Objectives: Median Arcuate Ligament Syndrome (MALS) is a rare vascular compression disorder causing chronic abdominal symptoms. Surgical decompression via the laparoscopic approach has gained popularity due to its minimally invasive nature and favourable outcomes. Methods: This was a prospective case series conducted at SMHS Hospital, Srinagar, Department of General & Minimal Access Surgery, between 2024 and 2025. Informed consent was obtained for all cases. Inclusion criteria were age >16 years, radiologically confirmed MALS, and laparoscopic release. Exclusion criteria were concomitant gastrointestinal pathology, incomplete data, or non-laparoscopic approach. Doppler ultrasonography (peak systolic velocity >200 cm/s), CT angiography/MR angiography with positional variation, CT enterography, gastric emptying studies, and upper GI endoscopy. All patients underwent laparoscopic release under general anesthesia (4–5 port approach). The procedure involved retraction of the left lobe of the liver, dissection of the crura of the diaphragm, exposure of the celiac axis, and division of the median arcuate ligament with surrounding fibrotic tissue. Decompression was confirmed either by intraoperative Doppler or visual pulsatility. The primary outcome was symptom relief at short-term follow-up, assessed with postoperative duplex ultrasonography. Secondary outcomes included operative time, blood loss, conversion rate, postoperative complications, and length of hospital stay. Results: Symptom relief was achieved at short-term follow-up with supportive evidence from postoperative duplex ultrasonography. Operative details, perioperative outcomes, and follow-up findings were recorded for all included patients. Conclusion: Laparoscopic release of the median arcuate ligament is a feasible and effective approach in selected patients with MALS, with favourable short-term outcomes and minimal perioperative morbidity.

Background: Artificial Intelligence (AI) is increasingly integrated into healthcare systems to enhance diagnostic accuracy, streamline workflows and improve patient outcomes. While the technological capabilities of AI are advancing rapidly, the attitudes and preparedness of medical practitioners remain underexplored, particularly in the context of developing healthcare systems. Existing research has predominantly focused on technical applications, with limited attention to end-user perceptions. Objective: This study aimed to assess medical practitioners’ perceptions of AI in clinical practice, focusing on familiarity, perceived benefits, barriers and ethical concerns. The goal was to identify factors influencing acceptance and readiness for AI adoption in healthcare. Methods: A convergent mixed-methods design was employed. Quantitative data were collected via a structured survey (n = 342) and qualitative insights were obtained through semi-structured interviews (n = 38). Descriptive statistics, chi-square tests, logistic regression and MANOVA were used for quantitative analysis, while thematic analysis was applied to qualitative transcripts. Results: A majority (82.1%) of respondents were familiar with AI and 54.3% perceived it as “very useful.” Radiologists and younger practitioners (<30 years) demonstrated the highest confidence and acceptance (p<0.001). Key barriers included limited training (37.0%) and data privacy concerns (43.5%). Thematic analysis highlighted the need for structured AI education and ethical governance frameworks. Conclusion: Medical practitioners generally hold favorable attitudes toward AI, yet substantial barriers remain. These findings underscore the importance of targeted training, interdisciplinary collaboration and policy development to ensure ethical and effective AI integration in clinical practice.

This study aims to characterise the structural impacts of missense mutations in the CYBB gene associated with Chronic Granulomatous Disease (CGD), by comparing them to wild-type CYBB and to assess their effects on protein stability and dynamics and thus on NADPH oxidase function. The goal is to elucidate the pathogenesis of CGD and inform personalised therapeutic strategies. The study used a computational approach combining data from the ClinVar database to identify and characterise CYBB missense variants. It included sequence conservation analysis, using multiple sequence alignments to identify conserved regions of the CYBB protein. DDMut, a deep-learning based stability assessment tool, was used to predict changes in Gibbs Free Energy (ΔΔG) upon mutation. Furthermore, molecular dynamics (MD) simulations were performed to investigate the stability and dynamics of CYBB and selected mutants. Root Mean Square Deviation (RMSD) and Root Mean Square Fluctuation (RMSF) data were analyzed to assess structural stability and flexibility, respectively. K-means clustering was used to group simulations. Analysis revealed numerous missense variants with varying pathogenicity classifications. Many variants classified as "likely benign" were predicted to destabilize the CYBB protein, while some "likely pathogenic" variants were predicted to increase stability. Mutations in conserved regions, including those classified as "likely benign," were found to be destabilizing. MD simulations revealed that some variants, despite maintaining overall structural similarity to the wild-type protein, induced substantial local dynamic alterations. Specific mutations within functional domains such as the transmembrane domain (e.g., S142P, R54G, A156D, I15V) and FAD and NAD-binding domains (e.g., P390L, W361R, G359R, E462A, C537F, K438R, Y476C, M465I) were predicted to be destabilizing. Some mutations outside the defined domains (C257R, F262C, I273V) were also found to be destabilizing. There are inconsistencies between ClinVar classifications and computational predictions regarding the impact of CYBB missense mutations on protein stability and dynamics. Many "likely benign" variants may have functional impacts and some "likely pathogenic" variants might not destabilize the protein. The study highlights the importance of using multiple computational approaches, including structural and dynamic analysis, to assess the impact of mutations in the CYBB gene. These findings contribute to a better understanding of the molecular mechanisms of CGD and will help in the development of more accurate diagnostic and therapeutic strategies. Experimental validation of these predictions is needed to further confirm these findings.

Objectives: We found that the analyzed studies reported a significant difference in hospital length of stay between patients undergoing laparoscopy and those undergoing laparotomy. Postoperative complications were significantly lower with laparoscopy than with laparotomy. This systematic review critically evaluates the existing literature comparing laparoscopy and laparotomy as surgical approaches for managing adhesive bowel obstruction in pediatric patients, aiming to guide clinicians in evidence-based care. Methods: This systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search focused on identifying studies that compared the outcomes of laparoscopic and open laparotomy procedures in pediatric patients (<18 years old) with ileus, bowel obstruction, or adhesive small bowel obstruction (ASBO), using the PubMed and Google Scholar databases. Data on each study’s origin, design, sample size, mean age at presentation, treatment modality, specific intervention(s), and key outcomes were extracted. The studies were then grouped into two categories (laparoscopy and laparotomy), followed by a descriptive analysis. Results: Our search identified three retrospective cohort studies that met the inclusion criteria and were selected for meta-analysis. This highlights the limited availability of high-quality evidence, as the findings rely solely on retrospective cohort studies. Conclusion: The study highlights the benefits and differences between laparoscopy and laparotomy in treating adhesive small bowel obstruction in children. Laparoscopy was found to be associated with fewer postoperative complications. Further research may strengthen these findings and explore the long-term outcomes of this treatment strategy.

This study investigated the coping mechanisms and resilience levels of cancer survivors in Ramapuram, employing a descriptive cross-sectional design. A total of 120 participants from the Ramapuram District Hospital oncology outpatient department were surveyed between January and March 2024 using validated instruments-the Brief COPE inventory and the Connor-Davidson Resilience Scale. Results revealed that spiritual or religious practices were the primary coping strategy for 68% of participants, while 54% relied heavily on family and community support; 42% reported using problem-focused coping approaches, such as seeking information and practical help. Notably, 76% of survivors exhibited moderate to high resilience, indicating a marked capacity to adapt positively in the face of cancer-related adversity. Statistical analysis showed that higher resilience was significantly associated with older age and stronger family support (p<0.05). These findings underscore the importance of culturally sensitive psychosocial interventions for cancer survivors in Ramapuram. Specifically, integrating spiritual counseling and bolstering family and community support within survivorship care plans are recommended. Such tailored approaches may further enhance the resilience and overall well-being of cancer survivors in this region.

Introduction: The World Health Organization (WHO) defines diabetes mellitus (DM) as a chronic metabolic condition with multiple etiologies. Diabetes mellitus happens when there is a disturbance in the insulin hormone level that results in an increase of glucose in the blood. The insulin hormone is necessary to regulate the blood sugar level to avoid its elevation or hyperglycemia. Objectives: The main objective of the study is to assess the knowledge and awareness level of the diabetic foot among diabetic patients in Saudi Arabia. Method: The study design was a descriptive cross-sectional study conducted from July 2024 to March 2025in Saudi Arabia. The study included diabetic patients with type 1 or type 2 from both sexes in Saudi Arabia. The questionnaire assessed knowledge and awareness of diabetic foot disease, care, prior education and complications. Furthermore, medical students obtained information via a Google Form questionnaire. The data was analyzed using the Statistical Package for Social Science (SPSS). Results: The purpose of this study was to determine the diabetic foot complications knowledge and awareness of 385 diabetic patients in Saudi Arabia. Results: 88% 'claimed to know the link between diabetes and foot problems; however, misconceptions remained, with 55.3% believing 'stable blood sugar abolishes symptoms. Awareness levels were moderate: 56.9% were moderate and only 16.1% were high. Moreover, 39.7% demonstrated both high knowledge and positive attitudes on diabetic foot care. Though a wealth of information on these complications exists, there is room to close these gaps in knowledge to enhance education around prevention and understanding of diabetic foot issues. Conclusion: The findings of this study reinforce the imperative need for greater educational efforts to improve diabetic patients’ knowledge and awareness of diabetic foot complications in Saudi Arabia. Gaps in understanding point to the need for tailored educational programs designed to meet the needs of diverse populations.

Introduction: Poor posture is one of the primary risk factors for musculoskeletal discomfort. Incorrect spinal alignment and prolonged shoulder flexion can be uncomfortable and even harmful. As future healthcare professionals, understanding the impact of good posture on back pain is crucial. Good posture ensures optimal alignment of the body's structures, preventing musculoskeletal imbalances and discomfort. By educating patients and promoting healthy postural habits, medical professionals can play a vital role in effectively managing back pain. Objectives: To assess the knowledge and awareness of the correct posture while studying among students in KSA. Method: This cross-sectional study was conducted in the Kingdom of Saudi Arabia. Convenience sampling techniques were used to recruit a representative sample of medical students from various educational institutions. The inclusion criteria included Saudi Arabian medical students of all levels and genders, as well as full-time enrollment. Exclusion criteria consisted of non-consenting participants, medical professionals, individuals with physical impairments, non-Saudi nationals, and part-time students. The data was collected using Microsoft Office Excel and analyzed using SPSS software. Results: This was a cross-sectional study of 288 medical students (mean age = 22.7 years; 65.6% female) in Saudi Arabia. Over half (52.8%) studied >5 hours daily, with 74.3% reporting pain, predominantly back pain (84.7%). Notably, 60.8% demonstrated a commendable posture knowledge level; female students, those aged 23, and higher academic years had better knowledge (p<0.05). Awareness correlated with academic performance and time spent studying. 83.3% recognized sitting as correct posture. Most (92.7%) believed that correct posture prevents musculoskeletal issues, and 49.3% advocated for including ergonomics in the curriculum, underscoring the need for targeted educational interventions to address posture-related musculoskeletal risks. Conclusion: This study highlights both the promising levels of awareness among Saudi medical students regarding the importance of correct posture and the significant prevalence of musculoskeletal pain linked to prolonged study routines. The findings emphasize the urgent need for educational reforms and personalized ergonomic interventions to mitigate health risks.

Background: Urinary Tract Infections (UTIs) are among the most prevalent bacterial infections in women, often caused by uropathogenic Escherichia coli (UPEC). The papE gene, a component of the P fimbriae operon, is recognised as a key virulence factor facilitating bacterial adhesion and colonization of uroepithelial cells. Objective: This study aimed to detect the presence of the papE virulence gene in clinical E. coli isolates obtained from women with UTIs using molecular methods. Methods: A total of 116 urine samples from women with clinically diagnosed UTIs were collected. E. coli isolates were identified using standard microbiological methods and confirmed by the VITEK® 2 Compact system. Genomic DNA was extracted from the isolates and PCR amplification of the papE gene was performed using gene-specific primers. Amplification products were analysed by electrophoresis on 1.5% agarose gels. Results: According to Sex Distribution: Out of the 116 clinical bacterial isolates, 41 (36.6%) were from male patients, while 71 (63.4%) were from female patients. The isolates’ resistance to quinolone antibiotics, which includes nalidixic acid, ciprofloxacin and levofloxacin, was at 82.5, 56.3 and 50%, respectively. Cephalosporins, which include cefoxitin, cefotaxime, ceftazidime, cefepime and ceftriaxone, had a resistance of 53.3, 60, 76.6, 66.6 and 53.3%, respectively, for each aforementioned antibiotic. The isolates’ resistance to carbapenems, which includes meropenem and imipenem, was at 22 and 35%, respectively. As for β-lactam combinations, which include Augmentin and piperacillin-tazobactam, the resistance was found to be at 60 and 40%. And as for the penicillin group of antibiotics that includes piperacillin, the resistance was found to be 46.6%. Tetracycline from the antibiotic group of the same name and chloramphenicol from the antibiotic group phenicol both had a resistance rate of 46.6%. Aztreonam, from the antibiotic group minocycline, had resistance at 73.3%. The isolates were capable of producing biofilms; 20 isolates (66.7%) were biofilm producers out of 30 isolates,7 isolates accounting for 35% were strong biofilm producers, while 8 isolates (40%) were moderate biofilm producers. The remaining 5 isolates, accounting for 25 % of the total isolates, were weak biofilm producers. Conclusions: The detection of the papE gene in clinical E. coli isolates highlights its potential role in UTI pathogenesis and underscores the importance of molecular surveillance of virulence factors in guiding therapeutic strategies. Future studies should explore the association of papE with antimicrobial resistance patterns and biofilm formation to develop targeted interventions.

Background: Home Enteral Nutrition (HEN) is an essential therapeutic option for patients unable to meet their nutritional needs orally. While it supports long-term care, malnutrition remains a common complication in community and home-based settings. Objective: To determine the prevalence of malnutrition risk and its predictors among Saudi adults receiving HEN using the Malnutrition Universal Screening Tool (MUST). Methods: A cross-sectional study of 210 Saudi adults (≥18 years) on HEN was conducted across three cities. Data collection included structured interviews, home visits, and medical records. Nutritional risk was assessed using MUST. Group comparisons used chi-square/Fisher’s exact tests for categorical data and Kruskal-Wallis tests for non-normal continuous variables. Multinomial logistic regression (low-risk reference) identified independent predictors of malnutrition risk. Results: Malnutrition risk was high, with 65.7% (95% CI: 59.3–72.1) classified as high risk, 27.1% (95% CI: 21.1–33.2) as low risk, and 7.1% (95% CI: 3.7–10.6) as medium risk. Lower BMI and greater unintentional weight loss were the strongest predictors of higher MUST risk (p<0.001). Acute illness (>5 days no intake) was exclusively observed in the high-risk group. Age and gender were not significant predictors in multivariable models. Conclusion: Malnutrition is highly prevalent among Saudi adults on long-term HEN, with BMI, weight loss, and acute illness emerging as the most important predictors. These findings highlight the importance of routine nutritional screening, individualized feeding strategies, and consistent dietitian follow-up to reduce malnutrition risk in this population.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for their analgesic, antipyretic and anti-inflammatory effects. However, their use is often limited by drug interactions and adverse effects, including gastrointestinal, hepatic, renal and cardiovascular complications. Analgesics remain the most frequently self-medicated drugs globally. Epidemiological studies indicate a high prevalence of analgesic use, with reports of up to 59% in Nepal and other developing countries. The misuse and overuse of prescription and over-the-counter pain relievers represent a significant public health concern. Accurate, accessible information is essential to ensure safe and effective use, particularly with regard to recommended dosages and potential side effects. Despite the widespread use of analgesics, gaps in public knowledge persist, especially concerning maximum dosage limits and associated risks. This underscores the need to assess current public awareness to guide health education strategies effectively. Objectives: This study aims to assess the level of knowledge and awareness among the general public in Saudi Arabia regarding the maximum recommended doses, potential side effects and complications of commonly used analgesics. Methodology: A cross-sectional survey was conducted from September 2024 to March 2025 using a structured and validated questionnaire, modified to suit the study context. The target population included Saudi residents aged 18 years and above who reported using analgesic medications. Participants were recruited through online platforms using convenience sampling. Individuals under 18 years of age or those who did not use analgesics were excluded. Informed consent was obtained from all participants. Results: A total of 791 participants completed the questionnaire. While 82% reported awareness of different types of analgesics, only 47.5% correctly identified the maximum daily dose of paracetamol. Awareness of adverse effects varied: 60.2% were aware of paracetamol-induced liver toxicity, 53.5% recognized NSAID-related gastrointestinal risks and 67.1% acknowledged renal complications. Notably, 89.9% agreed that increased analgesic doses lead to adverse effects; however, only 32.2% could accurately identify specific side effects. Overall, 52.5% of respondents demonstrated a high level of knowledge and 58.7% exhibited a positive attitude toward responsible analgesic use. Knowledge and attitude scores were significantly associated with demographic factors such as age, gender, education level and occupation (p<0.05). Conclusion: Although a moderate level of public awareness regarding analgesics exists, significant gaps remain particularly in understanding correct dosages and recognizing symptoms of overdose or toxicity. These findings highlight the urgent need for targeted public health campaigns and educational interventions to enhance safe medication practices and reduce the risk of analgesic-related complications in Saudi Arabia.

Objectives: Background: Many methods have been proposed to improve the rotation and projection of the nasal tip and thus achieve the desired appearance. TIG is one of the most successful and minimally invasive surgical procedures, which is conservative to control projection and rotation of the tip and to correct the deviation of the caudal septum and stabilize the base of the nose. The lateral crura suspension method is a simple and stable method that uses the cephalic parts of the lower lateral crura cartilages in the form of two flaps to suspend the tip of the nose to the septum to correct and stabilize the nasolabial angle. This technique is also easily repeatable. According to the mentioned materials, we decided to investigate the results of lateral crural suspension flap and TIG in patients with hanging columella at Imam Khomeini Hospital in Ahvaz. Methods: In this retrospective comparative study, documents of patients who referred to Imam Khomeini Hospital in Ahvaz for rhinoplasty were examined. Digital photographic images were prepared according to clinical standards before and six months after the operation, in the left and right lateral, anterior and basal views. In lateral images, Goods ratio, nasolabial angle, ala-columella ratio were examined. After general anesthesia, with open rhinoplasty technique and transcolumellar incision, all incisions were made in perichondrial and subperiosteal planes. After incision and skin flap, one of the two techniques of lateral crural suspension or TIG was applied to create the desired position of the nasal tip for the patient. All patients were followed up for 6 months and changes in nasolabial angle and nasal tip projection were evaluated by statistical tests. Results: In this research, 50 people with an average age of 26.5±4.23 years were examined. Half of the investigated people, 25 people, were in the lateral crural suspension group and the other half were in the TIG group. According to the Mann-Whitney test, the nasolabial angle of patients after rhinoplasty was compared, in both groups the angle was increased after the operation and this average difference between the two groups was not statistically significant (p>0.05). The Goode ratio of patients in both groups was increased after surgery and this average difference between the two groups was not statistically significant (p>0.05). The alar-columella ratio of patients after rhinoplasty decreased in both groups and this difference in the average of the two groups was not statistically significant (p>0.05). Conclusion: Either TIG and lateral crural suspension flap significantly improve postoperative aesthetic results and there was no statistically significant difference between them.

Background: Refugee displacement, driven by conflict, persecution and human rights violations, poses significant public health challenges. Displaced populations often face adverse living conditions, limited healthcare access and increased exposure to physical and mental health risks. Methods: This narrative review synthesizes current literature on the health impacts of refugee displacement. Sources were identified through a targeted search of peer-reviewed journals, international reports and organizational databases, focusing on global refugee health trends, risks and healthcare access barriers. Results: Refugees are disproportionately affected by communicable diseases, malnutrition and non-communicable conditions due to overcrowded shelters, disrupted preventive care and strained healthcare systems. Vulnerable groups, including women and children, face elevated risks related to reproductive health, child mortality and poor sanitation. Mental health disorders such as PTSD and depression are widespread, compounded by trauma and limited psychosocial support. Structural barriers-including language, discrimination and financial constraints-further restrict healthcare access. Conclusion: The health disparities faced by refugees require urgent, evidence-based responses from host countries, global health organizations and policymakers. Strengthening healthcare infrastructure, ensuring cultural and linguistic inclusivity and integrating refugee needs into national health strategies are critical to achieving equitable health outcomes.

Introduction: Cauda Equina Syndrome (CES) is a neurosurgical emergency characterized by motor and sensory deficits in the lower limbs, pelvic floor and sphincters. Hallmark symptoms include low back pain, saddle anesthesia, bilateral sciatica and bladder dysfunction. Delayed diagnosis and intervention can lead to irreversible neurological damage. This study assessed the diagnostic and management proficiency of emergency medicine and primary healthcare physicians, aiming to identify knowledge and training gaps contributing to CES-related delays. Methods: A multicenter cross-sectional study was conducted among 274 physicians in emergency and primary care settings across Saudi Arabia. Participants were interviewed using structured, scenario-based clinical vignettes to evaluate decision-making accuracy in realistic CES presentations. The sample included residents, specialists and consultants from family medicine, general practice and emergency medicine. Results: Scenario-level accuracy ranged from 42.0% for recognizing the need for urgent decompression within 48 hours to 63.1% for selecting MRI as the imaging of choice in classic CES. Diagnosis of CES in bilateral sciatica with urinary retention was correct in 60.6% of cases. Physicians with ≤10 years of experience demonstrated significantly higher overall diagnostic accuracy and urgency recognition (p≤0.001). Residents adhered more closely to recommended management protocols, while specialists exhibited greater diagnostic precision. Conclusion: This study revealed substantial gaps in CES knowledge and diagnostic accuracy, particularly among senior physicians. Targeted education and standardized protocols are needed to improve recognition of red flags and ensure timely intervention. Reinforcing awareness of CES and the critical 48-hour surgical window may help prevent irreversible neurological harm.

Depression is a pervasive mental health disorder characterized by persistent feelings of sadness, loss of interest, and diminished cognitive function. Method: The study, approved by the institutional ethics committee, used a quasi-experimental pretest-posttest control group design with a sample size of 150 participants, determined by power analysis. Seventy-five participants were assigned to the experimental group, and 75 to the control group, all meeting the inclusion criteria for depressive disorders. Inclusion criteria included adults aged 18-59, diagnosed with depression (Beck's Depression Inventory), and able to read Tamil and English. Exclusion criteria included individuals with certain medical conditions or severe depression. A non-probability purposive sampling method was used. Results: The experimental group showed significant improvements in biophysiological parameters (pulse rate, respiratory rate, blood pressure, BMI) and biochemical markers (serotonin, dopamine, fasting lipids), along with a reduction in depression (p = 0.008). The control group exhibited no significant changes in these parameters (p>0.05). Conclusion: The study concluded that light therapy is an effective treatment for reducing depression in adult patients. The findings highlight its positive impact on both biophysiological and biochemical parameters related to mental health, particularly in lowering depression levels.

Chronic rhinosinusitis (CRS) is a multifactorial inflammatory disorder of the nasal and paranasal sinuses that persists for more than 12 weeks, significantly affecting patient quality of life and imposing a substantial healthcare burden. Methods: A comprehensive literature review of papers recently published last decade articles was conducted using PubMed, Scopus, and Web of Science. The pathogenesis, diagnosis, treatment, and endotypes of CRS were discussed. This review incorporates peer-reviewed studies and established guidelines while excluding non-English and low-quality publications. Discussion: This review provides an accessible yet comprehensive overview tailored for medical students, outlining the current understanding of CRS pathophysiology, including the roles of mucosal barrier dysfunction, microbial dysbiosis, and immune dysregulation. Diagnostic approaches are discussed, with emphasis on clinical evaluation, endoscopic findings, and imaging techniques. Traditional management strategies such as saline irrigation, corticosteroids, and surgical intervention are reviewed alongside emerging biologic therapies and precision medicine approaches. Conclusion: Particular attention is given to the evolving classification of CRS into phenotypes and endotypes, which is reshaping treatment algorithms. By integrating current evidence with core clinical principles, this article aims to bridge foundational knowledge with recent advances, enhancing the educational value for early-career clinicians and students.

Objectives: Background and Aim: Examining the relationship among p21WAF1, Progression-Free Survival (PFS), TNM staging and tamoxifen treatment in hormone-sensitive breast cancer patients may yield insights into additional robust biomarkers for timely identification and prognosis of breast carcinoma. Patients and Methods: A prospective observational study was conducted including 78 female patients with breast cancer who were monitored for five years. The mean age among participants was 41.54 years and their mean weight was 75.62 kg prior to therapy. Patients receiving tamoxifen therapy were categorized into four groups based on TNM staging: T2N0M0 (30 patients), T2N1M0 (28 patients), T3N0M0 (14 patients) and the last group T4N1M0 (6 patients). Results: All patients are hormone receptor-positive and exhibited varying degrees of p21Waf1 expression, with nuclear p21 expression percentages ranging from 25% to less than 85%. The statistical analysis revealed a substantial reduction in p21Waf1 expression associated with increased tumor growth and lymphatic metastasis (TNM), with p<0.005. The influence of TNM staging in conjunction with p21Waf1 expression on Progression-Free Survival (PFS) duration indicates that patients classified as T3N0M0 have the shortest PFS, whereas an increased PFS is noted in T2N1M0, with further enhancement in T4N1M0 and T2N0M0 stages. Patient age and weight prior to treatment significantly impact Progression-Free Survival (PFS) in stages T2N0M0 and T2N1M0 more than in stages T3N0M0 and T4N1M0. Conclusion: The findings indicate that p21Waf1 is a crucial regulator of tumor response to tamoxifen and enhancing p21Waf1 levels may be effective in addressing acquired resistance.

Objectives: Given the frequent encounter of palliative care and DNR patients, the study aims to assess internal medicine residents’ attitudes and practices concerning the care of DNR patients, and to understand the knowledge and practice gap in between juniors to seniors’ residents. Methods: A cross-sectional study conducted among internal medicine residents in 4 training centers at Riyadh, Saudi Arabia. Electronic survey distributed among internal medicine residents that contains demographic data and items addressing three domains: Factors that determine the decision of DNR, frequency of encountering and applying interventions for DNR patients, and confidence in interventions and treating DNR patients. Results: More than half of the residents didn’t have formal teaching on dealing with DNR (56.6%). Out of the factors determining DNR decision, disease prognosis was deemed the most important factor in the decision making by the participants (95.4%, n = 187). On the other hand, patient culture and background ranked the lowest (11.4%, n = 23). Over half of the participants have rarely or never applied advance directives or used assessment tools to evaluate prognosis, quality of life, and symptom severity (73.5% n = 144, 61.7% n = 121). On level-based analysis, 73.3% of seniors confirmed a high confidence level in leading family meetings compared to 20% of juniors (p-value = 0.001). Assessing and managing fear of death was reported to be highly confidence among 20% of the participants. Similarly, only 14% of the participants reported highly confidence in discussing organ transplant. Conclusion: The study demonstrates educational and clinical gaps in dealing with DNR patients among medical residents. With the increase in demand, continuous and formal teaching is needed to sharpen the residents’ skills.

Stress has become an increasingly pressing concern in modern urban societies, with significant implications for both physical and mental health. This study explores the multifaceted impact of stress among individuals residing in Chennai, focusing on how demographic factors such as gender, age, education, occupation and living area influence stress responses and health outcomes. The research aims to analyses behavioral, psychological and physical manifestations of stress, as well as common coping strategies adopted by the urban population. Using a quantitative, empirical approach, primary data were collected from a total of 426 respondents selected through judgmental sampling. A structured questionnaire served as the primary tool for data collection, capturing both subjective perceptions and measurable experiences of stress. The independent variables included gender, age, education, occupation and living area, while the dependent variables comprised indicators such as stress’s effect on concentration, sleep, eating habits, physical symptoms and mental health. Descriptive statistics, bar and pie charts were used to visualize trends and Chi-square tests were employed to assess the significance of relationships between variables. The results revealed that stress significantly affects the cognitive and physiological well-being of individuals, with notable variations based on gender and living area. A higher proportion of male respondents reported seeking professional help, while more females exhibited behavioral symptoms such as emotional eating and disrupted sleep patterns. Urban respondents demonstrated heightened stress manifestations, particularly headaches and difficulty concentrating, compared to their rural counterparts. Statistically significant relationships were observed between gender and multiple stress indicators (p < 0.05), validating the alternative hypothesis. The findings underscore the complexity of stress as a public health issue and point toward the necessity of tailored, demographically sensitive interventions. Limitations of the study include the use of judgmental sampling and self-reported data, which may affect generalizability. Nonetheless, the study contributes valuable insights into stress management in urban India and emphasizes the importance of proactive mental health strategies.

Background: Short stature, defined as height significantly below the population average, can arise from various etiologies, including genetic mutations, hormonal imbalances and chronic illnesses. Despite increasing research, a comprehensive assessment of high-impact studies in this field remains lacking. This bibliometric analysis evaluates emerging research trends, methodological quality and the impact of the most-cited articles on short stature, highlighting strengths and identifying gaps in the literature. Methods: The 50 most relevant articles on short stature were organized in a bibliometric format and analyzed using R Studio with the packages “BiblioShiny,” “Bibliometrix” and “Meta.” The analysis included visualizing publication trends, identifying leading countries, authors and affiliations and calculating total citations. A thematic analysis assessed the frequency of key terms and research focus areas. Results: The analysis of the top 50 articles reveals that the USA dominates the publication landscape, contributing 58% of the articles, followed by the UK at 11%. Germany, Italy and the Netherlands contribute 5% each, while Switzerland, England and Japan provide 3% and Iran, Finland and France account for 2%. The studies utilize diverse methodologies, with genetic mutation research comprising 17 studies, alongside case-control studies, observational studies and systematic reviews. Genetic studies focusing on mutations in genes like PTPN11, FGFR3 and FGF23 are prevalent, elucidating conditions such as Noonan syndrome and Turner syndrome. Evidence levels vary, with many studies classified as Level 4, while comprehensive reviews and expert consensus papers are categorized as Level 1. Michael Holzer and Niklas Nielsen are the most productive authors, with citations of 1255 and 1231, respectively. The most prolific journal is “The American Journal of Medical Genetics Part A,” which published 17 relevant articles. Research volume has steadily increased over the past two decades, reflecting growing awareness of short stature as a significant public health issue. Conclusions: This analysis highlights significant contributions to short stature research, emphasizing the need for better translation of genetic findings into clinical outcomes. Future research should prioritize personalized treatments, advanced diagnostic tools and the psychosocial impacts on affected individuals.

The growing interest in the use of medicinal plants for treatment and healthcare necessitates thorough investigations into their safety profiles, many of which remain scarce. This research evaluates the acute toxicity of Streblus asper (SA) root aqueous extract, adhering to the OECD 420 testing guideline. Initially, a preliminary study administered increasing single doses of the extract, ranging from 5 up to 2000 mg/kg body weight, via oral gavage to female Sprague-Dawley rats. Following the determination of an appropriate starting dose, the main study included four additional rats. Over 14 days, subjects were monitored for mortality, toxicity signs, body weight and food consumption, followed by gross pathology analysis at the study's conclusion. The findings revealed no mortality or toxicity signs, consistent weight gain corresponding to food intake and no adverse effects on vital organs. Consequently, the study infers that the LD₅₀ of SA root extract exceeds 2000 mg/kg body weight in rats, indicating a potentially safe profile for therapeutic applications. This research contributes valuable data on the safety of medicinal plants, supporting their integration into healthcare practices.

Background: Acute appendicitis is considered one of the most common causes of abdominal pain that affects both adults and children. Typically requires emergency surgical intervention to prevent complications such as perforation and peritonitis. Objectives: This study aimed to fill the research gap by assessing the level of awareness and knowledge of appendectomy by identifying knowledge gaps that may impact health outcomes and complications among adults in Makkah City, Saudi Arabia. Methods: This is a cross-sectional study involving a random sample of 286 participants. Conducted from January to June 2025 in Makkah, Saudi Arabia. Using an online self-administered questionnaire assessing the demographics, personal medical history, awareness of appendicitis symptoms, understanding of surgical options and knowledge of postoperative complications. Data were analyzed using SPSS version 29, with chi-square and Fisher's exact tests. Results: About half of the participants (51.7%) have good overall knowledge, while 48.3% of the participants have poor knowledge. Females have significantly higher knowledge compared to males (55.1%) to 36% in males. The most common identifiable symptom was abdominal pain (93.7%), followed by nausea (65.7%) and vomiting (62.2%). About half (57.0%) of the participants recognized both surgical interventions for appendectomy, 22.0% only knew about laparoscopic surgery and 21% knew only the open surgery. Conclusion: Despite the good knowledge among the participants, there is still a substantial proportion who had a poor understanding, particularly among males and married individuals. These findings emphasize the need for a health education program to improve public awareness of acute appendicitis, its management and potential surgical outcomes.

Background: Needlestick and sharp injuries are percutaneous injuries caused by needles or sharp objects contaminated with blood or bodily fluids. They represent a significant occupational hazard to hospital staff. The aim of the study was to investigate the prevalence and contributing factors of Needlestick and Sharp Injuries in nurses from four hospitals in Kirkuk City. Method: A descriptive cross-sectional study was conducted among 200 nurses, purposively selected from the emergency department of four hospitals in Kirkuk City, between November 10, 2024, and May 10, 2025. A structured questionnaire and observational checklist served as data collection instruments. The Statistical Package for the Social Sciences (SPSS), version 26, was used for data entry and analysis. Both descriptive and inferential statistical methods were employed to analyze data. Result: Among the 200 enrolled nurses, 158 (79%) reported exposure to Needlestick and Sharp Injuries. Of those injured, 90 nurses (45%) reported their injuries. More than half of the injuries (67.1%) occurred during the morning shift. Syringe needles were the most common devices causing sharp injuries (70.9), and injections were identified as the primary procedures leading to these incidents (73%). Most injuries occurred during recapping (63.3%). No significant associations were found between injuries and age, gender, employment duration, or education; however, marital status showed a significant association. Conclusion: The study revealed a high prevalence of Needlestick and Sharp Injuries among nurses at Kirkuk hospitals. It emphasizes the need for targeted training on sharp object handling, strict adherence to safety protocols, improved reporting of incidents, and the elimination of risky practices like needle recapping to reduce injury rates and enhance occupational safety.

Objectives: Hepatitis B Virus (HBV) is a major public health concern, particularly among medical students who are at high risk due to clinical training, exposure to blood and the absence of mandatory screening programs, vaccination helps to reduce morbidity and mortality. This study aimed to elucidate HBV awareness and vaccination adherence among medical students in Western Saudi Arabia. Methods: From October 2023 to January 2024, a cross-sectional survey was. carried out in the Western Region of Saudi Arabia. An online self-administered questionnaire was used to collect data from a randomized sample of 376 undergraduate medical students across six governmental universities. Results: HBV vaccination adherence among medical students showed a significant association with their university (p<0.001). More than half were immunized, either through hepatitis B vaccination (43.6%) or due to a previous infection (10.9%). The most common reasons for non-vaccination were busy schedules 96 (25.5%) and forgetting to get vaccinated 86 (22.9%). Additionally, 60 (16%) of students expressed concerns about side effects or believed the vaccine was ineffective 52 (13.8%). Furthermore, 90 (28.8%) of students were unaware of or unable to access vaccination sites and 14 (3.7%) cited other reasons. Conclusion: More than half of the medical students had either been vaccinated against HBV or had acquired immunity from prior infections. However, knowledge of HBV was moderate, about 61% recognize that HBV is more contagious than HIV, while poor vaccination adherence persisted due to misunderstandings and gaps in knowledge. To improve vaccination adherence, evidence-based educational programs should be implemented, followed by effective immunization strategies and pre-clinical vaccine screening.

Background: Acute myocardial infarction (AMI) is a major cause of morbidity and death globally, resulting from a coronary artery blockage, changes in lipid profiles, and a pattern of myocardial infraction that monitors and confirms the early diagnosis of cardiovascular disease using a troponin marker. Objectives: The objectives of this study to assess the diagnostic and prognostic value of hs-CRP, troponin I, and lipid profile in AMI patients in Hawija City. Subjects and Methods: Fifty patients with an acute myocardial infarction and fifty healthy controls participated in the current investigation. An instrument contained the whole clinical profile, demographic information, and medical history of each patient. The High Sensitivity C-Reactive, troponin I, and lipid profiles of an acute myocardial infarction patients at Hawija City, all AMI patients were monitored for the first 24 hours after the onset of symptoms. The Results: The results show that the ratio of male to female in the study and control groups represents 56:0 and 44.0 respectively while the ratio of male to female in control group represents 50.0 in both groups. Furthermore, the outcome demonstrates that the comparison of hs-CRP levels between patients with AMI and the control group, as well as the mean and standard deviation in the study group is 7.44±1.24 and in the control group is 1.7919±0.52. The results also show that the lipid profile was higher in the study group compared to the control group, and the hs-CRP and lipid profile contrast in various early onset and late onset AMI and appear increase of hs-CRP and lipid profile in late onset of AMI 15.55±4.4 comparison in early AMI4.91±0.23. Conclusions: The study concluded that there are alterations in lipid profile and inflammatory marker in AMI cases. The results also reveal that the lipid profile increases in patients with AMI (study group) in a comparison with control group. The results find that the hs-CRP and lipid profile were high in the late AMI in a comparison with an early onset of AMI.

Background: There are approximately 140 million contact lens (CL) users globally, which is ever-increasing. Studies on the knowledge and risk factors of CL are scarce. Objectives: Thus, in this study, we aim to assess the attitude and awareness of CL use and the associated risk factors among Tabuk University, Saudi Arabia, medical students. Methods: This is across-sectional study that was developed based on a designed questionnaire to test the knowledge and risk factors of contact lenses. The questionnaire was composed of 33questions with a maximum score of 28 points. The study was conducted among 329 students of the University of Tabuk during the period from March to September 2024. Results: A total of 329 participants were included in this study; the majority were females (66.7%), aged 19-21 years and 40.4% were from the College of Medicine. Contact lens knowledge and attitude were poor among students at the University of Tabuk, Saudi Arabia, 5.05±2.38/28 and 12.74±5.13/28, respectively, poor knowledge was observed in 22.5% and poor attitude in 92.1%. Females 'knowledge and attitude were better among females compared to males, 95% CI 1.335-5.612 and p-value, 0.006 No differences were found regarding age, class and college, p-value >0.05. Conclusion: Contact lens knowledge was suboptimal among students in the University of Tabuk, Saudi Arabia. Female participants had higher total mean knowledges cores than males. Increasing the awareness about CLs and the implementation of mandatory CL education workshops are highly needed. Larger multicenter studies among the general population are recommended.

Objectives: Hemophilia in children is among the most prevalent and severe congenital coagulation factor deficiency disorders. This condition is characterized by a lifelong predisposition to bleeding, which may be spontaneous or disproportionate to trauma, resulting from the absence of clotting factors. This study aimed to assess public awareness regarding various aspects of pediatric hemophilia among residents of Tabuk City, Saudi Arabia. Methods: A cross-sectional, questionnaire-based survey was conducted involving 402 adult Saudi males and females residing in Tabuk City, representing a range of age groups and educational backgrounds. The questionnaire included 15 statements aimed at evaluating various aspects of hemophilia-related knowledge. Knowledge scores were calculated by assigning one point for each correct response, while incorrect or "do not know" answers were given a score of zero. Results: The study showed that 45.3% of participants had no prior knowledge of hemophilia. Only 12.7% demonstrated good knowledge, while 17.7% and 24.4% fell into the low and fair knowledge categories, respectively. Overall, public awareness of pediatric hemophilia was suboptimal. There were no statistically significant differences based on age, sex, or education level.” Conclusions: There is a significant deficiency in public knowledge regarding childhood hemophilia among the population of Tabuk City. These findings underscore the necessity of implementing comprehensive public health initiatives, such as educational programs and awareness campaigns to enhance understanding and early recognition of this serious bleeding disorder.

Background: Mothers of children with intellectual disabilities face greater challenges and stress compared to mothers of children without disabilities. Autogenic relaxation therapy is a powerful technique for reducing stress and anxiety. This study aims to assess the effectiveness of Autogenic Relaxation Therapy (ART) on psychological parameters and salivary cortisol among mothers of special children. Method: A prospective quasi-experimental study design was adopted, with 200 mothers assigned to either an experimental (n = 100) or control group (n = 100) by using non probability convenience sampling technique. The experimental group received Autogenic Relaxation Therapy twice a week for 8 weeks while the control group was not given any intervention during the time of data collection and they will be provided with intervention only after the data collection period. Psychological parameters such as stress, anxiety and depression were assessed using standardized scales such as becks depression inventory, becks anxiety inventory and berry and jones parental stress scales and salivary cortisol levels were estimated using the ECLIA method. Results: Significant reductions in stress (21.5%), anxiety (30.39%) and depression (27.68%) were observed in the experimental group. Salivary cortisol levels decreased by 41% in the experimental group, while increasing by 3.8% in the control group. Conclusion: The study demonstrates that the intervention was effective in significantly reducing psychological distress among parents of intellectually disabled children. Participants in the experimental group showed marked reductions in stress, anxiety and depression levels, along with a substantial decrease in salivary cortisol, a biological marker of stress.