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In the context of the global increase in the rate of cesarean deliveries, with an associated higher morbidity and mortality, this study aimed to investigate the role of maternal age and parity in the cesarean section rate among women in the Hail Region of Saudi Arabia. This retrospective cohort study used data collected from the labor ward of the Maternity and Child Health Hospital, Hail, over a period of 8 months, forming a cohort of 500 women. Women were categorized into four different parity classes. The results revealed that there was no significant relationship between cesarean deliveries and maternal age (p-value, 0.07). There was no significant difference in the mode of delivery between the study’s parity cohort group. A significant increase in cesarean deliveries was noticed among obese women with a BMI between 35–39.9 (52.14%). This increase was even greater among those with a BMI above 40 (63.83%). Fetal distress, malpresentation and abruptio placenta were the most significant indications for CS among all age groups (p-value 0.000, 0.021, and 0.048, respectively). Conclusions: The number of cesarean deliveries has no association with parity or age. However, there was a statistically significant association with BMI, a perineal tear after previous vaginal delivery, and a history of diabetes mellitus and gestational diabetes. The most reported reasons for CS were fetal distress, malpresentation, and abruptio placenta among all age groups.

To assess the factors affecting the transition of dental students from pre-clinical to clinical courses in an outcome-based curriculum. This cross-sectional study surveyed dental students in the third and fourth academic years of the Bachelor of Dental and Oral Surgery (BDS) program at the College of Dentistry, Jouf University. Ethically approved and powered by the G Power software, the study employed a modified questionnaire validated through a pilot test to assess five domains. Likert scale responses were analyzed using SPSS v.25, revealing insights into clinical workload, patient interaction, and learning experiences. Multiple regression analysis was used to assess the impact of clinical skill application, workload, transition to clinics, and patient interaction on learning experience as well as CGPA. The Mann-Whitney U test compared the ranks of two independent samples, making it less sensitive to outliers and more suitable for data with non-normal distributions. In this study, the response rate of the participants was 70%. A total of 44 dental students in their third and fourth years of the program completed the survey. The multiple regression analysis showed that the predictors collectively explained 36.1% of the variance in the learning experience (Adjusted R = 0.361). \"Transition to Clinics\" had a significant positive effect on learning experience (β = 0.292, = 0.012), \"Workload\" (β = -0.203, = 0.393) and \"Patient Interaction\" (β = 0.443, = 0.168) were not significant predictors. The Mann-Whitney U test revealed no significant gender differences in transition to clinics, workload, patient interaction, application of clinical skills, and learning experience (U = 33.09 to -40.33, > 0.05), but a significant difference in transition to clinics between third- and fourth-year students (U = 31.56 to -43.24, < 0.05). The results of this study demonstrate that the transition to clinical training can be intricate, and that multiple elements have an impact on this process. It is crucial to have support systems that facilitate the transition into the clinical learning environment.

Objectives: The study was conducted in a tertiary educational hospital based in Riyadh to explore faculty’s perception of using simulation-based teaching as part of the Cardiovascular Diploma Program (CDP) to improve patients’ safety. The study, also aimed to identify the benefits and challenges of utilizing simulation. Methods: Researchers used a qualitative approach. Semi-structured interviews were conducted online with ten faculty-members. The interviews were performed between July and September in the year 2019. Authors used convenient sampling techniques for recruitment. Data were transcribed and analyzed using a framework analysis approach. Results: Data analysis showed four emergent themes, i.e., the concept of simulation (it is a risk-free environment for training), simulation for patients’ safety (students first learn on the simulators and deal with patients), simulation as a safe learning environment (gives idea basic things about the working environment, knowing the symptoms of the patients, catheterizing the patient, knowing preparations for the procedure and post care), and the challenges of utilizing simulation (identify gaps between the theoretical and practical parts). Conclusion: Faculty has appreciated the role of simulation in improving patients’ safety. Simulation was underutilized due to the limited time allotted for simulation and lack of adequate experienced faculty. It is recommended that simulation should be integrated into the CDP curriculum. doi: https://doi.org/10.12669/pjms.39.2.6693 How to cite this: Alshehri AA, Alenazi FS, Alturki H, Khan FH. Exploring faculty perception of simulation-based education: Benefits and challenges of using simulation for improving patient safety in cardiovascular diploma program. Pak J Med Sci. 2023;39(2):354-360.  doi: https://doi.org/10.12669/pjms.39.2.6693 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Artificial intelligence (AI) has become a transformative force in precision medicine, enabling unprecedented personalization of healthcare therapies via sophisticated computational analysis of complex biomedical data. This review examines the evolving landscape of AI applications in precision medicine, highlighting both established technologies and emerging advances that are reshaping clinical practice. Current applications demonstrate the ability of AI to enhance diagnostic precision, refine treatment decisions, accelerate drug development, and improve patient outcomes across multiple disease domains. Despite significant progress, challenges related to data standardization, algorithmic bias, legal frameworks, and equi7 access remain key barriers to broader implementation. As technical capabilities advance and integration with healthcare systems deepens, AI-driven precision medicine is poised to profoundly transform therapeutic strategies via enhanced personalization based on individual biological, environmental, and clinical variables.

High parity is associated with the risk of fetomaternal complications such as gestational diabetes mellitus, hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, and perinatal and preterm mortality. The objective of the study was to compare fetomaternal complications in women of high parity with women of low parity. This involved a cohort study on a sample size of 500 women who had singleton births. Data were collected from the Maternity and Child Hospital, Ha’il, Kingdom of Saudi Arabia. Participants were classified into two groups according to parity, i.e., women of low parity and women of high parity. Socio-demographic data and pregnancy complications, such as gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, etc., were retrieved from participants’ files. Participants were followed in the postnatal ward until their discharge. The results revealed that women of high parity mostly (49%) were married before 20 years of age, less educated, obese, and were of un-booked cases. Premature babies and fetal mortality are significantly high (0.000) in this group. There is a significant difference between the two groups with respect to maternal anemia, gestational diabetes mellitus, joint pain, perineal tear, miscarriage, postpartum hemorrhage, preeclampsia, vaginal tear, and cesarean section. Determinants responsible for high parity should be identified via evidence-based medicine. Public health education programs targeting couples, weight control, nutrition, and contraception would be a cost-effective strategy for reducing the risk of possible fetomaternal complications.

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and chronic low-grade inflammation. Pro-inflammatory cytokines, particularly tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), contribute to impaired insulin signaling and metabolic dysfunction. Vitamin D possesses immunomodulatory properties and may influence inflammatory pathways associated with insulin resistance. This study aimed to evaluate the association between serum vitamin D levels, TNF-α and IL-6 expression, and glycemic control among insulin-resistant patients with T2DM. A hospital-based case-control study was conducted between September 2025 and February 2026 among 556 participants, including 426 insulin-resistant patients with T2DM and 130 age- and sex-matched healthy controls. Fasting blood samples were analyzed for serum vitamin D, TNF-α, IL-6, fasting blood glucose, insulin, and HbA1c. Insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Serum cytokine concentrations were measured using enzyme-linked immunosorbent assay (ELISA), while adipose tissue TNF-α and IL-6 gene expression was evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). Correlation and multivariable regression analyses were performed to examine associations between vitamin D status, inflammatory markers, insulin resistance, and glycemic indices. Serum vitamin D levels were significantly lower among T2DM patients than controls (17.9 ± 6.8 ng/mL vs. 31.4 ± 7.6 ng/mL, p < 0.001). Conversely, serum TNF-α (18.4 ± 5.2 pg/mL vs. 9.8 ± 3.1 pg/mL, p < 0.001) and IL-6 (12.6 ± 4.7 pg/mL vs. 5.3 ± 2.0 pg/mL, p < 0.001) were significantly elevated in T2DM patients. Adipose tissue analysis demonstrated a 2.8-fold increase in TNF-α expression and a 3.2-fold increase in IL-6 expression among cases compared with controls (p < 0.001). Vitamin D levels were inversely correlated with TNF-α (r = - 0.42), IL-6 (r = - 0.38), HbA1c (r = - 0.35), and HOMA-IR (r = - 0.39) (all p < 0.001). Multivariable regression analysis demonstrated that vitamin D remained an independent negative predictor of TNF-α and IL-6 expression after adjustment for potential confounding variables. Vitamin D deficiency was significantly associated with increased TNF-α and IL-6 expression, greater insulin resistance, and poorer glycemic control among patients with T2DM. These findings support a potential role of vitamin D in metabolic inflammation; however, prospective studies and randomized controlled trials are needed to determine whether improving vitamin D status can favorably influence inflammatory and metabolic outcomes in T2DM.

Cancer is the primary and one of the most prominent causes of the rising global mortality rate, accounting for nearly 10 million deaths annually. Specific methods have been devised to cure cancerous tumours. Effective therapeutic approaches must be developed, both at the cellular and genetic level. Immunotherapy offers promising results by providing sustained remission to patients with refractory malignancies. Genetically modified T-lymphocytic cells have emerged as a novel therapeutic approach for the treatment of solid tumours, haematological malignancies, and relapsed/refractory B-lymphocyte malignancies as a result of recent clinical trial findings; the treatment is referred to as chimeric antigen receptor T-cell therapy (CAR T-cell therapy). Leukapheresis is used to remove T-lymphocytes from the leukocytes, and CARs are created through genetic engineering. Without the aid of a major histocompatibility complex, these genetically modified receptors lyse malignant tissues by interacting directly with the carcinogen. Additionally, the outcomes of preclinical and clinical studies reveal that CAR T-cell therapy has proven to be a potential therapeutic contender against metastatic breast cancer (BCa), triple-negative, and HER 2+ve BCa. Nevertheless, unique toxicities, including (cytokine release syndrome, on/off-target tumour recognition, neurotoxicities, anaphylaxis, antigen escape in BCa, and the immunosuppressive tumour microenvironment in solid tumours, negatively impact the mechanism of action of these receptors. In this review, the potential of CAR T-cell immunotherapy and its method of destroying tumour cells is explored using data from preclinical and clinical trials, as well as providing an update on the approaches used to reduce toxicities, which may improve or broaden the effectiveness of the therapies used in BCa.

Patients with irritable bowel syndrome (IBS) often experience psychiatric disorders such as anxiety and depression. This study examined the association between IBS and anxiety and depression and explored how these variables interact with various IBS indices in the general population of Hail, Saudi Arabia. This cross-sectional descriptive study utilized standardized assessments for diagnosing IBS, anxiety, and depression. An online questionnaire was distributed to individuals in the Hail region. A total of 687 participants completed the questionnaire, of whom 508 (74%) were female. According to IBS diagnostic criteria, only 176 (26%) of participants had IBS. Based on the patient health questionnaire (PHQ) criteria for depression, 497 (72%) of participants were identified as depressed. Similarly, the generalized anxiety disorder (GAD) criteria indicated that 633 (92%) of participants suffered from GAD. The diagnosis of IBS was significantly associated with GAD, depression, and psychological symptoms such as annoyance, irritability, and concern about daily tasks. There is a significant association between IBS and anxiety and depression, suggesting that psychiatric disorders should be routinely screened for in patients with IBS. Recognizing and treating these comorbidities can improve outcomes for individuals with IBS.

Acne vulgaris is the commonest dermatological problem internationally and nationally. Its incidence is increasing every year in the Kingdom of Saudi Arabia (KSA). Though it is not a major health issue but it significantly affects the patient cosmetically, psychologically and socially. Previous studies have shown its association with lifestyle (age, diet, stress, sleep, smoking, exercise, obesity, etc.) and family history. By simple cost-effective lifestyle modification, its occurrence and late consequences could be minimized. Few hospital-based studies are done on this issue in Hail City, KSA. Hence present cross-sectional study was designed where data was collected by Google-Form from 484 residents of Hail City. Results have revealed that 65% of our respondents were suffering from mild to moderate Acne. Thirty percent of the respondents had BMI equal to more than 30. Majority of respondents (81%) had acne on whole face. Similarly, dairy products were also consumed by more than 50%. Majority of respondents (more than 50%) took chocolates, fast foods, oily foods and sea-foods. Nuts were taken quite often by 37% of respondents. Age between 21-25 years and oily skin have a highly significant association (p = 0.000) with development of acne. Other variables that show significant association with acne were being obese, stressful, irregular menstrual cycles and excessive intake of nuts.Hence there is a need to address this issue in order to design recommendations for the general public to minimize the incidence and consequences of acne vulgaris by simple lifestyle modifications.

Introduction: Menstrual hygiene is a critical aspect of adolescent girls' health, yet it remains a neglected topic, particularly in rural areas. Poor menstrual hygiene practices can lead to various health complications, including urinary tract infections, reproductive tract infections, and emotional distress. This study aims to assess the knowledge and practices related to menstrual hygiene among school adolescent girls in a rural community in Pakistan. Objective: To evaluate the menstrual hygiene knowledge and practices of school- going adolescent girls in rural Pakistan. Methodology: This cross-sectional study was conducted at different rural communities of Punjab, Pakistan during June 2024 to December 2024. Data include 650 adolescent girls attending schools in a rural community. Data were collected using a structured questionnaire that assessed participants' knowledge about menstruation, menstrual hygiene practices, and sources of information. Descriptive statistics were used to analyze the data, and knowledge and practices were categorized into adequate and inadequate based on predefined criteria. Results: 58% of the girls had adequate knowledge about menstruation, while 42% had inadequate knowledge. In terms of practices, 62% of girls reported using sanitary pads, whereas 38% used cloths or other materials, with a significant number of them not changing the material regularly. A majority of the participants (62%, 403/650) used sanitary pads, while 38% (247/650) relied on cloths. Among the younger age group (<14 years), 85% (139/163) used cloths, highlighting a greater reliance on traditional materials among younger girls, which poses a higher risk of infections. Conclusion: There is a significant gap in menstrual hygiene knowledge and practices among adolescent girls in rural Pakistan. Improving access to menstrual hygiene products, education, and sanitation facilities are critical for improving menstrual health outcomes. Categories: Obstetrics/Gynecology, Public Health, Epidemiology/Public Health.