Al-Kindy College Medical Journal

In the last few years, following the relative stability of the political, economic, and security environments, Iraq has embarked on a transformation towards an ambitious program of automation across various sectors. However, this automation program faces numerous challenges, including significant investments in technology and training, addressing social impacts, and combating widespread illiteracy

Physical activity has been considered as one factor that increases oxidative stress. However, the body's natural reaction to exercise might provide more contribution to increase the levels of endogenous antioxidants, including superoxide dismutase. This study aimed to determine how exercise affects the increase in superoxide dismutase enzyme. To reach the objective, the study traced a number of journal databases, including Embase, Pub med, Web of Science, Science Direct, and Scopus. The study considered a number of factors, especially studies that investigated antioxidants, physical activity, and superoxide dismutase. In addition, the studies must have been published within the last five years. Only articles published in non-reputable journals were excluded from our study. A total of 1,026 papers were located using Embase, Web of Science, Pub med, Science Direct, and Scopus databases. About ten carefully selected and peer-reviewed papers addressed the need for this systemic change. Systematic Preferred Reporting and Meta-analysis (PRISMA) items were used in the creation of the standard operating procedures of the investigation. The findings of the systemic analysis showed that exercise has been shown to increase superoxide dismutase levels. The presence of ROS during exercise is what causes the increase. Superoxide dismutase functions as an endogenous antioxidant to reduce free radical production. It is highly recommended to exercise to increase endogenous antioxidant levels which will improve health status. The limitation in this review is only discussing the effect of exercise on increasing SOD. For the next review, the effect of exercise on other endogenous antioxidants such as glutathione peroxidase and catalase can be studied in depth.

Background: Evaluation of tremors is critical in the management of essential tremors, starting from early diagnosis to initial medication and follow-up. Clinical rating scales, accelerometry, or electrophysiology can be used to determine the severity of tremors. However, clinical assessments are self-administered and may be influenced by intra- and inter-evaluator differences in experience and small changes in tremor severity.

Objectives: to demonstrate whether accelerometers are a valuable method for assessing patients with essential tremors.

Subjects and Methods: In the postural position, hand tremor was recorded using a unidirectional piezoelectric accelerometer placed on the dorsum of the index finger for 60 seconds. Fourier (spectral) analysis was used to determine the amplitude and frequency of the tremors.

Results: Significant correlations between log tremor amplitude and the Essential Tremor Rating and Assessment Scale were found.

Conclusions: unidirectional piezoelectric accelerometers can be used to objectively assess the intensity of essential tremors on routine basis, which may aid in treatment adjustment.

Background:

Trigeminal neuralgia (TN), or Tic Douloureux, is one of the most common neuropathic pains. Gamma knife stereotactic radiosurgery (GNSRS) has been considered one of the procedures for treating primary TN.

Objective:

This study evaluates the effectiveness of GNSRS in treating primary TN in patients who are unresponsive to medical treatment in a single-center experience.

Subjects and Methods:

This study was conducted on 180 patients from January 2018 to October 2021. The study utilized the Barrow Neurological Institute (BNI) pain intensity score to assess pain before and after GNSRS treatment.

Results:

A total of 180 patients with primary TN were included in this study, 108 female with a 1.5:1 female: male ratio.

Results showed significant pain score reduction post-GNSRS, indicating GNSRS as an effective second-line treatment for primary TN. The study suggests GNSRS's potential in decreasing medication dosage with minimal short-term complications, recommending further research to assess long-term benefits and side effects.

A notable decrease in medication usage was reported, with minimal short-term complications. These results support the consideration of GNSRS as a viable alternative for TN patients who have exhausted traditional treatment options. Further research is recommended to explore long-term outcomes and potential side effects associated with GNSRS.

Conclusion:

The study's findings demonstrate that GNSRS is an effective and safe second-line treatment for patients with primary TN unresponsive to medical therapy. Significant reductions in pain intensity, as measured by the BNI pain scale, were observed following GNSRS treatment.

Background: Interleukin-22 is an effector cytokine belongs to the IL-10 family. Signaling of this cytokine control tumor development by boosting cancerous cells growth. Toll-like receptor-2 act key function in activation of tumor cell proliferation besides increasing tumor cell invasion.

Objectives: to assess the level and reliability of IL-22 and TLR-2 in patients with breast cancer as a particular diagnostic and prognostic biomarkers in these patients

Subjects and Methods: Ninety breast cancer and sixty healthy control women participated in the current study. ELISA was utilized to measure IL-22 and TLR-2 in the serum of all participating individuals.

Results: The results revealed a significantly higher IL-22 concentrations in patients with breast cancer compared to controls (169.1±43.6 ng/L vs. 82.1±19.5 ng/L (P = 0.010)).Patients in Stage-IV and Grades -2 and -3 demonstrated elevated IL-22 concentrations (239±65.1 ng/L besides 201.2±36 ng/L and 321.2±62.6 ng/L respectively), while there is no significant differences in the concentrations of TLR-2 between patients (for different stages and grades) and control (39.1±11.2 ng/ml vs. 32.3±10.7 ng/ml (P = 0.062).

Conclusions: Increased serum concentrations of IL-22 in patients with breast cancer with higher concentration in advanced stages. This might confirm a potential value of this cytokine as a marker in the pathogenesis of the disease and its promising role as new diagnostic tools of this cancer. TLR-2 shows non-significant difference in the concentration in patients with breast cancer as compared to control group.

Background: Coronavirus disease 2019 (COVID-19) is an emerging zoonotic disease caused by the new respiratory virus SARS-CoV2. It has a tropism in the lung tissues where excess target receptors exist. Periostin plays a role in subepithelial fibrosis associated with bronchial asthma. Since the Coronavirus's target is the human respiratory system, Periostin has been recently described as a valuable new biomarker in the diagnosis and evaluation of disease in patients with COVID-19 lung involvement.

Objectives: To assess the level of Periostin in the serum of COVID-19 patients and to correlate its role in disease severity and prognosis.

Subjects and Methods: Periostin serum levels were measured for 63 patients attending three main COVID-19 Control Centers in Baghdad, compared to 25 healthy subjects, using an enzyme-linked immunosorbent assay (ELISA) from January 2021 to April 2022.

Results: Serum levels of Periostin among studied groups with (mild - moderate, severe - critical, post-COVID, and controls) were (17.3, 664, 597, and 48) ng/dl respectively. The serum concentration of Periostin was highly significant in (severe- critical and post-COVID) than in other groups.

Conclusions: The elevated level of serum Periostin in COVID-19 patients correlated with disease severity and post-COVID lung complications. The high Periostin level is consistent with high inflammatory markers, which might be used as an indicator of COVID-19 severity and predict a bad prognosis.

Background: The American Society of Anesthesiologists (ASA) physical status classification system was created to give doctors an easy way to categorize a patient's physiological status to forecast their risk for surgery. The study aimed to assess whether preoperative arterial blood gas analysis (ABG) in these patients affects the postoperative ventilation status regarding the number of patients intubated, needing oxygen support, or on room air.

Subjects and Methods: This prospective observational study was conducted on 100 patients over one year of ASA-Grade III & IV. An arterial blood sample was drawn under all aseptic precautions. An ABG analyzer was used to evaluate blood gas parameters. The quantitative variables were expressed as mean and standard deviation. All quantitative variables were analyzed using the independent students test, and categorical variables were analyzed using the chi-square test.

Results: Parameters evaluated were patients' postoperative ventilation status, a comparison of preoperative and postoperative ventilation status, an association of preoperative PH, PaO2, PCO2, bicarbonate, and lactate with postoperative ventilation status, the percentage of patients with serum electrolyte abnormalities, the preoperative mean blood glucose level, and the postoperative ventilation status of the patients. It was statistically significant (P=0.002) that the patients on acidosis before surgery were already intubated. Most preoperative acidotic patients needed postoperative mechanical ventilator support, which is statistically significant with P=o.oo8.

Conclusions: Our study observed a statistically significant association of preoperative PH, lactate, and blood glucose in ABG with patients requiring mechanical ventilation postoperatively. Higher preoperative mean blood glucose levels were associated with more intubated patients postoperatively.

Background: Iron deficiency (ID) is a global problem that affects women more prevalently, causing vast health consequences. Screening by hemoglobin and serum ferritin is currently applied for ID. Recently, interest in complete blood count parameters (CBC) has emerged for its close relationship with body iron stores.

Objectives: to examine whether hematological indices of CBC [namely red cell distribution width-coefficient of variation (RDW-CV) and platelets distribution width-coefficient of variation (PDW-CV)] can serve as a predictor for ID in Iraqi women.

Subjects and Methods: A cross-sectional study at the National Center of Hematology recruited 200 women into a study group: 100 anemic women and 100 healthy controls. Their demographics, hematological indices, and iron indicators (serum ferritin, iron, total iron binding capacity (TIBC), and transferrin saturation) were collected.

Results: The RDW-CV and platelet counts were statistically higher in the IDA cases, while PDW was lower. RDW had significant correlation to serum ferritin (r=-0.2, P=0.04), while PDW was significantly linked to serum ferritin (0.22, P=0.03) TIBC (r=-0.24, P=0.02) and TSP (r-0.23, P=0.02). RDW had the highest positive and negative predictive values, with 84 and 97 %, respectively, followed by platelet counts, which scored 72 and 78 %, respectively. RDW-CV cutoff value scored the highest sensitivity, 97%, and specificity, 82%, in discriminating ID cases from healthy controls with an area under the curve of 0.98 and P<0.001.

Conclusions: RDW showed significant correlations to iron indicators with strong discriminating power and high positive predictive value. RDW accessibility and affordability make them recommendable markers in earlier screening for ID.

Background: The obesity epidemic is affecting worldwide health, increasing the risk of cardiovascular diseases such hypertension, diabetes, dyslipidemia, and nonalcoholic fatty liver disease. this gave an impetus to study the new variables Insulin-like peptide 5, Phosphodiesterase 9 and their relationship as a cause or effect factors

Objective: To validate any associations between Phosphodiesterase 9 (PDE9) and, Insulin-like peptide 5 (INSL5), specific factors and obesity, and to explore how they might integrate with other established agents to combat obesity and improve metabolism.

Subjects and Methods: The study was based analytical cross-sectional research was conducted from (February 2022) to (August 2022). The study based on apparently healthy women (primary analyses were made, their blood sugar and lipid profile with the normal reference range) 50 women with age range (20 – 40) years. Fasting blood samples were collected from all the participants in this study, (5 ml) was poured in plane tubes and sera were separated by centrifuging the samples for 10 minutes at 3000rpm for the biochemical and hormonal investigations, therefore they were divided into two group: -first group: consisted of twenty-five obese women without previously diagnosed diseases (BMI>30 kg/m2) . second group: consisted of twenty-five women with normal BMI (BMI= 24.9-18.5 kg/m2).

Results: Serum insulin-like peptide 5 showed significant increase in obese women without previously diagnosed diseases (16.31±3.88 µIU/ml), in comparison with women with normal BMI (11.17±3.88 µIU/ml). Serum PDE-9A significantly ((P≤ 0.05) decrease in obese women (6.77±1.95ng/ml), in comparison with women with normal BMI (8.11± 1.52ng/ml),

Conclusions: Insulin-like peptide 5 (INSL5) could play in a role in promoting insulin resistance (IR), Phosphodiesterase 9 (PDE9) is a regulator of energy, Phosphodiesterase 9 (PDE9) inhibition is associated with increase the occurrence of insulin resistance.

Background: Medication reconciliation can include medication reviewing and providing counseling and a list of all the medications during every transition of care.

Objectives: to explore in-depth the perspectives of Iraqi physicians and pharmacists regarding the necessity of medication reconciliation at hospital discharge and identify the possible benefits and challenges that could face its implementation.

Subjects and Methods: A qualitative study included semi-structured interviews with pharmacists and physicians working at a public teaching hospital in Iraq. The interviews were conducted face-to-face from February to March 2023. Thematic analysis was used to analyze the qualitative data generated from the interviews.

Results: In this study, 18 healthcare providers were recruited: 12 pharmacists and six physicians. All participants supported medication reconciliation adoption at hospital discharge. Pharmacists can identify unintended medications discrepancies via discharge medication reviewing, patient counseling and providing discharge list. The most frequently reported challenges to establishing medication reconciliation were a lack of clear official instructions, suboptimal physician-pharmacist cooperation, and inadequate awareness.

Conclusions: The implantation of medication reconciliation has numerous benefits in terms of enhancing patient safety and avoiding medication errors. However, it needs several pre-requisites to be implemented routinely, including official enforcement and training courses to raise healthcare providers’ awareness.

Background: Up to 50% of people worldwide are infected with Helicobacter pylori, a bacterium with a spiral shape and a negative Gram stain. Negative impacts on oral health, including bad breath, dental caries, recurrent aphthous stomatitis, and glossitis, are caused by this particular pathogen.

Objective: This study aimed to evaluate the correlation between saliva pH, flow rate, alkaline phosphatase and periodontal status in patients with Helicobacter pylori.

Subjects and Methods: From December 2021 to July 2022, a case-control study was undertaken consisting of a group of 80 participants, consisting of both H. pylori-positive individuals as the study group (40) and healthy, H. pylori-uninfected individuals as the control group (40), all between the ages of 30 and 40. Both groups provided unstimulated saliva for the study. Alkaline phosphatase levels, pH, and flow rate are all measured during saliva analysis. Upon completing this routine, an assessment of periodontal pocket depth, bleeding on probing, and plaque is conducted.

Results: During the study, it was observed that the control group had lower plaque index, percentage of probing bleeding, and periodontal pocket depth compared to the study group. The difference between the two groups was statistically significant (p<0.05). The control group also had higher salivary pH and flow rate compared to the study group. Conversely, the study group had higher alkaline phosphatase levels than the control group. This difference was also statistically significant (p<0.05). Moreover, weak and non-significant correlations were found between the periodontal parameters and salivary pH and flow in both groups. The correlation was negative and statistically significant (P<0.05). The salivary pH of the BOP and the control group had a significant negative correlation as well.

Conclusions: Due to its status as a significant exterior origin of Helicobacter pylori, the oral cavity could hold significance in the periodontal health of those affected by Helicobacter pylori disease. In reference to the study group, the PH and flow rate of saliva were less than that of the control group, while alkaline phosphatase displayed higher levels, attaining statistical significance (P<0.05).

Background: Vitamin D is an essential agent in regulating body enzymes due to the wide distribution of vitamin D receptors throughout the body, the site where vitamin D acts. Vitamin D deficiency could be related to many factors. Polymorphism in receptor(s) and enzyme(s) responsible for vitamin D metabolism, like CYP24A1, could be liable for vitamin D deficiency.

Objective: This study aims to determine the impact of polymorphism in Vitamin D Receptor TaqI (rs731236) and CYP24A1 (rs2762934 and rs4809957) on vitamin D level and osteocalcin in postmenopausal women.

Subjects and Methods: Forty postmenopausal osteoporotic women (patients’ group) according to WHO osteoporosis diagnostic criteria were enrolled in the study. This group received 50000 IU/week of vitamin D for eight weeks. In addition, 30 postmenopausal non-osteoporotic women were set to be a control group. Genetic and biochemical analyses were applied for both groups.

Results: Serum levels of osteocalcin in the patients’ group were 9±6.19 and 4±6.6 in groups with vitamin D levels below 20nmole/L and above 20nmole/L, respectively, with a non-significant difference between them (p=0.49). Related to allele frequency, the A/G genotype of rs731236 of the vitamin D receptor, G/G genotype of rs2762934, and A/A genotype of rs4809957 of CYP24A1 showed non-significant differences among the study patients’ group.

Conclusions: Our data indicates that rs731236 with the A/G genotype, rs2762934 with the G/G genotype, and rs4809957 with the A/A genotype were more prevalent than the other genotypes and could be responsible for being osteoporotic through their effect on vitamin D level and resistance to vitamin D supplementations.

Background: In modern healthcare, decision-making processes are becoming increasingly data-driven, aiming to optimize patient care and resource allocation. Coronary artery bypass grafting (CABG) is a critical procedure for high-risk patients, and the use of intra-aortic balloon pump (IABP) assistance can significantly impact patient outcomes.

Objective: To identify preoperative factors that predict the need for IABP assistance in high-risk CABG patients and to develop a predictive model that can enhance clinical decision-making.

Subjects and Methods: The study involved fifty high-risk coronary artery bypass graft patients, with 24 cases necessitating intra-aortic balloon pump assistance and the rest not requiring it. Seven preoperative variables, including age, weight, ejection fraction, number of grafts, creatinine level, diabetic status, and blood pressure, were considered as potential predictors. SPSS was adopted to conduct a multi-variable regression analysis and derive the mathematical equations for the predictive model. A graphical user interface (GUI) was developed to utilize these equations for predicting the need for IABP support.

Results: The findings revealed a strong correlation among several preoperative factors and the likelihood of requiring IABP assistance. By employing the predictions from the model to guide preoperative intra-aortic balloon insertion, the potential for optimizing hemodynamic support during surgery was maximized.

Conclusions: This research emphasizes the importance of enhancing risk assessment techniques to empower medical specialists to tailor treatment plans to each patient's specific needs. Early identification of individuals at risk of requiring IABP can significantly enhance surgical outcomes and patient safety. Incorporating the predictive model into clinical practice allows for more individualized and effective care during high-risk CABG surgeries. This modern strategy has the potential to revolutionize cardiac outcomes, improve patient results, and extend the use of intra-aortic balloon support.

Infectious keratitis may be caused by viruses, bacteria, parasites, and fungi. Noninfectious can be caused by injury to the cornea, dryness of the cornea, allergies, and improper use of contact lenses. Fungi commonly responsible for corneal ulcers are Aspergillus (most common), Candida, and Fusarium. Both Aspergillus and Fusarium account for about one-third of all traumatic infectious keratitis. In the current case series, we submit 4 cases of Fusarium keratitis. A microbiological investigation like KOH mount is an important test that can confirm the presence of the fungal infection in samples. Topical and systemic anti-fungal treatment combinations give better outcomes in fungal keratitis patients. Culture is the gold standard, and fusarium species are rapid growers. All suspected patients should be screened for fungal culture in their primary visit to prevent further complications and disability.