Al-Rafidain Journal of Medical Sciences

Hypotension is a common consequence of spinal anesthesia for caesarean section. It is correlated with nausea, vomiting, dyspnea, and adverse effects on the fetus, including depressed APGAR scores and umbilical acidosis. Aim: To investigate the effect of Ondansetron to prevent hypotension and the need for vasopressors after spinal anesthesia during elective Cesarean section. Methods: This is a prospective double blind, randomized trial carried out in Obstetric Operation room of Baghdad Teaching Hospital, Medical city, Iraq from November, 2018 to August, 2019. Total number of 128 women assessed for eligibility and only 87 were included and allocated into 2 groups. The Ondansetron group (45 women) received 6 mg Ondansetron IV 1 min before induction of spinal anesthesia. The Placebo group received 3 ml normal saline as placebo before induction. The number of rescue drugs (vasopressors, antiemetic, anti-shivering), vital signs and side effects were recorded each 3 min from baseline to 45th min, fetal APGAR score was recorded after 1 min. Results: The incidence of hypotension, nausea, vomiting and the need for vasopressors and metoclopramide were significantly lower in Ondansetron group than placebo group (P=0.001, 0.02, 0.003, <0.001, and 0.001, respectively). Shivering and the need of pethidine was non significantly lower in ondansetron group than placebo group. APGAR score after 1 min was not significantly differ between the two groups. Conclusion: Preoperative administration of Ondansetron in cesarean section reduces the risk of spinal anesthesia-induced hypotension, prevents the nausea and vomiting attacks and decreases the need to vasopressors and metoclopramide.

Type 2 diabetes mellitus (T2DM) is becoming more prevalent at an alarming rate. With a better understanding of its pathophysiology, new treatment alternatives directed to different critical targets in T2DM have been created and studied. The development of novel therapeutics using various methods, such as novel medication combinations, changed drug molecules, and enhanced delivery systems, can eliminate some of the side effects of old drugs while also improving their efficacy. Newer pharmacological targets such as protein kinase B (Akt/PKB), AMP-activated protein kinase (AMPK), sirtuin (SIRT), and others are effective through different processes. They can be used to treat T2DM of various types and etiologies. Other medicines, such as end barrier, gene therapy, and stem cell technology, employ advanced ways to treat T2DM, and their promise remains untapped. Molecular targets in T2DM are also extensively evaluated because of their capacity to target problems at the molecular level. Antibody treatments and immunizations against T2DM are also investigated in this area. However, there are few current clinical studies, and development progress is modest. There are numerous medicines available to treat T2DM, each with its own set of benefits and drawbacks. The treatment plan that the patient prefers is usually determined by the patient's health and the treatment aim. Many aspects should be considered before choosing an ideal treatment option. Patient compliance, therapeutic efficacy and potency, bioavailability, and other pharmacological and nonpharmacological features are only a few examples.

Malaysians were less informed regarding genetic tests compared to developed countries. Little knowledge and interests in genetic testing for the risk of breast cancer detection are available for the students in University Technology Mara (UiTM). Aim: To detect the knowledge and awareness in genetic tests available for the detection risks of breast cancer among UiTM female students. Methods: A cross-sectional study using a self-administered questionnaire was conducted among medical and non-medical undergraduate students of the University Technology Mara (UiTM). A convenient sample was collected from those who fulfilled the inclusion criteria of this study. Results: Three hundred and eighty-six respondents were involved in the present study. 50.8% of them were familiar with the tests, while 49.2% did not know about the availability of tests that detect gene mutations. Regarding their interest to detect inheritable mutations, 35.8% were interested in the test, 38.3% were probably interested, 20.7% were considering the test, and 5.2% had no interest in the test at all. About their concerns about mutations detection, 67.9% agreed to get tested to learn their expected risk of getting breast cancer. In terms of their reason to avoid being tested, 40.7% better to be changed. Conclusion: There were inadequate knowledge and awareness in breast cancer genetic tests in tested female students. They are highly interested in the genetic test available for breast cancer risk detection.

The food storage at low temperature showed a significant drop down in its glycemic index. Aims: The present study aims to investigate the impact of freezing and thawing processes and duration on the glycemic response of Iraqi local white bread. Methods: In this prospective longitudinal study, twelve healthy subjects (seven males, five females), aged 21-53 years, were recruited from Al-Rafidain University College campus and the local community. After overnight fasting, commercial Iraqi local white bread (200 g) was administered as fresh bread, following 1-week or 2-week freezing and thawing. Peak glucose response, 2 hr incremental area under the glucose response curve (AUC0-120) was evaluated as an outcome. Results: The freezing and thawing processes and duration for the white bread resulted in a significant lowering blood glucose AUC values compared to AUC values of the fresh one (P< 0.05), AUC values of the fresh bread (14176±1134 mg min/dl), after 1-week of freezing and thawing (13205±660 mg min/dl), and after 2-weeks (12828±642 mg min/dl). Conclusion: freezing and thawing processes and duration significantly decreased the glycemic index of the fresh Iraqi local white bread.

Thrombocytopenia is an abnormal decrease in platelet count and a detrimental side effect of chemotherapy. It leads to hemorrhage in vital organs and negatively impacts the quality of life (QOL). Aims: To evaluate the effect of chemotherapy regimens and doses on thrombocytopenia incidence and severity among patients with solid tumors. Methods: This retrospective observational study was conducted at Penang Hospital, Malaysia. It includes 341 cancer patients with thrombocytopenia who were admitted between 2003 and 2009. The main statistical tests used were the Chi-square test and logistic regression. The level of significance was set at P<0.05. Results: Of the 341 patients included, 21 (6.2%) had thrombocytopenia before chemotherapy and developed in the remaining 320 (93.8%) after chemotherapy. The majority of patients had moderate thrombocytopenia (n=172; 53.8%), followed by mild (n=97; 30.3%), and severe thrombocytopenia (n=51; 15.9%). The 5-fluorouracil, epirubicin, cisplatin (FEC) regimen had strong associations and correlations with thrombocytopenia incidence and severity, but the associations and correlations for thrombocytopenia severity were stronger than those for incidence. The dosage of 5-FU, cyclophosphamide, docetaxel, and cisplatin play a critical role in thrombocytopenia incidence and severity. Conclusion: Monitoring hemoglobin levels for cancer patients treated with FEC, 5-FU+5-FU, Docetaxel, and Cisplatin specifically with high doses must be emphasized and a focus of particular attention.

Diabetes mellitus (DM) impairs cell metabolism and function in a variety of organs, increasing the risk of pathologies in organs such the kidney, neurological system, and eye, as well as fragility fractures. Advanced glycation end products (AGEs) are chemical moieties created by long-term hyperglycemia that interact with specific AGE receptors (RAGEs) to affect cellular metabolism and/or function. Some of the clinical effects of DM on cellular metabolism and organ function through the AGE-RAGE signaling pathway were detected through PubMed searches using the keywords "advanced glycation end product "RAGE", "sRAGE", "DM", and "complications." Tables were created for all published experimental and clinical research. Diabetic sequelae such as nephropathy, neuropathy, retinopathy, and osteopathy are all linked to AGE-RAGE signaling. Some clinical outcomes in diabetic individuals could be attributable to the effects of AGE-RAGE signaling. The AGE-RAGE signaling system, on the other hand, has some beneficial effects in a variety of tissues, including an increase in osteogenic function. As a ligand decoy, soluble RAGE (sRAGE) may increase in either RAGE production or destruction, and it cannot always reflect AGE-RAGE signaling. The AGE-RAGE axis can be targeted using a variety of drugs. They can also mitigate the negative outcomes. Although recombinant sRAGE can block the AGE-RAGE signaling pathway, it has numerous drawbacks, including AGE accessibility, an increase in other RAGE ligands, and a lengthy half-life (24 hours). It's linked to the loss of AGE/positive RAGE's effects. As a result, sRAGE is not a useful marker for assessing the RAGE signaling pathway's activation. Due to its limitations, recombinant sRAGE cannot be used in clinical practice.

Not applicable

Idiopathic Granulomatous Mastitis (IGM) is a rare chronic inflammatory disease that involves the development of an inflammatory mass in the breast, which may be difficult to differentiate from malignancy. Few patients have been reported in the literature presenting with arthritis accompanying IGM of the breast. Here we report a case of an Iraqi patient who presented as IGM with reactive arthritis and erythema nodosum.

Many epidemiological studies suggest a polyphenol-rich diet can help prevent Alzheimer's disease (AD), and examined the effects of various natural polyphenols on amyloid-protein (Aβ) aggregation using well-known in vitro and in vivo models of cerebral amyloidosis. In vitro studies showed that these polyphenols reduce Aβ oligomer-induced synaptic and neuronal toxicity by preventing Aβ oligomerization and fibril formation. Furthermore, polyphenolic compounds reduced soluble Aβ oligomers and insoluble A deposits in the brain of transgenic mice fed orally. According to a new review of the literature, natural polyphenols have anti-amyloidogenic effects on Aβ, in addition to anti-oxidant and anti-inflammatory properties. Well-designed clinical trials or polyphenol-based preventive treatments are required to prove polyphenols' disease-modifying efficacy.

Autophagy is a conserved homeostatic mechanism enabling cells to cope with various stresses. The pathways leading up to the activation of autophagy are interconnected with those of tumorigenesis. However, the relationship between the two events is not a straightforward one and very often context-dependent. Generally, autophagy appears to act against the tumor during the initiation stage and most often drives cancer progression subsequently. Published clinical trials for the treatment of various tumors, where autophagy was pharmacologically inhibited, were obtained and tabulated. Targeting autophagy for the treatment of tumors can be rewarding in the appropriate context, such as cancer type, grade, and microenvironment.

As our society ages, the incidence of chronic diseases increases, and so does drug use and polypharmacy. Aim: To evaluate the medication use behaviors of selected elderly patients who lived in Baghdad city. Methods: This cross-sectional study included 225 subjects aged >60 years who lived in Baghdad city and consumed chronically prescribed medications. Data were collected using a survey form, and the survey was conducted through face-to-face interviews. The data are presented as numbers, percentages, and averages. Results: The majority were treated through polypharmacy, using various drugs. The most commonly used drugs included those used to treat cardiovascular diseases, DM, and dyslipidemia. 74.6% did not know about the side effects of the drugs they used, and 55.6% did not read the product information leaflet (PIL) of the drugs. Also, 70.7% said that the health care personnel did not educate them about their drugs. Of the elderly who were informed about their drugs, 128 obtained the information from the physician and 91 from the pharmacist. Conclusion: The majority of the elderly subjects used more than one drug, and the main drug class used was the cardiovascular agents. they are unaware of the side effects of the prescribed agents.

Diabetes mellitus (DM) with uncontrolled blood sugar causes a variety of problems, including coronary artery disease, stroke, heart failure, hypertension, nephropathy, neuropathy, and retinopathy. These consequences harm the diabetic patients' lives. Many studies have shown that diabetic patients have a higher rate of heart failure and a worse prognosis than non-diabetic people. Sodium and glucose co-transporter receptor-2 (SGLT2) inhibitors are a relatively new class of anti-diabetic drugs. They not only regulate blood sugar but also have positive cardiovascular effects via a variety of mechanisms. This review intends to show that SGLT2 inhibitors, in addition to good glycemic control, possess a cardioprotective role. We conducted a literature review and identified 20 adequately powered clinical trials and animal studies in type 2 DM that investigated the cardiovascular (CV) effects of SGLT2 inhibitors (particularly heart failure and hypertension). These studies looked at the cardiovascular effects of three SGLT2 inhibitors: Empagliflozin, Canagliflozin, and Dapagliflozin. In diabetic patients, these three inhibitors of SGLT2 significantly lowered the risk of heart failure and hypertension, making them valuable therapy for lowering CV risks in high cardiovascular-risk individuals with T2DM. Finally, the use of SGLT2 inhibitors in patients without diabetes mellitus showed positive metabolic outcomes in weight and blood pressure control.

Despite their effectiveness as a crucial component of combination chemotherapy against solid tumors, platinum compounds have many serious side effects that limit their use. This review article focuses on the various toxic effects of platinum compounds in cancer patients and the mechanisms of associated toxicity. It also describes the future directions for developing novel platinum-based compounds using both animal and human studies. A list of publications was included after searching the Google and Google Scholar databases, PubMed, and scientific journals between 2005-2020. Platinum-based medicines, as soft nucleophiles, can freely bind to proteins containing thiol groups like glutathione and DNA in normal and malignant cells, particularly those in fast-growing tissues, causing a variety of dangerous side effects. Fast-growing tissues such as the mucous membranes of the mouth, throat, stomach, and intestines, bone marrow, and hair follicles can be damaged by cytotoxic chemotherapy, resulting in gastrointestinal toxicities, myelosuppression, and hair loss. Platinum compounds also cause nephrotoxicity and hepatotoxicity, which are well-known side effects. Current platinum-based chemotherapy treatments have been restricted in the last decade, prompting a search for novel platinum-based medications with mechanisms of action distinct from those of existing chemotherapeutics.

EOS (encoded by the IKZF4 gene) is a member of the zinc finger transcription factor IKaros family, and plays a critical role in Treg suppressor functions, and maintaining Treg stability. IL-6 is a soluble mediator with a pleiotropic effect on inflammation, immune response, and hematopoiesis. Aim: To estimate serum IL-6 level and EOS gene expression in Iraqi patients with psoriasis. Method: Twenty-two patients with psoriasis (8 females, 14 males) with age ranged 18-64 years, were recruited from Baghdad Teaching Hospital, Dermatology Clinic, Baghdad, and 24 healthy donors. The serum levels of IL-6 by ELISA and the gene expression of IKZF4 (EOS gene) by RT-qPCR technique. Results: The results showed a non-significant difference in the level of IL-6 in those treated with topical therapy and others treated with Etanercept compared to control. A non-significant increase in patients treated with topical therapy was reported compared to patients treated with Etanercept. There was a higher significant percentage of IKZF4 gene expression folding in psoriasis patients treated with Etanercept compared to control group, while no significant differences reported between patients treated with topical therapy, Etanercept, and the control group. Conclusion: Activation of Regulatory T cells (Tregs) with Etanercept enhances EOS expression and decreases IL-6 production more than topical treatment in patients with psoriasis.

Not applicable

Rheumatoid arthritis is the most common cause of inflammatory polyarthritis. Interleukin‐37 (IL-37) has been found to play an important regulatory role in the development of inflammatory diseases. Objectives: To assess serum IL-37 level in rheumatoid arthritis (RA) patients compared to controls, to evaluate its diagnostic and predictive utility in RA patients and to investigate IL-37 level correlation with demographic and clinical characteristics of RA. Methods: Eighty subjects, 40 RA patients aged between 23-63 years and 40 healthy controls aged between 28-67 years were evaluated. An enzyme-linked immunosorbent assay (ELISA) was used to analyze the serum IL-37 levels. Results: Serum IL-37 was significantly higher in RA patients compared to healthy controls. At optimum cut off value of >58.275 pg/ml, serum IL-37 had 100% accuracy, positive predictive value, negative predictive value, sensitivity, and specificity. Serum IL‐37 level was not significantly related to Disease Activity Score of 28 joints‐erythrocyte sedimentation rate (DAS28‐ESR), also not correlated with C-reactive protein(CRP), rheumatoid factor(RF) and anti-cyclic citrullinated peptide antibody (Anti-CCP). Also there was no correlation between the level of IL-37 and treatment. Conclusions: IL-37 was significantly higher in RA patients compared to healthy controls with a high diagnostic and predictive ability, and may be a potential biomarker for diagnosis and prediction of RA.

Oncologists considered platinum-based medicines as potent cytotoxic agents. Despite their efficacy in combination chemotherapy regimens for many solid tumors, they have many substantial side effects that limit their use. There is no known prophylactic strategy for platinum drugs-induced neurotoxicity, which limit a therapeutic dose benefit. This review highlights the etiology of platinum-drugs-induced neuropathy, and covers the preventative and therapeutic options for cancer patients. It focuses on clinical studies conducted between 2010 and 2020. Loss of functional indications such as touch, vibration and joint location, as well as diminished or missing deep tendon reflexes in the upper and lower limbs are all markers of neurotoxicity. These side effects may last for months or years after treatment, lower quality of life, and creating a substantial survivorship issue. DNA damage, oxidative stress, mitochondrial dysfunction, dysregulation of intracellular signaling, impairment of voltage gated ion channel function, and neuro-inflammation have all been proposed as mechanisms for chemotherapy-induced peripheral neuropathy (CIPN). There are no proven pharmaceutical or nutritional therapies to prevent CIPN. Several anti-CIPN medications have been investigated, but either had no effect or had an effect in a limited sample study. Supportive care medications such anti-epileptics and antidepressants are used to treat CIPN

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that impact daily life activities. The impact on work productivity is critical because of persistent work disability. Aim: To evaluate work productivity in RA patients compared to healthy controls, and to assess the impact of socio-demographic characteristics on work productivity. Methods: This was a case-control study conducted at the Rheumatology Unit of Baghdad Teaching Hospital, Medical City during the period from August 2020 to the end of March 2021. Seventy-two patients with RA were selected and compared with 72 healthy subjects as a control group. All patients were diagnosed according to ACR/EULAR 2010 RA classification criteria. The socio-demographic and clinical features, lifestyle practices, and disease activity of the patients and controls were all recorded during interviews. A standardized Arabic version of the Workplace Activity Limitation Scale (WALS) and the Job Limitations Questionnaire were used to assess the impact of RA on work productivity (WLQ-25). Results: The vast majority of patients were females (58.1%). Positive rheumatoid factor was reported in 94.4% of the patients. The patients showed a significantly lower WALS total score and higher WLQ-25 total score median (IQR) compared with controls. Conclusion: Active RA impairs the work productivity which was influenced by CDAI score and negatively associated with the use of DMARDs.

The link between red blood cell distribution width-to-platelet ratio (RPR) and disease activity in systemic lupus erythematosus (SLE) is not well understood. Aim: To investigate the association between RPR levels and disease activity in SLE. Methods: This was a case-control study conducted at Baghdad Teaching Hospital, Medical City from July 2020 to March 2021. Seventy SLE patients were compared with 70 healthy controls. The diagnosis was made using the American College of Rheumatology SLE criteria. Results: SLE patients had a mean age of 35.2±12.03 years, while controls had a mean age of 36.3±9.9 years (P=0.5). Females represent 97.1% of SLE patients and 88.6% of controls. The average disease duration was 4.98±0.05 years. The disease activity index (SLEDI) was 16.4±4.8. SLE patients had a lower platelet count than controls, and the median (IQR) of RDW was larger than that of controls. SLE patients had a greater median (IQR) of RPR than controls (0.058; 0.04-0.07 vs. 0.045; 0.039-0.053). The RPR and SLEDAI showed strong positive association. The optimal cutoff point for distinguishing SLE patients from controls was 0.0455, with 79% sensitivity and 51% specificity. The RPR was not significantly affected by sociodemographic or clinical factors. Conclusion: The RPR was positively correlated with disease activity in SLE patients, and may be a valid measure to differentiate between SLE patients and healthy controls. Sociodemographic and other clinical characteristics do not significantly affect RPR.

SARS-CoV-2 is the recent variation of the corona virus which is infecting people around the world and has affected more than 258 million people worldwide. Upon observation, the virus is similar to the coronavirus which spread from the horseshoe bat or wild animals to human beings. Up to date, there have been three major variants of the coronavirus which have been identified in UK, South Africa, and India which are spreading to other countries. Based on the current data, it is suggested that the incidents of repeated infection with SARS-CoV-2 is related to the level of neutralizing antibodies and the retained memory response which follows infection. Moreover, recently, a critical issue arises in relation to the association of black fungus and COVID-19, and urgent investigation is required. As a treatment method of COVID-19, FDA has recently approved the feasibility of Remdesivir to treat COVID-19 as emergency use authorization (EUA). There are also various possible antivirals which are still undergoing clinical trial. After widespread of the vaccine, the results showed that EUA vaccines have been effective in controlling COVID-19 in patients. However, these licensed vaccines ought to be reviewed to ensure they are also effective in combating the rising variants of SARS-CoV-2.

Acromegaly is an uncommon, chronic, debilitating condition characterized by hyperinsulinism, insulin resistance, diabetes and prediabetes. One possibility for managing acromegaly's questionable influence on glucose homeostasis is the somatostatin analogues. Aim: To analyze the frequency and risk factors for impaired glucose homeostasis in acromegaly patients treated with depot long-acting octreotide (octreotide LAR), as well as the relationship between risk and treatment duration. Methods: The study included 52 Iraqi adults with acromegaly receiving octreotide LAR. Demographic, anthropometric, and clinical data were collected, as well as the duration of Octreotide LAR administration. Growth hormone, IGF-1, and adenoma size were reported retrospectively from patient data. The glycemic state was assessed and classified as DM, prediabetes, or normal. Results: The prevalence of DM was 39% and prediabetes was 40%, with the exception of being male, which was substantially related with prediabetes. DM and octreotide LAR use had a non-significant correlation. However, octreotide use altered 13% of patients from normal glycemic to prediabetes, with no correlation to treatment duration. Other than hypertension and a family history of diabetes, no other variables were found to be significant. Conclusion: Acromegaly patients have abnormal glucose metabolism, which is associated with prediabetes owing to octreotide LAR medication. Hypertension and family history of diabetes are risk factors.

Treatment modalities of acromegaly and disease control impact differently on glucose homeostasis and lipid changes, and consequently on cardiometabolic risk. Aim: To investigate the possible association of lipid profile changes with the glycemic control status in acromegaly patients treated with octreotide LAR. Methods: This cross-sectional study included 52 Iraqi patients with acromegaly treated with octreotide LAR and not using statins. Demographic, anthropometric, and clinical data were collected, as well as the duration of Octreotide LAR administration. The glycemic state was assessed and classified as DM, prediabetes, or normal. Plasma levels of triglycerides, LDL cholesterol, HDL cholesterol, and non-HDL were evaluated using standard methods. Results: Most of the participants presented with low levels of triglycerides, LDL cholesterol, and HDL cholesterol. The lipid profile variables were not significantly correlated with the glycemic control status after treatment with octreotide LAR. Conclusion: Lipid profile parameters were not associated with the different glycemic control status of acromegaly patients treated with octreotide LAR.

The tail end of 2019 saw the identification of SARS-CoV-2 as the causative virus of COVID-19, which was followed in March 2020 by the assignment of pandemic status to this disease. COVID-19 has exacted terrible tolls on the lives, health, and economies of nearly every country on the planet since then. The major focus in fighting the pandemic has been on the fast development and deployment of vaccines. Despite the undoubted success of vaccines, a few COVID-19 cases will continue to be encountered that require medical interventions. The field of pharmacological treatment has been largely set aside with no emerging specific and effective therapies that are tailored and designed to combat SARS-CoV-2. This narrative review looks at pharmacological therapies that target parts of the viral replication cycle or counteract the body’s response to the presence of the virus. A literature search was undertaken using PubMed and Google Scholar databases to identify relevant medicinal therapies and clinical studies for the management of COVID-19.