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Road infrastructure serves as the primary medium of economic and agricultural transportation in developing countries. Afghanistan’s district roads play a critical role in connecting rural production centers to markets; however, systematic maintenance is often hindered by inadequate funding, lack of structural monitoring, and climatic deterioration. This research develops pavement condition assessment and deterioration prediction models using Pavement Condition Index (PCI), pavement age, characteristic rebound deflection (Dc), and Average Annual Daily Traffic (AADT). Multiple regression models were generated based on recorded field data across six district road sections in Herat Province. Regression coefficients demonstrated high goodness of fit (R² = 0.964 – 0.992), indicating reliable predictive capability. Based on PCI-based prioritization, maintenance strategies were ranked and scheduled under budget constraints. Results indicate that Sections D01 and D02 urgently require rehabilitation due to structural fatigue and distress propagation, while other sections can be preserved through preventive maintenance. This study provides a scientifically supported PMS framework for Afghan district roads, enabling optimized resource allocation, deterioration forecasting, and long-term serviceability planning.

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia and disrupted carbohydrate, fat, and protein metabolism, representing a growing health issue in Bosnia and Herzegovina, particularly among the elderly. This study evaluated the accumulation and distribution of identified risk factors among 108 elderly patients with type 2 diabetes (54 females and 54 males) treated at the Clinical Center University of Sarajevo. Evaluated risk factors included age, sex, hyperlipidemia, adiposity, family history, smoking, hypertension, and elevated fibrinogen levels. The overall mean number of identified risk factors was 4.11 per patient (SD = 1.32, range: 1–8). Female patients exhibited a slightly higher mean (4.26, SD = 1.36) than male patients (3.96, SD = 1.27), but this difference was not statistically significant (t = 1.18, df = 106, p = 0.240). Overall, 80.56% of patients presented with 3–5 risk factors, 12.04% with 6 or more, and only 7.41% with 2 or fewer, showing no significant association between sex and risk burden category (p = 0.670). In conclusion, elderly patients with type 2 diabetes exhibit a high cumulative risk-factor burden that is comparable between sexes, underscoring the need for comprehensive, multi-targeted intervention strategies in clinical practice.

Psychiatric disorders represent some of the most biologically complex challenges in medicine, arising from intricate interactions among genetic, epigenetic, environmental, developmental, and social factors. Advances in artificial intelligence (AI) have improved our ability to analyze large-scale biological datasets, identify biomarkers, and support precision medicine initiatives. However, the growing volume and complexity of genomic and multi-omic information increasingly challenge the capabilities of even the most advanced conventional supercomputers. Quantum computing offers a potential next step in biomedical discovery by enabling rapid analysis of multidimensional datasets, molecular simulations, and optimization problems relevant to genetic medicine and gene therapy. Extending these findings conceptually, we propose the forward-looking hypothesis that continued advances in quantum computing may eventually complement artificial intelligence and human expertise to facilitate increasingly sophisticated analyses relevant to psychiatric genetics and precision medicine. At present, no direct evidence of which we are aware demonstrates clinical implementation of quantum computing in psychiatric genomics. Accordingly, the concepts discussed in this Opinion should be viewed as a forward-looking scientific perspective that builds upon current advances in computational science and biomedicine while awaiting future experimental and clinical validation. Importantly, these advances should complement rather than replace human expertise. Human-in-the-loop systems remain essential for ensuring scientific rigor, ethical oversight, clinical judgment, and patient-centered care. The convergence of quantum computing, AI, genetic medicine, and human expertise may ultimately establish a transformative framework for future precision psychiatry and mental health therapeutics.

Background: Breast Cancer is the most common cancer in women and the quality of life of women with breast cancer is a significant healthcare issue specifically in developing and underdeveloped countries.Globally quality of Life (QoL) has become an important indicator to measure the outcomes of medical and nursing interventions. The QoL studies have an imperative role in healthcare especially in chronic disease as the latest diagnostic and treatment modalities have increased the survival rates and duration of cancer patients. Similarly, breast cancer itself and its treatment with Chemotherapy, in particular, has many complications and negative impacts on the QoL of cancer women. Aim: The aim of this study was to assess the QoL of Pakistani women with Breast Cancer patients undergoing chemotherapy and the relationship of QoL with socio-demographic variables.Methodology: A descriptive cross-sectional correlational study was conducted on 110 female breast cancer patients undergoing chemotherapy. FACIT-B questionnaire was used to assess the quality of life of these patients. Statistical analysis was done by using SPSS version 20 using the Pearson correlation coefficient, Chi-square test, and Spearman’s rho correlation coefficient. Results: The mean age of participants was (mean ± SD) 42.98 ± 8.98. A significant negative correlation was observed with age and QoL, r = -0.218, p - value 0.022. No significant association was observed between QoL and marital status; education status; and socioeconomic status.Conclusion: The majority of breast cancer women 59(53.6%) had moderate QoL and Chemotherapy also showed moderate impacts on different domains: physical, functional emotional, social, and sexual well-being of the women.

In this manuscript, we present an Hiatal hernia(HH) with situs inversus totalis(SIT) performed by transumbilical single-incision laparoscopic hiatal hernia repair and Nissen fundoplication, which is rarely reported previously. A 62-year-old woman was admitted with a diagnosis of hiatal hernia and gastroesophageal reflux disease (GERD), as proven by Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scoring, endoscopic, and radiologic findings. The patient had a history of spinal correction surgery for scoliosis five years ago, during which her SIT was identified. We performed a classic LHHR plus Nissen fundoplication for the patient, especially through a transumbilical single incision. An atraumatic method of liver retraction with a Veress needle sheathed by a latex tube and a convenient autosuturing device was used to overcome the difficulties. The patient experienced an uneventful recovery and presented complete resolution of GERD at the one-month follow-up.

Spinal muscular atrophy (SMA) is a devastating autosomal recessive neuromuscular disorder characterized by progressive muscle weakness, atrophy, and respiratory failure due to selective degeneration of lower motor neurons arising from homozygous deletion of exon 7 (95%) or mutation in the SMN 1 gene (5%),with severity correlating with SMN2 copy number—from fatal Type1 to milder Type 4—affecting 1:6,000–10,000 births worldwide and burdening India with 1,500–2,000 annual cases amid diagnostic delays. Although the backup SMN2 gene compensates a bit for SMN deficiency, a critical C→T transition in exon 7 leads to exon skipping and production of a truncated, unstable and nonfunctional SMN protein. Recent advances in disease-modifying therapies-including antisense oligonucleotides, small-molecule splicing modifiers, and gene replacement-have significantly improved clinical outcomes; however, they do not restore endogenous SMN expression in all tissues and often require repeated administration. Despite these medications like Spinraza injections, Zolgensma gene therapy, Evrysdi pills that increase SMN protein, the condition still has got significant morbidity: Type 1 babies frequently die before the age of two, 60–95% develop scoliosis, which makes spinal injections uncomfortable and dangerous, and lifetime expenses for each patient surpass $2 million. What if we could edit the nucleotide base of SMN2(T6C) using ABE10 to make it emulate like SMN1 gene to restore stable functional SMN protein that would be the permanent cure for SMA. This cutting edge molecular tool “AI-based Adenine Base Editors” would facilitate an endogenous regulation, laying the groundwork for precision medicine in rare disease management.

Introduction: Few studies have explored the vulnerability of women with polycystic ovary syndrome (PCOS) to developing cervical cancer and its precursor lesions. Objective: To describe the clinical, metabolic, and endocrine characteristics of a series of women with cervical squamous intraepithelial lesions and polycystic ovary syndrome, aiming to generate hypotheses regarding the potential pathophysiological mechanisms linking both conditions.Methods: A descriptive and hypothesis-generating study was conducted. The series consisted of nine women with a cytological diagnosis of cervical squamous intraepithelial lesions (SIL) who also met the Rotterdam criteria for PCOS. Characterization included age, sexual behavior, toxic habits, history of hypertension and diabetes mellitus, body mass index (BMI) and waist-to-hip ratio (WHR), metabolic parameters (insulin resistance, dyslipidemia), serum hormone levels (testosterone, prolactin, estradiol), human papillomavirus (HPV) 16/18 infection, grade of the lesion, and PCOS phenotypes. Results: The mean age was 37,11 ± 12,8 years. Abdominal obesity was detected in 55,5% and insulin resistance in 44,4% of cases. Hyperprolactinemia was present in 33,3%. HPV 16/18 infection was identified in 77,7% of cases. Most patients presented high-grade squamous intraepithelial lesions (HSIL) and PCOS phenotype D. Conclusion: The presence of HSIL in more than a third of the women in this case series is compatible with the hypothesis that PCOS, particularly those with insulin resistance, abdominal obesity, or hyperprolactinemia, may act as a multifactorial risk factor for cervical lesions, either independently or synergistically through metabolic and hormonal pathways that interact with HPV. These findings should be interpreted as preliminary observations that warrant confirmation in larger, controlled studies.

Background: Obesity is one of the most pressing global health challenges, with over one billion people now living with the condition worldwide. In Southeast Asia, nearly 40% of the population is projected to be overweight or obese by 2035, with Thailand reporting prevalence exceeding 42%. Intensive Lifestyle Modification (ILM) combined with Meal Replacement (MR) has emerged as a promising strategy for achieving sustainable weight loss, supported by landmark trials including the Diabetes Prevention Program, Look AHEAD, and DiRECT.Objective: To illustrate the clinical effectiveness of ILM combined with MR through detailed case presentations documenting anthropometric outcomes at baseline, 8 weeks, and 52 weeks, contextualized within international obesity management guidelines and comparative research across diverse populations. We hypothesized that selected participants undergoing the ILM+MR intervention would demonstrate clinically significant weight loss (≥5% of initial body weight) sustained through 52 weeks, with concurrent improvements in waist circumference indicating reduced central adiposity.Methods: Twelve participants (9 female, 3 male) from the ILM+MR arm of a previously published retrospective cohort study (n = 702) were selected based on complete longitudinal data and representativeness. The intervention comprised structured nutritional counseling, soy-based MR (220 kcal per serving, twice daily for 8 weeks), behavioral modification with group therapy, and physical activity guidance aligned with the 2013 AHA/ACC/TOS guidelines. Body weight and waist circumference were measured at baseline, 8 weeks, and 52 weeks.Results: Mean total weight loss was 38.2 kg (35.3% of initial body weight), with mean waist circumference reduction of 13.0 inches (33.0 cm) over 52 weeks. All 12 participants achieved clinically significant weight loss (>5%), substantially exceeding the 5–10% threshold recommended by international guidelines. Weight loss occurred in two phases: a rapid intensive phase (mean 14.0 kg during weeks 0–8) followed by continued loss during maintenance (mean 24.2 kg during weeks 8–52). All participants completed the 52-week follow-up.Conclusion: This case series demonstrates the potential for substantial, sustained weight loss through ILM+MR intervention, supporting findings from the larger Thai cohort study and international research including the DiRECT trial and systematic meta-analyses. These results reaffirm the foundational role of comprehensive lifestyle programs and highlight their relevance as scalable, culturally adaptable interventions for obesity management across diverse populations.

The dynamics of the glucose-insulin regulatory system are highly nonlinear and must be understood to be controlled effectively. Bifurcation analysis and multiobjective nonlinear model predictive control (MNLMPC) are performed on a glucose-insulin dynamic model. MATCONT was used for the bifurcation analysis, and for the MNLMPC calculations, the optimization language PYOMO is used in conjunction with the solvers IPOPT and BARON. The bifurcation analysis revealed a Hopf bifurcation point and a limit point. A Hopf bifurcation point is a tipping point where a system that was behaving steadily suddenly starts to oscillate or cycle on its own, like a machine that begins to vibrate instead of staying still. A limit point is a tipping point at which pushing a system a little further suddenly causes it to jump to a completely different state, rather than changing smoothly. MNLMC converged on the Utopia solution. The Hopf bifurcation point, which leads to an unwanted limit cycle, is eliminated by an activation factor. A limit cycle is a repeating pattern of behavior that a system naturally settles into over time, like a steady heartbeat or a clock that keeps ticking. The limit point (which causes multiple steady-state solutions from a singular point enables the Multiobjective nonlinear model predictive control calculations to converge to the Utopia point (the best possible solution) in the model. A Utopia solution in multi-objective nonlinear model predictive control is an ideal operating point at which all goals are simultaneously perfectly optimized.

Background: Nicotinamide adenine dinucleotide (NAD⁺) is a pivotal coenzyme and signaling substrate that integrates redox balance with mitochondrial energy production, DNA repair, epigenetic control, and cellular stress resilience. Declines in NAD⁺ availability—frequently observed with ageing, chronic inflammation, and metabolic stress—have intensified interest in NAD⁺ restoration as a potential strategy to influence disease biology across multiple organ systems.Objective: This narrative review summarizes contemporary mechanistic and translational evidence on NAD⁺ biosynthesis and turnover, highlighting the de novo kynurenine pathway and vitamin B3–dependent salvage routes (nicotinic acid, nicotinamide, nicotinamide riboside, and nicotinamide mononucleotide). We also examine how major NAD⁺ consumers and sensors, sirtuins, poly(ADP-ribose) polymerases (PARPs), and CD38 link NAD⁺ status to inflammation, oxidative stress, and tissue dysfunction in diverse clinical contexts.Methods: Peer-reviewed literature on NAD⁺ metabolism, NAD⁺-dependent signaling, and preclinical/clinical studies of NAD⁺ precursors was evaluated and organized into: (i) core biochemical functions in cellular energetics, (ii) NAD⁺ consumption in genome maintenance and immune signaling, and (iii) organ-focused evidence relevant to skin disorders, infertility and reproductive health, osteoarthritis, hearing loss, vision decline, gut barrier dysfunction, cardiovascular and renal metabolism, hepatic steatosis, neurological diseases, and skeletal muscle health.Results: NAD⁺ supports glycolysis, the tricarboxylic acid cycle, and oxidative phosphorylation, while acting as an essential substrate for PARP-driven DNA repair and sirtuin-mediated deacylation programs that shape mitochondrial fitness, inflammatory tone, and metabolic flexibility. Across experimental models, impaired NAD⁺ homeostasis repeatedly associates with mitochondrial dysfunction, heightened oxidative injury, and dysregulated immune–barrier responses, features shared by intestinal inflammation, neurodegeneration and ischemic injury, cardiometabolic disease, kidney injury, and fatty liver disease. Supplementation with NAD⁺ precursors (notably NR and NMN) reliably elevates NAD⁺ in preclinical systems and increases circulating NAD⁺ metabolites in humans, with early signals of pathway engagement; however, clinical outcomes remain heterogeneous across populations, dosing regimens, and endpoints. Evidence for intravenous NAD⁺ “drip” therapy is comparatively limited and insufficiently standardized, with constraints related to tolerability, dose consistency, and cost, underscoring the need for controlled trials.Conclusion: NAD⁺ occupies a central position at the interface of energy metabolism, genome integrity, and immunometabolic signaling, providing a coherent framework for understanding how cellular stress can propagate multisystem dysfunction. Although NAD⁺-boosting strategies are biologically plausible and mechanistically supported, definitive clinical benefit across skin, fertility, osteoarthritis, sensory decline, gut disorders, cardiovascular and hepatic disease, neurological conditions, and muscle health will require well-designed human studies with standardized biomarkers, safety surveillance, and clinically meaningful endpoints.