Background: One of the primary causes of chronic mastitis in small ruminants globally is infection by Staphylococcus aureus which has biofilm formation in which helps it survive and resist antimicrobial treatment. Objectives: The purpose of this study was to assess the frequency of S. aureus in clinical cases of mastitis and examine the molecular frequency of the biofilm-related genes icaA and icaD in isolates obtained from infected mastitis sheep and goats in Diyala Governorate, Iraq. Methods: A cross-sectional study was conducted involving 100 mastitic milk samples (50 from goats and 50 from sheep). The samples were cultured on different selective media (Blood Agar, Mannitol Salt Agar and Baird-Parker Agar). The presumptive S. aureus isolates were confirmed via phenotypic methods (catalase and coagulase tests) and the VITEK-2 Compact system. After genomic DNA was extracted from the confirmed isolates, the icaA (151 bp) and icaD (211 bp) genes were analyzed using a polymerase chain reaction (PCR). Results: The total frequency of S. aureus was recorded as 69% (69/100). There was a statistically significant higher frequency (χ² = 6.73, p = 0.0094) in sheep (82%, 41/50) than in goats (56%, 28/50). There was no statistically significant difference in icaA and icaD gene carriage between sheep and goats as all 69 isolates (100%) from the two species possessed both icaA and icaD genes. Conclusion: The investigation uncovers the existence of the severe impact of S. aureus mastitis, especially concerning sheep. The icaAD gene's omnipresence in all isolates indicates that the ability to form biofilms is most likely a conserved and important facet of virulence in S. aureus strains that are in circulation, increasing the difficulty of mastitis management and treatment in small ruminant herds.

Objectives: Radiation protection in diagnostic radiography involves optimization practices and communication with patients. Examining technologists’ self-reported practices alongside patients’ awareness and experiences can provide complementary information about these aspects of care. This study explored both perspectives through separate surveys in Jeddah, Saudi Arabia. Methods: An exploratory cross-sectional study was conducted in Jeddah, Saudi Arabia, during February-March 2025 using convenience sampling. Two independent groups completed separate structured questionnaires: 61 radiologic technologists working in general diagnostic X-ray departments and 110 patients undergoing diagnostic X-ray examinations. Technologist responses were collected through self-administered online questionnaires (n = 26) and face-to-face researcher-administered questionnaires entered directly into Google Forms (n = 35), while all patient responses were collected electronically. The questionnaires assessed technologists’ self-reported radiation protection practices, institutional support andbarriers andpatients’ self-rated awareness, reported experiences andprotective behaviors. Patient responses were not linked to individual technologists andpractices were not directly observed. The limited sample sizes restrict generalizability. Data were summarized using frequencies and percentages. Associations were evaluated using Pearson’s chi-square or exact tests according to expected cell counts, with Monte Carlo estimation for selected larger tables. All tests were two-sided, with significance set at p<0.05. Results: Among patients, 97.3% agreed that patients have the right to request protective equipment, 10.0% reported requesting additional protection and39.1% reported receiving lead shielding. Self-rated knowledge of radiation risks was not significantly associated with requesting protection (p = 0.220), but differed across age groups (p<0.001). Among technologists, 91.8% reported familiarity with ALARA and88.5% agreed that they had received adequate radiation protection training during their education or employment. The proportions reporting “always” were 85.2% for ensuring companions left the room, 80.3% for collimation, 59.0% for patient-specific exposure adjustment and45.9% for providing lead shielding. Experience was not significantly associated with shielding frequency (p = 0.533), exposure adjustment (p = 0.085), or collimation (p = 0.794). The most frequently reported barriers were workload (60.7%) and time constraints (49.2%). Conclusion: These separate surveys identified variation in technologists’ self-reported radiation protection practices and infrequent patient requests for protective equipment. Reported shielding frequency alone cannot establish whether practice was appropriate, because examination-specific indications and protocols were not assessed. The findings support further evaluation of protocol-based optimization, staff training andpatient communication.

Background: Artificial Intelligence (AI) is increasingly entering higher and professional education, yet evidence on students’ pre-implementation readiness remains limited in North African health professions education. This study examined factors associated with undergraduate nursing students’ behavioral intention to use AI in Moroccan paramedical education using an extended UTAUT-informed model. Methods: An analytical cross-sectional survey was conducted among 359 second- and third-year nursing students enrolled in public paramedical training institutes in the Casablanca-Settat region, Morocco. The questionnaire assessed performance expectancy, effort expectancy, social influence, facilitating conditions, AI readiness, positive attitude toward AI, AI literacy and behavioral intention. Descriptive statistics, reliability analyses, group comparisons, Spearman correlations and multiple linear regression were performed. Results: The regression model explained 59.6% of the variance in behavioral intention. Performance expectancy was the strongest independent predictor (β = 0.267, p<0.001), followed by social influence (β = 0.217, p<0.001), positive attitude toward AI (β = 0.206, p<0.001), academic level (β = 0.204, p = 0.004), AI readiness (β = 0.109, p = 0.018) and facilitating conditions (β = 0.087, p = 0.041). Effort expectancy and AI literacy were not independent predictors after adjustment. Conclusions: Students' intentions to adopt AI are predominantly shaped by factors such as perceived educational value, social influence, positive attitudes, readiness and conducive institutional conditions. These insights offer preliminary evidence to support the responsible integration of AI in Moroccan health professions education and similar settings.

Background: Oral isotretinoin is an effective systemic treatment for moderate-to-severe acne vulgaris; however, recurrence after treatment completion remains a concern in clinical practice. Objective: This study estimated the proportion of treatment completers reporting acne relapse after isotretinoin therapy and, secondarily, explored unadjusted associations between relapse and patient-related, clinical, treatment-related and adverse-effect factors in Al-Baha Province, Saudi Arabia. Methods: In this retrospective cohort study, patients prescribed oral isotretinoin at Prince Mishari Bin Saud Hospital between January and December 2024 were identified. Data were obtained from medical records and a one-time post-treatment interview using a structured questionnaire covering sociodemographic characteristics, acne features, family history, smoking status, body mass index, diet, treatment course, cumulative dose, treatment duration, adverse effects and patient-reported relapse after treatment completion. Post-treatment follow-up varied among participants, ranging from 6 to 18 months. Results: Of the 205 patients assessed, 116 completed therapy and were analyzed. Women accounted for 71.6% of participants and the mean age was 23±4.3 years. Relapse was reported by 49 of 116 treatment completers (42.2%). Among relapsed patients, 36 (73.5%) described the recurrence as less severe than at baseline and 32 (65.3%) experienced relapse within 12 months. The relapse rate decreased numerically across increasing cumulative-dose categories: ≤70 mg/kg, 18/39 (46.2%); 71-100 mg/kg, 12/27 (44.4%); 101-120 mg/kg, 8/20 (40.0%); and 121-150 mg/kg, 11/30 (36.7%). Relapse occurred in 41 of 83 females (49.4%) and 8 of 33 males (24.2%). Dry lips (92.2%), dry skin (83.6%) and dry eyes (75.9%) were the most common adverse effects. In an exploratory, unadjusted comparison, joint pain was reported in 53.1% of patients with relapse versus 32.8% of those without relapse (p = 0.029). Conclusion: These findings indicate that relapse was common among treatment completers, although most relapses were milder than baseline. Individualized dosing, adverse-effect management, maintenance therapy when indicated and structured follow-up are recommended. Larger prospective studies with standardized relapse definitions, longer follow-up, adherence assessment, hormonal evaluation and maintenance-therapy data are needed to clarify factors associated with relapse and inform relapse-prevention strategies for high-risk patients, particularly during the post-treatment follow-up period.

Objectives: Klebsiella pneumoniae bacteria are one of the most prominent causes of healthcare-associated infections globally, especially after the widespread proliferation of antibiotic-resistant strains, which are the cause of serious complications and increased mortality rates. Therefore, BOX-PCR and ERIC-PCR techniques were used to detect the genetic relationship between bacterial isolates, which is a necessary step to understand the epidemiological spread and limit their transmission. Methodology: The study involved the collection of 200 samaaaples: (150) clinical samples from various sources and (50) water samples from the Public Health Laboratory in Diyala Governorate. 26 isolates of Klebsiella pneumoniae bacteria were isolated. In this study, twelve antibiotics from different classes were tested to determine their effectiveness against Klebsiella pneumoniae bacteria using the Kirby-Bauer disk diffusion method. DNA was extracted from the 26 isolates using the boiling method. ERIC-PCR and BOX-PCR techniques were used to determine the genetic relatedness of these bacteria. Results: According to the source of the samples, they were distributed as follows: 5 out of 45 urine samples (11.1%), 4 out of 40 wound samples (10%), 4 out of 30 burn samples (13.3%), 3 out of 35 sputum samples (8.6%) and 10 out of 50 water samples (20%). Molecular typing using ERIC and BOX repetitive sequences showed clear diversity among Klebsiella pneumoniae isolates, with an absence of a direct correlation between the genotype and the source of the isolate. Dendrogram analysis showed the genetic relationship between antibiotic-resistant Klebsiella pneumoniae isolates. Conclusion: All Klebsiella pneumoniae bacteria were resistant to antibiotics and the genetic profiling techniques BOX-PCR and ERIC-PCR were used to detect the presence of genetic diversity among the studied isolates, with no correlation found between the environmental source and the genotype. It was also shown that these two techniques are essential for studying the genetic diversity of Klebsiella pneumoniae and they are simple, reproducible, rapid and inexpensive tools.

Objectives: deep Venous Thrombosis (DVT) is a preventable but potentially life-threatening condition with significant morbidity and mortality. Public awareness and preventive behaviors are crucial to reducing its burden. This study evaluated DVT knowledge, self-reported prevention practices and sociodemographic determinants among adults, utilizing the Health Belief Model (HBM) and the Capability, Opportunity, Motivation-Behavior (COM-B) model as conceptual interpretive frameworks. Methods: A community-based cross-sectional survey was conducted among 954 adults aged ≥18 years across Arar, Rafha, Turaif and surrounding municipalities. Participants were recruited using multistage stratified sampling. The survey assessed DVT knowledge, self-reported practices and information sources, with HBM and COM-B serving as conceptual interpretive frameworks. Associations with demographic factors were analyzed using Chi-square tests and binary multivariable logistic regression, where outcomes were dichotomized into "good" versus "poor/moderate. Behavioral determinants were interpreted to inform intervention strategies. Results: Of 954 respondents, 67.3% had moderate DVT knowledge, 29.7% had poor knowledge and only 3.0% had good knowledge. Good preventive practices were reported by 17.5% of participants. High awareness of classic mechanical risks such as immobilization (77.7%) and leg swelling (83.1%) contrasted with critical misconceptions: 43.2% incorrectly believed that bed rest prevents DVT and only 44.1% recognized that fluid restriction does not contribute to prevention. Digital channels predominated as primary information sources (social media 58.8%, internet 50.5%), while healthcare professionals accounted for 41.7%. No sociodemographic characteristic was significantly associated with knowledge or preventive practice in unadjusted analyses; in adjusted analysis, university or higher education was associated with lower odds of good preventive practice (AOR 0.71, 95% CI 0.51-1.00). Social media (58.8%) and internet sources (50.5%) were the most common sources of DVT information. Conclusion: Knowledge and preventive practices related to DVT are suboptimal among adults in Northern Saudi Arabia. Digital exposure without structured clinical guidance fosters misconceptions, such as the conflation of immobility with protection. Structured health education programs, integrated into primary care and public outreach, are urgently required to promote preventive behaviors and reduce the burden of venous thromboembolism.

Grown throughout Europe, the Middle East, and Asia, lavender (Lavandula spp.) is a herbaceous perennial plant of to the Lamiaceae family. The primary source of secondary metabolites, which are utilized in food, medicine, cosmetics, and other products, is these plants. Phenols, flavonoids, and carotenoids are the most valuable secondary metabolites found in lavender. To modify or improve bioactive metabolites in greenhouse production, a number of strategies have been employed, including the application of fertilizer, metabolism-inducing substances, and biological factor control. Two lavender species—Lavandula angustifolia and Lavandula x intermedia—are compared in this study. In 2021 and 2022, a greenhouse experiment was conducted. Four levels of phenylalanine treatment (0, 50, 100, or 150 mg/L) and three levels of Crest® (kinetin 0.010%; Indole Butyric Acid 0.005%; Gibberellic Acid 0.005%; Fine Americas, Inc., Walnut Creek, CA) (0, 25, or 50 mg/L) were applied before flowering in this factorial randomized complete block design. The majority of development features were shown to be positively impacted by phenylalanine levels. The results showed that applying phenylalanine and Crest® exogenously to lavender plants significantly boosted both kinds' plant growth. Compared to other treatments, phenylalanine at 50 mg/l and Crest® at 50 mg/l enhanced plant height, branch count, leaf area, flower count, fresh weight, and dry weight. Overall, we believe that the best way to improve lavender vegetative growth in greenhouse agriculture systems was to spray lavender plants with 50 mg/l phenylalanine and 50 mg/l Crest®. Crest® and phenylalanine may be a viable method for boosting the development of medicinal plants and may be crucial to the process. Crest® and phenylalanine may be a good way to boost the yield of therapeutic plants and may be crucial for the synthesis of phytochemicals in plants like lavender. Before farmers may employ phenylalanine and Crest® to maximize lavender yield, more research is required to assess growth dynamics and comprehend how these substances impact plants.

Background: Dry eye disease (DED), also known as keratoconjunctivitis sicca, is a multifactorial ocular surface disorder marked by tear film instability, hyperosmolarity, and ocular surface inflammation. It leads to symptoms such as discomfort, dryness, and blurred vision, significantly impairing vision-related quality of life. Contact lens wear is a well-established risk factor, contributing to increased tear evaporation, reduced tear production, and ocular surface irritation. Environmental and behavioral factors further exacerbate the risk, especially in regions with hot, arid climates like Saudi Arabia. Despite the rising popularity of contact lenses particularly among young adults there is a notable lack of research evaluating awareness and self-care practices related to DED in this population. Aim: To assess awareness, knowledge, and self-care behaviors regarding DED among contact lens users in Saudi Arabia and examine the relationship between lens-wearing habits and symptom severity. Methods: A cross-sectional study was conducted from July 2025 to May 2026 among Saudi residents. Participants (n = 518), recruited via social media, were adults aged 18–65 years who currently wear contact lenses and report DED symptoms. Exclusion criteria included recent ocular surgery, active ocular surface disease, and incomplete responses. Data were collected through a structured, bilingual (Arabic/English) self-administered questionnaire adapted from validated sources, covering demographics, symptoms, and lens-use practices. The minimum sample size of 384 was determined using prevalence-based estimation at a 95% confidence level. Data were analyzed using SPSS version 20. Results: The mean age of participants was 35.17±14.5 years, with females representing 59.5% of the sample. More than half (51.1%) reported experiencing dry eye symptoms. The most commonly reported aggravating factor was prolonged screen use (73.6%), followed by exposure to wind or dry weather (52.1%). Cosmetic contact lens use was reported by 29.5% of participants, with most users wearing lenses for less than 4 hours (44.6%) or 4–8 hours (44.1%). Discomfort during use was common (66%), and 47.7% discontinued cosmetic lenses due to symptoms. Only 37.6% had consulted an eye specialist, while 65.2% expressed willingness to participate in future studies. 25.9% had minimal DED, 35.8% mild, 26.3% moderate, and 12% severe level. Moderate-to-severe cases accounted for 38.3%. DESS severity was significantly associated with gender (χ²=17.832, p<0.001), education level (χ² = 42.901, p = 0.010), residential area (χ² = 29.518, p = 0.003), and contact lens use (χ² =14.314, p = 0.003). Conclusion: Dry eye symptoms are highly prevalent among the Saudi population, particularly among females and contact lens users. Although awareness of symptoms and triggers is moderate, professional consultation remains low. These findings highlight the need for targeted educational and preventive eye health programs, especially among contact lens users.

Background: Skin grafting remains one of the routinely used surgical procedures in the plastic and reconstructive department of any hospital. Many conventional therapies have been used to provide adequate adherence of skin grafts to their bed. One of the emerging methods that has been used as an alternative method for securing skin grafts is NPWT. Objective: To evaluate the effectiveness of NPWT in increasing skin graft survival by increasing its integration to the recipient site. Method: A prospective study conducted between 2025 to 2026 that included 20 patients who are present with soft tissue loss of different sites and cause. Those patients were managed using STSG that was secured using NPWT. In all of our patients, the recipient site was clean and free from infection before operation. Result: Results: On postoperative day 5, 18/20 patients (90%) had complete graft take. This percentage is not a measure of the percentage of graft area surviving, but rather the percentage of patients with complete graft take. No infections, contact dermatitis was reported and no patients reported pain and discontinued NPWT. Conclusion: Patients with STSG secured with NPWT show complete recipient site coverage with no complications. NPWT provides a simple and secure method that increases skin graft take. However, the cost of NPWT should be taken into consideration.

Background Provisional restorations must maintain color stability throughout the treatment period, as deterioration in this property compromises esthetic outcomes, and shade selection for the definitive prosthesis. Sports and energy drinks characterized by low pH, citric acid content and synthetic chromogenic agents represent a clinically relevant and increasingly prevalent dietary challenge, yet evidence on their effect on different types of provisional materials remains limited. Objective: To evaluate and compare color change (ΔE) of conventional self-curing polymethyl methacrylate (PMMA), bis-acryl composite resin, CAD/CAM 3D-printed resin, and CAD/CAM milled PMMA following immersion in two energy drinks (Red Bull and Power Horse), one sports drink (Gatorade). Methods: Disc-shaped specimens (14 mm diameter, 1 mm thickness, shade A2) for the four the four materials were immersed in assigned solutions at 37°C. Measurements were recorded at baseline, 1 day, 1 week, and 2 weeks using a spectrophotometer (Konica Minolta CM-700d) under D65 illumination for color. Three-way linear mixed models were used for statistical analysis; significance was set at p<0.05. Results: Material, solution, and time all produced considerable effects on both outcomes with some significant interactions. As for color change, immersion solution was the dominant factor (ηp² = 0.15). Milled PMMA showed no statistically significant difference ΔE under any condition or time point. Unifast III self-cured resin demonstrated the greatest progressive color change, reaching 2.20±0.96 after 2 weeks in Gatorade. The 3D-printed resin exhibited early high ΔE followed by a plateau, while Protemp 4 composite resin remained largely color-stable. Conclusion: CAD/CAM milled PMMA demonstrated superior performance in terms of color change. Conventional self-curing PMMA showed the greatest cumulative deterioration. Sports and energy drink consumption should be considered in provisional material selection and patient counselling.

Objectives: Somatic features may complicate assessment of depression in later life, particularly when physical illnesses and medication effects produce overlapping complaints. Evidence describing the ICD-10 somatic syndrome in Vietnamese geriatric clinical settings is limited. Methods: This single-centre, hospital-based cross-sectional study included 130 outpatients aged ≥60 years diagnosed with depression according to ICD-10 at the Geriatrics Department of Can Tho Central General Hospital between January 2022 and July 2023. The outcome was the presence of at least four of eight ICD-10 somatic syndrome features. Demographic, clinical and behavioural characteristics were examined descriptively and in reported logistic regression analyses. The precise recruitment strategy and assessment protocols require confirmation from the original study records. Results: Forty-seven of 130 participants (36.2%; reported as 36% in the original manuscript) met the somatic syndrome threshold. Loss of interest (57.7%) and early-morning awakening (51.5%) were the most frequently reported individual features. The reported adjusted odds ratios were 0.239 (95% CI 0.090-0.635) for the depression-severity coding, 0.397 (0.159-0.995) for anxiety, 0.341 (0.140-0.830) for treatment-adherence classification and 25.188 (1.867-339.860) for sleep classification. As the reference categories and data coding were not documented, direction-specific interpretation is not justified. The sleep estimate was highly imprecise, with only four participants in the no-sleep-disturbance group. Conclusion: Approximately one-third of this selected sample met the ICD-10 somatic syndrome threshold. Preliminary associations should be interpreted cautiously pending verification of model coding and reanalysis of sparse categories. Larger, multisite studies with explicit assessment of medical comorbidity are needed.

Background: Microdissection testicular sperm extraction (micro-TESE) is widely used for non-obstructive azoospermia (NOA), but direct comparisons with conventional TESE are methodologically heterogeneous. Initial surgery paired testicular sampling and rescue procedures answer different clinical questions. Objective: To reassess comparative evidence on sperm retrieval, reproductive outcomes and surgical harm, preserving the correct population, sequence and unit of analysis. Methods: PubMed, Scopus, Web of Science Core Collection and SciELO Citation Index were searched in October 2026. The four queries returned 1,269 records before cross-database deduplication. Sixteen primary comparative staged or specimen-level reports were analyzed. Four independent-group comparisons with usable patient counts were pooled using log risk ratios (RRs), Paule–Mandel random effects and modified Knapp– Hartung confidence intervals (CIs). Paired, rescue, genetic and specimen-level evidence was considered separately. Results: The four-study pool comprised 469 men. The unadjusted RR for sperm retrieval with micro-TESE was 1.36 (95% CI 0.94–1.97, I² = 0.6%, τ² = 0.00056). Two studies required unique integer reconstruction from arm sizes and one-decimal percentages. Excluding the study with inconsistent subgroup reporting gave RR 1.49 (95% CI 0.77–2.89). Conditional same-operation rescue yields ranged from 0/46 to 4/13; these were not pooled. No defensible comparative live-birth meta-analysis was possible. Confounding, incomplete reporting and uncertain prior-surgery status substantially limited inference. Conclusions: Available direct evidence is compatible with a retrieval advantage from micro-TESE, but the effect size remains uncertain, and the preferred small-sample interval includes no difference. The evidence does not establish a live-birth advantage. Rescue success, testis-level outcomes and combined-technique yields must not be presented as the effect of choosing micro-TESE initially.

Objectives: Prenatal health is an important factor in the wellbeing of the mother and fetus. One prenatal wellbeing factor has been determined as psychological flexibility that enables individuals to adapt to the evolving situation and cope with stress. Objectives: The purpose of this research is to test the mediation of the maternal-fetal attachment between psychological flexibility and prenatal wellbeing relationship. Methods: Data collection was carried out to 300 pregnant women at three pregnancy stages (first, second, and third trimesters) by adopting a mixed-methods design. The data was pre-processed using Min-Max Normalization and then Recursive Feature Elimination was used to determine the most relevant predictors. To predict prenatal wellbeing, a Random Forest Classifier was applied and the performance of the model was measured on accuracy and feature importance. It was analysed using Python, scikit-learn to perform machine learning, manipulate data using pandas, and statistically model using stats models. Results: The Random Forest Classifier has an accuracy of 87% in predicting the prenatal wellbeing, which means that it fits well to the model. The main predictive variables were psychological flexibility (particularly, mindfulness and emotional regulation) and maternal fetal attachment, which was reported to mediate the correlation between psychological flexibility and prenatal wellbeing. The statistical tests showed that psychological flexibility was statistically significant in the direct enhancement of prenatal wellbeing (p<0.01) and the indirect enhancement via maternal fetal attachment (p<0.05). Conclusion: The results emphasize the importance of psychological flexibility in enhancing the prenatal wellbeing, and maternal-fetal attachment is one of the main mediators. The high level of accuracy of the model implies that psychological flexibility-based interventions may be effective in improving maternal health and wellbeing in pregnancy.

Objectives: Smartphone overuse and obesity are two of the most significant public health concerns that are getting worse every day where youth spend their leisure time playing about on their devices. Excessive smartphone use may be an indication of smartphone addiction and affects users' social and physical health. The study aims to assess the prevalence smartphone excessive use and its association with obesity in youth. Subject and Study Design: A university-based cross-sectional study was conducted among university students aged 18–25 years in Arar city. A total of 403 participants completed a self-administered questionnaire that included socio-demographic characteristics and behavioral factors. Levels of smartphone use were assessed using the Smartphone Addiction Scale-Short Version (SAS-SV). Results: The prevalence of smartphone overuse among participants was 71.7%. Smartphone overuse was more common among males (76.9%) compared with females (67.0%), although the difference was not statistically significant (p = 0.07). A significant association was observed between smartphone overuse and age (p=0.001), with participants aged ≥21 years showing higher overuse rates. Students from non-medical faculties had higher smartphone overuse compared with those from medical faculties (p = 0.031). Participants who used smartphones for more than five hours daily showed significantly (p = 0.007) higher overuse (78.5%) than those using them for less than five hours (57.4%). No statistically significant association (p = 0.122) was found between smartphone overuse and BMI. Conclusion: Smartphone overuse is highly prevalent among youth in Arar city. Several demographic and behavioral factors were associated with excessive smartphone use, particularly age, faculty type, and daily duration of smartphone use. However, no significant association was observed between smartphone overuse and obesity.

Objectives: Obesity remains a major global health problem with widespread metabolic consequences. Laparoscopic sleeve gastrectomy (LSG) is a common bariatric operation, but detaching the natural gastric ligaments along the greater curvature can allow the gastric tube to twist or kink. This rotation can cause functional obstruction and lead to troublesome postoperative nausea and vomiting (PONV). In this study, we investigated whether adding posterior gastropexy during LSG helps reduce PONV. Patients and Methods: We carried out a prospective randomized comparative trial at Erbil International Hospital between July 2022 and July 2023. A total of 107 patients were randomly assigned to two groups: Group A underwent LSG with posterior gastropexy (n = 53), and Group B underwent standard LSG without gastropexy (n = 54). Nausea and vomiting were evaluated at one week, one month, and three months after surgery. Results: Both groups had similar baseline demographics and body mass index values. Surgeries took slightly longer in the gastropexy group (38.1±7.2 vs. 30.7±5.9 minutes, p<0.001). At one week and one month, we found no significant differences in nausea or vomiting between the two groups (1-week nausea: 22.6% vs 33.3%, p = 0.218; 1 week vomiting: 18.9% vs 20.4%, p = 0.840; 1-month nausea: 18.9% vs 18.5%, p = 0.960; 1-month vomiting: 20.8% vs 31.5%, p = 0.200). At three months, nausea was reported in 5 out of 53 patients (9.4%) in Group A compared to 0 out of 54 (0%) in Group B (p = 0.020), whereas vomiting rates remained similar (9.4% vs 5.6%, p = 0.400). Conclusion: Adding gastropexy during LSG increases operative time without reducing early PONV. The higher nausea rate observed at three months in the gastropexy group should be interpreted with caution and warrants further evaluation in larger trials.

Background: Obesity is a multifactorial condition with significant physical and psychological consequences. Gastric balloon placement is a minimally invasive intervention that promotes weight loss, but its psychological, behavioral, and neurocognitive post-operative impacts—including post-anesthesia delirium (PAD)—require detailed evaluation. Objective: To assess the psychological effects, behavioral changes, and incidence of post-anesthesia delirium associated with gastric balloon placement performed under general anesthesia, focusing on body image, eating habits, and long-term weight maintenance. Methods: This cross-sectional analytical study included 230 patients who underwent gastric balloon placement under general anesthesia for obesity treatment. Post-anesthesia delirium was evaluated in the post-anesthesia care unit (PACU) using standardized screening. Psychological outcomes, eating behavior, and weight maintenance were systematically tracked Diagnostic criteria evaluated exclusively via the CAM-ICU (Confusion Assessment Method for the ICU) by trained anesthesiologists in the PACU. Results: Significant improvements were observed in psychological parameters, with body image scores increasing from 3.1±0.8 to 4.2±0.7 and self-esteem from 2.9±0.7 to 4.0±0.6 (p<0.001). Anxiety and depression scores decreased from 3.8±0.9 to 2.6±0.8 and 3.5±0.8 to 2.4±0.7, respectively. Post-anesthesia delirium was identified in 8.7% of patients (n=20) in the PACU, correlating significantly with higher baseline pre-procedural anxiety (r = 0.42, p<0.01) and age >45 years. Behavioral changes included improved portion control (73.0%), healthier dietary adherence (67.8%), and increased physical activity (58.3%). Mean weight loss was 13.8±4.6%, with a BMI reduction of 5.2±1.9. Weight maintenance (>6 months) was achieved in 70.4% of patients. post-anesthesia delirium was assessed via CAM-ICU in the PACU. The multivariable logistic regression result for age >45 years is now reported with an adjusted effect estimate: Adjusted Odds Ratio (aOR) = 2.45, 95% CI: 1.08–5.54, p = 0.031. Conclusion: Gastric balloon placement under general anesthesia significantly improves psychological well-being, promotes positive behavioral changes, and supports effective weight loss. Post-anesthesia delirium represents a notable transient recovery complication in a subset of patients, emphasizing the need to integrate PACU neurocognitive monitoring alongside long-term behavioral and psychological management.

Objectives: Mental health problems in older people and a significant cost to their quality of life. This is an emerging non-pharmacological approach to improve psychological wellbeing in this population, called Mindfulness Based Interventions (MBIs). The aim of the present study was to identify the effectiveness of a mindfulness-based program administered over an 8-week period aimed at the reduction of stress, anxiety and depression. Methods: The study used a randomized controlled repeated-measures study design which included 132 subjects. The participants were randomly assigned to both groups. The study group were offered the 8-week MBI for older adults. The program conducted for about 10 to 15 minutes per session. Psychological outcomes were measured using standardized instruments, including the Perceived Stress Scale (PSS), Geriatric Anxiety Scale (GAS-10) and Geriatric Depression Scale (GDS). Results: The study findings revealed a statistically significant reduction in depression, stress and anxiety in the study group compared to the control group following the intervention (p<0.001). The control group showed only slight changes, however. Conclusion: The findings emphasize the need to further integrate structured mindfulness programs in resource-limited, community-based and geriatric health care in order to improve mental health and promote healthy aging.

Objectives: Artificial Intelligence (AI) based tools are increasingly used in prosthodontic design and occlusal analysis. They now appear at several steps of the digital workflow: crown design, registration of the occlusal relationship and correction of virtual occlusal contacts. It is not clear whether these tools give restorations that fit and occlude as well as those made with conventional workflows. This systematic review summarises the evidence on AI-assisted occlusal design and adjustment, with technical accuracy as the primary outcome. Methods: The review followed PRISMA 2020 and was not registered in advance. PubMed, Scopus and the Cochrane Library were searched for English-language articles published from 2015 to 2025. Eligible studies compared an AI-based tool for crown design, occlusal registration or occlusal contact correction with a conventional workflow. Two reviewers independently screened studies, extracted data and assessed risk of bias, using an adapted QUIN tool for laboratory studies and ROBINS-I for clinical studies. Results were synthesised narratively by intervention and outcome. Results: The search identified 150 records and 12 studies met the inclusion criteria: two comparative clinical studies (17%), one laboratory study with three supplementary clinical cases (8%) and nine laboratory studies (75%). No randomised trial was found. No study reported follow-up beyond the scanning or seating visit and none reported validated patient-reported outcomes. In a paired clinical study of 62 patients, AI-designed crowns were equivalent to conventionally designed crowns for most marginal and internal gap measures, but the lingual marginal gap and the occlusal discrepancy were larger with AI design (149±66 Vs 105±63 μm; mean difference 43.9 μm, 90% CI 38.6 to 49.4, outside the ±15 μm equivalence margin). In laboratory studies that measured it, AI crown design shortened design time. AI-based occlusal registration was less accurate than the scanner’s own articulation in three of four studies of the same platform. AI-driven Occlusal Contact Adjustment (AI-OCA) improved the trueness of virtual occlusal records at some interarch distances and reduced it at others. Four studies came from one research group using one platform. Heterogeneity precluded meta-analysis. Conclusion: The available studies measure technical accuracy at the time of fabrication. They say little about long-term clinical performance or patient benefit. AI-assisted crown design matched conventional design on most fit measures but produced larger occlusal discrepancies and results for AI-based registration and contact correction were mixed and depended on scanner and edentulous span. These findings are preliminary and should be treated as hypotheses. Well-designed clinical trials with standardized outcomes and long follow-up are needed before routine adoption.

Background: Plantar fasciitis is a common musculoskeletal condition associated with plantar heel pain and limitations in weight-bearing activities. The tibialis posterior dynamically supports the medial longitudinal arch, however, clinical evidence on targeted strengthening programmes for individuals with plantar fasciitis remains limited. Objective: To compare changes in tibialis posterior muscle strength and foot function following a six-week programme combining tibialis posterior strengthening with plantar fascia-specific stretching versus conventional exercises and conservative advice in individuals with plantar fasciitis. Methods: This randomised comparative intervention study included 42 adults aged 25–50 years with plantar fasciitis, allocated to two groups of 21 participants each. Group A received tibialis posterior-focused strengthening combined with plantar fascia-specific stretching, whereas Group B received gastrocnemius and soleus stretching, footwear advice, activity modification, and symptom-relief measures. Both programmes were administered three times weekly for six weeks. Tibialis posterior muscle strength was assessed using a modified sphygmomanometer, and foot-related symptoms and disability were evaluated using the Foot Function Index (FFI). Assessments were conducted at baseline, week 3, and week 6. Results: Descriptive findings indicated improvements in both groups. Mean tibialis posterior strength increased from 43.00 to 58.50 mmHg in Group A and from 42.25 to 50.25 mmHg in Group B. Mean FFI scores decreased from 54.50 to 26.00 in Group A and from 56.25 to 40.75 in Group B. The unadjusted between-group differences in mean change were 7.50 mmHg for muscle strength and 13.00 FFI points, favouring Group A. However, inconsistencies between the reported sample size and inferential-test degrees of freedom prevent confirmation of statistical significance from the available data. Conclusion: Both intervention programmes demonstrated favourable descriptive changes in muscle strength and foot function over six weeks, with larger mean changes observed in the combined tibialis posterior strengthening and plantar fascia-specific stretching group. These findings should be interpreted cautiously because statistical superiority and clinical importance remain unconfirmed pending participant-level reanalysis.

Objectives: Sepsis remains a leading cause of morbidity and mortality, where early recognition and timely antibiotic administration are critical. Artificial Intelligence (AI) has been increasingly investigated for sepsis prediction and clinical decision support across emergency and critical care settings. Objective: To systematically evaluate the diagnostic performance of AI models for early sepsis recognition and their reported effects on time-to-antibiotic administration and selected clinical outcomes. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, Embase and Google Scholar from 2015 to January 2026. Studies evaluating AI-based models for sepsis detection that reported diagnostic accuracy, time-to-antibiotics, mortality, or length of stay were included. Two reviewers independently screened and extracted data. Results: Ten studies were included (randomized trials, prospective and retrospective cohorts and before-and-after studies) conducted in emergency departments, intensive care units, hospital wards and prehospital settings. AI models showed AUROC values ranging from 0.83 to 0.92 across different validation approaches. Several implementation studies reported reductions in time-to-antibiotic administration (absolute differences ranging from approximately 10-16 minutes, or higher proportions of patients receiving antibiotics within 1-3 hours). Effects on mortality and length of stay were inconsistent across studies. Conclusion: AI-based systems demonstrate promising diagnostic performance for early sepsis recognition and, in selected implementation studies, appear to accelerate antibiotic administration. However, substantial heterogeneity in study designs, settings, sepsis definitions and outcome measures limits the ability to draw firm conclusions about consistent clinical effectiveness. Further prospective validation and implementation research are needed.

Objectives: The Rational Use of Medicines (RUM) requires that patients receive medicines appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period and at the lowest cost to them and their community. Pharmacists contribute to RUM in several ways, but the evidence for these contributions is dispersed across different practice settings, intervention types and outcome measures. Objective: To provide a narrative overview of the principal roles through which pharmacists may contribute to RUM, to describe the type and strength of the supporting evidence and to identify conditions that influence the transferability of pharmacist-led services. Methods: A narrative review was conducted using a structured, non-systematic search of PubMed/MEDLINE, Scopus and Web of Science, supplemented by Google Scholar, for English-language publications from 2000 to 2025. Systematic reviews, meta-analyses and original studies addressing pharmacists' roles in RUM were prioritised; guidelines and policy documents were used to provide definitions and context rather than evidence of effectiveness. No formal quality appraisal or quantitative pooling was performed and findings are presented descriptively. Results: Five themes were identified: medication review and optimisation; patient education and adherence; antimicrobial stewardship; pharmacovigilance and medication safety; and digital health technologies. The most consistent review-level evidence concerned pharmacist-led medication reconciliation at hospital transitions and hospital antimicrobial stewardship, both of which were associated with improvements in process and selected clinical outcomes. Evidence for medication review in older people, adherence interventions and digital tools was more heterogeneous, frequently of low certainty and sensitive to setting, intervention design and outcome measurement. Reported effects varied according to pharmacists' scope of practice, access to clinical information and integration with prescribers. Conclusion: Pharmacists have the potential to support RUM across hospital, primary care and community settings, but the size and consistency of benefit differ by intervention and context. Because this review did not systematically appraise or pool the evidence, it cannot establish the overall effectiveness of pharmacist interventions. Adequate training, access to patient information, interprofessional collaboration, regulatory support and rigorous evaluation appear to be prerequisites for realising this potential.

Background: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative approach intended to reduce surgical stress and promote early recovery. We describe postoperative recovery in patients with colorectal cancer who underwent laparoscopic resection with selected ERAS components. Methods: This prospective, single-centre, descriptive cohort study enrolled 30 of 82 screened adults (18-80 years) scheduled for elective laparoscopic colorectal resection at Government Medical College, Srinagar, between 10 August 2024 and 10 February 2026, with follow-up to six months after discharge. All 30 participants had malignant pathology. Adherence was recorded for 19 pathway elements. Primary postoperative stay was counted from the day of surgery to discharge from the index admission; total postoperative hospital days included readmissions within 30 days of discharge. Complications within 30 days of surgery were graded by the Clavien-Dindo system. Readmission was any unplanned readmission within 30 days of discharge and redo surgery was an unplanned return to theatre. Analysis was descriptive, with exact 95% Confidence Intervals (CI). Results: Mean age was 58.1±10.4 years and 70.0% were male. All patients had malignant pathology (adenocarcinoma 90.0%; rectosigmoid tumours 46.7%). All procedures were completed laparoscopically without conversion (0/30; 95% CI 0-11.6%). All 30 patients received non-opioid analgesia without rescue opioid and were mobilized on postoperative day (POD) 1; oral intake began on POD 1 in 21/30 (70.0%) and by POD 2 in all. The mean primary postoperative stay was 4.7±0.94 days (95% CI 4.4-5.1; median 5; range 3-8). Complications occurred in 8/30 (26.7%; 95% CI 12.3-45.9), five of them Clavien-Dindo grade ≥III. Readmission within 30 days occurred in 7/30 (23.3%; 95% CI 9.9-42.3) and added 22 hospital days (mean 3.1±1.2 days per readmission), so total postoperative hospital days including readmissions averaged about 5.5 per patient. Redo surgery was needed in 2/30 (6.7%; 95% CI 0.8-22.1). All patients completed follow-up at 1 week, 4 weeks and 6 months. Conclusion: In this small, uncontrolled cohort of patients with colorectal cancer, delivering selected ERAS components alongside laparoscopic resection was feasible, with a median primary stay of 5 days but nearly one in four patients was readmitted. Because there was no comparison group and the sample was small, these findings are descriptive associations and do not show that ERAS shortened hospitalization or improved outcomes. Adequately powered comparative studies are needed.

Background: Diabetic foot ulcers (DFUs) are associated with delayed healing and substantial morbidity. This study compared healing outcomes between structured, guideline-based wound care and traditional wound care according to WIfI clinical stage. Methods: The guideline-based cohort (n = 78) was recruited prospectively between Jun. and Nov. 2026, as eligible patients became available at different times. Each patient was followed individually for 12 weeks to assess wound-healing outcomes and determine healing time. The traditional-care cohort (n = 90) was identified through hospital records covering the same January–July 2026 period. Only patients with complete records documenting their wound-healing outcomes over the 12-week period were included. Wound healing outcomes were compared between the two groups over 12 weeks for each patient. Results: Complete wound healing within 12 weeks was achieved in 65/78 patients (83.3%) receiving guideline-based care, compared with 30/90 (33.3%) receiving traditional care (p<0.0001; OR 10.00, 95% CI 4.77–20.95). The observed healing rate was approximately 2.5 times higher with guideline-based care. Stage-specific healing rates were significantly higher with guideline-based care in WIfI Stage 1 (100.0% vs 19.0%, p<0.0001), Stage 2 (90.9% vs 48.0%, p = 0.0248), and Stage 3 (93.1% vs 42.1%, p<0.0002), but not Stage 4 (50.0% vs 24.0%, p = 0.1167). Among patients who achieved complete healing, mean healing time was shorter with guideline-based care overall (52.06±22.87 vs 66.52±16.58 days, p = 0.0025), with significant differences in Stage 1 (29.11±13.89 vs 50.64±7.82 days, p = 0.0077), Stage 2 (42.40±18.56 vs 59.27±18.40 days, p = 0.0455), and Stage 3 (63.04±16.95 vs 75.89±9.24 days, p = 0.0492). The difference in Stage 4 was not statistically significant (73.40±12.48 vs 79.09±5.92 days, p = 0.3168). Conclusion: Structured, guideline-based wound care was associated with significantly higher healing rates and shorter healing time, particularly among patients with WIfI Stages 1–3. Prospective multicentre studies are needed to confirm these findings.

Background: The Health Sector Transformation Program is a key part of Saudi Arabia’s Vision 2030. One of its main goals is to improve patient centered care through hospital clustering. However, limited evidence exists on how clustered and non-clustered hospitals differ in managing chronic diseases. Objective: To assess patient centered care in chronic disease management in clustered and non-clustered hospitals in Saudi Arabia. Methods: A mixed methods study was conducted in four hospitals in Mecca and the Eastern Province between 2016 and 2024. Two hospitals were clustered and two were not. Quantitative data were taken from hospital records to assess patient centered care indicators, digital health use and resource utilization. Qualitative data were collected through 53 in depth interviews with patients and physicians to explore care experiences and implementation challenges. Results: Clustered hospitals had higher patient centered care index scores than non-clustered hospitals (99.06 vs. 89.82, p<0.001). Patient satisfaction was higher (87.6 vs. 79.7, p<0.001) and readmission rates were lower (8.5 vs. 14.5%). Digital health adoption was greater in clustered hospitals (72.5 vs. 45.0, p = 0.02). Interview findings supported these results and showed better care coordination and accountability in clustered hospitals. Non clustered hospitals reported limited resources and uneven care processes. Conclusions: Hospital clustering under the Health Sector Transformation Program is associated with better patient centered care and improved chronic disease outcomes. Ongoing gaps in non-clustered hospitals highlight the need for focused investment in digital systems and workforce training to support equitable progress under Vision 2030.

Objectives: Berberis vulgaris, commonly known as barberry, is a medicinal plant whose fruit extract contains a rich profile of bioactive constituents. Berberine (Brb) is naturally present in several Berberis species; it has attracted extensive scientific attention due to its wide therapeutic potential. The present research aims to evaluate the anti-bacterial properties of a Silver nano-formulated B. vulgaris fruit extract. Methods: Ethanol extracts of B. vulgaris fruit were prepared and converted into silver nanoparticles, which were characterized using FTIR, TEM, and XRD. Antibacterial activity was assessed by Microbroth Dilution Method against Gram-positive and Gram-negative bacteria from human and animal sources. Antioxidant potential was evaluated using FRAP and DPPH assays. Results: FTIR analysis confirmed the presence of key bioactive compounds in B. vulgaris ethanolic extract, including berberine, phenols, and flavonoids. (TEM) images showed spherical silver nanoparticles with maximum sizes 145 nm, indicating uniform distribution, while X-ray Diffraction (XRD) patterns confirmed a well-defined crystalline structure. The silver nanoparticles and extract exhibited dose-dependent antibacterial activity, with varying MICs against human and animal isolates. For animal isolates, E. coli shows an MIC of 25 µg/ml, while S. aureus is more sensitive with an MIC of 12.5 µg/ml. Among human isolates, E. coli requires a higher MIC (50 µg/ml), indicating lower susceptibility. S. aureus from human samples shows the least sensitivity with an MIC of 100 µg/ml. In contrast, S. pyogenes is highly sensitive, showing the lowest MIC value of 6.25 µg/ml, sµggesting strong inhibitory activity against this organism. Antioxidant assays (DPPH and FRAP) demonstrated higher activity of nanoparticles compared to the crude extract, with superior reducing power over ascorbic acid. In Conclusion: The ethanolic extract and nanoparticles of Berberis vulgaris demonstrated significant bioactivity, including potent antioxidant and selective antimicrobial effects.

Repeated exposure to sub-inhibitory antibiotic concentrations can alter bacterial killing dynamics without a corresponding change in the Minimum Inhibitory Concentration (MIC). It remains unclear to what extent biofilm remodelling, persister enrichment and efflux activation arise concurrently in clinical Multidrug-Resistant (MDR) Pseudomonas aeruginosa. We studied 48 clinical MDR P. aeruginosa isolates, each conditioned separately with ciprofloxacin, meropenem and tobramycin, yielding 144 isolate-antibiotic pairs assessed from baseline to Day 7. Endpoints comprised normalised growth, crystal-violet biofilm biomass, viable biofilm burden, high-resolution time-kill kinetics, MDK99 (the minimum duration required to kill 99% of the starting population), persister fraction, relative functional efflux index, pharmacological efflux inhibition, MIC reassessment, antibiotic-withdrawal recovery, cross-challenge and targeted mexB, mexD, mexF and mexY expression, analysed in linear mixed-effects models with the clinical isolate as the random effect. In all 144 pairs, the 1/4-MIC condition retained 86.1% of matched unexposed growth at Day 3 (normalised growth 0.861; 95% CI, 0.854-0.868) and produced non-monotonic biofilm remodelling (Day-7 biomass 1.127-fold versus matched 0-MIC controls; 1.079-1.177). The primary tolerance analysis was restricted to the 130 of 144 pairs (90.3%) without a two-fold or greater Day-3 MIC rise, the remaining 14 pairs being analysed separately as resistance-associated shifts. In these 130 pairs, MDK99 increased by 0.334 h at Day 3 (95% CI, 0.224-0.443) and 0.360 h at Day 7 (0.201-0.520), with median persister-fraction increases of 2.11- and 2.69-fold. Functional efflux rose in all 144 pairs (+0.217 index units at Day 3; 0.164-0.271). In a predefined subset of 24 isolates (72 pairs), efflux inhibition lowered survival of the bactericidal challenge, defined as the proportion of the starting inoculum recoverable at 8 h, by 13.34 absolute percentage points (95% CI, 11.03-15.66). Persister enrichment was the only independent predictor of the change in MDK99 (β = 0.325 h per 1-log10 increase; 95% CI, 0.129-0.522; FDR-adjusted p = 0.00704); the changes in efflux and biofilm were not. After antibiotic withdrawal in 72 pairs, MDK99, persister fraction, efflux and biofilm biomass all shifted significantly back toward baseline without full normalisation and 7 of 72 pairs retained a two-fold MIC elevation; generalised cross-tolerance was uncommon (mean cross-MDK fold change 1.038; range 0.720-1.365). Repeated non-lethal antibiotic stress therefore induced a multidimensional, only partially reversible survival state that MIC-defined susceptibility testing did not capture. As an in vitro study of a modest isolate collection, with recovery, microscopy and expression endpoints assessed in predefined subsets and without genomic analysis, these findings require validation in infection models before clinical inference.

Background: Diabetic foot ulcer is one challenging problem that is associated with significant morbidity and can end with amputation. There are various agents being used for treatment of diabetic foot ulcer, with varying success rates. Objective and Study: To evaluate the efficacy of topical phenytoin in promoting wound healing in diabetic foot ulcer. Methods: This is a prospective, uncontrolled case series study that was conducted on 12 patients with diabetic foot ulcer. Patients with uncontrolled diabetes, vascular impairment and grade III, IV or V ulcers according to Wagner classification were excluded. Phenytoin was applied as a suspension (crushed phenytoin tablet dissolved in normal saline). The dose of phenytoin was applied according to the surface area of the ulcer. Wound healing was assessed according to the appearance of healthy granulation tissue, reduction in wound size, decrease in exudate and a decreasing pain score. Result: At the end of 14 days, the presence of healthy granulation tissue was documented in all of our patients, with reduction of wound exudate and pain score. The overall reduction in ulcer size was more than 60%. For those patients who had later skin grafting, the skin graft was completely taken. Conclusion: Based on our study, locally applied phenytoin for diabetic foot ulcers showed promising results in promoting early wound healing, with no local or systemic adverse effects observed.

Background: Inappropriate antibiotic prescribing in dentistry contributes to antimicrobial resistance and remains a concern in endodontic practice. Although evidence-based guidelines recommend restricting systemic antibiotics to specific clinical indications, gaps in antibiotic-prescribing knowledge persist among dental students. Evidence regarding the effectiveness of guideline-based educational interventions among dental students in Saudi Arabia remains limited. Objective: To assess baseline knowledge of evidence-based antibiotic prescribing for endodontic conditions among clinical-level dental students at Al-Baha University and evaluate changes in questionnaire-based knowledge following a structured, guideline-based educational intervention. Methods: A single-center, pre-post educational intervention study was conducted among male clinical-level dental students at Al-Baha University. Electronic questionnaires assessing knowledge of antibiotic indications, antibiotic selection, treatment duration and antimicrobial resistance were administered before and after a structured educational workshop based on European Society of Endodontology guidelines. Baseline responses were obtained from 81 students and post-intervention responses from 69 students. Individual-level matching between the two assessments has not been established. Results: The proportion of correct responses was higher in the post-intervention assessment across the evaluated knowledge domains. Correct responses regarding antibiotic use in irreversible pulpitis increased from 30.9% (25/81) before the workshop to 82.6% (57/69) afterward, while correct responses for localized apical abscess without systemic involvement increased from 28.4% (23/81) to 79.7% (55/69). Recognition of amoxicillin as a first-line antibiotic increased from 51.9% (42/81) to 88.4% (61/69). Awareness of antimicrobial resistance increased from 44.4% (36/81) to 91.3% (63/69). These findings represent descriptive differences between the two assessments. Conclusion: Higher proportions of correct questionnaire responses were observed following the guideline-based educational intervention, suggesting a potential benefit of structured antimicrobial stewardship education in undergraduate dental training. However, the absence of a control group and uncertainty regarding participant-level matching limit causal interpretation. Further studies incorporating validated assessments, matched longitudinal observations and clinical prescribing outcomes are warranted.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neurodevelopmental disorder characterised by inattention, motor hyperactivity and impulsivity, with significant subsequent impact on behavioural, emotional, cognitive, academic and social functioning. Executive function deficits and altered stress response are also associated with ADHD. While High-Intensity Interval Training (HIIT) may enhance neurobehavioral functioning and Median Nerve Stimulation (MNS) may alter neural activity, research on their integrated effects on neurobehavioral outcomes and salivary cortisol levels among children with ADHD is limited. Objective: This study aimed to determine the effects of MNS combined with HIIT on neurobehavioral outcomes and salivary cortisol levels among children with ADHD. Materials and Method: This pilot randomised study recruited 20 children with ADHD, with combined presentation, aged 8 to 12 years and randomly allocated them into two Groups. Group A received MNS with HIIT (n = 10), whereas Group B received Sham stimulation with HIIT (n = 10). The intervention was administered for 50 minutes, 5 sessions per week, for a total span of 8 weeks. Neurobehavioral outcomes were assessed using the parent-reported Vanderbilt ADHD Rating Scale and the Childhood Executive Functioning Inventory. Salivary cortisol was assessed as a stress biomarker. Data were analysed using paired and independent t tests. Results: Group A had significantly lower post test scores than Group B for inattention (10.50±1.080 vs. 19.80±2.098), hyperactivity (10.70±1.160 vs. 21.00±2.494), total ADHD symptoms (21.20±1.751 vs. 40.80±2.860), inhibitory factor (32.80±2.150 vs. 42.50±1.581) and working memory (33.50±2.461 vs. 51.00±3.162). Salivary cortisol levels increased more in Group A than in Group B (2.454±0.166 vs. 1.187±0.090). All between-group differences were statistically significant (p<0.001). Conclusion: This study concluded that MNS with HIIT may be more beneficial than Sham stimulation with HIIT in reducing neurobehavioral outcomes and improving salivary cortisol levels among children with ADHD.

Background: Low Density Lipoprotein Cholesterol (LDL-C) and cell free deoxyribonucleic acid (cfDNA) could be the important factors in the development of hypertension (HTN) and Chronic Bronchitis (CB). In view of inconclusive and controversial reports, we planned to clarify the impact of LDL-C and cfDNA in HTN and CB in adult men. Methods and Results: Adult male patients with HTN (n:130) and CB (n:130) compared with normal healthy adult males (n:130) had same range of age (51-60 years) and body mass index (BMI; 18.5-24.9 kg/m²). LDL-C and cfDNA in CB patients compared with NC did not present any significant variation (p>0.05). HTN vs. NC subjects showed significant increased levels for LDL-C (<0.001) and cfDNA (<0.001) in HTN. Furthermore, LDL-C plotted against cfDNA levels for HTN presented significant positive linear correlation (p<0.001). Plot of LDL-C against cfDNA in CB and association of all other variables with LDL-C and cfDNA in HTN and CB showed non-significant correlations. Conclusions: Present report provides information of the significant impact of increased levels and positive linear correlation of serum LDL-C and cfDNA in adult patients with HTN, possibly involving inflammatory conditions. Increase in BP may increase LDL-C and cfDNA and vice versa via tissue damage and inflammation.

The development of effective anticancer agents is challenging due to toxicity, drug resistance and poor physicochemical properties of current compounds. We synthesised a novel benzhydrol derivative, (4-acetamido(phenyl)phenyl) methyl acetate, through a two-step reduction-acylation process from 4-aminobenzophenone. Structural confirmation was validated via NMR spectroscopy. The compound's cytotoxic potential was evaluated against acute myeloid leukaemia (Kasumi-1) and normal haematopoietic stem cell (CD34+) lines using the MTT assay. The compound showed a time- and concentration-dependent decrease in Kasumi-1 cell viability, with an IC₅₀ of 21.30±2.47 µg/mL (p<0.0001) at 72 h (~74 µM), indicating moderate effectiveness against Kasumi-1 cells. No significant effect was observed on CD34+ cells; a selectivity index greater than 2.56 indicates substantial selectivity of the compound for cancer cells. In silico predictions indicated the compound's potential to interact with key apoptosis-related proteins. Morphological studies indicated apoptosis-related changes in Kasumi-1 cells, corroborating cytotoxic findings, further validated by flow cytometry and protein expression analyses. These findings highlight the pharmacological potential of (4-acetamido(phenyl)phenyl) methyl acetate, suggesting further chemical modifications to improve anticancer activity and pharmacokinetic properties. Additional mechanistic studies and evaluations in various cancer models are necessary to confirm its therapeutic potential.

Background: Mandibular parasymphysis fractures are among the most common facial injuries encountered in oral and maxillofacial trauma practice. Traditionally, the region is managed with two miniplates following Champy’s lines of osteosynthesis to resist torsional and compressive forces. However, the placement of a superior plate near the canine-premolar region carries a risk of iatrogenic injury to the mental nerve and dental roots. Objective: To compare the clinical and functional outcomes of single-plate and double-plate fixation in patients with simple, non-comminuted mandibular parasymphysis fractures. Methods: This prospective comparative study included 16 patients with simple, non-comminuted mandibular parasymphysis fractures. Eligible patients were aged 15-55 years, while the enrolled participants were aged 18-50 years. Patients were allocated into two groups of eight each. Group I underwent fixation using a single 2.5 mm miniplate along the inferior mandibular border, whereas Group II received two 2 mm miniplates placed along the superior and inferior borders. Clinical and functional outcomes were assessed through fracture union, occlusal stability, wound complications, iatrogenic dental injury, mental nerve paresthesia, operative duration, mouth opening and return to mastication. Results: Both groups achieved satisfactory fracture healing and occlusal stability during the six-month follow-up period. The mean operative duration was shorter in Group I (72.1±4.6 minutes) than in Group II (84.2±5.1 minutes; p<0.001). Iatrogenic dental injury was observed in four patients (50%) in Group II and none in Group I. The between-group difference in dental injury was not statistically significant using a two-sided Fisher's exact test (p = 0.077). Wound complications and plate exposure were observed more frequently in Group II. However, the small sample size limited the precision of complication comparisons. Conclusion: In this small prospective comparative study involving 16 patients, both single-plate and double-plate fixation achieved satisfactory clinical outcomes in selected simple, non-comminuted mandibular parasymphysis fractures. Single-plate fixation was associated with shorter operative duration and fewer observed iatrogenic dental injuries. However, the limited sample size restricts the precision and generalizability of these findings. Larger, adequately powered multicenter studies are required to confirm the comparative effectiveness and safety of these techniques.

Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important healthcare-associated pathogen for which preventive vaccine strategies remain under investigation. Recombinant lactic acid bacteria (LAB) are being explored as vectors for oral antigen delivery, but their relevance to MDR-AB requires careful distinction between direct and indirect evidence. This scoping review summarized English-language publications retrieved from PubMed, Scopus, and Google Scholar for the period January 2018 to December 2024. Out of the 213 articles found initially, 46 articles were included in the review and classified into three themes: LAB strain (n = 23), recombinant oral vaccines (n = 7), and A. baumannii antigen and vaccine (n = 16). LABs contributed to knowledge about strain properties, vector development, and mucosal antigen delivery, which included vaccines against bacteria other than A. baumannii. On the other hand, studies of A. baumannii have analyzed antigens such as outer membrane proteins, adhesions, and outer membrane vesicles mainly through the use of non-laboratory-adapted (non-LAB) vaccination methods. These two strands of research provide complementary evidence for the development of an oral recombinant LAB vaccine for A. baumannii but cannot demonstrate the direct efficacy of the vaccine. Research challenges are involved in antigen choice, stability of the construct, antigen expression, immunogenicity at both mucosal and systemic level, standardization of the challenge method and safety study. Therefore, while recombinant lactic acid bacteria (LABs) represent a promising approach to oral vaccines, their protective efficacy against MDR-AB is not yet proven.

Background: Accurate digital recording of implant positions is essential for the fabrication of full-arch implant-supported prostheses. The accuracy of intraoral scanners may vary because of differences in image acquisition and data-processing technologies. Objective: To compare the trueness and precision of three intraoral scanners for full-arch implant-supported prostheses and evaluate their linear and angular deviations. Methods: A completely edentulous maxillary model containing six implant analogs was scanned using three intraoral scanners: TRIOS 5 (3Shape, Denmark), Primescan (Dentsply Sirona, Germany), and Medit i900 (Medit, Republic of Korea). Ten repeated full-arch scans were obtained with each scanner, resulting in 30 experimental datasets. A laboratory reference scan was used for three-dimensional comparison. Trueness and precision were evaluated using root mean square (RMS) deviations, while implant positional accuracy was assessed through linear and angular deviations. Statistical comparisons were performed using one-way analysis of variance or the Kruskal–Wallis test, as appropriate, with post-hoc pairwise comparisons adjusted for multiple testing. Statistical significance was set at P<0.05. Linear and angular deviations were measured at the six implant positions, and the mean deviation across the six positions was calculated for each scan. These scan-level values were used for comparisons among scanner systems. Results: Mean trueness deviations were 42.6±7.8 µm for TRIOS 5, 58.4±10.1 µm for Primescan, and 76.9±13.5 µm for Medit i900. Corresponding precision deviations were 31.8±6.4 µm, 44.7±8.6 µm, and 61.2±11.3 µm, respectively. Mean linear deviations were 54.3±11.2 µm, 72.8±14.6 µm, and 96.5±18.7 µm, while angular deviations were 0.31±0.10°, 0.48±0.16°, and 0.71±0.22°, respectively. The manuscript reports overall differences among the scanner groups for all four outcomes (p< 0.001). Conclusion: Under the standardized laboratory conditions of this in vitro study, TRIOS 5 demonstrated the lowest mean trueness, precision, linear, and angular deviations, followed by Primescan and Medit i900. These findings indicate differences in the measured accuracy of the three scanner systems within the experimental model. Further clinical investigations are required to determine whether these differences influence prosthesis fit and clinical outcomes.

India's child-health programmes have traditionally concentrated on survival, nutrition, communicable diseases, congenital disorders and developmental problems. Rashtriya Bal Swasthya Karyakram (RBSK), introduced in 2013, brought these priorities together through systematic screening of children from birth to 18 years for the four Ds—Defects at birth, Deficiencies, Diseases and Developmental delays including disabilities. The RBSK 2.0 Operational Guidelines released in 2026 represent an important widening of this approach. While retaining the 4Ds, the revised programme incorporates emerging childhood health concerns including diabetes mellitus, hypertension, kidney disorders, behavioural and neurodevelopmental conditions, mental-health concerns and lifestyle-related risks. Healthy eating, physical activity, sleep and digital exposure have also entered the programme framework. Screening is linked with revised Mobile Health Teams, District Early Intervention Centres, specialist referral pathways and a longitudinal digital Health Report Card. This article reviews the major changes introduced through RBSK 2.0 and examines their public-health significance, particularly the emergence of childhood NCD screening within a national child-health programme. The transition is important because risk factors and early manifestations of several adult NCDs begin much earlier in life. At the same time, screening a large paediatric population for chronic and behavioural conditions raises important questions regarding measurement, false-positive referrals, workforce preparedness, confirmatory diagnosis, continuity of care and data use. The success of RBSK 2.0 will therefore depend not merely on the number of children screened, but on whether identified children complete the pathway from screening to diagnosis, treatment and long-term follow-up.

Background: Nitric oxide (NO) is a multi-functional gaso-transmitter which plays a crucial role in the maintenance of oral and systemic (especially cardiovascular) health. Routine use of antiseptic mouthwash may disrupt the oral microbiome that reduces dietary nitrate (NO₃⁻) to nitrite (NO₂⁻), impairing NO production. This study aimed to assess Saudi dental professionals’ knowledge of NO, it’s microbial pathway, and the impact of mouthwash, while also examining knowledge differences across demographic and professional groups. Method: This descriptive, cross-sectional study used an online face-validated questionnaire comprising 22 items to assess Saudi dental professionals’ general knowledge of the NO₃⁻–NO₂⁻–NO pathway and specific knowledge of oral bacteria and mouthwash effects on NO production. Results: A total of 248 participants completed the questionnaire. Most dental professionals taking part in the survey had previously heard of NO (75.4%). Among those, 50% either confused NO with nitrous oxide used in anaesthesia or were unsure. Only 17.7% knew about the NO3-NO2--NO pathway. The mean general knowledge score was 2.3±1.9 out of 7; only 6.85% scored >70%. The mean specific knowledge score was 0.9±1.1 out of 4; only 3.6% scored >70%. About 1/3 of participants (35.1%) linked mouthwash to cardiovascular risk and 60.1% didn’t know about toothpaste effects on NO3⁻– NO2⁻– NO pathway. Knowledge scores did not significantly differ between demographic groups. Conclusion: The findings reveal notable gaps in dental professionals’ understanding of NO physiology and its relationship to oral microbiota and mouthwash use, suggesting a need for improved education to support informed practice and patient guidance.

Background: Many low-risk human papillomavirus (lrHPVs) genotypes have been detected in a large number of benign and malignant head and neck lesions using different molecular techniques. The Study Aims: To detect low-risk human papillomavirus (lrHPV) genotypes and investigate their association with the overexpression of the Rb protein. It has been reported that increased rates of lr HPV prevalence and expression of pRb might have possible role in pathogenesis and development of laryngeal lesions. Methods: Various (157) formalin – fixed, paraffin –embedded (FFPE)laryngeal lesions tissue blocks specimens were collected. Molecular detection and genotypes of low-risk human papillomaviruses (lrHPVs) using a modern version of in situ hybridization with type-specific probes, alongside the assessment of Rb protein overexpression via immunohistochemistry. Results: The current results show no statistically significant association between HPV6/11 DNA in situ hybridization (ISH) scores or signal intensity and pRb protein immunohistochemistry (IHC) scores or staining intensity in laryngeal nodules, polyps, or malignant lesions as following; 2(25.0%) in moderate score and high intensity 2 (25.0%) for malignant lesions while in polyps benign lesions in 1 case (25%) in moderate score and high intensity 1 (25%) .In nodules benign lesions, the score was in low and moderate in 1 case (20%) for each whereas the intensity detected in 2 case. Overall, integrated HPV 6/11 DNA signals showed the highest mean percentage in malignant lesions (12.78±23.40%), followed by episomal (3.87±11.44%) and mixed patterns (1.91±8.12%). Integrated patterns showed the highest mean percentage in polyps (10.14±22.90%), whereas episomal patterns showed the highest mean percentage in nodules (6.62±11.10%). Mixed signals were also reported in the control group, although differences among signal patterns in this group were not statistically significant (p = 0.3710). Conclusion: The heterogeneity of HPV6/11 DNA-ISH patterns and pRb expression may reflect underlying cellular and tissue alterations associated with benign and malignant laryngeal lesions. These findings suggest a potential, indirect role of low-risk HPV in laryngeal lesion development; however, the lack of significant associations between HPV 6/11 signals and pRb expression in the lesion groups precludes establishing a causal relationship. Further studies are warranted to clarify the biological significance of these findings.

Background: As of 2021, 537 million adults worldwide were estimated to have diabetes mellitus; by 2030, that number is expected to rise to 643 million, making it a global public health challenge. Effective self-care is the foundation of glycaemic control and the avoidance of complications, although its application varies greatly between geographical, cultural and economic contexts. Aims and Objectives: To systematically examine diabetes self-care awareness, behaviours and complication-prevention strategies in Asia, the Gulf Cooperation Council (GCC)/wider Middle East and North Africa (MENA) and Western countries, and the cultural, religious and economic factors that influence self-care behaviour. Methods: This systematic review was reported according to PRISMA 2020; no protocol was prospectively registered. PubMed/MEDLINE, Scopus and Web of Science were searched on 1 September 2024 for English-language publications from January 2000 onwards, supplemented by grey literature (WHO, IDF, NICE) and reference-list screening. Two reviewers independently screened records; extracted data were verified against each source. Included sources were analysed in three separate evidence streams (primary studies; systematic reviews/meta-analyses; guidelines) to avoid double-counting, synthesised narratively following the SWiM guideline, and the certainty of evidence was rated with GRADE for prespecified outcome–intervention comparisons rather than for regions. Results: Of 5,305 records retrieved, 38 sources were included: 19 primary studies, 13 systematic reviews/meta-analyses/scoping reviews and six guidelines or consensus statements. Structured diabetes self-management education and mobile-health interventions reduced HbA1c in randomised trials (moderate-certainty evidence), but these trials were conducted mainly in Western or multi-regional settings; only two included primary studies came from GCC member states. Reported self-care practices, medication adherence and diabetes distress varied widely within, as well as between, regions. Because all but one cross-regional contrast relied on indirect comparison of studies using different populations, instruments and time periods, certainty in regional differences was very low and no ranking of regions could be established. The MENA region, which includes the GCC, had the highest age-adjusted diabetes prevalence among IDF regions in 2021 (18.1%). Ramadan fasting, cost and access barriers, health-system organisation and family dynamics were recurring, context-specific considerations. Conclusions: The evidence demonstrates heterogeneity and contextual differences in diabetes self-care rather than a ranking of health systems. Context-adapted self-care programmes should be evaluated locally with standardised outcome measures, and direct comparative studies using common instruments—particularly in GCC member states—are needed.

Purpose: To compare the effects of the Spencer technique and scapular stabilization exercises on shoulder pain and disability, upper-extremity function and shoulder range of motion in individuals with diabetes mellitus and Stage II adhesive capsulitis. Methods: This two-arm, parallel-group randomized controlled trial included 49 participants with diabetes mellitus and Stage II adhesive capsulitis. Participants were allocated to the Spencer technique group (Group A, n = 25) or the scapular stabilization exercise group (Group B, n = 24). Both groups received their assigned physiotherapy intervention for six weeks. SPADI and DASH raw item-sum totals were analysed as primary outcomes. We analysed active and passive shoulder abduction and external rotation, measured with a goniometer, as secondary outcomes. We compared groups using change scores, with the mean difference defined as the change in Group A minus the change in Group B. Results: Both groups showed reductions in SPADI and DASH raw total scores after six weeks. The mean SPADI reduction was 46.00 points in Group A and 49.75 points in Group B; the between-group mean difference was -3.75 points (95% CI, -9.50 to 2.00; p = 0.195). The mean DASH reduction was 50.12 points in Group A and 42.63 points in Group B, favouring Group A, with a between-group mean difference of 7.50 points (95% CI, 2.10 to 12.89; p = 0.007). The improvement in shoulder abduction was greater in Group A for active range of motion (between-group mean difference, 23.01°; 95% CI, 14.70 to 31.31; p<0.001) and passive range of motion (18.31°; 95% CI, 10.86 to 25.76; p<0.001). No statistically significant between-group differences were observed for active external rotation (1.12°; 95% CI, -3.07 to 5.31; p = 0.594) or passive external rotation (-0.37°; 95% CI, -2.98 to 2.25; p = 0.779). Conclusion: Both groups improved over six weeks. The change-score analysis favoured the Spencer technique for DASH raw total scores and shoulder abduction, while no statistically significant between-group differences were observed for SPADI or shoulder external rotation. These findings should be interpreted in the context of the raw-score method and differences in the intervention schedules.

Objectives: Migraine is a leading cause of disability worldwide and is associated with complex neurovascular and neuroinflammatory mechanisms. Magnesium (Mg) influences neuronal excitability, N-methyl-D-aspartate receptor activity, serotonin modulation, and vascular tone, suggesting a plausible role in migraine pathophysiology. Observational studies have reported reduced serum Mg in migraine; however, the relationship between serum Mg levels and migraine frequency and severity remains inconsistently reported. Objective: To synthesize evidence on the correlation between serum (total or ionized) Mg levels and the frequency and severity of migraine attacks in adults. Methods: This systematic review followed PRISMA 2020 guidance. PubMed, Google Scholar, Embase, Scopus, Web of Science, and Cochrane CENTRAL, ResearchGate were searched for English-language studies published from January 2010 to August 2025 assessing serum/ionized Mg levels in adults (≥18 years) diagnosed with migraine and reporting migraine frequency and/or severity outcomes. Study selection and data extraction were performed using a standardized approach, and risk of bias was assessed using RoB 2 for randomized trials and QUIPS for observational designs. Due to heterogeneity in designs, measurement methods, and outcome reporting, findings were synthesized narratively. Results: The search identified 211 records; after removal of 136 duplicates and full-text eligibility assessment, 13 studies were included. Included studies comprised predominantly observational designs (case–control and cross-sectional) and one clinical trial, with samples drawn from multiple countries. Most comparative studies reported lower mean serum Mg in migraine groups than controls, although not all findings were statistically significant. Several studies reported inverse associations between serum Mg levels and attack frequency and/or severity, while others found no significant correlations, indicating heterogeneity across settings and methodologies (e.g., total vs ionized Mg, interictal vs ictal sampling, and differing severity scales). Conclusion: Available evidence suggests an overall pattern of lower serum magnesium concentrations in adults with migraine compared with controls. Lower serum magnesium may be associated with greater migraine severity, while its association with attack frequency appears less consistent. However, the predominantly observational evidence and methodological heterogeneity limit causal interpretation. Standardized assessment of total and ionized serum magnesium, prospective migraine monitoring, and improved control of potential confounding factors are needed to clarify the consistency and clinical relevance of these associations.