Phoenix Hospital

Although topiramate and valproate are antiseizure medications that have many contraindications and could produce many side effects, they are still used as migraine preventive therapy in middle- and low-income countries. Several trials compared valproate versus topiramate in patients with migraine showed inconclusive results. We aimed to evaluate the tolerability and efficacy of valproate compared to topiramate in migraineurs from the Middle East and North Africa. Our single-blinded, multi-centre, randomized controlled trial had two parallel groups: the (A) group, which included 300 patients who received valproate, and the (B) group, which included 300 patients who received topiramate. In our trial, 574 patients completed the 3-month follow-up period. Topiramate achieved a greater reduction in migraine attack severity on VAS and HIT-6 than valproate to a degree that was statistically significant. 129 (43 %) patients in valproate group and 66 (22 %) in topiramate group had any adverse effects (HR 3.11; 95 % CI 1.08-6.13; P = 0.05), of which 23 patients (7.7 %) in valproate group and twelve patients (4 %) in the topiramate group stopped treatment prematurely due to intolerable adverse effects (HR 2.47; 95 % CI 1.04-5.88; P = 0.04). We concluded that, in adult patients with migraine, the regular use of topiramate 50 mg Bid for three months yielded significantly higher reductions in migraine attack severity and HIT6 score compared to using valproate 500 mg Bid; valproate led to a significantly higher percentage of patients who prematurely stopped treatment due to intolerable adverse effects. Trial registration: ClinicalTrials.gov, (NCT06248931)- 08 February 2024.

Prediabetes is characterized by impaired fasting glucose or impaired glucose tolerance (IGT), which can lead to cardiovascular complications. This study aims to determine the effects of lifestyle modification on glycemic outcomes in prediabetic individuals.

This quasi-experimental trial was conducted at the Department of Adult Cardiology, Phoenix Hospital, Abu Dhabi. Participants aged ≥18 years, of either gender, diagnosed with prediabetes as defined by hemoglobin A1c (HbA1c) levels between 5.7% and 6.4% were included in the study. Participants underwent a three-month lifestyle modification, adapted from cardiac rehabilitation principles, which included glycemic control, nutritional counseling, physical activity counseling, and exercise training. The primary outcome was the change in HbA1c levels following the intervention. Data analysis was performed using RStudio (Posit Software, Boston, MA).

A total number of 101 participants were enrolled, and 96 people completed the study. The average age of the participants was 44.80 ± 8.27 years. Most individuals were males, 85 (88.5%), and 11 females accounted for 11.5%. Postintervention, 25 participants (26%) reverted to normoglycemia, while 67 (69.8%) remained prediabetic, and 4 (4.2%) progressed to diabetes. Significant reductions in HbA1c levels were observed (p < 0.05). Subgroup analysis revealed no significant differences in outcomes based on age, gender, or clinical characteristics. The program demonstrated strong adherence, with a retention rate of 95%.

Lifestyle modification effectively improved glycemic control and reduced the progression of diabetes in prediabetic individuals. The findings support the integration of lifestyle interventions for managing prediabetes.

Many studies evaluated the efficacy and safety of ticagrelor versus clopidogrel in patients with ischemic stroke; none of these trials included North African participants, and all of these trials comprised only participants who experienced transient ischemic attack (TIA) or minor stroke.

We compared the efficacy and safety of ticagrelor versus clopidogrel in patients with first-ever noncardioembolic moderate or moderate-to-severe ischemic stroke.

Our trial involved 900 first-ever noncardioembolic patients with acute ischemic stroke (AIS) who randomly received either loading and maintenance doses of ticagrelor or clopidogrel within the first 24 h of stroke onset.

We involved 900 patients in the intention-to-treat analysis. A total of 39 (8.7%) patients in ticagrelor arm and 62 (13.8%) in clopidogrel arm experienced a new stroke [hazard ratio (HR) 0.46; 95% confidence interval (CI) 0.34-0.83; P value = 0.006]. A total of 57 (12.7%) patients in ticagrelor group and 80 (17.8%) patients in clopidogrel group experienced composite of new stroke, myocardial infarction (MI), or death due to vascular insults (HR 0.51; 95% CI 0.43-0.82; P value = 0.004). Participants who received ticagrelor experienced less frequent unfavorable outcomes. We found no significant variation between our study's two arms concerning the hemorrhagic and non-hemorrhagic complications.

Patients with noncardioembolic moderate or moderate-to-severe ischemic stroke who received ticagrelor within the first 24 h after ischemic stroke had better clinical outcomes based on recurrent stroke rates and unfavorable modified Rankin Scale (mRS) rates compared with those who received clopidogrel. There were no significant variations between ticagrelor and clopidogrel regarding hemorrhagic and non-hemorrhagic complications.

ClinicalTrials.gov identifier number NCT05553613.