Al-Rafidain Journal of Medical Sciences

Cancer cachexia affects approximately 80% of cancer patients and is characterized by skeletal muscle wasting and reduced fat mass, resulting in weight loss and short survival time. An in-depth understanding of the mechanisms of cancer cachexia can provide platforms for drug and non-pharmacological management of this condition that claims the life of around 20% of cancer patients. Most of the current work in this field is in the pre-clinical stages. However, such preliminary knowledge is anticipated to help guide the design of large and comprehensive clinical trials to establish the safety and efficacy of therapeutic interventions to treat cachexia.

Background: Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. Identifying novel biomarkers is critical for improving diagnosis, prognosis, and treatment strategies. This study investigates the serum levels of kisspeptin-1 (KISS1), its receptor (KISS1R), growth differentiation factor 15 (GDF15), and carcinoembryonic antigen (CEA) in Iraqi CRC patients. Objectives: Explore associations between serum levels of Kiss1, Kiss1R, GDF, and CEA and disease progression in Iraqi patients with CRC. Methods: A case-control study was conducted, including 72 CRC patients and 36 healthy controls. Patients were stratified into non-metastatic and metastatic groups. Serum biomarker levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses evaluated biomarker correlations, diagnostic accuracy, and associations with CRC stages. Results: Significant elevations of KISS1, KISS1R, GDF15, and CEA levels were observed in CRC patients compared to controls, with metastatic cases showing the highest levels. KISS1 and GDF15 demonstrated strong correlations and were particularly associated with metastatic disease. Receiver operating characteristic (ROC) analysis revealed high diagnostic accuracy for these biomarkers in distinguishing CRC stages. Conclusions: KISS1 and GDF15 are promising biomarkers for CRC progression and metastasis. Their coordinated elevation in metastatic cases suggests potential roles in disease monitoring and therapeutic targeting. Further studies are needed to confirm these findings and explore their clinical applications.

Background: Everyone contracts the common infection known as human herpesvirus 6 (HHV-6). Particularly associated with encephalitis, human herpesvirus 6B (HHV-6B) poses a risk of morbidity and death to recipients of allogeneic hematopoietic stem cell transplants. IL-1β and interleukin-1α (IL-1α) are critical for enhancing infection resistance. Objective: To ascertain whether HHV-6A and the IL1R1 rs2234650 gene polymorphism are related and could be risk factors for Iraqi infants developing acute lymphoblastic leukemia (ALL). Methods: This case-control study included 150 blood samples from 100 patients diagnosed with ALL and 50 from healthy subjects. The IL1R1 rs2234650 gene polymorphism was identified using the Sanger sequencing method, and HHV-6A using PCR. Results: Age group and sex were found to differ significantly. Of 100 samples, 32 percent had HHV6A. The polymorphism of the IL-1R1 rs2234650 gene revealed that the distribution of DNA polymorphisms according to C\C, C\G, G\G, C\T, T\T, and G\T was 30%, 28%, 16%, 8%, 6%, and 12%, respectively, in patients with ALL and 33.33%, 26.67%, and 16.67%, respectively. 3.33%, 13.33%, and 6.67% in the group that was deemed to be in apparently healthy control (AHC). The frequency of the polymorphism's genotype distribution varied significantly between the patient and control groups. Conclusions: HHV6A and IL1R1 rs2234650 polymorphisms of ALL variations may be risk factors in the pathophysiology of ALL in Iraqi children.

Background: Emotional regulation difficulties, depression, impulsivity, and anxiety are psychological factors that frequently co-occur with substance use in attention deficit hyperactivity disorder. These factors contribute to maladaptive coping strategies, increasing vulnerability to substance use patterns. Objective: To explore the psychological factors of the co-occurrence of ADHD with substance use, with a specific focus on emotional regulation, depression, impulsiveness, and anxiety. Methods: This cross-sectional study, conducted from September 2023 to September 2024 at a university in Eastern Odisha, explored psychological factors among undergraduate students aged 18–26 with ADHD and co-occurring substance use. Data collection utilizes validated tools, including ASRS-V1.1, ASSIST, HAM-D, HAM-A, DERS, and BIS. Results: The study analyzed 1,310 undergraduate students, showing 8.2% with ADHD, of which 52.3% reported substance use (SU). Impulsivity was significantly associated with SU, with higher impulsivity reported in SU individuals. Anxiety also showed a strong association with SU. However, emotional dysregulation and depression were not significantly linked to SU. These findings highlight key psychological factors influencing substance use in ADHD. Conclusions: This study underscores the significant role of impulsiveness and anxiety in the co-occurrence of substance use (SU) among individuals with ADHD, while emotional dysregulation and depression were not found to have a significant association. These findings highlight the need for targeted interventions addressing impulsiveness and anxiety to mitigate the risk of SU in this population.

Background: Obesity is recognized as a significant global health crisis, with over a third of the world's population affected, posing severe health and economic challenges. Objectives: To investigate the differences in subcutaneous adipose tissue (SAT) characteristics, specifically thickness and stiffness, between young (20-39 years) and middle-aged (40-59 years) obese individuals and examine sex-specific variations and associations with non-alcoholic fatty liver disease (NAFLD). Methods: One hundred obese participants were evaluated using anthropometric measurements (body mass index and waist-height ratio) and ultrasonic shear wave elastography to assess NAFLD and SAT structure across three anatomical sites. Results: Participants in their middle years had stiffer SATs, especially in the upper abdomen and distal triceps. However, there were no significant differences in BMI, waist-to-height ratio, or SAT thickness at the mid-thigh based on age. Additionally, NAFLD prevalence was found in 31 participants, with a notable correlation between its presence and SAT thickness & obesity metrics, although SAT stiffness did not significantly correlate with NAFLD. Conclusions: The dynamic nature of SAT as it relates to aging and sex, emphasizing the need for tailored therapeutic approaches in managing obesity and associated metabolic disorders. According to this study, elastography could be a non-invasive way to check for organ damage due to obesity and could aid in the prediction of NAFLD when combined with routine body measurements. Further research is warranted to refine assessment methodologies and validate anatomical site representativeness.

Background: Benign prostatic hypertrophy (BPH) is a significant health issue in the aging male population. BPH prevalence is on the rise, due to an increase in modifiable metabolic risk factors. The development of BPH has been linked to inflammation, cell proliferation, and oxidative stress. Objective: This study aimed to investigate the therapeutic potential of Cuscuta reflexa (CR) on testosterone-induced BPH in male Wistar rats. Methods: For four weeks, the rats were given an injection of testosterone propionate (3 mg/kg/day) to cause BPH. During the study, they were also given either CR ethanolic extract (400 mg/kg/day) or finasteride (5 mg/kg/day) along with the testosterone injection. Results: There was a significant rise in the prostate index, a rise in the prostate-specific antigen (PSA), and changes in the tissue that are typical of BPH after testosterone administration. Moreover, testosterone prompted an increase in inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta (TGF-β) and an increase in nuclear factor-κB (NF-κB) and oxidative stress indicators (increase in malondialdehyde (MDA) and decrease in glutathione (GSH)). However, intervention with CR extract effectively mitigated these changes, possibly via anti-inflammatory and antioxidative properties. Conclusions: These findings highlight the potential of CR extract as adjunctive therapies for BPH, offering an approach for targeting inflammation and oxidative stress. Additionally, long-term studies are necessary to assess the safety and efficacy of Cr extract in managing BPH.

Background: Zygomatic complex fractures are a common facial injury, often requiring surgical intervention. While traditional techniques involve multiple fixation points, recent studies have explored the efficacy of single-point fixation for minimally displaced fractures. The intraoral approach offers a less invasive option with minimal scarring, reduced operative time, excellent functional outcomes, and potential cost-effectiveness. Objective: To evaluate the functional recovery and cost-effectiveness of single-point fixation through an intraoral approach for minimally displaced zygomatic bone fractures, emphasizing reduced surgical time. Methods: We analyzed a prospective case series of patients with minimally displaced zygomatic bone fractures treated with single-point fixation via an intraoral approach. Methods: We assessed clinical outcomes such as facial symmetry, functional recovery (e.g., mastication, mouth opening, and vision), complications, operative time, and hospital stay duration. We performed a cost analysis to compare the economic implications of single-point fixation versus traditional techniques. Results: The study demonstrated successful anatomical reduction and functional recovery in all cases with minimal complications. Single-point fixation using an intraoral approach offers excellent stability, causes less visible scarring, takes less time to perform than traditional methods, leads to shorter hospital stays, and may save money by using fewer hospital resources. Conclusions: Using single-point fixation through an intraoral approach is a good treatment choice for patients with slightly shifted zygomatic bone fractures, providing a less invasive method that achieves similar results to traditional techniques, takes less time in surgery, allows for great recovery, and is cost-effective..

Background: Targeting problems in lipid metabolism for the treatment of Parkinson's disease (PD) has advanced significantly in recent years through the use of medications like metformin (MET). In a mouse model of rotenone-induced PD, MET, a commonly prescribed antidiabetic medication, may have a neuroprotective effect. Rotenone is an inhibitor of mitochondrial complex I that can lead to PD and dopaminergic (DA) cell loss. Objective: To evaluate the mechanisms behind the MET neuroprotective effect and possible additive benefits of MET/levodopa-carbidopa (L-DOPA/carbidopa) in rotenone-induced parkinsonism in male mice. Methods: Albino mice were given rotenone (1 mg/kg/48hr, subcutaneous) for 17 days. Following the administration of rotenone, a 30-day oral MET treatment (500 mg/kg/day) was initiated. The neuroprotective effect of MET on rotenone-induced dopaminergic toxicity was assessed by detection of α-synuclein and the neuroinflammatory marker tumor necrosis factor-α (TNF-α), and we also showed that DOPA decarboxylase (DDC) levels in plasma could detect PD using enzyme-linked immunosorbent assay (ELISA) kits. The behavioral tests were performed by wire hanging, catalepsy, and pole tests. Results: Metformin ameliorated the behavioral deficits in the Parkinsonian mouse model, significantly decreased the levels of α-synuclein and tumor necrosis factor-α (TNF-α), and serum DDC levels were significantly reduced. Conclusions: Metformin can alleviate rotenone-induced Parkinson's-like symptoms in a mouse model.

Background: Surgical removal of the lower third molar is one of the most common challenges in oral surgery. Their removal is associated with postoperative sequelae like pain, facial swelling, and trismus. All these sequelae are normal physiological responses of the body to tissue injury associated with surgical extraction. The pharmacological management is by analgesics, anti-inflammatory agents, and opioids perioperatively. One of the most used drugs is dexamethasone. Objective: Evaluating the effectiveness of using a single immediate postoperative intramuscular dexamethasone injection on pain, swelling, trismus, and tissue healing in the first seven days. Methods: A split-mouth technique was used on 16 patients with bilateral, similar impacted mandibular third molars that were extracted; one side was given an 8mg intramuscular injection of dexamethasone (study group), and the other side wasn’t given an injection (control group), and comparisons of the two sides were done in the following seven days. Results: 6 patients were excluded (not meeting criteria), so only 10 were left. All records showed a decrease in pain scores (significant only on the 1st and 2nd days), a decrease in swelling (not significant) measurements, and a decrease in limitation of mouth opening (significant only on the 1st day), while there were close healing scores for both groups. Conclusions: The use of a single immediate postoperative intramuscular dexamethasone injection showed a decrease in pain scores, a reduction in trismus, and a lessening in swelling but had trivial or no effect on healing at the operation site.

Background: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are autoimmune diseases with multifactorial etiology. Both diseases are characterized by chronic inflammation and autoantibody production. Objective: To investigate the role of Fractalkine (Fkn) and its receptor (CX3CL1-CX3CR1 axis) in the pathogenesis of these diseases. Methods: The study was carried out on eighty-four SLE patients (classified into 77 with SLE and 7 with SLE associated with RA) and thirty-five healthy individuals as a control group. Levels of soluble Fkns axis were measured by enzyme-linked immunosorbent assay. Clinical parameter correlations were assessed. ROC curves explored CX3CL1 and CX3CR1 diagnostic potential for SLE. Serum levels of CX3CR1 and CX3CL1 were significantly elevated in both SLE and SLE-RA groups compared to controls. Results: Demographic and clinical parameters showed significant differences in age distribution that were observed across SLE, SLE-RA, and control groups. WBC count was significantly elevated in SLE compared to controls. ESR was significantly increased in SLE compared to both controls and SLE-RA. No significant differences were observed in RBC and platelet counts between groups. The ROC analysis showed that ANA, CX3CL1, CX3CR1, and ESR were accurate for diagnosing SLE and SLE-RA in both groups. Conclusions: The elevated concentrations of sFkn and its receptor in SLE are higher than in SLE-RA and the control group. They played a crucial role in the pathogenesis of the disease, which might serve as a serologic inflammatory marker of disease activity and tissue damage.

Background: Lung cancer is a significant public health issue in the Middle Euphrates region of Iraq. Objective: To identify socio-epidemiologic and histopathologic patterns of lung cancer patients in this region. Methods: Medical records of lung cancer patients registered at the Middle Euphrates Cancer Center (January 2018 to December 2023) were analyzed. Demographic information and histopathologic classifications were reviewed. All confirmed lung cancer cases were included, while cases with incomplete data were excluded. Results: A total of 1,162 patients were included, with a mean age at diagnosis of 64.47 years. The majority (64.4%) were over 60 years of age, and those between 40 and 60 years of age (34%). Males accounted for 68% of cases, with a male-to-female ratio of approximately 2:1. Patients with low or no formal education comprised 87.9% of the study population. The most prevalent subtype was squamous cell carcinoma (SCC), with adenocarcinoma (AC) coming in second at 37% and small cell lung cancer (SCLC) coming in third at 10.5%. While SCC remained the predominant subtype, AC incidence increased over time (31.7% in 2018 vs. 41.4% in 2023), particularly among females, younger individuals, and those with higher education. The proportion of NSCLC-NOS diagnoses declined from 11.1% in 2018 to 3.2% in 2023. Conclusions: Lung cancer remains a major health concern, especially among older individuals. The rising incidence of AC underscores the need for enhanced screening strategies, targeted prevention programs, and tailored treatment approaches to address evolving risk factors.

Background: Artificial intelligence (AI) has invaded radiographic analysis in a massive way. Besides saving time and effort during decision-making and treatment planning, AI-assisted cephalometric analysis must be reliable, reproducible, accurate, and user-friendly. Objective: To assess fully AI-driven cephalometric analysis. Methods: 47 lateral cephalometric radiographs were used for comparing the accuracy of AI-operated and manually operated skeletal and dental cephalometric analysis. Both dental and skeletal analyses were digitally performed using web-based platforms (WebCephTM, Cephio, and Ceppro DDH Inc., Korea). SPSS was used for statistical analysis with paired t-test and intra-class correlation. Results: There were statistical differences between AI landmarking and manual landmarking regarding SNA, ANB, FH to AB, U1 to FH, U1 to SN, U1 to UOP, interincisal angle, U1 to NA (mm), and U1 to NA (deg). The intraclass correlation coefficient (ICC) data showed that the two sets of measurements were very consistent for most readings. Conclusions: Even though AI provides strong reliability and agreement between methods, the significant difference indicates that AI-operated and manually operated cephalometric analysis may not be interchangeable despite their consistency. AI-based analyses primarily function as assistant tools, and orthodontists need to make judgments or adjustments before making decisions.

Background: Anti-glutamic acid decarboxylase antibodies (GAD65A), anti-tyrosine phosphatase antibodies (IA-2), insulinoma-associated 2 autoantibodies (IA-2A), and anti-zinc transporter antibodies (Zn-T8A) are some of the most important blood tests used to diagnose type 1 diabetes mellitus (T1DM). Integrating zinc transporter 8 autoantibody (ZnT8A) into the conventional diagnostic protocol for T1DM may enhance the overall sensitivity of autoantibody detection and may predict early complications. Objectives: To analyze the presence of type 1 diabetes-related autoantibodies (GAD65A, IA-2A, and ZnT8A) and to determine any link with age, gender, and duration of the illness in adult populations. Methods: This case-control research was performed at four teaching hospitals in Basra city during a five-month period on 100 adult patients confirmed to have T1DM and on 50 apparently healthy controls. Serum concentrations of ZnT8A, GAD65A, and IA-2A were individually assessed utilizing ELISA in both cases and control groups. Results: A statistically significant difference exists in the concentrations of ZnT8A, GAD65A, and IA-2A autoantibodies between the case and control groups. All three immunological markers had no correlation with sex and duration of disease. ZnT8A positivity was associated with an earlier age of onset (OR=2.50, p=0.039) and the presence of IA-2A (OR=2.65, p=0.015). No correlation was found between ZnT8A and GAD65A. Conclusions: ZnT8A shows the highest concentration among the three studied autoantibodies in both the acute-onset and slowly progressive T1DM patient groups and is considered an important serological marker of T1DM with other immunological markers for this disease.

Background: Paliperidone PAL is a second-generation (atypical) antipsychotic medication widely used in the treatment of schizophrenia disorders. It is practically insoluble in water (class II) and has a first-pass metabolism, with oral bioavailability of about 28%. Objective: To optimize and evaluate PAL in a nanothermal residence gel as an intranasal in situ gel formula near or at the site of the nasal-brain delivery system. Methods: The previously prepared nanosuspension formula of PAL was introduced into the creation of in-situ gel formulas using Poloxamer 407 (18–20%w/v), hydroxypropyl methylcellulose HPMC K4 (0.5–1%w/v), and hyaluronic acid (0.5–1%w/v). The selected prepared formula was subjected to different in vitro evaluation studies. Results: The previously prepared nanosuspension formula of PAL, which enhanced its dissolution rate using Soluplus® as a stabilizer, was incorporated into mucoadhesive thermal sensitive gel formulas, using poloxamer 407 as a thermal gelling agent and different concentrations of mucoadhesive polymers. The formula NIG, which contains 20% w/w poloxamer 407 and 1%w/w HPMC K4, exhibited favorable and accepted Characteristics, including the ideal gelation temperature of 33°C and drug content of 99.96%, gel strength of 55.0 seconds, spreadability of 5.2cm, and 98.0% in vitro cumulative drug release extended for 6 hours in simulated nasal fluid (SNF) at pH 6.5 maintained at 34°C. Conclusions: The current mucoadhesive in situ gel PAL formula is a promising nasal-to-brain formula that can be used for the management of psychotic disorders drug therapy in the future.