Al- Anbar Medical Journal

Recurrent instability following first-time traumatic anterior shoulder dislocation occurs in 19-88% of patients. It is a major clinical challenge that requires a personalised treatment decision, especially in young and active people. Younger age at first dislocation, particularly below 25 years; male sex; participation in overhead and contact sports; and generalised hypermobility independently increase recurrence rates. Key structural factors, including bony Bankart lesions, off-track Hill-Sachs lesions, and glenoid bone loss exceeding 20%, play a central role in destabilising the glenohumeral joint. The glenoid track concept provides a biomechanical basis to understand bipolar bone loss and engagement risk. Additional contributors include capsuloligamentous insufficiency and neuromuscular deficits. Current predictive models have shown modest discriminative ability, and most clinicians depend on readily identifiable risk factors to plan treatment. The correct identification of patients with numerous high-risk characteristics, especially young and active males with structural injuries, is crucial for individualised risk stratification to guide appropriate management decisions. This narrative review synthesises current evidence on demographic, biomechanical, and structural risk factors associated with recurrent anterior shoulder instability in adults to guide clinical management.

Background: Postpartum depression (PPD) is a major health issue of concern to the population, and the occurrence of this condition among mothers is almost one in every five across the globe. This situation may impair women’s capacity to care for herself and her baby.
Objectives: To determine the prevalence of PPD and the risk factors that are related to the prevalence in women in Al Anbar Governorate, Iraq.
Materials and Methods: A total of 618 mothers eight weeks postpartum were recruited into a cross-sectional study that will be carried out at 23 primary health centers between February 2024 and February 2025. Structured interviews based on sociodemographic, obstetric, and psychosocial variables were used to collect the data with the help of the Edinburgh Postnatal Depression Scale.
Results: With a cut off of 11 or more, depressive symptoms were found in 42.4% of mothers. Notable predictors were ≥ 4 weeks postpartum (OR = 1.99, CI: 1.38–2.87, P-value < 0.001), adverse life events (OR = 1.80, CI: 1.22–2.64, P-value = 0.003), prenatal depressive symptoms (OR = 2.21, CI: 1.55–3.14, P-value = 0.001), lack of social support (OR = 2.49, CI: 1.62–3.83, P-value < 0.001), and irregular antenatal care (OR = 2.71, CI: 1.81–4.06, P-value < 0.001).
Conclusions: The problem of PPD was extremely common among women in Al Anbar. This observation underscores the necessity to enhance maternal health provision, such as psychosocial support and improved education in the primary care environment.

Background: Preeclampsia is a hypertensive disorder of pregnancy that can result in serious maternal and fetal complications and often affects multiple organ systems due to systemic vasospasm and endothelial dysfunction. Despite its clinical importance, there is limited research on university students’ understanding of preeclampsia. Poor knowledge may increase the risk of adverse maternal outcomes and influence health-seeking behaviors in future pregnancies.
Objectives: To assess the knowledge and attitudes towards preeclampsia and examine their association with sociodemographic factors among female students at the University of Cyberjaya.
Material and Methods: An analytical cross-sectional study was conducted among 421 female students using convenience sampling across faculties. A validated self-administered questionnaire was used to measure knowledge and attitudes towards preeclampsia. Data were analyzed using descriptive statistics to establish baseline knowledge and attitudes, and chi-square tests were performed to determine associations between sociodemographic factors and students’ knowledge and attitudes towards preeclampsia.
Results: Most of the participants were undergraduates (98.8%) and pursued studies in non-medical faculties (78.1%). About 2/3rd of participants had low knowledge, and less than half (48.9%) had positive attitudes towards preeclampsia. Knowledge was significantly associated with race, age group, and faculty type; with Malay, Chinese, older, and medical students having better knowledge (P-value < 0.05).
Conclusion: Most female students reported low knowledge of preeclampsia with notable gaps in recognizing symptoms, risk factors, and complications. They also demonstrated mixed attitudes, reflecting a grey zone for health promotion. Nevertheless, higher education institutions, especially those with medical programs, should serve as platforms for health education to strengthen young women’s preparedness for future maternal health challenges.

Background: According to statistics, chronic kidney disease (CKD) is the fourth leading cause of death in the world and its rate of 4.32% of total deaths in Iraq. Over the past few years, several single -nucleotide polymorphisms (SNPs) have been recognized to be associated with increased risk for CKD.
Objectives: To computationally evaluate the impact of nonsynonymous single-nucleotide polymorphisms (nsSNPs) in the coding regions of the XRCC1 and XPD genes using multiple predictive tools.
Materials and Methods: Several prediction methods and in silico theoretical models were used to examine non-synonymous SNPs in the XRCC1 and XPD genes. It has been demonstrated that the structure and function of the XRCC1 and XPD proteins, which are involved in deoxyribonucleic acid (DNA) repair, are affected by potentially harmful mutations rs25487, rs1799782, rs13181, and rs1799793.
Results: High-confidence three-dimensional structures of the human XRCC1 and XPD proteins were produced using the SWISS-MODEL platform. Mutant models with missense variations (rs25487, rs1799782, rs13181, and rs1799793) exhibited striking changes in protein stability and structure. Several variations have been shown to negatively impact protein function by in silico prediction techniques (i-Mutant, PolyPhen-2, PROVEAN, and SNPs and GO), with rs1799793 exhibiting the highest correlation with illness. The discussed polymorphisms appear to be highly relevant to DNA repair and genomic stability, a conclusion supported by additional analysis of protein–protein interactions, evolutionary conservation within and outside the species, as well as protein classification.
Conclusion: Our conclusion was that the rs1799793 variant impacted on the CKD. While the rs13181 polymorphism has shown protein stability increases, the others, including rs25487 and rs1799782 have shown decreases in their stability. Prediction tools (i-Mutant, PolyPhen-2, PROVEAN and SNPs&GO) indicated that XPD variants were generally benign, while the impact of XRCC1 variants could be deleterious.

Background: Pesticides, particularly organophosphates (OPs) such as chlorpyrifos, pose major public health risks through environmental contamination, dietary residues, and occupational exposure, with metabolites widely detected in human biomonitoring. Chlorpyrifos induces hepatorenal toxicity primarily through hepatic cytochrome P450-mediated bioactivation to chlorpyrifos-oxon, leading to reactive oxygen species overproduction, oxidative stress, and organ injury.
Objectives: To evaluate the protective potential of synthesized bis-chalcone derivatives against chlorpyrifos-induced oxidative stress and hepatorenal damage in male albino rats.
Materials and methods: Three bis-chalcone derivatives (A1-A3) were synthesized by environmentally friendly Claisen-Schmidt condensation, characterized by proton nuclear magnetic resonance and Fourier-transform infrared spectroscopy, and assessed for purity by elemental microanalysis (CHNO). Oxidative stress, liver, renal, and lipid biomarkers were measured in 56 male albino rats assigned to eight groups (7 rats for each group), comprising one control group, three groups receiving bis-chalcones (A1-A3) alone, one chlorpyrifos group, and three groups pretreated with A1, A2, or A3 followed by chlorpyrifos (oral gavage, 14 days).
Results: Chlorpyrifos markedly increased thiobarbituric acid reactive substances (TBARS), liver enzymes, total bilirubin, urea, total cholesterol, and triglycerides, while decreasing reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), total protein (TP), and albumin (ALB). A1 pretreatment most effectively normalized these indices (e.g., TBARS 28.76 ± 2.18 nmol/L, GSH 14.92 ± 0.56 µmol/L, aspartate aminotransferase (AST) 78.4 ± 4.1 U/L, and alanine aminotransferase (ALT) 58.7 ± 3.2 U/L; all P-values < 0.05 vs. chlorpyrifos).
Conclusion: Bis-chalcone derivatives, particularly A1, exert strong protective effects against OPs toxicity in rats by restoring oxidative balance and preserving hepatocellular, renal, and metabolic functions.

Background: Polycystic ovary syndrome (PCOS) affects 10-16% of Saudi women of reproductive age. Limited awareness and a lack of evidence-based information contribute to delayed diagnosis. Understanding regional health literacy and preferred educational strategies is essential for improving awareness and promoting early diagnosis.
Objective: To assess awareness and knowledge of PCOS, examine the relationship between sociodemographic factors and PCOS knowledge, and identify preferred methods for delivering PCOS-related health information.
Materials and Methods: A community-based cross-sectional study was conducted in the Eastern Province of Saudi Arabia. Using convenience and snowball sampling, 335 women completed a self-administered Arabic questionnaire assessing sociodemographic data, PCOS awareness, knowledge (score range 0–26), and educational preferences. Descriptive statistics and Kruskal-Wallis tests were used for analysis, with epsilon-squared (ε²) used to estimate effect sizes.
Results: Overall PCOS awareness was 83.3% (n=279), with a mean knowledge score of 13.1±5.02. Age (χ²=24.9, P-value<0.001, ε²=0.0746) and education level (χ²=8.03, P-value =0.045, ε²=0.0240) were significantly associated with knowledge scores, with younger women (18-24 years) achieving higher scores. Social media/internet (38.8%) was the most common information source, followed by family/friends (26.3%) and healthcare providers (21.2%). Video-based internet education was preferred by 57.9% of participants, and 60.3% rated it as highly effective. Traditional lectures and printed materials were less favored.
Conclusion: Older and less educated women demonstrated lower PCOS awareness. The strong preference for video-based education highlights the potential value of culturally tailored tele-education programs in improving PCOS knowledge, encourage earlier diagnosis, and support reproductive health initiatives.

Background: Craniotomy is used to treat open depressed skull fractures, often leading to a skull defect requiring cranioplasty. An alternative technique involving immediate reinsertion of fractured bone after cleaning and disinfecting was tested in rabbits.
Objectives: To evaluate autologous cranioplasty in treating open depressed skull fractures in rabbits, using 3% hydrogen peroxide to sterilize contaminated bone fragments before reimplantation.
Materials and Methods: Four groups of local rabbits (3.1–4.5 kg, 3–5 months old), each with 4 animals, were examined after surgery. Group A was assessed at 1 week postoperative, Group B at 3 weeks, Group C at 6 weeks, and Group D served as a control with normal bone tissue for histological reference. Rabbits were euthanized under deep anesthesia, wounds were re-explored, and bone fusion was examined by microscope.
Results: All treated groups differed from the control. Group A showed inflammation without regeneration. Group B demonstrated moderate tissue response and regeneration. Group C showed significant remodeling and new bone formation. Group D had matured, stable bone with no inflammation or healing activity.
Conclusion: Hydrogen peroxide-treated bone fragments enhanced healing and graft integration after cranioplasty in rabbits. Group C exhibited the highest healing response, and the method reduced the need for foreign implants or repeated surgeries.

Background: Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune inflammatory disease primarily affecting the joints. Despite the availability of diagnostic tools, identifying novel biomarkers that reflect joint pathology remains crucial for the accurate evaluation of RA.
Objective: To assess the serum levels of novel joint-related biomarkers (aggrecan, fibulin-1, lubricin, and human beta-defensin 3 [HBD-3]) in females with RA, and to determine their diagnostic performance compared to healthy controls (HC).
Materials and methods: This case-control study included 60 female RA patients and 60 age-matched HC. Serum concentrations of aggrecan, fibulin-1, lubricin, HBD-3, and anti-citrullinated protein antibody (ACPA) were determined using ELISA kits. Erythrocyte sedimentation rate (ESR) was measured via the standard Westergren method.
Results: Serum levels of aggrecan, fibulin-1, lubricin, and HBD-3 were significantly increased in RA patients compared to HC (P-value = 0.0001). For predicting disease status, the biomarkers yielded the following area under the receiver operating characteristic (AUROC) curve values: aggrecan (0.947, cut-off > 15.80 ng/mL), fibulin-1 (0.885, cut-off > 7.975 ng/mL), HBD-3 (0.885, cut-off > 325.2 pg/mL), and lubricin (0.719, cut-off > 169.4 pg/mL). Additionally, these biomarkers showed significant positive correlations with each other and with ACPA levels.
Conclusion: Serum aggrecan, fibulin-1, lubricin, and HBD-3 are significantly elevated in RA patients, indicating strong disease association and high diagnostic potential. Future longitudinal studies are required to establish definitive clinical utility in monitoring disease activity.

Background: A substantial proportion of patients with non-ST-elevation myocardial infarction (NSTEMI) have an acutely occluded culprit artery despite the absence of diagnostic ST-segment elevation on the presenting electrocardiogram.
Objective: To determine the prevalence of thrombolysis in myocardial infarction (TIMI) flow grade 0 total culprit-artery occlusion in percutaneous coronary intervention (PCI) treated NSTEMI and to identify its clinical, laboratory, echocardiographic, and angiographic correlates.
Materials and Methods: This prospective single-center observational study included consecutive patients with NSTEMI who underwent coronary angiography within 24 hours of presentation and culprit-vessel PCI at Kirkuk Cardiac Centre, Iraq, from September 2023 to September 2025. NSTEMI was diagnosed by ischemic symptoms, absence of persistent ST-segment elevation, and cardiac troponin I above the 99th-percentile upper reference limit (0.04 μg/L) with a serial rise/fall pattern. Patients were classified into the TIMI 0 and TIMI ≥1 groups based on pre-PCI culprit-vessel flow. Echocardiography was performed within 24 hours of admission and repeated before discharge. Group comparisons and multivariable logistic regression were performed.
Results: Among 225 patients, TIMI 0 total occlusion was present in 78 (34.7%). Compared with TIMI ≥1, TIMI 0 was associated with male sex, higher body mass index (BMI), smoking, arrhythmia, family history of coronary artery disease, higher troponin, lower high-density lipoprotein (HDL) cholesterol, lower left ventricular ejection fraction, and more frequent left circumflex culprit lesions. In multivariable analysis, higher BMI, family history of coronary artery disease, higher admission troponin, lower HDL cholesterol, and lower admission ejection fraction remained independently associated with TIMI 0, whereas diabetes mellitus showed an inverse association.
Conclusion: TIMI 0 total occlusion was common in PCI-treated NSTEMI and was associated with a distinct clinical and angiographic profile, including higher BMI and troponin levels, lower HDL cholesterol and left ventricular ejection fraction, and more frequent left circumflex culprit lesions.

Autogenous tooth transplantation (ATT) preserves the periodontal ligament (PDL) and alveolar remodeling. This case report describes the 3‑year outcome of ATT using a fully developed maxillary third molar to replace a non‑restorable maxillary first molar (#26) with vertical root fracture (VRF) and a large endodontic‑periodontic lesion. A 41‑year‑old female with a hypererupted, caries‑free maxillary left third molar (#28) presented with grade III mobility and deep probing depths on tooth #26. After atraumatic extraction of #26 and careful PDL‑sparing extraction of #28, the donor tooth underwent extraoral root‑end resection (1 mm), 3‑mm retrograde cavity preparation, and obturation with calcium‑enriched mixture (CEM) cement. Total extraoral time was 9 minutes (extraction: 2 min; preparation/filling: 5 min; moistening: 2 min). The recipient socket was larger than the donor root, providing no primary stability. The tooth was seated 0.5 mm infraocclusion and retained only with crossed silk sutures. The patient was instructed on a soft‑diet protocol (for 1 month) and to avoid chewing on the transplanted tooth. Clinically, at 3‑year recall, the tooth was functional/asymptomatic with normal mobility and probing depths <3mm. Radiographically, bone healing and no root resorption/ankylosis were evident at the same recall. ATT of a mature molar with root‑end filling/sealing with CEM, thorough extraoral moisture control, and soft tissue suture‑only retention, achieved long‑term stability/function. This biologically driven surgical approach needs validation through large sample clinical trials.

Background: Metabolic disorders are major contributors to cardiovascular morbidity and premature mortality worldwide. Conventional clinical assessment approaches typically evaluate individual metabolic parameters separately and may not adequately capture the complex interactions among metabolic pathways.
Objectives: To develop and evaluate the atherosclerosis and metabolic risk score (AMRS), a composite logarithmic index integrating anthropometric, biochemical, and demographic variables to quantify metabolic burden and classify individuals with metabolic abnormalities.
Results: AMRS demonstrated good discrimination against glycemic abnormalities and moderate discrimination for lipid and blood pressure disorders. Area under curve values were 0.81 for hyperglycemia, 0.81 for elevated HbA1c, 0.73 for hypertriglyceridemia, 0.71 for hypercholesterolemia, and 0.72 for hypertension. Sensitivity analyses demonstrated that the score retained moderate discriminatory ability even after the removal of outcome-defining variables. External validation showed consistent discrimination across outcomes.
Conclusion: The AMRS provides an integrated quantitative measure of cardiometabolic burden by combining multiple metabolic domains into a single composite index. The score demonstrated stable discrimination and robustness across analyses and may support population-level metabolic risk stratification and classification of metabolic burden.