Al-Rafidain Journal of Medical Sciences

The human microbiome consists of trillions of microbes (microorganisms) residing in various locations in the body, but primarily in the gut. It plays a vital role in health maintenance and influences several diseases, including cancer. Emerging evidence suggests that microbial dysbiosis, characterized by an imbalance in microbial numbers and diversity, may contribute to cancer development through several mechanisms, including the release of genotoxins, altered metabolism, immune system modulation, and chronic inflammation. This narrative review compiles existing insights into the interactions between the microbiome and cancer, with a particular emphasis on microbial mechanisms during carcinogenesis and the contributions of the microbiome to the diagnosis and treatment of cancer. We examine the potential use of prebiotics, probiotics, fecal microbiota transplants, and microbial therapies that may influence cancer and its response to treatment. Gaining a deeper understanding of the intricate relationship between microbial communities and cancer could lead to groundbreaking methods for cancer prevention and therapy.

Background: The rising rate of cesarean deliveries has generated concern about whether all procedures are medically justified. Limited data exist on how well first-time mothers understand the indications for their cesarean section in Iraq. Objective: To assess maternal knowledge of the medical reasons for first cesarean delivery and its relationship with sociodemographic, obstetric, and neonatal characteristics. Methods: A cross-sectional study was conducted from October to December 2023 among 158 Iraqi women who underwent their first cesarean delivery. Data were collected using a structured, self-administered online questionnaire that assessed demographic, obstetric, and knowledge-related factors. Results: Less than half of the mothers (48.1%) demonstrated good knowledge of the reason for their cesarean section, whereas 23.4% showed poor awareness. Knowledge level was significantly associated with residency (p=0.024), history of vaginal birth (p=0.001), place of delivery (p=0.001), type of cesarean section (p=0.001), and hypertension during pregnancy (p=0.025). Mothers from rural areas, those delivering in public hospitals, and those undergoing emergency procedures had the highest proportions of poor knowledge. Poor awareness was also linked with adverse neonatal outcomes, including low birth weight (p=0.036), preterm birth (p=0.003), and neonatal distress (p=0.001). Conclusions: A considerable proportion of first-time Iraqi mothers lack adequate understanding of the medical indications for their cesarean delivery. Educational interventions and improved patient–provider communication, especially in rural areas and public hospitals, are essential to promote informed decision-making and better maternal–neonatal outcomes.

Background: Adjuvant hormonal therapy with tamoxifen reduces recurrence rate, morbidity, and mortality. Tamoxifen increases endometrial thickness, resulting in relevant gynecological complications. Several studies revealed the benefits of co-administering metformin with tamoxifen to avoid endometrial hyperplasia, but the available clinical data are still limited. Objective: To evaluate the effect of metformin on endometrial thickness in a sample of postmenopausal Iraqi ER+ breast cancer patients on adjuvant tamoxifen therapy. Methods: A total of 63 postmenopausal breast cancer patients on adjuvant Tamoxifen therapy were enrolled in a double-blinded randomized control trial (RCT). Patients were randomly allocated to two groups in a 1:1 ratio, with one group receiving Metformin along with tamoxifen and the other group receiving Placebo along with tamoxifen for a 12-month duration. Baseline endometrial thickness was obtained using ultrasound, and follow-up visits were scheduled in 3,6,9, and 12-month periods to evaluate the ultrasound changes in endometrial thickness as well as related adverse events. Results: Over 12 months, the placebo group exhibited a significant ET increase (6.32mm), while the metformin group showed minimal change (4.13mm) (p<0.001). ANOVA confirmed a significant time effect and time × group interaction (p<0.001). PMB occurred in 6.7% of the metformin group vs. 26.7% in the placebo group (p=0.038). Conclusions: Metformin significantly ameliorates tamoxifen-associated endometrial thickness and the incidence of postmenopausal bleeding in postmenopausal women with estrogen receptor-positive breast cancer.

Background: Endometrial receptivity is a crucial factor for embryo implantation, and its deficiency is a major contributor to infertility and failure of in vitro fertilization (IVF). Low-Intensity Pulsed Ultrasound (LIPUS) has emerged as a promising non-invasive treatment for improving endometrial receptivity, with interest due to its affordability and minimal side effects. Objective: To assess the efficacy of LIPUS in enhancing endometrial receptivity for embryo implantation in infertile women with thin endometria. Methods: The study included sixty infertile women undergoing IVF treatment. The participants were randomly assigned to receive either LIPUS or traditional estrogen therapy (4 mg/day orally) for 14 days. The study assessed changes in endometrial thickness, blood flow, implantation, and pregnancy rates following treatment as indicators of endometrial receptivity. Results: LIPUS treatment significantly improved endometrial thickness (6.1-9.5mm), compared to a lesser increase in the estrogen group (6.2- 8.6mm, p=0.02). Doppler ultrasound parameters, including peak systolic velocity (PSV) and end-diastolic velocity (EDV), also displayed significant improvements in the LIPUS group (PSV: 36.4 vs. 31.3cm/s, p=0.01; EDV: 13.5 vs. 11.5cm/s). Although implantation and pregnancy rates were higher in the LIPUS group (60% vs. 40% and 53.3% vs. 33.3%, respectively), the differences were statistically insignificant. Conclusions: LIPUS may provide a feasible non-invasive alternative approach to traditional estrogen therapy for enhancing endometrial receptivity in IVF patients, potentially improving implantation and pregnancy outcomes, although further studies with larger sample sizes are required.

Background: Healthcare service accreditation serves as a vital tool that helps hospitals achieve better quality standards and safety measures. The effects of accreditation on healthcare quality remain unclear, especially for developing countries such as Jordan. Objective: To investigate Jordanian nurses about the effects of accreditation on the quality of healthcare services and the impact on management systems, leadership practices, and patient satisfaction levels. Methods: A quantitative cross-sectional approach was adopted. A self-administered survey was distributed to 312 registered nurses working at four accredited private hospitals in Amman, Jordan. The survey included demographic data and the participants' perceptions of accreditation effects on the quality of healthcare services. Results: Customer satisfaction and strategic quality planning received the highest ratings, but human resources utilization obtained the lowest ratings. The participants evaluated accreditation benefits more than staff involvement (3.76 and 3.71, respectively), which showed that staff participation from staff members directly affects their understanding of accreditation benefits. Data analysis revealed that the Accreditation Staff Involvement (Beta=0.48, p=0.001) and the Benefits of Accreditation (Beta=0.392, p=0.001) significantly predicted the overall quality of health care. R² value of 0.65, indicating that 65% of the variance in nurses' perceptions of quality improvement activities is attributed to the accreditation process. Conclusions: The accreditation process depends on nursing staff who determine healthcare quality perceptions based on understanding their benefits. A combination of active staff involvement with proper accreditation education could lead to improving the quality of healthcare services and may establish enhanced environmental quality in hospitals..

Background: Liver transplantation has transformed medicine, especially for patients with advanced liver disease and hepatocellular carcinoma, improving their lifespan and quality of life. Objective: To assess the one-year survival rate post-liver transplantation and analyze the factors influencing survival. Methods: A retrospective study conducted at Baghdad Gastroenterology Hospital analyzed data from liver transplant referrals over the last 5 years, based on the Model for End-Stage Liver Disease score. 100 Patients were classified as children (≤18 years) and adults (≥19 years) and followed-up for one-year post-transplant. Mortality analysis considered various etiological, clinical, and sociodemographic factors. Results: In adults, males were predominant among both patients (66%) and donors (71.7%). The most frequent cause was cryptogenic cirrhosis (39.62%), then viral and autoimmune hepatitis (20.75 and 18.87%), respectively. Of the 53 adult patients, 5 died (9.43%), and 48 survived (90.57%). The age gap and BMI were significantly different. In pediatrics, biliary atresia was the most common cause (36.17%). Of the 47 pediatric patients, 16 died (34%) and 31 survived (66%). However, there were notable differences in the causes of liver cirrhosis between deceased and surviving patients. BMI and age gap between donors and recipients significantly affect survival in adults, while biliary atresia, Caroli disease, and hyperoxaluria have the highest one-year mortality in pediatric patients. Conclusions: Over 90% of adults and 66% of children survive a year after receiving a liver transplant; in adults, age and BMI differences have a major impact. In contrast, pediatric survival was affected by the etiology of cirrhosis.

Background: Ulcerative colitis is a persistent mucosal inflammation of the bowel that impacts a high portion of the population worldwide. Preclinical data highlighted the role of the renin-angiotensin system in mucosal inflammation, and its inhibition improves colitis inflammation in animal models. Azilsartan is a new angiotensin II receptor blocker that was reported to be associated with the inhibition of intracellular inflammation and oxidative stress. Objective: To investigate the potential anti-inflammatory effects of azilsartan on dextran sodium sulfate-induced ulcerative colitis in rats. Methods: Thirty-two healthy adult albino rats were divided into 4 groups, as follows: group I is the normal control group, group II is the dextran sodium sulfate group, group III was administered dextran sodium sulfate+prednisolone (10 mg/kg/day) orally, and group IV was administered dextran sodium sulfate+azilsartan (10 mg/kg/day) orally. The colitis induction was prompted in rats by administering 3% dextran sodium sulfate in drinking water for 7 days. Results: The administration of azilsartan decreased edema index, spleen index, macroscopic changes scores, and microscopic changes scores that were produced by dextran sodium sulfate. Additionally, azilsartan markedly reduced the pro-inflammatory cytokine expression, including tumor necrosis factor-α and interleukin-6 in colon tissue. Furthermore, azilsartan significantly attenuated oxidative stress in colonic tissue by decreasing upregulated myeloperoxidase enzyme activity and increasing downregulated catalase antioxidant activity. Conclusions: Azilsartan has anti-inflammatory and antioxidant effects on experimentally induced colitis. It may have a beneficial therapeutic role in the treatment of ulcerative colitis.

Background: Caring for individuals with schizophrenia presents major emotional and psychological challenges, particularly in low-resource settings like Indonesia. Family caregivers often face high levels of burden and stress due to the lack of professional support and cultural expectations. Objective: To examine whether psychological distress mediates the relationship between caregivers’ quality of life (QoL) and relapse prevention behaviors with caregiver burden in the context of schizophrenia care. Methods: A cross-sectional study was conducted among 104 primary family caregivers at Puskesmas Sempor 1, Central Java. Data were collected through structured face-to-face interviews using validated instruments: WHOQOL-BREF for QoL, a self-developed 10-item relapse prevention behavior scale, the Perceived Stress Scale, and the Zarit Burden Interview (ZBI). Data were analyzed using ANOVA, multiple linear regression, and Hayes’ PROCESS Macro Model 4 with 5,000 bootstrap samples to test for mediation. Results: Most participants were female (78.8%), aged 36–55 (57.7%) and lived with the patient (92.3%). Mean scores reflected moderate levels across QoL (M=2.59), relapse prevention behavior (M=2.34), psychological distress (M=1.88), and caregiver burden (M=2.06). ANOVA indicated significant differences in psychological distress by QoL and relapse prevention levels (p < 0.001). Regression indicated that higher QoL and relapse prevention predicted lower distress, with distress partially mediating their effects on caregiver burden. Conclusions: Psychological distress partially mediates the association between quality of life, relapse prevention, and caregiver burden.

Advanced glycation end-products (AGEs) are chemically complex and varied substances that are made inside or outside the body during different biological processes. Condensation between the carbonyl groups of reducing sugars and the free amine groups of proteins, lipids, or nucleic acids produces them non-enzymatically. The accumulation of AGEs in vivo triggers a number of signaling pathways by binding with receptors for AGEs (RAGE) that are intimately linked to the development of chronic metabolic disorders. Because of their capacity to stimulate oxidative stress, inflammation, and apoptosis, AGEs are thought to have pathogenic implications. AGEs play a role in the onset and progression of a number of aging-related pathological conditions, including cancer, diabetes, cardiovascular diseases, liver or neurodegenerative diseases, and intestinal diseases. AGEs have an impact on health and aging, particularly in hyperglycemic people. Lowering the risk of AGE-related issues and maintaining overall health can be achieved by monitoring AGE levels and adopting nutritional interventions. This review aims to show the role of AGE in the health and pathologies of various diseases.

Background: Endodontically treated (ET) premolars with a compromised tooth structure have been recorded to end with a high prevalence of catastrophic fracture. Objective: To compare the fracture resistance (FR) of ET premolars with MOD cavities restored with two fiber-reinforced composites as cores or post-cores. Methods: 60 premolars were divided into six groups (n=10): five experimental groups (A-E) and one control group with sound teeth (F). The experimental groups with MOD cavities were endodontically treated and restored differently. Group A was restored with a core of one bulk fill composite resin (OBF). Groups B and C were fixed with either a core of EverX flow short fiber-reinforced composite (SFRC), a layer of Ribbond polyethylene fiber, or OBF. In order to fill a 6 mm post space within the palatal roots, groups D and E first underwent direct layering with SFRC or Ribbond and OBF coverage. Samples were thermocycled and subjected to a fracture resistance test using an Instron machine at 0.5mm/min. Results: The highest FR value was recorded for the sound teeth (1789N), and the least was for group A (938N). All the experimental groups recorded significantly lower FR compared with sound teeth (p<0.05). A significantly higher FR was recorded for both groups D and E compared with group A (p<0.05). Conclusions: Both SFRC and Ribbond, when used directly as post-core for ET premolars, enhanced the fracture resistance compared with a core of OBF only.

Background: The role of community pharmacists goes beyond dispensing of medicines; it includes health promotion (HP) and prevention of chronic disease. Objectives: To evaluate the level of HP among community pharmacies in Baghdad and determine the associated factors and barriers to this practice. Methods: The current investigation was a cross-sectional study conducted among community pharmacists in Baghdad, Iraq. An online questionnaire was used to collect data, and participants were recruited using convenience sampling. An HP score was calculated to quantify this practice. To analyze differences in HP practice between demographic groups, descriptive statistics and independent t-tests were used. Barriers were examined using exploratory factor analysis. Results: Data were collected from 670 pharmacists who completed questionnaires. The mean HP practice score was 4.1+1.16, which indicates moderate engagement in HP. Significant differences in HP scores were observed by pharmacy location and employment type, but not by gender. Most pharmacists reported providing HP activities daily (79.4%), the most common being adherence counselling (95.8%) and verbal education on the use of medicines (67.8%). There were three crucial categories of barriers to engagement in HP related to “the patient,” "organizational," and “lack of training.” Conclusions: Community pharmacists in Baghdad showed moderate engagement in HP activities, with greater involvement in medication counselling and less in other preventive services. Effective organizational policies, training, and the addition of systematic HP policies are necessary to improve public health practice by pharmacists in Iraq.

Background: Epistaxis is one of the most common emergencies detected in the otorhinolaryngology unit. Although it's mostly benign, sometimes it can lead to life-threatening conditions; however, there was no specific local cauterization available for the controlling of little-area anterior epistaxis in children. Objective: To evaluate the outcome of diode laser versus trichloroacetic acid in local cauterization of anterior epistaxis in children. Methods: A prospective randomized comparative study, conducted on 60 children with anterior epistaxis, where the bleeding point was identified in a little area of the nasal septum at the otorhinolaryngology unit, was divided into 2 groups: Group “A” included 30 children treated by diode laser, and group “B” included 30 children treated by trichloroacetic acid (TAC) in a 1-year study duration. Results: The mean age was 10.5±2.2 years in group A and 10.1±2.5 years in group B, with bleeding according to age groups (p>0.05), most of the children were 10 years old, being 26.66% in group A and 23.33% in group B. Males were 68.33%, and females were 31.67%. The efficacy of local cauterization (yes/no) was significant for males and females (p<0.05). The recurrence rate of epistaxis after 3 months of follow-up in group A was 16.7%, and in group B, 66.7% (p=0.0001). Conclusions: Diode laser local cauterization had significantly better results in the management of pediatric anterior epistaxis regarding bleeding site in comparison with that of trichloroacetic acid.

Background: Non-syndromic tooth agenesis and tooth transposition are uncommon anomalies that may arise from similar developmental irregularities during early odontogenesis. The understanding of their occurrence (individually and together) can support diagnosis and strategic clinical management, enhance diagnostic accuracy, and inform treatment planning. Objectives: To assess the prevalence and spatial patterning of permanent tooth agenesis (omitting third molars) among orthodontic patients in Fallujah, Iraq; evaluate variation by sex, arch, and laterality; and document cases in which agenesis occurrence coincides with tooth transposition. Methods: We performed a retrospective, clinic-based cross-sectional study of 1,240 consecutive patients aged 12–43 years who presented for orthodontic assessment or treatment at a private clinic in Fallujah between 2017 and 2024. Records and panoramic radiographs were assessed using consistent operational criteria. Descriptive statistics with 95% confidence intervals were computed; between-group comparisons involved chi-square tests, and an odds ratio was estimated to quantify the sex effect. Results: Tooth agenesis affected 10.48% of patients (95% CI 8.9–12.3); the prevalence was greater in females (11.98%) than in males (6.99%, p<0.05). Missing teeth clustered mainly in maxillary lateral incisors (36.0%) and mandibular second premolars (31.2%), with bilateral agenesis more common than unilateral. Three female patients had agenesis with maxillary canine–first premolar transposition (two bilateral, one unilateral), suggesting a developmental association. Conclusions: Hypodontia was relatively frequent with clear sex (and site)-specific patterns; its co-occurrence with transposition calls for early tailored multidisciplinary care and population-representative studies using CBCT and genetic/family history assessment..

Background: The Golden Billion theory posits global inequality where a small elite benefits at the world's expense, often linked to resources and geopolitical power dynamics. Objective: To explore beliefs about the Golden Billion theory and associated psychological stress, focusing on impacts on vaccine refusal and belief in man-made pandemics of COVID-19. Methods: This cross-sectional study in Jordan and Iraq explored beliefs about this theory and associated psychological stress. A convenience sample of 1113 participants was recruited via social media platforms (Facebook, WhatsApp, and X) between 14 June 2024 and 13 October 2024. Results: Sex, knowledge about the "Golden Billion theory," and vaccine-related conspiracy beliefs were significantly associated with anxiety levels (p<0.001). Higher education (OR=5.83, p=0.001), having heard about the “Golden Billion theory” (OR=3.43, p=0.001), believing COVID-19 was man-made (OR=2.38, p=0.001), and believing vaccines reduce world population (OR=3.83, p=0.001) were all linked to higher anxiety. Conclusions: The perception of intentional population control through pandemics and wars is strongly correlated with higher levels of anxiety, with significant associations identified between gender, knowledge of the “Golden Billion theory," and beliefs regarding vaccines.

Background: Melasma is a common pigmentary disorder predominantly affecting women. Thyroid hormones influence skin homeostasis and melanocyte activity, suggesting a possible link with melasma. Objective: To investigate the relationship between thyroid hormone levels and melasma in women. Methods: A case-control study was conducted with 100 women aged 18–45 years, including 50 patients with melasma and 50 healthy controls. Free triiodothyronine (T3), free thyroxine (T4), and thyroid-stimulating hormone (TSH) levels in the blood were evaluated in both the clinic and the lab. Results: Women with melasma were significantly older than controls (p=0.001). Compared to controls, melasma patients had lower median free T3 [3.0 (2.6–3.6) vs. 3.3 (3.2–3.5); p=0.02] and free T4 [1.3 (1.1–1.5) vs. 1.4 (1.3–1.4); p=0.001] and higher TSH levels [3.7 (2.8–4.2) vs. 2.2 (1.9–2.5); p=0.001]. These differences remained significant after adjusting for age. Overt thyroid dysfunction was uncommon and not significantly different between groups (p=0.35). Conclusions: Subclinical alterations in thyroid hormones may be associated with melasma in women, independent of age, although causation cannot be established.

Background: Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness, and early screening of at-risk infants is essential for reducing severity. PHC physicians’ knowledge of ROP risk factors and screening guidelines, attitudes toward the importance of early detection, and clinical practices related to referral and parental counseling are important for effective prevention. Objectives: To assess the knowledge, attitude, and practice (KAP) regarding ROP among physicians working in PHC centers in Baghdad, and to examine the influence of selected demographic factors on KAP. Methods: A cross-sectional study was conducted among PHC physicians in Al-Karkh and Al-Rusafa sectors in Baghdad from January to December 2025. A multistage sampling method was applied to select sectors and centers; all eligible physicians in selected centers were invited to participate. Data were collected using a self-administered questionnaire covering demographics and KAP domains. Pearson’s chi-square or Fischer exact tests were used to assess associations between demographic variables and KAP levels. Results: 286 physicians participated. Knowledge levels were predominantly fair (43.0%), while only 21.0% demonstrated good knowledge. Attitudes were mainly neutral (72.4%), with only 3.8% showing positive attitudes. Regarding practice, 77.6% demonstrated it was fair and 14.3% good. Academic level and medical specialty were significantly associated with knowledge, while age and specialty were associated with attitudes. Age and participation in educational activities were significantly associated with practice levels. Conclusions: Most physicians exhibited inadequate knowledge and predominantly neutral attitudes toward ROP, and practice levels were generally fair.

Seminoma is a prominent subtype of testicular cancer, which is the most prevalent solid tumor in young adult males, for the best patient’s outcome, where early diagnosis and management are crucial. Here we describe a male patient, age 22, who had an RT-sided gradual onset painless scrotal swelling for the last six months. On examination, a hard, well-defined intra-testicular mass was felt, which proved to be highly vascular on imaging. Alpha-fetoprotein and β-HCG were within normal range. The provisional diagnosis of seminoma was made, which was confirmed by a histopathological exam, where radical inguinal orchiectomy was performed. The current case emphasizes that although its malignant seminoma produces minimal symptoms, the tumor markers are within normal limits, which adds to the diagnostic challenges. It is important to keep in mind that prompt imaging and surgical management are necessary to achieve better patient outcomes, regardless of normal lab tests. A normal lab test does not exclude malignancy, and the malignant potential has to be kept in mind at the young age group.

Background: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality worldwide. Gemcitabine is an established effective agent in the treatment of NSCLC. However, resistance and dose-dependent toxicity limit the clinical efficacy of gemcitabine. Resveratrol, a polyphenolic compound, has been proposed as a chemosensitizing agent capable of modulating multiple survival pathways. Objective: To assess whether resveratrol enhances the anticancer activity of gemcitabine in A549 NSCLC cells. Methods: The viability of A549 cells was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method. The synergistic interaction was analyzed using a constant molar ratio of 1:75 (gemcitabine: resveratrol). The combination index (CI) and dose reduction index (DRI) values were calculated across multiple effect levels. To see how the combination changed the ability of cells to divide and migrate, we used the clonogenic and wound-healing assays, respectively. Results: The data showed that combining gemcitabine and resveratrol increased cytotoxicity compared to using either drug alone. This was shown by CI values that were consistently below 1.0 for all effect levels that were tested. The DRI values for both drugs were greater than 1.0 at all the effect levels, suggesting dose-sparing potential. In addition, the combination significantly decreased the colony formation and cell migration compared with individual drug treatments. Conclusion: Resveratrol potentiated the anticancer effects of gemcitabine in A549 cells via synergistic cytotoxicity and enhanced suppression of the clonogenic survival and migratory potential.

Background: The exploration of the epithelial targets of periodontal pathogens is crucial for our understanding of the underlying mechanisms of the host immune response and periodontal disease pathogenesis. Objective: To comprehensively review the current knowledge and key findings from relevant studies that contribute to this understanding. Source: PubMed database of the US National Library of Medicine. Study selection: Original articles (in vitro studies) published in the English language only and available as free text were included. Conclusions: Periodontal pathogen virulence factors are capable of directly targeting keratinocyte adhesion proteins, leading to the deterioration of epithelial barrier integrity, resulting in disease progression.

Background: Psychological well-being is crucial for breast cancer survivors facing chronic illness and psychosocial challenges, yet psychological well-being remains inconsistently defined in the literature. Objective: To clarify the definitions, attributes, antecedents, consequences, and empirical indicators of psychological well-being using the Walker-Avant concept analysis. Methods: A systematic literature review was conducted using PubMed, ScienceDirect, Google Scholar, and ProQuest. Empirical and theoretical full-text studies addressing psychological well-being were selected following PRISMA guidelines. Seven articles were analyzed using the eight steps of the Walker-Avant method. Results: Key frameworks from Ryff, Ryan and Deci, WHO, Diener et al., Keyes, Zhou et al., and Grassi et al. indicate that psychological well-being is a motivational process characterized by self-acceptance, emotional regulation, adaptive coping, positive social relationships, meaning in life, autonomy, and adaptive capacity. Antecedents include illness perception, early distress, social support, and self-efficacy, while consequences involve positive adaptation, improved quality of life, and emotional stability. Conclusions: Psychological well-being is a multidimensional, dynamic construct essential to the adaptation of breast cancer survivors aged 10–25 years and provides a theoretical basis for developing evidence-based nursing interventions to improve mental health and quality of life..

Background: Severe sepsis and tuberculosis are major causes of mortality due to infection all over the world. The impact of microRNAs (miRNAs) in activating the immune process during bacterial infections is essential and associated with managing gene expression of inflammatory markers. Objective: To find the available evidence regarding the diagnostic potential and mechanistic utility of total circulating miRNAs and EV-derived miRNAs in human bacterial infections, that is, sepsis and TB. Methods: This study is based on a PRISMA-DTA literature review. In this study, a comprehensive search was conducted on different databases such as PubMed, Embase, Web of Science, and Scopus between 1 January 2013 and 15 February 2025 for papers related to this topic. The risk of bias was assessed by the QUADAS-2 tool. Results: We evaluated 46 records on sepsis, tuberculosis, severe pneumonia, and bacterial meningitis out of 1,319 records. Most of the studies, about 74%, were case-control using 65% serum, 38% plasma, and 82% qRT-PCR. Sepsis circulating microRNAs showed moderate-to-high diagnostic accuracy where miR-155-5p AUC=0.81, miR-223 AUC=0.79, and multi-miRNA panels up to AUC=0.90; severe pneumonia showed miR-155 AUC=0.79, miR-34a AUC=0.81, and miR-150 AUC=0.83; tuberculosis showed miR-29a AUC=0.81 and panels including miR-144 and miR-197 AUC=0.87; and bacterial meningitis showed CSF miR-181a AUC=0.82, plasma miR-223 AUC=0.79, and CSF miR-125b AUC=0.84. Conclusions: MicroRNAs in the circulation have demonstrated moderate-to-high forms of diagnostic accuracy among various bacteria and their infections, such as sepsis, tuberculosis, severe pneumonia, and bacterial meningitis.

Background: Prescribing errors are common worldwide. They are exposing critically ill patients to increased morbidity and mortality and overwhelming healthcare systems. Limited data exist on the prevalence of prescribing errors for critically ill patients in Iraq. Objectives: To assess the prevalence and types of prescribing errors in the Cardiac and Intensive Care Units in Iraq. Methods: A retrospective study was conducted at a teaching hospital in Al-Muthanna, Iraq. Charts of patients admitted to the Cardiac and Intensive Care Units for at least one day between January and June 2024 were included, excluding those without a diagnosis. To detect prescribing errors, the latest American guidelines, the British National Formulary, and Medscape were used. Results: Out of 239 charts included, 107 showed prescribing errors. Patients were prescribed 7.66±2.32 medications. Meanwhile, 2.29±1.17 of them contain an error. Omission of indicated medications (81.3%) and dosing errors (43%) were detected due to non-adherence to treatment guidelines. Lack of monitoring for prescribed medications (59.8%) and prescribing drug-drug interactions (31.8%) were also common. The number of diseases and renal impairments were positively correlated with frequency of errors. Patient age, medical history, renal function, number of medications, and errors didn't significantly impact patients' mortality. Conclusions: Prescribing errors are prevalent in the cardiac ICU, mainly due to poor adherence to treatment guidelines. Despite the presence of errors, no significant relationship was reported between prescribing errors and patients' mortality.

Objective: This research was intended to elucidate the nephroprotective and hepatoprotective effects of semaglutide against doxorubicin-induced toxicity. Methods: Thirty-five female rats were allocated and classified into 5 groups: Negative control: distilled water for the period of seven days. The next group of rats, known as the positive control, was treated with only distilled water in addition to only one dose of doxorubicin (12 mg/kg) on the 7th day. Low dose of semaglutide (SL), moderate dose of semaglutide (SM), and high dose of semaglutide (SH). All semaglutide groups received treatment for the duration of 7 days and a single dose of doxorubicin on the 7th day. On the 8th day, all the animals underwent euthanization, and samples of blood were collected for the purpose of measuring (Liver enzymes, ADH, urea, creatinine, hs-CRP, TNF-α, IL-10, and CBC. Liver and kidney tissues were submitted for histopathological analysis. Results: Semaglutide groups significantly reduced serum creatinine and blood urea, with a maximum reduction observed in the SH group. The SH group significantly attenuated hs-CRP and TNF-α. All doses of semaglutide significantly elevated the level of IL-10 and ameliorated the granulocyte-to-lymphocyte and platelet-to-lymphocyte ratios compared to the positive control. The microscopical analysis by a histopathologic expert supports the biochemical results as well. Conclusions: Semaglutide possesses hepatic and renoprotective effects via attenuating the biomarkers of liver and kidney damage along with anti-inflammatory activity, with the maximum effects offered by the highest dose of semaglutide.

Background: The Apgar score assessed at five minutes serves as a vital measure of a neonate's capacity to survive and thrive. Objective: To assess the relationship between mode of delivery at term and neonatal APGAR score at 5 minutes and neonatal outcomes. Methods: This study was a descriptive cross-sectional study conducted in the labor ward of the department of Obstetrics and Gynecology in Azadi Teaching Hospital, Kirkuk City, Iraq, from 1st of October 2022 to 1st of October 2023. The study sample included 150 pregnant women at term with labor. The mode of delivery was decided by the obstetrician in the labor ward. The APGAR score at 5 minutes and other neonatal outcomes were assessed by the pediatrician in the labor room and followed up for one week after delivery. Results: The mode of delivery was distributed as follows: spontaneous vaginal delivery (26.7%), instrumental vaginal delivery (20.6%), elective cesarean section (26%), and emergency cesarean section (26.7%). The mean APGAR score at 5 minutes for neonates was 7; 12% of them had an intermediate APGAR score, and 17.3% of them had a low APGAR score. The mean APGAR score at 5 minutes was significantly lower in neonates delivered by instrumental vaginal delivery (p<0.001). Conclusions: The mode of delivery, particularly instrumental vaginal delivery, affects the low APGAR score at 5 minutes of neonates.

Background: Psychological well-being is crucial for breast cancer survivors, yet psychological well-being remains inconsistently conceptualized in literature and is often treated as a static psychological outcome rather than a dynamic process. Objective: This study aimed to clarify the concept of psychological well-being among breast cancer survivors by identifying its defining attributes, antecedents, consequences, and empirical referents using the Walker and Avant concept analysis framework. Methods: A systematic review of PubMed, ScienceDirect, Google Scholar, and ProQuest was conducted following PRISMA guidelines, and seven articles were analyzed using the Walker and Avant concept analysis method. Results: Psychological well-being intention is conceptualized as a multidimensional, motivational, and adaptive process rather than a passive psychological state. Key attributes include self-acceptance, emotional regulation, adaptive coping, social connectedness, meaning in life, autonomy, and adaptive capacity; antecedents involve illness-related stressors and personal resources, while consequences include positive psychological adaptation, improved quality of life, emotional stability, and treatment engagement. Conclusions: Psychological well-being intention represents an intentional and goal-directed process that underpins survivors’ capacity to adapt to breast cancer as a chronic condition. This clarification offers a theoretical basis for evidence-based interventions to support long-term psychological adaptation in breast cancer survivors.

Background: Acute musculotendinous injuries represent a substantial clinical and economic burden in professional football, leading to significant time loss and performance impairment. Objective: To comprehensively evaluate the anatomical distribution and grading of acute musculotendinous injuries among professional Iraqi League players using ultrasound and to analyze associations between injury patterns, playing positions, and sonographic findings. Methods: A cross-sectional study was conducted at the Private Radiology Clinic in Baghdad between January 2022 and January 2025. It initially included 92 professional male football players who complained of acute onset of muscle pain during an official match or training session and sustained acute musculotendinous injuries and underwent ultrasound examination within 72 hours of injury. Results: The most common site of injury is the hamstring muscle (47.8%); Grade 2 injuries were the most prevalent. There was a perfect agreement between the two radiologists, and this agreement was statistically significant (kappa=0.846, p=0.001). Older players, the striker position, and injuries during matches rather than during training emerged as key factors increasing the possibility of more severe injuries. The highest prevalence of hamstring muscle injuries was seen significantly among strikers and winger players (66.7%, p=0.001), while all goalkeepers suffered from adductor muscle injuries (100%). Conclusions: The study validates musculoskeletal ultrasonography as a rapid, cost-effective, and reliable technique for diagnosing and categorizing muscle injuries in a competitive sports environment. It further backs the use of pitch-side ultrasound to quickly and accurately detect injuries, which can help with important decisions about returning to play.

Background: Magnetic resonance imaging (MRI) is the primary noninvasive technique in the diagnosis of anterior cruciate ligament (ACL) injuries, and its performance is well described under ideal circumstances; however, the diagnostic accuracy in routine clinical practice is inadequately described. Objective: To determine the diagnostic accuracy of routine radiological MRI reports in the diagnosis of complete ACL tears when arthroscopy is used as the reference standard. Methods: This was a retrospective study, which involved 100 consecutive patients (28.8±7.8 years, and all males) who underwent knee arthroscopy with an intraoperative finding showing complete ACL tears. Preoperative MRI reports obtained from on-duty radiologists were reviewed and classified as complete, partial tear, or normal ACL. We calculated sensitivity for diagnosing complete tears in the ACL, and an exploratory analysis was done to examine the relationship between the MRI-arthroscopy interval and the accuracy of the diagnosis. Results: Routine MRI interpretation correctly detected complete ACL rupture in 61 cases with a sensitivity of 61.0% (95% CI: 51.2–70.0). It is significant to note that 32% of complete tears were underestimated as partial injuries, and 7% were misinterpreted as normal. The MRI-arthroscopy interval significantly influenced diagnostic outcomes (p=0.038); however, subgroup analyses were underpowered and remain hypothesis-generating. Conclusions: In routine clinical use, MRI interpretation achieved a suboptimal sensitivity (61%) in identifying arthroscopically proved complete ACL tears, and a significant proportion of cases were underestimated. To improve diagnostic accuracy, it is necessary to combine clinical examinations with imaging and employ radiologist-focused quality improvement programs.

Background: Fistula-in-ano is an abnormal connection between the anal canal and the skin of the perineum, affecting 1.7-2.3/10,000 persons/year. Appropriate evaluations and imaging are necessary to decrease recurrence rate. Objective: Determining accuracy of endocavitary and transperineal ultrasound relative to magnetic resonance imaging in evaluation of perianal fistulas. Methods: A cross-sectional study was conducted on 40 patients with perianal fistula. Endocavitary, transperineal ultrasound and magnetic resonance imaging (MRI) were done for all patients. Many variables were recorded, including location, number of tracts, their relation to the anal sphincters (course), internal opening, external openings, length of tract, distances from the anal verge, and any associated abscess or side branching. Results: Of the 40 patients studied, both modalities showed compatibility between US and MRI for location of fistula, nearly perfect for opening to skin and opening to anal mucosa, and substantial for course of fistula, association collection, and side branching. For fistula length, the analysis revealed a statistically significant mean bias of 4.575 (p<0.001), indicating that MRI measurement is higher than US. For distance from anal verge bias, it is 2.575 (p<0.001), with the MRI measurement being higher than the US. Conclusions: Ultrasonography is a reliable, cost-effective alternative to MRI for assessing fistula in ano. Although MRI may still be preferred for more complex cases, ultrasound demonstrated high agreement in evaluating location, opening positions, course of fistula, and associated anatomical features.

Background: Cortisol and serotonin are known to be biomarkers for psychiatric disorders. Their effects on epilepsy patients' mental health need further study. Objective: To assess the relationship between cortisol and serotonin levels in patients with focal and generalized epilepsy who also experience major depressive disorder (MDD), intermittent explosive disorder (IED), and mild depression. Methods: This exploratory cross-sectional pilot study was conducted at IMS and Sum Hospital in Bhubaneswar. A total of 78 epileptic patients were evaluated; 26 had MDD, 26 had IED, and 26 experienced mild depression. Each group had 13 focal and 13 generalized epilepsy patients. Blood samples were collected at 8 A.M. after 48 hours of an epileptic attack. The Cobas e 601 system from Roche Diagnostics Corporation measured cortisol, while the BA E-8900 from Imussmol SAS, Pessac, France, measured serotonin. Results: After investigation, focal epilepsy patients with MDD, IED, & mild depression experienced significant fluctuations in cortisol and serotonin, while generalized patients with these conditions showed significant cortisol variations but not in serotonin levels. Generalized patients with MDD showed higher cortisol levels than focal patients, while IED patients displayed the opposite trend. Furthermore, serotonin levels were lower in focal patients with MDD and IED than in generalized epilepsy, but the differences were not statistically significant. Conclusions: Cortisol and serotonin levels were substantially related to psychiatric disorders in both types of epilepsy patients.

Background: Psoriasis is to be treated not only as a skin problem but as a chronic disease, which is a consequence of the immune system and determined by genetic, environmental, and lifestyle factors. Objective: To determine the dysregulation of a particular microRNA, miR-146a, in blood among Iraqi patients who have psoriasis. Methods: The researchers recruited 80 Iraqi participants, divided into 60 patients with psoriasis (20 severe, 20 moderate, and 20 mild). To compare them, the researchers also took 20 healthy volunteers as a control of the same age and gender. We obtained serum and RNA and subsequently measured miR-146a levels in both participants using the stem-loop RT-qPCR, which is a very sensitive technique in the detection of small RNAs. Results: Our discovery was very dramatic; miR-146a was a lot more abundant in patients with psoriasis than in healthy individuals (p<0.001). What is more revealing is that the growth was not accidental and went shoulder to shoulder with the severity of the illness. The mean expression increased somewhat (distinctly in mild, moderate, and severe disease) to 3.0, 4.8, and 7.3, respectively. Conclusions: Serum miR-146a was overexpressed in Iraqi patients with psoriasis and positively correlated with the disease severity. miR-146a may serve as a potential biomarker reflecting inflammatory burden and clinical severity in psoriasis.

Background: Nasal trauma is a well-recognized iatrogenic complication in neonates with respiratory distress using nasal continuous positive airway pressure (NCPAP). The severity of nasal injury ranges from mild erythema to necrosis. Objective: to determine the frequency of nasal trauma and risk factors associated with the severity progression secondary to NCPAP. Methods: A prospective observational study was conducted in Mosul City. Newborns who received NCPAP were included to assess nasal trauma and its severity. Univariate and multivariate logistic regression were used to identify factors associated with the nasal trauma. The Mann-Whitney U test was used to compare continuous variables and nasal trauma stages, and the effect sizes were reported. Results: The incidence of nasal trauma was 46.2%. In univariate analysis, factors associated with increased odds of trauma were lower gestational age (OR=3.367; p<0.001), lower birth weight (OR=2.923; p<0.001), and NICU stay ≥7 days (OR=2.507; p=0.049), while the duration of NCPAP was not statistically significant (OR=1.341; p=0.515). However, in the multivariate analysis, none of the factors emerged as an independent predictor. NICU stay ≥7 days in the Mann-Whitney U test was the only significant predictor of severity progression (p=0.034), with a medium to large effect size. Conclusions: Nasal trauma is a common and significant complication of NCPAP in neonates. Severity is usually mild, but moderate and severe cases do occur. Lower gestational age, lower birth weight, and longer NCPAP duration are risk factors for nasal injury, but prolonged NICU stay appeared to be a strong predictor for nasal trauma progression.