Objective: To assess the quality and performance of public hospitals in Erbil Governorate, Iraq. Methodology: This cross-sectional, multicenter mixed-methods study was conducted in all 13 public hospitals under the Directorate General of Health in Erbil Governorate, Kurdistan Region of Iraq, between the 1st of October 2023 and the 1st of October 2025. Hospital quality was evaluated using a psychometrically validated Iraqi-adapted Kayakalp checklist covering 6 domains, 53 criteria, and 300 compliances. Items were scored as 0 (non-compliant), 1 (partially compliant), or 2 (fully compliant), and converted to percentage scores. Results: Overall hospital performance ranged from 309/600 to 387/600, corresponding to 51.5–64.5%. The highest-performing hospitals were Rapareen (64.5%), Hawler (62.0%), Hareer (61.8%), and Maternity (61.5%), whereas Eye (51.5%), Perman (52.5%), Zeravani (52.8%), and Rizgary (53.2%) had the lowest scores. Domain performance varied markedly: hospital upkeep ranged from 46.9% to 77.7%, sanitation and hygiene from 47.3% to 72.0%, support services from 30.0% to 82.5%, waste management from 36.0% to 83.0%, infection control from 37.0% to 73.0%, and hygiene promotion from 8.7% to 26.2%. None of the hospitals achieved the 70% Kayakalp recognition threshold overall. Conclusion: Public hospitals in Erbil Governorate showed moderate overall quality performance with substantial inter-hospital variation. Infection control and hygiene promotion were consistently the weakest domain, indicating a priority area for improvement.
Objective: To adapt the Physical Activity Scale for the Elderly (PASE) and the Community Healthy Activities Model Program for Seniors (CHAMPS) for the Indonesian context and to evaluate their psychometric properties. Methodology: This cross-sectional study involved 60 older women (≥60 years) in Depok, Indonesia. Adaptation involved translation and expert review. Analyses included descriptive statistics, Cronbach’s alpha for internal consistency, and Multi-Group Confirmatory Factor Analysis (MGCFA). Results: The Indonesian PASE and CHAMPS demonstrated excellent internal consistency (Cronbach’s α=0.963 and 0.928, respectively) and satisfied configural, metric, and scalar invariance across age groups. PASE showed Comparative Fit Index (CFI) values of 0.955–0.964 (ΔCFI≤0.006), while CHAMPS showed CFI values of 0.945–0.952 (ΔCFI≤0.004), indicating stable measurement properties across younger-old and older-old participants. Conclusion: The Indonesian versions of PASE and CHAMPS demonstrated preliminary evidence of acceptable reliability, validity, and measurement invariance for assessing physical activity among older women in this study setting. Further validation with larger, more diverse populations is needed to confirm their broader applicability in Indonesia.
Objective: To explore lived experiences, family support, and educational needs shaping self-management among adolescents with thalassemia. Methodology: This descriptive phenomenological study was conducted in two public hospitals in Bekasi, Indonesia, from May 2024 to February 2025. Participants were purposively selected and included nine adolescents, eight parents or caregivers, and four nurses. Data were obtained through interviews, focus group discussions, observations, and field notes, and were then analyzed using inductive thematic analysis and team review. Results: Four themes were developed: negotiating self-management within lifelong treatment demands; preserving normal adolescence amid bodily and social disruption; family support as a scaffold for autonomy; and transforming education into shared family routines. Treatment fatigue, irregular transfusion scheduling, chelation difficulties, stigma, disrupted schooling, and medicine access shaped self-management. Families provided transport, reminders, monitoring, reassurance, and advocacy. Nurses emphasized structured, family-inclusive education. Conclusion: Adolescent thalassemia self-management is relational and service-dependent. Family-centered nursing that combines education, caregiver coaching, psychosocial screening, and coordinated follow-up may strengthen adherence, autonomy, and well-being.
Objective: To investigate the demographic, clinical, and antimicrobial resistance (AMR) profiles of E. coli from women with UTIs Urinary tract infections (UTIs). Methodology: This cross-sectional study was conducted from July 2023 to July 2024 at the Institute of Microbiology, Shah Abdul Latif University and Microbiology Laboratory, Dept. of Pathology, Chandka Medical College (CMC), Larkana. Employing convenience sampling and standard sample size formula, 576 midstream urine specimens were collected from women aged ≥18 years presenting with UTI symptoms. Specimens were cultured on MacConkey agar, with E. coli confirmed via Gram staining, biochemical profiling. Antimicrobial resistance was assessed using the Kirby-Bauer disk diffusion method following CLSI (2023) guidelines. Data were analyzed using SPSS 26. Results: Most of the women were illiterate (91.23%) and housewives (97.37%). The most affected age group was 20-30 years (85.09%), with pregnancy emerging as a significant risk factor (80.70% of cases), especially during the second trimester (34.21%) and among primigravida women (67.54%). Antimicrobial susceptibility testing revealed alarmingly high resistance rates against Ampiclox (92.98%), cefaclor (91.23%), fluoroquinolones (Ofloxacin: 87.72%; Norfloxacin: 79.82%) and third-generation cephalosporins (Ceftazidime: 58.77%). In contrast, amikacin (71.05% sensitivity) and chloramphenicol (63.16% sensitivity) demonstrated better efficacy. Conclusion: These findings underscore the urgent need for antimicrobial stewardship to curb empiric use of beta-lactams and fluoroquinolones.
Objective: To evaluate the effect of printing orientation on the dimensional accuracy, trueness, and 9-month stability of two 3D-printed dental resins. Methodology: In this in vitro study, 108 specimens of Model Resin Material (MRM) and Interim Prosthesis Material (IPM) were printed at 0°, 45°, and 90° (n=9/group). Specimens were scanned immediately and after nine months using a 3Shape lab scanner. Dimensional accuracy was assessed by linear measurements and trueness by RMS deviation using GOM Inspect. Data were analyzed with ANOVA (α=0.05). Results: Printing orientation had no significant effect on dimensional accuracy or trueness (p>0.05). All groups showed significant post printing shrinkage (p<0.05). IPM demonstrated better trueness (0.231±0.051 mm) than MRM (0.498±0.168 mm; p=0.001) and maintained superior dimensional stability after nine months (p=0.001). Conclusion: Printing orientation minimally affects accuracy. IPM shows better trueness and long term stability than MRM, and surface based analysis detects deviations not identified by linear measurements.
Objective: To assess the prognostic value of tumor-infiltrating lymphocytes (TILs) in triple-negative breast cancer (TNBC) by menopausal status. Methodology: This retrospective cohort study included 442 TNBC patients treated at the University of Sulaimani from January 2015 to January 2025, including 275 premenopausal and 167 postmenopausal women. TILs were evaluated on hematoxylin and eosin-stained sections using International TILs Working Group criteria and classified as low, moderate, or high. Clinical, pathological, treatment, and survival data were analyzed using Cox regression. Results: TIL levels were significantly associated with tumor grade (p≤0.001) but not with menopausal status. Patients with high TIL infiltration had a 63% lower risk of death than those with low or moderate infiltration (HR=0.37, HR=0.37, HR=0.37, 95% CI: 0.20–0.70, p=0.002, p=0.002, p=0.002). Conclusion: Higher TIL levels predict better survival in TNBC regardless of menopausal status, supporting their role as a prognostic biomarker across both premenopausal and postmenopausal patients.
Objective: To describe the epidemiological profile of multidrug-resistant organisms (MDROs) in patients with hematologic malignancies. Methodology: This retrospective descriptive study was conducted at Haji Adam Malik General Hospital, Medan, Indonesia, from July 2022 to July 2023. Adult patients with hematologic malignancies and culture-proven bacterial infections were included. MDROs were defined as bacteria resistant to at least one agent in three or more antimicrobial categories. Data were analysed using SPSS version 29 and presented as mean values and percentages. Results: Thirty-one patients yielded 43 bacterial isolates. The most common pathogens were Klebsiella pneumoniae (18.6%), Escherichia coli (16.3%), and Staphylococcus aureus (14.0%). High resistance was observed against cefotaxime (97.7%), chloramphenicol (90.7%), and amoxicillin (90.7%). Meropenem and amikacin showed the highest sensitivity. ESBL-producing isolates demonstrated 100% sensitivity to amikacin and 75% to meropenem. Conclusion: Klebsiella pneumoniae was the predominant pathogen. Meropenem and amikacin remain effective options and may guide empirical antibiotic therapy.
Objective: To assess awareness, attitudes and barriers of cervical cancer screening and HPV vaccination among women in Najran City, Saudi Arabia. Methodology: This cross-sectional study included 400 women from Najran City, Saudi Arabia, from January to May 2026. Recruitment was conducted using a multistage sampling method. A structured self-administered questionnaire was used to collect data on the sociodemographic characteristics of the females, knowledge about cervical cancer and HPV vaccination, and attitudes toward screening and vaccination. Results: Moderate knowledge was observed among 45.75% of participants, with a mean knowledge score of 9.7±3.1 out of 15. Participants demonstrated moderately favorable attitudes, with a mean attitude score of 10.4±2.8 out of 18. However, only 11.25% of participants had undergone cervical cancer screening. The most reported barriers to screening were concerns related to modesty, embarrassment associated with the Pap smear procedure, and fear of social stigma. Conclusion: Women in an underserved setting like Najran demonstrated moderate knowledge and moderately favorable attitudes about cervical cancer screening and HPV vaccination with low screening uptake.
We report a case of primary pleural sarcoma in a 75-year-old male with asbestos exposure, initially suspected as sarcomatoid mesothelioma. Immunohistochemical analysis confirmed the diagnosis with Vimentin positivity and negativity for mesothelial markers (Calretinin, WT-1, D2-40) and epithelial markers; focal ERG positivity was noted, but CD31 and CD34 negativity excluded angiosarcoma. The patient began chemotherapy with Adriamycin and Dacarbazine, but serial F-18 FDG PET/CT after the third cycle revealed significant metabolic progression, indicating chemotherapy refractoriness. The regimen switched to Gemcitabine and Docetaxel, but the disease remained refractory, and the patient died three months post-diagnosis. This case highlights the diagnostic complexity of primary pleural sarcoma with asbestos exposure and the critical role of serial FDG PET/CT in early metabolic progression detection. Our findings suggest early metabolic imaging integration is essential in rapidly progressing pleural malignancies to identify treatment resistance and facilitate timely clinical management adjustments.
Androgen Insensitivity Syndrome is a rare genetic condition characterized by the body\'s inability to respond to androgen hormones, leading to various phenotypic presentations, including amenorrhoea and vaginal agenesis. These disorders result from mutations of the androgen receptor gene. A 22-year-old woman with complaints of no menstruation since puberty. The patient was born and raised as a female.[L2.1][AK2.2] Physical examination revealed enlarged breasts, widened hips, female external genitalia, and no Adam\'s apple. Expressed sexual orientation was towards males. MRI imaging of the pelvis found abnormal signal, considered as cryptorchidism, no uterus or ovaries. Hormone examination showed estradiol 23.6 pg/mL, testosterone 88.67 mmol/L, LH 30.9 mIU/mL. Karyotyping revealed 46,XY. Histopa[L3.1][AK3.2]thological examination showed testicular tissue, surrounded by a connective tissue capsule. The patient gendered herself as female, neovaginal surgery and orchidectomy were performed. Disruption of this gene lead to a mismatch between phenotype and genotype. Therefore, comprehensive examinations are important.
Objective: To examine WASH behaviors, identify factors associated with preventive practices, and assess cholera knowledge, attitudes, and preventive activities among households in Sennar State, Sudan. Methodology: This community-based cross-sectional survey included 768 households in Sennar State, Sudan, and was carried out from September to December 2025. Households were clustered by location, and individual adult participants were selected via convenience sampling. Data were collected using a Google Forms questionnaire covering socio-demographic characteristics, cholera KAP. Data were analyzed using descriptive statistics and Chi-square tests to assess associations between socio-demographic/WASH factors and preventive practices. Results: High cholera awareness (85%) was found. Most respondents correctly identified causes, symptoms, and severity, and 80% were willing to seek immediate care. However, only 58% perceived themselves at risk. Handwashing and latrine use were common practices, while safe food handling and clean water practices were less consistent. Preventive practices were significantly associated with age, education, occupation, and WASH behaviors. Conclusion: The study reveals generally good knowledge and acceptable hygiene practices, but important gaps remain in risk perception, ORS and vaccine awareness, and safe water and food handling. Socio-demographic factors significantly influence preventive behaviors, highlighting the need for targeted public health interventions in Sennar State. Strengthening community education and integrated WASH programs is recommended to improve cholera prevention outcomes in the region.
Objective: To assess coping strategies and life satisfaction among undergraduate medical (MBBS) students. Methodology: This cross-sectional study was conducted at Azra Naheed Medical College, Superior University, Lahore, Pakistan, from November 2024 to February 2025. Participants were recruited using a non-probability convenience sampling technique. Demographic information, including age, gender, and year of study, was recorded. MBBS students from first to final year were included, while those previously diagnosed with any psychiatric disorder or currently receiving psychiatric treatment were excluded. Coping strategies were assessed using the Brief COPE Inventory, which measures adaptive, emotional, and avoidant coping. Overall life satisfaction was evaluated using the Satisfaction with Life Scale (SWLS). Data were analyzed using SPSS 23, and linear regression was performed to examine the relationship between coping strategies and life satisfaction, with p-values <0.05 considered statistically significant. Results: Among the 273 participants, 184 (67.2%) primarily used adaptive coping strategies, 59 (21.5%) used emotional coping, and 30 (10.9%) used avoidant coping. Adaptive coping was a significant positive predictor of SWLS scores (β=0.31, p=0.001), whereas emotional coping was a significant negative predictor (β=-0.53, p<0.001). Avoidant coping did not significantly predict SWLS (β=0.07, p=0.284). Conclusion: Majority students used adaptive coping strategies to manage stress, while emotional and avoidant strategies were less common. Interventions aimed at promoting effective coping strategies may help improve overall life satisfaction among medical students.
Objective: To elaborate and present an integrated conceptual definition of clinical leadership in nurses, empowering, based on the results of a systematic literature review. Methodology: This study used Walker and Avant’s approach, which consisted of eight systematic steps. The literature search was conducted using electronic data from PubMed, Scopus, Science Direct, Sage Journal, ClinicalKey Nursing, and Proquest published from 2021 until 2025. Results: An integrated conceptual framework identified three key antecedents (structural empowerment, supportive leadership climate, clinical leadership capabilities) and four core attributes, including transformational influence, enabling empowerment, relational and collaborative competencies, and ethical and professional integrity. The consequences include nurse well-being and growth, clinical excellence and safety, innovation and service improvement. Conclusion: This conceptual analysis resulted in an integrated clinical leadership framework, conceptualizing clinical leadership in nurse empowerment as a system-level construct with interdependent components. These findings provide a strong theoretical foundation for the development of valid measurement instruments and the design of targeted interventions in clinical settings.
Objective: To describe the clinical presentation, surgical management, and early outcomes of advanced scalp squamous cell carcinoma (cSCC) in Sudan. Methodology: This retrospective, single-center study included all patients who presented with advanced scalp cSCC between January 2017 and December 2023. Results: Eleven patients were identified (mean age 70 years; 81.8% male), most of whom reported chronic occupational exposure to ultraviolet radiation. Most presented with chronic non-healing ulcerated bleeding scalp wounds. The median tumor diameter was 5 cm. Ten patients underwent surgical excision with reconstruction using a local scalp flap in six patients and a split-thickness skin graft in four patients. One patient, who presented with skull destruction and exposure to intracranial contents, was referred to a specialized center. The immediate outcomes were favorable: 90% of participants experienced no complications, while 10% developed partial graft necrosis. Conclusion: Advanced scalp cSCC in this cohort was characterized by delayed presentation and extensive local disease. In a limited-resource setting, surgical excision with an appropriate reconstructive method remains a feasible and effective primary treatment strategy.
We report a 57-year-old female who presented with a progressively enlarging, painful left pelvic mass over four months. Neck examination revealed a palpable thyroid mass. Thyroid function tests revealed atypical central hypothyroidism. Histopathology examination confirmed papillary thyroid carcinoma (PTC) in the thyroid and pelvic lesions. Imaging revealed expansile lytic lesions in the left iliac wing, consistent with bone metastases. FNAB of the pelvic mass demonstrated a metastatic involvement consistent with follicular-variant PTC. She underwent total thyroidectomy with modified neck dissection, followed by levothyroxine therapy and plans for radioiodine ablation. Early recognition and a multidisciplinary approach are critical for optimizing therapeutic outcomes and improving patient quality of life.
Objective: To compare vitamin D status and inflammatory cytokine responses between pregnant women with gestational diabetes mellitus (GDM) and normoglycemic controls. Methodology: This case-control study enrolled 218 pregnant women (109 GDM cases, 109 normoglycemic controls) at 24-28 weeks of gestation using consecutive sampling. Exclusion criteria included pre-existing diabetes, hypertensive disorders, multiple gestation, and recent vitamin D supplementation. Serum 25-hydroxyvitamin D levels were measured via ELISA, and IL-6 and TNF-α were quantified using multiplex immunoassays. Data were analyzed using SPSS 25, employing independent t-test and chi-square test at α=0.05. Results: Vitamin D deficiency (<20 ng/mL) was significantly more prevalent in GDM women (71.7%) than controls (45.0%) (p=0.003). Mean IL-6 (8.42±2.16 vs. 4.15±1.82 pg/mL) and TNF-α (12.37±3.28 vs. 6.94±2.41 pg/mL) levels were significantly elevated in the GDM group (p<0.001). A significant negative correlation was observed between vitamin D levels and both inflammatory cytokines (p<0.05). Conclusion: GDM women demonstrated higher prevalence of vitamin D deficiency and elevated pro-inflammatory cytokine profiles compared to normoglycemic peers, suggesting a potential immunomodulatory link between vitamin D and gestational diabetes.
Objective: To summarize recent evidence on gait-related mobility and functional recovery in older adults receiving inpatient rehabilitation in convalescent rehabilitation hospitals or wards after hip fracture surgery. Methodology: A systematic review was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library for studies published between January 1, 2023, and December 30, 2025. Clinical and observational studies involving older adults after hip fracture surgery in convalescent rehabilitation settings were included. Results: Eleven studies met the eligibility criteria, and all had observational study design. Five studies primarily addressed gait, mobility, or walking independence, whereas six focused on functional recovery, activities of daily living, or related clinical factors. Walking independence was associated with post-fracture knee pain, trunk muscle mass and quality, vitality, and admission-based clinical prediction factors. Functional recovery and ADL outcomes were associated with physical activity during hospitalization, sarcopenia status, nutritional condition, heart failure, and clinically meaningful Functional Independence Measure change. Conclusion: Recovery after hip fracture surgery in convalescent rehabilitation settings is multifactorial and influenced by both rehabilitation-related and patient-related factors. Further prospective interventional studies are required to identify effective strategies for improving walking and functional outcomes.
Objective: To evaluate the association between the Albumin-Bilirubin (ALBI) score and mortality risk in patients with hepatocellular carcinoma (HCC). Methodology: This retrospective cohort study was conducted at Haji Adam Malik General Hospital, Medan, Indonesia, from September 2024 to April 2025. Medical records of adult patients with HCC and complete clinical and laboratory data were analysed. ALBI scores were categorized into three grades. Associations with mortality were evaluated using the chi-square test and Mann-Whitney U test. Results: A total of 135 patients were included. Higher ALBI grades were significantly associated with increased mortality (p<0.05). Patients with ALBI grade III had lower serum albumin levels and higher total bilirubin levels than those with ALBI grades I and II. Mortality was highest among patients with Child-Pugh class C and BCLC stage D. Conclusion: The ALBI score is a simple and objective prognostic tool for predicting mortality in patients with HCC and may complement established prognostic systems such as the Child-Pugh and BCLC classifications.
Objective: To investigate factors associated with the psychosocial development of children aged 6-12 years, based on Erikson's theory, in Kupang City. Methodology: This cross-sectional study involved 165 participants selected through purposive sampling. The study variables included parental role, environmental role, and psychosocial development (industry vs inferiority) of children aged 6-12 years. Data were collected using a questionnaire and analyzed using the Spearman rank correlation test with a significance level of alpha=0.05. Results: Parental role (p=0.009) and environmental support (p=0.004) were significantly associated with psychosocial development. Parental involvement and the school environment significantly influenced the psychosocial development (industry versus inferiority) of children aged 6-12 years. Conclusion: Parental roles and environmental factors are strongly associated with the psychosocial development of school-aged children in the industry versus inferiority stage. Strengthening parental involvement and creating a supportive school environment are essential for achieving optimal psychosocial development.
Objective: To systematically investigate whether pelvic/lumbopelvic stabilization improves balance and functional activity in adults with acute/subacute stroke, and to summarize key intervention components and clinical applicability. Methodology: The PubMed and Embase databases for randomized controlled trials (RCTs) investigating pelvic/lumbosacral stabilization interventions in adults with acute/subacute stroke were searched. Eligible trials included a comparator and reported balance and/or functional outcomes. Seven RCTs were selected from a total of 356 articles after screening and full-text review according to the PRISMA principles. Results: Seven RCTs assessed ADIM-centered training (with/without breathing integration), feedback-assisted core activation, diaphragmatic–deep abdominal coordination, or additional core stabilization combined with usual rehabilitation. Most trials reported improvements in trunk control and balance-related outcomes, and several also showed gains in gait performance or activities of daily living indices. Findings varied across studies due to differences in intervention components, dosage, and outcome measures. Conclusion: In early post-stroke rehabilitation, pelvic/lumbopelvic stabilization training may improve trunk control and balance, and some studies have shown additional benefits for walking and activities of daily living.
