Al-Rafidain Journal of Medical Sciences

Pemetrexed (PMT) is a multi-target antifolate that has been confirmed for the treatment of lung cancer. It has significantly boosted the survival rate of patients with non-squamous non-small-cell lung cancer. Multiple Phase II clinical trials have demonstrated that pemetrexed is an effective monotherapy for a range of solid tumors, including colorectal, breast, neck, and head malignancies. Methods for consolidating pemetrexed with other chemotherapeutics and novel molecularly targeted drugs are currently under investigation. Pemetrexed is currently recommended for first-line dose management with platinum chemotherapies, second-line monotherapy drugs, and, in modern chemotherapy protocols, as continuation therapy following first-line therapy. Vitamin B12 (VB12) and folic acid (FA) supplements can aid to minimize the cytotoxicity of pemetrexed. FA/VB12 has been suggested to have an antagonistic effect on pemetrexed's efficacy. Patients who accept FA/VB12 have a higher tolerance for PMT and a longer lifespan. In this study, the pharmacodynamics, pharmacokinetics, and toxicity of pemetrexed were studied, as well as the implications of FA/VB12 as a co-medication with pemetrexed-based chemotherapy.

Background: Eating disorders represent a psychological problem characterized by abnormal eating behaviors and related emotions and thoughts. Aim: The study aims to assess the prevalence of eating disorders among medical students in Baghdad, Iraq. Methods: A cross-sectional study was conducted in medical departments that include medicine, dentistry, and pharmacy disciplines from January 2021 to March 2021 using an English version of a structured questionnaire. About 552 medical students participated in this study. Results: The study showed that in some individuals with normal Body Mass Index values, 64.47% suffered from eating disorders as diagnosed by EAT-26 while according to SCOFF, 23.5% of normal individuals suffer from eating disorders. Overweight individuals are more likely to have eating disorders than underweight individuals. According to SCOFF, 33.44% of the overweight and 4.18% of underweight individuals scored above the cutoff value. They were likely to have eating disorders. Similarly, in accordance to EAT-26, 19.70% of the overweight individuals and 9.48% of the underweight individuals were likely to have eating disorders. Conclusion: Many Iraqi medical students are predisposed to having eating disorders, with females being more vulnerable than males. To reduce the frequency of eating disorders among Iraqi medical students, a variety of initiatives and strategies are required.

Senescence is generally viewed as a mechanism to protect humans against the development of diseases including cancer in addition to its wider physiological functions. Through this mechanism, normal cells suffering from stress are converted into senescent cells which remain metabolically active but lose their proliferative capacity. However, the persistent presence of the senescent cells can lead to unwanted consequences in that they facilitate the onset of aging and enhance the development of cancer. This narrative review examines the role of senescence in cancer and the possibility of employing senotherapies for harnessing the effects of, or eliminating, senescent cells.

Breast cancer has the highest prevalence of all cancers in females, with roughly 2.26 million new cases diagnosed and an estimated 0.68 million deaths/year. Hormone receptor-positive (HR+) or human epidermal growth factor receptor-negative (HER2-) illness affects the vast majority of patients with metastatic breast cancer (MBC). Endocrine therapy (ET) with aromatase inhibitors (AIs) is the preferred first-line choice for this subpopulation. However, because most patients developed tolerance to these medications, demand for alternate endocrine regimens has surged. Inhibition of cyclin-dependent kinase 4 and 6 (CDK4/6) is proving to be a success in resistant patients as well as a first-line treatment. This review article highlights the current indications for CDK4/6 inhibitors in breast cancer that have been approved by the FDA. The literature search was confined to the years 2015 to 2020, and 27 articles and 6 studies were chosen for further research from a large number of publications. In hormone receptor-positive, HR RC+, HER2- advanced or metastatic breast cancer (ABC/MBC) patients, the use of currently available CDK4/6 inhibitors, either alone (abemaciclib) or in combination with endocrine therapy (Palbociclib and Ribociclib), showed a beneficial effect when compared to endocrine therapy alone. The use of CDK4/6 inhibitors resulted in longer progression-free survival (PFS), greater clinical benefit rates (CBR), and an overall response rate (ORR), as well as an overall survival (OS) advantage in patients previously treated with endocrine treatment (ET).

Dietary supplements (DS) are products that are intended to be consumed orally and serve the purpose of supplementing one's diet. Although, these products are very popular, their usage among undergraduate students in Iraq is still obscure. Aim: To evaluate the pattern, type, and reasons for supplement usage among Iraqi undergraduate students and to detect the source of information about dietary supplements. Methods: A sample of 442 students at different colleges in Baghdad were surveyed through a questionnaire composed of 13 questions and divided into four sections: socio-demographic, dietary supplement (DS) knowledge, DS intake, and reasons behind their usage. Descriptive statistics were conducted to determine the frequency and percentages of respondents for each variable. Results: A total of 442 participants were included in the study; 160 (36.2%) were males and 282 (63.8%) were females. Out of the total number of the participants, 329 (74%) were dietary supplement users, 139 (42.25%) were males, and 190 (57.75%) were females. Most of the participants (72%) used vit. D3 supplement, and the mean reason for using DS was to overcome nutritional deficiency. Conclusion: Most of the participants are dietary supplement users, with a higher percentage of females. The main reasons for both genders' resorting to dietary supplement use are to improve their health and improve their immunity.

A contemporary and expanding area of toxicology research is nanotoxicology. It focuses on evaluating the toxicological characteristics of nanoparticles (NPs) in order to determine whether and how much of a risk to society or the environment they pose. Fundamental characteristics of nanoparticles (consisting of shape, size, surface charge, surface area, solubility/dissolution, coating and crystal structure), in addition to coincidental aspects (like climate, pH, salinity, ionic potency, and organic material), generally impact on NP attitude, circumstance, and movement, and basically toxicity. The processes underpinning nanomaterials' (NMs) toxicity have recently been intensively researched. One such mechanism is the toxicity of reactive oxygen species (ROS). Excessive production of ROS causes oxidative stress, which causes cells to lose their capacity to sustain normal redox-regulated processes. This review consists of details referring to physical and chemical characteristics of nanomaterials and properties for convenient toxicological assessment, disclosure, and coincidental transport, fate, and genotoxic effects.

Genetically-driven variations in the proteins associated with drug action and adverse effects can lead to a significant influence on cancer therapy. Cancer cells can accumulate a plethora of somatic mutations, beyond any existing germline variants, during their progression from normalcy to malignancy. The narrow therapeutic index that characterizes cancer drugs and the life-threatening failure of therapy all point to the importance of considering the inclusion of pharmacogenomics when treating cancers. This narrative review discusses the application, merits and challenges of pharmacogenomics knowledge using a few representative examples. The adoption of a properly considered pharmacogenomic program during cancer treatments can be life-saving and rewarding.

Background: Pollution and genetic factors have increased the likelihood of cancer in the developing world. Cancer is now the leading cause of death in young patients. Scientists are focusing on developing new treatments with a lower risk profile than traditional cytotoxic drugs. Nigella sativa (black seed) has been used for centuries by ancient cultures to treat a variety of ailments. Thymoquinone, the main active compound found in Nigella sativa, is a useful therapeutic agent in various morbidities including cancer. Aim: The review aims to highlight thymoquinone's potential cytotoxic and chemoprotective effects. Methods: The most recent articles were found using reputable websites such as Google Scholar, PubMed, and Research Gate. Many titles, such as thymoquinone, breast cancer, leukemia, colon cancer, osteosarcoma, ovary cancer, and so on, have been used in searches. Then the information from an in vitro studies and animal experiments were collected; the preprint, article review, and meta-analysis study were all excluded. Results: Thymoquinone reduced cell viability and induced programmed cell death in breast cancer, colon cancer, leukemia, osteosarcoma, ovary cancer, and colon cancer. TQ causes cytotoxicity through a variety of mechanisms, including the induction of reactive oxygen species and the inhibition of NF-kB activity in some cancers. Conclusion: Thymoquinone is a promising future cytotoxic agent with fewer side effects than traditional cytotoxic agents.

Materials with external dimensions of one or more nanometers are referred to as nanomaterials. These structures result from a number of manufacturing processes. They are used in many industries, including pharmaceuticals, which is the most significant one. Numerous variables, including size, shape, surface morphology, crystallinity, solubility, etc., affect physical properties. While new physical and chemical processes are being created constantly, the biological method is the ideal strategy for synthesizing nanoparticles since it is straightforward, safe, and economical. Different kinds of nanoparticles can be metabolically synthesized by a wide variety of biological sources, including plants, bacteria, fungi, and yeast. There are many biomolecules, including proteins and coenzymes, that can change the metal salts into the necessary nanoparticles. There were numerous techniques for creating RNA nanoparticles. The first tactic makes use of the natural RNA nanoparticles' collection process. The second strategy entails extending the widely used DNA nanotechnology approach to the field of RNA; the third strategy uses computational methods to produce RNA nanoparticles; and the fourth strategy uses preexisting RNA structures or those with known properties as fundamental building blocks in the synthesis of RNA nanoparticles. The purpose of this paper is to give an overview of the significance of RNA nanotechnology, a novel idea in the field of nanotechnology.

The renin-angiotensin system (RAS) was thought to be in charge of managing blood pressure and electrolytes. It has been established that angiotensin II is also responsible for controlling inflammation in addition to blood pressure and potassium levels. Angiotensin converting enzyme 2 (ACE2), angiotensins (1–7), angiotensins (1–9), and other additional RAS components have been identified, and have anti-angiotensin II effects. Both angiotensin receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) are utilized as anti-hypertensive medications and protecting the heart and kidneys, and counteract the part played by Ang II in the initiation of inflammation. This review provides crucial details that help explain how ACEI and ARBs reduce inflammation. Using reliable websites like Google Scholar, PubMed, and ResearchGate, the most recent publications were reviewed. Search terms have included "RAS role of Ang II in inflammation," "influence of ACEI," and "effect of ARBs on PPAR-gamma." The data were gathered from controlled clinical trials, in vitro studies, and animal-based studies; preprints, article reviews, and meta-analysis studies were excluded. Both ACEIs and ARBs reduce inflammation via a variety of mechanisms, which explains their cardioprotective and nephroprotective effects. They reduce inflammation by modulating an inflammatory pathway through either similar or dissimilar mechanisms.

Unfortunately, anticancer medications are extremely harmful to normal cells. Doxorubicin (DOX) is a highly cardiotoxic medication that can result in cardiomyopathy. The most significant mechanism for DOX-induced cardiotoxicity is oxidative stress, while other pathways have also been put forth. This review aims to highlight the mechanisms of DOX-induced cardiotoxicity and the most updated managements. Trustworthy sites such as Google Scholar, PubMed, and Research Gate were used to find the most updated articles. Many titles have been used for searching, such as "doxorubicin and cardiotoxicity," "cardioprotection," and "cardio-protective effects of phytochemicals." Preprints, review articles, and research with meta-analyses were disregarded. Three pathways, including oxidative stress, mitochondrial damage, and calcium excess, were responsible for DOX-induced cardiotoxicity. Cardiotoxicity may be partially caused by cell death, activation of the ubiquitin-ligase-proteasome system, and changes in its gene expression brought on by DOX. In the instance of DOX cardiotoxicity, medications and nutraceuticals with antioxidants and iron chelating properties have been found to have cardio-protective benefits. In conclusion, doxorubicin-treated cancer patients have been linked to cardiotoxicity, making cardioprotection extremely important in these patients. All of the mechanisms included in this review's discussion might provide light on fresh approaches to the treatment and/or prevention of DOX-induced cardiotoxicity.

A third of recently created drugs have poor water solubility and absorption. Innovative methods, such as self-nanoemulsifying drug delivery systems (SNEDDS), are being developed to address issues with pharmaceutical delivery and bioavailability. These systems, which are referred to as isotropic mixtures, are made up of the drug, a suitable oil, a surfactant, and either a co-surfactant or co-solvent. These elements combine to create a "oil in water (O/W)" nanoemulsion after being lightly stirred. Colloidal systems, including microemulsions and nanoemulsions, are being used more commonly in food, cosmetics, and pharmaceutical preparations to encapsulate, protect, and transport lipophilic components. The nanoscale particles used in these kinds of delivery systems have a number of potential benefits, including enhanced long-term stability, enhanced solubility, enhanced optical transparency, and enhanced bioavailability. To create SNEDDS, one can utilize a phase diagram technique or statistical design of trials. For SNEDDS, switching from a liquid to a solid dose form may have improved stability as well as increased patient compliance. The design and production of SNEDDS and their effects on the bioavailability of several medications are the subject of numerous studies that are included in this review.

Solvents are important components in the pharmaceutical and chemical industries, and they are increasingly being used in catalytic reactions. Solvents have a significant influence on the kinetics and thermodynamics of reactions, and they can significantly change product selectivity. Solvents can influence product selectivity, conversion rates, and reaction rates. However, solvents have received a lot of attention in the field of green chemistry. This is due to the large amount of solvent that is frequently used in a process or formulation, particularly during the purification steps. However, neither the solvent nor the active ingredient in a formulation is directly responsible for the reaction product's composition. Because these characteristics have little bearing on how well or quickly the system in which the solvent is applied works, it appears unnecessary to use toxic, combustible, or environmentally hazardous solvents. However, the beneficial properties of the solvent required for the application are strongly linked to these unfortunate side effects of solvent use. Distillation can be used to recover and purify solvents because they are volatile; however, this process can produce unwanted air pollutants and be hazardous to workers during exposure.