Al- Anbar Medical Journal

Autoimmunity is a condition in which the immune system cannot recognize the self from non-self-antigens. Autoimmunity is relatively more common in females than males. The process of embryo implantation is considered the most significant restricting factor in female reproduction. The immunological system of the females may affect the success or failure of pregnancy by its effect on extremely important steps from ovulation to implantation processes, thus ensuring the importance of autoimmunity for women in sub-fertility. The association between autoimmunity and female reproduction receives increased attention nowadays. A successful conception is a result of multiple complex interactions between the developed embryo and the receptive uterus and is usually under immune-hormonal control. In certain circumstances, the female ovary can be a target of an autoimmune attack, like some organ‐specific or systemic autoimmune disorders subsequently resulting in clinically significant ovarian dysfunction, implantation failure, and sub-fertility. Consequently, the effect of a specific auto-antibody on the etiology of infertility remains unknown.. This review focused on auto-antibodies that may affect female fertility.

Probiotic use to improve health is not new; but recently, it has attracted much attention concerning human health and diseases. The human gut is a delicate ecosystem where bacteria and host cells interact with each other. This is an important part of gut homeostasis and human development. Disruption of this sensitive ecosystem may have detrimental health repercussions linked to impaired gut microbiota (GM). GM were extensively examined as an underlying mechanism for disease development and progression. Additionally, it was used as a tailored method for preventing and treating disease. Because of the strong association between GM, health, and disease, there has been much interest in employing probiotics or living microorganisms, to regulate GM to prevent or cure specific diseases. Herein, probiotics' role in enhancing women's and pediatric well-being was addressed as a marker of disease and as therapeutic avenues; where we discussed probiotics indications, efficacy, safety profiles, and future prospects in clinical practice.

The unprecedented impact of the coronavirus disease-19 (COVID-19) pandemic on society and the global economy has highlighted the urgent need for an effective and safe vaccine. One of the very rare side effects of this vaccine is myocarditis, which was realized to be a terrible complication of the COVID-19 mRNA vaccine. A recent study showed an increase in 1824 events of myocarditis reported to VAERS, 383 (21.00%) reported after receiving a single dose of vaccine, then 956 (52.41%) after injection of the second dose. The most common complaint is chest pain that appears within 1 week after the injection. Young and male patients have a high incidence. The pathophysiology of post-mRNA vaccination myocarditis remains unclear, with one study hypothesizing it to be due to hypersensitivity myocarditis and another study suggesting another possible mechanism is molecular mimicry. The main aim of this literature review is to improve knowledge, prevention, and management, as well as determine the incidence between the COVID-19 mRNA vaccine and myocarditis.

Background: Facial asymmetries are common in patients with skeletal class III malocclusion and posterior crossbite. Maxillary expansion and protraction (ME&P) and then fixed orthodontic treatment may affect positively on these asymmetries.
Objectives: We aimed to investigate the effects of applying ME&P by the rapid maxillary expansion (RME) and face mask and then fixed orthodontic treatment on soft tissue asymmetries in adolescent patients with skeletal class III malocclusion and posterior crossbite. For this purpose, the 3D facial imaging system of stereophotogrammetric (3dMD) recordings was analyzed quantitatively in the pre-treatment (T0), ME&P (T1), and post-fixed orthodontic treatment periods (T2).
Materials and methods: The study included 28 (11 females, 17 males) individuals with skeletal class III malocclusion and posterior cross-bite (5 patients with bilateral and 23 patients with unilateral cross-bite) and soft tissue facial convexity angle of 175.11º±1.06º with a mean age of 9.37 ± 0.54 years. Three-dimensional photographs were taken from the individuals before the ME&P (T0), 6 months after the ME&P procedure and before starting fixed orthodontic treatment (T1), and after removing all orthodontic appliances from the mouth at the end of the fixed orthodontic treatment (T2). 3dMD Vultus® software was used to evaluate the data of 34 linear and 16 volumetric as a total of 50 measurements in soft tissue analysis.
Results: The right-left volume differences, the Root Mean Square (RMS) values, and linear width measurements in the upper, mid, and lower face regions when evaluated at the T1-T0, T2-T1, and T2-T0 period intervals, were found to a decrease in these values and improvement of asymmetry.
Conclusion: The asymmetry in the soft tissue in all face regions was corrected with ME&P and fixed orthodontic treatment. The most obvious asymmetry improvement occurs in the lower face area. It should be taken into consideration that asymmetry will improve with RME and face mask application and fixed orthodontic treatment in adolescents with Class III malocclusion and posterior cross-bite and treatment planning should be done according to that.

Background: Leishmaniasis is an endemic disease in Iraq. There are three types of leishmaniasis; cutaneous, mucocutaneous, and visceral form. Cutaneous leishmaniasis (CL) is the most common type that causes skin sores. In Iraq, CL has 2 presentations, zoonotic cutaneous leishmaniasis which is caused by L. major, and anthroponotic cutaneous leishmaniasis caused by L. Tropica. Leishmaniasis, is transmitted by the bite of infected female phlebotomine sandflies.
Objective: We aimed to verify the clinical and epidemiology of cutaneous leishmaniasis in the Al Muthanna governorate.
Materials and methods: A prospective cross-sectional descriptive study was carried out in the outpatient dermatological clinic in Al Hussein Teaching Hospital during the period from the 1st of December 2021 to the 1st of April 2022 in Al Muthanna governorate, Iraq. Patients with CL of any age and both sexes were enrolled in the current investigation. Detailed information regarding the age, gender, residence, duration, site, number, and type (wet or dry) of the lesion was recorded for every participant.
Results: Two hundred fifty patients were diagnosed clinically as having CL. Males represented 132 (52.8%) patients. The majority of the cases were found in the age group 0-10 (n = 174, 69.6%) patients. Eighty percent (n = 200) of the participants were from rural areas. Most of the cases were presented in less than two months (n = 164, 65.6 %). Most of the lesions affected the face (n = 89, 35.6%), and the least was seen in the upper and lower limbs (n = 9, 3.6 %). The majority of the cases had a single lesion (n = 164, 65.6%) and of the dry type (n = 178, 71.2%).
Conclusion: CL is an endemic dermatological disease in the Al Muthanna governorate. Males were outnumbering females. The highest age group affected was 0-10 years. The majority of patients were from rural areas. The majority of the cases presented within two months, involved the face, had a single lesion, and were of a dry type.

Background: Anesthesiologists and their assistants, who have extensive skills and powerful impact, are major contributors to the COVID-19 management team. However, the procedures they perform expose them to the danger of infection.
Objectives: To estimate the prevalence rate of COVID-19 among anesthesiologists and the assistant staff in Al Anbar Governorate and factors that might affect the rate of infection.
Materials and Methods: A prospective survey study was conducted for the anesthesiologists and anesthetist assistants who worked in any hospital (12 in number) in Al Anbar Governorate, Iraq. The agreed participants were contacted by phone. Demographic and clinical data were recorded for each participant.
Results: Of 214, there were 100 participants responded to the questionnaires with a response rate of 46.7%. The prevalence of COVID-19 among them was 93%. The majority of the subjects were from the age group ≤ 40 years (65%), males (67%), and non-smokers (73%). Most of the individuals were sub-staff (90%), with a service duration of 1-2 years (44%), work in the operative room (60%), and they were not worked in an isolation hall (58%). There was no statistically significant difference between infected and non-infected groups regarding the above-mentioned variables (P-value > 0.05). The majority of the participants (92%) were vaccinated. There were 4 out of 92 from the vaccinated group and 3 out of 8 from the non-vaccinated group got an infection with a statistically significant difference (P-value = 0.0001). The majority (83) of the participants were taken the Pfizer vaccine. Most of the infected subjects with mild severity. Besides, there was a statistically significant difference between COVID-19 severity and the timing of the infection (P-value = 0.0001).
Conclusion: The prevalence of COVID-19 among the participants was 93%. Vaccination could have a protective effect against the disease.

Background: Rectal bleeding is commonly seen in daily practice. The colonoscopy is an essential diagnostic tool in detecting the various causes of this clinical entity.
Objectives: We aimed to detect the different pathological lesions in patients with rectal bleeding using colonoscopy and to find the correlation between colonoscopic findings and the age and gender of the patients.
Materials and Methods: This prospective cross-sectional study was conducted at the center of endoscopy and colonoscopy at Rizgary Teaching Hospital throughout the period from April 2018 to April 2019. Patients with bleeding from the rectum and subjected to colonoscopy of any age and gender were enrolled in the current study. Data regarding the age, gender, duration, family history of colorectal cancer, whether the bleeding was fresh or mixed with stool, spontaneous stoppage of bleeding or not, and the colonoscopic findings were recorded for every participant.
Results: of 91 patients with rectal bleeding, there were 55 (60.4%) male. The most affected age group was over 40 years old (n = 47, 51.6%). Only 11 (12.1%) of the participants gave a family history of colorectal cancer. Around three-quarters of the cases involved chronic bleeding. The bleeding was fresh in 60 (65.9%) cases. The majority of the bleeding (n = 74, 81.3%) stopped spontaneously. Hemorrhoids (49.45%) were the most common colonoscopic finding in patients with rectal bleeding, followed by no abnormality (18.68%), and the least diverticular disease (2.2%). There was a statistically significant difference between the age of the patient and the cause of rectal bleeding (P-value = 0.042). However, there was no such correlation regarding the patient's gender (P-value = 0.196).
Conclusion: Hemorrhoids were the most common colonoscopic finding in patients with rectal bleeding. The age of the patient can determine the cause of the rectal bleeding.

Background: Social media are online communities where people can share ideas and interests and make new friends. It is a technology used to show off personal creativity or to share information, ideas, business interests, or knowledge between different groups through different forms of communication, and everyone knows that this information is important, even decision-makers.
Objectives: To assess the influence of social media sites on physical and psychological health behaviors among college students.
Materials and Methods: A cross-sectional study was conducted at the Department of the Technical Nursing/Technical Institute-Suwaira in Middle Technical University, Wasit, Iraq. The sampling technique to select students was non-probability (convenience sample). The data collection was through the direct interview technique by the researcher with each participant for a period from 28th March 2022 to 15th October 2022. The data analysis approaches were used in order to analyze and assess the results of the study under the application of the statistical package for social sciences (SPSS) version 25.
Results: Three-quarters of the 300 participants were between the ages of 18 and 22, with 68.3% being female. Facebook was the most popular social media site used by the participants. The answer No was the most Student’s response about physical and psychological health and for the most of the items related to physical health, and less than half of their assessment were affected. There was a highly statistically significant association between the items related to physical and psychological health and gender, marital status, and economic status.
Conclusion: This study showed that although social media is essential for students in their studies, at the same time it might have some physical and psychological effects on the health of students.

Background: S. aureus can secrete enterotoxin. In this study, one non-synonymous single nucleotide polymorphism (nsSNP) that exhibits a missense impact on the enterotoxin type A protein was investigated, namely Thr136Arg.
Objective: The current investigation was carried out to predict the final consequences of this missense SNP on the enterotoxin type A protein structure, function, stability and binding affinity with antibiotics directed against this toxin.
Materials and Methods. Isolation and identification of S. aureus and genetic detection of enterotoxin A gene (sea) in this S. aureus isolates. After sequencing the sea gene, the 3-dimensional structure of the enterotoxin type A protein was generated, and this nsSNP was highlighted in the generated 3-dimensional structure of enterotoxin type A. Several in silico tools were used to study the effect of missense SNP on this protein’s structure and function. Subsequently, a set of five in silico tools was also implemented to evaluate the effect of this SNP on the stability of enterotoxin type A upon mutation.
Results. The cumulative results of structure-function in silico tools indicated clear deleterious consequences of Thr136Arg on the protein structure and function of the enterotoxin type A protein. Further deleterious consequences of Thr136Arg were evolutionary confirmed, and the highly conserved region of the investigated SNP was validated in enterotoxin type A. In addition to structure-function predictions, all tools that utilized stability-prediction showed that this SNP exhibited a remarkable reduction in protein stability with a noticeable negative effect on the stability of enterotoxin type A. Docking experiments showed a noticeable alteration in the binding of enterotoxin type A with nafcillin, with a considerable alteration in the conformation of its 3D dimension.
Conclusion: It has been found from cumulative in silico predictions that the Thr136Arg SNP may be involved in inducing a noticeable damaging and destabilizing role on enterotoxin type A, with several consequent negative impacts on the biological activities in which this protein is involved. The binding affinity of the destabilized enterotoxin type A with the antibiotic nafcillin would be altered accordingly. This study suggests that nafcillin would bind more effectively with the Thr136Arg-damaged enterotoxin type A, which may implying that the strains having this protein may exhibit altered susceptibility to antibiotic treatment.

Background: Obesity and insulin resistance elevate plasma leptin, while it lowers plasma levels of soluble leptin receptors (sOB-R).
Objectives: To measure the levels of sOB-R in patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) and compare it to healthy controls. The study also aimed to investigate the influence of metformin on the levels of sOB-R in patients with T2DM and MetS.
Materials and Methods: This study is a case-control and (pretest-posttest study), conducted on 66 participants (33 patients and 33 controls). Patients were divided into two groups; Group I included 17 newly diagnosed T2DM patients, and Group II included 16 patients with MetS. Patients were studied before and 3 months after treatment with 850 mg metformin treatment. Group III included 33 non-obese healthy individuals as a control group. Measurements such as height, weight, waist circumference, hip circumference, blood pressure examination, and biochemical tests including fasting blood sugar, HbA1c, total cholesterol (Ch), triglyceride, high-density lipoprotein (HDL), insulin level, plasma sOB-R levels were performed. Ch/HDL ratio, non-HDL cholesterol, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Waist Hip Ratio (WHR), and Body Mass Index (BMI) were calculated.
Results: No statistically significant difference was found among the groups regarding sOB-R levels initially, but after metformin treatment, T2DM patients showed a significantly higher level (10.19 ng/ml). There was a significant increase in the levels of sOB-R after metformin treatment, as it increased from 7.87 ng/ml to 9.71 ng/ml in T2DM, and from 6.92 ng/ml to 7.82 ng/ml in MetS patients.
Conclusion: Metformin significantly increases the plasma levels of sOB-R in T2DM patients but only slightly increases these levels in MetS patients.

Background: Adults who have periodontitis are more likely to lose teeth, which affects their quality of life and causes masticatory dysfunction. Most people agree that smoking tobacco makes them more likely to get oral mucosal and periodontal diseases and makes the oral microbiome less balanced. Melatonin is a naturally occurring hormone that is released in a variety of organs.
Objectives: To examine the relationship between smoking and salivary melatonin levels in periodontitis patients vs healthy people, and to establish a relationship between melatonin levels and periodontal parameters.
Materials and Methods: The study was conducted at the College of Dentistry, University of Baghdad, Baghdad, Iraq. The study period was from February to May 2022. There were a total of 74 male subjects aged 35-55 years, and they were divided into four different groups; Group 1: a control group of non-smokers (n = 12), Group 2: a control group of smokers (n = 12), Group 3: a group of individuals with periodontitis (n = 25), Group 4: a group of individuals with both periodontitis and a record of smoking (n = 25). A whole, unstimulated sample of the participant's saliva (5 ml) was taken, and this was followed by an evaluation of clinical periodontal variables (probing pocket depth and clinical attachment level). To measure melatonin concentrations, saliva samples were biochemically analyzed using the Enzyme-Linked Immunosorbent Assay (ELISA).
Results: Melatonin concentrations were shown to be lower in groups with periodontitis than in control groups, as well as lower in groups with smoking than in groups without smoking. It was found that there was a strong negative link between periodontal variables and the amount of melatonin in the saliva.
Conclusion: According to this study, a reduced melatonin level was noticed in the salivary fluid of the smoker (healthy and periodontitis) groups in comparison with the non-smoker (healthy and periodontitis) groups. This suggests that active cigarette smoking had a retarding effect on the salivary levels of melatonin.