Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )
Al-Rafidain Journal of Medical Sciences (AJMS) is a peer-reviewed international journal published by Al-Rafidain University College, Baghdad, Iraq. The journal’s full text is available online at www.ajms.iq The journal allows free access (Open Access) to its contents and permits authors to self-archive the final accepted version of the articles on any compliant institutional/subject-based repository. Publishing in the AJMS complies with the Committee on Publication Ethics (COPE) and endorses the International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals, as well as the GPP3 guidelines regarding authorship. Submission of a manuscript to the AJMS implies that all authors have read and agreed to its content and that the manuscript conforms to the journal’s policies. © 2021 The Author(s). Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/). Important Update Publication charge was changed for accepted submissions after January 1st, 2025 onward: - For authors resident in Iraq: Article processing fee of 500,000 ID (tax included in price) applies to all the accepted articles after January 1st, 2025. Bank charges must be defrayed by the authors. - For foreign authors: Article processing fee of 500 US Dollars (tax included in price) applies to all the accepted articles after January 1st, 2025.
Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).
Mapping the Landscape: A Bibliometric and Narrative Review of Programmatic Assessment in Medical Education
Background: Programmatic assessment is an evaluative framework designed to support learner development through continuous, multi-source, and integrated data collection, enabling more informed and robust summative decision-making. In medical education, it offers a holistic approach to assessing competencies. However, implementation practices and outcomes vary across institutions, highlighting the need for a comprehensive understanding of this approach. Objective: This study aims to synthesize the current literature on programmatic assessment in medical education by conducting a combined review and bibliometric analysis. The focus is on its implementation, core components, challenges, and educational impacts. Methods: This review was conducted in a Scopus, database for studies published between 2005 and 2025. Articles were included if they discussed programmatic assessment in undergraduate or postgraduate medical education. Thematic analysis was applied to identify recurring concepts. Additionally, from 1781 articles, a bibliometric analysis of 256 publications from Scopus (2005–2025) was performed to examine publication trends, key contributors, institutions, and funding sources. Results: Of 1781 articles screened, eight studies met the inclusion criteria. Key components of programmatic assessment included the use of multiple formative tools, structured feedback, mentorship, and panel-based summative decisions. Implementation challenges involved faculty resistance, administrative burdens, and limited facilitator training. Reported benefits included enhanced student engagement and positive learning perceptions. Bibliometric analysis indicated increasing research interest, peaking in 2022. Conclusions: Programmatic assessment holds considerable promise for enhancing assessment quality in medical education, though sustained institutional support and further research are essential.
Copyright (c) 2025 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Diverse Demyelinating Entity in Pediatric Patients
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder characterized by antibodies targeting the myelin oligodendrocyte glycoprotein, a protein of the myelin sheath in the central nervous system. Increasingly recognized as a distinct clinical entity, MOGAD requires tailored treatment strategies and careful long-term monitoring, rather than being considered a variant of multiple sclerosis and neuromyelitis optica spectrum disorder. While acute episodes respond well to immunotherapy, relapses are common and require long-term management. Progress in immune-based and remyelination therapies offers hope for improving outcomes.
Molecular Mechanism of Physical Exercise in Increasing Genetic Expression of Sirtuin 1 (SIRT1): A Systematic Review
Background: Obesity is associated with decreased levels of protein sirtuin 1 (SIRT1). This decrease can disrupt SIRT1 activity, leading to reduced antioxidant defenses, increased oxidative stress, impaired fatty acid oxidation, and reduced energy expenditure. These changes can contribute to a positive energy balance and long-term weight gain. Exercise is an alternative way to prevent decreased sirtuin 1 level. Sirtuin 1 plays a role in cell maintenance, stress markers, determining cell fate, maintaining energy balance, preventing DNA damage, and maintaining the stability and continuity of cell function. Objective: This study aims to determine and measure how the mechanism of physical exercise can increase the expression of SIRT1. Methods: Several journal databases, such as Embase, PubMed, Web of Science, ScienceDirect, and Scopus, were searched for this study. The criteria for this study included papers on oxidative stress, physical exercise, and SIRT1 published during the previous five years. The only publications rejected for inclusion in this analysis were those published in non-reputable journals. Using Embase, Web of Science, PubMed, ScienceDirect, and Scopus databases, a total of 1,891 publications were found. These systemic breakthrough criteria have been examined and discussed in about 9 studies. Results: Physical exercise can increase the expression of SIRT1. Conclusions: Physical exercise is proven to increase the expression of SIRT1 to influence the increase of biogenesis in mitochondria, which will have a favorable and beneficial impact on the degree of human health.
Stevens-Johnson Syndrome with a 24-Hour Onset Following a Single Dose of Ibuprofen: A Case Report and Review
Stevens-Johnson syndrome (SJS) is a rare, severe mucocutaneous disease. Most commonly triggered by infections or prolonged drug use, and reports of such atypical triggers are limited, here we present a case report of a female patient who developed rapid-onset SJS after a single dose of ibuprofen. A 21-year-old woman attended the Emergency Department (ER) with a diffused erythematous, crusted skin lesion associated with painful oral and genital mucosal erosions 24 hours after a single dose of ibuprofen. She was mildly feverish and anxious; her lab test was unremarkable. In the hospital, she received supportive therapy, local skin care, and systemic steroid 60 mg/kg. She gradually improved, and 10 days after admission, she was discharged home. Even a single dose of ibuprofen can trigger SJS, so clinicians must maintain high vigilance, as early recognition and prompt management are critical to prevent severe complications and improve outcomes.
Genetic Printing as a Predictor of Pregnancy Viability
Dexamethasone versus Fentanyl as Adjuvants to Intrathecal Bupivacaine Anesthesia in Cesarean Section: Impacts on Analgesia Duration and Postoperative Outcomes
Background: Effective postoperative analgesia after cesarean section is essential to facilitate early maternal recovery and reduce opioid-related side effects. Although fentanyl is commonly used as an intrathecal adjuvant to bupivacaine, concerns about adverse effects such as pruritus and nausea have prompted exploration of alternatives like dexamethasone. Objective: To compare the efficacy and safety of intrathecal dexamethasone versus fentanyl as adjuvants to 0.5% bupivacaine in spinal anesthesia for cesarean section. Methods: In this quasi-randomized clinical study, 70 women undergoing elective cesarean section were allocated to receive spinal anesthesia with bupivacaine plus either fentanyl (10–25µg; Group F) or dexamethasone (2–4mg; Group D). Hemodynamic parameters, duration of postoperative analgesia, incidence of side effects, ambulation time, and patient satisfaction were assessed using validated instruments. Results: Group D demonstrated significantly longer analgesia duration (median 5.0 h [IQR 4.0–6.0]) compared to Group F (3.0 h [IQR 2.0–4.0], p<0.001). Post-spinal systolic blood pressure and heart rate were significantly higher in the dexamethasone group but remained within physiological limits. Adverse events such as pruritus and postoperative nausea/vomiting were significantly more frequent in Group F, while back pain was reported only in Group D (20%, p=0.011). Patient satisfaction was higher in group F (p<0.001), potentially due to earlier ambulation. Conclusions: Intrathecal dexamethasone is a safe and effective adjuvant to bupivacaine in cesarean section spinal anesthesia, offering prolonged analgesia and fewer opioid-related side effects compared to fentanyl. Further randomized trials with longer follow-up and neonatal outcomes are warranted.
Tamoxifen-Induced Dyslipidemia in Hormone Receptor-Positive Breast Cancer Patients: A Cross-Sectional Study among Kurdish Population
Background: Each patient's risk-benefit profile must be carefully assessed because tamoxifen's anti-estrogenic properties may have an impact on lipid metabolism. Objectives: This research looks into how tamoxifen affects Kurdish women's lipid profiles. Methods: This cross-sectional study was conducted at the Azadi Hematology Oncology Centre in Duhok City, Kurdistan Region, Iraq, on 165 females with estrogen- and/or progesterone-positive breast cancer receiving adjuvant hormonal therapy with tamoxifen for three months or longer. Results: The mean age was 42.4 years; 83.6% were married and multiparous (77.6%), with a BMI of 29.1 kg/m². 56.1% of participants had normal lipid profiles, 32.4% had elevated levels, and 11.5% had low levels. Age showed minimal impact on lipid biomarkers, with very weak correlations. Obese patients had normal TC (68.6%), HDL-C (68.6%), LDL-C (44.8%), TC/HDL-C (73.1%), and LDL-C/HDL-C (88.1%) ratios, as well as elevated TG (65.7%) and VLDL-C (77.6%), with weak correlations. Patients treated with tamoxifen for ≥ 24 months showed higher proportions of normal and high lipid profiles, with minimal impact of treatment duration. Conclusions: Abnormal HDL-C, TG, VLDL-C, and TC/HDL-C were more frequent in obese patients, suggesting BMI had more impact on lipid profile than age or therapy duration. Tamoxifen had limited effects on lipid profile, with minimal associations with age or treatment duration.
Development and Assessment of a Self-Nanoemulsifying Drug Delivery System Containing Bilastine: An Effective Strategy to Improve Dissolution
Background: Innovative approaches, including self-nanoemulsifying drug delivery systems, have the potential to solve a variety of drug formulation challenges, such as solubility, stability, and bioavailability. The drug candidate in this research is the strong and extremely selective H1-antihistamine, bilastine, that belongs to BCS II with low solubility and high permeability. Objective: This research aims to formulate an oral self-nanoemulsion of bilastine to improve dissolution. Methods: A total of fifteen liquid self-nanoemulsion drug delivery systems (SNEDDS) formulas were developed using oleic acid, cremophor, and Transcutol as the appropriate oils, stabilizers, and co-stabilizers based on the solubility studies of bilastine in various oils, stabilizers, and co-stabilizers. We used pseudoternary phase diagrams to look at the behavior of the component phases and the area of the nanoemulsion. The physicochemical properties of the formulas, in addition to thermodynamic stability, droplet size, polydispersity index, zeta potential, self-emulsification time, drug content, and durability of the developed formulations, were assessed. Results: This study demonstrated that formula 5, with a 20% oleic acid, 27% cremophor, and 53% Transcutol composition, had lower globular size, acceptable drug content, better in-vitro drug release, and ex-vivo permeability characteristics than pure bilastine powder. Conclusions: The mentioned factors all point to the preparation of self-nanoemulsifying drug delivery systems as a potential means for improving the dissolution of poorly soluble drugs like bilastine.
Is it Possible to Manage Appendicular Mass Without Surgery?
Background: Three ways are available to manage appendicular mass; two of them include surgical intervention. The third approach is conservative treatment and follow-up without interval appendectomy. Objective: To evaluate the outcome of conservative treatment for the appendicular mass and to assess the incidence of acute appendicitis in those patients. Methods: In a study, 98 patients with appendicular mass were divided into two groups. Group A, consisting of 55 patients, was treated with conservative management without appendectomy, while Group B, consisting of 43 patients, was treated with conservative treatment followed by interval appendectomy 8 weeks later. For Group A, the mass was monitored via ultrasound examination every 3-5 days until it subsided, which took 12-25 days. Group B had two admission periods, initially and after the interval. Results: The study found that appendicular mass occurred frequently in patients aged 21–30 in both groups, and there were no significant differences in age and gender between group A and group B. The resolving time of appendicular mass and the duration of the symptom were also not significantly different between the two groups. However, there was a significant difference between Group A and Group B in terms of overall hospitalization time, with Group B having two admission periods. Conclusions: Conservative management, without interval appendectomy, is the preferred method for treating appendicular mass due to the low incidence of acute appendicitis recurrence. This method can avoid unnecessary surgical intervention and associated complications.
Effects of Rosuvastatin on the Histopathological and Inflammatory Markers of Hyperlipidemic Rat Kidneys
Background: Hyperlipidemia is a significant cause of cardiovascular disease and global death by inducing endothelial dysfunction and narrowing blood vessels. The kidney is the first organ damaged by hyperlipidemia that distracts endothelial capillaries and increases glomerulosclerosis due to decreased renal blood flow. Rosuvastatin has an anti-hyperlipidemic effect and also improves endothelial function and reduces inflammation and oxidative stress. Objectives: The present study aimed to investigate the impact of rosuvastatin on histopathological and inflammatory marker changes induced by hyperlipidemia in male rats. Methods: Forty-six normal male rats were randomly divided into three main groups: the control negative group, ten rats that received a standard diet and water. In the hyperlipidemic group, eighteen rats were fed a high cholesterol (atherogenic) diet (79% standard diet and 21% ghee fat) for seven weeks. The treatment group includes eighteen rats that received a high cholesterol (atherogenic) diet (79% standard diet and 21% ghee fat) for seven weeks and were then treated with rosuvastatin 10 mg/kg/day orally by gastric gavage for 4 weeks. Results: Rosuvastatin significantly decreased the proinflammatory markers (Interleukin-1, Interleukin-6, Tumor Necrosis Factor, and Cystatin C) and the pathological changes in the kidneys (p<0.005) compared with the hyperlipidemic group, while they were significantly increased in the hyperlipidemic group compared to the control group (p<0.005). However, rosuvastatin or hyperlipidemia did not significantly affect the body and the testicular weight. Conclusions: Rosuvastatin modulates the histopathological changes and decreases the proinflammatory cytokine levels in hyperlipidemic male rats.
High Levels of Depression Among Healthcare Workers Four Years After the COVID-19 Pandemic: A Cross-Sectional Survey from a High-Workload, Deteriorating Healthcare System
Background: Healthcare workers (HCWs) in Iraq have endured significant psychological burdens throughout the COVID-19 pandemic. Despite the prolonged impact of the pandemic, studies evaluating the long-term mental health consequences among HCWs remain scarce. To our knowledge. Objective: To assess the psychological impact of the COVID-19 pandemic on HCWs four years after the pandemic. Methods: A cross-sectional study was conducted between May and December 2024. The Patient Health Questionnaire-9 (PHQ-9) was utilized to evaluate depression. Multiple logistic regressions were performed to identify factors independently associated with depression. Results: 948 HCWs were included in this study. 60.3% of them were female, with a mean age of 28.81 years. We found a high level of depression, with 69.4% of HCWs being affected. Younger and single HCWs had a higher depression rate, with a prevalence of 67.4% and 74.3%, respectively. Higher levels of depression were associated with lower educational attainment (84.1%). Also, those with a history of medical, psychological, or family psychological conditions were strongly associated with higher depression levels. Depression affected 72.9% of individuals who had experienced COVID-19 infection before. Medical staff working on the frontlines showed particularly high depression rates at 80.3%. The mild and moderate depression symptoms were most common, since they affected 28.9% and 28.1%, respectively. Conclusions: For the first time in Iraq, this study revealed that 69.4% of healthcare workers (HCWs) suffered from depression four years after the COVID-19 pandemic. Depression was more prevalent among doctors or nurses and those with lower educational attainment.
Assessing Patient Activation Among Individuals with Idiopathic Parkinson’s Disease in Iraq: A Cross-Sectional Study Using the PAM-13 Tool
Background: The Patient Activation Measure (PAM-13) is a validated tool that evaluates individuals' knowledge, confidence, and skills in managing their health. While patient activation is widely acknowledged as crucial for managing chronic diseases, research is limited regarding patients' activation among the Parkinson's disease (PD) population, particularly in middle- and low-income countries such as Iraq. Objective: To evaluate patients' activation levels and examine their association with sociodemographic variables and disease stage among Iraqi individuals with idiopathic PD. Methods: This cross-sectional study included 100 patients with idiopathic PD attending outpatient neurology clinics in two hospitals and two private neurology clinics in Baghdad. The PAM-13 and a demographic questionnaire were used to collect data. Statistical analysis, such as independent sample t-test, one-way ANOVA, Fisher's exact test, and classification and regression tree model, was performed to identify key predictors of activation. Results: The mean PAM-13 scores were 47.2, indicating generally low-to-moderate activation. Over half of the participants (52%) fell into the lowest activation category (Level 1). Advanced age, reduced educational attainment, and advanced disease stage were significantly associated with decreased activation. Classification and regression tree analysis listed age as the principal predictor, while education and illness stage functioned as secondary determinants. Conclusions: This study demonstrated suboptimal activation levels among Iraqi individuals with idiopathic Parkinson's disease. Findings highlight the need for customized interventions to improve patient involvement and self-management, particularly among elderly patients with limited education and advanced disease stages.
Natalizumab Immunogenicity in Multiple Sclerosis: Evaluating Antibody Development and Clinical Outcomes in an Iraqi Cohort
Background: Natalizumab is an effective disease-modifying drug for multiple sclerosis (MS); nevertheless, the formation of anti-natalizumab antibodies (ANA) may reduce therapeutic effectiveness. Objective: To determine the prevalence of ANA, as well as the association between ANA and disease activity and clinical outcome. Methods: This cross-sectional research included 80 MS patients. Demographics and clinical profile, anti-natalizumab antibodies, and JCV status were all evaluated. Disease activity was determined using the Expanded Disability Status Scale (EDSS) and active/inactive disease categorization. To identify predictors of ANA development, correlation and multivariable logistic regression analyses were performed. Results: ANA were detected in 25 individuals (31.25%, 95% CI: 21.4–42.3%). 86% of participants showed ANA during the first 18 months of therapy, with a median time of 14.5 months (IQR: 8.2-22.1 months). Active disease was reported in 33(41.2%) of the 80 participants. There was no significant relationship between ANA levels and disease activity (p=0.927). The mean EDSS scores didn't differ between groups (ANA-positive: 3.70 vs. ANA-negative: 3.96; p=0.576). The ANA-positive cohorts showed reduced EDSS progression (1.58) compared to those with ANA-negative (2.03), although this difference was not statistically significant (p=0.517). Conclusions: Anti-natalizumab antibodies were prevalent in MS patients, although their existence had no meaningful correlation with clinical outcome. There was no link between disease activity and antibody production.
Central and Peripheral Auditory Pathway Integrity in Multiple Sclerosis: A Case-Control Study Utilizing ABR and OAE
Background: Multiple Sclerosis (MS) is a demyelinating neurodegenerative autoimmune disease. Auditory brainstem response (ABR) testing can detect subtle disturbances in auditory signal transmission, localize retrocochlear pathway lesions, and evaluate treatment effectiveness in MS patients. Objective: Evaluate the function of central and peripheral auditory pathways in MS patients using ABR and OAE. Methods: A case-control study was conducted involving 42 MS patients and 42 matched healthy controls. All participants underwent full clinical and audiological evaluation, including pure tone audiometry (PTA), tympanometry, ABR, and OAE. Results: Symmetrically prolonged absolute latencies of Wave III, Wave V, and interpeak latencies (IPLs) were observed in MS patients compared to controls, with no significant effects of sex or disease duration. ABR abnormalities were more frequent in MS than in controls, while no significant differences were found between study groups regarding transient evoked and distortion product otoacoustic emissions (DPOAE). Conclusions: The central auditory pathway appears to be mainly affected in MS, evidenced by the prolonged absolute latencies and ILPs on ABR testing. Peripheral auditory pathway involvement is generally less common, though significant dysfunction at 8 kHz can indicate early cochlear involvement. These findings reflect the importance of comprehensive audiological evaluation in the diagnosis and monitoring of MS patients.
Hysteroscopic Evaluation of Postmenopausal Bleeding
Background: Postmenopausal bleeding (PMB) is a common gynecological condition presented to national health institutes, and assessing the exact reason for postmenopausal bleeding is essential to detect the emergency status and to plan appropriately for management. For that, diagnostic technology is crucial in PMB. Hysteroscopy has proven to be a useful tool in visualizing and identifying common causes of PMB. Objective: To evaluate the role of hysteroscopy in identifying the most common causes of PMB and correlate clinically with histopathological findings. Methods: A cross-sectional study was conducted in the period from March 1, 2019, to February 28, 2025, involving 80 women with symptomatic ongoing postmenopausal bleeding who had been referred to hysteroscopy. Information was gathered from patient-based questionnaires, in addition to hysteroscopy and histopathology findings. Results: Most women were aged 50–59 years (51.2%), had a parity of ≥5 (62.5%), were overweight or obese (86.3%), and had been menopausal for ≤10 years (51.2%). Hysteroscopy detected abnormalities in 97.5% of cases. Histopathology confirmed abnormal findings comprising polyps (36.3%), hyperplasia (18.7%), submucous fibroids (16.3%), atrophic endometrium (15%), and endometrial adenocarcinoma (10%). Increased age was significantly associated with malignant lesions (p<0.001). Hysteroscopy showed high diagnostic accuracy for endometrial polyps (98.7%), submucous myoma (100%), atrophic endometrium (93.7%), and irregular growth (97.5%), but lower accuracy for polypoidal endometrium (71.2%). Conclusions: Hysteroscopy is a reliable and useful tool in visualizing the causes of postmenopausal bleeding and has shown that endometrial polyps are the most common cause of PMB.
Association Between Non-Alcoholic Fatty Liver Disease and Subclinical Atherosclerosis: A Study of Carotid Intima-Media Thickness
Background: Non-alcoholic fatty liver disease (NAFLD) is a major contributor to chronic liver disease worldwide. It is associated with metabolic syndrome, central obesity, insulin resistance, hypertension, hyperlipidemia, and cardiovascular risks. Carotid intima-media thickness (CIMT) is a recognized surrogate marker for atherosclerosis and cardiovascular risk. Objective: To evaluate the CIMT in patients diagnosed with NAFLD, highlighting potential pathophysiological correlations and clinical implications. Methods: A cross-sectional study was conducted at Al Kindy Teaching Hospital over 4 months from October 2023 to February 2024. The sample size was 100 patients showing ultrasonic signs of fatty liver changes (44 were males and 56 were females). These patients underwent carotid Doppler ultrasound, and the intima-media thickness was measured. Results: Of the 100 patients, 53 had a CIMT greater than 0.08 cm, 23 had grade I fatty liver, 24 had grade II fatty liver, and 6 had grade III fatty liver. Of the 47 patients with a CIMT < 0.08 cm, 16 had grade II fatty liver and 31 had grade I fatty liver. The results were statistically significant (p=0.015). The logistic regression shows a higher fatty liver stage significantly associated with increased IMT, but BMI is not significantly associated with thickened carotid intima-media. Conclusions: NAFLD patients exhibit a higher propensity for subclinical atherosclerosis, as evidenced by increased CIMT, and its monitoring may serve as a valuable noninvasive tool in cardiovascular risk stratification, especially in metabolically compromised NAFLD populations.
Comparison of Functional Outcomes Between Arthroscopic and Open Tenodesis in the Management of Biceps Long Head Tendonitis
Background: Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are utilized for treating long head biceps tendon (LHBT) pathology. The clinical advantage of one approach over the other is not well characterized. Objective: To compare arthroscopic tenodesis and open subcortical techniques concerning their functional outcome. Methods: The study included 20 patients aged 20-40 years with long head biceps tendonitis not responding to conservative management. They were randomly allocated into two groups of 10 each. Group 1 received open tenodesis, and group 2 received arthroscopic tenodesis. The outcome was measured, and each case was followed for 1 year based on the American Shoulder and Elbow Surgeons scoring system. Results: The mean ASES score of the open group at 3-month post-operation was 86.7, which did not significantly differ from that of the arthroscopic group (89.5). The mean score 6 months post-operation in the open group was 90.1, which was also not significantly different compared to the arthroscopic group (89.5). Meanwhile, the mean score of the open group after 1 year was 91.1, which was not significantly different from that of the arthroscopic group (91.3). Conclusions: Patients undergoing both procedures experienced similar improvement in the clinical outcomes, without differences regarding treatment failure and functional performance. The arthroscopic group showed increased incidence of residual pain in the early postoperative period.
Preliminary Evaluation of Tacrolimus Impact on Glycemic Control, Renal Function, and Hematological Inflammatory Markers in Kidney Transplant Recipients
Background: Tacrolimus, a widely used calcineurin inhibitor in kidney transplantation, has a narrow therapeutic window and is associated with metabolic, renal, and hematological effects. Objective: To evaluate the relationship between tacrolimus blood concentrations, glycemic status, kidney function tests, and hematological inflammatory indices in kidney transplant recipients. Methods: This pilot study included 28 kidney allograft recipients, divided into two groups according to tacrolimus trough level (<7.5 ng/mL and >7.5 ng/mL). Fasting blood glucose, serum creatinine, blood urea nitrogen (BUN), and hematological indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), were measured at baseline and three months post-transplant. Results: After three months, tacrolimus administration was associated with significant reductions in fasting blood glucose, serum creatinine, and BUN, particularly in female patients. Tacrolimus trough levels declined significantly in both sexes, with a more marked decrease in males. No significant changes were observed in NLR, MLR, PLR, or other hematological indices, and no significant associations were found between tacrolimus concentration groups and the studied parameters. Conclusions: Tacrolimus use over three months post-transplant was linked to improvements in glycemic control and renal function parameters without significant alterations in hematological inflammatory indices. Larger, long-term studies are warranted to confirm these findings and explore potential sex-related differences in tacrolimus pharmacokinetics and clinical effects.
Validity and Reliability of Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) in Type 1 Diabetic Patients
Background: Assessing medication adherence is crucial for patients with type 1 diabetes (T1DM), as it is a primary obstacle to achieving optimal glycemic control in this population. However, none of the currently available tools to assess medication adherence are specific to Iraqi patients with T1DM. Objective: To assess the reliability and validity of the Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) among Iraqi patients with T1DM. Methods: This cross-sectional study was conducted from January 29 to May 29, 2025, at the Faiha Specialized Diabetes, Endocrine, and Metabolism Center in Basrah, Iraq. It involved 100 Iraqi T1D patients aged≥12 years diagnosed for at least 12 months and on stable treatment for at least 3 months. Participants completed a paper-based IADMAS questionnaire at baseline. Reliability was assessed using Cronbach’s alpha. For test-retest reliability, 24 participants completed the questionnaire again after two weeks, and their scores were correlated using Spearman’s rho. Concurrent validity was examined by comparing IADMAS scores with HbA1c levels. Results: The internal consistency of IADMAS, assessed using Cronbach's alpha (0.217). It can be slightly elevated to 0.266 if item 4 is removed. Regarding the test-retest results, the correlation for the total IADMAS scores was 0.458(p=0.024). By inspecting individual items within IADMAS, two items showed significant differences between test and retest values. There was a non-significant association between IADMAS score and HbA1c (Spearman's ρ = −0.087, p=0.391). Conclusions: IADMAS has poor validity and reliability and hence it is not suitable to assess medication adherence among T1DM patients.
Effectiveness of an Educational Program on Hospital Nurses’ Attitudes and Barriers Regarding Truth-Telling to Terminally Ill Patients in Erbil City
Background: Truth-telling to patients who are near death is a debatable and challenging topic in medical ethics. Providing patients with accurate information about their condition, especially when the news is unfavorable, such as a terminal diagnosis or a poor prognosis, is known as “truth-telling” in healthcare. Objective: to assess the effectiveness of an educational program on hospital nurses' attitudes toward truth-telling with terminally ill patients in Erbil City. Methods: A quasi-experimental study was conducted at four teaching hospitals in Erbil City. A non-probability (convenience) sample of 128 hospital nurses was selected, comprising 64 nurses in the intervention group and 64 nurses in the control group. Both groups completed a pretest, and only the intervention group received the educational program. For both groups, the post-test was given one month after the educational program. Results: There was a highly significant difference regarding hospital nurses’ attitudes toward truth-telling to terminally ill patients between the period before and after applying the educational program. In the intervention group, the majority of participants (73.2%) had neutral attitudes at the pre-test. After application of the educational program, most nurses (68.1%) expressed a positive attitude at the post-test. Common barriers among nurses include patients feeling hopeless and families requesting. Only a significant association was detected between nurses' attitudes and their gender. Conclusions: The study concluded that implementing the educational program resulted in an improvement in nurses' attitudes toward truth-telling with terminally ill patients.
Public Awareness and Knowledge Regarding Toxicovigilance of Xenoestrogens in Iraq: A Cross-sectional Study
Background: Xenoestrogens are synthetic chemicals found in various plastics, sealants, consumer goods, preservatives, and pesticides. They can disrupt the endocrine system and have been linked to numerous health issues, including reproductive problems, hormonal imbalances, developmental abnormalities, and an increased risk of certain cancers. Objective: To identify the awareness, knowledge, and usage rate of XEs among individuals in different Iraqi governments and the human risk assessment for potential toxicity. Methods: This descriptive cross-sectional study utilized a random convenience sampling method from January to June 2024 throughout various regions of Iraq. Participants aged 18 to 70 years who provided verbal consent were recruited prior to enrollment in this study (n=304). The participants filled out the questionnaires in the presence of researchers, who then collected them for assessment. The questionnaire, partially modified from a prior study, gathered data on educational status, basic knowledge, and awareness of xenoestrogens and their health effects, as well as the safety and frequency of use of containers presumed to harbor xenoestrogens. Results: The findings will provide insights into the level of awareness and knowledge among healthcare providers, medical students, and academic professionals in Iraq regarding xenoestrogens and their potential health risks. Detailed results will be analyzed to determine the extent of knowledge and gaps that need to be addressed. Conclusions: Most of the Iraqi people did not have enough awareness and knowledge of XE's effects on general health and the environment. This highlights the importance of improving knowledge and awareness about these chemicals.
Immunohistochemical Expression of CD47 and Signal Regulatory Protein-α in B-Cell Lymphoma
Background: Lymphoma is one of many tumors that develop mechanisms to avoid the immune system. One mechanism of immune system evasion is CD47 interaction with various ligands, including signal regulatory protein alpha (SIRP-α). This interaction inhibits phagocytosis of lymphoma cells. Objectives: To assess and compare the frequency of combined immunohistochemical expression of CD47 and SIRP-α in B cell lymphomas in addition to studying its association with some clinicopathological parameters. Methods: A retrospective and prospective case series study of 51 cases of B-cell lymphomas collected randomly from the histopathological department of governmental and some private laboratories in Nineveh Province over a period of six months extending from September 2024 to February 2025. An immunohistochemistry investigation using CD47 and SIRP-α was performed, and the positive expression data were evaluated. Results: The mean age was 31.29 years for HL and 62 years for NHL, with slight male predominance (51%) and (66.67%) had nodal presentation. B-cell lymphoma cases included in this study show immunohistochemical expression of CD47 and SIRP-α, but with different staining grades. 64.71% and 33.33% were high expressors vs. 35.29% and 66.67% were low expressors for CD47 and SIRPA, respectively, with no significant association. Conclusions: Although CD47 and SIRPα showed divergent results, this study revealed that most B-cell lymphomas express CD47 and SIRPα proteins independently.
Smoking Trends, Influencers, and Attitudes Among Future Medical Professionals
Background: While medical students should model healthy behaviors, smoking is common among them. Data on smoking among Iraqi medical students remains limited. Objective: To determine the prevalence, attitudes, and influencing factors for smoking among Iraqi medical students. Methods: A cross-sectional study was conducted from December 2024 to March 2025, involving 250 medical students at Baghdad University. Participants completed a self-administered questionnaire that was newly developed based on relevant literature and validated by a panel of experts. The developed questionnaire was designed to assess smoking status and its influencing factors, attitudes towards smoking, quitting behavior and its influencing factors. Results: Participants' mean age was 21.02±2.16 years; most were single (93.2%) females (58.4%). 41.2% of participants smoked at least once in their life, with 52.42% of those being daily smokers. Cigarettes and hookah were the most tried smoking methods. Peer influence (29%) and stress (24%) were cited as smoking motivators. Additionally, male gender, older age, enrollment in Medicine College, higher academic level, and greater family income were all significantly linked to smoking trials. While 79.61% of smoking participants cited health issues as a quitting motivator, only 33.33% had tried to quit. Most participants had negative attitudes towards smoking. Conclusions: Smoking is highly prevalent among Iraqi medical students despite their negative attitudes towards it. Male gender, older age, enrollment in medical college, higher academic levels, greater family income, peer pressure, and stress increase smoking likelihood. Health concerns serve as motivators for smoking cessation; however, few smokers have attempted to quit.
Protective Effects of Irigenin against Cyclophosphamide-induced Nephrotoxicity in Male Rats: Comparative Study with Vitamin E
Background: Cyclophosphamide is an alkylating agent that is effective against a broad spectrum of tumors, with nephrotoxicity as a side effect. Irigenin is a natural isoflavonoid isolated from the rhizome of Belamcanda chinensis that has been reported to exert antioxidant activities. Objective: Evaluating the possible protective effects of irigenin on cyclophosphamide-induced nephrotoxicity in male rats. Methods: Fifty apparently healthy male albino rats were divided into five groups: (control, induction, irigenin, irigenin with cyclophosphamide, and vitamin E with cyclophosphamide. At the end of the experiment (day 29), all rats were sacrificed. Different parameters were evaluated, including urea and creatinine serum concentration, antioxidant markers reduced glutathione, glutathione peroxidase enzyme, and malondialdehyde level in kidney tissue homogenate, and kidney histological examination. Results: Upon cyclophosphamide administration, malondialdehyde, creatinine, and urea were increased, while their levels were reduced when irigenin was used as pretreatment. On the other hand, the reduced glutathione and glutathione peroxidase enzyme showed a reverse behavior. Additionally, the histological examination confirmed the nephroprotective effect of irigenin. Conclusions: Irigenin has a protective effect against renal damage induced by cyclophosphamide by amelioration of biochemical markers and oxidative stress parameters.
Illness Perceptions and Response to Treatment with Romiplostim in Iraqi Patients with Refractory Immune Thrombocytopenia Purpura: A Cross-Sectional Study
Background: Immune thrombocytopenia is an immune-related disorder that causes an impairment in platelet production and stimulates platelet destruction, causing variable bleeding symptoms. Objective: This study focuses on refractory immune thrombocytopenic purpura patients on romiplostim treatment and their level of illness perception related to treatment response. Method: A cross-sectional study was conducted from May 1st, 2025, to August 1st, 2025. Brief Illness Perception Questionnaires were administered to 84 patients with ITP to collect the data. The study took place at the Hematology and Bone Marrow Transplant Center, Medical City, Baghdad, Iraq. Results: The romiplostim response rate is 21 (25.0%), while the partial response rate is 41 (48.8%). The most frequent complaints were bleeding, 46 (54.8%), and joint pain, 30 (35.7%). In terms of illness perceptions, treatment control had the greatest mean score (6.9±2.85), and understanding had the lowest mean score (4.2±4.6). Conclusions: Romiplostim showed effective management among Iraqi patients, and the patients believe in its effectiveness. A low level of patient understanding was shown among the participants; education programs and patient counseling are required to increase health literacy among patients with immune thrombocytopenic purpura.
Protective Effects of Traditional Herbal Teas Against Obesity-Induced Hepatic and Hormonal Alterations in Rats
Background: Obesity, particularly when induced by a high-fat diet (HFD), is associated with metabolic disturbances and dysfunctions in the liver, kidney, and endocrine systems. Traditional herbal teas are widely consumed in Iraq for weight management, yet their protective effects remain underexplored scientifically. Objective: This study investigates the hepatoprotective, nephroprotective, and endocrine-modulating effects of three locally available herbal formulations, Slimming Pill, Japanese Powder Tea, and Shahana Tea, on HFD-induced obesity-related complications in rats. Methods: Twenty male albino rats were randomly divided into five groups: control, HFD-induced model, and three treatment groups receiving either Japanese Powder Tea, Slimming Pill, or Shahana Tea concurrently with HFD for four weeks. Body weight and serum levels of ALT, AST, ALP, creatinine, urea, uric acid, testosterone, T3, and T4 were measured. Statistical analysis was performed using one-way ANOVA with Tukey's post-hoc test. Results: The Slimming Pill reduced body weight significantly and improved liver enzyme profiles (ALT, AST, ALP), outperforming the other treatments. Japanese Powder Tea and Shahana Tea showed moderate improvements. All interventions reduced serum urea and creatinine, though not to statistically significant levels. Slimming Pill and Japanese Powder Tea significantly restored testosterone levels, while T4 remained unaffected across all groups. T3 levels were moderately reduced in treated groups compared to the model. Conclusions: Slimming Pill exhibited superior protective effects against obesity-related hepatic and hormonal disturbances. While all three formulations offered partial nephroprotective and endocrine benefits, extended intervention durations may be necessary to achieve full therapeutic efficacy.
Histopathological Detection of Post-COVID-19 Fungal Co-infection in the Respiratory Tract
Background: Invasive fungal infections can complicate the clinical course of COVID-19, especially in severely ill patients who require admission to the intensive care unit. Objective: To evaluate the histopathological features and severity score of post-COVID-19 fungal co-infection in the respiratory tract in Ninevah Province and correlate the result with age, sex, and diabetes. Methods: Thirty patients who presented with post-COVID-19 fungal co-infection from August to May 2022 were involved in this retrospective case series study. Hematoxylin/eosin stain and periodic acid Schiff stain were used to stain the biopsies. Disease severity was assessed using a scoring system that incorporated grades from I to III across multiple histological variables. Results: Mucormycosis is the only fungal infection found in the samples received, with female predominance and an age of 54.20 years. Perinasal facial pain and swelling were the most common clinical presentations, and 76.7% were diabetics. Necrosis of ≥ 50% was observed in 63.3% of cases with a severe degree of neutrophilic infiltrate, and angioinvasion in more than 3 vessels in 10 high-power fields was identified in 60% of cases. Histologically, grade II was found in 50% of the cases. Conclusions: Post-COVID-19 patients have a significant risk of mucormycosis, in which diabetes and steroid administration were the most important predisposing factors in addition to systemic immune alteration in COVID-19-infected patients. Acute inflammation, tissue necrosis, fungal load, and angioinvasion were proposed.
Early Detection of Miscarriage in Recurrent Pregnancy Loss Using a Novel Urinary Biomarker
Background: Recurrent pregnancy loss (RPL) is a multifactorial reproductive disorder characterized by the occurrence of two or more consecutive pregnancy losses before 20 weeks of gestation. Objective: To assess metabolic (HbA1c, TSH), immunological antiphospholipid antibodies (aPLA) (IgM and IgG), and urinary (chemerin, adipsin) biomarkers in women with recurrent pregnancy loss and to evaluate their potential as predictors of subsequent miscarriage. Methods: In this case-control study, 92 women participated; 46 had experienced two or more consecutive pregnancy losses before 20 weeks of gestation, and 46 were healthy control women. Venous blood samples were collected to assess levels of TSH, Hb, HbA1c, and aPLA (IgG and IgM). Additionally, urine samples were collected and processed for the examination of chemerin, adipsin, and cAMP concentrations. Results: A total of ninety-two women were involved in the study. The RPL group showed significantly higher TSH, HbA1c, aPLA (IgG, IgM), and urinary chemerin, adipsin, and cAMP compared with controls. Strong correlations with RPL were observed for HbA1c (r= 0.636) and urinary adipsin (r= 0.677), with moderate correlations for TSH (r= 0.514), chemerin (r= 0.598), cAMP (r= 0.474), aPLA IgG (r= 0.460), and aPLA IgM (r= 0.578). Logistic regression identified elevated HbA1c, TSH, adipsin, chemerin, aPLA IgG/IgM, and maternal age as significant predictors of RPL. Conclusions: Metabolic (TSH, HbA1c), immunological (IgG, IgM), and urinary biomarkers (chemerin, adipsin, cAMP) are significantly associated with increased risk of recurrent pregnancy loss. These urinary markers may offer novel approaches for early diagnosis and risk prediction in RPL.
Exploring the Impact of Systemic Conditions in Shaping Chief Complaints in Iraqi Dental Patients: A Focus on Their Prevalence
Background: Systemic health conditions can significantly influence oral health and are often associated with tooth loss and specific dental complaints. These diseases may accelerate periodontal breakdown or complicate existing oral conditions, thereby shaping patients' chief complaints and their reasons for seeking dental care. Objective: To assess the impact of systemic conditions on reasons for tooth extraction and evaluate the prevalence of these conditions within the study population. It also documented the most common chief complaints, categorized by gender, age, and systemic conditions. Methods: This prospective cross-sectional study was conducted amongst the Iraqi population, involving a total of 2,581 patients who attended the Oral and Maxillofacial Surgery Department for tooth extraction. Results: The most common chief complaint was a need for prostheses (43%), followed by dental pain (28.4%). Amongst the 2,581 patients, 659(25.5%) had controlled systemic diseases. The most frequently reported condition was hypertension (12.63%), then diabetes (9.33%), thyroid disease (2.24%), ischemic heart disease (2.16%), and respiratory disease (2.05%). A highly significant relationship was observed between diabetes and periodontal diseases, as indicated by the chi-square test (p= 0.004). Conclusions: This study offers the first epidemiological insights into the impact of systemic diseases on the reasons for tooth extractions among the Iraqi population. The findings reveal a significant correlation between specific systemic conditions and oral health issues that ultimately lead to tooth extraction. Additionally, the study underscores the high prevalence of medically compromised individuals.
Accuracy of Focused Assessment with Sonography for Trauma in Diagnosing Abdominal Injuries in Iraqi Emergency Department Settings
Background: The focused assessment with sonography for trauma (FAST) has played a pivotal role in the evaluation of patients presenting with abdominal trauma. Despite its proven advantages, the technique demonstrates variable sensitivity and carries certain limitations. Objective: To evaluate the diagnostic accuracy of the FAST scan in detecting emergent abdominal trauma compared to an abdominopelvic CT scan or intraoperative findings. Methods: A total of 228 patients with blunt or penetrating abdominal trauma were included. Following ATLS protocols and adequate resuscitation, patients without higher-priority conditions underwent FAST to detect intra-abdominal free fluid. Results were compared with CT or intraoperative findings to assess diagnostic accuracy. Results: Among 228 trauma patients. Intra-abdominal injuries were confirmed in 39.5% either by CT for stable patients or intraoperative findings for unstable patients. FAST scan identified free fluid in 33.3% of scans, with a sensitivity of 58.88%, specificity of 83.33%, positive predictive value of 69.73%, and negative predictive value of 75.65%. The overall diagnostic accuracy was 73.68%, with an area under the ROC curve of 0.711. Sensitivity was significantly higher in unstable patients than stable patients (p<0.001) and in penetrating trauma compared to blunt trauma (p<0.05). Conclusions: FAST scan shows moderate diagnostic accuracy for detecting intra-abdominal injuries in trauma patients in the ED. Its sensitivity is higher in hemodynamically unstable patients and those with penetrating trauma, while it is lower in stable patients and those with blunt trauma.
Renal Vascular and Morphological Alteration in Type 2 Diabetes with Preserved Renal Function: Comparative Analysis Study with Non-diabetic Subjects
Background: Diabetes is a chronic systemic disorder; it is a major cause of chronic kidney disease. Early diagnosis and timely intervention are crucial in preventing further progression. Objective: To evaluate renal changes in type 2 diabetes with normal renal function using ultrasonography compared to healthy controls. Methods: History, anthropometric measures, and laboratory investigations were performed for all participants. All participants were normotensive with normal renal function. For both groups, renal ultrasonography was used to evaluate renal length, parenchymal thickness, interlobar artery diameter, and renal resistive index of the kidneys. Correlation analysis was sought between renal parameters and clinical, anthropometric, and laboratory parameters for the diabetic group. Results: 105 diabetic and 110 healthy controls were included. The mean age of the diabetic group was 53.5 years and 53.6 years in the non-diabetic group. The mean body mass index (BMI) for diabetics was 27.5 and 26.7 in non-diabetics (p>0.05). A significantly higher HbA1c, fasting blood sugar (FBS), and S. creatinine level in diabetics. There was a big difference in the kidney parameters of both groups. Diabetic patients had a significantly longer left kidney, more parenchymal thickness, a resistive index, and a decrease in interlobar artery diameter compared to the non-diabetics. The right kidney length was the same between the groups. Patient age, BMI, diabetes duration, HbA1c, and FBS levels may have predicted these differences. Conclusions: Renal ultrasound is valuable in early detection of structural and vascular changes in the diabetic population.
Factors Influencing Continuous Positive Airway Pressure Outcome in Neonates with Respiratory Distress in Resource-Constrained Settings: Experience from Mosul, Iraq
Background: Neonatal respiratory distress (RD) remains a leading cause of morbidity and mortality, particularly in low- and middle-income countries (LMICs) with limited resources. Continuous Positive Airway Pressure (CPAP) is a cornerstone of management, but its efficacy and factors influencing outcomes in such settings require further investigation. Objective: To identify predictors of CPAP success or failure and subsequent survival in neonates with RD in a neonatal critical care institution in a post-conflict area like Mosul (a healthcare-constrained system). Methods: This prospective observational study included 119 neonates initiated on CPAP. Data on demographics, clinical characteristics, CPAP outcomes (success/failure), and final patient outcomes (discharge/death) were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Results: Overall, 79(66.4%) neonates achieved CPAP success, while 40(33.6%) experienced failure. Birth weight ≤1500 g and a 5-minute APGAR score <7 were independent predictors of CPAP failure. Mortality occurred in 29.4% of cases, with 87.5% of deaths occurring among those who failed CPAP (p<0.001). In multivariate analysis, low birth weight remained the sole independent predictor of death. Kaplan-Meier survival analysis showed significantly reduced survival in neonates weighing 1500 g or less. Conclusions: Low birth weight and low APGAR are strong predictors of CPAP failure, increasing the risk of death. In resource-constrained settings, improving antenatal care, ensuring the availability of surfactants, and expanding access to mechanical ventilation may help improve outcomes for high-risk neonates requiring CPAP.
Ex vivo and in vivo Assessment of Paliperidone Thermal in situ Gel as Nasal-to-Brain Delivery System in Rats
Background: Paliperidone (PAL), an antipsychotic drug, has limited brain availability when administered orally due to poor blood–brain barrier penetration and systemic side effects. Intranasal delivery offers a promising strategy for direct brain targeting. Objective: To investigate the pharmacokinetics and brain-targeting efficiency of paliperidone-loaded nanosuspension thermo-responsive in situ gel for nose-to-brain delivery. Methods: The optimized NB-IG7 formulation was evaluated for ex vivo permeation using a Franz diffusion cell with sheep nasal mucosa, employing simulated nasal fluid. The cumulative drug permeation, steady-state flux (Jss), and permeability coefficient (P) were determined spectrophotometrically. In vivo pharmacokinetic and brain-targeting studies were done on male rats, where NB-IG7 gel was administered nasally vs. an IV dose. Over 48 hours, plasma and brain drug levels were measured for pharmacokinetic measurements. Results: The ex vivo tests showed that NB-IG7 had 3.3 times higher permeation across the nasal mucosa than PAL suspension, which confirmed that it had better mucosal penetration. Intranasal administration of NB-IG7 achieved significantly higher brain concentrations of PAL compared with IV administration. The brain Cmax and AUC0–48hr were 1.89µg/ml and 63.6 hr·µg/ml, respectively, representing 2.66- and 2.68-fold increases over IV administration (Cmax 0.71µg/ml, AUC0–48hr 23.7hr·µg/ml). Plasma exposure was lower after intranasal delivery (Cmax 0.19µg/ml, AUC0–48hr 4.66hr·µg/ml) compared with IV dosing (Cmax 0.87µg/ml, AUC0–48hr13.98hr·µg/ml). Brain-targeting assessments showed markedly enhanced values (DTE 807%, DTI 8%, and %DTP 91%), confirming efficient nose-to-brain transport via olfactory and/or trigeminal pathways. Conclusions: The new formula had superior enhanced brain targeting with reduced systemic exposure.
Physiological Mechanisms of Acute Resistance Training in Reducing Blood Glucose Levels in Women with a Sedentary Lifestyle: A Randomized Controlled Trial
Background: Women with a sedentary lifestyle are prone to metabolic disorders, including insulin resistance and increased blood glucose levels, which are important risk factors for cardiovascular disease and type 2 diabetes. Acute physical exercise has been shown to increase glucose uptake by skeletal muscle. Objective: To determine how resistance training affects aerobic exercise on blood glucose levels in women with a sedentary lifestyle. Methods: This study involved thirty-three healthy women with a sedentary lifestyle. Experimental and control groups before and after were used in this experimental study. People were selected through random sampling and allocated to the treatment group (RT), which received resistance exercise intervention, or the aerobic exercise group (AT), while the control group (CO) did not do any activity. Data collection took place over two days, starting with the collection of information regarding the characteristics of the subjects. The volunteers' blood was then taken as pre-test data before going to the activity. The participants were then instructed to warm up. Thereafter, the participants are engaged in group-specific physical activities. Resistance and aerobic activities were among the exercises done. After the exercise intervention, blood samples were taken as post-test data. Results: Blood glucose levels in the resistance training group experienced a significant decrease in women with a sedentary lifestyle. Conclusions: The results demonstrated that acute resistance training significantly reduced blood glucose levels. Therefore, resistance training is highly recommended, especially for people with a sedentary lifestyle, to prevent various diseases and adverse effects of sedentary lifestyles.
Aquaporin-9 as an Essential Biomarker of the Inflammatory Process in Preterm Prelabour Rupture of Membranes
Background: Preterm pre-labor rupture of membranes (PPROM) is a prevalent obstetric condition causing significant maternal and fetal complications. Aquaporins (AQPs) are membrane proteins that contribute to inflammatory processes and carry out a pivotal role in transmembrane water transport. Since PPROM is an inflammatory process, aquaporin-9 is considered to contribute to its pathogenesis. Objective: To detect the aquaporin-9 concentration in the serum of cases with PPROM and to assess its association with reported adverse outcomes. Methods: A prospective case-control study was conducted on a sample of 90 pregnant women, divided into 2 groups: 45 women with PPROM and a control group of 45 healthy pregnant women. The serum aquaporin-9 was measured for all participants and compared between the two groups. The pregnant women with PPROM were followed up for neonatal and obstetrical outcomes. Results: The mean aquaporin-9 level was significantly higher in women with PPROM in comparison to controls. The aquaporin-9 level cut-off level > 4.22 ng/ml was with a sensitivity of 86.7% and a specificity of 84.4% for the diagnosis of PPROM. The mean aquaporin-9 level was significantly higher among preterm pregnant women with prelabour rupture of membranes with shorter time to delivery after membrane rupture. Conclusions: Aquaporin-9 is crucial for diagnosing PPROM. Higher levels can predict shorter time to deliver in PPROM cases, influencing management decisions.
Electrocardiographic T-Wave Changes in Patients with Liver Cirrhosis: A Marker of Decompensation
Background: Cirrhotic cardiomyopathy is an underrecognized complication that affects nearly half of patients with liver cirrhosis. Electrocardiographic T-wave changes and diastolic dysfunction may serve as an early sign of cardiac involvement. Objectives: To investigate the association between electrocardiographic and echocardiographic changes and/or the severity of liver cirrhosis, as well as estimated short-term mortality. Methods: This was an observational cross-sectional study conducted at Baghdad Teaching Hospital. Sixty patients with liver cirrhosis due to hepatitis B or hepatitis C viruses were enrolled in the study. Patients were grouped into three categories based on their Child-Pugh score and categorized into two groups based on the Model for End-stage Liver Disease (MELD-Na) score. We assess T-wave alterations in the ECG, together with systolic and diastolic dysfunction, to determine their correlation with the severity of liver cirrhosis and the likelihood of mortality within the subsequent months. Results: The average age of patients was 54.06 years. Seventeen patients had compensated liver cirrhosis, while 43 had decompensated disease (20 with category B and 23 with category C). There is a significant prolongation of QTc, prolongation of Tpe, an increase in the Tpe/QTc ratio, a reduction in left ventricle ejection fraction, and an increase in the percentage of diastolic dysfunction among patients with decompensated liver cirrhosis (Child-Pugh class B and C). Conclusions: Cirrhotic cardiomyopathy is related to the decompensation of liver cirrhosis. T-wave changes can be used as a marker of liver decompensation.
Formulation and Characterization of Novel Itraconazole-Loaded PLGA Nanoparticles for Potential Topical Delivery
Background: Itraconazole (ITZ) is a potent antifungal drug limited by poor water solubility and systemic side effects when taken orally. Topical administration offers a safer approach; however, efficient penetration through the stratum corneum remains a challenge. Objective: To develop and optimize ITZ-loaded PLGA nanoparticles (NPs) by investigating the effects of polymer type (PLGA 50:50 and 75:25) and stabilizers (Tween-80 and PVA) on the NPs size, PDI, and zeta potential, and to evaluate in vitro drug release of free ITZ and NPs. Methods: NPs were prepared by the nanoprecipitation method and were characterized using DLS for particle size, PDI, and zeta potential; FTIR spectroscopy for confirmation of drug encapsulation; FESEM and TEM for morphological assessment; and in vitro drug release studies. Results: All NP formulations were in the nano-size range. The optimal formulation, containing PLGA 75:25 and 1% Tween-80, had the smallest particle size and lowest PDI, with an encapsulation efficiency of 54.74%, a drug loading capacity of 8.46%, and a yield of 58.77%. FTIR spectroscopy confirmed successful incorporation of ITZ into the PLGA matrix, whereas FESEM and TEM revealed smooth, spherical NPs with uniform distribution and no aggregation. In vitro drug release studies of the NPs demonstrated a biphasic profile: an initial burst followed by a controlled release, as opposed to the rapid release of free ITZ. Conclusions: The NPs were successfully prepared. The optimized ITZ-loaded PLGA nanoparticles showed favorable physicochemical characteristics, efficient encapsulation, and controlled drug release, highlighting potential as a topical delivery system for antifungal therapy.
Hybrid 3D CNN and Swin Transformer for Autism Classification Through Structural and Functional Brain MRI
Background: Autism spectrum disorder is a prevalent neurodevelopmental condition characterized by social communication deficits and behavioral disturbance. Early diagnosis is essential for timely intervention and condition control. Yet current behavioral assessments are subjective and often delayed; neuroimaging provides objective insights into structural and functional brain alterations. Objective: To evaluate whether integrating structural MRI and functional MRI using a deep learning framework can improve the interpretability and diagnostic accuracy of autism spectrum disorders. Methods: In this retrospective diagnostic modeling study, a hybrid model architecture was proposed, combining 3D convolutional neural networks for structural MRI features with Swin Transformers for functional MRI representations. Features were fused through cross-attention and classified with a fully connected layer. The model was trained and validated on the Autism Brain Imaging Data Exchange II dataset (ABIDE II) Georgetown University site and externally tested on the larger ABIDE II dataset NYU-1 site. Performance metrics included accuracy, F1-score, and ROC-AUC. The hybrid model was compared to each model alone. Results: The model achieved 94.6% accuracy on the GU site, which also maintained a high testing performance on NYU_1. Attention-based fusion of structural MRI and functional MRI revealed brain regions connected to autism spectrum disorder, making the images easier to understand. Conclusions: Multimodal fusion of structural MRI and functional MRI demonstrates a clinically valuable AI tool for early autism spectrum disorder detection. This approach may increase diagnostic confidence and timely interventions.
Mode of Referral and Time to Primary PCI in ST-Elevation Myocardial Infarction
Background: ST-elevation myocardial infarction (STEMI) is a critical emergency where timely reperfusion via primary percutaneous coronary intervention (PCI) is vital. Delays in treatment, particularly during referral or transfer, can severely worsen patient outcomes. Objective: To evaluate transport modes and treatment delays among STEMI patients, focusing on critical intervals from pain onset to first medical contact (FMC) to electrocardiogram (ECG), ECG to PCI, FMC to PCI, and total ischemic time to evaluate factors influencing timely reperfusion and patient outcomes. Methods: This retrospective study included 152 STEMI patients (25–97 years) at Shar Teaching Hospital, Sulaimani, from November 2024 to May 2025. Data on demographics, transport mode, and key time intervals (pain-FMC, FMC-ECG, ECG-PCI, FMC-PCI, and total ischemic time) were analyzed. Results: Significant delays were observed in STEMI treatment processes and timelines. Pain to FMC averaged 11.08± 8.20 hours (13.8% < 30min). FMC to ECG was 9.68±2.99 min (71.7% <10min). ECG to PCI was 1.31±1.60hr (69.1% <1.0hr), and FMC to PCI was 1.46±1.59 hr (67.8% <1.5hr). Total ischemic time was 12.55±18.17 hr (4.6% <2.0 hr). Most patients (71.7%) arrived by private vehicles, while only 28.3% used Emergency Medical Services (EMS) transport, affecting outcomes. Conclusions: The study identified major delays in pain-to-FMC and total ischemic times, mainly due to low EMS use. In-hospital times (FMC-ECG, ECG-PCI) met guidelines, indicating efficient hospital care. Enhancing EMS utilization and prehospital transport could further reduce delays and improve outcomes.
Evaluating the Impact of a Healthcare Quality Course on Nursing Students' Knowledge: A Pre-Post Intervention Study from Jordan
Background: The evolving demands of modern healthcare necessitate that nursing education extend beyond clinical skills to include systems-based practices such as healthcare quality improvement, accreditation, and patient safety. While healthcare quality courses are increasingly integrated into nursing curricula globally, their effectiveness in improving student knowledge—particularly in low- and middle-income settings like Jordan—remains understudied. Objectives: To assess improvements in knowledge of healthcare quality, accreditation, and patient safety among nursing students at Jerash University, Jordan, following a 14-week course. Methods: A one-group pretest-posttest design was employed. After obtaining the ethical permission, a 30-item multiple-choice exam (10 items per domain: healthcare quality improvement, accreditation, and patient safety) and 10 demographic items were administered online via Google Forms as a pretest (5–12 March 2023) and post-test (22–29 June 2023) to 53 nursing bachelor students enrolled in an elective course, primarily targeting final-year students but open to students from other years. Results: Paired t-tests revealed significant improvements in mean scores from pretest to post-test across all domains: healthcare quality (4.08-6.67, p<0.001), accreditation (3.36-6.26, p<0.001), and patient safety (3.67 to 6.83, p<0.001). Conclusions: The course's effectiveness in enhancing students' knowledge offers evidence-based insights for curriculum development and ensuring nursing graduates are well-prepared for contemporary healthcare challenges.
Comparative Role of Heat Shock Protein 70 and tTG Autoantibodies as Biomarkers in Diagnosis and Follow-up of Marsh 3 Celiac Disease
Background: Celiac disease (CD) is an autoimmune disorder characterized by an abnormal immune response to gluten, leading to intestinal mucosal damage. Anti-tissue transglutaminase (anti-tTG) antibodies are well-known ways to diagnose CD. However, it is still not clear what role heat shock protein 70 (HSP70) plays in the disease and protecting the mucosa. Objective: To evaluate serum and tissue levels of anti-tTG antibodies and HSP70 in patients with celiac disease and assess their potential as biomarkers for disease diagnosis and progression. Methods: This case-control study included 64 CD patients and 26 healthy controls from Al-Anbar province. Anti-tTG IgA and IgG serum levels were analyzed, and HSP70 tissue expression was assessed in samples from a duodenal biopsy. Histopathological findings were graded according to the Marsh classification. Results: CD was more prevalent in females (56.5%) than males (37.5%). Serum anti-tTG IgA and IgG levels were significantly elevated in CD patients compared to controls and correlated with the degree of intestinal damage. Both antibodies showed a progressive increase from Marsh 3A to 3C, with Marsh 3C exhibiting the highest levels (tTG-IgA: 19.12 µg/mL; tTG-IgG: 13.44 µg/mL). In contrast, HSP70 tissue expression was low or absent in 53.2% of CD patients, particularly in those with severe mucosal injury (Marsh 3C). Conclusions: Anti-tTG antibodies remain useful for confirming CD diagnosis but are limited in predicting disease progression. HSP70 expression, which declines with increasing mucosal damage, may serve as a complementary biomarker reflecting cellular stress, mucosal integrity, and early disease activity.
The Relationship Between Melasma and Thyroid Dysfunction—Analyzing Anti-thyroid Peroxidase Antibody Profiles: An Immuno-dermatological Perspective
Background: Autoimmune mechanisms have been increasingly implicated in pigmentary disorders such as melasma. Thyroid autoimmunity, reflected by anti-thyroid peroxidase (anti-TPO) antibodies, can influence melanogenesis and disease severity. Objective: To evaluate the correlation between melasma severity and anti-TPO antibody levels. Methods: Fifty people with melasma took part in this case-control study and had their mMASI score and serum anti-TPO antibody levels evaluated. Age-matched controls (n=50) were included for comparison. Results: The mean anti-TPO level is significantly higher in melasma cases compared to controls (24.9±7.3 vs. 19.5±7.9; p=0.001). Within the melasma group, anti-TPO levels show a strong positive correlation with mMASI (r= 0.4, p=0.001), and age (r= 0.3, p=0.001). Melasma severity was higher in older age groups (p= 0.001). Conclusions: Anti-TPO antibodies are elevated in melasma and correlate with disease severity, supporting a potential autoimmune contribution to melasma pathogenesis.
Penetrating Cardiac Injury in a Child Following Nail Gun Accident: Clinical Implications and Public Health Concerns
Penetrating cardiac injuries caused by nail guns are exceedingly rare but often life-threatening, with reports showing an increasing trend. We described the case of an adolescent male who sustained accidental cardiac penetration by an iron nail while performing carpentry work. Rapid referral to a specialized cardiac center enabled timely surgical intervention, illustrating the pivotal role of early recognition, expedited transfer, and expert management in optimizing outcomes. This case also highlights the grave risks associated with the employment of minors in hazardous occupational settings, where exposure to unsafe environments may lead to catastrophic consequences.
Unusual Location for Common Tumor‒Vulvar Leiomyoma in a 40-Year-Old Woman: A Case Report and Review
Leiomyomas are common benign smooth muscle tumors of the uterus; their presentation in the vulva is rare and tends to impose diagnostic challenges, mistaken for other conditions. A forty-year-old, perimenopausal, unmarried patient attended our clinic complaining of a slowly growing vulvar mass for the last 6 months. General evaluation and past medical history were unremarkable. Upon local examination, a firm, non-tender vulvar mass measuring 3 × 4 cm was found, causing discomfort during walking. Preoperative lab investigation and ultrasonography suggested a benign tumor. The patient was advised to undergo surgical excision, which was done under general anesthesia. Histopathology confirms the case. Postoperative recovery was uneventful; she was followed every 6 months; no recurrence after 5 years of follow-up. Vulvar leiomyomas, although rare, should be excluded in a vulvar mass. Definite diagnosis requires histopathological confirmation. Surgical excision of the whole mass provides effective treatment and a better prognosis.