Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )
Al-Rafidain Journal of Medical Sciences (AJMS) is a peer-reviewed international journal published by Al-Rafidain University, Baghdad, Iraq. The journal’s full text is available online at www.ajms.iq The journal allows free access (Open Access) to its contents and permits authors to self-archive the final accepted version of the articles on any compliant institutional/subject-based repository. Publishing in the AJMS complies with the Committee on Publication Ethics (COPE) and endorses the International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals, as well as the GPP3 guidelines regarding authorship. Submission of a manuscript to the AJMS implies that all authors have read and agreed to its content and that the manuscript conforms to the journal’s policies. © 2021 The Author(s). Published by Al-Rafidain University. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/). Important Update Publication charge was changed for accepted submissions after January 1st, 2025 onward: - For authors resident in Iraq: Article processing fee of 500,000 ID (tax included in price) applies to all the accepted articles after January 1st, 2025. Bank charges must be defrayed by the authors. - For foreign authors: Article processing fee of 500 US Dollars (tax included in price) applies to all the accepted articles after January 1st, 2025.
Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).
Ear Problems in Relation to Temporomandibular Joint Disorders in Iraqi Adults
Background: Patients with temporomandibular disorder had many otological symptoms, which might result from anatomical and functional proximity between it and the ear. Objective: To evaluate the correlation between temporomandibular joint disease and ear signs and symptoms. Methods: A prospective, observational study, where 278 patients of 1375 with temporomandibular joint disorder (TJMD), according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), were selected. A questionnaire was applied for the severity of ear symptoms, such as earache, ear fullness feeling, tinnitus, hearing loss, and vertigo sensation, and was analyzed. Results: The frequency rate of TMD was 20.21%, with females (64.38%) and males (35.61%); it was detected most commonly (32.01%) in the age group between 51 and 60 years, on the right side (58.63%) and left side (41.36%), and also in the urban (58.99%) and rural (41.01%) areas; otological symptoms were otalgia (33.45%), ear fullness (28.05%), tinnitus (24.82%), hearing loss (09.35%), and dizziness/vertigo (07.55%). Significant associations were found with otalgia (p=0.011), ear fullness (p=0.024), tinnitus (p=0.032), and hearing loss (p=0.041), while no significant results were found between sociodemographic characteristics and TMD (p=0.0621). Conclusions: The study declared a significant correlation between temporomandibular joint disorders and the otological symptoms.
Exploring Nurse-Pharmacist Collaboration for Medication Safety in Iraqi Hospitals: A Qualitative Study from the Nursing Perspective
Background: Effective nurse-pharmacist collaboration is essential to medication safety, but evidence documenting this relationship from nurses’ viewpoints remains limited within Iraq. Objective: To explore nurses’ perspectives and experiences regarding collaborative practices with hospital pharmacists in promoting medication safety, identifying key challenges from a nursing standpoint, and providing recommendations for improvement. Methods: A qualitative study using semi-structured interviews with 30 nurses across eight public hospitals in two governorates (November 2025-January 2026). Participants were recruited using purposive and snowball sampling. The Stutsky and Laschinger Interprofessional Collaborative Practice framework guided the study, and data were analyzed using Braun and Clarke’s inductive thematic analysis. Results: A total of 30 nurses participated (17 male, 13 female), with experience ranging from 1 to 25 years. Six themes emerged: interprofessional communication, characterized by need-based consultation and pharmacist condescension deterring two-thirds of nurses; role understanding and dynamics, marked by role ambiguity and nurses assuming patient education responsibilities; collaborative practice and safety, reflecting universal error detection and nurse-reported improvements in care quality; systemic and organizational barriers, including staffing shortages (n=29), night-shift unavailability (n=25), and physician-stamp bureaucracy (n=25); institutional support and leadership, marked by the absence of formal collaborative policies; and enablers of collaboration, including mutual trust (n=23), joint education (n=22), and clinical pharmacist presence (n=10). Conclusions: Nurses acknowledge the clinical value of collaborating with pharmacists for medication safety, but structural, behavioral, and organizational barriers hinder this potential. Enhancing this collaboration requires institutionalizing joint training, expanding clinical pharmacy services, and developing clear collaborative policies.
Association of Infancy Breastfeeding with the Childhood Mono-Symptomatic Enuresis in Iraqi Children
Background: Enuresis is a common pediatric disorder that negatively affects children’s emotional well-being and family functioning. Its etiology is multifactorial, involving genetic, biological, and environmental influences. Early-life feeding practices, particularly breastfeeding, have been suggested as potential protective factors. Understanding these relationships may improve preventive and management strategies. Objectives: To assess the association between breastfeeding history and enuresis among children aged 6–14 years in Baghdad and to evaluate the role of risk factors including family history, body mass index, and selected sociodemographic characteristics. Methods: A case–control study was conducted from January to December 2025 on 200 children (6–14 years). The sample comprised 100 children with primary enuresis (cases) recruited from a pediatric clinic and 100 age- and sex-matched controls without enuresis from primary healthcare centers. Children with neurological disorders, urinary tract abnormalities, diabetes mellitus, sleep disorders, or medication use were excluded. Data were collected through structured maternal interviews covering sociodemographic characteristics, family history, and feeding practices. Results: Obesity was more frequent among cases than controls (52% vs. 26%). Bottle feeding (41% vs. 15%) and positive family history (74% vs. 16%) were also higher among cases. Logistic regression showed increased odds of enuresis with overweight (OR=3.533), obesity (OR=3.333), family history (OR=5.195), bottle feeding (OR=4.278), low socioeconomic status (OR=2.614), and parental loss (OR=76.20). Breastfeeding duration showed a protective effect (OR=0.215–0.273). Conclusions: Breastfeeding is protective against primary enuresis, while obesity and adverse socioeconomic factors increased risk.
Correlation of Isolated Masked Nocturnal Hypertension with Retinopathy in Diabetic Patients
Background: The most common cause of visual impairment in the working-age population is diabetic retinopathy. Hypertension is thought to directly or indirectly cause 35% to 75% of diabetes complications. The prevalence of masked hypertension and masked nocturnal hypertension is higher in diabetic patients. In those who have diabetes mellitus, nocturnal blood pressure appears to be more relevant for the development of diabetic retinopathy. Objective: To assess the relationship between isolated masked nocturnal hypertension and retinopathy in diabetic patients. Methods: An observational case-control study was conducted on 234 individuals with diabetes; 117 of them have retinopathy, while the remaining do not. All patients were assessed for hypertension by measuring blood pressure in the office and through 24-hour ambulatory blood pressure monitoring. Results: Twenty-three percent of all assessed patients had masked hypertension. Isolated masked nocturnal hypertension (IMNH) was detected in 15.4% of those with retinopathy, while it was 6% for those without retinopathy. There was a significant relationship between IMNH and the severity of retinopathy. IMNH was more prevalent in those aged 40 years and older, as well as in overweight and obese patients. Conclusions: The current study indicated that diabetic patients with retinopathy exhibited a higher prevalence of masked nocturnal hypertension than those without retinopathy. This result could indicate that masked nocturnal hypertension plays a contributory role in the development of retinopathy.
Impact of Nias Culture Based Physical Training on Students’ Cardiovascular Endurance
Background: Cardiovascular endurance among young adults is declining due to low engagement in conventional training. Culture-based physical training offers a promising alternative. However, empirical evidence remains limited. Objective: This study aims to evaluate the effectiveness of a structured Nias culture-based physical training program incorporating Fate’u and Fasukhu activities in improving cardiovascular endurance among young adults. Methods: A 12-week pre–post quasi-experimental study was conducted with 120 students (18–22 years) selected through purposive sampling and allocated into two groups: the Nias Culture-Based Physical Training (NCBPT) group and a conventional group (CG) that maintained their usual daily physical activities. Participants performed (NCBPT) three times per week (30–60 minutes/session). Cardiovascular endurance was assessed using the 20-m shuttle run test. Between-group differences in pre-post changes were analyzed using an independent samples t-test. Results: Each group improved cardiovascular endurance, with the NCBPT group showing greater gains (Δ = 6.16, 21.6%, Cohen's d = 1.02) than the conventional group (Δ = 1.20, 4.2%, Cohen's d = 0.94). These results indicate that the NCBPT program was significantly more effective in enhancing aerobic capacity than conventional physical activities. Conclusions: The NCBPT program demonstrated superior effectiveness in enhancing cardiovascular endurance compared to the control condition. This approach offers a practical and culturally relevant training strategy for improving aerobic fitness in sports and educational contexts.
Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) https://creativecommons.org/licenses/by-nc-sa/4.0
Adherence to Guideline-Directed Medical Therapy and its Impact on Clinical Outcomes in Heart Failure Patients Admitted to a Teaching Hospital
Background: Adherence to guideline-directed medical therapy (GDMT) remains suboptimal among heart failure (HF) patients despite proven benefits in reducing mortality and hospitalizations. Data on adherence patterns and their clinical impact in Middle Eastern settings remain limited. Objective: To evaluate adherence to GDMT among HF patients at Shar Teaching Hospital, Sulaimani; identify sociodemographic correlates; and assess associations with short-term clinical outcomes, including NYHA class, hospitalizations, and quality of life. Methods: This prospective observational study enrolled 140 adult patients with HFrEF (diagnosed >3 months) at Shar Teaching Hospital cardiology wards/outpatient clinics (April–December 2025). Adherence was assessed using the validated 8-item Morisky Medication Adherence Scale (MMAS-8), categorizing patients as low (<6), medium (6–<8), or high adherence. Sociodemographic/clinical data were collected via structured interviews and medical record review. Results: Low adherence predominated (81.43%, n=114), with medium (12.86%, n=18) and high adherence (5.71%, n=8) less common (p<0.001). Higher adherence correlated with older age (p=0.009) and being male (p=0.037). Key non-adherence barriers included lack of understanding (24.24%), cost (23.48%), and regimen complexity (21.21%). After GDMT optimization/adherence counseling, significant NYHA class improvement occurred (p<0.001), HF-related 3-month hospitalization was low (10.71%), and quality of life improved in 70.71%. Conclusions: Alarmingly high low-adherence rates exist among HF patients in this setting, though older age and being male predict better adherence. Higher adherence, supported by GDMT optimization and counseling, was associated with better NYHA class, fewer hospitalizations, and improved quality of life.
Impact of Obesity on Postoperative Recovery: An Epidemiological Study of Nutritional Practices and Surgical Complications
Background: Obesity is a major risk factor for postoperative complications and prolonged hospital stays, yet preoperative nutritional management remains insufficiently integrated, particularly in resource-limited settings. Objectives: To evaluate the impact of obesity on postoperative complications and to analyze nutritional management practices in hospitals. Methods: An ambispective analytical observational study was conducted in two public hospitals in Setif, Algeria. It included 2205 surgical patients in 2024 (retrospective phase) and 234 patients between August and November 2025 (prospective phase) to complement missing data on nutritional management; 62 healthcare professionals were also surveyed. Data were collected from medical records and structured questionnaires, including sociodemographic characteristics, body mass index (BMI), postoperative complications, length of hospital stay, and nutritional practices. Results: Obesity prevalence was 54.1%. Postoperative complications occurred in 33.97% of obese patients versus 23.79% of non-obese patients (RR=1.43; 95% CI: 1.25–1.64; OR=1.65; 95% CI: 1.37–1.99). Obese patients had a longer mean hospital stay (7.99±3.75 days) compared to non-obese patients (7.14±3.36 days). Only 1% of patients received preoperative nutritional support, 98% of surgical departments lacked dietitians, and 98% of healthcare professionals had no training in clinical nutrition, while all expressed a need for further training. Conclusions: Obesity is significantly associated with increased postoperative complications and prolonged hospitalization. These findings emphasize the need to integrate nutritional assessment into routine care, strengthen professional training, and recruit dietitians to improve surgical outcomes and quality of care.
ACR TI-RADS for Incidental Thyroid Lesions in Iraqi Patients Post Renal Transplants: A Single Center Study
Background: Long-term immunosuppression following renal transplantation has been linked to thyroid dysfunction and malignancy. However, data on thyroid nodule prevalence and characteristics in transplant recipients remain limited. Objective: To screen in RT recipients, stratifying nodule malignancy risk using the TI-RADS reporting system. Methods: A cross-sectional study evaluated thyroid nodules in 166 clinically euthyroid renal transplant recipients attending routine follow-up at the Transplant Center, Medical City, compared with 221 age- and sex-matched healthy controls. All participants underwent standardized ultrasound using the American College of Radiology Thyroid Imaging Reporting and Data System classification. Of 39 nodules biopsied, 14 were malignant and 25 benign. Results: The mean age of RT recipients was 42±12 years, with males comprising 77.7%. Incidental thyroid nodules were identified in 42.2% compared to 31.2% in the controls. Among transplant recipients, 51.4% of nodules were solitary and 48.6% were multiple. Following TIRADS classification, TIRADS-3 was reported in 9.6% of mildly suspicious nodules, while 11.4% of the nodules were moderately suspicious TIRADS-4, and 1.8% were highly suspicious TIRADS-5. Malignancy was confirmed in 10% of biopsied nodules. TIRADS stratification demonstrated a statistically significant association with malignancy, while other demographic and clinical variables, including immunosuppressive regimen, were not predictive. The ultrasound features of nodules in the transplant group were comparable to those observed in healthy controls. Conclusions: Thyroid nodule prevalence and malignancy risk in renal transplant recipients resemble the general population; immunosuppression may not be a key factor, but ACR-TIRADS surveillance supports early selective detection.
Chest Blunt Trauma of Less Than Three Rib Fractures: A Cohort of 250 Case Series
Background: The most frequent bone fracture, rib fractures, affects 10–20% of individuals with violent trauma and, in extreme circumstances, can also injure the internal organs. Objective: To share our experience in treating individuals who have isolated rib fractures due to trauma without concurrent trauma and evaluate the importance of patients’ follow-up. Methods: This was a retrospective study of 250 patients (aged approximately 10 or more). All patients were initially treated without surgery. After management, the following information was collected: sex, fracture characteristics, mechanism of injury, age, selective CT scan examinations, and median follow-up time. Results: 250 consecutive patients aged 10 or older were enrolled; 184 (73.6%) of these patients were men, and their ages ranged from 10 to 67 (mean: 61.4; median: 65). False ribs (VIII-XII) were more affected, and the most frequent mechanism of rib fracture was a household accident. Associated injuries occurred in only 13 (5.2%) patients, and pneumothorax was the most frequent complication, which was recorded in 10 (4%) patients. Conclusions: While dealing with patients who have sustained thoracic trauma, a trauma team needs to be more informed to offer them effective treatment options. Accurate diagnosis, sufficient analgesia, and efficient physical treatment are necessary to prevent complications. Estimating the number of broken ribs can help management decisions and is crucial for categorizing patients who are at a high risk of complications.
Risk Factors for Attention-Deficit/Hyperactivity Disorder among Iraqi Children
Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder of unknown etiology. In addition to genetic susceptibility, various exogenic risk factors have been linked to ADHD. Objective: The current study was conducted to identify and assess factors associated with an increased risk of ADHD in children. Methods: A case-control study included 185 ADHD children aged 6-15 years with age- and sex-matched controls recruited from the outpatient clinics of the same tertiary hospital, Baghdad, Iraq. Data were collected using a caregiver-administered structured questionnaire covering sociodemographic and clinical characteristics, perinatal factors, environmental exposure, and lifestyle factors. Variables showing significant univariate associations with ADHD were included in multivariate binary logistic regression to determine independent adjusted odds ratios. Results: The children included in the study had a mean age of 9 years, and males predominated. Four sociodemographic factors significantly relate to ADHD: first-born children, small household size, employed mothers, and young paternal age. Among perinatal factors, cesarean delivery, lower paternal age, maternal vaginal infections, and antibiotic use during pregnancy were significant in univariate analysis. However, multivariate analysis revealed four independent risk factors for ADHD, including antibiotic use during pregnancy, maternal employment, younger paternal age at time of delivery, and early exposure to screens. Conclusions: ADHD is influenced by a combination of sociodemographic and early life factors. Maternal employment, antibiotics use during pregnancy, younger paternal age, and early screen exposure were identified as independent risk factors for ADHD in children.
Pharmacokinetic Study of Intravenous Lomustine and Intranasal Lomustine-Loaded Solusome Nanovesicle in Rats for Brain Targeting
Background: Glioblastoma multiforme is a Grade IV, very aggressive malignancy and the most frequent primary cancer of the central nervous system. Despite its favorable alkylating agent property and use in the treatment of GBM, the low aqueous solubility and high dose-related systemic toxicity restrict the clinical use of lomustine. Objectives: The aim of the study was to design and optimize a high-performance liquid chromatography assay to measure lomustine and to assess the pharmacokinetic properties of a novel nano-vesicular delivery system, lomustine-loaded solusomes, to estimate nose-to-brain targeting. Methods: Solosomes of lomustine were developed by the thin-film hydration method. Their ability to target the brain was tested in vivo with 84 Wistar rats. The pharmacokinetic parameters were determined after intranasal administration of solusomal formulation and compared with intravenous administration of a lomustine solution for 72 hours. Results: When delivered intranasally, lomustine-loaded solusomes achieved greatly improved brain targeting with a 2.3-fold greater maximum brain concentration (Cmax) than with intravenous delivery and a shorter time to peak concentration (Tmax). The formulation showed high targeting efficiency, with drug targeting efficiency (DTE% 486.22) and direct transport percentage (DTP% 64.8). Histopathological analysis was used to establish the preservation of the integrity of nasal mucosa, and the formulation was found to be safe and non-irritating. Conclusions: Solusomes administered through the nasal route are effective in bypassing the blood-brain barrier through olfactory and trigeminal routes. The method has proven to be an effective way of increasing concentrations of therapeutic agents in the brain without worsening the safety profile.
Subclinical Cochlear Dysfunctions in Migraine Patients Assessed by Otoacoustic Emissions
Background: Migraine is a common neurovascular condition that is increasingly recognized to affect the auditory system, even in the presence of normal hearing thresholds. Subclinical cochlear dysfunction, particularly affecting outer hair cells, has been hypothesized but not well understood. Objective: To investigate cochlear function in migraine patients utilizing transient-evoked and distortion product otoacoustic emissions and to evaluate their relationship with migraine clinical characteristics and sex. Methods: This case-control study involved 120 participants (60 migraine patients and 60 age/sex-matched healthy controls) aged 18–45 years. All individuals had normal otoscopy, a type A tympanogram, and normal hearing thresholds on pure tone audiometry. Cochlear function is evaluated by transient-evoked and distortion product otoacoustic emissions (TEOAE, DPOAE). Migraine severity and disability were assessed using the Visual Analog Scale (VAS) and Migraine Disability Assessment (MIDAS). Results: Migraine patients had a significantly higher proportion of abnormal TEOAE responses (50.8%) than controls (0%) (p<0.05). DPOAE amplitudes were decreased significantly in migraine patients at all frequencies (2000-8000 Hz) while lower frequencies (1000-1500 Hz) remained unaffected. Signal-to-noise ratio values were significantly lower in migraine patients at most frequencies. Migraine patients with aura, longer illness duration, higher severity, and disability score had more cochlear damage. Conclusions: Migraine is associated with frequency-dependent subclinical cochlear impairment, primarily affecting higher frequencies. This dysfunction correlates with disease severity and clinical burden, suggesting that otoacoustic emissions are a sensitive technique for evaluating and monitoring migraine-induced auditory impairment.
Assessment of Efficacy and Patient Satisfaction with Fractional CO₂ Laser in Vitiligo Treatment
Background: Vitiligo is a common acquired depigmenting disorder with substantial psychosocial consequences. Conventional treatments, topical immunomodulators, phototherapy, and surgical techniques often yield partial or slow repigmentation, and relapse remains frequent. Objective: To assess the therapeutic efficacy of fractional carbon dioxide laser for vitiligo and to evaluate patient satisfaction. Method: A single-arm interventional study was conducted in a private dermatology clinic in Iraq, from February 2024 to February 2025, enrolling consecutive adults with stable, non-segmental vitiligo of Fitzpatrick skin phototypes III–IV. Treatment consisted of fractional ablative carbon dioxide laser sessions scheduled every two to three weeks. Outcomes were evaluated at three and six months from the first session. Results: Participants completed a median of six fractional CO₂ laser sessions (range 4–7). At three months, 50.0% achieved an excellent response, 26.7% a moderate response, and 23.3% a poor response. The mean patient-reported satisfaction score at three months was 3.6±1.0. By six months, 60.0% remained relapse-free. Compared with relapsers, non-relapsers were more often male (72.2% vs. 41.7%; p=0.018), had shorter disease duration (3.0±2.2 vs. 4.8±3.4 years; p=0.026), and reported higher satisfaction (4.0±0.6 vs. 2.9±1.1; p<0.001). The lesion site was highly correlated with outcomes (overall p<0.001). Conclusions: The fractional carbon dioxide laser resulted in statistically meaningful repigmentation and was tolerated reasonably well, with favorable patient-reported satisfaction. Our findings supported site-specific counseling and treatment duration, as site-specific results differed by lesion and duration of disease.
Kaiser Score in Multiparametric Breast MRI: Prospective Validation and Comparison with BI-RADS for Predicting Malignancy
Background: Early detection is essential to determine breast cancer prognosis. The reliability of BI-RADS diagnoses varies, and the level of agreement between radiologists who read the same test is moderate at best. Kaiser Score offers a framework for evaluating breast lesions. Objective: To evaluate the breast cancer diagnostic landscape in Iraq by analyzing the Kaiser Score compared to the combination with BI-RADS. Methods: A prospective, cross-sectional diagnostic accuracy study was conducted at Private Radiology Center in Baghdad during December 2023 to December 2025. The study comprised 52 female patients, with a total of 90 suspected breast lesions, who needed multiparametric MRI to assess a recent abnormality found through ultrasonography or mammography, or to diagnose breast complaints with available Kaiser Score parameters, and underwent histopathological examination for confirmation of diagnosis. Results: Kaiser score was significantly higher in malignant than in benign lesions (8.62 vs. 3.23, p<0.001). Regarding BI-RADS, the highest proportion of malignant lesions was seen significantly among lesions classified as BI-RADS 5 (95%, p<0.001). A Kaiser score >6 is a predictor for malignant breast lesions. It was 94.3% sensitive, 98.2% specific, and 96.7% accurate. Sensitivity for lesions with a score of 4 or 5 BI-RADS was 97.1%, specificity was 67.3%, and accuracy was 78.9%. Conclusions: With KS, we can achieve better overall accuracy and more specificity. On its own, BI‑RADS is quite sensitive, but it lacks specificity. Implementing a combination of the two could lead to better decisions and fewer needless biopsies.
Anti-inflammatory and Gastroprotective Effects of Saroglitazar in a Rat Model of Ethanol-Induced Gastric Ulcer
Background: Gastric ulcer is a prevalent gastrointestinal disorder characterized by several recurrences; each year, a million patients are diagnosed with gastric ulcers. Different groups of medications, using various strategies, participate in the prevention and treatment of gastric ulcers and in preventing ulcer relapses after treatment, but their negative effects limit their utility. Objective: To evaluate the possible anti-inflammatory and gastroprotective effects of saroglitazar in ethanol-induced gastric ulcers. Methods: Thirty-five male Wistar albino rats were randomly distributed into five groups, each group with 7 rats, as follows: negative control, positive control, Vonoprazan group, Saroglitazar 4 mg/kg group, and Saroglitazar 2 mg/kg group. All the medications were administered orally daily, and a single dose of ethanol (1 ml) was administered on day 15 for all except the negative control. After scarification, blood samples were gathered, and the stomachs were excised for gross evaluation. Results: TNF-α serum level reduced and gastric pH significantly Increased with Saroglitazar pretreatment groups; mucosal and vascular structure preservation, collagen restoration, and inflammation control were markedly recorded with the saroglitazar 4 mg/kg group and to some extent with the vonoprazan and saroglitazar 2 mg/kg groups. Gross examination of stomach images indicated marked protection in the pretreatment groups in different ranges. Conclusions: Saroglitazar shows gastroprotective effects on gastric ulcers induced with ethanol through anti-inflammatory properties, stomach content regulation, mucosal and vascular change protection, collagen restoration, and fibroblast activity stimulation.
Impact of Pharmacist-Led Intervention on Adherence and Self-Care Practices in a Sample of Iraqi Patients with Rheumatoid Arthritis
Background: Rheumatoid arthritis significantly impacts patients' daily lives and quality of life, which highlights the need for effective medication adherence and self-care practices. Objectives: To evaluate the impact of pharmacist-led intervention on adherence to medication and self-care practices among patients with RA. Methods: A one-group pre–post interventional study conducted at the rheumatology unit, Baghdad Teaching Hospital. Participants were given educational counseling and an educational booklet. Each participant received two educational sessions; the initial session was conducted immediately after obtaining the baseline evaluation of adherence using the General Medication Adherence Scale (GMAS) and self-care practices using the self-care questionnaire through a face-to-face interview, which lasted around 20-25 min, and the second session was held one month later as a 5-minute phone call. The evaluation of adherence using the GMAS and self-care practices using the self-care questionnaire was obtained again at the end of the study. Results: The study recruited 75 patients with a mean age of 47.12±10.15 years. The mean scores for adherence (p=0.022), self-care practices (p=0.002), and disease activity (p=0.012) were significantly enhanced after the intervention. Conclusions: This pharmacist-led educational intervention improved RA patients’ medication adherence, self-care practices, and CDAI score. Which highlights the potential value of integrating clinical pharmacists into rheumatology clinics to support patient management.
Belatacept Normalizes Specific Epigenetic-Cytokine Crosstalk in an Animal Model of Concanavalin A-Induced Acute Hepatic Injury
Background: Acute liver injury is still a major therapeutic problem. Studies have focused on the epigenetic environment that controls liver injury. MicroRNAs have become essential post-transcriptional regulators for the production of pro-inflammatory signaling cascades. Objective: This study evaluated the therapeutic potential of belatacept in hepatic injury by measurement of hepatic miRNA-155 and miRNA-223 and assessed its impact on IL-1β expression. Methods: Concanavalin-A was used to induce liver injury in Wistar rats, which were treated with prednisolone, belatacept, or a combination therapy. Hepatic expression of targeted miRNAs was quantified using RT-qPCR. Hepatic IL-1β was measured by the Western blotting technique. Results: The findings of this study identified that belatacept significantly normalized the expression of miRNA-155 and miRNA-223 (p<0.05). This epigenetic recovery was correlated with the stabilization of hepatic IL-1β level (p<0.01), Furthermore, belatacept demonstrated a therapeutic potency superior to prednisolone in mitigating liver injury, while combination therapy showed no significant synergistic advantage, suggesting a saturation of the common protective pathways. Conclusions: Belatacept ameliorates hepatic injury by targeting the miRNA-155/Akt/IL-1β pathway. Overall, miRNA-155 may offer a successful biomarker for treatment monitoring, and the miR-155/Akt pathway is a promising target for improving management of liver injury.
The Clinical Impacts of Stray Ammunition on Craniocerebral Injuries
Background: Stray ammunition injuries are firearm injuries inflicted outdoors by an unidentified assailant caused by shooting into the sky to celebrate a happy event or to express anger. Aerial shooting during a riot and mob control is noted in conflict zones. Objective: To assess the severity of stray ammunitions and the clinical impact of such injury on the craniocerebral structures. Methods: It was a case series study conducted retrospectively at the Neurosurgery Teaching Hospital, Baghdad, from the 1st of February 2019 to the 1st of October 2025. 109 patients with cranial stray bullet injuries, where patients with direct shootings to the head and blast injuries were excluded from the study. Results: There was male predominance, and the initial Glasgow Coma Scale (GCS) played a major role in indicating the severity of injury and was highly significant in relation to outcome (p=0.002) with a mortality rate reaching 43%. The worst outcome occurred from a deeper brain injury that reached the midline structures like the brainstem (p=0.001).Regression models were employed to identify variables that independently influenced functional recovery. Conclusions: Iraq is one of the countries that are affected by stray ammunition injuries, with a mortality rate reaching 43%. The initial GCS at presentation plays a crucial role in determining the fate and outcome of the injured patients, and understanding this fact helps us in the sorting and triage system in the emergency room. Thus, the use of guns and firearms must be restricted and under control.
Incidence and Associated Factors of Intraventricular Hemorrhage in Preterm Neonates at Ramadi Teaching Hospital for Maternity and Children, Ramadi City, Iraq
Background: Intraventricular hemorrhage (IVH) is a common complication in premature infants, and it is associated with a high risk of neurodevelopmental impairment and mortality. Objective: To estimate the incidence of IVH in preterm neonates and the associated factors that increase it. Methods: This is a prospective cohort study that included 89 preterm newborns admitted to the neonatal intensive care unit (NICU) in Ramadi Maternity and Children Teaching Hospital from December 2024 to June 2025. IVH was diagnosed by ultrasonography on day 3 and day 7 of the delivery and admission to the NICU. Results: 89 neonates revealed different grades of IVH in 15(16.9%). There are significant associations between IVH and neonate male sex (p=0.021), lowest gestational age (p=0.045), low birthweight (p=0.015), need for positive pressure (p=0.042), and the use of Continuous Positive Airway Pressure (CPAP) and surfactant (p=0.031). There is a significant association between sepsis and the incidence of IVH (p<0.001) and preterm infants who developed hypoglycemia (p=0.005). Preterm infants were found to have a murmur due to patent ductus arteriosus (p=0.02). Conclusions: The incidence of IVH in preterm neonates at Ramadi, Iraq, was 16.9%. Neonatal factors were male sex, decreased gestational age, low birth weight, the need for positive pressure for resuscitation, the need for CPAP and surfactant, having sepsis, hypoglycemia, and having a murmur due to patent ductus arteriosus. Regarding maternal factors: premature rupture of membrane and multiparity.
Integrated Assessment of Bone Health in Adults with Epilepsy Receiving Antiseizure Medications in Basrah, Iraq
Background: Antiseizure medications (ASMs) are associated with skeletal complications, yet most studies rely on dual-energy X-ray absorptiometry (DEXA) alone. Combining DEXA with bone turnover markers (BTMs) and the mineral axis may improve identification of adults at risk for bone loss. Objective: To evaluate the diagnostic value of integrating DEXA with serum biomarkers in adults with epilepsy on chronic ASM therapy in Basrah. Methods: A cross-sectional comparative study enrolled 45 adults with epilepsy on ASMs for 12 months or longer and 45 age- and sex-matched healthy controls. Fasting morning blood samples were analyzed for the full biomarker panel. BMD was measured at the lumbar spine (L1–L4) and proximal femur by DEXA. An exploratory uncoupling index and turnover phenotypes were derived. Results: CTX-I and DPD were significantly higher in cases (p<0.001 and p=0.045). Calcitonin was elevated in cases (p<0.001) and positively correlated with ALP among cases only (rho=0.304, p=0.043). Mineral-axis markers did not differ between groups. The resorption-dominant phenotype was significantly more prevalent among cases (55.6% vs. 11.1%, p<0.001) and was associated with lower femur T-scores (p=0.007) and higher low-BMD prevalence (p=0.002). Conclusions: Integrating DEXA with CTX-I, DPD, and calcitonin reveals a high-resorption phenotype in ASM-treated adults that DEXA or mineral-axis testing alone would miss. This combined approach improves early identification of skeletal risk in epilepsy care.
Public Perceptions, Trust, and Utilization of Community Pharmacy Services in Sulaymaniyah City: A Cross-Sectional Study
Background: Community pharmacies are among the most accessible healthcare providers worldwide, yet public perceptions of pharmacists’ roles differ across countries. In Sulaymaniyah City, limited data exists on how the public views and utilizes community pharmacy services. Objective: To evaluate public perceptions, satisfaction, trust, and willingness to use current and future pharmacy services. Methods: Between August and October 2024, a standardized questionnaire was distributed in pharmacies, clinics, and online to adults aged 18 years and older who were not healthcare professionals. Results: A total of 258 respondents participated; most were female (68.99%) and aged 18–39 years (72.87%). Pharmacies were primarily visited for prescription medicines (71.71%) and over-the-counter products (68.22%), with location being the most influential factor in pharmacy choice (70.54%). Nearly half of participants (45.74%) perceived pharmacists as more business-oriented than health-focused. Trust levels were moderate: 28% relied on the internet for medication-related information, while 30% consulted doctors or pharmacists. Key barriers to seeking advice included lack of privacy (38.37%), greater trust in physicians (29.84%), and pharmacist workload (29.46%). Overall, 51.55% of respondents reported being satisfied or very satisfied with pharmacy services. Willingness to use expanded services was high for minor ailment management (81.35%), medication counseling (77.17%), and health screening (72.62%) but lower for sexual health services (34.92%) and vaccination (32.80%). Conclusions: Respondents viewed pharmaceutical services positively, but they need improvements in privacy, trust, and acceptance of broader clinical roles.
Vaccine Literacy and Hesitancy Relating to Child Routine Vaccination among Jordanian Parents Post COVID-19
Background: The COVID-19 pandemic has created a debate about routine vaccination, mainly among parents, resulting in decreased immunization rates in some countries. Objective: To identify child routine vaccine hesitancy and health literacy post-COVID-19 pandemic among Jordanian parents and to investigate the factors predicting vaccine hesitancy. Methods: A descriptive cross-sectional study was conducted using the Parental Attitudes Towards Childhood Vaccines Scale and the Health Literacy Scale with 327 Jordanian parents recruited from maternal and child health centers from July to August 2024. Results: Vaccine hesitancy was reported by 51 parents who scored ≥ 50 out of 100, and 276 parents scored < 50 out of 100, indicating that the majority of parents were not hesitant. Parents had a moderate level of vaccine literacy (2.54±0.42), with a significant difference in the participants' functional vaccine literacy based on their educational level (p=0.001). Furthermore, functional vaccine literacy, number of children, and parents who received the COVID-19 vaccine were significant predictors of vaccine hesitancy (p<0.05). Conclusions: About 51% of parents were not hesitant, with moderate vaccine literacy and high vaccine trust. Functional vaccine literacy was a predictor of vaccine hesitancy. Policymakers and healthcare providers in the public and private sectors need to work together on this issue to be equipped with sufficient information to combat future health emergencies similar to those of COVID-19.
Predictors of Clinically Significant Findings and Diagnostic Yield in Upper and Lower Gastrointestinal Endoscopy: A Tertiary-Center Study
Background: Endoscopy has become a cornerstone of gastrointestinal (GIT) diagnosis and therapy, but there is limited evidence on the patterns of endoscopic practice and outcome predictors in Iraqi patients. Objectives: To describe GIT endoscopic indications and findings in Iraqi adults, determine independent predictors of clinically significant findings in both esophagogastroduodenoscopy (OGD) and colonoscopy, and compare the results of the diagnostic procedures and indications. Methods: This was a retrospective cross-sectional study involving 705 adults who had an endoscopy at Baghdad Teaching Hospital (January 2019 to January 2022). The diagnostic yield was computed by procedure and indication. Reporting was done as per the STROBE guidelines. Results: OGD accounted for 572 procedures (81.1%); epigastric pain/dyspepsia was the leading indication (43.2%), and gastritis was the most frequent finding (47.3%). The most frequently requested indication for colonoscopy (n=133) was bleeding per rectum 75(56.3%), and 37% were normal. On logistic regression, independent predictors of significant OGD findings were age ≥50 years (p=0.004), male sex (p=0.043), and hematemesis (p=0.006). For colonoscopy, age ≥50 years (p=0.031) and IBD evaluation (p=0.043) were independent predictors. The diagnostic yield was significantly higher in OGD (p=0.001). Conclusions: Endoscopy of the upper gastrointestinal tract has a higher diagnostic yield than colonoscopy, which reflects a selected disease burden. Age predicts findings; male sex, hematemesis, and inflammatory bowel disease improve yield, supporting risk-based referral and triage.
Efficacy of a SIRT1 Aptamer as an Anti-Angiogenic and Antioxidant Agent in in vitro, ex vivo, and in vivo Models
Background: Angiogenesis and oxidative stress are closely related processes that facilitate pathological vascular remodeling and cancer progression. Given that sirtuin 1 (SIRT1) modulates endothelial function, redox balance, and angiogenic remodeling in a context-dependent manner. Objective: To investigate the anti-angiogenic and antioxidant activity of a circular SIRT1 aptamer in multidesign settings. Methods: The endothelial response was evaluated in HUVECs via the XTT assay; antioxidant activity was assessed using the DPPH radical scavenging assay; ex vivo angiogenesis was measured in the rat aortic ring model; and in vivo validation was conducted with the chick chorioallantoic membrane (CAM) assay. Results: The impact of the aptamer on HUVEC was concentration- and time-dependent, with IC50 values of 3.910, 3.103, and 1.337 µM at 24, 48, and 72 hours, respectively. Furthermore, the aptamer exhibited substantial radical-scavenging activity in the DPPH assay, representing an IC50 of 0.0499 µM. It also inhibited microvessel sprouting in the rat aortic ring assay, with an IC50 of 0.613 µM, and suppressed CAM vascularization in a dose-dependent manner; the highest concentration tested produced an effect comparable to that of aspirin. These findings indicate that the circular SIRT1 aptamer possesses anti-angiogenic properties across in vitro, ex vivo, and in vivo models, in addition to its antioxidant capacity within cell-free systems. Conclusions: This aptamer has potential to act as a bioactive oligonucleotide scaffold for angiogenic applications; however, further research is necessary to determine its target specificity and translational significance.
Evaluation of Drug Utilization Patterns Using WHO Indicators in Patients with End-Stage Chronic Kidney Disease: A Cross-Sectional Study in Kirkuk, Iraq
Background: Chronic kidney disease (CKD) is a challenging problem. Drug use evaluation is an important issue for the recommended medications. Objective: To assess drug utilization patterns among end-stage CKD patients in Kirkuk, Iraq, based on World Health Organization (WHO) prescribing indicators. Methods: A cross-sectional study was conducted in Kirkuk, Iraq, involving data collection from Al-Amal Centre for Dialysis. A hospital-based convenience sampling technique was used to recruit a total of 314 patients diagnosed with end-stage CKD (stage 5) from October 2025 to January 2026. Results: Most patients were less than 60 years of age (59.24%), with a mean age of 57.1 years, and a male predominance (60.51%). The mean number of comorbidities per patient was 2.9. The encountered comorbidities in CKD patients were hypertension (89%), anemia (88%), and diabetes mellitus (41%). The average number of drugs per prescription was 13, and antibiotics were 42.35%. About 79.96% of drugs prescribed are generics, and injectables represent 82.48%, while the percentage of drugs prescribed according to the essential drug list is 48.76%. Conclusions: There is a critical prevalence of polypharmacy and a dependence on non-essential medications, which significantly increases the risk of severe drug responses and financial burdens for patients with chronic kidney disease. The high incidence of generic prescriptions is a positive step toward lowering costs, but it is overshadowed by the overuse of injectables and antibiotics, as well as the excessive number of medications per prescription.
Is Maternal Aspirin Intake Truly Safe in The Long Run?
Blockchain and Digital Healthcare: Promised Innovation or an Unfinished Revolution?
Insights Into the Molecular Mechanisms and Use of Cancer Dormancy and Reawakening
The ability of disseminated cancer cells from primary tumors to persist in a quiescent state for extended periods of years or even decades is a phenomenon known as cancer dormancy. This non-proliferative state represents a critical clinical challenge and constitutes a major barrier to therapy. Dormancy is often followed by stochastic relapses, or "reawakening," leading to metastasis of the primary cancer after its successful treatment. This narrative review synthesizes our current understanding of the complex and dynamic molecular mechanisms that govern dormancy and the eventual outgrowth of dormant cancer cells. We explore both cell-intrinsic factors and the microenvironmental determinants of establishing and maintaining dormant cancer cells. Crucially, this review translates these mechanistic insights into therapeutic strategies, highlighting the latest advances in targeting dormant cancer cells, preventing their reawakening, and the challenges of developing useful predictive biomarkers. By integrating our knowledge of the molecular underpinnings of dormancy, we aim to provide a roadmap for therapeutic interventions that can lead to a permanent state of cancer suppression.
Effects of Wearable Vibration Therapy on Foot Perfusion, Neuropathy, and Wound Healing in Adults with Type 2 Diabetes: Systematic Review
Background: Type 2 diabetes mellitus (T2DM) is a major global cause of lower-extremity complications, including diabetic peripheral neuropathy (DPN), impaired foot perfusion, and diabetic foot ulcers (DFUs). Wearable vibration-based devices have emerged as non-pharmacological adjuncts to improve microcirculation, sensation, balance, and wound healing; however, evidence remains fragmented. Objective: To synthesize the effects, safety, and feasibility of wearable vibration-based therapies across perfusion, neuropathy, functional, and wound-healing outcomes in adults with T2DM. Methods: A systematic review was conducted following PRISMA 2020 and SWiM guidelines. Four databases (Scopus, PubMed, ScienceDirect, and SAGE Journals) were searched (2016–2026). Eligible studies included adults with T2DM receiving vibration-based interventions. Two reviewers independently screened and extracted data. Risk of bias was assessed using RoB 2, ROBINS-I, and CASP. Results: Thirteen studies (n ≈ 370) were included. Eleven reported favorable outcomes. Interventions improved vibration perception threshold, ankle–brachial index, skin blood flow, plantar sensation, balance, gait, and neuropathic pain. Adjunct vibration therapy accelerated DFU healing by approximately 8 days and increased nitric oxide levels. No serious adverse events were reported. Conclusions: Wearable vibration-based therapies appear to be safe and may provide short-term improvements in perfusion, sensory function, balance, and wound healing in adults with T2DM. However, larger well-designed studies are required to confirm long-term effectiveness.
Strangulating Closed-Loop Ileal Obstruction Caused by Broad Ligament Hernia with Ileal Perforation: A Case Report
A broad ligament (broad band) hernia is a rare internal hernia caused by small bowel herniation through a defect of the broad ligament, often presenting as intestinal obstruction. Delayed diagnosis may progress to strangulation and generalized peritonitis. We report a case of strangulating closed-loop ileal obstruction caused by broad ligament hernia complicated by ileal perforation. A 51-year-old woman was initially treated conservatively for 10 days at Jepara District Hospital for colicky abdominal pain suspected to be adhesive small bowel obstruction, despite no prior abdominal surgery. Nasogastric decompression, intravenous fluids, and nutritional support resulted in temporary improvement, and she was discharged. Symptoms recurred one day later, and plain abdominal radiography suggested small bowel obstruction; conservative treatment was continued. The next day she developed diffuse abdominal pain worsening with movement. Repeat radiography revealed free air under the diaphragm, and she was referred to St. Elizabeth Hospital, Semarang, with generalized peritonitis due to intestinal perforation. Emergency laparotomy found gas, fibrin, pus, and fecal contamination, with a distended ileal segment trapped in the pelvic cavity on the left side of the uterus. Two constriction rings were identified, with a bowel perforation at one site. A ~2 cm defect in the left broad ligament was confirmed. The constriction ring was opened up, the bowel was freed, the defect was sewn up, and a loop ileostomy was done. The patient recovered well and was discharged on postoperative day seven. Internal hernia should be considered in small bowel obstruction without previous surgery, and early abdominal CT is recommended to improve diagnostic accuracy and prevent life-threatening complications.