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Objectives: The main objective of the current paper is to analyze the trends and patterns of fertility from 2009-2017. Also, related objectives are to compare the annual number of births and Total Fertility Rates (TFR) provided by the Ministry of Health and PACI. The second objective is to reflect on the implications of the above trends and patterns on the demand for domestic and other workers in future population growth and migration. Method: Using the annual publications from the Ministry of Health and the Central Statistical Bureau fertility among Kuwaiti nationals was studied. PACI provided the mid-year counts for each year from 2009-2017 for all Kuwaiti women between 15-49 age group, in order to obtain the denominator for calculating age specific, and total fertility rates for each subgroup was calculated according to the governorate of residence was calculated. Results: Consistent and linear decline in the TFR was noted in the last two decades by almost 2 children. During the last decade, the TFR declined further by 0.6 points, from 3.7 in 2009 to 3.1 in 2017. Thus, a fairly rapid fertility decline is occurring in the country. However, the TFR is still about one child higher than replacement level fertility. In age specific fertility rates (ASFRs), the largest decline occurred at ages 20-29. A comparison of governorate-level ASFRs shows a clear gap among the governorates. Conclusion: The trends in fertility differentials according to governorate are likely to have far-reaching implications on the relative composition of various subgroups in the country. Declining fertility may also affect future migration to Kuwait.

The surface of a living cell provides a platform for receptor signaling, protein sorting, transport, and endocytosis, whose regulation requires the local control of membrane organization. Previous work has revealed a role for dynamic actomyosin in membrane protein and lipid organization, suggesting that the cell surface behaves as an active composite composed of a fluid bilayer and a thin film of active actomyosin. We reconstitute an analogous system in vitro that consists of a fluid lipid bilayer coupled via membrane-associated actin-binding proteins to dynamic actin filaments and myosin motors. Upon complete consumption of ATP, this system settles into distinct phases of actin organization, namely bundled filaments, linked apolar asters, and a lattice of polar asters. These depend on actin concentration, filament length, and actin/myosin ratio. During formation of the polar aster phase, advection of the self-organizing actomyosin network drives transient clustering of actin-associated membrane components. Regeneration of ATP supports a constitutively remodeling actomyosin state, which in turn drives active fluctuations of coupled membrane components, resembling those observed at the cell surface. In a multicomponent membrane bilayer, this remodeling actomyosin layer contributes to changes in the extent and dynamics of phase-segregating domains. These results show how local membrane composition can be driven by active processes arising from actomyosin, highlighting the fundamental basis of the active composite model of the cell surface, and indicate its relevance to the study of membrane organization.

Foot-and-mouth disease (FMD) remains a devastating threat to livestock health and food security in the Middle East and North Africa (MENA), where complex interactions among host, environmental, and anthropogenic factors constitute an optimal endemic landscape for virus circulation. Here, we applied an interpretable machine learning (ML) statistical framework to model the epidemiological landscape of FMD between 2005 and 2025. Furthermore, we compared the ecological niche of serotypes O and A in the MENA region. Our ML algorithms demonstrated high predictive performance (accuracies > 85%) in identifying the geographical extent of high-risk areas, including under-reported regions such as the Southern and Northeastern Arabian Peninsula. Sheep density emerged as the dominant predictor for all FMD outbreaks and serotype O, with significant non-linear relationships with wind, temperature, and human population density. In contrast, serotype A risk was primarily influenced by buffalo density and proximity to roads and cropland. Our in-depth interaction and Shapley value analyses provided fine-scale interpretability by interrogating the threshold effects of each feature in shaping the spatial risk of FMD. Further implementation of our analytical pipeline to guide risk-based surveillance programs and intervention efforts will help reduce the economic and public health impacts of this devastating animal pathogen.

Groundwater is one of the world’s most essential and valuable natural resources, important to a country’s growth development; regions like Azad Kashmir, Pakistan, face unique challenges from rapid urbanization and climate variability, highlighting the need for detailed assessments of groundwater potential and recharge dynamics. The complexity of groundwater systems complicates the identification of potential and recharge zones. This study focuses on these issues in the Bagh region, which has distinct hydrogeological characteristics and a critical need for sustainable groundwater management. This study used geomatics and hydrogeophysical technologies to delineate the groundwater potential zone in the study area. This multidisciplinary method improves the precision and reliability of groundwater potential zone mapping. Groundwater potential zones were delineated by integrating the thematic layers created from the digital elevation model, sentinel 2, geophysical investigations, pre-existing maps, and field survey data into a GIS context. Different parameters were determined, reclassified, and standardized to shared ranges with weights. These parameters included rainfall, geology, slope, lineament density, drainage density, aspect, Topographic wetness index, Normalized difference vegetation index, Normalized difference water index, elevation, slope aquifer resistivity, and lithology. The analytical hierarchy process evaluation method developed the groundwater potential zonation map. The index was divided into three zones: High (33%) are located in areas with favorable conditions such as high rainfall, low slope, and permeable lithology, making them ideal for groundwater extraction; moderate (46%) have intermediate conditions; and low (21%) are characterized by steep slopes, low rainfall, and less permeable lithology, indicating limited groundwater availability. The generated map was validated using data from 30 existing water wells and springs and 50 geophysical data points derived from vertical electrical sounding. The validation results demonstrated moderate to good agreement with the evidence obtained, as indicated by an area under curve value of 79.6%.

Rhabdomyolysis is a rare adverse reaction that has a previously established association with levetiracetam use, which selectively binds the synaptic vesicle glycoprotein 2A (SV2A). Its structural analogue, brivaracetam, is a new third-generation antiseizure medication that has a higher affinity for SV2A, and current data suggests it provides a more favorable adverse event profile. Here, however, we report a case of rhabdomyolysis requiring dialysis in which serum creatine kinase level increased rapidly for several days until brivaracetam was discontinued. The delayed creatine kinase peak, rapid decline upon discontinuation of brivaracetam, and prior association of rhabdomyolysis with levetiracetam strongly suggest a causal relationship. To date, there are three reported cases of brivaracetam-associated rhabdomyolysis in the food and drugs administration adverse event reporting system (FAERS). Despite its favorable side effects profile, the use of brivaracetam may be associated with life-threatening rhabdomyolysis.

Lactoferrin (LF) is a primarily protein derived from the degranulation of neutrophils in plasma, and has been identified as a potential biomarker for dry eye disease (DED) and type 2 diabetes patients (T2D). This study aims to investigate the correlation between plasma lactoferrin and other inflammatory biomarkers, such as lactoferrin to neutrophil ratio (LFNR) and glycosylated hemoglobin A1c (HbA1C), in type 2 diabetic patients with dry eye disease (T2D-DED). This study was conducted at the Diabetes Center outpatient clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia. The study included two groups: 26 healthy individuals and 41 T2D-DED patients. The plasma samples were collected and analyzed in the hospital for laboratory routine tests for neutrophil, lymphocyte, C-reactive protein (CRP), glycosylated hemoglobin A1c (HbA1C), and albumin (ALB), and data were collected retrospectively from hospital medical records. The same plasma samples were tested for LF using an in-house enzyme-linked immunosorbent assay (ELISA). The plasma lactoferrin to neutrophil ratio (LFNR) and neutrophil to lymphocyte ratio (NLR) were calculated. All statistical analyses were performed using PRISM software, with a -value < 0.05 were considered significant. LF concentrations were found to be 1.10 ± 1.0 μgmL in T2D-DED patients and 0.5 ± 0.4 μgmL in healthy individuals. Inflammatory biomarkers, LF, CRP, HbA1C, and LFNR, showed elevated levels in patients with T2D-DED, with statistically significant differences groups compared to healthy individuals. Additionally, there was a significant positive correlation in T2D-DED patients between LF with LFNR in T2D-DED patients ( = 0.0001) and HbA1C with LF ( = 0.035). The study indicated that LF levels and other inflammatory biomarkers are elevated in patients with T2D-DED. There are significant positive correlations between LF and HbA1C, as well as LF and LFNR in T2D-DED patients, which differ from the correlations found in healthy individuals. This suggests that the diagnostic and prognostic relevance of these biomarkers depends on whether the disease is present.

Background Sigmoid volvulus is frequently reported in the “volvulus belt” (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause of large bowel obstruction in North America. It is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to diagnose sigmoid volvulus in children. Case presentation We present a 13-year-old Arabian girl who came with features suggestive of intestinal obstruction. Plain abdominal film revealed classic omega (coffee bean) sign of sigmoid volvulus. The volvulus was successfully decompressed by means of a rectal tube in our emergency department. The next day during the same admission the volvulus recurred and was successfully decompressed by endoscopy. She was discharged home on her parents’ request; she presented again 1 month later. This time the volvulus could not be decompressed non-operatively, so she underwent sigmoidectomy with primary anastomosis. Postoperatively she developed paralytic ileus that resolved after 10 days. Following that she did well and was discharged home. She is still free of symptoms 1 year after the resection. Conclusions Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group as a cause of intestinal obstruction. Pediatric surgeons should maintain a high index of suspicion, in order not to miss this important diagnosis, as any delay in instituting treatment has a devastating effect on morbidity as well as mortality. Early diagnosis and prompt treatment confer an excellent prognosis.

Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students' general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The \"intent to inherit existing practice\" and \"other academic or professional experiences prior to medical school\" had a positive association with choosing general practice while \"having a physician parent'' had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked \"clinical diagnostic reasoning\", \"community-oriented practice\", \"involvement in preventive medicine\", and \"frequent patient communication\" as highly important were more likely to choose general practice, whereas, \"access to advanced medical fields\", \"mastering advanced procedures\", and \"depth rather than breadth of practice\" were less likely to be associated with general practice aspiration. Conclusion The study's results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.

Background Trauma is the main cause of morbidity and mortality in the pediatric population. Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury, although uncommon (2 to 9%), is the fourth most common solid organ injury. Unlike other solid organ injuries, pancreatic trauma may be subtle and difficult to diagnose. Computed tomography currently is the imaging modality of choice. As the incidence of pancreatic injury in children sustaining blunt abdominal trauma is low, management remains a challenge. Case presentation We present a 7-year-old Bahraini boy who sustained blunt trauma to his abdomen. He presented with abdominal pain and vomiting. His examination revealed abdominal distension and an epigastric bruise. Contrast-enhanced computed tomography reported grade III liver injury, grade I bilateral renal injury, a suspicion of splenic injury, and a grade III to IV pancreatic injury. He was admitted to Pediatric Intensive Care Unit and was treated conservatively. Because he was stable, he was discharged to the surgical ward at day 3. At day 18 he developed a pancreatic pseudocyst that was aspirated and recurred at day 25 when a pigtail catheter was inserted. He was kept on total parenteral nutrition through a peripherally inserted central catheter. The pigtail catheter was removed on day 36 and a low fat diet was started by day 44. He was discharged home at day 55 in good health. Out-patient follow-up and serial abdominal ultrasound showed resolution of the cyst and normalization of blood tests. Conclusion Non-operative management of pancreatic injury is effective and safe in hemodynamically stable patients with no other indication for surgery.

Background: Hospital readmissions represent a critical challenge to global healthcare systems, particularly among high-risk patient populations. Nurse-led interventions, including transitional care, discharge education, and telemonitoring, have gained attention as strategies to reduce preventable readmissions. Objective: To systematically review and synthesize peer-reviewed evidence on the effectiveness of nurse-led interventions in reducing hospital readmission rates, and to evaluate associated outcomes including patient satisfaction, costeffectiveness, and quality of life. Methods: A systematic review adhering to PRISMA 2020 guidelines was conducted. Databases searched included PubMed, CINAHL, Scopus, Web of Science, Embase, and Google Scholar. Studies published between 2000 and 2025 that evaluated adult populations receiving nurse-led post-discharge care were included. Outcomes of interest included readmission rates (30-90 days), mortality, cost, and patient satisfaction. Results: Fifteen studies met inclusion criteria, including randomized controlled trials, quasi-experimental designs, and observational studies. Most interventions demonstrated statistically significant reductions in 30-day readmission rates, ranging from 5% to 20%. Transitional care models and structured education were among the most effective approaches. Technology-assisted interventions, such as telemonitoring, showed promise for scalability and impact. Conclusion: Nurse-led interventions are effective in reducing hospital readmission rates, particularly when delivered through structured, patient-centered models. These programs also improve satisfaction, quality of life, and healthcare costefficiency. Broader implementation requires institutional support and contextual adaptability.