More and more research is looking at how healthcare professionals may benefit from artificial intelligence (AI) chatbots powered by LLMs while making judgments. However, not much is known about how effective they are in structured endodontic treatment planning. The degree of agreement between the treatment plans generated by chatbots and the reference plans given in published endodontic cases was evaluated in this cross-sectional study using the Accuracy of Identified Prescriptive Instructions (AIPI) framework. The four chatbot systems that were analyzed were Glass Health, MedGebra GPT-4o, Gemini 2.5 Pro, and ChatGPT 4.5. We used the AIPI scale, which ranges from 0 to 3, to evaluate the platforms. There were a total of 192 conversations as each chatbot received sixteen published endodontic case reports at three different times. Although MedGebra GPT-4o had an average AIPI score of 1.69 (p < 0.05), the much higher scores were attained by ChatGPT 4.5, Glass Health, and Gemini 2.5 Pro, totaling 2.69. Although all of the platforms were reliable in terms of time, ChatGPT 4.5 demonstrated the greatest level of consistency at the case level (75%). As a conclusion, although MedGebra had poorer consistency and accuracy, ChatGPT4.5, Glass Health, and Gemini 2.5 Pro all worked dependably and excellently. While these findings provide support for AI chatbots as supplemental educational and decision-support tools, they also show how important it is to validate these systems in certain domains before integrating them into clinical practice and how dangerous it is to have inconsistent or incomplete outcomes in the clinic.

Background: Oral and maxillofacial imaging is indispensable in routine dental practice, but radiation exposure and improper disposal of radiographic waste remain important occupational and environmental concerns. In many private clinics in India, dental assistants help operate radiographic procedures and handle related waste without formal training or structured monitoring. This study therefore evaluated the knowledge, attitude, and practice of dental assistants employed in private dental clinics in Wardha district regarding radiation safety protocols and radiological waste management. Method: This cross-sectional questionnaire-based study used a pre-tested, validated 26-item instrument. The first section recorded demographic information, and the second section assessed knowledge, attitude, and practice related to radiation safety measures and radiological waste management. Scores were categorized as good when the participant scored at or above the mean and poor when the score was below the mean. Results: Of 126 eligible dental assistants, 108 completed the study, yielding a response rate of 85.7%. Poor knowledge was observed in 49 participants (45.4%), poor attitude in 57 (52.8%), and poor practice in 77 (71.3%). Females showed significantly higher mean knowledge and attitude scores than males, whereas most subgroup comparisons by age, education, and work experience were not statistically significant. Positive correlations were observed between knowledge, attitude, and practice scores. Conclusion: The dominant gap identified in this survey was poor practice, despite only moderate deficits in knowledge and attitude. Private dental clinics should therefore combine structured assistant training with mandatory clinic-level support for radiation protection, radiological waste segregation, monitoring, and safe disposal. Local dental bodies, clinic owners, and regulators should collaborate to implement competency-based certificate courses and periodic refresher programs.

Heterotopic ossification (HO) is the formation of extraskeletal mature bone in periarticular soft tissues, whereas Pellegrini-Stieda disease (PSD) refers to ossification or calcification adjacent to the proximal attachment of the medial collateral ligament. Both entities are uncommon in Guillain-Barré syndrome (GBS), and their coexistence in the same patient is exceptionally rare. We report a 27-year-old man with prior severe GBS who required a 4-month intensive care unit stay, mechanical ventilation, and prolonged immobilization, and who later presented with left hip pain, reduced hip range of motion, and subsequent right medial knee pain during rehabilitation. Radiography and non-enhanced computed tomography confirmed mature HO around the left hip, while knee radiography demonstrated a characteristic ossified fragment adjacent to the proximal medial collateral ligament, consistent with PSD. Serum calcium and phosphate were normal, whereas alkaline phosphatase was mildly elevated initially and normalized on follow-up, supporting maturation of the ossific process. This single case highlights that persistent pain or stiffness during rehabilitation after severe GBS should prompt early imaging evaluation for HO or PSD so that conservative management and timely surgical referral, when needed, are not delayed.

Objectives: To synthesize the available clinical evidence on beta-blocker therapy for arteriovenous malformations (AVMs) and related vascular lesions and to clarify the distinction between evidence derived from true AVMs and evidence derived from infantile haemangioma (IH)-dominant cohorts. Methods: This systematic review was prepared in accordance with PRISMA. PubMed, Scopus and Web of Science were searched for studies published between January 2016 and October 2025, supplemented by bibliography screening and Google Scholar searching. Eligible studies included randomized trials, observational studies and case reports evaluating systemic or topical beta-blockers. Because the included literature was clinically heterogeneous, a narrative synthesis was performed. Primary outcomes were radiological or clinical lesion response and symptom improvement; secondary outcomes were adverse events, need for additional intervention, recurrence/progression and functional outcomes. Results: Eighteen studies were included (2 randomized controlled trials, 10 observational studies and 6 case reports). The evidence base was dominated by IH and related vascular lesions, whereas true AVM-specific evidence was limited to case reports and small retrospective series. Across AVM-focused reports, propranolol was generally used at 1-2 mg/kg/day or equivalent fixed doses, usually for several months and was associated more often with symptom improvement or lesion stabilisation than with consistent radiological shrinkage. The randomized trials addressed IH rather than true AVMs and both were judged to have high risk of bias. Adverse effects included bradycardia, hypotension, wheeze, hypoglycaemia and gastrointestinal intolerance. Conclusion: Current evidence strongly supports beta-blockers in IH, but does not establish them as definitive primary therapy for true AVMs. In selected AVM cases, beta-blockers may provide symptomatic benefit or short-term stabilisation; however, they should presently be regarded as adjunctive or exploratory treatment pending higher-quality AVM-specific studies.

Background: Virdentopsy is a dental-focused extension of virtopsy that enables remote collection, transmission, and expert interpretation of post-mortem dental data when on-site forensic odontologists are unavailable. Objective: This narrative review summarizes the current concepts, workflow, advantages, limitations, and implementation barriers of virdentopsy in forensic odontology and disaster victim identification (DVI). Review Approach: Relevant literature on virtopsy, virdentopsy, teledentistry, forensic imaging, and digital dental identification published up to 2025 was narratively reviewed from major biomedical and forensic sources. Because this is a narrative review, no formal quality-scoring tool or quantitative meta-analysis was applied. Results: The available literature shows that remote dental evaluation can be supported by grouped digital inputs, including imaging (intraoral radiographs, panoramic imaging, CT/CBCT), photography (2D intraoral and extraoral images), scanning (photogrammetry, intraoral scanning, 3D surface capture), and communication tools (video review and live streaming). These methods can strengthen documentation, facilitate remote expert consultation, and support humanitarian identification work. However, the evidence remains heterogeneous and is limited by variable infrastructure, image quality, chain-of-custody requirements, and uneven legal readiness across jurisdictions. Conclusion: Virdentopsy is a promising but still evolving forensic workflow. It is best viewed as an adjunct to established dental autopsy practice rather than a universal replacement. Standardized capture protocols, secure data transfer, training, and validation studies are required before broad routine implementation.

Objectives: Basidiobolomycosis is an uncommon entomophthoromycosis caused by Basidiobolus ranarum that usually affects subcutaneous tissue and, less commonly, the gastrointestinal tract in otherwise immunocompetent hosts [1,2]. We report a 50-year-old Saudi man with progressive sore throat, odynophagia, dysphagia and a hot-potato voice caused by an oropharyngeal/posterior pharyngeal wall mass that initially raised concern for malignancy and deep neck infection. Contrast-enhanced CT demonstrated extensive left submandibular and masticator space collections with airway compromise, whereas repeated tissue sampling ultimately showed broad aseptate hyphae with granulomatous inflammation and a Splendore-Hoeppli reaction; PAS and GMS stains highlighted the organisms and fungal culture confirmed Basidiobolus ranarum [2,3,5]. The patient had no documented history of diabetes, chronic steroid exposure, malignancy, transplantation, or other known immunosuppressive condition in the available clinical record and he was treated successfully with oral voriconazole 200 mg twice daily for 6 months with serial clinical and radiologic improvement. This case underscores that rare fungal disease should remain in the differential diagnosis of unusual oropharyngeal masses and that repeated biopsy with fungal stains and culture may prevent unnecessary radical surgery [2,7].

Background: Gingival pigmentation may arise from physiologic melanin, systemic disease, or exogenous deposition. Cultural gingival tattooing is an uncommon but important differential diagnosis in multicultural clinical practice and may mimic more serious lesions if history is not obtained carefully. Case Description: Three West African women (19–56 years) presented with incidental bilateral pigmentation of the maxillary attached gingiva. The lesions were flat, symmetrical, sharply demarcated, and clinically stable. Clinical examination, palpation, and radiographic assessment revealed no inflammatory change, induration, ulceration, or associated osseous/radiopaque pathology. A detailed history confirmed prior traditional gingival tattooing performed for cultural and esthetic reasons. Conclusion: Cultural gingival tattooing should be recognized as a benign exogenous pigmentation. Careful history-taking, pattern recognition, and selective use of radiographs can prevent unnecessary biopsy, overtreatment, and patient anxiety. Clinical Significance: General dentists increasingly encounter culturally diverse patients; awareness of gingival tattooing improves differential diagnosis and supports culturally competent care.

Background: Menstrual disorders are common among young women and may be influenced by nutritional status and body mass index (BMI). Nursing students represent a relevant population because academic stress, hostel living, sleep disturbance, and dietary variation may influence menstrual health. Methods: This cross-sectional study included 301 female nursing students aged 19-25 years from KAHER Institute of Nursing Sciences, Belagavi. BMI was calculated from measured height and weight. Menstrual variables assessed using a structured questionnaire included age at menarche, dysmenorrhea, oligomenorrhea, menorrhagia, cycle regularity, inter-menstrual interval, menstrual flow, duration of flow, body aches, abdominal cramps, and irritability. Associations between BMI categories and menstrual variables were tested using chi-square analysis and multiple logistic regression. Results: Most participants had normal BMI (49.5%), while 36.5% were underweight and 14.0% were overweight. The most frequent menstrual complaints were abdominal cramps (81.4%), irritability (71.1%), body aches (69.8%), and dysmenorrhea (47.2%). Oligomenorrhea and menorrhagia were reported by 17.9% and 15.6% of participants, respectively. Across BMI categories, significant differences were observed for age at menarche (p<0.01) and menstrual flow (p<0.05), whereas most other menstrual variables did not show statistically significant associations. Conclusion: BMI alone was not consistently associated with most menstrual variables in this sample; however, underweight students reported a greater symptom burden and selected menstrual characteristics differed significantly across BMI groups. Nursing colleges should incorporate menstrual health screening, nutrition counselling, anaemia risk assessment, and referral pathways for students with persistent or severe symptoms.

Background: Color stability is critical to the long-term esthetic success of resin composite restorations because visible discoloration often results in patient dissatisfaction, repolishing or restoration replacement. This in-vitro study compared the color stability of nanofilled, microhybrid and nanohybrid resin composites after immersion in commonly consumed beverages. Methods: Disc-shaped A2 specimens (10 mm×2 mm; final analyzed n = 150, with 10 specimens per subgroup) were prepared from Filtek Z350 XT, Filtek Z250 and Tetric N-Ceram. Specimens were randomly assigned to coffee, black tea, cola, raspberry juice or distilled water and stored at 37°C. Color was measured at baseline and after 7, 14 and 30 days using a spectrophotometer and the CIELAB system. This continuous immersion model represented accelerated staining and did not include thermocycling. Results: All beverage groups showed significantly greater color change than distilled water (p<0.001). Raspberry juice produced the highest discoloration in all materials (30-day DeltaE range: 8.94+0.87 to 12.67+1.23), followed by coffee, black tea and cola. Filtek Z350 XT showed the best overall color stability, Filtek Z250 showed the poorest performance and Tetric N-Ceram demonstrated intermediate behavior. By day 30, all beverage-exposed groups exceeded the clinical acceptability threshold (DeltaE >3.3); raspberry juice and coffee crossed this threshold earliest. Conclusion: Under this accelerated in-vitro model, commonly consumed beverages caused clinically unacceptable discoloration of all tested resin composites over time. Nanofilled composite demonstrated the greatest resistance to staining, whereas raspberry juice and coffee produced the most pronounced color change. These findings support material selection and patient dietary counseling but clinical extrapolation should be cautious because thermocycling, abrasion and intermittent exposure were not simulated.

Background: Artificial intelligence (AI) is increasingly shaping healthcare education and clinical practice; however, the preparedness of healthcare students in Saudi Arabia to adopt AI remains unclear. Aim: To assess AI literacy and examine its relationship with intention to use AI among healthcare students at Majmaah University. Methods: A cross-sectional study was conducted with 802 undergraduate students from Nursing, Applied Medical Sciences and Medicine. Data were collected using MAIRS-MS and a TAM-based behavioural intention scale. Descriptive statistics, correlation and hierarchical regression analyses were performed. Results: A notable “education–interest gap” emerged. Although students reported high interest in AI (M = 5.13), 80% had little to no formal AI education and relied mainly on self-learning (71.7%) and social media (65.1%), with only 37.5% learning through coursework. Intention to use AI was moderately strong (M = 4.85/7), while overall readiness was moderate (M = 3.02/5). Domain scores showed higher “Ability” (M = 3.15) than “Cognition” (M = 2.90) or “Ethics” (M = 2.93). AI literacy correlated positively with intention (r = 0.381, p<0.001). Regression analysis confirmed AI literacy as a significant predictor, explaining an additional 11.2% of variance in intention (β = 0.383, p<0.001). Conclusion: Students show strong interest but limited formal preparation for AI adoption. Enhancing AI education, particularly theory and ethical/legal content, is essential to support safe and effective clinical integration aligned with Vision 2030.

Background: Because cervical vertebrae undergo measurable shape changes during somatic growth, lateral cephalograms may provide a practical estimate of skeletal maturity without additional hand-wrist radiation. This cross-sectional validation study evaluated whether an objective cervical vertebral bone age (CVBA) formula derived in a South Indian population is applicable to Maharashtrian children aged 9-16 years (N = 300). Methods: CVBA was calculated from C3 and C4 vertebral ratios on lateral cephalograms and compared with chronological age (CA) and hand-wrist bone age (TW3 method). Results: CVBA showed strong correlation with hand-wrist bone age in both sexes (males r = 0.907; females r = 0.953), but mean differences remained significant across CA, CVBA, and hand-wrist bone age on ANOVA/Tukey testing. Conclusion: Thus, employing newly derived equations exclusively for the Maharashtrian population would be beneficial to avoid erroneous skeletal maturity assessment. Population specificity should be emphasized when using formula based methods for bone age estimation.

Objectives: Hospital housekeepers perform repetitive bending, lifting, reaching and prolonged standing, all of which may contribute to chronic low back pain and work-related disability. Pain self-efficacy-the confidence to remain active and functional despite pain-may influence the extent to which symptoms translate into disability. Methods: This cross-sectional survey included 365 hospital housekeepers with chronic low back pain. Participants completed a demographic and work-exposure questionnaire together with the Oswestry Disability Index (ODI) and the Pain Self-Efficacy Questionnaire (PSEQ). Descriptive statistics and chi-square/Fisher exact tests were used to examine associations. Because only three participants were classified as having severe disability, the regression model was retained as exploratory and interpreted cautiously. Results: Most participants reported mild low back pain (67.7%), minimal disability (89.9%) and very high self-efficacy (60.8%). Self-efficacy level was significantly associated with disability category and pain intensity differed significantly across both disability and self-efficacy strata (p<0.001). Female sex was associated with higher disability levels (p = 0.008). Longer work experience, longer work hours and tasks involving repetitive bending or reaching were associated with lower self-efficacy. Conclusion: Among hospital housekeepers with chronic low back pain, lower pain self-efficacy was associated with worse pain and disability profiles. The findings support an integrated occupational-health approach combining ergonomic risk reduction with education and self-management strategies; however, causal inferences cannot be drawn from this cross-sectional study.

Objectives: To compare conventional physiotherapy alone with conventional physiotherapy plus proprioceptive training for improving balance, lower extremity function and Bone Mineral Density (BMD) in postmenopausal women with unilateral Knee Osteoarthritis (KOA). Methods: This randomized pretest-posttest study included 30 postmenopausal women with unilateral KOA allocated to Group A (conventional physiotherapy) or Group B (conventional physiotherapy with proprioceptive training). Conventional physiotherapy comprised interferential therapy, stretching, quadriceps and hamstring isometrics, straight-leg raises, knee extension in high sitting and supervised retro-walking. Outcomes were assessed at baseline and after 8 weeks using the Knee injury and Osteoarthritis Outcome Score (KOOS), Timed Up and Go (TUG) test and Dual-energy X-ray Absorptiometry (DXA) T-score. Paired and unpaired t-tests were used, with p<0.05 considered significant. Results: Both groups showed significant within-group improvement in KOOS and TUG scores (p<0.001). Between-group post-test comparisons favored Group B for KOOS (p = 0.046) and TUG (p<0.001), indicating superior improvement in function and balance with added proprioceptive training. Three participants in Group B were lost to follow-up. BMD did not change significantly within or between groups over the 8-week intervention period (p>0.05). Conclusion: Adding proprioceptive training to conventional physiotherapy improved balance and lower extremity function more than conventional physiotherapy alone; however, no significant between-group change in BMD was observed over 8 weeks.

Objectives: To assess asthma-related knowledge and self-reported management behaviours among mothers of children with asthma in Taif, Saudi Arabia and to explore their association with selected sociodemographic factors. Methods: A cross-sectional study was conducted from January 2023 to April 2023 among 224 mothers of children aged 1–12 years with asthma who had hospital files at Children’s Hospital, Taif, Saudi Arabia. Data were collected through telephone interviews using a modified Arabic questionnaire based on the Chicago Community Asthma Survey-32 (CCAS-32). The questionnaire assessed maternal knowledge and self-reported behaviours related to asthma management. Results: Of the 224 mothers, 151 (67.4%) were older than 30 years, 112 (50.0%) had university-level education and 167 (74.6%) were housewives. Good knowledge was observed in 49.6% of participants, whereas 71.0% demonstrated good behaviour scores. Mothers of female children had significantly better knowledge and behaviour scores. Younger mothers (<30 years) and mothers from larger families also showed significantly better behaviour scores. Mothers with good knowledge demonstrated significantly better behaviours (p<0.001). Despite generally favourable medication-related practices, potentially suboptimal behaviours persisted, including the use of homemade or complementary remedies by 35.7% of respondents. Conclusion: Maternal asthma knowledge in this hospital-based sample was moderate, whereas self-reported management behaviours were generally better. Targeted caregiver education is still needed, particularly to address persistent gaps in trigger avoidance, evidence-based home management and avoidance of unsupported complementary practices.

Background: Road Traffic Injuries (RTIs) are a source of many preventable deaths and fatalities. National-level statistics allow us to examine changes over short periods of time, affected groups and the severity of injuries. They also give us hints about disability, functioning and the use of mobility aids, which help us plan orthopedic trauma care and rehabilitation for the future. Methods: We conducted a retrospective secondary analysis using the Saudi Arabian national road traffic injury and death data from 2018 to 2020. We calculated the yearly totals and changes in the number and percentage from year to year. We analyzed the injuries and deaths in five age groups (<18, 19-30, 31-40, 41-50 and ≥51 years) over three years, with the proportion of each group and the death-to-injury ratio (case-fatality ratio, CFR: deaths per 1,000 injuries). We calculated the age-specific injury and death rates per 100,000 population using the mid-year population estimates. We also analyzed the differences in injuries and deaths by sex, with male-to-female ratios and sex-specific CFRs. Results: For 2018 to 2020, there were 89,050 injuries and 16,159 deaths. Injuries increased from 30,579 in 2018 to 32,910 in 2019, then decreased to 25,561 in 2020. Deaths increased from 5,787 to 5,754, then to 4,618. The marked 2020 decline likely reflects reduced exposure during the COVID-19 pandemic and associated movement restrictions rather than a routine secular trend. The CFRs remained relatively stable (189.25, 174.84 and 180.67 deaths per 1,000 injuries for 2018-2020), with little change in the fatality rate despite large variations in the number of injuries and deaths. The three largest three-year injury proportions were for the 19-30 (26,465; 29.72%) and 31-40 (23,424; 26.30%) age groups. The ≥51 group accounted for 11,148 injuries (12.52%) but 2,326 deaths (14.39%) and had the highest three-year CFR (208.65 per 1,000). In 2019-2020, the highest injury rates per 100,000 population were for the 19-30 group (140.0 in 2019; 105.8 in 2020) and this group also had the highest death rates (24.8 in 2019; 20.4 in 2020). Conclusion: National data from 2018-2020 show that road injuries were concentrated in young adults, whereas older adults had higher fatality ratios. Injuries and deaths declined substantially in 2020, likely in relation to pandemic-related mobility changes, while the deaths-per-injury pattern remained relatively stable. These findings primarily describe national RTI trends and suggest likely orthopaedic and rehabilitation implications, rather than directly measuring orthopedic clinical workload.

Objectives: Oral submucous fibrosis (OSMF) is a chronic fibrotic oral potentially malignant disorder that compromises tissue resilience, sulcular depth, denture border extension, retention and oral function. Evidence describing how pathological severity affects short-term prosthetic outcomes remains limited. Methods: This prospective clinical follow-up study enrolled 45 clinically and histopathologically diagnosed OSMF patients requiring removable prosthetic rehabilitation. Patients were classified according to the Khanna and Andrade staging system into mild, moderate and severe groups (n = 15 each). Individualized prosthetic rehabilitation was performed using modified impression approaches and flexible denture-base materials when required. Maximum mouth opening (MMO), masticatory efficiency (ME), speech intelligibility, comfort and patient satisfaction were assessed at baseline, 1 month and 3 months. Results: Mean baseline MMO in Groups I, II and III was 23.5±4.2 mm, 18.9±3.7 mm and 14.1±2.9 mm, respectively; values increased to 28.7±3.8 mm, 24.2±3.4 mm and 19.3±2.7 mm at 3 months (all within-group p < 0.001). ME improved by 38%, 31% and 24%, respectively. Satisfaction at 3 months remained highest in mild disease (8.6±0.7), followed by moderate disease (7.8±0.9) and severe disease (6.9±1.1). Retention and adaptation remained the weakest domains in severe fibrosis. Conclusion: Removable prosthetic rehabilitation improved oral function and patient-reported satisfaction across all OSMF severity grades over 3 months. Outcomes were most favourable in mild disease, whereas severe fibrosis continued to limit retention and adaptation; therefore, patient counselling, physiotherapy and severity-based prosthetic modification remain essential.

Background: Breastfeeding may be difficult in mothers with flat, inverted, or retracted nipples because reduced nipple protrusion can interfere with infant latch. Hoffman's exercise is a simple manual technique intended to stretch peri-nipple adhesions and improve nipple protractility. Methods: This single-center quasi-experimental study included 50 primiparous postnatal mothers screened after 24 hours of delivery using the nipple pinch test. Mothers with non-protractile nipples were taught Hoffman's exercise and supervised five times daily for four consecutive days. Breastfeeding success was assessed using the LATCH score on Day 1 and Day 5. Results: The mean LATCH score improved from 3.24±0.85 on Day 1 to 8.56±0.86 on Day 5, with a mean difference of 5.32 points (paired t = -32.199, p<0.05). Most mothers were aged 23-26 years (54%), 64% had cesarean delivery, and flat nipples were the most common nipple type (72%). Conclusion: Within the limits of this small single-center study, Hoffman's exercise was associated with improved short-term breastfeeding success. The technique may be used as an adjunct to routine lactation support, but longer follow-up and comparative studies are needed.

Background: Creativity in healthcare management is increasingly recognized as essential for improving organizational performance, patient outcomes and adaptive decision-making. Objective: This study aimed to examine the relationship between psychological empowerment and managerial creativity among healthcare workers in a major health cluster in Riyadh. Methods: A descriptive cross-sectional survey was conducted among 316 healthcare workers. Psychological empowerment was measured using Spreitzer’s 12-item scale and managerial creativity was assessed using a 13-item creativity scale. Results: Participants demonstrated high levels of psychological empowerment and managerial creativity. All empowerment dimensions showed significant positive correlations with creativity (p <0.01). Regression analysis revealed that competence (β = 0.344, p = 0.000) and impact (β = 0.289, p = 0.000) were significant predictors of managerial creativity, while meaning (β = 0.119, p = 0.055) and self-determination (β = −0.048, p = 0.294) were not. The model explained 37.4% of the variance in creativity. Conclusion: Psychological empowerment plays a meaningful role in shaping managerial creativity among healthcare workers, with competence and perceived impact emerging as the strongest influences.

Background: Implant surface characteristics influence both osseointegration and early microbial colonization. The present in-vitro study compared machined, sandblasted and acid-etched (SLA), anodized and laser-modified titanium surfaces to determine how different modification protocols affect roughness and 24-hour bacterial adhesion. Methods: Eighty commercially pure titanium grade 4 discs were randomly allocated to four groups (n = 20 each): machined, SLA, anodized and laser-modified. Surface characterization was performed using optical profilometry (Ra, Rz, Rq, Rsk and Rku) and scanning electron microscopy. Early bacterial adhesion at 24 hours was assessed using Streptococcus mutans under aerobic conditions and Porphyromonas gingivalis under anaerobic conditions. Colony-forming units (CFU/mm²) and fluorescence microscopy coverage percentages quantified adhesion. One-way ANOVA, Tukey post-hoc testing and Pearson correlation analysis were applied at a significance level of p<0.05. Results: SLA surfaces exhibited the highest roughness (Ra 2.34±0.28μm), followed by laser-modified (1.87±0.23μm), anodized (1.12±0.18μm) and machined surfaces (0.43±0.09μm) (p<0.001). SLA also showed the greatest bacterial adhesion. Compared with SLA, laser-modified surfaces demonstrated approximately 38.2% lower S. mutans counts and 38.8% lower P. gingivalis counts despite remaining moderately rough. Strong positive correlations were observed between Ra and bacterial adhesion parameters (r = 0.80-0.85; p<0.001). Conclusion: Surface modification protocols significantly influence both roughness and early bacterial adhesion on titanium. Within the limitations of this 24-hour single-species in-vitro model, laser-modified surfaces showed a favourable balance between moderate roughness and lower bacterial adhesion than SLA surfaces and therefore appear promising rather than definitive for future implant surface design.

Background: Immediate implant placement in fresh extraction sockets is an established treatment option, but its initial biomechanical environment differs from that of delayed placement in healed sites. This controlled in vitro study compared stability and interface parameters between the two placement models under standardized artificial mandibular bone conditions. Methods: Forty polyurethane Sawbones blocks simulating type II/III mandibular bone were allocated to a fresh extraction socket model (Group A, n=20) or a healed osteotomy model (Group B, n=20). Identical SLA-surfaced titanium implants (4.0 × 10 mm) were inserted by a single operator. Primary outcomes were implant stability quotient (ISQ) and insertion torque value (ITV); secondary outcomes were removal torque value (RTV), bone-implant contact (BIC), contact area and gap volume assessed by micro-computed tomography. The artificial model evaluated mechanical stability only and did not simulate biological healing. Results: Healed site models demonstrated significantly higher stability than fresh socket models. Mean ISQ was 72.4±4.8 in Group B versus 64.2±5.6 in Group A (p<0.001). Mean ITV was 38.6±6.2 Ncm versus 28.4±5.8 Ncm (p<0.001) and mean RTV was 32.4±5.4 Ncm versus 24.8±4.9 Ncm (p=0.002). Mean BIC was 68.3±7.4% in healed sites and 52.6±8.2% in fresh socket models (p<0.001). Gap volume was substantially lower in healed sites (4.8±2.1 mm³) than in fresh socket models (12.4±3.2 mm³) (p<0.001). Conclusion: Within the limits of this in vitro polyurethane mandibular model, healed site placement showed greater primary stability and closer implant-bone adaptation than immediate placement in fresh socket models. Immediate placement may therefore require additional stabilization measures and cautious loading decisions when initial stability is borderline.

The Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed significant challenges in understanding host antiviral immune responses. Among these, interferons (IFNs) play a critical role as the first line of defence against viral infections. IFNs are classified into three major types: type I, type II and type III, each contributing to antiviral immunity by activating interferon-stimulated genes that inhibit viral replication. This review aims to summarise current evidence regarding the role of interferons in SARS-CoV-2 infection, with a particular focus on airway epithelial cell models. These models are especially valuable as they closely mimic the structural and functional characteristics of the human respiratory epithelium, including the expression of Angiotensin-Converting Enzyme 2 (ACE2) receptors, thereby providing a physiologically relevant platform for studying viral entry, replication and host immune responses. A comprehensive literature search was conducted on 15 July 2025 using databases and keywords including “airway epithelial cells,” “SARS-CoV-2,” “COVID-19,” and “interferon.” A total of 86 articles were identified, of which 50 were included based on predefined relevance criteria, including studies focusing on interferon responses in airway epithelial models, experimental or clinical relevance to SARS-CoV-2 infection and availability of full-text articles in English. The findings indicate that interferon responses vary depending on cell type, viral variants and host factors such as age and environmental exposure. In conclusion, interferons play a pivotal role in the pathogenesis and potential treatment of COVID-19. Airway epithelial cell models remain essential tools for elucidating these mechanisms and for developing targeted antiviral therapies.

Background: Endodontic retreatment depends on effective removal of previous obturation materials so that the canal can be re-cleaned, disinfected and re-obturated. The retreatability of contemporary bioceramic and resin-based sealers remains clinically relevant because their different bonding mechanisms may influence how much material persists after reinstrumentation. Objective: This in vitro study compared the efficacy of three continuous-rotation retreatment systems-ProTaper Universal Retreatment (PTR), D-RaCe (DRC) and R-Endo (REN)-in removing bioceramic and resin-based sealers from instrumented root canals. The primary outcome was percentage residual filling material on CBCT. Secondary outcomes were retreatment time and stereomicroscopic residual score. Methods: Ninety extracted human mandibular premolars with single canals were prepared to ProTaper Universal F3 (30/.09 taper) and obturated with gutta-percha plus either bioceramic sealer (n = 45) or resin-based sealer (n = 45). Each sealer group was randomly subdivided into PTR, DRC and REN subgroups (n = 15). Baseline and post-retreatment residual filling volumes were assessed using CBCT volumetric analysis. Retreatment time was recorded and stereomicroscopic scoring was performed after longitudinal sectioning. Chloroform (0.1 mL) was used only when necessary according to the same retreatment protocol. Results: Resin-based sealer showed significantly higher residual material than bioceramic sealer across all systems (p<0.001). Mean residual filling percentages for bioceramic sealer were 8.42+2.18% (PTR), 11.36+3.24% (DRC) and 12.84+2.96% (REN), whereas corresponding values for resin-based sealer were 14.28+3.46%, 18.52+4.12% and 19.74+3.88%. PTR demonstrated superior cleaning efficacy (p = 0.002) and shorter retreatment time. Residual material was concentrated predominantly in the apical third. None of the systems achieved complete removal. Conclusion: Under the conditions of this in vitro model, PTR was the most effective of the tested systems and bioceramic sealer was easier to remove than resin-based sealer. However, all systems left residual material, especially in the apical third, indicating that supplementary cleaning procedures may still be required during retreatment.

Background: Elastic stable intramedullary nailing (ESIN) is widely used for paediatric diaphyseal long-bone fractures, but its role in heavier children remains debated because increased load may compromise alignment control and implant stability. The conventional 50-kg threshold is often cited, yet the evidence base remains heterogeneous. Aim: To evaluate whether body weight (<50 kg vs ≥50 kg) was associated with fracture characteristics, short-term clinical outcomes and selected postoperative findings in children treated with ESIN. Methods: This retrospective cohort study included 54 children aged 3-17 years treated with ESIN at a tertiary hospital between 2015 and 2024. Because the available dataset included femoral fractures, tibial fractures and combined injuries, analyses were reported for the whole ESIN-treated cohort. Variables included age, sex, fracture site, fracture side, fracture stability, fracture pattern, hip range of motion (ROM), varus/valgus deformity and length of stay. Categorical comparisons used the chi-square test or Fisher’s exact test as appropriate. Logistic regression was planned for complication assessment; however, interpretation was kept cautious because the ≥50 kg subgroup was small (n=12). Results: Forty-two children (77.8%) weighed <50 kg and 12 (22.2%) weighed ≥50 kg. Femoral fractures were more frequent in the <50 kg group (88.6% vs 57.9%; p=0.010) and fracture type differed significantly by weight group (p=0.031). No statistically significant differences were observed for fracture side, fracture stability, fracture pattern, hip ROM, varus/valgus deformity or hospital stay. These findings suggest that within this selected retrospective cohort, weight was associated more strongly with fracture distribution than with the recorded postoperative outcomes. The small heavier subgroup reduced power to detect modest differences in complications. Conclusion: In this single-centre retrospective cohort, ESIN-treated children weighing ≥50 kg did not demonstrate clearly worse recorded short-term outcomes than lighter children; however, the small number of heavier patients, missing operative-detail variables and mixed fracture-site dataset limit broad safety conclusions. Weight should therefore be considered alongside age, fracture stability and pattern when planning fixation.

Background: Nursing is a demanding profession often associated with high occupational stress, which can negatively influence nurses’ well-being and compromise patient care. Assessing how nurses cope with workplace stress is crucial for developing strategies that enhance resilience and clinical performance. Objective: This study aimed to evaluate the coping strategies used by nurses working in the Riyadh Region and to examine the association between these coping mechanisms and key demographic variables. Methods: A cross-sectional, quantitative descriptive study was conducted at the second cluster hospital in Riyadh Region (King Fahad Medical City, Prince Mohamed and King Khalid Majmaah Hospital. A total of 425 nurses employed in major hospitals across the Riyadh Region, Saudi Arabia, participated in the study. Data were collected using the validated Coping Strategy Indicator (CSI) tool. Results: Problem-solving emerged as the predominant coping strategy, with 56.2% of nurses demonstrating high usage (mean score: 26.1±4.6). Seeking social support was moderately utilized, with 53.6% reporting moderate use (mean score: 24.2±5.1), while avoidance strategies were also used at moderate levels (58.4%; mean score: 23.4±4.6). Significant associations were observed between problem-solving coping and age, educational level, work experience and clinical work area (p<0.05). Seeking social support was significantly associated with age (p = 0.028), whereas avoidance coping showed significant associations with educational level, work experience and work area (p<0.05). Conclusion: Nurses predominantly adopt adaptive coping strategies; however, younger and less-experienced nurses remain more vulnerable to stress and are more likely to rely on avoidance mechanisms. Strengthening coping skills through targeted interventions may promote psychological wellbeing and enhance patient care outcomes.

This narrative review synthesizes published evidence on global public health interventions intended to reduce oral health disparities across low-income communities, rural populations, racial and ethnic minorities, indigenous groups, migrants, children and older adults. For transparency, the review focuses primarily on literature published from 2010 to 2024 and organizes evidence across individual, community and policy/system levels. Evidence from community water fluoridation, school-based preventive programs, integration of oral health into primary care, culturally tailored community engagement models, workforce innovations and selected digital delivery approaches suggests that structural and multi-level interventions are generally more effective than education-only approaches in narrowing inequity gaps. However, the strength of evidence varies substantially across settings, particularly in low- and middle-income countries and many reports describe average improvement rather than explicit reduction in disparity gaps. Community water fluoridation, school-based fluoride/sealant programs and primary-care integration appear to offer the strongest and most scalable equity-oriented benefits, whereas technology-enabled approaches require careful attention to digital exclusion, privacy and implementation feasibility. As a narrative review, this paper provides an interpretive synthesis rather than a formal systematic review; therefore, selection bias and heterogeneity in outcome reporting should be considered when applying these findings to policy.

ackground: Excessive sun exposure is a key risk factor for pigmentary skin disorders, especially in high-UV regions like Saudi Arabia. Despite increasing awareness, gaps remain between knowledge and protective behaviors. To assess public knowledge, practices and awareness regarding sun exposure and photoprotection and their association with sociodemographic factors. Methods: A cross-sectional online survey was conducted among 305 adults in Saudi Arabia. The questionnaire evaluated knowledge, practices, barriers and awareness. Data were analyzed using descriptive statistics and non-parametric tests, with p<0.05 considered significant. Results: Most participants recognized the risks of sun exposure (93.8%) and peak harmful hours (78.4%). However, only 27.2% consistently used sunscreen despite good awareness. SPF ≥50 use was reported by 51.8% and 76.7% used multiple protection methods. Misconceptions and inconsistent practices were common. Significant associations were observed between knowledge and sociodemographic factors. Positive correlations were found between knowledge, awareness and practices (p<0.01). Conclusion: Although awareness is generally good, a gap persists between knowledge and consistent sun protection practices. Targeted education and public health interventions are needed to improve photoprotection behaviors.

Background: Frankincense (Boswellia sacra) has been widely used in traditional medicine for its perceived health benefits, including potential effects on sexual and reproductive health. Despite its cultural significance, scientific evidence supporting these claims remains limited, particularly in human populations. Objective: To evaluate the knowledge, perceptions and attitudes regarding the use of frankincense for sexual and reproductive health among adults in Saudi Arabia. Methods: This descriptive cross-sectional study was conducted across all regions of Saudi Arabia from March to August 2024. A total of 822 participants aged ≥18 years were included using a non-probability convenience sampling technique. Data were collected through a pre-tested, self-administered questionnaire assessing awareness, usage patterns and perceptions of frankincense. Results: Among the participants, 25.1% were well-informed about frankincense, while 66.4% had some knowledge. The primary sources of information were relatives and friends (77.7%) and social media (63.6%). Approximately 23.6% of participants reported using or considering frankincense for sexual and reproductive health and 24.2% reported personal experience with perceived effects. While 53% believed frankincense could serve as a natural alternative to medical treatment, a large proportion of respondents expressed neutral attitudes toward its effectiveness. Marital status showed a significant association with exposure to and consideration of frankincense use (p<0.001), with married and divorced individuals more likely to report use compared to single participants. Conclusion: There is substantial awareness and moderate acceptability of frankincense use among the Saudi population; however, its application in sexual and reproductive health remains limited.

Objectives: The current study was conducted to explore the perspectives of Saudi Arabian nursing students towards the issue of patient safety in the College of Nursing, Jeddah. Method: The study used cross-sectional survey design to collect systematic empirical data on nursing students in the four years of study (levels 1 to 4) of the Bachelor of Science in Nursing (BSN) curriculum at the College of Nursing, Jeddah. The investigation was done with a group of participants who were a convenience sample, specifically 184. Data were collected using a structured, self-administered questionnaire based on the Health Professional Education in Patient Safety Survey (H-PEPSS), covering domains including teamwork, communication, safety risk management, human factors, error recognition and reporting and clinical safety practices. Results: The research has found that, nursing students were highly confident on infection control (90%) and hand hygiene (85%) but showed relatively low confidence in evaluating safety risks (76%) and failure of identification (78%). Some of the main barriers that were identified were lack of adequate training in clinical settings (35%), lack of adequate supervision (25%) and time-restricting issues (15%). To the effect, students insisted on greater exposure to clinical practice (30%) and more training to develop communication skills (25%) as a response to better patient safety education. In addition, three-quarters of participants found their clinical training to be effective in incorporating patient safety practices, even though only two out of five believed patient safety was given enough focus in the curriculum. Conclusion: The research identifies a huge gap in patient-safety pedagogy among Saudi Arabian nursing undergraduates, in particular, their proficiency with acute high-risk situations and detection of safety deficiencies. The results however suggest that the clinical training is in need of recalibration, stricter supervision and more entrenchment of patient safety material in the nursing curriculum. Through filling up these gaps, nursing students would be better equipped to achieve the safety protocols in practice, thus improving safety and quality care provided.

Background: Breast cancer is one of the leading causes of morbidity and mortality among women worldwide. Objective: To evaluate the role of demographic characteristics and associated factors across different clinical and risk profiles in patients with breast cancer. Methods: This cross-sectional analytical study was conducted at IMBB, the university of Lahore during September 2024 to September 2025. A total of 158 female patients diagnosed with breast cancer were included using non-probability consecutive sampling. Data were collected through structured questionnaires and medical record review, including demographic variables, reproductive history, lifestyle factors and clinical characteristics such as TNM staging and recurrence. Results: The mean age of participants was 54.01±16.65 years. Left-sided breast cancer was more common (56.3%). Most patients presented at Stage II (45.6%) and Stage III (33.5%), with recurrence observed in 34.2% of cases. Overweight and obesity were prevalent in 76.6% of patients. A majority belonged to the middle socioeconomic class (54.4%) and had low educational levels. Reproductive factors showed high parity, with 46.8% having three pregnancies, while miscarriage (92.4%) and abortion (74.7%) histories were notably high. Lifestyle factors revealed high rates of smoking (53.2%), low physical activity (61.4%) and frequent fast-food intake (70.3%). Contraceptive use was reported in 71.5% of patients and all participants had exposure to paraben-containing products. Conclusion: It is concluded that breast cancer is influenced by a multifactorial interplay of demographic, reproductive, lifestyle and environmental factors.

Background: Online health information is frequently consulted by patients before clinical encounters and may shape expectations about healthcare providers. In Saudi Arabia, the use of digital platforms is common but there is limited evidence on their role in selecting orthopedic surgeons. Objectives: To examine how patients in Saudi Arabia use online health information when selecting orthopedic surgeons and to explore the selection criteria associated with their decisions. Methods: A cross-sectional survey was conducted from May to December 2024 among adults attending private orthopedic clinics across five regions of Saudi Arabia. A total of 416 participants completed the survey, of whom 341 who had consulted an orthopedic surgeon in a private setting were included in the final analysis. The questionnaire assessed digital platform use and the importance of clinical, interpersonal and institutional selection criteria, including medical knowledge, surgical skill, bedside manner and hospital reputation. Results: Among participants, 63.6% reported using digital platforms prior to consultation. However, only 42.3% perceived social media popularity as indicative of professional competence. Core clinical attributes were rated highest, with medical knowledge (79.2%) and surgical skill (75.7%) most frequently considered “very important.” While online reviews were moderately valued, they ranked lower than clinical factors. Higher importance assigned to clinical attributes was significantly associated with greater patient satisfaction (p<0.001). Conclusion: Patients in Saudi Arabia commonly use online information when selecting orthopedic surgeons but clinical competence remains the key determinant of choice and satisfaction.

Background: The burden of diabetes in adults requires robust and comparable long-term data because of the changing estimates depending on the definition of diabetes, age groups and standardization of data. Therefore, a secondary retrospective analysis of internationally harmonized indicator series was conducted to describe trends in diabetes prevalence and treatment coverage in Saudi Arabia, using NCD-RisC as the main analytical series for 2000–2022 and IDF/WDI estimates as a descriptive 2024 cross-series anchor. Methods: A country-level ecological time-series analysis was conducted using internationally harmonized annual indicators. The primary outcome was the age-standardized prevalence of diabetes in adults aged 18 years and older, with sex differentiation as appropriate. Secondary outcomes were treatment coverage in people with diabetes aged 30 years and older and sex gap measures (female minus male; percentage points). Results: In the main NCD-RisC 18+ series, pooled age-standardized prevalence of diabetes decreased from 25.10% to 20.62% (decrease of 4.48 percentage points) between 2000 and 2022, with a temporary mid-series rise around 2014-2016 before resuming its downward trend. Over the period 2000-2022, prevalence demonstrated a significant linear decrease in both men (slope = -0.181 pp/year; R² = 0.817; p = 3.3×10⁻⁹) and women (slope = -0.276 pp/year; R² = 0.957; p = 7.4×10⁻¹⁶), with strong monotonic correlations (Spearman ρ: men = -0.878, women = -0.987). Treatment coverage in people with diabetes (≥30 years) increased from 40.44% to 51.50% (increase of 11.06 pp) and generally increased, with highly significant linear increases in men (slope = +0.574 pp/year; R² = 0.977; p = 9.1×10⁻¹⁹) and women (slope = +0.469 pp/year; R² = 0.981; p = 1.1×10⁻¹⁹). Conclusion: Using harmonized national indicators, adult diabetes prevalence was found to statistically decrease from 2000 to 2022, while treatment coverage in people with diabetes significantly and substantially increased, with small but measurable changes in sex differences.

Background: Balance impairment is a major contributor to falls, mobility restriction, and reduced quality of life following middle cerebral artery (MCA) stroke. Conventional physiotherapy improves balance primarily through repetitive task practice, yet outcomes often plateau due to limited sensory feedback and inadequate engagement of postural control mechanisms. Objective: To examine the effectiveness of sensor-augmented lower-limb proprioceptive neuromuscular facilitation (SA-PNF) incorporating real-time biofeedback on balance, postural stability, and functional mobility in individuals with MCA stroke. Methods: Thirty individuals with chronic MCA stroke (age 45–75 years) and moderate balance impairment were randomly allocated to SA-PNF (n = 15) or conventional physiotherapy (n = 15). Interventions were delivered three times weekly for eight weeks. Primary outcomes included the Berg Balance Scale (BBS) and instrumented postural sway parameters. Secondary outcomes were Timed Up and Go (TUG), Limits of Stability (LOS), and gait symmetry index. Data were analyzed using mixed-model ANOVA. Results: Both groups showed significant improvements over time (p<0.05). However, the SA-PNF group demonstrated significantly greater gains in BBS (+12.1 vs +5.3), TUG (−8.2 s vs −3.6 s), mediolateral sway reduction (−34% vs −14%), and LOS excursion (+31% vs +12%) compared with conventional physiotherapy (Group × Time interaction, p<0.001). Conclusion: Sensor-augmented PNF produced superior balance and postural control improvements compared with conventional physiotherapy. The integration of real-time feedback with neurophysiological facilitation appears to enhance motor relearning and postural adaptability after MCA stroke.

Background: Birth preparedness and complication management (BPCM) is a core component of safe motherhood because it promotes advance planning for delivery and early recognition of maternal and newborn danger signs. Assessing BPCM knowledge in final-year trainees is important because these students are close to entering clinical practice. Methods: This descriptive cross-sectional study was conducted among 150 final-year nursing and midwifery students from selected colleges in North Karnataka using purposive sampling. Data were collected between December 2024 and January 2025 through a structured self-administered Google Form based on WHO recommendations and the JHPIEGO Birth Preparedness and Complication Readiness Index. Descriptive statistics and chi-square tests were used for analysis. Results: Overall, 54.7% of students had moderate knowledge, 28.0% had adequate knowledge, and 17.3% had inadequate knowledge. The mean knowledge score was 18.27±6.32. Knowledge level showed significant association with academic year or semester (chi-square = 16.615, p = 0.002) and gender (chi-square = 28.901, p = 0.001), while age group and religion were not significantly associated. Conclusion: Final-year nursing and midwifery students demonstrated predominantly moderate knowledge of BPCM, indicating the need for stronger competency-focused teaching. Structured simulation, case-based learning, and reinforcement of danger-sign recognition and emergency preparedness should be emphasized before graduation.

Background: Physical inactivity and sedentary behaviour are major modifiable risk factors for non-communicable diseases, yet evidence from universities in Saudi Arabia indicates persistently high inactivity levels among health sciences students. This study assessed the prevalence of physical inactivity and sedentary behaviour among applied medical sciences students using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Methods: A cross-sectional survey was conducted among 343 students at the College of Applied Medical Sciences, Majmaah University, Saudi Arabia (February-May 2024). Physical activity and sedentary behaviour were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Activity was categorized as Inactive, Minimally Active or Health-Enhancing Physical Activity (HEPA Active) according to IPAQ guidelines and high sedentary behaviour was defined as sitting ≥7 hours/day. Descriptive statistics and multivariable logistic regression were used to examine prevalence and predictors of inactivity. Results: Among 343 participants, 57% were inactive, 30% minimally active, and 13% HEPA active. Mean MET-min/week increased across activity levels (285, 812, and 1650, respectively), with males reporting higher activity than females (p<0.05). Daily sitting time decreased with higher activity levels (7.4, 6.9, and 6.5 h/day; p = 0.001), and prolonged sitting (≥7 h/day) was most common among inactive participants (64%) compared to minimally active (52%) and HEPA active groups (45%; p = 0.003). Conclusions: Over half (57%) of applied medical sciences students are Inactive, with high sedentary time (58%) and significant gender disparities, highlighting a knowledge-practice gap. We recommend implementing mandatory curriculum-integrated physical activity modules and establishing fitness facilities to address these disparities, align with Vision 2030 and reduce NCD risks in future healthcare professionals.

Because inflammatory lesions may involve the adjacent mental neurovascular bundle, mental nerve paraesthesia represents an uncommon complication of apical periodontitis affecting the mandibular premolars. In this case study, we meet a 27-year-old female patient who, four weeks after having root canal treatment for tooth no. 45, complained of continuing numbness in her right lower lip. Radiographs revealed an insufficient root filling, an apical radiolucency next to the mental foramen, and sinus tract tracing verified that the numbness was endodontic in origin. The patient had a conservative nonsurgical endodontic retreatment while isolated by a rubber dam and seen under a dental operating microscope. Intracanal medicine of calcium hydroxide and supplementary vitamin B complex were also administered. After one week, patients reported a marked improvement in their subjective sense of touch. Three weeks later, they claimed that all symptoms had disappeared, and radiographs taken at 18 months showed that the periapical area had healed completely and that the cortical bone had grown back. Early nonsurgical retreatment seems to be a good tooth-preserving alternative for mental nerve paraesthesia due to apical periodontitis, according to a subjective neurosensory evaluation and one clinical instance.

Background: The interpretation of multiple heterozygous Variants of Uncertain Significance (VUS) poses a significant challenge in clinical genomics, particularly in consanguineous pedigrees. Case Presentation: An example of a child with a severe multisystem disorder is that of a 10 year-old boy born out of a consanguinity relationship with manifested symptoms of chronic inflammatory bone pain (diagnosed with chronic non-bacterial osteomyelitis through biopsy), severe growth failure and chronic gastrointestinal symptoms. Whole-exome sequencing showed a heterozygous likely pathogenic variant in PAH (c.898G>T; p.Ala300Ser), a heterozygous likely pathogenic variant in PRKRA (c.796G>A; p.Ala266Thr), a heterozygous VUS in ALDH18A1 (c.1619A>G; p.Glu540Gly) and a compound heterozygote VUS in the SI gene. Conclusion: Variant prioritization was guided by ACMG/AMP classification, phenotypic concordance and pathway-level biological plausibility, with additional support from segregation analysis and functional correlation, including biochemical confirmation of sucrase-isomaltase deficiency. We suggest a hypothesis of a synergistic heterozygotic effect of PRKRA variants on inflammatory signaling, along with metabolic stress factors of the PAH and ALDH18A1 variants and nutritional deficiency of partial Sucrase-Isomaltase deficiency (SI) reduced the initiation threshold to severe CRMO.

Background: Generalized Joint Hypermobility (GJH) is described as excessive range of motion in multiple synovial joints of human body beyond normal physiological range. Usually it is asymptomatic, GJH has been associated with modified biomechanics, neuromuscular deficits and increased risk of ligamentous and overuse injuries in athletic populations. Limited data exist regarding its prevalence among recreational football players in Saudi Arabian populations. Objective: To find out the prevalence of generalized joint hypermobility among university recreational football players in Saudi Arabia. Methods: A cross-sectional prevalence study was conducted between January and March 2024 at the Majmaah University International Rehabilitation Centre, Saudi Arabia. All registered male recreational football players aged 18–29 years (N = 284) were screened using the standardized 9-point Beighton scoring system. A cut-off score ≥4/9 defined GJH. Prevalence and exact (Clopper–Pearson) 95% confidence intervals were calculated. Results: Among 284 screened players, thirty‑two met criteria for GJH, there is a prevalence of 11.26% (95% CI: 7.8%–15.5%). The mean Beighton score for the entire cohort was 1.9±1.4, whereas hypermobile players (score ≥4/9) demonstrated a mean score of 4.8±0.9. Conclusion: Approximately one in nine recreational university football players demonstrated generalized joint hypermobility, a rate that is similar to previously reported prevalences in recreational and sub‑elite football cohorts and slightly higher than some non‑athletic university populations. These findings support the implementation of routine hypermobility screening in university athletic programs.

Objectives: Optic nerve health is essential for proper function of the visual system. However, the pathophysiology of certain neurodegenerative disease processes affecting the optic nerve, such as glaucoma, is not fully understood. Recently, it was hypothesized that a lack of proper clearance of neurotoxins such as amyloid-beta, tau proteins and other metabolic byproducts contributes to neurodegenerative diseases. The ability to clear metabolic waste is essential for tissue homeostasis in mammals, including humans. While the brain lacks the traditional lymphatic drainage system identified in other anatomical regions, there is growing evidence of a Glymphatic system in the central nervous system, which structurally includes the optic nerve. Aim: This study performed a narrative review to examine the anatomical and functional relationship between the glymphatic system and the optic nerve, synthesizing evidence from experimental, histopathological and neuroimaging studies. Methods: A narrative review methodology was utilized for this study. Relevant literature was identified through structured narrative search of PubMed, Embase, Cochrane Library, Scopus and Google Scholar using keywords such as glymphatic system, optic nerve disorders and neuro-ophthalmology. Eligible studies include randomized controlled trials, observational studies and meta-analyses published within the last five years (2020–2025). Non-English, animal studies were excluded. The search strategy yielded 1 case control study and 2 observational studies met inclusion criteria. Results: The pathogenesis of retinal illnesses including glaucoma and age-related macular degeneration is significantly influenced by the presence of a glymphatic-like system in the retina and optic nerve. Conclusion: However, only three eligible human studies were identified, representing a major limitation of the current evidence base.

Introduction: Vascular endothelial growth factor receptor 2 (VEGFR2) plays an important role in cancer progression, especially in tumor growth and metastasis. Although several FDA-approved drugs target VEGFR2, they are often associated with side effects. Therefore, there is a need to identify safer and effective alternative molecules. Methods: In this study, the VEGFR2 protein (PDB ID: 2OH4) was obtained from the Protein Data Bank and prepared for molecular docking. A total of 18 garlic-derived phytochemicals and a standard drug, famitinib, were retrieved from the PubChem database. Molecular docking was performed using AutoDock Vina in PyRx to evaluate binding affinity. Basic pharmacokinetic properties of selected compounds were also assessed. Results: Among the tested compounds, three molecules (CID: 5280343, 5280863 and 5280805) showed better binding affinity (-9.6, -9.4 and -9.1 kcal/mol, respectively) compared to famitinib (-8.3 kcal/mol). These compounds also formed stable interactions within the VEGFR2 active site and showed acceptable pharmacokinetic properties. Conclusion: The results suggest that garlic phytochemicals may act as potential inhibitors of VEGFR2. However, these findings are based on computational analysis and require further validation through experimental studies.

Background: Ankle sprains commonly result in persistent functional deficits and delayed return to sports activities. While Functional Performance Tests (FPTs) guide return-to-sport decisions, their sensitivity varies. Side Hop Test (SHT) requires dynamic stability and rapid lateral control and therefore can detect subtle deficits better than the Single-Leg Hop (SLHT). Henceforth the present study was aimed to compare both tests and examine their relationship with self-reported ankle instability using the Cumberland Ankle Instability Tool (CAIT). Methods: Twenty-eight male participants with a history of ankle sprain within the previous 1-12 months completed the CAIT. Each participant performed the Single-Leg Hop Test (SLHT) and Side Hop Test (SHT) on both injured and uninjured ankles. Results: Side-HT completion time was significantly longer for the injured ankle (8.56±4.18 s) compared with the uninjured ankle (7.82±3.38 s; t = 2.27, p = 0.03). Although SLHT distance was lower for the injured ankle (128.4±33 cm) than the uninjured ankle (132±35 cm), this difference was not statistically significant (t = −1.45, p = 0.15). Pearson correlation analysis showed a significant negative association between CAIT scores and Side-HT performance for both injured (r = −0.39, p = 0.041) and uninjured ankles (r = −0.43, p = 0.023), whereas no significant relationship was observed with SLHT. Conclusion: The Side Hop Test appears to be a more sensitive measure for identifying functional deficits following ankle sprain. Future research should establish clinically meaningful cut-off values at specific post-injury time points to support safe return-to-sport decision-making.

Background: Cervical radiculopathy is a common cervical spine disorder resulting from nerve root compression, leading to radiating upper limb pain, weakness and sensory disturbances. The infraspinatus muscle, a key component of the rotator cuff innervated primarily by the C5–C6 nerve roots, plays a critical role in shoulder stability and external rotation. Methods: This cross-sectional study was aimed to investigate the involvement of the infraspinatus muscle in individuals with cervical radiculopathy and its impact on symptom severity and upper limb function. Sixty patients clinically diagnosed with cervical radiculopathy underwent MRI as well as nerve conduction studies and electromyography (where available), were included. Participants were assessed for infraspinatus tenderness, external rotation strength using a handheld dynamometer, pain intensity using the Visual Analogue Scale (VAS) and functional status using the Upper Extremity Functional Index (UEFI). Results: Sixty participants with mean age of 31.9±4.9 years were included and the he mean pain score was 4.6±1.9. Significant associations were found between pain severity and cervical radiculopathy (χ² = 6.210, p = 0.044), infraspinatus tenderness (χ² = 6.105, p = 0.047) and painful resisted external rotation (χ² = 7.890, p = 0.019). Baseline infraspinatus strength was reduced (7.65±1.36 kg) and was associated with higher pain and functional limitation. Strength improved in a subset following targeted rehabilitation (14.98±2.28 kg; p<0.001), though the findings of the results cannot be generalized because of the low sample size. Conclusion: Infraspinatus muscle dysfunction is significantly associated with pain and functional limitation in cervical radiculopathy, particularly at C5-C6 levels. Clinical signs such as tenderness, painful resisted external rotation and reduced strength highlight cervico-scapular interdependence. While strength improvements were observed in a subset, causal inferences are limited by the cross-sectional design. Further longitudinal and electromyographic studies are needed to guide targeted rehabilitation.

Objective: To compare gestational weight gain between pregnant women receiving a structured antenatal physical activity program and those receiving standard antenatal care with routine daily activity. Methods: This parallel-group randomized controlled trial included 100 pregnant women with singleton pregnancies between 20 and 24 weeks of gestation. Participants were allocated equally to a structured physical activity group (n=50) or a routine activity group (n=50). The intervention comprised supervised low- to moderate-intensity exercise totalling 150 minutes per week from recruitment until delivery. Gestational weight gain was the primary outcome; gestational age at delivery and adverse maternal events were secondary outcomes. Results: All randomized participants were included in the final analysis. The structured physical activity group demonstrated significantly better regulation of gestational weight gain than the routine activity group (p<0.001). No exercise-related maternal complications or adverse neonatal events were reported during the study period. Conclusion: A structured, supervised antenatal exercise program may help regulate gestational weight gain without compromising maternal or neonatal safety. The findings support the inclusion of physiotherapist-guided exercise as an adjunct to routine antenatal care, although future studies should report detailed effect sizes, adherence, dietary monitoring and neonatal indicators.

Background: The incidence of proximal humeral fractures has increased in the last decades. There is still a debate regarding conservative and operative indication and type of fixation or replacement. Therefore, long-term post-therapeutic follow up is essential to identify the posttherapeutic outcome of different interventions. In this context, fracture registries were recently introduced and facilitated outcome improvement. The goal of this research is to review the post-therapeutic outcome and complication of proximal humeral fractures after management with ORIF with angular stable plating. Methods: All patients who had a proximal humeral fracture and were managed with angular stable plating over 10 years period (2012-2022) in King Fahad Hospital Hofuf were identified. AO/OTA and Neer classification systems were used. Long-term functional outcome was assessed primarily through a validated patient-reported questionnaire, the Munich Shoulder Questionnaire (MSQ), from which Constant score equivalents were derived. We analyzed the demographic data like age, follow up interval, fracture type and functional parameters of the MSQ and Constant score. Exclusion criteria were patients with: polytauma, open fractures, neurovascular associated injuries, neurological disorders, follow up under 12 months, patients younger than 16 and older than 95 years old and patients unable to consent. Results: All Patients with proximal humeral fractures who were treated with angular stable plating (n = 595) were identified in our center between 2012-2022 with female predominance (n = 378; 63,6%). About 268 questionnaires were successfully completed (45% response rate). 268 patients were managed with angular stable plating with 3- and 4-part fractures was 160 and 108 respectively. Mean MSQ score after angular stable plating of 3- and 4-part fractures was 86,3 and 72,8 respectively. Postoperative complications after angular stable plating were: 2,5% secondary varus malalignment, 2,23% AVN, 2,61% shoulder stiffness, 0,37% shoulder impingement, 2,61% cut out, 0,74% non-union. Conclusion: In this single-center retrospective cohort, ORIF with angular stable plating was associated with generally acceptable patient-reported functional outcomes and a relatively low recorded complication frequency among respondents. The most commonly recorded complications were screw cutout and shoulder stiffness. These findings should be interpreted cautiously because of the retrospective design and the 45% questionnaire response rate.

Objectives: To evaluate the anatomical and physiological role of the lymphatic system in immune response and fluid regulation. Methods: A descriptive cross-sectional study was conducted on 150 participants aged 18-65 years. Non-invasive methods including blood assays, ultrasound imaging and clinical examination were used to assess immune markers, lymph node status and fluid balance. Results: The majority of participants (86.67%) showed no oedema, indicating normal fluid balance. Mild axillary lymph node enlargement was observed in 4% of cases. Immune markers, including white blood cell count and lymphocyte distribution, remained within normal ranges. T-cell activity increased significantly following immune challenge (p = 0.02), indicating an active immune response. Conclusion: The lymphatic system plays a critical role in immune surveillance and maintenance of fluid homeostasis. Early detection of lymphatic dysfunction may help prevent disease progression and improve clinical outcomes.