Al- Anbar Medical Journal

Telogen effluvium (TE) is defined as non-scarring diffuse scalp hair loss, varying from 150 to more than 400 hair falls per day. TE is a very important cosmetic query that cannot be ignored, especially for women. Different kinds of search literature were reviewed, regarding the mechanism of hair shedding, causes, clinical types, the role of diagnostic tools, and potential treatment modalities. The deviations in the follicular cycle period led to telogen hair loss. The disease exists in an acute or chronic state, sometimes associated with trichodynia. Diagnostic evaluations include the hair pull test, the clip test, trichoscopy, the modified wash test, and less frequent histopathological studies. Almost all cases of acute disorders can be cured by eliminating the identified causative factors. As a result, for most of them, no exact therapy is necessary. The chronic form is considered a challenging treatment goal for physicians, and many modes of treatment for telogen effluvium have been used with different benefits. Newly approved causes include post-hair transplantation, vitamin D deficiency, and coronavirus disease-19. Until now, limited treatment choices with variable benefits have been offered. This narrative review article evaluates the acute and chronic presentation, available investigations, and treatment options for telogen hair loss.

Background: Age can affect seminal fluid parameters (SFPs); many studies reported that SFPs are reduced in older men. Although these alterations may not necessarily cause infertility, they can make it harder for older men to conceive.
Objective: We aimed to examine which SFPs are mostly affected by age among Iraqi population.
Material and Methods: A retrospective observational study recruited 120 eligible male participants attending an infertility center, Bagdad, Iraq. The participants were grouped according to their ages into 3 groups as follows: Group I: 21-30 years (41/120); Group II: 31-40 years (43/120), and Group III > 40 years (36/120). For each participant, we collected firstly male demographic and clinical criteria that include age, infertility type, and its duration, in addition to abstinence days. Secondly, SFPs, that include volume, viscosity, liquefaction time, sperm concentration, viability, motility, normal and abnormal morphology, and round cell count. The correlation of age with SFPs was examined.
Results: Analysis showed insignificant differences in seminal fluid volume, total motility, and viscosity among the three groups. Group I showed the lowest liquefication time, and had the highest sperm counts and normal morphology. Abnormal sperm morphology was highest in group III and was statistically meaningful across the groups.
Conclusion: SFPs of older men > 40 years had the lowest number of sperm number and live sperm the highest immotile, non -progressive, and abnormal morphological sperms. Since the average paternal age is rising, it is imperative to educate men that advancing age reduces fertility potential and impacts offspring health.

Background: Cancer-associated thrombosis (CAT) is the second cause of death for cancer patients. National Comprehensive Cancer Network (NCCN) guidelines recommend assessing CAT risk for all ambulatory cancer patients by Khorana score and prescribing thromboprophylaxis for high-risk patients. Unfortunately, clinical practice in many countries fails to apply this guideline effectively.
Objectives: To determine the level of venous thromboembolism (VTE) risk among ambulatory cancer patients and the oncologists' role in prescribing thromboprophylaxis to high-risk patients in Al-Diwaniyah Teaching Hospital, Al-Qadisiyah, Iraq.
Materials and methods: A cross-sectional study was conducted from September to October 2023 in the Oncology Center at Al-Diwaniyah Teaching Hospital, Al-Qadisiyah, Iraq. The oncologist's role in prescribing thromboprophylaxis for newly diagnosed ambulatory cancer patients visiting the oncology center was assessed after calculating the thrombosis risk score using the validated Khorana score.
Results: 49 patients newly diagnosed with cancer were enrolled in the study. Most of the participants were females with a normal body weight. Breast cancer was the most common cancer type among study participants. Regarding the risk of VTE, eight (16.3%) participants had a high risk, 24 (48%) had a moderate risk, and 17 (36%) had a low risk. All of the study participants regardless of their thrombosis risk were not prescribed thromboprophylaxis by oncologists.
Conclusion: Most newly diagnosed ambulatory cancer patients had moderate to high risk of VTE. Oncologists did not prescribe thromboprophylaxis to any of these patients. Therefore, we recommended that all oncologists must be adherent to NCCN thromboprophylaxis guidelines.

Background: Delayed presentation of cryptorchidism, or undescended testis (UDT), is still a common problem worldwide, despite the clear recommendations of most international guidelines for early referral and correction at 6–12 months of life. Identifying the underlying causes of this delayed presentation is an important step in overcoming this problem.
Objectives: To identify the causes and risk factors associated with delayed UDT presentation.
Materials and Methods: A cross-sectional study was conducted over 17 months, and included patients with UDT up to 14 years old age. Patients were divided into two groups according to their age at the time of presentation, early (≤ 1 year) and late (> 1-14 years) groups. The causes of delayed UDT presentation were identified in the late group. Both groups were compared regarding possible risk factors of delayed UDT presentation.
Results: Of 204 cases with UDT, there were 121 (59.3%) patients presented beyond the recommended age of orchiopexy. The main causes of delayed presentation were parental ignorance and unawareness in 43 (35.5%) patients, false advice from medical and nonmedical personnel in 17 (14.1%) and 28 (23.1%) patients, respectively, the presence of another medical disease in 18 (14.9%) patients, and poverty in 15 (12.4%) patients. Patients in the late group had a significantly less urbanized level of residency (P-value = 0.036), a lower maternal education level (P-value = 0.012), less parent information about UDT (P-value = 0.013), more likely to be first-born boys in their families (P-value = 0.036), and to have another medical disease(s) (P-value = 0.049). We found insignificant differences between the two groups regarding family history of UDT (P-value = 0.300), paternal education level (P-value = 0.288), side (P-value = 0.759), and site (P-value = 0.073) of UDT.
Conclusion: Delayed presentation of UDT was attributed mainly to the limited knowledge of the community and medical care providers about its management. Increasing public awareness about UDT and establishing effective measures for earlier detection and referral of patients with UDT are important initial steps to solving this problem in our society.

Background: Resistin in humans is classified as an adipokine and has been proposed as an inflammatory marker, associated with the development of atherosclerosis and coronary artery disease.
Objectives: To evaluate serum resistin levels in patients with acute coronary syndrome (ACS) with and without type 2 diabetes mellitus (T2DM). In addition, correlating serum resistin with clinical and biochemical parameters was another objective.
Materials and Methods: This study included 60 patients with ACS diagnoses. The participants were categorized into two groups: 30 patients with both ACS and T2DM and 30 patients with ACS but without T2DM. The control group comprised 30 healthy individuals who matched the patient groups regarding sex and age. Levels of serum lipids, fasting blood glucose (FBG), Hemoglobin A1c (HbA1c), C-reactive protein (CRP), troponin I, and resistin, were estimated for each participant.
Results: The levels of resistin in the serum were significantly higher in ACS with T2DM or ACS without T2DM patients compared to healthy individuals (1.184 ± 0.271 ng/mL and 1.249 ± 0.358 vs. 0.601 ± 0.141 ng/mL, respectively, P-value = 0.001). The analysis of the data exhibited a significant positive correlation between serum resistin and CRP levels in the ACS with T2DM (r = 0.412; P-value = 0.018) and the ACS without T2DM (r = 0.467; P-value = 0.01). There was no significant correlation between serum resistin levels and other variables in these two groups. The receiver operating characteristic (ROC) analysis in ACS with T2DM exhibited that serum resistin level larger than 0.896 ng/mL was correlated with an elevated incidence of ACS (Area Under the Curve = 0.988, sensitivity = 93.33%, specificity = 93.33%, and likelihood ratio = 14). In contrast, ROC analysis in ACS without T2DM exhibited that a serum resistin level greater than 0.830 ng/mL was correlated with an elevated incidence of ACS (Area Under the Curve = 0.978, sensitivity = 90%, specificity = 90%, and likelihood ratio = 9).
Conclusion: Serum resistin can be used to predict ACS in patients with or without T2DM. Also, resistin is an effector molecule of the inflammatory response that contributes to ACS.

Background: Hepatitis B virus (HBV) infection is a common health problem; all over the world, around 300 million people have had chronic HBV infection in 2019. Healthcare staff and medical students are at four times greater risk of acquiring HBV infection than the general population.
Objective: To assess medical students' awareness, attitude, and practice towards the HBV vaccine.
Materials and methods: We selected a convenient sample of 300 students from Mosul Medical College, from different academic stages, and a cross-sectional study was conducted from May 1st, 2023, to September 30th, 2023. Data were collected through a direct interview using a special questionnaire form, then tabulated, and analyzed using Excel 2010 and SPSS software Version 24.
Results: The participants were mainly from the 4th, 5th, and 6th stages (82%), and a good percent of student’s awareness (96%) of HBV transmission via contaminated blood, with 73% knowing vertical transmission of the virus from pregnant mother to their fetus. For vaccination awareness, 89% of students agreed that vaccination should be given to health care workers and 75% knew that full immunization consists of 3 doses, 53% of students have received the HBV vaccine, 50% of them received full 3 doses and half of vaccinated students received it at 4th and 5th stage. Around 90% of the non-vaccinated students don’t know when and where to get the vaccine.
Conclusion: Despite good knowledge of HBV transmission, control, and vaccination schedule; only half of the participants have received the vaccine. One of the most important causes for the non-receiving vaccine was a lack of knowledge about the time and place for receiving the vaccine.

Background: Medical ethics are moral values that direct the doctor’s profession to enhance patient outcomes and community health. It guides doctors' obligations to patients, colleagues, and society, upholding beneficence, nonmaleficence, justice, respect for autonomy, and confidentiality.
Objectives: To assess the knowledge, attitudes, and practices of doctors regarding medical ethics.
Materials and methods: An analytic cross-sectional study was conducted in Wasit province, Iraq. A self-administered questionnaire was distributed to 258 randomly selected doctors from the three main governmental hospitals in Al-Kut City, Iraq. This questionnaire consisted of four main parts, including sociodemographic features, knowledge (14 items), attitudes (6 items), and practice questions (5 items). In addition to inquiring about who to consult when facing ethical issues.
Results: An analysis of 240 completed questionnaires revealed that the highest percentage of doctors (89.6%) were aware of the importance of confidentiality when treating patients, and the same percentage (89.6%) didn’t agree that consent is required only for surgical intervention. The majority of doctors (88.8%) didn’t agree with helping patients to die even though they requested it. Regarding attitude, most doctors (84.2%) strongly disagreed and disagreed with the commission for sending patients to tests. This was followed by 83.7% who believed that doctors should not tell patients that tests are normal when not conducting them. The highest percentage of doctors mentioned witnessing unethical behavior from their clinical team. Knowledge of doctors was significantly related to their sex and years of experience (P-values = 0.001 and 0.001, respectively). While attitude was related to both job description and years of experience, with a P-value of 0.001 and 0.049. Those doctors who received a medical ethics postgraduate course had a significantly higher percentage of good knowledge scores than those who didn’t receive it (P- value = 0.001). Around 40% of the sample mentioned consulting their families and friends when facing any ethical problem.
Conclusion: Even though the majority of the doctors in this study had good knowledge and positive attitudes toward medical ethics, it was found that new doctors who received postgraduate courses in medical ethics were more knowledgeable than other doctors.

Background: Due to the physical and work nature demands, physiotherapists (PTs) face a high risk of developing musculoskeletal disorders.
Objectives: To compare the prevalence and risk factors of work-related musculoskeletal disorders (WMSDs) between pediatric and adult PTs in China.
Materials and Methods: A cross‑sectional study was conducted between December 2023 to February 2024 among pediatric and adult PTs. It involved distributing a self-administered questionnaire to 129 PTs in three Chinese provinces, including five tertiary hospitals. This questionnaire collected demographic characteristics and data on the presence of musculoskeletal complaints within the last 12 months.
Results: Out of 192, there were 129 PTs responded to the questionnaire (67.18%). These include 62 pediatric PTs and 67 adult PTs group. The prevalence of WMSDs among the pediatric group was 53.9%, compared to 63.8% among the adult PTs group. However, significant differences in the body mass index and work experience were observed between the PTs groups (P-values = 0.019 and 0.018 respectively). Furthermore, no significant differences in demographic and associated factors, including workload, were found among PTs groups. Lower back was the most affected region in pediatric PTs (n = 46, 74.2%) and adult PTs (n = 44, 65.7%).
Conclusion: In China, PTs frequently experienced WMSDs, with the lower back being the primary affected region. This study provides valuable insights to inform the development of strategies aimed at reducing WMSDs among PTs, thereby improving their occupational health and safety. It explores unique challenges and differences in population conditions between pediatric and adult PTs.

Background: Colorectal carcinoma is one of the most common cancer related morbidities and mortality. Only a few clinicopathological parameters give a prediction of the patient′s outcome. Therefore, there is a demand for additional prognostic markers, which may also assist in detecting the benefits of treatment.
Objectives: To assess the frequency of SATB2 immunohistochemical expression in colorectal carcinoma, and to assess the relation of SATB2 expression with variable clinicopathological parameters.
Materials and methods: In this retrospective case series study, a study for SATB2 was done by immunohistochemical technique on 50 cases of primary colorectal carcinoma, using mouse monoclonal antibodies (AMAb90635, clone CL0276, Atlas Antibodies AB, Stockholm, Sweden). Results: The patients′ ages ranged from 22-85 years (mean ± SD = 58.6 ± 14.46 years), with a male-to-female ratio of 1:1. Diffuse expression of SATB2 was detected in 70% of cases and a complete absence of expression was seen in 6 cases. A significant association was detected between SATB2 expression and tumor grade and lymph node metastasis (P-value 0.0116 and 0.0218, respectively). While no significant association was detected with patients′ age, sex, tumor site, histological subtypes, or stage of the tumor.
Conclusion: SATB2 expression may help in the identification of particularly aggressive colorectal cancer cases and can add additional prognostic information for subgrouping the cases within the same grade and stage.

Background: Pain assessment is a crucial aspect of neonatal care in the neonatal unit. It involves observing specific physiological and behavioral changes by nursing staff to ameliorate pain and discomfort in neonates.
Objectives: To assess the knowledge, perceptions, and attitudes of the nursing staff of neonatal care units about the assessment and management of neonatal pain.
Materials and Methods: A descriptive cross-sectional study was executed on all nurses working in neonatal care units at four pediatric teaching hospitals in Baghdad/Rusafa from the 1st of January to the 31st of December 2022. A total sample of 121 nurses was recruited from these hospitals. Demographic criteria of the nursing staff were collected, including age, sex, years of experience in neonatal care, and whether they had received previous neonatal care training. Nurses’ knowledge and attitude toward neonatal pain were assessed using a two-point Likert scale, with ten agree and ten disagree questions. Scores were then categorized into two grades based on the median cut-off point: Scores between 5 and 10 were graded as acceptable, while scores below 5 were categorized as poor.
Results: The mean age of the recruited participants was 32.6 ± 9 years. The study revealed that 86 nurses (71.1%) had an acceptable score regarding their knowledge of neonatal pain perception, while 81 nurses (69.4%) had an acceptable score regarding their practices in neonatal pain management. Characteristics such as age, gender, having children, previous neonatal training, and working in neonatal care units for two years or more were significantly related to nurses' knowledge and practices in neonatal pain perception and management (P-value < 0.05).
Conclusion: Most nursing staff demonstrate a satisfactory score regarding their knowledge and attitudes about neonatal pain. Variables such as age, gender, having children, previous neonatal training courses, and working in neonatal care units for two years or more impacted the nurses' scores.

Background: Vocal fold leukoplakia (VFL) is a benign lesion of the vocal folds, that if left untreated, possesses the potential to develop into a malignant, high-risk carcinoma of the larynx. There are several risk factors, such as smoking, alcohol consumption, and exposure to chemical irritants affecting the disease severity and recurrence post-surgical intervention.
Objective: To examine the demographic and clinical characteristics associated with VFL, to investigate the recurrence of VFL following surgical removal, and to identify prognostic factors that can predict lesion recurrence.
Materials and methods: In the current prospective cohort study, 85 adult patients with VFL were recruited. The selected patients underwent a direct laryngoscope, followed by surgical stripping and biopsy sampling for histopathological examination, with subsequent one-year follow-up.
Results: Out of 85 patients with VFL, there were 29 patients (34.11%) with recurrence. There were 67 (78.8%) males. The mean age of men was 63.0 ± 6.6 years, compared to 61.1 ± 7.0 years for women. Sixty percent (51) of the cases had a history of smoking. There was no significant impact of sex, age, and smoking on VFL recurrence (P-value > 0.05). However, high-risk histopathological grades and bilateral VFL with involvement of the anterior commissure were significantly correlated with recurrence (P-values of 0.001 and 0.012, respectively). Univariate analysis presented a significant association between high-risk histopathological grade (P-value = 0.001) and bilateral VFL (P-value = 0.012) and recurrence. The high-risk histopathological grade was found to be independently effective in predicting the recurrence of VFL after treatment by utilizing multivariate analysis.
Conclusions: VFL had a high recurrence rate. Findings from a high-risk histopathological grade and bilateral VFL with involvement of the anterior commissure can be employed to predict VFL recurrence after surgery. Embracing a healthy and conscious lifestyle by minimizing exposure to risk factors could impede the progression and recurrence of VFL, specifically among individuals who are at higher risk of developing the aggressive form of the disease.

Background: Quality of life assessment is an important parameter in assessing how survivors cope with the impact of the disease and its treatment.
Objective: To assess the quality of life for breast cancer women and to determine socio-demographic factors affecting it.
Methods: A descriptive-analytic cross-sectional study design was used. Data regarding socio-demographic characteristics were collected from a purposive sample consisting of 250 breast cancer women in Baghdad City for the period from June 20th 2023 to November 31th 2023. We used the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-C30 and QLQ-BR-23) for the assessment of the patients.
Results: The average age of the women was 46.83 ± 12.32 years. The worst quality of life results was recorded in the domain of financial impact, with a mean score of 2.36 ± 0.79. In symptom scales: Pain, fatigue, and hair loss were the highest symptoms, followed by appetite loss and arm symptoms, which had a moderate effect. The mean scores for physical and role function of quality of life had a low and moderate assessment in all items. Regarding the psychological domain, anxiety and depression, had the highest score of 2.35, followed by thinking and body image, which had a moderate score of 2.01 and 2.03 respectively. While the memory and concentration scale had a lower score (1.58). The mean score for the sexual activity scale had a relatively moderate score in all items. There are high statistically significant differences between all socio-demographic variables and quality of life domains for breast cancer women (P-value < 0.05).
Conclusion: Breast cancer and its treatment affect all domains of the quality of life of breast cancer women. The age, education, marital status, occupational status, and monthly income of breast cancer women might be affected by their quality of life.

Background: Foremost, the diagnosis of ovarian carcinoma is light microscopic in nature. However high-graded tumors and some equivocal cases may require contemporary tests.
Objectives: To examine ovarian carcinoma types in Duhok-Iraq using morphology and available immunohistochemical panels.
Materials and Methods: In this retrospective cross-sectional study, paraffin blocks of 164 ovarian carcinoma cases were retrieved from Duhok pathology centers between January 2012 and December 2022. Tumor microsections were taken from these paraffin blocks, stained with Hematoxylin and Eosin (H&E), and examined under the light microscope. After morphologic diagnosis, tumors were classified. High-grade and equivocal cases were subjected to different immunohistochemical panels depending on the light microscopical morphology and the available antibodies. The immunohistochemical technique applied was the automated immune-stainer (Dako-Denmark) on deparaffinized tumor sections using the avidin-biotin–peroxidase complex technique.
Results: The study cases included 125 primary and 39 metastatic carcinomas. All women were over 20 years with a mean age of 42.8 years. Among the primary tumors, high-grade serous carcinoma (33.5%) was the commonest, followed by mucinous carcinoma (22.6%), endometrioid carcinoma (14%), clear cell carcinoma (2.4%) and transitional cell carcinoma (1.2%). The remaining primaries comprised 4 (2.4%) Malignant Mixed Mullerian tumor. The 39 metastatic carcinomas were adenocarcinomas, average age was 36.9 years. Sites of origin included: 18 colonic (including appendix), 7 gastric, 4 endometrial, 5 breast, 3 pancreatobiliary, and 2 ampullary carcinomas.
Conclusion: High grade serous carcinoma topped the list of ovarian carcinoma cases (primary and metastatic). Diagnosis of most carcinoma cases was made using routine H&E light microscopic sections. Difficulties arise in high-grade and metastatic cases, particularly cases exclusive to an ovary. Metastatic cases have primarily emerged from the colon (including appendix), stomach, endometrium, pancreatobiliary, breast, and ampulla. Such cases need contemporary tests, like immunohistochemistry.

Background: Measles is one of the acute and very contagious diseases for children, but it can be successfully controlled by vaccination.
Objectives: To evaluate the impact of measles vaccination coverage on the severity of measles among children aged less than five years in Diyala Province, Iraq, during the year 2024 outbreak.
Materials and Methods: A cross-sectional study was conducted from January to March 2024 at the Al-Batool Teaching Hospital, Baquba, Diyala, Iraq. Ninety-two children admitted with symptoms of measles underwent detailed clinical and serological examinations. We used descriptive, bivariate, and multiple logistic regression analyses to analyze the data. We set the statistical significance at a P-value of less than 0.05.
Results: The total number of cases were 92 children with a mean age of 26 ± 2.46 months, and 44.6% were below 1 year old. Most of the children were unvaccinated (84.8%), severely infected (80.4%), and complicated with pneumonia (70.7%), with positive IgM antibodies for measles (83.7%). Multiple logistic regression analysis showed that children below one year of age [Odds Ratio (OR) = 7.909, 95% CI: 1.610 to 38.860, P-value = 0.011], unvaccinated (OR = 6.300, 95% CI: 1.489 to 26.657, P-value = 0.012), and those with low-educated mothers (OR = 4.013, 95% CI: 1.982 to 16.389, P-value = 0.035) were significantly associated with severe illness.
Conclusion: During the year 2024 measles outbreak in Iraq, the severity of the illness was exacerbated among unvaccinated children aged below one year and those with low-educated mothers.

Background The importance of obesity in the progression of Type 2 Diabetes Mellitus (T2DM) is represented by defective biochemical markers' production and release that may interact with each other, resulting in negative outcomes for the diabetic state. When neuropeptide Y is released and interacts with adipose tissue, it may affect the adiponectin release, which plays a role in glucose metabolism and insulin sensitivity.
Objectives: To estimate the serum levels of neuropeptide-Y and its impact on adiponectin release in obese T2DM patients in relation to the insulin resistance state.
Materials and Methods: Eighty-seven T2DM patients attending the clinic of the National Center of Diabetes Treatment and Research, Baghdad, Iraq, were categorized into two groups; Group 1: 45 obese T2DM patients with BMI of ≥ 30 kg/m2 and age 31-59 years, and Group 2: Normal body weight T2DM patients with BMI of 18.5-24.9 kg/m2, included 42 patients, with an age 33-60 years. Fasting blood specimens were utilized to measure serum neuropeptide-Y, adiponectin, and glycemic markers for each participant.
Results: The fasting blood glucose (FBG), glycated hemoglobin (HbA1c), Homeostasis Model Assessment Insulin Resistance (HOMA-IR), and neuropeptide-Y values were significantly elevated (P-value = 0.001) in Group 1 in comparison with Group 2. Serum insulin and adiponectin levels were significantly higher (P-value = 0.001) in Group 2 compared to Group 1. Furthermore, serum neuropeptide-Y, FBG, HbA1c and HOMA-IR were negatively correlated with adiponectin serum levels, where (rho = -0.617, P-value = 0.001), (rho = -0.684, P-value = 0.001), (rho = -0.359, P-value = 0.001), and (rho = -0.271, P-value = 0.011) for neuropeptide Y, FBG, HbA1c and HOMA-IR, respectively, while the fasting serum insulin was positively correlated with adiponectin serum level (rho = 0.310, P-value = 0.003).
Conclusion: Elevated serum neuropeptide-Y and declined adiponectin levels in obese as compared with normal-weight diabetic patients may reflect the negative impact of serum levels of neuropeptide-Y- on adiponectin release. Furthermore, adiponectin levels were negatively correlated with glycemic markers; which is an indication of its beneficial role in T2DM improvement.

Background: A genetic abnormality in chronic myeloid leukemia (CML) involves a translocation between the long arms of chromosomes 9 and 22, known as t(9;22)(q34;q11.2), resulting in the Philadelphia chromosome (Ph). This translocation fuses the Abelson (ABL1 gene on chromosome 9 with the breakpoint cluster region (BCR) gene on chromosome 22, creating the BCR-ABL1) fusion gene, which is a key feature of CML.
Objectives: To assess the prevalence and genetic anomalies of the Ph and BCR-ABL1 fusion gene in individuals diagnosed with CML. Besides, we aimed to investigate the relevance of CML corresponding with type of treatment, and the effectiveness of cytogenetics and molecular response with each other in addition to hematological response.
Materials and methods: Quantitative real-time polymerase chain reaction (qRT-PCR) for specific fusion genes and cytogenetic analysis for Ph chromosome was done for 55 previously diagnosed CML patients, who were attended at Anbar Cancer Center in Anbar Governorate, Iraq, between March 2023 and February 2024.
Results: In a study of 55 previously diagnosed CML patients, with a median age of 45. The commonest symptom was anemia (n = 50, 90.91%). The majority were male (61.82%). Hematological and molecular investigations revealed a significant improvement in the number of white blood cells (WBCs), the stability of red blood cells (RBCs), and hemoglobin (Hb) in the blood, accompanied by a reduction in the level of the BCR-ABL 1 gene according to the results of the qRT-PCR and a decline in the rate of abnormal cells shown by the karyotype.
Conclusions: Monitoring CML effectively involves hematological, molecular, and cytogenetic evaluations. qRT-PCR offers a more rigid analysis than karyotype. Complete blood count (CBC) parameters are crucial along with qRT-PCR for follow-up disease stages and guiding treatment decisions.

Background: Embolic stroke of undetermined source (ESUS) occurs when the recommended diagnostic workup fails to identify a convincing underlying cause. ESUS is more common among male patients of younger age. One of the most common underlying findings among ESUS patients is a patent foramen ovale (PFO). Transesophageal echocardiography (TEE) offers enhanced diagnostic information for certain patients due to its proximity to the heart and major vessels, making it superior to transthoracic echocardiography in various conditions.
Objectives: To assess the diagnostic yield of the TEE in young patients with ischemic stroke who fulfil the diagnostic criteria of ESUS.
Materials and Methods: This was a descriptive-observational cross-sectional study. It was conducted at Shaheed Al-Mehrab Center for Cardiac Catheterization from January 2, 2024, to June 1, 2024. The study included young patients with ischemic stroke, referred by their treating neurologist, who fulfilled ESUS diagnostic criteria and underwent TEE. We designed a specific questionnaire to document relevant information.
Results: -A total of 13 patients were enrolled in the current study. The mean age was 36.77 ± 4.88 years, with the majority of cases (n = 8) being males. Among patients with ESUS, TEE detected PFO in 23.1% and atrial septal aneurysm in 15.4%. All patients had normal left atrial appendage (LAA) parameters and ejection fraction. The mean body mass index was significantly lower in patients with PFO. The mean of early and late LAA emptying velocities were significantly lower in patients with PFO.
Conclusion: TEE was effective in identifying underlying cardiac abnormalities in ESUS patients, with a significant detection rate for PFO and atrial septal defects. We recommend further studies with larger sample sizes to confirm the study's results.

Background: Burn is associated with several consequences, including an increased incidence of infection, extended duration of hospitalization, and an increased mortality rate. Both PPARα and PPARβ are shown to play crucial roles in the keratinocyte response to skin damage.
Objective: To evaluate the healing effects of saroglitazar (SAR) in thermally induced burns.
Materials and Methods: Twenty male adult Wistar rats were allocated into four groups: Negative control, positive control, SAR treated, and silver sulfadiazine (SV) treated groups. The burn was induced thermally in all groups except the negative control, and the treatments started after the induction and continued daily for 21 days. Burn areas were measured on days 0, 7, 14, and 21. On day 21, the animals were euthanized and the blood samples were used to measure the complete blood count, hs-CRP, tumor necrosis factor-α (TNF-α), VCAM-1, and interleukin-10 (IL-10). Burned areas were sent for histopathological analysis.
Results: The burned areas significantly decreased after 14 days of treatment with SAR, and more significant attenuations occurred after 21 days, along with decreased VCAM level and significant attenuation of hs-CRP and TNF-α and nonsignificant elevation of IL-10. The histopathological findings support the biochemical findings and show remarkable improvements in skin regeneration and lesion scoring.
Conclusion SAR has shown a notable burn-healing effect comparable to that of SS which could be attributed to its anti-inflammatory effects. This finding suggests SAR a candidate to be tested in a clinical setting.