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Leishmaniasis is a common protozoal infection that could be cutaneous (CL), mucocutaneous (MCL), or visceral. CL, which is the most common form, is typically localized. Therefore, it becomes more difficult to diagnose it when presenting with diffuse lesions. In this case, a 54-year-old man presented with skin lesions involving his trunk, extremities, and face, including the nasal mucosa. His past medical history was remarkable for MCL with synovial leishmaniasis, systemic lupus erythematosus (SLE), and non-Hodgkin's lymphoma (NHL). Skin biopsies showed intracytoplasmic leishmania amastigotes; polymerase chain reaction (PCR) was positive for leishmania DNA; and a culture from purulent skin lesions grew Pseudomonas aeruginosa. So, MCL with superimposed cellulitis was diagnosed, and the patient was treated with intravenous liposomal amphotericin B and ceftazidime. Leishmaniasis is an infection that has accurate diagnostic tests and various treatment options. However, the difficulty is in being able to suspect it clinically, as it can mimic a wide range of diseases with cutaneous involvement. Therefore, visual awareness of the spectrum of disease presentations is arguably the most challenging and important skill to acquire in the diagnosis and management of CL. This case represents a rare form of MCL., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Taleb et al.)

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder affecting premutation carriers of the FMR1 gene. This case report presents a 65-year-old male who was diagnosed with FXTAS after presenting with an acute exacerbation of neurological symptoms in the setting of a COVID-19 infection. The case highlights the potential for viral infections to trigger the worsening of FXTAS symptoms and emphasizes the importance of comprehensive evaluation in such scenarios., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ghasham et al.)

Background: Hip fractures are among the most common fractures encountered in the emergency departments by orthopedic trauma teams. The optimal treatment method and implant choice for unstable intertrochanteric fractures are subject to debate, with various options available, including intramedullary and extramedullary implants., Methods: In this descriptive cross-sectional study, the researchers examined patients with unstable intertrochanteric fractures (classified as 31A2 according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification) who had undergone open reduction and internal fixation with a 95° dynamic condylar screw (DCS). The study was conducted at the Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) during the latter half of 2022. Functional outcomes were assessed using the modified Harris Hip Score (mHHS)., Results: A total of 30 patients were enrolled in this study, with a mean age of 73 ± 12.27 years. Of these, 11 (36.7%) were male, and 19 (63.3%) were female. The mHHS was 73.6 ± 14.654. Among the surveyed patients, seven (23.3%) reported poor outcomes, 13 (43.3%) reported fair outcomes, six (20%) reported good outcomes, and four (13.3%) reported excellent outcomes. The Kruskal-Wallis test revealed statistically differences in mean mHHS scores between gender groups (p = 0.024) and between age groups (p = 0.04). However, no significant differences were found across different modes of trauma groups (p = 0.73), affected hip groups (p = 0.35), comorbidity groups (p = 0.84), or postoperative complication groups (p = 0.06)., Conclusion: Our study found that DCS treatment for unstable intertrochanteric fractures yielded acceptable functional outcomes, making it a viable and effective treatment option., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Gezira Centre for Orthopedic Surgery and Traumatology issued approval SUD24/GCOST-13. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abdalla et al.)

Background: Histidine-tryptophan-ketoglutarate (HTK) cardioplegia induces cardiac arrest through membrane hyperpolarization. Aortic valve pathology leads to pathophysiological changes in left ventricular vascularization that may prevent adequate cardioplegic distribution. The objective of the study was to ascertain whether the use of Bretschneider cardioplegia in aortic valve surgery yields different outcomes for male and female patients., Methodology: Our study compares the perioperative data of 300 adult patients who underwent aortic valve replacement between June 2023 and June 2024 at the Emergency Cardiac Disease and Transplant Institute, Tîrgu Mures, Romania. Concomitant procedures, age under 18 years, retrograde or combined cardioplegia, and emergency surgery were excluded. The main outcome was operative mortality, and secondary outcomes were postoperative complications and paraclinical data such as ejection fraction and cardiac enzymes., Results: Male patients comprised 190 (62%) of the sample. The most common age group was 61-70 years in both groups. The mortality rate was 6 (5.4%) for women compared to 9 (4.7%) for men. Preoperative left ventricular ejection fraction was the primary covariate determining 30-day postoperative mortality. Left ventricular ejection fraction decreased by 2.2% in men and 1.1% in women 30 days after surgery., Conclusions: The myocardial adaptation to aortic valve pathology exhibits gender-specific differences. However, the utilization of HTK cardioplegia obviates this disparity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee of Emergency Institute for Cardiovascular Disease and Transplantation, Tîrgu Mures issued approval 3240, 15.04.2024. The study was conducted in accordance with the Declaration of Helsinki. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ghiragosian et al.)

Postpartum depression (PPD) has been widely studied, assessed, and promptly intervened in new mothers. However, paternal postpartum depression gained attention not long ago. Postpartum depression in men could present over one year following the birth of the child, frequently presenting with symptoms like irritability, low mood, sleep disturbances, changes in appetite, fatigue, and loss of interest in everyday activities; amongst other symptoms of Major Depressive Disorder which may hinder them from taking care of themselves and the baby. Paternal PPD significantly impacts partner relationships causing maternal PPD, poor infant bonding, and therefore, affecting overall child development. The following narrative review is based on a literature search of articles published on paternal postnatal depression. The primary emphasis of this review has been to provide an overview of the current comprehension of paternal postpartum depression regarding prevalence, global incidence, and risk factors and to explore potential diagnostic tools for assessment and interventional strategies to treat this condition. Interestingly, pandemic-related stressors have been positively attributed to an increase in PPD prevalence post-pandemic. While more research is being conducted on this subject, research on the measurement characteristics of the diagnostic tools is highly recommended to implement well-defined criteria for early diagnosis of paternal PPD. The significant adverse consequences of PPD for not just the new mother, but also the infants, necessitate proper and timely diagnosis of PPD. Despite its severity, there have been no specific treatment modalities., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Attia Hussein Mahmoud et al.)

Emphysematous gastritis is a rare condition with a high mortality rate. We present a rare case of haemorrhagic emphysematous gastritis in a 70-year-old woman with a background of relapsed endometrioid ovarian cancer previously treated with chemotherapy and recent prednisolone use. A CT scan showed a grossly distended stomach with gas in the stomach wall and gas in the gastric and portal veins in the liver. The duodenum and small bowel were not dilated, suggesting gastric outlet obstruction potentially secondary to serosal deposits. Endoscopic evaluation showed an ischaemic oesophagus and posterior wall of the stomach, with necrosis of the greater curve. Histology showed complete loss of the gastric epithelium along with transmural necrosis along with intense acute and chronic inflammation. She was treated conservatively, as she was not fit for surgery due to her co-morbidities. She symptomatically improved and was discharged under the palliative care team. There are no current clear guidelines on treatment approaches. After a patient is haemodynamically stabilised, treatment options currently include surgical intervention (gastrectomy) or conservative options (fluid resuscitation, nasogastric decompression, broad-spectrum antibiotics/antifungals and supportive management). Historically, emphysematous gastritis was conventionally managed surgically. There has been a shift towards conservative management in recent literature, reporting good patient outcomes in patients successfully managed without surgical intervention., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mansour et al.)

Introduction: The integration of artificial intelligence (AI) in healthcare, particularly through language models like ChatGPT and ChatSonic, has gained substantial attention. This article explores the utilization of these AI models to address patient queries related to hypertension, emphasizing their potential to enhance health literacy and disease understanding. The study aims to compare the quality and reliability of responses generated by ChatGPT and ChatSonic in addressing common patient queries about hypertension and evaluate these AI models using the Global Quality Scale (GQS) and the Modified DISCERN scale., Methods: A virtual cross-sectional observational study was conducted over one month, starting in October 2023. Ten common patient queries regarding hypertension were presented to ChatGPT (https://chat.openai.com/) and ChatSonic (https://writesonic.com/chat), and the responses were recorded. Two internal medicine physicians assessed the responses using the GQS and the Modified DISCERN scale. Statistical analysis included Cohen's Kappa values for inter-rater agreement., Results: The study evaluated responses from ChatGPT and ChatSonic for 10 patient queries. Assessors observed variations in the quality and reliability assessments between the two AI models. Cohen's Kappa values indicated minimal agreement between the evaluators for both the GQS and Modified DISCERN scale., Conclusions: This study highlights the variations in the assessment of responses generated by ChatGPT and ChatSonic for hypertension-related queries. The findings highlight the need for ongoing monitoring and fact-checking of AI-generated responses., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Vinufrancis et al.)

Saudi Arabia guarantees citizens the right to receive medical care and treatment during emergencies or sickness and aging. However, with the consistent increase in expenditure and inability to provide access, the transformation was an unavoidable action. Therefore, this paper aims to address the potential and risks behind the National Transformation Program (NTP) in Saudi Arabia through the lens of the Value Transformation Framework. Multiple research databases (PubMed, Web of Science, UpToDate, Google Scholar, and Summon) were searched between 2016 and 2024. Relevant articles were selected by scanning the title and abstract, yielding 34 references after the screening, exclusion, and inclusion criteria were met. Citation software was used to identify additional sources as analysis proceeded, in accordance with the hermeneutic approach in mapping and classification. The most cited concerns were the sustainability and workforce of the healthcare system. In terms of care delivery, the literature was extensive. In contrast, insufficient studies have been conducted on infrastructure and people. Furthermore, limited information is available on how to assess the transformation, which remains an unaddressed research question. NTP could meet several hurdles. However, through the measurement, assessment phases, and development tracking, success could be achieved., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alkhurayji et al.)

Hepatocellular adenoma (HCA) is an uncommon benign liver tumor that exhibits a variety of subtypes, each distinguished by unique molecular alterations. This case report describes a 43-year-old man with a history of alcoholism who presented with stomach pain. Imaging revealed multiple hepatic lesions and sigmoid colon inflammation, while laboratory tests showed mild neutrophilic leukocytosis and elevated liver enzymes. Tumor markers were normal. A liver biopsy confirmed HCA with hepatocyte nuclear factor-1 alpha (HNF-1α) inactivation, characterized by negative immunostaining for glutamine synthetase, nuclear beta-catenin, serum amyloid A, C-reactive protein, and liver fatty acid-binding protein (L-FABP). This case is unique due to the patient's gender and the absence of typical risk factors such as abnormal hormone levels. HCAs in males, particularly with HNF-1α inactivation, are rare and pose diagnostic challenges. Comprehensive diagnostic approaches, including biopsy and immunohistochemical analysis, are crucial for accurate subtype identification. The potential for malignant transformation, particularly in male patients, underscores the need for vigilant monitoring and appropriate management. This case highlights the importance of considering HCA in differential diagnoses regardless of gender and typical risk factors, contributing valuable insights into the diverse presentations and risks associated with HCA, and emphasizing the need for awareness and further research to improve diagnosis and management of this rare condition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Moliya et al.)

E-cigarettes (ECs) deliver chemicals, including nicotine. They can cause respiratory distress, addiction, cardiovascular effects, and death. More research is needed, especially regarding their impact on the cardiovascular system (CVS) and during pregnancy. Our article aims to fill this gap by summarizing studies elaborating upon the current impact of ECs and the components thereof on the CVS. Acute respiratory distress outbreaks, nicotine addiction, CVS effects, and deaths have been occasionally reported within this cohort, although these events are not uncommon with neighboring age groups. Randomized control trials implying ECs have some contribution toward quitting smoking have been studied. To regulate EC distribution, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have created key checkpoints. Additionally, taxation, pricing, age restriction, and media campaigns could be modulated to significantly reduce illicit sales. Education to the users, distributors, and regulators about this product can also play an aiding role in promoting responsible EC use. Another strategy about licensing could be employed, which could incentivize genuine resellers. The effects on CVS and child-bearing by ECs are grim, which calls for strict regulation, awareness, and avoidance by the teetotaler public. They may help individuals stop smoking but not without harming themselves. Strict regulations are necessary to prevent non-judicious use of these devices., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chaturvedi et al.)

Introduction: In Saudi Arabia, the prevalence of celiac disease (CeD) was 2.7% greater than the global pooled prevalence of 1.4%. Patients who strictly adhere to a lifetime gluten-free diet (GFD) may develop nutritional deficiencies potentially contributing to obesity, increased cardiovascular risk, and lower bone density. Therefore, this study aims to assess the knowledge of health students in the Jazan region regarding nutritional deficiencies in patients with CeD who are on a GFD and to determine the associated socio-demographic factors., Methods: A descriptive cross-sectional study was conducted among health college students of Jazan University, including students from the College of Medicine, Pharmacy, Nursing, Dentistry, Public Health and Health Informatics, and Allied Health Sciences, aged 18 and above, excluding internship students, students who did not complete the survey, and those who refused to participate. The minimum calculated sample size was 368. The questionnaire was adopted from the literature and translated into Arabic. It contained a socio-demographic section and a knowledge section that included 12 questions focusing on the content of macro- and micronutrients in a GFD and the impact of the diet on the health of patients with CeD., Results: The study included 369 participants, with 235 (64%) aged 17-22, 280 (76%) being females, and 341 (92%) being single. The College of Medicine and the College of Applied Medical Sciences had the highest representation, and the College of Dentistry was the lowest. Most participants were in the fourth year (30%) and sixth year (24%). The grade point average (GPA) had a median of 4.3. Approximately 59.1% were aware of nutritional deficiencies among CeD patients. None of the sociodemographic factors were associated with health students' knowledge regarding CeD. Participants from the College of Pharmacy had a lower knowledge of CeD nutrient deficiencies than those from the College of Medicine. (OR: 0.45, 95% CI: 0.22, 0.90) . Most students stated that CeD patients should be advised to take multivitamin drugs and vitamin D supplements. Most acknowledged vitamin D, vitamin B12, and folic acid deficiencies in CeD patients. Similarly, most were aware of iron and calcium deficiencies, with a small percentage aware of zinc and copper., Conclusion: Approximately 59.1% had an acceptable level of knowledge, which is considered a low knowledge level among students who will be future physicians and healthcare workers to whom CeD will represent the first-line disease exposed to. Rising knowledge and awareness among those students will guarantee correct diagnosis, treatment, and better outcomes among CeD patients, thus decreasing the disease burden and increasing the quality of those patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Scientific Research Ethics Committee at Jazan University, Saudi Arabia issued approval (REC-44/11/704). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ageely et al.)

Introduction: Surgical intervention for rectal cancer is widely recognized for its potential to significantly impact quality of life, chiefly due to the high probability of permanent colostomy and the associated postoperative complications., Objective: This study aimed to evaluate the short-term outcomes and morbidity associated with total mesorectal excision for middle and lower rectal cancer within an Iraqi cohort, in a prospective setting., Methods: This study prospectively collected and analyzed data from 89 patients who underwent a standardized radical rectal resection, with a follow-up period extending to one month post-surgery., Results: The mean age of patients was 54.4 ± 12.9 years, with a gender distribution of 46 males and 43 females. A total of 33 patients presented with preoperative comorbidities, which heightened the risk of adverse short-term outcomes by a factor of 7.51. The most prevalent comorbidities were hypertension and diabetes mellitus, affecting 22 and 20 patients, respectively. Patients aged 60 years and above were at a 3.97 times greater risk of developing complications. The overall complication rate was 21.35%, with wound infections (9.0%) and cardiovascular events (3.4%) being the most common. Mortality during the follow-up was 1.1%., Conclusion: The findings indicate that increased age and the presence of comorbidities are significant risk factors for morbidity and mortality post-surgery. Neoadjuvant chemoradiotherapy or radiotherapy was shown to reduce morbidity and mortality rates while improving survival. The morbidity and mortality rates observed in this study concur with existing literature., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Iraqi Board of Medical Specializations issued approval 916. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mahmood et al.)

Background Oral cancer screenings are often on the back burner in the face of other cancer screenings. In high-risk individuals, early detection of oral cancer has a better prognosis and survival. Hospitalization may offer an opportunity to target high-risk populations. This study evaluates the prevalence of women at high risk for oral cancer among hospitalized women and their preference for oral cancer screening. Design and participants Five hundred and ten cancer-free women admitted to the hospital under the internal medicine service at an academic center were enrolled to participate in the study. Three hundred and seventy women were at high risk for developing oral cancer, defined by smoking status, alcohol use, or both. High-risk women received bedside smoking cessation counseling and oral cancer informational handouts and were offered oral screening examinations during hospitalization. Six months after discharge, study participants received a follow-up phone call to determine if these women discussed oral cancer screening with their primary care physicians at the follow-up visit. Results Seventy-three percent of the hospitalized women were at high risk for developing oral cancer. Fifty-seven percent of high-risk women reported having no primary dentist. High-risk women were more likely to be younger, reported a disability, and had a lower comorbidity burden than the average-risk group. Only 41% of high-risk hospitalized women received oral cancer screening examinations during the hospital stay. Post-hospitalization, 66% of high-risk patients discussed oral cancer screening with their primary care. Conclusion Almost three-fourths of hospitalized women are at high risk for developing oral cancer. Hospitalization provides an opportunity to educate and screen high-risk populations., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board/Ethics Committee of Johns Hopkins Bayview Medical Center issued approval IRB00049608. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pothiwalla et al.)

Introduction Magnetic resonance enterography (MRE) has emerged as a promising technique for evaluating the extent and severity of Crohn's disease activity. To compare how we measure Crohn's disease activity with MRE and endoscopy. Material and methods We retrospectively reviewed MRE studies of 60 patients with suspicious Crohn's disease who underwent 1.5-T MRI examinations (T1-weighted images pre- and post-IV contrast medium administration and T2-weighted images) and endoscopy within one month, and they were evaluated by one radiology consultant with experience of 17 years. Endoscopy was used as the reference standard for diagnosing active Crohn's disease cases. Data analysis was performed using the websites (www.graphpad.com and www.medcalc.org) and Microsoft Excel (Microsoft® Corp., Redmond, USA). Results A total of 35 patients were included in the study. The remaining 25 patients were excluded either due to non-available data in the endoscopy report or cases of non-Crohn's disease. The MRI examinations were reviewed by one radiology consultant and revealed 27 active and eight non-active Crohn's disease cases compared to 30 active and five non-active Crohn's disease cases in endoscopy. The sensitivity of MRI in detecting active cases of Crohn's disease compared to endoscopy was 83.3% and the specificity of 60%. The strength of agreement between both methods was fair to good (Kappa = 0.347, p-value = 0.4497, Chi-squared = 0.571 with one degree of freedom). Conclusion MRE statistically has a good impact on the assessment of Crohn's disease as well as endoscopy with the parameters used in this study. Non-invasiveness and the changes of activity seen in the bowel proximal to the ileocecal junction undetectable by endoscopy make MRE more practically applicable in this aspect., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Deanship of Scientific Research at Majmaah University, Al Majma'ah, Saudi Arabia issued approval MUREC-June 8/COM-2023/21-6. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alkhaldi et al.)

Cardiac arrest is a leading cause of mortality globally, and mechanical CPR devices like the LUCAS system are designed to improve outcomes by enhancing consistency and reducing rescuer fatigue. However, this case report of a 76-year-old female who suffered cardiac arrest post-flight reveals significant complications associated with mechanical CPR. Despite achieving initial resuscitation, she developed extensive liver damage and additional complications, which ultimately led to her death. This case underscores the importance of precise training and strict adherence to guidelines when using mechanical CPR devices. It highlights that while these devices offer potential benefits, they also pose risks, especially for vulnerable patients, necessitating careful consideration and ongoing evaluation to optimize safety and effectiveness., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Harb et al.)

This report describes a patient with Pasteurella multocida pneumonia. The patient was a man in his 70s with significant comorbid conditions, including chronic obstructive pulmonary disease (COPD), and is an example of the diverse presentations of P. multocida infections increasingly found in the literature. The novelty of this case lies in the manifestation of P. multocida pneumonia in a patient with underlying respiratory conditions and its successful management, outlining a unique clinical scenario and a tailored therapeutic approach. A 71-year-old male with a medical history of COPD, asthma, tremors, hypertension, and arthritis presented to the emergency department with progressive shortness of breath, productive cough, and chest tightness. The initial diagnosis was COPD exacerbation and left lower lobe pneumonia, for which a regimen of ceftriaxone and azithromycin was initiated. The patient's condition was further complicated by the persistence of symptoms. Following sputum culture analysis, P. multocida infection was identified. Consequently, the antibiotic regimen was tailored, transitioning the patient to doxycycline, which led to substantial clinical improvement, enabling discharge with a 10-day course of oral doxycycline. This case elucidates the importance of precise microbiological diagnosis in patients with complex respiratory conditions, as it guides more targeted antibiotic therapy. It highlights the need for clinical vigilance for atypical pathogens like P. multocida in patients with COPD exacerbations, especially when conventional treatment strategies yield suboptimal responses. The successful resolution of the pneumonia underscores the effectiveness of antibiotic stewardship guided by sputum culture findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Moliya et al.)

We present a rare case of Moraxella catarrhalis meningitis in a 51-year-old immunocompetent woman after surgical resection of a fourth ventricle ganglioma. Notably, the patient had no history of sinusitis or otitis media, which are typical predisposing factors for Moraxella infection. She developed symptoms including headache, altered mental status, and neurological deficits three days post discharge, leading to her diagnosis confirmed by cerebrospinal fluid culture. This case highlights the diagnostic challenges and management complexities of atypical meningitis post neurosurgery. The occurrence emphasizes the necessity of considering Moraxella catarrhalis in differential diagnoses, particularly following neurosurgical procedures. This instance contributes to the scarce documentation of such infections in immunocompetent adults, underscoring the importance of vigilant microbiological evaluation and tailored antimicrobial therapy in postoperative settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Harb et al.)

Introduction Anterior cruciate ligament (ACL) tears are common injuries that can considerably impact an individual's quality of life and athletic performance. In these cases, surgical reconstruction of the ligament can be considered to restore stability to the knee. This study aims to investigate the time taken for individuals to return to sport post-ACL reconstruction, assess the rate of re-injury and evaluate the reliability of the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scoring systems in predicting a return to sport at the pre-injury level. Methods In this retrospective study, a total of 104 patients who underwent ACL reconstruction between January 2016 and December 2022 by one surgical team at Mater Dei Hospital, Malta were evaluated using a self-administered questionnaire. The questionnaire was based on different components including the sport practised at the time of injury, sport engagement classification, return to sport, the ability to return to pre-injury levels of performance and re-injury. The participants then had to fill in IKDC and KOOS evaluation forms. Results In this study, 73% (n=76) of individuals successfully returned to sport after ACL reconstruction, with no significant difference being found between professional and recreational athletes (Chi-squared=0.00455, p=0.95). After reconstruction, 31.7% (n=33) of participants experienced an ipsilateral or contralateral ACL tear, with those returning to sport within six months showing a fivefold increase in re-injury risk compared to individuals who returned at eight or 12 months, suggesting a significant association between return duration and re-injury. The relationship between scoring systems and return to sport at the pre-injury level of performance was analysed using binary logistic regression, revealing that achieving scores of 85.6 or higher in IKDC or 89 or higher in KOOS meant having a 95% probability of returning to sport at the pre-injury level. Conclusions By considering these scoring systems with other post-operative criteria, clinicians can offer a more customised rehabilitation plan tailored to each patient who undergoes ACL reconstruction., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Paris et al.)

Introduction X-rays are widely used in medicine for diagnosis and treatment. Such beneficial uses may cause potentially hazardous situations for patients and workers in the cardiac catheterization laboratory. The present study aims to estimate the radiation dose scattered in different parts of the catheterization units and doses absorbed by workers in this unit, and patients who underwent cardiac catheterization procedures to evaluate all changes in hematological parameters and damaged cells (the cells that contain a number of chromosomal aberrations) after exposure to radiation at Azadi Teaching Hospital in the Duhok City of Iraq. Methodology The study was conducted in one year and involved 19 male workers chronically exposed to X-ray machines in the cardiac catheterization laboratory, and 45 patients, 20 males and 25 females, who have been exposed to lower doses of X-ray during the cardiac catheterization process. There were 32 healthy individuals, 19 males and 13 females, as a control. Scattered radiation was calculated using an area monitoring detector. Optically Stimulated Luminescence (OSL) dosimeter and Flat Panel Detector (FPD) were used to calculate absorbed doses by workers and patients, respectively. Twelve hematological parameters before and after radiation were examined between study groups; the cytogenetic effects, damaged cells, and chromosomal aberrations of the white blood cells of workers, patients in the catheterization unit, and individuals of the control group were analyzed. Results The results showed that the scattered X-rays in the catheterization unit after one year of continuous detection did not change significantly compared to the data before the start of the trial. The results of all blood parameters looked to be significantly different (p<0.05) compared to the controls but within the normal range. There is no significant difference (p>0.05) in corpuscular hemoglobin, white blood cells, red distribution width, and neutrophil values for workers after one year of exposure as compared with the control. Also, there was no significant difference (p>0.05) in white blood cells, neutrophils, and monocyte values for patients after the operation. The current study showed the damaged cells in workers were significantly different compared to the control. At the same time, the differences were non-significant for all workers (p=0.0962) after one year of exposure. The differences in damaged cells in patients were highly significant after the operation (p=0.0003). The present study demonstrated that the inductions of dicentrics, acentric, chromosome break, and ring chromosomes in human lymphocytes were intimately related to the irradiation dose. Conclusions The present study found that the scattered X-rays in the catheterization unit after the end of the experiment did not change significantly. The current study also revealed that the exposure to X-rays had no significant effects on the blood indicators of workers and patients in the catheterization unit, whereas the damaged cells in patients did not change significantly compared with the control group at the beginning of the experiment. In patients, these cells were increased after the operation but were present at a high level in the workers, as compared with controls. The damaged cells in workers remained constant from the beginning of the experiment till the end. Finally, patients had increased damaged cells after the end of the trial period compared to workers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Hussein et al.)

Introduction Triple-negative breast cancer (TNBC) is known for its aggressive nature and poor prognosis. Despite its responsiveness to chemotherapy, TNBC presents challenges in terms of survival, recurrence, and mortality rates, particularly in diverse populations. Limited research in the Middle East hampers comprehensive understanding and tailored management. Methods A retrospective study at the King Hussein Medical Center in Jordan between the period 2009 to 2023 explored TNBC patients (n=110) who underwent adjuvant chemotherapy after local excision or modified radical mastectomy (MRM). Data encompassed demographics, clinical variables, and operative details. Statistical analysis employed Wilcoxon and chi-squared tests, examining mortality risks and associations between variables. Results Among 110 TNBC patients (mean age 52), 84% underwent MRM, 16% wide local excision and axillary clearance (WLE&AC). Lymphovascular invasion (LVI) was observed in 41%, linked to higher lymph node positivity. Neoadjuvant therapy preceded MRM in 25% of cases. While 75% had grade III tumors, the prevalence of invasive ductal carcinoma was 85%. Conclusions This study contributes crucial insights into TNBC characteristics and management in Jordan. Despite limitations such as retrospective design and sample size, the findings underscore the need for tailored interventions in TNBC patients, emphasizing the importance of neoadjuvant therapy and vigilant consideration of LVI status in treatment planning. Future longitudinal research should delve into disease progression and treatment outcomes in diverse populations, facilitating optimized TNBC management strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Al Husban et al.)

In the literature, there is a lot of variation in how well visually impaired youngsters can distinguish between tactile images. This systematic review investigated tactile functioning approaches' clinical perspective on blind children. PubMed, SCOPUS, Web of Science, Science Direct, and Cochrane Library were systematically searched to include the relevant literature. Rayyan QCRI was used throughout this systematic approach. The study included nine studies with a total of 394 children, 246 (62.4%) were males, and 148 (37.6%) were females. Textured graphical objects, images, drawings, and illustrations were used as stimuli to test tactile functioning in blind children. The findings of this comprehensive review showed that tactile stimuli for blind children were most effective in the form of textured images, words, and objects. It has been shown that the complexity, familiarity, and category information all influence how easy or challenging picture recognition is. Blind people can effectively use pictorial displays, but when foreshortening is used in complex representations of three-dimensional objects, they may benefit from instruction., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Fardan et al.)

Background Esophageal neoplasm carries significant implications for end-of-life care. Despite medical advancements, disparities in the location of death persist. Understanding the factors influencing the place of death for esophageal neoplasm patients is crucial for delivering patient-centered care. Objectives The primary objective of this study is to inspect and evaluate mortality patterns in patients with malignant esophageal neoplasms over the past two decades. Materials and methods Using the CDC-WONDER database, the authors analyzed 309,919 esophageal neoplasm-related deaths. Data was categorized by age, gender, race, and location of death, enabling a detailed examination of the factors influencing the place of death. Result This analysis revealed significant disparities in death locations. Age, gender, race, and geographic region all played substantial roles in determining where esophageal neoplasm patients spent their final moments. Notably, males consistently experienced higher mortality rates across all settings. Geographic disparities indicated varying mortality rates by census region, with the Southern region reporting the highest rates. Racial disparities were also evident, with white individuals having the highest number of deaths. Conclusion This study underscores the importance of recognizing and addressing disparities in the place of death among esophageal neoplasm patients in the United States. By shedding light on the demographic influences on end-of-life decisions, it paves the way for more targeted and patient-centered approaches to end-of-life care for this patient population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Vijayakumar et al.)

Background: Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children. This study examines the extent of pre-eclampsia knowledge and awareness among Saudi women aged 18 to 49. Recognising informed and proactive healthcare decisions is pivotal in managing and preventing pre-eclampsia., Methods: It is a prospective cross-sectional community-based study design. We calculated a minimum sample size of 385 participants using the Raosoft online calculator, aiming for a 5% margin of error and a 95% confidence interval. The structured questionnaire was distributed via various social media platforms to collect the data. The questionnaire consisted of two sections, namely demographics and medical history. Additionally, the questionnaire explored pre-eclampsia risk factors, symptoms, and complications. We analysed data using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). We applied statistical tests, including the Chi-squared test (χ2) and the Mann-Whitney test for non-parametric variables., Results: Most of our participants were young, with a mean age of 25.94 and single (69.5%). Moreover, many (68.8%) had a bachelor's degree. A notable portion of participants stated they had no family history (86.1%) of pre-eclampsia and (98.1%) no previous experience with pre-eclampsia. Approximately 50% recognised hypertension as a symptom, while 44.1% identified persistent headaches. However, complications such as fetal and maternal death were better-known consequences of pre-eclampsia. 11.3% of participants had adequate knowledge about pre-eclampsia, 39.3% had moderate knowledge, and 49.4% had inadequate knowledge. It is a fact that higher levels of knowledge are positively correlated with advanced age, prior pregnancy experience, and a family history of pre-eclampsia., Conclusion: This study highlights the limited knowledge and awareness of pre-eclampsia among Saudi women of reproductive age. Addressing this knowledge gap is crucial for preventing pre-eclampsia-related maternal and fetal complications. Policymakers and healthcare providers should consider implementing educational programs to raise awareness and improve outcomes for pregnant women in Saudi Arabia and similar regions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Radwan et al.)

Robot-assisted Heller myotomy (RAHM) is an increasingly popular alternative to the traditional laparoscopic Heller myotomy (LHM) in the surgical management of achalasia, with similar outcomes and potentially lower complication rates. We aimed to systematically review the literature by comparing the technical success, outcomes, and complications of RAHM and LHM. We searched PubMed, Medline, and Cochrane Central Register for articles published between 2001 and 2023. Data on technical success, clinical outcomes, length of hospital stay, esophageal perforation rate, and overall mortality were extracted. A total of 11 articles were included in the study, comparing a total of 3,543 RAHM and 15,434 LHM cases. The mean operative time was significantly higher in the RAHM procedure with a total mean difference of 23.95 (95% confidence interval (Cl) 17.09, 30.81; p < 0.00001; I 2 = 99%). However, the RAHM was associated with a significantly shorter hospital stay, with a total mean difference of -0.24 (95% Cl = -0.40, -0.08; p < 0.00001; I 2 = 81%). The volume of blood loss was significantly smaller in RAHM with a total mean difference of -61.11 (95% CI = -150.31, 28.09; p < 0.00001; I 2 = 99%). Esophageal mucosal perforation was significantly lower in RAHM with an odds ratio of 0.36 (95% CI = 0.16, 0.82; p = 0.02; I 2 = 22%). Both procedures were associated with similar rates of symptom relief. Although no mortality was recorded in patients who underwent RAHM as opposed to 16 cases in patients who underwent LHM, no statistically significant difference could be reached. Our results demonstrate that while both procedures yield comparable clinical outcomes, RAHM is associated with a lower overall complication rate, particularly a lower rate of esophageal mucosal perforation, shorter hospital stay, and possibly a lower mortality rate. This confirms that RAHM is a viable and justifiable alternative to the conventional LHM in the surgical management of achalasia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ataya et al.)

Introduction Veterinarians and other professionals who interact with animals on a daily basis encounter an elevated risk of exposure to both known and as-yet-undiscovered microbial agents. Additionally, they are also exposed to physical, chemical, and environmental hazards. Enhancing occupational health and safety in this context carries significant global significance. Methods This study aimed to comprehensively identify and outline the various biological, physical, chemical, and environmental health threats that were encountered by veterinarians in Saudi Arabia. To achieve this, we designed a self-completed questionnaire for 529 participants. The survey encompassed potential occupational hazards such as microbial diseases, injuries resulting from animal bites and scratches, allergies, and environmental risks like sunstroke and dust storms. Results Among the 529 participating veterinarians, 45.9% (243 individuals) reported instances of zoonotic diseases within the past five years. Notably, potential viral agents included Middle East respiratory syndrome coronavirus, avian influenza, and foot-and-mouth disease virus. Bacterial diseases were also frequently documented, with brucellosis (18.7%) and salmonellosis (7.9%) being notable pathogens. Protozoal infections were led by Leishmaniosis, constituting the most commonly detected protozoa (29 /529, 5.5%). Interestingly, 345 (65.2%) of the individuals reported that they have experienced animal bites and scratches. Needle stick injuries were also a common occupational hazard, with an incidence rate of 19.1%. Additionally, chemical exposure was prevalent, particularly to disinfectants (57.5%) and veterinary drugs (23.4%). The study participants also reported their exposure to various environmental hazards, including sunstroke, dust, sandstorms, and heavy rains. Conclusion The findings of this study draw attention to a concerning trend among veterinarians in Saudi Arabia. Their personal health and safety appear to receive inadequate attention, potentially heightening the risk of occupationally related health hazards. These outcomes highlight the need for a reevaluation of safety protocols and infection control practices within the veterinary profession. The implications of this study can potentially inform the development of policies and initiatives aimed at mitigating occupationally related health hazards among veterinarians in Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al-Harbi et al.)

Aims: Cataracts, a leading global cause of blindness, are associated with ionising radiation exposure. This audit aimed to enhance lens exclusion during non-contrast head computed tomography (CT) scans at Newham University Hospital (NUH) using two CT scanners., Methods: A retrospective audit of non-contrast head CT scans at NUH excluded scans for trauma and imaging of orbital structures. A one-week audit in April 2023 assessed lens exclusion, compared to the Royal College of Radiologists (RCR) standards. A total of 101 consecutive scans were analysed and 63 (62%) scans were included in the final study. Thirty-eight percent of the scans were excluded according to the exclusion criteria of head, neck and facial traumas, orbital infections and papilledema. Results were presented, followed by a three-month radiographer re-education period, emphasizing gantry tilt and patient positioning. A reaudit in August 2023 evaluated outcomes. For the reaudit, 183 consecutive scans were analysed, with 131 (72%) scans included in the final study and 52 (28%) scans excluded according to the same exclusion criteria as the first audit., Results: Lens exclusion in non-contrast head CT scans improved significantly from 0/63 (0%) compliance to 19/131 (14.50%) (p=0005) compliance with the standards. Variability in radiographer practices, 'near misses' and time constraints were identified as challenges. Staff turnover impacted compliance., Conclusion: This audit has shed light on a critical aspect of patient care in the field of radiology. This research underscores the importance of rigorous and standardised protocols in radiological procedures, particularly when it comes to protecting the lens of the eye. By enhancing lens exclusion during non-contrast head CT scans, we have taken a significant step in mitigating the risk associated with ionising radiation exposure. Although substantial improvements were made, achieving the RCR audit standard remained elusive. Ongoing re-education, reaudits and a multidisciplinary approach are necessary to optimise radiographer adherence and reduce ionising radiation exposure to the lens during head CT scans. This quality improvement project proves that continued emphasis on gantry tilt and patient positioning in radiographer education and training can make a significant difference in patient safety. As we move forward, let us remember that even small improvements can make a big difference in safeguarding the health and well-being of patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Abay et al.)

Background The human experience involves the inevitable end of life, whether sudden or expected. Ensuring a dignified end-of-life encounter necessitates understanding influential factors. Cardiomyopathy, a group of heart muscle diseases, has varying mortality implications, including heart failure and arrhythmias. Disparities in place of death (hospital, home, or hospice) can significantly alter the end-of-life care for a patient. Methods The aim of this study is to identify variations in death locations for U.S. cardiomyopathy patients between 1999 and 2020, based on age, gender, race, and census region, utilizing the CDC WONDER ( CDC Wide-Ranging Online Data for Epidemiologic Research) database, which contains a wide array of public health information. Data were categorized by age, gender, race, and location, and further subcategorized according to place of death. Statistical analysis was done via R programming software. Result The aggregate data of 528,401 cardiomyopathy-related deaths from 1990 to 2020 were obtained. Findings revealed age, gender, and regional disparities in death location. Notably, cardiomyopathy is found to be prevalent in the 75+ years age group, male gender, and people belonging to Caucasian descent, and maximal in the Southern census area. The study's logistic regression analysis unveiled a significant association between demographic factors and death locations. Conclusion This research underscores the significance of understanding disparities in the place of death for cardiomyopathy patients, shedding light on demographic influences and paving the way for patient-centered end-of-life care approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al Hussein et al.)

There are approximately 1.3 million cases of neonatal sepsis reported worldwide with deaths occurring more commonly in preterm and low-weight newborns. Neonatal sepsis is the third major cause of neonatal deaths resulting in 203,000 deaths per year. It is divided into two subtypes based on time of occurrence: early-onset neonatal sepsis (ENS), occurring within the first 72 hours of birth usually due to perinatal risk factors, and late-onset neonatal sepsis (LOS) usually occurring after the first week of life and up to 28th day of life. There are many complications associated with neonatal sepsis including septic shock, multiple organ failure, and death. It is vital for clinicians to know the signs and symptoms of neonatal sepsis in order to diagnose it early. Preventive measures, early diagnosis, appropriate antibiotic administration, timely supportive management, and the establishment of efficient management are vital in the prevention of severe complications or death. In this review, we aim to provide the most up-to-date information regarding risk factors, pathophysiology, signs and symptoms, diagnosis, and treatment of neonatal sepsis. We discuss the maternal and neonatal risk factors involved in the pathogenesis of neonatal sepsis and the signs and symptoms of early and late neonatal sepsis. We focus on the different pathogens involved and the markers used in the diagnosis and treatments available for each., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Attia Hussein Mahmoud et al.)

Cardiometabolic syndrome (CMS) is a complex interplay of metabolic dysregulation, cardiovascular disease (CVD), and diabetes risk factors. It encompasses obesity, insulin resistance, dyslipidemia, hyperuricemia, and hypertension, with obesity triggering metabolic disturbances. The global prevalence of CMS, driven by rising obesity rates and sedentary lifestyles, varies across regions. Underlying CMS mechanisms intertwine genetics, sedentary behaviors, poor diets, and hormonal imbalances. Genetic predisposition interacts with environmental factors, while sedentary lifestyles and poor diets amplify obesity and insulin resistance. Hormonal disruptions further complicate the syndrome's development. CMS has far-reaching clinical implications, extending beyond CVD and diabetes to conditions such as non-alcoholic fatty liver disease, cancer, and sleep apnea. Innovative CMS approaches revolve around biomarkers, personalized medicine, lifestyle interventions, and pharmacological breakthroughs. Emerging biomarkers offer early insights, while personalized medicine tailors interventions based on genetic profiles. Lifestyle modifications, encompassing dietary changes and tailored exercise, foster metabolic recalibration. The pharmaceutical frontier targets CMS facets, promising more precise treatments., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khan et al.)

Background This study evaluated the comprehension and awareness of human papillomavirus (HPV) infection and vaccination among women in Jeddah, Saudi Arabia. Methods A cross-sectional study included 696 female respondents from Jeddah between the ages of 18 and 60. Ethical approval and informed consent were obtained before administering the questionnaire through social media. The data collected included social demographic information and information about HPV and vaccination. Results According to the results, only 332 respondents (47.70%) demonstrated good knowledge about HPV. Less than half (47.84%) were aware of the HPV vaccine. However, a slightly higher percentage (53.02%) would be willing to receive the vaccination if it were free. Individuals who were not willing to accept the vaccine believed it had side effects (25.70%), was unsafe (19.92%), or was unnecessary as HPV was a rare infection (17.55%). Demographic variables, such as educational level and occupation, were found to be predictors of HPV knowledge since their corresponding p-values were statistically significant. Conclusion It is crucial to raise awareness about HPV and its vaccine among adult women in Jeddah due to the alarmingly low levels of knowledge and awareness. The importance of HPV vaccination must be emphasized repeatedly to ensure that this critical information is understood and acted upon. Overall, there is low knowledge and awareness about HPV and its vaccine among adult women in Jeddah. Therefore, it is imperative to increase awareness while reiterating the importance of HPV vaccination., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Radwan et al.)

This review explores the psychosocial impact of vitiligo on patients, its consequences for their quality of life, and the need for holistic support. Vitiligo's psychosocial burden, driven by the need to conceal lesions and societal beauty ideals, leads to stress, sadness, and low self-esteem. Social stigma affects self-esteem, especially in cultural contexts, exacerbating the need for culturally sensitive support. Anxiety and depression are common due to visible differences and societal pressures. Vitiligo significantly reduces the quality of life, especially in younger patients, impacting daily activities, careers, and relationships. Disease severity worsens these effects, particularly in visible areas and among individuals with darker skin tones. Long-term disease activity may improve acceptance and quality of life. Psychological support and counseling are crucial, as many patients don't seek medical help. Education plays a key role, improving understanding and reducing anxiety. Raising awareness about the impact of vitiligo can challenge perceptions and contribute to enhancing patients' well-being. In conclusion, this review highlights the interplay between psychosocial factors, quality of life, and the importance of addressing social stigma, providing psychological support, and advancing education and awareness for those with vitiligo., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Salama et al.)

Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Elder et al.)

Surgical site infection (SSI) is a growing global concern. The principal explanation for this is its adverse clinical outcomes, such as morbidity and mortality. However, the link between the economic burden of SSIs and patient outcomes needs to be sufficiently characterized. This review aims to describe the financial implications of SSIs on patient outcomes in low- and middle-income countries (LMIC). Despite the heterogeneity in study designs from multiple LMIC countries, there is a significant correlation between SSI-associated healthcare costs from increased length of stay (LOS), readmissions, reoperations, and adverse patient outcomes. This varies based on the size, degree of infection, or other patient comorbidities. SSIs are much more prevalent in LMICs. The additional financial burden incurred in managing SSIs reinforces the need to prioritize practicing interventions to prevent this complication, which resource-limited health institutions are unequipped to do and consequently have significant adverse patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Costabella et al.)