Real-world outcomes of Axicabtagene Ciloleucel CAR-T therapy in large B-cell lymphoma: a single-center observational study.

Unintentional falls are a leading cause of injury and mortality among older adults, with a growing burden in rapidly ageing regions like the Middle East and North Africa. Despite this, the availability, scope and geographical distribution of epidemiological evidence on fall-related outcomes in the region remain poorly characterised, limiting policy and prevention efforts. This evidence gap map systematically identifies, categorises and maps existing observational research on fall-related outcomes among older adults in the Middle East and North Africa. We searched PubMed, Web of Science, Google Scholar and Google (up to November 2025) without time restrictions to identify primary studies and systematic reviews reporting on fall prevalence, frequency, risk and fear of falling, self-reported perceived reasons for falling and postfall consequences in older adults (aged ≥60) in the Middle East and North Africa. Two reviewers independently conducted screening, data extraction and quality assessment. We included 203 primary studies, representing data from 424 112 older adults. Evidence from low-income countries was scarce (one national health survey from Sudan, one retrospective study from Yemen, no study for Syria). Upper-middle-income countries (Iraq, Jordan and Libya) contributed limited evidence (4.9%; 10/203). High-income countries contributed registry-based and national-level data. Most studies were conducted in lower-middle-income countries (113/203; 55.7%); in both genders (96.6%; 196/203) and in urban settings (157/203; 77.3%). The most frequently studied populations were the general population and outpatients (each 45/203; 22.6%). Under-researched outcomes were fear of falling and self-perceived reasons of fall. This evidence gap map highlights substantial data gaps across several countries, with marked underrepresentation of rural, low-income and conflict-affected settings, and limited evidence on key fall-related outcomes across the Middle East and North Africa. Strengthened surveillance using validated context-adapted tools, hospital-based registries and integrated national survey fall indicators are essential to inform effective and equitable fall prevention strategies in the region.

The use of electronic nicotine delivery systems (ENDS) has increased globally. Evidence of the association between xerostomia and ENDS remains limited. We evaluated the association between nicotine product use and xerostomia severity in a multinational sample from the Middle East and North Africa (MENA) region. In this cross-sectional study, adults aged 18-40 years from 18 MENA countries were recruited via convenience sampling through social media platforms between December 2023 and March 2024. Xerostomia symptoms were assessed using the xerostomia Inventory (XI). Directed acyclic graphs guided confounder selection. Regression models examined the association between nicotine product use and xerostomia symptom scores. Among 11,451 participants (6975 [60.9%] non-users, 1913 [16.7%] exclusive ENDS users, 1778 [15.5%] exclusive combustible tobacco users, and 785 [6.9%] dual users), all current-use categories were associated with higher XI scores than non-use after adjustment for age, sex, and exercise frequency: exclusive ENDS users (standardised β = 0.385; p < 0.001), exclusive combustible tobacco users (β = 0.201; p < 0.001), and dual users (β = 0.324; p < 0.001). Current use of any nicotine product was associated with higher xerostomia scores than non-use, with the strongest associations observed among exclusive ENDS users and dual users.

Spinal motion restriction in the emergency healthcare setting: A cross-sectional study of knowledge, attitudes, and practices.

IntroductionFew studies have been reported on intracerebral Hemorrhage (ICH) in elderly patients at Middle East and North Africa region (MENA). It is thought that epidemiological, radiological characteristics, and neurological outcomes differ in elderly patients from younger age group. Our study’s aim is detection of the difference between them as regard clinical and radiological characters, functional outcome, and its predictors.MethodsAll patients with spontaneous ICH were divided into two groups, elderly group (≥ 70 years old) and younger age group. All clinical and-radiological data were collected. The patients were classified into four categories (probable Cerebral Amyloid Angiopathy, Hypertensive, Vascular and Undetermined). One-month mortality and three months’ functional outcome, using modified Rankin Scale (mRS). were determined. Multivariate logistic regression was performed to determine the predictors of favorable functional outcome.ResultsProspective cohort study was conducted on 71 old age patients from 238 patients (30.3%). Hypertension, higher NIHSS (National Institutes of Health Stroke Scale) lower GCS (Glasgow Coma Scale) and previous medications of antiplatelet or anticoagulant were more common in elderly group with statistically significant difference (P value: < 0.017, 0.002, 0.002, and 0.003, respectively). Probability of CAA (Cerebral Amyloid Angiopathy) was common in elderly patients. Younger age group had better outcome as regard three months’ functional outcome and one-month mortality (44.3% versus 19.7% with p value: < 0.001, 21.6% versus 39.4% with p value: 0.006, respectively). GCS and NIHSS are predictors of favorable functional outcome.ConclusionSpontaneous ICH in elderly has different demographic, clinical and radiological findings with worse One-month mortality and functional outcome. Higher GCS and lower NIHSS are predictors of favorable functional outcome.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12883-026-05023-z.

Premature atherosclerotic cardiovascular disease (ASCVD) is increasingly recognized as a major public health challenge in the Middle East and North Africa (MENA) region, where cardiovascular events occur at younger ages than in Western populations. Despite ongoing policy reforms and improvements in healthcare infrastructure, premature ASCVD remains underrecognized and insufficiently addressed. This review summarizes the epidemiology, economic burden, policy initiatives, and current barriers related to premature ASCVD in MENA, while proposing targeted interventions to support policymakers and improve health outcomes. Recent evidence demonstrates that premature ASCVD occurs approximately 10-12 years earlier in MENA populations than in Western countries. The high prevalence of traditional risk factors, including dyslipidemia, obesity, diabetes, hypertension, smoking, and physical inactivity, together with genetic predisposition and familial hypercholesterolemia, contributes substantially to earlier disease onset. Available economic data indicate a considerable burden associated with ischemic heart disease, stroke, and acute coronary syndromes across the region. Multiple initiatives have focused on cardiovascular risk reduction through screening programs, tobacco taxation, trans-fat elimination policies, and strengthening acute care systems. However, significant barriers persist, including healthcare inequities, fragmented health-information systems, workforce limitations, financing constraints, and insufficient implementation of preventive strategies. Premature ASCVD represents an underrecognized and growing challenge in the MENA region. Addressing this burden requires integrated policy reforms emphasizing early screening, aggressive risk-factor management, strengthened primary healthcare systems, improved digital health infrastructure, expanded workforce capacity, and sustainable financing strategies. Coordinated regional efforts are essential to reduce the long-term clinical and economic consequences of premature ASCVD.

BackgroundHuman papillomavirus (HPV) infections that cause cervical cancer (CC) are transmitted through sexual contact. Certain sexual behaviors influence the risk of HPV acquisition and transmission.AimThis study aimed to evaluate the global burden, temporal trends, and future projections of CC attributable to sexually acquired HPV infections among individuals aged 10-54 years to optimize prevention strategies.MethodsData were extracted from the Global Burden of Disease (GBD) Study 2021. We analyzed deaths and disability-adjusted life years (DALYs) associated with CC linked to sexual transmission of HPV in the 10-54 age-group, stratified by age, Sociodemographic Index, and GBD region. The estimated annual percentage change was utilized to analyze trends from 1990 to 2021. Furthermore, Autoregressive Integrated Moving Average (ARIMA) models were applied to predict the disease burden trajectory through 2050.OutcomesThe primary outcomes assessed were the absolute counts and age-standardized rates (ASRs) of CC-related deaths and DALYs attributed to sexual transmission of HPV.ResultsIn 2021, there were 117 060 (95% uncertainty interval [UI], 106 690-128 467) CC deaths and 5 572 161 (95% UI, 5 057 538-6 116 191) DALYs globally among individuals aged 10-54 due to sexually acquired HPV infections. While the absolute numbers of deaths and DALYs increased by 23.9% and 23.1%, respectively compared to 1990, the age-standardized death and DALY rates significantly declined to 2.31 and 110.12 per 100 000. India and China bore the highest absolute burden, whereas Southern sub-Saharan Africa exhibited the highest standardized rates. Conversely, the Middle East and North Africa region reported the lowest burden. ARIMA models predict an increasing global burden in this demographic between 2021 and 2050.Clinical ImplicationsTargeted public health policies and increased HPV vaccination coverage are urgently required, particularly in high-burden, low- and middle-income regions, to counteract the projected rise in CC cases associated with sexual transmission of HPV.Strengths and LimitationsThis study provides valuable insights into the HPV-associated burden of CC over 3 decades; however, it is limited by the GBD’s reliance on a standardized risk factor definition that may not capture all local behavioral nuances, potential underreporting in historical data due to undeveloped registry systems, reliance on modeling for data-scarce regions, and incomplete global data on HPV vaccine coverage.ConclusionWhile ASRs of CC associated with sexually acquired HPV are declining, the absolute burden remains substantial and geographically disparate, highlighting the need for sustained global intervention.

High sensitivity, low specificity: Validation and diagnostic accuracy study of the PCL-5 in an Arabic-speaking treatment-seeking sample.

Research productivity has increased in the Middle East North Africa (MENA) region despite a generally non-supportive research environment. This study builds on existing scholarship by exploring researchers' self-assessed skills, capabilities and the barriers they encounter in conducting research and applying research ethics in their contexts. We conducted an exploratory cross-sectional online survey with 152 regional research networks from any discipline in six countries across the MENA region. Inclusion criteria were researchers over the age of 18 and having been actively engaged in research involving human participants within the past five years. Descriptive and bivariate analyses, Chi-square and Fisher's exact tests were used to examine statistical differences in respondents' characteristics, knowledge and perceptions of research ethics by gender and education level. A total of 117 researchers completed the survey; 64% were female, 55% had doctoral degrees, 43% worked at private universities, and 48% conducted research in low- and middle- income countries. The main fields of research were public health (28%), social sciences (18%), medicine (16%), and nursing (16%). Findings were observed at the intrapersonal and research environment levels. At the intrapersonal level, most respondents reported the presence of institutional ethics review processes (91%) and familiarity with ethics procedures (92%), however, only 46% felt confident resolving ethical dilemmas independently, with 83% seeking advice or consulting guidelines. Many expressed the need for more training and mentorship despite the high percentage (68%) reporting having received ethics training. Several challenges were reported at the level of the research environment, including limited time to conduct research (77%), insufficient funding and support (70%), lack of collaboration opportunities (63%), and restricted freedom in disseminating research findings (32%). Although the vast majority of researchers had received training in research and research ethics, and many were familiar with relevant research ethics guidelines in their field and institution, gaps remained - particularly at the institutional level. Findings highlight the need for systemic improvements in research capacity, ethics support, and supportive institutional environments.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in the Middle East and North Africa (MENA) region, yet published estimates of prevalence and outcomes remain uncertain because the underlying denominators are inconsistently defined. This perspective argues that MENA MASLD epidemiology is systematically biased by three interacting mechanisms: distorted sampling frames, referral pathway selection, and structural undercapture of rural and displaced populations. Much of the current evidence is derived from convenience cohorts concentrated in urban, tertiary care settings where diagnostic availability and follow-up are greater than in the general population, leading to directional rather than random error. In parallel, risk stratification pathways that rely on two-step testing can funnel case detection toward specialty rich settings, overrepresenting advanced disease while missing earlier stages managed outside hepatology services. MASLD nomenclature change and incomplete alignment of coding and clinical documentation may further introduce artefactual inflection points that complicate trend interpretation. We highlight how underdiagnosis and under-recording in primary care propagate bias across downstream estimates and how validation of administrative algorithms and text-based ascertainment can quantify hidden disease reservoirs within routine data systems. Building on regional priority settings, we propose denominator-focused actions: probability-based sampling embedded in noncommunicable disease surveys; purposeful inclusion of rural and displaced groups; linkable data across primary care, laboratories, hospitals, and mortality registries; and harmonized coding and terminology. By decision-grade denominators, we refer to population denominators that are sufficiently representative, transparent, and linkable to support national surveillance, resource allocation, and trial-readiness decisions.

Globally, the multiple myeloma (MM) landscape varies widely, with incidence, treatment patterns, outcomes, and healthcare resource utilization (HCRU) differing across countries and regions. Many factors contribute to these differences, including ethnicity, awareness, and socioeconomic influences. This is the first analysis aiming to explore factors associated with myeloma incidence and patient characteristics in the Middle East and North Africa (MENA) region. A literature search was conducted using PubMed and Embase from 1 January 2015 to 30 May 2025. Articles reporting outcomes of interest in patients with MM in the relevant MENA countries (Egypt, Saudi Arabia, Turkey, and the United Arab Emirates) were identified. Of 1400 articles identified in the search, 94 were included; four articles were added post hoc as gray literature. Most reported findings from retrospective observational studies (n = 66); more than half were conducted in Turkey. The age-standardized incidence rate in MENA was 1.49 per 100,000 people in 2019; median age at diagnosis was lower in the region (range 43-70years) than that in global reports (70years). Nearly half (49.7%) of all patients were treated with a regimen containing bortezomib; the second-most frequently used drug was lenalidomide in newly diagnosed MM and daratumumab in relapsed/refractory MM. Few patients (< 1%) were treated with quadruplet regimens. Overall response rates were generally high (35-90.2%), while survival outcomes varied (median progression-free and overall survival ranged from 2-97.7months and 4-125.3months, respectively). Adverse events were inconsistently reported across the studies; hematologic adverse events and peripheral neuropathy were commonly reported. HCRU data in the region were limited. We identified a paucity of comprehensive data on the epidemiology and management of MM in MENA. Improved understanding of treatment patterns and HCRU in the region may provide pathways to advancing access to newer therapies that can alleviate the disease and treatment burden of MM in MENA.

The online version contains supplementary material available at 10.1007/s40200-026-01956-x.

Maternal outcomes and access to maternal healthcare services among migrant, refugees and forced displaced women in the Middle East and North Africa: A systematic scoping review.

Children and adolescents in the Middle East and North Africa (MENA) experience a high burden of mental health problems, yet school-based services remain fragmented. Schools offer a strategic platform for prevention and early intervention, but implementation evidence in MENA is limited. We conducted a systematic review and evidence map of PreK-12 school-based mental health and related health-promoting interventions in MENA countries. Searches were conducted from database inception to August 2025. Implementation strategies were coded using the ERIC framework, and implementation outcomes were classified using Proctor's taxonomy. Twenty-four studies met inclusion criteria. Interventions included targeted mental health programs, universal promotion initiatives, health-promoting curricula with psychosocial components, and digital safety interventions. Common strategies were training school staff, cultural adaptation, and integration into existing routines. Adoption and feasibility were frequently reported; fidelity, sustainment, cost, and equity outcomes were rarely assessed. Strengthening school mental health in MENA requires policy integration, structured workforce support, equity-focused implementation metrics, and sustainable financing mechanisms. School-based mental health interventions are increasing across MENA, but systematic implementation planning is essential for long-term scale and impact.

Strengthening regional surveillance: MenMap Network's year 1 findings on bacterial meningitis in Jordan, Egypt, and Iraq (2023-2024).

The World Health Organization's (WHO) guidance to the Middle East and North Africa (MENA) region, alongside post-Arab Spring legal reforms, has prompted many countries to prioritize Universal Health Coverage (UHC). Despite these efforts, progress remains uneven, and reforms have not consistently translated into improved population health outcomes. While global monitoring data reveal wide variation in UHC advancement, academic analysis of the factors behind these differences-particularly across countries with varying performance levels-remains limited. This paper addresses this gap through two objectives: first, to identify general enablers and barriers to UHC and assess the usefulness of these categories; and second, to examine how these factors operate in the MENA context. A scoping review, guided by PRISMA-ScR, was conducted using a six-dimension analytical framework. MENA countries were classified as low, middle, and high UHC performers based on the WHO Service Coverage Index (SCI), with one representative country from each category selected for in-depth review. Findings highlight six dimensions shaping UHC progress-social infrastructure, economic infrastructure, service delivery, governance, health resources, and financing-revealing both shared and context-specific influences. While financial inputs remain critical, strong governance and political commitment are equally essential for advancing coverage, equity, and quality. The study provides a nuanced understanding of UHC progress in the MENA region and offers actionable guidance for designing context-sensitive and sustainable health reforms.

Background/Objectives: Recent advancements in digital health have facilitated the expansion of mobile health (mHealth) apps. This study examines the top-ranked Arabic wellness mHealth apps in the Middle East and North Africa (MENA) region and evaluates wellness apps in Saudi Arabia for their potential to promote health-related behavior change using the App Behavior Change Scale (ABACUS). Methods: A cross-sectional review was conducted using a systematic three-phase approach to identify and evaluate Arabic wellness apps, with the dataset extracted from the Sensor Tower platform. In Phase 1, apps were identified based on predefined country, language, and wellness criteria. In Phase 2, app descriptions were screened for behavior change features. In Phase 3, eligible apps available in Saudi Arabia were downloaded and evaluated using the ABACUS. Results: Egypt had the highest number of identified Arabic wellness apps (n = 9), followed by Iraq and the United Arab Emirates (UAE) (n = 8 each), while Yemen had the fewest identified apps. For potential behavior change apps, Tunisia and the UAE had the highest apps (n = 7), whereas Yemen and Libya had the lowest (n = 1 each). All Arabic wellness apps identified in Saudi Arabia were classified as promoting physical activity with only one app encouraging healthy eating. The total ABACUS scores were relatively consistent, ranging from 15 to 17 out of 21. Conclusions: Arabic mHealth wellness apps identified across the included MENA countries were limited in number, while apps available in Saudi Arabia showed variability in the incorporation of behavior change features.

Objective: Nutrition is critical for people living with human immunodeficiency virus (PLHIV); nonetheless, nutritional interventions have not been conducted among PLHIV in the Middle East and North Africa region. This study evaluated the effects of a nutrition-related education intervention on total knowledge, attitude, and practice (KAP) scores and on the intake of immune-enhancing foods and nutrients among PLHIV. Methods: Sixty-three PLHIV were recruited from an outpatient HIV clinic in Dubai, United Arab Emirates, between August and November 2023 and randomly assigned to an intervention (n = 31) or control group (n = 32). The intervention group participated in an individualized, six-session nutrition education program based on the Health Belief Model, whereas the control group received usual care plus a nutrition education brochure on HIV nutrition and health. Data were collected at baseline and after the five-month intervention period using validated instruments assessing HIV-related nutrition knowledge, attitudes, and practices. A food frequency questionnaire and two non-consecutive 24 h dietary recalls were used to assess the intake of immune-enhancing nutrients. Results: Post-intervention KAP score distributions differed significantly between the control and intervention groups for knowledge, attitude, and practices (p < 0.001, 0.003, and 0.001, respectively). Immune-enhancing vitamin intake did not differ significantly between groups, except vitamin E, which increased in the intervention group (p = 0.042). Conclusions: The intervention improved participants’ nutrition-related KAP scores but did not increase the intake of immune-enhancing nutrients, except for vitamin E. Further studies are warranted to develop interventions that improve the intake of immune-enhancing nutrients.

BackgroundClinical trials (CTs) play a crucial role in developing new cancer treatments and enhancing patient outcomes. However, being part of these trials remains low across many regions, including the middle east and north Africa region (MENA). This study aims to evaluate the knowledge and attitudes of the general population regarding cancer clinical trials and to examine determinants of limited awareness and unfavorable attitudes.MethodsA multinational cross-sectional study was conducted from March 1 to May 31, 2024, initially involving 5,528 participants, with a final sample of 5,422 respondents after data cleaning. Data was collected using a standard population-based cross-sectional survey, distributed both online via Google Forms and in-person. Convenience sampling was employed, with Countries and centers were selected based on accessibility, willingness to participate, and representation of different healthcare systems across the MENA region. Data analysis was conducted using Jamovi 2.3.28 software.ResultsOf the 5,422 responses, significant participation was observed from Egypt (22.9%) and Bahrain (20.9%). Knowledge of CTs was moderate overall, with 63.5% of participants being familiar with the concept; however, only 9.1% exhibited a high level of knowledge. Attitudes toward CT participation were largely unfavorable, with 83.8% of respondents expressing reluctance to participate, despite 77.6% indicating an interest in receiving more information about CTs. Multinomial logistic regression indicated that private and governmental employees had higher knowledge levels compared to unemployed individuals(OR = 1.65, p = 0.007, and OR = 1.87, p < 0.001, respectively). Participants with chronic illnesses and those with prior research participation also demonstrated high knowledge(OR = 2.92, p < 0.001). Attitude scores, on the other hand, were significantly correlated with age and gender (p < 0.003). Sperman’s revealed a positive correlation between knowledge and attitude indicating that higher knowledge levels are associated with more favorable attitudes.ConclusionThis study provides insights into the general knowledge and attitude toward cancer clinical trials among the MENA population while identifying significant gaps in understanding and willingness to participate. The findings highlight the necessity of targeted educational interventions and public awareness campaigns to enhance knowledge about clinical trials and encourage a more favorable attitude toward participation.

Background: Vitamin D receptor (VDR) polymorphisms have been widely investigated as genetic determinants of neurodegenerative diseases, yet findings remain inconsistent and population-dependent. Evidence from the Middle East, North Africa, and Türkiye (MENA&T) regions, which is characterized by widespread vitamin D deficiency and distinct genetic backgrounds, has not been comprehensively synthesized. Methods: We conducted a systematic review and meta-analysis evaluating associations between four common VDR polymorphisms (ApaI rs7975232, FokI rs2228570, TaqI rs731236, and BsmI rs1544410) and the risk of multiple sclerosis (MS), Parkinson's disease (PD), and Alzheimer's disease (AD) in MENA&T populations. Six databases were searched from inception to November 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using fixed- and random-effects models across multiple genetic contrasts. Subgroup analyses by ethnicity were conducted for MS. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Nineteen unique case-control studies (20 reports), including 4744 participants, were included. For MS, the ApaI polymorphism showed consistent associations with increased risk across genetic models (random-effects ORs = 1.4-1.9), with stronger effects in Arab and Iranian populations and no association in Turkish cohorts. FokI showed associations with MS under selected genetic models, particularly recessive and homozygous contrasts, although findings were not consistent across all analytical approaches. TaqI showed model-dependent associations with substantial heterogeneity, while BsmI showed no significant association. For AD, a meta-analysis of two studies showed no significant associations. For PD, ApaI showed associations with increased risk across several models without heterogeneity; however, these findings were based on a limited number of studies. Overall certainty of evidence ranged from very low to moderate. Conclusions: In MENA&T populations, VDR ApaI polymorphism shows consistent evidence of association with MS susceptibility, while FokI may be associated under specific genetic models; evidence for AD and PD remains limited and should be considered exploratory. These findings highlight population-specific genetic heterogeneity and underscore the need for further large-scale studies to confirm these associations. These population-specific genetic associations underscore the importance of incorporating VDR genotyping into precision medicine frameworks for neurodegenerative disease risk stratification in MENA&T populations, where vitamin D deficiency is highly prevalent.