18,767 multimodal ophthalmic images was collected — 1,877 labeled and 16,890 unlabeled. Three transformer-based architectures —ViT-Base, DeiT-Base, and MaxViT-L—were used for supervised learning. Semi-supervised learning employed pseudo-labeling with a confidence threshold ≥ 0.98. For unsupervised learning, SimCLR-based contrastive learning and K-means clustering were implemented on extracted features. Performance was evaluated using classification accuracy, AUC, F1-score, clustering indices (Silhouette Score, DBI, CH Index), and computational metrics. In supervised learning, ViT-Base achieved the highest accuracy (92.47%), followed by DeiT-Base (89.38%) and MaxViT-L (85.27%). After pseudo-labeling, MaxViT-L achieved the best accuracy (97.49%) and AUC (0.9982). Contrastive learning significantly improved feature clustering, with MaxViT-L reaching a Silhouette Score of 0.556 and a reduced DBI of 0.541. However, computational analysis revealed that MaxViT-L exhibited the highest computational complexity (81,713 MFLOPs) and longest inference (~ 102 ms), while ViT-Base and DeiT-Base showed considerably lower FLOPs (39,120.6 MFLOPs) and faster inference (~ 52 ms). On external validation set, MaxViT demonstrated the best overall performance. Although ViT-Base achieved the highest accuracy in supervised training, MaxViT-L demonstrated the most favorable trade-off between performance and model generalization in semi- and unsupervised settings, Despite its higher computational complexity and longer inference time, MaxViT-L consistently achieved strong accuracy and clustering performance. This approach minimizes dependence on expert annotations, supporting scalable and automated ophthalmic diagnosis.

Purpose To compare the efficacy and safety of one-site versus two-site phacotrabeculectomy in the management of concurrent cataract and glaucoma through an updated systematic review and meta-analysis of randomized controlled trials. Methods Systematic searches were conducted across seven electronic databases through February 2025. Only randomized controlled trials comparing one-site versus two-site phacotrabeculectomy were included. Primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included anti-glaucoma medication (AGM) use, visual acuity, endothelial cell loss, and complications. Meta-regression analyzed the effects of mitomycin C (MMC) usage, age, and follow-up duration on outcomes. Results Sixteen randomized controlled trials (1087 eyes) were included. Both techniques achieved comparable IOP reduction at most timepoints. Although two-site surgery demonstrated a trend toward greater IOP reduction at select intervals (e.g., day one and 18 months), these differences were not statistically significant. AGM requirements were similar between groups at 12 months (mean difference: 0.05; 95% CI − 0.16, 0.27). Visual outcomes were comparable, though influenced by age (p = 0.004) and MMC use (p = 0.025). Endothelial cell loss was initially greater with two-site surgery but stabilized over time. Complication rates, including hyphema (OR: 0.99; 95% CI: 0.56, 1.76) and bleb-related complications (OR: 1.09; 95% CI 0.55, 2.16), were similar between groups. Conclusions One-site and two-site phacotrabeculectomy demonstrate comparable efficacy and safety profiles. While two-site surgery shows a trend toward greater IOP reduction, the differences are not clinically significant. Surgical approach should be individualized based on patient characteristics, surgeon experience, and specific surgical goals rather than assumed superiority of either technique.

Infantile-onset Pompe disease (IOPD) is a rare genetic disorder associated with a deficiency of a lysosomal enzyme, the acid alpha-glucosidase. It is characterized by the accumulation of lysosomal and non-lysosomal-bound glycogen in various organs, such as the heart, skeletal muscle, and brain tissue, resulting in muscle weakness, hypertrophic cardiomyopathy, respiratory insufficiency, and other complications. Without treatment, IOPD has a very high mortality rate, with patients dying within the first year of life. Over the past few decades, significant therapeutic advancements have been made to improve the prognosis and quality of life for IOPD patients. Enzyme replacement therapy (ERT) with recombinant human GAA has been the cornerstone of treatment, demonstrating efficacy in prolonging survival and reducing cardiac hypertrophy. However, ERT has limitations, including the development of immune responses, inconsistent skeletal muscle uptake, and the inability to cross the brain barrier. Recent research has focused on enhancing ERT through adjunctive therapies such as immune modulation, gene therapy, and chaperone-mediated approaches to improve enzyme delivery and function. Additionally, advancements in early diagnosis, including newborn screening, have enabled timely intervention, which is crucial for better outcomes. This review comprehensively examines the current therapeutic strategies for IOPD, their efficacy, challenges, and future directions for managing this disease.

Background: Endophthalmitis is a rare but severe eye inflammatory disorder caused by bacterial infection that can occur after cataract surgery. Most bacteria are part of the patient’s natural flora, and even with antibiotic treatment, it causes considerable ocular morbidity and vision loss. Purpose: To investigate the preoperative conjunctival flora and their antibiotic susceptibility in patients undergoing cataract surgery at Ibn Al-Haitham Teaching Eye Hospital, a tertiary ophthalmology center in Baghdad, Iraq. Methods: This cross-sectional, single-center study based on conjunctival swabs of patients prior to cataract surgery and cultured using blood agar, chocolate agar, MacConkey agar, and Sabouraud agar. Bacterial isolates were identified using Gram staining and biochemical tests, and antibiotic sensitivity was determined using the disc diffusion method according to CLSI guidelines. Statistical analysis was done by SPSS Statistics Version 23. Results: A total of 200 patients (200 conjunctival swabs of consecutive 200 eyes) scheduled for cataract surgery were included. Positive cultures were found in 45 (24%) patients. Coagulase-negative Staphylococcus epidermidis was the most frequently isolated microorganism (75% of isolates), followed by Staphylococcus aureus (14.58%), Aspergillus species (6.25%), and E. coli (4.17%). S. epidermidis showed the highest sensitivity to ofloxacin (97.2%) and chloramphenicol (94.4%) and the lowest sensitivity to fusidic acid (11.1%) and ceftazidime (5.6%). S. aureus exhibited the highest sensitivity to chloramphenicol (100%) and tobramycin (85.7%) but was completely resistant to ceftazidime and fusidic acid (100% resistance). E. coli isolates were 100% sensitive to ciprofloxacin, ofloxacin, and chloramphenicol. Conclusion: The study revealed conjunctival microbial colonization in 24% of cataract surgery candidates, with S. epidermidis being the most prevalent isolate. Chloramphenicol, ofloxacin, Tobramycin, and Ciprofloxacin showed high sensitivity. Fusidic acid and Ceftazidime exhibited negligible sensitivity.