Search Results (6,292)

Background/Objectives: Double-J (DJ) ureteral stents are prone to luminal occlusion, which causes renal dysfunction and complicates exchange. Risk stratification in chronically stent-dependent patients is poorly defined, and the management of confirmed occlusion is not standardised. We aimed to identify independent risk factors for DJ stent occlusion in a chronically stent-dependent population and to evaluate stent-type substitution at first confirmed occlusion. Methods: We conducted a single-centre retrospective cohort study at a tertiary urology service in Melbourne, Australia (January 2023 to December 2025). Patients requiring three or more sequential DJ replacements were eligible. Mechanical occlusion was defined as inability to pass a guidewire through the stent lumen at fluoroscopic exchange, an objective intraoperative surrogate; clinical failure events (nephrostomy conversion, septic admission, or acute kidney injury requiring intervention) were recorded separately. Midstream urine culture and pre-exchange renal ultrasound were obtained at each visit. Cox proportional hazards modelling with robust patient-level clustering was performed. Results: We analysed 125 ureters (97 patients) over a mean follow-up of 20.6 months. Occlusion occurred in 55 ureters (44.0%). Four predictors were robust to Bonferroni correction: indwelling urethral catheter (hazard ratio [HR] 4.62), urinary stone disease versus malignant disease (HR 4.02), retroperitoneal fibrosis versus malignant disease (HR 3.24), and bacteriuria at exchange (HR 2.76). Two further associations, Eastern Cooperative Oncology Group (ECOG) performance status 2 to 4 (HR 2.31) and prior pyelonephritis (HR 1.89), did not survive correction and are exploratory. After stent-type substitution at first occlusion, 43 of 55 ureters (78.2%) had no further occlusion without interval shortening. Summer accounted for 45.1% of events (p < 0.001). Conclusions: In chronically stent-dependent patients, several factors were independently associated with DJ stent occlusion, four of them robust to multiple-comparison correction. Stent-type substitution was associated with occlusion-free outcomes in most cases without interval shortening; because the analysis was uncontrolled and regression to the mean cannot be excluded, this observation is hypothesis-generating. All hazard estimates are exploratory in view of an events-per-variable ratio below ten and a survivor-selected cohort, and apply only to patients with established chronic stent dependency. Prospective randomised evaluation is warranted. Full article

Background: Oral lichen planus is a chronic oral potentially malignant disorder requiring timely diagnosis and long-term follow-up, yet its diagnostic pathway remains poorly characterised. This study assessed diagnostic and follow-up intervals in patients with oral lichen planus and explored associated clinical and healthcare-related factors. Methods: This retrospective cohort study included 199 patients with clinically and histopathologically confirmed oral lichen planus managed at the Oral Medicine Unit of the University of Murcia. Diagnostic time points were defined using an adapted Aarhus framework. Patient, primary care, specialist diagnostic and total intervals were analysed using multivariable quasi-Poisson regression. Loss to follow-up was assessed using Cox regression. Results: Older age was associated with longer patient, primary care and total intervals. Women had a shorter patient interval than men (IRR = 0.44; 95% CI: 0.21–0.91; p = 0.03), but a longer primary care interval (IRR = 3.09; 95% CI: 1.12–10.2; p = 0.04). Compared with erosive oral lichen planus, mixed and reticular forms showed shorter primary care intervals and shorter specialist diagnostic intervals, with IRRs ranging from 0.21 to 0.36 (all p < 0.01). Daily alcohol consumption was associated with the longest total interval. Older age was associated with a higher risk of loss to follow-up (HR = 1.02; 95% CI: 1.00–1.04; p = 0.01), whereas non-pharmacological treatment was associated with a lower hazard of loss to follow-up (HR = 0.31; 95% CI: 0.16–0.60; p < 0.001). Conclusions: Diagnostic delay in oral lichen planus is multifactorial and appears to depend on patient characteristics, clinical presentation and healthcare pathway factors. Improved recognition of erosive disease, clearer referral criteria and structured follow-up strategies may enhance care continuity. Full article

In modern societies, the renewed concept of food as medicine coexists with unprecedented consumption of highly processed foods, food additives, environmental xenobiotics, and pharmacological agents, contributing to the increasing prevalence of metabolic and degenerative diseases and accelerated aging. Although modern pharmacotherapies have transformed disease management, long-term drug exposure introduces additional metabolic burdens, off-target effects, and cumulative toxicities that are profoundly influenced by nutritional status. Collectively, dietary constituents, environmental chemicals, endogenous metabolic by-products, and therapeutic agents constitute a complex exposome that requires continuous recognition, utilization, detoxification, and clearance. Within this context, the liver sinusoidal clearance system (LSCS) emerges as a central regulator of systemic homeostasis. We propose a conceptual framework in which circulating molecules are classified as self (S), modified self (M), and foreign (F) molecules according to their physiological handling by the LSCS. Through coordinated hepatic utilization of S molecules and selective clearance of M and F molecules, fenestrated liver sinusoidal endothelial cells (LSECs) maintain metabolic homeostasis, immune tolerance, and physiological pharmacokinetics. Conversely, chronic dietary overload, poor dietary quality, food processing, and sustained exposure to pro-inflammatory and oxidative dietary and environmental molecules initiate chronic low-grade inflammation, which promotes LSEC capillarization, impairs hepatic clearance, increases the modification of S molecules into M molecules and establishes a feed-forward cycle that further amplifies chronic inflammation and metabolic dysfunction. Finally, we discuss recent advances in the programmable modulation of the LSCS, including its transient suppression to prolong therapeutic exposure and its activation to enhance the clearance of metabolically harmful M and F molecules through coordinated upregulation of the endoglin–stabilin-2–FcγRIIb axis and the LSEC markers Oit3 and Dnase1L3. We highlight dual-function supramolecular nanofiber platforms that enable bidirectional regulation of the LSCS through nanofiber complexes with therapeutic proteins, thereby expanding their therapeutic potential and enhancing efficacy in the treatment of metabolic, inflammatory, and age-related diseases. Full article

Conventional oral and injectable drug administration still struggles with unstable plasma levels, weak targeting, and considerable systemic toxicity, problems that become especially acute in chronic disease management. Implantable and wearable biomedical devices offer one path around these limits, yet device-only platforms continue to fall short on drug loading, release control, and protection of fragile therapeutics. Integrating nanoparticle-based biomaterials into such devices has therefore moved from a research curiosity to a serious clinical strategy. As a result, understanding the design principles, translational challenges, and clinical potential of these hybrid platforms has become increasingly important. This review provides a comprehensive assessment of four major nanoparticle families—polymeric carriers (PLGA, chitosan, and micelles), lipid-based vehicles (liposomes, SLNs, and NLCs), inorganic systems (gold, mesoporous silica, iron oxide, and calcium phosphate), and hybrid composites—focusing on how their physicochemical properties govern drug encapsulation, release behavior, and tissue compatibility. These classes are then linked to specific implantable formats such as drug-eluting stents, nano-enabled scaffolds, and reservoir depots, and to wearable formats including transdermal patches, microneedle arrays, biosensor-coupled patches, and patient-actuated devices. A dedicated section addresses stimuli-responsive release driven by pH, enzymes, temperature, and electrical or magnetic fields, alongside closed-loop platforms that pair real-time biosensing with on-demand dosing. Surface engineering strategies, ligand targeting, antifouling coatings, antimicrobial layers, and immune-modulating chemistries are also discussed, together with the central translational hurdles: long-term stability, foreign body response, scale-up, sterilization, and regulatory classification of combination products. Finally, the review outlines near-term directions, including AI-driven dosing, 4D bioprinting, biomimetic nanocarriers, gene therapy delivery, and bioresorbable electronics, that together suggest where these hybrid platforms are likely to mature next. Full article

Advances in healthcare have led to substantial growth in the global population of cancer survivors, yet young adult cancer survivors (YACS) aged 18–39 years remain an underrepresented population in cancer survivorship research. This review examines the health challenges and psychosocial factors that shape nutritional status in YACS, with the aim of informing age-appropriate nutritional care. YACS face significant financial and psychosocial demands unique to this life stage, balancing education, early careers and family responsibilities. They report greater unmet nutritional and health needs than other age cohorts, in addition to concerns regarding long-term side effects, financial strain, fear of cancer recurrence and increased responsibility for managing their own care. Cancer treatment can cause nutrition impact symptoms (e.g., nausea, taste changes, fatigue, dysphagia and gastrointestinal (GI) disturbances) that may persist for years, and YACS are vulnerable to late effects such as endocrine dysfunction, cardiometabolic disease, chronic pain and osteoporosis, all of which can be influenced by diet. Poor dietary patterns have been observed in YACS, indicating low intakes of fruits, vegetables, fibre and dairy, and higher consumption of saturated fat, sodium and processed foods. This narrative review evaluated fourteen nutritional intervention studies targeting YACS aged 18–39. Most existing interventions demonstrate minimal recruitment and retention rates, small sample sizes, and a reliance on self-report methods rather than objective nutritional measures. These limitations highlight the need for a deeper understanding of YACS’ specific nutritional needs and more effective strategies to engage this cohort. Future research should prioritise larger, more representative samples, incorporate objective nutritional and clinical measures, and explicitly address psychosocial and age-related barriers to healthy eating in young adulthood. Full article

Background: Obesity is a chronic, multifactorial disease that demands personalized and sustainable management approaches. Digital health technologies, such as artificial intelligence, wearable devices, mobile health apps, and virtual reality (VR), may support obesity care by providing enhanced behavioral monitoring, personalized feedback, and patient engagement. Objective: This critical narrative review discusses the current evidence on artificial intelligence, wearable technologies, and VR in the context of precision nutrition and obesity management and their possible clinical applications and limitations. Method: A critical narrative review was conducted using peer-reviewed literature published between 2019 and 2026 and identified through PubMed and Google Scholar. Search terms included combinations of “precision nutrition,” “personalized nutrition,” “obesity,” “weight management,” “metabolic health,” “digital health,” “artificial intelligence,” “machine learning,” “mobile health,” “wearable devices,” and “omics” using Boolean operators. Evidence from randomized controlled trials, systematic reviews, meta-analyses, and key conceptual studies was critically synthesized due to substantial heterogeneity in interventions and outcomes. Result: Wearables and mobile applications can enable continuous self-monitoring of physical activity, dietary intake, sleep, and physiological measures. Artificial intelligence may improve dietary personalization, risk prediction, glycemic control, and adaptive feedback. VR offers an immersive way to tackle behavioral and cognitive mechanisms related to overeating such as cravings, food cue reactivity, and inhibitory control. However, the evidence is heterogeneous, with many studies limited by short follow-up periods, small samples, variable adherence, and insufficient clinical validation. Conclusions: Artificial intelligence, wearable technologies, and VR are promising tools for precision obesity management, but their long-term clinical effectiveness remains uncertain. Future research should prioritize adequately powered trials, longer follow-up, standardized outcomes, transparent algorithms, ethical data governance, and integration with multidisciplinary nutrition and obesity care. Full article

Kartagener syndrome (KS) is a rare form of primary ciliary dyskinesia (PCD) characterized by chronic respiratory infections, bronchiectasis, chronic rhinosinusitis, and situs inversus. Evidence regarding biologic therapies in this setting is currently lacking. We report the case of a patient with KS and severe refractory chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab after failure of conventional medical and surgical management. Treatment resulted in marked improvements in symptom burden, olfactory function, endoscopic findings, and quality of life, with sustained benefit throughout the 12-month follow-up. This observation suggests that type 2 inflammation may contribute to disease burden in selected patients with PCD and supports further investigation of biologic therapies in this challenging clinical setting. Full article

Background/Objectives: The advent of immune checkpoint inhibitors (ICIs) and targeted therapies has revolutionized advanced cutaneous melanoma care, shifting it from an acutely fatal illness to a chronic, manageable condition. While extending survival, these modern therapies introduce a new spectrum of persistent immune-related adverse events (irAEs) and long-term toxicities. This study aims to explore the “Toxicity-HRQoL Paradox” to comprehensively evaluate the true price of survival across the melanoma treatment continuum. Methods: This narrative review, based on a systematic database search, synthesizes quantitative patient-reported outcomes, health-related quality of life (HRQoL) trajectories, and health-economic data. It evaluates the impact of surgical, regional, and modern systemic therapies utilizing data derived from validated instruments, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), EuroQol 5 Dimensions (EQ-5D), Functional Assessment of Cancer Therapy-Melanoma (FACT-M), and comprehensive score for financial toxicity (COST). Results: Historically, extensive locoregional surgeries and high-dose interferons caused profound, debilitating drops in physical and overall QoL. Today, modern systemic therapies are associated with high rates of severe (Grade ≥ 3) acute toxicities and irreversible chronic conditions, such as permanent endocrinopathies. Despite this, global HRQoL frequently remains stable or even improves. This “toxicity-HRQoL paradox” occurs because the profound psychological relief of durable disease control effectively offsets the physical symptom burden. Furthermore, neoadjuvant ICI approaches demonstrate superior long-term HRQoL by enabling tailored surgical de-escalation. Ultimately, extended survivorship unmasks hidden burdens, revealing high prevalences of fear of cancer recurrence (FCR) (81–86%) and substantial financial toxicity. Conclusions: Despite the severe physical toxicities of modern melanoma treatments, the psychological benefit of survival largely preserves overall HRQoL. However, optimizing the modern survivorship experience requires the widespread adoption of melanoma-specific HRQoL tools and proactive, multidisciplinary care models to manage chronic toxicities, psychosocial distress, and financial burdens. Full article

Background and aim: Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract resulting from a complex interplay among genetic susceptibility, immune dysregulation, environmental factors, and alterations in the gut microbiota. Among these, diet has emerged as a key modifiable factor influencing intestinal inflammation, barrier integrity, and disease progression. This review aims to critically evaluate the role of dietary patterns and food additives in the pathogenesis and management of Crohn’s disease, with particular emphasis on their effects on intestinal inflammation, epithelial barrier function, and host–microbiota interactions. Methods: A comprehensive literature search was conducted using the PubMed, Scopus, and Web of Science databases up to March 2026. Clinical trials, observational studies, and mechanistic research were included based on their relevance to dietary factors, food additives, and intestinal inflammation in CD. Evidence was synthesized narratively to integrate clinical and experimental findings. Results: Dietary interventions such as the Crohn’s disease exclusion diet (CDED), specific carbohydrate diet (SCD), low-FODMAP diet, and Mediterranean diet (MD) demonstrate varying degrees of efficacy in improving clinical symptoms and, in some cases, inflammatory markers. In contrast, high consumption of ultra-processed foods is consistently associated with increased disease risk and activity. Emerging evidence highlights the role of food additives—particularly emulsifiers and artificial sweeteners—in disrupting gut barrier integrity, promoting dysbiosis, and enhancing inflammatory responses. Recent human studies further suggest that exposure to these compounds may correlate with disease activity, supporting their potential role in CD pathophysiology. Conclusions: Diet plays a significant adjunctive role in the management of Crohn’s disease. Reducing exposure to ultra-processed foods and potentially harmful food additives, while promoting balanced dietary patterns, may improve clinical outcomes. Further research is needed to clarify long-term effects and to develop personalized, evidence-based nutritional strategies for patients with CD. Full article

Background: Giant African Land Snails originate from Africa. Although these snails are becoming more popular as exotic pets in Europe, there is a lack of comprehensive information about their diseases and how to treat them. Reported medical issues included failures in husbandry and feeding (often leading to aestivation, calcium deficiency or renal disease), trauma, poison, prolapse, and ecto- and endoparasites, as well as bacterial and fungal infections. Although their reproductive system has been well studied, dystocia has not yet been reported in terrestrial snail species. Patient Presentation: Two cases of dystocia in pet Giant African Land Snails are presented. Case 1 involved a 5.5-year-old Lissachatina fulica with esophageal prolapse and severe chronic dystocia, as indicated by radiographic and computed tomographic findings, ultimately leading to euthanasia. Case 2 involved a 3-year-old Lissachatina albopicta also affected by dystocia, with computed tomography again showing findings consistent with the diagnosis, but subsequently laying most of the pathological clutch with supportive, conservative treatment. Conclusion: Dystocia in Giant African Land Snails is a significant health concern that can lead to severe complications and mortality. Early diagnosis using imaging techniques is crucial for identifying reproductive issues and determining appropriate treatment strategies. However, because these terrestrial snails have an open circulatory system and vascular anatomy remains incompletely characterized, the reproductive tract remains difficult to access surgically. Furthermore, there is currently insufficient evidence to support hormonal induction of oviposition as a therapeutic approach for egg retention in this species. Consequently, conservative management remains the primary supportive therapy. Full article

Psoriasis vulgaris is a chronic immune-mediated inflammatory disease in which treatment response is assessed using clinical indices such as the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), despite their limited ability to capture systemic inflammation and underlying immunological activity. This narrative review aims to summarize current evidence on inflammatory biomarkers for monitoring treatment response and to evaluate their potential clinical utility. A structured, non-systematic literature search was performed in April–May 2026 across PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov, focusing primarily on literature published during the preceding 10 years, with selected earlier studies being retained when directly relevant. Emerging data indicate that multiple biomarker domains may reflect therapeutic outcomes, including cytokines and chemokines, acute-phase proteins, complete-blood-count (CBC)-derived inflammatory indices, genetic markers, micro(mi)RNAs, metabolomic and lipidomic profiles, and tissue-based markers. These biomarkers may serve as severity-associated, baseline-predictive, pharmacodynamic, or prognostic markers, and these roles should not be interpreted interchangeably. Nevertheless, discrepancies between biomarker dynamics and clinical improvement occur, reflecting the partial dissociation between local and systemic inflammation, disease heterogeneity, and differences in response kinetics. Although inflammatory biomarkers provide a biologically grounded framework for assessing treatment response, their clinical implementation remains limited. Further large-scale, standardized studies are required to validate candidate markers and support the development of integrated, multi-omics approaches for personalized management. Full article

Background/Objective: Cinnamaldehyde (CA) is a naturally occurring bioactive compound derived from the leaves, bark, roots, and flowers of the Chinese medicinal plant Cinnamomum cassia. It exhibits a broad spectrum of pharmacological properties, encompassing antioxidant, antibacterial, anti-diabetic, antifungal, and anticancer activities. Notably, it has shown potential therapeutic benefits in the management of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Ochratoxin A (OTA), a common contaminant found in foods such as cereals, coffee, and raisins, is also present in traditional Chinese medicinal materials, including Astragalus and liquorice. T2DM and NAFLD share intertwined pathophysiological pathways, including insulin resistance, dyslipidaemia, chronic low-grade inflammation and oxidative stress, with insulin resistance serving as the common pathological hub for both conditions. Consequently, they frequently co-occur and exacerbate each other. OTA exerts dual-targeted toxicity to the pancreas and liver, which may synergistically drive the development of the comorbidity of T2DM and NAFLD. These two processes are mutually causal and together constitute the pathological basis of metabolic comorbidity. Methods: Network toxicology employs toxicological data, gene expression, and protein–protein interaction (PPI) networks to predict the targets of toxins, while network pharmacology, based on systems biology principles, reveals how drugs exert regulatory effects through multiple targets and pathways. In this study, we employed an integrated network toxicology and network pharmacology approach to jointly decipher the potential mechanisms by which CA intervenes in OTA-induced comorbid T2DM-NAFLD. First, a network toxicology approach was employed to preliminarily screen for core toxicological targets responsible for OTA’s pathogenicity. Subsequently, network pharmacology was used to identify potential targets of CA-mediated intervention in the disease. Finally, the common overlap among the CA intervention targets, OTA toxicity targets, and disease targets was defined as the final set of potential targets for CA-mediated intervention in OTA-induced T2DM-NAFLD comorbidity. A PPI network was constructed using the STRING database, and topological analysis was performed with Cytoscape. Core targets were selected using the median values of six parameters—betweenness centrality, closeness centrality, degree centrality, eigenvector centrality, LAC (local average connectivity) score, and network centrality—as cut-off thresholds, and the top 10 key genes were further identified using the cytoHubba plugin. Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted via the DAVID database, and the results were visualized on the CNSknowall platform. Lastly, molecular docking of the core targets was performed using the CB-DOCK2 platform to validate binding affinity. Results: Based on an integrated analysis of network toxicology, network pharmacology, and molecular docking, 10 key targets were systematically identified. These may serve as potential mediators of cinnamaldehyde in the treatment of OTA-induced T2DM-NAFLD comorbidity. Among these, six targets—albumin (ALB), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), interleukin-6 (IL-6), tumor necrosis factor (TNF), actin beta (ACTB), and estrogen receptor 1 (ESR1)—possess crystal structures amenable to molecular docking. KEGG enrichment analysis revealed that CA and OTA jointly participate in key pathological processes such as the cancer pathway, the lipid and atherosclerosis pathway, the advanced glycation end-products–receptor for advanced glycation end-products (AGE-RAGE) signaling pathway, the phosphatidylinositol 3-kinase–protein kinase B (PI3K-Akt) signaling pathway, the TNF signaling pathway, and the interleukin-17 (IL-17) signaling pathway. OTA exacerbates inflammatory responses, impairs insulin signaling, promotes hepatic steatosis, and disrupts systemic metabolic homeostasis, ultimately contributing to T2DM-NAFLD comorbidity. Conversely, cinnamaldehyde counteracts these pathological processes through multiple mechanisms, including antioxidant and anti-inflammatory effects as well as regulation of glucose and lipid metabolism, thereby restoring metabolic homeostasis. Conclusions: This study has preliminarily identified the toxicological targets of OTA and the potential intervention targets of CA, offering new avenues for preventing and intervening in OTA-induced metabolic toxicity. Furthermore, it provides a theoretical basis for CA as a potential multi-target therapeutic agent and presents novel insights worthy of further investigation into the prevention of T2DM-NAFLD comorbidity. Full article

Background: Chronic obstructive pulmonary disease (COPD) disproportionately affects older adults. While targeted biologic therapies have shown efficacy in type 2 eosinophilic endotypes, elderly patients remain underrepresented in pivotal clinical trials. This narrative review examines the pathophysiological rationale, efficacy data, and unique geriatric challenges of biologic therapies in older adults. Methods: A literature search was conducted in PubMed and Scopus for phase II and III randomized controlled trials (RCTs) and observational studies evaluating biologic agents (anti-IL-5, anti-IL-4/IL-13, and anti-alarmins) in COPD, focusing on populations aged ≥ 65 years, comorbidities, and frailty. Discussion: Phase III data for dupilumab and mepolizumab indicate significant reductions in annualized exacerbations in patients with blood eosinophils ≥ 300 cells/μL. However, the mean age in the landmark trials (65 years) is a decade lower than the real-world average. Age-related immune remodeling—specifically immunosenescence and inflammaging—coexists with disease-specific pathways, potentially altering therapeutic responses. Furthermore, clinical trials systematically exclude older individuals with severe multimorbidity, physical frailty, cognitive impairment, and malnutrition. Conclusions: Biologics provide a precise, mechanism-based approach, yet evidence in the oldest-old remains limited. Future management should utilize the treatable traits framework, shifting selection criteria from chronological age to biological age metrics, including frailty status and functional reserve. Full article

Background: Health literacy is widely recognized as a fundamental determinant of chronic disease self-management. Despite the escalating burden of diabetes mellitus in Saudi Arabia, the relationship between health literacy and diabetes self-care management within specific urban–peripheral communities remains inadequately characterized. This study aimed to examine the relationship between health literacy and diabetes self-care management among adults with diabetes residing in southern Riyadh, and to examine associations with key sociodemographic variables, including age, income, gender, and educational attainment. Methods: A non-experimental, cross-sectional, correlational design was employed. A purposive sample of 92 adults with a confirmed diagnosis of diabetes was recruited from primary healthcare centers in southern Riyadh. Data were gathered using the Arabic-validated 12-item European Health Literacy Scale (HLS-Q12) and the 8-item Arabic Summary of Diabetes Self-Care Activities (SDSCA). Descriptive statistics and Spearman rank-order correlations were computed using IBM SPSS Statistics, Version 25. Results: A significant positive correlation was identified between health literacy and diabetes self-care management (rs = 0.64, 95% CI [0.50, 0.75], p < 0.01). Income level demonstrated significant positive associations with both health literacy (rs = 0.41, p < 0.01) and self-care practices (rs = 0.40, p < 0.01). Age exhibited significant negative correlations with health literacy (rs = −0.36, p < 0.01) and self-care management (rs = −0.49, p < 0.01). Educational attainment was significantly associated with both self-care management (rs = 0.29, p < 0.01) and health literacy (rs = 0.26, p < 0.05). Gender was not significantly associated with either outcome. Conclusions: Health literacy was significantly associated with diabetes self-care management in southern Riyadh and may represent a potentially modifiable target for nursing intervention. Findings point to the urgency of designing equity-sensitive, culturally responsive interventions targeting older adults and economically marginalized populations. These preliminary findings may carry implications for nursing practice, diabetes education, and health policy in Saudi Arabia, pending confirmation in larger, prospective samples. Full article

Objective: While advancements in radiotherapy and systemic agents have significantly improved survival rates in head and neck squamous cell carcinoma (HNSCC), managing long-term, treatment-induced toxicities remains a critical clinical challenge. This study aimed to develop a personalized, supervised machine learning-driven predictive model for multiple chronic toxicities by integrating clinical, dosimetric, and genetic data specifically evaluating the impact of the NBN gene rs1805794 (c.553G>C) polymorphism. Methods: This study enrolled 125 patients with HNSCC who received curative-intent radiotherapy and remained disease-free during follow-up with a median of 98 months. Comprehensive clinical and dosimetric data were collected, and chronic toxicities were recorded. Peripheral blood samples were analyzed for the NBN rs1805794 polymorphism using allele-specific PCR (AS-PCR). Following feature selection, four supervised machine learning classifiers were trained and evaluated to identify the optimal model for predicting multiple chronic toxicities. Results: The XGBoost algorithm emerged as the highest performing model. Baseline clinico-dosimetric predictors of multiple chronic toxicities included PTV70 volume, the addition of concurrent chemotherapy, advanced T and N stages, and continued smoking. Integrating the NBN rs1805794 genotype into the XGBoost architecture enhances its predictive capability. The final model accurately identified patients at high risk for multiple chronic toxicities, achieving an area under the curve (AUC) of 0.78, an accuracy of 0.77, a sensitivity of 0.74, and a specificity of 0.79. Conclusions: Integrating clinical, dosimetric, and genetic data within a machine learning framework effectively predicts multiple chronic toxicities in HNSCC. This approach enabled early risk stratification, providing the potential for personalized therapy. Full article