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Purpose: Stroke frequently causes severe deficits in upper limb function, which makes it difficult for patients to carry out daily tasks. An organized home-based intervention called the Graded Repetitive Arm Supplementary Program (GRASP) was developed to help stroke patients regain function in their hands and arms. This systematic review assesses the data demonstrating beneficial effects of the GRASP approach on hand function, gross and fine motor control of the upper limb in individuals post-stroke.Methods: A systematic search was performed in databases including PubMed, Scopus, CINAHL, and Cochrane Library up to April 2025. We searched the data using Keywords such as “GRASP,” “Graded Repetitive Arm Supplementary Program,” “stroke rehabilitation,” “upper limb recovery,” “fine motor skills,” and “gross motor control.” Inclusion criteria were randomized controlled trials (RCTs), quasi-experimental studies, and cohort studies involving adult stroke survivors undergoing GRASP. Studies were excluded if they were non-English and focused on other forms of intervention. Quality assessment was performed using the PEDro scale and Cochrane risk-of-bias tool.Results: Out of 243 studies initially screened, 8 met the inclusion criteria. Most studies reported significant improvements in upper limb function, including enhanced hand dexterity, grip strength, and coordination following participation in GRASP programs. High adherence rates and participant satisfaction were consistently noted. Some studies indicated that benefits were maintained at follow-up, suggesting long-term efficacy. Common outcome measures included the Fugl-Meyer Assessment (FMA), Box and Block Test (BBT), and Action Research Arm Test (ARAT).Discussion: The findings suggest that GRASP is an effective adjunct to conventional stroke rehabilitation, particularly for enhancing hand function and motor control. The structured yet flexible nature of GRASP allows for scalability and adaptability to various patient needs. Limitations of the reviewed studies include small sample sizes, heterogeneity in intervention duration, and variability in outcome measures. Further research with standardized protocols and larger samples is warranted.Conclusion: The GRASP approach appears to be a promising intervention for improving functional ability of the hand, and gross and fine motor control in the upper limbs post-stroke. Incorporating GRASP into home-based rehabilitation could enhance recovery and reduce long-term disability. Continued research is essential to establish best practices for implementation and to optimize patient outcomes.

Geothermal energy, with a global installed capacity of 16.7 GW by 2023 and an annual generation of more than 97 TWh, is consolidating its position as a key pillar in the energy transition. From the pioneering Lardarello plant (1913) to The Geysers complex in California (the largest in the world with 1.5 GW of capacity), this energy source has demonstrated its potential to supply baseload electricity 24 hours a day, with a carbon footprint up to 10 times lower than fossil fuels. The article explores how the architectural design of these plants integrates geological, environmental, and technological factors. Systems such as binary cycles (which operate at 90°C and reduce emissions by 95%) allow the exploitation of low-temperature resources, expanding their applicability to non-volcanic regions. However, challenges remain: reservoir exploration is 30-40% uncertain, and initial costs exceed $4,500 per installed kW, according to the U.S. Department of Energy. Iconic cases like The Geysers illustrate innovative solutions. Since 2003, its recharge project with treated wastewater (11 million gallons/day) has revitalized the reservoir, extending its lifespan by decades. This circular economy approach not only optimizes resources but also reduces water conflicts in arid areas. The future points to disruptive designs: Enhanced Geothermal Systems (EGS), which could increase global potential tenfold by enabling dry reservoirs, and urban heating districts with heat pumps, capable of providing heating at -20°C. By 2030, drilling innovations—such as smart drill bits and robotics—could reduce costs by 50%, accelerating adoption. In a world that needs to double clean energy by 2040, geothermal energy is emerging not only as a renewable source, but as an architectural canvas where engineering and sustainability converge to redefine the energy landscape. Its evolution will depend on creatively overcoming technical barriers, transforming the Earth’s heat into the cornerstone of a decarbonized era.

Vochysia haenkeana extract (Vh-E) was assessed against the neuromuscular blockade induced by Bothrops jararaca venom on chick biventer cervicis (BC) preparation. Pre- and post-venom incubation treatments (Pre-vit and Post-vit) were analysed here. Contractures ACh (110 µM) and KCl (20 mM) were evoked before and after addition of venom without stimulation. Vh-E (600 µg/mL) under Pre-vit was more efficient to neutralize the neuromuscular blockade by venom (40 µg/mL) [72.5±4.6% (venom) vs. 45.2±14% (Vh-E) of blockade, p<0.05, n=4]. Vh-E (600 µg/mL) did not cause significant changes under Post-vit [72.5±4.6% (venom) vs. 63.4±8.2% (Vh-E) of blockade, n=4]. The Pre-vit inhibited the blockade of the contracture to ACh (106±17% of response; n=4) while the Post-vit was able to attenuate the effect of the venom on this contracture (55±5% of response; n=4); related to those contractures to KCl both of treatments with Vh-E attenuated the blocker effect of the venom (62.5±7.7% and 55±5% of response for Pre-vit and Post-vit, respectively; n=4). In conclusion, Vh-E neutralizes partially the neuromuscular blockade in Pre-vit, an effect that can be related to preserved function of “extrinsic” post-synaptic receptors, by measured contractures in response to ACh. The myotoxicity of the venom was significantly reduced by Vh-E in both, Pre-vit and Post-vit, by measured contractures in response to KCl.

Hepatitis B virus (HBV) is one of the world’s major infectious diseases with 350 million people who are chronic carriers of HBV [1]. Significant minorities go on to develop liver cirrhosis or hepatocellular carcinoma and over 1 million die annually from HBV-diseased liver. Janahi E. at faculty of science, Bahrain University, Bahrain has submitted the following information [2], on HBV-genome organization as part of his Ph.D. degree (2007) in Imperial College, England. HBV genomic organization has 4 Open Reading Frames (ORFs) i.e. Pre-S/S Gene, Pre-C/C ORF, P ORF and X ORF. Regulatory Elements has 4 promoters (pre S2, pre S1, C promoters and X promoters), Pregenomic RNA, Enhancers (Enh 1 and Enh 2) where they are involved in cccDNA formation, Glococorticoid-Responsive Element which is located in X ORF and P ORF overlapping, Polyadenylation Signal (Direct Repeat 1 (DR1) and Direct Repeat 2 (DR2)), Epsilon-Stem Loop and Post-Transcriptional Regulatory Element. HBV genotype D is prevalent in our Middle East area. The HBV genome is a partially relaxed-circular dsDNA molecule consisting of a full length strand (minus strand) with a single unique nick and a complementary (positive strand) of variable length. HBV is considered as a para-retrovirus because its replication involves the reverse transcription of an intermediate-RNA function, of pre-genomic RNA (pgRNA). Replication of HBV genome starts with the encapsidation of the pgRNA and encodes HBV polymerase into an immature nucleocapsid formed by the viral core antigen.

Polyamines are aliphatic amines found in all living cells, and they are necessary for several fundamental cell processes. Their protective role against various abiotic stress factors has been reported in different plant species, while the mechanism by which polyamines act during plant-microbe interaction is still poorly understood. The several types of the interactions between the plants and the microbes outline a divers and complex picture of the action mechanisms. The present review focuses on this aspect of the mode of action of polyamines and polyamine metabolism during biotroph and necrotroph interactions between plants and pathogens. It seems that apoplastic metabolism of polyamines of the host and the accumulation of H2O2 as a result of polyamine catabolism play important signalling role in plant-pathogen interactions. The manipulation of the members of the polyamine-induced signalling pathways could increase the host plant resistance to biotic stresses.

The 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of arterial hypertension introduces important updates compared with the 2017 version. Given the global impact of hypertension as a major cause of cardiovascular morbidity and mortality, and the coexistence of multiple international and national recommendations, the Mexican Expert Group on Arterial Hypertension (GREHTA) conducted a structured review and comparative analysis. We contrasted the 2025 AHA/ACC recommendations with those of the European Society of Hypertension (ESH 2023), the European Society of Cardiology (ESC 2024), the Latin American Society of Hypertension (LASH 2024), and the National Medical Care Protocol of Mexico (PRONAM 2025). Our goal is to provide clinicians with a clear, evidence-based synthesis to guide practical decision-making. Key topics include definitions and thresholds, diagnostic methods, cardiovascular risk stratification, therapeutic strategies, special populations, and resistant hypertension. GREHTA emphasizes a pragmatic, regionally adapted approach, highlighting early combination therapy, risk factor integration, and systematic follow-up.

Introduction: Forensic odontology is a specialized field at the crossroads of dentistry and law, focusing on the analysis of dental evidence in legal investigations. Due to their resistance to decay and environmental degradation, teeth serve as a vital resource in age estimation and gender determination. Various techniques, including microscopic examination of the incremental lines in enamel and cementum, neonatal lines, and dentin translucency, are commonly employed for forensic analysis. To enhance the accuracy and ease of examination, there is an increasing demand for high-quality, non-demineralized tooth sections that are durable, easy to handle, and maintain uniform thickness. Aims and objectives: 1. Evaluate the effectiveness of the Rosin stain in identifying incremental lines in hard dental tissues. 2. Compare Rosin stain with Haematoxylin and Eosin stain as well as with unstained sections. Materials and methods: Sixty sound teeth were included in the study. Thin longitudinal sections of 2 mm were prepared using a diamond disc, and ground sections of 25 µm were prepared on Arkansas stone. The sections were divided into three groups: (A) sections stained with Rosin, (B) sections stained with H&E, and (C) unstained sections. The longitudinal ground sections were examined under both the Light Microscope and the Phase Contrast Microscope. The Microstructures of the teeth, such as incremental lines of enamel, dentin, and cementum, were assessed.Result  and conclusion: Rosin-stained ground sections observed under phase contrast microscopy provided better visualisation of dental microstructures than unstained or H&E-stained ground sections, suggesting Rosin enhances the identification of incremental lines in forensic dental analysis.

Sagittal split osteotomy (SSO) of the mandible is still an important part of orthognathic surgery, but “bad split” fractures that happen during the surgery are still a big problem. This report describes a rare case of bilateral bad split associated with highly compact mandibular bone (D1–D2 type) in a 53-year-old male undergoing mandibular advancement. The bone was too hard for the piezoelectric and rotary tools to work, and there was very little bleeding. This caused fractures in the cortex and lingual. Postoperative computed tomography confirmed the presence of highly dense bone, correlated with delayed healing and recurrence. Consistent pre-surgical CT scanning for an assessment of the density of the mandibular bone can provide essential information about the potential risk of the osteotomy procedure in the patient. Performing a careful bone quality and density examination pre-operatively will allow the surgeons to select the most appropriate instruments and surgical techniques that will fit the patient’s individual anatomy. Such a point escalates to being very significant when dealing with the geriatric population, as bone density increase can not only alter the fracture behavior but also the recovery process during and after surgery. The inclusion of regular CT-based bone density evaluations into the preoperative routine not only facilitates the anticipation of surgical difficulties but also results in safer and more efficient osteotomies.

Background: Employee performance appraisal is essential for improving healthcare service delivery through systematic staff evaluation. In the health sector, effective appraisals support decision-making and professional development.Objective: This study aims to map and categorize existing employee performance appraisal methods in the health system using a scoping review approach.Methods: This scoping review was conducted using the JBI 2024 protocol. Articles published up to December 2024 were identified through four databases: PubMed, Scopus, Web of Science, and Google Scholar. The keywords used were “Personnel appraisal,” “Health workers,” and “Health workforce.” The inclusion criteria focused on studies assessing employee appraisal methods in health systems.Results: Of the 1,245 articles initially identified, 18 met the inclusion criteria. Appraisal methods were classified into traditional and modern categories. Traditional methods included ranking, critical incidents, and graphic rating scales. Modern approaches involved 360-degree feedback, Management by Objectives (MBO), and Behaviorally Anchored Rating Scales (BARS).Conclusion: No single appraisal method suits all healthcare environments. A hybrid approach tailored to organizational context and job roles is recommended. Emphasis should be placed on objective evaluation, customization, and the degree of scientific connection between the evaluator and the evaluated person to improve performance outcomes.

Background: WHO grade II Low-grade gliomas (LGGs) need multi-disciplinary treatment from different specialties, directed by new molecular classifications and prognostic markers. Yet regional practice patterns and obstacles are not reported, especially in MENA countries.Method: A cross-sectional survey of physicians from MENA countries (including neurosurgeons, radiation oncologists, and medical oncologists) was conducted. An electronic anonymous survey, including clinical scenarios and evidence-based treatment choices, was distributed at professional conferences. The feedback included responses regarding surgical interventions, adjuvant treatment preferences, and barriers to adoption of IDH-mutant inhibitors.Results: 137 physicians (37.23% neurosurgery, 32.85% radiation oncology, 29.93% medical oncology). Most had 6–15 years of experience (56.21%) and worked in government (51.82%) or academic hospitals (25.55%). Maximal safe resection (MSR), if applicable, was preferred over biopsy (89.05% vs. 10.95%). For residual Astrocytoma, concurrent radiotherapy (RT) with temozolomide (TMZ) (42.34%) was the preferred adjuvant, while 44.53% prefer observation after gross total resection (GTR). For residual Oligodendroglioma, RT followed by PCV (45.99%) was preferred, with 59.85% offered observation post-GTR. Most (96.35%) agreed that resection extent impacts outcomes, while 72.99% objected to extending TMZ beyond six cycles. High-risk stratification varied: 46.72% used age ≥40 years, and 88.32% prioritized residual tumor volume. Although 64.96% supported IDH-mutant inhibitors, 58.39% cited limited availability as a barrier, followed by cost (40.88%) and insufficient long-term data (31.39%). Specialty-specific differences emerged: radiation oncologists tend more to provide adjuvant radiotherapy in the context of persistent seizure post-operatively (χ² = 20.50, p < 0.05), and medical/radiation oncologists more often used age ≥40 for high-risk stratification (χ² = 10.10, p = 0.038).Conclusion: There is a wide variation in the WHO grade II LGGs management among physicians in MENA Countries. These data highlight the importance of locally derived guidelines, the increased availability of molecularly directed therapies, and ongoing collaboration between multiple disciplines to ensure optimal patient outcomes.Key points:•    Maximal safe resection (89.05%) is the dominant surgical approach for WHO grade II LGGs, taking into consideration the location and extent of infiltration, among specialists in MENA Countries, reflecting global consensus on resection extent impacting outcomes (96.35% agreement).•    Adjuvant therapy preferences vary: concurrent RT+TMZ for astrocytomas (42.34%) and sequential RT+PCV for oligodendrogliomas (45.99%), with 59.85% observing post-GTR in oligodendrogliomas.•    IDH-mutant inhibitors (e.g., Vorasidenib) are supported by 64.96% of oncologists, but limited availability (58.39%) and cost (40.88%) hinder adoption.Importance of the study: This multicenter survey is the first to evaluate real-world management trends and barriers for WHO grade II low-grade gliomas (LGGs) among physicians in MENA Countries. While all specialists align with international guidelines in surgical strategies (e.g., maximal safe resection), significant heterogeneity exists in adjuvant therapy choices, particularly for astrocytomas versus oligodendrogliomas. Crucially, we identify systemic barriers—such as limited access to molecular therapies (IDH inhibitors) and cost constraints—that disproportionately affect WHO grade II LGGs care in the MENA Countries. Our findings underscore the urgent need for regionally adapted guidelines and multidisciplinary collaboration to standardize practices aligned with international guidelines. By highlighting disparities in resource availability and specialty-specific decision-making (e.g., radiation oncologists prioritizing post-resection seizures, p < 0.05), this study provides a roadmap for optimizing WHO grade II LGGs management in resource-limited settings and advocates for the inclusion of Arab populations in global trials of novel agents like Vorasidenib.