Objectives: Acute limb ischemia (ALI) is a vascular emergency characterized by a sudden reduction in limb perfusion, threatening limb viability. It affects 10-12 individuals per 100,000 annually in Europe, with common causes including arterial thrombosis, embolism due to cardiac disease, and trauma. Timely intervention typically within 6 to 12 hours is critical to avoid irreversible damage, amputation, or death. The Rutherford Classification system provides a standardized framework to stratify the severity of ALI and guide management. Objective: To evaluate the clinical patterns, management strategies, and outcomes of adult patients presenting with acute limb ischemia in government emergency departments in Northern Saudi Arabia from October, 2021 to December, 2024. Methods: This observational analytic study was conducted at two tertiary care hospitals North Medical Tower Hospital and Prince Abdulaziz Bin Musaad Hospital. Data were retrospectively collected from medical records of adult patients presenting with post-traumatic or thromboembolic ALI. Variables included demographic details, comorbidities, Injury Severity Score (ISS), transfer timing, Rutherford classification, imaging and intervention details, and clinical outcomes. Results: A total of 27 patients with ALI were identified. The majority were males (81.4%), aged 40-60 years (55.5%). Common comorbidities included hypertension (33.3%), smoking (37%), and diabetes (14.8%). Most cases involved the lower limb (85.1%), with trauma and arterial thrombosis being the predominant etiologies. Preoperative CT angiography was performed in 55.5% of cases, particularly in Rutherford Class IIa and IIb patients. Class I (viable) was the most frequent presentation (85.1%), followed by Class IIa (7.4%), IIb (3.7%), and Class III (3.7%). Catheter-directed thrombolysis (48.1%) and surgical embolectomy (40.7%) were the most common interventions. Limb salvage was achieved in 92.5% of patients. Amputation was required in one Class III case, and one mortality occurred in a Class IIb case presenting with atrial fibrillation. Conclusion: The Rutherford Classification is a valuable tool for prognostication and decision-making in ALI. Lower limb involvement is more prevalent and associated with poorer outcomes, particularly when referral and intervention are delayed. Early recognition, timely referral to vascular surgery, and appropriate use of thrombolysis or embolectomy are crucial for optimizing limb salvage in resource-limited settings.

The rapid expansion of electronic commerce in medicinal products has brought both new opportunities and significant risks for consumers worldwide. While e-pharmacies enhance accessibility, convenience, and price transparency, they also present challenges such as exposure to counterfeit medicines, misuse of personal data, and legal uncertainty across jurisdictions. This article aims to analyse the legal issues surrounding the protection of consumers’ rights in the field of online pharmaceutical trade and to identify the prospects for harmonizing national and international standards. The study employs an interdisciplinary methodology combining legal, comparative, and policy analysis. It draws on international instruments (UN, WHO, OECD, EU regulations), national legal frameworks, and academic literature to assess the current state of consumer protection. Key findings reveal a high level of regulatory fragmentation, particularly in low- and middle-income countries, where legal safeguards and quality control mechanisms are insufficient. The article highlights international best practices, including the .pharmacy domain initiative, EU logo certification, and blockchain-based supply chain traceability. It concludes that effective consumer protection in the e-pharmacy sector requires coordinated action from international organizations, national regulators, businesses, and consumers. Recommendations are proposed to strengthen legal frameworks, improve enforcement, and foster global convergence of standards in the digital pharmaceutical market.

Objectives: Obesity is strongly associated with chronic low-grade inflammation and immune system dysregulation, contributing to metabolic complications such as insulin resistance. Sleeve gastrectomy, a common bariatric surgery, is known for its weight-reducing effects, but its impact on inflammatory markers and immune response remains underexplored, particularly in Iraqi populations. This study aims to evaluate how sleeve gastrectomy influences specific blood cytokine levels, weight loss, and insulin sensitivity over time. Materials and Methods: A total of 40 obese patients (BMI >35 kg/m²) undergoing sleeve gastrectomy were enrolled from a private clinic in Baghdad. Participants were grouped based on the time of evaluation: before surgery, 3 months post-surgery, and 6 months post-surgery. Data collected included demographic information, BMI, fasting blood glucose, insulin, CRP, and serum levels of IL-1β, IL-12, IL-23, IL-33, IFN-α, IFN-γ, and MCP-1. Cytokines were measured using ELISA kits, and insulin resistance was calculated using the HOMA-IR model. Statistical analysis was conducted using ANOVA and Pearson correlation. Results: Following surgery, patients showed significant reductions in BMI and fasting blood glucose. Levels of IL-1β, IL-12, and IL-23 decreased markedly at both 3 and 6 months post-surgery (P<0.001), with additional reductions between the two postoperative periods. IL-33, IFN-α, and IFN-γ levels also declined significantly after surgery, although no notable difference was observed between 3 and 6 months. MCP-1 levels remained stable across all groups. Improvements in weight and inflammation were positively correlated, suggesting an immunomodulatory benefit of surgery. Conclusion: Sleeve gastrectomy leads to substantial weight loss and a significant reduction in systemic inflammation, reflected by lower cytokine levels. These changes may enhance immune balance and metabolic health, supporting the broader therapeutic value of bariatric surgery in managing obesity-related inflammation.

Background: Computer-assisted technologies such as CAD/CAM systems, 3D imaging and robotic-assisted surgery are reshaping oral and maxillofacial surgical practices by enhancing diagnostic precision, treatment planning and procedural outcomes. Despite these advancements, their adoption among dentists remains inconsistent. This study assessed the knowledge, usage patterns and barriers to the implementation of such technologies among dentists in Saudi Arabia. Methods: A cross-sectional survey was conducted between November and December 2024 using a validated, self-administered online questionnaire. A total of 422 licensed dentists across Saudi Arabia participated. The survey assessed demographics, awareness, usage, perceived benefits, barriers and training needs related to computer-assisted technologies. Data were analyzed using descriptive statistics, chi-square tests and multivariate regression (p<0.05). Results: Awareness was high for CAD/CAM systems (91.3%) and surgical navigation tools (85.1%), yet practical usage was notably lower-only 41.2% and 56.4%, respectively, reported using these technologies. Robotic-assisted surgery had the highest usage rate (78.7%). Key barriers included high equipment costs (44.5%), lack of adequate training (22.7%) and limited institutional support (12.1%). Knowledge and adoption rates were significantly higher among prosthodontists, orthodontists and private practitioners, while female dentists and those working in government hospitals reported lower adoption. Conclusion: A clear gap exists between awareness and practical application of advanced dental technologies, primarily due to financial, educational and infrastructural constraints. To bridge this gap, it is recommended that digital dentistry be fully integrated into undergraduate curricula and continuing professional development programs. Institutions should enhance training accessibility and provide funding or subsidies to support technology adoption. These measures are critical for aligning clinical practice with the innovation goals outlined in Saudi Vision 2030.

Background: Cytokine storm is a life-threatening immune reaction contributing to the severity of various infectious diseases such as COVID-19, sepsis, Ebola, and Dengue. Understanding its pathophysiology is critical for timely diagnosis and effective treatment. Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science (September 2024 – January 2025). Keywords included “cytokine storm,” “pro-inflammatory cytokines,” “COVID-19,” “sepsis,” “targeted therapy,” and “personalised medicine.” Studies were analysed thematically. As a narrative review, the findings are limited by the heterogeneity and potential bias of included studies, and no quantitative synthesis was performed. Results: The review outlines key mechanisms of cytokine storm, such as IL-6, IL-10, and TNF-α overproduction, and presents clinical cutoff values (e.g., IL-6 > 19.5 pg/mL) associated with disease severity. Targeted therapies (e.g., tocilizumab, anakinra), immunomodulators (e.g., JAK inhibitors), stem cell therapy, and plasmapheresis were reviewed. A personalised approach to treatment based on biomarkers and comorbidities was emphasised. Conclusions: Cytokine storm remains a major challenge in infectious disease management. While therapeutic strategies are evolving, individualised, biomarker-driven treatment offers the greatest potential for improving outcomes.

Background: The Saudi Arabia Vision 2030 focuses on advancing the nursing profession with an increasing number of Saudi nurses. New nurses face challenges with clinical competency during their transition phase. Virtual simulation is essential resource in nursing for a smooth transition into a practical setting. It enhances their confidence, competency, decision-making and critical thinking skills in clinical care. In KSA, the process of virtual simulation is at the beginning phase. Objective: The major goal of this study was to evaluate the awareness and readiness towards virtual learning among new nursing graduates. Methods: A cross-sectional descriptive study was conducted among the new nurses who graduated from the University of Tabuk, Saudi Arabia. The sample size was 156. A structured validated questionnaire was used to assess the awareness and readiness in Virtual simulation learning. Results: The participants reported high awareness of virtual simulation learning as the teaching method (Mean-84.92±12.68), Mean readiness score was (58.58±10.01). 71.5% of them reported high awareness, whereas only half of them (50.6%) of them were ready for the practice. Age, GPA, prior information, preference to apply and working area were significantly associated with awareness and readiness for the application of virtual simulation as part of clinical learning. Conclusion: Virtual learning is a promising tool, which helps to develop independent learning among the new nurses. The results of this study highlighted that the nurses are aware of the process and benefits of virtual learning. However, the readiness to apply in their practice is lacking. It is essential to identify the novice nurses expectations in successful implementation of this technology.

Gout is a prevalent noncommunicable inflammatory arthritis caused by the deposition of monosodium urate crystals, primarily due to hyperuricemia. If left untreated, it can lead to chronic joint damage and systemic complications. Public awareness and perception of its risk and preventive factors are essential for early diagnosis, effective management, and disease prevention. Objectives: To assess the awareness and perception of risk and preventive factors related to gout among the adult population in Arar city, Northern Saudi Arabia. Methods: A descriptive cross-sectional study was conducted from September 1, 2024, to January 31, 2025, targeting adults aged 18 years and older residing in Arar. Data were collected via a validated, bilingual (Arabic-English) structured questionnaire disseminated online through social media platforms. The survey covered sociodemographic data, knowledge of risk factors, and preventive measures. Convenience sampling was used. Descriptive statistics were analyzed using SPSS Version 27. Results: A total of 400 participants responded (mean age: 36.4 ± 12.7 years; 52.5% male). Among them, 67.2% recognized high blood uric acid as the primary cause of gout, and 80.2% identified excessive meat consumption as a key risk factor. Preventive awareness was high, with 91% agreeing that gout is preventable, primarily through lifestyle modification (87.2%) and medication use (82.5%). However, knowledge gaps persisted regarding hereditary factors, comorbidities, and less commonly known dietary influences. Conclusion: While the general public in Arar city demonstrates a fair level of awareness about gout and its modifiable risk factors, significant misconceptions and knowledge deficiencies remain especially regarding genetic predisposition and long-term complications. Targeted health education interventions and culturally tailored public awareness campaigns are recommended to improve understanding and preventive behaviors.

Background: Patients with obstructive bowel obstruction often develop severe infections, which can lead to death in 45-88% of cases. These complications are thought to be caused by bacteria in the intestine. However, treatments that affect these bacteria have not helped to reduce the number of complications. It is important to find other possible sources of infection in intestinal obstruction. The experiment was done to study how the intestinal wall changes during 48 hours of obstruction. Methods: The experiment was conducted on 13 white rats. The animals were separated into two groups. In the first (control) group, 5 rats experienced a laparotomy (abdominal incision) without affecting the intestines. In the second group, eight rats had their small intestine ligated after laparotomy to cause a complete blockage. Then the abdomen was sutured and after a specific time, the intestines were examined after 12, 24, 36 and 48 hours. Results: The results showed no changes in the control group. The histological examination revealed that the average thickness of the intestinal mucosa was 0.48±0.02 mm and the muscle layer was 0.92±0.02 mm. Healthy enterocytes with a clear structure were observed. In the group with intestinal obstruction, after 12 hours, the intestine dilated to 6-9 mm above the obstruction site and fluid appeared in the abdominal cavity. After 48 hours, the intestine became 2.5 times wider, blue-purple in colour and cloudy in fluid. The study showed that there were no changes in the control group. However, in the group with obstructive obstruction, purulent inflammation of the intestine began within 12 hours. It first appeared on the mucous membrane because the protective layer of the villi was damaged. Then, the inflammation spreads to the muscle and serous layers. Inflammation happened not only at the place of the blockage but also in the part of the intestine above it. Conclusions: The source of purulent complications in intestinal obstruction involves both intestinal microbes and structural damage to the bowel wall above the blockage. These findings underscore the need for early surgical intervention and strategies to protect the intestinal barrier, not just target the microbiota.

Background and Aim: Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, necessitating the development of accurate predictive models for early diagnosis. Therefore, this study aimed to evaluate and compare the performance of three machine learning models-Random Forest, Decision Tree, and K-Nearest Neighbors-in predicting cardiovascular disease based on key risk factors. Method: This retrospective study utilized patient data from Shar Hospital in Sulaimaniyah City. The dataset included demographic and clinical risk factors such as age, smoking status, diabetes, hypertension, and family history of cardiovascular disease. The three machine learning models were trained and tested using various data-splitting ratios, and their performance was assessed using accuracy, F1-score, recall, precision, and specificity. Statistical analysis and model validation were conducted using Python in Jupyter Notebook. Results: A total of 300 patient records were included in the study. The Random Forest model demonstrated the highest predictive accuracy compared to Decision Tree and K-Nearest Neighbors, consistently outperforming the other models across different training-testing configurations. Feature importance analysis revealed that age and family history were the most influential predictors of cardiovascular disease, whereas gender and marital status had minimal impact. The confusion matrix further confirmed the reliability of the Random Forest model, showing a high number of correctly classified cases with minimal false positives and false negatives. Conclusions: The findings indicate that Random Forest is the most effective model for cardiovascular disease prediction, with strong classification performance and high accuracy. The study also highlights the importance of age and family history as dominant risk factors. These results support the application of machine learning in clinical settings for early detection and risk assessment, enabling better-informed medical interventions.

Aim: This systematic review aims to evaluate the relationship between tooth brushing practices and cervical abrasion in adult population. The review explores the influence of different brushing techniques, toothbrush types, frequency and brushing force on the prevalence and severity of cervical abrasion. Background: Cervical abrasion (CA), a form of non-carious cervical lesion, has been increasingly associated with tooth brushing habits, raising concerns about the role of mechanical and chemical factors in the etiology of this condition. A comprehensive search was conducted across major scientific databases to identify studies published in the last two decades that investigate the impact of tooth brushing parameters on cervical abrasion. The review includes both observational and experimental studies that explore the role of manual versus electric toothbrushes, bristle hardness and toothpaste ablativity. Results: Our review selected 25 studies from an initial 120 titles. We found significant differences in prevalence of CA in relation to toothbrushing frequency, brush type and brushing technique. There were definite conclusion regarding type of teeth affected and appropriate management to enhance quality of life of the patients. Findings indicate that improper brushing techniques, excessive brushing frequency and the use of hard-bristled toothbrushes are significantly correlated with increased cervical abrasion. Conclusion: Cervical abrasion varies in prevalence across countries. However, it exhibits definite improper technique related increase. There is no gender predilection. The frequency of toothbrushing, type of brush, brushing technique, influences the prevalence. Certain teeth are more susceptible to abrasion than others. Resin-modified glass ionomers were reported to be better for treating this condition. However, evidence regarding electric toothbrushes remains inconclusive. Clinical Significance: The review highlights the need for standardized methodologies in future research to better understand the multifactorial nature of cervical abrasion and provide evidence-based recommendations for oral hygiene practices. This affects data on prevalence, habits and management.

Background: Triage is a critical process in emergency medicine that involves the rapid assessment and prioritization of Pediatrics based on the severity of their conditions. Objective: The present study aimed to evaluate the effect of an instructional program on nurses' skills pertaining to pediatric Interagency Integrated Triage Tool at pediatric emergency departments in hospitals in Mosul. Methods: Quasi experimental design study was carried out at pediatric emergency departments in Mosul hospitals from September 5, 2024, to December 25, 2024. Sample selection was conducted in collaboration with nursing departments in Mosul hospitals for both the intervention and control groups. A random selection process was then used to choose nurses from hospitals for the experimental group and the control group. The instructional program was lecture-based and the questionnaire survey was constructed by the researchers and distributed among nurses to evaluate the effect of the instructional program on nurses’ skills pertaining to pediatric Interagency Integrated Triage Tool. The instructional content contained five lectures with the questionnaire was divided into two sections. The validity was tested by a panel of 20 experts, who substantiated the construct validity and content clarity. To statistically test the reliability of instruments, a pilot test was run from September 22-26, 2024 by used Cronbach's alpha, the results was (0.810) Results: The statistical analysis of nurses' skills of the pediatric Interagency Integrated Triage Tool showed that all aspects of nurses’ skills in the experimental group in the pretest were at a 70.0% non-acceptable level, while in the posttest they reached 66.7%, an excellent level. As well as the t-test and ANOVA test, which showed that the experimental group was high significant relationship between pretest and posttest results but there was non-significant relationship for control group at p-value ≤0.05 level. Conclusion: The effect of an instructional program was proven by the highly significant relationship between nurses' skills pertaining to pediatric interagency integrated triage tool in the two research groups, one receiving instructions on the guideline and the other not.

Background: Expressive art therapy has emerged as a significant intervention method in both psychological and physical health realms, allowing individuals to utilize various artistic mediums for emotional expression and healing. Aim: The study aimed to evaluate the effectiveness of expressive art therapy on physiological parameter and salivary cortisol among women in selected destitute home. Methods: The study employed a quasi-experimental approach to evaluate the effectiveness of an intervention on destitute women, divided into age groups of below 40 and above 41 years, residing in various destitute homes. Purposive sampling method was used. The study utilized purposive sampling to recruit 120 participants, distributing them evenly with 60 in the experimental group and 60 in the control group. Those who were sick, or taking psychiatric medication were excluded. Socio demographic variables, Biophysiological parameters and biochemical parameters were measured before and after the intervention. Results: The study result showed that the intervention significantly reduces salivary cortisol levels was contained in the experimental group between post-test and control (p<0.001). ANOVA showed the group, test and the group x test interaction to be significant (p<0.001). Moreover, unusual improvement in the physiological parameters (p<0.001) was observed in the experimental group, while no significant changes were found in the control group. Conclusion: The study result suggests that expressive art therapy is an effective intervention for stress reduction in destitute women. Future research should build upon these results by exploring long-term effects and potential applications across diverse demographics and clinical settings.

Background/Objectives: Inter-Professional Education (IPE) boosts inter-professional communication and healthcare delivery. This study aims to navigate the attitudes and perceptions of undergraduate healthcare students toward the benefits and challenges of IPE. Methods: A cross-sectional study was conducted among 372 undergraduate healthcare students (i.e., Medical, Applied Medical Sciences, Nursing, Pharmacy and Dentistry) at Northern Border University, using a convenient sampling approach. Data were collected through structured electronic questionnaires assessing attitudes towards IPE, including teamwork, professional identity, roles and responsibilities and perceived benefits and challenges. Statistical analysis evaluated attitudes and their associations with demographic and academic factors. Results: Most students exhibited positive attitudes towards IPE, with 52.4% to 70.7% fully agreeing on the benefits of collaborative learning. However, notable negative attitudes were also observed, particularly concerning time wastage and perceived non-essentiality of IPE (21.8% to 31.2% disagreed or fully disagreed). Previous exposure to IPE significantly influenced attitudes, with higher mean scores among those with prior experience (p = 0.000). Discipline-specific variations were evident, with pharmacy students showing the highest mean attitude scores (p = 0.030). Challenges identified included logistical issues, resource limitations and faculty support discrepancies. Conclusion: While overall attitudes towards IPE were positive, significant barriers and discipline-specific differences exist. Addressing logistical and resource constraints, alongside early integration of IPE, could enhance its acceptance and effectiveness. Future research should explore longitudinal impacts and tailored strategies for different healthcare disciplines.

Background: Risk-Assessment Models may not accurately predict Venous Thromboembolism (VTE). This study prospectively assessed the use and decision-making accuracy of the Caprini and Padua risk-assessment models for antithrombotic prophylaxis in predicting VTE. Methods: Prospective study was conducted on 1075 Baghdad Teaching Hospital patients from December 1, 2022, until January 1, 2024. All patients and the subgroup examined for RAM discrimination using baseline medical and demographic data. Assessing Caprini and Padua scores' sensitivity and specificity. We analyze each score using the ROC curve and AUC. Results: The study observed 37 VTE cases. Individuals with VTE events had a significantly higher mean age (±SD) of 60.62 (15.8), p = 0.001. VTE occurs in 54% of acutely infected and/or rheumatologic patients P 0.002. Survival time and event-free period mean was 83.099 days (95% CI: 81.877-84.322) for patients without thromboprophylaxis and 74.085 days for those utilizing it. The Caprini RAM predicted VTE with 0.652 AUC, lower than Padua's 0.724. The Caprini RAM had 54.1% sensitivity and 61.7% specificity, whereas the Padua prediction score had 97.3% and 36.0%. Conclusion: The Caprini scores and Padua Prediction Score may improve hospital patients' thromboembolic risk classification compared to current practice.

There is a solid theoretical foundation for the understanding that the intake of certain nutrients may have an impact on the established processes for neurodegeneration, proven by plausible biological mechanisms. This study focuses on compiling important studies giving insight into dietary patterns that can prevent cognitive deterioration. Methods: The selected keywords facilitated a thorough and methodical search for relevant published articles, utilizing indexing sources including Scopus, Web of Science and PubMed. Evaluating the connection between nutrition and neuroscience efficiently. Only studies conducted with older adults and elderly individuals, for which complete articles were available, were included. The search strategy yielded 65 studies, reviews and meta-analyses concerning diet and cognition, supplemented by an additional 33 studies identified through reference lists of the reviews and meta-analyses. A total of 98 studies were identified, with 36 selected based on comprehensive abstracts and texts. A total of 26 studies were identified regarding the Mediterranean diet's impact on cognitive function or dementia, alongside 15 studies examining other dietary patterns related to cognitive function. Five studies conducted analyses on the Mediterranean diet in comparison to other dietary patterns. Two reviewers (OVDR and AAMB) independently conducted study selection, data extraction and quality assessment. Discussions: This review shows how diet affects memory loss, stressing the complex relationship between nutrition and neurobiology. The Mediterranean and DASH diets have high in antioxidants, anti-inflammatories and brain-healthy nutrients. These nutrients may reduce neuroinflammation, increase neuroplasticity and boost neurotrophic factor production. The gut-brain axis and microbiome modulation in cognitive function are also explored in this review. This shows that conservative diets can prevent memory decline and improve cognitive performance in older persons without drugs. This analysis lays the groundwork for future study and dietary recommendations to improve aging adults' quality of life and cognitive health. Conclusions: Effective nutritional strategies significantly reduce the overall rate of cognitive decline, particularly among the elderly population. The dietary pattern has demonstrated the potential to enhance cognitive functions within a few weeks of consistent adherence; individuals with diabetes mellitus experience advantages from the ketogenic diet; and those with obesity gain benefits from the MIND diet.

Pre-teen girls, aged 9 to 12, undergo crucial developmental changes during puberty, impacting their physiological, psychological and social well-being. Among pre-teen girls, elevated BMI levels are associated with an increased risk of developing comorbidities, like type 2 diabetes and cardiovascular diseases. This study is aimed to evaluate the effectiveness of a nurse-led intervention on Body Mass Index (BMI), total cholesterol, sr.estrodiol and Thyroid Stimulating Hormone (TSH) among pre-teen girls. Methods: A randomized controlled trial design was adopted to study 100 pre-pubertal girls from 8 to 12 years, divided into intervention and control groups. Each group consisted of 50 participants. The nurse led a physical activities program consisted of 30-minute daily aerobic exercises combined with parent counselling for twelve weeks. The control group received usual care, the BMI was taken four times, pre-test and post-test at 1 month, 2 month and 3 month. Serum total cholesterol, estradiol and TSH were measured two times, pre-test and post-test at 3month. Results: The research outcomes indicate a significant improvement BMI among the experimental group over the three-month study period, while the control group showed no changes, (p<0.001). The experimental group demonstrated a significant decline in estradiol level between pre-test and 3 months (p=0.009) although there were no significant changes found in Total cholesterol or TSH results. Conclusion: The study provides evidence for the effectiveness of the intervention in controlling BMI among the experimental group while maintaining stable biochemical profiles. Overall, the study highlights the need for continued efforts to develop and implement effective weight management strategies between body weight, hormonal balance and socio-demographic factors.