Diabetes mellitus (DM) is a significant public health and economic concern in Saudi Arabia, affecting more than 20% of adults. Insulin remains a cornerstone in DM management, but the country relies significantly on imported products. Hence, this results in high healthcare expenditures and variable availability. In line with Vision 2030, Saudi Arabia has prioritized the localization of insulin manufacturing to ensure sustainable access, reduce import dependency, and enhance national health security. This paper explores the clinical, economic, and policy implications of localizing insulin production in the Kingdom. The current work used a case study methodology to assess the feasibility, challenges, and strategic opportunities for the domestic production of innovative insulins, such as Degludec and IDegAsp. The study supports the development of public-private partnerships, investment in biotechnology infrastructure, and regulatory reform to foster a robust local biopharmaceutical ecosystem. By 2027, Saudi Arabia aims to meet 50% of its insulin demand through local production, making it the first country in the GCC region to produce innovative insulin. This initiative is expected to promote affordability and position the Kingdom as a leader in insulin innovation.

This research analyzes the impact of Financial Constraints, Income Shifting, and Sustainability Reporting on tax avoidance, with Institutional Ownership as a moderating variable. The sample consists of 34 manufacturing companies listed on the Indonesia Stock Exchange from 2021 to 2023, using purposive sampling methods. Data were analyzed using panel data regression with EViews 12. The results indicate that Income Shifting and Sustainability Reporting significantly affect Tax Avoidance, while Financial Constraints do not impact Tax Avoidance. Additionally, Institutional Ownership moderates the effect of Income Shifting on Tax Avoidance but does not moderate the effects of Financial Constraints and Sustainability Reporting on Tax Avoidance. This study meets classical assumption tests and found no issues with multicollinearity, heteroscedasticity, or autocorrelation. The findings highlight the importance of Institutional Ownership in monitoring tax avoidance and the need for transparency in sustainability reporting.

Late blight, caused by Phytophthora infestans, is a devastating disease of tomato, primarily driven by asexual reproduction through sporangia and zoospores. This study presents the first confirmed report of self-fertile P. infestans isolates in Northeast India, capable of producing sexual oospores, signifying a major shift in the pathogen's survival strategy. Infected tomato plants collected between November and December were cultured on rye agar at 18 ± 1°C. Oospore initiation occurred after 28 days, with mature oospores averaging 35 µm in diameter. These self-fertile isolates formed oospores independently and exhibited pathogenicity as confirmed by Koch's postulates. Field observations over five years in semi-temperate conditions (10–17°C, high humidity) confirmed oospore formation in senescing tissues. This discovery suggests that P. infestans may now overwinter in soil via oospores, increasing its persistence and genetic diversity, and possibly resulting in earlier and more severe outbreaks. These findings highlight the urgent need for integrated management strategies targeting both asexual and sexual propagules.

The inadequate supply of educational teaching aids and truly functional laboratories to aid teaching and learning of sciences across Nigeria, particularly Zamfara State, due to high cost incurred in acquiring them has necessitated the invention of a multifunctional mobile teaching aid and intervention laboratory for schools. The invention is a home-grown, purpose-built game changer to positively leverage the educational sector to enhance quality and effective Science, Technology. Engineering and Mathematics (STEM) education in Nigeria. Thus, the article x-rays banditry activities in Zamfara State and feasibility of integrating mobile-laboratory-intervention for skills acquisition in Zamfara State. The study adopted a mixed method research design using both qualitative and quantitative data. Four research questions and hypotheses were formulated to guide the study. The population consisted of 280 principals selected from three educational zones in Zamfara State using multi-stage sampling technique. A self-designed instrument was used for data collection. The questionnaire was subjected to face-and content validity by experts in education and gave a reliability coefficient of 0.85 using Cronbach Alpha reliability test. Mean and standard deviation were used for answering the research questions while t-test analysis was used in testing the hypotheses for the study at 0.05 level of significance. The findings revealed no significant difference in the opinion of the respondents on the impact of banditry activities on STEM education for skills acquisition in Zamfara State. The study recommended among others that the provision of multifunctional mobile laboratory intervention, organization of workshops and conferences on the significance of STEM education should be encouraged at all levels.

Background: Cancer cachexia, often referred to as cancer wasting, is a multifactorial syndrome characterized by involuntary weight loss, muscle wasting, and systemic inflammation. It affects up to 80% of patients with advanced malignancy and is a major cause of morbidity and mortality. Despite increasing recognition, it remains underdiagnosed and inadequately treated. Objective: This meta-analysis aimed to evaluate the prevalence, clinical consequences, and effectiveness of interventions for cancer cachexia across malignancies. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library up to December 2024. Randomized controlled trials (RCTs), cohort studies, and meta-analyses reporting prevalence, outcomes, or interventions in adult cancer patients were included. Studies were pooled using a random-effects model. Primary outcomes were prevalence and overall survival; secondary outcomes included treatment tolerance, quality of life, and intervention efficacy. Results: Forty-eight studies comprising 23,400 patients were analyzed. The pooled prevalence of cachexia was 49.2% (95% CI 43.1–54.8), highest in pancreatic (74%) and lung cancer (63%) populations. Cachexia was associated with a 41% higher risk of mortality (HR 1.41; 95% CI 1.23–1.61) and reduced chemotherapy tolerance (RR 1.38). Nutritional interventions alone were insufficient, whereas multimodal approaches (nutrition, pharmacologic agents, exercise) improved weight stabilization and quality of life. Anamorelin drug showed moderate efficacy in increasing lean body mass, though survival benefit remained unproven. Conclusion: Cancer cachexia is highly prevalent and clinically significant, yet interventions remain suboptimal. Early identification and multimodal treatment should be integrated into oncology practice. Future research must focus on biomarkers, standardization of diagnostic criteria, and novel therapeutic targets.

The integration of neuroanatomophysiology and neuropsychopharmacology links the structural and functional organization of the nervous system with the pharmacological modulation of neural processes, cognition, mood, and behavior, creating an interdisciplinary bridge between neuroscience and clinical practice. Differentiating neurodivergence, understood as natural variations in brain structure and function, from neurological disorders, involving impairments or degenerative processes, is essential for diagnostic accuracy and social inclusivity. Advances in neuroimaging, biomarkers, and targeted pharmacotherapies have enabled earlier detection, better characterization, and personalized interventions. This study aimed to analyze how these fields interact in understanding, diagnosing, and treating neurodivergence and neurological disorders through an integrative bibliographic review. Searches in SciELO, LILACS, BVSMS, and Google Scholar used controlled descriptors and free-text terms, with inclusion of qualitative review articles in Portuguese, English, or Spanish. Data extraction emphasized objectives, methods, and findings, prioritizing methodological rigor to integrate theoretical and applied perspectives for improved clinical outcomes.

Stereotactic lesioning has re-emerged as a feasible option to deep brain stimulation (DBS) for severe Parkinson's disease (PD), especially in individuals with restricted access to device-based therapy. Although single-target lesioning of the ventral intermediate nucleus (Vim) or globes pallidus internus (GPi) effectively addresses certain motor disorders, dual-target lesioning within the same hemisphere is yet little investigated. To assess the effectiveness and safety of dual-target stereotactic lesioning (Vim + GPi) against single-target lesioning (Vim or GPi alone) in individuals with advanced Parkinson's disease and medication-resistant motor symptoms. A prospective observational research with 450 consecutive patients with advanced Parkinson's disease was carried out at two neurosurgical centers in Iraq. Patients underwent either single-target (n = 321) or dual-target (n = 129) radiofrequency lesioning. Outcomes were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS-III) and complication rates over a follow-up period of 1–2 years. Statistical comparisons were made using t-tests and p-values < 0.05 were considered significant. Dual-target lesioning yielded significantly greater improvement in tremor (↓ 85.7%), rigidity (↓ 75.7%), and bradykinesia (↓ 82.4%) compared to single-target approaches (all p < 0.0001). However, complication rates were higher in the dual-target group, particularly for speech (27.1% vs. 13.1%, p = 0.0016) and balance disturbances (37.2% vs. 17.1%, p < 0.0001). No notable variations were detected in age, illness duration, or baseline LEDD across the groups. In comparison to single-target ablation, dual-target stereotactic lesioning is associated with a higher incidence of adverse effects; nevertheless, it is significantly more successful in managing motor symptoms in advanced Parkinson's disease (PD). The meticulous selection of patients and the adjustment of lesion characteristics are essential to enhance benefits while concurrently limiting issues. In individuals unsuitable for deep brain stimulation (DBS) or seeking more comprehensive symptom relief, these findings advocate for the targeted application of dual-target approaches.

The BRICS bloc, which includes Brazil, Russia, India, China, and South Africa, has become a unified economic bloc that is busily reshaping the frontiers of world governance. Representing more than forty percent of the global population and a growing portion of world GDP, BRICS expresses a different vision of multilateralism, which systematically challenges the normative and institutional dominance of the Western order. This paper conceptualizes BRICS as a norm-entrepreneurial alliance that has the goal of transforming the global orders in finance, trade, and development cooperation without compromising the values of state sovereignty, policy autonomy, and South-South solidarity. This study is based on constructivist international relations theory and the global political economy of institutional change to provide a complete analysis. The qualitative discourse analysis of BRICS summit declarations between 2009 and 2024 and policy communiques is enhanced with the quantitative analysis of the trade, investment, and financial-flow indicators retrieved at the World Bank, IMF, and UNCTAD. The analysis has shown that BRICS has played a tangible role in the spread of multipolar governance norms, and it has also helped to introduce parallel institutions, including the New Development Bank and the Contingent Reserve Arrangement. However, the ability of BRICS to cause major transformation is constrained by domestic imbalance in economic strength, political systems, and strategic goals among the participants. The findings have established that though BRICS could drive a more inclusive and equitable global order, its potential is limited to a large extent due to deep gaps between members of the bloc in terms of economic power, political frameworks, and strategic concerns. BRICS exemplifies the irony of global change by shaking the existing power order and at the same time relying on it to maintain stability the multi-faceted nature of reform and continuity that characterizes the modern age of global change. It is important to recognize this duality to comprehend the way international governance is changing in the modern multipolar and highly contested world.

The world financial system is growing more volatile, and it is questionable whether the conventional reserve currencies will remain as strong as ever. This paper examines whether the euro can meaningfully challenge the U.S. dollar's dominance as increasing economic volatility and the appearance of new competitors like the Chinese Yuan raise this question. This study applies a qualitative and descriptive-quantitative study design. The analysis in this paper draws on empirical data from institutions including the IMF and the BIS. To guide the analysis, this paper uses three key theories: hegemonic stability theory, network effects, and institutional trust. While the U.S. dollar is still the main global currency, it's losing ground. Its share used to be above 70%, but now it's decreased to 53.6%. The euro, on the other hand, has maintained a consistent 20% share and has been remarkably stable. The euro gets its strength from the EU's reliable banking policies and a strong legal system. However, internal division stalls its growth as a global heavyweight. Specifically, the lack of a common fiscal policy and constant political disagreements among member states act as a drag on its overall performance. The Yuan is growing, but it still only accounts for about 2% of the world’s reserves. Despite China's massive economy, the currency is held back by 'red tape' and trust issues specifically, strict controls on moving money, government intervention in its value, and a general lack of transparency. This paper concludes that no single currency will take the lead in the future. Rather, the world is moving toward a multipolar reserve system where the dollar, euro, Yuan, and selected digital currencies will coexist.

Beta-thalassemia major (β-TM) is a prevalent hereditary condition. Because they are highly prone to infection, the patients will have higher rates of infection-related death and morbidity. Meteorin-like protein (METRNL) a minor secreted protein and weighs about 28 kDa, which comprise 311 amino acids. This study aimed to evaluation immune inflammatory markers METRNL in sera patients with β-TM groups. Thalassemia Unit" at the "Al Zahra Teaching Hospital" in Najaf, Iraq, registered 60 patients with β-TM, including children and adolescents. They were 28 females and 32 males, ages 7 to 20. during the January–March 2022 timeframe. In the current study, it is found a significant increase in serum levels of FSG, insulin, and HOMA-IR, as well showed significantly lowered in BMI, HOMA-β, and METRNL in patients with β-TM as compared with control group. The linear regression analysis showed that the levels of FSG, insulin and HOMA-IR were significantly negative correlation with METRNL. ROC curve form METRNL that might be diagnosis of patients with β-TM with an AUC (0.748), the cut-off value was 29.0025 (ng/mL) for serum METRNL (95% CI: 0.585-0.911; p=0.003), a sensitivity of 73.3% and a specificity of 78% were acquired for METRNL in β-TM patients. The lower serum METRNL levels in β-TM patients than the healthy group, may be used potential risk indicator of the patients' worse prognosis, for induces endothelial dysfunction and lead to inflammation in most organs tissues could be later outcome to heme induce damage.

The paper examines the impact of mobile health applications on patient adherence through a literature-based research approach. Key questions explored include the impact of mHealth on treatment compliance, the efficacy of app-based interventions, and barriers to adoption. The study aims to assess mHealth’s influence on adherence, identify success factors, and evaluate its potential to address healthcare gaps. The methodology involved a systematic literature review of peer-reviewed articles, clinical trials, and case studies from 2015 to 2023, utilizing qualitative and quantitative analysis to synthesize findings. Data were collected on app features, user engagement metrics, and adherence outcomes from databases like PubMed, IEEE Xplore, and Google Scholar. Results show that mHealth apps significantly improve adherence through reminders, educational content, and personalized feedback, with a notable impact on chronic disease management. Challenges such as low digital literacy and privacy concerns hinder efficacy. The study concludes that mHealth has transformative potential but depends on user-centered design, robust data security, and healthcare system integration. Contributions include a framework for optimizing app-based interventions and policy recommendations to support digital health adoption. Practical applications include reduced treatment gaps and healthcare costs, while limitations like sample bias and technological evolution highlight the need for longitudinal research. Future directions include investigating AI-driven personalization and cross-cultural adaptability.

Background: Telehealth or telemedicine primarily focuses on patient benefits and safety including improved accessibility, enhanced patient satisfaction, and establishing and maintaining continuity of care. The John Hopkins Aramco Healthcare (JHAH) pharmacy aimed at establishing the pharmacist-led medication management clinics (MMC) clinics as a model of medication management and patient counseling. Objectives: To describe and compare the outcome of implementing telehealth services managed via a pharmacist-led medication management clinic (MMC) to confer person-centered patient care services at JHAH. Methodology: The retrospective observational study was conducted in a single-centered tertiary care institution, John Hopkins Aramco Healthcare, Saudi Arabia for a duration of six months from June 2021 to December 2021 among ambulatory care patients. Results: There were few significant differences between the gender distribution between patients of tele MMC and MMC that TELEMMC were more preferable choice for the age group 61-70 years compared to MMC, where as in MMC age group 51-60 years were more preferable. Both TELEMMC and MMC demonstrated a high level of satisfaction with general medicine department with 63% of patients. Conclusion: The present study demonstrates the impact of TELEMMC on clinics, indicating a substantial increase in the number of individuals, particularly geriatric patients, opting for telemedicine consultations. The widespread acceptance of this new method reflects the positive impact it has had on healthcare delivery and patient outcomes

The objectives of this cross-sectional study were: To conduct a reflective analysis on the issues surrounding the pedagogical supervision of continuing education trainees; To assess the degree of satisfaction among these trainees regarding the quality of guidance provided by their pedagogical supervisors. The trainees’ perceptions of pedagogical supervision were collected through a questionnaire designed specifically for this study. It was developed based on recommendations from the literature and underwent both internal and external validation of its content. The surveyed trainees expressed their opinions in response to the items administered. In total, twenty-eight (28) Physical Education and Sports teachers all continuing education students at the Higher Institute of Physical Education and Sports undertaking internships at three (3) colleges in Brazzaville (CEG 28 Novembre in Moukoundo, CEG Bayonne in Nkombo, and CEG Ibaliko in Massengo), constituted our research field. These were the institutions where the students were assigned for practical training. The results of our study show that 87.50% of the continuing education students surveyed believe that discussions with supervisors are very important. This positive perception is explained by the fact that nearly all the students 95% reported enjoying freedom of expression during these discussions, which fostered a sense of trust. In this regard, our study is of great utility to education policymakers, who may use its findings to take appropriate measures aimed at improving teaching and learning in schools. Acknowledging that this study only scratches the surface of the broader issue of pedagogical supervision for student-teachers, we believe it would be worthwhile to pursue further research exploring this same issue from different perspectives in order to build a more complete picture of the current situation.

This study developed a machine learning-based failure predictive application software to improve the operational efficiency and reliability of turbo-compressors in gas injection plants. The Gas injection plant produced below maximum capacity due to failure problems of the Turbo-compressors, these affected the targeted oil production negatively. The unavailability and unreliable gas plant led to revenue losses. The failure analysis revealed that equipment and material issues, human factors, external factors, and management-related issues contributed to equipment failures. Machine learning techniques, specifically Logistic Regression, Support Vector Machines (SVM), Boosted Trees, and Artificial Neural Networks (ANN), were employed to develop the failure predictive application software. The results showed that the Efficient Linear SVM model achieved a true positive rate of 99.5% for detecting failures and 99.9% classification precision for non-failure events. The Boosted Trees model achieved a true positive rate (TPR) of 99.5% for detecting failures, although it demonstrated a 0.5% false negative rate, highlighting the need for further optimization and integration with ensemble techniques to minimize operational risks. The SVM model further showcased 99.9% classification precision for non-failure events and a minimal false negative occurrence. The nearly perfect R-values across training, validation, and test datasets, coupled with minimal MSE values at the optimal number of epochs displayed by the ANN model further confirmed that the model can generalize effectively to unseen data. The outcomes of this research yielded a highly effective, computationally efficient machine learning-based application software capable of reliably predicting turbo-compressor failures. The study concluded that the developed application software is a powerful tool for predicting failures in gas injection plants, supporting decision-making processes, and enhancing operational safety. Recommendations for future works included refining existing models, exploring additional feature engineering techniques, and evaluating the robustness of the models under varying operational conditions.

Penile strangulation is a rare event that requires emergency treatment. Metal rings are most commonly used on the penis for autoerotic or aggressive purposes or to enhance sexual performance. We report a case of a 19-year-old male patient undergoing psychiatric treatment at the Dalal Xél health center in Fatick, who was admitted to the emergency department of Kaffrine Regional Hospital (in Senegal), for penile strangulation by a metal ring. The ring had been placed at the root of the penis three days earlier. The patient had no urinary disorders. Treatment consisted of removing the ring and providing psychiatric care. However, to prevent urinary and sexual complications, treatment must be provided early. Through this observation and data from the literature, the authors report the subtlety of the management of this pathological situation, highlighting the psychotic context which favors this type of self-aggressive behavior.