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Background: In recent decades, opioid misuse has become a major global public health concern, with significant contributions to morbidity and mortality. Emergency departments (EDs) are frequent sites of opioid initiation, yet prescribing practices vary widely among physicians. Previous research in the Western region of Saudi Arabia demonstrated variability in prescribing influenced by physician demographics and experience. However, no prior study has assessed these patterns in the Qassim region.

Aim: This study aimed to evaluate the pattern and influencing factors of opioid-prescribing behavior among emergency physicians in the Qassim region of Saudi Arabia.

Methods: A cross-sectional study was conducted in March 2025 among emergency physicians in Qassim hospitals. A self-administered 22-item questionnaire assessed demographic and professional characteristics along with determinants of opioid-prescribing behavior using a five-point Likert scale. An overall agreement score was calculated. Descriptive statistics, t-tests, and one-way ANOVA with Tukey's post-hoc analysis were performed using SPSS v26, with p<0.05 considered significant.

Results: A total of 104 physicians completed the survey. The most highly rated determinants of prescribing were the patient's apparent distress (4.4±0.8), medications already administered (4.3±0.8), reported pain score (4.0±0.9), vital signs/physical exam findings (4.0±1.1), and diagnosis thought to be the cause of pain (4.0±0.9). The least influential factors were family/friends' experiences (1.9±1.0), the belief that EDs are a major source of illicit opioids (2.5±1.2), and colleagues' prescribing culture (2.6±1.2). The agreement score differed significantly by gender (p=0.007), number of shifts per month (p=0.004), and years of practice (p<0.001). Post-hoc analysis confirmed that physicians with >10 years of experience scored significantly higher than those with 1-2 years.

Conclusion: Emergency physicians in Qassim demonstrated prescribing patterns primarily guided by objective clinical indicators of pain. Unlike the Western region, significant variation was observed by gender, workload, and years of practice. These findings highlight the need for structured educational interventions for junior physicians, optimization of shift schedules, and region-specific guidelines to ensure safe and consistent opioid prescribing.

Background: Envenomation by viper species remains a clinically relevant medical problem in the Caucasus region and is frequently associated with systemic toxicity, including vascular injury, coagulation disturbances, and inflammatory responses. Although antivenom therapy is the standard treatment, supportive agents capable of reducing systemic complications are of continuing interest. Taurine is a sulfur-containing amino sulfonic acid with well-documented cytoprotective and vasomodulatory properties.

Objective: The aim of this study was to evaluate the protective effect of taurine against systemic toxicity induced by Macrovipera lebetina obtusa venom in an experimental mouse model.

Methods: Male mice were administered M. lebetina obtusa venom intraperitoneally at a dose of 2.5 LD50. Taurine (1-500 mg/kg) or selected taurine conjugates were injected immediately after envenomation. Survival rate, mean survival time, and changes in venom LD50 were determined using the Behrens and Miller-Tainter methods.

Results: Taurine administration at a dose of 100 mg/kg resulted in a partial improvement of survival probability (33%) under hemotoxic envenomation conditions and increasing the venom LD50 from 1.8 to 2.4 mg/kg. Taurine conjugates, including sodium taurocholate and retinylidene taurine, did not demonstrate protective effects.

Conclusion: Taurine demonstrated a dose-dependent protective effect against systemic toxicity caused by M. lebetina obtusa venom in mice. These findings suggest that taurine may be considered as a potential supportive agent alongside standard antivenom therapy. Further experimental and clinical studies are required to clarify its mechanisms of action and clinical relevance.

Introduction: Assessment of wound healing in the oral cavity is essential for clinical decision-making after soft tissue surgical procedures. In palatal donor sites managed with wound coverings, direct visual evaluation of epithelialization is limited, creating the need for a dedicated and standardized closed-healing assessment tool.

Objective: To describe and clinically validate the Closed Palatal Mucosal Healing Index (CPMHI) for the assessment of palatal donor site healing under conditions of wound coverage.

Materials and methods: A total of 192 patients undergoing surgical treatment involving palatal donor tissue harvesting were initially enrolled as part of a broader clinical dataset. For the purposes of CPMHI validation, the present study specifically analyzed two groups (Groups 3 and 4; n=64) in which the donor site was managed using a collagen sponge fixed with sutures and covered with either ethyl or butyl cyanoacrylate adhesive. Clinical evaluation of healing was performed on postoperative days 7 and 14 using the CPMHI. Statistical analysis was conducted to compare healing dynamics between the two groups.

Results: On postoperative day 7, the majority of patients in both groups demonstrated satisfactory healing (CPMHI score 3), with no statistically significant differences between Group 3 and Group 4 (p>0.05). By day 14, most patients achieved good or excellent healing (CPMHI scores 4-5), indicating effective integration of the wound covering and minimal inflammatory response. No statistically significant intergroup differences were detected at either time point (p>0.05).

Conclusion: The Closed Palatal Mucosal Healing Index demonstrated clinical applicability, objectivity, and convenience for assessing palatal wound healing in the presence of wound coverings. CPMHI represents a reliable tool for standardized evaluation of closed healing dynamics in clinical practice and research settings.

Background: Glycated hemoglobin (HbA1c) is the primary biomarker for assessing long-term glycemic control in type 2 diabetes (T2D). However, its wait time of 2-3 months, affects the timely intervention for the identification of acute metabolic enhancements resulting from lifestyle modifications. On the other hand, fructosamine reflects the glycemic regulation for over a period of 2-3 weeks and may provide supplementary short-term monitoring functions. Nevertheless, there is scant information comparing these markers across varying levels of physical activity and body mass index (BMI) strata in people with type 2 diabetes (T2D).

Objective: To assess HbA1c and fructosamine as indicators of glycemic control in physically active and sedentary people with Type 2 Diabetes, and to investigate if BMI, sex, and glucose-lowering drugs influence the association between physical activity and these glycemic markers.

Methods: This cross-sectional study was conducted at Thumbay Labs in the United Arab Emirates from January to October 2025, included 185 persons with Type 2 Diabetes (T2D), classified as physically active (n=98, engaging in ≥150 minutes of activity per week for over 3 months) or sedentary (n=87). HbA1c and fructosamine were assessed utilizing standardized laboratory techniques. Multivariable linear regression models evaluated the relationships between physical activity and glycemic indicators, controlling for age, sex, BMI, and primary glucose-lowering drug classes, while explicitly testing for interactions between Activity and BMI, as well as Activity and Sex.

Results: Physically active participants exhibited lower HbA1c (6.84% vs. 8.07%, p<0.0001) and fructosamine levels (301.0 vs. 362.0 µmol/L, p=0.0001) compared to sedentary individuals. A significant Activity × BMI interaction for HbA1c (β=0.156, p=0.0002) was found, indicating decreased glycemic benefits of physical activity with higher BMI, persisting after controlling for diabetes medications. A similar but weaker effect for fructosamine (β=7.481, p=0.0019) was noted. No notable differences were observed between sexes regarding these markers when BMI was considered.

Conclusions: Physical activity is associated with glycemic control, which is supported by HbA1c and fructosamine levels, even though obesity declines this effect, especially in long-term glycemic memory (HbA1c). Individuals who fall under the T2D and increased BMI category need stronger lifestyle interventions for similar glycemic benefits as those with lower BMI. HbA1c is a more reliable marker for activity-related metabolic benefits in stable T2D, while fructosamine is a useful short-term indicator but not interchangeable.

Background: Salmonellosis remains a relevant public health problem, requiring continuous epidemiological monitoring based on reliable surveillance data.

Aim: To analyze long-term trends in salmonellosis incidence in the Republic of Kazakhstan during 2013-2024, with assessment of temporal dynamics, age-specific patterns, and laboratory confirmation indicators based on official monitoring data.

Materials and methods: A retrospective epidemiological analysis was conducted using aggregated laboratory surveillance data provided by the Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring of the Ministry of National Economy of the Republic of Kazakhstan. Incidence rates were analyzed for the total population and defined age groups. Long-term dynamics were assessed using descriptive statistics, average annual change indicators, and the Cochran-Armitage trend test.

Results: During 2013-2024, salmonellosis incidence in the Republic of Kazakhstan exhibited a statistically significant long-term decline (average annual rate of change, CAGR: -4.5% per year; p<0.001), accompanied by marked interannual variability. This trend was strongly influenced by a pronounced reduction in reported incidence during the COVID-19 pandemic period (2020-2021). The highest incidence rates were consistently recorded among children under 1 year of age and those aged 1-2 years, in whom statistically significant decreasing trends were observed (p≤0.001). Among children aged 3-6 years and 7-14 years, no significant linear temporal trends were identified (p>0.05), indicating fluctuating incidence without a consistent directional change over time. The proportion of laboratory-confirmed cases demonstrated a statistically significant increasing trend over time (p<0.001).

Conclusions: Salmonellosis incidence in the Republic of Kazakhstan demonstrates a statistically significant long-term downward trend with persistent interannual fluctuations, which should be interpreted in the context of changes in surveillance intensity and healthcare utilization during the COVID-19 pandemic. Early childhood remains the most affected age group, while the absence of significant temporal trends among preschool and school-aged children indicates stable incidence levels over time and supports the need for continued epidemiological surveillance in these populations.

Background: Snakebite envenomation stands as a neglected tropical disease which creates major health and economic challenges that affect mostly people who work in agriculture and rural areas. The UAE has low snakebite incidence rates but the dangerous systemic effects of snakebites require knowledge about local epidemiology and clinical presentation and treatment results.

Objective: The study analyzed snakebite cases from Al-Dhaid Hospital in UAE during twelve years to identify patient characteristics and clinical indicators and evaluate treatment effectiveness and identify variables that caused longer hospital stays.

Methods: The study analyzed all confirmed snakebite cases which occurred from January 2012 through December 2023. The researchers used structured forms to obtain demographic information along with clinical and laboratory data. Statistical analyses were performed using SPSS version 25, employing Fisher's exact test and independent-sample t-tests to identify associations between patient variables and length of hospital stay (LOS).

Results: Out of 153 patients, 91% were male, and 90% were aged between 19 and 60 years. The majority (57%) presented to the hospital within 24 hours of the bite, and 54% had a hospital stay shorter than 24 hours. Lower limbs were the most frequent bite site (43%). Local pain (82%) and swelling (36%) were the predominant symptoms, while 88.9% received antivenom. The most affected nationalities were Pakistani (56.9%) and Bangladeshi (17.7%). A prolonged hospital stay was found to be associated with an age of the patient of 60 or older (p = 0.04), an elevated INR of 1.5 or greater (p=0.04) and a prolonged prothrombin time of 15 seconds or greater (p=0.001). Sex differed significantly between LOS groups; male patients were more frequently observed in the short-stay group (p=0.002), indicating shorter hospitalization among men in this cohort. No mortality was recorded during the study period.

Conclusion: Snakebite incidents in Al-Dhaid predominantly affected young male agricultural workers, with most cases being mild and successfully treated through early hospital access and timely antivenom administration. Coagulopathy emerged as the primary morbidity and was linked to longer hospital stays. Strengthening preventive education, promoting protective gear use, and sustaining rapid-response medical systems remain key to minimizing snakebite morbidity in the UAE.

Background: Hypertension is a major global health issue, particularly in low- and middle-income countries. Lifestyle modification, especially dietary intervention like the DASH (Dietary Approaches to Stop Hypertension) diet, plays a vital role in blood pressure control.

Aim: This study aimed to evaluate the effectiveness of health education on the knowledge level of hypertensive patients regarding the DASH diet in Mosul city, Iraq.

Methods: A quasi-experimental one-group pre- and post-test design was conducted among 50 hypertensive patients attending outpatient clinics in hospitals of Mosul city from September 2024 to January 2025. Data were collected using a special questionnaire before and after dietary education.

Results: The majority of participants (88.0%) were aged 45 years or older. There were 9 (18%) males and 41 (82.0%) females. Pre-intervention results showed that (88.0%) had poor knowledge about the DASH diet. After the intervention, 66.0% achieved good knowledge scores, with a statistically significant improvement in Mean±SD of knowledge scores from 30.5±13.77 to 71.5±14.25 and significant p value (p<0.001).

Conclusion: This dietary educational intervention significantly improved participants' knowledge regarding the DASH diet. Health education programs should be integrated into routine care to promote lifestyle modification and support self-management among hypertensive patients.

Aim: To examine perceived professional competence of nurses in Kazakhstan's primary health care system and identify organizational and workforce factors associated with competence and collaboration.

Methods: Between April and June 2022, primary health care nurses in urban and rural Kazakhstan completed a 64-item questionnaire assessing perceived professional competence, nurse-physician collaboration, availability of resources, and preparedness for epidemic conditions. A context-specific instrument was developed based on national PHC regulations and COVID-19 protocols. Data were analyzed using descriptive statistics, Spearman correlation, multiple linear regression, and exploratory factor analysis.

Results: A total of 1,134 nurses participated, with 56.66% holding technical or vocational qualifications. Most respondents rated nurse-physician collaboration positively (80% "Yes"). Higher perceived competence was associated with preparedness for pandemics, regulatory knowledge, and use of triage algorithms. Three factors explained 65% of the variance: organizational effectiveness, workforce characteristics, and epidemic-related conditions.

Conclusions: Nurses' perceived competence in Kazakhstan is shaped by organizational readiness, particularly in rural areas. Strengthening preparedness and regulatory literacy is key to enhancing resilience in PHC.

Background: Uropathogenic Escherichia coli (UPEC) represents the leading cause of urinary tract infections (UTIs) worldwide and remains a growing clinical concern due to increasing antimicrobial resistance. Data describing the molecular epidemiology of UPEC in Georgia are limited.

Methods: Ninety E. coli isolates obtained from patients with genitourinary infections were analyzed. Species identification was confirmed by 16S rRNA gene sequencing. UPEC strains were identified by PCR detection of virulence-associated genes (c3509, c3686 (yrbH), and chuA). Phylogenetic grouping was performed using the Clermont multiplex PCR method. Antimicrobial susceptibility testing was carried out by disk diffusion in accordance with EUCAST guidelines.

Results: Eighty-one isolates (90%) were classified as UPEC based on the presence of at least one virulence marker. Twenty-nine strains carried all three genes, whereas 22 harbored a single marker. Phylogenetic analysis demonstrated a predominance of group B2, with additional representation from groups A, B1, F, and clade I/II; several isolates remained unclassified. Resistance rates among UPEC strains were highest for trimethoprim (55%), ciprofloxacin (47%), and ceftriaxone (42%). Nitrofurantoin (5% resistance) and fosfomycin (3% resistance) remained highly effective. Notably, B2 strains exhibited higher frequencies of trimethoprim and ciprofloxacin resistance compared with non-B2 strains.

Conclusion: UPEC strains circulating in Georgia exhibit marked phylogenetic diversity but relatively low levels of multidrug resistance. Continued surveillance is warranted to support evidence-based antimicrobial therapy and stewardship.