Background: Radical Antegrade Modular Pancreatosplenectomy (RAMPS) was developed to improve oncological clearance during distal pancreatectomy by providing systematic lymphadenectomy and facilitating appropriate posterior retroperitoneal margin dissection. With advances in minimally invasive surgery, laparoscopic RAMPS (Lap-RAMPS) has emerged as a technically demanding approach that combines the principles of RAMPS with the potential perioperative advantages of laparoscopy. This study evaluated the feasibility, safety, perioperative characteristics, and short-term outcomes of laparoscopic RAMPS in patients with malignant tumours of the pancreatic body and tail. Methods: A prospective observational study was conducted in the Department of Minimal Access and General Surgery, Government Medical College, Srinagar, over an 18 month period from August 2024 to February 2026. Thirty consecutive adult patients with resectable malignant tumours of the pancreatic body and tail underwent planned RAMPS. Demographic characteristics, clinical presentation, operative approach, conversion, intraoperative complications, postoperative morbidity, pancreatic fistula, pathological findings, and short-term functional outcomes were assessed. All procedures were performed using the anterior RAMPS approach. Postoperative clinical assessment was performed at 1 and 3 weeks after discharge. Results: The study included 30 patients with a mean age of 57.0±7.2 years (range, 34-67 years). Eighteen patients (60%) were male and 12 (40%) were female, giving a male-to-female ratio of 1.5:1. Abdominal pain was the commonest presenting symptom (73.3%), followed by weight loss (53.3%) and anorexia (40.0%). Laparoscopic RAMPS was successfully completed in 27 patients (90%), while three patients (10%) required conversion to open surgery because of intraoperative technical difficulty and bleeding, including splenic artery-related vascular injury. Four intraoperative complications occurred (13.3%). No intraoperative blood transfusion or intraoperative mortality was recorded. Histopathological examination revealed pancreatic adenocarcinoma in 25 patients, pancreatic neuroendocrine tumour in four, and squamous cell carcinoma in one. R0 resection was achieved in all 30 patients. Postoperatively, six patients (20%) developed complications. Two patients developed postoperative pancreatic fistula, classified as Grade B according to the International Study Group of Pancreatic Surgery criteria, and were managed conservatively. Delayed gastric emptying occurred in six patients. Splenic vein thrombosis occurred in one patient. Endocrine and/or exocrine pancreatic insufficiency was documented in eight patients, while new-onset diabetes mellitus was identified in 16 patients during follow-up assessment. There was no major postoperative morbidity, reoperation, or 30-day mortality. Conclusion: Laparoscopic RAMPS was technically feasible in 90% of patients in this single-centre prospective series and was associated with acceptable short-term morbidity and no perioperative mortality. The findings support the feasibility of laparoscopic RAMPS in appropriately selected patients when performed by an experienced surgical team. Larger multicentre studies with longer oncological follow-up are required to determine its long-term survival and recurrence outcomes.

Background: Prolactin hormone disorder is considered an increasingly common endocrine dysfunction that affects the hypothalamic-pituitary axis. Prolactin secretion is stimulated by dopamine antagonists, in addition to thyrotropin-releasing hormone (TRH). Objective: The study aims to determine the prevalence of abnormal Prolactin levels (hyperprolactinemia and hypoprolactinemia) in married Females. Patients and methods: The cross-sectional study included 1,059 married female participants who attended Al-Batool Teaching Hospital in Diyala, Iraq between January 2024 and March 2025 at the same hospital. The demographic data of the patients participating in the study were collected from ward records after obtaining informed consent. At the same time, prolactin levels were measured in the hospital’s biochemistry laboratories using the German-made Cobas e 411 analyser. Results: Among married female participants, 46.4% had hyperprolactinemia, 9.8% had hypoprolactinaemia, and 43.8% showed normal levels. Prolactin levels were not significantly associated with marriage duration (p = 0.006), number of children (p = 0.018), and sleep duration (p = 0.084). Longer marriages and fewer children correlated with higher prolactin levels. Additionally, a negative correlation (r = -0.084) between sleep duration and prolactin suggests that shorter sleep may elevate prolactin, potentially reflecting the physiological impact of chronic stress and reproductive strain. Conclusion: The current study noted that there is a high prevalence of hyperprolactinemia among married women at Al-Batool Teaching Hospital in Diyala province, significantly linked to longer marriage duration, fewer children, and shorter sleep duration.

Background: Lupus nephritis with immune dysregulation and renal involvement is a severe, potentially life-threatening complication of systemic lupus erythematosus (SLE). Assessment of immune and serologic parameters is important in determining disease activity and monitoring renal injury. Objective: This study was conducted to evaluate some immunological and biochemical parameters in lupus nephritis (LN) patients and their correlation with disease activity. Methods: A cross-sectional study was conducted among patients diagnosed with LN and age-matched healthy controls. Blood and urine were obtained to assess different immunological parameters (antinuclear antibody, ANA; anti-dsDNA antibodies; complement levels: C3 and C4). Serum creatinine, blood urea, albumin and proteinuria were also measured by standard laboratory procedures. Comparison of patient groups and control groups was conducted through statistical analysis, and P < 0.05 was considered statistically significant. Results: A total of 110 participants were included in this study, with a mean age of 39.0±11.76 years. The majority of participants were females (99.1%). The ANA test was positive in 33.7% of patients, while 66.3% were negative. Anti-dsDNA antibodies were positive in 10% of cases. The mean MYD88 level was 5.31±2.74, ranging from 2.01 to 13.64, indicating variability in immune marker expression among participants. Lupus nephritis patients had much higher amounts of immunological markers, in particular anti-dsDNA antibodies and lower complement (C3 and C4) levels than healthy controls (p<0.05). Biochemical analysis showed significantly higher serum creatinine and proteinuria, with decreased levels of serum albumin, which indicated impaired renal function. Conclusions: It is concluded that the combined evaluation of immune and biochemical indices can be helpful in assessing disease activity and renal involvement in patients with lupus nephritis. These markers could be useful to aid in the diagnosis and monitoring of disease progression, as well as guiding therapeutic intervention.

Obesity is an excessive accumulation of adipose tissue in the body. Obese women are at increased risk of developing various metabolic, endocrine, and gynaecological problems, including menstrual dysfunction and subfertility. Objectives: The objective of the study was to determine the association of body mass index with menstrual cycle abnormalities in young women. Methods: This study was conducted in Hail from September 2025 to February 2026, with a sample size of 315 participants. The data were collected using a pre-designed questionnaire from young women aged 18-35 years living in Hail who had no prior gynaecological disease. The questionnaire included demographic information, details of their menstrual cycle, and any associated problems. Participants were asked about their weight (kg) and height (cm), and their BMI was calculated. These indices were then analysed statistically using SPSS version 22. The 95% confidence level and confidence intervals were employed. The chi-square test was used to assess the association between obesity indices and menstrual problems. P<0.05 will be considered significant. Multivariable logistic regression analyses were conducted for all menstrual outcomes to identify independent associations between BMI and menstrual characteristics. Results: BMI showed significant associations with multiple menstrual parameters. Higher BMI was linked to greater cycle irregularity, altered cycle duration, and disrupted cycle frequency. Obese participants exhibited the highest rates of irregular, shortened, and prolonged cycles. Dysmenorrhea severity also varied by BMI, with pain patterns shifting across weight categories. Multivariable logistic regression demonstrated that higher BMI independently predicted lower odds of irregular cycles (AOR 0.70, 95% CI 0.50–0.93) and reduced dysmenorrhea (AOR 0.95, 95% CI 0.92–0.99), while cycle length decreased slightly with increasing BMI. No significant associations were observed for menstrual flow, intermenstrual bleeding, or cycle frequency after adjustment. Conclusion: This study demonstrates that BMI is significantly associated with multiple menstrual cycle abnormalities. This research could help identify targeted treatments for women with abnormal BMI and menstrual dysfunction, potentially improving reproductive health. It supports that weight management should be a key part of menstrual health treatments.

The immune system is greatly impacted by urinary tract infections (UTIs), which cause both systemic and local immune responses meant to eradicate the infection and stop its spread. However, persistent or recurrent infections can result in immune dysregulation. The current study aimed to determine the serum levels of interleukin in the fifteenth and fortieth tests in a sample of children with UTI. This study was conducted at Al-Batoul Teaching Hospital for Women and Children in Diyala Governorate from August 2025 to January 2026. Ninety samples were collected from children, fifty of whom were diagnosed with urinary tract infection by the consultant doctor at the hospital, twenty of them female and thirty males. The sick children were divided into three age groups: the first group ranged in age from 2-3 year The second year is between 4-5 years and the third year is between 6-7 years, depending on their arrival at the hospital during the study. ELISA serological testing was used to determine the serum levels of interleukin 15 and interleukin 40 from blood serum. The study showed a decrease in the level of interleukin 15 when comparing patients and healthy individuals, By a huge margin, P = 0.001. The same samples also showed a big increase in interleukin 40 when comparing patients to healthy people (P = 0.001). In short: the rise of interleukin 40 in patients versus the drop in interleukin 15 matches inflammation that hasn’t reached the kidneys yet, meaning the inflammation is acute or happens repeatedly.

Background: Inflammation, fibrosis and cellular stress are all pathological processes that coexist in heart failure with reduced ejection fraction (HFrEF). NT-proBNP and other current diagnostic biomarkers provide little information about these particular mechanisms. Growth Differentiation Factor-15 (GDF-15), Matrix Metalloproteinase-cleaved Galectin-3 (MMP-Gal-3) and ST2 (sST2), a panel of serum-based parameters, may offer a more thorough and clinically useful profile. Objective: To estimate serum levels of sST2, MMP-cleaved Galectin-3 (MMP-Gal-3) and GDF-15 in patients having cardiomyopathy with HFrEF compared with healthy controls and to compare the diagnostic accuracy of these parameters (Soluble ST2 (sST2), Growth Differentiation Factor-15 (GDF-15) and Matrix Metalloproteinase-cleaved Galectin-3 (MMP-Gal-3)) against NT-proBNP for enhanced diagnosis of HFrEF. Methods: This was a prospective case control study that had enrolled 60 patients having cardiomyopathy with stable HFrEF (LVEF ≤40%)) and 60 age- and sex-matched healthy controls. It was done in commercial and home-made formatted sandwich ELISAs to measure the _SST2, MMP-Gal-3 (a new assay which measures one characteristic cleavage neo-epitope) and GDF-15 serum levels. Diagnostic performance was assessed using the receiver operating characteristic (ROC) curve as well as compared with NT-proBNP. Results: All three biomarkers were significantly higher in patients with HFrEF than in controls.among the patients having cardiomyopathy with HFrEF (p<0.001). Diagnostic performance of composite panel, CARdiac Axis Nexus (CAN) Score was observed to be better when compared to NT-proBNP alone, that is, AUC = 0.96(95% CI: 0.93-0.98), sensitivity = 93% and specificity = 90%. Can Score (r =-0.79, p<0.001) also correlated strongly with LVEF. Conclusion: An incredibly useful, synergistic and practical addition to the precise diagnosis of patients with cardiomyopathy with HFrEF is the combination of inflammation (sST2), active fibrotic turnover (MMP-Gal-3) and integrated cellular stress (GDF-15) using an ELISA-based serum panel.

Background: Nomophobia or fear or discomfort associated with being without access to a mobile phone, is an emerging concern among adolescents. This pilot study examined the effectiveness of Nomophobic Therapy on behaviour, emotion and developing insight among high school students with nomophobia. Objective: To assess the effectiveness of Nomophobic Therapy on behaviour, emotion and developing insight regarding nomophobia among high school students with nomophobia. Methods: A randomized controlled pilot study was conducted among 40 high school students with nomophobia. Participants were randomly allocated to either the experimental group (n = 20) or the control group (n = 20). Pre-test and post-test assessments were conducted using the Nomophobia Questionnaire (NMP-Q), Strengths and Difficulties Questionnaire (SDQ) and a self-structured questionnaire assessing knowledge and insight regarding nomophobia. The experimental group received structured Nomophobic Therapy consisting of eight group sessions, delivered twice weekly, with each session lasting approximately 40 minutes. Results: The experimental group showed significant pretest-posttest improvements in emotional problems, conduct problems, hyperactivity, peer problems, prosocial behaviour, total difficulty score and insight related to nomophobia (p≤0.05). In the posttest comparison, the experimental group demonstrated significantly better outcomes than the control group in all domains except prosocial behaviour (p = 0.142). Overall, the findings indicate that Nomophobic Therapy was effective in improving emotional, behavioural and insight-related outcomes among high school students with nomophobia. Conclusion: Nomophobic Therapy showed promising preliminary effects on selected behavioural, emotional and insight-related outcomes. These findings support further evaluation in a larger adequately powered study using a standardized intervention protocol and validated outcome assessment.

Background: Student-Selected Components (SSCs) are a key element of student-centered medical education, promoting self-directed learning, research skills and academic engagement. However, their implementation varies considerably across institutions, particularly in low- and middle-income settings. Despite ongoing curriculum reforms, there is a lack of national-level empirical evidence on SSC implementation in Iraq. This study aimed to assess the implementation of SSCs in undergraduate medical education across Iraqi medical colleges, identify institutional barriers and resource requirements and examine associations between institutional characteristics and SSC implementation. Methods: A national cross-sectional survey was conducted among governmental medical colleges in Iraq between September 2024 and May 2025. A structured, expert-validated questionnaire was distributed electronically to all eligible institutions. Descriptive statistics were used to summarize institutional characteristics and SSC practices and associations were examined using Fisher’s exact test. Results: A total of 27 medical colleges participated. SSCs were implemented in 40.7% of institutions, while 59.3% had not adopted them. Implementation was significantly associated with curriculum model (p = 0.008) and geographic region (p = 0.027), but not with accreditation status (p = 0.692). The main barriers identified were limited administrative support (56.3%) and resource constraints (50.0%). Key requirements included teaching materials (75.0%), faculty training (68.8%) and administrative support (62.5%). Conclusion: SSC implementation in Iraqi medical colleges remains limited and uneven. Addressing institutional barriers and strengthening faculty capacity, resources and digital infrastructure are essential for wider adoption. Targeted national policy interventions, curriculum reform strategies and institutional capacity strengthening are required to support sustainable SSC integration.

Objectives: This study aims to evaluate the impact of seasonal variations on periodontal health as perceived and experienced by adults in Saudi Arabia. Data were collected via a self-administered questionnaire addressing periodontal symptoms including bleeding, swelling, halitosis and discomfort. Moreover, the study investigated various behavioral and environmental factors associated with these seasonal changes. Objectives: To determine whether adults perceive changes in their gum health based on seasonal variations. Methods: This cross-sectional study evaluated how adults in Saudi Arabia perceive the impact of seasonal variation on periodontal health and explored associated behavioral and environmental factors. A structured, self-administered online questionnaire was distributed between July and December 2025 to Saudi adults aged ≥18 years, recruited via social media platforms. The survey collected sociodemographic data, self-reported periodontal symptoms (gingival bleeding, swelling, pain and halitosis) across seasons and information on oral hygiene practices, hydration, smoking and stress. Data from 1,001 fully completed questionnaires were analyzed using descriptive statistics and chi-square tests. Results: The sample was relatively young (mean age 31.3 years), with 56.3% females and 39.5% students. Overall, 54.5% reported gingival bleeding while brushing, 46.9% gingival swelling, 48.0% gum pain and 48.8% persistent bad breath. Summer was the most frequently reported season of symptom exacerbation for bleeding (32.9%), swelling (27.9%), pain (27.5%) and halitosis (25.7), followed by winter. More than half (58.5%) perceived that their gum health changes across seasons and 62.2% believed that symptoms and related habits vary seasonally. Smoking prevalence was 15.3% and 44.2% reported that seasonal changes in stress levels affected their gum health. Knowledge scores about the impact of seasonal changes on periodontal health were low in 47.1% of participants and high in 29.9%, whereas awareness scores were high in 49.8% and low in 39.2%. Knowledge and awareness were significantly associated with educational level and awareness also varied by profession and self-rated general health. Conclusion: These findings indicate that a substantial proportion of Saudi adults perceive seasonal fluctuations in periodontal symptoms, particularly during summer and winter and link them to modifiable behaviors and environmental conditions, highlighting opportunities for season-sensitive preventive strategies.

Enterobacter cloacae is a gram-negative, anaerobic bacterium that is capable of causing a variety of infections. Our study is focusing on the inflammatory role of Enterobacter cloacae across different immune cell cultures in vitro, including splenocytes and lymph nodes. The results of our study suggested a pro-inflammatory role of Enterobacter cloacae, inducing inflammatory gene markers of interest after cultivation with immune cells that were isolated from experimental animals(mice), mimicking the environmental human body conditions by using the immune cell culture technique. In our study, the fold change of proinflammatory gene markers of T lymphocytes, B lymphocytes, myeloid lineage and IL6 was investigated compared with the control group (inactivated immune cells group). Interestingly, the results of qPCR indicated a severe activation of all proinflammatory markers in gene expression, including CD3, CD19, GMCSF and IL6 in the activated group compared with the non-activated group. All in all, our results suggested the pro-inflammatory role of Enterobacter cloacae activated Lymphoid lineage and myeloid lineage, where these markers have been investigated in vitro by using immune cell culture technique.

Polycystic ovarian syndrome (PCOS) is currently considered as being one of the most widespread endocrine and metabolic diseases in the reproductive age women across the world. It is approximated that about 116 million women worldwide with a proportion of some 3.4 of the total number of women is affected by PCOS. Methods: A total of 145 female participants took part in this case-control study, including 105 cases with PCOS and 40 controls, and they were recruited in a number of private clinical centers in Erbil Governorate within the Kurdistan Region of Iraq. The data gathering was done over a span of time, which is between June 2024 and November 2025. Measurements of height, body weight, hip circumference, waist circumference, and body mass index were taken during a comprehensive physical examination. Results: The statistically significant difference between the PCOS and non-PCOS groups was established based on the body mass index (BMI) (p = 0.034). There was also a significant difference in the anthropometric measures of various measurements used in the two groups. To be exact, the BMI in the PCOS group was considerably more than in the non-PCOS one (p = 0.002. Moreover, the volumes of both right and left ovaries were also found to be much higher in partakers of PCOS than those without the condition (p = 0.001). bilateral ovarian volume, bilateral FNPO, and FDP, none of the investigated variables demonstrated a statistically significant independent association with the outcome. RI and PI measurements were not statistically significant independent predictors of the outcome in this multivariable logistic regression model. Among the variables examined, PI left showed the strongest positive association (OR = 21.127, p = 0.066) Conclusion: This study demonstrated that women with PCOS had higher BMI values and were more likely to present with clinical features such as irregular menstrual cycles, acne, and hirsutism compared with non-PCOS women. Ultrasonographic assessment showed significant differences in ovarian morphology, including ovarian volume and follicle number, and in selected Doppler vascular parameters between the PCOS and non-PCOS groups. However, ovarian morphology and Doppler indices did not demonstrate significant independent associations in multivariable analyses.

Objectives: Enterobacter hormaechei, a significant opportunistic pathogen, is associated with antimicrobial resistance including Urinary Tract Infections (UTIs). Limited genomic information is available from Iraqi clinical isolates of E. hormaechei. This research involved an investigation of the antimicrobial resistance genes and genomic-level determinants of a single E. hormaechei clinical isolate, recovered from a UTI patient in Mosul, Iraq. The isolate was initially identified through standard bacteriological testing and 16S rRNA gene sequencing. Whole-Genome Sequencing (WGS) was performed using the Illumina NovaSeq X platform after library preparation with the Illumina TruSeq Nano DNA Library Preparation Kit (350-bp insert size), generating 150-bp paired-end reads and the reads were assembled de novo using SPAdes. Genome annotation was performed using the RAST server, resistance genes were screened using CARD (v3.2.6) and phylogenomic placement was assessed using TYGS and MEGA-11. Results: The isolate, designated ESE.iq, was resistant to 13 of the 14 antibiotics tested, with meropenem remaining active. The isolate therefore met the XDR criterion based on the tested antimicrobial classes. The draft genome assembly comprised 63 contigs totaling 4,748,095 bp, with a G+C content of 55.25% and 4,544 Predicted Coding Sequences (CDSs). CARD identified 17 resistance-associated genes, including blaCTX-M-15, blaTEM-1B, blaOXA-1, qnrB1, fosA2, tet(A), sul2, dfrA14 and aac(6')-Ib-cr. Whole-genome phylogenomics placed ESE.iq closest to E. hormaechei subsp. xiangfangensis LMG 27195 (isDDH 93.8%). The BioProject accession is PRJNA1215288, whereas JBLHDI000000000 is the genome assembly accession. Conclusion: The ESE.iq draft genome contained diverse resistance-associated determinants that were consistent with the observed XDR phenotype. Genome-based analysis supported assignment of the isolate to E. hormaechei and identified multiple predicted resistance mechanisms. These isolate-specific findings provide genomic information from Mosul, Iraq and support continued surveillance of antimicrobial resistance in Enterobacter. Functional studies and comparative analyses of additional Iraqi isolates are needed to determine the broader epidemiological significance of these findings.

Preoperative screening tests are important for recognizing medical conditions that may mark surgical or anesthetic outcomes. This study evaluated the usefulness of routine coagulation screening in detecting bleeding risks prior to elective surgery. Over one year (January 2023–January 2024), 500 patients referred for preoperative assessment at Al-Shams Medical Laboratory in Diyala Governorate were studied (220 males, 280 females; age range 2–76 years). All patients underwent basic coagulation tests, including PT, APTT, TT, fibrinogen level, and platelet count. Patients with abnormal results were referred for advanced diagnostic investigations. Coagulation abnormalities were detected in 20 patients (4%), pre-analytic errors being the most common reasons for these abnormalities, followed by immune thrombocytopenic purpura, Glanzmann’s thrombasthenia, VWF deficiency, factor VII, IX, and XIII deficiencies, Hypofibrinogenemia, and disseminated intravascular coagulation. Most of those patients were asymptomatic and had no prior history of bleeding, Therefore, coagulation secerning tests is vital preoperative to detect undiagnosed coagulation abnormalities and avoid bleeding and complications through operative.

Background: T2DM (type two diabetes mellitus) is a metabolic disorder marked by reduced insulin activity and/or secretion. Objectives: This study aims to measure serum Sortilin-1 levels in T2DM patients, prediabetes and healthy control groups .and to evaluation their ability discrimination between of Prediabetes and T2DM individuals. Methods: A cross sectional study was consisting of 120 individuals devided into 60 healthy individuals as control group with age range (30-60 years), (31 males,29 females), and 30 prediabetic individuals with age range (30- 60 years) (15 males,15 females), and 30 individuals with T2DM (15 males,15 females), all individuals were diagnosed according to the American Diabetes Association(ADA)2024 criteria. Results: The Median (IQR) age in years across groups was 47.15(10.98), and Median (IQR) age within each group (49.5 (23.25),45.5 (21.50),45.0 (21.0)) for the control, prediabetes, and T2DM, respectively. Furthermore, at p>0.05, there was no significant difference in The Median (IQR) age across groups, the data analysis revealed to very high significant difference in the the Median (IQR) study groups (P<0.001) for all parameters in the study. Conclusion the findings clearly showed that Sortilin-1 has a significant ability to discrimination between of prediabetes and T2DM individuals.

Background: Empty nest syndrome may develop when grown children depart from their family residence and can be accompanied by loneliness, depression, anxiety, stress and reduced quality of life. Laughter therapy may provide a simple community-based psychosocial intervention for older adults experiencing this transition. Objective: To evaluate the effect of laughter therapy on empty nest syndrome and selected psychological outcomes among elderly population. Methods: A quasi-experimental design was adopted. Twenty elderly participants aged 60-75 years were recruited through purposive sampling from selected community areas of Kottayam, Kerala. The study and comparison groups consisted of 10 participants each and were selected from two different Panchayats to minimize contamination between groups. Data were collected using the Empty Nest Syndrome Scale-Indian Form and the WHO Quality of Life-BREF. The study group received laughing therapy for 20 minutes per session, four days per week, for one month. Results: A notable decrease was seen in the study group in empty nest syndrome scores from 129.10±23.17 to 91.70±17.45 (p = 0.0003). Significant reductions were also observed in depression (p = 0.0131), anxiety (p = 0.0213), stress (p = 0.0004) and loneliness (p = 0.0056). Significant improvements were observed in psychological health and environment domains of quality of life. Posttest comparison showed significantly better outcomes in the study group for empty nest syndrome, depression, anxiety, stress, loneliness, psychological health, social relationships and environment. Conclusion: Laughter therapy showed promising preliminary effects on empty nest syndrome and selected psychological outcomes among elderly population. The findings support further evaluation using a larger adequately powered sample.

Background: Parental satisfaction is a primary goal of healthcare systems; it is a key criterion for achieving high-quality nursing services, expressing how well nursing care meets parental expectations. The aim of this study is for assessing parental satisfaction and how it differs according to demographic characteristics. Methods: A cross-sectional, non-experimental quantitative was conducted on 460 parents of children hospitalized in 5 teaching hospitals in Mosul city. We used Empowerment of parents in the Intensive Care “EMPHATIC” questionnaire to conduct in-person interviews in order to gather data. Results: There are 460 participants in the study. Over half of them for both sex (male = 196, female = 264) were between the ages of 18 and 35 and 45% have obtained a primary school certificate. The average score for overall parental satisfaction was moderate, in the amount of 3.57 points. Findings revealed that 72, 24 and 4% parents were highly satisfied, moderate satisfied and low satisfied respectively in the criterion of “care and treatment”. Regarding "information" provided by nurse 39.1, 38.7 and 22.2% of parents expressed moderate, high and low levels of satisfaction, respectively.in regard to "parental participation" 54.8, 33.5 and 11.7% of parents expressed moderate, high and low levels of satisfaction, respectively. 48.7, 47 and 4.3% of parents reported average, high and low satisfaction with "organization," respectively and for "Professional Attitude" of the nurses 87.8, 9.6 and 2.6% of parents expressed high, moderate and low levels of satisfaction, respectively. Conclusion: overall parent satisfaction with the nursing care given to the child admitted to the pediatric ward was moderate. Parental age, education level and occupation significantly influence parental satisfaction; similarly, the child's age, duration of stay, types of admission and the hospital also significantly influence satisfaction.

Background: Labour pain is a physiological process that can significantly affect maternal comfort, labour progress, and childbirth satisfaction. Objective: To compare the effectiveness of perambulation and birthing ball exercises on the progress of the first stage of labour in terms of pain and maternal satisfaction among primi parturient mothers. Methods: This study selected a quasi-experimental design. A pilot study was conducted among 20 primi parturient mothers at ACS Medical College and Hospital. Participants were selected using purposive sampling and allocated non-randomly into two groups: the perambulation group (n = 10) and the birthing ball group (n = 10). The interventions were administered during the first stage of labour, and post-test assessments were carried out to compare the outcomes between the two groups. Results: The pilot study showed preliminary evidence of differences between the two groups. The birthing ball group had a significantly lower mean pain score (6.10±1.44) than the perambulation group (9.50±0.84), while maternal satisfaction was higher in the birthing ball group (74.00±1.05) compared with the perambulation group (63.50±1.71). An independent t-test demonstrated statistically significant differences between the groups (p<0.001). Conclusion: This pilot study provides preliminary evidence that birthing ball exercises may reduce labour pain and improve maternal satisfaction, supporting the feasibility of a larger study.

Background: Facial acne scarring is a common sequela of acne vulgaris and is frequently associated with long-term psychosocial burden. Long-pulsed 1064-nm Nd:YAG laser therapy provides deep dermal penetration with a favorable safety profile, particularly in darker skin phototypes; however, prospective real-world data remain limited. Objective: To evaluate within-subject changes in facial acne scar severity and treatment tolerability following long-pulsed 1064-nm Nd laser therapy in patients with Fitzpatrick skin types III and IV. Methods: This prospective, single-arm before-and-after study enrolled 98 adult patients with facial acne scars treated at a tertiary dermatology center. Participants received six sessions of long-pulsed 1064-nm Nd:YAG laser therapy at two-week intervals, applied unilaterally to standardize treatment exposure. Scar severity was assessed at baseline and six months after treatment using the Goodman and Baron acne scar grading system and the Scar Severity Scale (SCAR-S). Scar morphologies and treatment-related pain were also evaluated. Results: Following treatment, statistically significant reductions in acne scar severity were observed across both outcome measures. The median Goodman and Baron score decreased from 8.0 (IQR: 3.0) at baseline to 5.5 (IQR: 2.0) after treatment, with a median change of −2.0 (IQR: 2.0; Z = −8.025, p<0.001; effect size r = 0.81). The median SCAR-S score decreased from 3.0 (IQR: 2.0) to 2.0 (IQR: 1.0), with a median change of −1.0 (IQR: 1.0; Z = −7.072, p<0.001; effect size r = 0.71). Improvement was observed in 85.7% and 58.2% of participants according to the Goodman and Baron and SCAR-S measures, respectively. Significant score reductions were detected across all major atrophic scar subtypes, including ice-pick, boxcar, and rolling scars (all p<0.001). Treatment-related pain was generally mild, and no clinically evident post-inflammatory hyperpigmentation or serious adverse events were observed during routine clinical follow-up. Conclusion: Long-pulsed 1064-nm Nd laser therapy was associated with statistically significant reductions in facial acne scar severity and demonstrated good tolerability in patients with Fitzpatrick skin types III and IV. The observed score changes were accompanied by large statistical effect sizes; however, their clinical meaningfulness should be interpreted cautiously in the absence of an established minimally clinically important difference for the outcome measures used. Because this was an uncontrolled before-and-after study, the observed changes cannot be attributed definitively to the intervention. Controlled comparative studies are needed to establish treatment efficacy.

Background: Creatine Kinase (CK-MB) and Glutathione Peroxidase (GPx) - Total Antioxidant Capacity (TAC) is associated with vascular complications in Type 2 diabetes mellitus, primarily through oxidative stress. However, the specific connection between (CK-MB) (GPx) (TAC) levels and oxidative stress in diabetic patients remains unclear and debated in the current literature. This study aims to measure (CK-MB) (GPx) (TAC) levels in Type 2 diabetes patients compared to healthy control and to investigate their relationship with clinical and biochemical indicators of metabolic imbalance. This observational case-control study involved 90 adults, including 50 with Type 2 diabetes and 40 age- and sex-matched non-diabetic controls. Fasting (CK-MB) (GPx) (TAC) levels were assessed using an enzyme-linked immunosorbent assay, while demographic and clinical data, such as age, sex, disease duration, glycemic measures and oxidative stress biomarkers, were gathered. Statistical comparisons between groups were conducted using the independent t-test, Pearson’s coefficient was used to evaluate relationships between variables. Patients with Type 2 diabetes had significantly higher (CK-MB) levels (49.94±8.03 ng/mL) than healthy control (7.22±3.1 ng/mL), (p<0.001). Significantly low (GPx) levels (11.04±3.88 ng/mL) than healthy control (28.36±5.90 ng/mL), (p<0.001). Significantly low (TAC) levels (157.90±57.37 ng/mL) than healthy control (533.7±114.9 ng/mL), (p<0.001). Low antioxidant capacity and poor glycemic control were found to be independently associated with increase oxidative stress, according to multivariate analysis. Conclusion: (CK-MB) is significantly higher and (GPx) (TAC) significantly low in patients with Type 2 diabetes than in healthy controls. This finding supports the vasculotoxic impact through an oxidative imbalance that can serve as an additional risk factor for vascular complications in diabetes. Future longitudinal studies are needed to demonstrate the cause-and-effect linkage and assess potential clinical implications.

Background: Surgical Site Infections (SSIs) remain an important cause of postoperative morbidity in children, resulting in prolonged hospitalization, additional interventions and increased healthcare costs. Although perioperative antibiotic prophylaxis is widely used to reduce SSI risk, recommendations differ across pediatric surgical procedures and the overall effectiveness of prophylaxis remains uncertain. Objective: To evaluate the effectiveness of perioperative antibiotic prophylaxis in preventing surgical site infections among pediatric surgical populations and to synthesize evidence across different prophylactic strategies. Methods: This systematic review and meta-analysis was conducted according to the PRISMA 2020 statement. PubMed/MEDLINE, Scopus and Web of Science were searched from database inception to December 15, 2025. Eligible studies included randomized and non-randomized comparative studies involving patients aged 0-18 years that evaluated perioperative antibiotic prophylaxis or prophylaxis strategies against no prophylaxis, standard care or an alternative antibiotic prophylaxis strategy and reported surgical site infection outcomes. Risk of bias was assessed using ROBINS-I and the certainty of evidence was evaluated using the GRADE framework. Results: Six studies comprising 10,351 observations and 258 SSI events were included in the quantitative synthesis. The studies evaluated different perioperative antimicrobial strategies across general pediatric, abdominal, neurosurgical, orthopedic and mixed surgical settings. Random-effects meta-analysis showed no statistically significant overall association with SSI (odds ratio 0.84, 95% confidence interval 0.66-1.08; p = 0.19; I² = 0%). Despite negligible statistical heterogeneity, important clinical and methodological differences were present across the included studies. The overall certainty of evidence was rated as low. Conclusions: The available evidence did not demonstrate a statistically significant overall reduction in SSI associated with the perioperative antibiotic prophylaxis strategies evaluated. Because the evidence was observational and clinically heterogeneous, the pooled estimate should not be interpreted as evidence against established procedure-specific antibiotic prophylaxis recommendations. Further high-quality prospective studies are needed.

Background: Energy equilibrium and metabolic homeostasis are disturbed by hypothyroidism, which is characterised by insufficient Thyroid Hormone (TH) production. The metabolic effects of chemerin, a newly identified adipokine produced from adipose tissue, have drawn attention. It attaches itself to the G-protein-coupled receptor CMKLR1, sometimes referred to as GPCR-DEZ or Chem R23. Objectives: assessment of Chemerin level in Iraqi diabetic female patients with hypothyroidism. Topics and approaches: During the period of "1 June 2024-1 September 2024," 50 patients who were at least 30 years old and had been diagnosed with diabetes mellitus with hypothyroidism by a specialist were recruited for the study from the Al-Yarmouk Teaching Hospital. A 40 controls of seemingly healthy individuals was selected among those who were not ill at the time, taking into account the patients' age and sex. Results: Findings: The baseline mean level of serum chemerin was considerably different between patients and controls (p<0.001), and there was a significant difference between study groups (p<0.001). chemerin level demonstrated high sensitivity and specificity for distinguishing between patients and controls, as well as a flawless AUC. Conclusion: In hypothyroidism, chemerin, an inflammatory marker, tended to be elevated and statistically significant. The role of adipokine and inflammation in the development of hypothyroidism and to assess whether these parameters could serve as potential biomarkers.

Background: Clinical learning is a core component of nursing and midwifery education, shaping the development of professional competencies and students’ engagement in real care settings. While quantitative studies have widely examined factors influencing clinical learning, fewer studies have explored students’ lived experiences through qualitative approaches, particularly in low- and middle-income contexts such as Morocco. Aim: To explore the factors perceived by nursing and midwifery students as facilitating or hindering their clinical learning experiences in Northern Morocco. Methods: A descriptive qualitative study was conducted using inductive thematic analysis of responses to two open-ended questions embedded within a broader quantitative survey. Of the 311 students participating in the quantitative study, 289 provided usable responses to the two qualitative questions, which addressed factors that facilitated and hindered learning during clinical placements. Participants were second- and third-year nursing and midwifery students enrolled at Higher Institutes of Nursing and Health Techniques (ISPITS) in Northern Morocco. Results: Two main thematic axes were identified. Facilitating factors included support and availability of healthcare staff (63.7%), positive relational dynamics and team spirit (55.3%), integration of theoretical knowledge into clinical practice (43.1%), diversity of clinical situations and procedures (38.3%), and personal motivation and engagement (28.0%). Hindering factors included insufficient clinical supervision (72.0%), high numbers of trainees and workload pressure (64.6%), lack of equipment and material resources (56.6%), relational difficulties and lack of recognition (38.9%), stress and anxiety (35.0%), and organizational and coordination problems (30.9%). Conclusion: Clinical learning in Northern Morocco appears to be shaped by a fragile balance between relational and pedagogical facilitators and persistent structural constraints. Supportive relationships with healthcare professionals and positive team dynamics can foster students’ engagement and learning, but insufficient supervision, overcrowding, resource limitations, and organizational difficulties substantially restrict learning opportunities. These findings provide context-sensitive evidence to inform improvements in clinical supervision, placement organization, and pedagogical support in Moroccan nursing and midwifery education.

Introduction: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age, with prevalence estimates ranging between 6% and 20% depending on diagnostic criteria and population studied Conventional therapies, though effective, often have limitations, prompting interest in herbal interventions. Aim: To assess the biochemical and hormonal impacts of fenugreek seed extract in women with PCOS. Methods: A comprehensive literature search was undertaken across PubMed, Scopus, Cochrane Library, ScienceDirect, and Google Scholar to identify relevant studies published between 2000 and 2026. Eligible research included investigations, and observational cohort studies focusing on women aged 18 to 45 years diagnosed with polycystic ovarian syndrome. Data were systematically extracted regarding sample characteristics, sample size, fenugreek seed extract dosage, intervention duration, and biochemical and hormonal outcomes. Results: Eighteen studies met inclusion criteria. Fenugreek supplementation significantly lowered fasting glucose levels, insulin levels, and HOMA-IR, alongside improvements in lipid profile. Hormonal effects included decreased testosterone, improved LH/FSH balance, and increased estradiol and progesterone levels, contributing to better ovulatory function and menstrual regularity. Clinical improvements in hirsutism and acne were also reported. Conclusion: Fenugreek seed extract demonstrates significant promise as a safe, cost-effective, and culturally acceptable adjunct therapy for PCOS.

Background: The Mandibular Lingual Canals (MLCs) and Mandibular Lingual Foramina (MLFs) are important anatomical structures of the anterior mandible that transmit small neurovascular bundles. Their considerable variation in number, size, course and anatomical position may increase the risk of hemorrhagic and neurosensory complications during dental implant placement and other surgical procedures. Cone-Beam Computed Tomography (CBCT) provides three-dimensional visualization of these structures and allows detailed preoperative assessment. Objective: To evaluate the anatomical and morphometric characteristics of mandibular lingual canals and foramina in adults using CBCT and to determine their associations with sex and age. Methods: This retrospective cross-sectional study analyzed 72 CBCT scans of adults aged ≥18 years obtained from a private hospital in Sulaymaniyah, Iraq. The sample included 27 males and 45 females and was divided into two age groups: 18-49 years (n = 57) and ≥50 years (n = 15). The number of lingual canals, foramen diameter, canal length, canal direction and distances from the canal to the alveolar crest (L1), adjacent anterior tooth apex (L2), inferior mandibular border (L3) and Labial Cortical Plate (LC/CP) were assessed. Midline canals were classified as supraspinous, interspinous, or infraspinous. Statistical analyses were performed using independent-samples t-test, Mann-Whitney U test, chi-square test, or Fisher’s exact test, as appropriate. Results: Among the 72 patients, two lingual canals were most common (43, 59.7%), followed by one canal (21, 29.2%) and three canals (8, 11.1%). No significant differences were found in the number of canals according to sex (p = 0.998) or age group (p = 0.849). Males demonstrated a significantly greater mean canal diameter than females (1.27±0.38 mm vs. 1.08±0.30 mm; p = 0.018). No significant sex-related differences were observed for canal length, L1, L2, L3, or LC/CP. The mean L2 distance was significantly greater in participants aged ≥50 years than in those aged 18-49 years (11.99±5.32 mm vs. 9.78±3.05 mm; p = 0.039). A total of 131 canals were identified, with oblique canals being the most frequent (45.0%), followed by vertical (32.1%) and horizontal (22.9%) canals. Supraspinous and infraspinous positions each accounted for 40.5%, while interspinous canals accounted for 19.1%. Conclusion: Mandibular lingual canals and foramina demonstrate considerable anatomical and morphometric variation in the anterior mandible. Significant sex-related differences were observed in canal diameter, while age was significantly associated with the distance between the canal and the adjacent anterior tooth apex. CBCT assessment should therefore be considered an important component of preoperative planning for implant placement and other surgical procedures involving the anterior mandible to minimize the risk of neurovascular injury and hemorrhagic complications.

Background: Spontaneous abortion is a common adverse pregnancy outcome caused by a number of infectious and metabolic risk factors. Toxoplasma gondii infection has been associated with loss of pregnancy and obesity and type 2 Diabetes mellitus (T2DM) are becoming increasingly important determinants of reproductive health in women. However, there is limited information on the combined effect of these factors on women in Saudi Arabia. Methods: In this study, the association between Toxoplasma gondii infection, obesity, T2DM, and spontaneous abortion was investigated in women in Makkah, Saudi Arabia. We employed a case-control study among 194 women of reproductive age who were in Makkah hospital and pregnant. The participants were classified into cases (women with a history of spontaneous abortion) and controls (women who did not have a history of spontaneous abortion). Sociodemographic, clinical, and obstetric records were collected using a questionnaire. Body mass index (BMI) was measured for obesity status and T2DM status was retrieved from medical records. Serum samples were examined for anti-Toxoplasma gondii IgG and IgM antibodies by enzyme-linked immunosorbent assay (ELISA). The association between study variables and spontaneous abortion was tested by Chi-square tests and multivariable logistic regression. We calculated adjusted odds ratios and 95% confidence intervals (CIs) for these studies. Results: For 189 participants, the Toxoplasma gondii seropositivity was higher in women with a history of spontaneous abortion than in controls. The multivariable logistic regression of T. gondii infection revealed that T. gondii infection was associated with a higher likelihood of spontaneous abortion independently, and obesity and T2DM were also associated with pregnancy loss independent of any other potential factors. Additionally, toxoplasmosis and metabolic disorders were correlated to a higher chance of spontaneous abortion than without either exposure. T. gondii infection, obesity, and type 2 diabetes mellitus were associated with spontaneous abortion in women in Makkah. Conclusion: In conclusion, this study demonstrates that Toxoplasma gondii infection, obesity, and type 2 diabetes mellitus are independently associated with spontaneous abortion among women in Makkah, Saudi Arabia. Furthermore, evidence suggests a possible synergistic interaction between infectious and metabolic factors. These findings underscore the importance of integrated reproductive health strategies that address both infectious disease prevention and metabolic risk management to reduce the burden of spontaneous abortion.

Background: Chemotherapy remains the mainstay treatment strategy to combat early breast cancer as a major global health problem. Simultaneously, it causes various adverse effects, including fatigue and psychological distress. This study examines the impact of a Nurse-led self-care educational program in improving fatigue and psychological distress among women with early breast cancer undergoing chemotherapy. Methods: A quasi-experimental study with a non-equivalent design was conducted at Hiwa Hospital in Sulaymaniyah, Kurdistan Region of Iraq. Through non-probability purposive sampling, a total of 108 patients were recruited and allocated into two groups. The control group received standard care, while the intervention group received three sessions of a structured self-care educational program using a dedicated booklet. Both groups were assessed at baseline in the first cycle and post-test intervention after two months of receiving chemotherapy using a questionnaire including the FACIT-F and HADS. Data were analyzed with SPSS using descriptive and inferential statistics. Results: At baseline assessment, both control and intervention groups did not differ statistically (p-value >0.05). The post- intervention test confirmed that the nurse-led self-care educational program significantly improved the fatigue level (p-value <0.001), HADS-Anxiety (p<0.001), HADS-Depression (p<0.002) and fatigue severity (p<0.001). Positive strong correlation was found between anxiety and depression (ρ = 0.607, p<0.01) and significant negative correlations between fatigue and both anxiety (ρ = -0.293, p<0.05) and depression (ρ = -0.340, p<0.05). Clinically, fatigue was significantly affected by duration of diagnosis (p<0.015), type (p<0.017) and regimen (p<0.003) of chemotherapy. Psychological distress was influenced by la terality of breast cancer (HADS-A: p<0.049, HADS-D: p<0.045), age (HADS-D: p<0.016) and chemotherapy regimen (HADS-D: p<0.039). Conclusion: A nurse-led structured self-care educational program significantly shared in the improvement of fatigue and psychological distress in women with early breast cancer undergoing chemotherapy. Formal implementation of such programs in outpatient chemotherapy settings, especially in Kurdistan and Iraq, will empower patients' self-management against physical and psychological distress and improve quality of life during chemotherapy.

Background: Acne vulgaris can impair dermatology-related quality of life by affecting emotional well-being, participation, education, relationships and daily activities. This patient-reported burden is distinct from psychiatric morbidity and may not align with clinical disease severity. Objective: This study evaluated dermatology-related quality-of-life impairment among Saudi adolescents and young adults with acne and examined sociodemographic differences. Methods: A descriptive, exploratory cross-sectional online survey using non-probability convenience sampling was conducted from January to August 2024. Saudi participants aged 16-30 years with acne vulgaris provided demographic information and completed the validated Arabic version of the Dermatology Life Quality Index (DLQI). Data were analyzed using descriptive and inferential statistics; statistical significance was defined as p<0.05. Results: Among 1,095 participants, the mean age was 23.0±4.5 years and 61.0% were female. A total of 892 participants (81.5%; 95% Confidence Interval [CI]: 79.1-83.7%) reported at least some impairment and 35.2% experienced a very large or extremely large effect. The mean DLQI score was 7.7±6.0. A moderate or greater effect was observed in 56.7%. At least some physical symptoms were reported by 73.9% of participants and embarrassment or self-consciousness was reported by 71.4%. Among age groups, participants aged 16-18 years had the highest mean DLQI score (8.8±6.0). Conclusion: A total of 81.5% of participants reported at least some DLQI impairment, with 35.2% experiencing a very large or extremely large effect. These findings should not be interpreted as nationally representative. Quality-of-life assessments may help identify individuals who require evaluation, counseling and psychosocial support as part of acne management in dermatology and primary care settings.

Background: Lead (Pb) is present in the environment and is a neurotoxic substance that has important implications for global public health and ecosystem stability. Given its high genetic similarity and short developmental time, the zebrafish (Danio rerio) has become a model organism of choice to study these effects. A clear mechanistic link between molecular triggers and functional neurobehavioral deficits is crucial to improve environmental risk assessment. Methods: Literature published in PubMed, Scopus and Web of Science (2013-2026) was used for the synthesis, which was organized into a structured narrative format. This review concentrated on the molecular signalling, developmental biomarkers and the changes in behaviour induced by exposure to Pb that have been studied during the past decade. Results: Oxidative stress is synthesized evidence as a major initiating event that leads to involvement of mitochondrial dysfunction, lipid peroxidation and apoptotic signaling. The main molecular alterations are related to alterations of dopaminergic and cholinergic pathways and they are related to a specific ontogenetic transition - hyperactivity in the larvae and anxiety-like behavior and cognitive impairment in the adults. Markers of acute stress, like Heme Oxygenase-1 (HO-1) and Brain-Derived Neurotrophic Factor (BDNF), are sensitive markers but new evidence points to transgenerational risks through epigenetic remodeling. Conclusions: Zebrafish is a powerful tool to map the neurotoxic cascade. There are, however, methodological variations among studies and a lack of consistency in the doses applied, with supra-environmental doses used that are not representative of in situ aquatic hotspots (10-50 µg/L). Future studies should focus on standardization of behavioral testing methods and chronic low-dose exposures to mimic the exposures used in the Ecological Risk Assessment (ERA) framework to increase translational relevance (Figure 1).

Background: Osteoarthritis is the most prevalent joint disease and a leading contributor to disability. It significantly limits patients' capacity to carry out everyday duties. Nurses play a crucial role in helping people with osteoarthritis in hospitals and health facilities. In addition to teaching patients pain management techniques and educating them about the disease. Objectives: The aim of the study is to evaluate the effectiveness of nursing education program on Nurses knowledge concerning management of Osteoarthritis Patients at Azadi Teaching Hospital. Methods: The present study used a quasi-experimental (one group pretest-posttest) study design during the period between 1 of November,2025 and 10 of March 2026.A non-probability(purposive) sampling of (30) Nurses who working in Orthopedic, medical, surgical unit and consultation clinics of Rheumatology and Rehabilitation units) in the Azadi Teaching Hospital. The study instrument is composed of six main parts. Results: The current study show that the overall assessment of nurses’ knowledge about management of osteoarthritis in the pretest show that nurses demonstrating poor to moderate level of overall knowledge with mean score 17.90 and they need a specific educational program about management of osteoarthritis patients. Also, the study concludes that the nurses’ overall knowledge increased to good among 70% with mean score 36.07 During the posttest and after engagement in educational program that indicates an effective role of educational program in enhancing nurses’ overall knowledge about management of osteoarthritis. Conclusion: The study concluded that the educational program significantly improved nurses’ knowledge based on posttest with mean ranks reported higher in the posttest comparing to pretest. Recommendation: Conducting an educational program related to osteoarthritis patients to improve nurses’ knowledge who working at Orthopedic unit and consultation clinics of Rheumatology and Rehabilitation units.

Objectives: Forward Head Posture (FHP) is a common postural deviation among young adults characterised by reduced craniovertebral angle and neck pain. Pilates Mat exercises enhance posture and core stability, whereas Kendall exercises correct postural muscular imbalances through strengthening and stretching. The study was intended to assess the effects of Pilates Mat and Kendall exercises on craniovertebral angle, pain and neck impairment in young adults with FHP. Methods: Thirty-four young adults with FHP were randomly assigned to Pilates Mat and Kendall exercise groups. Photogrammetry, the Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to measure craniovertebral angle, pain intensity and neck disability at baseline, four weeks and eight weeks. Results: Baseline parameters were similar between groups (p>0.05). All outcome measures (CVA, NPRS, NDI) had significant main effects of time, group and time × group interaction (all p<0.001). At T8, the Pilates Mat group had greater improvements compared to the Kendall Exercise group in CVA (MD = 5.06°, 95% CI: 4.16-5.95, p<0.001), NPRS (MD = −2.53 points, 95% CI: -3.25 to -1.81, p<0.001) and NDI (MD = −13.59 points, 95% CI: −14.51 to −12.66, p<0.001). Bonferroni-adjusted comparisons showed substantial improvements in both groups across all time intervals (all p<0.001). Conclusion: Both Pilates Mat and Kendall exercise improved the craniovertebral angle and reduced pain severity and neck disability among young adults with forward head posture; with greater improvements observed following Pilates Mat Exercise.

Objectives: To evaluate the clinical effectiveness of silver diamine fluoride (SDF) in the management of dentinal hypersensitivity following vital teeth preparation. Methods: A single-arm prospective interventional study was conducted among patients attending the Department of Prosthodontics, College of Dentistry, Majmaah University, who required a posterior fixed partial denture and met the criteria for vital tooth preparation. At baseline (before tooth preparation), the sensitivity of the selected tooth following exposure to air blast, tactile stimulation, thermal stimulation, and bite force was recorded using the Visual Analog Scale (VAS) prior to tooth preparation. All selected teeth were prepared for porcelain-fused-to-metal crowns under local anesthesia, and after completion of the procedure, a provisional crown was placed. At 24-hour follow-up, the provisional crown was gently removed, and the tooth was coated with 38% SDF solution using a micro-brush and allowed to dry for 10 minutes. The tooth’s sensitivity was recorded as similar to baseline (immediate effect of SDF application), and the temporary crown was re-cemented. At the end of the first week of follow-up, the tooth’s sensitivity was reassessed (delayed effect of SDF application) before cementing the final prosthesis. Intra-group comparison of sensitivity scores at baseline, 24 hours, and one week after the procedure was done using the Friedman test followed by the Wilcoxon signed rank test as post hoc analysis using SPSS (Version 24.0). Results: There was a significant reduction (p-value < 0.05) in the VAS score for sensitivity following air blast, tactile, thermal, and bite force tests, on both the buccal and lingual aspects of the tooth preparation, at the end of one week, compared with the baseline score. Similarly, the VAS score for sensitivity following bite force also decreased significantly at the end of one week compared with the baseline VAS score. Conclusions: Dentin hypersensitivity after full-coverage vital tooth preparation declined significantly between 24 hours and one week in teeth treated with 38% SDF. Since this is an uncontrolled, single-arm study design the findings are preliminary and warrant confirmation in a randomized controlled trial with longer follow-up period.

Objectives: This study assessed the prevalence of low bone mineral density and its association with hormonal profiles in adult patients with β-thalassemia major. Methods: A cross-sectional study of 141 adults (≥18 years) with β-thalassemia major was conducted at the Erbil Thalassemia Center from September 2024 to March 2025. Bone mineral density was measured using DXA (lumbar spine, femoral neck) and classified using Z-scores: osteopenia (-1 to -2.5) and osteoporosis (≤ -2.5). Serum levels of ferritin, sex hormones, thyroid function, PTH, and vitamin D were analyzed. Statistical analyses were performed using SPSS version 21.0. Non-normally distributed continuous variables were presented as medians (IQRs) and analyzed using the Kruskal–Wallis and Spearman's correlation tests. Statistical significance was set at p<0.05. Results: The mean age ±SD was 24.3±5.5 years; 68 (48.2%) were male. Severe iron overload was found (median ferritin: 4255 ng/dL). Osteoporosis prevalence was high: 79 (56.0%) at the spine and 58 (41.1%) at the femoral neck. Sex hormone disturbances were significantly associated with bone mineral density (BMD) at both sites. For vertebral BMD, patients with osteoporosis had significantly lower median testosterone (1.8 ng/mL (95% CI: 0.5–3.2); p = 0.045), estradiol (13.0 pg/mL (95% CI: 5.0–22.0); p = 0.028), and LH (2.5 mIU/mL (95% CI: 1.5–3.5); p = 0.008) compared to those with normal BMD. For hip BMD, similar patterns were observed, with lower testosterone (1.6 ng/mL (95% CI: 0.5–3.0); p = 0.005), LH (2.4 mIU/mL (95% CI: 1.5–3.5); p = 0.006), and FSH (3.0 mIU/mL (95% CI: 2.0–5.0); p = 0.043) in patients with osteoporosis. Conclusion: Osteoporosis is highly prevalent in adult β-thalassemia major patients and is significantly related to hypogonadism.