Al-Kindy College Medical Journal

Tirzepatide is a revolutionary and promising medication with a high impact in the treatment of Obesity and T2DM with their complications. Its efficacy was proven through different trials in achieving favorable weight loss and a significant reduction in glycemic index. It also treated a large diversity of related co-morbidities, including fatty liver, cardiovascular disease, dyslipidemia, and more. Tirzepatide is well tolerated, has a good safety profile, and is highly reliable and suitable for use in a population.

Exercise is one of the non-pharmacological therapies that functions to improve public health. This study seeks to determine how increased IGF-1 levels during exercise as a hormone can trigger growth. For this study, a number of journal databases were searched, such as PubMed, Web of Science, Embase, and Science Direct. This study considers several aspects, such as research on exercise and IGF-1 published in reputable journals over the past five years. Our analysis only includes items published in reputable international journals. Using databases total of 159 publications were found. In this comprehensive analysis, about ten carefully selected and peer-reviewed papers were included. The standard operating procedure for this investigation was developed using Preferred Reporting Systematics and Meta-analysis (PRISMA). Based on the results of this systemic investigation, exercise has been shown to increase IGF-1 levels, a hormone that promotes growth. Physical exercise as a therapeutic effort and a means of improving public health.

Background: Carotid cavernous fistulas (CCFs) are abnormal arteriovenous connections between the carotid arterial system and the cavernous sinus, presenting with complex neuro-ophthalmic manifestations due to the redirection of arterial blood into the venous system. This study systematically reviews the diverse neuro-ophthalmic presentations of CCFs, emphasizing the influence of venous flow dynamics.



Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science, focusing on keywords such as \"carotid cavernous fistula,\" \"neuro-ophthalmic presentations,\" and \"optic nerve compression.\" Recent and historical studies were analyzed to assess the neuro-anatomical impacts on neuro-ophthalmic symptoms from CCFs. This review aimed to consolidate knowledge and refine diagnostic and therapeutic strategies for CCF management.



Results: The findings demonstrated that the neuro-ophthalmic presentations were quite distinctive, depending on the direction of venous flow. Anterior flow, overall, was associated with proptosis, conjunctival arterialization, and red, dilated vessels. In contrast, posterior flow was associated with cranial nerve complications, most notably abducens nerve palsy and trigeminal neuralgia, manifesting as double vision and facial pain, respectively. It therefore seems that the symptomatology and severity of CCFs is heavily dependent on the direction of blood flow.



Conclusion: The flow direction through the veins is of significant importance in the clinical presentation and prognosis of CCFs. These dynamics must be appreciated to improve diagnosis and allow for optimal treatment, thus averting the risk of fatal complications. In this review, the need for tailored therapeutic strategies through detailed vascular and neuro-ophthalmologic analysis is outlined.

Background: Cervical cancer (CRC) is a public health problem because it is the fourth most common gynecologic neoplasm worldwide. The screening tests used to diagnose this pathology are cervical cytology, which in suspected malignancy or with malignancy requires colposcopy to identify the affected area and thus guide the biopsy, which is the gold standard for diagnosis. Therefore, these tests are complementary, and a high diagnostic concordance is required to make a confident diagnosis.

Subjects and Methods: A retrospective, cross-sectional, observational, and analytical study was performed. A total of 1470 medical records were analyzed, of which 175 patients met the inclusion criteria. The cyto-colposcopic diagnostic yield was compared with the histopathologic yield. The concordance between screening tests and the gold standard was calculated using Cohen's kappa coefficient

Results: The sample comprised 175 subjects who met the selection criteria (11.9%). The mean age was 34.59 + 11.01 years, ranging from 17 to 65 years. The mean sexual debut was 16.6 years, with a mean of 3.1 ± 2 sexual partners. When patients were classified according to lesion type, the highest percentages were found in low-grade squamous intraepithelial lesions (LSIL). With 45.71, 61.14, and 49.14% for cytologic, colposcopic, and histopathologic examination, respectively. The highest concordance between histopathology and cytology was found in the high-grade squamous intraepithelial lesion (HSIL) with 0.41, and the concordance between histopathology and colposcopy in HSIL and cancer was 0.55 and 0.74, respectively.

Conclusions: Papanicolaou tests and colposcopy showed moderate concordance with histopathologic findings; the diagnostic accuracy of colposcopy is superior to that of cytology.

Background: CD15 is emerging as a recent prognostic marker with potential as a future therapeutic target in human malignancies. Its biological role in human cancer involves facilitating tumor cell adhesion through interaction with E-, L-, and P-selectins. This interaction allows adhesion to endothelial cells, enhancing metastatic potential.

Objective: to study CD15 expression and its relationship to some pathologic parameters to provide the first Iraqi data-driven analysis of this growing concept in women with breast cancer. Subjects and Methods: A retrospective study was carried out utilizing tissue samples obtained from 85 patients with invasive breast cancer. Materials included one formalin-fixed paraffin-embedded tissue block, one hematoxylin and eosin-stained histological section, and two immunohistochemical-stained ER and HER2/NEU sections for each patient. The samples were obtained through core needle biopsy under ultrasound guidance. Data review and immunohistochemical staining with CD15 were conducted, followed by statistical analysis using the chi-square test to explore correlations.

Results: CD15 expression was observed in 55% of breast cancer samples. There was a highly significant statistical relationship between CD15 expression and the presence of axillary lymph node metastasis (proven by fine needle aspiration cytology). However, there was no significant statistical relationship between CD15 expression and the histological grade, ER receptor, HER2-NEU status, and tissue calcification.

Conclusion: CD15 expression was detected in breast cancer cells, with a highly significant association observed between CD15 expression and axillary lymph node metastasis at presentation. CD15 could serve as a prognostic marker as association with axillary lymph nodes reflects negative impact on prognosis and at the same time a promising therapeutic target for patients with breast cancer as blockage of CD15 antigen’s function will result in reduction of the metastatic potential and it could be an immunotherapeutic target.

Background: Approximately 13-59% of myocardial infarction patients develop ischemic mitral regurgitation, impacting left ventricular function and increasing mortality risk. Optimal management of moderate ischemic mitral regurgitation remains controversial, raising the question of whether adding mitral valve surgery to coronary artery bypass graft (CABG) has an overall advantage over revascularization or not.

Objective: To investigate the early and mid-term comparison between the two techniques.

Subjects and Methods: This randomized clinical trial was conducted at Assuit University Heart Hospital, on 50 patients randomized into two groups: Group A: 25 patients underwent CABG and Group B: 25 patients had CABG and mitral valve repair. Inclusion criteria was multi-vessel coronary artery disease, moderate ischemic mitral regurge (MR). All patients were subjected to full history taking, routine physical, laboratory investigations and transthoracic echocardiography. Intraoperative data was collected. Early outcomes included MR degree, and left ventricular (LV) diameters and function, ICU stay duration, and in-hospital mortality. Mid-term outcomes included MR degree, LV diameter and function.

Results: Groups had similar age and gender distribution. Repair procedures showed longer ischemic and operative times than CABG alone (P≤0.0001 and P=0.0012). Early post-operative, repair reduced MR significantly (P≤0.0001). At six months follow-up, CABG group had more rate of improvement than repair group (P≤0.0001).

Conclusions: In moderate ischemic mitral regurgitation with multi-vessel ischemic heart disease, adding mitral valve repair to CABG may reduce mitral regurgitation severity early and at six months compared to CABG alone. However, CABG alone offers shorter ischemic times and operative durations.

Background: Acute coronary syndrome (ACS) is still one of the main causes of morbidity and mortality worldwide, to decrease mortality rates if diagnosed early. The ACS classification into three subtypes depends on electrocardiogram. miRNA-499-5p was found to be substantially elevated in AMI patients as compared with the non-AMI group and healthy control and it was already detectable in the plasma 1h after the onset of chest pain in AMI patients

Objectives: To evaluate the role of measuring serum miRNA-499-5p value in early diagnosis of ACS and compare with hscT-I

Subjects and Methods: A total of 120 patients (72 males and 48 females) aged≥30 years were consecutively selected from those who were admitted and diagnosed with ACS. The healthy subjects as controls for this study were recruited from those who had no current illness. The serum miRNA-499-5P and hscT-I were measured.

Results: It was shown that miRNA-499-5p levels had an overall significant difference among study groups (p<0.001), also the miRNA-499-5p mean level was significantly different between each ACS subgroup and controls (P<0.001)

miRNA-499-5p showed a significant positive correlation with hscT-I 0hrs in STEMI and NSTEMI but UA showed a non-significant correlation. miRNA-499-5p level had perfect AUC and high sensitivity and specificity for discrimination between subgroups of ACS patients.

Conclusions: The present study found the values of serum miRNA-499-5p expression in patients with ACS patients are significantly higher compared with controls after 1h of onset of chest pain, additionally, miRNA-499-5p expression have high sensitivity and specificity for differentiation between subgroups of ACS and from controls.

Background: Dental caries represents a multifaceted disease impacting teenagers across the globe. A combination of factors, including fermentable carbohydrates, acid-producing bacteria, saliva, and host-related characteristics, influences its development. Salivary statherin controls microorganisms by aggregating them and preventing them from adhering to hard tissue and epithelium. Salivary statherin may maintain tooth integrity.

Objective: This research investigated the potential of salivary statherin as a biomarker for dental caries, examining its connection to the nutritional status of adolescents.

Subjects and Methods: This comparative (observational) research included 90 15-year-old adolescents of both sexes. Participants were divided into two distinct groups: 30 individuals without caries, serving as the control group, and 60 individuals with caries, referred to as the study group. Following the World Health Organization guidelines, adolescents with varying caries experiences were further categorized. Thirty of them exhibited a moderate level of caries, with 1 to 3 affected teeth, while the remaining thirty were classified as having severe caries, with a Decay-Missing-Filled Teeth (DMFT) score greater than 10. The DMFT Index measured caries experience. Salivary statherin analysis from unstimulated saliva. Height, weight, and body mass index measured nutrition, classifying adolescents as normal weight, overweight, or obese.

Results: Statherin levels decreased with the severity of caries increasing. There was a significant result in the overweight, healthy, and total sample among caries severity groups (P value <= 0.05). There was a significant difference in the severe caries group, while statherin levels increased with nutritional status (P value ≤ 0.05).

Conclusions: Caries severity reduces salivary statherin. In severe caries patients, nutritional status increased salivary statherin. Dietary status and dental caries severity affected statherin levels. No association was found between statherin levels and salivary pH or flow rate across different nutritional statuses or caries severity groups. However, salivary statherin may play a role in maintaining tooth integrity

Background: Solitary rectal ulcer syndrome (SRUS) is a benign, uncommon rectal disorder characterized by combination of symptoms, clinical findings, and histological abnormalities. It has wide range of presentations and variable endoscopic findings.

Objectives: to study the prevalence of SRUS in patients presenting with lower gastrointestinal bleeding and to further evaluate this syndrome in the affected patients.

Subjects and Methods: A retro-prospective descriptive study conducted in Basrah Gastroenterology and Hepatology Hospital involved revision of 350 colonoscopic reports performed for the period from January 2022–June 2023 for patients presented with bleeding per rectum. Fifteen patients fulfilled the diagnostic criteria of SRUS were reviewed and followed up.

Results: the prevalence rate was 4.28%; nine male (60%), seven female (40%), mean age (22 ±9.3) years (12-45years). Mean duration of symptoms until diagnosis (8.22 ±4) weeks (3-17) weeks, females had shorter diagnosis time compared to males (5.5±2.3) (8.2±5.3) weeks respectively. The most frequent single associated symptom with the bleeding per rectum was constipation (96.3%), 20% had multiple associated symptoms.

On endoscopic examination:11 (73.4%) had ulcerated lesions,4 (26.6%) non ulcer lesions [3(20%) had polypoidal lesion,1(6.6%) had only hyperemic mucosa] Majority of rectal lesions located anteriorly 13 (86.6%). At follow up; symptoms improved in 7 (46.6%), endoscopic improvement in 8 (53.3%) and histological improvement in 11(73.4%), 2(13.3%) underwent endoscopic treatment and 3(20%) ended with surgery.

Conclusions: SRUS is chronic, benign disorder related to straining or abnormal defecation. It has variable clinical presentations and variable endoscopic findings rather than solitary ulcer as the name imply with different therapeutic options are available.

Background: Adalimumab is approved for Rheumatoid Arthritis (RA). In 2021, A biosimilar (ABP501;Amgevita®) was licensed in Iraq. The current study aimed to ensure safety and Efficacy of Amgevita in RA Patients in Iraq.

Patients and Methods: A Cross sectional Observational study Started on 69 RA Records receiving Amgevita. Data collected from local registry then examined for disease activity and adverse reactions for 9 months follow up.

Results: Thirty patients completed the 9 months period of the study: aged (49±14) years; 77.5% females. After 3, 6 and 9 months of follow up, patients\' mean (SD) CDAI 27.8 ( 13.60 ) which was statistically lower (19.80) (6.96), 17.70 (2.790), and 19 (1.040), p<0.001. With a mean change of CDAI: 8 (p<0.001), 10.1 (p<0.001), and 8.78 (p<0.001) after 3, 6, and 9 months. Cumulative percentage of responders was 55.00% and Cumulative percentage of probability of change of disease activity was 86.00%, No patient achieved remission and no significant Side effects recorded. In conclusion Amgevita is Effective and Safe in RA.

Background: periodontal disease is one of the most frequent human diseases. Depending on the severity of the inflammation, the destructive process may affect both the gingiva (gingivitis) and/or the periodontal ligament and alveolar bone that surround and support the teeth (periodontitis).

Objective: The study aimed to determine and compare the level of salivary Neutrophil gelatinase-associated lipocalin in periodontal health and disease (gingivitis and periodontitis stage I-III).

Subjects and Methods: A total of 90 individuals participated in the research separated into five groups, clinically healthy (n=10), gingivitis (n=20), stage I periodontitis (n=20), stage II periodontitis (n=20) and stage III periodontitis (n=20), periodontal parameters were recorded, and the level of salivary Neutrophil gelatinase-associated lipocalin was assessed by using the enzyme-linked immunosorbent assay.

Results: Neutrophil gelatinase-associated lipocalin salivary level was significantly higher (p<0.05) in periodontal disease groups compared to healthy controls. A statistically significant difference was also found between gingivitis and advanced periodontitis (stageII-III) (p<0.05). No significant difference (p>0.05) was found between different stages of periodontitis.

Conclusions: Neutrophil gelatinase-associated lipocalin is associated with periodontal diseases and my play a role in its pathogenesis

Background: Among women of the reproductive age, the most prevalent endocrine disease with (15-44) percentile is the polycystic ovarian syndrome (PCOS). Last decades, many studies indicated that vitamin D deficiency in women with PCOS may aggravate hyperandrogenism and insulin resistance.

Objectives This study was designed to investigate the role of some biochemical markers and hormonal status in evaluation the efficacy of vitamin D supplementation in treatment of polycystic ovary syndrome.

Subjects and Methods: This cross-sectional study was carried out at Department of Biochemistry, College of Medicine, University of Baghdad. It included: group I: Twenty-five women with PCOS who were treated with metformin and followed for 8 weeks, and group II: Twenty-five women with PCOS who were treated with vitamin D3 and followed for 8 weeks. Serum investigations included measurements of HOMA-IR, 25 hydroxyvitamin D3, adiponectin, androgen indices by ELISA technique

Results: The mean (±SD) values of HOMA-IR, free testosterone, dihydrotestosterone, and adiponectin levels were significantly improved after treatment in both groups of metformin and vitamin D supplement compared with before their treatment (p < 0.05). In addition, there was no significant differences after treatment between women treated with metformin and those treated with vitamin D supplement for all the measured parameters (p > 0.05). PCOS women treated with vitamin D showed significant negative correlation between SHBG and BMI (r= -0.976, p <0.001)

Conclusions: Measurements of serum free testosterone, dihydrotestosterone and adiponectin are good indicators for efficacy of vitamin D supplement in improvement of insulin resistance and androgen disturbances of PCOS.

Background: The collagen triple helix repeat containing 1 (CTHRC1) protein has been connected to decreased levels of vitamin D and calcium, as well as obesity. This study aimed to investigate the relationship between CTHRC1 and osteoporosis in post-menopausal women and compare with healthy subjects.

Subjects and Methods: A cross-sectional study consisted of 86 women were enrolled in this study and divided into three groups based on the results of dual-energy densitometry (DXA): 30 women with osteoporosis, 30 women with osteopenia, and 26 healthy women. Data on demographic and clinical features and laboratory values of Calcium (Ca) and Vitamin D3 (V.D3) were recorded.

Results: Women with osteoporosis had significantly increased levels of CTHRC1 (P = 0.0001) compare to HS groups. The CTHRC1 showed negative correlation with Ca and V.D3 value at (r= -0.453, P=0.001 and r= -0.415, P= 0.022) respectively in osteopenia patients. CTHRC1 alone show excellent discrimination power (AUC= 0.9) in identifying women with osteoporosis.

Conclusions: Serum CTHRC1 is a valid biomarker that can distinguish women with osteoporosis from HS group with high accuracy. Low calcium and vitamin D levels in this age group may be linked to an increase in the CTHRC1 levels and this could make it a Therapeutic target in future studies.

Background: The collagen triple helix repeat containing 1 (CTHRC1) protein has been connected to decreased levels of vitamin D and calcium, as well as obesity. This study aimed to investigate the relationship between CTHRC1 and osteoporosis in post-menopausal women and compare with healthy subjects.

Subjects and Methods: A cross-sectional study consisted of 86 women were enrolled in this study and divided into three groups based on the results of dual-energy densitometry (DXA): 30 women with osteoporosis, 30 women with osteopenia, and 26 healthy women. Data on demographic and clinical features and laboratory values of Calcium (Ca) and Vitamin D3 (V.D3) were recorded.

Results: Women with osteoporosis had significantly increased levels of CTHRC1 (P = 0.0001) compare to HS groups. The CTHRC1 showed negative correlation with Ca and V.D3 value at (r= -0.453, P=0.001 and r= -0.415, P= 0.022) respectively in osteopenia patients. CTHRC1 alone show excellent discrimination power (AUC= 0.9) in identifying women with osteoporosis.

Conclusions: Serum CTHRC1 is a valid biomarker that can distinguish women with osteoporosis from HS group with high accuracy. Low calcium and vitamin D levels in this age group may be linked to an increase in the CTHRC1 levels and this could make it a Therapeutic target in future studies.

Background: Psoriasis is a common inflammatory condition worldwide, with an average prevalence ranging from 2% to 3%. However, the incidence of psoriasis varies among different ethnic groups and regions. Elevated leptin levels have been associated with increased cellular proliferation, including T-cells. Additionally, high leptin levels may stimulate the synthesis of proinflammatory cytokines such as ILـ6 and TNFـα.

Objectives: To evaluate the effect of Apremilast on Leptin in obese psoriatic patients.

Subjects and Methods: Thirty patients with psoriasis were included in This prospective cohort study to measure the levels of serum Leptin by using the ELISA technique, before and after receiving Apremilast.

Result: The present work found the concentration of Leptin before receiving Apremilast was 2.365 ng/ml, and after six months from baseline, it was reduced to 1.933 ng/ml, which was statistically significant (P<0.05).

Conclusion: This prospective cohort study provides evidence that Apremilast can decrease elevated Leptin levels in individuals diagnosed with psoriasis. The study observed a 0.42 ng/ml reduction in Leptin levels after 6 months of Apremilast treatment.

McKusick-Kaufman (MKS) syndrome is a rare, autosomal recessive disorder, determined by genetic mutation in the MKKS gene on chromosome 20. MKS commonly manifests with three primary components: Polydactyly, Congenital Heart Defects, and Genital and Urogenital Abnormalities. Most reported cases are of Amish descent, with only one Arabic documented case. We present a case of a genetic mutation of MKKS gene in an Iraqi female neonate who presented with repeated non-projectile non-bilious vomiting and abdominal distension. The examination showed a postaxial polydactyly in the hands and feet, an ejection systolic murmur, and an abdominal mass. Perineal examination revealed no vaginal orifice. Diagnosing MKS may necessitate a comprehensive approach due to its rarity and diversity in manifestation. Ruling out Bardet-Biedl syndrome, which shares MKS features, was difficult due to genetic test unavailability; for that patient was kept on follow-up. A high suspicion index, early diagnosis, and customized treatment strategies are essential to address each case's distinct symptoms and requirements, frequently using a multidisciplinary medical team to prevent complications.

Metagenomics is a branch of genomics that involves sequencing genetic material directly from environmental samples. Metagenomic data could facilitates evidence-based decisions while providing a more complete view of the microbial ecosystem in a pandemic setting. It would provide critical knowledge for future pandemic preparedness programs

Drug use disorder is a global health issue and one of the leading causes of premature deaths and disability. There is an increase recognition of the need for a public health rather than criminal justice approach to mitigate the current health burden and prevent future health loss