Background/aim: The PMS2 gene was evaluated for its role in the pathogenesis of breast cancer by analyzing its expression in blood samples obtained from healthy postmenopausal women, newly diagnosed breast cancer patients, and the same patients following surgical and therapeutic treatment. Materials and Methods: A total of 47 blood samples were analyzed, including 7 from healthy controls, 20 from newly diagnosed breast cancer patients (disease group), and 20 from the same patients’ post- treatment (cure group, 4 months’ post-surgery or therapy). RNA extraction, cDNA synthesis, and RT-PCR analysis were performed on blood samples to determine the expression levels of the PMS2 gene across groups, providing insight into the genetic changes associated with breast cancer progression and the impact of clinical interventions. SPSS was used for statistical analysis, including correlation and paired-sample t-tests. Results: PMS2 expression exhibited a highly significant difference between group 1 (healthy control), which showed no expression, and group 2 (disease group), which demonstrated upregulation of the PMS2 gene (P < 0.001, paired sample t-test) with a 99% confidence interval. A downregulation of gene expression was observed in group 3 (cure group) after treatment, and the comparison between the disease and cure groups revealed a statistically significant difference (P = 0.042, paired t-test) with a 95% confidence interval. The majority of patients aged 50–60 were diagnosed with stage 2 invasive ductal carcinoma. This systematic regulation of PMS2 expression highlights its role in disease development, progression, and therapeutic response. Conclusion: The data confirmed the involvement of the PMS2 gene in breast cancer aggressiveness and progression.

Virtual and augmented reality are key components of mixed reality, enabling users to interact seamlessly with real or simulated environments based on clinical needs. Integrating mixed reality into dental loupes holds promise for enhancing clinical efficiency by reducing treatment times and minimizing the need for practitioners to divert their attention from patients to external computer monitors. This study evaluates the impact of mixed reality adoption by analyzing digital screen usage during oral surgical procedures and examining whether its necessity varies by treatment type. The retrospective analysis involves two oral surgeons performing procedures on their regularly scheduled patients in a clinical setting. To assess the feasibility of incorporating mixed reality into dental loupes, data was collected on the frequency and duration of digital computer interactions, categorized by procedure type. For bone graft procedures, statistical analysis focused on the influence of intravenous (IV) sedation on computer usage and treatment duration, given the additional monitoring required for vital signs. A two-sample t-test showed a statistically significant 95.9% increase in computer usage with IV sedation compared to local anesthesia, though no significant difference in treatment duration was observed. An ANOVA test revealed significant differences in computer usage across various oral surgery procedures, indicating that the potential benefits of mixed reality integration may vary by procedure. These findings suggest that incorporating mixed reality into dental loupes could enhance workflow efficiency and reduce reliance on external screens in oral surgery practices.

This study provides an overview of the consequence of the use of oral corticosteroid in the treatment of severe asthma in adults; it also identified recent evidence based alternative drug regimen for asthma management to prevent long term negative effect of oral corticosteroids. Asthma is a chronic inflammatory airway disease affecting about 300 million people globally. Approximately 4% to 8% of asthma patient’s symptoms remain uncontrolled and exacerbations occur frequently despite high-intensity treatment, hence the need for corticosteroid treatment for sustain symptom control and to prevent flare-ups. Oral corticosteroids are powerful anti-inflammatory medicine which helps by quickly reducing the swelling in the lungs. There is no doubt that the use of oral corticosteroids (OCS) plays a vital role in the management of asthma, particularly in the management of acute exacerbations and severe asthma. However, there is clinical evidence that both long- and short-term use of corticosteroids in asthma has complicated relationship with some referring to them as a ‘frenemy, as side effect of oral corticosteroids has detrimental effect on quality of life of asthma patients. The study utilized literature review of web-based articles and journals using multiple databases. Studies both on short term and long- term use of OCS was reviewed to have better understanding of the subject matter. Studies in children populations were excluded as the focus of this study is on adult patients living with asthma. Following the literature search, ten articles met the inclusion criteria and were selected. The study concluded that due to widely acknowledged side effects, and advances in care, there is clinical support for a shift away from a reliance on OCS in the treatment of severe asthma to other alternative management.

Background: Dilated cardiomyopathy (DCM) poses a significant health risk in pediatric populations, yet its pathophysiological mechanisms remain unclear. This study aims to explore new biomarkers as potential predictors in pDCM. Methods: A total of 84 pediatric patients diagnosed with dilated cardiomyopathy (DCM) and 34 age-matched healthy controls were prospectively recruited. Inclusion criteria were based on clinical diagnosis, echocardiographic findings, and relevant exclusion criteria for other cardiac or systemic conditions. Serum levels of total carnitine, procollagen type III N-terminal propeptide (PIIINP), cystatin C (Cys-C), β2-microglobulin (β2M), and haptoglobin (Hp) were quantitatively assessed using enzyme-linked immunosorbent assay (ELISA). Expression of acylcarnitine was assessed via qRT-PCR. Results: There were significantly higher plasma levels of total carnitine (p=0.001), PIIINP (p=0.016), Cys-C (p=0.001), β2M (p=0.009), and haptoglobin (p=0.001) in pDCM compared to matched controls. Total carnitine, PIIINP and β2M at cut-off points 65 umol/ml &3 & 2 mg/L showed 73&79% & 75% sensitivity and 91& 56% & 81% specificity respectively for predicting risk of pDCM. Haptoglobin at cutoff point 164 mg/L has highest specificity (100%) but with low sensitivity 56%). Combined β2M, PIIINP, and total carnitine demonstrated the best accuracy (83.5%) with 75% sensitivity, 92% specificity, 90% PPV, and 79% NPV for the presence of pDCM. A significant upregulation of the acylcarnitine expression gene was also observed in the DCM group compared to controls. Conclusion: Acylcarnitine, PIIINP, Cys-C, β2M and heptoglobin are potential emerging predictors for pDCM and might have a pathogenic role in pDCM with mechanistic associations.

Stereotactic lesioning has re-emerged as a feasible option to deep brain stimulation (DBS) for severe Parkinson's disease (PD), especially in individuals with restricted access to device-based therapy. Although single-target lesioning of the ventral intermediate nucleus (Vim) or globes pallidus internus (GPi) effectively addresses certain motor disorders, dual-target lesioning within the same hemisphere is yet little investigated. To assess the effectiveness and safety of dual-target stereotactic lesioning (Vim + GPi) against single-target lesioning (Vim or GPi alone) in individuals with advanced Parkinson's disease and medication-resistant motor symptoms. A prospective observational research with 450 consecutive patients with advanced Parkinson's disease was carried out at two neurosurgical centers in Iraq. Patients underwent either single-target (n = 321) or dual-target (n = 129) radiofrequency lesioning. Outcomes were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS-III) and complication rates over a follow-up period of 1–2 years. Statistical comparisons were made using t-tests and p-values < 0.05 were considered significant. Dual-target lesioning yielded significantly greater improvement in tremor (↓ 85.7%), rigidity (↓ 75.7%), and bradykinesia (↓ 82.4%) compared to single-target approaches (all p < 0.0001). However, complication rates were higher in the dual-target group, particularly for speech (27.1% vs. 13.1%, p = 0.0016) and balance disturbances (37.2% vs. 17.1%, p < 0.0001). No notable variations were detected in age, illness duration, or baseline LEDD across the groups. In comparison to single-target ablation, dual-target stereotactic lesioning is associated with a higher incidence of adverse effects; nevertheless, it is significantly more successful in managing motor symptoms in advanced Parkinson's disease (PD). The meticulous selection of patients and the adjustment of lesion characteristics are essential to enhance benefits while concurrently limiting issues. In individuals unsuitable for deep brain stimulation (DBS) or seeking more comprehensive symptom relief, these findings advocate for the targeted application of dual-target approaches.

The paper examines the impact of mobile health applications on patient adherence through a literature-based research approach. Key questions explored include the impact of mHealth on treatment compliance, the efficacy of app-based interventions, and barriers to adoption. The study aims to assess mHealth’s influence on adherence, identify success factors, and evaluate its potential to address healthcare gaps. The methodology involved a systematic literature review of peer-reviewed articles, clinical trials, and case studies from 2015 to 2023, utilizing qualitative and quantitative analysis to synthesize findings. Data were collected on app features, user engagement metrics, and adherence outcomes from databases like PubMed, IEEE Xplore, and Google Scholar. Results show that mHealth apps significantly improve adherence through reminders, educational content, and personalized feedback, with a notable impact on chronic disease management. Challenges such as low digital literacy and privacy concerns hinder efficacy. The study concludes that mHealth has transformative potential but depends on user-centered design, robust data security, and healthcare system integration. Contributions include a framework for optimizing app-based interventions and policy recommendations to support digital health adoption. Practical applications include reduced treatment gaps and healthcare costs, while limitations like sample bias and technological evolution highlight the need for longitudinal research. Future directions include investigating AI-driven personalization and cross-cultural adaptability.

The integration of neuroanatomophysiology and neuropsychopharmacology links the structural and functional organization of the nervous system with the pharmacological modulation of neural processes, cognition, mood, and behavior, creating an interdisciplinary bridge between neuroscience and clinical practice. Differentiating neurodivergence, understood as natural variations in brain structure and function, from neurological disorders, involving impairments or degenerative processes, is essential for diagnostic accuracy and social inclusivity. Advances in neuroimaging, biomarkers, and targeted pharmacotherapies have enabled earlier detection, better characterization, and personalized interventions. This study aimed to analyze how these fields interact in understanding, diagnosing, and treating neurodivergence and neurological disorders through an integrative bibliographic review. Searches in SciELO, LILACS, BVSMS, and Google Scholar used controlled descriptors and free-text terms, with inclusion of qualitative review articles in Portuguese, English, or Spanish. Data extraction emphasized objectives, methods, and findings, prioritizing methodological rigor to integrate theoretical and applied perspectives for improved clinical outcomes.

Diabetes mellitus (DM) is a significant public health and economic concern in Saudi Arabia, affecting more than 20% of adults. Insulin remains a cornerstone in DM management, but the country relies significantly on imported products. Hence, this results in high healthcare expenditures and variable availability. In line with Vision 2030, Saudi Arabia has prioritized the localization of insulin manufacturing to ensure sustainable access, reduce import dependency, and enhance national health security. This paper explores the clinical, economic, and policy implications of localizing insulin production in the Kingdom. The current work used a case study methodology to assess the feasibility, challenges, and strategic opportunities for the domestic production of innovative insulins, such as Degludec and IDegAsp. The study supports the development of public-private partnerships, investment in biotechnology infrastructure, and regulatory reform to foster a robust local biopharmaceutical ecosystem. By 2027, Saudi Arabia aims to meet 50% of its insulin demand through local production, making it the first country in the GCC region to produce innovative insulin. This initiative is expected to promote affordability and position the Kingdom as a leader in insulin innovation.

Background: Cancer cachexia, often referred to as cancer wasting, is a multifactorial syndrome characterized by involuntary weight loss, muscle wasting, and systemic inflammation. It affects up to 80% of patients with advanced malignancy and is a major cause of morbidity and mortality. Despite increasing recognition, it remains underdiagnosed and inadequately treated. Objective: This meta-analysis aimed to evaluate the prevalence, clinical consequences, and effectiveness of interventions for cancer cachexia across malignancies. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library up to December 2024. Randomized controlled trials (RCTs), cohort studies, and meta-analyses reporting prevalence, outcomes, or interventions in adult cancer patients were included. Studies were pooled using a random-effects model. Primary outcomes were prevalence and overall survival; secondary outcomes included treatment tolerance, quality of life, and intervention efficacy. Results: Forty-eight studies comprising 23,400 patients were analyzed. The pooled prevalence of cachexia was 49.2% (95% CI 43.1–54.8), highest in pancreatic (74%) and lung cancer (63%) populations. Cachexia was associated with a 41% higher risk of mortality (HR 1.41; 95% CI 1.23–1.61) and reduced chemotherapy tolerance (RR 1.38). Nutritional interventions alone were insufficient, whereas multimodal approaches (nutrition, pharmacologic agents, exercise) improved weight stabilization and quality of life. Anamorelin drug showed moderate efficacy in increasing lean body mass, though survival benefit remained unproven. Conclusion: Cancer cachexia is highly prevalent and clinically significant, yet interventions remain suboptimal. Early identification and multimodal treatment should be integrated into oncology practice. Future research must focus on biomarkers, standardization of diagnostic criteria, and novel therapeutic targets.