Al-Iraqia Medical College Journal

Uropathogenic Escherichia coli (E. coli) produces cytotoxic necrotizing factor 1 (CNF-1). This factor influences epithelial cells and is a key virulence factor of uropathogenic E. coli, playing an essential role in bladder and prostate cancers.

Molecular identification of the cnf1 gene in uropathogenic E. coli isolated from patients with bladder and prostate cancer was performed using polymerase chain reaction (PCR). This cross-sectional study included 150 urine samples obtained from patients with prostate and bladder cancer attending various hospitals in Baghdad, Iraq, from November 2024 to February 2025. All urine samples were analyzed both microscopically and macroscopically, cultured on blood agar and MacConkey agar, subjected to biochemical testing, and validated using the VITEK-2 system. Antibiotic susceptibility testing and molecular identification of isolated E. coli were performed by PCR targeting the cnf1 gene.

Of 150 urine samples, only 59.3% showed growth, with several bacterial species identified. Just 16% of samples were identified as E. coli and were obtained from prostate and bladder cancers. PCR analysis revealed that only 8 isolates contained the cnf1 gene. The antibiotic susceptibility test demonstrated varying levels of sensitivity and resistance. All 8 isolates containing the cnf1 gene showed elevated resistance to cefclidine (100%). The remaining 16 isolates lacking the cnf1 gene exhibited greater resistance to loracarbef (100%).

The research found that the cnf1 gene is genotoxic and can influence cellular differentiation, apoptosis, and proliferation. These findings underscore the importance of the cnf1 gene in urological infections and highlight the need for further studies on its association with antimicrobial resistance.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system with immune-mediated demyelination.

Proinflammatory cytokines, including IL-6 and TNF-α, play a crucial role in neuroinflammation, and immunoglobulin dysfunction (IgA and IgG) reflects humoral immune reactivity. In Iraqi patients, the relationship between these markers remains poorly recognized.

The study aims to assess serum levels of IL-6, TNF-α, IgA, and IgG in Iraqi patients with MS and to examine their interrelationships.

Sixty patients with clinically diagnosed MS and 60 age- and sex-matched healthy controls, aged 18–60 years, were included in the case-control study. Serum IL-6 and TNF-α levels were measured by enzyme-linked immunosorbent assay (ELISA), and IgA and IgG levels were measured by nephelometry. Statistical analyses were performed using t-tests and Pearson\\\\'s correlation; p < 0.05 was considered statistically significant.

The serum levels of IL-6 and TNF-α were significantly higher in patients with MS (15.87 ± 4.62 pg/mL; 24.65 ± 6.73 pg/mL) than in controls (7.94 ± 2.18 pg/mL; 12.18 ± 3.54 pg/mL, respectively; p<0.001). Levels of IgG (14.52 ± 2.96 g/L) and IgA (3.01 ± 0.78 g/L) were also significantly elevated in patients compared with controls (11.84 ± 2.41 g/L and 2.35 ± 0.65 g/L, p < 0.01). Significant positive correlations were found between IL-6 and IgG (r = 0.418, p < 0.001) and between TNF-α and IgA (r = 0.496, p < 0.001).

A strong association exists between cytokines and immunoglobulins, and concurrent elevations of IL-6, TNF-α, IgA, and IgG are observed in Iraqi MS patients. The strong correlation between TNF-α and IgA may reflect distinct genetic or environmental factors, underscoring the need for region-specific biomarker research and tailored monitoring plans.

Embryo evaluation and selection are the most important determinants of outcomes in assisted reproductive technology. The objective of this review is to provide a comprehensive overview of recent technologies for embryo assessment and selection.

In assisted reproductive treatment, including their scientific background, clinical evidence, strengths, and weaknesses. A detailed narrative review was conducted using the PubMed, Scopus, and Web of Science databases. Articles reporting conventional morphology, time-lapse imaging, and/or morphokinetic analysis, pre-implantation genetic testing, or non-invasive embryo assessment techniques, including those based on artificial intelligence pathways, were included if they were peer-reviewed studies. Clinical outcomes focused on implantation, clinical pregnancy, live birth, and miscarriage rates. Conventional morphology remains an essential part of daily practice; however, its ability to predict chromosomal competence and live birth is limited. Time-lapse imaging improves monitoring and standardization of development, yet it remains unclear whether it routinely improves live birth rates. The clinical applications of pre-implantation genetic testing for monogenic disorders and structural rearrangements are well defined. However, its use for aneuploidy is more patient-specific and has been controversial. Non-invasive molecular techniques and artificial intelligence-based embryo selection systems show promising predictive capacity, but they are not yet prospectively and multicenter validated for universal clinical use.

Therefore, combining traditional assessment with genotype tests and AI applications, applied selectively based on solid clinical evidence, established outcome reporting, and ethical oversight, is the most balanced approach to enhancing reproductive performance in assisted reproductive treatment.

Breast cancer is the most prevalent malignancy among women and one of the leading causes of cancer-related deaths globally. Many individuals are still diagnosed at advanced stages, and its incidence continues to rise due to lifestyle, hormonal, and hereditary factors.

The disease is biologically diverse, with molecular subtypes (luminal, HER2-positive, triple-negative) that influence prognosis and therapy. Despite progress in screening and targeted treatments, recurrence and therapy resistance remain major challenges, highlighting the need for new prognostic markers and improved therapeutic strategies.

The study aims to evaluate immunological markers to assess the prognostic value of Forkhead Box P3 (FOXP3). Positive Tregs and their correlation with Heat Shock Protein 90 (HSP-90) in breast cancer. This case-control study, conducted over three months (November 2024 to February 2025), included 140 females from the Baghdad Medical City (Oncology Educational Hospital) who underwent a three-milliliter blood aspiration. Participants were divided into two groups; one group consisted of 70 patients with breast cancer, while the other group consisted of 70 apparently healthy people (control group). ELISA measured serum levels of FOXP3 and HSP-90. Participants provided demographic information, including age, sex, family history, and medical history. The study samples ranged in age from 19 to 85 years, with a mean age of 49.86 ± 12.71 years. The majority of the sample (46.4%) was in the 46-60 age range. Women with breast cancer had significantly higher mean values of HSP-90 than the control group (P<0.001). In contrast, women with breast cancer had significantly higher mean levels of the immune protein Forkhead Box P3 (FOXP3) than the control group (P<0.001).

Immunological markers can be used for the analytical evaluation of FOXP3 and HSP-90 in breast cancer patients and are proposed as indicators for early diagnosis.

Certain trace elements, such as iron, zinc, magnesium, and copper, have been extensively studied for their impact on thyroid health. Imbalances or shortages of these elements can interfere with thyroid function and lead to thyroid-related issues.

This study aimed to evaluate imbalances in zinc, copper, iron, and magnesium and to assess relationships among trace elements, myeloperoxidase (MPO), and C-reactive protein (CRP) to understand their potential roles in patients with papillary thyroid cancer (PTC).

Thirty-four patients diagnosed with papillary thyroid cancer and thirty-one healthy individuals were enrolled in this study. Myeloperoxidase levels were determined using an ELISA kit, and CRP was measured using a Cobas c 311 automated analyzer from Roche Diagnostics. The determination of Zn, Cu, Mg, and Fe was performed using standard calibration curves for atomic absorption spectrophotometry.

The results indicate that PTC patients exhibit elevated levels of MPO, C-RP, and Cu, whereas Zn, Fe, and Mg levels are diminished. These alterations could be associated with inflammation and deficiencies in trace elements. They may also reflect a connection among inflammatory processes, oxidative stress, and metabolic changes in the tumor microenvironment.

Nonetheless, this research did not establish the causal relationship between MPO and the trace elements, nor their clinical relevance. Additional studies are required to elucidate the underlying mechanisms and possible clinical implications of these results.

Keratoconus (KC) is increasingly recognized as a complex, multifactorial, and heterogeneous disease that may arise from multiple independent metabolic and biochemical factors.

Corneal collagen cross-linking (CXL) using riboflavin (vitamin B2) with ultraviolet A (UVA) irradiation has recently been introduced as a new therapeutic option. This study aimed to evaluate intraocular pressure (IOP) changes after CXL in a sample of Iraqi patients with keratoconus. This prospective study included 28 patients with bilateral keratoconus (56 eyes) who underwent CXL with riboflavin and UVA irradiation in both eyes. IOP measurements were performed with a Tonopen, and optical coherence tomography (OCT) was used to evaluate corneal thickness immediately before treatment and at 3- and 6-month post-treatment.

Intraocular pressure (IOP) was significantly increased (P<0.001) after 3 and 6 months compared to baseline. The IOP rise remained significant (P<0.001) after correcting IOP measurements for corneal thickness decrease (from 475.1 μm to 447.5 μm after 3 months and from 475.1 μm to 470.1 μm after 6 months). The percentage increases in IOP after three months were 11.2% and 27.1% before and after IOP correction, respectively. The percentage increases in IOP after six months were 16.8% and 20.1% before and after IOP correction, respectively.

In conclusion, in patients with keratoconus, CXL with riboflavin and UVA irradiation resulted in a significant increase in IOP as measured with the Tonopen, even after correction for corneal thickness changes. This finding may have been due to increased corneal rigidity rather than a true increase.

Hypertension is a major cause of premature renal failure and is often associated with metabolic and hormonal abnormalities in men.

The growing body of evidence indicates that testosterone deficiency can increase renal susceptibility through mechanisms involving endothelial dysfunction. The purpose of the present study was to determine the association between total testosterone, free testosterone, sex hormone-binding globulin (SHBG), and early renal impairment in hypertensive men.

The study included 100 male patients diagnosed with essential hypertension (cases) and 60 male volunteers (control group). Participants were selected from internal medicine outpatient clinics at AL-Numan hospital; venous blood was centrifuged at 3000 rpm for 10 minutes to obtain serum.

Hypertensive individuals had significantly lower total testosterone (10.81 ± 2.92 nmol/L) and free testosterone levels (175.11 ± 48.24 pool/L), along with high levels of SHBG. These hormonal derangements were associated with a decrease in estimated Glomerular Filtration Rate (eGFR) and significant changes in Albumin-to-Creatinine Ratio (ACR), uric acid, and bicarbonate imbalances.

The current study shows significant differences in serum levels of androgenic markers between patients and controls. Quantitative analysis of serum parameters in hypertensive men found that free testosterone and SHBG showed a high correlation with renal dysfunction.

Rotaviruses are a leading cause of severe gastroenteritis in newborns and young children. The fat-soluble vitamin D plays an important role in immune regulation and gut health. The current study aimed to evaluate the anti-inflammatory effect of vitamin D in pediatric patients with rotavirus gastroenteritis.

A prospective, non-randomized clinical study was conducted at Mohammed Baqir Al-Hakim Hospital on 60 children under 5 years of age with vitamin D deficiency and confirmed rotavirus infection. Participants were divided into two equal groups: Group I (control) received conventional rotavirus gastroenteritis treatment. In contrast, Group II received the same treatment plus a single oral dose of vitamin D of 100000 IU for ages less than 1 year and 300000 IU for ages more than 1 year. Serum vitamin D levels were measured at baseline and after 7 days. Laboratory parameters were measured on days 1, 4, and 7.

According to baseline characteristics, there were no significant differences in demographic and baseline laboratory parameters between groups I and II. Significant time-related changes in C-reactive protein (CRP) and lymphocyte-to-monocyte ratio (LMR) were observed in both groups (P < 0.05). In Group I (control), CRP decreased from 32.8 ± 13.15 to 27.80 ± 10.39, and LMR showed a minimal change from 3.07 (2.49–3.51) to 3.11 (2.56–3.61). In Group II (vitamin D), more pronounced improvements were noted, with CRP declining from 33 (24–36) to 12 (6–12) and LMR increasing from 2.34 (2.10–3.69) to 4.75 (4.30–5.12) (P < 0.001).

The findings indicated that vitamin D acts as an immunomodulatory and anti-inflammatory agent, particularly by lowering pro-inflammatory markers in individuals with baseline deficiency or high inflammation.

Particularly in developing nations, anemia throughout pregnancy is a significant global public health issue.

Serious health consequences may arise for both the mother and the fetus as a result. Several past epidemiological studies have documented the extent of the issue. This study aimed to determine the prevalence of anemia during pregnancy in Iraq over the last 10 years.

A thorough evaluation of all available studies on anemia in Iraq over the past decade (2014–2023) has been conducted. Relevant research was located through the online databases ScienceDirect, MEDLINE, and Scopus. Data from numerous Iraqi studies conducted in different cities were merged into a unified format. The primary data collection sources consist of Scopus and PubMed.

The lowest documented prevalence of anemia during pregnancy over a decade was thirty-four percent, while the highest reached 84 percent. Most of the anemic pregnant women received sufficient prenatal care and were only mildly anemic during the third trimester. Some of the anemic women in the study consumed vegetables, fresh fruits, and meat regularly during their pregnancy. In contrast, others had a limited intake, as determined by dietary patterns and nutritional assessment.

This review highlights the growing prevalence of anemia among pregnant women in Iraq, with one study reporting a rate of 84.8%, indicating a critical public health concern. This issue is widespread and not confined to Baghdad, affecting multiple provinces across Iraq. High rates of anemia notably increase maternal morbidity, adverse birth outcomes, and long-term health risks for mothers and children across Iraq.

This research sought to assess the relationships among circulating adipokines, pro-inflammatory cytokines, and glycemic control in pediatric patients with type 1 diabetes mellitus (T1D).

A case-control analysis was conducted from April 12, 2025, to February 1, 2026, in pediatric and endocrine clinics in Thi-Qar. The study included 150 participants: 100 children with type 1 diabetes and 50 healthy controls matched by age and sex. Clinical and demographic information was documented, and fasting blood samples were gathered for biochemical analysis. Glycemic indicators, lipid profiles, adipokines (adiponectin, leptin, resistin, visfatin), and inflammatory cytokines (TNF-α, IL-6, IL-1β, CRP) were assessed using automated analyzers and ELISA techniques under controlled laboratory conditions.

Hemoglobin A1c (HbA1c) levels were significantly elevated in T1D patients compared to controls (p<0.001), indicating insufficient glycemic control. Children with diabetes showed notably higher fasting glucose levels and adverse lipid profiles, including elevated cholesterol, triglycerides, and low-density lipoprotein cholesterol (LDL-C), along with decreased high-density lipoprotein cholesterol (HDL-C). Additionally, adiponectin concentrations were markedly lower in the T1D group (p<0.001), while proinflammatory markers increased substantially, including leptin (p<0.001) and TNF-α (p<0.001). These markers showed significant positive correlations with HbA1c (P<0.001), indicating a robust association between systemic inflammation and glycemic dysregulation.

Pediatric type 1 diabetes is linked to an imbalance of adipokines and increased pro-inflammatory cytokines, which are associated with inadequate glycemic control. Persistent high blood sugar can activate inflammatory pathways and disrupt adipose tissue, leading to metabolic issues and immune system activation that worsen disease progression.

Alzheimer\'s disease (AD) is a neurological disorder, a condition that significantly impacts both physical and mental health and ultimately leads to death.

Alzheimer\'s disease is the seventh major cause of death, disability, and dependence. Several Determinants for dementia include depression, social isolation, inactivity, alcohol consumption, smoking, obesity, diabetes, high blood pressure, and age. Additionally, smoking, depression, and social isolation are notable risk factors.

The article provides a recent survey of prevalent data for staging and diagnosis of AD, regarding the role of epigenetic, chemical, and environmental factors, Classification of different indicators for early identification and prognosis in AD, and Diagnostic approach of AD, and studies the relationships among Alzheimer\'s disease, diabetes mellitus, and hypertension. Additionally, Research highlights the profound impact of previous studies conducted in Iraq.

Oxidative stress and metal ions are examples of chemical and environmental factors. Modifiable environmental variables, such as nutrition, exercise, and cognitive engagement, significantly influence AD. Advances in biomarker analysis (e.g., β-amyloid Aβ, Tau, apolipoprotein E4 APOE ε4) and neuroimaging techniques, including MRI and PET scans, have revolutionized diagnostic approaches, enabling earlier detection and intervention. The vital interaction between hereditary and environmental factors alters the epigenetic landscape in AD, affecting gene expression patterns linked to major clinical processes underlying disease etiology.

The study concludes that Diabetes, hypertension, elderly individuals, low income or socioeconomic status, limited education, hearing or vision impairments, and functional limitations are associated with increased risk of falls. In addition to epigenetic factors, chemical and environmental factors also serve as risk factors for Alzheimer\'s disease (AD).

Low back pain (LBP) is a common worldwide health issue that significantly affects everyday activities. However, it has been thoroughly examined among healthcare professionals in Iraq.

The impact on university academic staff has not been adequately investigated, despite their prolonged periods of sitting and standing. A cross-sectional study with analytical components was conducted using a convenience sample of 98 academic staff (both clinical and non-clinical) in Babylon, Iraq, to assess the prevalence of LBP across various timeframes and to determine associated socio-demographic, occupational, and anthropometric factors. Participants completed the Nordic Musculoskeletal Questionnaire. Prevalence was evaluated at the lifetime, 12-month, 4-week, and point (current-day) intervals.

The lifetime prevalence of LBP was 56.1%, decreasing to 35.7% over the past year, 31.6% in the last four weeks, and 25.5% on the day of the survey. Daily working hours showed a significant difference (p=0.035), with individuals with LBP working fewer hours (average 5.4) compared to those without LBP (average 5.6). This counterintuitive result challenges the hypothesis that longer working hours raise the risk of LBP. Of those with 12-month LBP (n=35), 54.3% reported activity limitations. Working 6 or more hours per day was associated with lower odds of LBP, but this association was not statistically significant. A significant association was found with height (p=0.004); individuals with LBP tended to be taller. This may indicate ergonomic mismatches or biomechanical stress. No significant links were found for age, years of teaching, gender, chronic disease, or job type (p>0.05), possibly reflecting the characteristics of academic work.

Low back pain is a common issue among the studied group of Iraqi academic personnel. The negative correlation with working hours suggests the presence of potential ergonomic or activity-level confounders. It is advisable to implement ergonomic interventions.

Reduced kidney function significantly influences breast cancer (BC) pathophysiology by disrupting hormone metabolism, leading to elevated systemic exposure to endogenous estrogens and their metabolites. This study aimed to investigate the relationships among estradiol (E2), progesterone (P4), and CA15, as well as renal function parameters (Urea and Creatinine) in women diagnosed with BC.

A total of 160 Iraqi women participated and were categorized into Group A (n=40, BC with normal renal function), Group B (n=40, BC with renal dysfunction), and Group C (n=80, healthy controls). CA15.3 was measured using a Cobas automated analyzer (Roche). Estradiol (E2) and Progesterone (P4) levels were determined using ELISA kits provided by BioCompare. Urea and Creatinine (Cr) were determined using spectrophotometric techniques.

The findings revealed statistically significant differences (P < 0.001) in E2, P4, Cr, urea, and CA15.3 between the patient and healthy groups. CA15.3, E2, and P4 demonstrated the highest discriminative ability (P<0.001), whereas Cr showed the strongest diagnostic performance, with an AUC of 0.868 (P<0.001). Pearson correlation analysis revealed that CA15.3 was negatively correlated with both E2 and P4 (p<0.001). In addition, a strong negative correlation was found between Estradiol (E2) and both Urea and Creatinine (r = -0.5728, r = -0.5728, p<0.001). Moreover, strong negative correlations were found between Progesterone (P4) and both Urea and Creatinine (r = -0.4831, r = -0.5212, p < 0.001).

Reduced kidney function establishes a complex, tumor-promoting environment that greatly affects the pathophysiology of BC. The association is fueled by a mix of hormonal imbalance, ongoing inflammation, and modified toxin metabolism, which collectively encourage cancer development and progression.