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ABSTRACT Objective: To compare the outcomes of three-port versus four-port laparoscopic cholecystectomy(LC) and assess the safety and efficacy of three-port LC as routine procedure. Study Design: Retrospective comparative study. Place and Duration of Study: Combined Military Hospital Kohat/CMH Multan, from Oct 2013 to Dec 2016. Methodology: Total of 403 patients were selected and were divided into two groups based on the principles of non-randomized clinical trial; group A having three-port laparoscopic cholecystectomy(LC) and group B having four-port laparoscopic cholecystectomy(LC). Fourth port in right axillary line at umbilicus level was not established in group A. Outcomes were recorded in terms of operating time, complications, pain assessment/ analgesic requirement and hospital stay. Results: A total of 218(54.09%) patients in group A and 185(45.91%) patients in group B were assessed. The difference in terms of verbal pain score, analgesic requirement and duration of hospital stay/return to activity were significant statistically, all being less in group A. Cosmetic outcome as perceived by patients was also better in the group A because of less numbers of scars. Operative time(minutes) was less in group A in our study(35.59 ± 10.75) as compared to group B(50.17 ± 10.14). Results of other variables including intra-operative/post-operative complications were comparable among the two groups. Conclusion: Three-port LC has advantages of being less painful, with less analgesics requirement and reduced hospital stay without compromising the safety and efficacy. It is more acceptable to patients due to less numbers of scars and better cosmesis.

Hypertension (HTN) affects over a billion people worldwide, with most cases in low- and middle-income countries (LMICs) where awareness and control remain low. In Pakistan, general practitioners (GPs) are usually the initial contact for hypertensive patients. Through the Train the Trainer (TTT) initiative, a group of consultant cardiologists were trained as master trainers to conduct training for GPs across Pakistan. This study aimed to assess the effectiveness of the TTT initiative regarding knowledge of GPs about the diagnosis and management of HTN. This study included 540 GPs from all over Pakistan. Participants attended HTN training workshops run by Master Trainers under the TTT model and completed a structured online questionnaire in relation to knowledge of HTN before and 1-3 months after training. Knowledge scores were derived from correct responses for 19 items. Pre-training GPs demonstrated low HTN knowledge scores with a median of 26.3 [IQR: 15.8-36.8] and 92% scoring less than 50. In contrast, post-training medians increased significantly to 42.1 [IQR: 31.6-63.2], with 38.5% of GPs achieving moderate or high knowledge scores ≥50 (p < 0.001). Overall, gains were observed across all demographic groups; significant improvement was observed among female and younger GPs. The TTT initiative effectively improved knowledge in both the diagnosis and management of hypertension among GPs, thus standing to potentially improve the current gaps in HTN care in many LMICs through similar models. Further studies are warranted to document the long-term clinical impact of this kind of training on patient outcomes and hypertension control.

Telemedicine is one of the most important technological developments in primary health care, contributing to enhancing universal access to medical services for patients. This review explores the role of telemedicine in improving healthcare outcomes by facilitating remote consultations, patient monitoring, and collaborative care between primary care physicians and nurses. The integration of technologies such as remote patient monitoring, artificial intelligence, and virtual reality can enhance diagnostic accuracy, reduce healthcare costs, and enhance patient engagement. Despite its potential, telemedicine faces challenges including privacy concerns, technological limitations, and resistance to adoption. This review highlights the advantages and barriers of telemedicine in primary health care, focusing on its future trajectory and its impact on healthcare delivery and improved chronic disease management.

In this study, we will present an efficient and selective adsorbent for the removal of Cu(II) ions from aqueous solutions. The silica-based adsorbent is functionalized by 2-phenylimidazo[1,2-a] pyridine-3-carbaldehyde (SiN-imd-py) and the characterization was carried out by applying various techniques including FT-IR, SEM, TGA and elemental analysis. The SiN-imd-py adsorbent shows a good selectivity and high adsorption capacity towards Cu(II) and reached 100 mg/g at pH = 6 and T = 25 °C. This adsorption capacity is important compared to other similar adsorbents which are currently published. The adsorption mechanism, thermodynamics, reusability and the effect of different experimental conditions, such as contact time, pH and temperature, on the adsorption process, were also investigated. In addition, a theoretical study was carried out to understand the adsorption mechanism and the active sites of the adsorbent, as well as the stability of the complex formed and the nature of the bonds.

Purpose Congenital microcephaly (CM) is an important birth defect with long term neurological sequelae. We aimed to perform detailed phenotypic and genomic analysis of patients with Mendelian forms of CM. Methods Clinical phenotyping, targeted or exome sequencing, and autozygome analysis. Results We describe 150 patients (104 families) with 56 Mendelian forms of CM. Our data show little overlap with the genetic causes of postnatal microcephaly. We also show that a broad definition of primary microcephaly —as an autosomal recessive form of nonsyndromic CM with severe postnatal deceleration of occipitofrontal circumference—is highly sensitive but has a limited specificity. In addition, we expand the overlap between primary microcephaly and microcephalic primordial dwarfism both clinically (short stature in >52% of patients with primary microcephaly) and molecularly (e.g., we report the first instance of CEP135 -related microcephalic primordial dwarfism). We expand the allelic and locus heterogeneity of CM by reporting 37 novel likely disease-causing variants in 27 disease genes, confirming the candidacy of ANKLE2, YARS , FRMD4A , and THG1L , and proposing the candidacy of BPTF , MAP1B , CCNH , and PPFIBP1 . Conclusion Our study refines the phenotype of CM, expands its genetics heterogeneity, and informs the workup of children born with this developmental brain defect.

MicroRNA (miRNA) polymorphisms are increasingly recognized as important regulators of reproductive outcomes, but their role in recurrent pregnancy loss (RPL) is still unexplored in specific populations. This case control study investigated six miRNA polymorphisms (miR-10-A > T, miR-125-G > A, miR-146a-C > G, miR-149-T > C, miR-323b-C > T, miR-499-A > G) in 50 Saudi women with idiopathic (≥ 2 losses) and 50 matched controls (≥ 1 live birth, no loss history) using PCR Sanger sequencing. Significant associations were found for heterozygous genotypes of miR-146a-C > G (OR=2.29, 95% Cl:1.02–5.18, *p* = 0.046) and miR-149-T > C (OR=2.67, 95% Cl:1.08–6.61, *p* = 0.034) with higher prevalence in RPL patients versus controls, while other polymorphisms showed no significant association (*p* > 0.05). These results suggest miR-146a and miR-149 can contribute to RPL susceptibility in Saudi women, highlighting their potential as population-specific genetic biomarkers and underscoring the need for further research into miRNA-mediated pregnancy maintenance mechanisms.

Background Depression among medical students is a significant mental health challenge globally, with increased prevalence rate in the Arab region. Aim To systematically review the prevalence and risk factors for depression among medical students in the Arab region. Method A systematic search of databases (PubMed, Medline, CINAHL, PsycINFO) and grey literature identified 16 observational cross-sectional studies conducted between 2019 and 2024. Results The studies included data from 9,243 participants, with a depression prevalence rate ranging from 40% in Palestine to 77.9% in Sudan. Risk factors associated with depression were grouped into five categories: sociodemographic, social and family dynamics, academic, behavioral, and lifestyle, and health and mental health history. To illustrate, younger age, female gender, and preclinical years of medical school are associated with a higher level of depressive symptoms. Social challenges, such as living apart from family and lacking adequate social support, were risk factors for psychological distress. Furthermore, academic pressure and uncertainty increase the possibility of having depressive symptoms. Maladaptive coping mechanisms such as substance abuse and excessive screen time, further exacerbate the condition. Conclusion This review underscores the critical need for tailored mental health strategies in Arab medical schools. Interventions should address stigma, enhance social and academic support, and include culturally relevant stress management and resilience-building programs. Future research should explore the impact of socio-political instability and evaluate interventions tailored to collectivist cultural norms.

Vitamin D, causally implicated in bone diseases and human malignancies, exerts its effects through binding to the vitamin D receptor (VDR). VDR is a transcription factor modulating the expression of several genes in different pathways. Genetic variants in the VDR gene have been associated with several cancers in different population including colorectal cancer. To assess the association of VDR gene polymorphisms in relation with colorectal cancer (CRC) in a Saudi population. The polymorphisms of VDR gene (BsmI, FokI, ApaI and TaqI) were analyzed by the polymerase chain reaction amplification of segments of interest followed by Sanger sequencing. One hundred diagnosed CRC patients and 100 healthy control subjects that were age and gender matched were recruited. We did not observe significant association of any of the four VDR polymorphisms with colorectal cancer risk in the overall analysis. Although not statistically significant, the AA genotype of BsmI conferred about two-fold protection against CRCs compared to the GG genotype. Stratification of the study subjects based on age and gender suggests statistically significant association of CRC with the 'C' allele of ApaI in patients >57 years of age at disease diagnosis and BsmI polymorphism in females. In addition, statistically significant differences were observed for the genotypic distributions of VDR-BsmI, ApaI and TaqI SNPs between Saudi Arabian population and several of the International HapMap project populations. Despite the absence of correlation of the examined VDR polymorphisms with CRCs in the combined analysis, ApaI and BsmI loci are statistically significantly associated with CRC in elderly and female patients, respectively. These findings need further validation in larger cohorts prior to utilizing these SNPs as potential screening markers for colorectal cancers in Saudi population.

Elderly and patients with comorbid conditions have higher risk of infection and complications. Vaccination hesitancy is defined as the refusal of vaccine or the delay in accepting it despite the availability of vaccines and vaccination services. This study was aimed at assessing knowledge, perception, and acceptability of healthcare staff towards different types of COVID-19 vaccination. A multicenter hospital-based descriptive cross-sectional study was implemented to study the knowledge, perception, and acceptability of healthcare staff towards COVID-19 vaccination. Multistage sampling technique was applied. Data were collected through a self-administered questionnaire filled by the participants. 400 participants were studied. 61% of the participants were females, and the most frequent age reported was between 18 and 35 years (67%). A statistically significant association (p=0.048) was found between knowledge about vaccination and professions. The most common vaccine type known and accepted was AstraZeneca vaccine. On assessing acceptability of COVID-19 vaccination, acceptance rate was high (63.8%) and 22.7% of the participants had already got vaccinated. The rejection rate among our staff was 27.4%. This study was conducted in April, 2021. Majority of our healthcare staff believed that vaccination is the key to combat the pandemic. One of the issues and concerns about vaccination was the safety and the risk of developing acute adverse events (p=0.001). Encouraging factor for vaccination was the fear of getting infection themselves and their families. The present study revealed the presence of good knowledge and acceptability among medical staff towards COVID-19 vaccinations in Sudan.

In this work, we are interested in finding new catalysts for catecholase, whose principle is based on the oxidation reaction of catechol to o-quinone. In this context, we have studied a series of seven quinoline-based compounds. The present work indicates that the complexes formed between seven selected quinoline compounds and the copper salts viz. Cu(OAc)2, CuSO4, Cu(NO3)2, and CuCl2 elicit catalytic activities for the oxidation of catechol to o-quinone. The complexes formed with the Cu(OAc)2 salt show a much higher catalytic activity than the others, whereas the Cu(NO3)2 and CuCl2 salts formed complexes with low catalytic activity. This study also shows that the oxidation rate depends on two factors, namely the chemical structure of the ligands and the nature of the ions coordinated with the copper.