Objectives: Surrogacy constitutes a significant component of assisted reproductive healthcare and falls within the broader framework of reproductive rights and maternal health governance. In the context of India, the rapid expansion of commercial surrogacy prior to legislative intervention positioned the country as a global hub for reproductive medical tourism. While this growth reflected advancements in reproductive health services and affordability, it also exposed significant concerns regarding maternal exploitation, regulatory vacuum and asymmetrical bargaining between intended parents and surrogate mothers. The enactment of the Surrogacy (Regulation) Act, 2021 represents a transformative regulatory shift from an unregulated commercial model to a prohibitionist regime permitting only altruistic surrogacy under narrowly defined statutory conditions. While the legislation seeks to align India’s reproductive governance with the objectives of SDG 3 (Good Health and Well-Being) by promoting ethical medical practices and safeguarding maternal health, it simultaneously raises serious constitutional and public health concerns. This study undertakes a doctrinal and constitutional analysis of the 2021 Act, evaluating whether its restrictive framework genuinely advances reproductive health protection or instead undermines reproductive autonomy, equality and access to safe assisted reproductive technologies. The research argues that although the legislation intends to curb exploitation, its exclusionary provisions may paradoxically generate new forms of inequality and health insecurity, thereby challenging India’s commitment to universal access to reproductive healthcare under the Sustainable Development Goals framework. The study concludes by proposing regulatory reforms that balance maternal protection, reproductive autonomy and public health oversight within India’s federal structure, ensuring that surrogacy governance meaningfully contributes to the realization of SDG 3 while remaining constitutionally sound.

Non-invasive blood glucose monitoring offers pain-free and patient-friendly alternatives to invasive finger-prick testing and minimally invasive Continuous Glucose Monitoring (CGM). Among optical modalities, Near-InfraRed (NIR) Spectroscopy (NIRS) has attracted particular interest because it can probe glucose-related absorbance and scattering features in tissue while remaining compatible with compact, low-cost hardware. This systematic review synthesises developments in NIRS-based non-invasive blood glucose monitoring between 2019 and 2025. Major scientific databases (Scopus, PubMed, Web of Science, IEEE Xplore and ScienceDirect) were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and 16 studies met the inclusion criteria. The included works span laboratory-grade spectrometers, fiber- and free-space optical systems and light-Emitting Diode (LED)-photodiode sensor modules in transmittance, reflectance and interactance configurations, together with chemometric and machine-learning models for calibration. Across these studies, correlation coefficients between NIRS-based estimates and reference glucometers generally ranged from about 0.85 to 0.95, with Root Mean Square Error (RMSE) and Root Mean Square Error of Prediction (RMSEP) values typically between 12 and 25 mg/dL. Clarke Error Grid (CEG) analyses most often placed 85-95% of predictions in Zone A and the remainder mainly in Zone B, indicating clinically acceptable performance under controlled conditions. Recent trends include multi-wavelength NIR sources, LED-based hardware, multimodal sensing and advanced modelling approaches. However, accuracy frequently degrades across subjects, anatomical sites and free-living conditions and no NIRS-based system has yet obtained regulatory approval for insulin-dosing decisions. Overall, NIRS appears most suitable at present as an adjunct for trend tracking and alerts rather than a full replacement for invasive methods and future progress will require larger, more diverse clinical studies and the translation of spectroscopic and machine-learning advances into practical, low-cost reflective NIR sensor platforms.

Background: The National Family Health Survey (NFHS) is India's principal source of nationally representative data on demographic characteristics, reproductive health, maternal and child health, nutrition, behavioural risk factors and non-communicable disease (NCD) indicators. This study compared key public health indicators between the Himachal Pradesh NFHS-5 (2019-21) and NFHS-6 (2023-24) Fact Sheets to assess the state's evolving public health profile and identify areas of progress and persistent challenges. Methods: A comparative secondary analysis of the Himachal Pradesh NFHS-5 (2019-21) and NFHS-6 (2023-24) Fact Sheets was conducted. Comparable state-level indicators related to population characteristics, family planning, maternal and child health, infant and young child feeding, nutrition, women's empowerment, gender-based violence, behavioural risk factors and NCD risk factors were extracted and compared using absolute percentage-point differences. Results: Himachal Pradesh demonstrated substantial improvements across multiple public health domains between NFHS-5 and NFHS-6. Health insurance coverage increased from 38.9-61.4%, while internet use increased from 49.7-75.4% among women and from 52.7-83.0% among men. Maternal healthcare utilization improved considerably, with first-trimester antenatal care increasing from 72.4-84.0%, four or more antenatal care visits from 70.6-83.2% and iron-folic acid supplementation for at least 180 days during pregnancy from 43.0-62.9%. Institutional deliveries increased from 88.2-91.7%, while full immunization among children aged 12-23 months reached 90.1%. Marked improvements were observed in child nutritional status, with stunting declining from 30.8-20.6%, wasting from 17.4-10.4% and underweight from 25.5-16.8%. However, modern contraceptive use declined (63.4-58.3%), exclusive breastfeeding among infants aged below six months decreased (69.9-60.8%), preschool attendance among children aged 2-4 years declined (64.7-50.9%) and access to improved drinking-water sources decreased (96.2-89.5%). Simultaneously, overweight or obesity, elevated blood glucose and hypertension increased among adults, indicating a growing burden of non-communicable diseases. Conclusions: The findings demonstrate that Himachal Pradesh has made substantial progress in maternal and child healthcare, childhood nutrition, immunization, financial protection, digital inclusion and several dimensions of women's empowerment. Nevertheless, declining modern contraceptive use, reduced exclusive breastfeeding, lower preschool attendance, reduced access to improved drinking-water sources and the increasing burden of obesity, hypertension and diabetes represent emerging public health challenges. Sustained, evidence-based and multisectoral strategies integrating maternal and child health, nutrition, environmental health and NCD prevention will be essential to consolidate recent gains and accelerate progress towards Universal Health Coverage and the Sustainable Development Goals.

The interaction between healthcare provider experiences and health insurance reimbursement represents a critical dimension of healthcare system performance, institutional financial viability and continuity of care. Inadequate, delayed or inconsistent reimbursement processes impose heavy administrative burdens, strain provider morale and undermine efforts toward universal health coverage. This study examines provider and stakeholder perspectives regarding health insurance reimbursement practices, billing efficiency and financial stability in Chennai. The study utilizes an empirical research approach, primary data were collected via convenience sampling across public areas in and around Chennai. Following data validation and cleaning, a finalized sample of 213 responses was analyzed to evaluate the operational impact of demographic variables-such as age, educational qualification and occupation-on reimbursement perceptions and system satisfaction. A majority of respondents aged 21 to 30 () strongly agreed that administrative burdens associated with insurance reimbursement have increased over time, while of respondents aged 31 to 40 and of undergraduates agreed that reimbursement complexity directly contributes to provider burnout. Perceptions of financial instability caused by reimbursement delays varied significantly across age groups, with working-age respondents aged 31 to 40 reporting the highest level of agreement () regarding the negative financial impact of delayed claim settlements. Perceptions regarding rate fairness and system transparency also differed across demographic strata, as younger respondents aged 21 to 30 () and undergraduates () were predominantly inclined to view reimbursement rates as fair across services compared to older demographics. To streamline workflows, respondents strongly favored standardizing billing and coding practices ( in the private sector, among undergraduates) and implementing standardized electronic billing systems (). Addressing reimbursement challenges requires policy reforms aimed at standardizing coding requirements, automating claim submissions through integrated Electronic Health Record (EHR) systems, establishing transparent reimbursement guidelines and enforcing strict regulatory timelines for payment settlements to ensure institutional sustainability and improve healthcare delivery in Chennai.

Background: Lower Crossed Syndrome (LCS) is a widespread postural impairment among athletes, marked by tightness of the hip flexors and lumbar extensors alongside weakness of the gluteal and abdominal muscles. Total Resistance Exercise (TRX), a suspension-based training method, had not previously been compared directly with Conventional Exercise (CE) in cricketers affected by LCS. This trial set out to determine which approach more effectively improves flexibility and core strength among college-level cricket players with LCS. Methods: Thirty-six male cricket players aged 18-25 years with a clinical diagnosis of LCS were randomized into two equal groups of 18: A TRX group (Group 1) and a conventional exercise group (Group 2), using a computer-generated randomization sequence with allocation concealed in sequentially numbered, opaque, sealed envelopes. Sample size was calculated a priori with G*Power 3.1 (large effect size, α = 0.05, power = 80%), indicating a minimum of 18 participants per group. Both groups trained three times weekly for six weeks, roughly 50 minutes per session. Flexibility and core strength were evaluated with the Sit and Reach Test (SRT), Double Leg Lowering Test (DLLT) and Single Leg Glute Bridge Test (SLGBT) at baseline, Week 3 and Week 6. Results: Both groups improved significantly at every time point (p<0.001). The TRX group achieved significantly greater improvement than the CE group on all three outcomes at Week 6: SRT flexibility (mean difference 4.32 cm, 95% CI 3.24-5.39, Cohen’s d = 2.72, p<0.001), DLLT lumbopelvic stability (-6.96°, 95% CI -8.23 to -5.69, d = -3.71, p<0.001) and SLGBT gluteal endurance (14.60 s, 95% CI 12.63-16.55, d = 5.01, p<0.001), showing a consistent TRX advantage across all outcomes rather than the split pattern originally hypothesized. As only male college-level cricketers were enrolled, these findings should be interpreted with this population restriction in mind when considering external validity. Conclusions: TRX produced significantly greater improvement than conventional exercise across all three outcomes-flexibility, lumbopelvic stability and gluteal endurance-in cricket players with LCS. While CE also produced meaningful within-group gains, TRX was the superior intervention on every outcome measured, indicating that TRX should be considered the preferred rehabilitation approach for this population, with CE potentially serving as an adjunct pending further study of combined protocols.

Background and Aim: Pediatric cardiac catheterization is a complex, high-risk clinical procedure that requires competent nurses with adequate knowledge and clinical skills to improve patient outcomes. Inadequate regular training programs for nurses in pediatric cardiac catheterization has been shown to increase the risk complications during and after the procedure. The aim of this study is to evaluate the effect of a structured educational program on nurses’ knowledge and performance regarding pediatric cardiac catheterization. Method: A quasi-experimental study using a convenience sampling method was conducted among nurses working at the Surgical Specialty Hospital-Cardiac Center in Erbil City from February 5th, 2025, to August 28th, 2025. A total of 100 nurses were included in the study and equally allocated into intervention (n = 50) and control (n = 50) groups. Data were collected using a structured, self-administered questionnaires assessing nurses’ sociodemographic characteristics, knowledge and clinical performance related to pediatric cardiac catheterization. Data were analyzed using SPSS version 25.0 through descriptive statistics, Mann-Whitney U-tests, Spearman’s correlation, effect size analysis and multivariable linear regression. Results: No significant differences were observed between groups at baseline. Following the educational intervention, the intervention group demonstrated significantly higher knowledge and performance scores at posttest 1 and posttest 2 across all assed domains compared with the control group (p<0.01). A statistically significant positive correlation was observed between knowledge improvement and performance improvement (r = 0.752, p<0.01), while a negative correlation was observed between the pretest knowledge and performance scores with their respective improvements (r = -0.530 and r = -0.487, p<0.01). Conclusion: The structured educational program significantly improved nurses’ knowledge and performance regarding pediatric cardiac catheterization, with sustained effects over time. Implementing structured educational interventions may enhance nursing performance and promote safer pediatric cardiac care.

Background: Kabaddi’s demanding physical nature-frequent bodily contact and intense physical output-leaves amateur competitors prone to muscle soreness and reduced flexibility, with the lower back and legs affected most. Objective: This study examined whether myofascial release (MFR) combined with cryotherapy produces greater improvement in soreness and flexibility than Static Stretching (SS) combined with cryotherapy among amateur college-level kabaddi players. Methods: This was a randomized comparative experimental trial. Thirty-four male athletes aged 18-25 years were recruited through convenience sampling and randomly divided into two equal groups of seventeen. Group A received myofascial release alongside cryotherapy and Group B received static stretching alongside cryotherapy. Flexibility was measured with the Sit and Reach Test and soreness with the Likert Scale for Muscle Soreness, both recorded at baseline (D0) and again on Days 2, 4 and 7; between-group differences were analyzed using the Mann-Whitney U test. Results: Both groups improved over the course of the study but Group A showed substantially greater flexibility gains (D0-D7 mean difference 1.12; p<0.001) and a larger reduction in soreness (D0-D7: 1.94±0.55 vs 2.59±0.79; p = 0.011) than Group B, with the advantage emerging only after Day 4. For the D0-D7 interval, between-group effect sizes were large for both outcomes (Sit and Reach Test: Cohen’s d ≈ 2.92, 95% CI 0.86 to 1.38; Muscle Soreness: Cohen’s d ≈ 0.96, 95% CI 0.19 to 1.11), calculated from the reported group means and standard deviations. Conclusions: Myofascial release combined with cryotherapy produced greater and more durable improvements in flexibility and soreness relief than static stretching combined with cryotherapy, with the benefit increasing progressively across the intervention period.

Background: Anticoagulation is crucial for preventing stroke and Atrial Fibrillation (AF) is a significant risk factor for thromboembolism. However, because of changed medication metabolism and coagulation profiles, treating anticoagulation in patients with concurrent Liver Disease (LD) is difficult. The safety and effectiveness of direct oral anticoagulants (DOACs) and warfarin in patients with AF and LD are compared in this meta-analysis. Methods: A comprehensive literature search was implemented through January 2025. The study included ten observational studies that involved 417,754 patients with AF and LD. The outcomes that were evaluated included all-cause mortality, intracranial hemorrhage, stroke or systemic embolism, major bleeding and gastrointestinal bleeding. Random-effects models were employed to calculate pooled Odds Ratios (ORs) with 95% Confidence Intervals (CIs). The I² statistic was employed to evaluate heterogeneity. Results: DOACs were associated with substantially reduced risks of all-cause mortality (OR = 0.76, 95% CI: 0.58-0.99; p = 0.04), intracranial hemorrhage (OR = 0.48, 95% CI: 0.24-0.94; p = 0.03) and major bleeding (OR = 0.65, 95% CI: 0.49-0.87; p = 0.003) compared to warfarin. There were no significant differences observed in the incidence of stroke or systemic embolism (OR = 0.76, 95% CI: 0.56-1.02; p = 0.07) or gastrointestinal hemorrhage (OR = 0.97, 95% CI: 0.79-1.20; p = 0.81). Substantial heterogeneity was observed among outcomes (I²>90% in multiple analyses). Conclusion: It appears that DOACs provide comparable efficacy and enhanced safety in patients with AF and LD when compared to warfarin. Nevertheless, the observational design of the included studies and the substantial heterogeneity of the data necessitate caution in the interpretation of these results. Additional randomized controlled trials are required to verify these findings and inform clinical decision-making.

Background: Contact lenses are widely used for refractive correction; however, discontinuation of lens wear and poor adherence to recommended lens care practices remain common concerns that may affect visual outcomes and ocular health. Aim: To identify factors associated with contact lens discontinuation and evaluate measures to improve adherence among contact lens wearers. Methods: A quantitative pilot study with a quasi-experimental pre-test and post-test design was conducted among 30 contact lens users attending a tertiary eye care center. Participants underwent comprehensive ocular examination, visual acuity assessment, slit lamp evaluation and counseling on appropriate lens wear and care practices. Data were collected using demographic and clinical assessment tools. Descriptive statistics were used for data analysis. Results: The mean age of participants was 29.3±4.7 years and 76.7% were working professionals. Monthly disposable lenses were the most commonly used type (53.3%). Nearly half of the participants (46.7%) had used contact lenses for 1-3 years and 63.3% adhered to recommended replacement schedules. The mean daily wear duration was 13.2±2.8 hours. The mean refractive power was -3.4±1.6 D in both eyes, while the mean Tear Break-Up Time was 10.1±1.5 seconds. Although unaided distant visual acuity varied among participants, all achieved N/6 distance and near visual acuity following contact lens correction. At follow-up, 100% maintained N/6 best-corrected visual acuity and slit lamp examination findings remained normal. Conclusion: Contact lenses provided effective refractive correction with excellent visual outcomes and favorable ocular health. Proper lens fitting, adherence to replacement schedules and appropriate lens care practices were associated with successful contact lens wear and maintenance of optimal visual performance.

Background: The COVID-19 pandemic has reversed years of accumulated longevity gains worldwide. While sex differences in life expectancy at birth are well documented, global evidence for older age groups remains limited. This study describes 2000–2021 trends in life expectancy at birth and at age 60 across 185 countries and territories, quantifies sex gaps in longevity and their cross-national variation at both ages and evaluates the impact of COVID-19 on longevity gains and disparity patterns. Methods: An ecological trend analysis was performed using standardized data from the WHO Global Health Observatory. Two indicators were calculated separately by sex: Life expectancy at birth and remaining life expectancy at age 60. Sex gaps were defined as female life expectancy minus male life expectancy for each indicator. All global estimates were presented as unweighted arithmetic means at the country level. Results: Unweighted global life expectancy at birth rose from 66.98 years in 2000 to a peak of 72.62 years in 2019, before declining by 1.33 years to 71.29 in 2021. Remaining life expectancy at age 60 followed a nearly identical pattern, increasing from 18.05 years in 2000 to a pre-pandemic peak of 19.97 years in 2019 and then falling by 1.22 years to 18.75 in 2021. Females consistently showed longer survival, with mean sex gaps of 4.84 years at birth and 2.75 years at age 60, reflecting a substantially smaller female survival advantage in older populations. Cross-national variation in life expectancy exceeded 40 years at birth across the full sample of country-years. Conclusion: Two decades of global longevity gains have been reversed by COVID-19, for both life expectancy at birth and at age 60. The female survival advantage is observed across all national populations but diminishes substantially at older ages. Persistent cross-national disparities highlight the need for gender-sensitive health policies and targeted post-pandemic recovery strategies.

Background: Arsenic contamination and increasing environmental exposure to microplastics have emerged as important public health concerns due to their potential adverse effects on reproductive health. While both toxicants have been independently associated with male reproductive dysfunction, evidence concerning their combined impact on sperm quality remains inadequate. Objective: To investigate the effects of arsenic and polystyrene microplastics, alone and in combination, on epididymal sperm characteristics in adult Wistar rats and to evaluate the potential protective effect of imperatorin. Methods: Thirty adult male Wistar rats were randomly assigned to five groups (n = 6): G1 (control), G2-(arsenic), G3 (Microplastics), G4 (arsenic + Microplastics) and G5 (arsenic + Microplastics + imperatorin Epididymal sperm concentration, motility and morphology were measured after 28 days of exposure. Statistics were evaluated using the Kruskal-Wallis test, with p<0.05 considered significant. Results: Individual exposure to arsenic or polystyrene microplastics adversely affected epididymal sperm parameters compared with the control group. The combined exposure caused the most harm, as sperm concentration, motility and morphologically normal sperm decreased. Administration of imperatorin attenuated these detrimental effects, leading to a partial improvement in sperm quality when compared with the combined exposure group; however, the measured parameters remained below those observed in the control animals. Conclusion: Co-exposure to arsenic and polystyrene microplastics produced more severe adverse effects on epididymal sperm quality than individual exposures, indicating increased reproductive toxicity. Imperatorin partially protected against these alterations, indicating its potential as a treatment for environmental pollutant-induced male reproductive dysfunction.

Autoimmune Thyroid Disorders (AITDs) are characterized by immune dysregulation that may influence activation of the complement system. Complement components C3 and C4 play important roles in innate and adaptive immunity and may reflect immunological alterations associated with thyroid dysfunction. This study aimed to evaluate serum complement C3 and C4 levels in Iraqi patients with autoimmune thyroid disorders. Methods: This cross-sectional comparative study included 90 participants: 30 healthy controls, 30 patients with hyperthyroidism and 30 patients with hypothyroidism. Blood samples were collected from Baqubah Teaching Hospital and Al-Batoul Teaching Hospital for Women and Children in Diyala Governorate between October 2020 and January 2021. Serum C3 and C4 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using One-way analysis of variance (ANOVA) followed by Tukey’s post-hoc test, with p<0.05 considered statistically significant. Results: Serum C3 levels were significantly lower in patients with hypothyroidism (1.32±0.084 mg/mL) than in healthy controls (2.12±0.78 mg/mL), whereas patients with hyperthyroidism showed significantly higher C3 levels (4.97±1.61 mg/mL; p = 0.032). Serum C4 levels were lower in the hypothyroidism group (0.06±0.003 mg/mL) and slightly higher in the hyperthyroidism group (0.11±0.02 mg/mL) compared with controls (0.09±0.03 mg/mL); however, these differences were not statistically significant. Conclusion: Serum complement C3 levels were significantly associated with thyroid dysfunction, whereas serum C4 levels showed no significant differences among the study groups. These findings suggest that C3 may be a more sensitive indicator of immunological alterations in autoimmune thyroid disorders. However, larger studies incorporating thyroid autoantibody profiling are required to confirm these observations.

Objectives: Background: The penetration of smart phones has reshaped the whole communication, education and entertainment. Although smartphones are being used more among the students of universities, the occurrence of text neck is becoming more common among the younger generation. Aim: This study is to examine the usage and it association of Text Neck Syndrome among university students. Methods: A quantitative approach with a descriptive cross sectional survey study design was adopted with a purposive sampling technique of 112 university students. A semi-structured questionnaire was used to gather data. SPSS software was used for descriptive analysis using Frequency and Percentage and Association was done using one way ANOVA. Results: The data showed that 46.4% of people did not have any neck disability, 39.3% had a mild disability, 12.5% had a moderate disability and 1.8% had a severe disability. Similarly, 46.4% reported no neck pain, 39.3% had mild pain and 14.3% experienced moderate pain. Overall, most participants had no or mild neck disability and pain. Conclusion: According to the results of this study, the use of smartphones for long periods increases the occurrence of text neck syndrome in the university students more importantly for those who are studying in heavy technology area.

Objectives: Purpose: The current study aimed to identify the X-ray usage in surgical versus non-surgical orthopedic emergency situations across healthcare institutions in Saudi Arabia's Northern Border Region. Methods: This retrospective, cross-sectional study was conducted in the emergency departments of the hospitals across the Northern Border Region of Saudi Arabia. Using the convenient sampling approach the sample size was calculated to be 200. Data was analyzed using SPSS v. 27, chi-square test was applied to identify categorical association between the variables. A p-value of less than 0.05 was considered as significant at a 95% confidence interval. The data including demographics, injury details, X-ray reports and clinical outcomes were collected from patient medical records. A standardized data collection form was developed to extract relevant information. The patient records were divided into two groups based on the actual management pathway received within 30 days of the emergency visit: Group 1 (Surgical), which tracked surgery type, X-ray-to-surgery time and outcomes; and Group 2 (Non-Surgical), which recorded referral details, follow-up and outcomes. Results: Accident 149 (74.5%) was the most common reason for presenting complaint. The most common site of injury was upper arms in 131 (65.5%) cases followed by legs in 129 (64.5%) cases. Fracture was found to be the most common type of injury as documented in 172 (86%) patient records. Amongst the reported cases, 71 (35.5%) had open wound injury and that was significantly (p-<0.001) associated with accident (history of presenting complaint) and fracture (type of injury). As reported in 191 (95%) cases x-ray was ordered for every suspected case and also when there was a positive relevance of trauma in history, however, 129 (64.5%) records showed that x-ray was not advised if there was presence of swelling only. Patients without open wounds had positive management outcomes and as many as 19 (26.7%) patients with open wound had faced complications such as post-surgical pain and infection. Comment: The conclusion is relevant, but it would be stronger if it gave one direct recommendation for improving emergency X-ray protocols. Conclusion: X-rays were recommended for almost all patients as first investigations and fractures and accidents were strongly linked to open wounds. Injury type, empirical diagnosis, patient benefit and equipment availability were the main justifications for X-ray use. To curb overutilization, we recommend that emergency department’s mandate the use of validated selective imaging guidelines (e.g., Ottawa rules) tailored to high-incidence injury presentations like open-wound accidents.

Background: Metal staples play a vital role in anchoring bristles to the toothbrush head, ensuring mechanical stability during brushing. However, prolonged use exposes these staples to moisture, toothpaste abrasives and cyclic stress, potentially leading to corrosion and mechanical degradation. Objective: To evaluate the effect of usage duration on the mechanical properties and structural integrity of metal staples extracted from used toothbrushes. Methods: Used toothbrushes from various brands were categorized into three groups based on duration of use: 1 month, 3 months and 6 months (n = 20 each). Staples were extracted and analyzed for tensile strength and flexural resistance using a universal testing machine. Surface morphology, microcrack formation and phase alterations were examined using microscopy and X-Ray Diffraction (XRD). Results: A progressive reduction in mechanical strength was observed with increased duration of use. Mean ultimate tensile strength declined from 280 MPa at 1 month to 180 MPa at 6 months, while flexural resistance decreased from 90 N/mm² to 55 N/mm². Microscopic examination revealed surface pitting, corrosion deposits and deformation in prolonged-use samples, indicating cumulative fatigue and environmental degradation. Conclusion: Toothbrush staples undergo significant mechanical and structural deterioration with extended use, primarily due to corrosion and cyclic stress. Replacement of toothbrushes within three months is recommended to maintain functional integrity and hygiene. The development of corrosion-resistant materials and protective coatings is essential to enhance staple durability and toothbrush longevity.

Background: microRNA (miRNA) is a short, non-coding RNA molecule that regulates gene expression by binding to messenger RNA (mRNA) to prevent it from being translated into proteins or by causing its degradation. (Removed). miRNA-152 belongs to the miR-148/152 family . It is often downregulated in various cancers, including colorectal cancer, acting as a potential tumor suppressor by targeting genes involved in cancer cell growth, migration and invasion. Objective: to study the microRNA-152 gene expression in colorectal cancer compared to colorectal diseases. Methods: The Al-Iraqia University College of Medicine has given its approval to the study. Three groups of participants were formed: The first group included thirty patients with Colorectal Cancer (CRC), the second group included thirty patients with Colorectal benign Diseases (CRD) and the third group consisted of ten healthy people (control group). Five milliliters of blood were collected from all group participants who were gathered from the Medical City Directory (Baghdad Educational Hospital and Oncology Educational Hospital) Removed. The study plan ran for three months, from November 2024 to January 2025. MicroRNA-152 can be detected by using RT-qPCR. Results: A Significant decrease in gene expression (p<0.05) of MicroRNA-152 was identified among patients with colorectal cancer compared to patients with colorectal benign diseases (61.1% Vs 38.9%, respectively). Conclusion: The expression of microRNA-152 was significantly downregulated in colorectal cancer patients compared to the Colorectal Disease (CRD) group, which needs further study to evaluate its predictive value the findings suggest the potential of miRNA-152 as a non-invasive biomarker, which may be used alone or in combination with traditional tumor markers for improved diagnostic and prognostic applications in CRC.

Objectives: Globally, the Lower Segment Cesarean Section (LSCS) was the most commonly performed abdominal procedure, with an incidence of 25%. It is an obstetric operative procedure where a surgical incision is made in the abdominal wall and the lower uterine segment to deliver the fetus. It is performed for maternal and fetal issues and at the mother’s request. This assessor-blinded, quasi-randomised controlled clinical trial aimed to evaluate, in a structured manner, the efficacy of 6-inch Double Leg Raise Hold exercises compared with conventional postnatal exercises after LSCS. An odd-even sequence of quasi-randomisation was used for the assigned thirty women (15/group). Outcome assessment was blinded. The main outcomes were the Trunk Flexor Endurance Test (TFET) and the Postpartum Physical Function Scale (PPFS). Normality was tested with the Shapiro–Wilk test. Paired t-tests were used for within-group comparisons and independent t-tests for between-group differences. Cohen’s d and 95% confidence intervals were reported. Sample size was calculated using G*Power (80% power, α=0.05). Both groups improved trunk flexor endurance, but the intervention group was more effective in improving postpartum physical function outcomes. Structured 6-inch double-leg-raise hold exercises may be included in post-LSCS rehabilitation to improve trunk endurance and functional recovery.

Background: The present study aimed to evaluate the impact of nutrition education on snacking patterns among college students based on the Theory of Planned Behavior (TPB). Methods: An experimental study design was conducted. A total of 265 students were selected through a cluster sampling method and divided into an intervention group of 128 and a control group of 137. The self-administered questionnaire was used to collect data. The intervention group received three educational sessions, each lasting 55-60 minutes and consisting of lectures, educational brochures, discussions and question-and-answer activities. The data were collected at two stages (once at baseline and once three months after the intervention). Results: Students who received nutrition education showed improvements in the consumption of fruits (p = 0.002), vegetables (p = 0.045), milk (p = 0.004) and nuts (p = 0.019). Furthermore, a significant decrease in the consumption of soft drinks and energy drinks (p = 0.035), (p = 0.013), respectively) was observed in the intervention group compared to the control group. No significant differences were observed in the remaining snacking patterns between the two groups. Conclusion: The study found that students in the intervention group showed improvements in some snacking patterns. However, we strongly recommend that policymakers consider nutrition sessions in the higher education curriculum and improve access to healthy snack options on university campuses.

Background: Burn injuries are associated with significant functional impairment, scar formation and psychological distress, which may adversely affect recovery and quality of life. Early rehabilitation combined with psychological support has been proposed as an effective strategy to optimize outcomes in burn survivors. Objective: To evaluate the effectiveness of early multimodal rehabilitation combined with psychological intervention on functional outcomes and scar quality in patients with upper limb burn injuries. Methods: A single-center prospective cohort study was conducted in 33 patients with upper-limb thermal burns. Participants received an early multimodal rehabilitation program consisting of physiotherapy, occupational therapy, scar management and cognitive behavioral therapy-based psychological counseling. Functional outcomes were assessed using the Cochin Hand Function Scale (CHFS), while scar quality was evaluated using the Vancouver Scar Scale (VSS) at baseline, three months and six months. Results: Thirty-three participants completed the study. Functional outcomes improved significantly over the six-month follow-up, with mean CHFS scores changing from 3.2±1.1 at baseline to 5.8±1.3 at three months and 7.4±1.0 at six months (repeated-measures ANOVA, p<0.001). Mean VSS scores decreased from 10.5±2.3 to 4.9±1.5 over the same period (p<0.001). Anxiety reduction averaged 65±12.4% and rehabilitation compliance reached 78±10.2% during follow-up. Conclusion: Early multimodal rehabilitation combined with psychological intervention may enhance functional recovery, improve scar quality and promote psychological well-being in patients with burn injuries.

Background: Bacterial diseases play a major role in urinary tract infections and Staphylococcus aureus (SA) is one of the most common causes of UTIs in humans. Infections caused by Staph. aureus can develop into invasive, potentially life-threatening infections due to disruption of the body's defense mechanisms, such as bacteremia. Objectives: The present study aimed to evaluate the correlation between phenotypic beta-lactamase production and PCR-based detection of the blaZ gene among urinary Staphylococcus aureus isolates in Diyala province. Methods: One hundred samples were collected from sources of urinary tract infections and cultured on blood agar, nutrient agar and mannitol agar. Bacterial isolates were identified using biochemical tests and molecular detection of beta-lactamase using beta-lactamase-specific blaZ primers. Results Out of 100 urine samples collected, 40 isolates of Staphylococcus aureus were identified. The isolates in our study showed 40 (100%) production of hemolysin, 32 (80%) production of urease and 28 (70%) production of biofilms. They also produced 62.5% of gen of beta-lactamase blaZ. Molecular detection of the gene responsible for beta-lactamase production revealed its presence in 100% of bacterial isolates that phenotypically expressed beta-lactamase. Conclusion: Variations in the production of virulence factors, including hemolysin, urease, cell membrane factor and beta-lactamase enzymes, were observed in the bacterial isolates. The bacteria demonstrated resistance to antibiotics, particularly amoxicillin. The presence of the gene responsible for beta-lactamase production was also detected in the isolates, contributing to the bacterial resistance to antibiotics.

Background: Repeated inversion-type ankle sprains frequently give rise to Chronic Ankle Instability (CAI), a condition marked by ongoing balance difficulties and a heightened wariness toward movement. This study set out to compare two rehabilitation strategies-elastic tubing exercise and proprioceptive training-in a group of college students diagnosed with CAI. Methods: Forty participants between 18 and 25 years of age who met the diagnostic criteria for CAI were assigned to either an elastic tubing exercise group or a proprioceptive training group. Each group trained three times weekly across four weeks. Outcomes were tracked using the Cumberland Ankle Instability Tool (CAIT), the Tampa Scale of Kinesiophobia (TSK) and the Y-Balance Test (YBT). Forty-four participants were originally recruited and randomized via a computer-generated sequence; four withdrew for reasons unrelated to the intervention, leaving 40 participants (20 per group) in the final analysis. The trial was registered at ClinicalTrials.gov (NCT07367334). Results: Both groups showed meaningful gains in ankle stability, balance and fear-of-movement scores. The proprioceptive training group, however, posted larger improvements on all three measures-CAIT, TSK and YBT-than the elastic tubing group. Between-group analysis of change scores, however, reached statistical significance only for the Y-Balance Test (mean difference 1.42, 95% CI 0.98 to 1.86, Cohen’s d ≈ 2.05, p<0.001); the between-group differences for CAIT (mean difference 2.18, 95% CI -0.22 to 4.58, p = 0.074) and TSK-17 (mean difference -2.52, 95% CI -6.27 to 1.23, p = 0.182) did not reach significance when properly tested between groups, in contrast to the within-group comparisons reported in the original tables. Conclusions: For college students living with chronic ankle instability, proprioceptive training appears to offer greater benefits than elastic-tubing exercises in improving balance and reducing kinesiophobia.

Background: Diabetic Retinopathy (DR) is the major cause of vision loss worldwide. Early detection of microvascular damage is crucial for preventing vision loss. The usual marker for long-term glycemia, haemoglobin A1c (HbA1c), has significant drawbacks. Glycated Albumin (GA) measures short-term glycaemic exposure and may detect risk earlier. To summarise current evidence on the role of GA and GA/HbA1c ratio in detecting early DR. Methods: A narrative literature review was carried out using Medline (via PubMed), Google Scholar and ScienceDirect. We considered peer-reviewed human studies published in English between 2014 and 2025 that investigated GA, GA/HbA1c ratio, or glycaemic variability in connection to DR. Joanna Briggs Institute critical evaluation tools were used to select studies, retrieve data and assess quality. Results: Fifty-nine studies using cross-sectional, case-control and longitudinal cohort designs were included. The studies quality ranged from moderate to good. Numerous studies found a link between higher GA (range from 10 to 16%) levels and DR, regardless of HbA1c. The GA/HbA1c ratio (1.8 to 2.6) and visit-to-visit GA variability were consistently linked with DR risk, indicating that GA captures clinically meaningful glycaemic fluctuations not captured by HbA1c alone. Conclusion: Glycated albumin is a promising biomarker for the detection and risk stratification of diabetic retinopathy, particularly in clinical situations where HbA1c may be unreliable or inconsistent. However, the conclusion should emphasize that GA serves as a complementary marker rather than a replacement for HbA1c or retinal imaging.

Background: Parenting a child with a health condition, such as Autism Spectrum Disorder (ASD) and/or an acute pediatric illness often results in higher levels of maternal stress. Aim: This is a cross-sectional comparative study between the stress level and associated factors in mothers of children with ASD and mothers of children admitted with acute non-chronic pediatric illnesses, conducted at Saveetha medical hospital, Chennai, India. Methods: A cross-sectional comparison study was undertaken. The study included 100 mothers, comprising 50 mothers of children diagnosed with Autism Spectrum Disorder (ASD). Participants were selected using purposive sampling after screening criteria. Standardized questionnaires were used to determine maternal stress, perceived social support, coping styles and quality of life. Results: Moms of kids with ASD reported greater stress compared to mothers of kids with acute paediatric illness. They also mentioned that they had less perceived social support, made more use of maladaptive coping mechanisms and had less quality of life. Conclusion: The results of this study are important for understanding and recognizing that mothers of children with ASD may be at increased risk for higher levels of stress than are mothers of children with other health conditions.

Background: Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP) are major causes of morbidity, mortality and antimicrobial use in intensive care settings, particularly where Multidrug-Resistant (MDR) organisms are prevalent. Saudi Arabia has reported increasing resistance among Gram-negative pathogens; however, national evidence on pathogen distribution and resistance trends in HAP/VAP remains fragmented. This systematic review synthesizes available data on pathogen burden and Antimicrobial Resistance (AMR) patterns in HAP and VAP across Saudi hospitals. Methods: The review followed PRISMA guidelines. Electronic databases (PubMed, Scopus, Web of Science, Google Scholar) were searched for studies conducted in Saudi Arabia reporting microbiological profiles and/or antimicrobial susceptibility in HAP or VAP. Eligible studies included original research using defined diagnostic criteria and reporting pathogen distribution and/or resistance data. Risk of bias was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Results: Eleven studies met inclusion criteria, spanning adult, pediatric and mixed ICU populations. Gram-negative bacilli predominated across all settings. The most frequent pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, with MRSA representing the principal Gram-positive contributor. Five studies reported quantitative antimicrobial susceptibility data. Across these studies, carbapenem resistance among Acinetobacter baumannii isolates consistently exceeded 90%, while Klebsiella pneumoniae demonstrated high resistance to β-lactam antibiotics. Resistance patterns among Pseudomonas aeruginosa were variable across settings. Colistin generally retained activity against most isolates, although emerging resistance was reported in some centers. Overall, MDR and XDR phenotypes were common, particularly in ICU environments. Conclusion: Available evidence from Saudi tertiary-care hospitals suggests that HAP/VAP is predominantly caused by multidrug-resistant Gram-negative pathogens, with A. baumannii and K. pneumoniae representing the most critical therapeutic challenges. The available evidence indicates increasing carbapenem resistance and early reports of declining colistin susceptibility among selected centers highlight the urgent need for standardized national surveillance, antimicrobial stewardship and strengthened infection-prevention strategies. Coordinated molecular monitoring and optimized empirical therapy are essential to mitigate resistance escalation in Saudi critical-care settings.

Objectives: Though technological advancements contributed many electronic devices, cellphones are the inevitable part of everyone’s daily life. Due to experimentation, exploration and risk-taking behaviour, adolescents are at risk to develop addictive usage pattern of smart phone that may lead to physical and mental health problems. Present study was conducted to assess the magnitude of smartphone addiction and to point out its determinants among adolescents. Methodology: Study was conducted among 804 high school students of 13-16 years of age and studying in different high schools of Thiruvananthapuram District of Keralam, state of South India. Descriptive analytical design was used and sampling technique was multi stage cluster sampling. Socio personal information were collected through structured questionnaire and smartphone addiction was assessed by Smartphone Addiction Scale- Shortened Version (SAS-SV), using a self- report technique. Data were analysed by descriptive statistics, Chi square test and logistic regression. Results: Smartphone addiction among the school going adolescents in this study was 20.4 %, with more prevalence among boys (27.0%), than girls (13.7%). Adolescents whose mothers had only primary or lower education (OR = 3.93; 95% CI: 1.809-8.552; p = 0.001), participants from nuclear families (OR = 2.146; 95% CI: 1.325-3.475; p = 0.002), those with substance use in the family (OR = 1.68; 95% CI: 1.088-2.599; p = 0.019) and adolescents with duration of smartphones use as 3-6 hours or more per day (OR = 3.348; 95% CI: 2.191-5.116; p<0.001) were the significant contributing factors of addiction. Conclusion: The study findings point out that even after the re-opening of schools and online classes after COVID 19, smart phone addiction among the school level adolescents are not much reduced. Factors associated with this problem reveals family related matters and demand the need for family education or parents focused interventions.

Background: The Lymphocyte-to-Monocyte Ratio (LMR) is an inexpensive complete blood count-derived marker that may reflect the balance between host immune status and the leukemia-associated microenvironment. This prospective cohort study evaluated baseline LMR as an exploratory prognostic biomarker in adults with de novo non-M3 Acute Myeloid Leukemia (AML). Methods: We prospectively enrolled 100 treatment-naive adults with de novo non-M3 AML at the Clinical Hematology Unit, Zagazig University Hospitals. Receiver operating characteristic analysis identified an LMR cutoff of 3 for survival outcomes (Area Under the Curve [AUC], 0.613; 95% Confidence Interval [CI], 0.511-0.709; sensitivity, 73.33%; specificity, 55%; p = 0.047). Overall Survival (OS) and Disease-Free Survival (DFS) were estimated using Kaplan-Meier analysis. Cox proportional hazards models were used to assess prognostic factors. Results: Over a median follow-up of 7.7 months (range: 0.5-33.2 months), patients with LMR ≤3 demonstrated significantly inferior outcomes compared with those having LMR >3: lower Complete Remission (CR) rates (51.6% vs. 73.7%; p = 0.029), worse 3 year OS (0 vs. 44.9%; p = 0.03) and poorer 3 year DFS (0 vs. 45%; p = 0.021). Mortality and relapse rates were significantly elevated in the low LMR group (71.0 vs. 42.1%, p = 0.004; 62.5 vs. 12.6%, p = 0.009, respectively). Multivariate Cox regression identified low LMR as an independent adverse prognostic factor for DFS (HR 4.51; 95% CI: 1.57-12.97; p = 0.005). Conclusions: Low baseline LMR was associated with adverse DFS in this exploratory cohort. LMR should be considered a candidate supplementary biomarker rather than a replacement for established molecular and cytogenetic risk stratification. Multicenter validation is required before routine clinical use.

Background: Toothbrushes are essential tools in maintaining oral hygiene; however, with prolonged use, they become reservoirs for microbial growth. While microbial contamination of bristles has been widely studied, little attention has been given to the metal staples that anchor the bristles potential hidden niches for biofilm development. Objective: To assess and compare microbial contamination and biofilm formation on the metal staples of toothbrushes used for 1, 3 and 6 months. Methods: Thirty manual toothbrushes were collected from users after 1 month (n = 10), 3 months (n = 10) and 6 months (n = 10) of regular use. Metal staple areas were swabbed under sterile conditions and microbial load was quantified using CFU counts on blood agar, MacConkey agar and Sabouraud agar. Microbial species were identified using standard biochemical methods. Biofilm structure and maturity were evaluated using confocal laser scanning microscopy (CLSM). Results: Microbial load significantly increased with duration of toothbrush use. Mean aerobic CFUs rose from 2.6×10⁴ at 1 month to 13.7×10⁴ at 6 months (p<0.001). CLSM revealed increased biofilm thickness (7.8-36.2 µm), greater EPS production and declining live/dead cell ratios with time. SEM confirmed dense, multilayered biofilm formation over the metal staples in 6 month samples. Conclusion: Metal staples in toothbrushes serve as significant microbial reservoirs, particularly with prolonged use. Replacement of toothbrushes within 1 to 3 months may help minimize microbial risks and maintain better oral health.

Background: Diabetic Ketoacidosis (DKA) is a potentially life-threatening complication of diabetes and it is one of the most common causes of death in children with Type 1 Diabetes Mellitus (T1DM). While international management protocols are available, Iraq lacks a standardized local nursing guideline for children with DKA. Objective: To evaluate the effectiveness of Evidence-Based Practice (EBP) nursing guidelines on clinical outcomes in children with DKA. Method: A quasi-experimental design was conducted for the study between May 2025 to January 2026. A total of 60 children, aged 6–16, diagnosed with DKA, were allocated into two groups of 30. One group, the control, received routine hospital care and the other, the intervention group, was managed using an EBP nursing guideline. The outcome measures included biochemical recovery, the duration to DKA resolution, the length of hospitalization, complications and the assessment after two months of discharge. Results: Compared to the control group, the intervention group showed a significantly greater reduction in blood glucose (mean difference: -166.93 mg/dL; p<0.001) and shorter DKA resolution time (median: 18 Vs 27 hours; p<0.001, r = 0.636), shorter hospital stays (2 Vs 3 days, p<0.001), lower persistent acidosis (16.7% Vs 80.0%; p<0.001) and fewer multiple complications (30.0% Vs 63.3%; p<0.007). Finally, the readmission rates were significantly lower in the intervention group (34.5% Vs 65.5%; p<0.019). Conclusion: The findings showed that implementing an EBP nursing guideline for pediatric DKA resulted in enhanced metabolic recovery, a decrease in complications and a reduction in readmission rates. According to these results, using structured nursing care and supported by EBP nursing guidelines in emergency settings positively affects the clinical outcomes of children with DKA.

Background: Dentin hypersensitivity is frequently associated with improper toothbrushing techniques that result in cervical abrasion and dentin exposure. Although instruction in atraumatic brushing methods is routinely advised, long-term adherence remains inconsistent. It is hypothesized that real-time auditory feedback may enhance compliance with recommended brushing techniques. Aim: To evaluate and compare the long-term effectiveness of a modified toothbrush with auditory beat feedback and a conventional toothbrush-both following vertical brushing instruction-in reducing tooth sensitivity over a 12-month period. Methods: This assessor-blinded, randomized controlled clinical trial included 80 participants diagnosed with dentin hypersensitivity. Participants were randomly allocated into two groups. Group A used a conventional manual toothbrush and received standardized instruction in vertical brushing. Group B used a modified toothbrush with beat sound feedback in addition to the same vertical brushing instruction. Tooth sensitivity was evaluated using the Visual Analog Scale (VAS) and Schiff Sensitivity Scale at baseline, 1, 3, 6 and 12 months. Statistical analysis was performed using repeated-measures ANOVA and intergroup comparison tests. Results: Both groups demonstrated a reduction in tooth sensitivity over time. However, Group B exhibited a significantly greater and sustained reduction in VAS and Schiff sensitivity scores from 3 months onward (p<0.05). The improvement in Group B was maintained throughout the 12-month follow- up period. Conclusion: While instruction in vertical brushing alone resulted in measurable improvement, the addition of auditory feedback significantly enhanced long-term compliance and clinical outcomes. Themodified toothbrush demonstrated superior effectiveness in reducing dentin hypersensitivity over 12 months.

Objectives: The public health threat of extended-spectrum \beta-lactamase (ESBL)-producing Escherichia coli continues to escalate, driven by rising resistance to common antibiotics and a dwindling pool of effective treatments. This laboratory-based cross-sectional study was designed to evaluate the phenotypic prevalence and antimicrobial resistance profiles of these clinical isolates using the automated VITEK 2 system. Methods: Over a two-month period (from February 18 to April 15, 2026), we collected and analyzed 75 unique clinical isolates of E. coli using the VITEK 2 platform integrated with the Advanced Expert System (AES). All statistical computations, including Pearson's chi-square and Fisher's exact tests, were carried out using IBM SPSS Statistics (v32), with significance set at P < 0.05.  Results: Of the 75 isolates evaluated, a striking 89.3% (67 isolates) were confirmed as ESBL producers. The vast majority of these samples originated from urine specimens (86.7%, 65/75). We observed that ESBL-positive strains carried significantly higher resistance rates to several key antibiotics, including piperacillin/tazobactam (P = 0.022), cefotaxime (P < 0.001), ceftazidime (P < 0.001), cefepime (P = 0.007), and ciprofloxacin (P = 0.003). Additionally, multidrug resistance (MDR) was highly prevalent, affecting 66.7% (50/75) of the isolates. On a positive note, imipenem, meropenem, and amikacin maintained excellent in vitro efficacy against almost all tested strains.  Conclusion: Our findings highlight a worrying prevalence of both phenotypic ESBL production and multidrug resistance among local clinical isolates of E. coli. While carbapenems and amikacin remain highly reliable therapeutic options, these results must be interpreted cautiously. The study's scope was bounded by certain limitations, such as a relatively small sample size, a heavy reliance on urine samples, geographical restriction to a single region, and the lack of molecular assays to identify specific ESBL resistance genes.