Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )
Al-Rafidain Journal of Medical Sciences (AJMS) is a peer-reviewed international journal published by Al-Rafidain University, Baghdad, Iraq. The journal’s full text is available online at www.ajms.iq The journal allows free access (Open Access) to its contents and permits authors to self-archive the final accepted version of the articles on any compliant institutional/subject-based repository. Publishing in the AJMS complies with the Committee on Publication Ethics (COPE) and endorses the International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals, as well as the GPP3 guidelines regarding authorship. Submission of a manuscript to the AJMS implies that all authors have read and agreed to its content and that the manuscript conforms to the journal’s policies. © 2021 The Author(s). Published by Al-Rafidain University. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/). Important Update Publication charge was changed for accepted submissions after January 1st, 2025 onward: - For authors resident in Iraq: Article processing fee of 500,000 ID (tax included in price) applies to all the accepted articles after January 1st, 2025. Bank charges must be defrayed by the authors. - For foreign authors: Article processing fee of 500 US Dollars (tax included in price) applies to all the accepted articles after January 1st, 2025.
Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).
Effectiveness of Mouthwashes Based on Ozonated Oil
Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
Identification of Potential Drug-Drug Interactions in the Pediatric Intensive Care Unit of a Tertiary Care Teaching Hospital of Odisha, India
Background: To accomplish a specific therapeutic purpose, drugs are frequently used in combination. Concurrent drug use can result in drug-drug interactions (DDIs), which can have negative effects on patients. Information about potential drug-drug interactions (PDDIs) should be made available to healthcare providers. The article reviews our hospital's drug interaction (DI) trend and examines whether it is related to polypharmacy. It also assess the degree of seriousness of potential drug-drug interactions (PDDI). Objective: To evaluate our hospital's drug-drug interaction trend. Methods: In this cross-sectional observational study, we examined the prescriptions of children between the ages of one month and fifteen years who were admitted to the PICU. Using drug interaction checking software, we classified the prescriptions according to the severity (Unknown, minor, moderate, and major), the number of concurrent medications used, and the possible consequences of these PDDIs. Results: We discovered 482 PDDIs out of 101 prescriptions, of which 64.9% were moderate, 19.29% were minor, 12.4% were unknown, and 7.67% were major. The average number of PDDIs per prescription was highest for prescriptions including more than 10 drugs (7.8). Third-generation cephalosporins, ureidopenicillin, carbapenem, and aminoglycosides accounted for 39% of PDDIs, followed by salbutamol (20.12%) and antiepileptic medications (18.67%). Low potassium (11.2%) was the most common possible consequence. Conclusions: The findings of this study may help with the planning and execution of future research as well as the monitoring and prevention of PDDIs associated with adverse events in children in critical care.
Serum Neurofilament Light Chain as an Independent Biomarker of Axonal Damage of Psychiatric Burden in Multiple Sclerosis
Background: Multiple sclerosis (MS) is a chronic neuroinflammatory disorder associated with neurological disability and psychiatric comorbidity. Serum neurofilament light chain (sNfL) is a biomarker of axonal injury, yet its relationship with psychiatric symptoms in MS is unclear. Objective: To assess depression and anxiety prevalence in Iraqi MS patients and the associations with sNfL. Methods: A cross-sectional case–control study was conducted at the MS Consultation Clinic, Iraqi Medical City, Baghdad (October 2024–January 2025). Depression and anxiety were evaluated with the Hospital Anxiety and Depression Scale (HADS), disability with the Expanded Disability Status Scale (EDSS), and sNfL with Enzyme-Linked Immunosorbent Assay (ELISA). Results: A total of 150 MS patients and 50 healthy subjects (controls) were enrolled. Depression and anxiety were evaluated with the Hospital Anxiety and Depression Scale (HADS), disability with the Expanded Disability Status Scale (EDSS), and serum NfL with ELISA. MS patients had significantly higher depression (31.3%) and anxiety (14.7%) than controls (4.0% and 10.0%; p<0.001). Depression correlated with lower socioeconomic and educational status, while female sex and marital status predicted higher anxiety. Median sNfL levels were elevated in MS (169.6 vs. 98.9 pg/mL; p<0.001) but showed only a weak negative correlation with depression (r= –0.174, p=0.034). Conclusions: Depression and anxiety are prevalent in Iraqi MS patients and strongly linked to sociodemographic and disability measures. While NfL, as a marker of axonal injury, had limited value for detecting psychiatric comorbidity, emphasizing the need for integrated neurological and mental health care.
The Correlation Between Thyroid Status, Family History, and Melasma Severity: A Cross-Sectional Dermatological Analysis
Background: Although family history is well recognized as a major predisposing factor in melasma, the extent to which hereditary background correlates with disease severity or underlying thyroid function abnormalities remains unclear. Objective: To assess the influence of family history on the severity of melasma and to determine if thyroid hormone levels or thyroid autoimmunity vary between women with and without a familial history of melasma. Methods: This cross-sectional study included 50 women diagnosed with facial melasma, who were stratified into two groups: those with a positive family history (n=10) and those without a family history (n=40). All participants underwent clinical evaluation using the modified Melasma Area and Severity Index (mMASI). Laboratory assessment included serum FT3, FT4, TSH, and anti-thyroid peroxidase (anti-TPO) antibodies measured via standardized immunoassays. Results: The mean mMASI scores were slightly lower in patients with a family history compared to those without, although the difference did not reach statistical significance (12.9±1.5 vs. 13.5±0.8; p=0.10). Thyroid hormone levels (FT3, FT4, TSH) showed no significant differences between groups. However, anti-TPO antibody levels were significantly higher in the non-familial group (26.0±7.2 vs. 20.3±6.0 IU/mL; p=0.02), suggesting increased thyroid autoimmunity in patients without hereditary predisposition. Conclusions: Family history did not significantly influence melasma severity or thyroid hormone levels. However, elevated anti-TPO titers among women without a family history indicate a potential autoimmune component in non-hereditary melasma.
Comparative Analysis of Renal Function and Lipid Profile in Diabetic Patients Across Gender, Age, and Glycemic Control: A Cross-sectional Study in Basrah, Iraq
Background: Poor glycemic control adversely affects lipid and renal function; however, the modifying roles of age and sex have not been sufficiently characterized, particularly among Middle Eastern countries. Objective: To evaluate the associations between glycemic control and renal and lipid biomarkers in adults with type 2 diabetes (T2DM) and characterize the independent and combined modulating effects of age and sex. Methods: A cross-sectional comparative study was conducted during 12 months on 4767 subjects attending an outpatient clinic in Basrah, Iraq (4421 with diabetes and 346 with prediabetes). They were grouped according to glycemic control (good: HbA1c<7.0%, suboptimal: 7.0-8.9%, poor: ≥9.0%), age (<40, 40-59, ≥60 years), and gender. Renal function and lipid indexes were analyzed using rank-based tests and regression analysis. Results: Median levels of urea, creatinine, low-density lipoprotein, and triglycerides were significantly higher in the poorly controlled group, whereas HDL levels were lower (p<0.001). Aging is directly related to kidney injury, mainly reduction in eGFR, while male sex is associated with a more atherogenic lipid profile and higher values of renal biomarkers. Multivariate analysis revealed that the impact of age and sex might be disproportionate to, if not greater than, that of HbA1c. Conclusions: In T2DM, the relationship between renal and lipid abnormalities is sex asymmetrical, age-dependent, and glycemic-control-influenced. A personalized, demography-integrated strategy for complication assessment should be adopted to improve diabetic care.
COVID-19 and Public Health in Algeria: The Mitigating Role of Physical Activity
Background: Coronavirus (COVID-19) is a respiratory illness with global spread and significant health risks, particularly for individuals with comorbidities or weakened immunity. Objectives: This study evaluated the impact of COVID-19 on appetite, olfactory and gustatory functions, associated diseases, and the role of physical activity in health maintenance. Methods: A cross-sectional retrospective survey was conducted among 323 Algerian adults previously infected with COVID-19 (43.74±17.48 years; 175 females, 148 males). The questionnaire collected data on demographics, anthropometrics, COVID-19 symptoms, comorbidities, and physical activity levels. Results: Overweight and obesity were prevalent in 40.25% and 14.55% of participants, respectively, with significantly higher rates in those over 40 years (p=0.022). Sensory disturbances during infection were common: 84.21% experienced loss of smell, 75.54% loss of taste, and 37.46% appetite loss. A total of 21.98% reported COVID-19-related illnesses, primarily respiratory and cardiac complications. Notably, there was a strong inverse association between physical activity and disease occurrence (p<0.001; r=0.783), indicating that higher levels of physical activity are linked to a lower incidence of COVID-19-related illnesses. Conclusions: COVID-19 significantly affects sensory functions and contributes to comorbid conditions, especially among overweight and obese individuals. Regular physical activity appears to be a protective factor associated with reduced risk of COVID-19-related illness.
Incidence and Risk Factors of Hypersensitivity Reactions to Intravenous Ceftriaxone in Iraqi Hospitals: Nationwide Prospective Study
Background: Ceftriaxone is a widely used cephalosporin in Iraqi hospitals. Despite its broad-spectrum safety profile, hypersensitivity reactions are underreported and poorly characterized in the local setting. Objective: To estimate the incidence of intravenous ceftriaxone-associated hypersensitivity reactions among hospitalized Iraqi patients and identify predictors of risk. Methods: A nationwide, prospective cohort study was conducted from April to July 2024 across ten public hospitals selected for high ceftriaxone use and geographic representation. Inpatients receiving ceftriaxone infusions were actively monitored until discharged. Standardized forms captured demographics, medical history, ceftriaxone dosing, co-medications, and infusion details. Reactions within 12 hours were graded according to the Ring and Messmer scale. Data were audited monthly. Incidence was calculated for predictors of allergic reactions. Results: Of 5,732 patients, 50 experienced hypersensitivities (0.87%; 95% CI 0.65–1.15). Most reactions were mild (Grade I, 70%), followed by Grade II (24%) and Grade III (6%). Rates varied regionally (0–7.3%). Univariate analysis identified prior allergies (OR=3.29), budesonide use (OR=3.04), and fewer ceftriaxone doses (OR 0.80) as risk factors for increased risk. In multivariate models, budesonide use (OR=3.39, p=0.022) and the number of doses (OR=0.78 per additional dose, p=0.036) remained significant. Conclusions: Ceftriaxone-related hypersensitivity in Iraqi public hospitals occurs at a low incidence similar to global reports. Key predictors include underlying atopy (indicated by recent budesonide use) and fewer administered doses. Hypersensitivity reactions mostly occur early in the treatment course. Therefore, active pharmacovigilance and increased clinical monitoring are important during the first few doses of ceftriaxone.
Dynamics of Soluble HLA-G and the 14-bp Insertion/Deletion Polymorphism as Predictors of Therapeutic Response in Acute Myeloid Leukemia
Background: Acute myeloid leukemia (AML) exploits immune escape mechanisms such as human leukocyte antigen-G (HLA-G), a non-classical HLA-I molecule involved in immune checkpoints and associated with the 14-bp insertion/deletion (Ins/Del) polymorphism for cancer prognosis. Prospective data regarding the dynamics of these parameters and their relation to therapy outcomes in AML patients remains limited. Objectives: Determine the relationship between the serum level of soluble human leukocyte antigen-G (sHLA-G) and the 14-bp deletion/insertion (Ins/Del) polymorphism of the sHLA-G gene in AML patients before and after chemotherapy. Methods: A longitudinal study with a prospective follow-up was executed. Forty-six adult patients diagnosed with AML were recruited. ELISA was used to measure serum levels of sHLA-G at diagnosis (T0) and six months after induction chemotherapy (T1). PCR genotyping was done on the HLA-G 14-bp polymorphism. This study focuses on the interaction of sHLA-G dynamics and genotype with the outcomes of clinical response, which could be Complete Remission (CR) or Non-Remission (NR). Results: sHLA-G levels reduced markedly after induction chemotherapy (28.5±15.3ng/mL at T0 vs. 7.6±6.1ng/mL at T1, p<0.001). Baseline sHLA-G values greater than 30ng/mL were significant predictors of non-response to treatment, demonstrating 82% sensitivity and 70% specificity. However, there were no significant variations in the distribution of HLA-G 14-bp genotypes between responders and non-responders (p=0.45). Conclusions: sHLA-G is a sensitive and dynamic biomarker of leukemic load; high baseline levels are significantly associated with non-response to induction therapy. In contrast, the HLA-G 14-bp polymorphism was not identified as an independent predictor of therapeutic response in this cohort.
Game-Based versus Circuit Training: Impacts on Aerobic Capacity (VO₂max) and Cardiovascular Health Outcomes
Background: Several training models to increase VO₂max capacity have been discussed in previous studies. However, there is a scarcity of research on student engagement to improve outcomes. Objectives: To assess the extent to which training and circuit training methods improve students' VO₂max capacity. Methods: This study involved 34 students in a comparison/control group and used a two-group pretest-post-test design in a quasi-experimental study. The control group received circuit training, while the experimental group received the play training method. The process was three stages: pretest, therapy, and post-test. Initial data were collected for the pretest, and then there was a 16-session treatment phase, followed by a post-test phase. A multistage fitness test (bleep test) generated VO₂max capacity data. Results: The average pre-test score was 36.0±5.2, the average post-test score was 40.3±4.3, and the percentage increase was 11.9% in the "Enough" category. The experimental group had a significant impact on increasing VO₂max capacity (p<0.05). The control group also significantly increased VO₂max capacity (p<0.05). With an average pre-test score of 35.9±5.3 and an average post-test score of 40.8±5.2 and a percentage increase of 13.6% in the "enough" category. Therefore, the circuit training method provides a greater increase in VO₂max capacity. Conclusions: The play-training method and the circuit-training method have been proven to have a positive effect on increasing VO₂max capacity. This research is important for instructors, coaches, and PJOK teachers to be able to apply this training method in increasing VO₂max capacity.
Impact of Ambient Air Pollutants and Extreme Temperatures on Pregnancy Outcomes: A Clinical-Epidemiological Case-Control Study
Background: The interaction between environmental issues and maternal-fetal health is a pressing social health issue, which is intensified by climatic change. The major risk factors in relation to negative pregnancy outcomes in Iraq are air pollutants and temperature changes. Objective: To investigate the impact of environmental pollution and extreme temperatures on pregnancy outcomes (preterm birth and congenital anomalies). Methods: The study was a case-control study involving 180 pregnant women (90 cases, 90 controls) in Basrah Maternity and Children's Hospital. The exposure to pollutants and heat was measured using the GIS and multivariate logistic regression models. Results: In the case group, PM2.5 (46.4µg/m³) and NO₂ (30.0µg/m³) were significantly higher as compared to controls. The statistical analysis revealed that each one-unit increase in PM2.5 increased the likelihood of adverse pregnancy outcomes by 8%, and NO2 increased the likelihood by 20%. Importantly, a one-degree Celsius increase in maximum temperature increased the risk by 53%. The first and the third trimesters were confirmed as the critical periods of extreme environmental sensitivity. Exposure to pollutants and heat in these trimesters had close relations with preterm birth and congenital anomalies and a synergistic impact of high temperatures and toxicity of pollutants on increasing health risks. Conclusions: There is a strong relationship between ambient atmospheric pollutants and extreme heat and the risks of poor pregnancy in Basrah, and those environmental and health programs should be implemented timely to stem the effects on pregnant women.
Modulating Effects of Fimasartan and Omega-3 on Cisplatin-Induced Testicular Toxicity in Rats
Background: Cisplatin is a widely used antineoplastic drug in different types of cancers (ovarian, testicular, and hematological) with several types of adverse effects, including testicular toxicity. Fimasartan is a newer angiotensin-receptor blocker (ARB) that has antioxidant and anti-inflammatory properties. Omega-3 is an unsaturated fatty acid that has antioxidant and anti-inflammatory effects. Objective: to evaluate the protective effects of fimasartan alone or in combination with omega-3 against cisplatin-induced testicular toxicity. Methods: Thirty Wistar rats were divided into five groups: control group, cisplatin-treated group, fimasartan+cisplatin group, fimasartan+omega-3+cisplatin group, and omega-3+cisplatin group. Treatments were administered for 10 consecutive days. On day 10, a single intraperitoneal dose of cisplatin (7mg/kg) was given to induce testicular toxicity. On day 11, animals were sacrificed. Testicular tissue homogenates were used to measure malondialdehyde (MDA), reduced glutathione (GSH), and superoxide dismutase (SOD). Serum levels of testosterone and inhibin-B were measured using ELISA. Histopathological examination of the testes was also performed. Results: Cisplatin administration significantly increased MDA levels and significantly decreased GSH, SOD, testosterone, and inhibin-B levels compared with the control group. Treatment with fimasartan alone or in combination with omega-3 significantly attenuated these alterations and improved histopathological changes in testicular tissue. Conclusions: Fimasartan exerts protective effects against cisplatin-induced testicular toxicity through its antioxidant and reducing oxidative stress effects, and its combination with omega-3 enhances these protective effects.
Association Between Sublingual Varices and Hypertension: A Cross-Sectional Study
Background: Sublingual varices are dilated and tortuous veins located on the ventral surface of the tongue. Their etiology is unknown, but several risk factors have been proposed, including hypertension. Objective: To evaluate the association between sublingual varices and hypertension. Methods: Patients were classified according to blood pressure measurements into three groups: normal, Grade 1 hypertension, and Grade 2 hypertension. Hypertension status was further categorized as controlled or uncontrolled. Sublingual varices were clinically assessed, and their morphological features were described. The presence of venous dilation in other sites was also recorded. Results: Sublingual varices were identified in 58.4% of participants. Increasing age and the presence of hypertension were significant predictors of sublingual varices. Hypertensive patients were 2.7 times more likely to present with sublingual varices compared with normotensive individuals. Patients with uncontrolled hypertension showed the highest prevalence (79.5%; p=0.001). Although a higher prevalence was observed in patients with Grade 1 and Grade 2 hypertension, these differences were not statistically significant. Two morphological patterns of sublingual varices were observed: linear branching pattern (63.6%) and papular pattern (36.4%). Fifteen percent of patients had venous dilation in the sublingual caruncle area. Conclusions: The presence of sublingual varices may reflect vascular alterations associated with elevated blood pressure and could serve as a visible clinical marker for hypertension.
Metabolic, Electrolyte, and Hepatobiliary Complications of Parenteral Nutrition in Neonates: A Prospective Case-Series Study
Background: Parenteral nutrition (PN) is a life‑saving intervention for neonates who are unable to meet their nutritional requirements through enteral feeding. Despite its essential role, PN is frequently associated with metabolic, electrolyte, and hepatobiliary complications. Objective: To evaluate the frequency and pattern of metabolic, electrolyte, and hepatobiliary complications associated with PN administration in neonates. Methods: A prospective case-series study was conducted in two tertiary neonatal intensive care units (NICUs) in Baghdad, Iraq. Term and preterm neonates who received PN for at least five days were included. PN‑related metabolic, electrolyte, hepatobiliary, and hematological complications were recorded and analyzed. Results: Of the 94 neonates included in the primary outcome. The incidence of hypoglycemia is 35.1%, and hyperglycemia is 31.9%. Cholestasis 11.7%, hypokalemia 20.2%, hyponatremia 18%, hypocalcemia 27.6%, and thrombocytopenia 28.7%. The mean ± standard deviation of gestational age was 32.1±3.8 weeks; for postnatal age at the start of PN, it was 9.72±17.4 days; for the duration of TPN exposure, it was 12.65±9.27 days; and for the weight of the patients at the start and end of TPN, it was 1.7±0.70 and 1.84±0.74 kg, respectively. Conclusions: PN‑related metabolic, electrolyte, and hepatobiliary complications are common in neonates. Close monitoring and individualized PN management are essential to improve neonatal outcomes.
Metabolic–Renal Divergence in Diabetic Patients Three Months After COVID-19: Evidence from a Real-World Cohort
Background: The short-term impacts of COVID-19 in diabetes are still unknown as well. When glycemic improvement is followed by renal stabilization in a patient after treatment of COVID-19 infection. Objective: To evaluate three-month glycemic and renal trajectories following COVID-19 infection and to identify predictors of persistent poor glycemic control. Methods: This retrospective real-world cohort study included 301 adults with diabetes and confirmed COVID-19 infection. Baseline measurements were obtained at the first post-COVID clinical assessment, and follow-up measurements were recorded approximately three months later. Paired t-tests assessed within-subject changes in HbA1c, fasting plasma glucose (FPG), and serum creatinine. McNemar’s test evaluated shifts in glycemic control category (HbA1c<8%). Multivariable linear and logistic regression analyses identified predictors of glycemic change and persistent poor control. Effect sizes were calculated using Cohen’s d. Results: HbA1c was significantly decreased (9.08±2.22% to 8.43±2.04%. FPG was reduced (51 mg/dL; p < 0.001). The creatinine level remained similarly in line but slightly rose in diabetic patients at 3 months of chronic comorbidity (+ 0.094mg/dL; p=0.001), an indication of metabolic-renal divergence. Significant improvement of the glycemic control category was observed as well (p<0.001). Conclusion: Three months after COVID-19 treatment, there was a positive correlation between glycemic control and glucose decline, along with a reasonable renal outcome. This clearly illustrates an acute need for early cardiometabolic care after infection.
Association of Left Atrial Coupling Index with Infarction Site and Cardiac Biomarkers in Patients with First Episode of Acute Myocardial Infarction
Background: Acute myocardial infarction leads to elevation of left ventricular pressure, which is transmitted to the left atrium, resulting in changes in left atrial volume and function. LACI is a novel echocardiographic parameter that reflects the left atrioventricular interaction and may provide insight into infarction size and early risk stratification. Objectives: To evaluate LACI and its association with infarction site and cardiac biomarkers, including troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP), in patients experiencing a first episode of acute myocardial infarction. Methods: This cross-sectional study enrolled forty-two patients with the first episode of acute myocardial infarction. Peak serum troponin and NT-proBNP were recorded for each patient. Transthoracic echocardiography was performed to assess regional wall motion abnormality, left ventricular ejection fraction, and LACI, which was calculated as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Results: The mean LACI was 0.46±0.13, with significantly higher LACI values observed in patients with anterior myocardial infarction compared to inferior or lateral infarctions. LACI shows a positive correlation with troponin and NT-proBNP and was inversely associated with LV ejection fraction. Higher values were noted in patients with severe regional motion abnormality, particularly akinesia. Receiver operating characteristic (ROC) analysis demonstrated a moderate discriminatory ability for identifying patients with higher levels of cardiac biomarkers. Conclusions: LACI may reflect the infarction severity and ventricular dysfunction and could serve as a useful noninvasive tool for risk stratification and assessment of hemodynamic burden.
Molecular Insights into Gallstone Disease: Association of FXR and CYP7A1 Expression with Gallstone Composition in Iraqi Females
Background: Gallstone illness is a common problem of the biliary system, and its development is known to involve more than one factor. Changes in metabolism, bile composition, and genetic background may all contribute to the formation of gallstones. Objective: The recent work aimed to assess the expression of the bile acid–related genes FXR and CYP7A1 in Iraqi individuals with gallstone illness and to examine their relation to gallstone composition and clinical findings. Methods: A case–control study was carried out on female individuals with gallstone illness and healthy controls. Gene expression of FXR and CYP7A1 was measured using quantitative real-time PCR. Gallstones were examined based on their physical appearance and analyzed via Fourier transform infrared (FTIR) spectroscopy. Clinical and hematological data were collected and statistically analyzed. Results: Individuals showed differences in body mass index and some hematological markers when relative to controls, and a positive family history was more commonly observed. Individuals exhibited reduced expression levels of both FXR and CYP7A1, particularly among individuals with a familial predisposition to gallstones. Gallstone analysis revealed pigment, cholesterol, and mixed types, with mixed stones being the most common form. Conclusions: The results suggested that gallstone illness contributes to alterations in the expression of bile acid-related genes and heterogeneous stone composition. The prevalence of mixed stones seems to indicate that gallstone development follows multiple mechanisms rather than a singular pathway.
Evaluating a Bundled Protocol to Reduce Aspiration Pneumonia in Critically Ill Tube-Fed Patients
Background: Patients who are severely ill and are fed through a nasal tube mostly suffer from aspiration pneumonia. Objective: To evaluate the degree to which an exploratory, evidence-based, and multifaceted method lowered the aspiration pneumonia in critically ill tube-fed patients. Methods: A historical observation group study was carried out by the Critical Care Unit at a tertiary care hospital. For the period of January to December 2021, a control group consisting of 415 individuals got usual care. This group was compared to an experimental group consisting of 2,120 individuals who received additional help for the period of January 2022 to December 2024. As part of the combining method, 30–50 mL of water were flushed after each enteral dose, drugs were given as normal (crushing, decreasing, and flushing between doses), and overnight fasting was strictly limited to six hours. The main effect was incidents of aspiration pneumonia. Results: The intended surgery reduced aspiration pneumonia from 14.7% to 7.8%. After controlling for other factors, the method reduced aspiration pneumonia by 52% (OR=0.48, 95% CI=0.35–0.66). Bundling adherence (≥90%) was linked to decreased incidence (5.2% vs. 13.3% for poor adherence). Reduced median ICU stay (7.0 days vs. 9.0 days) and 22% fewer antibiotic days were noteworthy advantages. Conclusions: Placing forward a cohesive aspiration prevention plan approach led to fewer incidents of aspiration pneumonia and favorable secondary clinical outcomes in critically ill patients who received nutrition by tube. In critical care, this practical procedure assists in making enteral nutrition safer and superior.
Time Lag of Acromegaly Diagnosis and Associated Comorbidities in Sulaymaniyah City/Iraq
Background: Acromegaly is a rare endocrine disease. The insidious onset and symptom overlap with frequently found diseases, resulting in an often delayed diagnosis. Objective: To evaluate diagnostic delay in patients with acromegaly and its association with patient findings in Sulaymaniyah, Iraq. Methods: A retrospective cross-sectional study was conducted in 49 patients diagnosed with acromegaly. Patient data were collected through interviews and medical record review. The diagnostic delay was determined as the period between the onset of symptoms and the formal diagnosis. Results: The average diagnostic delay was 3.3 years, and the majority of patients were diagnosed with five years of symptom onset. Hypertension was observed in 32.7% of patients, and unemployment, lower education, cumulative comorbidity burden, and abnormal colonoscopy findings were significantly associated with longer delays. In patients <40 years old, the delay can be more extreme, wherein close to half had not undergone a colonoscopy. Normal finding (34.6%), polyps (15.4%), and malignancy (3.8%). However, in patients aged ≥40 years (46.9%), all underwent colonoscopy; 65.2% were normal, 26.1% had polyps, and 8.7% had malignancy. Overall, colorectal cancer was detected in three patients (6.1%), and there was a statistically significant correlation between age group and colonoscopic findings. Conclusions: Acromegaly diagnostic delay is substantial in the Kurdistan Region and is related to socioeconomic factors, asymptomatic onset, and comorbidity. Increased awareness, access to endocrinology, and broader colorectal screening are essential to improve outcomes.
Effectiveness of 577-nm Pro-Yellow Laser in Managing Inflammatory Acne: Results from a Quasi-Randomized Clinical Trial
Background: Acne has been treated with many types of lasers in recent years. It has been found that vascular laser effectively and safely reduce inflammation in acne lesions. Objective: To evaluate the efficacy and safety of a 577-nm pro-yellow laser with traditional treatment for patients with mild to moderate inflammatory acne. Methods: A quasi-randomized clinical trial study was conducted in a private dermatology clinic in Baghdad from January 2025 to January 2026 on 140 patients diagnosed with mild to moderate inflammatory acne and randomly divided into two groups: Group A (70 patients) underwent three laser treatment sessions/week, and group B (70 patients) received traditional treatment (topical, systemic, adjunctive, or a combination thereof). Both groups were assessed at the first session (baseline) and after one and six months from treatment. Results: Acne severity and inflammatory lesion count show greater reduction in group A (p<0.05). 70% of patients in group A and 48.6% in group B didn’t report any side effects. After six months, group A was more satisfied with the laser procedure than group B. The recurrence rate after six months was significantly higher in group B. The greatest predictor of successful 577 nm pro-yellow laser treatment was the baseline GAGS score reduction. Conclusions: Although traditional treatment is effective, the 577-nm pro-yellow laser is more promising, effective, and well-tolerated for mild to moderate inflammatory acne with favorable satisfaction and lower 6‑month recurrence relative to routine care.
Intralesional 5‑Fluorouracil in the Management of Resistant Warts: Outcomes from a Single-Arm Clinical Trial
Background: Treating resistant warts is inconvenient and frustrating both for patients and for treating physicians. One possible therapy option is 5-fluorouracil, an antimetabolite that has shown better results when administered intralesionally rather than topically. Objective: To evaluate the efficacy and safety of intralesional 5-fluorouracil in treating warty lesions not responding to other options of treatment in a sample of Iraqi patients. Methods: A single-arm clinical trial study conducted in Al-Imamain Al-Kadhmain Medical City, Baghdad, Iraq, during a period of 18 months from March 2024 to September 2025. It included 110 patients diagnosed with warts not responding to different treatment options for at least one year. Each patient received an intralesional 5-fluorouracil injection in each session, repeated every two weeks for four sessions or less if the lesions are completely resolved. Results: The differences in mean size and number of warts during visits were significantly decreased (p<0.05) compared to baseline size. The level of pain significantly decreased after six weeks compared to that after two weeks (p=0.001), and no pain was reported after three months. The level of satisfaction of patients significantly increased after three, six, and 12 months compared to that after two weeks (p=0.001). Conclusions: To treat warts that typically don't react to conventional treatments, intralesional 5-FU may represent a promising therapeutic option. It shows promise as a primary treatment for resistant warts.
Clinical Management of Fused Supernumerary Tooth with Upper Central Incisor
The tooth fusion occurs in about 0.1% to 1% of permanent teeth. I aimed to report the fusion of a supernumerary tooth with the upper central incisor. A 37-year-old male was referred to me for management of a fused supernumerary tooth with the upper right central incisor. The tooth exhibited a positive vitality test. A periapical radiograph revealed the tooth with two fused roots with separated root canals. CBCT showed the bifid crown with two pulp chambers, and there was a connection between them. After surgical separation of the crown, we performed a three-sided flap to complete the separation of the roots. Then vital pulp therapy and direct composite restoration were done for the upper right central incisor. The limitation of this case report is the lack of clinical follow-up.
Giant Serous Cystadenoma of The Pancreatic Tail: Diagnostic Significance of CT Scanning in a Rare Case
Giant serous cystadenoma (SCA) of the pancreas is a rare benign tumor that typically remains asymptomatic and undetected until it reaches a considerable size, highlighting the diagnostic challenge in differentiating it from other pancreatic cystic lesions. This study seeks to present an uncommon instance of giant pancreatic SCA and underscore the diagnostic and therapeutic methodology. A case report design was used involving a 35-year-old female patient presenting with a painless epigastric mass without associated gastrointestinal or systemic symptoms. Physical examination revealed a firm, non-tender mass in the left upper abdomen. Diagnostic imaging using contrast-enhanced computed tomography (CT) identified a 15 cm multiloculated cystic lesion with thin septations and central calcifications in the body and tail of the pancreas. Surgical intervention consisted of distal pancreatectomy and splenectomy. Histopathological examination confirmed a diagnosis of serous cystadenoma confined to the pancreatic tail, characterized by multiple cystic spaces lined with cuboidal epithelium and clear cytoplasm. The patient experienced an uneventful recovery and was discharged on the fifth postoperative day. This case underscores the critical role of radiologic evaluation in differentiating SCAs from other cystic lesions such as pseudocysts and mucinous cystadenomas to support accurate preoperative planning. The findings suggest that, despite their benign nature, early recognition and surgical management of large SCAs are essential to preventing complications, and improved awareness is needed to enhance diagnostic accuracy and avoid overtreatment or delayed intervention.
Renal Cell Carcinoma in Pregnancy From a Gynecological Perspective: A Case Report and Review of Management Algorithm
Renal cell carcinoma (RCC) is a rare urological malignancy that may present during pregnancy. There is a lack of standardized management protocols, which makes RCC diagnosis and treatment challenging due to the need to balance maternal oncologic results and fetal safety. Using imaging modalities is restricted by the pregnancy-related limitations, and surgery carries the risk of preterm delivery. A multidisciplinary approach and minimally invasive technique had improved the outcome. A 25-year-old primigravida with 23 weeks of gestation reported left flank pain and hematuria. The ultrasonography showed a solid left renal mass of 4.5 by 4 cm, which was later defined using non-contrast MRI as suspicious of RCC. At 26 weeks, a left radical nephrectomy using a retroperitoneal approach was done under epidural anesthesia with close intraoperative supervision with obstetric standby following multidisciplinary consultation and informed patient consent. The surgery went smoothly with an intraoperative blood loss of 400 mL and stable maternal-fetal measurements. Diagnosis: Histopathology showed clear cell RCC, pT1bN0Mx, WHO/ISUP grade 2, with free margins. After an uneventful recovery, the patient delivered a healthy female child by caesarean delivery at the 38th week. RCC should be considered in pregnant women who report persistent urinary symptoms, hematuria, flank pain, or masses. Ultrasound continues to be the main diagnostic modality, with MRI having better tissue characterization without radiation exposure. A multidisciplinary decision-making process that is unique and considers the tumor biology, size, gestational age, and preferences of the patient will maximize both oncologic and obstetric results.
Xerosis Cutis as a Presentation of Hypothyroidism in a Pediatric Patient: A Case Report
The skin is probably one of the main target organs of the thyroid hormone effects. We report a case of a 6-year-old girl with hypothyroidism in which marked xerosis was the most conspicuous and impressive clinical manifestation, probably a rare manifestation of thyroid disease. This case illustrates the role of subtle dermatological signs as a window to the presence of thyroid disease and an effective intervention in the form of levothyroxine replacement therapy to restore growth and reverse cutaneous findings in a child with hypothyroidism. Investigations for thyroid dysfunction in cases with unexplained cutaneous findings may be advantageous.
An Overview of Metastatic Organotropism: Mechanisms and Emerging Therapeutic Targets
The main cause of cancer-related mortality is metastasis, which is the spread of tumor cells from their initial location to distant sites in the body. The process is not random but follows a distinct pattern of organotropism, in which certain cancers preferentially colonize distant sites. For example, estrogen-positive breast cancer may metastasize to the bones or colorectal cancer to the liver. Understanding the molecular drivers of organotropism is critical for developing effective therapies. This work combines the traditional "seed and soil" theory with modern molecular discoveries to provide a thorough overview of the current mechanistic framework underlying metastatic organotropism. We describe the multistep journey of circulating tumor cells, emphasizing key determinants such as the intrinsic properties of cancer cells, the creation of a favorable pre-metastatic niche, the interactions between disseminated cells and the microenvironment, and the role of the immune system in metastasis. We discuss organ-specific strategies aimed at disrupting the metastatic cascade, including targeting niche-forming pathways, intercepting cancer cell adhesion and modulating the immune microenvironment. Finally, we outline future challenges and opportunities, emphasizing the need for advanced models and integrative multi-omics to underscore the shifting therapeutic paradigm from late-stage generalized treatment to early targeted prevention of metastasis.
Types and Effectiveness of Digital Interventions for Labor Pain Management and Maternal Labor Experiences in Maternity Services: A Systematic Review
Background: Labor pain is a complex physiological and psychological experience that occurs globally and influences maternal outcomes and labor satisfaction, thus emphasizing the importance of effective non-pharmacological management strategies. Objective: This systematic review synthesizes digital technology-based non-pharmacological interventions and evaluates their effectiveness in reducing labor pain, improving maternal labor experience (satisfaction and fear), and optimizing clinical outcomes, including labor duration and use of epidural analgesia. Methods: This review followed the PRISMA 2020 guidelines. A systematic search was conducted in Scopus, PubMed, ProQuest, ScienceDirect, and EBSCO databases for studies published between 2021 and 2026. Study quality was assessed using the JBI critical appraisal tool, and findings were synthesized using thematic and narrative analysis. Results: The search identified 2,042 articles, of which eight studies met the inclusion criteria. Overall, digital-based non-pharmacological interventions demonstrated consistent effectiveness in reducing labor pain, improving maternal labor experiences, and supporting better clinical outcomes. Conclusions: Digital interventions have the potential to be evidence-based, mother-centered labor pain management strategies. Future research should evaluate long-term outcomes, objective clinical measures, and scalability of implementation to support broader integration into maternity health care systems globally.