Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )
type: channel
description: 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.
publisher: Al-Rafidain University
language: en-US
publication name: Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )
issn: 2789-3219
copyright: 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/).
items: Identification of Potential Drug-Drug Interactions in the Pediatric Intensive Care Unit of a Tertiary Care Teaching Hospital of Odisha, India
items: Serum Neurofilament Light Chain as an Independent Biomarker of Axonal Damage of Psychiatric Burden in Multiple Sclerosis
items: The Correlation Between Thyroid Status, Family History, and Melasma Severity: A Cross-Sectional Dermatological Analysis
items: Comparative Analysis of Renal Function and Lipid Profile in Diabetic Patients Across Gender, Age, and Glycemic Control: A Cross-sectional Study in Basrah, Iraq
items: COVID-19 and Public Health in Algeria: The Mitigating Role of Physical Activity
items: Incidence and Risk Factors of Hypersensitivity Reactions to Intravenous Ceftriaxone in Iraqi Hospitals: Nationwide Prospective Study
items: Dynamics of Soluble HLA-G and the 14-bp Insertion/Deletion Polymorphism as Predictors of Therapeutic Response in Acute Myeloid Leukemia
items: Game-Based versus Circuit Training: Impacts on Aerobic Capacity (VO₂max) and Cardiovascular Health Outcomes
items: Impact of Ambient Air Pollutants and Extreme Temperatures on Pregnancy Outcomes: A Clinical-Epidemiological Case-Control Study
items: Modulating Effects of Fimasartan and Omega-3 on Cisplatin-Induced Testicular Toxicity in Rats
items: Association Between Sublingual Varices and Hypertension: A Cross-Sectional Study
items: Metabolic, Electrolyte, and Hepatobiliary Complications of Parenteral Nutrition in Neonates: A Prospective Case-Series Study
items: Metabolic–Renal Divergence in Diabetic Patients Three Months After COVID-19: Evidence from a Real-World Cohort
items: Association of Left Atrial Coupling Index with Infarction Site and Cardiac Biomarkers in Patients with First Episode of Acute Myocardial Infarction
items: Molecular Insights into Gallstone Disease: Association of FXR and CYP7A1 Expression with Gallstone Composition in Iraqi Females
items: Evaluating a Bundled Protocol to Reduce Aspiration Pneumonia in Critically Ill Tube-Fed Patients
items: Time Lag of Acromegaly Diagnosis and Associated Comorbidities in Sulaymaniyah City/Iraq
items: Effectiveness of 577-nm Pro-Yellow Laser in Managing Inflammatory Acne: Results from a Quasi-Randomized Clinical Trial
items: Intralesional 5‑Fluorouracil in the Management of Resistant Warts: Outcomes from a Single-Arm Clinical Trial
items: Modulatory Role of Saroglitazar on Novel Hematological Inflammatory Ratios and Metabolic Parameters in Animal Model of 5-Fluorouracil Toxicity
items: Adapting Hydralazine as a Reliable Low-Toxicity Alternative to Cobalt Chloride for Hypoxia Modeling in Breast Cancer Cells
items: Systemic Immune-Inflammation Index and Hematological Ratios as Indicators of Hepatic Dysfunction in Thalassemia-Associated Liver Disease
items: Efficacy of Chromium Picolinate in Reducing Acanthosis Nigricans Severity in Adolescents with Insulin Resistance
items: Predictive Value of Circulating Renalase for Left Ventricular Hypertrophy in Non-Dialysis CKD Patients
items: Predictors of Patient Activation among Individuals with Multiple Sclerosis: Evidence from a Cross-Sectional Study
items: Peri-Procedural Clinical Characteristics and Short-Term Renal Outcomes of Metformin-Treated Patients with Type 2 Diabetes Mellitus Undergoing Coronary Angiography
items: Acute Remote Ischemic Preconditioning Alters Autonomic Function, Corrected Left Ventricular Ejection Time, and Pulse Transit Time in Healthy Adults
items: Inflammatory and Hematological Biomarkers as Indicators of Psoriatic Arthritis in Patients Attending Dermatology Clinic
items: The Difference Between Conventional and Simulation-based BLS Training on Nursing Students’ Knowledge Acquisition and Self-Efficacy in Jordan
items: Laparoscopic Heller's Myotomy for Achalasia Cardia: An Outcome and Experience of a Single-Center Study
items: Percutaneous Partial Plantar Fascia Release as a Minimally Invasive Treatment Following Failure of Conservative Management for Chronic Plantar Fasciitis: A Prospective Study
items: Effect of Yoga as an Add-On Therapy for Negative and Cognitive Symptoms in Patients with Schizophrenia—A Randomized Controlled Trial
items: Clinicopathological Characteristics and Recurrence Risk in Basal Cell Carcinoma Patients: A Cross-Sectional Study at Kariadi General Hospital Semarang, 2012–2023
items: Ravitch versus Nuss for Adolescent Pectus Carinatum: Multicenter Evidence to Guide Deformity-Specific Surgical Decision-Making
items: Effectiveness of Mouthwashes Based on Ozonated Oil
items: Reducing Cardiovascular Risk in Lupus Pregnancy: A Structured Multi-Phasic Management Model
items: Clinical Management of Fused Supernumerary Tooth with Upper Central Incisor
items: Giant Serous Cystadenoma of The Pancreatic Tail: Diagnostic Significance of CT Scanning in a Rare Case
items: Renal Cell Carcinoma in Pregnancy From a Gynecological Perspective: A Case Report and Review of Management Algorithm
items: Xerosis Cutis as a Presentation of Hypothyroidism in a Pediatric Patient: A Case Report
items: Prenatal Diagnosis of a Rare Dicephalic Parapagus Twin at 21 Weeks: A Case Report
items: An Overview of Metastatic Organotropism: Mechanisms and Emerging Therapeutic Targets
items: Types and Effectiveness of Digital Interventions for Labor Pain Management and Maternal Labor Experiences in Maternity Services: A Systematic Review

Identification of Potential Drug-Drug Interactions in the Pediatric Intensive Care Unit of a Tertiary Care Teaching Hospital of Odisha, India
type: item
description: 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.
creator: Paramita Parida
creator: Sagar Parida
creator: Debasish Misra
creator: Debasmita Rath
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-01
publication date: 2026-04-01
volume: 10
number: 2
starting page: 1
ending page: 5
doi: 10.54133/ajms.v10i2.2797

Serum Neurofilament Light Chain as an Independent Biomarker of Axonal Damage of Psychiatric Burden in Multiple Sclerosis
type: item
description: 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.
creator: Fatima Moufeed Hassan
creator: Mohammed Mahmood Mohammed
creator: Gheyath Al-Gawwam
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-02
publication date: 2026-04-02
volume: 10
number: 2
starting page: 6
ending page: 14
doi: 10.54133/ajms.v10i2.2675

The Correlation Between Thyroid Status, Family History, and Melasma Severity: A Cross-Sectional Dermatological Analysis
type: item
description: 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.
creator: Noor-Aldeen Jamal Hasan Al-Ansare
creator: Tin Htay Khain
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-03
publication date: 2026-04-03
volume: 10
number: 2
starting page: 15
ending page: 21
doi: 10.54133/ajms.v10i2.2820

Comparative Analysis of Renal Function and Lipid Profile in Diabetic Patients Across Gender, Age, and Glycemic Control: A Cross-sectional Study in Basrah, Iraq
type: item
description: 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.
creator: Zainab Muzahim Mohammed
creator: Ahmed Bader Abdulwahid
creator: Halah Muzahim Mohammed
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-04
publication date: 2026-04-04
volume: 10
number: 2
starting page: 22
ending page: 29
doi: 10.54133/ajms.v10i2.2827

COVID-19 and Public Health in Algeria: The Mitigating Role of Physical Activity
type: item
description: 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.
creator: Zouheyr Hadri
creator: M'hamed Benada
creator: Rachida Kirdi
creator: Sofiane Boudalia
creator: Hadil Subih
creator: Badreddine Moussaoui
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-06
publication date: 2026-04-06
volume: 10
number: 2
starting page: 43
ending page: 49
doi: 10.54133/ajms.v10i2.2681

Incidence and Risk Factors of Hypersensitivity Reactions to Intravenous Ceftriaxone in Iraqi Hospitals: Nationwide Prospective Study
type: item
description: 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.
creator: Ban Abdulameer Al-Shimran
creator: Haydar Adnan Fawzi
creator: Alaa Fadhel Hassan
creator: Manal Mohammed Younus
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-06
publication date: 2026-04-06
volume: 10
number: 2
starting page: 50
ending page: 57
doi: 10.54133/ajms.v10i2.2694

Dynamics of Soluble HLA-G and the 14-bp Insertion/Deletion Polymorphism as Predictors of Therapeutic Response in Acute Myeloid Leukemia
type: item
description: 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.
creator: Zainab Khalid Khaleel
creator: Ikram Khazal Qasim Al-hasso
creator: Zinah Makki Al-Yozbakee
creator: Ihsan Mardan Al-Badran
creator: Asaad Khalaf
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-13
publication date: 2026-04-13
volume: 10
number: 2
starting page: 73
ending page: 78
doi: 10.54133/ajms.v10i2.2861

Game-Based versus Circuit Training: Impacts on Aerobic Capacity (VO₂max) and Cardiovascular Health Outcomes
type: item
description: 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.
creator: Riand Resmana
creator: Mardepi Saputra
creator: Mario Febrian
creator: Sepriadi Sepriadi
creator: Muhammad Arnando
creator: Rully Effendi
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-13
publication date: 2026-04-13
volume: 10
number: 2
starting page: 97
ending page: 83
doi: 10.54133/ajms.v10i2.2819

Impact of Ambient Air Pollutants and Extreme Temperatures on Pregnancy Outcomes: A Clinical-Epidemiological Case-Control Study
type: item
description: 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.
creator: Nadia Ali Habeeb
creator: Hibbah Salman Dawood
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-14
publication date: 2026-04-14
volume: 10
number: 2
starting page: 85
ending page: 91
doi: 10.54133/ajms.v10i2.2864

Modulating Effects of Fimasartan and Omega-3 on Cisplatin-Induced Testicular Toxicity in Rats
type: item
description: 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.
creator: Victoria Saad Kareem
creator: Ali Faris Hassan
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-15
publication date: 2026-04-15
volume: 10
number: 2
starting page: 92
ending page: 97
doi: 10.54133/ajms.v10i2.2691

Association Between Sublingual Varices and Hypertension: A Cross-Sectional Study
type: item
description: 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.
creator: Shahad Abbas Waheed
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-15
publication date: 2026-04-15
volume: 10
number: 2
starting page: 98
ending page: 103
doi: 10.54133/ajms.v10i2.2862

Metabolic, Electrolyte, and Hepatobiliary Complications of Parenteral Nutrition in Neonates: A Prospective Case-Series Study
type: item
description: 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.
creator: Dalya Abdul Kareem Mohammed
creator: Yasir Ibrahim Abdulridha
creator: Mustafa Ghazi Alabbassi
creator: Saad Abdulrahman Hussain
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-16
publication date: 2026-04-16
volume: 10
number: 2
starting page: 104
ending page: 112
doi: 10.54133/ajms.v10i2.2818

Metabolic–Renal Divergence in Diabetic Patients Three Months After COVID-19: Evidence from a Real-World Cohort
type: item
description: 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.
creator: Saba Hameed Majeed
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-17
publication date: 2026-04-17
volume: 10
number: 2
starting page: 113
ending page: 116
doi: 10.54133/ajms.v10i2.2814

Association of Left Atrial Coupling Index with Infarction Site and Cardiac Biomarkers in Patients with First Episode of Acute Myocardial Infarction
type: item
description: 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.
creator: Harith Imad Shwailia
creator: Oday Jasim Al-Salihi
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-19
publication date: 2026-04-19
volume: 10
number: 2
starting page: 123
ending page: 126
doi: 10.54133/ajms.v10i2.2873

Molecular Insights into Gallstone Disease: Association of FXR and CYP7A1 Expression with Gallstone Composition in Iraqi Females
type: item
description: 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.
creator: Hala Mohammed Hussien Al-Bakri
creator: Nuha Joseph Kandala
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-20
publication date: 2026-04-20
volume: 10
number: 2
starting page: 127
ending page: 134
doi: 10.54133/ajms.v10i2.2866

Evaluating a Bundled Protocol to Reduce Aspiration Pneumonia in Critically Ill Tube-Fed Patients
type: item
description: 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.
creator: Khulood Batarseh
creator: Mona Abdulhamid Al Nsour
creator: Haneen George Zureikat
creator: Mohammad Hazza Bani Khaled
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-24
publication date: 2026-04-24
volume: 10
number: 2
starting page: 137
ending page: 141
doi: 10.54133/ajms.v10i2.2872

Time Lag of Acromegaly Diagnosis and Associated Comorbidities in Sulaymaniyah City/Iraq
type: item
description: 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.
creator: Aso Nasih Qadir
creator: Taha Othman Mahwi
creator: Zagros Ghaffor Rashid
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-26
publication date: 2026-04-26
volume: 10
number: 2
starting page: 145
ending page: 151
doi: 10.54133/ajms.v10i2.2875

Effectiveness of 577-nm Pro-Yellow Laser in Managing Inflammatory Acne: Results from a Quasi-Randomized Clinical Trial
type: item
description: 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.
creator: Rusul Sahib Hussein Mohammed
creator: Rena Raad Helmi
creator: Monaf Faik Al-Samarraee
creator: Haider Al-Sabak
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-26
publication date: 2026-04-26
volume: 10
number: 2
starting page: 152
ending page: 158
doi: 10.54133/ajms.v10i2.2880

Intralesional 5‑Fluorouracil in the Management of Resistant Warts: Outcomes from a Single-Arm Clinical Trial
type: item
description: 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.
creator: Ethar Falah Hasan
creator: Noor Subhi Fadhil
creator: Dhuha Amer Khudhair
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-26
publication date: 2026-04-26
volume: 10
number: 2
starting page: 159
ending page: 163
doi: 10.54133/ajms.v10i2.2903

Modulatory Role of Saroglitazar on Novel Hematological Inflammatory Ratios and Metabolic Parameters in Animal Model of 5-Fluorouracil Toxicity
type: item
description: Background: 5-Fluorouracil (5-FU), a widely used chemotherapeutic agent, causes oxidative stress, inflammation, and multi-organ damage, particularly cardiotoxicity. Saroglitazar, a dual peroxisome proliferator-activated receptor α/γ agonist with lipid-lowering, insulin-sensitizing, and anti-inflammatory effects, may ameliorate these adverse outcomes. Objective: To evaluate how saroglitazar influences hematological inflammatory ratios and metabolic parameters in a rat model of 5-fluorouracil-induced toxicity. Methods: 35 adult males Wistar rats were categorized into five groups: Control (NC), 5-FU-treated positive control (PC), N-acetylcysteine (NAC) (100mg/kg) + 5-FU, SAR low (0.5mg/kg)+5-FU, and SAR high (5.0mg/kg)+5-FU. 150mg/kg 5-FU was given intraperitoneally on the 10th day of treatment. Biochemical markers were evaluated, including cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose, and HbA1c; inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR); and hematological markers such as hemoglobin concentration (Hb), red blood cell count (RBC), and white blood cell count (WBC). Results: 5-FU treatment caused significant metabolic alteration, including dyslipidemia, hyperglycemia, systemic inflammation, and hematological suppression. Saroglitazar, on the other hand, improved lipid profiles by reducing cholesterol, triglycerides, and LDL and showed a glucose-lowering effect. It also reduced NLR and MLR, demonstrating their superior anti-inflammatory activity. Saroglitazar also improved RBC count and Hb levels, indicating its influence on erythropoiesis and bone marrow function. Conclusion: Saroglitazar mitigates 5-fluorouracil-induced metabolic, inflammatory, and hematological disturbances, supporting its potential as an adjunct to chemotherapy. Assessing its long-term effectiveness and practical use is recommended.
creator: Hani Hadi Mohammed
creator: Roza Haroon Rasheed
creator: Tavga Ahmed Aziz
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-28
publication date: 2026-04-28
volume: 10
number: 2
starting page: 164
ending page: 170
doi: 10.54133/ajms.v10i2.2325

Adapting Hydralazine as a Reliable Low-Toxicity Alternative to Cobalt Chloride for Hypoxia Modeling in Breast Cancer Cells
type: item
description: Background: Hypoxia represents a critical characteristic of the breast cancer microenvironment, responsible for tumor progression and therapeutic resistance. Although cobalt chloride (CoCl₂), which is used to induce cellular hypoxia, its application is restricted by severe cytotoxicity and off-target side effects. Objective: To evaluate hydralazine as an alternative for hypoxia induction in human MCF-7 breast cancer cells. Methods: MCF-7 cells were treated with increasing concentrations of hydralazine and CoCl₂ to compare the efficacy and cytotoxicity. Cell viability and stabilization of hypoxia-inducing factor-1 alpha (HIF-1α) were assessed using MTT and Western blotting assays, respectively. GAPDH protein was used as a loading control. Results: Hydralazine maintained near 98% cell viability across all tested doses up to 1600 µM at 24 hours, whereas CoCl₂ treatment resulted in dose-dependent cytotoxicity with a significant viability reduction to approximately 50% at the same maximum concentration. Furthermore, prolonged exposure (72 hours) to 1600 µM CoCl₂ caused severe cytotoxicity (<20% viability), while hydralazine-treated cells maintained significantly higher viability, enabling safer conditions for chronic hypoxia during long-term studies. Interestingly, Western blot results showed that hydralazine induced and stabilized HIF-1α protein, with a higher expression level than observed in CoCl₂-treated cells across the 50 to 150 µM concentration range. Conclusions: Hydralazine efficiently induces hypoxia in MCF-7 cells with favorable biocompatibility compared to CoCl₂ and can be a simple, safer, and more reliable chemical model for investigating signals mediated by HIF-1α in luminal breast cancer research, avoiding the variability of confounding heavy metal toxicity.
creator: Zakariya Al-Mashhadani
creator: Inam Sameh Arif
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-29
publication date: 2026-04-29
volume: 10
number: 2
starting page: 171
ending page: 176
doi: 10.54133/ajms.v10i2.2860

Systemic Immune-Inflammation Index and Hematological Ratios as Indicators of Hepatic Dysfunction in Thalassemia-Associated Liver Disease
type: item
description: Objective: This study aimed to investigate the relationship between systemic inflammatory biomarkers and clinical and biochemical indicators of liver dysfunction in patients with thalassemia-associated liver disease. Methods: A cross-sectional study was conducted involving 50 patients with thalassemia-associated liver disease. Demographic characteristics, hematological parameters, inflammatory biomarkers, and liver function tests were collected. Inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) were calculated from routine complete blood count parameters. Pearson correlation analysis was performed to evaluate associations between inflammatory biomarkers and indicators of hepatic dysfunction, including prothrombin time (PT) and international normalized ratio (INR). Multivariate regression analysis was applied to identify independent predictors of symptom burden. Results: The mean age of participants was 52.1±19.7 years, with a predominance of female patients. C-reactive protein (CRP) showed significant positive correlations with NLR (r=0.45, p=0.001), PLR (r=0.41, p=0.003), and SII (r=0.50, p<0.001) and a significant inverse correlation with LMR (r=−0.50, p<0.001). NLR exhibited a strong correlation with SII (r=0.91, p<0.0001). However, leukocyte-derived indices were not significantly associated with PT or INR. Both PT and INR correlated significantly with CRP and LMR. Multivariate analysis identified PT as the only independent predictor of symptom burden (p<0.0001). Conclusions: Inflammatory biomarkers reflect systemic immune activation in thalassemia-associated liver disease, whereas PT remains the most reliable indicator of disease severity. Integrating inflammatory indices with conventional liver function markers may improve clinical assessment.
creator: Tavga Ahmed Aziz
creator: Shvan Burhan Rafiq
creator: Hozan Jaza Hama Salh
creator: Hero Khurshid Rashid
creator: Lena Nawzad Amin
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-29
publication date: 2026-04-29
volume: 10
number: 2
starting page: 177
ending page: 183
doi: 10.54133/ajms.v10i2.2883

Efficacy of Chromium Picolinate in Reducing Acanthosis Nigricans Severity in Adolescents with Insulin Resistance
type: item
description: Background: Acanthosis nigricans (AN) is a well-known skin condition characterized by the development of hyperpigmented skin patches associated with abnormal texture and is closely related to metabolic syndromes characterized by insulin resistance. Chromium picolinate supplementation, especially, is suggested to improve insulin function in peripheral tissue by stimulating the insulin receptors. Which might ultimately improve the severity of acanthosis nigricans. There is not enough evidence to support the significance of this correlation. Objective: To determine the efficacy of chromium picolinate in reducing the clinical severity of acanthosis nigricans and improving insulin resistance in Iraqi adolescents and report any adverse effects. Methods: 95 adolescent patients with insulin resistance and acanthosis nigricans were randomly allocated into two groups in a 1:1 ratio. Group I (n=48) received chromium supplementation for 24 weeks, while Group II (n=47) received identical placebo capsules for the same duration. Changes in the baseline insulin resistance status and Acanthosis Nigricans severity were then recorded during follow-up visits at 8, 16, and 24 weeks. Results: Chromium supplementation significantly reduced Burke scores from baseline (mean 8.96±2.00) to 24 weeks (5.45±2.14) compared to placebo (9.04±1.92 to 8.00±1.88. HOMA-IR decreased markedly in the chromium group (4.10±0.92 to 2.75±0.89) versus placebo (3.96±0.84 to 3.62±0.85). Changes in HOMA-IR and Burke scores were strongly correlated (r=0.749, p<0.001). Conclusions: Chromium supplementation effectively improves insulin resistance and acanthosis nigricans severity in at-risk adolescents, supporting its use as a safe adjunctive therapy for metabolic dysfunction.
creator: Ghasak Kais Abd-Alhussain
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
volume: 10
number: 2
starting page: 184
ending page: 191
doi: 10.54133/ajms.v10i2.2841

Predictive Value of Circulating Renalase for Left Ventricular Hypertrophy in Non-Dialysis CKD Patients
type: item
description: Background: Chronic kidney disease (CKD) is a global health burden strongly associated with cardiovascular morbidity and mortality. Left ventricular hypertrophy (LVH), a hallmark of cardiac remodeling in CKD, is a major predictor of heart failure and sudden cardiac death. Current biomarkers fail to capture early remodeling risk adequately, underscoring the need for novel predictors. Objective: To evaluate serum renalase levels in non-dialysis CKD patients (stages 3–5) and determine its predictive value for cardiac remodeling, particularly LVH. Methods: A cross-sectional study was conducted, including 89 CKD patients, 40 heart failure patients, and 37 healthy controls. Demographic, clinical, biochemical, and echocardiographic data were collected. Serum renalase was measured using ELISA. Logistic regression models and receiver operating characteristic (ROC) analyses were applied to assess the independent predictive value of renalase for cardiac remodeling. Results: CKD patients with cardiac remodeling had significantly higher renalase levels compared to those without (36.31ng/mL vs. 33.05ng/mL, p=0.009). ROC analysis yielded an AUC of 0.656, with a cutoff value of >37.64 ng/mL (sensitivity, 47.5%; specificity, 83.3%). Logistic regression confirmed renalase as an independent predictor of remodeling (adjusted OR: 1.105, 95% CI=1.036–1.178, p=0.002), alongside uncontrolled hypertension (OR=3.462, p=0.014). Conclusions: Serum renalase is independently associated with LVH in non-dialysis CKD patients and demonstrates moderate discriminative ability with high specificity. These findings highlight renalase as a promising biomarker for early cardiac risk stratification in CKD, warranting further longitudinal validation and standardization of measurement protocols.
creator: Karrar Mohammed Abbas
creator: Mohammed Mahmmod Mohammed
creator: Mohammed Abdel Alhassan Hamas
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
volume: 10
number: 2
starting page: 192
ending page: 201
doi: 10.54133/ajms.v10i2.2721

Predictors of Patient Activation among Individuals with Multiple Sclerosis: Evidence from a Cross-Sectional Study
type: item
description: Background: Multiple sclerosis (MS) is a chronic neurological disease that requires long-term self-management and active patient engagement. Patient activation reflects an individual’s knowledge, confidence, and skills to manage their health, yet evidence in MS populations, particularly in low- and middle-income countries, remains limited. Objective: To determine the level of patient activation in people with MS and investigate its connection with demographic and clinical characteristics. Methods: This is a cross-sectional study carried out on 100 individuals diagnosed with MS and admitted to a specialized MS center of Baghdad Teaching Hospital. The Patient Activation Measure (PAM-13) was used to measure patient activation. The demographic and clinical factors were represented by age, gender, educational attainment, marital status, residential status, and level of disability assessed by the Expanded Disability Status Scale (EDSS). Results: The average age of the participants was 33.98±10.4 years, with an average PAM-13 score of 77.18±3.83. The majority (98%) of the participants fell to the highest level of activation (level 4). Patient activation did not have any significant association with demographic or clinical variables. Conclusions: Patients with MS were highly patient activated, which means that they were very active in the self-management of the disease.
creator: Ali Mahdi Mohammed
creator: Samer Imad Mohammed
creator: Zuhair Abdul-Ghafoor Al-Johar
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-03
publication date: 2026-05-03
volume: 10
number: 2
starting page: 202
ending page: 209
doi: 10.54133/ajms.v10i2.2901

Peri-Procedural Clinical Characteristics and Short-Term Renal Outcomes of Metformin-Treated Patients with Type 2 Diabetes Mellitus Undergoing Coronary Angiography
type: item
description: Background: Patients with type 2 diabetes mellitus (T2DM) frequently undergo coronary angiography because of their increased cardiovascular risk. Periprocedural management of metformin remains important because of concerns about renal safety, contrast-associated acute kidney injury (CA-AKI), and lactic acidosis. Objective: To describe the peri-procedural clinical characteristics and short-term renal outcomes of metformin-treated patients with T2DM undergoing coronary angiography and to examine the relationship between short-term serum creatinine change and selected clinical and procedural factors. Methods: This prospective observational study was conducted at Azadi Cardiac Centre, Kirkuk, Iraq, from May 2022 to May 2024. One hundred adults with T2DM receiving metformin and undergoing coronary angiography were enrolled. Baseline demographic, clinical, and laboratory data were recorded before the procedure. Patients continued metformin throughout the peri-procedural period, low-osmolality contrast medium was used, and serum creatinine was remeasured 72 hours later. Results: Hyperlipidemia (64%) and hypertension (55%) were the most common comorbidities. Mean serum creatinine increased slightly from 0.73±0.13mg/dL to 0.75±0.19mg/dL at 72 hours, but this change was not statistically significant (p=0.103). Only one patient developed post-procedural kidney injury and recovered with hydration and monitoring. No clinically evident lactic acidosis was observed. Creatinine change was not significantly associated with metformin dose, contrast volume, or left ventricular systolic function. Conclusions: Short-term renal function remained generally stable in metformin-treated patients with T2DM undergoing coronary angiography. These findings support a cautious, individualized approach to peri-procedural metformin management in lower-risk patients.
creator: Raad Hassan Najim
creator: Mufeed Akram Taha
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-05
publication date: 2026-05-05
volume: 10
number: 2
starting page: 210
ending page: 215
doi: 10.54133/ajms.v10i2.2913

Acute Remote Ischemic Preconditioning Alters Autonomic Function, Corrected Left Ventricular Ejection Time, and Pulse Transit Time in Healthy Adults
type: item
description: Background: Remote ischemic preconditioning (RIPC) leads to systemic protective responses via neural, hormonal, and endothelial pathways, with autonomic modulation as a key mediator. While most studies focus on heart rate variability (HRV) and arterial stiffness, limited data exist on RIPC’s acute effects on cardiac systolic timing and vascular pulse conduction. Objective: To investigate the acute effects of RIPC on autonomic function, heart rate-corrected left ventricular ejection time (cLVET), and pulse transit time (PTT) in healthy adults. Methods: Fifteen healthy young men completed RIPC and sham RNIPC protocols. RIPC involved four 5-min cycles of upper-arm cuff inflation to 230 mmHg followed by 5-min deflation; sham used 30 mmHg. Continuous ECG and digital pulse wave recordings were obtained before and after each intervention. HRV indices, PTT, PWV, and cLVET were derived from ECG-gated waveform analysis. Results: Following RIPC, mean RR interval, SD1, pNN50, high-frequency power, and SD2 increased significantly, while systolic blood pressure decreased. PTT increased significantly, with a corresponding reduction in calculated PWV. In addition, cLVET decreased significantly after RIPC. In the sham RNIPC condition, no significant changes were observed in HRV indices, PTT/PWV, or cLVET, although systolic blood pressure also declined significantly. Conclusions: Acute RIPC induced coordinated changes in autonomic and cardiovascular timing, including enhanced vagal HRV, prolonged PTT, reduced PWV, and shortened cLVET, suggesting cLVET and PTT as useful markers for short-term autonomic–cardiovascular responses in healthy adults.
creator: Dhuha Mohammed Abd Al Sajjad
creator: Amal Yousif Al-Yasiri
creator: Bassam Talib Al-Gailani
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-08
publication date: 2026-05-08
volume: 10
number: 2
starting page: 219
ending page: 225
doi: 10.54133/ajms.v10i2.2925

Inflammatory and Hematological Biomarkers as Indicators of Psoriatic Arthritis in Patients Attending Dermatology Clinic
type: item
description: Background: Psoriatic arthritis (PsA), a heterogeneous inflammatory arthropathy where inflammatory biomarkers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) show normal levels in over half of cases in spite of having clinically active disease. Hemoglobin, a readily available parameter, remains a largely underexplored surrogate of systemic inflammatory burden in PsA. Methods: Consecutive sampling was used to enroll 132 PsA patients (CASPAR criteria) attending the Dermatology Outpatient Clinics of Al Yarmouk Hospital via a cross-sectional study. Disease activity was stratified based on the Disease Activity Index for PsA (DAPSA) into low (≤13), moderate (14–27), and high (>27). Demographic and lab tests, hematological and inflammatory (full blood count, CRP, and ESR), were measured for all. Anemia was defined by WHO sex-specific thresholds. Results: mean age of enrolled cases (46.3±14.3 years; 61.4% female). High disease activity was reported in 58.4% of patients. All hematological and inflammatory indicators show significant differences across DAPSA strata. Hemoglobin fell negatively with rising disease activity (12.80±1.95g/dL in moderate vs. 11.30±1.6g/dL in high activity). Anemia (56.1%) was independently associated with higher DAPSA scores (51.9±39.2 vs. 35.4±40.2; p<0.001), increased acute-phase reactants, and female gender. Psoriasis duration correlated negatively with hemoglobin (r= −0.28, p=0.001) but not with CRP or ESR. Conclusions: Hemoglobin is a cost-free, available, and clinically meaningful biomarker that matches DAPSA-defined disease activity in PsA more reliably than CRP or ESR in real-world practice.
creator: Rena Raad Helmi
creator: Mustafa Alhayali
creator: Fadhil Abbas Abdul Rasool
creator: Wassan Nori
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-10
publication date: 2026-05-10
volume: 10
number: 2
starting page: 226
ending page: 231
doi: 10.54133/ajms.v10i2.2939

The Difference Between Conventional and Simulation-based BLS Training on Nursing Students’ Knowledge Acquisition and Self-Efficacy in Jordan
type: item
description: Background: Advanced technology in education and training is a challenging task that requires appropriate assessment of new, innovative methods. Objective: To evaluate the difference between conventional and simulation-based basic life support (BLS) training on nursing students’ knowledge acquisition and self-efficacy. Methods: A pretest-posttest quasi-experimental design was utilized. 87 nursing students (43 in the control and 44 in the intervention groups) were recruited. The data were analyzed using descriptive statistics, an independent-samples t-test, a paired-samples t-test, Spearman's correlation, ANCOVA, and a multiple linear regression. Results: Significant differences were reported in exam scores between the intervention control groups pre- and post-intervention. Post-intervention exam scores were statistically higher in the simulation group (difference= 2.8), with both groups achieving pass scores. Significant differences between the groups in the total self-efficacy scores for resuscitation were reported. ANCOVA results showed significant differences in exam scores between the two groups (p=0.013), and the intervention had a significantly positive effect on students’ knowledge (7% of the variance in exam scores) (η²=0.07). Conclusions: Students' BLS knowledge and self-efficacy significantly improved after training, regardless of the training method, although simulation-based training showed statistically significant improvement in BLS knowledge acquisition. The modest difference indicates limited educational significance, particularly in the context where conventional training already achieves the competency threshold. Educators and policymakers should consider including simulation-based BLS training in nursing education. However, traditional BLS training is still efficient in improving student knowledge and self-efficacy, especially in limited-resource countries.
creator: Khaldoun Hamdan
creator: Rabia Allari
creator: Ahmad Al-Bashaireh
creator: Muntaha Gharaibeh
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-13
publication date: 2026-05-13
volume: 10
number: 2
starting page: 232
ending page: 241
doi: 10.54133/ajms.v10i2.2867

Laparoscopic Heller's Myotomy for Achalasia Cardia: An Outcome and Experience of a Single-Center Study
type: item
description: Background: Achalasia cardia is a rare disease mostly caused by myenteric plexus degeneration. The main clinical presentations are dysphagia, regurgitation, chest pain, and weight loss. Objectives: This study aimed to evaluate the feasibility and outcome of laparoscopic Heller's myotomy. Methods: This is a prospective study involving 52 patients with achalasia diagnosed by OGD, barium swallow, and esophageal manometry. All patients underwent laparoscopic surgery. Results: This study includes 23 males and 29 females with a male/female ratio of 1.26. The mean age of patients was 36.8 years. The mean operative time was 85.12 minutes, with a mean hospital stay of 4.27 days. All patients had undergone laparoscopic Heller's myotomy with Dor fundoplication; there were no conversions to open surgery. Intraoperatively detected complications involve 4 patients with esophageal mucosal injury, 1 patient with gastric mucosal injury, and 2 patients with minute pleural injury and no significant intraoperative bleeding, adjacent organ injury, or surgical emphysema. Regarding the early postoperative complications, 3 patients (5.76%) had atelectasis, 1 patient (1.92%) had pneumonia, and 1 patient (1.92%) had a leak due to a missed esophageal mucosal injury discovered on the third postoperative day; 3 patients (5.88%) with mild dysphagia were successfully treated conservatively, and one patient (1.92%) died on the sixth postoperative day. About late complications, 4 patients (7.84%) developed mild GERD, and 1 patient developed recurrent dysphagia. Conclusions: Laparoscopic Heller's myotomy is feasible and effective therapy for achalasia cardia. DOR fundoplication is a competent anti-reflux procedure to decrease the rate of postoperative GERD.
creator: Noori Hanoon Jasim
creator: Muntadher Abdulkareem Abdullah
creator: Khalid Shaker Abdulkarim
creator: Ali Dawood Al-hilfi
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-15
publication date: 2026-05-15
volume: 10
number: 2
starting page: 242
ending page: 247
doi: 10.54133/ajms.v10i2.2949

Percutaneous Partial Plantar Fascia Release as a Minimally Invasive Treatment Following Failure of Conservative Management for Chronic Plantar Fasciitis: A Prospective Study
type: item
description: Background: Chronic recalcitrant plantar fasciitis influences 5–10% of patients who are unresponsive to conservative treatment, necessitating surgical intervention. Percutaneous partial plantar fascia release is an emerging minimally invasive technique, but there is limited prospective evidence available proving the safety and effectiveness of the technique under general anesthesia. Objective: To evaluate the clinical outcomes, safety, and efficacy of percutaneous partial plantar fascia release done under general anesthesia. Methods: This prospective interventional study comprised 32 patients with chronic plantar fasciitis, unresponsive to a minimum of six months of conservative management. All patients underwent percutaneous medial plantar fascia release under general anesthesia. We used the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) score to measure the outcomes of surgical intervention at baseline and six months after surgery. Results: The mean VAS score decreased from 8.1±0.9 preoperatively to 1.6±0.8 at six months after surgery (−6.5; p<0.001). The mean AOFAS score increased from 46.73±8.73 to 93.80±10.46 (47.07; p<0.001). There was no significant difference between the patients with calcaneal spur and those without it (p > 0.05). Complications were infrequent (6.25%). Conclusions: Percutaneous partial release of the plantar fascia under general anesthesia is a safe and effective minimally invasive procedure for chronic plantar fasciitis that provides significant pain relief and improves functional status with a minimal incidence of complications. Large-scale comparative studies with extended follow-up are needed.
creator: Raed Abbas Saadoon
creator: Ahmed Sabah Kadhim
creator: Mohammed Jaffer Jawad
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-18
publication date: 2026-05-18
volume: 10
number: 2
starting page: 253
ending page: 257
doi: 10.54133/ajms.v10i2.2938

Effect of Yoga as an Add-On Therapy for Negative and Cognitive Symptoms in Patients with Schizophrenia—A Randomized Controlled Trial
type: item
description: Background: People with schizophrenia usually present with deficits of several neurocognitive domains—including attention, processing speed, working memory, verbal and visual memory, and executive function. Pharmacological treatment options are limited for both negative and cognitive symptoms. However, several non-pharmacological interventions, like yoga, have been tried with evidence of effectiveness in providing measurable cognitive gains and improving negative symptoms. Objective: To find out the effect of yoga on negative and cognitive symptoms through a randomized controlled trial. Methods: A single-blind randomized controlled trial was conducted at a tertiary care hospital from June 2023 to June 2025. Patients were screened with the PANSS scale, and scores <75 were included for the study. The sample size was calculated as 104. Two groups were formed with 60 participants in each group randomly: Group A, with patients who were given yoga intervention along with standard pharmacotherapy, and Group B, with patients who continued with the standard pharmacotherapy (olanzapine up to 30mg). Baseline PGIBBD and CTT scores were obtained from each participant at baseline and after the yoga intervention. Results: After 3 months of intervention, Group A showed a marked and statistically significant reduction in symptom severity, with substantial improvements observed in both negative and cognitive symptom domains as measured by SANS scores, PGIBBD, and CTT scores. Conclusions: The concurrent improvement in both symptom severity and cognitive measures in the yoga intervention group addresses not only clinical symptoms but also associated cognitive deficits, which are critical determinants of functional outcome.
creator: Bhagyashree Nanda
creator: Suvendu Narayan Mishra
creator: Lagnajit Dash
creator: Rakesh Mohanty
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-20
publication date: 2026-05-20
volume: 10
number: 2
starting page: 258
ending page: 264
doi: 10.54133/ajms.v10i2.2745

Clinicopathological Characteristics and Recurrence Risk in Basal Cell Carcinoma Patients: A Cross-Sectional Study at Kariadi General Hospital Semarang, 2012–2023
type: item
description: Background: Basal cell carcinoma (BCC) is responsible for 70–80% of all skin malignancies. Histopathologically, it is classified into two types: high-risk and low-risk. Evidence linking clinicopathological features of BCC to recurrence risk remains limited in Indonesia, particularly in tertiary referral centers such as Kariadi Hospital. Objective: This study aims to assess the clinicopathological features of BCC in relation to other factors influencing recurrence risk in Indonesia. Methods: A retrospective cross-sectional analytic study was conducted using medical records and anatomical pathology examination results of BCC patients diagnosed between January 2012 and December 2023. Results: Among the 405 patients included, 47.4% were classified as having high recurrence risk. Variables analyzed included age, sex, occupation, ulcer size, and tumor location. The risk of recurrence was evaluated according to lesion size, anatomical location, histological subtype, and surgical margins. Ulcer presence showed a significant association with high recurrence risk, with a prevalence ratio (PR)=1.631; 95% CI: 1.337-1.989; p<0.001. Other variables, including age, sex, occupation, ulcer size, and tumor location, did not show statistically significant associations with recurrence risk. Conclusions: The fact that an ulcer was present could be considered one of the factors in determining the risk of BCC recurrence.
creator: Meira Dewi Kusuma Astuti
creator: Endang Mahati
creator: Suhartono Suhartono
creator: Ambar Mudigdo
creator: Selamat Budijitno
creator: Udadi Sadhana
creator: Ignatius Riwanto
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-21
publication date: 2026-05-21
volume: 10
number: 2
starting page: 265
ending page: 270
doi: 10.54133/ajms.v10i2.2940

Ravitch versus Nuss for Adolescent Pectus Carinatum: Multicenter Evidence to Guide Deformity-Specific Surgical Decision-Making
type: item
description: Background: Pectus carinatum (PC) is a congenital malformation of the chest wall, affecting adolescent males predominantly and associated with psychosocial effects. In the Middle East, many studies address the same topic. Objective: To evaluate outcomes of modified Ravitch and Nuss procedures in Iraqi adolescents. Methods: A multicenter retrospective cohort study (2020–2025) involved 102 adolescents (12–18 years) who underwent PC correction using Ravitch (n=52) or Nuss (n=50) techniques. Procedure selection was based on the severity of deformity, rigidity of the chest wall, and expertise of the surgeon. Outcomes included operative time, hospital stay, complications, aesthetic results, and patient satisfaction (5-point Likert scale). A severity-stratified subgroup analysis was performed. Results: Baseline characteristics were comparable, although severe deformities were more frequent in the Ravitch group (65.4% vs. 16.0%, p<0.001). The Nuss procedure had a shorter operation time (65±15 vs. 85±20 minutes, p<0.001) and less hospitalization (1.5±0.4 vs. 2.1±0.6 days, p<0.001). The rates of complications were identical (13.5% vs. 14%; p=0.93). Severity-stratified analysis showed higher Nuss operation efficiency in moderate levels of deformities with comparable rates of complication and satisfaction at severity levels. Favorable aesthetic outcomes were obtained in 82.7% of Ravitch and 88% of Nuss, and more than 90% of patients were satisfied after two years of follow-up. Conclusions: The two techniques are safe and effective in PC correction, supporting the Nuss procedure for moderate deformities, and the Ravitch technique is preferred for severe or rigid cases.
creator: Bassam Maddah Al-Alosi
creator: Mohammed Jawdat Kadhim
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-24
publication date: 2026-05-24
volume: 10
number: 2
starting page: 271
ending page: 277
doi: 10.54133/ajms.v10i2.2909

Effectiveness of Mouthwashes Based on Ozonated Oil
type: item
description: N/A
creator: Valentino Natoli
creator: Francesco Mileti
creator: Vincenzo Natoli
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-23
publication date: 2026-04-23
volume: 10
number: 2
starting page: 135
ending page: 136
doi: 10.54133/ajms.v10i2.2968

Reducing Cardiovascular Risk in Lupus Pregnancy: A Structured Multi-Phasic Management Model
type: item
description: N/A
creator: Ali Muhammad Murad
creator: Manaf Jarallah Yaseen
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-07
publication date: 2026-05-07
volume: 10
number: 2
starting page: 216
ending page: 218
doi: 10.54133/ajms.v10i2.3017

Clinical Management of Fused Supernumerary Tooth with Upper Central Incisor
type: item
description: 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.
creator: Othman Husham Abdulhameed
creator: Maha Abdulkareem Mahmood
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-07
publication date: 2026-04-07
volume: 10
number: 2
starting page: 58
ending page: 60
doi: 10.54133/ajms.v10i2.2839

Giant Serous Cystadenoma of The Pancreatic Tail: Diagnostic Significance of CT Scanning in a Rare Case
type: item
description: 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.
creator: Sigit Adi Prasetyo
creator: Parish Budiono
creator: Nani Wijaya
creator: Ignatius Riwanto
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-07
publication date: 2026-04-07
volume: 10
number: 2
starting page: 61
ending page: 63
doi: 10.54133/ajms.v10i2.2794

Renal Cell Carcinoma in Pregnancy From a Gynecological Perspective: A Case Report and Review of Management Algorithm
type: item
description: 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.
creator: Amenah Fadhil
creator: Wassan Nori
creator: Saad Dakhil Farhan Daraji
creator: Shaymaa Khalid Abdulqader
creator: Alea Farhan Salman
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-19
publication date: 2026-04-19
volume: 10
number: 2
starting page: 117
ending page: 122
doi: 10.54133/ajms.v10i2.2879

Xerosis Cutis as a Presentation of Hypothyroidism in a Pediatric Patient: A Case Report
type: item
description: 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.
creator: Wasnaa Hadi Abdullah
creator: Basma Adel Ibrahim
creator: Abdulameer Jasim Al-Gburi
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-24
publication date: 2026-04-24
volume: 10
number: 2
starting page: 142
ending page: 144
doi: 10.54133/ajms.v10i2.2900

Prenatal Diagnosis of a Rare Dicephalic Parapagus Twin at 21 Weeks: A Case Report
type: item
description: Background: Dicephalus parapagus twinning (DPT) is the rarest conjoined twinning entity of all conjoined twins. The presence of DPT is always associated with mortality before or after delivery. Antenatal diagnosis is crucial for planning labor, assembling a team, and providing counseling. Case presentation: A 23-year-old patient (G2P1A0) at 21 weeks of pregnancy attended the ultrasound clinic for routine care. A monoamniotic-monochorionic pregnancy was observed; the twin fetuses had two heads but one body, which corresponded to dicephalus parapagus twinning. A detailed ultrasound and fetal echocardiography reveal one heart without congenital anomalies. The liver, kidneys, and bladder appeared to be normally developed. Fetal MRI and karyotyping were not carried out after counseling the parents regarding the poor outcome. A multidisciplinary team followed the case; the patient chose to continue the pregnancy. A planned elective cesarean delivery was done at 36 weeks in a tertiary medical facility. A 3,200 g newborn baby boy was delivered alive; however, he quickly developed respiratory insufficiency and failure of heart function. He deceased within 4 hours of birth; an autopsy was declined. Conclusion: The prenatal diagnosis of DPT helps manage the case thoroughly and carefully to avoid maternal complications. All cases of DPT have a very poor prognosis. Prenatal confirmation permits structured, proactive management rather than emergent, multidisciplinary responses.
creator: Wassan Nori
creator: Wasnaa Hadi Abdullah
creator: Basma Adel Ibrahim
creator: Munaf Jarallah Yaseen
creator: Mawasim Mazyad
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-15
publication date: 2026-05-15
volume: 10
number: 2
starting page: 248
ending page: 252
doi: 10.54133/ajms.v10i2.2942

An Overview of Metastatic Organotropism: Mechanisms and Emerging Therapeutic Targets
type: item
description: 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.
creator: Ismail Ibrahim Al-Janabi
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-05
publication date: 2026-04-05
volume: 10
number: 2
starting page: 30
ending page: 42
doi: 10.54133/ajms.v10i2.2774

Types and Effectiveness of Digital Interventions for Labor Pain Management and Maternal Labor Experiences in Maternity Services: A Systematic Review
type: item
description: 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.
creator: Yusrah Taqiyah
creator: Mekar Dwi Anggraeni
rights: Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
license: https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-10
publication date: 2026-04-10
volume: 10
number: 2
starting page: 64
ending page: 72
doi: 10.54133/ajms.v10i2.2837