Magnetic Resonance Imaging (MRI) is a crucial imaging modality for evaluating gynecological pelvic disorders particularly those affecting the uterus, such as uterine fibroids. However, visualizing small uterine fibroids (less than 3 cm in diameter) can be challenging due to poor lesion conspicuity, image noise and low local contrast. This study evaluated the impact of digital image enhancement techniques on the visibility of small uterine fibroids in MRI images. The study included three patients with uterine fibroids smaller than 3 cm, utilizing 81 selected images from MRI sequences. These images were processed using Gaussian filtering followed by three independent enhancement methods: Laplacian edge sharpening, Contrast Limited Adaptive Histogram Equalization (CLAHE) and Discrete Wavelet Transform (DWT). Three experienced radiologists independently evaluated both the original and the corresponding enhanced images using a visual rating scale ranging from 1 lowest to 10 highest, where higher scores indicated improved lesion visibility. Inter-rater agreement and reliability were assessed using the Intraclass Correlation Coefficient (ICC) and weighted Cohen’s kappa, while repeated-measures analysis was employed to account for the repetitive nature of the evaluations. The results demonstrated a generally good-to-high level of inter-rater agreement and reliability, with Intraclass Correlation Coefficient (ICC) values ​​ranging from 0.717 to 0.887. Weighted Kappa values ​​also indicated moderate-to-high agreement between pairs of raters. Repeated-measures analysis revealed statistically significant differences in ratings based on the rater and the imaging sequence, whereas the interaction between the rater and the imaging sequence was not statistically significant. These findings suggest that digital image enhancement may improve the visibility and prominence of small uterine fibroids on MRI scans. However, given that the study included only three patients and did not employ an independent diagnostic reference standard, these results are preliminary and should not be interpreted as evidence of improved diagnostic accuracy.

Background: Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are clinically distinct disorders in which inflammatory and oxidative processes may contribute to symptoms and tissue injury. The Nrf2-Keap1 system is an important regulator of cellular antioxidant responses but circulating biomarker changes do not by themselves establish pathway-mediated clinical effects. Objective: To compare clinical, biochemical, inflammatory and short-term radiological outcomes among adults with OA or RA receiving standard arthritis therapy alone versus standard therapy supplemented with silver nanoparticles (AgNPs) and to examine changes in biomarkers related to oxidative stress and Nrf2-associated signaling. Methods: This prospective comparative study included 255 adults with clinically confirmed OA or RA. Participants were consecutively recruited and categorized according to the therapeutic approach received: standard therapy alone (n = 128) or standard therapy supplemented with AgNPs (n = 127). No random allocation is described in the submitted study record. Clinical outcomes included VAS pain, WOMAC for OA and DAS-28 for RA. Oxidative-stress, antioxidant, inflammatory and Nrf2-related biomarkers were assessed using the reported laboratory methods. Radiological assessment was performed at baseline and after 12 weeks. Safety monitoring included routine hematological, hepatic and renal assessments. Results: In the submitted dataset, VAS pain decreased from 7.4±1.1 to 3.1±1.4 in the AgNP group and from 7.3±1.2 to 5.4±1.6 in the standard-therapy group (reported p<0.001). Among OA participants, the manuscript reports a 48.6% improvement in WOMAC with AgNP supplementation versus 22.3% with standard therapy. Among RA participants, the reported DAS-28 reduction was 2.1±0.6 versus 1.0±0.5, respectively (p<0.001). Nrf2, HO-1, SOD and catalase were reported to increase more in the AgNP group, while MDA, TNF-α, IL-6 and CRP decreased. Short-term radiological stabilization/improvement was reported in 39.5% versus 18.2%. These findings require confirmation with complete baseline/follow-up values, confidence intervals, disease-specific analyses and verification of the original statistical output. Conclusion: AgNP-augmented therapy was associated with greater short-term clinical and biochemical changes than standard therapy alone in this prospective comparative cohort. However, because treatment allocation was non-randomized, follow-up was limited to 12 weeks and important nanoparticle, molecular, imaging and statistical details require verification, the findings should be considered preliminary. The observed Nrf2-related biomarker changes support further mechanistic investigation but do not establish a causal Nrf2-Keap1 mechanism or long-term disease modification.

Background: Obesity is a major contributor to the development and progression of type 2 diabetes mellitus (T2DM). Although lifestyle modification remains the cornerstone of management, sustained weight loss is often difficult to achieve. The intragastric balloon has emerged as a minimally invasive adjunctive therapy to enhance weight reduction and improve metabolic outcomes. Objective: To evaluate the effectiveness of intragastric balloon therapy as an adjunct to lifestyle modification in achieving weight loss and improving glycemic control in patients with obesity and T2DM. Methods: This prospective interventional study included 255 adult patients with obesity (BMI ≥30 kg/m²) and established T2DM. All patients underwent endoscopic intragastric balloon placement combined with structured dietary, physical activity, and behavioral counseling. The balloon was removed after six months. Patients were followed for 12 months. Primary outcomes were percentage total body weight loss (%TBWL) and change in HbA1c at six months. Secondary outcomes included fasting blood glucose, BMI reduction, medication adjustments, and safety outcomes. Results: The mean baseline BMI was 34.8±3.9 kg/m² and mean HbA1c was 8.4±1.2%. At six months, mean %TBWL was 14.5±3.6%, and BMI decreased to 29.7±3.2 kg/m². HbA1c improved significantly to 7.1±0.9%. At 12 months, sustained %TBWL of 11.9±3.4% was observed, with HbA1c maintained at 7.3±1.0%. A total of 89.8% achieved ≥5% weight loss, and 65.9% required reduction in antidiabetic medications. Early intolerance symptoms occurred in 24.3%, while 4.3% required premature balloon removal. No major complications were reported. Conclusion: Intragastric balloon therapy combined with lifestyle modification resulted in significant weight loss, improved glycemic control, and reduced medication requirements with an acceptable safety profile. It represents an effective intermediate option between conservative therapy and bariatric surgery for patients with obesity-related T2DM.

Background: Sustainable dentistry aims to reduce the environmental impact of oral healthcare while maintaining patient safety and quality of care. Understanding dental professionals’ awareness, attitudes and implementation needs can inform efforts to promote environmentally responsible practice. Aim: To assess knowledge, attitudes, practices, perceived barriers and willingness to adopt sustainable dentistry among dental professionals in Saudi Arabia. Methods: A cross-sectional online survey recruited 306 dental professionals through social media platforms and professional dental societies. A structured, self-administered questionnaire assessed demographic characteristics, sustainability awareness, attitudes, reported practices, perceived barriers and willingness to adopt sustainable measures. Descriptive statistics summarized participants’ responses. Results: Awareness regarding sustainable dentistry concept was reported by 79.7% of participants. Positive attitudes were common: 87.6% agreed or strongly agreed that sustainable dentistry should be prioritized, 91.2% supported incorporating sustainability training into dental curricula and 82.0% believed sustainable practices could be implemented without compromising patient care. Willingness to invest in eco-friendly equipment and materials despite higher costs was reported by 61.8%. Overall, 78.8% expressed willingness to participate in sustainability training and 86.0% indicated that financial incentives would encourage adoption. However, only 48.4% reported existing workplace support for sustainability initiatives. Conclusion: Respondents reported substantial familiarity with sustainable dentistry, favorable attitudes and strong willingness to undertake training. Integrating sustainability into dental education and continuing professional development, alongside financial and institutional support, may help translate this willingness into routine practice.

Background: Adolescence and young adulthood are high-risk phases in type 1 diabetes mellitus (T1DM). Age-related differences in glycemic control, insulin practices, complications, and comorbidities remain insufficiently characterized. This study compared glycemic control, management practices, complications, and comorbidities between adolescents and young adults with T1DM in Hail, Saudi Arabia. Subjects & Methods:  In this cross-sectional study, we recruited 302 participants with T1DM from endocrinology outpatient clinics in the Hail region: 152 adolescents aged 10–18 years and 150 young adults aged 19–35 years. Data was collected through interviews and medical record review. Clinical, behavioral, and metabolic variables were compared between groups. Results: Adolescents had poorer glycemic control, with HbA1c ≥9.1% more common than in young adults (28.9% vs 15.3%, p<0.001), despite their higher use of continuous glucose monitoring (89.5% vs 76.0%, p=0.001). Young adults had higher BMI (26.38±4.79 vs. 21.45±5.62, p<0.001), higher rates of overweight/obesity, greater insulin omission (28% vs. 16.4%, p=0.043), and higher rates of recurrent hypoglycemia (>3 episodes: 52.0% vs. 27.6%, p<0.001). Chronic complications and psychological comorbidities were also more frequent in young adults. Conclusions: Distinct age-related risk profiles were identified among individuals with T1DM. Adolescents were particularly vulnerable to poor glycemic control despite greater use of modern monitoring devices, whereas young adults carried a greater burden of insulin omission, obesity, recurrent hypoglycemia, chronic complications, and psychological comorbidities. These findings support age-specific multidisciplinary interventions and structured transition care to improve long-term outcomes.

Objective: The main aim of this expreimental research study is to explore the impact of Betel Quid (BQ) on the Histopathological and morphometric alterations in the liver of adult mice (Swiss albino mice), focusing on discerning any significant  differences  in  Histomorphometric  effects  between  the  application  of  Betel Quid with and without tobacco. Methods: This study was conducted as an controlled experimental animal investigation at the Department of Anatomy and Postgraduate Laboratory of Isra University over a period of six months, involving the selection of 30 adult mice (Swiss albino mice) of varying genders. Inclusion criteria for the sample population consisted of healthy male mice weighing between 25-40 grams and healthy female mice weighing between 20-40 grams, aged between 3-6 months. Exclusion criteria included unwell mice,  offspring,  moribund  specimens,  pregnant  mice,  underweight  and  malnourished  mice. Following a 30-day period of administering appropriate nutrition to each mouse, euthanasia was performed via cervical dislocation. Subsequently, the livers were extracted, rinsed with normal saline, assessed for gross morphological parameters (such as weight and size) and any Histopathologic macroscopic abnormalities were documented (such as Infiltration, necrosis, fatty cahnges and more). The livers were then fixed in 10% formalin for a duration of 48 to 60 hours. Histological observations were conducted on 4-micron-thick liver sections stained with Haematoxylin and Eosin using standard paraffin embedding techniques. The animals were categorized into three main groups, each consisting of 10 mice: 1: Control group A (n = 10) received a standard diet and clean water, 2: Experimental group B (n = 10) received a standard diet supplemented with BQ containing tobacco, 3: Experimental group C (n = 10) received a standard diet supplemented with BQ without tobacco. Each of these groups was further divided into two subgroups of 5 male and 5 female mice each for more detailed analysis. Results: The result revealed significant Histopathologic and morphometric effects in the livers of adult mice when comparing the control group A with the experimental group B who chewied Betel Quid with tobacco, group C who chewied Betel Quid alone without adding of tobacco, Both experimental groups induced statistically significant hepatic alterations compared to the control group (Group A, p = 0.001). Both treated cohorts exhibited marked reductions in overall body weight and liver weight (Group B 1.18±0.13 g, Group C 1.33±0.04 g, while the Control group A 1.63±0.04 g, p = 0.001). Histopathological evaluation revealed extensive liver tissue damage across both experimental groups, characterized by significantly elevated rates of inflammatory infiltration, fatty changes, necrosis and collagen fiber fibrosis (p = 0.001 for all parameters versus control). Direct comparison between the exprimental Groups B and C showed that tobacco co-administration resulted in a significantly greater loss in liver weight (p = 0.004), a similar outcome was observed in the comparison between control and experimental group B (mostly with p-value 1.000). Furthermore, no significant discrepancy was identified when comparing Histopathologic and morphometric effects between group C and group B in both genders (p>0.05). In conclusion, it was determined that the consumption of BQ, with or without tobacco, induced similar significant effects on the livers of mice, notably affecting liver weight, degenerative alterations, fatty changes, necrotic manifestations, modifications in collagen fibers, liver infiltration changes and overall body weight. The comparative analysis between the two experimental groups led to the conclusion that the consumption of Betel Quid alone carries comparable risks to its consumption in conjunction with tobacco.

Background: Education may play a role in digital health adoption. Yet, how exactly it influences the Technology Acceptance Model (TAM) among existing users of virtual healthcare consultation apps is not clear in India. This paper explores whether different levels of education change the effects of main TAM variables on the acceptance of virtual healthcare apps by the people of West Bengal, India. The study focuses on existing users of virtual healthcare consultation apps. Methods: This quantitative cross-sectional study collected data from 341 individuals from three education groups through online-only recruitment. The study used a 19-item questionnaire adapted from validated TAM, technology acceptance and telehealth studies on virtual healthcare app usage and purposive stratified sampling was used to ensure group representation. After assessing reliability, validity and measurement invariance, multi-group structural equation modelling in IBM AMOS 20.0 was used to test five moderation hypotheses. Results: The measurement model across the three education groups produced the results of reliability and validity within acceptable limits. Configural and metric invariance were both supported. However, the structural weights model demonstrated a significant chi-square difference which pointed to path coefficients varied across the groups. Education significantly moderated the influence of attitude on behavioural intention (Δχ² = 18.063, df = 2, p<0.001) and the influence of behavioural intention on actual use (Δχ² = 15.789, df = 2, p<0.001). The effects of trust on attitude, perceived usefulness on attitude and perceived ease of use on attitude were not significantly moderated by education. Conclusion: Education level significantly moderated two of the five TAM pathways examined: The relationship between attitude and behavioural intention and the relationship between behavioural intention and actual use. The relationships from trust, perceived usefulness and perceived ease of use to attitude were not significantly moderated by education. Therefore, in digital health research, education factor evaluation when considering TAM pathways across user groups should not be overlooked.

Metabolic syndrome is a complex condition that includes obesity, high blood pressure, unhealthy cholesterol levels, and insulin resistance. It poses some serious public health problems across the globe, and in Saudi Arabia these issues are quite acute. Through synthesis of some epidemiological studies, clinical trials, and public health reports, this review provides an overview of the burden of metabolic syndrome among the Saudi community. The data point out a worrisome trend: There is increasing MS in Saudi Arabia. Such an increase is also correlated with things like urbanization, a sedentary lifestyle, and dramatic transformations to diets that contribute to our reliance on high-calorie and processed foods. In addition to posing risks to individual health, in Saudi Arabia, these trends pose serious obstacles to our healthcare system. In order to understand metabolic syndrome, we need insight into its multitude of risk factors. This review examines genetic factors that may predispose some people to MS in addition to local culture influences. In this context, traditional notions regarding exercise and diet are a big part of the picture. For example, the consumption of fatty and sugary diets (in conjunction with a loss of physical activity) has adversely affected the health of the population. The review also identifies existing treatment modalities for the prevention, diagnosis, and management of metabolic syndrome. It highlights the need for culturally relevant interventions, aligned with local values, to be received by those in greatest need. The strong national health policy is one way to avoid the consequences including metabolic syndrome and its cardiovascular risks and play a critical role in an integrated healthcare system. In the end, this synthesis will be a key insight for public health practitioners, policy makers, and researchers. It supplies the necessary information to guide decision-making on metabolic syndrome in Saudi Arabia which provides insights for action on decisions and formulation of strategies. Effective health policies and appropriate solutions to the changing trends of metabolic syndrome will help in preventing social and economic suffering among a healthier future for the citizens of the country.

Mustard—specifically the Brassica nigra L. variety—is a crop of industrial significance, as its seeds are renowned for containing between 41% and 48% high-quality oil. Amidst global climate change, there is an urgent need to utilize humic acid to enhance mustard growth. In this context, a field experiment was conducted in Babylon Governorate, Iraq, during the 2024–2025 growing season to investigate the effects of compound fertilizer (NPK) and organic fertilizer (humic acid) on the growth and productivity of black mustard, employing a Randomized Complete Block Design (RCBD) with three replicates. Using variance analysis and means comparison with the LSD test at a probability level of 0.05, the results showed that the foliar application of humic acid had a significant impact on the growth parameters of black mustard. A 3x3 two-factor experiment was conducted. Adding a balanced NPK complex fertilizer (20:20:20) was the first factor. In two batches, the first two weeks following germination and the second when blooming starts, at concentrations of (0, 30, or 60) kg/dunum. . After placing the fertilizer in the furrows approximately 10 cm beneath the plant and covering it with dirt, the plant was watered. Spraying three different quantities of organic fertilizer (humic acid) (0, 2, or 4) ml.l-1 was the second factor. It was observed from the results that adding NPK complex fertilizer and organic fertilizer (Humic acid) has a significant effect on the characteristics of vegetative growth, as is evident from the fact that the levels of NPK complex fertilizer and spraying with organic fertilizer (Humic acid) have a significant effect on the productive characteristics of the plant The experiment's conclusion is that the 60 kg overlap treatment is the most efficient way to feed the black mustard plant under the given circumstances, and it produced the best outcomes in terms of enhancing the plant's vegetative and productive qualities. 1 dunam-1 NPK with three 2 ml sprays.l-1 of organic fertilizer (Humic acid), which increased the features of vegetative development and delivered the greatest rate of mustard number. Plant-1 and seed count.  Mustard-1 and seed weight. Plant-1 and the amount of seed yield per dunum. application of 45 ppm humic acid with 60/kg – per dunum (per 2500 square meters) would be the best option to maintain better growth, yield and quality in black mustard.

Background: Surgical site infection (SSI) remains a common complication following appendectomy. Although preoperative antibiotic prophylaxis is routinely recommended, it remains unclear whether continuing antibiotics postoperatively reduces SSI beyond a single preoperative dose, or whether prophylaxis can be omitted in low-risk patients, particularly in uncomplicated (non-perforated) appendicitis, where postoperative antibiotics serve no therapeutic role. This systematic review compared these strategies for preventing SSI in adults undergoing appendectomy. Methods: A systematic search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar was performed for studies published between January 2015 and December 2025. Studies involving adult patients undergoing open or laparoscopic appendectomy that evaluated preoperative antibiotic prophylaxis and reported SSI outcomes were eligible for inclusion. Randomized controlled trials and observational studies were included, whereas pediatric studies, case reports, editorials, conference abstracts, and studies evaluating antibiotics solely for therapeutic purposes were excluded. The review followed PRISMA 2020 guidelines. Risk of bias was assessed using RoB 2 for randomized trials, ROBINS-I for non-randomized studies, and the Newcastle–Ottawa Scale for cohort studies. Owing to heterogeneity in antibiotic regimens, comparators, and study designs, findings were synthesized narratively. The protocol was not registered. Results: Thirteen studies met the inclusion criteria. Given clinical and methodological heterogeneity, no meta-analysis was performed. Ten studies compared single-dose preoperative prophylaxis with prolonged postoperative antibiotic regimens, while three evaluated prophylaxis versus no prophylaxis in selected patient populations. Across studies, extending antibiotics into the postoperative period did not result in a consistent reduction in SSI compared with a single preoperative dose, irrespective of operative approach. Several studies reported increased healthcare costs, longer hospital stay, or greater antibiotic exposure with prolonged regimens. In the three studies evaluating omission of prophylaxis, all in highly selected populations, SSI rates did not differ significantly with or without prophylaxis; however, event numbers were small and the findings are not generalizable. Conclusions: In adults with uncomplicated or non-perforated appendicitis, limited evidence of variable quality suggests that a single preoperative dose may be adequate, as postoperative continuation did not consistently reduce SSI and may increase unnecessary antibiotic use. These findings should not be extrapolated to complicated appendicitis, and evidence supporting omission of prophylaxis is restricted to highly selected low-risk patients.

Background: The association between the maxillary denture-bearing area and the greater palatine neurovascular bundle may be affected by anatomical variation of the Greater Palatine Foramen (GPF). Using Cone-Beam Computed Tomography (CBCT), this study assessed GPF and greater palatine canal measures and looked at how they varied by side, gender and age. Methods: Seventy CBCT scans from 30 men and 40 women who were at least 18 years old were included in this retrospective cross-sectional investigation. The scans were selected from a private radiology archive during January 2025 and January 2026. Ninety-three eligible consecutive scans were selected among which 23 cases were excluded and 70 patients were included. One-hundred and forty foramina were obtained from the evaluation of both sides. Multiplanar reconstructions were used to quantify the canal emergence angle, GPF-to-midpalatal suture distance and GPF-to-alveolar crest distance. Paired-samples t-tests were used to compare bilateral measurements. Independent-samples t-tests and patient-level bilateral means were used to compare gender and age groups. Relationships between measurements were evaluated using Pearson correlation. Results: The canal emergence angle was 123.69±8.23°, the GPF-to-midpalatal suture distance was 13.02±1.68 mm and the GPF-to-alveolar crest distance was 12.42±3.37 mm. The left side had a considerably larger GPF-to-alveolar crest distance than the right (12.71±3.27 versus 12.12±3.47 mm; p = 0.009). Additionally, it was considerably higher in patients between the ages of 18 and 49 than in those 50 years and over (13.22±3.20 versus 11.66±3.14 mm; p = 0.043). There was little side-to-side variation in midpalatal distance and emergence angle. There were no discernible relationships between measures or gender differences. Conclusion: There was significant individual diversity in GPF anatomy. Its association to the alveolar crest was impacted by age and anatomical side. When current CBCT imaging is clinically available for examination, patient-specific assessment may promote proper maxillary full denture contouring and lessen pressure on the greater palatine neurovascular area.

Background: One of the main causes of injury around the world is osteoarthritis (OA) of the knee. Lifestyle factors that can be changed; like being overweight; physical inactivity, smoking, and unhealthy diet, may be very important in deterioration of knee osteoarthritis (KOA), especially when combined with risk factors that can't be modified, like age, sex, genetics, and a history of injury. Aim: Our objectives were expression of the risk factors for KOA both modifiable and non-modifiable. We also want to see how these risk factors are linked to a poor lifestyle and the prevalence of KOA among Saudi and Egyptian populations. Methods: A cross-sectional survey will be distributed throughout Saudi and Egyptian participants between November 2025 to January 2026. An online questionnaire was designed, it includes informed consent of participants, sociodemographic data, questions about knee osteoarthritis, poor lifestyle, modifiable and non-modifiable risk factors. Data was collected through online questionnaires or interviews with people. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS Inc, Chicago, IL, USA, version 25). Results: The prevalence of KOA was nearly the same in both nations (29.6% Saudis vs. 31.5% Egyptians). Two thirds of participants from males (65%) from each nation, the average age was 35.0±0.74 (Saudis) and 44.5±2.07 (Egyptians) which was significantly different at p-value 0.001. Most of them from 20-40 years (56% Egyptians vs. 72.2% Saudis), in addition, about 22.5% who were more than 60 years-old from Egyptians vs. 8.6% Saudis. Obese participants were found among Saudis (29.6%) vs Egyptians (23.7%) at p-value = 0.010. The family history of knee pain was more among Saudis (28.6%) vs 11% of Egyptians, also, genetic joint disorder (12.5% Saudis) vs. 6.5% in Egyptians (at p-value = 0.017). The main factor to knee osteoarthritis previous knee injury and aging in Egyptians (28.7% and14.6%) vs. Saudis (7.3% and 11%) at p-value= 0.023. Egyptians were suffering from knee OA mainly at adult and old age of 31-60 years (24.8%), while Saudi participants suffered from KOA from young age at 20 years (p = 0.033). Egyptians was found to perform activities that put stress on the knees in running more than Saudis (p = 0.037), while Saudis more in weightlifting and squatting. Sedentary was found more among Saudis, while high level of physical activity such as football and running was found among Egyptians. Consuming fresh vegetables and fruits and whole grains (64.5% Egyptians vs 51.2% Saudis). On the other hand, poor lifestyle, Saudis consumed more sugars, carbohydrates, and fats (74.4%) vs Egyptians (57.7%) at p = 0.041. Conclusion: This study compared between Saudis and Egyptians in the prevalence of KOA (which not significantly different), and the modifiable and non-modifiable risk factors related to the KOA symptoms. The most effective plans to prevent KOA were some positive changes in lifestyle like encouraging physical exercises and some active duties and decreasing sedentary lifestyle. Also, controlling BMI, through healthy diets like vitamins, vegetables, fruits, and avoiding fast food, more sugars and carbohydrates. Protective policies should be applied at a young age and awareness at schools to prevent obesity in childhood. So, this study provided some respected insights for healthcare providers, physicians and consultants who are dealing with KOA in Saudi Arabia and Egypt.

Objectives: Fibromyalgia Syndrome (FMS) is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive dysfunction and psychological distress. Epidemiological evidence from Saudi Arabia remains limited and heterogeneous. Objective: To synthesize evidence on the prevalence of fibromyalgia in Saudi Arabia and identify associated demographic, psychological, lifestyle and clinical factors. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Embase and Google Scholar were searched for articles published before 30th June 2026, with no restriction on the earliest publication date. Eligible studies evaluated fibromyalgia prevalence or associated factors among participants in Saudi Arabia using established diagnostic or screening criteria. Prevalence estimates and associated demographic, psychological, lifestyle and clinical factors were synthesized. Results: The included studies represented diverse community, university, occupational and patient populations with selected clinical conditions. The pooled prevalence was 11.2% (95% CI, 9.09%-13.73%), with substantial between-study heterogeneity (I² = 87.16%). Female sex, anxiety, psychiatric illness, sleep disturbances, chronic comorbidities and lifestyle and occupational factors were associated with fibromyalgia. Variations in diagnostic criteria, sampling strategies and population characteristics may have contributed to heterogeneity. Conclusion: Fibromyalgia was prevalent across the populations studied; however, the diversity of the included populations limits interpretation of the pooled estimate as a nationally representative prevalence for Saudi Arabia. However, its occurrence is associated with demographic, psychosocial, clinical and lifestyle factors. Standardized diagnostic criteria and longitudinal studies are needed to improve the comparability of evidence and clarify associated factors.

Background: Active learning strategies are essential in health professional education. Three novel educational puzzle formats: (1) Diagnostic Riddles, (2) Clinical Case Puzzles and (3) Medical Crosswords-were designed, implemented across four subject areas and comparatively evaluated among undergraduate health professional students as teaching and formative assessment tools. Methods: A within-subject (repeated-measures), comparative observational study (January-December 2025) enrolled 164 second-and third-year undergraduate students from the health sciences colleges of the University of Hail, Saudi Arabia. A pre-validated 30-item Likert questionnaire assessed perceptions across seven domains. Statistical analysis included descriptive statistics, repeated-measures ANOVA (or linear mixed-effects model), paired post-hoc comparisons with correction for multiple comparisons and chi-square/Cochran's Q tests as appropriate (IBM SPSS v.20). Results: Response rate was 100% (n = 164). Clinical Case Puzzles (Type 2) achieved the highest overall mean satisfaction score (4.84±0.36),  followed  by  Diagnostic  Riddles (Type 1; 4.77±0.41)  and  Medical  Crosswords (Type 3; 4.63±0.48). One-way ANOVA revealed significant inter-format differences (F (2,489) = 8.42, p = 0.0002, η² = 0.033). Post-hoc Tukey HSD confirmed Type 2 was significantly preferred over Type 3 (p<0.001). Chi-square analysis confirmed that curriculum inclusion preference was significantly associated with puzzle format (χ² = 12.34, df = 2, p = 0.002). [EDITOR/AUTHOR NOTE: The F-, p- and χ²-values above were computed treating repeated observations from the same students as independent (one-way ANOVA/ordinary chi-square). Per Reviewer Comments 32-39 and 41-42, these must be recalculated using a repeated-measures ANOVA or linear mixed-effects model (and, if applicable, a repeated-measures categorical method) before resubmission; the values here are retained from the original submission pending that reanalysis]. Conclusions: All three puzzle formats were highly rated and positively perceived active learning tools. Clinical Case Puzzles are most strongly endorsed for formative assessment; Diagnostic Riddles are optimal for vocabulary and lower-order recall; Medical Crosswords were designed to target higher-order clinical reasoning, although this was not independently measured in the present study. A tiered, format-differentiated implementation strategy is recommended for health sciences curricula.

Objectives: Tuberculosis (TB) remains among the top 10 causes of death globally. A total of 1.23 million people died from TB in 2024. Accurate and timely identification of TB is essential to initiate anti-TB medication promptly. Aim: This study aims to evaluate the diagnostic performance of Ziehl-Neelsen staining and the GeneXpert MTB/RIF assay for detecting Mycobacterium tuberculosis in clinical samples and to analyze the phylogenetic relationships of the gyrA and gyrB genes from a local isolate in Mosul, Iraq, with 15 other global isolates. Methods: 190 sputum and other clinical samples were analyzed using Ziehl-Neelsen staining, GeneXpert assay and PCR detection of gyrA and gyrB genes. Results: Of the 190 tuberculosis-suspected patients, 49 samples tested positive by the GeneXpert method and 43 samples tested positive using Ziehl-Neelsen staining method. Sequence analysis of the gyrA (OQ955242.1) and gyrB (OQ955243.1) genes from the local isolates (Mosul, Iraq) showed limited sequence variation compared with 15 global strains in the NCBI database. Conclusion: GeneXpert MTB/RIF is a highly sensitive and accurate method for detecting Mycobacterium tuberculosis in clinical samples compared with Ziehl-Neelsen staining. gyrA and gyrB genes of the local Mycobacterium tuberculosis isolate are closely related to global strains.

Background: Artificial intelligence (AI) models are increasingly evaluated for diagnosis in medical imaging and pathology, but reported performance depends on validation strategy. Methods: PubMed, Embase, Cochrane Library, IEEE Xplore and Web of Science were searched for open-access English-language studies from January 2021 to February 2026 reporting the area under the receiver operating characteristic curve (AUC) of a diagnostic AI model. AUC values were summarized descriptively by validation strategy, architecture and modality. Studies with 2×2 data from an external validation set were pooled with a bivariate random-effects model. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: Of 1,503 records screened, 170 studies (one model each) were included. AUC was ≥0.90 in 119 studies (70.0%); mean AUC was 0.945 (internal and external validation), 0.929 (internal), 0.912 (external) and 0.798 (four randomized trials). Seven externally validated studies of unrelated conditions provided 2×2 data (summary sensitivity 92.1% (95% confidence interval 88.5–94.6), specificity 90.1% (81.3–95.0); wide prediction region). Risk of bias was frequently unclear (patient selection 71.8%, flow and timing 64.7%). Conclusions: High reported AUC values reflect discrimination in selected, mostly retrospective datasets and do not establish clinical effectiveness or readiness for routine use.

Background: Plantar fasciitis (PF) is a common and potentially debilitating cause of chronic plantar heel pain involving the plantar fascia and its surrounding structures. Radial extracorporeal shock wave therapy (rESWT) is widely accepted as a non-invasive treatment modality. Aim of Study: To determine the effectiveness of rESWT compared with physiotherapy in controlling pain intensity and functional stability in people with chronic PF. Methods: Patients who suffered from unilateral chronic PF and met the inclusion criteria were recruited to participate in this prospective randomized controlled trial (November 2022–November 2025). Patients were randomly assigned to two groups: group A (GA) received rESWT, and group B (GB) received physiotherapy. Pain intensity was the primary outcome measured by the visual analogue scale (VAS), and the American Orthopedic Foot and Ankle Society (AOFAS) score was the secondary functional outcome. Data were collected based on the AOFAS clinical classification system and VAS. These data were then statistically analyzed using SPSS version 27.0 (IBM Inc., Chicago, IL, USA). Results: In total, 296 patients who fulfilled the inclusion criteria remained for the final assessment; allocated equally, with 148 patients in each group. Their mean age was 46.3 years, with female predominance (77%). Both treatment groups showed significant within-group improvements in VAS and AOFAS scores from baseline to post-treatment (p<0.0001). The mean VAS decreased from 8.6 to 3.6 in GA and from 9.1 to 4.1 in GB, showing an equal average decrease of 5.0 points in both groups. AOFAS scores also improved considerably within-group in both groups, improving from 42.2 to 85.6 in GA and from 42.9 to 84.8 in GB. On the other hand, there was no significant difference in the between-group change in VAS (p = 0.637) and AOFAS scores (p = 0.663). Conclusion: Both rESWT and PT showed considerable improvements in pain and foot function among patients with chronic PF. Neither one had a better outcome than the other.

Background and Aim: Primary school teachers play a critical role in identifying and managing students with Attention-Deficit/Hyperactivity Disorder (ADHD), yet many lack adequate training. This deficit can hinder effective classroom management and lead to poor education outcomes for affected children. This study aimed to evaluate the effectiveness of a structured teaching program on the improvement of teachers' knowledge and performance regarding ADHD in Sulaimani City, Iraq. Method: This quasi-experimental study with intervention and control groups was conducted between September 2024 and August 2025, including baseline assessment, post-intervention and follow-up phases. In selected public and private primary schools in Sulaimani City. A total of 175 teachers were recruited. Data were collected at baseline, immediately after the intervention and at follow-up using two standardized instruments: The Knowledge of Attention Deficit Disorder Scale (KADDS) and the Teacher Performance Scale on ADHD (TPS_ADHD), along with socio-demographic data. Data were analyzed using SPSS version 26.0. Descriptive statistics, chi-square tests, independent-samples t-test and mixed linear models were employed, with statistical significance set at p<0.05. Results: The intervention group demonstrated significantly greater improvements in both knowledge and classroom performance than the control group (p<0.001). The intervention groups' mean knowledge score increased from 33 51 at baseline to 69.21 immediately after the intervention and remained significantly higher than baseline at follow-up, with a mean of 59.98. Similarly, mean performance scores improved substantially from 29.15 at baseline to 65.43 immediately after the intervention and 67.00 at follow-up. Linear mixed model analysis demonstrated significant effects of group, time and group×time interaction on both knowledge and performance (p<0.001). Conclusion: A structured teaching program has a clear positive impact on primary school teachers' understanding of ADHD and their ability to manage related challenges in the classroom. Introducing organized, school-based training initiatives could serve as a feasible and effective approach to building teacher competence in supporting students with ADHD, especially in educational environments with limited resources.

Objectives: There is a growing body of literature on occupational health of Saudi Arabia, but there is a lack of evidence regarding the interventions either implemented/proposed and the outcomes effectiveness. Methods: We performed a systematic search within PubMed, Scopus, Web of Science and Google Scholar (2018-2023) according to PRISMA guidelines. We included studies that examined occupational health problems and the related interventions/effectiveness that were implemented or suggested within the context of Saudi Arabia. Results: Following removal of duplicates and screening for resulting data extraction, 15 studies met inclusion criteria. Most studies evaluated cross-sectional data (≈80%) with a high predominance of the healthcare sector. Common challenges included musculoskeletal disorders, psychological stresses and occupational infections. Intervention effectiveness was measured in a few studies, but ergonomic and disease-prevention strategies were the most frequently described. Strategies. Conclusion: There is considerable disparity between occupational health challenges identified and rigorously evaluated interventions in Saudi Arabia, particularly in high-risk sectors such as construction and manufacturing. Longitudinal and experimental designs should be valuable in future research.

Objectives: The accuracy of indirect restorations plays a critical role in their longevity and clinical performance. Inlays and onlays as conservative alternatives to full crowns, require optimal marginal and internal adaptation to prevent microleakage, recurrent caries and loss of bond integrity. With the increasing integration of Three-Dimensional (3D) printing in dentistry, a systematic evaluation of additive versus subtractive fabrication for these restorations is warranted. Objective: This systematic review aimed to synthesize evidence comparing the adaptation, trueness and precision of inlay and onlay restorations fabricated by Additive Manufacturing (AM) with those produced by Subtractive Milling (SM) or conventional methods. Methods: This review followed the PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Embase, Web of Science and Scopus from inception to October 30, 2025. Eligible studies included in vitro experiments on natural teeth or standardized dies prepared for inlay or onlay restorations, with AM as intervention and SM or conventional fabrication as comparators. Outcomes of interest were Marginal Gap (MG), Internal Gap (IG), Absolute Marginal Discrepancy (AMD), Overall Discrepancy (OD), trueness and precision. Risk of bias was assessed with the QUIN tool. Results: A total of 866 records were identified through database searches. After removal of duplicates and screening against eligibility criteria, seven in vitro studies involving 402 specimens were included in the review. Across studies, AM restorations demonstrated MG values between 54-290 µm, generally comparable to SM (58-509 µm) and conventional methods (50-108 µm). IG values for AM ranged from 35-280 µm versus 62-509 µm for SM. Trueness outcomes often favored SM, particularly with zirconia, while limited evidence suggested favorable precision or reproducibility with AM, although the metrics used differed across studies. Many reported gap measurements were within the historically cited 120-µm benchmark, although substantial method- and site-specific exceedances were observed. Risk of bias was graded as low in 2 studies and medium in 5 studies. Conclusion: Under laboratory conditions, additive manufacturing yielded adaptation comparable to subtractive milling and conventional methods, although outcomes varied among studies and measurement approaches. Trueness often favored certain milled materials, while the limited evidence on precision and reproducibility sometimes favored AM. These findings support AM as a potentially viable restorative approach. However, clinical equivalence or superiority cannot be established from the currently available in vitro evidence.

Background: Paediatric burn injuries require timely, safe and coordinated quality of nursing care because burn severity, fluid loss, wound infection, pain, scarring and psychological distress can affect recovery and long-term function. Structured education may help nurses translate burn quality nursing care guidelines into clinical care. The study assessed the effect of an educational programme on nurses’ quality of care in the burn and plastic surgery centre in Kirkuk, Iraq. Methods: A quasi-experimental pre-post test study with a control group was conducted among 66 nurses at the Burn and Plastic Surgery Centre of Azadi Teaching Hospital in Kirkuk, Iraq. Nurses were recruited using a non-randomised purposive sampling method and allocated to an intervention group (n = 33) or a control group (n = 33). The intervention group received a structured two-week educational programme on quality nursing care for children with burn injuries. Data were collected at baseline, two weeks and two months after completion of the educational programme using a structured self-administered questionnaire. Knowledge was assessed using a total score ranging from 0 to 34, while practice was assessed using participant-level median scores across three predefined domains. Longitudinal changes were analysed using generalized estimating equations with group, assessment time and group × time effects to account for repeated measurements within participants. Results: Significant group × time interactions were identified for knowledge and all three practice domains (all Holm-adjusted p<0.001). Knowledge in the intervention group increased from 9.70±2.32 at baseline to 26.45±2.08 at the two-week assessment and remained at 21.24±3.08 at two months, compared with 11.48±3.86, 13.00±4.35 and 13.70±4.24, respectively, in the control group. The differential improvement was 15.24 points at two weeks (95% CI 14.25-16.23) and 9.33 points at two months (95% CI 8.12-10.55). Significant intervention-related improvements were also observed across all three practice domains. Practice outcomes showed a more sustained intervention effect, as the intervention group achieved higher scores across initial nursing care, nursing care documentation and burn wound nursing care at two weeks and two months. Conclusion: The educational programme was associated with a strong early improvement in nurses’ knowledge and with higher self-reported paediatric burn nursing practice across both follow-up assessments. Knowledge gains declined by the two-month follow-up but remained greater than baseline and the corresponding control-group trajectory.

Objectives: Intracoronary autologous bone marrow-derived cell therapy has been proposed to enhance myocardial repair after Acute Myocardial Infarction (AMI), but the included cell products and trial designs vary considerably across the RCT literature. Methods: PubMed, Embase, Cochrane CENTRAL, Scopus and Web of Science were searched from inception to 2025 for randomized controlled trials of intracoronary autologous bone marrow-derived cell therapy (Bone Marrow Mononuclear Cells [BMMNC], BMMNC/peripheral blood mononuclear cell mixtures, or selected CD34+/BMMNC combinations) versus standard care following AMI, reporting change in Left Ventricular Ejection Fraction (LVEF). Study selection, data extraction and Risk-of-Bias assessment (Cochrane RoB 2.0) were performed by a single reviewer. Random-effects meta-analysis (DerSimonian-Laird, with a Paule-Mandel estimator as a sensitivity analysis) was used to pool the Mean Difference (MD) in LVEF. This review was not prospectively registered. Results: Six RCTs (738 patients: 411 cell therapy, 327 control) met inclusion criteria. Pooled LVEF change favored cell therapy (MD +1.60%; 95% CI 0.72-2.47; I² = 0%), a result unchanged under the Paule-Mandel sensitivity estimator. No significant effects were observed for all-cause mortality (RR 0.94; 95% CI 0.71-1.25), major adverse cardiac events (MACE; RR 0.89; 95% CI 0.68-1.16), or infarct size (MD-1.5%; 95% CI-3.8 to 0.8). Certainty of evidence, graded by GRADE, ranged from low to very low across outcomes, driven primarily by risk of bias and imprecision. Conclusion: Intracoronary autologous bone marrow-derived cell therapy produces a small, statistically significant improvement in LVEF after AMI, without a demonstrated effect on mortality, MACE, or infarct size in this dataset. The clinical relevance of the LVEF effect remains uncertain and the certainty of the underlying evidence is low.

Objectives: MDROs are defined as bacteria that are resistant to multiple classes of antibiotics, rendering standard treatment options ineffective. Methods:  A prospective study was conducted at Panimalar Medical College Hospital and Research Institute in the Intensive Care Units (MICU, SICU, ICCU and Neuro ICU) during November 2023. Patients aged over 18 years admitted to the ICU were included, while inpatients below 18 years, those from wards and outpatients were excluded.  Results: The results showed that, among 123 ICU patients, 34 (27.6%) were culture-positive for Multidrug-Resistant Organisms (MDROs), while 89 (72.4%) were culture-negative. Klebsiella pneumoniae and Escherichia coli were the predominant organisms, particularly among elderly females and patients with multiple risk factors, highlighting the importance of effective infection-control measures and appropriate antimicrobial management in the ICU. Conclusion: The study found that MDROs were common among ICU patients, especially in elderly females and those with multiple risk factors like prior antibiotic use, prolonged ICU stays and comorbidities. These findings highlight the need for better infection control, proper antibiotic use and focused care for high-risk patients to reduce MDROs in ICUs.

Background: The aim of this study was to estimate the prevalence of self-reported lactational mastitis and identify potential factors contributing to the condition among breastfeeding mothers. Methods: This cross-sectional study involved 284 breastfeeding mothers in the first six months of their infants' lives in Al-Ahsa, Eastern Region of Saudi Arabia. The primary outcome of interest was lactational mastitis, which was determined by a self-reported combination of breast symptoms, including redness and swelling and flu-like symptoms, experienced during the six-month period following birth. No minimum symptom duration or predefined combination of symptoms was required for outcome classification. The investigation further sought to identify factors associated with reporting lactational mastitis, using both bivariate and multivariable binary logistic regression analyses. Results: The self-reported prevalence of lactational mastitis was 26.8%, 95% CI ranged between 21.9% and 32.1%. Maternal age was significantly associated with lactational mastitis (p=0.008), with affected women being younger (28.2±5.0 years) than those without lactational mastitis (30.1±6.1 years). A multivariable explanatory model incorporating nipple cracks, breast congestion, and ductal obstruction was significantly associated with lactational mastitis (p<0.05). Nipple cracks were associated with fourfold higher odds of lactational mastitis (AOR = 4.330, 95% CI: 2.142–8.753), while breast congestion was associated with about 11-fold higher odds (AOR = 10.702, 95% CI: 4.970–23.049). Blocked milk ducts were also associated with higher odds of self-reported mastitis (AOR = 2.813, 95% CI: 1.215–6.514) Conclusion: Lactational mastitis is a common postpartum problem affecting over a quarter of breastfeeding mothers in Al-Ahsa. Key detected associated factors, included cracked nipples, breast congestion, and ductal obstruction. These findings emphasize the need for targeted interventions, such as breastfeeding education, proper nipple care, and strategies to prevent and manage breast engorgement.

Background: Physiological stress and psychological distress after caesarean section can lead to poor early breast milk secretion and thereby impact lactation of mothers who had a caesarean. Objective: To evaluate the impact of a structured psychophysiological intervention on breast milk production in post-caesarean women and to evaluate if the change in the psychological status of the mother was intervening in this effect. Methods: Quasi-experimental two group pretest-posttest study with 220 post-caesarean mothers. The intervention consisted of 12 in total sessions of back massage and affirmation based relaxation four times a day for three days. Breast milk output was quantified and psychological factors were evaluated using well-developed scales. Data were analysed with t-tests and adjusted linear regression with control of baseline milk secretion and covariates. The bootstrapping (5000 samples) PROCESS Model 4 was used to test mediation. Results: The intervention group had significantly higher increases in breast milk secretion: 2.95 ml (95% CI: 2.53-3.38, p<0.001). The adjusted effect remained significant (B = 2.90, 95% CI: 2.19-3.61; p<0.001). Psychological distress significantly decreased in the intervention group (depression: mean difference -1.29, 95% CI: -2.03 to -0.55; anxiety: -1.95, 95% CI: -2.58 to -1.31; stress: -3.49, 95% CI: -4.34 to -2.64; all p<0.001). Results: The intervention was linked with a higher output of breast milk. Results are consistent with a cumulative psychophysiological pathway between the psychological changes in the mother and lactation outcomes which warrants consideration of such strategies in the postpartum care.

Background: The Objective Structured Clinical Examination (OSCE) is a commonly used assessment tool for medical students. Cognitive, psychomotor, and professional behavior are some of the competencies assessed by the tool. Understanding how students perceive OSCE is critical in ensuring that it is optimally designed, fair, and educational, particularly during early clinical training. Purpose: The objective of this study was to evaluate the perceptions of second-year medical students regarding the OSCE at Umm Al-Qura University, encompassing aspects such as preparation, design, fairness, validity, reliability, and stress.  Methods: The study incorporated a cross-sectional descriptive analytical research design. Self- administered questionnaires were distributed to the second-year medical students after completing the OSCE assessment. Perception across five domains, including preparation and resources, design and experience, fairness and effectiveness, validity and reliability, and stress and anxiety were evaluated. Descriptive statistics such as medians and interquartile ranges were calculated. Cronbach's alpha was used to assess the internal consistency of the questionnaire, and the chi-square tests were utilized to evaluate the associations between gender and selected perception items, with significance set at p<0.05. Results: 252 students were involved in the study, yielding a response rate of 54.4%. The median age was 20 years (Interquartile range = 1). The majority of the respondents were female (n = 128, 50.8%) compared to males (n =  124, 49.2%). Overall, students reported positive attitudes towards the OSCE in all domains, with a median score of 4 for most of the items. Internal consistency the survey ranged from good to acceptable across all domains (Cronbach’s alpha range: 0.695 –0.844). Based on the chi-square analysis, there were no significant gender differences for the selected perception items; however, a significant association was found between gender and perception of OSCE validity (χ² (2, N  =  252)  =  7.06, p  =  0.03). Male students demonstrated that they were more likely to agree that OSCE scores reflected essential clinical skills compared to females. Conclusion: Generally, the OSCE was perceived as a fair, valid, and effective assessment tool by the second-year medical students. However, the moderate response rate (54.4%) represents a limitation that may affect generalizability. The findings support the use of OSCE as an assessment tool in early medical training and highlight opportunities to improve student support and assessment design.

This study evaluated whether the expression of psmα and hld is associated with HPLC-detected heme release from human erythrocytes after exposure to clinical S. aureus isolates. A total of 90 human clinical samples were examined, including wound swabs, pus aspirates, blood-culture isolates and catheter-tip isolates. S. aureus was identified using culture, Gram staining, catalase, coagulase, mannitol fermentation and automated biochemical confirmation. Thirty confirmed S. aureus isolates were selected for the erythrocyte-exposure experiment. Bacterial isolates were incubated with washed human erythrocytes for 2 h at 37°C. Total RNA was extracted from bacterial pellets, converted into cDNA and analyzed by RT-qPCR for psmα and hld, using gyrB as the housekeeping gene. Free heme released into the supernatant was quantified by reverse-phase HPLC using a hemin chloride calibration curve. S. aureus was recovered from 42/90 samples, giving an isolation rate of 46.7%. Among the 30 selected isolates, 15 were classified as high heme-release isolates and 15 as low heme-release isolates. High heme-release isolates showed significantly higher psmα expression than low heme-release isolates, with mean fold expression of 3.41±1.02 versus 1.48±0.51, respectively. The hld gene was also significantly upregulated in high heme-release isolates, with mean fold expression of 2.87±0.94 versus 1.26±0.42. HPLC analysis showed significantly higher free heme concentration in the high heme-release group than in the low heme-release group, 38.6±9.4 µM versus 12.4±5.1 µM. psmα expression correlated positively with HPLC-detected heme concentration, while hld expression also showed a significant positive correlation. Clinical S. aureus isolates with increased psmα and hld expression showed greater HPLC-detected erythrocyte heme release.

Type 1 diabetes mellitus (T1DM) in children poses significant lifelong challenges. Current insulin-based therapies effectively manage glycemic control but do not offer a cure. Stem cell therapy has been investigated as a promising treatment for T1DM. This review consolidates current evidence regarding stem cell therapies for managing T1DM in children, focusing on stem cell sources, mechanisms of action, clinical outcomes, and associated challenges. Methods: A structured narrative review was conducted. Relevant studies, clinical trials, and reports were sourced from PubMed and other scientific databases. Priority was given to pediatric studies, mixed-population studies with extractable pediatric data, and clinical trials assessing efficacy, safety, and feasibility. Results: Evidence suggests that various stem cell types including hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), and pluripotent-derived β-like cells have the potential to enhance C-peptide levels, reduce the need for exogenous insulin, and modulate autoimmunity. In one study of autologous HSCs transplantation, 59% of participants achieved insulin independence within 6 months, while 32% remained insulin independent at the last follow-up. HbA1c decreased accompanied by an increase in C-peptide. However, these effects have largely been demonstrated in small studies involving adolescents, young adults, or mixed-age populations and have been achieved using immunosuppressive regimens associated with toxicity, whereas MSCs based studies generally demonstrate more improvements in β-cell function and insulin requirements. These findings must be interpreted cautiously because pediatric-specific studies are still limited, and outcomes vary considerably depending on the disease stage, cell type, delivery method, and immunosuppression protocols. Conclusion: Stem cell therapy represents a promising yet still experimental approach for pediatric T1DM. Well-designed pediatric clinical trials are essential to establish efficacy and ensure safety before these therapies can be widely implemented in clinical practice. Future pediatric trials should consequently prioritize approaches that achieve immune modulation or β-cell replacement without myeloablative or intensive immunosuppressive conditioning.

Novel of saccharin derived 1,3,4-thiadiazole derivatives were synthesized from the reaction of sodium saccharin with allyl chloride, then allyl saccharin was hydrolyzed with equimolar KOH, the product was achieved after neutralized with HCl to pH = 5 to form 2-(N-allyl sulfamoyl) benzoic acid, which in turn was reacted with thiosemicarbazide in the presence of phosphorous oxychloride (POCl₃) to give 2-amino-5-(N-allyl-6-sulfamoyl phenyl)-1,3,4-thiadiazole. The previous compound finally was diazotized with some substituted phenols with NaNO₂ and HCl to afford the target products (1a-7a). The (1a-7a) derivatives were characterized using the analytical and spectral methods like Uv-Vis, FTIR, 1H-NMR and 13C-NMR shown in this work. The compounds were tested for their biological activity, where derivatives (3a and 4a) exhibited the highest activity against the tested bacteria (Staphylococcus aureus and Escherichia coli). Higher activity was recorded for compounds (3a and 4a) against Escherichia coli, moderate activity was recorded against Staphylococcus aureus were recorded for the same compounds. Moderate activity for (1a and 2a) were estimated against both bacteria, while the remaining showed low activity. The derivatives were tested as antioxidants (reducing activity) against Fe (III) and Cu II) to reduce them to Fe (II) and Cu (I) respectively, the results showed that the highest antioxidant activity derivatives against Fe (III) and Cu (II) were (3a and 4a) where (3a: 0.0085, 4a: 0.0082) against Fe(III) and (3a: 0.76, 4a: 0.73) against Cu (II).

Background: COVID-19 has significantly influenced world health, with vaccinations essential in preventing severe illness and transmission. Platelet indices, such as platelet count and mean platelet volume (MPV), are valuable indicators for understanding inflammatory and coagulation processes in COVID-19 patients. However, the relationship between these characteristics and vaccination status is poorly understood. This study is set to investigate the association between platelet count, MPV, and COVID-19 vaccination status among COVID-19 patients in the Riyadh region of Saudi Arabia, focusing on variations in vaccine type and dosage number. Material and Method: This retrospective study involved 186 COVID-19 patients (vaccinated and unvaccinated) from King Fahd Medical City in Riyadh between April 2020 and February 2024. Demographic information, vaccination records, and platelet indices were obtained from patient medical records to examine relationships, statistical comparisons were made using Mann–Whitney U test, Kruskal–Wallis test, Chi-square test, and Fisher’s exact test. Results: The mean platelet count was 249.2±109.4 x10³/μL, whereas the MPV was 10.4±1.4 fL. There was no significant difference in platelet count or MPV between vaccinated and unvaccinated groups (p = 0.064 and p = 0.029, respectively). There was no significant variance in platelet count between dosages, while MPV varied significantly, especially in those who had received three doses of vaccinations. Conclusion: Our study found that COVID-19 vaccines had a negligible effect on platelet count, but MPV showed significant variations in dose-response. This suggests no potential regulatory influence of vaccination on platelet function in COVID-19 patients. These findings underscore the importance of considering hematologic parameters in the context of COVID-19 and vaccination status, and they provide valuable insights for future research in this area.

Resistance of drug has been a serious problem in cancer treatment and docetaxel is an anti-microtubule agent with antitumor activity in prostate cancer. Therefore, it is necessary to investigate key genes and understand the molecular mechanisms of prostate cancer cell resistance to docetaxel. In the present study, combined analysis of microarray data by R packages to identify the mechanisms behind resistant prostate cancer cells against docetaxel was achieved. The top-upregulated differentially expressed genes (DEGs) included IGFBP3, ABCB1, GSPT2, ROBO1, FSTL1, NID2, S100A4, CDH1 and top-downregulated DEGs were detected as CD24, ZNF587B, OCLN, ADGRG2, POP7. Common gene ontology (GO) in down and upregulated genes mainly related to regulation of biological process, cell death, stimulus response and process of apoptotic. The TFs related to upregulated genes mainly included SRF, TBPs, POLR2A, TAF1 and RREB and downregulated genes as IRFs, ZEB1, PRDM1, SPI1, JUNs, FOSs and NFKBs. According to protein-protein interaction (PPI) analysis, COL4A1, LOX, SMAD2, TIMP1 and FOS as top-upregulated hub genes and EXO1, RRM2, CDC45, KIAA0101, MCM10 and HMMR as top-downregulated hub DEGs were identified. In addition, top-upregulated consensus hub genes including LOX, SERPINE1, FOS and PTK2 and top-downregulated consensus hub genes including BRCA1, EGFR, IL6 and CXCL8 were identified by twelve methods. Accordingly, the upregulated hub genes mostly related to prognosis and invasion of tumors, apoptosis and oncogene. Moreover, the downregulated hub genes mainly associated to tumor progression, metastasis and proliferation of prostate cancer cells. Some key genes of the present study were compared with reported studies as validation based on external literature and experimental molecular tests including qRT-PCR in vitro and clinical validation are required. The identified key genes could be potential targets for improving the efficacy of prostate cancer treatment as well as understanding the molecular mechanisms in docetaxel-resistant prostate cancer cells.

Background: Medical student syndrome (MSS) is a circumstantial manifestation of health-related anxiety, operationalized in this study through illness perception and distress scores. This is characterized by increased anxiety about contracting diseases during medical studies. Exposure to disease-related knowledge, academic stress, and cognitive biases can all exacerbate this anxiety in medical students, thereby compromising their mental health and academic performance. This study aimed to determine the prevalence and severity of MSS and health- related anxiety among medical students at the University of Tabuk, as well as the relationship between these disorders and their academic performance. Methods: This cross-sectional survey was carried out between June and October 2025 on 526 medical students at the University of Tabuk. A self-administered questionnaire was used to collect data, which included demographic information, the Short Health Anxiety Inventory (SHAI), Medical Student's Disease (MSD) perception and distress scores, and a record of physician visits. We conducted descriptive statistics, t-tests, one-way ANOVA, and correlation analysis. A p-value of <0.05 indicated that the results were significant. Results: Nearly 25.3% of participants exhibited elevated health anxiety (SHAI ≥18). Elevated health anxiety was significantly correlated with advanced age, clinical academic years (p = 0.010), lower GPA, and increased medical consultations. Male students indicated significantly higher levels of MSD distress (3.10 vs. 2.94). Higher health anxiety levels were linked to lower academic performance. Conclusion: Both features of MSS and health anxiety are prevalent among medical students at the University of Tabuk. They exhibit a significant cross-sectional correlation with academic progression, performance, and healthcare utilization. Early identification of at-risk students may help mitigate adverse academic and psychosocial outcomes.

Purpose: Pancreatic cancer is among the most lethal gastrointestinal malignancies, and type 2 diabetes mellitus (T2DM) is both a modest risk factor for the disease and, when of recent onset, a possible early manifestation of it. Concern has been raised that dipeptidyl peptidase-4 (DPP-4) inhibitors, one of the two classes of incretin-based therapy, may be associated with pancreatic disease. The aim of this study was to describe the frequency of documented long-term DPP-4 inhibitor exposure before diagnosis in a single-center series of patients with pancreatic cancer, and to compare routinely available clinical and laboratory characteristics between exposed and non-exposed patients. By design, the study does not evaluate whether DPP-4 inhibitor therapy causes or increases the risk of pancreatic cancer. Materials and Methods: This was a single-center, retrospective, case-only study. The records of 87 patients diagnosed with pancreatic cancer at Sivas Cumhuriyet University Faculty of Medicine between April 2021 and April 2023 were screened. Ten patients who had attended the institution only to receive treatment, and for whom institutional data were unavailable, were excluded; 72 patients with complete institutional records constituted the analytic sample. Demographic data, laboratory values obtained at the time of diagnosis and pre-diagnostic medication histories were extracted from the hospital database. Documented DPP-4 inhibitor use for at least three years before the diagnosis was applied as the predefined exposure criterion. Exposed and non-exposed patients were compared using independent-samples t tests; because sixteen laboratory variables were compared, results were additionally evaluated against Bonferroni- and false-discovery-rate-corrected thresholds and are otherwise reported as exploratory. Results: Of the 72 patients analyzed, 16 (22.2%) had documented DPP-4 inhibitor exposure meeting the predefined criterion and 56 (77.8%) did not. The mean duration of exposure among users was 44.50±17.22 months. The sample comprised 37 women (51.4%) and 35 men (48.6%) with a mean age of 66.03±10.71 years; 24 patients (33.3%) had a recorded diagnosis of diabetes mellitus. HbA1c was higher in exposed than in non-exposed patients (7.727±0.969 vs 6.135±1.098; p<0.001), and this was the only difference that remained significant after correction for multiple comparisons. Nominally significant differences in lipase, hematocrit, alkaline phosphatase and gamma-glutamyl transferase did not survive correction and are reported as exploratory. Conclusion: In this single-center retrospective sample of patients with pancreatic cancer, 22.2% had documented DPP-4 inhibitor exposure meeting the predefined three-year criterion. Because the study lacks a comparison group without pancreatic cancer and includes only a small exposed subgroup, these findings cannot determine whether DPP-4 inhibitor therapy increases pancreatic cancer risk. The higher HbA1c among exposed patients is most plausibly explained by the indication for treatment rather than by a drug effect. Large, multicenter, controlled and preferably longitudinal studies with adequate adjustment for confounding are required.

Background: Chronic ankle instability (CAI) is a common long‑term consequence of lateral ankle sprains and is characterised by persistent symptoms, perceived ankle instability, and functional deficits that impair athletic performance. Volleyball players are extremely vulnerable to ankle injuries due to frequent jumping, landing, and rapid directional changes during play. However, the factors associated with CAI in this athletic population—especially in Saudi Arabia—remain underexplored. Objective: This study aimed to investigate the association between Cumberland Ankle Instability Tool (CAIT) scores and selected demographic, training-related, and clinical variables among male professional volleyball players in Saudi Arabia. Methods: A cross-sectional study was conducted among 117 male professional volleyball players, recruited through cluster sampling from multiple volleyball clubs across the country. Participants provided demographic, anthropometric, and training-related information. CAI was assessed using the validated Arabic version of the CAIT. Spearman’s correlation was used to examine associations between CAIT scores and selected variables, while multiple linear regression identified independent factors of CAIT scores. Statistical significance was set at p<0.05. Results: The mean age of participants was 25.76±3.72 years, and the mean BMI was 23.53±3.05 kg/m². Players reported an average of 5.11±2.47 years of training experience and trained approximately 2.09±0.93 hours per day. Limb dominance scores (1.27±0.45) indicated predominant right-sided dominance. CAIT scores are significantly associated with previous ankle instability (ρ = 0.031, p<0.01) and reinjury (ρ = 0.046, p<0.01). However, the direction of these associations should be interpreted in relation to how the binary injury-history variable is coded and the scoring direction of CAIT. The regression model was significant (F (10,117) = 167.66, p<0.001), explaining 83.5% of the variance (R² = 0.835). Previous ankle instability (β = 0.72, p<0.001), age (β = 0.07, p = 0.002), and reinjury (β = 0.17, p = 0.006) emerged as significant predictors. Age, prior ankle instability, and reinjury were significantly associated with CAI among Saudi male volleyball players. Conclusion: These findings support the crucial need for targeted prevention strategies and structured neuromuscular rehabilitation following initial ankle sprains to reduce chronicity and recurrent injury in this population.

This study investigated the antimicrobial susceptibility patterns of clinical Vibrio cholerae isolates from Erbil, Iraq and evaluated the in vitro antibacterial and anti-virulence activity of aqueous pomegranate (Punica granatum) peel extract. Fifteen confirmed non-duplicate clinical V. cholerae isolates obtained from 257 diarrheal stool specimens (2024-2025) were identified by conventional microbiological methods, O1/O139 serotyping, VITEK 2 and confirmed by 16S rRNA gene amplification. Antimicrobial susceptibility testing was performed across ten antimicrobial agents according to CLSI guidelines. Antibacterial efficacy of the aqueous peel extract was evaluated by minimum inhibitory concentration (MIC), agar well diffusion and growth kinetic assays. Transcriptional responses of virulence-associated genes (flaA, vpsT and luxO) following exposure to 10 and 20 mg/mL of extract were quantified by RT-qPCR using the method. All isolates (100%) were resistant to amoxicillin-clavulanic acid, whereas high susceptibility was retained for chloramphenicol (93.3%), imipenem (86.7%), amikacin (80.0%), tetracycline (80.0%) and doxycycline (73.3%), with intermediate responses in erythromycin (60.0%) and ciprofloxacin (53.3%). The aqueous peel extract demonstrated dose-dependent antibacterial activity, with MIC values ranging from 3 to 50 mg/mL MIC₅₀ = 25 mg/mL (; MIC₉₀ = 50 mg/mL) and inhibition zones of 19-24 mm at 50 mg/mL. Significant downregulation of flaA and vpsT was observed following 10 and 20 mg/mL treatment (p<0.001), whereas luxO expression showed variable, moderate reduction. These findings provide updated regional baseline data on antimicrobial resistance in clinical V. cholerae and demonstrate that aqueous pomegranate peel extract exhibits direct in vitro growth-inhibitory and transcriptional modulatory activity. These findings remain strictly limited to in vitro laboratory observations and do not establish therapeutic efficacy; further chemical profiling of the aqueous phase, phenotypic motility/biofilm assays and in vivo functional validation are required.

Background and Aims: Health professional students are exposed to a vast number of terminologies and concepts within a short academic period, making it challenging to achieve sufficient practice and consistency for effective learning. This study evaluated undergraduate health professional students’ perceptions of the usefulness of crossword puzzles as an active teaching-learning strategy to reinforce scientific terminology and concepts. Methods: This descriptive, cross-sectional survey study included 375 health professional students who completed a crossword-puzzle learning activity in 2024. Data were collected using a pre-validated, self-structured questionnaire (content validity established by review of three subject-matter experts; internal consistency was not formally assessed) assessing four domains: student engagement, collaborative and competitive features, learning utility and effectiveness in recognizing key concepts and terminology. Results: Most students (91%) reported improved recognition of essential terms and concepts, while 85% agreed that crossword puzzles enhanced critical thinking and facilitated discussion. Additionally, 96% perceived crossword puzzles as more effective than other small-group learning methods, particularly for improving spelling accuracy and expanding scientific vocabulary. Conclusion: Crossword puzzles were positively perceived by students as an engaging, student-centered supplementary teaching strategy that may support vocabulary acquisition, conceptual understanding and engagement; controlled studies with objective learning outcomes are recommended to confirm their educational effectiveness.

Background: Exendin-4 (Ex-4), a stable glucagon-like peptide-1 receptor (GLP-1R) agonist, has transcended its initial role as a glycemic regulator to become a potent mediator of cellular inflammation. This review synthesizes the molecular crosstalk between Ex-4 and tissue-specific inflammatory environments, emphasizing its therapeutic trajectory. Summary: At the cellular level, Ex-4 exerts anti-inflammatory effects primarily through the inhibition of the NF-κB and NLRP3 inflammasome pathways and the activation of the SIRT1/AMPK axis. In the central nervous system, it facilitates a phenotypic shift from pro-inflammatory M1 to reparative M2 microglia. In peripheral tissues, it attenuates fibrosis via TGF-β/Smad suppression and restores airway homeostasis through the PKA-PPARγ-FOXA2 pathway. While there were signaled challenges in motor-score endpoints for Parkinson’s disease, the peptide shows robust efficacy in treating Idiopathic Intracranial Hypertension (IIH) and polycystic ovary syndrome (PCOS). Conclusion: Exendin-4 remains a cornerstone of metabolic-inflammatory research. Future therapeutic success likely hinges on the development of "smart" delivery systems-such as ligand-functionalized nanoparticles and sustained-release hydrogels-to optimize bioavailability and minimize systemic side effects (Figure 1).

Background: Advancing age is accompanied by a progressive accumulation of senescent cells that drive chronic, low-grade inflammation-a state widely termed ‘inflammageing’. This persistent inflammatory milieu profoundly impairs adaptive immunity, blunting the very T-cell and B-cell responses upon which cancer vaccines depend. Senolytics, a class of pharmacological agents that selectively eliminate senescent cells, have emerged as a promising strategy, although direct evidence for improved cancer-vaccine outcomes in humans remains limited, to recalibrate immune homeostasis and potentially restore vaccine responsiveness in older patients. Objective: This systematic review synthesises evidence on the mechanistic and clinical relationships between cellular senescence, Senescence-Associated Secretory Phenotype (SASP)-driven immunosuppression and cancer vaccine efficacy in older adults and critically examines whether senolytic preconditioning can improve vaccine outcomes. Methods: A systematic search of PubMed, Scopus, EMBASE, Web of Science and ClinicalTrials.gov was conducted from inception to March 2026 following PRISMA 2020 guidelines. Studies examining cellular senescence, SASP, immune senescence, senolytics (including dasatinib, quercetin, navitoclax, fisetin, ABT-263 and related agents) and cancer vaccination in aged models or human subjects were included. Quality appraisal used the Newcastle-Ottawa Scale and GRADE framework. A total of 2,847 records were identified; after removal of duplicates, 2,163 records were screened and 54 studies met full inclusion criteria. Results: Senescent cells were found to exert multi-layered suppression on anti-tumour immunity, including downregulation of T-cell receptor signalling, promotion of regulatory T cells and impairment of dendritic cell maturation-all mediated largely through SASP-derived interleukin-6 (IL-6), IL-1β, tumour necrosis factor-alpha (TNF-α) and prostaglandin E2 (PGE2). Senolytic treatment in murine models restored vaccine-induced CD8+ T-cell expansion and tumour rejection. The dasatinib-plus-quercetin (D+Q) combination demonstrated the most reproducible clearance of p16INK4a+ and p21CIP1+ senescent cells in cell-based and murine models; corroborating evidence from human clinical studies remains preliminary. Emerging clinical data from early-phase trials confirm safety in older adults and biomarker evidence supports transient SASP reduction following senolytic dosing. Conclusion: The available body of evidence, although predominantly preclinical, offers strong biological plausibility-as distinct from demonstrated clinical efficacy-for using senolytics as immunological primers before cancer vaccination in older adults. Well-designed clinical trials incorporating senolytic preconditioning windows prior to vaccine administration are urgently needed to translate these findings into practice.

Dietary patterns have become an important focus of nutrition research because health outcomes are influenced not only by individual nutrients but also by the overall combination, quality and quantity of foods consumed. Alongside well-established dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, numerous plant-based, carbohydrate-restricted, fasting-based, therapeutic, elimination and commercially promoted diets have gained popularity. These dietary approaches differ considerably in their composition, intended purpose, scientific evidence, nutritional adequacy, feasibility and potential health effects. This narrative review provides a concise overview of commonly followed dietary patterns, including Mediterranean, DASH, vegetarian, vegan, flexitarian, whole-food plant-based, Nordic, MIND, Portfolio, low-fat, low-carbohydrate, ketogenic, Atkins, Paleolithic, high-protein, low-glycaemic-index, intermittent fasting, time-restricted eating, gluten-free, low-FODMAP, macrobiotic, raw-food, carnivore, alkaline, blood-type, detox and selected commercial diets. Evidence regarding cardiovascular health, obesity, diabetes, metabolic outcomes, gastrointestinal disorders and other relevant health effects is summarized, together with important nutritional and practical limitations. Overall, dietary patterns emphasizing minimally processed foods, vegetables, fruits, whole grains, legumes, nuts and appropriate sources of protein and unsaturated fat have the most consistent evidence for long-term health. Highly restrictive dietary patterns may have selected therapeutic applications but generally require greater attention to nutritional adequacy, sustainability and clinical supervision.