Al- Anbar Medical Journal

Background: Preeclampsia (PE) is a systemic disorder of pregnancy that is associated with significant perinatal morbidity and mortality. Calcium (Ca) and magnesium (Mg) play a pivotal role in regulating the contractility and tone of the cardiac and vascular muscle fibers.
Objectives: To assess the role of serum levels of Ca, Mg and Ca/Mg ratio as predictors of PE severity.
Materials and methods: A prospective cohort study was conducted that included 200 pregnant women who attended three prenatal checkups at 11, 24, and 35 weeks of gestation. Serum Ca and Mg levels were measured at each visit.
Results: At the 11th week, the mean serum Ca level, Mg level and Ca/Mg ratio were 9.09 ± 0.60 mg/dl, 2.92 ± 0.72 mg/dl and 3.28 ± 0.76, respectively. At the 24th week, women with early PE had the lowest mean serum calcium (7.94 ± 0.64 mg/dl) as compared to those without the health problem (9.12 ± 0.60 mg/dl). At the 35th week, preeclamptic women had significantly reduced serum calcium, magnesium, and Ca/Mg ratio compared to non-preeclamptic women. The lowest mean serum levels of Ca, Mg, and Ca/Mg ratio were found in severe compared to mild PE (P-value < 0.05). At the 11th week, the cutoff values of 8.18 mg/dl for serum Ca, 2.04 mg/dl for Mg and 3.09 for Ca/Mg ratio were valuable for predicting the severity of PE at the 35th week of pregnancy with 100% sensitivity and a specificity of 87%, 91% and 81%, respectively.
Conclusion: The serum Ca, Mg, and the Ca/Mg ratio, measured at the 11th week of gestation, were critical predictors of severe PE at the 35th week.

Background: Hernia surgery is one of the most common operations worldwide. Surgery remains the primary treatment for hernias, with limited benefit from conservative management—initially, laparoscopic repair offered better diagnostics, less chronic discomfort, and reduced postoperative pain. TAPP (transabdominal preperitoneal) repair enhances anatomical recognition, identifies vascular structures, and reveals contralateral groin hernias.
Objectives: To report our institution’s experience with TAPP repair, including complications and long-term outcomes.
Materials and methods: We retrospectively reviewed all patients who underwent TAPP groin hernia repair between January 1, 2017, and December 31, 2022. The analysed variables included age, sex, hernia type and site, size, mesh type, fixation method, conversion to open repair, operation duration, previous surgery, comorbidities, surgeon expertise, and follow-up.
Results: Among the 1104 patients, 97.3% were male and 2.7% were female, with a mean age of 47.44±12.54 years. Hypertension was the most common comorbidity (10.1%). Recurrent Hernias were present in 9.4% of cases, while indirect hernias accounted for 49.3%. Around 2/3rd cases were performed by senior surgeons. Inguinoscrotal hernias were observed in 11.3% of the patients. Intraoperative complications occurred in 3.4% of cases. Postoperative seromas (5.9%) and chronic pain (4%) being the most frequent postoperative issues.
Conclusion: TAPP repair for inguinal hernias is an effective and feasible approach with satisfactory outcomes. It is also suitable for training junior surgeons with no significant predictors of postoperative complications.

Background: Ovarian cancer (OC) is the third most common cancer in women all over the world which is often characterized by vague symptoms leading to late-stage diagnosis.
Objectives: To investigate the relationship between the development of OC and certain sociodemographic characteristics as well as risky exposures and practices.
Materials and Methods: A case-control study was conducted in Mosul City, Northern Iraq. The study included 100 women with histopathological diagnosis of OC (cases) and 200 women free from any ovarian abnormality by ultrasound (control) were collected from the attendants to three different hospitals. Detailed lifestyle and sociodemographic characteristics were obtained from each participant.
Results: There was a progressive increase in the risk of OC with increasing age, being single or widowed, and having lower than university level education. Housewives had a significant two-time risk for OC, while lifestyle factors like the history of using herbal remedies show a significant four-time risk. Additionally, the consumption of tanker water consumption was significantly associated with OC occurrence (OR = 6.73, P-value = 0.003). Similarly, psychological trauma carries about seven times the risk which is highly significant. On the other hand, urban residence has a highly significant protective effect against OC.
Conclusions: This study highlights important concerns regarding potential carcinogenic factors for OC development like educational attainment, women's work, using herbal remedies, tanker water consumption, rural residence, and the presence of psychological trauma that call for implementing educational programs regarding those risk factors.

Background: Iraq was one of the first countries to establish kidney transplantation services in the Arab world, in 1973. This long history has affected people's attitudes towards organ donation; however, Iraqis, like all Middle Eastern people, are heavily influenced by religious, cultural, and tribal norms and traditions.
Objectives: To explore the current view of Iraqis towards organ donation, their possible explanation, and ways of raising people's awareness towards organ donation.
Materials and Methods: This cross-sectional study targeted adult Arabic-speaking Iraqis. Between December 2021 and June 2022, a self-administered questionnaire was distributed through the Facebook platform. The questionnaire comprised 10 specific questions covering important aspects of organ donation ethics and knowledge. The collected data were analysed using descriptive and inferential statistics.
Results: We collected a total of 2411 responses. Females predominated, making up around three-quarters (72.8%). The mean age was 25.6 years, and around half were university students (48.5%). The limited organ donation practice has been attributed to the lack of health awareness in the general population by 56.5% of the responders. Studied Iraqis hold adequate knowledge about organ donation in terms of time, age, donatable organs, and possible recipients. Only 24.4% of the responders reported some conflict between their religious beliefs and organ donation. Interestingly, sex and education level affected only answers related to the time of donation and the willingness to donate organs after death (P-values were 0.023 for the association between time of donation and education level and 0.001 for the other three associations).
Conclusion: This study would provide a deep understanding of the Iraqi attitude toward organ donation and help plan future regulations and practices of this vital aspect of health care.

Background: Cisplatin (Cis) is the primary chemotherapeutic agent for treating non-small cell lung cancer (NSCLC). β-sitosterol (Bs), a plant-derived polyphenol, inhibits tumor proliferation in several malignancies.
Objectives: To evaluate whether Bs in combination with Cis (BCcomb) enhance Cis' anticancer activity against NSCLC cells. Additionally, it investigated the possibility of lowering the Cis dosage when combined with Bs in the treatment of NSCLC.
Methods: The study, conducted in 2024, utilized the A549 cell line as an NSCLC model, with control and three treatment groups (Bs, Cis, and BCcomb). Cell viability was assessed via the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and trypan blue exclusion assays. Bs-Cis interaction was analyzed using a combination index, isobologram, and Bliss independence model. The dose reduction index was also used to predict a dose reduction for Bs and Cis in the combination. Expression of apoptotic-related genes (p53, BAX, BCL-2, MCL-1) and the activities of both caspase 3/7 and reactive oxygen species (ROS) were quantified.
Results: This study is the first to demonstrate that Bs, in combination with Cis, significantly synergizes to suppress NSCLC cells, enabling lower doses of Bs or Cis in the BCcomb without reducing efficacy. The combination of Bs with Cis markedly enhances their cytotoxic efficacy, as evidenced by the activation of apoptotic markers and elevated intracellular ROS generation, demonstrating the superiority of the BCcomb compared to Bs or Cis monotherapy.
Conclusion: This study provides evidence that BCcomb may hold promise as a prospective therapeutic strategy for clinically improving NSCLC treatment outcomes.

Background: Artificial intelligence (AI) is rapidly transforming dental practice and education worldwide. Despite growing international interest, there is limited research assessing the awareness and perceptions of AI among dental students in Tunisia.
Objectives: To evaluate the knowledge and perceptions of Tunisian dental students regarding AI and its applications in dentistry and to identify potential gaps that support future curriculum development.
Materials and Methods: A cross-sectional survey was conducted among 502 dental students at the Faculty of Dentistry in Tunisia. The questionnaire gathered sociodemographic data, assessed knowledge of AI principles and applications, and explored students’ perceptions of AI in clinical practice and its integration into dental education.
Results: Among the 502 participants, 49% reported having basic knowledge of artificial intelligence, and 48% were familiar with its applications in dentistry. The most frequently reported source of information was social media, cited by 76% of the respondents. While 53% believed AI would significantly advance dentistry, 44% disagreed with the idea that AI could replace dentists. AI was considered valuable for diagnosis (58% for dental caries), treatment planning (58%), implantology (54%), and forensic dentistry (44%). Nearly half of the students supported integrating AI into both undergraduate and postgraduate dental education.
Conclusion: This study highlights moderate knowledge and generally positive perceptions of AI among Tunisian dental students. Integrating AI-related content into dental curricula is essential to better prepare future practitioners for the evolving technological landscape. Further studies are recommended to explore the continued influence of this educational approach.

Background: Hyperprolactinemia is a common condition resulting from excessive prolactin secretion by pituitary lactotrophs. Both overt and subclinical hypothyroidism (ScH) contribute to its development.
Objectives: To assess the prevalence of hyperprolactinemia in patients with subclinical and overt hypothyroidism and explore its association with polycystic ovary syndrome (PCOS) and body mass index (BMI).
Materials and Methods: This retrospective cross-sectional study included 917 women who underwent thyroid function and serum prolactin testing at Faiha Specialized Diabetes, Endocrine, and Metabolism Center in Basra between 2017 and 2023. Patients were categorized into euthyroid, ScH, and overt hypothyroidism based on thyroid-stimulating hormone (TSH) and free tetra-iodothyronine (FT4) levels. Hyperprolactinemia was defined as serum prolactin ≥ 20 ng/mL.
Results: The prevalence of hyperprolactinemia was 24.2%, with higher rates in ScH (36.1%) and overt hypothyroidism (35.9%) compared to the euthyroid group (21.7%). The median TSH levels were significantly higher in overt hypothyroidism than in ScH and euthyroid groups, while FT4 levels were significantly lower in overt hypothyroidism. PCOS was observed in 15.4% of participants, with no significant association with thyroid dysfunction. However, PCOS patients had significantly higher prolactin levels than non-PCOS patients. A moderate positive correlation was observed between TSH and prolactin levels in overt hypothyroidism, while no significant correlation was found in ScH.
Conclusions: Prolactin levels were significantly elevated in subclinical and overt hypothyroidism, emphasizing the need for prolactin assessment in these patients. PCOS patients exhibited higher prolactin levels. Future community-based assessments can strengthen these findings.

Background: Comparative analysis of liver and kidney function in patients with beta-thalassemia major (BTM) and beta-thalassemia trait (BTT) is relatively underexplored in the existing literature.
Objectives: This study compares liver and kidney function in children with BTM, BTT, and healthy controls, and investigates the potential protective role of ferritin in reducing iron-related tissue damage in BTT patients.
Materials and methods: A case-control study was conducted on 93 male children (ages 2–12) from Ibn Al-Atheer and Ibn Sina Hospitals in Mosul, Iraq, divided into three groups: BTM (31), BTT (31), and healthy controls (31). Serum levels of liver and kidney biomarkers (ALT, AST, ALP, DBIL, TBIL, urea, creatinine, uric acid, and ferritin) were measured. Statistical analysis was performed using SPSS (version 26.0) with a significance level of P-value < 0.05.
Results: In the BTM group, levels of ALP, AST, urea, and uric acid were significantly higher compared to the control group, while no significant differences were observed between the BTT and control groups for these parameters. ALT, TBIL, DBIL, creatinine, and ferritin levels were elevated in both BTM and BTT groups relative to controls. Notably, all parameters except TBIL were significantly higher in the BTM group than in the BTT group. Additionally, a significant positive correlation was observed between ferritin and ALP in the BTM group, whereas a significant negative correlation was found between ferritin and creatinine in the BTT group.
Conclusion: BTM significantly impaired liver and kidney function, while BTT showed mild increases in ALT, TBIL, DBIL, creatinine, and ferritin. In BTM, ferritin correlated with ALP, indicating potential iron toxicity, whereas in BTT, the negative correlation with creatinine may suggest a protective mechanism. Further research is needed to clarify ferritin thresholds for toxicity versus protection.

Background: Drug therapy problems (DTPs) are related to many health outcomes, such as increased morbidity and mortality in geriatric diabetic patients with hypertension.
Objective: To determine DTPs and the relationship between DTPs, blood pressure, and HbA1c control in elderly type 2 diabetic patients with hypertension.
Material and methods: A cross-sectional study was carried out for two months at the Diabetes and Endocrine Center in Sulaimani City, Iraq. The participants were 96 elderly type 2 diabetes mellitus (T2DM) patients with hypertension who were taking at least one antidiabetic agent and at least one antihypertensive agent, and who were aged ≥ 65 years. Cipolle’s method was used to categorize DTPs.
Results: Overall, 356 DTPs were observed among patients. Commonly recorded DTPs were non-compliance (41.85%) and adverse drug reactions (18.82%). A highly significant association between the number of DTPs and uncontrolled HbA1c was observed (P-value = 0.0001). However, there was no statistically significant relation between the number of DTPs and uncontrolled blood pressure (P-value = 0.059).
Conclusion: The prevalence of DTPs was high among elderly patients with T2DM and hypertension, and these DTPs were associated with poor HbA1c control. It is recommended that comprehensive pharmaceutical care service be implemented for all elderly T2DM patients with hypertension.

Background: Regular transfusions in thalassemia major lead to iron buildup, especially in the liver, causing oxidative damage and fibrosis. While liver biopsy remains the gold standard, transient elastography offers a reliable, non-invasive alternative for assessing fibrosis.
Objectives: To measure the correlation between hepatic fibrosis assessed by transient elastography with ferritin level in transfusion dependent thalassemia patients.
Materials and Methods: A cross-sectional study that included 81 individuals with thalassemia major aged 12 years and older. Participants were collected from the thalassemia center in Najaf. The serum ferritin level, alanine transaminase (ALT) and aspartate transferase (AST) were analyzed from a blood sample obtained from the participants. A fibrosis score was measured in kilopascals (kPa) by transient elastography machine and categorized as (F0 to F1) which indicates absence or minimal hepatic fibrosis (2-7 kPa), (F2) score: Moderate hepatic fibrosis (8-9 kPa), (F3) Significant fibrosis (9-14 kPa); and (F4) score cirrhosis or severe hepatic fibrosis (14 kPa or higher).
Result: There were 81 participants, 41 men and 40 were women. The mean age of patients was 22 years. Our result showed about two-thirds of participants had mild fibrosis (F0-F2, 67.9%), while one-third had significant fibrosis (F3-F4, 32.1%). There was a significant correlation (P-value = 0.035) between serum ferritin and liver fibrosis measured by transient elastography. In addition, a statistically significant positive correlation between liver enzymes (ALT, AST) and hepatic fibrosis (P-value = 0.0001) was also confirmed.
Conclusion: This study demonstrated a significant linear relationship between serum ferritin levels and the degree of liver fibrosis, as assessed by transient elastography. Incorporating fibroscan, together with ferritin monitoring, may enhance early detection and management of liver complications in this high-risk population.