Background: Lumbosacral intervertebral disc degeneration (IDD) is a common cause of low back pain and has recently been attributed to ischemic causes. Magnetic resonance imaging (MRI) can accurately assess the presence and degree of IDD, while the common carotid artery (CCA) intima-media thickness (IMT) measured on ultrasound (US) has been accepted as a reliable imaging marker for the presence of atherosclerosis. Aim of the Study: To assess the association between CCA-IMT with the presence and grade of lumbosacral IVD as evident on MRI in patients with LBP. Patient and Methods: This cross-sectional study was done on 200 patients with LBP (115 females and 85 males) referred for lumbosacral spinal MRI at the MRI unit in AL-Sader Medical City for eight months duration. MRI examination involved L1/L2 ,L2/L3,L3/4 ,L4/L5 \& L5/S1 intervertebral discs levels. Patients with a history of lumbosacral surgery, trauma, or tumor were excluded. CCA-IMT was measured using a B-mode US scan, while the degree of IDD was assessed on MRI using I-V Pfirrmann's grading system. Results: Older age, male gender, higher body mass index, presence of cardiovascular comorbidities, and specific occupations were associated with a higher grade of IDD. However, the mean CCA-IMT was independently associated with the advancing grade of IDD at all levels with a statistically significant difference (P<0.001). A significantly larger mean CCA-IMT was found in relation to grade V (0.946 ±0.28), and the lowest mean was found in those with grade I (0.468 ±0.1). The grading of IDD was fair in the prediction of thicker CCA-IMT. Conclusion: IDD was directly correlated with CCA-IMT, and patients with higher grades of IDC tend to have thicker mean CCA-IMT. IDD may be a manifestation or predictor of atherosclerosis. However, future long-term cohort studies to assess causal association are recommended.

Recently, circulating microRNAs (miRNAs) have emerged as potential new biomarkers for diagnosing and prognosis a wide range of disorders. The study aimed to compare the sera levels of miRNA21 and miRNA124 among newly diagnosed patients e with type 2 diabetes mellitus (T2DM) patients with their levels in apparently healthy subjects using blood samples. The time frame for this case-control research is August 2022 through March 2023, and it took place at Al-Sadr Teaching Hospital/Madina in Masin. One hundred patients with a recent di recently patients with T2DM (50 females) and 100 control participants appeared to be healthy but were really between the ages of 5 and 70. We took 2 ml of blood from each patient and healthy person, placed it in an EDTA tube with 1 ml of Trizole as a preservative, and put the tubes in the freezer at -20 degrees Celsius until we were ready to analyze the samples. Recent studies prove the relationship between miR-124 and inflammatory processes and insulin resistance; our emphasis suggests the role miR-124 in insulin resistance in T2DM. Studies have explored the potential of miR-124 as a diagnostic biomarker for T2DM. Altered expression levels of these miRNAs have been detected in sera of newly T2DM-diagnosed patients, which promises to be a non-invasive technique for the disease. Regarding therapeutic scope, miR-124 may be used as a target for insulin sensitivity. Modulating this miRNA may have a potential therapeutic impact in managing T2DM. It is important to note that significant progress has been made in understanding the involvement of miR-124 in T2DM. New studies may provide additional knowledge on its mechanism to decrease insulin receptor resistance and beta cell function, hence, the pathophysiology of T2DM.

Introduction: Many eye conditions, including cataract, glaucoma, and diabetic retinopathy, are among the major causes of blindness in the world. There were many studies on the subject worldwide but fewer in the Middle East; hence, the subject needs more investigation. This research is significant as it fills the gap in the literature on the awareness of common eye diseases in Saudi Arabia. This study was carried out to assess the awareness of common eye diseases among college students at a Saudi University. Methodology: This was a cross-sectional study, including college students at Prince Sattam bin Abdulaziz University (PSAU), Saudi Arabia. Data was collected using a self-administered questionnaire and was analyzed using the SPSS program. Results: Our study included 579 participants. 62.7% of participants reported no family history of eye diseases, and among those who did, dry eye was the most frequently mentioned condition, with 27.8%. Cataract, glaucoma, and diabetic retinopathy had lower reported family histories at 12.3%, 5.9%, and 3.5%, respectively. Concerning awareness, 60.3% of participants were aware of dry eye, followed by cataract (38.7%) and glaucoma (33.3%). However, 26.9% reported no awareness of any eye disease. The internet emerged as the most significant source of information (46.7%), while family, friends, and relatives were also prominent sources (35.4%). Regarding knowledge of specific eye diseases, there were varying awareness levels. For example, 58.4% recognized cataract as treatable, and 42.5% knew glaucoma could cause blindness. Conclusion: A significant proportion of participants exhibited awareness of conditions like dry eye, cataract, and glaucoma; there is room for improvement. Study findings underscore the importance of educational interventions aimed at enhancing awareness, especially for students in non-medical disciplines.

Background: Strategies for modulating the tumor microenvironment (TME) have opened up new treatment paths in various malignancies, with dramatic but variable intertemporal success. Consequently, studying TME's molecular players may aid in understanding how tumor cells and TME interact. Tumor cells and infiltrative tumor lymphocytes express immune checkpoint proteins, including Cluster of Differentiation 80 (CD80) and CD86 on their surface. CD80 and CD86 are members of the immunoglobulin superfamily (IgSF). The costimulatory protein CD28, which is present on the outermost portion of all T cells, and the inhibitory receptor CTLA-4 (cytotoxic T-lymphocyte antigen-4, also known as CD152) are ligands for CD86 and CD80. CD28 and CTLA-4 have essential yet opposing functions in T cell activation. T-cell responses are stimulated when they bind to CD28 but suppressed when they connect to CTLA-4. Aim of the study: The goal was to determine how much the CD80 and CD86 genes were expressed genetically in five blood malignancies and ten solid tumors. Methods: Clinical specimens were collected from patients with different cancers attending Kirkuk Oncology Centre. Patients were categorized into two main groups: the solid tumor group and Blood derived cancer group alongside their control counterparts. The study investigated the genetic expression of the CD80 and CD86 genes using q RT-PCR technologies. Results: Using q RT- PCR, we measured the expression of a gene CD80 /CD86. The results showed different levels of elevation in patient samples of solid and hematological tumors, which were compared with the control group for this study. First, evaluation of this marker CD80/CD86 in solid tumors showed a significant increase in patients with brain cancer compared to their counterparts in the control group. Secondly, the second solid tumor appears to have increased gene expression as ovarian cancer. The least expressed solid tumors are breast cancer. As for cancers that occur in the Blood, lymphoma has an upregulation expression. The lowest expression is CD80/CD86, which was in ALL. Conclusion: There is evidence that several cancer types and immune cells have expressed CD80 and CD86. This investigation demonstrated that the cell surface markers CD80/CD86 have a role in the progression of brain carcinomas.

Objective: The most common technique for fixing patella fractures is tension band wiring (TBW). The current study aimed to assess the functional and radiological outcomes of the patellar fractures treated by TBW. Patients and Methods: This retrospective cohort study was performed on 78 patients who underwent TBW of patellar fracture in Akhtar Orthopedic Hospital, Tehran, Iran, from September 2015 to April 2018 and had completed a two-year follow-up. A surgical intervention consisting of open reduction and internal fixation was performed on all patients using TBW. Patients were evaluated two years postoperatively by clinical examination, radiographic investigation, and three scales (Tegner activity score [TAS], Lysholm knee score [LKS], and lower extremity functional scale [LEFS]). Result: Of the 78 patients, 48 (61.5%) were male, with a mean age of 36.7\(\pm\)13.1 years. Postoperatively, 41 (52.6%) patients had anterior knee pain, and four (5%) patients had an infection. Knee range of motion was limited in 20 (25.6%) patients. The mean postoperative TAS, LKS, and LEFS mean scores were 4.3\(\pm\)1.34, 85.97\(\pm\)9.21, and 69.62\(\pm\)6.68, respectively. Age was inversely correlated with LKS and LEFS, as both scores decreased with increasing age (p\(<\)0.001, r:-0.4). Younger patients (under 30 years old) were more likely to reach their pre-injury TAS score than older patients (p\(<\)0.001). In addition, patellofemoral osteoarthritis and patella baja were significantly higher in patients with comminuted fractures than in those with simple fracture patterns (p\(<\)0.001). Conclusion: We found acceptable outcomes after fixation with TBW, especially in younger patients; LKS and LEFS scores were lower in the elderly, and younger patients were more likely to reach closer to their pre-injury TAS score. Furthermore, patellofemoral osteoarthritis and patella baja were associated with comminuted patella fractures.

Background: There is an urgent need for mortality predictors for COVID-19 so that clinicians can diagnose severe cases and triage them as soon as possible. Many studies have suggested using hematologic markers to predict mortality and severity of COVID-19 disease. This study investigates the use of monocyte-to-high density lipoprotein cholesterol ratio (MHR) as a predictive marker for COVID-19 severity and mortality. Methods: This retrospective cross-sectional study was performed on 81 PCR-confirmed COVID-19 patients between 25 March 2020 to 26 June 2020. Patients were classified into two presentation categories: the non-severe group (n=37) and the severe group (n=44). Patients in the severe group were also divided into two subgroups: severe survivors (n=14) and severe non-survivors (n=30). In the receiver operating characteristic (ROC) analysis, optimal cut-off values of the monocyte count, high-density lipoprotein cholesterol (HDL-C), and MHR were calculated for the differentiation of severe and non-severe COVID-19 patients, as well as survivors and non-survivors. Results: A total of 81 patients, 29 (35.8%) males and 52 (64.2) females, with a median age of 71 (IQR 63-81) years. Both HDL-C and MHR showed a reasonable ability to distinguish severe disease from non-severe disease, while MHR had a higher area under curve (AUC) than HDL-C (0.799, 95%CI 0.704-0.894, p\(<\)0.001 vs 0.734, 95% Cl 0.626-0.843, p\(<\)0.001). Only MHR could distinguish survivors from non-survivors with an ROC AUC of 0.735 (95%Cl 0.619-0.850). The optimal cut-off values of MHR for predicting severe disease were 0.0061 (sensitivity: 66% and specificity: 66%) and 0.0066 (sensitivity: 70% and specificity: 62%) for predicting mortality. The optimal cut-off value of MHR for predicting severe disease was 0.0061 (sensitivity: 66% and specificity: 66%), and it was 0.0066 for predicting mortality among patients with severe disease (sensitivity: 70% and specificity: 62%). Conclusion: Our results showed that MHR was observed to be able to distinguish severe COVID-19 patients from non-severe patients as well as survivors from non-survivors.

Background: Informed consent is a fundamental ethical principle in healthcare, representing mutual understanding and agreement between healthcare providers and patients, particularly crucial in surgical contexts. However, the patient's perspective on this process remains underexplored, especially in resource-constrained regions like Muzaffarpur and Bihar. Materials and Methods: This qualitative investigation employed a phenomenological research design to explore the experiences of 23 adult patients who underwent surgical procedures in Muzaffarpur. Semi-structured interviews, conducted in Hindi, were used to gather data, which were subsequently analyzed thematically. Results: The study revealed several key themes: (1) Limited Information Disclosure, (2) Short Timeframes for Decision-Making, (3) Varied Communication Styles, (4) Trust in Healthcare Providers, (5) Sociocultural Factors, and (6) Desire for More Information. These findings highlight the need for improved patient-centered communication, transparent information disclosure, trust-building, cultural sensitivity, and time allocation in the informed consent process. Conclusion: The patient's perspective on informed consent in surgical settings in Muzaffarpur, Bihar, underscores the importance of tailoring practices to local contexts. Enhancing communication, trust, and information accessibility can promote patient autonomy and improve the informed consent experience. These insights are vital for advancing ethical healthcare in resource-constrained regions.

Background: While protective immunity against some viruses, such as coronaviruses, is relatively short-lived, healing from acute infections of many different viruses, such as those caused by yellow fever, polio, measles, and smallpox, can give cell-mediated and humoral immunity for a lifetime. The main element in the long-term prevention of reinfection by most viruses might be due to the specific antibodies generated by plasma cells. Aim: This study aims to estimate the levels of SARS-CoV-2 Anti-Spike S1 RBD IgM, IgA, and IgG in serum among people in Baghdad after one month of receiving the Pfizer-BioNTech vaccine, infected with the SARS-CoV-2 virus after vaccination and COVID-19 infected patients respectively. Methods: A total of 120 volunteers were enrolled in this study, which was conducted between the 1st of November 2022 and the 13th of January 2023, and they were divided into four groups, each group containing 30 individuals. The study groups were categorized after one month into vaccinated with the Pfizer-BioNTech vaccine (BNT162b2), infected with SARS-CoV-2 after Pfizer vaccination, COVID-19 patients, and control. Results: The study presented a significant difference where (P value < 0.05) in the serum levels of Anti-Spike S1 RBD IgM, IgA, and IgG for all groups compared to the control. Serum levels of S1 RBD IgM Anti-Spike of SARS-CoV-2 in all groups were significantly increased (P value >0.05) compared to each other. For Anti-Spike S1 RBD IgA and IgG, there was no significant difference (P value >0.05) between the COVID-19-infected patients group and those infected by SARS-CoV-2 after the Pfizer vaccination group. Positive correlations were found among Anti-Spike S1 RBD IgM, IgA, and IgG levels in the serum. Conclusions: Natural infection by SARS-CoV-2 or vaccination with Pfizer-BioNTech (BNT162b2) provides significant humoral Immunological protection.

Background: Head and neck cancer (HNC) patients may have considerable anatomical alterations with IMRT and VMAT. Maintaining dosage precision and minimizing tissue damage using adaptive radiotherapy (ART) improves patients' quality of life. However, the optimal time to initiate ART in HNC patients remains undetermined. Objective: This research aimed to identify the optimal time to start ART in HNC patients using a novel method to evaluate anatomical modifications. Materials and Methods: The research included 48 people with HNC who had undergone dynamic IMRT. The size of the patient's PTV was used to divide them into different groups. Both the ER of the original PTV and the ER of the revised PTV were determined. ER differences (dER) were correlated with volume decrease percentage (%dV). Pre-treatment CT images were taken, and then again at fractions 7, 14, and 21 throughout therapy. Results: The PTV volume distributions were verified to be expected. Small, medium, and high ER volumes showed statistically significant variations between the first and second phases (p<0.001). Fraction 14 was the optimum time to administer ART in cases with a PTV of less than <100cc, whereas fractions 7 and 21 were best for cases with a PTV of 100cc to 500cc. Conclusions: The optimal time to begin PTV-based adaptive radiotherapy in HNC patients has been determined. The ER technique improves the clarity of presenting the gap between the reference isodose volume and the PTV, which is valuable information for ART.

Background: Chronic myelogenous leukemia (CML) is a blood malignancy that affects hematopoietic stem cells. Also, it is commonly identified by the Philadelphia chromosome. This chromosome produces a protein with strong tyrosine kinase activity and functions as a tumorigenic factor. Objective: This study aimed to investigate the Immunological and Molecular of BCR-ABL1 gene expression and ABL1 protein in patients admitted to the Oncology and Hematology Center of the Kirkuk Governorate, Iraq. Materials and Methods: A study was conducted in Kirkuk Governorate, Iraq, from the beginning of November 2022 to May 2023 on Chronic Myeloid Leukemia patients in the Oncology and Hematology Center, which was hospital-based and cross-sectional. The study comprised fifty-three patients with Chronic Myeloid Leukemia. They were diagnosed using a complete blood count (CBC), a molecular test BCR-ABL1, and an immunological test ABL1 protein. The research did not include patients with missing data and those without consent. Fifty-three peripheral blood samples from 53 CML patients at chronic stages of CML were taken, and using automated Gene Xpert BCR-ABL1 Ultra assay, BCR-ABL1 transcript quantification was conducted on them. Results: The research included fifty-three patients in total (27 males, 28 females), with a mean age of 47.3\(\pm\)12.8 years. The average of BCR\_ABL1 by RT\_ qPCR 3.22\(\pm\)0.09 and the mean of ABL1 by Enzyme-linked Immune sorbent assay (ELISA) reigned is 981\(\pm\)891. Conclusion: Values of the quantitative real-time reverse transcription polymerase chain reaction (RT\_ qPCR) by Gene Xpert Ultra level range between 38.62 and 0.00 with a mean of 3.22\(\pm\)0.09. The RT\_ qPCR level showed that 22% of the patients were in good condition, 11% of them had a strong response to treatment, and other 11% showed a complete cytogenetic response (CCyR), which is also a good outcome; however, 78% of the patients either not taking their medication, or there is true resistance. These two methods used different techniques; the former is a nuclear-derived method that detects the presence of specific genetic materials of any pathogen; in the current research, BCR-ABL1 is the target. The latter is a test that detects and measures antibodies, antigens, proteins, and glycoproteins in biological samples, so ABL1 is the target.

Advanced breast cancer (ABC) with type 2 diabetes mellitus could be an uncommon, however profoundly forceful frame of breast cancer, which accounts for less than 5% of all locally progressed introductions. The clinical introduction of advanced breast cancer regularly contrasts altogether from that of non-advanced breast cancer; immunohistochemistry uncovers a few recognizing highlights. The more forceful triple-negative and HER2-positive breast cancer subtypes are overrepresented in advanced breast cancer compared to non-advanced breast cancer, with a poorer guess in reaction to routine treatments and plasma glucose level control with hyperglucosemia modification. Current understanding of breast tumor chemoresistance - breast cancers localized at essential breast areas and treated early can still relapse because of the presence of cancer cells and the change of cancer cells into a moderately forceful phenotype. This audit summarizes the current proof recommending that inflammatory signaling pathways are up-regulated, which may give a road for novel therapeutics against the background of diabetes. The part of the tumor microenvironment, through tumor-associated macrophages and infiltrating lymphocytes, is additionally examined, recommending that these tumors' outward variables may offer assistance in accounting for the contrasts in behavior between advanced breast cancer with high plasma glucose levels and non-advanced breast cancer. There are different novel treatment techniques currently underway in clinical trials; they require encouraging the improvement of preclinical models of this uncommon but forceful disease is vital.

Background: The internet has become a primary source of health information, particularly for cancer patients. This study evaluated the quality of online health information related to colon cancer in Arabic. Objective: To assess the reliability, accountability, legitimacy, and readability of Arabic websites providing information on colon cancer. Methods: A search was conducted on major search engines using Arabic keywords related to colon cancer. After initial screening, 13 websites were selected for evaluation. The Journal of the American Medical Association (JAMA) benchmarks, DISCERN instrument and website certification (Health on the Net - HON code) were used for assessment. Readability was analyzed using the Flesch Reading Ease Score and Flesch-Kincaid Grade Level. Results: Non-government websites, particularly Wikipedia, msdmanuals.com, and primomedico.com, demonstrated higher compliance with JAMA benchmarks. Six websites scored high on the DISCERN instrument, indicating reliable treatment information. Only one website was HON-code certified. Readability analysis revealed that text comprehension is challenging for most websites. Conclusion: Private agencies and hospitals managed non-government websites generally outperformed government websites' reliability, quality, and readability. However, overall improvement in Arabic's online health information landscape is essential to enhance accessibility and credibility for colon cancer patients.

Introduction: Stress is prevalent among Healthcare students worldwide. Studies have shown that these students are more likely to suffer from mental health issues and have lower levels of life satisfaction. This research aimed to examine physical therapy students' experiences with academic stress and how it relates to and affects their academic performances. Methods: The study was done among the physical therapy students of AIHMS New Delhi. Using Yamane's formula, the sample size of 260 participants was calculated. The study sample was 272, and participants were asked to fill out a Perceived Mean Stress Score (PMSS) questionnaire using convenient sampling. The data was analyzed by using SPSS version 25. The mean and standard deviation for each response were calculated as a part of descriptive statistics, whereas the Student t-test and ANOVA were applied for inferential statistics to assess the impact of academic stress on their performance. Results: 272 students participated in the study, of which 173 and 99 respondents were females and males, respectively. The respondents were tested for differences in Perceived Mean Stress Score for 13 dimensions. Mean stress scores were significantly higher in students with lower GPA scores and less in students with high GPA scores. Personal finances and Accommodation were found to impact stress ratings significantly (P=0.036*,0.018*). The stress scores were significantly higher in the final years compared to the initial years in Physiotherapy school(P<0.05*). Conclusions: High mean scores for stress and anxiety necessitate early identification, especially in the initial years of Physiotherapy school, and integration of preventive mental health services in routine clinical services for Physiotherapy students.

Aim/Objective: The level of frailty increases in the elderly population. It is known that preoperative frailty may cause negative consequences in the postoperative period. This study aimed to determine the effect of preoperative frailty level on postoperative recovery of elderly patients undergoing surgery in general surgery clinics. Material and Method: The research is descriptive - cross-sectional type. The study was conducted between September 1 Eylül, 2021, and October 31, 2022. The study population consisted of 242 patients aged 65 and over who underwent surgery in the General Surgery Clinic. The study sample consisted of 97 patients selected by random sampling method. "Patient Information Form," "Edmonton Frail Scale (EFS)," and "Postoperative Recovery Index (PoRI)" were used for data collection. Data were collected in 3 stages: preoperatively, postoperatively, and after discharge. In the first stage, patient information form and EFS were applied in the preoperative period. In the second stage, PoRI was performed between 24-48 hours in the postoperative period. In the third stage, the PoRI was re-administered at the time of the patient's first visit to the outpatient clinic (on average 1-2 weeks later). Face-to-face and telephone interviews were used to collect the data. Data were evaluated in the IBM Statistics (SPSS) 25.0 program. Quantitative data in the study were shown as number, percentage, mean, and standard deviation values. Kolmogorov Smirnov test, One-Way ANOVA, Mann-Whitney U test, Kruskal Wallis test, and Shapiro Wilk test were applied when necessary. Cronbach's Alpha value was 0.784 for the Edmonton Frailty Scale, and the Postoperative Recovery Index was 0.950 in the first and 0.941 in the second measurement. All ethical permissions were obtained. Results: The mean age of the patients included in the study was 70.82 \(\pm\) 6.47 years. It was found that 54.7% of the patients were male, and 90.3% were not working. In the Edmonton Frail Scale's measurements, approximately 73.1% of the elderly patients were found to be frail, although their level was different. In the study, PoRI mean1 = 2.9 \(\pm\) 0.99 in the first 48 hours and PoRI mean2 = 2.0 \(\pm\) 0.74 in the post-discharge control time. There is a significant difference between EFS and PoRI- 1st and EFS and PoRI- 2nd measurements. It was found that patients with higher mean EFS had more difficulty in recovery. As the patients' frailty level increased, difficulties were identified in improving psychological, physical, nutritional, and general symptoms. When EFS and sociodemographic characteristics were compared, it was observed that elderly individuals with low income had higher rates of frailty. Conclusion: Research results show that the level of frailty present before surgery delays recovery in the postoperative period. Patients aged 65 years and older also have a significantly high level of frailty. In this context, it would be appropriate to conduct frailty screening with measurement tools to determine the level of frailty in the preoperative period for elderly patients and to evaluate the care to be applied accordingly. In this way, frailty, an inhibiting factor in front of recovery, can be managed and will constitute evidence for objective consideration.

Background: Minimal invasive surgical techniques have gained prominence for their safety and efficiency compared to traditional open surgeries. These techniques, including laparoscopy and robotic-assisted surgery, offer advantages such as reduced postoperative pain and shorter hospital stays. However, successful adoption relies on extensive training and knowledge among surgical residents. Materials and Methods: This cross-sectional survey study was conducted among surgical residents in Muzaffarpur, Bihar, India. Stratified random sampling ensured representation from government and private healthcare institutions. A structured questionnaire collected data on demographic information, knowledge levels, training experiences, and perceived knowledge gaps. Data were analyzed using descriptive and inferential statistics. Results: Among 50 participants, 80% received formal training, 70% attended workshops/seminars, and 96% observed live surgeries in minimally invasive techniques. However, only 60% had hands-on experience. Perceived knowledge gaps included lack of hands-on training (24\%), limited exposure to complex cases (36%), and difficulty in applying techniques (24%). Knowledge levels improved with years of residency, which is consistent with Indian studies. Conclusion: Addressing knowledge gaps and enhancing training in minimally invasive surgery is essential for surgical residents in Muzaffarpur. Increasing hands-on opportunities, diverse case exposure, and mentorship programs can improve proficiency and patient outcomes.

Background: Independent of conventional risk factors, patients with rheumatoid arthritis (RA) have a significantly increased risk of cardiovascular disease (CVD). Aims of the Study: To evaluate the actual and perceived 10-year CVD risk among Iraqi patients with RA as well as their level of knowledge about CVD risk. Patients and methods: This cross-sectional study included 100 RA patients (85 females and 15 males) who visited Baghdad Teaching Hospital/Rheumatology Unit from January 2021 to July 2021. The Framingham Risk Score (FRS) was used to calculate the actual 10-year risk of CVD. The Heart Disease Fact-Rheumatoid Arthritis Questionnaire (HDFQ-RA) was used to assess the subjects' knowledge of cardiovascular disease. Results: Among hundred Iraqi patients with RA, the median age was 51.23 \(\pm\) 8.4 years. The study's findings revealed that 23% had a high risk for CVD and 27% & 50% had moderate and low risk, respectively, based on the FRS calculator. The risk of CVD was significantly affected by the age of disease onset and seropositivity and steroid use (p-value 0.001). When the perceived risk was compared to the actual risk of cardiovascular disease, there was a weak agreement between them; only 31% had corresponding answers. Conclusions: The study showed an elevated risk of CVD in rheumatoid arthritis patients and a gap between actual and perceived CVD risk.

Volleyball is an anaerobic team sport that involves various complex movements and requires adequate body position sense. Therefore, volleyball players' most important physical characteristics are balance, agility, endurance, reaction speed, explosive strength, and quick strength. This study aimed to evaluate the relationship between core strength and functional performance of lower extremities in male and female volleyball players. A total of 19 (11 female, eight male) volleyball players aged 16-20 years (11 female, eight male) who were students of Ondokuz Mayıs University Yaşar Doğu Faculty of Sports Sciences participated in the study voluntarily. The inclusion criteria were determined as athletes with at least three years of active sports history and regular training. Height, weight, and Body Mass Index measurements were taken at the first visit. Then, shuttle test, plank test, push-up, single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (\(90^\circ\)) with hop for distance (MRH) and Y Balance Test were performed with randomized practice cards. When the push-up, sit-up, and plank tests were compared between men and women, a significant difference was found in the shuttle parameter (p\(>\)0.05). When the athletes' Single Leg Hop test parameters were evaluated, there was no significant difference, only in SH between the sides in men. At the same time, there was no significant difference only in medial rotation (\(90^\circ\)) with hop in women (p\(>\)0.05). While there was a significant difference in triple hop for distance, crossover triple hop for distance, medial side triple hop for distance (MSTH) and medial rotation (\(90^\circ\)) with hop between the parties in men, a statistically significant difference was found in single hop for distance, triple hop for distance, crossover triple hop for distance, medial side triple hop for distance parameters in women (p\(<\)0.05). When single-leg hop Tests LSIs were compared between male and female groups, no statistically significant difference was found in all parameters (p\(>\)0.05). When the findings of our study were examined, it was determined that although there was a significant difference in Single Leg Hop test parameters between dominant and non-dominant sides in the groups, the LSI values seen in male and female groups were between normal values, and there was no limb asymmetry. However, there was no difference between genders in LSIs, and similar results were found for men and women. In the core strength tests, while similar results were seen between genders in push-up and plank parameters, the significant difference in the shuttle test revealed that men had better core strength than women.

The article aims to comprehensively study the health care system as an important factor of social security and elaborate a modern paradigm of its development. The factors that negatively affect the population's health and social security in general have been identified. Tendencies to reducing the number of medical employees have been analyzed, and measures to improve the sector's staffing have been suggested. The necessity of digitizing data, medical statistics, and patient routing has been proved. It has been emphasized that the basis of national interests should be social security as a collective ability to counteract possible risks enhanced by the appropriate level of health care provision with the help of specific organizational and legal measures. It has been offered to apply an integrated nationwide approach for guaranteeing the proper level of the health care system, which is to provide the population with high-quality and affordable medical care, forming a unified medical space, implementing information and communication systems and other legal and financial mechanisms for the functioning of the sector by the needs of the time.

Background: Vitamin D deficiency (VDD) is a widespread issue, especially in Saudi Arabia, with implications for various health conditions. The study aimed to evaluate VDD's prevalence and associated factors among children visiting King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia, to inform public health strategies. Methods: Employing a retrospective study design, medical records from 391 pediatric patients aged 1-14 who visited KKUH from April 2023 to October 2023 were analyzed for vitamin D levels, demographic data, comorbidities, and supplementation status. Based on established thresholds, vitamin D levels were categorized into normal, insufficiency, and deficiency. Statistical analyses, including chi-square tests, assessed the association between vitamin D levels and independent variables. Results: Out of the 391 subjects, 56.8% had normal vitamin D levels, 17.6\% were deficient, and 25.6\% were insufficient. Treatment or prophylaxis was reported in 75.2% of those with normal levels. The prevalence of VDD was not significantly related to gender (p = 0.635) but was significantly associated with age (p < 0.001), with higher deficiency rates observed in older children (10-14 years). Most children (84.4%) were asymptomatic, while specific symptoms like bone ache and fatigue were less commonly reported. Conclusions: The study highlighted a substantial prevalence of vitamin D insufficiency and deficiency among children in a Saudi Arabian tertiary care setting, with age identified as a significant correlate. These findings emphasize the need for regular screening and targeted vitamin D supplementation strategies in pediatric healthcare practice to mitigate the risks associated with VDD.

This research was designed to study some hormonal and physiological aspects of women with Premature Ovarian Insufficiency (POI). Blood samples were collected from the Infertility and Gynecology Unit at Al-Batoul Teaching Hospital in Baqubah and private women's clinics, including ages between 20 and 40. The study took place from 12/1/2022 until 5/1/2023, and informed consent was obtained from all patients. The study included 45 women with premature ovarian insufficiency. It was compared to a control group that consisted of 45 healthy women after confirming their fertility, at ages ranging from 20 to 40 years. The study investigated the effects of specific physiological and biochemical parameters on the disease. This was done by examining hormone levels and various biochemical levels in women with premature ovarian insufficiency. Some of the hormones examined were anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), progesterone, and thyroid hormone. The levels of vitamin D, calcium, and magnesium were also measured. The results of the current investigation showed that the age groups had a significant difference (P\(<\)0.05) with the study groups. (patients and healthy people). The age groups 31-35 and \(>\)35 years recorded the highest percentages (33.3% and 31.1%) in female patients compared to the groups \(<\)20-25 and 26-30 years, which recorded the lowest percentages (15.6% and 20.0%), respectively. The outcomes of the current investigation regarding the concentration of reproductive hormones showed a significant difference. (P\(<\)0.05) between the AMH, FSH, and LH hormone levels in the two study groups (patients and healthy individuals). The levels of FSH and LH were higher in patients (6.780 \(\pm\) 15.54 and 5.44 \(\pm\) 12.40) compared to healthy individuals (4.75\(\pm\) 6.51 and 4.04 \(\pm\) 0.94), respectively. On the other hand, AMH levels were lower in patients (0.18 \(\pm\) 0.42) compared to healthy individuals (0.92 \(\pm\) 3.15). In terms of TSH, E2, and Progesterone hormone levels, there were no significant differences (P\(>\)0.05) between the two study groups. About the physiological investigation that included measuring the concentration of magnesium, calcium, and vitamin D, the current study demonstrated a significant difference (P\(<\)0.05) in the concentration of magnesium between the two groups. (patients and healthy people). The level of magnesium was low in patients (0.29 \(\pm\) 0.75) compared to healthy people (0.30 \(\pm\) 2.07). There was also a statistically significant difference (P\(<\)0.05) in the level of calcium concentration between the two study groups (patients and healthy people). The calcium level was high in patients (0.45 \(\pm\) 8.33) compared to healthy people (0.58 \(\pm\) 8.02). Also, significant differences (P<0.05) in the levels of vitamin D were observed between the two groups of study (patients and healthy individuals). The levels of vitamin D were low in the patients (8.62 \(\pm\) 18.88) compared to the healthy people (11.53 \(\pm\) 44.15).

Introduction: This research examines the effects of depression and anxiety on patients' recovery and quality of life following cardiac intervention, highlighting the frequent occurrence of these psychological conditions after ICU stays and intensive rehab, emphasizing the need for addressing pain perception and providing patient education and counseling. Methodology: A descriptive cross-sectional research design was used, and the research was conducted in Saudi Arabia from April 2023 to September 2023. All participants were from Saudi Arabia and had cardiac intervention. Questionnaires collected data: The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) questionnaire. Results: Among the 543 patients included who underwent cardiac intervention, 61.3% (n=333) were males, and 38.7% (n=210) were females. The most common types of intervention were percutaneous coronary intervention (30.8%, n=167) and coronary artery bypass grafting (26.7%, n=145). Notable comorbidities included arrhythmia (22.1%, n=120), diabetes (42.7%, n=232), high cholesterol (41.8%, n=227), hypertension (52.3%, n=284), a sedentary lifestyle (37.8%, n=205), and smoking (33.1%, n=180). Patients with depressive and anxiety symptoms were further categorized into different levels of severity based on their PHQ and GAD-7 scores, respectively. Conclusion: Our study indicated a high prevalence of depressive and anxiety symptoms in this population. Factors such as comorbidities, demographics, and intervention characteristics were associated with the presence and severity of these symptoms. The findings highlight the importance of addressing psychological well-being and implementing targeted interventions to improve the mental health outcomes of cardiac intervention patients in Saudi Arabia.

Background: After cardiovascular and cancer, the third leading cause of death is trauma. Death due to trauma usually occurs in the first four decades of life. Thoracic injuries are a severe problem due to high-speed vehicle accidents. The two significant types of trauma are penetrating trauma and blunt trauma. Penetrating injuries usually result in the disruption of tissue structure, while blunt injuries result in organ damage or any structure under the tissue without damaging the integrity of that tissue. Blunt injuries include falling from a height, a traffic accident, or job-related injuries. Method: This is a cross-sectional study conducted for one year, and a sample size of 293 was taken. The study encompassed the bodies of patients eligible for autopsy, excluding those with mutilated or decomposed bodies, as well as those with insufficient historical information. Autopsies were conducted following proper patient identification and examination. A T-test was employed to compare male and female groups, while the chi-squared test assessed differences in categorical variables between groups. Data analysis was performed using SPSS version 24.0. A value of P \(<\) 0.05 was considered significant. Result: The study revealed that most of the chest trauma cases occurred in males 70.3% and females 29.7%. Maximum number of trauma was seen between the age group of 21 to 30 years. Out of 293 victims, 235 have blunt injuries, and 58 have penetrating injuries, lung contusion is the most common 51.8% followed by rib fracture, which has occurred in 46.4% victims. Conclusion: The rate of occurrence of chest trauma is higher in males between the age group of 21 to 30 years than females of the same age group. Similarly, the prevalence of blunt chest trauma is much higher as compared to penetrating chest trauma. In blunt injury, the incidence of traffic-related injuries is higher, while in penetrating injuries, stabbing is more common than any other injuries.

Aims: This review examines the Current State of the Integrated Healthcare approach and assesses the impact of integrated care models on patient health outcomes. Methodology: A systematic review using PubMed database and Google Scholar database. Using period 2019-2023 and keywords Clinical Medicine AND Diagnosis AND Treatment AND Integrated Approach and "integrated care" AND "diagnosis and treatment" AND "clinical medicine" AND "multidisciplinary care" were employed to identify relevant studies from PubMed and Google Scholar. Finally, 18 articles were sampled. Results: The systematic literature review on integrated diagnosis and therapy in clinical medicine shows many study designs and sample sizes. RCTs, the gold standard, are included in the review, along with Prospective Cohort Studies, Retrospective Studies, Cross-Sectional Studies, and Post-hoc Analyses. Some studies have large populations and rich datasets, whereas others have smaller samples. These studies provide varied approaches and timeframes for applying the integrated approach in clinical practice and discuss integrated healthcare approaches that use multidisciplinary teams, innovative technologies, and targeted interventions to treat chronic disorders and multi-morbidities. Integrated healthcare enhances patient outcomes, adherence to recommendations, and quality of life, emphasizing the need for tailored care in modern medicine. Scientific Novelty: Exploring a complex, integrated clinical medicine diagnosis and treatment approach to find patient care solutions. Conclusion: Clinical medicine's integrated diagnosis and treatment strategy is dynamic and promising. It can improve patient care, lower healthcare costs, and improve the quality of life for people with diverse health issues.

Objectives: The COVID-19 pandemic has become a great teacher, and online teaching-learning has become the need of the hour during this crisis. In order to improve online medical education and include innovative methods to increase the cognitive, affective, and psychomotor domains of teaching-learning, it is essential to understand students' perceptions of this online teaching method. Methodology: A cross-sectional study was conducted among medical undergraduates at a tertiary healthcare institution involving students of third, sixth, and eighth semesters. All the students who were willing to participate were included in the study. Data was collected using a predesigned, self-administered validated questionnaire consisting of socio-demographic variables, perceptions about course content, teachers and online assessments, their rating of traditional classes compared to online classes, and their experiences with online learning. Results: A total of 295 Undergraduate medical students belonging to the third, sixth, and eighth semesters of the MBBS course were included in the study. 85% of the students felt that the online OG classes during the COVID pandemic were enjoyable. A statistically significant association was found between student's course content and gender. The ease of staying at home, studying at one's own pace, and saving the transport cost were more acceptable to the students. Lack of communication between the patients and teachers and network issues were identified as problem areas. Conclusions: Hence, online teaching may replace traditional medical teaching during the COVID-19 pandemic.

The current article concerns wastewater contamination with lead and cadmium due to their toxicity and negative impacts on living creatures and the ecosystem. The study included the assessment of the physiochemical properties and the concentrations of some ions in the wastewater of some industrial plants in Kirkuk governorate Coded (Area 1 to Area 5). The physiochemical properties include temperature, pH, total dissolved solids (T.D.S.), total suspended solids (T.S.S.), electrical conductivity (\(E.C^\circ\)), total hardness, and turbidity. The concentration of ions includes nitrate (\(NO^{-}_{3}\)), magnesium (\(Mg^{2+}\)), calcium (\(Ca^{2+}\)), sulphate (\(SO^{2-}_{4}\)), chloride (\(cl^{-}\)), sodium (\(Na^{+}\)), phosphate (\(PO^{3-}_{4}\)), lead (Pb) and cadmium (Cd). The findings demonstrated that the phosphate (\(PO^{3-}_{4}\)) and lead (Pb and Cd) concentrations were more than the permitted limits. All the physiochemical properties have shown elevated levels compared to the normal values except for those related to total hardness and turbidity, which were unacceptable.