Al-Rafidain Journal of Medical Sciences

Background: Diabetes nephropathy is one of the most important complications of type 2 diabetes mellitus (T2DM). Albuminuria is an early clinical indicator for investigating diabetes nephropathy. Age, poor glycemic control, long duration of diabetes, and hypertension increase the risk of albuminuria. Objectives: To determine the relationship between albuminuria, HbA1c, and comorbidities in elderly patients with T2DM. Methods: A cross-sectional study was carried out on 136 elderly patients with T2DM at the Diabetes and Endocrine Center in Sulaimani City. Data was obtained from each patient through face-to-face interviews and laboratory tests for HbA1c, serum lipid profiles, and albumin levels in the urine. Results: Out of 136 patients, 82 elderly patients with T2DM were normoalbuminuric, 37 had microalbuminuria, and 17 had macroalbuminuria, respectively. The female gender was at greater risk of developing albuminuria (19.1% microalbuminuria and 6.6% macroalbuminuria) than the male gender (8% microalbuminuria and 5.8% macroalbuminuria). The risk factors for microalbuminuria and macroalbuminuria were poor glycemic control (HBA1c >7.5) (16.9% microalbuminuria and 6.6% macroalbuminuria), long-term diabetes (5–10 years) (13.9% microalbuminuria and 5.1% macroalbuminuria), and coexisting comorbidity conditions (21.3%) microalbuminuria and 10.2% macroalbuminuria, mainly hypertension (20.5% microalbuminuria and 8.8% macroalbuminuria). Conclusion: Our findings showed that the incidence of albuminuria in elderly patients with T2DM was high in patients with poor diabetes control, a long duration of diabetes, and comorbidity conditions, particularly in patients with hypertension.

Background: Lower gastrointestinal bleeding (LGIB) is responsible for 25 percent of overall GI bleeding patients in the general population. In the US, the LGIB incidence is thought to be 21–27/100,000 per year, while the rate of hospitalization is thought to be 20–30/100,000 per year. According to reports, 2–4% of patients hospitalized with LGIB die. Despite the fact that upper GI complications associated with portal hypertension have received a lot of attention, few studies have explored lower GI complications. Objective: To study the prevalence and 28-day outcome of patients hospitalized with lower gastrointestinal bleeding in liver cirrhosis and its correlation with model for end-stage liver disease (MELD). Method: A single center-based cross-sectional study was conducted for a duration of eighteen months. The main source of data is from patients hospitalized at the Department of General Medicine and Department of Medical Gastroenterology at the Institute of Medical Sciences and SUM hospital, with a minimum of 100 cases. Results: Out of 100 patients, internal hemorrhoids were observed in 50 patients, external hemorrhoids were found only in 1 patient, and rectal varices were present in 17 patients. The MELD score for the 28th day outcome was found to be 21.85 on follow-up. It was 27.0 in discharged patients by the 28th day. Conclusions: An essential element of the condition, portal hypertension, appears to be responsible for the poor prognosis.

Background: Despite the importance of vaccines in preventing COVID-19, the willingness to receive COVID-19 vaccines is lower among RA patients than in the general population. Objective: To determine the extent of COVID-19 knowledge among RA patients and their attitudes and perceptions of COVID-19 vaccines. Methods: A qualitative study with a phenomenology approach was performed through face-to-face, individual-based, semi-structured interviews in the Baghdad Teaching Hospital, Baghdad, Iraq, rheumatology unit. A convenient sample of RA patients using disease-modifying anti-rheumatic drugs was included until the point of saturation. A thematic content analysis approach was used to analyze the obtained data. Results: Twenty-five RA patients participated in this study. Regarding knowledge about COVID-19, most participants were able to define COVID-19, realize its contagious nature, and see the need for masks to get protection from this infection, while only a minority knew COVID-19 symptoms. Most participants obtained information about COVID-19 from TV programs and the public. Regarding COVID-19 vaccines, about 1/4 of the participants knew vaccine side effects, and only 12% of them had positive attitudes toward the vaccine. Additionally, 19 participants were unwilling to take the vaccine. The most common reasons behind this reluctance to take the vaccine include fear of the vaccine's short- and long-term side effects and the worsening of RA. Conclusion: RA patients' knowledge about COVID-19 and its vaccines was poor, and their attitudes toward COVID-19 vaccines were negative.

Background: In recent years, the prevalence of obesity has climbed sharply. Still, only a few safe and effective medications are approved as weight-loss drugs. Objective: This study aims to assess the knowledge and practice of community pharmacists in Iraq regarding the use of Liraglutide and Semaglutide as weight-loss medications. Method: A cross-sectional survey was implemented using a validated questionnaire and a convenient sample of Iraqi community pharmacists from different governorates. The questionnaire was created after conducting a literature review of the most important articles about liraglutide and semaglutide. The questionnaire consists of three sections. The first part was used to collect demographic information. The second and third parts assessed community pharmacists' knowledge and practice of the anti-diabetic weight-loss agents Liraglutide and Semaglutide, respectively. Results: A total of 225 community pharmacists participated in this survey. The mean number of successfully answered knowledge questions by all participants was 15 out of 20, indicating a good knowledge of the Iraqi community pharmacists regarding using Liraglutide and Semaglutide as weight-loss medications. The current study revealed that the mean score for the practice section is 3.97, indicating that the participating pharmacists have good practice regarding using these medications. Conclusions: Community pharmacists have demonstrated adequate knowledge about correct administration escalation, storage, adverse effects, and other aspects of using Liraglutide and Semaglutide for weight loss. There is a knowledge gap between younger and older pharmacists.

Background: While warfarin and direct oral anticoagulants (DOACs) are used to manage thromboembolic events, they possess several features that impact adherence. Objective: To assess medication adherence and self-efficacy in patients receiving warfarin or DOAC treatment. Methods: A cross-sectional study was performed at Ibn Al-Bitar Hospital in Baghdad from December 2022 to May 2023 on patients receiving either warfarin or DOACs. The Arabic version of the Adherence to Refills and Medications Scale (ARMS) questionnaire and the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C) questionnaire were used to assess adherence and self-efficacy. Results: 181 patients were enrolled in the study, of whom 56.9% received warfarin and 43.1% received DOACs. The mean ARMS score was 13.71, and 81.77% of the patients were adherent to anticoagulant therapy. There was a significant difference in adherence between the warfarin and DOAC groups. The mean SES6C score for the participants was 50.01. Patients in the DOAC group had significantly higher self-efficacy compared to those in the warfarin group. The adherence score correlated significantly with patients’ gender, education level, hospitalization and duration of anticoagulant use, while the SES6C score did not correlate with any of the independent variables. There was a significant negative correlation between self-efficacy scores and medication adherence scores. Conclusions: Patients receiving DOACs showed a higher self-efficacy to manage chronic diseases and lower medication adherence as compared to warfarin. Higher self-efficacy was associated with higher adherence to treatment.

Background: Using dual-energy X-ray absorptiometry, body fat mass has been determined. The assessment of body fat mass was conducted utilizing dual-energy X-ray absorptiometry analysis of the pelvis and vertebral column. While it is acknowledged that osteoporosis can impact both body fat mass and bone mineral density, the particulars of this relationship currently remain uncertain. Objective: The aim of the present investigation is to assess gender differences in the effects of osteoporosis on the body fat mass of the upper and lower extremities. Method: 170 individuals participated (85 males and 85 females) in this study. Patients who presented with bone discomfort consisted of 40 males and 40 females. In addition, 90 apparently healthy volunteers, consisting of 45 males and 45 females, were studied and considered to constitute the control group. Dual-energy X-ray absorptiometry was utilized to determine the bone mineral density and body fat mass of every participant for all body parts. Results: Statistically significant disparities in body fat mass were observed between males and females, as well as between the control group and patients diagnosed with osteoporosis. Conclusions: Our results indicate that the patients with osteoporosis showed an increase in body fat mass (for both sexes). Other results obtained from this research revealed that females were more frequently suffering from osteoporosis than males.

Background: Methylenetetrahydrofolate reductase (MTHFR) C677T is a single nucleotide polymorphism (SNP) that affects the production of 5-methyltetrahydrofolate (5-MTHF), the active folate that enables the recycling of homocysteine (Hcy) to methionine. Objective: to investigate the association between the MTHFR (C677T) polymorphism and the outcomes of intracytoplasmic sperm injection (ICSI). Methods: A prospective cohort study included 85 infertile women undergoing ICSI treatment at the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies in Baghdad, Iraq. The study period extended from January 2022 to September 2023. The MTHFR C677T polymorphism genotyping was evaluated in these patients, and they were classified into three groups according to genotyping results: normal (CC), heterozygote mutated (CT), and mutated homozygote (TT). In addition, we conducted a comparative analysis of oocyte, embryo and pregnancy rates among these three groups. Results: In comparison to the CT and TT genotypes, the total number of oocytes, total embryos, mature oocytes, good-quality embryos, and pregnancy rate were all found to be significantly higher (p<0.05) in the CC genotype. Compared to the CC group, the proportion of immature oocytes and poor-quality embryos was significantly higher in the TT and CT groups (p<0.05). The rate of fertilization was comparable among the study groups. Conclusions: The maternal MTHFR C677T polymorphism is linked to oocyte number, maturity, total embryo, embryo quality, and pregnancy in ICSI. In light of this, MTHFR polymorphism in our community offers useful data regarding the success of ICSI.

Background: L-methioninase is an enzyme that was found in Pseudomonas spp. It changes L-methionine into α-ketobutyrate, ammonia, and methanethiol. It has been thoroughly investigated for possible antibacterial and anticancer activities. Objective: The goal is to find out how well L-methioninase kills colon CaCo-2 and liver HepG2 cancer cells. Methods: The enzyme was taken from 33 different types of Pseudomonas, and their ability to make L-methioninase was tested on M9 media that had been changed. An MTT assay was used to evaluate the cytotoxic activity of HepG2 and CaCo2 cell lines. Results: Only 15 isolates were able to make L-methioninase. The best isolate had a specific activity of 1.4 μg/U protein. The enzyme's cytotoxicity showed that it stopped the growth of the HepG-2 cell line with an IC50 of 67.44 μg/ml, compared to an IC50 of 140.0 μg/ml for the crude enzyme, and it stopped the growth of the CaCo-2 cell line with an IC50 of 20.57 μg/ml, compared to 154.3 μg/ml for the crude enzyme. Conclusions: Isolation of L-methioninase from microbial sources can be an efficient source to produce this cytotoxic agent.

Background: Pleomorphic adenoma of the minor salivary gland is a rare benign tumor. It commonly occurs in the hard and soft palates. Treatment by surgical excision achieved success in improving the patient’s health. Objective: To evaluate the recurrence rate after surgical treatment of pleomorphic adenoma in minor salivary glands. Methods: This retrospective study included patients who attended the Maxillofacial Surgery Unit in Ghazi Al-Hariri Hospital, Baghdad, from 2019 to 2021, complaining of soft tissue lumps involving the soft and hard palate, buccal mucosa, and upper lip. After the provisional diagnosis of these lesions, a total surgical excision of the tumor with a safe margin of 1 mm was performed, and the biopsy was sent for histopathological examination. A follow-up evaluation was performed for all patients two years after surgery. Results: Twenty-three patient data sheets with minor salivary gland pleomorphic adenoma were screened and initially included in this study. Only 12 patients (8 males and 4 females) were eligible, and 11 were excluded. Out of the patients who had total surgical excision, two women experienced tumor recurrence during the follow-up period. One had an ulcerated pleomorphic adenoma in the hard palate, and the other had a pleomorphic adenoma in the soft palate with mucosal tethering. Conclusions: Wide surgical excision is a successful treatment to decrease the recurrence rate, especially in cases of ulceration and tethering.

Objectives: To assess the qualifications and performance of newly graduated pharmacists and explore factors that affect their performance in public hospitals. Methods: This qualitative study included face-to-face, semi-structured interviews with hospital practitioner pharmacists. It was conducted between March and May 2023 in Kerbala province, Iraq. The participating pharmacists were selected purposefully because they had three or more years of work experience at governmental hospitals. The audio-recording interviews were transcribed. Thematic analyses were used to generate themes and subthemes from the interviews. Results: Twenty-seven hospital pharmacists participated in this study. The study found that there are several factors that have a negative impact on the performance of newly graduated pharmacists, including college-related and hospital-related factors. Education factors include classic methods of college teaching and the inadequate qualifications of new colleges. Hospital features, including inadequate qualifications for continuous medical education, tools and resources, can also impact pharmacist performance. Additionally, the overwhelming number of pharmacists negatively impacts their training and qualifications. Conclusions: Greater emphasis should be placed on enhancing the pharmacists' practical skills. Close and integrated collaboration between the Ministry of Higher Education and the Ministry of Health is pivotal to enhancing the performance level of prospective pharmacists in hospitals. Finally, controlling the number of admitted students to pharmacy colleges is critical to providing them with adequate training.

Objective: To explore the beneficial effects of azilsartan in rat models of burn wounds. Methods: Forty male rats were divided into four groups: The negative control group (NC) of 4 animals used as controls. Positive control group (PC), azilsartan-treated group (AZ), and silver-sulfadiazine group (SV). Each group consisted of twelve rats with burn injuries, subdivided into three subgroups each of four (euthanized on days 7, 14, and 21 post-burn injury induction). Results: The levels of RBC, platelets, and HGB in the treated groups did not vary significantly. The AZ group had significantly greater WBC levels, while the AZ and SV groups had significantly higher lymphocyte levels than the PC group. After 7 days of treatment, both the PC and AZ groups showed a significant improvement in lesions and burn area, but the SV group showed no significant improvement. The improvement was considerable after 14 days of treatment in the SV-treated group and the AZ group, with no meaningful changes evident after 7 days of treatment in either of the indicated groups. When compared to the initial day of induction, no significant reduction was found in the PC group after 7 and 14 days of treatment. After 21 days of induction, the control group showed a considerable reduction in lesion and burn area. On the last day of treatment, however, the AZ and SV groups showed a more dramatic decline. Conclusions: Azilsartan heals the burnt area effectively, which could be related to limiting the local effects of Ag II, and deserves to be evaluated in a clinical environment..

This segment explores spirituality in elderly care, emphasizing its significance and challenges. It highlights Cicely Saunders' pioneering holistic approach integrating spirituality into patient care, especially in palliative settings. The lack of universally defined research concepts and cultural diversities impeding the understanding of spiritual care practices in elderly care environments is emphasized. It underscores how contemporary secular societies redefine spirituality from traditional religious institutions, yet its importance in addressing existential questions remains intact. We outline the study's methodology evaluating spirituality's impact on elderly quality of life in Iran. It details the systematic review and meta-analysis used to synthesize findings from relevant studies, assessing the influence of religious-spiritual education, notably theotherapy, on quality of life. Factors affecting intervention efficacy, such as cultural norms, are discussed. The study showed the positive outcomes post-intervention, indicating improvements in various life quality dimensions. The potential of theotherapy is noted, acknowledging cultural influences on effectiveness. Insights into spirituality's role in emotional stability, leadership, and organizational practices within Malaysian contexts, particularly amidst Industry 4.0, are presented. The need for comprehensive caregiver education and incorporating culturally aligned religious-spiritual education for the elderly's well-being is underscored. Additionally, the significance of emotional stability and effective organizational practices in Malaysia's evolving socio-economic context for quality care among elderly is emphasized. This conclusion stresses the holistic approach necessary for optimized elderly care and organizational success.

Objective: To provide an overview of the status of applying genome editing, particularly CRISPR/Cas9, in the management of cancer. Method: Several search tools were consulted in the preparation of this manuscript to obtain peer-reviewed articles using the given evaluation and selection criteria. Main points: CRISPR/Cas9 and its associated variants stood out as the technology of choice for manipulating cancer cells and managing the disease. This genome-editing technology can positively contribute to the elucidation of the roles of cancer genes, establish animal models to study the disease, and therapeutically empower the development of next-generation immunotherapies. Conclusions: The manipulation of the human genome using CRISPR/Cas9 to treat cancer has only recently begun. Several clinical trials are ongoing, and the results are eagerly awaited. In the meantime, improvements and advancements in genome editing are being developed at a rapid pace to take advantage of this evolving technology.

Background: Acromegaly is a rare endocrine disorder; it has an incidence of 4 per million annually and a prevalence of 40 per million. It is due to a growth hormone-secreting pituitary adenoma. Objective: To evaluate the levels of β-arrestin in patients with acromegaly with and without obstructive sleep apnea (OSA). Methods: One hundred and five registered patients with acromegaly at the National Diabetes Center, Mustansiriyah University, were enrolled in the study. Of the 105 patients with acromegaly, 81 have OSA, while the remaining 24 have no OSA. Obstructive sleep apnea affects 81.8% of males and 72% of females. All recruited patients have given oral consent to participate in the study, which was conducted from January to October 2023. Results: Males with OSA had a mean age of 52 years, while those without OSA had a mean age of 46 years. The Epworth sleepiness scale is higher among those with OSA. β-arrestin is higher in males with OSA (6.309 pg/ml), while in females with OSA, it is 6.278 pg/ml. In no OSA group, the β-arrestin level was 3.067 pg/ml, while in those with OSA, it jumped to 6.29 pg/ml. Conclusions: The results showed that β-arrestin was elevated in patients with acromegaly and obstructive sleep apnea versus those without obstructive sleep apnea. OSA is more common in males, particularly when they get older.

Background: Extravasation and sepsis are two of the many side effects linked to the use of intravascular devices during parenteral nutrition (PN). Objective: To assess the incidence of sepsis and extravasation in Iraqi neonates receiving PN in the critical care unit. Methods: From January 27, 2022, to January 15, 2023, a case-series prospective study was carried out in two tertiary neonatal intensive care units (NICUs) in Children Welfare Hospital and Baghdad Teaching Hospital, Baghdad, Iraq. The study reports the rate of sepsis and extravasations and correlates their occurrence to other neonatal features. Results: Of the 94 newborns examined, 24 patients (25.5%) experienced 35 instances of stage IV extravasation, and 34.04% of them experienced 40 episodes of sepsis in total. They have a strong and significant correlation with the newborns' body weight, treatment duration, gestational age, and postnatal age. Conclusions: The administration of PN to neonates in Iraq has been linked to severe side effects such as sepsis and extravasation.

Background: Meclizine hydrochloride (MCZ) is an antihistamine that is used as an antiemetic to prevent and cure nausea and vomiting. Because of its limited water solubility and first-pass metabolism, it exhibits variable absorption. Objective: To formulate and evaluate MCZ as an intranasal in situ gel with increased residence time and permeability. Methods: We made an inclusion complex of MCZ using various cyclodextrins as a complexing agent to help the drug dissolve better. The complexes were studied, and the ones that were better at dissolving were chosen to be used in the creation of an in situ gel with poloxamer 407 (17–20% w/v) and hyaluronic acid (0.25–0.75% w/v). Prepared formulas were subjected to various evaluation tests, and the optimum formula was subjected to an ex vivo permeation study. Results: Hydroxypropyl-cyclodextrin (HP-CD) complexation increased the solubility of MCZ. A prepared complex (10 mg of MCZ) was used for nasal in situ gel preparation. Formula (F3) containing 17% poloxamer 407 and 0.75% hyaluronic acid exhibited favorable characteristics, including optimal gelation temperature (33.33°C), drug content (100.51%), gel strength (35.0 seconds), spreadability (4.2 cm), and 98.52% in vitro drug release over 5 hours in simulated nasal fluid (pH 6.8), and provided considerably high permeability. Conclusions: A mucoadhesive in situ gel formulation of MCZ (HP-β-CD) is a promising nasal formulation for the management of nausea and vomiting.

Background: Diabetic cardiomyopathy (DCM) is a serious complication of poorly managed diabetes. Inflammation, hyperglycemia, oxidative stress, hyperlipidemia, and other factors all play a role in DCM pathogenesis. Objective: To investigate the cardioprotective effects of cardamom oil-loaded lipid carrier nanoparticles (CEO-LC NPs) on streptozotocin (STZ)-induced diabetes in rats. Methods: Twenty-four male rats were randomly divided into four groups of six each. STZ (50 mg/kg) caused diabetes in all groups but the negative control. The diabetic control group (G1) received a normal saline solution. For 28 days, group G2 received CEO-LC NPs (600 mg/kg), group G3 received empagliflozin (10 mg/kg), and group G4 (no diabetes) received normal saline as a negative control. On day 29, blood samples were taken to determine blood glucose, cholesterol, LDL, HDL, and triglyceride levels, as well as oxidative stress markers. Additionally, atherogenic indices were calculated. Heart tissue was sent for histopathological examination. Results: In diabetic rats treated with CEO-LC NPs, serum glucose, cholesterol, LDL, and triglyceride levels were significantly reduced, while HDL levels increased. The CEO-LC NP treatment also reduced oxidative stress by increasing total antioxidant capacity while decreasing malondialdehyde (MDA). Furthermore, diabetic rats treated with CEO-LC NP had significantly lower AIP, CRI-I, and CRI-II ratios. Conclusions: CEO-LC NPs improve cardioprotection in STZ-induced diabetic rats by lowering plasma lipid levels and oxidative stress.

Background: Ultrasound is a valuable tool for evaluating fetal problems throughout pregnancy. Amniotic fluid anomalies have been associated with unfavorable maternal, fetal, and obstetrical outcomes. Objective: To determine the effect of echogenic amniotic fluid during term pregnancy on the presence of meconium stain liquor and pregnancy outcome. Methods: A cross-sectional study was conducted on 1080 term pregnant women who visited Al-Elwiya Maternity Teaching Hospital from May 1st, 2021, to May 1st, 2023. Ultrasound was used to analyze echogenic amniotic fluid and turbid liquor. The liquor state was tested either after an artificial membrane rupture in the vaginal delivery trial or during a cesarean section. Results: Echogenic amniotic fluid or turbid liquor was detected in 120 cases, while clear liquor was found in 960. Meconium-stained amniotic fluid was discovered in 39 of the 120 instances with turbid liquor, whereas bloody liquor was found in four. In contrast, clear fluid with vernix caseosa was identified in 55 cases, while just 22 cases had clear liquor. Clear liquor was found in 640 of the 960 cases, vernix caseosa liquor in 200, and meconium-staining liquor in only 120 cases. Conclusions: Presence of echogenic amniotic fluid or turbid liquor increases the chance of meconium-stained liquor, but it could also be caused by vernix caseosa. Other indicators, such as fetal movement and the non-stress test, should be used to determine the manner of delivery.

Dental trauma occurs unexpectedly and without prior notice. Dental practitioners and their offices must be adequately equipped to quickly and properly treat patients who require emergency and urgent intervention to ensure the best possible outcome, and as soon as possible, with proper management protocols that will affect the future prognosis of the affected teeth. This report covers the case of a 13-year-old female patient who suffered partial subluxation of her left maxillary central and lateral incisors, difficulty closing her mouth, and soft tissue laceration. The case was treated immediately following the approved protocol and monitored for three years until the soft tissues were completely healed and the anterior permanent teeth were properly aligned.

Background: Essential cytokines like tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) play a critical role in immune regulation, particularly in conditions like polycystic ovary syndrome (PCOS). Objective: To compare TNF-α and IL-10 levels in patients with and without PCOS undergoing intracytoplasmic sperm injection (ICSI) and their effects on ICSI. outcome Methods: This study involved a cohort of 125 patients undergoing ICSI, divided into two groups: those identified with PCOS according to Rotterdam criteria (n=65) and those without PCOS (n=60). The ELIZA method was used to measure the levels of TNF-α and IL-10 in the blood in order to see if they were related to PCOS and to look into a possible connection between these cytokines and the outcome of the ICSI. Results: Significant differences were found in the serum levels of TNF-α and IL-10 between the two groups, suggesting a distinct immunological profile in PCOS patients undergoing fertility treatment. There is no significant correlation between these cytokines and the total number of retrieved oocytes, oocyte maturity, fertilization rate, or pregnancy rate. Conclusions: The study revealed notable differences in serum TNF-α and IL-10 levels between PCOS and non-PCOS groups, suggesting a unique immunological profile in PCOS patients undergoing fertility treatments. Both cytokines did not significantly correlate with the total number of retrieved oocytes, oocyte maturity, fertilization rate, or pregnancy rate. Other factors might be more influential in determining crucial fertility outcomes.

Background: Entamoeba histolytica is the causative agent of amoebic dysentery and hepatic abscesses. Despite the efficacy of metronidazole in alleviating infectious diseases, the global dissemination of drug-resistant parasites raises the possibility that Punica granatum could serve as an effective natural alternative treatment. Objective: To evaluate the effect of P. granatum methanolic and aqueous extracts of various parts against E. histolytica trophozoites in an in vitro setting. Methods: Various concentrations (0.14, 0.7, 1.4, and 2.8 mg/ml) of P. granatum extracts of the flowers, leafs, peels, and seeds were chosen for this purpose. A culture medium containing 0.05x106/ml E. histolytica trophozoites was treated with different concentrations of these extracts. The incubation period was 48 hours at 37°C. For every set, an untreated control was also performed. The standard medication metronidazole (17 μg/ml) was employed as a comparative control. Results: All parts of P. granatum showed high efficacy against E. histolytica trophozoites, but utilization of the methanolic extract proved to be quite effective compared to aqueous extract. Under a light microscope, several morphological changes were also seen. These include changes to the plasma membrane, reorganization of vacuoles that hold cell waste, and major changes to the cytoplasmic granules. Conclusions: The leaf, seed, flower, and peel extracts of P. granatum effectively inhibit the growth of E. histolytica trophozoites in vitro. The use of methanolic extract was more effective compared to the aqueous extract, and can be used as a natural alternative treatment for amoebic dysentery.

Background: Psoriasis is a chronic inflammatory skin condition that affects multiple systems. Topical therapy is one of the most important modalities in the treatment of this disease, and efforts are directed toward developing more effective topical therapies. Objective: To investigate the possible anti-psoriatic effect of Nebivolol 5% topical cream in mice based on observational, histopathological, and biochemical outcomes. Methods: Forty-five male Swiss Albino mice were divided into five groups; each group contained nine mice with shaved dorsal skin. Group I remained as the control group while the rest of the groups were induced psoriasis by Imiquimod (IMQ) for six consecutive days and underwent different interventions for each group for eight consecutive days, including administering Nebivolol 5% topical cream. The clinical, pathological and laboratory effects were then measured. Results: Topical nebivolol significantly reduced the inflammatory signs of the psoriatic lesions, and these findings were supported by the histopathological examination. Topical Nebivolol also significantly decreased IL-17 levels, as well as Tumor Necrosis Factor-alpha (TNF-α) levels and Vascular Endothelial Growth Factor (VEGF) levels, in comparison with the non-treated Imiquimod-induced psoriatic mice group. Conclusions: Nebivolol has a comparable anti-psoriatic effect to the effect of clobetasol due to its anti-inflammatory and antioxidant effects. It could be a promising future treatment for psoriasis as an alternative to steroids.

Background: The roles of AI in the academic community continue to grow, especially in the enhancement of learning outcomes and the improvement of writing quality and efficiency. Objectives: To explore in depth the experience of senior pharmacy students in using artificial intelligence for academic purposes. Methods: This qualitative study included face-to-face individual interviews with senior pharmacy students from March to May 2023 using a pre-planned interview guide of open-ended questions. All interviews were audio-recorded. Thematic analysis was used to analyze the data. Results: The results were obtained from 15 in-depth face-to-face interviews with senior pharmacy students (5th and 4th years). Eight participants were male, and seven were female (21–25 years old). All participants used ChatGPT for a few months for academic purposes, especially when writing take-home assignments. The perceptions were positive about the students’ gains from using ChatGPT. Still, at the same time, they admitted that AI might negatively impact the student’s motivation to learn new academic skills. Conclusions: The students believed that AI was very helpful, with concerns that it did not enhance their critical thinking or writing skills. Thus, educators need to change their strategies for teaching and testing students to improve student skills and identify students’ own work.

Background: Chemokines and toll-like receptors (TLR) have a synergistic role in the initiation and progression of breast cancer. TLR-4 is involved in the invasiveness of cancerous cells. Interleukin-8 (IL-8) has a significant role in boosting the angiogenesis and growth of cancer cells. Objective: To measure the level of soluble TLR-4 and interleukin-8 in patients with breast cancer and to study the possibility of using them as diagnostic and prognostic biomarkers in these patients. Methods: The study enrolled a total of 200 female subjects: 100 patients who were diagnosed with breast cancer and 100 healthy controls. Soluble TLR-4 and IL-8 levels in the blood were evaluated by the enzyme-linked immunosorbent assay. Results: upregulated levels of soluble TLR-4 as well as interleukin-8 in individuals with breast cancer compared to controls (5.79 vs. 1.01 ng/ml for TLR-4 and 29.1 vs. 7.1 pg/ml for IL-8). The concentration of soluble Toll-like receptor-4 besides interleukin-8 is significantly higher in stage IV than in other stages. A substantial increase in these biomarkers in grade 3 was detected compared to other grades. ROC curves show that both biomarkers were useful in differentiating between healthy females and those who have breast cancer. Conclusions: High concentrations of soluble TLR-4 as well as IL-8 have been linked to advanced stages of breast cancer, and these markers were effective in detecting the disease and predicting its prognosis.

Background: There have been cases of acute pancreatitis brought on by steroids, but identifying it is challenging and necessitates careful monitoring. However, according to new research, 3–5% of all cases of illness may be caused by drug-induced acute pancreatitis, making it the third most common cause. Objective: Evaluation of the effect of hydrocortisone injections on pancreatic structure immunohistochemically using BAX and eNOS markers. Methods: White New Zealand female rabbits weighing between 1.2 and 1.5 kg were used, and they were given free access to food. The rabbits were split into six groups, with five animals in each group receiving intramuscular hydrocortisone injections for 14 and 21 days, respectively, at a dose of 5 mg and 20 mg/kg for short and long durations, and two control groups. Results: There was an increase in weight in both long-duration groups (GL1 and GL2) after week 2 of injection when compared to both control and short-duration groups. There was a highly statistical difference in the expression of BAX in both short- and long-duration groups compared to the control group, and there was also a decrease in the expression of BAX when duration increased. Similarly, there was a highly statistical difference in the expression of eNOS in both the GS and GL groups when compared to the control group. Conclusions: The pancreas can be injured by high and low doses of hydrocortisone if used for more than 2 week

Background: Insulin resistance (IR) is commonly associated with obesity, which plays a role in the pathogenesis of reproductive disorders. Objectives: To evaluate the impact of insulin resistance and obesity on ICSI outcomes in Iraqi infertile females. Methods: Ninety women who were unable to conceive received an intracytoplasmic sperm injection and have various infertility causes; Age range: 18–40 participated in this prospective clinical cross-sectional study. Three groups of patients were formed based on their body mass index (BMI) rankings. The ovarian hyperstimulation antagonist protocol was administered to all women. Serum glucose, insulin and HOMA-IR were measured for all participants on the ovum pickup day. In addition, the results of ICSI were determined. Results: The insulin levels and HOMA-IR were significantly higher in obese females than in overweight and normal weight groups. There was significantly lower BMI, waist/hip ratio, and HOMA-IR in pregnant females when compared with non-pregnant ladies. There is a significant negative correlation between fasting insulin, HOMA-IR with metaphase II oocytes, maturation rate, grade 1 embryos and pregnancy outcome. The cutoff values of fasting serum insulin and HOMA-IR levels were ≤ 4.64 (ng/ml) and ≤ 1.1, respectively, as predictors of positive pregnancy in women undergoing ICSI. Conclusions: Insulin resistance impairs the ICSI outcomes of infertile women. Furthermore, obesity may increase the risk of insulin resistance in infertile women; therefore, enhancing HOMA-IR and BMI will positively impact ICSI outcomes.

Background: Polymorphisms in the TNF-α gene affect the development and progression of rheumatoid arthritis. Objective: To investigate the associations between (-806 T/C) and (-857 T/C) SNPs with rheumatoid arthritis severity and susceptibility in a sample of Iraqi patients. Methods: A case-control study was conducted in Baghdad, Iraq. Twenty healthy controls and 63 patients confirmed to be newly diagnosed with rheumatoid arthritis were included. Those are divided into two groups (patients and controls), and the patients were further subdivided into severe and mild-moderate groups. Samples from those participants were analyzed for clinical and inflammatory parameter measurements. Genotyping by the Sanger method was performed to study the SNPs. Results: No associations were demonstrated between rheumatoid arthritis and polymorphisms at positions -806 and -857. Additionally, there were no differences in the distribution of those SNP genotypes and alleles among the severe and mild-moderate groups. Also, the (-806 C/T) SNP was found to be correlated with DAS 28 in all patients and with hs-CRP in the mild-moderate group. Finally, the -857 C/T SNP was found to be correlated with TNF-α within the mild-moderate group. Conclusions: Polymorphisms at positions -806 and -857 were not associated with rheumatoid arthritis susceptibility, and the CT genotype of -806 C/T SNP was associated with disease activity.

Background: Acute myeloid leukemia (AML) is characterized as an aggressive blood cancer with rapid growth of immature leukemic cells. It appears that each subtype of AML displays a distinct miRNA profile. miRNAs play a role in regulating gene expression that is implicated in AML pathogenesis. Objective: This study was designed to assess the level of miRNA-126 gene expression in relation to chemotherapy resistance in various AML groups with the hope of developing a novel marker for targeted therapy and the early diagnosis and prognosis of cancer stem cells in AML patients. Methods: 120 AML cases were studied. Based on the chemotherapy stage, 40 patients were assigned to each group (newly diagnosed, under treatment, or relapsed). Baghdad Teaching Hospital, Iraq, provided the cases and samples from February 2022 to April 2023. This study also included 40 healthy controls. We used the qRT-PCR method to count the genes after setting them to the same level as a housekeeping gene (GAPDH). This method uses the ∆Ct-value and fold change (2-∆∆Ct). Results: In this study, there were significant elevated levels of miRNA-126 in AML patients compared to controls, with a higher fold change detected in the newly diagnosed group. Conclusions: The miRNA-126 upregulation is suggested to be linked to AML development and relapse, with a contribution to leukemic stem cell proliferation and treatment failure. We hypothesized that miR-126 could be an effective target for eradicating the LSC in AML.

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Background: Proper injecting technique ensures maximum effectiveness and minimizes the incidence of enoxaparin-related local side effects. Objective: To develop a pharmacist-led educational program and evaluate its benefit in improving the nurses' enoxaparin injecting technique for hospitalized patients. Methods: A pre-post study design was conducted from March to July 2023, involving nurses working the day shift at Baghdad Teaching Hospital. Nurses were given an interactive education through a brief lecture with open discussion and training on the correct enoxaparin injecting technique. A clinical pharmacist observed and recorded the enoxaparin injecting technique for each nurse twice: once at the start of the study and again after the nurse's enrollment in the educational program. Results: At the baseline level, only 12.5% of the participating nurses had a good technique for injecting enoxaparin. The nurse's gender, level of education, work history, or workplace did not significantly affect her poor enoxaparin injection technique. After enrolling nurses in the pharmacist-led educational program, the number of nurses with a good enoxaparin injection technique significantly increased from 12.5% to 59%. Conclusions: Effectiveness was improved considerably by the currently developed interactive pharmacist-led nurse education.

Background: Antimicrobial prescribing patterns have an important role in the emergence of resistance, and community pharmacists have a substantial influence on this issue. Objective: To assess community pharmacists' behaviors and attitudes toward antimicrobial dispensing, determine their proportion and categories, and examine the underlying rationales for this practice. Methods: A descriptive cross-sectional survey of community pharmacists in Iraq was conducted from June to August 2023, using a self-administered validated questionnaire. The attitudes, practices, and motivations driving the distribution of antimicrobials without a prescription (AWP) were explored in three areas. Results: A sizable proportion (61.6%) of respondents rejected dispensing AWP at community pharmacies. Patients primarily seek antibacterials from community pharmacies owing to budget constraints, according to 82.7% of respondents, rather than for consultation and diagnostic services. The most powerful element in a pharmacist's decision to administer AWP is that patients will seek antimicrobials from another pharmacy if they are not dispensed by the pharmacist, owing to the pharmacist's experience in infection management. The study found that 50%-74% of patients who visited community pharmacies sought AWP. Antimicrobials are most commonly provided without a prescription for cold and flu and urinary tract infections (37.3% and 27.7%, respectively). Conclusions: The majority of pharmacists regularly dispense AWP. To guarantee compliance with Iraqi legislation and laws governing AWP distribution, ongoing training programs should be created to educate the public on the most effective methods.

Background: There is a significant molecular response to imatinib given at standard doses in individuals with chronic myeloid leukemia (CML) whose ABCB1 polymorphisms are present. Objective: To investigate the impact of the polymorphism in the ABCB1 gene rs1128503 on the effectiveness of nilotinib or imatinib therapy. Methods: From May 2022 until the end of January 2023, the current study was carried out in a single research institution, the National Center of Hematology, Baghdad Teaching Hospital at Medical City, Iraq. 76 people with chronic phase myeloid leukemia (CML-CP), who had previously received a diagnosis using the European Leukemia Net (ELN) criteria, enrolled in the trial. The PCR product was delivered to Macrogen Corporation, Korea, for Sanger sequencing on an automated DNA sequencer, the ABI3730XL. After receiving the results by email, Geneious Prime software was used for analysis. Results: Patients receiving imatinib or nilotinib did not differ significantly in terms of age or gender. In contrast, BCR-ABL1 transcript levels were considerably greater at sampling in patients receiving nilotinib. Different types of the MDR-1 gene rs1128503 genotypes were not found in groups that were treated with either imatinib or nilotinib. Conclusions: BCR-ABL1 transcript levels are lower in patients still receiving imatinib than in those receiving nilotinib.

Background: Self-nanomicellizing solid dispersion is a new formulation that combines the advantages of solid dispersion with nanomicelle methods to increase drug oral bioavailability. The technique employs an appropriate carrier to produce a solid dispersion that self-assembles into nanomicelles when in contact with gastrointestinal fluids, improving medication solubility and absorption. Objective: The study aims to develop a self-nanomicellizing solid dispersion of canagliflozin and compare it to non-nanomicellizing formulations. Methods: The solvent evaporation approach was chosen to create a solid dispersion system with soluplus and poloxamer 407 as carriers. Different canagliflozin-to-carrier ratios were investigated in order to develop nanomicellar systems with improved canagliflozin dissolving characteristics. Solid-state analysis was used to characterize the optimum self-nanomicellizing and non-self-nanomicellizing formulations. Results: The physicochemical tests revealed that canagliflozin's crystalline structure transitioned to an amorphous state in the solid dispersion system of both carriers, as evidenced by powder X-ray diffraction and differential scanning calorimetry. Particle size analysis reveals that only soluplus, in all ratios tested, produces self-nanomicellizing solid dispersion of canagliflozin, whereas poloxamer 407 does not. Self-nanomicellizing systems incorporating soluplus had a faster dissolving profile than pure drug and non-self-nanomicellizing formulae. Conclusions: Canagliflozin nanodispersion systems with Soluplus as a carrier may improve solubility, dissolving rate, and bioavailability.

Background: Needle-stick injuries cause occupational health and safety challenges for healthcare workers on a global scale. Needle-stick injuries can potentially expose individuals to dangerous blood-borne pathogens. Objectives: To determine the prevalence of needle stick injuries and their main causes, as well as the nurse’s behavior after being injured by needle stick injuries. Methods: A self-reported cross-sectional study was conducted in Sulaimani city governmental and non-governmental tertiary hospitals in the Kurdistan Region of Iraq. The data was collected by constructing a questionnaire form from 300 nurses who provide medical care by non-probability convenience sampling from October 1, 2022, to March 1, 2023. Results: 74.3% of the 223 nurses who participated in the study experienced needle stick injuries. The needle syringe (88.7%) was the most common tool involved. The sterilization of wound area 48.9% was the number-ranked action of the nurses after injury, followed by pushing the injured area 28.4% to drain blood. Most of the nurses did not receive post-injury prophylaxes (57.4%) or send their blood to additional tests (73.1%). Conclusions: Syringe needles were a major cause of the needle sticks, which injured three out of four participants. Additionally, the nurses' top priority after receiving a needle stick was to sterilize the exposed portion of the wounds.

Background: Inflammatory bowel disease (IBD) is a collection of chronic, recurrent inflammatory illnesses of the gastrointestinal system, including Crohn's disease (CD). Infliximab is one of the biological medications used to treat CD. Therapeutic drug monitoring has evolved as a treatment in IBD, aiming to optimize benefit while meeting more demanding, objective end criteria. Objective: To determine the achievement of target trough level (TL), develop anti-drug antibodies (ADAs) to infliximab, assess response to therapy, and study TL relations with different variables. Methods: The present study was cross-sectional and conducted from May 2022 to November 2022. It included 40 CD patients allotted into 2 groups: group 1 patients achieved the TL target and group 2 patients did not achieve the TL target. Results: Twenty-two patients achieved target TL, while 18 patients did not. Dose escalation is recommended for 11 patients, switching therapy for 15 patients, and continuing the same dosage regimen for 14 patients. In addition, erythrocyte sedimentation rate, C-reactive protein, serum calprotectin and ADAs were significantly lower in patients who achieved target infliximab TL. Only serum calprotectin can be used to predict the achievement of the target TL of infliximab. Conclusions: Therapeutic drug monitoring of infliximab to determine the TL and ADAs can help to explain why some patients do not respond to this drug. Serum calprotectin may be used as a novel marker to predict the TL and response to infliximab.