Background: The Family Adoption Program (FAP) enables MBBS students to interact directly with households and understand how socio-cultural beliefs shape health behaviour. During these visits, students encountered practices linked to menstruation, newborn care, hygiene, gender norms and healthcare-seeking patterns. This study analyzes the socio-cultural issues observed, student perceptions and the advice they provided. Methods: A qualitative exploratory design was used. 1st year MBBS Students of Indira Gandhi Medical Collge, Shimla, Himachal Pradesh conducted home visits, informal interviews and observations, documenting responses as field notes. Data were analyzed thematically to identify recurring beliefs, attitudes and counselling approaches. Ethical principles of verbal consent, confidentiality and cultural respect were maintained. Results: Eight themes emerged: stigma and restrictions around menstruation; honey/ghutti feeding as a cultural blessing; gender and decision-making hierarchy; preference for traditional remedies over preventive care; hygiene practices based on familiarity rather than science; secrecy around reproductive issues; households showing positive adaptation; and marriage norms and contraceptive silence linked with socioeconomic factors. Students’ perceptions shifted from viewing these practices as misinformation to understanding their cultural and emotional significance. Their advice focused on menstrual hygiene, exclusive breastfeeding, boiling water, timely medical care and open communication-offered in a respectful, non-confrontational manner. Conclusion: Socio-cultural practices were maintained due to tradition, identity and generational influence rather than lack of knowledge alone. The program enabled students to learn empathy, cultural competence and real-world communication skills. Improving community health therefore requires partnership, trust-building and gradual behaviour change rather than direct rejection of tradition.

Background: Obesity is a growing global health challenge associated with significant morbidity, mortality and economic burden. Conventional management strategies such as lifestyle modification and pharmacotherapy often fail to achieve sustainable results in patients with morbid obesity. Bariatric surgery has emerged as the most effective intervention, offering not only durable weight reduction but also improvement or remission of obesity-related comorbidities including type 2 diabetes, hypertension and dyslipidaemia. However, variations in outcomes between different surgical procedures such as sleeve gastrectomy and gastric bypass remain an area of clinical interest. Objective: To evaluate weight loss and metabolic outcomes in patients undergoing bariatric surgery, with comparison between sleeve gastrectomy and gastric bypass procedures. Methods: This cross-sectional analytical study included 345 patients who underwent bariatric surgery. Patients aged 18-65 years with morbid obesity were enrolled, while those with prior bariatric or gastrointestinal surgery and incomplete records were excluded. Baseline demographic and clinical data were collected and postoperative weight loss and metabolic outcomes were assessed at 6 and 12 months. Weight loss was measured using total weight loss percentage (%TWL) and excess weight loss percentage (%EWL). Metabolic remission was defined as normalization of parameters without pharmacotherapy. Data were analysed using SPSS version 26, with p<0.05 considered significant. Results: Of the 345 patients, 198 (57.4%) underwent sleeve gastrectomy and 147 (42.6%) gastric bypasses. The mean baseline BMI was 44.3±6.7 kg/m². At 12 months, mean % TWL was 27.8±7.1 in the sleeve group and 29.7±7.6 in the bypass group (p = 0.02), while mean %EWL was 60.4±12.1 vs. 65.2±12.5 (p = 0.01). Complete remission of type 2 diabetes was achieved in 61.2% of sleeve patients and 68.7% of bypass patients, with a greater HbA1c reduction observed after bypass (p = 0.03). Hypertension resolved in 52.9% and 58.0% of sleeve and bypass patients, respectively, while dyslipidaemia normalized in 45.7% and 51.9%. Postoperative complications were generally low, though slightly higher after bypass (30%) compared to sleeve (21%). Conclusion: Both sleeve gastrectomy and gastric bypass result in significant weight loss and improvement in metabolic comorbidities, with gastric bypass demonstrating modestly superior outcomes. Bariatric surgery should be considered not only as a weight reduction procedure but also as a metabolic treatment option for patients with morbid obesity.

The development of fungal infections and their spread through leaves, stem and soil in greenhouses for agricultural crops is a threat to many diverse agricultural crops due to the environmental conditions they provide, resulting in economic losses for both farmers and the country. In the current laboratory study, the types of fungi were isolated and diagnosed for a group of different plants in the plastic house, namely (pepper, cucumber, chard, spinach, eggplant, strawberry). After isolation and diagnosis, the types of fungi (Penicillium, Fusarium, Aspergillus, Alternaria, Rhizopus) were obtained, as they were the reason for the appearance of dark spots in the leaves of the plants under study. Alternaria spp. and Fusarium spp. were used to test plant extracts on them and demonstrate their inhibitory abilities. Three types of aqueous extracts were tested separately: cloves (Dianthus caryophllus), cinnamon (Cinnamomum verum) and ginger (Zingiber officinale) at two concentrations 25, 50% as a first step. Then, in the second step, the most inhibitory extract was mixed, which had a 100% inhibition rate, which is cloves and tested on two fungi (Alternaria, Fusarium) at the same concentrations 25, 50% with the cinnamon once and with ginger again, the process of mixing two types of extracts gave equal inhibitory results, which are 100% For both types of fungi, unlike using only one type of extract, the result was varying inhibition of fungal cultures. This opens the door to the possibility of using types of plant extracts and mixing them together to combat agricultural pests, as they contain active substances in varying proportions. When combined, they provide more inhibitory antibodies to pathogenic fungi and are used as environmentally friendly biocides.

Objectives: Sauna use has numerous cardiovascular health benefits and has been shown to decrease the risk of cardiovascular disease (CVD). This study investigates the prevalence and determinants of sauna use in Saudi Arabia, focusing on public knowledge and attitudes toward its cardiovascular health benefits. Methods: We conducted a cross-sectional survey among 576 adults using a structured questionnaire distributed via social media. The questionnaire assessed sauna habits and knowledge of cardiovascular benefits and identified key motivators and barriers to sauna use. Results: Our findings reveal that sauna usage is notably low, with (N = 428, 74.3%) of participants reporting they do not use saunas. Knowledge of the cardiovascular benefits is equally limited with most of the population having poor levels of awareness (N>318, >55%); particularly, only a small fraction of the population is aware of the reduced risk of cardiovascular mortality associated with regular sauna use (N = 43, 7.5%). Increased knowledge of the knowledge parameters was associated with increased sauna visitation frequencies (p<0.003). Men and smokers generally displayed higher awareness of the circulatory benefits. The motivators with major importance in reinforcing sauna use included personal enjoyment (N = 211, 36.6%) and the availability of free time (N = 211, 36.6%), while the main barriers were lack of time (N = 250, 43.4%), lack of motivation (34.9%, N = 201), financial constraints (25.7%, N = 148) and limited awareness of health benefits (N = 131, 22.7%). Conclusion: The study underscores a critical gap in the adoption and understanding of sauna use as a preventive health measure in Saudi Arabia. Enhanced public health initiatives are essential to improve awareness and accessibility, which could facilitate wider adoption of sauna use.

Background: Clinical reasoning (CR) involves intertwined cognitive and affective processes, yet the specific contribution of emotional competence (EC) sub-dimensions to CR remains underexplored in undergraduate nursing education. Identifying which EC components matter can inform targeted, low-cost educational routines to support decision quality and patient safety. Aim: To examine the association between EC and CR and to determine, among PEC dimensions (intrapersonal, interpersonal) and the ten PEC sub-dimensions, which independently predict CR in undergraduate nursing students. Methods: A cross-sectional study was conducted in Morocco (Tanger-Tétouan-Al Hoceïma region, March-May 2025). Students completed the Profile of Emotional Competence (PEC, 50 items) and the Nurses’ Clinical Reasoning Competence Scale (NCRCS). Analyses included descriptive statistics, Pearson/Spearman correlations and multiple linear regressions. Results: Clinical reasoning (CR) was positively associated with both intrapersonal emotional competence (EC) (r = 0.23, p<0.01) and interpersonal EC (r = 0.19, p<0.01). In the two-dimensional model, the regression was significant (F(2, 308) = 11.27, p<0.001, R² = 0.07), with independent contributions from intrapersonal EC (β = 0.19, p = 0.002) and interpersonal EC (β = 0.13, p = 0.027). In the ten-subdimension model, overall fit remained significant (F(10, 300) = 3.56, p<0.001, R² = 0.106, adjusted R² = 0.076). Two intrapersonal subdimensions, emotional expression (β = 0.15, p = 0.013) and task-oriented use of emotions (β = 0.17, p = 0.005), emerged as independent predictors of CR when modeled simultaneously. Conclusion: Two intrapersonal emotional micro-skills, expressing emotions and using them in a task-oriented way are priority targets to strengthen clinical reasoning. Embedding brief metacognitive prompts and structured debriefings (including simulation) may offer scalable, cost-effective ways to improve decision quality in undergraduate nursing.

Background: Plantar fasciitis has been identified to affect 11-15% of all foot-related problems, globally. Despite its prevalence, knowledge and awareness with regards to plantar fasciitis remain scarce. Objectives: This study aims to assess the knowledge and practice towards plantar fasciitis among the general population in Arar, Saudi Arabia. Methods: A cross-sectional survey of 260 people in the Northern Border Region of Saudi Arabia used demographic data, knowledge scores consisting of five questions, and practice scores consisting of five questions on PF. Knowledge and practice levels were rated as excellent, good, or inadequate. The chi-square test and ANOVA were used in the evaluation of the relation of demographics with the total scores. Results: Mean scores of knowledges (7.58±5.07 out of 20) and practice (9.00±2.93 out of 15) were lower, as only 10% and 21.5% of participants respectively had excellence, and 68.5% and 39.6% had inadequate knowledge and practices, respectively. However, only 35.4% of them used supporting shoes, and 29.6% had preventive exercise practices. The educational status of participants had significant association with mean scores of knowledges and practices (p = 0.002). Conclusion: A lack of understanding about plantar fasciitis, in terms of its prevention, exists in Arar, Saudi Arabia. Education has been identified as the best indicator of understanding and proper practice, indicating the importance of appropriate public health interventions.

Background: Diabetes is managed by prescribed medication and dietary measures to control hyperglycemia, but self-management is a vital aspect that drastically affects patients’ quality of life (QoL). Objective: To find the association between self-management practices (SMP) and QoL in patients with type 2 diabetes mellitus (T2DM). Methods: This descriptive cross-sectional study included 391 patients with T2DM at the Diabetes and Endocrine Centre, Sulaimaniyah, Iraq, from September 2024 to May 2025, using a non-probability convenience sampling technique. Data were collected through face-to-face interviews using a structured questionnaire that consisted of six parts, including patients’ sociodemographic data, medical data, self-care behaviors, knowledge on diabetes management, QoL, and the presence of common diabetes complications. Results: Regarding glucose management among patients, most patients (61.6%) fairly practised diabetes self-management with a mean score of 68.56±13.62. For QoL, most patients (38.62%) are satisfied with QoL, with a mean score of 60.02±18.71. Subsequently, diabetes-related SMP in glucose control, dietary habits, healthcare use, physical activity, or general self-care has a substantial impact on individuals' QoL (p = 0.001). Additionally, education, the number of comorbidities, and body mass index significantly influenced SMP (p ≤ 0.001), while age, gender, and smoking habit did not (p ≥ 0.05). Finally, both sociodemographic characteristics and clinical data significantly influenced the patient’s QoL (p≤0.001). Conclusions: A direct correlation was observed between patients’ SMP and QoL; however, there is a need for targeted educational programs and tailored approaches to improve diabetes SMP and QoL among the studied population to better control diabetes.

Background: Emergency nursing is a demanding specialty that requires advanced knowledge, clinical competence and flexibility to manage acute and life-threatening conditions. In Saudi Arabia, emergency departments are facing increasing pressure due to population growth, chronic diseases and high accident rates. Objective: This study aimed to assess the knowledge, attitudes and practices of emergency nursing specialists in Saudi Arabia and to identify the main challenges they encounter in their professional practice. Methods: A descriptive cross-sectional study was conducted among emergency nurses working in hospitals in the Kingdom of Saudi Arabia. Data were collected using a validated self-administered questionnaire adapted from previous validated tools covering four domains: Demographic characteristics, knowledge, attitudes and practices. Descriptive and inferential statistics were performed to examine KAP levels and their associations with demographic variables. Results: A total of 220 emergency nurses participated. The mean age was 34.7±8.0 years and the mean years of experience was 16.0±7.3 years. The overall KAP analysis showed moderate knowledge levels (Mean = 3.62±0.81), attitudes (Mean = 3.48±0.84) and adequate but constrained practices (Mean = 3.39±0.89). Knowledge was highest for triage familiarity and management of life-threatening emergencies. Attitudes were generally positive; however, workload concerns persisted. Practices demonstrated good clinical capability but were limited by staffing shortages and restricted training opportunities. No statistically significant differences were found in KAP scores across gender, age or education (p>0.05). Conclusion: Emergency nurses in Saudi Arabia show good knowledge and skills but face challenges of workload, staffing and limited training. Addressing these gaps is essential to improve emergency care and support Vision 2030 goals, regarding raising the level of health services and improving public health.

Background: Anti-Müllerian Hormone (AMH), Follicle-Stimulating Hormone (FSH), and Prolactin are key hormonal markers in female reproductive function. AMH and FSH assess ovarian reserve, while Prolactin reflects pituitary activity. Methods: A cross-sectional study was conducted on 29 infertile women. Serum levels of AMH, FSH, and Prolactin were measured. Pearson correlation and ROC analysis were performed to examine relationships and diagnostic performance. Results: No statistically significant correlations were found between AMH and FSH (r = 0.217, p = 0.258), AMH and Prolactin (r = -0.119, p = 0.539), or FSH and Prolactin (r = -0.185, p = 0.336). ROC analysis showed that Prolactin had high diagnostic accuracy (AUC = 0.983), whereas AMH and FSH demonstrated limited utility. Conclusion: Within this small cohort, expected hormonal correlations were not observed. Prolactin shows potential as a diagnostic biomarker, while AMH and FSH should be interpreted cautiously. Larger, well-designed studies are recommended to validate these findings.

Aims and Objectives: To identify the causes of osteoarthritis in young population. To describe clinical presentation and laboratory findings. Highlight the differences between osteoarthritis in young and older population. 4. Compare the observed findings with published literature. Results: A total of 30 cases of Osteoarthritis in Young Patients (15-50 years) was studied and reveals the following causes. Genu Varus 8 (26.7%). Genu Valgus 3 (10%) Obesity 4 (13.3%) Trauma 3 (10%) Coxa Vara 10 (33.3%) Coxa Valgus 1 (3.3%) Alcoholic 1 (3.3%). Regards to clinical presentation pain is most common symptom (100%) followed by difficulty walking (50%) restriction of movements (43%). Duration of Arthritis and its clinical features varied from 1 year (Genu Varus) to 9 years (Obesity). Regards to sex, males (76.6%) are affected more than females (23.4%). Regards to Age, minimum age at onset of Arthritis is 28 years (trauma) to maximum of 50 years (Genu Varum). Inflammatory Markers (ESR is within normal limits and CRP is negative in all patients) suggesting the degenerative nature of disease and ruling out infectious/inflammatory process. Biopsy is not advised in any one of the patients. Methods: Patients with signs and symptoms of osteoarthritis in the age group of 15-50 years are selected and studied during period of one year (1-6-2024 to 1-6-2025). Characteristics included in the proforma are age, sex possible cause, duration, clinical presentation (sign/symptom), site/joint involved, imaging finding, laboratory features such as CBP, CRP, ESR including biopsy changes. The descriptive findings are mentioned. Discussion: Osteoarthritis in young generation is a hidden and masked entity which need to be detected at earliest stage to prevent progressive joint disease. Identification of the underlying causes and the avoidance /treatment can slow or prevent the condition. The clinical presentation and pathological features can vary in contrast to adult variant. The pathogenesis depends upon the underlying cause and prognosis is related to the severity of the underlying condition. Conclusion: In the present study various risk factors for osteoarthritis has been identified. These modifiable conditions can be treated earlier or avoided by proper interventions to prevent or slow the joint damage and progressive disease.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social communication, restricted and repetitive behaviors, and narrowed interests. Aim: The study aimed to assess the effectiveness of Snoezelen therapy in improving behavioral patterns among children with Autism Spectrum Disorder. Methods: A quasi-experimental design was applied to a sample of 20 children with ASD, divided equally into experimental and control groups. The experimental group received 48 individualized Snoezelen therapy sessions over six months, whereas the control group continued with conventional care. Behavioral changes before and after the intervention were evaluated using the Childhood Autism Rating Scale (CARS-2). Results: The experimental group exhibited significant improvements in several behavioral domains of the CARS-2, such as social interaction, imitation, emotional response, adaptability, and communication (p<0.05). In contrast, no notable changes were observed in the control group receiving routine care. Conclusion: Findings indicate that Snoezelen therapy effectively enhances sensory processing and behavioral functioning in children with ASD.

Transthyretin (TTR) is a homotetrameric transport protein primarily synthesized in the liver and choroid plexus. It serves as a carrier for thyroxine and retinol-binding protein but also exhibits broader biological functions, including neuroprotection and proteolytic activity. TTR also regulates myeloid cell development to regulate immune cell reaction. Structural destabilization of TTR can lead to its misfolding and aggregation into insoluble amyloid fibrils, resulting in transthyretin amyloidosis (ATTR), a group of systemic disorders characterized by extracellular amyloid deposition in multiple organs. Two major forms of ATTR have been described: hereditary (variant, ATTRv) and wild-type (ATTRwt) amyloidosis. ATTRwt arises from the aggregation of non-mutant TTR, primarily causing cardiomyopathy, whereas ATTRv results from pathogenic TTR gene mutations associated with neuropathic, cardiac or mixed phenotypes. Although current therapies can stabilize TTR tetramers or facilitate amyloid clearance, they primarily manage disease progression rather than achieve cure. This review aims to integrate current knowledge on the molecular structure and physiological functions of TTR, its immunomodulatory and cell-protective roles and its pathological involvement in amyloidogenesis. By highlighting the intersection between TTR’s biological and immunological functions, the review underscores its relevance in understanding disease mechanisms and developing targeted therapeutic strategies.

Background: College students worldwide are using smartphones more frequently. These users' health is suffering and they are wasting their valuable study time. Aim: This study aimed to identify the effects of smartphone addiction on vision syndrome and fatigue of college students. Methods: Cross-sectional study designed from 2024 to 2025. A purposive sample was 1700 university students from universities in Mosul City. Data collection was executed using a questionnaire that sought data regarding demographics, Smartphone addiction, fatigue and vision syndrome. Analysis of data by using descriptive and inferential statistics. Results: The results of the study showed that 48.4% had moderate addiction to smartphones, while 37.8% had severe addiction. Moderate fatigue considered as 38.1%, while 40.4% had moderate vision syndrome. Smartphone addiction was recorded as a significant association with vision syndrome and fatigue among university students. The correlation coefficients between Smartphone addiction and fatigue (p≤0.01) and with vision syndrome (p≤0.01) showed significant associations. Conclusion: Excessive use of smartphones has led to increased fatigue and vision syndrome among students. Focusing on these results is justified. Therefore, awareness campaigns and intervention programs should be initiated immediately to protect Mosul University students from the negative effects.

Introduction: Job satisfaction among healthcare workers influences the organizational performance of primary healthcare centers (PHCs) and the quality of care. However, the specific factors affecting job satisfaction within PHCs remain underexplored. This study investigates job satisfaction among healthcare workers in PHCs and assesses the relationship between job satisfaction and various worker characteristics. Methods: A cross-sectional observational study was conducted using a convenience sampling strategy. An electronic questionnaire was distributed to healthcare workers across 52 PHCs in five geographical areas in Makkah, Saudi Arabia. Univariate, bivariate, and multivariate statistical analyses were performed. Results: A total of 654 healthcare workers aged 21 to 55 years participated in this study, of whom 59% were male. Female healthcare workers exhibited lower satisfaction "Teamwork" (β = -1.00, p = 0.007) and "Leadership" (β = -0.64, p = 0.033) within the PHCs. Participants aged 35-44 and 45-54 reported lower satisfaction in the "Communication" (β = -1.08, p = 0.026; β = -1.27, p = 0.025). Additionally, healthcare workers with 5 to less than 10 years and those with 10 or more years of experience reported lower satisfaction with "Reward/Recognition" offered in PHCs (β = -2.16, p = 0.038; β = -2.07, p = 0.044). Conclusion: Examining the influence of various factors on job satisfaction scores suggests that fostering an environment that prioritizes teamwork, communication, and recognition could increase job satisfaction among healthcare workers and ultimately improve overall healthcare outcomes.

Objectives: Background: Ischemic stroke is a major public health burden globally and in Iraq, often leading to long-term disability and poor quality of life. Thrombolytic therapy with recombinant tissue Plasminogen Activator (rtPA) has been shown to improve acute and long-term outcomes in eligible patients, yet its real-world impact remains underexplored in low-resource settings such as the Kurdistan Region. Objective: To evaluate the impact of thrombolytic therapy on stroke severity, in-hospital complications, functional disability and Quality of Life (QoL) in ischemic stroke patients compared to those receiving usual care. Methods: A comparative cross-sectional study was conducted among 60 ischemic stroke patients admitted to Shar Hospital in Sulaymaniyah. Thirty patients received intravenous thrombolysis with rtPA within the recommended time window, while 30 matched patients were managed with usual care. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, discharge and three months post-stroke. Disability was evaluated using the modified Rankin Scale (mRS) at admission and three months post-stroke and quality of life was assessed with the Stroke-Specific Quality of Life Scale (SS-QoL) at three months post-stroke. Complications were documented during hospitalization. Results: There was no significant difference in initial NIHSS scores between groups (p = 0.938), confirming baseline comparability. However, thrombolysis significantly reduced stroke severity at discharge (p = 0.001) and at three months (p = 0.004). A greater proportion of patients in the thrombolysis group achieved favorable functional outcomes (mRS ≤2) and reported good QoL (66.7%) compared to the control group (16.7%, p = 0.001). Additionally, thrombolysis was associated with fewer in-hospital complications (p = 0.018). The thrombolysis group also scored significantly higher across multiple QoL domains, including mobility, self-care, mood and upper extremity function. Conclusion: Thrombolytic therapy significantly improves neurological recovery, functional independence and quality of life in ischemic stroke patients, while reducing complication rates. These findings highlight the urgent need to expand thrombolytic stroke care services in Iraq, particularly in underserved regions. Implementation of time-sensitive stroke pathways and public awareness campaigns may enhance treatment access and outcomes.

Background: Maternal awareness and practices regarding respiratory infections in children under five are crucial for improving health outcomes. Knowledge about early symptoms, preventive measures and environmental risks can reduce infection rates. Aim: This study aimed to assess mothers' awareness and practices regarding early signs of respiratory infections in children under five. Methods: A descriptive study design was employed. The sample size was 100 mothers of children under the age of five. The sampling technique was convenient sampling. Data were collected by means of a structured questionnaire that elicited information on socio-demographics, knowledge of respiratory infections and health-seeking practices. Descriptive statistics were employed to summarize and present the data. Chi-square tests were used for inferential analyses. Results: The study found that most mothers had a medium level of knowledge, some had a high level and a few had a low level of knowledge regarding early signs of respiratory infection. Conclusion: While many mothers understood the early signs and severity of respiratory infections, gaps remain, especially regarding home treatment and when to seek medical help. Targeted health education programs are needed to correct misconceptions and promote timely medical intervention, improving child health outcomes.

Objectives: This systematic review consolidates current evidence to delineate the spectrum of alemtuzumab-induced thyroid autoimmunity in patients with MS. Methods: PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials.gov were searched up to June 2025 for studies reporting thyroid outcomes following alemtuzumab in MS. Eligible designs included randomized trials and observational cohorts. Data were extracted on incidence, subtype distribution, time to onset and management. Study quality was assessed using the Newcastle–Ottawa Scale and Cochrane/ROBINS-I tools. Results: Out of 2,397 records, 11 studies met inclusion criteria, encompassing approximately 1,626 participants. AITD occurred in about one-third of treated individuals. Graves’ disease was the predominant phenotype (33–65% of cases), followed by Hashimoto’s thyroiditis and TRAb-positive hypothyroidism. Onset typically occurred 18–30 months after the first infusion, peaking around year 3. Fluctuating courses between hyper- and hypothyroidism were reported in up to 15% of cases. Most events were mild or moderate and controlled with antithyroid drugs or levothyroxine; radioiodine or thyroidectomy were rarely required. Conclusion Autoimmune thyroid dysfunction is a frequent and distinctive complication of alemtuzumab in MS. The majority of cases are manageable, but the unpredictable course warrants regular thyroid-function testing every three months for at least four years after treatment and continued long-term surveillance.

Objective: This work seeks to elucidate the molecular mechanism by which kaempferol inhibits the growth of Gastric Cancer (GC) cells via the ferroptosis pathway. Methods: The CCK8 detection was used to assess the viability of GC cells treated with kaempferol and oxaliplatin, both individually and in combination, to evaluate potential synergistic effects, while the EDU experiment was employed to determine the impact of kaempferol on DNA synthesis. The PCR array of cell death pathways was used to screen ferroptosis related genes in GC cells intervened by kaempferol and the levels of key markers were quantified with specific assay kits. Mitochondrial morphological alterations were also discovered using the transmission electron microscope. The protein expression levels of NQO1, p53, SLC7A11 and GPX4 in GC cells were analyzed by Western blot experiment following kaempferol treatment. Results: Kaempferol concentration dependently reduced the viability and DNA synthesis of GC cells, with IC50 values of 92.75 μM in HGC27 and 69.74 μM in MKN45 cells. When combined with oxaliplatin, with a Loewe synergy score of 17.621 for HGC27 cells and 13.931 for MKN45 cells, showing a synergistic effect. The PCR array detection indicated that following kaempferol intervention, P53 expression was increased, while NQO1, SLC7A11 and GPX4 expressions were downregulated. Meanwhile, kaempferol markedly decreased GSH levels while elevating MDA, Fe²⁺ and ROS levels in GC cells. The results of the Western blot experiments corroborated the PCR array findings, demonstrating that kaempferol induced ferroptosis in GC cells by modulating the P53/SLC7A11/GPX4 pathway. Conclusion: Kaempferol could promote ferroptosis in GC cells through the P53/SLC7A11/GPX4 signaling pathway, even for act as a sensitizer agent when combing with oxaliplatin for the treatment of GC.

Background/Objectives: Primary dysmenorrhea is common among young women and often associated with smoking as a modifiable risk factor. This study explores the relationship between smoking exposure and dysmenorrhea among female undergraduate students. Methods: A cross-sectional study was conducted among 294 female students at a public university using a structured online questionnaire that assessed smoking exposure (active and passive), menstrual characteristics, dysmenorrhea severity, and socio-demographic data. Data were analyzed using chi-square tests and logistic regression. Results: Passive smoking was reported by 42.9% and active smoking by 6.9% of participants. Students exposed to smoking (active or passive) reported a higher prevalence of dysmenorrhea and greater reliance on pain medication compared with non-exposed peers. Smoking exposure was significantly associated with age, marital status, and BMI. Dysmenorrhea had higher pain intensity and greater reliance on medication. Regular menstrual cycles were significantly associated with dysmenorrhea. Conclusion: This cross-sectional analysis indicates that passive smoking is associated with increased dysmenorrhea prevalence among female university students. The findings underscore the importance of campus-based smoking cessation and menstrual health education programs to reduce the burden of menstrual pain and improve student well-being.

Background and Aims: Despite the global prevalence of Vitamin D deficiency (VDD) even within sun-rich areas like the Middle East, the awareness remains a key concern. The aim of this study was to assess the awareness of the health consequences of VDD among female employees at the University of Kirkuk. Methods: This research employed a cross-sectional survey design at the University of Kirkuk, Iraq, from December 3, 2024, to March 31, 2025. A stratified random sample was used to select 300 female employees. They provided informed consent and completed a structured questionnaire covering sociodemographic factors, medical history and VDD awareness. Statistical analysis included descriptive and inferential methods, such as one-way independent t-test, performed with SPSS version 23. Results: Mean awareness score was 54.40±17.43. Only 14.4% of participants demonstrated full awareness, while 46.8% were partially aware and 38.8% were unaware of the health consequences of VDD. A self-reported history of VDD was reported by 78.6% of participants. Awareness was significantly associated with educational background (p<0.001), occupational roles (p<0.001) and marital status (p = 0.016). However, age, employment duration, residence or economic status were not associated with awareness. Conclusion: Awareness of VDD consequences was generally low among female employees, suggesting a weak perceived severity of the condition. Significant gaps were found among administrative staff, services staff and widowed participants. Targeted workplace education is necessary to address these gaps, focusing specifically on the wider health consequences of VDD to promote preventive behaviors.

Education is fundamental to development of any society anywhere and effective assessment is crucial for ensuring the quality and results of educational processes. With the swift progress in technology, Artificial Intelligence (AI) has become a revolutionary tool in education, especially in assessment techniques. This review examines the use, advantages, challenges, and future directions of AI-driven assessments in medical education. A systematic literature review was performed utilizing PubMed, Scopus, and Google Scholar, concentrating on studies that investigate the role of AI in medical education and evaluation. From an initial pool of 3,051 studies, 31 were selected based on strict inclusion criteria after a thorough multi-stage selection process. The findings suggest that AI can improve assessment accuracy, transparency, and efficiency through automated grading, adaptive testing, and prompt feedback. AI-driven assessments also have the potential to reduce human biases, lessen the workload for educators, and promote personalized learning experiences. However, challenges such as data privacy, algorithmic bias, and the necessity for AI literacy among educators continue to pose significant issues. In summary, the integration of AI into medical education assessments offers a chance to enhance evaluation standards, support competency-based education, and cultivate the development of more proficient healthcare professionals.

Individuals receiving maintenance hemodialysis for Chronic Kidney Disease (CKD) frequently encounter complex physical, emotional and social challenges that substantially diminish their Quality of Life (QoL). Mindfulness-Based Stress Reduction (MBSR) has increasingly been recognized as a supportive, non-pharmacological strategy for enhancing well-being in populations with chronic illness. This pilot investigation examined the potential influence of an MBSR program on QoL outcomes among patients undergoing hemodialysis. A quasi-experimental pretest–posttest framework was applied with ten participants recruited from a dialysis unit. The intervention cohort engaged in an eight-week structured MBSR program involving weekly one-hour sessions incorporating focused breathing, mindfulness meditation and body-scan practices, while the control cohort continued with standard clinical care. QoL was assessed before and after the intervention using the Kidney Disease Quality of Life Short Form (KDQOL-SF v1.3). Analytical procedures included paired and independent t-tests, in addition to correlational analyses exploring associations with demographic and treatment-related parameters. Notable improvements were observed in the intervention group across multiple domains Symptoms and Problems (p = 0.0018), Effects of Kidney Disease (p = 0.0284), Sleep (p = 0.0468), Physical Functioning (p = 0.0265) and Role Limitations due to Physical Health (p = 0.0211). Post-intervention patterns indicated that demographic attributes and dialysis-related variables influenced specific QoL dimensions. These preliminary findings suggest that MBSR may offer meaningful benefits for both physical and psychological dimensions of QoL among hemodialysis patients and merits further evaluation in larger controlled studies.

This paper analyses the way war-related disabled people in Ukraine use digital rehabilitation devices by relying on three complementary data sources, such as diary self-observation (n = 50), in-depth interviews (n = 12) and digital footprint analytics on a state support platform (n = 117). The results show the similarity in behavioural patterns among datasets, as well as the inclination towards personalised modes such as online consultations and information browsing and a lack of use of automated services because of the emotional reluctance, complexity of interface and doubts in digital interaction. Interview data indicate the importance of psychological safety, trust and perceived predictability in digital use and metrics of digital footprint indicate that there are often problems with registration and short-term engagement with instructional content. The research defines the main usability and cognitive obstacles that restrict successful digital application and presents user-oriented guidelines of enhancing the development of rehabilitation instruments. These findings add to a more subtle comprehension of the digital rehabilitation practice in wartime and the necessity of the further studies based on larger and more diverse samples.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a complex lung disorder marked by persistent respiratory symptoms such as breathlessness, cough and sputum production due to airway and/or alveolar damage. Methods: A quasi-experimental pretest-posttest design was employed, assessing 10% of the projected sample size (n = 200) using convenience sampling at Saveetha Medical College and Hospitals, Chennai. The experimental group received a three-month intensive PR program in addition to standard medical care per GOLD guidelines, while the control group received only standard care. The intervention included education on COPD management, breathing exercises, physical training and psychological support. Outcomes were measured at just before starting the study, 6th week and 12th week using 6-Minute Walk Test (6MWT). Results: Both the groups were comparable at just before the study initiation regarding clinical and demographic characteristics. The experimental group showed a significant increase in 6MWT distance over 12 weeks (from 320±45 m to 400±48 m; F = 42.18, p<0.001), whereas the control group exhibited only minimal improvement. Conclusions: A comprehensive pulmonary rehabilitation program significantly improved the exercise capacity in COPD patients regardless of demographic or clinical variables, highlighting its importance as an adjunct to standard medical treatment.

Background: Nursing competencies must be in harmony with patients' care needs for enhancing the quality of care and patient satisfaction, especially in high acuity clinical environments. Introduction The AACN Synergy System provides a systematic process of linking patient characteristics to relevant nursing competences30 but research conducted in Middle East healthcare systems is scarce. Objective: This study aimed to investigate the effect of using the Synergy System on nursing competency and patient satisfaction in surgery intensive care units. Methods: A prepost-phase II quasi experimental study took place at Sohag University hospitals, Egypt. A nonprobability sample design was employed with the participation of 100 staff nurses and 100 hospitalized patients. Nursing competencies of the nurses were evaluated by AACN-based Nursing Competency Scale and patient satisfaction level was assessed with a structured satisfaction questionnaire. We then used paired t-test, chi-square test and Pearson correlation coefficient for statistical analysis with p<0.05 indicating significance. Results: After the Synergy System educational program, the mean±SD global competency score was increased in nurses (pre 17.6±4.2 vs post 31.8±3.9; p<0.001). The proportion of competent nurses increased from 17% before to 91% after intervention. There was also a significant increase in patient satisfaction scores (pre 62.7±2.4 vs post 124.6±3.8; p<0.001). There was a significant positive relationship between nurses and their knowledge competence after implementation (r=0.79, p<0.001). Conclusion: Implementation of the Synergy System resulted in significant improvement of nursing capability and patient’s satisfaction. The introduction of this conceptual model to hospital training and competence assessment processes could enhance nursing quality and promote person-centred care results.

Objectives: To assess parental recall of post-sedation effects of Oral Midazolam (OM) in paediatric dental patients and its association with patients’ age, gender and type of dental treatment. Methods: This cross-sectional study used structured phone interviews involving parents or guardians of children treated with OM from February 2023 to February 2024 at the Paediatric Dental Specialist Clinic, Universiti Sains Malaysia (USM) Specialist Hospital, Malaysia. The structured phone interview contained sociodemographic data and OM post-sedation effects. Results: Fifty-four respondents participated in this study. On sedation day, most children slept on the way home (48.1%), taken a prolonged nap (29.6%) and experienced difficulty awakening (7.4%). A few experienced fevers (7.4%), eating problems (3.7%) and nausea (1.9%). By the next day, only 1.9% (n = 1) children had a post-sedation effect, each for prolonged naps, fever and difficulty awakening. The most common treatment was tooth extraction (96.3%), with only 2 (3.7%) cases involving stainless steel crown placement. A significant correlation was found between fever and the patient’s gender (p = 0.004). Conclusion: Post-sedation effects of OM sedation include sleeping on the way home, prolonged naps and difficulty awakening. OM sedation is relatively safe since most children recover within a day of post-sedation. Further prospective research is needed to explore its safety margin among paediatric dental patients.