Objectives: Background: Cardiovascular diseases are one of the most common chronic conditions and smoking is known to be one of the main contributors as to developing a cardiovascular disorder. The study aims to assess the impact of smoking and smoking cessation on the quality of life among CVD Saudi population compared to its impact on non-diagnosed. Methodology: This is a cross-sectional study where a WHO-based questionnaire was distributed through multiple social media platforms. Inclusion criteria for this study are adults aged 18 years or older, current smokers or individuals who have quit smoking within the past 6 months, participants diagnosed with Cardiovascular Disease (CVD), participants without a diagnosis of CVD, residents of Saudi Arabia and able to provide informed consent. The sample size has been calculated to be a minimum of 384 participants using the Raosoft sample size calculator. In this study, both descriptive statistics and the chi-square tests were used. Results: The total number of participants was 574. The study demonstrated that smoking significantly diminishes Health-Related Quality of Life (HRQoL) among individuals with CVDs in Saudi Arabia. Non-smokers exhibited HRQoL scores averaging 75, while smokers reported scores of 60, indicating a 25% reduction. Additionally, participants with higher educational attainment experienced HRQoL scores that were 20% higher than those with lower education levels. Notably, approximately 35% of smokers reported dissatisfaction with their emotional well-being, correlating with elevated levels of depression and anxiety. These findings underscore the urgent need for targeted smoking cessation interventions to enhance the quality of life for CVD patients. Conclusion: The current study provides valuable insights into the impact of smoking and smoking cessation on the quality of life among patients with cardiovascular diseases. The findings underscore the urgent need for effective smoking cessation interventions tailored to the unique cultural and socioeconomic contexts of patients.

Environmental health in healthcare settings is essential for ensuring patient safety, protecting public health and promoting sustainable development-especially amid rising global concerns such as pandemics, climate change and antimicrobial resistance. The Kingdom of Saudi Arabia (KSA) has recognized the significance of environmental health as part of its healthcare policy framework and national development strategy under Vision 2030. This review explores how KSA has developed and implemented environmental health initiatives in its healthcare sector, particularly those governed by the Ministry of Health (MOH). The study analyzes publicly available policy documents from the MOH to assess the current scope of environmental health measures in medical facilities. These are then compared with international standards and guidelines, including those from the World Health Organization (WHO), the United States and the European Union. Key policy areas reviewed include waste management, energy efficiency, water conservation, indoor air quality, chemical safety, green building design, sustainable transportation and emergency preparedness. Findings reveal that while KSA has made substantial progress in advancing environmental health practices, notable policy gaps remain-particularly in areas such as recycling programs, green procurement and sustainability education for healthcare personnel. The review concludes by recommending policy enhancements to align more closely with global best practices. Strengthening environmental health measures in healthcare facilities can improve public health outcomes, reduce operational costs and support national sustainability goals.

Background: Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is the most common enzyme disorder worldwide and an X-linked hereditary condition that can result in hemolytic anemia, particularly in response to oxidative stress. While G6PD deficiency is prevalent in the Middle East, regional and gender-specific pediatric data remain limited. This study aimed to assess the prevalence and hematological profile of G6PD deficiency among children in Madinah, Saudi Arabia. Methods: A retrospective cross-sectional study was conducted among 3,623 children aged 10 years and below who visited the Maternity and Children Hospital in Madinah between January 2020 and January 2023. G6PD status was assessed using a qualitative fluorescent spot test. Hematological parameters including RBC count, Hemoglobin (Hb), Hematocrit (Hct), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC) and red blood cell distribution width (RDW) were recorded. Statistical analysis was performed using SPSS v26; group comparisons were conducted using independent sample t-tests, with significance set at p≤0.05. Results: The overall prevalence of G6PD deficiency was 9.88% (n = 358), with a significantly higher prevalence in males (7.48%) than females (2.40%) (p<0.001). G6PD-deficient children showed reduced Hb (11.39±2.55 g/dL), Hct (38.46±6.22%) and MCH (28.17±1.67 pg), while other red cell indices remained within reference ranges. Hematological parameters were significantly higher in deficient females compared to males (p<0.05). Conclusion: G6PD deficiency is relatively common among children in Madinah and disproportionately affects males. Given its role in neonatal jaundice and hemolytic crises, early detection is critical. The findings support implementing region-wide newborn screening and premarital counseling programs as part of Saudi Arabia’s public health strategy.

Objectives: This study aimed to assess the effectiveness of an instructional program in enhancing individuals' awareness regarding the prevention of neck disability and corrective exercises for Text Neck Syndrome (TNS). It also sought to explore the relationship between participants’ awareness and their demographic characteristics. Methods: A quasi-experimental design was employed using non-probability purposive sampling at the Kirkuk Center for Rehabilitation. A total of 40 participants with a Neck Disability Index (NDI) score of 5 or higher (≥10%) were included and assigned to study and control groups. Individuals with a history of neck surgery were excluded. Both groups completed pre- and post-tests. The study group received a structured instructional program over four weeks, consisting of weekly 45-60 minute sessions covering TNS anatomy, prevention strategies and corrective exercises, supported by visual materials. Data collection involved a validated and reliable questionnaire (test-retest reliability = 0.80) and analysis was conducted using SPSS version 26.0. Results: No significant differences were found in baseline demographic characteristics between the groups. In the study group, awareness of preventive measures increased significantly from 55% low to 95% good and awareness of corrective exercises improved from 95% poor to 100% good in the post-test. Effect sizes were large (~0.88) for both outcomes, indicating strong intervention impact. In contrast, the control group showed minimal improvement with smaller effect sizes (0.497 for prevention and 0.316 for corrective exercises). A statistically significant association was observed between occupational status and awareness (p = 0.013), while other demographic factors showed no significant relationships (p>0.05). Conclusions: The structured instructional program led to significant improvements in awareness in the intervention group, with effect sizes indicating a strong impact, while the control group exhibited minimal changes.

Background: Medication errors, defined as preventable events that may lead to inappropriate medication use or patient harm, remain a persistent global challenge contributing to adverse drug events, increased morbidity, and escalating healthcare costs. While prior research has primarily examined system-level and technological factors, limited attention has been given to the emotional and experiential dimensions influencing medication error occurrence and reporting. Objective: This study aimed to investigate public awareness, attitudes, and experiences related to medication errors, with a particular focus on the perceived role of artificial intelligence (AI) in enhancing medication safety. Methods: A cross-sectional descriptive design was employed using a structured, self-administered online questionnaire. A total of 501 valid responses were collected from adult residents in Saudi Arabia. The survey included items on demographics, knowledge of medication errors, attitudes toward AI in pharmacy practice, and preventive behaviors. Descriptive statistics and binary logistic regression were used for data analysis. Results: Approximately 79.9% of respondents reported awareness of medication errors, though 75.7% relied on informal online sources for information. While 47.6% strongly believed AI could improve dispensing accuracy, concerns regarding data privacy, reliability, and job displacement were noted. Logistic regression indicated a strong association between pro-AI attitudes and willingness to adopt AI, though model convergence was limited due to polarized responses. Conclusion: Findings highlight the necessity of fostering non-punitive reporting cultures, strengthening digital health literacy, and carefully integrating AI into pharmacy practice. These measures are critical to enhancing patient safety and align with national healthcare transformation goals, including Saudi Arabia’s Vision 2030.

Background: The integration of Artificial Intelligence (AI) into healthcare systems has introduced substantial advancements in clinical and pharmaceutical practices. As future healthcare providers, pharmacy students are expected to engage with AI-enabled tools; however, limited empirical data are available on their familiarity with and attitudes toward, AI technologies. Objective: This study aimed to assess pharmacy students’ knowledge of AI, their perceptions of its application in pharmaceutical settings and their intentions to incorporate AI into future practice. Methods: A cross-sectional descriptive study was conducted among 501 undergraduate pharmacy students in Saudi Arabia. Data were collected through a structured, self-administered online questionnaire consisting of demographic variables, AI familiarity, attitudinal measures and future intentions. Descriptive statistics and chi-square (χ²) tests were used to examine associations between demographic characteristics and AI-related attitudes. Results: Of the 501 respondents, 48.61% reported moderate familiarity with AI, with online resources cited as the predominant source of knowledge (75.70%). Approximately 50.6% agreed that AI could reduce medication errors, while 54.98% affirmed that pharmacists would continue to play a critical role despite technological advancements. A total of 62.95% indicated a likelihood of using AI in their future practice. Statistically significant associations were identified between gender, academic year and both AI familiarity and willingness to adopt AI (p<0.001). Conclusion: The findings suggest a generally positive orientation among pharmacy students toward AI in pharmaceutical practice, alongside notable concerns regarding data privacy, job security and ethical implications. These results underscore the need for structured AI education within pharmacy curricula to enhance digital readiness and support responsible integration of AI technologies in future pharmaceutical services.

The present investigation aimed to identify the effect of the drug pregnyl on the histological structure of the lungs in male Swiss mice (Mus musculus). The study included the use of 14 mice divided into two groups, with 14 mice in each group, and the animals of each group were placed in a separate cage. The first group, which is the control group, its animals were treated with distilled water only for 30 days, while the mice of the second group, which is the experimental group, were injected by concentration of 0.2 mg of pregnyl/kg of body weight intraperitoneally, for 30 days too. On the last day, the animals were sacrificed, their lungs were extirpation, and their tissue sections were prepared. The results obtained from the histological study showed that all animals treated with pregnyl exhibited pathological histological changes in the lungs, represented by degeneration and necrosis of the cells lining some bronchi and the separation of some cells from the epithelial layer. It was also noted that there was a gap between the epithelial tissue and the submucosal layer. The results of the study showed the occurrence of edema between the alveoli and alveolar sacs and an increase in the thickness of the wall between the alveoli. On the other hand, congestion and bleeding occurred in the blood vessels, and cellular infiltration was observed between the alveoli and alveolar sacs. It was also noted that there was a break in the wall of the alveoli and alveolar sacs and their accumulation inside the alveolar cavity. It was also noted that there was a collection of inflammatory cells and blood congestion between the alveoli and alveolar sacs. It was also noted that there was a rupture between the alveoli and the occurrence of blood bleeding. The blood vessel was distorted and congested with the appearance of a blood clot inside the blood vessel, in addition to the occurrence of fibrosis and infiltration of inflammatory cells around the vessel. In addition, active transport vesicles inside the vessels appeared, indicating a high activity of the blood vessel lining.

Objectives: Introduction: Nurses are responsible for the direct and indirect continuous care of pressure injuries. To achieve the highest quality care, the article discusses the knowledge and attitude of nurses during the care of pressure ulcer patients and highlights their behavior, as knowledge is important in reducing the presence and development of ulcers. Objectives: The purpose of this study is to evaluate Saudi Arabian nurses' attitudes and level of knowledge about caring for pressure ulcers. Methodology: This study is a cross-sectional study conducted from July 2024 to February 2025 in Saudi Arabia. The inclusion criteria are random nursing students in internship years and nursing staff in Saudi Arabia. All nursing students are excluded from their internship years. The minimum target sample size of 384 was calculated using a formula based on prevalence estimation, 95% confidence level and 5% acceptable error. Results: The study assessed the knowledge and attitudes of 394 nurses in Saudi Arabia regarding pressure ulcer care. The participants, predominantly young and well-educated, demonstrated a strong understanding of immobility as a primary risk factor for pressure injuries, with 82% recognizing its significance. However, there were notable gaps in their perceptions of comprehensive care, as 66% believed topical creams were the sole preventive measure. While 74.1% consistently assessed patients’ skin, only 20.3% exhibited high knowledge levels. Overall, nurses displayed moderate attitudes towards pressure ulcer prevention, highlighting the need for enhanced education and training to improve care practices and outcomes. Conclusion: In conclusion, the findings of this study underscore the necessity for ongoing training and support to bridge the gaps identified in knowledge and practice regarding pressure ulcer management among nurses in Saudi Arabia.

Background: Diabetes Mellitus (DM) affects all body parts and is the 2^nd foremost reason for blindness and foot ulcers globally. It can cause severe short/long-term complications extending from brain impairment to amputations and heart ailments. Objectives: To assess risk factors of Diabetic Foot Ulceration (DFU) among patients. Methods: A cross-sectional study was done at two Kirkuk Hospitals in Kirkuk City, Iraq, on 100 patients diagnosed with DFU from 1st November 2021 to 5th June 2022. A developed questionaire comprised patients' sociodemographic data, medical data and assessment of risk factors causing DFU. Results: Most patients were males (54%), aged 60-69 years (40%), lived in an urban area (74%), married (78%), had a disease complaint of >9 years (66%), had hypertension (24%) and had a family history of DM (78%). Diseases in the peripheral nerves, smoking, foot injury, carelessness of the foot and not taking medications regularly were significantly associated with the chances of DFU. A significant difference between the risk factors of diabetic foot and each patient's age and education status (p≤0.05) was observed. Conclusions: The most profound risk factors were having diseases in the peripheral nerves, smoking, having injury in the foot, neglecting the foot and not taking medications regularly. Age, gender and education level directly correlated with the risk factors.

Objectives: Triploidy is a lethal chromosomal abnormality characterized by an additional complete haploid set of chromosomes. It often leads to early miscarriage, severe congenital anomalies and Intrauterine Fetal Death (IUFD) in later gestation. We report a case of a 25-year-old primigravida whose fetus was diagnosed with triploidy (69,XXY) after prenatal ultrasound revealed extensive multisystem anomalies, including central nervous system, skeletal, renal and cardiac defects. Despite full counseling and the offer of termination, the couple opted to continue the pregnancy, which ended in IUFD at 25 weeks. This case highlights the critical role of detailed anomaly scanning, genetic testing and multidisciplinary counseling in such complex scenarios.

Objectives: Healthcare customer fraud has emerged as a significant challenge for India's healthcare system, impacting its financial stability, operational efficiency and the quality of patient care. As the healthcare sector expands, particularly with the integration of digital health records, insurance schemes and a growing private sector, opportunities for fraudulent activities have increased. This study aims to assess the prevalence and types of healthcare customer fraud in India, evaluate its impact on healthcare institutions and examine the effectiveness of current fraud prevention measures. Using an empirical research methodology, data was collected from 412 respondents in public areas around Chennai, with a focus on demographic factors such as age, gender, education, occupation and place of residence. The study identifies key issues, including the erosion of trust in the healthcare system, inflated medical bills, false claims and unnecessary treatments, all of which contribute to financial and operational strain on healthcare providers. Despite ongoing initiatives such as the Ayushman Bharat scheme and the National Digital Health Mission, existing measures remain insufficient. The study suggests that advanced technologies like Artificial Intelligence (AI), Machine Learning (ML) and blockchain can play a crucial role in improving fraud detection and prevention. Furthermore, strengthening regulatory frameworks, increasing public awareness and fostering public-private partnerships are vital to mitigate fraud risks and enhance the integrity of the healthcare system. The findings underscore the need for comprehensive policy reforms to safeguard the healthcare system’s sustainability and effectiveness, ensuring a more transparent and reliable healthcare environment for all stakeholders.

Introduction: Plantar fasciitis (PF) is a prevalent musculoskeletal disorder and a leading cause of heel pain, particularly among the elderly, women, obese individuals and those engaged in prolonged standing or weight-bearing activities. While PF has been widely studied globally, its prevalence in Saudi Arabia remains insufficiently studied. This study aims to assess the prevalence of PF and its associated risk factors among patients attending King Abdulaziz Medical City. Methods: A retrospective cohort study was conducted at three primary healthcare centers within King Abdulaziz Medical City. We included all patients aged ≥18 years diagnosed with PF between January 2017 and December 2022. Data were extracted from electronic health records using the Best Care system, including sociodemographic variables (age, gender, marital status, occupation, BMI) and clinical characteristics (hypertension, diabetes mellitus, dyslipidemia, calcaneal spur). Results: The median age at diagnosis was 56 years, with 73% being females. Among PF patients, 10% had hypertension, 7.7% had diabetes, 23% had dyslipidemia, and 0.2% had calcaneal spur. The median BMI was 33.2 kg/m². The overall prevalence of PF among the 68134 patients in the three healthcare centers was 1.7%, with Iskan Al Yarmouk recording the highest prevalence (0.9%), followed by Health Care Specialty Center (0.6%) and National Guard Comprehensive Specialized Clinic (0.2%). Conclusion: The prevalence of PF among patients attending primary healthcare centers at King Abdulaziz Medical City was 1.7%, with a strong association with obesity and female gender. Targeted interventions, particularly among high-risk groups, are recommended such as incorporate weight management counseling and appropriate footwear guidance into routine care for patients at risk of plantar fasciitis. Further research is needed to explore long-term outcomes and optimize treatment strategies for PF patients in Saudi Arabia.

Type 1 Diabetes (T1D) is an autoimmune disease driven by the destruction of insulin-producing beta cells. Genetic susceptibility includes variations in the *INS* gene, which encodes insulin. We hypothesized that T1D-associated *INS* mutations may alter insulin’s structure, affect its immunogenicity and contribute to autoimmunity. To investigate this, we conducted the first comprehensive structural analysis of all T1D-linked *INS* missense variants reported in ClinVar, using a multi-faceted computational approach. We curated all reported INS missense variants linked to T1D from ClinVar and analyzed their impact using Molecular Dynamics (MD) simulations. Leveraging the InterPro database, we mapped PR proinsulin’s domain architecture and assessed evolutionary conservation via multiple sequence alignment. MD simulations evaluated each mutation’s effect on insulin stability, using Root Mean Square Deviation (RMSD) for structural shifts and Root Mean Square Fluctuation (RMSF) for flexibility. K-means clustering grouped variants based on these metrics. Among 41 identified INS mutations, several occurred in highly conserved regions, suggesting functional significance. Variants such as T97S, A24V, P52R, L68M and G32S showed increased flexibility, with L68M displaying the highest RMSD, indicating structural destabilization. Based on MD data, we classified mutations as "Unstable," "Flexible," or "Stable." Our findings suggest that structural alterations caused by INS mutations may generate neoantigens, contributing to T1D autoimmunity. This classification provides insight into variant pathogenicity and highlights the importance of conserved regions for insulin function, with potential implications for diagnostics and therapeutics.

Background: The rate of women who are delaying their pregnancy and childbirth to their 4th decade of life appears to be increasing recently, and this may be because of various reasons such as education and delayed marriage. Objective: Thus, the study aims to assess maternal and fetal outcomes in all pregnant women with advanced maternal age Methods: This is a retrospective cohort study conducted in the National Guard Hospital (NGH) in Riyadh, Saudi Arabia. The delivery records were searched for pregnant women in the designated hospital between the period of January 1^st, 2019, to 31^st March 2019. 1257 patients in total were included according to the inclusion criteria Result: In this study, we collected data for 1257 pregnancies where the prevalence of mothers older than 30 years old was 25.2% (N = 253). Moreover, older women (>35) had a higher risk for needing CS than younger participants (RR = 1.78, 95% CI: 1.34: 2.36, p = 0.001) where the prevalence of CS in the older group was 41.5% compared with 28.5 5 of the younger group. Conclusion: Advanced maternal age is associated with a range of adverse pregnancy and fetal outcomes.

Introduction: Mothers of special children may feel more worried and depressed, leading to issues with their physical and mental health. Autogenic Relaxation Therapy (ART) has emerged as a promising intervention for mitigating these adverse effects. This study aimed to investigate the efficacy of ART in reducing psychological and bio-physiological distress among mothers of special children. Methods: A prospective quasi-experimental design was employed, recruiting 40 mothers of special children with borderline to moderate depression. Participants were assigned to either an experimental group (n = 20) receiving ART sessions twice weekly for 8 weeks or a control group (n = 20) receiving no intervention. Outcome measures included stress, anxiety, depression, respiratory rate, pulse rate, blood pressure, and salivary cortisol levels. Results: The research showed that mothers caring for special children who underwent ART had improved psychological and physiological well-being. The scores for stress, anxiety, and depression were 27.1, 37.2, and 36% lower, respectively, and the two-way repeated measures ANOVA proved that the treatment resulted in significant decreases as the time passed (p<0.001). However, the control group didn’t experience significant changes or only slight increases in various parameters. Researchers found significant drops in pulse rate and cortisol as well as an improved respiratory rate (p<0.001). Conclusion: The findings highlight the effectiveness of Autogenic Relaxation Therapy (ART) in reducing psychological and biophysiological distress among mothers of special children. Significant reductions in stress, anxiety, depression, and physiological parameters indicate that ART can serve as a valuable, non-pharmacological adjunct to conventional caregiver support.

Objectives: Background: Self-medication with psychotropic drugs, particularly anti-anxiety medications such as benzodiazepines and Selective Serotonin Reuptake Inhibitors (SSRIs), presents a growing public health concern in countries with limited pharmaceutical regulation. In Saudi Arabia, the accessibility of prescription medications without adequate clinical supervision has raised critical questions about misuse and its associated risks, including dependency and adverse health outcomes. Despite increasing use, limited empirical research has addressed the prevalence and underlying factors driving this behavior in the Saudi context. Objective: This study aimed to assess the prevalence, knowledge, attitudes and behaviors related to self-medication with anxiety drugs among the Saudi population and to examine sociodemographic variables associated with these practices. Methods: A cross-sectional survey was conducted using a structured electronic questionnaire targeting adults across Saudi Arabia. The instrument collected data on demographics, awareness of anxiety disorders and medication side effects, attitudes toward self-medication and self-reported behaviors. Chi-square tests were used to identify significant associations between variables. Results: Of the 807 participants, 24.6% reported using anti-anxiety medication without a prescription. While 84.1% had heard of anxiety disorders, only 16.1% identified addiction as a potential side effect. Stress, particularly related to academic or occupational demands, was the most commonly cited motivation. Higher education levels were significantly associated with greater awareness (p = 0.001), whereas no significant associations were found with gender. Conclusion: The findings indicate a pressing need for targeted health education, improved mental health services and stricter regulatory enforcement. Enhancing public knowledge and ensuring responsible access to psychotropic medications are essential steps toward advancing mental health priorities within the framework of Saudi Arabia’s Vision 2030 healthcare reforms.

Background: Diabetes Mellitus (DM) is a common metabolic disorder resulting from insufficient insulin secretion or insulin action that leads to elevated blood glucose levels. The metabolic disorders associated with DM cause secondary pathophysiological changes in multiple organ systems leading to acute and chronic complications. Insulin resistance is frequently higher in patients with diabetes or microalbuminuria in the context of renal disease, which may accelerate the progression of Diabetic Kidney Disease. Methods: A cross-sectional study conducted at the Galiawa Teaching Center in Erbil, Iraq. The study included 100 patients who had been diagnosed with type 2 diabetes mellitus. lipid profile, glycated hemoglobin (HbA1C) and albumin creatinine ratio (ACR) were done for them, then statistically analyzed. Results: 100 participants were included, the mean age was 57±9 years, ranging from 34 to 80 years. About 60% of the participants were females and 40% were males. The most frequent category was stage A2, observed in 37 patients (37%). Additionally, 86% of participants had an eGFR within stages 1 to 3a. low-density lipoprotein (LDL) levels showed a statistically significant difference between ACR groups A1, A2 and A3 (p-value = 0.000), with the highest mean observed in group A3 (136±26 mg/dL). Conclusion: There is a significant correlation between mean LDL and UACR. And insignificant association between mean TC, mean TG and mean HDL with UACR.

Objective: This study evaluates the vertical maxillary effects produced by banded and bonded RPEs in 12 to 18 year-old adolescents, comparing the changes obtained by both types of expanders, through CBCT and cephalometric analyses. Methods: Eight articles in adolescents with age ranging from 12 to 18 years were analyzed and applied both Cone Beam Computed Tomography (CBCT) and lateral cephalograms. Outcomes of interests were differences in LAFH, SN-GoGn and the inclination of the occlusal plane. The results were synthesized to express mean with Standard Deviation (SD) and the significance of effect size was examined with p -values and effect sizes (Cohen’s d). The quality of all included studies was assessed by the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. The protocol for this study has been registered on PROSPERO and the whole protocol is available on request. Results: Bonded tightens achieved significantly smaller vertical effects compared to banded tightens (eg., LAFH: bonded = 0.9±0.4 mm vs. banded = 2.3±0.6 mm; p<0.01, d = 1.27). Bounded expanders had less increase in the SN-GoGn angle (0.7±0.3°) than the banded group (1.9±0.5°, p<0.05, d = 1.05). The CBCT results indicated the amount of the posterior vertical movement and molar tipping in the bonded groups were decreased. Conclusion: In 12-18 year old adolescents, bonded expanders result in more controlled vertical maxillary changes and less mandibular rotation than do banded expanders. Bonded expanders are the method of choice when less than 2 postubes movement is desired. Additional longitudinal study is required to establish the long-term stability of these results.

Background: Mycoplasma pneumoniae is often responsible for community-acquired pneumonia and Lower Respiratory Tract Infections (LRTI). Objective: This study aimed to develop a novel duplex real-time PCR assay to detect M. pneumoniae, which includes a built-in internal real-time PCR control and to assess real-time nucleic acid sequence-based amplification (NASBA) compared to conventional PCR. Methods: A total of 103 samples from 110 clinical patients with LRTI were analyzed using duplex real-time PCR, NASBA and conventional PCR. Clinical symptoms and laboratory findings, e.g., Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) were compared between M. pneumoniae-positive patients and those with other LRTIs. Results: Evaluation of 103 test samples revealed Mycoplasma pneumoniae infection in 14 (13.59%) of 110 patients with LRTI using a combination of molecular tests. A comparison of clinical symptoms existed between patients with M. pneumoniae-positive and those with different lower respiratory tract infections. The clinical presentation between M. pneumoniae infections showed various characteristics, including a lower patient age combined with chill symptoms and a higher level of ESR and CRP, levels that produced statistically significant results (p<0.05). Molecular diagnostic approaches performed better than other methods for the identification of M. pneumoniae, providing faster and more accurate results. Conclusion: The study concluded that PCR along with loop-mediated isothermal amplification (LAMP) provides a highly sensitive and specific diagnostic evaluation that serves as a beneficial diagnostic alternative for the clinical diagnosis of Mycoplasma pneumoniae.

Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal condition characterized by pain and functional limitation of the lateral elbow. Despite its high incidence, challenges persist regarding standardized diagnostic criteria, optimal conservative treatments, and the role of emerging therapeutic modalities. Objective: This review aimed to synthesize recent evidence regarding the diagnosis, management strategies, and rehabilitation interventions for lateral epicondylitis, focusing on studies published within the last five years. Methods: A structured literature search was conducted across major databases to identify relevant systematic reviews, meta-analyses, and narrative reviews. Seven studies met the inclusion criteria and were analyzed. Results: Eccentric strengthening exercises combined with manual therapy demonstrated a significant reduction in pain (up to 42% improvement in VAS scores) and improved functional outcomes (up to 35% in grip strength). Ergonomic modifications and patient education emerged as critical elements in preventing recurrence and optimizing outcomes. Considerable heterogeneity was observed in diagnostic criteria across studies. Conservative management is favored as the initial approach, with surgical intervention reserved for persistent or refractory cases. Emerging therapies such as extracorporeal shock wave therapy and platelet-rich plasma injections showed comparable short-term effectiveness to corticosteroid injections (with reported improvement rates ranging from 30% to 45%) but should be used adjunctively. Conclusion: Current evidence supports a multimodal, individualized rehabilitation approach for effective management of lateral epicondylitis. There is an urgent need for greater consensus on diagnostic definitions and further high-quality studies to refine treatment protocols and evaluate long-term outcomes.

Background: Proton Pump Inhibitors (PPIs) have progressively replaced the traditional therapies for acid-related diseases and are effectively used in treatment and prophylaxis from peptic ulcer disease and Gastro Esophageal Reflux Disease (GERD). Aim: Evaluation of the indicators, cons and pros upon extended use or misuse of PPIs among Saudi and Egyptian patients. Methods: A cross-sectional survey was distributed throughout Saudi and Egyptian patients who received PPIs, interviewed (Face to Face) and asked questions according to well-designed questionnaire about benefits and adverse effects upon short and long-term use of PPIs. Saudi patients were chosen from university of Ha’il Clinic, KSA and healthcare centers, while Egyptian patients were from different private medical centers, Egypt between October 2024 to December 2024. Data was collected and statistically analyzed using SPSS software (Inc, Chicago, IL, USA, version 25). Results: The mean of participant ages in years (35.99±1.46 Saudis vs. 45.65±3.16 Egyptians). About 46.2% of Saudi participants vs. 67.9% of Egyptian are working in the medical field and low percentage of Saudis who used PPI according to medical consultant are 24.3% vs. Egyptians 68.2%. High percentage of Egyptian participants using PPIs for prophylaxis from peptic ulcers mainly due to long term usage of NSAIDs followed treatment of heartburn. While high percentage of Saudi participants using PPI for treatment of GERD more than Egyptians. High percentages of Egyptian patients completed the course of PPI compared to Saudis and the causes of uncompletion in Saudis due to disappearance of symptoms and presence of side effects more than Egyptians (p-value<0.05). Mild side effects due to using PPI was higher percentage among Egyptian vs. Saudi participants (p-value<0.05). The most predominant side effects were bloating followed by headache then nausea, abdominal pain and diarrhea. Severe side effects due to long-term PPIs usage was higher among Egyptian vs. Saudi participants but not significantly different. The most predominant side effect was osteoporosis followed by increased risk of fractures, iron deficiency anemia, then mineral deficiency. On the other hand, Saudi participants suffered more from deterioration of kidney functions, increase risk of gastroenteritis, dementia and gastric cancer than Egyptian. Conclusion: The long-term hazards, such as kidney disease, fractures and infections, require careful thought and constant monitoring, even if the short-term side effects are usually modest and controllable. Such risks are further boosted by PPIs misuse and over-prescription, which highlights the importance to follow guidelines based on evidence for its usage. Relatively high number of participants developed severe side effects like osteoporosis and increased risk of fractures which are not common in young age group. This indicates that physicians, pharmacists and patients should be cautious on prescribing or taking PPIs even if the patient within young age. To ensure secure and effective use of these important medications in the future, patients and healthcare professionals need to work together and the risks of using long-term PPI must be weighed against the benefits.

Background: Social Anxiety Disorder (SAD), sometimes known as Social Phobia (SP), is described as the dread of social settings, including those involving interaction with strangers. People dread humiliating themselves in circumstances such as social events, talks and meeting new individuals. Individuals with SP have general anxieties about performing specific tasks, such as speaking in front of people or eating. For students, SP is an overpowering dread of speaking in front of people or making presentations. Objective: To assess the prevalence of SAD among the medical students at Northern Border University, Saudi Arabia. Methods: A cross-sectional study was undertaken. An anonymous, self-administered questionnaire was employed. The questionnaire consisted of two components. The first portion contains sociodemographic characteristics. The 2^nd section is the validated Social Phobia Inventory (SPIN) questionnaire. Results: A total of 150 students participated in the survey, with a mean age of 22.5±1.6(19-26), more than half males (54%). Of the examined participants, more than half (56%) experienced SP with 21.3, 20 and 14.7% suffering from mild, moderate and severe social phobia, respectively. Conclusion: Our findings revealed a significant prevalence of SAD (56%) among the medical students at Northern Border University, most of them had a mild degree of illness.

Granulosa Cell Tumor (GCT) of the ovary is a rare, low-grade malignant neoplasm arising from sex cord-stromal cells, accounting for 2-5% of all malignant ovarian tumors. The coexistence of GCT with a mature cystic teratoma is extremely rare, with fewer than ten cases reported in the literature. These mixed tumors present diagnostic and therapeutic challenges due to their distinct origins and biological behavior. We report the case of a 37 year-old premenopausal woman (para one) who presented with acute left lower abdominal pain. Imaging revealed a large left adnexal mass measuring 9.25×8.80×5.90 cm with both solid and cystic components. Surgical management included left salpingo-oophorectomy and right ovarian cystectomy. Histopathological examination confirmed an adult-type granulosa cell tumor of the left ovary coexisting with bilateral mature cystic teratomas. No metastatic spread was observed. This case highlights the rare synchronous occurrence of adult-type granulosa cell tumor with bilateral mature cystic teratomas in a premenopausal woman. Given the indolent nature of GCT and the reproductive age of the patient, fertility-preserving surgery was successfully performed. Awareness of such rare combinations is critical for accurate diagnosis and individualized surgical planning.

Background: Cognitive Behavioral Therapy (CBT) and counseling have emerged as significant interventions in enhancing academic performance among late adolescents. The aim of the present study to determine the effectiveness of cognitive behavioural therapy verses counselling on academic performance among late adolescence. Methods: The study was conducted over a period of one year, from June 2023 to June 2024. Ethical approval for the study was obtained from the SMCH Institutional Ethics Committee (Approval Number: 003/08/2022/IEC/SMCH). Out of 900 students who met the inclusion criteria, 330 were selected through a simple random sampling technique. Experimental Group I consisted of 110 students and Experimental Group II consisted of 110 students and the Control Group included 110 students. Result: The study results showed that following the intervention, both Experimental Group I and II showed significant improvement in academic performance (p<0.001), with Experimental Group I achieving higher post-test scores (27.28±0.337) than Experimental Group II (26.21±0.381). The interventions were effective, with Experimental Group I and Experimental Group II demonstrating comparatively better results than the control group. Conclusion: The study found cognitive behavioral therapy showed slightly more effective results than counseling for enhancing academic success. The study highlights the potential of cognitive behavioral therapy to more effectively enhance academic performance compared to counseling.

Background: Street-vended food plays a significant role in daily nutrition for many urban populations, especially in developing countries. However, it presents serious public health concerns due to the risk of foodborne illnesses. In Khartoum Central Market, the lack of hygiene among food vendors and poor sanitation conditions may contribute to microbial contamination of ready-to-eat foods. Methods: A cross-sectional experimental study was conducted to assess the microbiological safety of street-vended sandwiches. A total of 30 samples-including chicken, mutton and egg sandwiches-were randomly collected from different parts of Khartoum Central Market. Samples were transported under sterile conditions and analyzed using the pour plate method to determine the Total Viable Bacterial Count (TVBC). Results were compared to the permissible limit set by the Sudanese Standards and Metrology Organization (5×10² cfu/g). Results: All samples exceeded the recommended TVBC limit. Chicken sandwiches had TVBC values ranging from 3.8×10⁴ to 2.26×10⁸ cfu/g. Mutton samples ranged from 6.0×10⁵ to 3.43×10⁷ cfu/g, while egg sandwiches showed bacterial loads between 1.32×10⁵ and 1.91×10⁷ cfu/g. The highest contamination levels were observed in samples from central and western zones of the market. Conclusion: The majority of food samples were found to be microbiologically unsafe for human consumption. Contamination was primarily linked to unhygienic food handling practices, poor personal hygiene and inadequate sanitation facilities. Immediate interventions are required to safeguard public health.

Background: The common chronic autoimmune disease known as type 1 diabetes (T1D) results in insulin insufficiency because it promotes the death of pancreatic β-cells through inflammation. This study sought to assess the immunological markers Angiopoietin-like protein 8 (ANGPTL8) and Transforming Growth Factor Beta 1 (TGF-β1) levels in Iraqi patients with type 1 diabetes in comparison to healthy controls, as well as any correlations with age and gender. Material: There were two groups of patients in the case control study: a healthy group of 12 women and 28 men, and a group of 27 females and 23 males with T1D. In accordance with their ages, the participants were split into three groups: Group I consisted of people aged 20 to 39, Group II of people aged 40 to 59, and Group III of those aged 60 to 80. The latex agglutination test was used to assess CRP, and the levels of ANGPTL8 and TGF-β1 were determined using the ELISA technique. Results: The findings demonstrated that patients' TGF-β1 concentrations were comparatively higher 18.82±4.49 ng/mL than those of healthy individuals 17.45±3.77 ng/mL. In contrast to the healthy control 519.71±18.90 ng/mL, the ANGPTL8 protein's concentration in patients was somewhat lower 509.53±34.7. There was a significant difference in ANGPTL8 levels between the age groups of 20-39, 0-59, and 60-80 years; male ANGPTL8 levels were found to be higher and to decline with age. TGF-β1 declined in women as they aged, but it rose in men. Conclusion: Age and gender are important confounding variables for TGF-β1 and ANGPTL8 levels in T1D. When evaluating these biomarkers or creating future T1D predicting research, these demographic factors need to be taken into consideration.