Al-Rafidain Journal of Medical Sciences

Background: Global clinical trials have shown that bevacizumab, along with chemotherapy, is beneficial for people with metastatic colorectal cancer (mCRC). Nevertheless, there isn't a useful biomarker to predict its effectiveness. Objectives: The study's goal was to analyze and evaluate the practical pretreatment biomarker in people with metastatic colorectal cancer (mCRC) to predict bevacizumab efficacy. Methods: This study, which is retrospective, includes 157 patients diagnosed with mCRC who received bevacizumab in association with chemotherapy from three centers in Iraq. The study looked at how clinical data and biomarkers relate to disease control (DC), overall survival (OS), and progression-free survival (PFS). It also looked at how well they could predict these outcomes. The cutoff values of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were examined with ROC analysis. Results: For all patients, the median follow-up duration was 12 months. The PLR, NLR and median alkaline phosphatase (ALP) values were considerably lower in disease-control (DC) patients than in non-DC patients. The carcinoembryonic antigen (CEA) baseline level significantly correlated with shorter OS, while the ALP baseline level did not significantly correlate with shorter PFS. Among the clinical data, only multiple organ metastases showed a strong correlation with a shorter PFS and OS. Conclusions: A low pretreatment N/L ratio and P/L ratio might be good predictors of bevacizumab efficacy for metastatic colorectal cancer patients, and it could be clinically useful for choosing responders.

Background: Proanthocyanidin is often used to prevent urinary tract infections (UTIs) in susceptible E. coli strains. Objective: To explore how grape seed proanthocyanidin extract (GSPE) affects type 2 diabetic patients (T2DM) with recurrent urinary tract infections (rUTIs). Method: The efficacy of GSPE in the treatment of T2DM with rUTIs was assessed in this randomized, single-blind controlled study. Sixty adults with diagnosed T2DPs and urinary tract infections were randomly assigned to treatment for 12 weeks with metformin (0.5 g t.i.d.) in Group A (Control Group) and a combination of GSPE (300 mg q.d.) and metformin (0.5 g t.i.d.), Group B, with the end of follow-up being 24 weeks, according to the study. Results: The medicinal plant GSPE reduces the recurrence of urinary tract infections in patients with T2DM after 12 weeks of treatment, compared with pre-treatment values and the control group. After 12 weeks of treatment for T2DM, fasting plasma glucose levels, creatinine, urea, and uric acid in both groups decreased non-significantly compared to control. There were fewer recurrent UTIs in the intervention group (77.8%), the control group (48.1%), and the GSPE (7.1%), compared to the control group (12.7%), the GSPE (7.1%), and the intervention group (33.7%) over the course of 24 weeks. Conclusions: Utilizing GSPE to treat, prevent, and minimize recurrent urinary tract infections in T2DM will help them better grasp the benefits and hazards associated with the daily administration of an appropriate GSPE dose.

Background: Ketoconazole (KZ) is categorized as class II according to the Biopharmaceutics Classification System (BSC) classification, which shows a strong pH-dependent solubility where its solubility is enhanced under an acidic medium (pH below 3). This strong pH dependence results in unpredictable absorption and a wide range of bioavailabilities. Objective: To prolong the gastric residence time of KZ’s tablet to enhance KZ’s solubility and hence its bioavailability for better therapeutic activity. Methods: To prepare mucoadhesive tablets, we use both direct and wet granulation methods. We employed various evaluation tests to assess the prepared tablets. These tests encompass a range of assessments, including weight variation, hardness, thickness, friability, disintegration test, swelling study, mucoadhesive strength study, and in vitro drug release studies. Results: The study found that polymer viscosity, as well as polymer concentration, have a significant effect on mucoadhesive strength and drug release, whereas diluent type has a non-significant influence on drug release. We selected Formula 7, which employs xanthan gum as a mucoadhesive polymer in a 1:1 drug polymer ratio, as the optimum formula because it provides an accepted physico-mechanical property and releases 87% of the drug over 8 hours. Conclusions: Gastric mucoadhesive tablets may be an effective method of delivering active ingredients, as they provide a favorable environment that enhances their dissolution by extending their duration in the stomach, thereby increasing their bioavailability.

Background: Cervical cancer poses a significant health challenge globally, with an increase in nations with poor or medium incomes, including Iraq. Objective: This study investigates the molecular interaction between microRNA-155 (miR-155-5p), interleukin-1β (IL-1β), and the tumor suppressor gene JADE-1, exploring their roles in the pathogenesis of cervical cancer among Iraqi women. Methods: By analyzing samples from 40 cervical cancer patients and 40 healthy controls, the study investigated the expression levels of miR-155-5p and its impact on IL-1β and JADE-1 through qRT-PCR and ELISA techniques. Results: The study reveals a significant upregulation of miR-155-5p in patients compared to controls, alongside a notable downregulation of JADE-1. While slightly elevating the serum level of IL-1β (p>0.05). These changes at the molecular level point to miR-155-5p possibly playing a role in cancer by creating an inflammatory environment around the tumor and decreasing the activity of pathways that stop tumors from growing through JADE-1. Conclusions: The study paves the way for further exploration into the mechanistic pathways of these molecules, offering potential biomarkers for early detection, prognosis, and the development of targeted therapies, thus aiming to improve the management and outcomes for women afflicted with cervical cancer in Iraq.

Background: Thalassemia is a group of inherited blood disorders that affect the production of hemoglobin, a protein in red blood cells that carries oxygen throughout the body. Iron overload is a condition in which the body absorbs and stores too much iron. In addition to repeated blood transfusions, increased gastrointestinal tract (GIT) iron absorption plays an important role in iron overload with thalassemia. Quercetin, a common flavonoid present in fruits and vegetables, exhibits diverse biological effects. Objective: To assess the effect of quercetin on iron overload parameters in blood transfusion-dependent thalassemia patients (TDT). Methods: A randomized, double-blind, placebo-placebo group-led study was conducted on 110 TDT patients, more than 12 years of age, who were supplemented with either quercetin or a placebo capsule daily (500 mg) for 3 months. A blood sample was obtained for laboratory parameters at baseline and at the end of 3 months. Results: At the baseline time of the study, the demographic features and iron overload parameters of patients and the placebo group were not statistically different, while after three months of supplementation, there was a significant decrease in levels of serum iron, UIBC, serum ferritin and ferritin saturation rate, and a significant increase in TIBC in the patients compared with the placebo group. Conclusions: The study shows the significant role of quercetin on iron overload parameters in blood transfusion-dependent thalassemia patients.

Background: Rheumatoid arthritis is an autoimmune inflammatory condition that impacts the small and larger joints. Ixifi® is a biosimilar medication derived from infliximab that exclusively targets Tumor Necrosis Factor-α. Serum Ixifi® trough concentration is necessary to manage disease activity in rheumatoid arthritis. Objective: Assess the impact of the Ixifi® trough level on disease activity and inflammatory biomarkers. Methods: A cross-sectional observational study was undertaken at Baghdad Teaching Hospital, involving forty-two patients diagnosed with rheumatoid arthritis according to ACR/EULAR 2010 criteria. After 3 months after initiating therapy with Ixifi®, the serum concentrations of Ixifi®, as well as CDAI, ESR, and CRP biomarkers, were measured. Results: After 3 months of therapy with Ixifi®, the patients in the remission group had a higher concentration of Ixifi® compared to the mild, moderate, and severe disease activity groups. Ixifi® trough level in remission was 5.45 µg/ml, while in mild, moderate, and severe groups, it was 3.575 µg/ml, 2.2 µg/ml, and 0.66 µg/ml, respectively. The CDAI scores were in the severe group (26.0), moderate group (19.0), mild group (7.0), and remission group (2.0). Furthermore, the findings indicate an inverse correlation between the Ixifi® trough level and both ESR and CRP. Conclusions: A drop in Ixifi® levels leads to an increase in disease severity and inflammation, while high concentrations of Ixifi® decrease disease activity, ESR, and CRP.

Background: Rituximab is a chimeric IgG1 kappa immunoglobulin that has been genetically modified to incorporate human constant region sequences together with murine light- and heavy-chain variable region sequences. People use it to treat rheumatoid arthritis and certain malignancies. Objective: The study aimed to assess the potential association between the serum levels of Factor I, CD59, interleukins (IL)-6, and interferon-gamma (IFN)-γ and the response to Rituximab treatment in Iraqi rheumatoid arthritis patients. Methods: A cross-sectional study was conducted at the rheumatology center at Baghdad Teaching Hospital. Ninety adult patients who have been diagnosed with rheumatoid arthritis and are receiving Rituximab intravenous infusions were included. The enrolled patients were divided into a responder group (45 patients) and a non-responder group (45 patients). The response to Rituximab was assessed according to the 28-joint Disease Activity Score (DAS28). Results: The serum levels of Factor I and CD59 were significantly higher in the non-responders group in comparison to the responders group. In addition, the serum IL-6 and IFN-γ levels were significantly elevated in the non-responders group in comparison to the responders group. The estimated marker serum levels showed a strong, significant correlation with the 6-month change in DAS28. Conclusions: In Rituximab nonresponder RA patients, serum levels of Factor I, CD59, Factor H, IL-6, and IFN-γ are higher, and they have good potential to be used in the assessment of the response to Rituximab therapy.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Rituximab (RTX), a monoclonal antibody with anti-CD20 action, is now used as a treatment. Even with proper RTX use, some patients showed variations in response. Objective: To assess the association of different sociodemographic data and disease characteristics with RTX responsiveness in RA patients. Methods: A cross-sectional study was conducted in the Specialized Center of Rheumatology at Baghdad Teaching Hospital in Baghdad, Iraq. The study included 90 RA patients who received a 1000mg RTX intravenous infusion for at least six months. The collected sociodemographic data included age, gender, smoking status, body mass index (BMI), disease characteristics such as co-morbidities, and the use of previous biological agents. The activity of RA was assessed by the 28-joint Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI). Results: Upon measuring the DAS28, the enrolled patients were divided into RTX responders (50 patients) and RTX non-responders (40 patients). Patients with a family history of RA were significantly higher in the RTX responders (21% versus 2% in the non-responders group). The responders had a significantly longer RA duration (p=0.030).The mean of CDAI and DAS28 were significantly higher in patients with no family history of RA than in those with a family history of RA. Conclusions: Disease duration, family history, and the use of previous biological agents could be considered as possible predictors of response to RTX, thereby saving time and treatment costs.