Journal of the Faculty of Medicine Baghdad

Life expectancy at birth is one of the most critical indicators of a population\'s health, reflecting the cumulative effects of healthcare access, lifestyle, socioeconomic factors, and public health strategies (1). Between 2000 and 2022, life expectancy trends in Iraq were shaped by political instability, conflicts, economic sanctions, and evolving risk factors such as lifestyle-related diseases, environmental hazards, and fragmented health services. This article explores these trends, focuses on statistical data and regional comparisons, and recommends actions to address Iraq’s public health challenges.

Background:Bronchiectasis is a chronic disease characterized mainly by chronic cough with the production of purulent sputum.It is still seen in Iraq and developing countries, although its incidence is much lower in the developed countries.Objectives:To highlightthe etiology and the diagnostic workupof patients affected by thisdisease processand to assess the outcome of the surgical intervention in aproperly selected patient.Methods:Fifty-six patients were enrolledin the current study.Thirty patientswere excluded as they were not surgical candidates.Twenty-six patients met our criteria,as they were surgical candidates,whosefiles were studied retrospectively.All the cases were admittedtothe Thoracic and Vascular Department of the Surgical Specialties Hospital of the Medical City Teaching Complex,Baghdad/Iraq, from 1stJanuary 2018 to 31stDecember 2022. All casesunderwent pre-operative blood investigations,diagnostic imaging,and bronchoscopy.They were subjected to surgeries with different resection procedures. Results:Twenty of the cases were females(76.9%).while six patients were male (23.1%).The youngest patient was a seven-year-oldfemaleandthe oldest was a 59-year-oldmale.The mean age was 27.3years, and themedian was33years. The most common symptoms were cough with purulent sputum.A CT scan of the chest was performed on all patients.The right middle lobe andtheleft lower lobe were the most affected. Twenty-five patients underwent classical postero-lateral thoracotomy.The right middle lobe and the left lower lobe were the most common lobes resected.Only one patient underwentvideo-assisted thoracoscopic surgery (VATS).The histopathological results were consistent with bronchiectasis in 24 patients. Post-operative morbidity included atelectasisin three patientsandwound infection in one patient,they were managedsuccessfullymedically.No mortality wasreported in thestudy.Conclusion:Once bronchiectasis is well-established, surgery in properly selected patients, with complete resection of the involved lobe or lobes, offers the best chance of cure and optimum control of the patient’s symptomsز

Background: Hepatitis A virus, a single-stranded RNA virus from the family Picornaviridae, is primarily transmitted via the fecal-oral route. The World Health Organization reports about 1.5 million hepatitis A cases annually, with the incidence rates closely linked to socioeconomic conditions. This vaccine-preventable disease is the focus of our research.

Objectives: The current research aimed to elucidate the incidence, clinical presentation, and outcomes of hepatitis A in Iraq, highlighting the importance of appropriate preventive measures.

Methods: It wasconducted as a retrospective cohort study from January 2019 to July 10, 2022, and a prospective cohort study from July 11, 2022, to September 30, 2022. A total of 238 confirmed HAV cases 189 retrospective and 49 prospective were analyzed. Data included demographic characteristics, clinical presentations, laboratory findings, and ultrasonographic results. HAV IgM positivity was confirmed using the MAGLUMI HAV IgM Chemiluminescent Immunoassay CLIA).

Results: Most cases were observed in the 6 to 10-year-old age group p=0). Gender distribution was nearly equal, with males at 50.8% and females at 49.2%. Clinical profiles included jaundice 96.2%), hepatomegaly 45.4%), abdominal distention 15.6%), splenomegaly 7%), and bleeding 5.9%). Ultrasound findings showed an enlarged liver 45.4%), thickened edematous gallbladder wall 31.2%), enlarged spleen 14.9%), and ascites 4.2%). Biochemical analysis revealed mean values of SGPT 786.8 U/l), SGOT 647.6 U/l), TSB 10.34 mg/dl), Alb 3.9 g/dl), PT 14.9 sec), PTT 36.45 sec), and INR 1.15). Severe cases were 8 in number, with acute liver failure 4 deaths) and 6 with hepatic encephalopathy 5 deaths), and a mortality rate of 2.1% of which the male-to-female ratio was 4:1.

Conclusion: This study underscores the need for vaccine implementation to prevent and control HAV infection in Iraq, given the high incidence and ongoing risks.

Background: Doctors and patients communicating effectively is a very important base in cancer clinics and out-patient, the “Bad” news is any information that drastically alters a patient’s prospect of their life and forthcoming possibilities. It includes facts about diagnosis, recurrence, and treatment failure in clinical oncology settings.
Objective: To assess the attitudes of cancer patients toward receiving bad news of their condition and the relationships of some sociodemographic variables to these attitudes.
Methods: A cross-sectional study was conducted from the 19th of February to the 1st of June 2017 at the Oncology Hospital in the Medical City Teaching Centre/Baghdad. A group of 212 cases completed the questionnaire, which included socio-demographic information (age, gender, marital status, occupation, and education). The preference and attitude questions were set as in the recommended steps of the SPIKES protocol, which is a six-part method for sharing bad news with patients (Setting, Perception, Invitation, Knowledge, Emotions, and Summary).
Result: Patients were classified into two age groups: those 50 years or older (64.2%) and those below 50 years (35.8%). Of the 212 cases, 46.2% were housewives, and 20.8% were government employees. The majority of patients (80.2%) preferred to be informed about their disease, its type, its prognosis, treatment, and life expectancy on the first visit. Most of the participants (67.9%) thought that the most experienced and skilled doctors have to notify them completely about their medical condition. The majority of them (81.1%) preferred that the physician use the word (disease) instead of "cancer. Most patients (75.5%) thought that it is better to train healthcare professionals in communication skills and how to break bad news.
Conclusion: Patients diagnosed with cancer are willing to learn about the diagnosis and are keen to receive details as early as possible about its type and prognosis, treatment, and life expectancy.

Background: Interprofessional collaboration (IPC) is the best way to provide high-quality and safe healthcare for the patient, reduce costs and length of hospital stay, as well as increase job satisfaction of the staff. However, many factors may hinder the achievement of interprofessional collaboration (IPC), and these need to be determined.
Objective(s): Determining the national status of interprofessional team collaboration among healthcare team members, including nurses, physicians, and clinical pharmacists, in Critical Care Units, and examining the statistical difference between the professional qualities of the subjects and their levels of interprofessional team collaboration, are the goals of this study.
Methods: A descriptive cross-sectional design was used in the present study. The current study was conducted in the Intensive Care Units (ICU) and Cardiac Care Units (CCU) of eight hospitals of the Najaf Governorate, in the Republic of Iraq. The 364 participants recruited in this study were healthcare team members, which included physicians, nurses, and pharmacists. The instrument used in the study is the Assessment of Interprofessional Team Collaboration Scale-II. Arithmetic means, frequencies, and percentages, as well as the Kruskal-Wallis and Mann-Whitney tests, were the statistical methods used in the study.
Results: The level of interprofessional collaboration (IPC) was moderate among the physicians with a mean score (MS) of 3.25, and pharmacists with 2.55, while it was lower in nurses at 2.06. Of equal importance, significant mean differences were observed between the overall scores of Interprofessional Team Collaboration among the healthcare team members and their sexes, number of physicians, academic preparation, specialization, work shift, and educational level.
Conclusion: The current study showed that Interprofessional Team Collaboration was not consistent with the standard expected level. Further, the professional qualities of many subjects exert significant effects on this level.

Background: Patients with spinal cord injuries often face unique challenges related to their dietary regimen. Adequate knowledge about dietary regimens is crucial for their overall health, well-being, and management of specific nutritional needs.
Objectives: To evaluate the effectiveness of the instructional intervention in enhancing knowledge about dietary regimens among patients with spinal cord injuries and to compare the knowledge levels between the intervention group and the control group.
Methods: The study was conducted from 8th of March 2023 to 15th of February 2024. Sixty patients at Ibn Al-Kuff Hospital for Spinal Cord Injuries in Baghdad were studied based on power analysis to detect the difference in knowledge acquisition between the intervention and control groups. The targeted age was 18-60 years. Individuals with cognitive impairments affecting comprehension were excluded. Participants were randomly assigned to either the intervention or the control group using computer-generated randomization. A structured instructional program was administered to the intervention group to enhance knowledge about diet therapy, while the control group received no specific intervention. Pre- and post-intervention assessments were conducted to evaluate participants' knowledge levels. The assessments employed a validated rating and scoring scale tailored for assessing knowledge about dietary regimens in the context of spinal cord injuries.
Results: In pre-intervention, both groups had poor knowledge scores but in post-intervention, the intervention groups mean became good while the control group’s score remained “moderate”. the intervention group showed a notable increase in knowledge (p < 0.05), while the control group had a non-significant improvement (p = 0.345).
Conclusion: The dietary intervention had a positive impact on enhancing participants' knowledge levels related to dietary therapy for spinal cord injuries. Continued assessment and multidisciplinary strategies should be prioritized to ensure the provision of effective and holistic support services to patients with spinal cord injury.

Background: It is believed that vitamin D is a major environmental factor that can affect the occurrence of many inflammatory and autoimmune disorders, such as Behcet's disease.
Objectives: To evaluate the impacts of medical treatment and body mass index on vitamin D3 and certain oxidative stress markers (Glutathione, Nitric Oxide) in Iraqi patients afflicted by Behcet disease. Additionally, it sought to explore any potential correlations between such markers and Vitamin D3 with the severity of Behcet disease, and the diagnostic potential of saliva in measuring such markers.
Methods: This is a case-control study conducted at Merjan Teaching Hospital in Babylon, Iraq. between December 2023 and March 2024. Forty-five patients suffering from Behcet disease, and meeting international criteria, were divided into three groups: 15 on azathioprine treatment, 15 newly diagnosed untreated cases, and 15 on anti-TNF-α (Infliximab) biological therapy. A control group of 15 subjects matched for age and sex was included. Serum and salivary 25-hydroxy vitamin D levels were measured using an enzyme-linked immunosorbent assay. Spectrophotometric methods were used to assess levels of reduced Glutathione and Nitric Oxide in serum and saliva across the groups. Statistical Package for the Social Sciences software, version 26, was used to analyze data. A significance level of P ≤ 0.05 has been established as statistically significant.
Results: Vitamin D3 level was significantly lower in newly diagnosed Behcet disease patients as well as those on Infliximab therapy compared with controls. The greatest serum Glutathione level was found in cases of Infliximab treatment compared with other groups. Serum Nitric Oxide showed an inverse correlation with a highly significant difference in disease severity.
Conclusion: Newly diagnosed Behcet disease cases and those on Infliximab therapy were linked to vitamin D deficiency. A positive correlation between serum and salivary D3 was established. Salivary Nitric Oxide increased during Behcet disease. Since serum Nitric Oxide levels fall as the disease progresses, it could evaluate the severity of Behcet disease.

Background: Urinary bladder cancer (UBC) is the most common urinary tract malignancy, ranking tenth worldwide. In Iraq, UBC is ranked as the seventh most prevalent cancer among the top 10 cancers. Numerous established risk factors for bladder cancer including genetic and hereditary factors, smoking and nicotine behaviors, occupational exposure to certain chemicals and pigments, and environmental pollution from drinking water contaminated with arsenic may also be problems, as well as disorders including chronic cystitis, and infectious diseases like schistosomiasis. Urine cytology and cystoscopy are the gold standard for detecting UBC.
Objectives: To analyze and characterize urinary bladder cancer (UBC) diagnosed in a group of Iraqi patients.
Methods: A total of 70 paraffin-embedded tissue blocks of bladder cancer were obtained from the archive of the Histopathology Unit of the Martyr Ghazi Al-Hariri/ Medical City, Al-Yarmouk Teaching Hospital, and several private laboratories in Baghdad, Iraq for cases diagnosed between 2019 and 2024. Clinical data in addition to the age and sex of the patients were collected from the patients\' clinical records. Histological examination was conducted to determine the tumor characteristics including type, tumor age, sex, size, stage, and grade.
Results: The results revealed that 82.9% of UBC cases were males, and 62.9% were between the ages of 60 and 79 years. The most common tumor size was 2-5 cm, with stage T1 accounting for 80% of the total. A high tumor grade was observed in 60% of UBC cases. The most prevalent histological type observed was papillary urothelial carcinoma (77.1%).
Conclusion: UBC was found to be mainly a disease of males and older age. Papillary urothelial carcinoma was the most frequently seen, mostly at stage T1 and high grade, more likely to be of a small or moderate size.

Background: Insulin produced by pancreatic β cells ceases in people with type1 diabetes mellitus, an endocrine disease caused by autoimmune damage. It can cause weight loss. Energy balance controls the secretion of ghrelin, a peptide hormone made by entering endocrine cells found in the oxyntic glands of the stomach fundus.
Objectives: This study aimed to investigate the relationship between serum ghrelin and body mass index in newly diagnosed children with type 1 diabetes mellitus.
Methods: The study involved 120 pediatric participants aged 2-14 years conducted from February to May 2024. They were divided into four groups: group 1 contains 40 lean patients with type 1 diabetes mellitus and a body mass index ≥85 percentile, group 2: 40 underweight patients with type1 diabetes mellitus and a BMI ≥5 percentile, group 3: 22 healthy lean controls with a body mass index <85 percentile, group 4: 18 healthy underweight controls with a body mass index ≥5 percentile. The study measured fasting serum glucose, ghrelin, and HbA1c. Results: Diabetic patients had significantly lower ghrelin levels compared to controls. Underweight diabetics had higher mean HbA1c and fasting blood glucose compared to lean and underweight controls.
Conclusion: In type 1 diabetes mellitus patients, ghrelin levels are lower than in controls. Ghrelin correlates positively with FBG, HbA1c, weight, and height in healthy control participants (lean and underweight) and age in lean control subjects. No association was found between ghrelin and the patient (T1DM).

Background: Cataract surgery is one of the commonest surgeries. Changes in intraocular pressure (IOP) might occur after surgery and some post-operative medications might affect it.
Objectives: To evaluate the effects of the non–steroidal anti–inflammatory drug Bromfenac 0.09% ophthalmic solution on intraocular pressure after phacoemulsification and to report any side effects of the drug.
Method: It was a prospective study done at Jenna ophthalmic center, Baghdad- Iraq from May 2023 to January 2024 involving adult patients with cataract prepared for phacoemulsification with intraocular lens implantation. The patients were divided into two groups: Group I: received 0.09% Bromfenac ophthalmic solution twice daily in addition to Moxifloxacin 0.5% ophthalmic drops every 6 hours and Dexamethasone phosphate 0.1% ophthalmic drops every 4-6 hours post-operatively. Group II: received only Moxifloxacin 0.5% every 6 hours and Dexamethasone phosphate 0.1% ophthalmic drops every 4-6 hours without the administration of Bromfenac 0.09% ophthalmic drops post-operatively. The intraocular pressure was measured pre-operatively and 6 weeks post-operatively by Goldman applanation tonometry.
Results: Eighty-seven eyes of 87 patients are enrolled in the study. The preoperative mean of intraocular pressure in group I and group II were 16.6 ± 2.37 mmHg, and 17.1 ± 3.33 mmHg respectively (not significantly different), while the postoperative mean of intraocular pressure in group I and group II, were 16.0 ± 2.32 mmHg and 16.7 ± 2.9 mmHg respectively. There were no significant changes in IOP post-operatively in either group, and the only side effect reported was punctate epithelial corneal erosion in five patients in group I.
Conclusion: The effect of Bromfenac 0.09% ophthalmic solution administration postoperatively on IOP in cataract patients was insignificant. The medication resulted in punctate epithelial erosion in some patients.

Background: Most individuals with inflammatory arthritis are diagnosed with rheumatoid arthritis (RA), which is an immunological disorder characterized by the development of autoantibodies, particularly anti-cyclic citrullinated peptide (ACCP) antibodies, which play a significant role in initiating inflammatory responses. Recent studies have shown that the production of cytokines contributes to the progression and dissemination of RA.
Objectives: To assess the predictive capability of Interleukin 41 (IL-41) compared with ACCP and its correlation with disease activity and treatment response in a group of Iraqi patients afflicted with RA.
Methods: One hundred patients with RA and fifty healthy controls constituted the total number of participants in this case-control study. The research was conducted in Baghdad Teaching Hospital from November 2023 to February 2024. The American College of Rheumatology 2010 criteria were used for patient recruitment. In order to evaluate the role of the biomarkers, an enzyme-linked immunoassay (ELISA) technique was used.
Results: The level of IL-41 in RA patients (5.2 ± 2.65 ng/mL) was significantly higher than in healthy controls (3.0 ± 1.43 ng/mL). The mean serum IL-41 concentration was highest in the severe form (6.8 ± 2.91 ng/mL), followed by moderate and low disease activity. A positive correlation was also detected between the serum IL-41 level and the ACCP. Serum IL-41 was significantly higher among patients taking methotrexate (5.8 ± 3.30 ng/mL), more than both etanercept (5.1 ± 2.47 ng/mL) and etanercept + methotrexate (4.6 ± 1.82 ng/mL).
Conclusion: Elevated concentrations of IL-41 in the serum of RA patients potentially serve as diagnostic markers for RA. It helps as an indicator of disease activity and therapeutic response.

Background: Alopecia areata (AA) is a complex, multifactorial autoimmune disease in which a person's genetic predisposition plays a significant role. Alopecia areata has been linked to various autoimmune conditions. There is a significant likelihood that autoimmune thyroid disorders will coexist with these conditions.
Objectives: To determine the association between alopecia areata and subclinical thyroid dysfunction, and to assess serum cortisol levels and their relationship with AA.
Methods: ‏The case-control study, conducted at the Dermatology Center of Baghdad Teaching Hospital from October 2023 to February 2024, involved 80 AA patients and 40 healthy controls. Thyroid hormones and cortisol levels were measured using electrochemiluminescence immunoassay.
Results: The mean age of AA patients was (29.4±10.49) years compared to (30.1±8.77) years in controls, with no statistically significant difference (p=0.75). Serum T3 levels were significantly higher in AA patients (1.5 ± 0.04 ng/ml) compared to controls (1.4 ± 0.03 ng/ml, p=0.03), though all values remained within the normal range. In contrast, no significant differences were observed in T4 levels (8.4 ± 0.21 vs. 8.7 ± 0.16 μg/dl, p=0.25) or TSH levels (1.7 ± 0.11 vs. 1.6 ± 0.08 μIU/ml, p=0.31) for the AA and controls, respectively. Serum cortisol levels were significantly higher in AA patients (11.1 ± 0.52 ng/dl) compared to controls (8.6 ± 0.23 ng/dl, p<0.0001). However, all measured cortisol levels in both groups remained within the normal reference range.
Conclusion: Significant differences in T3 and cortisol levels exist between alopecia patients and controls, suggesting hormonal involvement in AA. No significant differences were found in T4 and TSH levels, requiring further investigation.

Background: Methamphetamine (METH) is a potent synthetic stimulant that significantly impacts the central nervous system and can lead to severe liver damage. Prolonged METH use causes hepatocytes damage and fibrosis, marked by increased laminin deposition, a key component of the extracellular matrix produced by stellate cells during liver injury.
Objectives: This study aimed to investigate the effects of METH abuse on liver function and laminin (LN) levels, correlating these with the duration and concentration of METH use.
Methods: Conducted from January to August 2024, this case-control study involved 75 male participants with METH addiction (6-120 months of use) and 75 healthy controls aged 18-51. Key biomarkers were measured, including serum laminin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), Gamma-Glutamyl Transferase (GGT), albumin and the serum concentration of methamphetamine levels.
Result: The study revealed a significant increase in serum laminin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and Gamma-Glutamyl Transferees. A notable significant decrease in albumin was detected. Additionally, the study demonstrated a positive correlation between LN levels and the duration of drug abuse, as between the concentration of methamphetamine levels with aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, Gamma-Glutamyl Transferees, and albumin, and correlation between methamphetamine of duration with aspartate aminotransferase, alanine aminotransferase, Gamma-Glutamyl Transferees.
Conclusions: The results indicate that METH addiction leads to elevated laminin levels and liver enzyme activity, suggesting progressive liver fibrosis and injury correlating with the duration of substance abuse.

Background: Indomethacin is a widely used nonsteroidal anti-inflammatory drug for treating pain and fever. It is coupled with oxidative stress and an inflammatory response, which accounts for several detrimental effects on the body’s organs.
Objectives: This study aimed to assess the potential of using Saw palmetto extract to counteract the oxidative stress and inflammatory response resulting from Indomethacin treatment in rat models.
Methods: The study involved 20 male albino rats, arbitrarily sorted into four groups of 5 animals each group. Group 1 (control group) was neither induced nor treated. Groups (2-4) were treated with oral Omeprazole (20 mg/kg/day) and Saw palmetto extract (20 mg/kg/day) suspensions, respectively, for 15 days. On day 15 of the study, blood samples were taken by heart puncture for the determination of superoxide dismutase, glutathione peroxidase, tumor necrosis factor-alpha, and interleukin-6.
Results: Saw palmetto extract treatment was found to elevate serum levels of superoxide dismutase and glutathione peroxidase significantly compared to the Indomethacin-induction group. Conversely, tumor necrosis factor-alpha and interleukin-6 levels were markedly reduced compared to the Indomethacin-induction group. The antioxidant and anti-inflammatory activities of Saw palmetto extract are contingent on its bioactive flavonoids and sitosterols content.
Conclusion: The antioxidant and anti-inflammatory influence of Saw palmetto extract could be a promising approach to counteract oxidative stress and inflammatory response due to Indomethacin treatment.

Background: Previous studies suggest a significant relationship between type 2 diabetes mellitus (T2DM) and a lack of zinc. A lack of zinc can negatively impact insulin synthesis, storage, and secretion, leading to insulin resistance and inadequate glycaemic control. Nevertheless, the correlation between serum zinc levels and glycaemic control in T2DM has not been well studied in various populations.
Objective: To investigate the relationship between serum zinc levels and glycaemic control, assessed by HbA1c, in individuals diagnosed with type 2 diabetes mellitus.
Methods: This case-control study was carried out between April 2018 and July 2019 at Omdurman Teaching Hospital in Khartoum State, Sudan. The study included 100 participants: 50 were T2DM patients, and the other 50 were healthy individuals who served as controls. Serum zinc levels were determined with atomic absorption spectrophotometry, while HbA1c levels were evaluated with the Ichroma system. Data analysis was performed using SPSS, version 25. A comparative analysis was conducted on the groups, with correlation coefficients being calculated to investigate the correlations between age, serum zinc, and HbA1c levels.
Results: The diabetics showed notably lower zinc levels in their blood compared to the control group, along with notably elevated HbA1c levels. In diabetic individuals, age correlated positively with HbA1c and serum zinc levels. Additionally, diabetic patients showed a significant inverse correlation between their serum zinc levels and HbA1c values.
Conclusion: This research indicates that individuals with diabetes might exhibit decreased zinc levels in their bloodstream and that a connection could exist between age, zinc levels in the bloodstream, and HbA1c levels in these individuals. The results of this research may impact how diabetes mellitus and zinc deficiency are managed.

Background: Birth defects are the leading cause of both neonatal and post-neonatal deaths, as an estimated 240,000 neonates die in their first month of life worldwide each year. In Iraq, local studies have shown varying frequencies and types of congenital anomalies.
Objectives: To provide a new insight into the incidence and types of congenital anomalies and to explore their possible risk factors in Baghdad City.
Methods: In this cross-sectional observational study, a total of 2007 neonates were enrolled from six hospitals in Baghdad during the period extending between September and December 2020. Hospital records and personal interviews were used for data collection. These data included the neonates\' demographic and clinical characteristics, maternal, pregnancy, and immediate postnatal conditions. Description of the defects in those with birth defects was recorded from hospital records and as described by the parents. Statistical analysis was performed as required.
Results: There were 64 (3.2%) neonates with birth defects, i.e., an incidence of 32/1000 total births (28/1000 live births); of them, 38 (59.4%) were males, 8 (12.5%) were stillborn, 43 (66.2%) were born with a cesarean section, the majority (87.5%) had maternal age between 20 and 40 years, and 35 (54.6%) had a low birth weight and were statistically significant. In addition, reduced fetal movement, prematurity, and not receiving tonics during pregnancy were also statistically significant. Among the 64 births with congenital anomalies, multiple congenital anomalies were the most common defects [26 (40.6%)]. An isolated defect was detected in 38 (57.8%) of them. The predominant system involved was the gastrointestinal tract (GIT) [12 (18.8%)] cases, followed by the central nervous system (CNS) with 11 (17.2%) cases, and the musculoskeletal system (MS) with 6 (9.4%) cases.
Conclusion: The incidence of birth defects in Baghdad is close to global figures at 28/1000 live births, with multiple congenital anomalies, gastrointestinal, central nervous, and musculoskeletal system defects being the most frequent, while cardiovascular, genitourinary, and skin defects are the least frequent. Possible risk factors included maternal age, drug intake, and not receiving tonics during pregnancy.

Background: Gastric ulcer is a prevalent gastrointestinal disorder caused by environmental factors and a higher intake of non-steroidal anti-inflammatory drugs (NSAIDs).
Objective: To investigate the prophylactic effects of melatonin on the histology, severity of gastric ulcers, and levels of inflammatory and oxidative stress markers (Interleukin-1beta (IL-1β) and Malondialdehyde (MDA)) in a rat model of indomethacin-induced ulcers.
Methods: This study was performed at Al-Mustansiriyah University's Research Center for Cancer and Medical Genetics from November 2023 to May 2024. Fifty healthy male albino rats weighing between 150 - 250 grams were used. After 24 hours of fasting, these rats were divided into five groups, each with 10 rats. Group A: Received 1 ml of indomethacin vehicle (carboxymethylcellulose 1%) orally (negative control). Group B: Received 60 mg/ kg of indomethacin orally (positive control). Group C: Received 20 mg/ kg of omeprazole orally 30 minutes before indomethacin induction. Group D: Received 20 mg/ kg of melatonin solution orally 30 minutes before indomethacin induction. Group E: Received 30 mg/ kg of pioglitazone solution orally. After 1 hour, rats received a melatonin solution of 20 mg/ kg and waited for 30 minutes before induction.
Results: The group that received melatonin pretreatment at a dosage of 20 mg/kg exhibited a statistically significant reduction in the severity of stomach ulcers and histological damage score. The administration of melatonin at a dose of 20 mg/kg to the pre-treated group reduced inflammatory and oxidative stress markers (IL-1β and MDA) levels similar to those observed with the reference medication.
Conclusions: Melatonin alone or a combination of pioglitazone and melatonin effectively reduce gastric mucosal injury, oxidative stress, and pro-inflammatory cytokine levels, comparable to standard omeprazole drugs.

Background: Klebsiella oxytoca is an emerging pathogen causing hospital- and community-acquired infections. Hypermucoviscous phenotype and biofilm development are considered markers of hypervirulence, causing invasive infections in healthy adults
Objective: The current study aimed to evaluate the ability of K. oxytoca isolates to form biofilms and incorporate hypermucoviscous characteristics.
Method: One hundred K. oxytoca isolates were collected from hospitals in the Medical City Teaching Hospital Complex, in Baghdad, Iraq. The isolates were identified by conducting manual and biochemical tests. The hypermucoviscous characteristic was analyzed by using the string test. The Congo red agar method was used to detect biofilm formation, while quantitative methods like tube adherence and microtiter plates were used to measure its strength. Statistical analysis was performed by using the SPSS Statistical package (Version 26; SPSS, IBM) and Microsoft Office Excel (2010) for drawing the figures except for the receiver operating characteristic (ROC) curve.
Results: K. oxytoca was obtained from 54/100 (54%) male and 46/100 (46%) female specimens. The specimens were from inpatients 62/100 (62%), and the rest, 38/100 (38%), were from outpatients. The isolates were significantly (P = 0.0001) from urine specimens 39/100 (39%), followed by blood specimens 16/100 (16%). The string test identified 14/100 (14%) isolates as hypermucoviscous, with 21.1% being from outpatients. The biofilm was positive in 80/100 isolates. By utilizing the tube method, a strong adhesion was detected in 23/80 (28.75%) isolates. The microtiter plate method (MTP) yielded a strong biofilm in 25/80 (31.25%) isolates. The strongest biofilm was found in isolates from urine specimens (40%).
Conclusion: By forming a strong biofilm and developing hypermucoviscous, the virulence potential of K. oxytoca isolates exhibited a risk to the community. Urine was considered to be the main source of the strongest biofilm-forming isolates.

Background: An individual’s quality of life is adversely affected by overactive bladder (OAB) symptoms. The key element that characterizes OAB is urgency, which, together with nocturia and urge urinary incontinence, are considered the most irksome symptoms. The side effects of the anticholinergic medication have caused a significant number of patients to discontinue their treatment. More recently, there has been research conducted on the potential correlation between an anticholinergic burden and the development of dementia. The detrusor muscle has been demonstrated to relax as a result of the activation of β3 adrenoceptors, which in turn facilitated the development of the first β3 adrenoceptor agonist. Mirabegron is the initial medication in this category to receive approval for the treatment of an overactive bladder.
Objectives: To explore the effect of mirabegron on bladder capacity in patients with OAB.
Methods: A case series study was performed on 40 patients diagnosed with OAB from October 2023 to March 2024 in the Medical City Complex (Ghazi AL-Hariri Hospital) Urology Outpatient Clinic. These patients took a single dose of mirabegron 50 mg per day for four months and were assessed for the effect of this drug on the bladder capacity measurement, in milliliters, measured by ultrasound.
Result: Following treatment with Mirabegron, a statistically significant increase in bladder capacity was found from the baseline level after two and four months.
Conclusion: Mirabegron is an effective drug for the treatment of OAB, as it increases bladder capacity.