Objectives: Background Non-Melanoma Skin Cancers (NMSC) are the most common malignant tumors of the skin and are often located in cosmetically and functionally important regions such as the face. Complete elimination of the tumour with an acceptable aesthetic result and without impairing functions including speech and oral competence, continues to be a major surgical challenge. Gold standard for margin control remains Mohs micrographic surgery, but its availability is restricted in many areas. FSE-assisted resection provides a feasible intraoperative option that allows such patients to be approached in one operating session with structural balance between oncological safety and reconstruction. The outcomes: Thirty patients with histologically proven NMSC received excision under frozen section, followed by adequate reconstruction in this prospective study. The average age was 54.9 years (range, 17–81) and there were more females 18 (60%). Two-thirds of cases 20 (66.7%) were BCC and one-third 10 (33.3%) were SCC. The cheek, the scalp and the nose were most frequently involved 6 (20% each). Forty percent of the patients were closed primarily, 20% underwent skin grafting and 40% received flap coverage. Flap techniques were more commonly associated with injuries to the nasal area and lips than minimally, from an aesthetic aspect as well as functional preservation, important regions (p = 0.003). On multivariate logistic regression, tumour size larger than 2 cm was the only independent predictor for flap reconstruction (OR = 24.9; CI: 1.48–420.2; p = 0.026). Conclusion: These results substantiate that frozen section- guided excision is a safe and accurate method for NMSC in cosmetically sensitive regions, when Mohs surgery is not available. Tumour size is still the main factor which determines the reconstructive difficulty and large multicentric studies with long-term results are needed to validate our findings.

Background: Pulmonary nodules are often the earliest radiological markers of lung cancer and their timely detection is essential for improving survival outcomes. While Computed Tomography (CT) remains the gold standard for nodule detection, concerns regarding cumulative radiation exposure have led to increasing use of Low-Dose Computed Tomography (LDCT). Objective: This study aimed to assess whether LDCT protocols can effectively reduce radiation exposure without compromising diagnostic yield in pulmonary nodule detection. Methodos: This cross-sectional analytical study was conducted in the Department of Radiology at Hail city from Jan 2025 to July 2025, including 75 patients aged ≥18 years who underwent CT chest for pulmonary nodule evaluation. Each patient received both standard-dose CT and LDCT protocols. Radiation dose was recorded in millisieverts (mSv) and two blinded radiologists independently reviewed the scans for presence, size and type of nodules. Standard-dose CT served as the reference standard. Results: The mean radiation dose for standard CT was 6.8±1.2 mSv, while LDCT reduced exposure to 1.9±0.5 mSv, representing a 72% dose reduction (p<0.001). Pulmonary nodules were identified in 41 patients (54.7%) on standard CT and in 39 patients (52.0%) on LDCT. The sensitivity, specificity, positive predictive value and negative predictive value of LDCT were 95.1, 94.1, 95.1 and 94.1%, respectively. LDCT successfully detected all clinically significant nodules ≥6 mm, though it missed two sub-5 mm ground-glass nodules. Inter-observer agreement was excellent for both standard CT (κ = 0.92) and LDCT (κ = 0.89). Conclusion: LDCT significantly reduces radiation exposure while preserving high diagnostic accuracy in pulmonary nodule detection. Although its sensitivity for very small ground-glass nodules is slightly limited, LDCT demonstrates equivalent performance to standard CT for clinically relevant nodules, supporting its use in lung cancer screening and surveillance protocols.

Background: Clinical reasoning (CR) is a core competency in undergraduate nursing education, directly influencing patient safety and quality of care. Artificial intelligence (AI)–enabled educational tools are increasingly integrated into nursing curricula; however, their effectiveness in enhancing CR remains uncertain due to heterogeneous technologies, outcome measures and study designs. Objective: To systematically evaluate the effectiveness of AI-enabled educational tools in improving clinical reasoning among undergraduate nursing students compared with traditional teaching approaches or no AI intervention. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched for studies published between January 2022 and January 15, 2026. Eligible studies involved undergraduate nursing students and reported explicitly operationalized outcomes related to clinical reasoning, clinical judgment or clinical decision-making. After removal of 332 duplicates, 1,015 records were screened; 33 full texts were assessed and 9 studies met inclusion criteria. Methodological quality was appraised using Joanna Briggs Institute (JBI) checklists. Results: Nine studies (n = 9) were included, comprising two randomized controlled trials, quasi-experimental designs and qualitative studies. Interventions included AI-enhanced simulations, rule-based educational chatbots, generative AI/LLM tools and AI-integrated tutoring systems. Improvements in self-reported clinical reasoning were observed in some studies, whereas others reported null or mixed findings. Performance-based or proxy measures yielded heterogeneous results and qualitative studies highlighted perceived benefits in information organization and confidence alongside concerns regarding dependency and reduced critical engagement. Risk-of-bias assessment revealed methodological limitations, particularly in non-randomized designs. Conclusion: Current evidence suggests preliminary and context-dependent educational potential for AI-enabled tools in supporting aspects of clinical reasoning. However, findings are heterogeneous, frequently based on self-reported or proxy measures and limited by methodological constraints. AI should therefore be considered a complementary pedagogical resource rather than a substitute for supervised clinical mentorship. Further rigorously designed studies using standardized performance-based CR measures are needed.

Background: Hypertension remains one of the most prevalent non-communicable diseases globally, contributing substantially to cardiovascular morbidity and mortality. Limited awareness and poor attitudes toward disease management exacerbate health outcomes, particularly in low- and middle-income settings. Objective: To evaluate the effectiveness of a structured health education program in improving the attitudes of patients with hypertension in Ranya City, Kurdistan Region, Iraq. Methods: A one-group quasi-experimental pre-post intervention study was conducted among 75 hypertensive patients attending a primary health care center in Ranya City, Kurdistan Region of Iraq. Participants completed a structured attitude questionnaire before and after a nurse-led education program. The intervention consisted of structured group-based educational sessions covering diet, physical activity, stress management, medication adherence and smoking cessation, delivered in small groups for 45-60 minutes per session. Participants attended a minimum of two sessions over a four-week period, with standardized educational materials and interactive discussions. Pre- and post-intervention attitude scores were compared using the Wilcoxon signed-rank test and effect size was calculated to estimate the magnitude of change. Results: Participants were predominantly female (64.0%), married (98.7%) and urban residents (98.7%), with most reporting a family history of hypertension (81.3%). Post-intervention, significant improvements were observed in participants’ attitudes toward exercise, dietary modification, regular healthcare visits and blood pressure monitoring. The mean attitude score increased from 2.26±0.50 pre-intervention to 3.82±0.40 post-intervention (p<0.001), indicating a shift from generally negative/neutral attitudes toward clearly positive attitudes on a five-point Likert scale where higher scores reflect more favorable attitudes toward hypertension self-management. Effect size analysis demonstrated a large improvement (r = 0.868). Conclusion: The structured nurse-led health education program was associated with substantial improvements in patients’ attitudes toward hypertension management within a one-group pre-post design. Although the findings suggest strong short-term attitudinal gains, the absence of a control group limits causal inference. The results support the feasibility and potential value of integrating structured nurse-led education into primary care settings in resource-limited contexts.

Background: Toxoplasma gondii infection is a globally prevalent parasitic disease with serious implications during pregnancy, where maternal infection may lead to miscarriage, intrauterine growth restriction, preterm delivery, stillbirth, or congenital anomalies. Objectives: To determine the seroprevalence of Toxoplasma gondii infection in pregnant women and to assess its association with adverse pregnancy outcomes. Methods: This cross-sectional analytical study was conducted on 125 pregnant women attending antenatal clinics at tertiary clinics over a period of one year. After informed consent, demographic and clinical data were collected through a structured questionnaire. Serum samples were tested for T. gondii–specific IgG and IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Adverse pregnancy outcomes were recorded, including miscarriage, preterm delivery, intrauterine growth restriction (IUGR), stillbirth, and congenital malformations. Results: The mean age of participants was 27.8±5.4 years, and 56.8% were multigravida. The overall seroprevalence of toxoplasmosis was 40.0%, with 32.8% IgG-positive and 7.2% IgM-positive cases. Adverse pregnancy outcomes were observed in 33 women (26.4%), most commonly preterm delivery (12.0%) and miscarriage (9.6%). Women with T. gondii seropositivity had significantly higher rates of adverse outcomes compared to seronegative women (42.0% vs. 16.0%; OR: 2.52, 95% CI: 1.20–5.32, p = 0.012). Conclusion This study highlights a notable seroprevalence of toxoplasmosis among pregnant women and demonstrates a significant association with adverse pregnancy outcomes. A large proportion of women remained seronegative, reflecting ongoing susceptibility to primary infection. These findings emphasize the need for preventive measures, maternal education, and consideration of targeted screening strategies to reduce the burden of maternal and neonatal complications.

Background: The current study aimed to determine the teratogenic effect of the drug Semaglutide on the histological structure of the lungs in the albino mouse. Methods: The experimental mice were injected with the drug Semaglutide for a period of thirty days at a concentration of 14 mg/kg/day. Twenty male albino mice of Mus musculus type were used. They were randomly divided into two groups. Each group included 10 mice. The animals were randomly divided into two groups. The control group was administered physiological saline for 30 days, whereas the treated group was administered Semaglutide at a dose of 14 mg/kg/day for 30 consecutive days. At the end of the experimental period, the animals were anesthetized and sacrificed. The lungs were removed and fixed, then embedded in paraffin wax. Tissue sections were prepared and stained with Hematoxylin and Eosin (H&E). The sections were examined under a light microscope. Result: The results of examination of histological sections of the lungs in the experimental groups dosed with the drug showed the occurrence of pathological histopathological changes represented by the detachment of the epithelial layer of the bronchioles from the layer of the basement membrane on which it rests and its accumulation in the lumen of the bronchioles, with the occurrence of necrosis and degeneration in their walls and congestion of the blood vessels, accompanied by bleeding in some parts. Also, increased the thickness of the alveolar walls and their ducts, in addition to the expansion of the alveoli, degeneration and destruction of the alveolar walls, infiltration of inflammatory cells and thickening of the nuclei, swelling and bronchial degeneration were observed, in addition to the occurrence of fibrosis. The lungs showed blood vessel deformation and congestion, alveolar bleeding, fibrosis around vessels and bronchioles and swollen alveolar cells with thickened nuclei.

Background: Visual Snow Syndrome (VSS) is characterized by persistent visual disturbances such as visual static, afterimages, photophobia, and impaired night vision. Despite growing global recognition, data from Middle Eastern populations remains limited, particularly on prevalence, symptomatology, and awareness. Objectives: To estimate the prevalence of VSS, evaluate symptom patterns, assess awareness, and identify associated factors among adults in Saudi Arabia. Methods: A cross-sectional online survey using convenience sampling through social media was conducted among Saudi adults (≥18 years). The questionnaire collected demographic data, VSS symptoms, awareness, comorbidities (migraine, tinnitus, anxiety, depression), lifestyle factors, family history, and impact on daily life. Data were analyzed using descriptive statistics and Fisher’s exact test (p<0.05). Results: Of 343 respondents, 3.8% met symptom-based criteria for VSS, aligning with international prevalence (2%–5%). Awareness was low (12.8%), mainly via media rather than healthcare providers. Common symptoms were afterimages (32.7%) and photophobia (30.6%). Significant comorbidities included migraine (17.5%), anxiety (20.4%), tinnitus (11.1%), and depression (5%). Extended screen time and low physical activity were common lifestyle factors. Additionally, 16.3% reported a family history of visual disturbances and 8% noted stress exacerbation. Conclusion: This study highlights the prevalence, poor awareness, and symptom burden of VSS in Saudi Arabia. Findings underscore the need for targeted education and further research to improve clinical recognition and patient care.

Background: Hospitalization is a stressful experience for the child and can result in serving increased levels of anxiety and emotional distress. Non-pharmacological interventions such as music therapy have become important for promoting psychological wellbeing and support emotional adjustment in hospitals among children. Aim: The aim of this study is to determine the effectiveness of music therapy in the reduction of stress and anxiety in hospitalized children aged 6-12 years. Methods: The research design of a quantitative true experimental pre-test and post-test research design was adopted. The research was carried out in the pediatric department of a selected hospital. A total of 10 children were chosen by means of a simple random sampling method and assigned to experimental and control group. The experimental group received music therapy intervention and the control group received routine care. Stress and anxiety levels were measured before and after the intervention using standardized measures. Data were analyzed with the help of descriptive and inferential statistics. Results: In experimental group, a significant reduction in the mean stress scores was observed between the pre-test and post-test and the difference was found to be statistically significant (t = 11.45, p<0.001). The mean anxiety scores also showed a statistically significant decrease (t = 11.05, p<0.001. No major changes were seen in the control group. Post-test findings showed a significant change in perception to low anxiety and moderate levels of stress in cases of the experimental group. Conclusion: The results of the study indicated that music therapy had a potential to be an effective non-pharmacological approach to reduce stress and anxiety in children in the hospital. The results imply that the use of music therapy in pediatric care could potentially enhance emotional well-being but larger studies are necessary to substantiate the effectiveness thereof and justify routine clinical use.

Background: The term “silent disease” has been used to describe osteoporosis. That is because many osteoporotic patients are asymptomatic and often not aware of the impact of the disease on their bones until complications such as fractures occur. This study aimed to assess and investigate lifestyle risk factors related to osteoporosis development among university females. Method: A descriptive cross sectional research design was adopted for this study, which enlisted 265 women. A self-reported questionnaire about osteoporosis risk factors and lifestyle habits was used to collect data. Result: Mean age of participants was 34.63±9.18 and about two thirds were Saudi citizen. More than half of the study females don't participate in any type of physical activity, and most are exposed to less than half an hour of sunlight a day. A statistically significant relation was found between participants’ age, nationality, education level, occupation and marital status and their Body Mass Index where p. value was ˂0.05. Conclusion: The study findings highly recommend creating educational programs for osteoporosis to increase women’s awareness and therefore reduce the risk of developing osteoporosis.

Objectives: Background: One of the main causes of cancer-related fatalities globally, breast cancer is the most prevalent malignancy in women. Many individuals are still detected at advanced stages and its occurrence keeps rising due to lifestyle, hormonal and hereditary factors. The disease is biologically diverse, with molecular subtypes (luminal, HER2-positive, triple-negative) that influence prognosis and therapy. Despite progress in screening and targeted treatments, recurrence and therapy resistance remain major challenges, highlighting the need for new prognostic markers and improved therapeutic strategies. Objective: Analytic immunological markers for assessment of prognostic values of CD8, CD20 and their correlation with heat shock protein 90 in breast cancer. Methods: Al-Iraqi University's College of Medical Sciences gave its approval for the project. The trial, which lasted three months (November to February 2025), involved 140 females from the medical city (Oncology Educational Hospital) who donated three ml of their blood divided into two sets of participants. One group consisted of 70 patients with breast cancer, while the other group consisted of 70 healthy people. Serum levels of CD8, CD20 and HSP-90 were estimated using ELISA assays. Participants in the study provided demographic information, including age, sex, family history and medical history. Results: The study samples ranged in age from 19 to 85 years, with a mean of 49.86±12.713. The majority of the sample (46.4%) was in the 46–60 age range. The mean levels of CD8 and CD20 were significantly higher (18.93541±4.743529 Vs 4.82896±1.858044), with significant mean differences of -14.106457 (t = -23.167, df138, p = 0.000) for CD8 and (1.71293±0.212769 Vs 0.91524±0.206988), with significant mean differences of - 0.797686 (t = -22.483, df138, p = 0.000) for CD20.The mean value of HSP-90 was significantly higher (47.85257±3 8.893877 Vs 14.57260±5.176012), with a significant mean difference of -33.279971 (t = -27.058, df: 138, p = 0.000) respectively. Conclusion: CD8, CD20 and HSP-90 can be used to evaluate the immune response of breast cancer disease patients and serve as a marker for early diagnosis.

Background: Traffic accidents in Saudi Arabia induce severe morbidity, disability, and mortality. Radiologic imaging plays a vital role in the early diagnosis and treatment, and no local data exists on imaging and outcome of injury in Hail or northern Saudi Arabia. The research is the first to estimate the connection between the timing of imaging and the results of trauma in this area. Objective: To evaluate injury patterns of victims in road traffic accidents with several radiological imaging modalities and examine the connection between the timeliness of imaging, the extent of injuries, clinical management, and outcomes. Methods: A retrospective study involved 1000 traffic accident victims in the tertiary centers in Hail (2021- 2024). Medical and imaging data were analyzed to give demographics, characteristics of the injury, type of imaging, time-to-imaging, and outcomes. Statistical analysis was done with Chi-square and exact probability tests (p<0.05). Results: The majority of victims were men (78.0%), and the average age of the victims was 28.9±15.6. The most frequent modality was CT, particularly in severe injuries (p = 0.001). There were more favorable results of early imaging (less than 15 minutes) with reduced ICU admissions and mortality rates (p = 0.019). Deaths due to multi-region trauma amounted to 88.9 (p = 0.008). Conclusions: Fast imaging (CT as well as ultrasound) enhances the survival rates. Road traffic accident morbidity and mortality in Saudi Arabia are minimized through imaging within the first 15 minutes.

Background: Adequate lymphadenectomy is a key determinant of oncologic outcomes in right-sided colon cancer, influencing staging accuracy, adjuvant therapy and long-term survival. D3 lymphadenectomy combined with Complete Mesocolic Excision (CME) has demonstrated superior nodal yield and oncologic clearance compared with conventional resections. However, the laparoscopic approach remains technically demanding and prospective data from the Indian subcontinent are limited. This study aimed to evaluate the feasibility, safety and short-term oncologic outcomes of laparoscopic D3 right hemicolectomy. Methods: This prospective observational study was conducted at a tertiary care teaching hospital between January 2018 and December 2025. Patients aged ≥18 years with histologically confirmed right-sided colon adenocarcinoma undergoing elective laparoscopic D3 right hemicolectomy were included. A standardized medial-to-lateral approach with central vascular ligation and CME was used in all cases. Primary outcomes included feasibility, lymph node yield and R0 resection rate, while secondary outcomes included operative parameters, postoperative recovery and 30-day morbidity and mortality. Results: A total of 142 patients underwent laparoscopic D3 right hemicolectomy. All procedures were completed laparoscopically with a conversion rate of 0%. The mean operative time was 146±34 minutes and mean intraoperative blood loss ranged from 100 to 150 mL. The mean lymph node yield was 45±8.4. R0 resection was achieved in all patients. Early postoperative recovery was observed, with tolerance of solid oral diet at a mean of 24 hours and a mean hospital stay of 7 days. Major complications included anastomotic leak in 3 patients (2.1%) and wound-related complications in 5%, with no 30-day mortality. Conclusion: Laparoscopic D3 right hemicolectomy is a safe, feasible and oncologically sound procedure in experienced centers. The high lymph node yield, zero conversion rate and acceptable morbidity support its role in the management of right-sided colon cancer. Further multicentric studies with long-term follow-up are required to establish survival benefits.

Background: Bone metastases are a common complication of advanced malignancies. Data on their patterns in northern Saudi Arabia are scarce. Objective: To characterize the prevalence, anatomical distribution and scintigraphic image of bone metastases of cancer patients undergoing SPECT/CT bone scan in the Hail region. Methods: Retrospective evaluation of patients with solid tumors (adults) who received Tc-99m MDP whole-body SPECT/CT bone scintigraphy at King Khalid General Hospital between January 2020 and December 2024 (n = 222). Demographic, clinical and imaging data were analyzed using descriptive statistics and the chi-square test, while multivariate logistic regression was performed to identify independent associations with bone metastasis. Results: Breast cancer was the highest primary tumor (71.6%) followed by prostate (9.9%). Definite bone metastases were detected in 23.4% of the patients and 63.5% had no involvement of the skeleton. Among the patients with abnormal scans, multiple lesions (2-10) were the predominant pattern (24.8% of all patients), with the lumbar spine (70.0%), ribs (64.3%), thoracic spine (57.1%) and pelvis (57.1%) being the predominant sites of involvement. Suspected as benign uptake was recorded in 65.3% of patients mainly caused by degenerative changes. In multivariate analysis, age, gender and type of primary tumor and pathological fracture were not independent risk factors for bone metastasis. Conclusion: In this regional cohort population there was a predominance of metastatic bone tumors to the axial skeletal system with breast cancer and prostate cancer being the predominant tumor in group observed. Bone scintigraphy with SPECT/CT is a useful screening tool for potential whole-body diseases, however, the high rate of uptake classified as most likely benign makes it critical to provide careful clinical correlation and more specific use of other imaging modalities.

Background and Objectives: Strain Ratio (SR) elastography is an emerging adjunct to conventional ultrasound in breast imaging, providing a semi-quantitative assessment of tissue stiffness. However, its diagnostic performance and correlation with histopathological subtypes remain insufficiently studied in Middle Eastern populations. Objective: To evaluate the diagnostic accuracy of SR elastography in differentiating benign from malignant breast lesions and to assess its association with histopathological subtypes and BI-RADS classification. Methods: This prospective diagnostic accuracy study included 179 breast masses examined at a tertiary center in the Kurdistan Region between June 2024 and July 2025. All participants underwent B-mode ultrasound, mammography and SR elastography. Histopathology served as the reference standard. Diagnostic performance was evaluated using receiver Operating Characteristic (ROC) analysis. The Kruskal-Wallis test and Pearson correlation analysis were applied where appropriate. Results: SR elastography demonstrated excellent discriminatory ability, with an Area Under the Curve (AUC) of 0.90 (95% CI: 0.844–0.957, p<0.001). An SR cutoff value of 3.45 for predicting malignancy yielded a sensitivity of 86.3% and specificity of 85.5%. Malignant lesions had significantly higher SR values than benign lesions (4.98±2.15 Vs 2.34±1.34, p<0.001). SR values differed significantly across histopathological subtypes (p<0.001), with invasive ductal carcinoma demonstrating the highest stiffness. Moderate positive correlations were observed between SR and ultrasound BI-RADS (r = 0.423) and mammographic BI-RADS (r = 0.438). Conclusion: SR elastography shows high diagnostic accuracy for distinguishing benign from malignant breast lesions and demonstrates significant associations with histopathological subtypes and BI-RADS classification. Incorporating SR into routine breast ultrasound protocols may improve diagnostic precision and reduce unnecessary biopsies. Larger multicenter studies are required to validate cutoff values and standardize clinical implementation.

Background: Adnexa is defined as the accessory structures that are involved in protecting and supporting the function of the eye. Understanding ophthalmic procedure trends aids considerably in developing healthcare plans. This research seeks to study trends in eye and adnexa procedures in Australia from 2000 to 2023. Method: This study was a descriptive time-trend study. We collected procedure data from the Australian Institute of Health and Welfare (AIHW), National Hospital Morbidity Database (NHMD) and population data from the Australian Bureau of Statistics (ABS) dataset between 2000 and 2023. Eye and adnexa procedures were identified using the codes (160-256). We analyzed procedure data based on gender, age and same-day status. Results: Over the study period, the total number of eye and adnexa procedures of recorded cases in Australia was 10,567,738. Procedure’s rate increased from 1,041.39 (95% CI 1036.86-1,045.92) to 3,474.91 (95% CI 3,467.95-3,481.86) per 100,000 population-years. The annual number and rate of eye and adnexa procedures increased by 3.61 times and 2.34 times, respectively. The bulk of cases were between females and the older population. Regarding the same-day status, the same-day procedures accounted for most cases. Besides, procedures on “anterior segment-lens” accounted for most cases (65.6%) of eye and adnexa procedures. Conclusion: There has been a significant increase in eye and adnexa procedures in Australia, partly due to an aging population. Anterior segment-lens procedures accounted for the majority of eye and adnexa procedures. Targeted prevention strategies for age-related lens diseases are needed. Implementing age- and gender-specific strategies, based on the type of procedure prevalent in each group, could help reduce the number of procedures required by the population, thereby reducing the burden on the population and healthcare services.

Background: Tuberculosis (TB) remains a major global public health challenge and further complicated by the emergence of drug-resistant strains. Age may influence drug-resistance patterns due to differences in prior treatment exposure among adults, reactivation of latent infection in the elderly, and ongoing transmission dynamics in younger populations. Objective: To evaluate age-wise differences in the distribution of resistance-associated genetic markers—rpoB, katG, inhA, gyrA, gyrB, rrs, and eis—among bacteriologically confirmed tuberculosis patients. Methods: A laboratory-based cross-sectional analytical study was conducted among 317 confirmed TB patients referred for molecular drug susceptibility testing between January and December 2024. Patients were stratified into four age groups (≤17, 18–40, 41–60, and ≥61 years). Genomic DNA extracted from clinical specimens was analyzed using GenoType MTBDRplus Version 2.0 and MTBDRsl Version 2.0 line probe assays. Age-wise distributions of wild-type (WT) and mutant (MUT) probes were compared using the Chi-square test. Results: Across all age groups, WT probes were predominated for all resistance-associated genes analyzed. No statistically significant association was observed between age and most molecular resistance markers (p>0.05). A significant age-wise association was identified only for rpoB MUT1 p = 0.022, with higher mutation frequency among patients aged 18–40 years and ≥61 years. Mutations associated with isoniazid, fluoroquinolone, and injectable drug resistance did not vary significantly across age categories. Conclusion: Age was not a major determinant of molecular drug resistance patterns in tuberculosis patients, except for rpoB MUT1. These findings indicate that molecular drug susceptibility testing should be applied uniformly across all age groups, and diagnostic decisions should not be influenced by patient age alone. Larger, multicentric age-stratified studies are warranted to detect subtle epidemiological trends in drug-resistant TB.

Exendin-4 is a synthetic analogue of the glucagon-like peptide-1 (GLP-1) that has a potent GLP-1 receptor agonist activity primarily approved for the treatment of Type 2 Diabetes Mellitus. Beyond its well-established metabolic actions, research has increasingly revealed the pleiotropic effects of Exendin-4, particularly in regulating inflammation, cellular proliferation, and tissue repair. Given that many dermatological conditions, including psoriasis and chronic wounds, share underlying pathogenic mechanisms such as systemic inflammation and impaired healing, the role of Exendin-4 in skin disorders presents a promising avenue for therapeutic exploration. This review examines the current evidence, primarily from in vitro and animal studies, regarding the direct and indirect influence of Exendin-4 on skin pathology, focusing on its impact on inflammatory dermatoses, wound healing and potential anti-cancer effects.

Background: The parasite Echinococcus granulosus is still endemic in many nations worldwide, particularly in developing nations. The main organ where the parasite infests is the liver. is a significant zoonotic infection that mostly affects endemic areas and impacts millions of people globally. Techniques. A granulomatous tissue reaction is caused by an ongoing infection with an E. granulosus hydatid cyst, progressively establishing an immunological milieu marked by the buildup of monocytic and lymphocyte cells. IL-10-producing CD8+ T cells and CD4+ T-cell-mediated cellular immune responses are essential during the establishment phase of secondary E. granulosus s.s. infection. Methods: Liver samples (40 infected liver and 20 non-infected) from animals infected with hydatid cysts were collected from licensed governmental butchers and slaughterhouses located in local markets within the Diyala Governorate; no animals were harmed for this study, as the samples were from previously sacrificed animals. Results: The study examined clinical and histological alterations in liver tissue sections, with a focus on the impact of hydatid., The results of histological examination of liver sections showed that the infected livers contained increased sinusoid and central vein dilation; portal and central vein congestion; necrosis of hepatic tissue; atrophy; and increased inflammatory cell infiltration. compared to the noninfected livers, which had no histologic lesions. The current work involves assessing the expression of PD-L1, CD4, CD8 proteins in the liver infected with E. granulosus. Conclusion: In addition to increased inflammatory cell infiltration in the liver, a hydatid cyst infection results in a variety of clinical and biochemical alterations. These results open the door for further studies focused on early detection, prevention and focused treatment approaches for this common illness.

Background: Tissue processing is a pivotal step in histology and molecular biology that profoundly impacts the analysis of cellular and tissue structures. The techniques of cryosectioning and paraffin embedding are two of the most commonly used methods for preserving tissue samples. Each of these methods offers distinct advantages and limitations, influencing downstream applications such as histopathological evaluation, immunohistochemistry (IHC), and molecular analysis. Objective: This review aims to compare cryosectioning and paraffin embedding by examining their methodologies, applications, and impacts on tissue preservation, morphology, and molecular analysis, including protein, RNA, and DNA studies. Methods: The article analyzes key aspects of both tissue processing methods, including their process time, preservation quality, suitability for molecular techniques, and impact on antigen preservation. Key studies are reviewed to highlight the strengths and weaknesses of both techniques. Discussion: Cryosectioning is ideal for applications requiring rapid tissue processing, such as intraoperative diagnostics and preserving labile molecules like proteins and lipids. However, it is limited by the degradation of RNA and challenges with long-term storage. Paraffin embedding, on the other hand, provides excellent morphological preservation and long-term tissue storage, making it suitable for archival studies. While it supports molecular analyses, especially DNA, the process is slower, and antigen retrieval is necessary for effective IHC staining. Conclusion: Both cryosectioning and paraffin embedding are valuable tissue processing techniques, each with specific strengths suited to particular applications. The choice between these methods should be based on the tissue type, molecular analysis requirements, and time constraints of the study or diagnostic procedure.

Background: Acanthamoeba culbertsoni is an opportunistic protozoan capable of causing severe infections in humans, including Acanthamoeba keratitis (AK), which predominantly affects contact lens users. Current therapeutic options remain inadequate, as no available treatment can completely eradicate the infection, primarily due to the formation of resistant cysts. Natural plant-derived compounds such as those from Clitoria ternatea L. have gained attention for their potential antimicrobial properties. Objectives: Thus, the study aimed to evaluate the in vitro anti-amoebic activity of C. ternatea L. flower aqueous extract against A. culbertsoni genotype T4, as well as to assess its cytotoxic effects on human host cells. Methods: The A. culbertsoni strain (ATCC MH791017) isolated from contact lens paraphernalia was used throughout the study. Amoebicidal, encystation and excystation assays were performed to determine the extract’s efficacy against trophozoite and cyst stages. Trophozoite viability was assessed using trypan blue exclusion with haemocytometer counting, while cytotoxicity was evaluated using the MTT assay on human keratinocyte (HaCaT) cells. Data were analysed using appropriate statistical tests, with significance set at p<0.05 and IC₅₀ values were calculated to determine dose-dependent effects. Results: The aqueous extract exhibited significant amoebicidal activity (p = 0.001), with 5 mg/mL markedly reducing trophozoite viability and complete inhibition observed at 30 mg/mL. Dose-dependent suppression of both encystation and excystation processes was observed with concentrations >20 mg/mL showing significant inhibition (p<0.05). Cytotoxicity assays demonstrated a dose-dependent reduction in HaCaT cell viability, with substantial cytotoxic effects detected at concentrations >5 mg/mL. Conclusion: Overall, C. ternatea flower aqueous extract demonstrated potent in vitro activity against both trophozoite and cyst stages of A. culbertsoni, likely attributable to its anthocyanin and related phytochemical constituents. These findings support further investigation to optimise efficacy, minimise cytotoxicity and validate therapeutic potential in in vivo models.

Background: This study aimed to measure the incidence of drug-related problems (DRPs) among patients visiting the emergency department (ED) at King Salman Armed Forces Hospital (KSAFH). Methods: This cross-sectional study enrolled 300 patients who visited the ED between January and April 2015. Collected data included demographics, chief complaint, and medication history. DRPs were identified through structured patient/caregiver interviews and verification of electronic medication records. Results: The incidence of DRPs was 24.7% (95%CI: 20%, 30%). Among the DRPs, 48.6% were considered definitely preventable, 41.9% were possibly preventable, and only 9.5% were non-preventable. The most common DRPs were non-compliance (54.1%) and adverse drug reactions (ADRs, 22.9%). There was a significant association between DRPs and the adult age group (p = 0.001). The elderly age group was significantly associated with the occurrence of ADRs (P = 0.030). All the non-preventable DRPs were caused by ADRs (p<0.001). The mean number of medications was significantly higher in the elderly age group (5.81±1.71) compared to the pediatric (3.00±1.58, p = 0.002) and adult age groups (4.14±2.13, p = 0.002). Conclusion: Non-compliance and ADRs are major contributors to ED visits due to DRPs. Appropriate measures should be considered to improve patient adherence to the treatment regimen. Close monitoring and follow-up of patients’ drug therapy is crucial to avoid preventable ADRs, particularly in at-risk elderly patients. Physicians should instruct their patients about the importance of adhering to treatment, and provide the necessary information related to drug dosage and regimen, the expected adverse effects, and any early signaling manifestations of ADRs that warrant seeking medical care.

Background: Obesity is a complex multifactorial chronic disease characterized by excessive accumulation of body fat leading to increased risk of multiple health conditions. Aim: This study aims to determine the prevalence of obesity and associated health problems among adults residing in selected urban areas of Thiruvallur District, India, considering the lifestyle and cultural context of urban Indian populations. Methods: This cross-sectional study included 150 adults selected through simple random sampling. Ethical approval was obtained prior to the study. BMI was calculated using standard procedures, and associated health problems were assessed using structured tools. Results: Among the participants, 40.0% had normal BMI, 26.7% were overweight, and 23.3% were obese. Only 10.0% were underweight. Diabetes (13.3%), hypertension (16.7%), joint pain/osteoarthritis (10.0%), high cholesterol (8.0%), and sleep apnea (3.3%) were reported, with significantly higher prevalence among obese individuals. Conclusion: Adult obesity can be effectively reduced through structured lifestyle interventions, dietary modification, and community-based health education programs implemented by public health nurses and primary care providers.

Gout, osteoarthritis, fibromyalgia and muscle damage following exercise have all been linked to increased inflammation and oxidative stress in the body. Tart cherries (Prunus cerasus L.) may be useful as a healing aid due to their high levels of bioactive constituents, including anthocyanins, flavonoids and other phenolic compounds, all of which have demonstrated antioxidant and anti-inflammatory properties. Tart cherries may help provide a protective effect against muscle damage. The purpose of this review, in particular, is to consolidate and evaluate various clinical and experimental studies about the potential benefits of tart cherry on the management of exercise-induced muscle damage, osteoarthritis, gout and fibromyalgia. To identify pertinent information, a thorough literature review was conducted across the databases PubMed, Google Scholar, Web of Science and Scopus, with the last update on September 30, 2025. Research has shown that tart cherry supplementation (specifically the Montmorency variety) has been proven to improve post-exercise recovery by decreasing muscle soreness, fatigue indices and oxidative stress. Additionally, tart cherry products have been shown to relieve symptoms of osteoarthritis, gout and fibromyalgia due to their antioxidant, uric acid-lowering and anti-inflammatory properties. These studies show promising results; however, more studies are needed to determine the specifics of how tart cherry remedies work and how effective they are in the long term.

Background: The aim of this study was to assess physical activity, sedentary behaviour, and quality of life in adults by gender and activity level. Methods: A total of 257 female and 415 males participated in the study. Height, weight, physical activity and sedentary behaviour (sitting time) were measured using the IPAQ questionnaire and the SF-36 quality of life scale. Normality tests, Mann-Whitney U, Kruskal-Wallis and Tamhane's T2 tests were used to compare results by gender and activity level, and Spearman's correlation was used for variable relationships. Results: Female were shorter, lighter and had a lower BMI than male, who had less sitting time and higher weekly MET activity scores. Male scored higher in physical functioning (PF) and role emotional (RE) on the SF-36, whereas female had better mental health (MH) scores. Female were more likely to engage in moderate-intensity activities, while male preferred high-intensity activities. Significant differences in age, BMI and sitting time were observed between activity levels for both sexes. Conclusion: Differences in SF-36 scores and sitting time suggest that male's physical roles and societal expectations contribute to higher PF and RE scores, whereas female's mental health benefits may have related to their use of emotion regulation strategies. Female's higher intensity activity was also correlated with fewer emotional problems and better general health. Overall, regular physical activity, even at lower intensity levels, has a positive effect on emotional wellbeing by reducing the risk of stress, depression and anxiety.

Background and Objectives: Social Anxiety Disorder (SAD) is a common psychiatric condition characterized by excessive fear of social interaction. It significantly impairs academic and occupational functioning, with individuals frequently avoiding social situations or experiencing distress when exposed to them. Despite the burden of mental health disorders in the Kurdistan Region of Iraq, studies on SAD among medical students remain scarce. In light of this, the present study aimed to assess the prevalence of SAD among medical students in Zakho and Duhok medical colleges and to examine the extent of beta-blocker usage for symptom relief. Methods: This cross-sectional study was conducted from 10^th October 2024 to 1^st February 2025, among medical students in the Kurdistan Region of Iraq. A total of 769 medical students were included in the final analysis. A validated self-administered survey comprising 28 items, structured into four sections; demographic characteristics, academic details, beta blocker usage and Social Phobia Inventory (SPIN) scale, was delivered to students via a pen-and-paper method. Participants’ responses were rated using a five-point Likert scale. Results: The participants’ mean age was 20.61±1.9 SD. Among the participants, 394 (51.8%) were male. The prevalence of SAD was (31.86%), with 148 (19.25%) and 64 (8.32%) of the students reporting mild and moderate forms, respectively. Only 46 (6%) of the students used a beta-blocker and the main reason for their use was to reduce stress and anxiety (60.9%). Older students (OR = 0.662, 95% CI = [0.49-0.90]), those with a negative family history (OR = 0.57, 95% CI = [0.37–0.86]) and clinical stage students (OR = 0.43, 95% CI = [0.30-0.61]) had a lower probability of developing SAD (p-value <0.05). Conclusion: Social anxiety disorder was observed in about one-third of medical students, with most cases classified as mild. Beta-blocker usage was infrequent and primarily reported to reduce stress and anxiety. Furthermore, significant associations were found between the presence of SAD and age, stage and family history of SAD.

Introduction: Adequate knowledge and awareness of the surgical process among elective preoperative patients are vital for reducing anxiety, improving confidence, and enhancing satisfaction with surgical care. Structured health education interventions can play a crucial role in improving patients’ preparedness and postoperative recovery outcomes. Methods: A quasi-experimental pre-test/post-test design was conducted among 220 patients (Mean age = 34.6±8.9 years) attending the Preoperative Health Education Outpatient Department Clinic. Participants scheduled for elective surgeries across multiple specialties received a standardized health education program comprising audiovisual presentations, interactive group discussions, and printed information leaflets. Patients’ knowledge of surgical procedures, confidence in postoperative pain management, and expected recovery time were measured using validated questionnaires administered before and after the intervention. Results: Post-intervention analysis showed significant improvements in patients’ knowledge of surgical procedures (Mean score = 5.25±1.2 vs. 9.32±1.4, p<0.001, z = 11.38) and confidence in pain management (5.94±1.5 vs. 9.09±1.3, p<0.001, z = 9.02). Participants who attended group-based interactive sessions demonstrated higher post-test knowledge scores than those who attended lecture-only sessions (p<0.001). Moreover, the expected recovery duration decreased significantly (2.95±0.8 weeks to 2.22±0.6 weeks, p = 0.002, z = −3.09). Conclusion: The structured preoperative health education program effectively enhanced patients’ understanding of the surgical process, increased their confidence in managing postoperative pain, and improved recovery expectations. Incorporating multimodal educational strategies, especially interactive group sessions, into routine preoperative care can foster patient empowerment and optimize surgical outcomes.

Background: Emotional Intelligence (EI) and psychological resilience are essential to mental health, social functioning and dealing with stress. Emerging research suggests that polymorphic genes might contribute to variation in these traits, with biological sex doing some moderating. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. Detailed searches were conducted in PubMed, Scopus, Web of Science and PsycINFO and were further complemented by manual searches in trial registers. Eligible studies included those that examined genetic polymorphisms linked to EI or resilience. Results: The systematic search yielded a limited number of studies (n = 6) that met full inclusion criteria and conducted primary genetic analysis. Among these, polymorphisms in genes such as 5-HTTLPR, BDNF Val66Met and COMT Val158Met were investigated. Evidence suggested gender-specific patterns, with associations between certain alleles and facets of EI being more frequently reported in female cohorts. However, the total pooled sample size was small (n = 1,248) and the literature was heterogeneous in design and measurement. Conclusion: Biological sex may moderate some reported genetic associations but the evidence base is far too limited and preliminary to inform clinical practice or personalized interventions. This review highlights the scarcity of high-quality, sex-stratified genetic research on these traits and underscores the need for larger, well-powered and methodologically rigorous studies.

Objectives: Chronic kidney disease (CKD) is a serious health issue in Saudi Arabia. In Saudi Arabia, there is limited research on CKD and related risk factors among the general population. The primary objective of this study was to explore the knowledge of kidney function, risk factors, signs and preventive measures of CKD among the general population. Methods: A population-based, descriptive, cross-sectional study design using a pre-designed, structured questionnaire was undertaken among the adult general population in Arar City, Northern Saudi Arabia, during the period from March 1 to September 30, 2024. Results: A total of 400 participants were included, with a mean age of 28.5±10.4, 68.3% males, 64.5% single, the majority being university educated or above (79.8%), 17.8% hypertensive and 15% diabetic. The most often reported kidney function was blood cleansing (84.4%) and urinalysis was the most often indicated renal function test (76%). High blood pressure and excessive salt consumption were mentioned as the most common (71%) risk factors for CKD, while urine retention was the most often reported symptom of CKD (72.3%). The most frequently cited preventive factors for the development of CKD were staying fit and active (72.8%), maintaining proper blood pressure (70.3%), eating healthy food and maintaining a healthy body weight (69.8%). Conclusion: This study offered preliminary insights into CKD-related knowledge among the general population in northern Saudi Arabia.