Al- Anbar Medical Journal

Increased atherosclerosis is a major risk factor for atherothrombotic disorders in patients with type 2 diabetes mellitus (T2DM). Changes in platelet metabolism and alterations in intra platelet signaling pathways are the main contributors to the pathogenesis of atherothrombotic complications of diabetes. In addition, advances in understanding the action of some anti-diabetics have demonstrated probable effects of these agents on platelet function and thrombotic state in T2DM. This review aimed to explore the possible mechanistic association between anti-diabetic agents and the development of thromboembolic disorders, considering the effect of drugs on platelet function and their impact on cardiovascular outcomes in diabetic patients. The cochran Library, PubMed, and Google Scholar were searched to analyze related publications. The relationship between anti-diabetic medications and the alterations in platelets function, in addition to the impact of the drugs on the occurrence of thromboembolic disorders in diabetic patients and their relation to cardiovascular events, were the main targets. Ninety-three published articles from November 1999 until February 2024 met the requirements for inclusion in this review. We realized various mechanisms responsible for enhanced platelet aggregation in T2DM, represented by immature, large, or activated platelets in the altered metabolic environment, against the background of vascular damage in DM. In parallel, analyzing the impact of anti-diabetics on platelet aggregation revealed that most of them are believed to have favorable protective effects against thrombotic disorders via reducing platelet activation and aggregation. Conversely, some anti-diabetics may exhibit negative consequences by exacerbating platelet hyperactivity and possibly predisposing to a higher incidence of thrombotic events in diabetic patients. When prescribing anti-diabetic agents to patients with T2DM, especially those at high risk of developing cardiovascular problems, we should consider these outcomes with proper monitoring of coagulation status.

Low exercise and a sedentary lifestyle are independently attributed to a rise in the level of morbidity and mortality. In the past four decades, explosive progress in knowledge and application has been made in the field of exercise physiology. Exercise can be regarded as an evolutionary stimulus for ameliorating human cardiovascular health. Several studies showed that heart attack patients who implement a formal exercise program can have a reduced death rate of 20-25%. The cardiovascular beneficial effects of regular physical activity are suggested mainly due to the exercise-induced changes in different cardiovascular risk factors such as obesity, dyslipidemia, and high blood pressure. We conducted an extensive literature search on various electronic databases such as PubMed, Science Direct, Scopus, and Web of Science. This review aimed at providing further advancement of our understanding of how different cardiovascular aspects can be modulated by exercise which could be considered as novel therapeutic strategies to prevent or treat different cardiovascular disorders. The present knowledge regarding exercise-induced cardiovascular adaptation, including processes and bioactive substances, has been improved, but many molecular/cellular aspects remain to be elucidated.

Background: Bullying is a harmful behavior that involves repeated aggressive actions intended to cause harm or distress to an individual. It is a major public health concern affecting children and adolescents. There is no local relevant study regarding this issue.
Objectives: To determine the prevalence of bullying in primary schools.
Materials and Methods: A cross-sectional study was carried out from 1st September 2023 to the 10th of April 2024 for a sample consisting of 1216 pupils. The sample of the present study was a group of pupils in fifth and sixth primary school classes for both sexes; those were found in the selected schools out of 201 schools currently found at Al-Najaf city, Iraq. The data collecting tools were direct interviews with the participants and a questionnaire composed of two parts, the first consisting of the demographic characteristics data and the second being the bullying items among primary school pupils.
Results: The prevalence of bullying was 81.7%. The study shows 3.5% bullyer, 37.3% bullied, 41% bullyer/victim, and 18.3% were non-victims non bullyer. With the exception of the number of close friends in class, all other items were related to (P-value < 0.05) the prevalence of bullying roles (bullyer, bullied, and bullyer/victim).
Conclusion: The study found a high prevalence of bullying among primary school students in Najaf City, which is concerning. An inverse relationship between protective factors and the prevalence of bullying has been identified. To address this, teachers should dedicate class time to discussing the harms of bullying and promote tolerance, while also supporting strategies to reduce school violence.

Background: Self-medication is a prevalent practice worldwide, playing a vital role in managing minor ailments and symptoms, particularly in regions with limited healthcare access. However, prevalence, impact, and justifications for self-medication are varied across communities.
Objectives: To evaluate the prevalence and identify determinant factors related to self-medication practices among the residents of Sulaimani city in the Kurdistan region of Iraq.
Methods: A descriptive cross-sectional study was conducted in Sulaimani City from November 2022 to March 2023. All adults (≥ 18 years) were eligible for this study. The data was collected from different zones of the city via the convenience sampling method. A structured questionnaire was prepared and applied via face-to-face interviews, which took place in large malls and door-to-door approaching individuals in residential neighbourhoods, and recruiting participants, for data collection.
Results: The survey involved 500 participants; the self-medication prevalence was 73.4%. The age, educational level, and occupation of the participants were factored into the practice of self-medication (P-value = 0.001). Pharmacists were the main providers of information on self-medication (54.5%) and primary sources of medications (92.9%). The primary reason for self-medication was participants' perception that their illness was not severe (65.4%). Headache was the most common ailment (64.6%), followed by the common cold and flu (57.2%). Analgesics were the most frequently used drugs (82.3%). The majority of self-medicated individuals (71.9%) did not report experiencing any adverse effects from self-medication.
Conclusions: Self-medication was highly prevalent in Sulaimani City, primarily for minor ailments, with headaches being the most common reason. Pharmacies are crucial for information and drug procurement. Even though, the study suggests that while self-medicated individuals are unlikely to experience adverse effects from their drugs, promoting rational drug use is recommended to mitigate its negative consequences.

Background: Multi-drug-resistant Acinetobacter baumannii (MDR A. baumannii) infections are an ongoing problem in many hospitals, particularly in intensive care units. One of the most difficult infections to treat is A. baumannii because it forms a biofilm.
Objectives: To identify MDR A. baumannii biofilm producers from clinical isolates and detect some biofilm-related genes.
Materials and methods: During the period from October 2023 to February 2024, a total of 26 A. baumannii clinical isolates were collected from the laboratory of Ghazi Al-Hariri Hospital, Baghdad, Iraq. The automated VITEK®2 system was used to identify A. baumannii isolates phenotypically. The blaOXA51 gene confirmed A. baumannii isolates genotypically. The microtiter plate test and scanning electron microscopy were performed to assess biofilm formation. The presence of the biofilm-forming genes OmpA and blaPER-1 was evaluated.
Results: Overall, most of the specimens were from sputum (38.5%), and all the isolates were MDR with a high resistance percentage to imipenem at 100%, meropenem, ceftriaxone, and ciprofloxacin. The isolates showed 80.77% resistance to trimethoprim/sulfamethoxazole and 100% sensitivity to colistin. The results showed that among the 26 isolates, 31% were moderate biofilm formers, 54% were weak biofilm formers, and only 4 isolates were non-biofilm formers (15%). The occurrence rates of the biofilm-related genes OmpA and blaPER-1 were 16 (61.5%) and 1 (3.8%), respectively.
Conclusion: The current study suggests the presence of MDR A. baumannii isolates harbouring the biofilm OmpA and blaPER-1 genes.

Background: Strabismus is a relatively widespread disorder. However, there is no local relevant study examined its prevalence.
Objectives: To measure the prevalence and types of strabismus.
Materials and methods: The study was a hospital-based cross-sectional study involving 10257 participants. Each participant underwent comprehensive ophthalmological examinations to assess strabismus, evident through their various characteristics. The patients were divided into two main groups: Concomitant and incomitant groups. Detailed data regarding the demographic (age, sex, and age at presentation and family history of strabismus) as well as the presence of amblyopia and diplopia were registered for every patient.
Results: Of 10257 participants, 6836 (66.6%) were male. The patients ranged in age from 4 months to 57
years, with a mean age of 1.68 years. The prevalence rate of strabismus was 6.5%. Esotropia (52.9%)
was more prevalent than other types of strabismus. Strabismus was more common in ages under ten years
old and in the ages of presentation under ten years old. There were no statistically significant differences (P-
value > 0.05) between these two variables and strabismus. While male sex was significantly associated
with a higher prevalence rate of strabismus (P-value = 0.019). A positive family history of strabismus,
the presence of amblyopia or diplopia were more common in patients without strabismus than those
with strabismus (P- value < 0.05).
Conclusions: Strabismus was a common (6.5%) disease. Esotropia was the most common type of strabismus. The study primarily observed strabismus in younger individuals and males, underscoring the significance of early screening in these groups. Contrary to expectations, the study found that having a family history of strabismus, amblyopia, or diplopia does not significantly impact the likelihood of developing it, suggesting that other factors may play a greater role in its prevalence.

Background: Children with autism spectrum disorder (ASD) are increasingly exposed to screens that correlate to negative health effects.
Objectives: To identify possible risk factors associated with long screen viewing in ASD children and identify the effects of prolonged screen time.
Materials and methods: A cross-sectional study recruited children with ASD who were followed in the Psychiatry Department in the Central Child Teaching Hospital, Baghdad, Iraq over 7 months. For all children, personal data (age, age at diagnosis, sex, sleeping duration at day and night, and aggressive behavior) and both parents' data (age, educational level, and occupation) and screen data (duration of screen exposure, type of device used for, and the content of screening) were collected for each participant.
Results: A total of 138 children with a mean age of 5.25 ± 2.85 years were included in the study with a male-to-female ratio of 5.6:1. One-third of ASD children had long-duration of screen exposure (≥ 2 hours per day). Although none of the studied patient’s characteristics was related to the duration of screen exposure, two maternal factors were significantly related to the longer duration of screen exposure (lower level of education and being a housewife with P-values of 0.008 and 0.02 respectively. Children diagnosed at younger ages are subjected to a higher duration of screen exposure with a correlation coefficient r = - 0.337 and P- value = 0.027.
Conclusion: Maternal level of education and occupation represent significant determinants of screen time in children with ASD. Long screen exposure in ASD children correlates with the patient’s age at diagnosis but has a non-significant effect on their social communication.

Background: Cluster of differentiation 44 (CD44) is the most commonly reported immune marker of the cancer stem cells in renal cell carcinoma.
Objectives: To assess the frequency of CD44 expression in renal tumors, to assess the expression of CD44 in different histological types, and to detect its association with variable clinicopathological parameters.
Materials and methods: In this retrospective case series study, 76 cases of primary renal tumors were obtained by nephrectomy, and a study of CD44 was done by using the immunohistochemical technique.
Results: The age of the patients ranged from 29-82 years with a mean of 54.8 ±11.96 with a male to female ratio of 1.05:1. Tumor size ranged from 2-17 cm with a mean of 6.2 ±3.23. Clear cell renal cell carcinoma was forming 61.83% of the cases. Among all cases, a positive CD44 expression was observed in 35 (46.05%) cases; among the malignant cases, CD44 was positive in 32 (45.71%). CD44 immunohistochemical stain showed significantly higher expression in cases with higher nuclear grade and tumor stage (P-value of 0.0376 and 0.0075, respectively). CD44 cannot differentiate between benign and malignant renal tumors.
Conclusion: CD44 immune marker can be used as a prognostic factor to predict the aggressive behavior of renal tumors. It can also be used with standard prognostic markers to add prognostic information for subgrouping cases within the same grade and stage.

Background: Harmaline is a naturally occurring indole alkaloid with many medicinal effects. Its antimicrobial effect against different pathogens has been reported previously.
Objective: To explore the ability of harmaline to revers oxacillin resistance in the methicillin-resistant strain of Staphylococcus aureus (MRSA).
Materials and methods: Briefly, 124 isolates of MRSA were procured from different wards of the Medical Complex City, Baghdad, Iraq. The type of the bacteria and the strain had been checked using conventional methods to identify MRSA. Oxacillin resistance was checked using the conventional antibiotic sensitivity test. Moreover, the bacteriostatic and cidal effects of each harmaline and oxacillin were screened to determine their IC50 and IC90 for each effect. Eventually, the interaction between the two drugs for the bactericidal effect was screened using the well-known isobologram technique.
Results: The results showed that harmaline got a mild to moderate bactericidal effect against MRSA and produced a moderate synergistic effect when both drugs were combined at a ratio of 3:7 and 5:5 (harmaline/oxacillin). Besides, an additive effect or mild synergy was noticed in the other combinations.
Conclusion: Overall, harmaline can be suggested as a chemo-sensitizer or a pharmacophore to develop better synergistic drugs for oxacillin against MRSA but further safety and pharmacokinetic studies are indicated to optimize this effect.

Background: Human chorionic gonadotropin (hCG) is one of the chief embryonic signals in primates. It modifies the uterine environment, encourages uterine receptivity, and plays a key role in embryo implantation.
Objectives: To determine the impact of intrauterine infusion of hCG at day of ovum pickup on the endometrial receptivity using ultrasound measurement of endometrial thickness and sub-endometrial blood flow indices like resistance index (RI), pulsatility index (PI), and systole/diastole (S/D) ratio, and on improvement of intra-cytoplasmic sperm injection (ICSI) outcome.
Material and methods: This comparative study included 90 infertile females from the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Baghdad, Iraq. The patients were randomly classified into three groups: Group A (30 women received intrauterine insemination of 700 IU hCG); Group B (30 women received 500 IU hCG); and Group C (30 women received no intervention). Ultrasound examination and assessment of plasma hormone level on cycle days 2-3 were done for all patients like follicle stimulating hormone, luteinizing hormone, estradiol E2, prolactin, and thyroid stimulating hormone. Embryo transfer, luteal support, and serum beta-hCG on day 14 after embryo transfer were performed, and the pregnancy rate was registered.
Result: Group A had significantly lower means for the RI, PI, and S/D ratio than groups B and C (P-value = 0.001, 0.002, and 0.027, respectively). Group A had a significantly higher pregnancy rate (P-value = 0.035) than group C. However, there was no significant difference between groups A and B (P-value > 0.05).
Conclusion: Infusion of 700 IU hCG can improve sub-endometrial blood flow by reducing the RI and PI. These effects will improve the pregnancy rate in patients undergoing the ICSI cycle.