Al-Rafidain Journal of Medical Sciences

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Background: Although obstructive sleep apnea is the most common sleep-disordered breathing, there are fewer studies estimating the prevalence of OSA and its risk factors in urban and rural populations in Odisha. Objective: To estimate the prevalence and risk factors of obstructive sleep apnea in a tertiary care teaching hospital in Odisha, India. Method: It is an observational, retrospective study that was conducted in a sleep study lab for a duration of 4 years (January 2016 to December 2019) by the Department of Physiology and Department of Pulmonology of a tertiary care teaching hospital in Odisha. Patients were first screened for high-risk sleep apnea disorder by the Berlin questionnaire, and then they underwent a level 1 sleep study. Results: Total study patients were 1423, of whom 718 and 705 were from urban and rural areas. The mean age of urban and rural patients was 50.81±12.5 years and 51.63±15.3 years, respectively. The prevalence of OSA in urban areas by AHI criteria was 5.9%, and in rural areas it was 4.9%. The mean AHI of urban OSA patients was 37.86±23.46 and that of rural patients was 16.96±13.8. Conclusion: The prevalence of OSA was higher in urban areas than in rural areas. Both BMI and NC were higher for urban patients than for rural patients. The risk factors were mainly diabetes mellitus and hypertension.

Background: Diabetic nephropathy (DN) is a highly malignant chronic microvascular complication of diabetes that is the principal cause of end-stage renal disease (ESRD). Objective: The purpose of this study is to ascertain the correlation between diabetic nephropathy and Tenascin-C (TNC), in addition to quantifying TNC levels at different phases of this pathogenesis. Methods: Thirty healthy subjects and ninety T2DM patients participated in this cross-sectional study. Patients were divided into three groups according to the albumin-creatinine ratio (ACR): normal albuminuria, microalbuminuria, and macroalbuminuria. By employing an ELISA reagent, the serum TNC concentration was ascertained. Results: Significant disparities were observed in the concentrations of TNC and FBG, TC, TGs, HDL, LDL, and VLDL between individuals with diabetic nephropathy and those who were in good health. There were also substantial differences between the levels of TNC and kidney function in patients with various disease stages. Furthermore, a noteworthy positive correlation was identified between TNC and blood concentrations of ACR, urea, and creatinine. Conclusions: Based on the available evidence, it can be deduced that TNC may serve as the most precise predictor of diabetic nephropathy and may be associated with its progression.

Background: The Corona virus pandemic had a crushing impact on the mental health of medical undergraduates. Objective: The current research was conducted to evaluate the prevalence of psychological impacts, viz., anxiety, stress, and depression, in undergraduates undertaking medicine courses and assess their quality of life. Methods: A prospective cross-sectional study was undertaken with an online questionnaire using Google with a WhatsApp link. Informed consent (online) was obtained before enrollment in the study. This study used the DASS-21 questionnaire and a Quality of Life questionnaire for analysis. The total number of participants was 559 during the study period. Descriptive statistics, the non-parametric Chi-square test, the binomial test, the Kruskal-Wallis test, and the Mann-Whitney test were used for analysis. p<0.05 was considered to be statistically significant. Results: Out of 559 respondents, the majority were 21 years of age or older, with a male predominance of 60.6%. It was found that those who were smoking or consuming alcohol had higher DAS scores. Quality of life (QoL) was lower for those who were on medication for hypertension. Stress levels were significantly higher in males. The relationship between anxiety levels and males was statistically significant. Conclusions: COVID-19 had a psychological impact on the medical students. Therefore, early evaluation, timely intervention, and student counseling services need to be made available to solve this problem and remain prepared for all potential future pandemics.

Background: Hand parameters have been suggested to be useful indicators for gender identification. Objective: To detect gender from hand parameters in a sample of Iraqi individuals. Methods: Hand parameters (hand length, width, hand index, index and ring lengths, and index to ring ratio) of 100 participants were measured using traditional techniques. The data were tested statistically using appropriate statistical methods. Results: Females display a higher 2D/4D ratio compared to males. In contrast, males show a higher hand index compared to females. The study proposes a 2D/4D cutoff point of 0.9722, where a ratio < 0.9722 was regarded as male and a ratio ≥ 0.9722 was regarded as female. Alternatively, a hand index (HI) cutoff point was 40.2154, where an HI > 40.215 was regarded as male and an HI ≤ 40.215 was regarded as female. Consequently, the study verifies that hand parameters can be used for gender determination in medical legal examinations. Conclusion: Hand parameters may be valuable indicators of sexual dimorphism in medico-legal examination and may have a great implication in cases of natural disasters and wars when an isolated hand is subjected to examination.

Background: One way to target polypharmacy and inappropriate medication in hemodialysis (HD) patients is with medication deprescribing. Objective: To assess the impact of implementing a pharmacist-led deprescribing program on medication adherence among HD patients. Method: A prospective interventional, one-group pretest-posttest-only design study was conducted at a hemodialysis center in Wasit Governorate, Iraq. Medication reconciliation followed by medication review based on the deprescribing program was done for all eligible patients, and the patients were monitored for three months for any possible complications. Results: Two hundred and seventy patients were screened for eligibility. Only one hundred and eighteen were enrolled in the deprescribing program. The median age was 51.5 years, 56.8% were males, and hypertension was the most common etiology for their chronic kidney disease (CKD); 78% had comorbidities. After deprescription, there was a significant reduction in the number of medications from 6.0 to 4.0 and a reduction in the number of pills from 7.0 to 5.0. Medication adherence accessed using the Arabic version of Morisky, Green, and Levine’s (MGL) adherence scale also had a significant reduction from 2.0 to 1.0. Conclusion: A pharmacist-led deprescribing program is a successful strategy for decreasing the number of medications and daily pills prescribed while simultaneously improving hemodialysis patients' adherence to their regimens without compromising the patient’s safety.

Background: Acute pancreatitis is a complex and challenging disease. The revised Atlanta Classification emphasizes accurate characterization of collections that complicate acute pancreatitis and standardizes terminology across specialties, which helps to decide the treatment strategy. As a result, the role of imaging in the management of acute pancreatitis has substantially increased. Objective: This study aimed to categorize the fluid collections in acute pancreatitis using the 2012 ATLANTA classification and to compare the type of collection with the patient's clinical variables like length of hospital stay, ICU stay, presence of organ failure, type of organ failure, presence of infection, and outcome. Methods: This descriptive cross-sectional hospital-based study was conducted for two years. A total of 120 patients with acute pancreatitis-associated fluid collections were included in the study. Results: In our study, hospital and intensive care unit admission, as well as the length of stay, presence of organ failure, presence of infection, and the patient's outcome, all showed statistically significant relationships with walled-off necrosis (WON). Conclusions: The revised ATLANTA classification provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria and thereby helps to determine the proper patient outcome and management.

Background: Tazarotene (TZ) is a novel acetylenic class retinoid that selectively targets RARβ/γ. It is not particularly soluble or bioavailable, yet it is used to treat melanoma. Objective: To improve the tazarotene gel formula's transdermal distribution. Methods: TZ-incorporated binary ethosomes (TZ-BES) were developed for the current study. The cold technique and optimized Box-Behnken statistical design tools were used to synthesize the TZ-BES. The improved ethosome (TZ-BES13) was mixed with carbopol gel and tested for stability and ex vivo skin penetration, as well as viscosity, pH, spreadability, and drug content. Results: The optimal ethosomes (TZ-BES13) had a vesicle size of 168 nm, a PDI of 0.367, a zeta potential of -30 mV, and an entrapment effectiveness of 79.94%. TZ is enclosed in the ethosome matrix, as seen by the differential scanning calorimetry thermogram. FTIR shows that the TZ and additives are compatible. TZ-BES13-G2, the optimized TZ-BES13 gel, has a spreadability of 7.82 cm2, a pH of 6.52, a viscosity of 17235, and a drug content of 99.82±1.04%. Compared to the plan TZ-gel (43.54%), the TZ-BES13-G2 exhibits a much higher TZ release (89.22%). In 6 hours, rat abdomen skin permeability for TZ-BES13-G2 was 66.22±3.31%, much greater than that of plan TZ-gel (24.67%). The flow of TZ-BES13-G2 was 2.68 times greater than that of plan TZ-gel. The stability analysis showed that the formulation's properties had not changed significantly. Conclusion: Ethosomal gel offers an alternative mode of TZ administration when used topically.

Background: An increase in terminal hair in androgen-dependent regions is known as hirsutism. It is not solely caused by hyperandrogenemia; idiopathic forms are also frequently seen. Objective: To examine the modified Ferriman Gallwey (mFG) cut-off score in female Iraqis as well as the etiological, biochemical, and clinical characteristics of hirsutism. Methods: This prospective cross-sectional study included one thousand young girls with a normal BMI. The features associated with clinical hirsutism were identified using the mFG scoring system. We eliminated eighty-eight young girls who were diagnosed with PCOS. Samples of blood were drawn for biochemical analyses. Results: 53.1%, 19.6%, and 1.2% of females had mild, moderate, or severe hirsutism, respectively. For the young females participated in the study, their mean mFG scores were 7.07, 11.26, 16.26, and 29, respectively. Only 5% of girls with mild hirsutism had high serum free testosterone levels, despite a considerable difference in free testosterone levels between them and the normal girls. The chin, upper lip, and lower abdomen were the sites that contributed the most to mFGs. Of the girls who were moderately hirsute, 55% had a positive family history of hirsutism. Conclusion: Iraqi women do not need to consider the mFG score system's cut-off number of 8. The endocrine society's guidelines for hirsutism estimation should be adhered to by the examiner.

Objective: To measure the effect of the pharmacist-led medication reconciliation service before hospital discharge on preventing potential medication errors. Methods: This behavioral interventional study took place in a public teaching hospital in Iraq between December 2022 and January 2023. It included inpatients who were taking four or more medications upon discharge from the internal medicine ward and the cardiac care unit. The researcher provided the patients with a medication reconciliation form and reconciliation form (including medication regimen and pharmacist instructions) before discharging them home. Any discrepancies between the patients’ understanding and the actual medication recommendations prescribed by the physician were identified and solved. Results: Fifty inpatients received a pharmacist-led medication reconciliation review before hospital discharge. Out of 50 patients, 44% had a clear understanding of their medications before the intervention. In contrast, 56% of the patients had at least one potential medication error before the reconciliation, which was addressed by the pharmacist's intervention. Approximately two-thirds (89.4%) of the potential medication errors were clinically significant, and 5.3% of these errors were serious. The most frequent potential error that prevented this was duplication (31.5%) (the patient was about to duplicate the same medication from different manufacturers or different medications from the same pharmacological class). Conclusion: Lack of medication reconciliation can cause significant medication errors, which might be serious and cause harm to patients. This study has the potential to shape policies and practices that prioritize medication safety and optimize patient outcomes during transitions of care.

Background: Fluoroquinolones are the most effective antibiotics against Staphylococcus aureus isolates. In hospitals, excessive use of antibiotics has led to the emergence of highly resistant strains of S. aureus isolates. Objective: The aim of this study was to detect the mutations that occur in the gyrA gene encoding for DNA gyrase, which is one of the targets for fluoroquinolone resistance. Methods: Fifty clinical isolates were diagnosed as S. aureus according to molecular and bacteriological methods. The susceptibility tests were performed on all bacterial isolates by the disc diffusion method using methicillin and six fluoroquinolone antibiotics. Results: Out of fifty isolates, twelve were resistant to methicillin and all six antibiotics (nalidixic acid, lomefloxacin, ciprofloxacin, norfloxacin, ofloxacin, and levofloxacin). From the fifty isolates, 12 were resistant, 3 were intermediate, and 38 were sensitive to three or more tested antibiotics. The resistance of S. aureus isolates was also confirmed by the minimum inhibitory concentration test. The main sources of isolates were burns (10%), nose (16) wounds (8%), operation room (10%), ear (20%), urine (8%), skin (6%), and throat (22%). Twelve resistant isolates were used to examine the mutations in the gyrA gene. A direct sequence analysis found eight mutations in the gyrA gene; these mutations included 2 (25% missense mutations), 1 (12.5%) deletion mutation, and 5 (62.5%) silent mutations at various sites. Conclusion: gyrA mutations resulting from the excessive use of antibiotics may be one of the mechanisms leading to fluoroquinolone resistance.

Background: It's believed that HBD-3 is involved in the tissue remodeling process of articular cartilage. Also, HBD-3 has anti-inflammatory properties. Objectives: The purpose of this study is to assay human beta-defensine-3 (HBD-3) in serum from rheumatoid arthritis (RA) patients and investigate its correlation with proinflammatory cytokines. Methods: In this case-control study, fifty-eight RA patients were aged 20–65 years, and 29 age-matched healthy subjects (HS) had no inflammatory rheumatic diseases. The disease activity score-28 joint erythrocyte sedimentation rate (DAS28-ESR) was used to measure RA activity. CRP, ACPA, HBD-3, TNF-α, and IL-1β were assessed using the enzyme-linked immunosorbent assay technique (ELISA). Results: There was a significant increase in RF, ACPA, CRP, proinflammatory cytokines, and HBD-3 in the RA group compared with the HS group. There was no significant difference in HBD-3 levels according to the activity of diseases. The results of the correlation between HBD-3 and proinflammatory cytokines showed a significant positive relationship in the RA group. Conclusions: Inflammatory markers and S.HBD-3 demonstrated fair diagnostic performance to differentiate RA from HS. The current study supports the hypothesis that there is a correlation between HBD-3 and the immunoregulatory response.

Health-related quality of life (QOL) has been a major concern for both breast cancer survivors and patients seeking treatment. Studies were done to address this issue; however, not much is known about the benefits of the Adjuvant Hormonal Therapy-Emotional Freedom Technique (AH-EFT). The study's objective is to evaluate the therapy's efficacy in breast cancer patients. The Adjuvant Hormonal Treatment-Emotional Freedom Method was examined in the current study using a review of the literature (AH-EFT). The finding indicates that integrating this therapy with conventional treatment improves the patient's quality of life during these times. Nurses working in the cancer ward are advised to use this therapy for clinical improvement. Future studies are required to evaluate the intervention with different populations and dosages or durations.

Background: Immediate implant placement in the maxillary anterior region was challenging, especially with the jumping gap and limited primary implant stability. Objective: To assess the autogenous dentin graft biomaterial's ability to improve the esthetic outcomes of an immediately inserted implant. Methods: Twenty patients with non-restorable retained roots in the maxillary non-molar region surrounded by natural sound teeth were included in this study after a complete clinical and radiological examination, including patient health and clinical fitness for the immediate dental implant procedure. A single dental implant was inserted for each patient, and the resulting jump distance was filled with the mineralized dentin graft and covered by gel foam with the figure of eight suturing. The Pink Esthetic Score index of the implant-supported prostheses was evaluated six months after the initial surgery. Results: Twenty eligible patients were included in this study. The assessment of the clinical measurements of the alveolar ridge width and gingival biotype before surgical intervention and after 6 months showed no significant differences between them. The mean Pink Esthetic Score (PES) was 7.75. Only two patients achieved a total esthetic score of 10; another three patients had a score of 8, four with a score of 7, and the rest with a score of 6. Conclusion: An autogenous dentine graft effectively achieves acceptable esthetic results with an isolated immediate dental implant inserted in the anterior maxillary area.

Background: Chronic pulmonary arterial hypertension (PAH) is a rare, long-lasting illness that makes pulmonary artery endothelial cells (PAEC) not work properly and leads to heart failure and death. Objective: To evaluate the effect of nicorandil in the treatment of PAH compared to tadalafil in a rat model of monocrotaline-induced PAH. Methods: Monocrotaline injection (60 mg/kg) was used for the induction of PAH in male rats; healthy control and induction groups were not treated. The other 4 groups were treated with either nicorandil or tadalafil with or without treatment blockers (glimepiride and N-Nitroarginine methyl ester (L-NAME)) for 21 days orally. Serum was obtained for assessment of endothelin-1 (ET-1) and tissue harvested for nuclear factor kappa B (NFκB) by ELISA, western blot analysis of endothelial nitric oxide synthase (eNOS), and an apoptosis assay to examine the endothelial function. Results: Nicorandil showed a significant reduction in ET-1 and significant elevation in eNOS compared to the induction group, with comparable efficacy to tadalafil; blocker groups showed significantly elevated levels of ET-1 and reduced levels of eNOS compared to healthy control; NFκB was significantly inhibited in nicorandil and tadalafil groups and significantly elevated in blocker and induction groups; while in the TUNEL apoptosis assay, nicorandil showed the highest level of inhibition to apoptosis with apparently normal endothelium lining. Conclusions: Nicorandil shows anti-inflammatory, antiapoptotic, and enhanced endothelial morphology and function compared to the induction model.

Background: Elevated levels of microRNAs have been linked to breast cancer and other types of cancer. It has been discovered that miRNA-199a-5p overexpression contributes to the epithelial-mesenchymal transition (EMT) in breast cancer. Objective: To examine the expression of microRNA 199a-5p in tissues from both benign and malignant breast cancers. Methods: We use 50 FFPE tissue samples divided into two groups based on their histology and cytological characteristics. The first group comprised 25 samples classified as benign, while the second group comprised 25 samples classified as malignant. To calculate the expression levels of miRNA-199a-5p, we use a real-time RT-PCR method based on SYBR green. Results: It was found that the folding value of miRNA-199a-5p in malignant tumors was 2.908 compared to benign tumors (2.027). However, the statistical significance of these differences was not significant. Conclusion: Depending on the specific context and molecular targets, miRNA-199a-5p plays a dual role in breast cancer development, acting as both an oncogene and a tumor suppressor.

Background: Thyroid peroxidase (TPO) gene mutations are one of the most common causes of thyroid disorders. Objective: To investigate the effect of genetic polymorphisms in the TPO promoter region on gene expression in early-diagnosed hyperthyroid patients. Methods: Genomic DNA was extracted from 100 blood samples (75 hyperthyroid patients and 25 healthy controls), then the TPO promoter region was amplified and sequenced for genotyping rs2071399, rs2071400, and rs2071403 SNPs. Total RNA was also isolated, and cDNA synthesis was performed to determine quantitatively the expression of TPO by using qPCR. The level of TPO antibodies in serum was determined by using an enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of hyperthyroidism in women was significantly higher than in men, as were serum levels of TPO-Abs. There was a significant increase in serum TPO-Abs in hyperthyroid patients (235.29 IU/ml) compared with healthy controls. Genotypes of three SNPs (rs2071399 G/A, rs2071400 C/T, and rs2071403 A/G) in the TPO promoter region were TPO rs2071399 AG and GG, and rs2071400 CT and TT genotypes were more frequent in hyperthyroid patients. There are no significant differences between rs2071403 polymorphic and non-polymorphic genotypes among hyperthyroid patients and healthy controls. The rs2071399 G/A and rs2071400 C/T gene promoter polymorphism significantly down-regulated constitutive TPO gene expression in hyperthyroid patients, but rs2071403 A/G has no major effect on gene expression. Conclusion: There was an association between the mutation in the promoter region of TPO and the incidence of hyperthyroidism.

Background: Because Klebsiella pneumoniae resistance to the majority of antibiotics is developing quickly, it is important to study the efflux pump system that bacteria carry and the genes that encode them in order to find effective ways to stop or limit this resistance. Objective: To find out how common OqxAB-efflux pump genes are and if there is a link between these genes and antibiotic resistance in Klebsiella pneumoniae that has been isolated from different clinical sources. Method: In this investigation, 174 various clinical specimens were collected from Baghdad hospitals. Based on morphological characteristics, culture media, biochemical testing, the Vitek-2 system, and molecular diagnosis by the 16S rRNA gene, only 97 isolates were recognized as Klebsiella pneumoniae. The antibiotic susceptibility of the isolates to 21 antibiotics was also determined. The presence of the active efflux pump was determined phenotypically (ethidium-bromide cartwheel method) and genotypically by multiplex PCR. Results: All isolates were resistant to ampicillin and amoxicillin-clavulanate (100%). On the other hand, the percentage of resistance to cefotaxime, ceftazidime, and cefixime was 95.87%, 94.84%, and 95.87%, respectively. While tigecycline had the lowest resistance rate (11.43%), In the genotype detection assay for efflux pump genes, the results show that the percentages of oqx A and oqx B are 65% and 83.6%, respectively. Conclusion: The oqxA and oqxB genes have a direct relationship with antibiotic resistance in Klebsiella pneumoniae.

Background: The diversity of autism spectrum disorder presentation necessitates the use of simple tests. Quantitative electroencephalography is a low-cost, simple instrument that is being investigated as a clinical tool for monitoring abnormal brain development. Objective: To study brain waves by computer-analyzed EEG (quantitative EEG) in autistic children and correlate the changes to the clinical severity of autistic children. Methods: The study involved 65 children; 30 were recruited from the autism center and the pediatric neurology consultant in the child welfare teaching hospital, Medical City, and met the DSM-5 criteria for autism. Another 35 age-matched, normally-developed children ASD children met the DSM-5 criteria, the Childhood Autism Rating Scale, for autism severity. Absolute and relative spectral power measurements were used to investigate brain activity. Results: The absolute and relative delta power increased in the patients as compared to the controls (p<0.05) in all brain regions. There is an association between the disease severity score and absolute and relative delta and theta power in brain areas. The absolute power of the delta wave peaked in the occipital and temporal regions. The relative delta power peaked in the temporal region. Conclusions: The spectrum delta power can aid in the evaluation and classification of ASD. QEEG testing revealed abnormalities in all ASD children and can be a helpful assessment instrument for ASD children.

Background: HLA-G antigens are unconventional “class Ib” entities that are found on human leukocytes; they are essential in immunomodulation and regulation of inflammatory processes. Studies on the effects of the gene variations of HLA-G on rheumatoid arthritis have inconsistent results. Objective: To estimate the potential relationship between soluble HLA-G and the rs66554220 14 base-pair insertion/deletion polymorphism of HLA-G with disease activity parameters of rheumatoid patients in Iraqi patients. Methods: Using a DNA extraction kit, the genomic DNA was retrieved from 190 rheumatoid cases and 190 control individuals. Using primers for the HLA-G gene, the polymerase chain reaction was utilized for the genotyping of HLA-G 14ֺ base-pair insertion/deletion variants. The levels of soluble HLA-G were assessed by means of an ELISA test. Results: The results did not show a link between polymorphic HLA-G 14 base-pair insertion/deletion alleles and the possibility of getting rheumatoid disease. Serum levels of soluble HLA-G were substantially lower than those of controls (median=1.548 vs. median=7.391 U/mL), respectively. sHLA-G has a statistically substantial adverse link with ESR (r= -0.245, p<0.05). Furthermore, there is a statistically substantial differences between the DAS-28 activity score and the sHLA-G level. Conclusion: There is no link between the risk of developing RA and polymorphic HLA-G 14 base-pair insertion or deletion in Iraqi patients. However, sHLA-G might serve as a diagnostic predictor of disease activity.

Background: Adipokines (fibulin-1, chemerin, and omentin-1) affect the hypothalamic-pituitary-gonadal axis and ovarian steroidogenesis. Adipocyte-secreted adipokines are dysregulated in females with polycystic ovarian syndrome (PCOS). Objective: To investigate the role of serum fibulin-1, chemerin, omentin-1, total cholesterol (TC), high-density lipoprotein (HDL), triglyceride (TG), progesterone (PROG), and prolactin (PRL) in PCOS and the development of infertility. Methods: 150 PCOS, infertile PCOS women and control women aged 20–40 years were enrolled in this observational study and divided into three groups: 40 women who were control, 60 women who had PCOS only and 50 women who had infertility and PCOS. Analyses of fibulin-1, chemerin, omentin-1, lipid profile, PROG, and PRL were performed for all participants. Results: The results showed elevated levels of fibulin-1, chemerin, and PRL in both PCOS and infertile PCOS when compared with control, while omentine-1 and PROG decreased in both PCOS and infertile PCOS when compared with control. The levels of TC, HDL, and TG weren’t affected in PCOS alone, but in cases of infertility, TC and TG increased while HDL decreased. Conclusions: The increased level of fibulin-1 may be a new marker for PCOS and infertility. Chemerin shows a high level in both infertile PCOS and PCOS women, while omentin-1 shows a low level in both infertile PCOS and PCOS women.

Systemic sclerosis (SSc) is a rare connective tissue disorder characterized by fibrosis, vascular alterations, and organ dysfunction. Juvenile systemic sclerosis (jSSc), an infrequent form of the disease, primarily affects children, with an incidence of 0.27 to 1 per million. This report details the case of a 10-year-old male patient diagnosed with jSSc complicated by interstitial lung disease (ILD) and myositis. The patient initially presented with characteristic signs of skin thickening and Raynaud's phenomenon, which later advanced to the emergence of ILD and myositis. The case emphasizes the importance of vigilant screening for ILD in jSSc patients, given the severity and associated increased mortality of the complication, and improves our understanding of the underlying clinical features of this disease. It also calls attention to the challenges of managing the disease effectively and necessitates further research to improve treatment outcomes for such patients.

Background: Toll-like receptors (TLRs) play a significant role in the activation of adaptive immunity and may have an essential role in the development of rheumatoid arthritis (RA). Objectives: To assess the gene expression of TLR4 in individuals with RA compared to healthy individuals. Methods: From July to December 2022. A total of 100 individuals were encompassed in the study, consisting of 50 individuals diagnosed with RA, of whom 42 were females and 8 were males, with an average age of 45.22 years. Additionally, there were 50 healthy control participants, 40 of whom were females and 10 were males, with an average age of 45.64 years. To assess the TLR4 transcript levels, blood samples were collected from each participant, and RNA extraction was performed. cDNA synthesis was carried out, and real-time PCR was utilized for the analysis. The researchers also assessed the clinicopathological characteristics of the patients. Results: The serum TLR4 gene was significantly overexpressed in RA patients (fold change 2.59) compared to the controls (fold change 1.07). The expression level of the TLR4 gene was correlated with the clinicopathological characteristics of the patients, including erythrocyte sedimentation rates (ESR), RF, anti-CCP antibody, and DAS28. Conclusion: TLR4 was overexpressed in RA patients and was correlated with disease activity. It might be a therapeutic target and may contribute to the pathogenesis of RA.

Background: Thrombocytopenia is the most common hematological disorder in pregnant women, second only to anemia. A platelet count of less than 150x109/L is regarded as low. It is the most common cause of thrombocytopenia during pregnancy when the platelet count does not fall below 70x109L. Methods: A case-control study was carried out in the department of obstetrics and gynecology at Azadi Teaching Hospital, Kirkuk, Iraq. Two hundred pregnant women were enrolled in the study; they were divided into 100 cases and 100 controls. All participants were in labor at the time of admission. The cases were pregnant women with gestational thrombocytopenia, while the controls were pregnant women with normal platelet count. A platelet count was performed for all participants using the Swelab Alfa Plus system. Results: mean gestational age and platelet count were significantly lower in patients than controls, while there was no statistically significant difference in age or parity between the study groups. Preterm labor, postpartum hemorrhage (PPH), intrauterine fetal growth restriction (IUGR), and intrapartum fetal distress were significantly higher in the patients than in the controls, and the mean APGAR score at 5 minutes was significantly lower in the patients compared to the controls. Conclusions: Pregnant women with gestational thrombocytopenia may be at higher risk of preterm labor, postpartum hemorrhage, IUGR, intrapartum fetal distress and a low neonatal APGAR score.

Background: Research methodology is now part of the MBBS curriculum, which is a substantial adjustment to MCI standards. Objective: To assess the student's comprehension of the subject, level of interest and how it is used in clinical studies. Methods: We created a standard set of 25 questionnaires to assess postgraduate and PhD students' attitudes, awareness, and knowledge about research ethics and committees. Statistical analysis was used to compare the mean knowledge scores of several groups (age, gender, education, past research experience, etc.). Results: Students had a good attitude and understanding of research ethics and research ethics committees. We observed that past research experience and training are critical in predicting knowledge ratings. The study findings indicated a significant difference in the mean knowledge score depending on past research experience. Similarly, we observed that prior research ethics training had a significant impact on mean scores. Conclusions: A functioning research ethics committee should be present in every hospital. Students should be informed of the role and responsibilities of the ethics committee. Students must be informed of research ethics before undertaking any human subjects research. To broaden student comprehension, the ethics committee must offer seminars, workshops, and conferences on a regular basis.

Background: Evaluating medical colleges' teaching staff performance is an essential topic for evaluating academic performance. Objective: To assess the academic performance of the teaching staff in the pediatric, surgical, and gynecology branches in comparison to the medicine branch performance from 2014 to 2018. Methods: The total number and the number of failed students being examined in final years were obtained officially from the examination committee in Mustansiriyah Medical College for the final 6th-year students for the four main branches (medicine, pediatrics, surgery, and obstetrics and gynecology). The students' number in the medicine branch was used as the control group against which the performance of other branches was compared. We utilized the odds ratio from meta-analysis statistics and compared student failure and success rates. Results: The odd ratio of pediatric branch performance versus medicine branch was 1.02 with a 95% confidence interval of 0.68–1.53, while for surgery, it was 0.67 with a 95% CI (0.46 to 0.98) and 3.13 with a 95% CI (1.79 to 5.47) for the obstetrics and the gynecology departments. Conclusion: The performance of the pediatric branch was the only one compatible with the performance of the medicine branch. In contrast, both the surgery and gynecology branches significantly deviated from the medicine branch's performance. Further research is needed to pinpoint the causes of these performance deviations.

Background: Assisted reproductive technology has resulted in a progressive rise in the incidence of twin pregnancies, which affect both mother and child in terms of antepartum complications. Objective: To assess the perinatal outcomes of twin pregnancies and the influence of chorionicity on them in a tertiary healthcare facility. Methods: It is a hospital-based cross-sectional study that was carried out in the Obstetrics and Gynecology Department of S.C.B. Medical College Hospital, Cuttack, during the period from 2013 to 2015. All mothers having twin pregnancies (with 28 weeks of completed gestation) admitted to the antenatal (ANC) ward and labor room during this period were taken as a study group, and written informed consent was taken after explaining the details of the study. Results: A total of 150 cases are identified; among them, 98 cases (65.33%) are dichorionic diamniotic, 50 cases (33.33%) are monochorionic diamniotic, and 2 cases (1.33%) are monochorionic and monoamniotic pregnancies. The majority (66%) of the twin pregnancies were between 35-38 wks of gestational age at the onset of labor. It is also observed that macerated births, stillbirths, and neonatal deaths are higher in mono-chorionic twins as compared to dichorionic twins. Conclusions: Twin pregnancies carry a greater risk of adverse outcomes, especially perinatal mortality and neonatal morbidity, in monochorionic twins than dichorionic twins. Good antenatal care, early diagnosis of chorionicity, and antepartum assessment of placentation will prevent mortality and morbidity.

Background: Oocyte-secreted proteins can provide evidence about folliculogenesis and express the quality of oocytes and the quality of the resulting embryos. Objective: To evaluate the ability of serum and follicular fluid growth differentiation factor 9 (GDF-9) and bone morphogenic protein 15 (BMP-15) in predicting oocyte and embryonic quality, subsequent embryonic development and pregnancy rate. Methods: A prospective cohort study involved 114 sub-fertile females who sought intracytoplasmic sperm injection (ICSI) to treat infertility. They are 18 to 43 years old, and their body mass index (BMI) ranged from 19 to 30 kg/m2. Before ICSI, there was controlled ovarian stimulation and pituitary down-regulation. Following oocyte collection, microscopic assessment of oocyte and embryo quality was done. Serum was collected on the second day of the menstrual cycle, while follicular fluid was collected on the day of oocyte collection, and GDF-9 and BMP-15 were measured in both using a special kit by ELIZA. Results: The pregnancy rate was 35.2%. Follicular fluid GDF-9, serum and follicular fluid BMP-15 showed significant positive correlations with the total number of mature oocytes. Follicular fluid BMP-15 showed significant positive correlations with total oocyte count and fertilization rate. Follicular fluid BMP-15 showed a significant and positive correlation to the total embryo quality count. Conclusions: Serum and follicular fluid BMP-15 are good predictors of oocyte number and quality but have no role in predicting embryonic quality, blastocyst count or pregnancy rate.

Background: Insulin is available as an injectable drug and remains the mainstay of therapy. Researchers have attempted to develop an oral formulation of insulin, particularly utilizing nanoparticles (NPs). Objective: To assess the efficacy and safety of insulin-loaded D-α-Tocopherol polyethylene glycol succinate (TPGS)-emulsified PEG-capped PLGA NP in comparison to insulin-loaded PLGA NP and subcutaneous (SC) insulin in an in vitro and in vivo diabetic rat model. Methods: Two biocompatible and biodegradable NPs were used, in which 20 IU/kg of recombinant human soluble insulin was incorporated. NP1 was PLGA-loaded with human insulin, while NP2 was PLGA-PEG-TPGS-loaded with human insulin. The physical characteristics of the NPs were examined in an in vitro and in vivo study on a hyperglycemic rat model for a 24-hour duration. Results: For the first 3 hours, SC insulin showed a better reduction in serum glucose levels (SG) compared to both NP1 and NP2. A smooth, sustained reduction in SG was observed and maintained till the end of 24 hours with both NPs. NP1 maintained SG reduction for 6 hours before experiencing an increase, while NP2 demonstrated superior sustained reduction in SG beyond the 12-hour evaluation period. Conclusions: PLGA-PEG-TPGS NP can act as a potential carrier for oral insulin delivery and maintain good glycemic control for up to 24 hours.

Background: In young adults, multiple sclerosis is a prevalent chronic inflammatory demyelinating condition. It is characterized by white matter affection, but many individuals also have significant gray matter involvement. A double-inversion recovery pulse (DIR) pattern was recently proposed to improve the visibility of multiple sclerosis lesions. Objective: To find out how well a DIR sequence, FLAIR, and T2-weighted pulse sequences can find MS lesions in the supratentorial and infratentorial regions. Methods: A total of 37 patients with established diagnoses of multiple sclerosis were included in this cross-sectional study. Brain MRI was done using double inversion recovery, T2 and FLAIR sequences. The number of lesions was counted and compared in the three sequences. Results: The DIR sequence detected more infratentorial lesions when compared to the T2 and FLAIR sequences. In the supratentorial region, DIR detected more lesions than T2 and FLAIR. Conclusion: The DIR sequence is highly superior to both the T2 and FLAIR sequences in depicting the lesions, regardless of their anatomical distribution. Moreover, the DIR sequence detected more multiple sclerosis lesions in the infratentorial region than the traditional T2W and FLAIR sequences.

Background: Obesity is considered an important risk factor for periodontal disease. It has been reported that reactive oxygen species linking both diseases, systemic melatonin supplementation as antioxidant therapy, was addressed as an adjuvant to scaling and root surface debridement (SRP) to enhance the treatment of periodontitis. Objective: To investigate the efficacy of systemic melatonin administration on periodontitis-obese patients as an adjuvant to scaling and root surface debridement (SRP). Methods: A randomized clinical trial was conducted at a dental-specialized center. Eighty subjects were included and allocated into group-I: twenty periodontium-healthy, normal-weight people; group-II: 30 obese patients with stage-III treated only with SRP, and group-III: 30 obese patients with stage-III periodontitis treated with SRP and 5mg melatonin. periodontitis and subjected to estimation serum levels of Receptor Activator of Nuclear Factor-Kappa B Ligand (RANKL) were estimated in all groups. Probing pocket depth (PPD), Bleeding on probing (BOP), and relative attachment level (RAL) were estimated in Groups II and III at baseline and after a one-month visit. Results: RANKL baseline visits were significantly different between the control and studied groups, with no significant difference in clinical parameters except for PPD. The 2nd visit showed a significant difference in BOP score-1 compared to RAL and BOP score 0. In the 2nd visit, only weak negative and positive significant correlations were found between RANKL and BOP. Conclusion: Daily use of 5mg melatonin improves periodontal parameters and decreased serum RANKL levels.

Background: Elevation of the marker neopterin is associated with the progression and consequences of diabetes. Although the clinical relationship between the high levels and peripheral neuropathies other than diabetic peripheral neuropathy is unknown, it has been linked to them. Objective: To evaluate the difference in serum neopterin levels between diabetic individuals who have peripheral neuropathy and those who do not. Methods: This seven-month cross-sectional study at the Diabetic Center began in December 2022 and included 126 patients with the second type of diabetes mellitus. Following verbal consent, the included patients were subjected to neurological and physical evaluations. Along with the blood pressure, the weight and height were noted. Glucose, TG, CH, HDL-c, fasting insulin, and neopterin were all analyzed using serum. Formulas were used to compute BMI, LDL-c, and VLDC. Results: When diabetic individuals with peripheral neuropathy were compared to those without, the serum levels of neopterin in the former group revealed a marginally higher level than in the latter, but this difference was not statistically significant. Conclusion: Neopterin levels were not altered in diabetic individuals with peripheral neuropathy, indicating that it is not a reliable indicator of the condition.

Background: Osteogenesis imperfecta (OI) is a rare congenital condition that results in bone fragility, recurrent fractures, and various extra-skeletal manifestations. Currently, intravenous bisphosphonate is the mainstay of medical treatment in OI. Objective: To identify the effect of current management strategies on Iraqi children diagnosed with OI. Methods: A retrospective study enrolled OI patients who were registered in Central Child Teaching Hospital, Baghdad, Iraq from January 2015 to December 2022. We enrolled confirmed OI cases (either clinically and/or radiologically) who received cyclic pamidronate therapy for at least 3 cycles. They neither received other types of bisphosphonates nor underwent surgical intervention. Results: A total of 52 cases of OI had been identified, but only 36 patients were eligible for the current study. The mean age of the patients was 6.64±4.22 years. A statistically significant drop in the annual fracture rate in OI patients who received intravenous pamidronate cycles was seen, along with a significant rise in weight for age Z-score, lumbar spine bone mineral density DEXA Z-score, and alkaline phosphate levels. No significant improvement was documented in height for age Z-score in OI patients. Conclusions: Intravenous pamidronate cycles to Iraqi children with osteogenesis imperfecta works to lower their risk of breaking bones every year and raise their weight, lumbar spine bone mineral density, and alkaline phosphate levels. Pamidronate did not result in an improvement in the height of OI children.

Background: Preeclampsia is a prevalent complication that frequently arises during pregnancy. It is a disorder of the trophoblasts. Given that human chorionic gonadotropin is secreted by the trophoblast, this complication may have an impact on its serum concentration. Objective: To compare the β-hCG levels of expectant women who are preeclamptic and those who are normotensive. Methods: A prospective cross-sectional study design was implemented at Al-Elweyia Maternity Teaching Hospital for this investigation. One hundred fifty expectant women in their third trimester are participating. The study participants were allocated into three cohorts, each consisting of 50 women: normotensive, mild preeclamptic, and severe preeclamptic. β-hCG levels in maternal serum were determined using an enzyme-linked immunosorbent assay (ELISA) in every instance. Results: Compared to expectant women with normotensive conditions and patients with mild preeclampsia, the levels of maternal serum β-hCG were significantly elevated in patients with severe preeclampsia. β-hCG levels were not significantly affected by maternal age across all three groups. Conclusion: β-hCG concentrations are greater in pregnant women with moderate and severe preeclampsia compared to normotensive women, with severe preeclampsia being more pronounced than mild.