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.

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Background: Acromegaly is a rare endocrine disorder characterized by elevated levels of insulin-like growth factor-1 and growth hormone, which are typically brought on by a somatotroph adenoma of the pituitary gland. It has an incidence of 4 per million annually and a prevalence of 40 per million. The elevated IGF-1 levels cause somatic growth and metabolic effects, with subsequently increased morbidity and mortality, particularly when GH and IGF-1 levels remain persistently elevated. Objective: To evaluate the levels of filamin-A (FLNA) in patients with acromegaly with and without diabetes mellitus type 2 (T2DM) compared to a control group. Methods: In this case-control study, one hundred patients with acromegaly registered at the National Diabetes Center, Mustansiriyah University, were enrolled in the study. 76 participants as control. All recruited participants have given oral consent to participate in the study, which was conducted from February 2024 to August 2024. Results: The age distribution differences were not statistically significant. The gender distribution showed 47 females and 53 males in the acromegaly group. The FLNA level was higher among patients compared to controls and showed the highest level in acromegaly and DM (687.24 ng/L), followed by acromegaly without DM (359.39 ng/L), controls with DM (205.96 ng/L), and controls without DM (143.29 ng/L). Conclusions: The results showed that serum FLNA was elevated in patients with acromegaly in comparison to the control group and in the T2DM group versus those without T2DM.

Background: Community pharmacists endure significantly elevated levels of work-related stress and depression, posing a threat to their overall well-being and possibly affecting the quality of patient care. Objectives: To explore workplace-associated stress and depression in Iraqi community pharmacists. Methods: This observational study was conducted using a cross-sectional design. Information was gathered through the utilization of an internet-based survey. The study involved a community pharmacist with a minimum of one year of experience working at community pharmacies. The survey utilized pre-validated questionnaires. The level of stress experienced was assessed using the Perceived Stress Scale (PSS)-10, while the level of depression was assessed using the Patient's Health Questionnaire (PHQ)-9. Results: The study included a total of 251 community pharmacists, with the majority being female (62.2%). The average score of the Perceived Stress Scale (PSS)-10 is 21±5.86, suggesting that perceived stress levels are generally moderate to low. The Patient Health Questionnaire-9 results showed that the average total scores for the individuals were 10.41±4.801, indicating a moderate state of depression. The only characteristic that is adversely linked to work-related stress in community pharmacy is the age of community pharmacists. In addition, there is a negative association between age, work experience, educational level, and the level of depression. Conclusions: Community pharmacists are experiencing a moderate amount of perceived stress along with moderate depression symptoms. The current study found that age was inversely connected with both stress and depression, meaning that as age increased, levels of stress and despair tended to decrease.

Background: Periodontitis is an inflammatory disease that destroys tooth-supporting tissue, with proteins like osteonectin and osteopontin playing roles in bone metabolism and inflammation, making them potential biomarkers for assessing periodontal healing after treatment. Objectives: The effect of non-surgical periodontal treatment (NSPT) on concentrations of osteonectin and osteopontin within the saliva of periodontitis individuals who smoke and those who do not. Methods: Twenty-eight periodontist patients were allocated into 14 nonsmokers and 14 smokers with probing depths of 4-6mm who were treated by root surface debridement (RSD). Plaque index, bleeding on probing, probing pocket depth, and clinical attachment level were measured. In addition, osteonectin (ON) and osteopontin (OPN) in saliva were measured at baseline and 1-month and 3-month follow-up visits by ELISA. Results: Osteonectin levels in saliva increased in nonsmoker patients (4.80±3.52ng/ml and 21.47±1.92 ng/ml) and were significantly greater than in the smoker patients (1.30±1.26ng/ml and 4.02±3.29ng/ml) in 1 month and 3 months, respectively, while osteopontin levels in saliva decreased in both groups, the nonsmokers group (4.62±1.91ng/ml and 5.78±1.39 ng/ml) and the smokers group (5.46±2.30 ng/ml and 6.76±2.88 ng/ml) in 1 month and 3 months, respectively, but with no significant differences between them. Conclusions: NSPT increases ON in both smoker and non-smoker unstable periodontitis individuals, with a higher increase observed in non-smokers. However, NSPT decreases OPN in these groups, with no significant difference post-treatment.

Background: Saliva is probably the most promising sample for the finding of biomarkers for oral squamous cell carcinoma (OSCC), as its collection is easy, non-invasive, fast, and cost-effective. Objective: The aim of this study was to examine increased salivary levels of lactate dehydrogenase (LDH) and matrix metalloproteinase-9 (MMP-9) that have been assessed as possible biomarkers for the diagnosis of OSCC. Methods: In this case-control study, participants were divided into 30 healthy controls (15 male and 15 female), and 65 patients (45 male and 20 female) were diagnosed with OSCC. Saliva samples were obtained to measure levels of both LDH and MMP-9 spectrophotometrically using standard LDH and MMP-9 kits. One-way ANOVA, the chi-square test, and Pearson’s correlation test were applied to analyze the data. Results: The salivary levels of LDH and MMP-9 in OSCC patients were significantly higher than those in the control groups. Significant associations were noted between LDH and MMP-9 salivary levels. Conclusions: Patients with OSCC had higher saliva levels of both LDH and MMP-9 than the healthy subjects in the control group. Assessment of salivary LDH and MMP-9 can be beneficial for diagnosing OSCC.

CD40 is a type 1 transmembrane protein composed of 277 amino acids, and it belongs to the tumor necrosis factor receptor (TNFR) superfamily. It is expressed in a variety of cell types, including normal B cells, macrophages, dendritic cells, and endothelial cells, as a costimulatory molecule. This study aims to summarize the CD40 polymorphism effect and its susceptibility to immune-related disorders. The CD40 gene polymorphisms showed a significant association with different immune-related disorders and act as a risk factor for increased susceptibility to these diseases.

Background: The goal of root canal filling is complete sealing of the canal system. The moisture level is crucial for effective sealing and adhesion. Objective: To quantitatively evaluate the effect of root canal dentin moisture conditions on the apical sealing of two root canal sealers. Methods: 54 single-rooted mandibular premolars were instrumented and randomly divided into two groups (n=27) according to the types of sealers used: group MTA Fillapex and group One-Fil bioceramic sealer. Then, both groups were randomly divided into 3 subgroups (n=9) according to different intracanal moisture conditions before obturation: dry (the canals were dried with paper points until the last one came out dry), moist (only one paper point was used), and wet (canals left wet without drying). After completing the obturation using sealers and gutta-percha, the apical leakage was evaluated by the dye extraction method using a spectrophotometer. Results: The lowest leakage value was 0.006 for subgroup One-Fil, wet. While the highest leakage was 0.058 for subgroup MTA and dry. The statistical analyses revealed that One-Fil in wet conditions had significantly lower leakage than in moist and dry conditions. MTA in moist conditions had significantly lower leakage than in wet and dry conditions. There was a significantly lower value for One-Fil, wet, compared with MTA, wet, and MTA, moist compared with One-Fil, moist. Conclusions: One-Fil sealer showed the lowest microleakage in wet conditions. While MTA Fillapex showed the lowest microleakage in moist conditions.

Background: Magnetic resonance imaging (MRI) is highly sensitive to detect clinically suspected lesions that mammography and sonography may miss. However, routine postoperative MRI surveillance is not recommended unless there is concerning clinical or radiological evidence. Objective: To evaluate the role of MRI in assessing postoperative breast lesions and distinguishing benign changes from recurrence. Methods: This prospective cohort analysis was conducted at the National Center for Early Detection of Breast Cancer, Oncology Teaching Hospital, Medical City, from January 2022 to August 2022. The study enrolled breast cancer patients who had undergone breast-conserving surgery (BCS) or mastectomy within the past 24 months and were currently under radiological surveillance or presented with a new clinically detected mass. Results: A total of 42 lesions from 32 patients were analyzed; 21(65.7%) were under routine follow-up, while 11(34.3%) presented with a new mass. Mammography and/or ultrasound detected 36(85.7%) lesions, while MRI identified six (14.3%) additional lesions. Histopathology confirmed malignancy in 22(68.2%) patients. Five of six MRI-discovered lesions were malignant in histology, with a mean diameter of 7.5mm ranging from 6-11mm. Irregular shape, speculated margin, heterogeneous enhancement, and diffusion restrictions were significantly associated with malignancy. Using histopathology as the gold standard, MRI demonstrated 100% sensitivity, 55% specificity, and 78.6% accuracy. Conclusions: Dynamic contrast-enhanced MRI can improve the characterization of postoperative breast lesions. This method can help minimize benign lesion biopsies and detect recurring malignancies and multifocality when traditional imaging fails.

Background: Valsartan is an angiotensin II receptor inhibitor prescribed to regulate heart pressure. The bulk of studies documented the impact of antihypertensive drugs on the gingival tissues; however, none have investigated the effect of valsartan on the gingival architecture. Objective: To investigate the histological effect of valsartan administration on the gingival tissue architecture in rats. Methods: Twenty Wistar male rats (2–3 months old) were randomly assigned to the control and valsartan groups. 10mg/kg/day valsartan was administered subcutaneously for two weeks. Then all the animals were sacrificed, and full-thickness samples of gingival tissue were harvested from the palatal aspect of the rat's molar teeth and prepared for examination under a microscope. Results: Although the results revealed that the valsartan group showed thicker epithelium (mean=0.1280 mm) compared to the control group, the difference did not reach a statistical significance. In the lamina propria, the thickness change was statistically significant (0.07400±0.0143 mm) compared to the controls (0.0573±0.00696). The submucosa thickness measures were equivalent for both groups. The count of blood vessels showed no variation between the two experimental groups. Conclusions: Treatment with valsartan resulted in a significant increase in lamina propria thickness with no influence on epithelial thickness, submucosal thickness, or blood vessel count in rat gingival tissue.

Objective: To determine the prevalence of thyroid dysfunction in pediatric patients and its association with the progression of chronic kidney disease (CKD), growth development, blood pressure, and different treatment strategies. Methods: We assessed 51 children with CKD, with a mean age of 8.3 years, of whom 58.8% were boys. We evaluated their kidney function (serum creatinine and eGFR), thyroid hormones (TSH and free T4), blood pressure, and body mass index (BMI). Additionally, we reviewed their medical history, medications, and whether they were on dialysis or had received a kidney transplant. Statistical tests helped us compare thyroid function across different CKD stages and assess possible connections with other health factors. Results: Our findings revealed that 15.7% of the children had hypothyroidism, with a significantly higher prevalence among girls. Interestingly, thyroid hormone levels did not show significant fluctuations between the early and late stages of CKD. As expected, kidney function worsened with CKD progression, but thyroid problems did not appear to be directly linked to this decline. Moreover, no significant relationship was found between thyroid dysfunction and elevated blood pressure. Conclusions: Thyroid disturbances are common in children with CKD, especially in girls, but they don’t seem to worsen as kidney disease progresses. Since thyroid problems can affect growth and overall health, regular screening in these children, especially those at higher risk, may help catch and manage them early. More long-term studies are needed to better understand this relationship.

Background: Gastric ulcer disease is a common and recurring gastrointestinal condition affecting millions annually. Several medications are available for the treatment of gastric ulcers; however, their adverse reactions attenuate their usefulness. Objective: To evaluate the possible synergistic gastroprotective effects of combining bezafibrate with Ginkgo biloba (GKB) in ethanol-induced gastric ulcers. Methods: Thirty male Wistar albino rats were randomly distributed into six groups, each of 6 rats, as follows: negative control, positive control, esomeprazole group, bezafibrate group, GKB, and bezafibrate + GKB. All the medications were administered orally on a daily basis, and a single dose of ethanol (1 ml) was administered on day 14 for groups III, IV, V, and VI. After scarification, blood samples were gathered, and the stomachs were excised for gross evaluation. Results: The combination group showed decreased gastric free and total acidity and LDH and raised gastric pH and GSH levels. Gross evaluation of stomach images showed remarkable protection in the combination group. Conclusions: The combination of bezafibrate with ginkgo biloba extract in the current study exerted more gastroprotective effect than each alone, comparable to the esomeprazole effect, suggesting they could work synergistically to guard the gastric mucosa from ethanol-induced destruction via decreasing gastric acidity and inflammatory mediators and boosting the antioxidant system.

Background: Diabetes is frequently not diagnosed until complications appear. Therefore, diabetes can be considered the top candidate for early detection and management. Objectives: To assess the non-compliance level of the 2nd visit of the screening program for diabetes and to evaluate the effect of diet and exercise modification on glycemic control. Methods: The first part was a cross-sectional study with analytic components, and the second was an interventional study during a period of one year, from September 2023 to September 2024. It included 400 adults aged ≥ 40 years, who were included in the program of early diabetes detection and showed an elevated blood sugar level; then they were scheduled for the 2nd visit for follow-up. HbA1c %, body mass index, and waist circumference were evaluated, and then these patients were put on a diet and exercise program to be evaluated again after three months. Results: The prevalence of non-compliance is 64.4%. Lower educational level, not enough time to explain problems by the provider, fear and worry about diagnosis, hesitation to treatment, and not giving an appointment for a 2nd visit are independent risk factors. Means of BMI, WC, and HbA1c were significantly decreased after three months of lifestyle modification. Conclusions: Non-compliance with the 2nd visit of the program of early detection of diabetes is a common problem among Iraqis. The primary care infrastructure and expertise are lacking in Iraq, and healthcare provision relies heavily on secondary and tertiary care.

Background: Effective weight management is difficult when there is obesity, especially when genetic factors are involved. Objective: This study evaluated the efficacy of three medications—Metformin, Ozempic (semaglutide), and Saxenda (liraglutide)—in promoting weight reduction. Methods: A total of 165 participants were included in the study, with 70.9% classified as obese. Participants were treated with Metformin, Ozempic, or Saxenda, and their weight loss outcomes were monitored. Kaplan-Meier survival analysis was used to assess time-to-weight reduction, and Cox regression analysis was employed to identify predictors of weight loss. Results: GLP-1 receptor agonists (Ozempic and Saxenda) demonstrated significantly greater weight reduction compared to metformin. Mean weight loss was 8.72 kg for Ozempic and 9.81 kg for Saxenda, compared to only 1.17–1.18 kg for Metformin. Kaplan-Meier analysis revealed that participants on Ozempic and Saxenda achieved weight reduction faster than those on Metformin. Cox regression analysis identified physical activity as the only significant predictor of weight reduction (HR=1.64, p=0.006), while age, diet, and smoking status were not statistically significant. Conclusions: GLP-1 receptor agonists (Ozempic and Saxenda) are highly effective for weight reduction in individuals with obesity, particularly those with genetic predispositions, and should be considered as first-line treatments. Physical activity plays a critical role in enhancing weight loss outcomes and should be integrated into obesity management plans.

Background: Parkinson’s disease (PD) is a neurodegenerative disorder that is second to Alzheimer’s regarding its prevalence. It is characterized by motor and non-motor symptoms. The outcomes of the latter can be used to evaluate and depict prognoses of the quality of life in PD patients. Objectives: To evaluate the autonomic function patterns in PD patients in three settings using electromyography (EMG). Methods: The current study is a case-control study involving 40 PD patients and 40 healthy controls collected from Ghazi Al-Hariri Hospital (Baghdad, Iraq). R-R interval variability (RRIV) of each participant was estimated at rest (RRIVr), deep breath (RRIVdb), and Valsalva maneuver (RRIVv). Results: The results showed a significant reduction in the RRIV values of PD patients compared to the control. The most significant reduction was observed in RRIVv value. Moreover, the values of RRIV were correlated positively in PD patients. Also, RRIVv has shown excellent sensitivity in the diagnosis of PD with 97% sensitivity and 90% specificity, which was better than RRIVr and RRIVdb. Conclusions: Thus, using RRIVv settings can reflect a very sensitive tool in the assessment of autonomic function for the diagnosis and prognosis of PD that can overwhelm the other RRIV settings for better management of PD patients.

Background: Breast cancer (BC) is one of the most malignant types of cancer in women. Triple-negative breast cancer (TNBC) is a subtype of breast cancer with poor prognosis and high recurrence and invasive metastasis rates. Ferroptosis is a non-apoptotic form of cell death characterized by iron-dependent accumulation of reactive oxygen species (ROS). Although ferroptosis induced by erastin has been widely studied, the ability of erastin to induce apoptosis has not been extensively investigated. Objective: To evaluate the effect of erastin on the viability of MDA-MB-231 breast cancer cells and also to investigate the potential of erastin to induce ferroptosis and apoptosis. Methods: MDA-MB-231 breast cancer cells were cultured in Dulbecco’s modified Eagle’s medium (DMEM) and treated with erastin. Cell viability was assessed by 4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide (MTT) assay. The total cellular labile iron pool (LIP) was detected based on the calcein-acetoxymethyl ester (C-AM) method. Cellular ROS level was detected using an ROS fluorometric assay kit. Cell apoptosis was detected using an annexin V-fluorescein isothiocyanate (FITC) and propidium iodide (PI) apoptosis detection kit. Results: Erastin inhibited the growth of MDA-MB-231 cells and significantly increased the levels of ROS, LIP, and MDA in MDA-MB-231 breast cancer cells. The results have also demonstrated that erastin had the ability to induce apoptosis. Conclusions: Erastin induced two forms of cell death, ferroptosis and apoptosis, in MDA-MB-231 breast cancer cells. These findings suggest that erastin may be further investigated as a novel anti-TNBC agent.

Erdheim-Chester disease is multisystemic involvement of almost all organs and tissues of the body by excessive production of white blood cells by histiocytes. This present case showed the involvement of the urological system in bilateral swollen kidneys, which was seen in both ultrasound as well as contrast computed tomography. Renal parameters and urine culture were normal. Uroflowmetry showed signs of stricture, which was confirmed through retrograde urethrography. There were no clinical signs of other systemic involvement. Radiological examinations were conducted, which showed asymptomatic involvement of sclerosis in bilateral knees. To confirm, further bone biopsy was performed, which had foamy histocyte infiltration along with Touton-like giant cells on immunohistochemistry. Though the prognosis of this disease is poor, early diagnosis and alleviating symptoms require accurate judgment by clinicians in multidisciplinary teamwork.

Background: Psoriasis is a persistent, inflammatory skin condition characterized by distinct clinical and histological features. The disease is linked to systemic inflammation and immune system dysregulation. High Mobility Group Box 1 (HMGB1) is one of the innate immunity components that have been implicated in disease development and severity. Objective: Evaluate the mean serum levels of High Mobility Group Box1 Protein (HMGB1) in Iraqi patients with psoriasis and analyze its potential association with disease severity and complications. Methods: A case-control study was conducted on 110 individuals. The patient group included 60 randomly selected patients with a mean age of 37.23±8.26 years old, and the control group included 50 randomly selected volunteers (35.32±7.53 years). Blood specimens were obtained from all participants after acquiring verbal permission. The ELISA technique was used to measure the serum levels of HMGB1. Results: the mean level of HMGB1 was 7.21±0.75 ng/ml in patients compared to 6.42±0.69 ng/ml in controls, although the difference was non-significant (p=0.451). The mean level of HMGB1 was significantly associated with response to treatment. Also, the mean level of HMGB1 was significantly higher in individuals with metabolic syndrome. In contrast, the mean level of HMGB1 was non-significantly associated with other complications and disease severity. Conclusions: HMGB1 serum level was elevated non-significantly in psoriasis patients, but it was significantly correlated with metabolic syndrome and good treatment response, so it could be used as a predictor for metabolic syndrome and good management.