Al- Anbar Medical Journal

In recent years, there has been an increasing interest in using proton beam therapy to treat certain types of cancer in many countries around the world. However, some countries never used proton beam therapy and do not have any center for it. One of these countries is Iraq. Although the advantages of proton beam therapy over photon beam therapy to treat several types of cancer, it remains unused in Iraq and several countries. This may be due to the high cost of building a proton beam therapy center, a lack of information about this advanced modality that can save many lives, or the absence of a trained staff of oncologists, medical physicists, and technicians who know how to work with the proton beam therapy center. Here in this review, light will be shed on proton beam therapy and its advantages and disadvantages, and the specific types of cancers should be treated by this modality rather than photon beam therapy.

Background: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting a significant proportion of women and can lead to amenorrhea and infertility. High levels of prostatic specific antigen (PSA) were observed in PCOS, however, there is insufficient evidence regarding its efficacy as a diagnostic marker for this condition.
Objective: To evaluate the efficacy of PSA in the diagnosis of PCOS and to assess its relation with abnormal lipid profile observed in this syndrome.
Materials and methods: A case-control study including 60 patients with PCOS and 60 healthy women as a control group. Demographic data, including age and body mass index (BMI), were collected. Blood samples were obtained from each participant to measure PSA levels and lipid profile parameters. The association of PSA with lipid profile parameters was made.
Results: PCOS patients had a significantly higher BMI compared to normal controls. The mean serum level of PSA in PCOS patients was significantly elevated in comparison to the control group. The cut-off value of PSA at ≥ 0.025 ng/ml was observed to be a diagnostic marker for PCOS. The highest percentage of PCOS patients were obese, with a BMI ≥ 30 kg/m2. On the contrary, most women in the control group had a normal weight. Obese women in the PCOS and control groups had significantly higher mean serum PSA levels in comparison to those who were normal or overweight. A non-significant correlation was observed between PSA levels and BMI in patients with PCOS. The mean serum levels of cholesterol (CHO), triglyceride (TG), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) were significantly higher in PCOS patients than in controls. In contrast, the mean high-density lipoprotein (HDL) level was significantly lower in PCOS in comparison to control. A significant positive correlation was observed for PSA with the lipid profile parameters (CHO, TG, LDL, VLDL) in PCOS patients.
Conclusion: Elevated PSA levels in PCOS patients, closely linked with an abnormal lipid profile, indicate its efficacy as a potential marker for the diagnosis and monitoring of the condition.

Background: Colon cancer is considered the third most frequent malignant tumor in the world as well as the leading cause of mortality. Unlike other antiviral agents, remdesivir has been investigated for new therapeutic options in various cancer types, but its impact on colon cancer cell death and immune response has not been well documented.
Objectives: To assess the effects of remdesivir on the viability of SW480 colon cancer cells and the modulatory effect on immune responses in the colon cancer cell line.
Materials and methods: SW480 colon cancer cells were exposed to different doses of remdesivir (62,5, 125, 250, 500, 1000, and 2000 µg/mL). Cell viability was measured in MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay, and the immune response was probed through the expression of cytokines directly using enzyme-linked immunosorbent assay method of IL-23 (interleukin-23), TGF-β (tumor necrosis factor-β), and TNF-α (tumor necrosis factor-α). The control group included cells incubated along with the same medium without the addition of any compounds, whereas the experimental group included cells exposed to different doses of remdesivir.
Results: Remdesivir exhibited the highest inhibitory effect on SW480 colon cancer cell viability at a dose of 1000 µg/µl. Remdesivir had an influence on the immune response, as evident, IL-23 and TGF-β demonstrated mild decrease, and TNF-α demonstrated a sharp increment at the highest concentration of 125 µg/µL.
Conclusion: Remdesivir has demonstrated potential for its cytotoxic effects on colon cancer cells, and it has potentially a significant modulatory effect-related cytokines.

Background: Doxorubicin (Dox) is a powerful chemotherapy medication in the anthracycline antibiotic group. However, due to its substantial toxic side effects in various non-target organs, its clinical application is restricted, which leads to hepatotoxicity and cardiotoxicity.
Objectives: To investigate the role of vitamin E and bee propolis as protective agents to ameliorate Dox-induced hepatic toxicity.
Materials and methods: A total of 50 adult male albino rats weighing 240±55g were randomly divided into seven groups. The time interval for the experiment was extended to 22 days. Liver function tests and histopathological inspection were performed according to documented protocols. At the end of the experiment, blood samples were collected, and serums were separated, numbered and used to assess the liver functions, including alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), serum albumin, and total serum bilirubin. Also, the liver was preserved and later examined microscopically with H & E stains.
Results: A severe decline in albumin levels was observed with 20 mg/kg of Dox, compared to the control, confirming the damaging effect of Dox on the hepatocyte-producing ability of albumin. The bee propolis or vitamin E showed significant protective effects on the liver by keeping the normal levels of total bilirubin, AST, ALT, and ALP compared to the control. Furthermore, the bee propolis or vitamin E in combination with Dox showed non-significant changes in the level of albumin compared to the Dox group. The histological investigation was in parallel with biochemical data in confirming the protective effects of bee propolis and/or vitamin E against Dox-induced hepatic toxicity.
Conclusion: The administration of specific drugs, like bee propolis and vitamin E, has demonstrated a protective effect against Dox-induced toxicity.

Background: Klebsiella oxytoca (K. oxytoca) is a progressively noted pathogen in healthcare services. K. oxytoca can produce cytotoxins, which play a role in the pathogenesis of bacteria and are the main virulence factors. K. oxytoca can make cytotoxin, a biofilm, resistance, and a hypermucoviscous phenotype, all of which are important for the virus's ability to infect others.
Objective: To investigate the occurrence of the toxin-producing K. oxytoca (pehX, npsA, and npsB) genes from different Iraqi isolates that were multi-drug resistant, could produce a biofilm, and had a hypermucoviscous phenotype.
Materials and methods: A total of 100 K. oxytoca isolates were collected from hospitals in Baghdad, Iraq. The isolates were identified by manual and biochemical tests. The string test was used to determine the hypermucoviscousity. The antibiotic sensitivity test was uncovered using the Kirby-Bauer method. Biofilm formation was detected by the qualitative Congo red agar method and the quantitative microtiter plate method (MTP). K. oxytoca galacturonase-specific gene (pehX) and the cytotoxin marker genes (npsA and npsB) were detected using real-time polymerase chain reaction.
Results: K. oxytoca was isolated from 62/100 inpatients and 38/100 outpatients. Antibiotic sensitivity tests showed different levels of resistance. The pehX gene was positive in 35/50 of the isolates. The npsA/npsB PCR targets were positive in 12/35 isolates. Of these 12 isolates, 3/12 (25%) were from urine and 2/12 (16.7%) from blood.
Conclusion: Cytotoxin-producing K. oxytoca was a common emerging pathogen in Iraqi patients. Biofilm formation, hypermucoviscous, and antibiotic resistance increase the virulence of this bacterium.

Background: Doxorubicin (DOX), a chemotherapeutic drug, is effective against various cancers but can cause liver and kidney damage due to oxidative stress and inflammation.
Objectives: To determine whether managing albino rats with an aqueous extract of the baobab plant can reduce the potential histological effects of DOX on the renal and hepatic tissues.
Materials And Methods: Forty rats were acclimatized under controlled conditions and divided into four groups: Control group receiving saline, DOX group receiving one intraperitoneal injection of 15 mg/kg DOX, DOX + baobab group co-administered with DOX at 15 mg/kg intraperitoneally plus baobab extract (500 mg/kg/day) orally, and the baobab-only group administered with 500 mg/kg/day baobab extract. Then, the baobab effects on liver and kidney function after the use of DOX were evaluated.
Results: Rats treated with DOX had higher serum urea and creatinine levels. While baobab extract, when co-administered with DOX, reduced urea and creatinine levels, thus bringing them closer to the control group and pointing towards the protective potential of baobab against DOX-induced nephrotoxicity. The effect of DOX treatment was an increase in the levels of the liver markers (alanine aminotransferase and aspartate aminotransferase), whereas baobab resulted in significant decreases in these liver markers. After receiving DOX, the baobab extract exists in advanced hepatic and renal function in association with the control group. Baobab had significant possessions on kidney function and may be experienced incompatible tissue damage spread by DOX.
Conclusion: Co-administration of baobab extract with DOX improved kidney and liver function.

Background: Diabetic nephropathy (DN) is the most prevalent complication of diabetes. Timely diagnosis of DN is important to prevent long-term renal damage and to assess the prognosis of DN patients.
Objectives: To investigate the levels of newly circulating Src homology 3 (SH3) domain-containing Ysc84-like 1 protein (SH3YL1) in various stages of DN among type 2 diabetes mellitus (T2DM) patients and to determine the relationship between SH3YL1 levels and DN by comparing them with traditional diagnostic biomarkers.
Materials and methods: This case-control study included 108 participants, comprising 81 patients with T2DM divided into three subgroups based on the albumin creatinine ratio (ACR): G1 only (27 T2DM with normoalbuminuria), G2 (27 T2DM with microalbuminuria), and G3 (27 T2DM with macroalbuminuria) compared with G4 (27 healthy subjects' group (HS)). All participants underwent a comprehensive history, examination, routine laboratory analysis, and SH3YL1 measurement via enzyme-linked immune sorbent assay. Furthermore, the ROC curve comparison of SH3YL1 with traditional biomarkers was conducted using the DeLongs test.
Results: A significant increase in serum SH3YL1 levels was shown in G2 and G3, followed by T2DM patients compared to the G4 group. SH3YL1 levels were positively correlated with blood urea and creatinine, while they were negatively correlated with estimated glomerular filtration rate (eGFR) (P-value < 0.0001). Additionally, in multivariate regression analysis, SH3YL1 was found to be significantly independent of blood urea and eGFR (P-value < 0.05). The receiver operating characteristic curve analysis indicated that SH3YL1 effectively discriminates T2DM and DN patients from HS, with an area under the curve of 0.98 and a cut-off value of >1.1.
Conclusion: SH3YL1 protein may serve as a biomarker for T2DM with different stages of DN, particularly in cases of macroalbuminuria, potentially aiding in early detection and treatment. SH3YL1 and routine biomarkers of DN patients may enhance and improve the diagnostic ability.

Background: Metabolic factors associated with type 2 diabetes mellitus (T2DM) remain poorly understood, especially in the context of population-specific influences and varying environmental settings.
Objectives: To investigate the modulation of albumin, lipid profile biomarkers, and glomerular filtration rate (eGFR) in T2DM patients attending the Bamenda Regional Hospital in Cameroon.
Materials and Methods: Briefly, 153 patients were interviewed on their socio-demographic and anthropometric information, and their fasting blood glucose (FBG) level, lipid profile, albumin, and eGFR were determined.
Results: The majority (61.4%) of participants were females and almost half (45.7%) of the population was obese. The FBG level was lower in the older age group (70-79 years, 165.62±17.95 mg/dL) than those moderately younger (≤69 years, 241.26±12.96 mg/dL). Also, the eGFR (65.97±4.03 ml/min/1.73m2) and high-density lipoprotein (HDL) level (54.06±2.84 mg/dL) decreased in older patients, particularly in the age 70-79 years. Male participants had higher albumin levels than the females (4.77±0.12 g/dL vs. 4.38±0.11 g/dL). Moreover, albumin was higher in the younger population (39-49 years; 4.99±0.22g/dL) as compared to older individuals (80-89 years; 4.07±0.22 g/dL). Correlation analyses revealed significant associations of FBG, albumin, eGFR, triglycerides, HDL, and low-density lipoprotein with age, gender, and body mass index.
Conclusion: The findings suggested significant variations in albumin, lipid biomarkers, and eGFR among diabetic patients, with age, gender, and cholesterol levels being the key modulators. Older patients seem particularly affected, making them a critical group for targeted management of T2DM.

Background: Medical students worldwide are experiencing a higher occurrence of anxiety, but there is no available data specifically from the Kurdistan region, Iraq.
Objectives: To estimate the prevalence of generalized anxiety disorder (GAD) and to assess the major stresses and risk factors that lead to the onset of GAD.
Materials and methods: A cross-sectional study was done at the College of Medicine, University of Duhok, Duhok, Iraq. 422 medical students participated, and they were assessed for GAD by using the GAD-7 score. The GAD-7 has seven items, each item reflecting the diagnostic criteria of the DSM-5.
Results: A total of 422 students participated in the study. The study revealed that 70.7% of participants had GAD with 38.2%, 19.2%, and 13.3% having mild, moderate, and severe anxiety, respectively. The results revealed that females (female = 84, male = 53), those living in family homes (family homes = 97, dormitory = 40), those residing in urban (urban = 341, rural = 81), those with poorer academic performance, and those in grades 1, 2, and 3 were affected by more severe anxiety.
Conclusion: The prevalence of GAD was high among medical students in Duhok Medical College, and has a significant correlation with gender, residence, academic performance, and student grade. It is recommended to give psychological support and exercise special caution for diagnosing and managing students that may help overcome this psychological condition.

Background: Oxidative stress is the principal contributor to the pathogenesis and progression of age-related cataract (ARC), the most prevalent type of cataract.
Objectives: The current study was designed to evaluate the therapeutic potential of taurine to prevent the progression of the nuclear subtype of ARC.
Material and Methods: In total, 61 participants, 115 eyes with the grade I or II nuclear subtype of ARC, were included in this single-arm, open-label, pre-post intervention clinical trial. Participants were instructed to apply taurine-containing eye drops four times a day for one year. Ophthalmological examinations, including best corrected visual acuity (BCVA), were performed at the baseline visit and subsequent follow-up visits at 3-month intervals for one year. The trial was registered at ClinicalTrials.gov (NCT06639711).
Results: The study cohort comprised 15 males (24.6%) and 46 females (75.4%). The median age of the participants was 62 years (IQRs 58-68). At the baseline visit, the mean logMAR BCVA was 0.2 ± 0.19. In this study, BCVA was stable throughout the study (Wald Chi-square = 1.254, P-value = 0.534). Additionally, age and female sex were found to have significant deteriorating effects on BCVA (P-value < 0.001 and P-value = 0.028, respectively).
Conclusion: This interventional study demonstrated that taurine-containing eye drops can serve as an effective therapeutic option to prevent further deterioration of BCVA and potentially inhibit the progression of nuclear ARC. In addition, age and sex were key factors that influenced the progression of ARC. Further studies incorporating randomized controlled designs, extended follow-up, and multiple centers are recommended.

Urinoma, a retroperitoneal urine collection, is a rare sequela of genitourinary disruption attributable to trauma, obstruction, or surgical interventions. Pregnancy-associated urinoma is tremendously rare. This case reports tourist attractions about an exceptional instance of bilateral spontaneous urinoma developed at the end of the first trimester. A pregnant lady of 27-year-old visited the urology clinic with left abdominal discomfort and low-grade fever at 12 weeks of gestation. Imaging revealed bilateral perinephric collections, confirmed as perinephric urinoma by aspiration and chemical analysis. The patient’s infirmity settled spontaneously at week 25 of gestation through conservative treatment and careful monitoring without unfavorable consequences on maternal or fetal health. Proper cover of antibiotics, regular ultrasound examination, and monitoring of renal function were adequate to warrant resolution, despite the preliminary worries about the possible complications. The report of this case emphasizes the importance of customized care, careful monitoring, and the prospective cure in non-interventional treatment for a rare pregnancy-associated disorder.