Background: Ovarian granulosa cell tumors (GCTs) are rare, hormonally active tumors that account for a significant portion of sex cord-stromal tumors. While FOXL2 mutations have been identified as a critical factor in adult-type GCTs, the broader transcriptional drivers involved in tumorigenesis remain poorly understood. Objective: This study aims to investigate the role of FOXL2 mutations and other transcriptional drivers such as WT1and SOX9 in the development and progression of ovarian granulosa cell tumors, and to assess their association with clinical outcomes. Methods: A prospective cohort study was conducted eastern region from January 2025 to august 2025, involving 220 patients diagnosed with ovarian granulosa cell tumors. The study utilized genomic sequencing, RNA sequencing, and immunohistochemistry to analyze FOXL2 mutations, WT1, and SOX9 expression levels. Clinical data including tumor stage, treatment response, survival, and recurrence rates were also collected and analyzed. Results: FOXL2 mutations were present in 90% of adult-type GCTs, with FOXL2-positive tumors showing significantly better progression-free survival (48.5±11.3 months) and overall survival (55.2±10.5 months) compared to FOXL2-negative tumors (PFS = 30.1±8.7 months, OS = 41.3±7.9 months). WT1 and SOX9 expression were lower in FOXL2-positive tumors, suggesting a regulatory role of FOXL2 in tumor differentiation and progression. FOXL2-negative tumors were associated with advanced stages and higher recurrence rates (31.8%). Conclusion: FOXL2 mutations play a pivotal role in granulosa cell tumor pathogenesis, with FOXL2-positive tumors showing more favorable clinical outcomes. The study also identifies WT1 and SOX9 as important transcriptional drivers. These findings suggest that FOXL2 mutations can serve as diagnostic markers and prognostic indicators, and that targeted therapies addressing FOXL2 and related pathways may improve patient outcomes.

Objectives: To study the educational environment in the College of Medicine at Dar Al Uloom University and compare it to a previous study done in 2021. Introduction: Education is a lifelong journey influenced by various factors, with the Educational Environment [EE] being one of the most significant. This environment includes all elements that impact learning, academic performance and the overall quality of education. Methods: This observational, cross-sectional study was conducted using an online questionnaire hosted by Online Surveys. The Dundee Ready Educational Environment Measure [DREEM] questionnaire in both Arabic and English will be administered to 300 medical students at Dar Al Uloom University, including those in basic science and clinical years. The responses will be recorded in Microsoft Excel and analyzed using SPSS. Results: The total DREEM score was 110.12/200, which indicates a more positive than negative environment. However, it is lower when compared to previous study done in 2021 which had total DREEM score of [122.49/200]. The comparison reveals a notable negative shift in students' overall perception, though the 2025 score still places the environment in the generally "More positive than negative” range. This overall decline is primarily driven by substantial drops in two domains: Atmosphere and Teachers, with Social Life continuing to be the lowest-rated domain in both years. Conclusion: According to the DREEM score [110.12/200], DAU's educational environment is more positive than negative. Clinical years students and female had the lowest score. The areas of instruction: atmosphere and social support receiving the highest concerns. Efforts should be made to improve the quality of instruction, lessen stress and improve social inclusion and mentoring. Frequent evaluations of DREEM will aid in tracking advancement.

Background: Smartphones have become indispensable to modern medical students, offering academic support but also fostering excessive use and psychological dependence, including nomophobia. Understanding these patterns is essential for safeguarding students’ well-being. This study assessed smartphone usage behaviours, health effects and nomophobia among MBBS students at IGMC Shimla. Methods: A descriptive cross-sectional study was conducted among 406 MBBS students using a structured, self-administered Google Form. The questionnaire captured sociodemographic data, smartphone ownership and usage patterns, behavioural practices, sleep and health effects and nomophobia using selected core items of the validated NMP-Q. Descriptive statistics were applied for analysis. Results: Participants were mainly aged 20-22 years (52.8%) with slightly more females (52.2%) and most belonged to urban areas (58.1%). Nearly all owned smartphones (99.3%), primarily Android devices (75.4%) and had used them for an average of 5.84±1.92 years. Daily screen-time exceeded four hours for 70.2% of students and 89.9% had constant internet access. Social media (89.7%), entertainment (81.5%), academics (73.4%) and communication (68%) were the most common uses. Behavioural dependence was notable: 86% used phones before sleep, 81.5% after waking, 78.1% in the toilet, 71.2% during lectures and 23.2% woke at night to check phones. Sleep delay (64.8%), sleep disturbances (55.4%), headaches/eyestrain (50.7%) and daytime sleepiness (40.1%) were frequently reported. Social media apps were most used (90.4%). Item-wise NMP-Q scores showed high reliance on convenience and information access. Overall, moderate nomophobia affected 70.7% of students, while 19% had severe nomophobia. Conclusion: Medical students showed extensive smartphone use, strong behavioural attachment, significant sleep disturbances and high levels of nomophobia, highlighting the need for targeted digital wellness interventions.

Background: Long-term use of removable prostheses is widespread, yet prolonged wear may predispose to mucosal pathology and functional deterioration. this study was planned to evaluate prosthesis condition and oral mucosal changes among long-term denture wearers and examine associations with duration of use. Methods: In a cross-sectional clinical study, 120 adults (≥40 years) wearing complete dentures (CDs) or removable partial dentures (RPDs) for ≥5 years underwent interviews and standardized oral examinations. Variables included demographics, prosthesis type and age, hygiene practices and mucosal findings (denture stomatitis, traumatic ulcer, angular cheilitis, inflammatory hyperplasia). Descriptive statistics summarized distributions; Chi-square tested associations (α=0.05). Results: Among 120 long-term denture wearers (mean age 62.4 years), complete dentures were more common than partial dentures. Nearly three-quarters of participants exhibited at least one mucosal lesion. Denture stomatitis was the most frequent condition, followed by traumatic ulcers, angular cheilitis and inflammatory hyperplasia. Lesion prevalence increased progressively with longer denture use, demonstrating a significant association between prosthesis age and mucosal pathology (p < 0.05). Common prosthesis-related issues included occlusal wear and compromised base adaptation, particularly in older dentures. Conclusion: Oral mucosal lesions are highly prevalent in long-term denture wearers and show a clear correlation with increasing prosthesis age. Regular surveillance, timely relining or replacement, strict hygiene reinforcement and avoidance of nocturnal wear are essential to reduce tissue morbidity and enhance oral health–related quality of life.

Background: In the practice of otolaryngology, otomycosis is a prevalent issue. However, because many patients exhibit resistance to antifungal drugs and have a high recurrence rate, we typically face certain challenges when treating them. This study aimed to identify the fungi that cause otomycosis and how susceptible they are to the widely used antifungal medications. Moreover, to determine the primary causes of antifungal resistance. Methods: From March 2025 to April 2025, we performed experimental descriptive research on 50 patients who had been clinically diagnosed with otomycosis. Specimens of auditory discharge were gathered for fungal culture and direct microscopic analysis. The commonly used antifungal medications were tested for in vitro antifungal susceptibility. We examined the enzymatic activity of the isolated fungus. Results: Patients frequently get otomycosis, a fungal infection of the ear. Fifty samples tested positive for fungus. conducted mycologic investigations on scraping samples and debris from the external ear canals of fifty patients with otomycosis clinical diagnoses. Forty-one samples (82.0%). Aspergillus niger 18 (43.9% of all isolates), Aspergillus fumigatus 16 (39.0%) and Candida albicans 7 (17.1%) were the most prevalent pathogens. The highest clearing zone around the colony, where the strain's xylanolytic activity was seen, was between 12 and 7.2 cm. At 80% saturation, the dialysed enzyme precipitation produces 3.1U/mg of protein-specific activity. And Concentrations were made of the fractions having the highest specific activity (numbers 19-25). With a specific activity of 1102 U/mg, xylanase was purified 97 times. Conclusion: The most prevalent fungal isolates in otomycosis are Aspergillus and Candida species. The high enzymatic activity of fungal infections is responsible for their high pathogenicity. Antifungal empirical use needs to be discouraged. Ion-exchange chromatography using DEAE-cellulose provided an efficient means of isolating and concentrating xylanase with high specificity and yield. The results are consistent with other recent the continued use of this method as a standard for fungal enzyme purification.

Background: The possible relationship between chronic Toxoplasma gondii infection and metabolic disturbances, including obesity and metabolic syndrome (MS), remains unclear. This study assessed the prevalence of chronic toxoplasmosis, obesity, and MS among women in Saudi Arabia and examined their statistical associations. Methods: A cross-sectional study was conducted among 275 women attending outpatient clinics in Makkah. Data were collected through structured questionnaires, anthropometric and clinical measurements, and ELISA-based detection of T. gondii IgG. Obesity and MS were classified using established diagnostic criteria. Statistical analysis was performed using SPSS. Results: Chronic toxoplasmosis was identified in 24.7% of participants, obesity in 78.9%, and MS in 14.9%. Chronic toxoplasmosis showed no significant association with obesity (p = 0.118) or MS (p = 0.465). Obesity showed a significant association with MS (p = 0.048), and more than 90% of women with MS were also classified as obese. Age demonstrated significant associations with both obesity (p = 0.014) and MS (p = 0.007). MS was also associated with education level (p = 0.0001) and years of marriage (p = 0.007). No sociodemographic or reproductive factors showed significant associations with chronic toxoplasmosis (all p > 0.05). Conclusion: Obesity and metabolic syndrome were common and strongly linked in this population, whereas chronic toxoplasmosis showed no measurable association with either condition. Metabolic risk appeared to be influenced primarily by age and sociodemographic factors rather than parasitic infection. Further longitudinal and mechanistic studies are recommended to explore these pathways in greater depth.

The current study was conducted in the Mycology Laboratory of the Department of Life Sciences - College of Education for Pure Sciences during year 2023-2024 with the aim of exploring the possibility of using anthocyanin pigment extracted from some plants in staining fungi. The cold water extract of four plant species was used: leaves of red cabbage (Brassica oleracea var. capitata f. rubra), tuber of red beet (Beta vulgaris L.), seeds of pomegranate (Punica granatum L.) and peels of eggplant (Solanum melongena L.). The extract was used as a stain in preparing and examining glass slides of two fungi that contaminate stored seeds, which were Aspergillus niger and Rhizopus sp. and compared with the blue lactophenol stain. The extracts of the four plants showed high efficiency in staining fungi and studying fungal structures clearly, thus outperforming the chemical blue lactophenol. Therefore, this result is important in achieving the Sustainable Development Goals for maintaining health by reducing dependence on chemical compounds and reducing the risks resulting from their continuous use, on the one hand and it is also inexpensive and successful in microscopic studies of fungi.

Background: Thoracoscopic repair of tracheoesophageal fistula (TEF) offers cosmetic and musculoskeletal advantages compared to open thoracotomy. However, intrathoracic CO₂ insufflation in fragile neonates may predispose to hypercarbia and acidosis, raising concerns regarding intraoperative stability. Objective: To compare the incidence of intraoperative hypercarbia and acidosis between thoracoscopic and open TEF repair and to evaluate early clinical outcomes. Methods: This comparative cohort study included 430 neonates who underwent primary TEF repair, with 252 treated thoracoscopically and 178 by open thoracotomy. Hypercarbia was defined as PaCO₂ or EtCO₂ ≥60 mmHg and acidosis as arterial pH <7.25. Intraoperative parameters, corrective interventions and postoperative outcomes (ventilation duration, anastomotic leak, early stricture and 30-day mortality) were recorded. Data were analyzed using chi-square, t-test and multivariable logistic regression. Results: Hypercarbia occurred in 46.4% of thoracoscopic cases versus 28.7% of open cases (p<0.001), while acidosis was observed in 22.2% versus 14.0% (p = 0.03). Median hypercarbia duration was longer in the thoracoscopic group (18 vs. 9 minutes, p<0.001). Hemodynamic instability was also more frequent with thoracoscopy (15.5% vs. 8.4%, p = 0.03) and 5.6% required conversion to open repair. Despite these intraoperative differences, early postoperative outcomes were comparable: anastomotic leak (7.1% vs. 6.7%, p = 0.88), stricture (8.7% vs. 7.3%, p = 0.60) and 30-day mortality (4.0% vs. 5.1%, p = 0.62). On multivariable analysis, thoracoscopic approach (aOR 1.92, 95% CI 1.28-2.89) and longer operative duration independently predicted hypercarbia, while thoracoscopy (aOR 1.58, 95% CI 1.01-2.49) and operative time also predicted acidosis. Conclusion: Thoracoscopic TEF repair is associated with higher incidence and longer duration of hypercarbia and acidosis compared to open repair, largely due to CO₂ insufflation and longer operative times. These derangements are generally manageable and do not adversely affect early outcomes, supporting the continued safe use of thoracoscopy with vigilant anesthetic monitoring and low insufflation pressures.

Background: Teaching engagement played a critical role in nursing education, as it supported student motivation, learning outcomes, and professional growth through cognitive, emotional, and behavioral participation. This study aimed to examine the perceptions of nursing students regarding faculty teaching engagement in both classroom and clinical settings. Methods: A quantitative, descriptive-correlational design was employed, involving 292 nursing students from José Rizal University who were selected through stratified sampling to ensure representation across all academic year levels. Data collection was conducted through Google Forms, and statistical analyses were performed using Microsoft Excel, Google Sheets, and JASP. Results: Findings revealed that students generally perceived faculty teaching engagement as very high in both lecture and Related Learning Experience (RLE) environments. No significant differences were found in perceptions based on sex or age; however, a statistically significant difference in behavioral engagement was observed across year levels (F = 2.88, p = 0.04). Conclusion: The study found that nursing students consistently perceived faculty teaching engagement as very high in both lecture-based and clinical settings, with cognitive and behavioral engagement, instructional clarity, and feedback provision rated most positively.

Background: Obesity has become a critical public health challenge in Saudi Arabia, driving growing interest in pharmacological weight-management options, including off-label use of GLP-1-based therapies such as tirzepatide (Mounjaro). This study aimed to assess public knowledge, perceptions and interest in Mounjaro among adults in Ha’il, focusing on awareness sources, perceived effectiveness, safety concerns, eligibility criteria and understanding of FDA approval status. Methods: A cross-sectional electronic survey was distributed via social media platforms between December 2024 and February 2025, yielding responses from approximately 200 participants. Data were analysed using SPSS version 27, employing descriptive statistics and Chi-square tests with a significance threshold of p<0.05. Results: The findings revealed high general awareness of Mounjaro (93%), with healthcare staff, family and social media serving as the primary information sources. Despite broad awareness, detailed knowledge remained limited, as 48% reported low and 25% no knowledge of the medication. Most participants perceived Mounjaro as effective for weight loss (92.5%) and were familiar with common side effects such as nausea and vomiting. Education level and knowledge significantly influenced the likelihood of consulting a doctor, while gender differences showed higher awareness among females. A strong majority (88%) expressed a need for increased public education. Conclusion: These results highlight widespread interest but insufficient understanding of Mounjaro, emphasizing the need for targeted awareness campaigns and evidence-based health communication strategies.

Background: Aspergillus fumigatus is the most common causes of Aspergillosis. CYP51 and calmodulin are considered virulence genes related with the progression of invasive Aspergillosis. Objectives: To detect the role of mutations for CYP51 and Calmodulin genes in azoles resistance of A. fumigatus isolated from different clinical samples. Methods: One hundred fifty samples were collected (asthma, cutaneous and sinusitis) patients. Aspergillus fumigatus was identified using C-Zapek Dox agar medium incubating at 37°C for 72 hours. The susceptibility of A. fumigatus isolates was tested toward Amphotericin B (20 µg) and itraconazole (10 µg). Ten isolates of A. fumigatus were tested to detect of substitution mutations for both genes. Results: The percentage of A. fumigatus isolated from diabetic Aspergillosis patients and non diabetic aspergillosis patients were 20.5% and 14.5% respectively. The molecular weight of CYP51 and Calmodulin genes for A. fumigatus isolates were 140 bp and 461 bp, respectively. All A. fumigatus isolates for sinusitis and asthma patients have substitution mutations in both genes. For non diabetic patients, one isolate of sinusitis sample has substitution mutation for CYP51 gene only. Conclusions: CYP51 gene play a role in azole resistance of A. fumigatus among Aspergillosis diabetic patients.

Background: The term "eczema" refers to a group of skin conditions that include nummular eczema, seborrheic dermatitis, contact dermatitis and Atopic Dermatitis (AD). AD, characterized by itching and redness, is increasingly prevalent and linked to other allergic diseases. Objective: The purpose of this research is to determine the prevalence of eczema in Saudi Arabian infants, as well as related prenatal risk factors and parental eczema knowledge. Methodes: This study is a cross-sectional study conducted from July 2024 July 2025 in Saudi Arabia. The study plans to recruit Parents through social media platforms like Twitter, Snapchat, Instagram, WhatsApp and Facebook. Inclusion criteria for this study consisted of parents residing within the Kingdom of Saudi Arabia. Conversely, exclusion criteria encompassed parents living outside of Saudi Arabia. Results: The prevalence of eczema among Saudi Arabian infants was studied, with special emphasis on prenatal risk factors and parental knowledge about eczema. The mean age was 36.1 years in the 415 participants, who also consisted of a huge majority (71.6%) of mothers. The results showed: 54% of children were not already diagnosed with eczema and the results underscore the importance of more education and early intervention. It was diagnosed most often in the first year of life (32.5%) with a tendency towards the arms (53.9%) and face (40.8%). Importantly, we found that psychological disorder was present in 41.4% of mothers during pregnancy, indicative of a possible underlying maternal risk factor. Conclusion: In this study we highlighted the high prevalence rate of eczema in infants in Saudi Arabia and highlight the importance of increased parental awareness of eczema. So, the findings show worrying gaps in both diagnosis and knowledge, there is much here that is not well understood when it comes to preventive measures and good management strategies. Prenatal risk factors, such as maternal psychological stress and genetic predisposition, also highlight the multiple facets of eczema. Therefore, Educational programs targeting parental awareness are essential to improve early detection and management of eczema.

Background: Accurate tumour localization in laparoscopic colorectal surgery remains challenging due to limited tactile feedback and dynamic bowel movement. Conventional modalities, including preoperative colonoscopy and cross-sectional imaging, may miss small or flat lesions, increasing the risk of mis-localization. Intraoperative colonoscopy (IOC) provides real-time mucosal visualization and can assist in confirming tumour position, resection margins and anastomotic integrity. Objectives: To assess the safety, feasibility and clinical utility of intraoperative colonoscopy during laparoscopic left-sided colorectal surgery. Methods: This prospective observational study included 30 patients with left-sided colorectal tumours undergoing elective laparoscopic resection at the Department of General Surgery, GMC Srinagar (March 2023–August 2024). IOC was employed to verify tumour localization, inspect resection margins and perform anastomotic leak testing. Demographic, intraoperative and postoperative variables were recorded and analysed using SPSS v24. Statistical significance was set at p<0.05. Results: The mean patient age was 42.1±6.8 years; 56.6% were male. The sigmoid colon (46.7%) and rectum (30%) were the most common tumour sites. IOC altered or corrected tumour localization in 46.6% of cases with uncertain preoperative findings. No IOC-related complications, such as perforation or bleeding, occurred. All patients had intact postoperative anastomoses with no detected leaks. Conclusion: Intraoperative colonoscopy is a safe and feasible adjunct in laparoscopic colorectal surgery. By improving intraoperative tumour localization and verifying anastomotic integrity, IOC enhances surgical decision-making and may reduce postoperative complications.

Background: Public perception and awareness of anesthesia and anesthesiologists are often limited, despite the critical role anesthesiologists play in patient safety and perioperative care. Misconceptions and insufficient knowledge may affect trust and communication between patients and healthcare providers. Objectives: This study aimed to assess the level of public awareness and understanding of anesthesiology, including perceptions of anesthesiologists' roles, qualifications and responsibilities and to identify factors influencing this awareness among residents in Makkah, Saudi Arabia. Methods: A cross-sectional study was conducted using a structured self-administered questionnaire distributed to residents of Makkah. The survey collected sociodemographic data and assessed participants’ knowledge and perception of anesthesia and anesthesiologists. Data were analyzed using SPSS version 26 to identify trends and associations between variables. Results: Preliminary findings indicate varying levels of awareness, with many participants demonstrating limited knowledge of anesthesiologists’ roles and training. Factors such as age, gender and previous surgical experience were associated with differences in perception and trust. Conclusion: There is a significant gap in public understanding of anesthesiology in Makkah. Increasing public education and engagement-particularly through preoperative discussions and awareness campaigns-may improve trust and promote more informed patient decision-making.

Introduction: Obesity is a highly prevalent chronic disease and is associated with high morbidity. Bariatric surgery is an effective, durable management. Glucagon-like receptor-1 agonists (GLP-1 agonists) showed high effectiveness in weight management with cardiac and renal benefits. Studies comparing bariatric surgery and GLP-1 agonists are scarce. This meta-analysis aimed to compare the effects of bariatric surgery and GLP-1 agonists on weight, HbA1c, major adverse cardiovascular events (MACE) and heart failure. Methods: We searched PubMed/, Google Scholar, Cochrane Library and Web of Science for relevant articles. We used the keywords bariatric surgery, sleeve gastrectomy, gastric bypass, gastric banding, GLP-1 agonists, twin-cretins, semaglutide, tirzepatide and liraglutide, MACE, acute coronary syndrome, fatal, myocardial infarction, stroke and non-fatal infarction. Out of the 1142 articles retrieved, 716 remained after duplication removal, 22 full texts were reviewed and 7 full texts were included in the final meta-analysis. Results: Bariatric surgery reduced the BMI more than GLP-1 agonists, Standard mean difference (SMD), -8.23, 95% CI, -11.02-5.45, with no differences regarding the HbA1c, MD, 0.08, 95% CI, -0.45-0.6. however, HbA1c was lower in bariatric surgery after eliminating heterogeneity, MD, -0.35, 95% CI, -0.37--0.32. The MACE was lower in bariatric surgery compared to GLP-1 agonists, odds ratio, 1.50, 95% CI, 1.13-1.98 (the result was similar after eliminating heterogeneity, odds ratio, 1.34, 95% CI, 1.15-1.56) and heart failure was lower in bariatric surgery compared to GLP-1 agonists, odds ratio, 1.87, 95% CI, 1.46-2.40. Conclusion: Bariatric surgery reduced weight, MACE and heart failure more than GLP-1 agonists, with similar effects on the glycated haemoglobin. Further larger clinical trials investigating the best GLP-1 and bariatric surgery in obesity and its comorbidities management.

Background: Sepsis caused by Salmonella spp. represents a critical public health challenge due to its potential to cause severe systemic inflammation, multi-organ failure and high mortality rates. Despite advances in medical research, the precise immunological mechanisms driving sepsis remain poorly understood. Investigating the interplay between innate and adaptive immune responses during bacterial sepsis is essential for identifying novel therapeutic strategies to mitigate inflammation and immune dysregulation. Objective: This study aimed to investigate the innate and adaptive immune responses in rats during Salmonella spp. sepsis. Methods: We monitored antibody production, immune cell populations and inflammatory cytokine levels throughout the course of infection in a rat model. Results: Our findings revealed a transition from innate to adaptive immunity during the early phase of sepsis. This phase was characterized by increased levels of pro-inflammatory cytokines, neutrophils and macrophages. Adaptive responses, including antibody production, followed this initial activation. Conclusion: These results provide valuable insights into the immunological shifts during bacterial sepsis, offering a basis for potential therapeutic interventions targeting immune modulation.

Background: Esophageal Varices (EV) in pediatric patients, primarily resulting from portal hypertension, pose life-threatening risks of gastrointestinal bleeding. However, pediatric-specific data remain limited, particularly in Middle Eastern settings. Objective: To evaluate the clinical presentations, endoscopic findings and procedural outcomes of pediatric patients diagnosed with esophageal varices at a tertiary hospital in Saudi Arabia over a ten-year period. Methods: This retrospective study included 22 pediatric patients (aged 0–18 years) diagnosed with esophageal varices at King Saud Medical City between March 2015 and May 2024. Medical records were reviewed for demographic, clinical and endoscopic data. Descriptive statistics were used for analysis. Results: Males accounted for 63.6% of the sample. The most common etiologies were portal vein thrombosis alone (27.3%) and portal vein thrombosis with hepatic fibrosis or cirrhosis (27.3%). Most patients presented with Grade II or III varices and gastric varices were observed in 45.5% of cases. Treatment modalities included band ligation (59.1%), sclerotherapy (31.8%) and injection therapy (68.2%), with 45.5% receiving combination therapy. Evidence of recent or active bleeding occurred in about one-third of patients. Conclusion: Pediatric esophageal varices show diverse etiologies and complex presentations, often with coexisting gastric or duodenal pathology. Early endoscopic screening, individualized treatment and long-term follow-up are essential to optimize outcomes and prevent recurrence.

Background: Autophagy is an essential self-degradative process critical for cellular homeostasis, acting as a quality control mechanism by removing damaged organelles, misfolded proteins and intracellular pathogens. While fundamental for cell survival and preventing diseases like cancer and neurodegeneration, its deregulation can paradoxically contribute to pathology. The complex dual role of autophagy, coupled with recent advances in understanding its selective forms, necessitates a consolidated review to bridge the gap between mechanistic insights and therapeutic application. Methods: A systematic literature search was conducted using major scientific databases (e.g., PubMed, Scopus, Web of Science) for articles published between January 2015 and March 2025. The search focused on keywords including autophagy, autophagy mechanisms, selective autophagy, mitophagy, autophagy and cancer, autophagy therapeutics and autophagy regulation. Included studies were critically appraised to synthesize data on the core molecular machinery, regulatory pathways and its multifaceted role in disease pathogenesis and prevention. Results: The analysis reveals significant progress in delineating the molecular execution of autophagy, particularly the machinery of selective autophagy. We found compelling evidence that specific disruptions in autophagic flux and cargo recognition are foundational to diseases ranging from neurodegenerative disorders to metabolic syndromes and cancer. A key synthesis of the data highlights that autophagy's role is not simply binary (protective vs. destructive) but is highly context-dependent, influenced by cell type, disease stage and genetic landscape. This clarifies its paradoxical functions, acting as a tumour suppressor early in carcinogenesis but promoting tumour survival in established cancers. Conclusions: This review consolidates the current understanding that precise modulation of autophagy, rather than its broad inhibition or activation, represents the most promising therapeutic avenue. The findings underscore the critical need to develop agents that target specific forms of selective autophagy. Future research must focus on resolving the spatial and temporal control of autophagic pathways to translate these mechanistic insights into effective clinical interventions for a wide spectrum of human diseases.

Background: Secondary peritonitis is a common surgical emergency in low- and middle-income countries, with mortality rates ranging from 15 to 30%. Objective: To compare the predictive accuracy of the Peritonitis Mortality Prediction (POMPP) score and the Peptic Ulcer Perforation (PULP) score in patients with secondary peritonitis. Methods: This cross-sectional validation study was conducted at the North Surgical Ward, Department of Surgery, Mayo Hospital, Lahore, from January 2025 to June 2025, included 159 patients aged 18-75 years presenting with secondary peritonitis. POMPP and PULP scores were calculated for each patient. Patients were followed until discharge or death and mortality outcomes were recorded. Results: The mean age of patients was 44.7±13.2 years, with a male-to-female ratio of 1.9:1. The most frequent cause of peritonitis was perforated duodenal ulcer (39.6%), followed by appendicular perforation (21.4%) and typhoid ileal perforation (18.2%). The overall mortality rate was 21.4% (34/159). The POMPP score demonstrated higher sensitivity (85.3%), specificity (81.6%), NPV (93.4%) and overall diagnostic accuracy (82.9%) compared to the PULP score, which showed sensitivity of 72.1%, specificity of 76.4%, NPV of 87.2% and accuracy of 75.5%. Conclusion: Both POMPP and PULP scores are effective in predicting mortality in patients with secondary peritonitis; however, POMPP outperformed PULP in this study and may be preferred as a simple, reliable bedside tool in resource-limited settings.

Background: Menstrual irregularities are common among adolescent girls and are often influenced by stress, poor nutrition, and sedentary habits. These lifestyle factors can disrupt hormonal balance and metabolic function, leading to irregular menstrual cycles. Aim: The aimed to evaluate the effectiveness of a nurse-led intervention on selected biophysical and biochemical parameters among adolescent girls with menstrual irregularities. Methodology: The study utilized a quantitative approach with pre-experimental design. The study was conducted among 20 adolescent girls aged 12–18 years attending the Gynecology OPD at Government Thoothukudi Medical College Hospital. Data were collected using structured tools assessing demographic details, menstrual patterns, BMI, and laboratory parameters. Results: The results showed a significant reduction in BMI, indicating improved weight status. Levels of hemoglobin and white blood cells increased significantly, suggesting enhanced hematologic function. Biochemical improvements were also noted in triglyceride and triiodothyronine (T3) levels, while other physiological and biochemical parameters remained stable. Conclusion: The nurse-led intervention effectively improved BMI, hematological, and biochemical parameters among adolescent girls with menstrual irregularities.

Objective: This study aimed to explore parental perceptions of robot-assisted diabetes education delivered through the Pepper humanoid robot among children with T1DM. Methods: A descriptive cross-sectional study was conducted using a validated questionnaire based on the Technology Acceptance Model and Theory of Planned Behavior for parents whose children participated in a robot-assisted diabetes education program. Parents’ perceptions were measured across domains of perceived usefulness, trust and safety, engagement, satisfaction and behavioral intention. Both Likert-scale items and open-ended questions were included. Results: Parental perceptions were highly positive. The highest scores were observed for perceived usefulness (mean = 4.44±0.47) and child engagement (mean = 4.28±0.58). Trust and safety were also rated favorably. Parents with greater technological familiarity reported higher satisfaction scores (p<0.05). Significant negative correlations were found between HbA1c and perceived usefulness (ρ = -0.52, p = 0.024) and trust and safety (ρ = -0.48, p = 0.039). Open-ended responses emphasized the robot’s role in simplifying complex information, sustaining children’s attention and promoting independence, while also recommending improvements in technical performance and cultural adaptation. Conclusion: Parents viewed SARs as valuable, safe and engaging tools for pediatric diabetes education. Their integration into clinical care holds promise for enhancing engagement and self-management in children with T1DM, provided that issues of cultural relevance and digital literacy are carefully addressed.

Quinoline Yellow (QY) is a synthetic dye frequently used in numerous products, such as foodstuffs and drinks, which raises concerns about its potential health hazards. This study aimed to assess the impact of QY on albino mice, with a specific focus on examining its effects on DNA and chromosomal integrity in bone marrow cells, as well as its influence on the proper functioning of the liver and kidney. It is an experimental in vivo study design. Six groups of Albino mice (each group containing 10 mice) were orally administered different dosages of QY and assessed using the Chromosomal Aberrations (CAs) assay and the Micronucleus Test (MNT) methods. To determine the influence of QY on liver and kidney function, serum markers, such as AST, ALT, urea and creatinine levels, were quantified. The most prevalent type of CA observed at all QY concentrations was sticky chromosomes. In each treatment group, a significant elevation (p<0.05) in AST, ALT, urea and creatinine levels was observed compared to the control group. Conclusively, the QY demonstrated a genotoxic impact and damage to bone marrow cell lines and had severely affected the normal functions of the liver and kidneys of the mice. Considering its usage, further research is crucial to ascertain the safety implications of QY in food and consumer products.

Introduction: The global prevalence of End-Stage Renal Disease (ESRD) requiring hemodialysis is rapidly increasing. In Morocco, many patients turn to Medicinal Plants (MP), driven by socioeconomic and cultural factors. However, unsupervised MP use poses a risk of acute renal failure. Objectives: This study's objective was to assess the prevalence of MP use among hemodialysis patients in northern Morocco, identify the species used and analyze correlations between the type of medicine preferred and the participants' socioeconomic characteristics. Methodes: A cross-sectional study surveyed 329 ESRD patients at public centers (Sept 2024-Apr 2025) using a questionnaire for sociodemographic and ethnobotanical assessments. Only medicinal plant users (248) completed it. Data was analyzed using SPSS (v. 27.0), employing Spearman's correlation. Results: The population was mainly female (51.6%), illiterate (66.5%) and had no income (79.4%). MP consumption is very high, with 76.8% using them for their ESRD, particularly those aged 60 and over. Fifty-three MP species were identified (e.g., Lamiaceae, Apiaceae), including Allium sativum and Moringa oleifera, mostly used in decoction. The type of medicine used, traditional or combined, was significantly associated with age (r = -0.245, p<0.001), educational levels (r = 0.141, p = 0.026), monthly income (r = 0.210, p = 0.001) and social security coverage (r = 0.167, p = 0.008). Conclusion: Medicinal plant use is frequent among older, low-income hemodialysis patients in northern Morocco. However, the misuse of these plants poses significant health risks, including potential kidney damage and adverse interactions with prescribed medications. This underscores the urgent need for targeted awareness campaigns to educate patients about the safe use of medicinal plants and to mitigate these risks.

Background: Traumatic brain injury (TBI) remains a leading cause of death and disability worldwide, requiring accurate early imaging for diagnosis and prognosis. While computed tomography (CT) is the first-line modality for detecting acute lesions, magnetic resonance imaging (MRI) offers greater sensitivity to diffuse and subtle injuries. Objective: To evaluate and compare the diagnostic and prognostic value of CT and MRI in adult TBI patients and determine optimal imaging timing for outcome prediction. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases including PubMed, Scopus, and Web of Science were searched for studies from 2015–2025 assessing CT and MRI for TBI diagnosis and prognosis. Pooled sensitivity, specificity, odds ratios, and confidence intervals were calculated using a random-effects model. Results: Among 62 eligible studies (n = 4,387 patients), CT demonstrated high sensitivity (0.82, 95% CI: 0.74–0.89) for acute hemorrhagic and skull injuries but limited detection of microstructural damage. MRI achieved higher sensitivity (0.91, 95% CI: 0.85–0.96) and prognostic accuracy, particularly for diffuse axonal and brainstem injuries. Early MRI (within 72 hours) significantly improved prediction of 6-month outcomes compared with delayed imaging (OR: 3.12, 95% CI: 2.41–4.65). Conclusion: MRI provides superior prognostic information and should complement CT within the first 72 hours after injury for optimal patient stratification. Integrating both modalities can enhance diagnostic precision, guide rehabilitation, and improve long-term outcomes in TBI care.

Introduction: Effective leadership is essential to guaranteeing precise diagnosis, prompt results and top-notch patient care in the hectic and strictly controlled world of hospital laboratories. In addition to overseeing technical operations and compliance, laboratory leaders are also responsible for motivating and assisting interdisciplinary teams. Leadership styles must change along with healthcare. Aims: This study aims to investigate how task and relationship leadership styles affect the hospital labs. Methods: A variety of data collection techniques, including questionnaires, in-depth interviews, focus groups and non-participant observations, were used in a mixed method study with a sequential design. Results: Total number of ninety-nine (n = 99) Medical Laboratory Employees (MLS) (response rate: 66%) answered the leadership behavior questionnaire (LBQ) in the first phase of the quantitative data. In phase two, 96 hours were spent conducting in-depth interviews with 17 MLS selected through purposive sampling, conducting focus groups with 10 MLS in total and gathering observational data. Phase 1 showed that the two laboratories' MLS scores differed. In general, the qualitative findings' information supported and clarified the quantitative data's conclusions. Effective leadership, the effects of ineffective leadership and leadership problems on medical laboratory services were the three primary themes found in the phase two qualitative findings. Conclusion: The results revealed a range of leadership behavior scores, indicating the necessity of standardized management and leadership programs to ensure that all laboratories operate at the same high standard. The diversity of professionals, inadequate communication, collaboration and cultural concerns are just a few of the difficulties that the leaders of these medical laboratories must deal with.

Background: Artificial Intelligence (AI) has the potential to transform healthcare; however, its implementation faces ethical and perceptual barriers among different stakeholders. This study examined some of these stakeholders’ attitudes toward AI in healthcare, including those with medical sciences, computer science/information technology (IT) backgrounds, as well as the general public from other backgrounds. Methods: A cross-sectional survey was conducted in Tabuk, Saudi Arabia, from November 24, 2024, to May 15, 2025. A validated 43-item questionnaire assessed demographics, technology affinity, AI familiarity, and attitudes. Data analysis included descriptive statistics, chi-square, and Kruskal-Wallis tests. Results: Among 581 participants (mean age 31.24, 52.8% male), 15% were of medical background, 18.2% from the computer science/IT field, and 66.8% represented the general public. Technology affinity and AI familiarity were highest among the computer science/IT group, followed by the medical sciences group and then the general public (p<0.001). Significant attitude differences emerged on nine of 26 items, with a clear divide between them regarding ethical issues and patient safety potentials, as the medical sciences group disagreed on the liability in the case of harm. All groups agreed on the necessity of physician oversight. The computer science/IT group showed the most positive sentiment, followed by the general public from other backgrounds, while the medical sciences group showed the greatest caution (p<0.001). Conclusions: This study suggests that those with a medical sciences background, although they have a higher technology affinity than the general public, are more cautious toward AI, while those with an IT background are the most optimistic. It also highlighted the gaps that need to be addressed to bridge the divide between these stakeholders, including the development of clear policies governing medicolegal and ethical issues.

Background: Academic stress is a common challenge faced by pre-university students, typically stemming from factors like high expectations, demanding coursework and peer competition. This type of stress can have detrimental effects on both mental health and academic performance, making it essential to find effective methods for managing stress. Aim of the Study: The study aimed to evaluate the effectiveness of stress management strategies on academic stress and biochemical marker among pre university students in selected colleges. Methods: The study adopted a quasi-experimental design, conducted at the Government Pre-University College in Bidadi, Karnataka. The study involved 200 students, divided into an experimental group (100) and a control group (100), selected through non-probability convenient sampling. The experimental group underwent an eight-week stress management program focused on enhancing psychological resilience, while the control group followed their usual academic routine. Academic stress levels were evaluated using the Perceived Stress Scale (PSS) and the Academic Stress Scale (ASS), while salivary cortisol levels were measured as a biological indicator. Data was collected at the start of the study, after four weeks and after eight weeks. Results: The study revealed significant reductions in both academic stress and perceived stress (p<0.001) in the experimental group compared to the control group. Furthermore, post-test cortisol levels were markedly lower in the experimental group (t = 3.665, p<0.001), demonstrating the effectiveness of the intervention. Conclusion: The findings suggest that stress management strategies are highly effective in reducing academic stress and cortisol levels among pre-university students.

This case report describes an exclusively breastfed (EBF) infant who did not defecate for over two weeks but remained healthy and resumed regular bowel movements without medical intervention. The goal is to highlight the importance of recognizing normal variations in stooling patterns among breastfed infants and to emphasize pediatricians' role in carefully assessing abnormal stool changes during routine well-baby visits. Although similar benign cases of infrequent stooling in EBF infants have been reported, they remain rare. This report provides a detailed description of the full clinical course, reinforcing that careful observation and reassurance are often enough when there are no warning signs. Awareness of such benign presentations helps healthcare providers distinguish harmless stooling delays from early signs of true gastrointestinal disorders, thereby avoiding unnecessary investigations and reducing caregiver anxiety. Overall, the report emphasizes that infrequent stooling in healthy, exclusively breastfed infants can occur without an underlying illness.