Mustansiriya Medical Journal

Head‑and‑neck cancers (HNCs) refer to a diverse group of cancers that originate in the soft tissues of the head‑and‑neck area. This category
includes all tumors that start in areas such as the oral cavity, pharynx, larynx, thyroid gland, and cervical esophagus. The application of
biomarkers in managing HNCs has grown significantly due to advances in genomics, proteomics, transcriptomics, and related technologies.
These biomarkers are valuable for the early diagnosis of head‑and‑neck squamous cell carcinoma (HNSCC) and play a crucial role in
enhancing patient outcomes. HNSCC develops through a series of stages marked by the accumulation of phenotypic and genetic alterations.
Identifying particular biomarkers is crucial for specifying the various stages of cancer, making it essential for managing HNSCC. The absence
of appropriate biomarkers for monitoring disease progression can result in a poor prognosis due to late‑stage diagnosis. The objective of this
review is to highlight emerging biomarkers relevant to HNSCC, covering primary locations such as the oral cavity, oropharynx, hypopharynx,
larynx, and thyroid.

Background: Urolithiasis is a common disease worldwide; many options are now available for its management, but evaluation of patient‑ and stone‑related factors helps to select the treatment modality. Aim of Study: The objective of the study was to compare the efficiency and integrity of semi‑rigid ureteroscopy (URS) versus extracorporeal shock wave lithotripsy (ESWL) regarding stone‑free rate and potential complications for patients with upper ureteric stone. Patients and Methods: A prospective study was performed, comprising 100 patients with upper ureteric stone sized < 10 mm. They were assigned into two equal groups: one group underwent ureteroscopic pneumatic lithotripsy and the other group underwent ESWL sessions. Patients’ follow‑up done at 1 month and 3 months for stone clearance and eventual complications, many factors related to the patient and stone were evaluated. Results: The mean age of all patients was 42.54 ± 14.07 years; 69% of patients were males. The initial stone‑free rate (SFR) was statistically significant between the two groups (80% for URS and 62% for ESWL), SFR for ESWL group increased to 76% and 82% after the 2nd and 3rd sessions, respectively; however, it remained higher in the URS group after 3 months of treatment. Complications were minor in the two groups. Analysis of stone‑ and patient‑related factors revealed no significant impact of patient’s age, gender, height, and body mass index in both groups, whereas stone size, stone density, and ureteral wall thickness had a significant effect on SFR, the significance of proximal ureteric diameter (PUD) and renal pelvis anterior–posterior diameter was noticed in ESWL group only. Conclusion: Both ESWL and URS were safe and effective means for treating upper ureteric stones smaller than 10 mm, but evaluation of several factors related to patient and stone may help improve stone outcome.

Background: Diabetic nephropathy (DN) is a problem that arises from microvascular complications with type 2 diabetes mellitus (T2DM).
It especially denotes the deterioration of renal function. Adropin, a regulatory peptide hormone, has attracted interest for its potential role in
regulating metabolism, specifically glucose metabolism and insulin resistance. Objective: To assess Adropin’s role in the identification and
severity of T2DM nephropathy. Methods: A cross‑sectional study which involved an 88 patients with DN was conducted in the National
Diabetes Center/Mustansiriyah University during the period from October 2023 to April 2024. Body mass index, blood analysis for sugar
levels, lipid profile, renal function test, and albumin to creatinine ratio in urine were conducted. In addition, the content of human adropin was
evaluated using an enzyme‑linked immunosorbent assay. Results: Much more fasting blood sugar, glycated hemoglobin, insulin, homeostasis
model assessment insulin resistance, cholesterol, triglycerides, low‑density lipoprotein (LDL) and very LDL, urea, and creatinine were found
in the microalbuminuria and macroalbuminuria groups of DN patients than in the normoalbuminuria group. The amount of adropin in the
blood was lowered in people with microalbuminuria and macroalbuminuria (245.91 ± 59.47 and 179.86 ± 51.96 pg/ml, respectively) than in
people with normoalbuminuria (377.97 ± 98.69 pg/ml) as well. While the subject attempts to identify the difference between the groups of DN,
adropin works very well and is very sensitive. Conclusion: This study establishes a correlation between reduced adropin levels and impaired
kidney function in individuals diagnosed with T2DM. Adropin content in the serum is able to serve as a biomarker for the early recognition
of DN, by its role in glucose metabolism and insulin resistance

Background: Chronic myeloid leukemia (CML) is defined by the Break point cluster region and Abelson Genes (BCR-ABL) fusion gene, which produces a continuously active tyrosine kinase known as the primary driver responsible for initiating and sustaining the disease. The RNA editing enzyme adenosine deaminase acting on double-stranded RNA 1 (ADAR1) converts adenosine into inosine in double-stranded RNA substrates. This enzymatic process is crucial in cellular RNA editing and can impact disease progression and therapeutic responses in CML. Objective: Analysis of ADAR1 gene polymorphisms, ADAR1 levels, and hematological parameters in Iraqi patients with CML. Materials and Methods: From January 2021 to February 2023, one hundred and twenty samples of whole blood were collected from patients with CML at the National Center of Hematology/Mustansiriyah University. The control group in this study comprised thirty samples of fresh whole blood. Total DNA genomic extraction was done to detect the ADAR1 gene polymorphism by sequencing. Furthermore, serum was used to detect ADAR1 enzyme level. Results: According to the age and male/female ratio, the patients’ groups were matching with control group. A group of CML patients on treatment, 65 out of 100 patients were on imatinib, while 35 were treated with other tyrosine kinase inhibitors. The patient groups in terms of age and gender ratio were matched with the control group. Among CML patients receiving treatment, 65 out of 100 were using imatinib, while 35 were treated with other tyrosine kinase inhibitors. In the newly diagnosed CML group, ADAR mutations were present in 35% of cases, and among treated CML patients, this proportion was 36%, whereas the control group showed no mutations (P < 0.001). The distribution of DNA polymorphisms—A/G, G/T, and G/G—was 42%, 30%, and 28%, respectively, among patients with CML, compared to 34%, 20%, and 46%, respectively, in the control group. There are significant differences between different groups according to genotyping of ADAR1 (P < 0.05). Based on ADAR1 mutation, there is a significant difference observed between the newly diagnosed CML group and the CML patients in the treatment group compared to the control group (P < 0.001). Specifically, the differences between the new diagnosis CML group and the treatment group were not statistically significant (P = 0.326). Furthermore, both the new diagnosis CML group and the relapse group showed significant differences compared to the control group (P < 0.001). The P value associated with the correlation between ADAR mutation and these groups is <0.001, indicating a highly significant correlation. Conclusion: The current findings suggest that ADAR1 polymorphisms and ADAR1 enzyme levels in Iraqi patients with CML could potentially influence disease progression and deepen our understanding of its mechanisms. These factors may also contribute to disease development and affect how patients respond to treatment.

Background: Sclerotinia sclerotiorum is one of the most important fungal species capable of manufacturing silver nanoparticles (AgNPs),
which are formed through the biosynthesis process extracellular from silver nitrate solution (AgNo3) to the culture medium using a fungal cell
filter; this study aims to explore the biosynthesis of AgNPs using S. sclerotiorum. Materials and Methods: AgNPs were produced by adding
AgNo3 to the culture and then incubating for 72 h at 37°C. The nanoparticles were formed inside the cytoplasm and on the outer surface of the
S. sclerotiorum fungus. These molecules were characterized using ultraviolet radiation, and the highest absorbance of AgNPs for S. sclerotiorum
fungus was measured at 450 nm. AgNPs were also characterized using infrared analysis (Fourier transform infrared) and scanning electron
microscope (SEM) to determine the size and crystal structure of these molecules. Results: S. sclerotiorum is a well‑known phytopathogenic
fungus with significant potential beyond its role as a plant pathogen. Various isolates of this fungus have diverse applications in agriculture,
biotechnology, and nanotechnology. Notably, these isolates have demonstrated potential in reducing silver ions (Ag⁺) to (AgNPs), highlighting
their promise in nanoparticle synthesis. In addition, the intensity of the absorption peak associated with the nanoparticles was found to increase
over time, further supporting their potential for research and application. Conclusion: AgNPs produced by S. sclerotiorum is predominantly
spherical, ranging from 5 to 50 nm, and are stabilized by a capping agent. These nanoparticles, found mainly on the fungal cell walls, likely
result from fungal enzyme activity. Their antifungal properties are due to their interference with microbial DNA and disruption of metabolic
processes, highlighting their potential as effective antifungal agents.

Background: Missed miscarriages (MMs) occur when an embryo without a cardiac pulse or gestational sac is not expelled from the uterus.
Fibroblast growth factor‑21 (FGF‑21), a member of the fibroblast growth factor family, plays an important regulatory role in metabolism, primarily
in glucose and lipid metabolism. Objective: The aim of this study is to investigate whether serum levels of FGF‑21 are associated with MM in
8–14 weeks of gestation. Materials and Methods: This case–control study consisted of 88 pregnant women; they were divided into two groups:
healthy pregnant (HP), composed of 40 women with a normal viable pregnancy at 8–14 weeks of gestation with mean age (29.07 ± 6.96 years);
and study group that included 40 women with MM diagnosed by ultrasound at the same gestational age (GA) with mean age (28.27 ± 7.74 years).
Demographic criteria and maternal serum FGF‑21 levels were recorded for comparison. ELISA technique was used to measure FGF‑21
in circulation. Results: This study revealed a statistically significant increase in serum levels of FGF‑21 in MMs (142.47 ± 48.036 pg/ml)
compared to normal pregnant women (87.9 ± 30.86). The cutoff point was ≥149.97, with high sensitivity (73.2%) and specificity (97.9%).
There was no significant correlation between FGF‑21 levels and age, GA, body mass index, or gravidity. Conclusion: The MM group’s serum
concentrations of FGF‑21 were markedly elevated within a time frame of 8–14 weeks compared to the HP group, suggesting its involvement
in the development of MM. Based on the findings, FGF21 demonstrates a remarkable capacity for diagnosing MM.

Osteogenesis imperfecta (OI) is a group of inherited disorders of connective tissue characterized by increased bone fragility. The disease can
manifest in a range of severities, from mild cases with few fractures and minor skeletal deformities to severe forms that may result in stillbirth
or birth with multiple fractures and other complications. We report a case of OI (probably type III) with concomitant ostium secundum atrial
septal defect in an 8‑day male neonate who had no family history of the disease from North Central Nigeria. The baby had progressive
respiratory distress with hypoxia from the 2nd day of life. He was managed conservatively, discharged after 7 days of hospitalization, and
remained clinically stable on follow‑up visits. This is to highlight the sporadic occurrence of Osteogenesis Imperfecta (OI), its co-occurrence
with congenital heart disease, and the challenges in providing care.