Background: Anticoagulation therapy becomes more challenging in patients with chronic kidney disease (CKD) due to the increased risk of thromboembolic and bleeding events. While DOACs have several benefits over more conventional treatments, there is still much we don't know about their pharmacokinetics and safety in CKD. Objective: In order to conduct a comprehensive analysis of the relative safety and pharmacokinetic variability of DOACs in CKD patients. Methods: In accordance with PRISMA 2020 standards, a systematic review was carried out. Up to December 2025, electronic databases were combed through. We considered studies that looked at the pharmacokinetics, bleeding risk, and thromboembolic outcomes of DOACs in CKD. Eleven research, comprising pharmacokinetic studies, randomized trials, and cohort studies, fulfilled the inclusion criteria. Results: Significant pharmacokinetic variability was observed across DOACs. Dabigatran showed high renal dependence and increased accumulation risk in advanced CKD, while apixaban demonstrated stable pharmacokinetics and minimal dialyzability. Rivaroxaban exhibited intermediate characteristics. In hemodialysis populations, dabigatran and rivaroxaban were related to higher rates of bleeding, but apixaban consistently linked with a decreased major bleeding risk than warfarin. Evidence regarding thromboembolic outcomes was mixed, with some studies showing no significant benefit of anticoagulation in dialysis patients. Conclusion: DOACs demonstrate variable safety and pharmacokinetic profiles in CKD. Apixaban appears to offer the most favorable balance between efficacy and safety, while dabigatran should be avoided in advanced CKD. Individualized treatment decisions are essential, and to determine the best anticoagulation therapies for this group, further randomized trials are required.

Background: Mint and basil are medicinal plants with bioactive compounds used in traditional medicine, food flavoring, and pharmaceutical industries. Their essential oils and extracts have antimicrobial, antioxidant, anti-inflammatory, and anticancer properties due to volatile secondary metabolites. Gas Chromatography-Mass Spectrometry (GC-MS) can identify and quantify these compounds, providing valuable information on their chemotypes, bioactive compound diversity, and potential therapeutic applications. Method: Gas chromatography – mass spectrometry (GC–MS) method was used in the current research to establish and compare the bioactive chemical constituents of extracts from mint (Mentha spicata L.) and basil (Ocimum basilicum L.). Both plants' fresh leaves were put into ethanol for extraction, then concentrated vacuum distillation. Each one-of-a-kind combination of volatile and semi-volatile compounds found in the mint and basil leaf extracts was detailed in the GC-MS chromatograms. Results: In in Mint Extract by GC–MS the predominant constituents were Estragole 43.9%, Pulegone (32.9%) and Eucalyptol (22.8%), which are known for their antimicrobial and antioxidant properties. In contrast, Basil Extract showed major peaks corresponding to Pulegone (22.9%), Eucalyptol (22.8%), and Piperitone (17.8 %), compounds recognized for their aromatic and therapeutic activities. rather than those that harm people but compounds known for aromatic or medicinal use. Conclusion: Mint and basil extracts were discovered to have completely different chemical compositions when compared directly. This demonstrates that mint and basil may be sources of natural agents with phytochemical structures unrelated to manufactured chemicals. Our findings thus provide scientific validation for both their traditional usage and potential commercial uses. Both basil and mint are now recognized for what they really are: sources of bioactive compounds for medicines or functional foods.

Objectives: Psychological distress is associated with Disorders of Gut-Brain Interaction (DGBIs), including Irritable Bowel Syndrome (IBS) and Gastroesophageal Reflux Disease (GERD). This nationwide post-COVID study assessed whether mental health symptoms preceded IBS/GERD and examined associations with age, sex, work status and family history. Methods: A cross-sectional online survey was conducted in Saudi Arabia between August 2022 and July 2023 among adults aged ≥18 years. Participants completed a structured questionnaire covering demographics, self-reported IBS, GERD, anxiety, depression, stress, timing of symptom onset, family history, treatment and outdoor activity. Data were analyzed using SPSS v23, with associations tested using Pearson’s χ² (α = 0.05). Results: Among 2,067 respondents, 72.4% were women, 66.0% were aged 18-29 years and 53.2% were students. Psychological symptoms were reported by 60.7%, IBS by 48.7% and GERD by 36.3%. Psychological symptoms were the most commonly first-noticed condition (~51%), compared with IBS (33.9%) and GERD (24.3%). Significant differences were observed across age, sex and employment status (p<0.001). GERD prevalence increased with age, IBS peaked in middle age, while psychological symptoms were highest among younger participants and students. Women reported more IBS and psychological symptoms, whereas men reported more GERD. Conclusions: In this post-pandemic Saudi cohort, psychological distress commonly preceded or accompanied IBS and GERD, particularly among younger individuals. These findings highlight the importance of early mental health screening and integrated care approaches for DGBIs. Longitudinal studies are needed to clarify temporal relationships and underlying mechanisms.

Background: Laparoscopic cholecystectomy is considered one of the most common interventional procedures in surgery globally. Despite being generally safe with minimal operative and postoperative complications, it carries a risk of a serious complication, which is bile duct injury. Research is still ongoing to evolve surgical maneuvers to decrease the incidence of bile duct injury. Aim of the study: This study aimed to assess the risk of biliary tract injury in laparoscopic cholecystectomy while using posterior first dissection with blunt dissection using Lahey. Methods: This retrospective study included 100 patients admitted for laparoscopic cholecystectomy. All cases operated upon were complicated conditions like acute calculus cholecystitis, empyema of gall bladder or mucocele of gall bladder. The surgical approach was using posterior first dissection in laparoscopic cholecystectomy with blunt dissection using Lahey to release the adhesions and safe dissection in Calot triangle avoiding injury to biliary tree. Results: The current study involved 100 patients (72 females and 28 males). All patients were subjected to laparoscopic cholecystectomy while using posterior first dissection with blunt dissection using Lahey. None of the included patients reported injury to bile duct injury.Conclusion: Using posterior initial dissection and blunt dissection with Lahey during laparoscopic cholecystectomy demonstrated to be a safe method for lowering the risk of bile duct damage.

Background: Pain management in Saudi Arabia is a complex clinical challenge due to variability in drug response, increasing opioid-related risks, and the demand for personalised treatment strategies. This narrative review evaluates the potential applications of artificial intelligence (AI) and machine learning (ML) for optimising pain medication management within the Saudi healthcare context, in alignment with Vision 2030. Methods: A narrative literature review was conducted using PubMed, Embase, Scopus, Web of Science, IEEE Xplore, and Google Scholar. Relevant studies addressing AI and ML applications in pain management, analgesics, opioid safety, and clinical decision support were identified and screened. The findings were synthesised thematically to highlight key domains of application. Results: Applications of AI and ML were identified in several domains, including prediction of pain chronicity, development of personalised medication regimens, opioid risk forecasting, medication safety, objective pain assessment, and remote monitoring. Predictive models demonstrated up to 85% accuracy. Real-time electronic health record (EHR) analysis reduced opioid-related adverse drug reactions by approximately 30%. Machine learning-driven personalisation improved pain relief by 20% and reduced opioid use by 15%. AI implementation reduced medication errors by up to 65% in polypharmacy settings. Conclusion: AI and ML demonstrate significant potential to transform pain medication management by enabling predictive, personalised, and safer approaches. However, challenges related to validation, bias, and implementation must be addressed to ensure effective clinical integration.

Background: The prevalence of modern telecommunication technology development and the introduction of new distance healthcare methods have fueled the growing interest in telemedicine. This work analyses the progress of telemedicine in Ukraine and identifies the main development factors, constraints, and considers foreign countries' experience with the implementation of telemedicine services. Methods: An analysis of the scientific literature and regulatory documents, a study of the current legislation framework, and a comparative analysis of telemedicine service in Ukraine and in the world were performed. Results: As a result of the study, it has been determined that telemedicine improves healthcare accessibility and service quality in remote regions and with the personnel who are on combat duty and for individuals with chronic non-communicable diseases, over 70% of healthcare organizations did not use unified telemedicine systems, and only 37% of health staff have been trained for telemedicine. Over 70% of teleconsultations were performed during the pandemic/wartime and the amount of telemonitoring services has increased from 8% to 26%, the biggest obstacles are the weak digitalization, shortage of practical experience, distrust from patients; it's effective in remote and war regions where there is no necessity for a personal survey of the patient, better treatment adherence and telerehabilitation, a positive role in drug safety can be played by digital pharmacovigilance. Conclusion: The wide application of telemedicine could be vital for improving the sustainability of the healthcare system of Ukraine, but is accompanied with a necessity of the legislative change, healthcare digitalization and of training of relevant specialists.

Background: Screw head stripping remains a clinical challenge in implant dentistry because it complicates retrieval, increases treatment costs, and may compromise long-term prosthesis stability. Although various screw head geometries have been developed to improve torque transfer and reduce mechanical wear, comparative evidence on their performance under repeated tightening and loosening is limited. This study evaluated the resistance of Torx and Torx Plus (Torx+) screw designs to stripping under repeated torque cycles. Methods: Thirty titanium abutments with corresponding screws were divided into two groups (n = 15): Group A (Torx) and Group B (Torx+). Each fixture was embedded in acrylic resin and subjected to cycles of tightening to 35 Ncm followed by complete loosening. Baseline and follow-up surface changes were examined using scanning electron microscopy (SEM) at 10 cycles and at the point of stripping. The number of cycles until stripping was recorded, and the groups were compared using an independent samples t-test (SPSS v26, α = 0.05). Results: The Torx group withstood a significantly greater number of cycles before stripping (mean 60.47±5.58) than the Torx+ group (mean 30.13±5.66) (t = 18.76, p<0.001). SEM analysis revealed irregular material displacement in Torx screws, whereas Torx+ screws showed edge rounding and smoother abrasion. Conclusions: Screw head geometry influences resistance to stripping. The Torx design demonstrated superior durability compared with Torx+, indicating potential advantages for clinical situations that require repeated screw manipulation. Further research is needed to confirm these findings in vivo and to assess other geometries.

Background It is known that systemic administration of vancomycin to mice results in its accumulation in liver and spleen tissues. Vancomycin was injected intraperitoneally at 20 mg/kg in healthy adult mice. Liver and spleen were removed, weighed, homogenized and extracted for drugs. The developed HPLC method was found to be linear in the concentration range of 1–100 µg/mL. The accumulations of drugs in the liver and spleen increased rapidly with time, reaching a maximum at 1–2 h and then gradually decreased. The Results indicate that vancomycin is well-distributed in the liver and spleen of mice hence aiding in the optimization of formulations and dosage levels. Results: The validated HPLC method exhibited a good linearity range comprising 1-100 µg/mL for vancomycin (R² > 0.999) with a retention time of 6.2±0.1 min. Reliability of the measuring procedure for vancomycin in biological tissues was proven by accuracy (95–102%) and precision (%RSD < 5%). Data showed that following intraperitoneal injection, vancomycin concentrations in liver and spleen tissues increased quickly with a Cₘₐₓ observed at 1-2 h post-injection, and then declined approximately bi-exponentially, indicating first-order elimination. Concentrations of the drug in the liver were always higher than those observed in the spleen throughout the course of this study, demonstrating increased hepatic deposition. Was then seen, indicating that systemic clearance had occurred. Conclusion: Results indicate that vancomycin efficiently penetrates into hepatic and splenic tissues of mice; however, the distribution varies among organs. These findings are important in establishing reference parameters for future pharmacokinetic and toxicity studies, as well as helping determine the dose regimen and design better vancomycin preparations.

In Saudi Arabia, universal hepatitis B virus (HBV) vaccination was introduced in 1989, resulting in large declines in HBV endemicity over the last three decades. This structured narrative review evaluates the published evidence (1989-2025) on long-term vaccination outcomes, breakthrough infections, occult hepatitis B infection (OBI), and future elimination challenges in Saudi Arabia. Relevant studies were identified from PubMed, Scopus, Embase, Web of Science, and regional grey literature sources and narratively synthesized. Available evidence shows a decline in HBsAg prevalence from about 8% pre-universal vaccination to <1% in vaccine-era populations, confirming the significant public health impact of the national immunization program. However, HBV DNA positivity and occult infections are still being reported, particularly in blood donors, hemodialysis patients, healthcare workers, and other high-risk groups. Suggested contributors include waning of anti-HBs immunity, host immunogenetics, the predominance of genotype D, and vaccine-escape mutations. Current evidence also highlights important gaps in national molecular surveillance and sequencing data. While mass vaccination continues to be a very effective strategy for preventing chronic HBV infection, sustainable control will depend on improved molecular surveillance, targeted surveillance of high-risk groups, and evidence-based booster strategies. This review discusses the success of HBV vaccination in Saudi Arabia and the emerging post-immunization challenges pertinent to the goal of HBV elimination.

Introduction: A valve known as the mitral valve, bicuspid valve, or left atrioventricular valve guards the mitral orifice. It is the entrance connecting the left atrium and left ventricle. Its purpose is to guarantee unidirectional blood flow and prevent regurgitation. Methods: This study utilized 100 fresh cadaveric human hearts procured from the Forensic Department of Rajarajeshwari Medical College and Hospital, Bengaluru, Karnataka, India, Measurements were performed using digital Vernier calipers, dissection forceps (pointed, toothed and blunt), scalpel, scissors and string to outline the mitral annulus. The inclusion and exclusion criteria included hearts from individuals aged 20-60 years; those from individuals below 20 years or above 60 years were excluded. Results: The cadaveric study on 100 Indian hearts (20–60 years) established normative mitral annulus dimensions using the Anterior–Posterior Length (APL), Inter-Commissural Length (ICL) and Mitral Annular Circumference (MAC) measurements. A significant age-related increase was observed in APL (p = 0.034), while ICL (p = 0.142) and MAC (p = 0.678) showed no significant variation. Conclusion: Age-related alterations in the mitral valve annulus, particularly annular dilation, may contribute to functional changes such as regurgitation or stenosis, potentially increasing the complexity of surgical management in older adults.

This study aimed to evaluate the anti-proliferative effects of crude alkaloids extracted from Trigonella foenum-graecum on some pathogenic bacterial cells. The effects of crude alkaloid extract from plant seed to antioxidant, the research explored the ability of crude alkaloid to induce arrest at the metaphase stage in human lymphatic cells, comparing its efficacy to the established drug Colchicine. The antimicrobial activity of crude alkaloid extract from the plant Trigonella foenum-graecum was tested against Streptococcus. mutans S. vestiularis, Klebsilla Protues and E. coli by using the diffusion technique. The higher inhibition zone was observed in Streptococc mutans, S.vestiularis were (18.5 mm, 17.4 mm), respectively, followed by Klebsiella (12.7), Proteus (16.1) and E. coli (13.2 mm). The antioxidant activity was tested using the stabilised free radical compound DPPH. The results showed that horsetail fern is effective in eliminating free radicals at the concentrations used The inhibition rate depends on Trigonella foenum-graecum the concentrations used, as it increases with increasing concentration The crude alkaloid extract has an inhibitory effect after interacting with DPPH. It started at a concentration of 15.1 µg/mL, the inhibition rate reached 73.47%. This percentage increases to 85.30, 88.10, 88.50, 89.17, 90.30 and 94.50% respectively. A significant difference was observed between the concentration of 15.1 µg/mL and ascorbic acid, while the differences were not significant in the rest of the concentrations.

Introduction: Adolescent alcohol use is a public health problem with negative physical, psychological and social impacts. Pre-university students are especially at risk due to increased independence, peers and new social environments. Aim: The aim of the study was to determine the knowledge and attitude among the pre-university students regarding the effect of alcohol. The quantitative cross-sectional survey design was used in this study, which involved 100 students in the pre-university of Lowry Memorial College, Bengaluru, using a purposive non-probability sampling technique. The self-structured questionnaire was used for data collection. Analysis was done using descriptive and inferential statistics such as the chi-square test and Pearson's correlation coefficient. Results: Most students were between 16 and 17 years old (58%) and male (93%). Alcohol effects: Most students had average knowledge (81%), 11% had poor knowledge and 8% had good knowledge. In terms of attitudes, 35% of the students were found to have favourable attitudes and 65% were moderately favourable. The mean knowledge score was 14.96±3.87 and the mean attitude score was 23.88±2.27. A weak negative and not significant correlation between knowledge and attitude score was observed (r = -0.029, p>0.05). There was only a significant association between the source of health-related information and knowledge scores (χ² = 10.815, p<0.05) among the baseline variables. Conclusion: The overall level of knowledge of pre-university students towards the bad effects of alcohol was moderate and the attitude of the students was somewhat positive. There was no significant correlation between knowledge and attitude.

This study presents a comprehensive bibliometric analysis of global research trends in Artificial Intelligence (AI) in healthcare and education from 2000-2025. A total of 3,101 peer-reviewed publications retrieved from OpenAlex were analysed using VOSviewer to map co-authorship networks, keyword co-occurrence and institutional collaboration patterns. Five major thematic clusters were identified: technical foundations, learning theory, clinical applications, governance and ethics and point-of-care applications. Citation analysis highlighted the ten most highly cited articles, primarily focusing on challenges related to AI implementation and interpretability. Leading institutions included Harvard University, Stanford University and University College London. While North America and Western Europe dominate research output, contributions from emerging regions, particularly South Asia and the Gulf, have increased since 2020. The findings indicate a shift toward human-centered AI, interdisciplinary education and explainability. However, persistent challenges remain, including data interoperability, privacy concerns and algorithmic bias.

Objectives: Gender-Affirming Hormone Therapy (GAHT), commonly referred to as cross-sex hormone therapy (CSHT), represents an essential healthcare intervention that supports individuals in achieving congruence between their physical characteristics and gender identity. Access to such affirming medical care contributes to improved mental health outcomes, psychosocial stability and overall quality of life, particularly among gender-diverse populations who often experience disparities in health and well-being. This study aims to review and analyse the neuropsychological outcomes of CSHT, focusing on cognitive, emotional and behavioural domains among transgender individuals. The primary objective is to examine how hormone-based interventions influence cognitive functioning, emotional regulation and behavioural adaptation, while contributing to improved psychological resilience and social participation. Data for this research were collected through a mixed-method approach, including primary data from questionnaires administered to 406 participants and secondary data derived from previously published scholarly literature on related topics. The findings indicate that testosterone therapy in transgender men may enhance visuospatial abilities and increase energy levels, whereas estrogen therapy in transgender women may promote heightened emotional responsiveness while potentially influencing certain spatial skills. Emotional outcomes largely demonstrate reductions in gender dysphoria, anxiety and depressive symptoms, along with improvements in self-esteem and social functioning. Behaviourally, individuals undergoing CSHT often report increased confidence, improved interpersonal engagement and greater adaptability in social environments, although variations in libido and aggression remain individualized. Neuroimaging evidence from existing studies further suggests structural brain changes that increasingly align with affirmed gender identity. In conclusion, CSHT contributes to meaningful neuropsychological changes that support enhanced mental health, emotional well-being and social inclusion. These findings highlight the importance of equitable access to gender-affirming healthcare and the need for continued longitudinal research and interdisciplinary, patient-centred care approaches to address individual variability and promote sustainable health outcomes across diverse populations.

Background: Crohn's Disease (CD) is a chronic, relapsing inflammatory bowel disease that substantially impairs patients' dietary behaviour, medication adherence and psychological well-being. In Erbil City, Kurdistan Region of Iraq, structured patient-education initiatives targeting these three domains simultaneously remain scarce. Objectives: To assess the effects of a structured educational program on dietary pattern adherence, medication adherence and inflammatory bowel disease distress among patients with Crohn's disease attending Rizgary Teaching Hospital, Erbil City. Methods: A quasi-experimental, pre-post design was used. Ninety-six adult patients with confirmed CD were recruited by convenience sampling. Data were collected across four time-points: Pre-program (baseline), post 1 (immediately post-intervention), post 2 (one month) and post 3 (three months). Instruments comprised a structured sociodemographic and medical questionnaire, a 21-item Dietary Pattern scale (Cronbach's α = 0.947), the 8-item Morisky Medication Adherence Scale (MMAS-8; α = 0.904) and the 28-item Inflammatory Bowel Disease Distress Scale (IBD-DS; α = 0.973). The educational program consisted of five interactive Arabic-language lectures (35-45 minutes each) delivered over the study period. Data were analysed using descriptive statistics, the Chi-square test, Fisher's Exact Test and Pearson correlation coefficients (SPSS v.25). Results: Highly significant improvements were observed across all three domains and all post-intervention phases (p<0.001). Poor dietary pattern declined from 93.8% at baseline to 12.5% at post 3; non-adherence to medication fell from 93.8 to 7.3% and severe IBD distress was eliminated entirely by post 2 (from 74.0 to 0.0%), with 68.8% of patients reporting no distress at post 3. Significant negative correlations were identified between dietary pattern, medication adherence and IBD distress at every assessment phase (p<0.001), indicating that improvements in one domain were systematically associated with improvements in the others. Conclusion: A structured educational program was associated with substantial, sustained imrovements in dietary behaviour, medication adherence and psychological distress in patients with Crohn's disease in a resource-limited Middle Eastern setting. Routine integration of nurse-led educational programs into gastroenterology care and controlled trials are needed to confirm causality is recommended.

Objectives: Systemic Lupus Erythematosus (SLE) is associated with frequent Emergency Department (ED) utilization due to disease flares and comorbidities. However, data from Saudi Arabia and the Middle East remain limited. To describe the causes of ED visits among SLE patients and identify predictors of frequent ED visits (≥2 visits/year) in a Saudi tertiary center. Methods: This retrospective cohort study included adult SLE patients presenting to the ED at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2019 and December 2023. SLE was defined using 2019 EULAR/ACR criteria. Data on demographics, disease characteristics, comorbidities, laboratory parameters, treatment and medication adherence were collected. ED visit causes were categorized into musculoskeletal, gastrointestinal, infectious, neurological and cardiovascular groups. Logistic regression was used to identify predictors of frequent ED visits (≥2 visits/year). Results: A total of 288 patients were included (87.2% female; mean age 38.3 ± 12.5 years). The most common ED visit causes were musculoskeletal complaints (24.7%) and gastrointestinal disorders (21.5%), followed by infections (16.7%). Independent predictors of frequent ED visits (≥2 visits/year) included younger age (OR 0.95, 95% CI 0.92–0.97; p<0.001), longer disease duration (OR 1.09, 95% CI 1.03–1.15; p = 0.002) and higher serum creatinine (OR 1.004, 95% CI 1.001-1.008; p = 0.025). Medication non-adherence was the strongest predictor (OR 6.45; p<0.001), while absence of glucocorticoid use (OR 2.03; p = 0.040) and gastrointestinal involvement (OR 2.87; p = 0.012) were also significant. Conclusion: frequent ED visits (≥2 visits/year) in SLE was associated with younger age, longer disease duration, renal impairment and medication non-adherence. Improving adherence and strengthening early outpatient management may help reduce avoidable ED visits.

Introduction: Transcerebellar diameter (TCD) is a significant ultrasound parameter to estimate gestational age (GA). Development of the cerebellum is evident in the second trimester in the posterior cranial fossa. TCD is believed to be reliable especially in cases where GA cannot be reliably established by the time of the last menstrual period or early scans and it helps in the evaluation of fetal brain development. Aim: To determine ultrasonographic appearances of the fetal cerebellum with advancing GA, establish reference values of TCD between 19 to 35 weeks and compare TCD to cerebellar vermis and biparietal diameter (BPD) to predict GA. Methods: A hospital-based cross-sectional study was conducted among 260 pregnant women with gestational ages ranging from 19-35 weeks attending the antenatal clinic. Inclusion criteria included known Last Menstrual Period (LMP) confirmed by first-trimester ultrasonography and intact membranes. Standard fetal biometric parameters such as biparietal diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC) and Estimated Fetal Weight (EFW) were measured. Axial sections of the fetal posterior fossa were used to determine transcerebellar diameter (TCD) and cerebellar vermian dimensions. Correlation and regression analyses were performed using SPSS version 22.0. Results: The mean gestational age was 23.98 weeks. The mean TCD, BPD, vermian craniocaudal (CC) and anteroposterior (AP) diameters were 26.2, 58.52, 11.92 and 7.81 mm, respectively. Significant positive correlations were observed between TCD and gestational age (r = 0.971), BPD (r = 0.953), vermian CC diameter (r = 0.952) and vermian AP diameter (r = 0.899). Regression analysis demonstrated significant linear relationships, with TCD showing the strongest association with gestational age (R² = 0.943), followed by vermian CC diameter (R² = 0.906) and vermian AP diameter (R² = 0.808). Conclusion: TCD and cerebellar vermian measurements showed strong positive correlations with gestational age and may serve as reliable reference parameters for fetal age estimation and assessment of cerebellar growth. Among these parameters, TCD demonstrated better predictive accuracy for gestational age than vermian AP diameter.

Objectives: Herpes Zoster (HZ) is a significant health concern caused by reactivation of latent varicella-zoster virus, particularly among older adults and individuals with chronic comorbidities. Despite the availability of an effective Recombinant Zoster Vaccine (RZV), uptake remains low in Northern Border Region in Saudi Arabia. To assess Knowledge, Attitudes and Practices (KAP) regarding HZ and its vaccination among the general population in Northern Border Region in Saudi Arabia. Method: A cross-sectional descriptive survey was conducted among population residing Northern Border region of Saudi Arabia. A self- administered questionnaire assessed demographic characteristics, knowledge of HZ, attitudes toward vaccination and vaccination practices. Data were analyzed descriptively and inferentially. Results: A total of 708 participants were included. Overall knowledge of HZ was low among 63.7% of respondents. Only 42.8% knew that the vaccine is offered free by the Ministry of Health. Positive attitude was detected in 60.7% of the participants, whereas 39.3 % had a negative attitude. Only 10.0% had good practice regarding the shingles vaccine, while 90.0% had poor practice. Age was a significant predictor, with participants aged 30-39 years (OR = 2.718, 95% CI: 1.462–5.055, p = 0.002) being more likely to have information about the HZ vaccine compared to those aged 50 years or older. Gender was a significant factor (p = 0.008), with females (65.8%) showing a higher percentage of positive attitudes compared to males. Participants aged 18-29 were more than twice as likely (OR = 2.75, 95% CI: 1.30-5.82, p = 0.008) to have a positive attitude compared with those aged ≥50. Conclusion: Despite the significant burden of HZ in Saudi Arabia, awareness and vaccination uptake remain inadequate. Strengthening public education, enhancing healthcare provider engagement and integrating vaccination into routine clinical pathways are essential to improving coverage and reducing HZ-related morbidity in the Kingdom.

Objective: Hyperlordotic osteoporotic postmenopausal women (HOP) women are at risk of developing pelvic floor muscle dysfunction (PFD) due to weak pelvic floor muscles, altered spinal alignment and reduced core stability. While pelvic floor muscle training (PFMT) and core stabilization are standard interventions, gamified PFMT (GPFMT) may enhance engagement and outcomes. This study aimed to evaluate the effect of GPFMT combined with core stabilization (CSE) on PFD in this population. Methods: A randomized controlled trial was conducted with 74 postmenopausal women from a medical college and hospital in Tamil Nadu,India. Participants were allocated to a GPFMT group (n = 37) or traditional PFMT (TPFMT) group (n = 37). Both groups received their respective PFMT along with CSE for 1 hour/day,4 days/week over 12 weeks. Outcomes assessed were postural alignment using a digital inclinometer, core endurance using plank endurance test, pelvic floor muscle strength using the Modified Oxford Scale and QoL using the IIQ-7 SF. Data was analysed using Wilcoxon Signed Rank and Mann Whitney U tests (p<0.05). Results: The GPFMT group demonstrated greater improvements across all the outcomes compared to TPFMT, including postural alignment, core endurance, pelvic floor muscle strength and IIQ-7 SF scores (p<0.05). Conclusion: In HOP women, GPFMT combined with CSE was more effective than traditional PFMT in improving posture, core endurance, pelvic floor strength and quality of life, supporting the value of engaging, interactive rehabilitation approaches for PFD.

Diabetes mellitus and major depressive disorder frequently coexist, creating a bidirectional relationship that worsens clinical outcomes, glycemic control and quality of life. Emerging evidence suggests that serotonergic dysfunction may represent a key mechanistic link between metabolic dysregulation and mood disorders. This review explores the prospective role of serotonin (5-hydroxytryptamine, 5-HT) disturbances in the pathophysiology of diabetic-induced depression by integrating findings from both preclinical and clinical studies. Preclinical investigations using streptozotocin-induced, diet-induced and genetic models of diabetes consistently demonstrate alterations in central and peripheral serotonin levels, impaired tryptophan metabolism, changes in tryptophan hydroxylase and monoamine oxidase activity and regio-specific reductions of 5-HT within mood-regulating brain structures such as the hippocampus, cortex and hypothalamus. These neurochemical changes are frequently accompanied by depressive-like behaviors in validated behavioral paradigms. Additionally, diabetes is associated with modifications in serotonin transporter (SERT) function and altered expression of several serotonin receptor subtypes, including 5-HT1A and 5-HT2 receptors, suggesting disruption of serotonergic signaling pathways involved in emotional regulation and neuroplasticity. Clinical evidence further supports this relationship, indicating that diabetic patients often exhibit serotonergic abnormalities, inflammatory activation, insulin resistance-related neurotransmitter changes and gut-brain axis alterations that may contribute to depressive symptomatology. Therapeutically, selective serotonin reuptake inhibitors (SSRIs) and other serotonin-modulating strategies show potential benefits not only in alleviating depressive symptoms but also in influencing metabolic parameters. Collectively, the available evidence positions serotonin dysfunction as a promising mechanistic bridge between diabetes and depression. Understanding these interactions may open new avenues for integrated therapeutic strategies targeting both metabolic and neuropsychiatric components of diabetic-induced depression.

Paternity testing in families with missing fathers depends on indirect genetic comparison because direct paternal DNA is unavailable. Such cases create legal and familial uncertainty and require methods that can strengthen kinship interpretation when conventional comparison becomes more difficult. The study aims to evaluate whether targeted Sanger sequencing could support short tandem repeat (STR) profiling in six Iraqi families with missing fathers. Inferred paternal profiles were reconstructed from the child, the mother, and available paternal-side relatives and were assessed descriptively against the routine short tandem repeat interpretation. Thirty individuals were analyzed by routine STR profiling across 20 autosomal loci, and targeted Sanger sequencing was performed for D18S51, TPOX, CSF1PO, and FGA. STR profiling generated the primary kinship dataset for all six families and revealed several microvariant alleles across the examined loci. Sequence analysis showed complete child-to-inferred-paternal agreement across the four sequenced loci in five cases, whereas one case showed agreement at two loci and disagreement at two loci. Comparison between sequence-based calls and fragment-length STR designations showed broad family-level concordance while also clarifying locus-specific differences. Routine short tandem repeat profiling remained the principal method for missing-father paternity assessment, whereas targeted Sanger sequencing served as a focused confirmatory approach for selected loci. Given the small case series and the four-locus sequencing design, the findings should be interpreted as exploratory.

Exendin-4, a potent glucagon-like peptide-1 receptor (GLP-1R) agonist, has emerged as a critical modulator of vascular homeostasis beyond its established role in glucose metabolism. This review explores the multifaceted effects of Exendin-4 on vascular endothelial cells (ECs), vascular smooth muscle cells (VSMCs) and the surrounding immune microenvironment. We examine the ultrastructural and signaling pathways-including AMPK/SIRT1, PKA/Epac1 and Akt/eNOS- through which Exendin-4 preserves barrier integrity, inhibits pathological VSMC remodeling and attenuates atherosclerotic progression. By integrating evidence from recent clinical trials and basic cell biology, we highlight the therapeutic potential of Exendin-4 in treating vascular-related complications such as atherosclerosis, hypertension and ischemic injury (Figure 1).

Background: Surgical extraction of impacted mandibular third molars is one of the most common oral surgical procedures. Despite its routine nature, it is frequently associated with postoperative pain, swelling, trismus, and transient periodontal compromise. Among the various surgical approaches, the triangular and envelope flap designs remain the most widely used, yet there is no clear consensus on their relative clinical efficacy. Objective: This study aimed to compare the postoperative outcomes pain, facial swelling, trismus, and periodontal pocket depth between the triangular and envelope flap techniques following the surgical removal of impacted mandibular third molars. Materials and Methods: A prospective comparative study was conducted on 40 healthy patients aged 18–50 years requiring surgical removal of impacted mandibular third molars. Participants were equally divided into two groups: Group A (Triangular flap) and Group B (Envelope flap). All extractions were performed under local anesthesia using standardized aseptic and operative protocols. Pain (VAS 0–10), facial swelling (linear measurements), mouth opening (inter- incisal distance), and periodontal pocket depth (distal to the second molar) were evaluated. Patients were followed up on postoperative days 1, 3, and 7, and at 3 months to assess both early and late postoperative outcomes. Statistical analysis was performed using SPSS v20.0 with p ≤ 0.05 considered significant. Results: Both flap designs showed significant improvement over time (p<0.001). The envelope flap demonstrated significantly lower facial swelling on days 3 and 7 (p<0.01) and faster recovery of mouth opening (p = 0.03), while pain reduction was comparable between groups (p>0.05). A transient increase in probing depth was observed in the envelope group on day 7 (p<0.001), which resolved by 3 months (p = 0.157). Conclusion: Both flap designs are effective and safe for third molar surgery. However, the envelope flap offers superior short-term outcomes in terms of reduced postoperative swelling and faster functional recovery, without compromising long-term periodontal health.

Background: Among the neurotropic viral infections that increasingly being associated with various brain tumors, Epstein–Barr virus (EBV) and Human Papillomavirus (HPV) are 2 most prevalent oncogenic viruses in humans, have recently been documented and / or implicated in the pathogenesis and tumorigenesis of several types of central nervous system tumors and / or cancers. Objectives: To investigate the prevalence of EBV and HPV-16 infections in CNS tumor tissue samples obtained from Iraqi patients who underwent surgical resection for different histopathological types of brain and CNS tumors. Methods: This retrospective study analyzed 129 CNS tissue specimens. Among them, 79 tumor tissues were obtained from patients aged 2–79 years who underwent neurosurgery for various kinds of brain and CNS tumors. Additionally, 50 non-tumorous brain tissue samples were included as a control group. Conventional polymerase chain reaction (PCR) was used to detect HPV-16 and EBV DNA sequences in the examined tissues. Results: HPV-16 and EBV DNA were detected in 26.6% and 36.3% of CNS tumor tissues, respectively. The highest HPV-16 positivity was observed in Diffuse Fibrillary Astrocytoma (42.9%), while Chordomas and Medulloblastomas showed no HPV-16 detection. EBV DNA was also most frequently detected in Diffuse Fibrillary Astrocytoma (41.4%), followed by Pilocytic Astrocytoma and Anaplastic Oligodendroglioma (17.2% each), Glioblastoma Multiforme (10.3%), and Craniopharyngioma, Chordomas, and Medulloblastoma (3.4% each). A statistically significant association was found between viral detection and tumor types (p<0.03). HPV-16 positivity was significantly higher in tumors than controls, while EBV showed no significant difference. Conclusion: Overall, this research demonstrated significant preliminary observational evidence of association of HPV-16 and EBV with certain brain and CNS tumors. These viruses, in their uneven distribution of across CNS tumor subtypes, are criticizing further studies to unravel their involvement, either directly or as cofactors, in the pathogenesis and progression of these tumors.

Objectives: Effective pain control during management of deep carious lesions in children is challenging due to needle phobia and anxiety. Hydrogel-based topical anesthetic delivery offers a non-invasive alternative, but comparative pediatric evidence is limited. Aim: To compare the efficacy of intrasulcular articaine hydrogel and lignocaine hydrogel for pain control during management of deep carious lesions in children. Methods: This randomized, double-blind, parallel-group clinical trial included 60 children aged 5–9 years requiring restorative treatment for deep carious primary molars. Participants were allocated into articaine hydrogel, lignocaine hydrogel and placebo groups. Hydrogels were applied intrasulcularly for 5 minutes before caries excavation. Procedural pain was assessed using the Visual Analog Scale (VAS). Secondary outcomes included Wong–Baker pain scores, onset time, need for rescue anesthesia, physiological responses and postoperat0ive tissue reactions. Data were analyzed using appropriate statistical tests (p<0.05). Results: Both anesthetic hydrogels significantly reduced procedural pain compared to placebo (p<0.001). Lignocaine hydrogel showed lower pain scores, while articaine demonstrated faster anesthetic onset. The need for rescue anesthesia was lowest in the articaine group. No adverse effects were observed. Conclusion: Intrasulcular hydrogel-based anesthesia is an effective needle-free modality in pediatric dentistry. Lignocaine provides superior surface analgesia, whereas articaine offers faster onset, emphasizing formulation-dependent clinical performance.

Introduction: The widespread use of analgesics has raised global concerns regarding inappropriate consumption and associated adverse effects. Artificial Intelligence (AI) offers the potential to enhance safety, improve adherence and provide personalised medication guidance. This study aimed to evaluate the Knowledge, Attitudes and Practices (KAP) of Saudi adults concerning the role of AI in analgesic prescribing. Method: A cross-sectional survey was conducted among Saudi adults over six months, from February to July 2025. Composite KAP scores were generated. Data were analysed using descriptive statistics, chi-square tests, ANOVA and Pearson correlation coefficients, with statistical significance set at p<0.05. Results: A total of 665 valid responses were analysed (response rate: 99%), with females representing 53.7% of participants and young adults (18-29 years) comprising 50.5%. Less than half (47.8%) were aware of analgesic side effects, while 44-47% expressed openness to AI-supported pain management. Approximately 79% perceived AI alerts for reducing or discontinuing analgesics as beneficial and 77% favoured AI-based adherence systems. Notably, 44.1% trusted AI more than physicians for detecting side effects. Paracetamol was the most frequently used analgesic (57.0%), predominantly for headaches (45.6%). Significant associations were observed between KAP scores and gender, education, smoking status, chronic disease and medication use (p<0.05). Correlation analysis showed a moderate relationship between knowledge and attitudes (r = 0.586, p<0.001) and between attitudes and practices (r = 0.468, p<0.001). Conclusion: This study highlights moderate awareness of analgesic risks and cautious acceptance of AI in prescribing, with trust contingent on physician oversight. Strengthening health literacy, regulatory frameworks and patient education is essential for the safe integration of AI into pain management.

Background: Metabolic dysfunction associated steatotic liver disease (MASLD) is a common cause of chronic liver disease. It is becoming a major public health concern, with projections indicating a substantial increase in prevalence over the coming decades. Objectives: To evaluate the relationship of the Gamma Glutamyl transpeptidase (GGT) to high-density lipoprotein cholesterol (HDL-c) ratio and determine the fatty liver index (FLI) in patients with MASLD treated with pentoxifylline (PTX) and Vitamin E (VE). Patients and Methods: This randomized, single-blind, interventional study was conducted on 180 patients with MASLD in the Gastroenterology and Hepatology Teaching Hospital, Sulaimaniyah, Iraq, from January 2022 to June 2023. Patients were equally divided into three groups (n = 60 each): Group 1 received a placebo (control); Group 2 received VE; and Group 3 received PTX. Patients were received the treatments orally at a dose of 400 mg, twice daily for 6 months. Then, liver aminotransferase tests, haematological biomarkers, lipid profiles and FLI were measured before and after intervention. Results: The majority of patients were males (n = 96), with an age range of 20-40 years. All groups showed significant reductions in aminotransferase levels, lipid profile, high- sensitivity C-reactive protein (Hs-CRP), FLI, GGT/HDL-c and GGT/body mass index (BMI) ratio after 6 months of treatments with either VE or PTX. Conclusions: PTX and more specifically, VE reduced FLI, GGT/HDL-c and GGT/BMI ratio. They also significantly improved hepatic aminotransferase levels, lipid profiles and Hs-CRP levels.

Background/ Aim: The continuous development in dental materials and the increased awareness of preserving natural dentition have driven techniques to enhance the treatment of endodontically treated teeth. Prefabricated fiber reinforced (FRC) posts became popular due to their superior aesthetics, adhesive bonding, and modulus of elasticity similar to dentine, which reduces stress concentration and root fracture. Their main limitation is the required canal reshaping to fit the circular post, causing loss of intact dentine and poorer adaptation in roots with elliptical morphology, leading to increased cement thickness and risk of debonding. To avoid unnecessary dentine removal, customized FRC posts were introduced by adding composite resin to the prefabricated post and polymerizing it in situ to replicate the canal anatomy. The aim of this study was to compare the retention of customized and conventional FRC posts. Method: Twenty-extracted single rooted human teeth were decoronated, endodontically treated, and post spaces were prepared at equal lengths. Specimens were divided into 2 groups (n = 10), based on the post system used: G1 prefabricated fiber posts (GC), and G2 customized fiber posts using composite. Self-adhesive resin cement was used to cement both post systems. After cementation, the specimens were stored in saline for a duration of 30 days. Pull-out test parallel to the longitudinal axis of the post was carried out using Instron Universal Testing Machine. Data were analyzed using Student t-test (α = 0.05) and the coefficient of variance as the ratio of standard deviation to the mean. Results: The mean pull-out retention strength was 58.54±2.47 N for the prefabricated fiber posts, and 156.02±2.27 N for the customised fiber posts (p<0.05). Conclusions: The composite customized fiber posts exhibited significantly higher retention forces compared to the prefabricated fiber posts.

Background/Aim: Hypertension is a prevalent chronic medical condition where the force of blood against the artery walls is high exceeding 130/80 mmHg. The vessel wall has collagen and matrix content in it. Thus the MMPs plays a role in the regulation and remodelling of the vessel wall architecture. The early stage of hypertension is regulated by MMP 9 leading to arterial stiffness and debilitation. The current research is delving into the complex interaction between MMP-9 and various inflammatory markers to uncover the fundamental mechanisms behind hypertension and discover novel avenues for more efficient treatment strategies. This study seeks to assess the levels of plasma MMP-9, serum lipid, liver and renal profile in individuals with primary hypertension, aiming to explore potential associations between these biomarkers. Methods: Fifty hypertensive individuals aged between 40 to 60 years from rural areas from south Indian population were included in this study. A control group comprised of twenty-five normotensive individuals matched for age and gender was included in the study. Under aseptic conditions, 5 ml of venous blood samples were collected in three different test tubes (EDTA, oxalate/citrate, and plain tubes), while urine samples were obtained in a fasting state. List of parameters analysed includes complete hematogram, Plasma Sugar, serumUrea and creatinine, serum Uric acid, serum Lipid profile, liver function test -LFT (SGOT, SGPT), Serum sodium, potassium, chloride, Serum MMP9 and Urinary excretion of albumin. Results: SPSS15 software has been used for Statistical analysis. There was significantly higher level of total cholesterol, TGL, LDL-C in hypertensive subjects compared to control. There was no significant change in serum HDL-C. The levels of serum MMP 9 was significantly higher in hypertensive subjects compared to controls. Urine albumin was within the normal range. Conclusion: Thus our study concludes that the MMP 9 level is elevated in hypertensive individuals and is also associated with other inflammatory markers like lipids, urea, creatinine and blood glucose levels.

Background: Iron deficiency anaemia (IDA) is the most common nutritional deficiency among children under five years globally. Caregiver knowledge and feeding practices are critical modifiable determinants of childhood IDA, yet data from the Kurdistan Region of Iraq remain limited. Objectives: To assess caregiver knowledge and feeding performance regarding IDA and examine their association with children's haematological parameters. Methods: A cross-sectional descriptive study was conducted among 180 caregiver–child pairs (children aged 12–59 months with moderate IDA) at Rapareen Paediatric Teaching Hospital, Erbil, from February to June 2025. Caregiver knowledge and feeding performance were assessed using purpose-developed, internally validated instruments. Haemoglobin, serum ferritin, and serum iron were measured. Spearman's correlation was used to assess associations. Results: Poor caregiver knowledge (71.1%, n = 128) and poor feeding performance (71.7%, n = 129) predominated, with mean scores of 11.81±2.80 and 5.71±5.49, respectively. Only 0.6% (n = 1) of caregivers demonstrated good knowledge, and none achieved good feeding performance. Significant IDA risk factors included family history of anaemia (27.8%), intestinal parasitic infections (26.7%), recurrent diarrhoea (24.4%), and pica (24.4%) (all p<0.001). No statistically significant correlations were found between caregiver knowledge or feeding performance and haematological parameters (all p>0.05 after Bonferroni correction). One unadjusted association between feeding performance and serum iron in the nutritional education subgroup (ρ = −0.254, p = 0.049) did not survive multiple-comparison correction and is considered exploratory. Conclusions: Caregiver knowledge and feeding performance regarding IDA are critically inadequate. Structured, skill-based nutritional education programmes should be integrated into routine paediatric care to improve feeding practices and reduce IDA burden.