Al-Rafidain Journal of Medical Sciences

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Background: Klebsiella pneumoniae is the second most frequent pathogenic bacterium in the Enterobacteriaceae family, after E. coli. It is also regarded as a major pathogen responsible for healthcare-associated infections around the world. Objective: To look at how overexpressing the elastase gene (lasB) in K. pneumoniae affects biofilm development and antibiotic resistance. Methods: 25 clinical isolates of K. pneumoniae were received from Baghdad's Chemistry Analysis Center (CAC) and re-identified using the Vitek-2 method. The microtiter plate was used to measure biofilm production with ELISA. The disc diffusion method was used in antibiotic sensitivity tests in accordance with the CLSI 2022 criteria. The PlasB plasmid was transformed into K. pneumoniae via electroporation. Results: Out of 25 isolates, 11 (44%), 11 (44%), and 3 (12%) produced strong, moderate, and weak biofilms, respectively. One strong biofilm producer (KA1) was chosen for further investigation. The lasB plasmid was successfully transformed into KA1, yielding the KA1 (plasB) isolate. KA1 (plasB) formed considerably fewer biofilms than KA1, and it was more susceptible to tetracycline, doxycycline, and amoxicillin-clavulanic acid than KA1. Furthermore, KA1 (plasB) has shown a significant decrease in ampicillin resistance and an increase in ciprofloxacin sensitivity, but no variations in susceptibility to levofloxacin, cefotaxime, piperacillin-tazobactam, amikacin, or erythromycin when compared to KA1. Conclusions: Overexpression of the elastase gene (plasB) has a major impact on biofilm development and antibiotic resistance in K. pneumoniae.

Background: It is estimated that more than half of pregnant women all over the world are anemic. The potential of erythroferrone (ERFE) and growth differentiation factor-15 (GDF15) as indicators for iron deficiency could be used to detect various types of anemia, cardiovascular and metabolic diseases. Objectives: To assess whether variations in erythroferrone and Growth Differentiation Factor-15 in blood levels among pregnant women might be used as a marker for anemia. Methods: A cross-sectional study recruited 120 pregnant women into a study group: 60 anemic pregnant women and 60 healthy pregnant controls. Their demographics, hematological indices, and biomarkers (growth differentiation factor-15, erythroferrone, serum ferritin and iron) were collected. Results: It has been found that anemic pregnant women have statistically higher levels of Growth Differentiation-15, Erythroferrone, and other iron status compared to healthy pregnant women. The average concentration of ERFE in anemic pregnant women was 5.6 ng/mL, while in healthy pregnant women, it was 2.2 ng/mL.. For GDF-15, the average concentration was 457.27 pg/mL for anemic patients and 228.89 pg/mL for healthy pregnant women. The cutoff value of both GDF-15 and ERFE had the highest sensitivity and specificity in differentiating anemic pregnant women, 1.000 (p<0.0001) for the area under the curve in the case of healthy controls. Conclusions: The markers erythroferrone and GDF-15 have a significant correlation with iron indicators and are recommended for screening anemic pregnant women.

Background: Psoriatic arthritis (PsA) is an inflammatory condition linked to psoriasis. According to studies, there is little correlation between arthritic patterns and PsA. Objective: To find relationships between psoriasis symptoms and PsA arthritis patterns. Methods: 100 PsA patients were enrolled in a cross-sectional study at Baghdad Teaching Hospital from December 2021 to June 2022, using CASPAR criteria. We gathered thorough demographic and clinical information, examined arthritis patterns, classified them into five kinds, and evaluated eight types and sites of psoriasis. Disease activity was measured using clinical and psoriasis indicators. Results: a weak negative connection among 100 individuals with psoriatic arthritis, plaque psoriasis, and distal interphalangeal (DIP) arthropathy. Erythrodermic psoriasis and spondylitis (with or without sacroiliitis) showed a slight positive connection. There was also a slight positive association between scalp psoriasis and DIP arthropathy. A comparable positive and weak relationship was found between polyarthritis and age, as well as polyarthritis and psoriatic arthritis disease activity. In contrast, asymmetrical oligoarthritis and PsA disease activity had a modest negative connection. Furthermore, enthesitis and DIP arthritis showed a weak negative connection. Body mass index and spondylitis (with or without sacroiliitis) showed a positive and weak correlation. The most significant finding was a modestly favorable relationship between skin psoriasis and psoriatic arthritis disease activity. Conclusions: There are weak but significant associations between particular psoriasis types and locales and arthritis patterns in PsA patients. These findings point to the possibility of developing individualized therapeutic regimens for PsA that take into account both dermatological and rheumatological signs.

Objective: To provide a basic overview of the status of CAR-T cell therapy and foresee its future applicability in cancer treatment. Method: The search engines PubMed, Google Scholar, ResearchGate and Web of Science were employed in obtaining peer-reviewed articles using the criteria outlined in the method section. Main points: CAR-T cell therapy has proved a lifesaving option for hematological malignancies despite its huge cost per treatment. Clinical trials are still ongoing to improve the effectiveness of this therapy for solid tumors as well as make it more affordable and easier to set up. Conclusion: CAR-T cell therapy represents a useful addition to the arsenal in the fight against cancer, particularly in lifesaving scenarios in dealing with serious hematological malignancies.

Background: Chemotherapeutic medication treatment for cancer is typically used in conjunction with other techniques as part of a routine regimen. It is well established that the capacity of different chemotherapeutic drugs to induce apoptosis is correlated with their anticancer efficacy. Quinazolinone-based drugs have demonstrated excellent responses from several cancer cell types. These substances have a lot of potential for use as building blocks in the creation of apoptosis inducers. Objective: To assess the new quinazolinone derivatives (M1 and M2) that were recently synthesized for their potential to halt wound healing and to use the acridine orange/propidium iodide (AO/PI) double stain to assess their capacity to induce apoptosis in the chosen cancer cell lines. Methods: Using the breast carcinoma cell line (MCF-7) and the lung adenocarcinoma cell line (A549), two quinazolinone derivatives (M1 and M2) were investigated for their capacity to inhibit wound healing and induce apoptosis. Results: In both cell lines, the chemicals were found to be effective inducers of apoptosis and to considerably limit wound healing. Conclusions: In cancer cell lines (MCF-7 and A549), compounds M1 and M2 efficiently inhibited wound repair and triggered apoptosis.

Background: Cancer remains a leading global health challenge. Its management is complex and patient satisfaction depends on many factors, such as the patient's pathophysiology, types of cancer, types of treatment and the facilities available. Objectives: To assess the variables that determine cancer patients' satisfaction with the quality of healthcare. Methods: A cross-sectional study was conducted at the Middle Euphrates Cancer Center in the Al-Najaf Al-Ashraf Governorate from July 1, 2021, to September 20, 2023. We used expert advice to ensure the validity of the questionnaire and conducted a preliminary pilot study to confirm its dependability. A questionnaire was used to conduct structured interviews that yielded data, which was then thoroughly analyzed using descriptive and inferential statistical techniques using SSPS. Results: Out of 400 cancer patients, 77.3% had received chemotherapy, 22.0% had just received a breast cancer diagnosis and 49.3% had stage I cancer metastases, while the majority (54.25%) had no co-morbidities. In the study, 53.3% of patients showed unsatisfactory responses to the healthcare services provided. Diagnosis, co-morbidities, cancer metastasis, and independence level significantly influenced patient satisfaction with the quality of healthcare. Conclusions: The majority of participants (>50%) were unsatisfied with the provided healthcare services. Based on these variables, healthcare practitioners should tailor their care to enhance the wellbeing of cancer patients.

Background: Intervertebral disc (IVD) water is a basic factor for modeling tissue growth and nutritional diffusion and its amount is directly related to the development of degenerative processes. Objective: direct assessment of human IVD water contents in different disc regions in correlation to age and disc degeneration processes. Methods: 103 IVD samples that were taken from 30 cadavers underwent a lyophilization process to assess their water contents. The results were tabulated and tested statistically in relation to different parameters, including gender, age, spinal level and degeneration grading. Results: This study reveals that the water content was significantly less in the group whose age was more than the median age (83 years) when compared with the group whose age was less than the median age. Additionally, the study shows that the water content is dramatically and significantly reduced in individuals who have degenerative changes. Conclusions: The water content of the intervertebral disc directly correlates with age and the degeneration process, decreasing as age and degeneration progress.

Background: Febrile neutropenia (FN) is one of the most serious complications of cancer chemotherapies. To avoid life-threatening complications from treatment delays, appropriate empirical antibiotics treatment should be initiated. Objective: To highlight the common bacteria encountered at Hiwa Hospital, the current state of the hospital's antibiogram and recommendations for resistance management. Method: From January 2021 to December 2022, we retrospectively collected culture-confirmed FN cases from the Hiwa Hospital system database in Sulaimani, Iraq. Results: We collected 144 culture-confirmed cases, with ninety-four from hematology wards and fifty from oncology wards. The participants’ ages ranged from 2–79 years. Seventy-three of them were male, with a male-to-female ratio of 1:0.9. Gram-negative bacteria comprised 50.7% of the total cases, 47.9% had gram-positive bacteria, and only 1.4% had fungal growth. The most common isolated pathogens were Staphylococci species (38.9%), E. coli (29.2%), Klebsiella pneumoniae (9%), Streptococcus spp. (8.3%), and Pseudomonas spp. (8.3%). A large number of Staphylococcus spp. were resistant to amoxicillin/clavulanic acid, ceftriaxone, cefepime, and levofloxacin. In contrast, E. coli was resistant to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin/tazobactam. Klebsiella spp. exhibited significantly higher levels of resistance to amikacin, cefepime, and ciprofloxacin. MRS strains were found in 48.2% of Staphylococci spp., 74% of gram-negative bacteria, and 12.3% of extensive drug-resistant (XDR) isolates. Conclusions: There is a high prevalence of antibacterial resistance among cancer patients, which contributes to quinolone-induced collateral damage.

Background: Bacterial infections of the eye are treated by administering ophthalmic solutions containing corticosteroids and antibacterial agents. The main challenges faced when used for topical instillation are precorneal fast clearance and multiple applications, particularly with gatifloxacin. Objectives: To develop an ocular gel that utilizes both ion-induced and thermal-sensitive mechanisms to achieve gelation. Methods: We prepared and compared formulations containing different percentages of poloxamer 407 and gellan gum (F1–F24) in terms of gelation temperature, gelling capacity, gelation time, and permeation. We tested the optimum formulation for isotonicity and irritation in rabbits. Results: The formulations' pH varied from 6.7 to 7.3. Formulations that passed the gelation temperature test successfully were F6, F7, F9, and F10. For both drugs (F6, F7, F9, and F10), the drug content percentages ranged from 98.64% to 99.95%. In situ, gels (F6, F7, F9, and F10) showed pseudoplastic shear-thinning rheological behavior, which means that their viscosity decreased as the angular velocity went up. F7, which contains 17% poloxamer and 0.5% gellan gum, had 15 seconds of gelation time at 34oC and remained in gel form for 270 min. It was isotonic and did not change the size or shape of RBCs when topically applied. The rabbit's eyes did not experience irritation due to the extended release of both drugs. Conclusions: The new in situ gel formulation may be a superior alternative to the traditional eye drops of gatifloxacin and betamethasone for ocular infections.

Background: Simvastatin (SIM) is a lipid-lowering agent to prevent disorders caused by clogged blood vessels. Because of its low solubility, it has low bioavailability. The adsorption technique is effective in improving drug solubility and dissolution rate. Objective: To use magnesium aluminum silicate (MAS) as an adsorbent in combination with Soluplus® as a hydrophilic polymer to formulate SIM as immediate-release tablets (IRTs). Methods: We used the solvent evaporation method to make MAS-loaded SIM in the presence of Soluplus®, making sure that the ratio of SIM to MAS to SOLU was 1:6:3. We then used this mixture to make IRTs. Using the direct compression method, we made all of the SIM-IRT formulas. We used diluents like Avicel®PH102, Avicel®PH101, and starch, as well as super disintegrants like Crospovidone (CP), Croscarmellose sodium (CCS), and sodium starch glycolate (SSG). We evaluated these formulas for their weight variation, hardness, friability, disintegration time, drug content, and dissolution profile. Results: We prepared the tablet formula (T5) using MAS-loaded SIM, Avicel®PH102 as a diluent, and CCS 3% as a super disintegrant. This formula showed the shortest disintegration time (0.61 min) and best drug release in phosphate buffer pH 7.0, releasing more than 80% of the drug within 30 minutes. Conclusion: Using suitable excipients, adsorption was an efficient method to enhance the solubility of SIM for preparation as IRTs.

Background: Approximately one out of every four diabetic patients will acquire a diabetic foot ulcer (DFU) in their lifetime. Human beta-defensin (HBD) promotes wound healing. Objective: To find the correlation between HBD-2 and ulcer grade, diabetic foot infection, and the type of bacterial isolates recovered from bacteriological culture. Methods: We included forty-nine patients with DFU and obtained blood samples and wound swabs from each participant between October 2023 and December 2023. We measure HBA1c using ARCHITECT c4000 system, and HBD-2 using the ELISA technique. Classification of DFU was done based on Wagner’s method. Swabs from foot ulcers are used for isolation and preliminary identification of bacteria based on standard guidelines. The VITEK® 2 system confirmed the diagnosis. Results: The patients' mean age was 57.31 years, and the male/female ratio was 1.57. Grade 3 was the most common type (57.1%). We observed the highest significant level of HBD-2 in grade one, non-infected DFU patients, and ulcers infected with gram-positive bacteria. Patients infected with Staphylococcus aureus showed the highest HBD-2 level according to the type of isolate, while patients infected with Proteus mirabilis showed the lowest level. Conclusions: HBD-2 levels might reflect the impaired or dysregulated immune response in patients with type 2 diabetes mellitus (T2DM) and have a negative impact on wound healing. The type of bacteria influenced this level, with Staphylococcus aureus infections reporting the highest level.

Background: The treatment of schizophrenia typically involves the use of olanzapine (OLZ), a typical antipsychotic drug that has poor oral bioavailability due to its low solubility and first-pass effect. Objective: To prepare and optimize OLZ as nanoparticles for transdermal delivery to avoid problems with oral administration. Methods: The nanoprecipitation technique was applied for the preparation of eight OLZ nanoparticles by using different polymers with various ratios. Nanoparticles were evaluated using different methods, including particle size, polydispersity index (PDI), entrapment efficiency (EE%), zeta potential and an in vitro release study. The morphology was evaluated by a field emission scanning electron microscope (FESEM) and an atomic force microscope (AFM). We also perform differential scanning calorimetry (DSC). Results: Characterization studies of OLZ nanoparticles showed that OLZ-6 was the best formula with a particle size of 115.76 nm, a PDI of 0.24, a high EE% of 78.4%, and a high zeta potential of -19.01 mV. The in vitro release of OLZ was higher than that of other formulations. FESEM reveals the spherical shape of the nanoparticles, and AFM screening confirms that the OLZ-6 size is comparable to what the Zeta sizer finds. The DSC results confirm the purity of OLZ and the compatibility between the drug and polymer. Conclusions: OLZ-6, as a transdermal delivery system, is a promising formula to overcome the problems associated with oral drug administration and could enhance its bioavailability.

Background: Clozapine (CLZ) is a potent antipsychotic drug that suppresses the symptoms of schizophrenia and mania. Clozapine falls into Class II (BCS); its poor bioavailability is attributed to low water solubility and an extensive first-pass effect. Objective: To prepare CLZ as a nanosuspension (NS) to improve its low water solubility and load it in a sublingual film to enhance oral bioavailability. Methods: CLZ nanosuspensions are prepared by the “solvent anti-solvent precipitation” method using Soluplus as a stabilizing agent. We evaluated the polydispersity index (PDI) and the particle size of the CLZ nanosuspension formulations. The optimized formula of CLZ nanosuspension is loaded directly onto a sublingual thin film, eliminating the need for freeze-drying for solidification by the solvent casting approach. The sublingual films were characterized by thickness, surface pH, folding endurance, disintegration time, and in vitro dissolution rate. Results: We selected the formula F1 sublingual film as the best, as it demonstrated a uniform thickness of 0.087mm, good flexibility, and a surface pH of 6.7. It disintegrated quickly in 13 seconds and had a faster in vitro dissolution rate (3 min) compared to the CLZ ordinary films. Conclusions: The results confirmed the success of CLZ NS as a sublingual thin film for dissolution rate enhancement, which may improve oral bioavailability.

Background: Previous studies have stated that the higher the LP VAS, the better the outcome. However, there is no quantification of this relationship. Objectives: To maximize the understanding of the effect of symptom duration and intensity of leg pain on surgical outcome at one year, ascertain whether the level of radiculopathy influences outcome, and examine the possible factors that may lead to repeat surgery at the same level in young and middle age groups. Methods: Retrospective data was collected from patients who underwent primary, single-level lumbar decompression surgery with a 12-month follow-up period. We used the ROC curve to determine the LP VAS cutoff value. Results: 500 patients were included. There was a significant improvement in LBP VAS and LP VAS after 12-month follow-up (84% and 95%, respectively). There was a significant relationship between the reoperation rate and LP VAS, with a p-value of 0.001. LP VAS (>7.0) is the maximum area under the curve, with 92% sensitivity and 37% specificity to predict reoperation. There was no significant relationship with the duration of radiculopathy. Conclusions: Patients (92%) with a preoperative LP VAS >7.0 are more susceptible to re-operation surgery. LP cannot be used as a predictor of surgical outcome independently of other factors. Surgeons should be more cautious in selecting patients for surgery and not base their decision only on preoperative leg pain.

Background: The widespread administration of quinolones may have led to an increase in bacterial resistance development. Objective: To synthesize and characterize manganese oxide nanoparticles (MnO2NPs) and evaluate their effects on the viability and biofilm formation of quinolone-resistant gram-positive and negative pathogenic bacteria. Methods: We prepared MnO2NPs using the photo-irradiation method and recorded their characteristics using XRD, TEM, and SEM. Staphylococcus aureus, Streptococcus pneumonia, Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa were collected from the wastewater of Baghdad hospitals during the period from July 3rd to July 14th, 2023. We used the VITEK2 system to confirm and identify all of the isolates. We conducted biofilm formation and antibiotic susceptibility tests using nalidixic acid, ciprofloxacin, norfloxacin, aztreonam, levofloxacin, and ofloxacin, and also detected the qnrA and qnrB genes. Finally, we evaluated the effects of the prepared nanoparticles on the viability and biofilm formation of bacterial isolates. Results: MnO2NPs characterizations showed a diffraction peak at 2θ values with 21 nm average sizes; qnrA and qnrB genes were found in three and four isolates, respectively; and significant effects of MnO2NPs against viability and biofilm formation were recorded. Conclusions: The synthesized nanoparticles have antibacterial and anti-biofilm activities against a variety of bacteria possessing qnr genes. Even multi-resistant bacterial isolates have the potential to be strong antimicrobial agents against these pathogens.

Background: Bladder cancer (BC) is the most common malignant tumor in the urinary tract and the tenth most common malignancy worldwide. Exosomes are 40–100 nm-diameter nanovesicles that are either released straight from the plasma membrane during budding or merged with the plasma membrane by multivesicular bodies. Objectives: To assess the proportion of serum and urinary Exosome levels in urinary bladder cancer patients, as well as their impact on the disease. Methods: From January 2023 to June 2023, a total of 45 samples of blood and urine were collected from individuals diagnosed with bladder cancer at the Ghazi Hariri Hospital for Specialized Surgery. They included 45 male and female patients, varying in age, as well as 45 healthy controls. The samples were analyzed for exosome levels using the ELISA method. Results: The mean serum and urine exosome levels in the patients' group (14.18 and 20.04) were significantly higher than in the control group (8.21 and 8.94), respectively. Serum exosomes exhibited a significant positive and moderate correlation with urine exosome levels. Conclusions: Serum and urine levels of exosomes can be used as biomarkers to detect bladder cancer, and the urine level seems to be preferential.

Background: Adverse drug reactions (ADRs) are unintended harmful effects caused by medications that can occur at any dose. ADRs are a significant contributor to hospital admissions and are responsible for numerous fatalities, particularly among older adults with multiple chronic illnesses who take multiple medications. Reporting ADRs is critical for identifying the harmful effects of medications and monitoring patients in hospitals. Objective: ADRs have a significant impact on mortality rates, but no previous studies in Iraq have focused on death-related reports. To address this problem, we conducted a study to assess mortality rates associated with ADRs in Iraq and identify the drugs most frequently involved. Methods: We collected the ADR reports of Iraqi patients that were registered as fatal from January 2010 to January 2024 in The World Health Organization (WHO)pharmacovigilance database, VigiBase. The case-non-case method will be used to investigate the reporting risk in Iraq versus the rest of the world. Results: A total of 329 fatal ADRs were found, and the mean age of affected patients was 36 years, with a male-to-female ratio of 1.25:1. Antineoplastic agents ranked first among drugs that caused fatal ADRs (38.4%), and pembrolizumab was the leading active ingredient (27 cases, 6.85%). Conclusions: This study is the first to identify and describe fatal ADRs in Iraq and found them less common in Iraq, and the risk is lower in Iraqi women compared to Iraqi men.

Background: The bone mineral density of the lumbar vertebra has been assessed according to the results of the Dual-Energy X-Ray Absorptiometry (DEXA). Although anemia is known to affect bone mineral density, at the present time, it is not clear which vertebra is more affected by this disease. Objective: To evaluate the effects of anemia on the bone mineral density of the lumbar vertebra in comparison with a normal subject and determine which part of the lumbar vertebra is more affected by anemia. Methods: All 205 participants in this study complained of bone pain (90 males and 105 females). 95 patients, including both sexes, suffered from anemia. Additionally, the study included 110 seemingly healthy volunteers as the control group. All participants were studied regarding their bone mineral density for lumbar vertebrae using dual-energy x-ray absorptiometry. Results: The DEXA outcomes revealed highly statistically significant differences between the control and patients of each lumbar vertebra in the same sex. In addition, there were significant differences in bone mineral density among the lumbar vertebrae of the same sex. Conclusions: Our findings suggest that examining the bone mineral density of the lumbar vertebrae is a more effective and appropriate method for studying the bone mineral density (BMD) of the bony skeleton in any subject, with L1 and L4 vertebrae being more susceptible to osteoporosis than other vertebrae.

Background: Bilastine (BLA) is a second-generation H1 antihistamine used to treat allergic rhinoconjunctivitis. Because of its limited solubility, it falls under class II of the Biopharmaceutics Classification System (BSC). The solid dispersion (SD) approach significantly improves the solubility and dissolution rate of insoluble medicines. Objective: To improve BLA solubility and dissolution rate by formulating a solid dispersion in the form of effervescent granules. Methods: To create BLA SDs, polyvinylpyrrolidone (PVP K30) and poloxamer 188 (PLX188) were mixed in various ratios (1:5, 1:10, and 1:15) using the kneading technique. All formulations were evaluated based on percent yield, drug content, and saturation solubility. The formulae with the greatest solubility enhancement were subjected to in vitro dissolution studies, Fourier transform infrared, and thermal analysis to study drug crystallinity and drug-polymer interactions. The best SD formula was made as effervescent granules using wet granulation and tested further. Results: The SD3 formula, which contained PVP K30 in a 1:15 ratio, had the highest solubility and release. In phosphate buffer (pH 6.8), over 88.43% of the BLA was released within the first 15 minutes. The optimum formula's effervescent granules demonstrated excellent flow qualities, a disintegration time of 87 seconds, an acceptable pH of 5.9, and 9.7 mg of BLA dissolved in the first 5 minutes. Conclusions: BLA dissolution can be improved via solid dispersion technique allowing for successful effervescent granules formulation.

Background: Papillary thyroid carcinoma (PTC) is the most prevalent form of thyroid cancer, making up about 80% of cases. It is influenced by both genetic and environmental factors, making it the most prevalent form of thyroid cancer. Objective: Determine the connection between PTC and polymorphisms in the thyroid peroxidase gene (TPO, rs2048722) as a risk factor, as well as the changes in thyroid hormone serum levels. Methods: The study involved 52 PTC patients and 48 healthy controls. We looked into the link between a type of TPO polymorphism and the risk of getting PTC by finding and genotyping TPO (rs2048722) C/T in healthy people and people who had PTC using T-ARMS-PCR and checking thyroid hormone levels in the Al-Diwaniyah Governorate. Results: The polymorphism TPO (rs2048722) increased the PTC risk. According to multiple genetic models, homozygous TT genotypes increased the risk of PTC in the test by 4.03 times relative to other genotypes, and a heterozygous C/T genotype increased the risk by 2.09 times. Patients with PTC have elevated TSH. Patients over 50 exhibited greater mean values than the control group. In addition, T3 and T4 blood levels dropped significantly and increased overall. Compared to other groups, patients aged 50 and older had lower mean T3 levels. Conclusions: In the Al-Diwaniyah Governorate, there was strong evidence that the TPO rs2048722 polymorphism was linked to a higher risk of PTC. This risk was affected by age, gender, and serum thyroid hormone levels.

Background: Sinus lifting is a common surgery for bone loss in the posterior part of the maxilla. It facilitates inserting prostheses and rehabilitating the edentulous posterior maxilla. If the alveolar bone remains less than 5 mm, direct sinus lifting using the rotatory handpiece is used to perform the lateral window approach. Objective: To compare piezosurgery and rotary techniques in direct sinus lifting. Methods: A cross-sectional study was conducted from October 2022 to August 2023. We enrolled 15 patients, ranging in age from 45 to 66 years, who required bilateral direct sinus lifting. Piezosurgery was performed on one side, while rotary surgery was performed on the other. We assessed the intraoperative time of opening the bony window, as well as the postoperative pain, swelling, and mouth opening at 1 hour, 2 days, 7 days, and 1 month after the procedure. Results: With rotary tools, the time for opening a bony window was significantly shorter. Piezosurgery resulted in significantly less swelling after 2 days, but there was no significant difference between the two groups after 7 days and 1 month. Regarding mouth opening, the piezo group yielded a significantly larger difference after 2 days, but the two groups demonstrated no significant difference after 7 days and 1 month. Regarding pain, the piezo group demonstrated a lower score after 6 hours and 2 days, but the two groups demonstrated no significant difference after 7 days. Conclusions: Postoperatively, piezosurgery for sinus lifting leads to less pain, swelling, and limited mouth opening.

Background: Osteoarthritis (OA) degrades cartilage and bone. Osteochondral autograft, allograft, and total replacement knee surgery have limitations, such as prompt immune responses, lack of cartilage tissue obtainability, invasiveness, and a loosening implant that may require further correction. Tissue engineering, which involves injecting chondrocytes into 3D porous scaffold carriers in the joint, seems promising for tissue repair and growth. Objective: To develop gelatin/poly DL-lactide-co-glycolide (PLGA) microspheres as a porous scaffold for chondrocyte carriers. Methods: The double emulsion method is one of the most popular and best methods for forming microspheres. In summary, in the PLGA oil phase, we emulsified a gelatin solution representing the inner aqueous phase. Next, in an external aqueous phase of polyvinyl alcohol (PVA), we emulsified the resultant first emulsion. The double emulsion was stirred to evaporate organic solvent and centrifuged to collect gelatin and PLGA microspheres. Results: The Mastersizer result showed polydispersed particles with 23.53% of the desirable cell injection size range between 1-300 µm. Scanning electronic microscope (SEM) images revealed spherical and porous microspheres with smooth surfaces. The average absolute zeta potential value was -30.7±4.895, indicating stable preparation. Conclusions: Gelatin and PLAGA polymers worked together to make 3D scaffold microspheres that were the right size, had the right number of holes, and were strong.

Background: Research identifies enteric adenoviruses as the third most common cause of infantile gastroenteritis, while Cryptosporidium causes parasitic gastroenteritis. Many studies have revealed the role of IFN-γ in inflammation and autoimmune diseases. Objective: To investigate the IFNG rs1861494 gene polymorphism among Iraqi pediatric patients with gastroenteritis co-infected with cryptosporidium and adenovirus. Method: This case-control study enrolled 75 pediatric patients with severe gastroenteritis, whose ages ranged from 3–120 months and had a mean age of 30.64 months. The apparently healthy control (AHC) in this study included 25 pediatric individuals with a mean age of 27.64 months. We extracted DNA from stool specimens to further extract total genomic DNA, extract the human adenovirus (HADV) viral genome via PCR, and detect the IFNG rs1861494 polymorphism using the ARMS PCR technique. Results: The male gender percentage in patients and AHC groups was 54%, while the female counterpart was 46%. The positive PCR result for HADV7 was 28%, whereas the positive result for Cryptosporidium was 6%. In the studied groups, the GG genotype increased at a rate OR=2.67 as compared to the AG and AA genotypes. HADV7 and Cryptosporidium showed a strong correlation with the SNP IFNG rs1861494 results in gastroenteritis (r=0.968, p=0.007 and r=0.984, p=0.008). Conclusions: The identified enteric co-infection of Cryptosporidium and HADV-7, as well as the IFNG rs1861494 polymorphism, may shed light on possible pathogenic roles in gastroenteritis.

Background: Next-generation sequencing (NGS) can monitor the transmission of COVID-19 and viral alterations. Objectives: To provide information about testing techniques and infection control measures, as well as to direct the development of vaccines and treatments for the Corona virus. Methods: Six Iraqi SARS-CoV-2 strains were investigated using whole-genome sequencing using the next-generation sequencing method. The sequencing was carried out with an Illumina MiSeq system, and phylogenetic analysis was carried out for all Iraqi sequences retrieved from GISAID. Results: The analysis of the isolates from this study showed that all the sequences from the most recent wave, which happened in the summer of 2022, were primarily clustered in the 20A clades and the 21K, 21L (Omicron) clade, as determined by the GISAID and Nextclade systems. On the other hand, the PANGO system revealed that six sequences were of the BA.1 lineage in Iraq, while four were of the BA.2 lineage. We found that throughout the country's subsequent pandemic waves, SARS-CoV-2 clades and their lineages exhibited circulation patterns and dominance. Conclusions: NGS continues to supply vital COVID-19 evidence to academics, vaccine and medication makers, and public health regulators.

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy of reproductive-age women that imposes metabolic and cardiovascular risks. Systemic immune inflammation index (SII), an inflammatory biomarker calculated from a complete blood count, was linked to many metabolic and cardiovascular illnesses. Objective: To evaluate the SII correlation with clinical, biochemical, and hormonal parameters characteristic of PCOS cases for screening and diagnostic values. Methods: For fifty PCOS patients who were eligible, we did a cross-sectional study and collected three types of information on each person: demographic information like age, menstrual cycle length, and body mass index (BMI); hormonal information like LH/FSH ratio, testosterone, and fasting insulin; and biochemical information like the homeostasis model assessment of insulin resistance (HOMA-IR), serum cholesterol, serum HDL, and serum LDL. The systemic inflammatory index (SII) was calculated from a complete blood count. Results: We found a strong positive correlation between SII and BMI, LH/FSH ratio, testosterone, fasting serum insulin, HOMA-IR, cholesterol, and LDL. However, the correlation between SII and HDL and menstrual cycle days was negative. Regarding the other parameters (HOMA-IR, testosterone, cholesterol, BMI, and LH/FSH ratio), the best subset regression model figures out how strongly SII is linked to each one. Conclusions: SII was strongly and significantly correlated to PCOS clinical, biochemical, and hormonal parameters, which makes it recommendable for screening. Its feasibility, affordability, and meaningful correlation inspired therapeutic and prognostic applications in practice.

Background: Several studies linked the development of steroid-resistant nephrotic syndrome (SRNS) to genetic variations in the multidrug resistance 1 (MDR1) gene, though a disparity in findings was underlined among children with different ethnic origins. Objective: This study examined the relationship between MDR1 variants (rs2032582 and rs2032583) and the risk of developing SRNS in Iraqi patients with idiopathic nephrotic syndrome (INS). Methods: This case-control study included children with steroid-sensitive INS (SSNS; n=30) and SRNS (n=30) from the Babylon Hospital for Maternity and Pediatrics. Sanger sequencing was used to determine the participants’ genotypes. Results: The rs2032582 genotypes and alleles were not associated with SRNS development risk. It was also found that kids who had both the wild or mutant homozygous genotypes for rs2032583 and rs2032582 variants were more likely to get SRNS [OR (95%CI):30.18 (1.55–588.5), p=0.008] than kids who had both the heterozygous genotypes for rs2032583 and either genotype of rs2032582. Conclusions: Nephrotic children who have homozygous genotypes (wild or mutant) for the rs2032583 and rs2032582 variants likely resist prednisolone therapy, and an alternative therapeutic regimen may be warranted. Further investigations are needed to elucidate the potential implications of MDR1 variants for personalizing drug therapy in INS children.

Background: Quickly dissolved oral films are a widely accepted method of delivering drugs and help patients adhere to treatment regimens. Nanosuspensions (NS) are colloidal dispersions of drug particles with a submicron size, and their large surface area enhances the solubility and dissolution of low-water-soluble drugs. Febuxostat (FXT) is a non-purine xanthine oxidase inhibitor with a low dissolution rate that limits its absorption. Objective: To develop fast-dissolving oral films (FDOFs) containing FXT NS and convert NS into solid dosage forms to ease administration and accelerate drug release. Methods: FXT NS was prepared using Soluplus as a stabilizer and Tween80 as a co-stabilizer through an anti-solvent precipitation technique. We prepared FDOFs using a solvent casting method, utilizing hydrophilic polymers like pullulan, polyvinyl alcohol (PVA), gelatin, and plasticizers like polyethylene glycol (PEG400) and glycerin. The study assessed the film's thickness, weight, folding endurance, drug content, disintegration time, and drug release. We validated the drug's compatibility using FTIR, and conducted a crystallinity study using DSC and X-ray powder diffraction. Results: F4 was the optimized formula prepared using PVA and PEG400. In just three minutes, the F4 dissolution rate increased significantly (99.63% vs. 11.23%) compared to the FXT ordinary film. Also, it had good mechanical properties. Conclusions: FXT NS were successfully loaded into FDOFs with accepted properties.

Background: Evidence indicates a potential link between PCOS and low-grade infections. IL-17, also known as IL-17A, is an essential immunological regulator, especially in disorders such as polycystic ovarian syndrome (PCOS). The human cytomegalovirus is a β-herpesvirus that causes inflammation and remains dormant in the host for life. The cytomegalovirus has been central to several PCOS-related concepts. The role of IL-17A in CMV infection remains unknown. Objective: To establish the correlation between PCOS and CMV, as well as the connection between PCOS and serum levels of IL17A. Methods: A case-control study included 60 women with PCOS compared to 40 healthy controls. Samples were analyzed regarding CMV via the real-time PCR technique. Furthermore, the ELISA technique measured serum levels of the IL-17A cytokine. Every sample was taken between September 2023 and January 2024. Results: Positive results for CMV were seen in 50 (83.3%) of patients with PCOS compared with 10 (16.7%) who had negative results, while 6 (15.0%) of healthy control subjects had positive results and 34 (85.0%) had negative results; the difference was highly significant. Furthermore, women with polycystic ovary syndrome had a significantly higher IL-17A serum level when compared to healthy controls. Conclusions: In Iraqi women, HCMV Infection in patients with PCOS can be considered as a risk factor. Moreover, the results show that IL-17A is an excellent prognostic marker of polycystic ovary syndrome.

Background: Many data indicate a strong relationship between CCN3 and the intensity and length of RA symptoms. Furthermore, RA patients' bone deterioration, joint degeneration, and impaired functional status strongly correlate with serum CCN3 levels. Objective: To evaluate the levels of CCN3 protein, IL6, and anti-MCV biomarkers with the activity of RA disease and determine if there is any relationship between CCN3, anti-MCV, and IL6 in RA patients. Methods: In this prospective case-control study, 60 patients with RA were selected and subdivided according to disease activity, and 60 healthy individuals were served as controls. An enzyme-linked immunosorbent test (ELISA) was used to evaluate blood levels of CCN3, RF, anti-CCP, anti-MCV, and IL-6. Results: A significant correlation was reported for CCN3 with high and moderate disease activity and ulnar deformity but not with IL6, anti-MCV, anti-CCP, sex, or duration of disease. There is a strong positive correlation between anti-MCV and disease duration, as well as anti-MCV and RF. Conclusions: CCN3 has a significant association with disease activity and joint deformity with high sensitivity and specificity compared to other parameters, making it a good prognostic biomarker for RA.

Background: Cyclophosphamide (CP) is a widely used anticancer and immunosuppressant drug. However, CP's significant toxicities and adverse effects restrict its clinical use. Doxofylline (DF) is a phosphodiesterase inhibitor that has antioxidant and anti-inflammatory properties. Objective: To determine the protective effect of doxofylline on rats exposed to a single dose of CP. Methods: We randomly assigned thirty Sprague-Dawley male rats to three groups. On the sixth day, the apparently healthy control group (AH) received normal saline; the induction group (IN) received normal saline and a single dose of CP (100 mg/kg); and the DF group received DF (50 mg/kg) and a single dose of CP (100 mg/kg). Treatment in all groups was given once daily and intraperitoneally. At the end of treatment, caudal fluid is used to determine sperm parameters. A blood sample was taken to determine the testosterone levels. We determined the levels of testicular glutathione peroxidase and malondialdehyde. The testes were harvested, allowing for histological examination. Results: Sperm parameters, testosterone and oxidative stress markers were notably declining in testicular tissue among the IN compared with AH, although these measures can be markedly improved with DF. Histopathological analysis revealed a substantial change in the testicular tissue structure in the CP group, although doxofylline co-treatment significantly attenuated and even reversed these changes. Conclusions: Doxofylline may function as a protective agent, mitigating the testicular damage caused by CP therapy in rats. The proposed process may be attributed to its phosphodiesterase inhibitory and antioxidant properties.

Background: Procrastination can be seen as a form of self-sabotage. In educational contexts, this is often called academic procrastination, which means putting off academic tasks. Individuals who procrastinate might begin to feel overwhelmed and despondent, experiencing a decline in their self-assurance. This outlook can darken their view of the future and potentially result in diminished self-esteem. Objective: This study aimed to assess the relationship between academic procrastination and self-esteem among medical students. Methods: This cross-sectional study was conducted among 317 undergraduate medical students and data were collected through a questionnaire using the Procrastination Assessment Scale-Students (PASS) and the Rosenberg Self-Esteem Scale. The data were analyzed using descriptive analysis, an independent student’s t-test, an ANOVA, and Pearson’s correlation test. Results: Regarding gender, no significant difference was observed in the mean procrastination scores or the mean self-esteem scores and the difference found was non-significant. A negative correlation was found between procrastination and self-esteem, which was also found to be statistically significant (r= -0.138, p=0.036). Conclusions: Students with high self-esteem procrastinate less, whereas those who procrastinate more have comparatively lower self-esteem. Interventions designed to bolster students' problem-focused coping mechanisms can boost their motivation, help them manage their self-esteem more effectively, empower them to identify and tackle problematic scenarios with clear objectives and come up with various solutions.

Background: The isatin molecule is present in many natural substances, including plants and animals, and is used to prepare compounds with various biological activities. Objectives: To synthesize a new series of isatin derivatives with the expectation that they will have antimicrobial activity. Methods: Thiazole Schiff bases were synthesized from various Mannich bases of isatin to evaluate their antimicrobial properties. Initially, Mannich bases (2a–e) were synthesized by reacting isatin with formaldehyde and different secondary amines. Subsequently, they were treated with 2-aminothiazole to yield the final compounds (3a–e). Spectroscopic characterization was done via FT-IR and 1H-NMR. The antimicrobial screening was conducted on all derivatives. Molecular docking and ADMET analysis were performed on the final compounds, comparing them with standard drugs (ciprofloxacin and fluconazole). Results: The antimicrobial activity was assessed on two Gram-positive bacteria, Staphylococcus aureus and Bacillus licheniformis; two Gram-negative bacteria, Escherichia coli and Acinetobacter baumannii; and one fungus species, Candida albicans. Molecular docking has recorded higher docking scores for 3d and 3e compared to ciprofloxacin and fluconazole. The virtually active molecules showed an adequate drug-like profile and desired pharmacokinetic properties in the ADMET analysis. Conclusions: Most derivatives displayed significant antimicrobial activity, with compound 3e being the most active, followed by compound 3b. Molecular docking revealed higher scores for compound 3e compared to fluconazole and for compounds 3d and 3e compared to ciprofloxacin. ADMET analysis of compound 3e showed excellent absorption, consistent with its strong GIT absorption.