Welcome to Al-Kindy College Medical Journal (KCMJ) KCMJ is a peer-reviewed open access publication ( three issues/year) of Al Kindy College of Medicine, University of Baghdad, Iraq. It founded in January 2004. Mission and vision The mission of the KCMJ is to provide a platform for high-quality medical knowledge exchange for Iraqi researchers and scientists from abroad. New findings and observations on issues related to preventive and clinical medicine are our targets. The aim of this journal is to contribute to scientific exchange, stimulate new research questions, find practical solutions, and adapt evidence-based professional action in the field of medical practice. The Journal prefers articles on studies that are well designed, supported by adequate and reliable data from all parts of the world. Focus and Scope The Journal publishes Original Articles, Editorials, Case Reports, Review Articles, and Letters to the Editor. Peer review KCMJ operates a double-blind review process. All submissions will be initially assessed by the Editorial Committee for suitability for the journal. Papers considered suitable are then typically sent to a minimum of two independent expert reviewers to assess the scientific quality of the paper. The double-blind review is the practice of this journal, which means the identities of the authors are concealed from the reviewers, and vice versa. More information is available on our website The Editorial Committee is responsible for the final decision regarding acceptance or rejection of articles. Availability The journal is published in digital and printed form. Full-text articles can be accessed for free via the internet. P- ISSN (print):1810-9543, E-ISSN (online): 2521-4365 No submission fee, an only publication fee of 100, 000 ID if the works are accepted. We waive the publication fee for authors from outside Iraq.
AL-Kindy College of Medicine - University of Baghdad
Dual Origin of Hematuria in Concomitant Lupus Nephritis and Nutcracker Syndrome: A Case Report
Background: Systemic lupus erythematosus is a multisystem autoimmune disease where lupus nephritis is a major cause of morbidity. Nutcracker syndrome, a rare vascular condition caused by left renal vein compression, presents with similar urinary findings. The coexistence of both is exceptional and creates a significant diagnostic challenge. Case Presentation: A 17-year-old female diagnosed with active Systemic lupus erythematosus and renal involvement, including proteinuria and microscopic hematuria. Investigations: Initial investigations revealed proteinuria (1.19 g/24h) and significant microscopic hematuria (84 RBCs/HPF). While renal biopsy confirmed class III-A focal proliferative lupus nephritis, persistent postprandial abdominal pain led to an abdominal computed tomography scan, which demonstrated narrowing of the left renal vein between the aorta and superior mesenteric artery, consistent with anterior Nutcracker syndrome. Treatment: The patient received pulse methylprednisolone, oral corticosteroids, hydroxychloroquine, and mycophenolate mofetil. Outcome and Follow-up: After six months, Systemic lupus erythematosus activity significantly decreased (SELENA-SLEDAI score from 15 to 4) and proteinuria resolved completely. However, while abdominal pain resolved, microscopic hematuria persisted (24 RBCs/HPF) despite immunosuppressive therapy. Conclusion: This case illustrates a dual mechanism of hematuria, involving lupus nephritis associated with the mechanical effect of Nutcracker syndrome. Recognizing Nutcracker syndrome as an independent cause of persistent hematuria in treated lupus nephritis is essential to prevent unnecessary escalation of immunosuppressive therapy.
Copyright (c) 2026 AL-Kindy College Medical Journal http://creativecommons.org/licenses/by/4.0
Placental Gene Silencing of sFlt-1 and Soluble Endoglin as a Precision Therapeutic Strategy for Severe Early-Onset Preeclampsia
Severe early-onset preeclampsia, defined by disease onset before 34 weeks of gestation, remains one of the most challenging obstetric complications because the only definitive treatment, placental delivery, often necessitates premature birth to safeguard maternal health. Advances in understanding its pathogenesis have identified placental ischemia and maladaptation as key drivers of excessive production of the antiangiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). These circulating mediators disrupt vascular endothelial growth factor, placental growth factor, and transforming growth factor-β signaling, resulting in widespread maternal endothelial dysfunction, hypertension, proteinuria, and multiorgan injury. As the placenta is the principal source of these pathogenic factors and a transient organ, targeting their placental production represents a rational disease-modifying strategy rather than merely alleviating clinical manifestations. This review critically examines the biological and clinical rationale for placental silencing of sFlt-1 and sEng as a therapeutic approach for severe early-onset preeclampsia. We review the evidence that they are causal mediators and biomarkers, the limitations of current management strategies, and the mechanistic basis for correcting the antiangiogenic imbalance at its source. Emerging preclinical studies using rodent and nonhuman primate models show that decreased placental sFlt-1 expression lowers circulating antiangiogenic burden and ameliorates disease phenotypes while highlighting the potential and challenges of concomitant sEng targeting. However, no placental gene-silencing therapy has yet entered routine clinical practice, underscoring that current evidence remains predominantly preclinical. We also cover maternal-fetal safety, therapeutic timing, translational hurdles, and ethical considerations and conclude that placental gene-silencing therapies have moved from theoretical concepts to promising preclinical therapeutic candidates for precision medicine in pregnancy.
Emerging Markers in Osteoporosis, A Review
Osteoporosis is a global health concern with bone frailty and high fracture risk. Existing diagnostic paradigms largely rely on bone scanning and bone mineral density evaluation which are hindered by the delayed prediction of fractures, especially in high-risk groups. This review assesses existing and novel Osteoporosis biomarkers, their mechanisms, clinical efficacy, drawbacks, and discusses the best biomarkers in Osteoporosis risk stratification and management, to convert them into better patient care. An online search was conducted, including PubMed, Web of Science, Embase, and Google Scholar up to June 2026. Passed studies were reviewed critically and organized biomarkers into five different panels: traditional and bone turnover markers, mineral metabolism and endocrine regulators, inflammatory and immune mediators, novel metabolic and multi-omics biomarkers, and combined biomarker panels. The traditional markers are still useful in therapeutic monitoring, although they have a natural biological variability that cannot be used to achieve optimum diagnostic use. Combined and inflammatory mediator panels showed greater discriminative ability, with Net Reclassification Index improvements of 0.15-0.23, appropriately reclassifying 15-23 percent of intermediate-risk patients who were misidentified by traditional screening. The highest performance acquisition was experienced in diabetic cohorts, where density-based measurements often miss. The management of osteoporosis should be changed to precision medicine with multi-dimensional biochemical profiling. The clinical utility and cost-effectiveness of the integrated approach in biomarkers make them a mandatory complement to imaging and a crucial point in holistic patient care for improved prognosis.
Trends and Projections of Bladder Cancer Burden in Iraq from 1990 to 2035: Global Burden of Disease Study 2023-based Analysis
Background: Iraq carries a disproportionately high burden of bladder cancer compared with global averages, with limited contemporary epidemiological characterization. This study provides a comprehensive analysis of BC burden in Iraq using GBD-2023 data from 1990 to 2023, with projections to 2035. Subjects and Methods: Data were extracted from the GBD-2023 database. Incidence, deaths, DALYs, YLLs, and YLDs were analyzed. Average annual percentage change was computed using log-linear regression. Risk factors were assessed through GBD-2023 comparative risk assessment data. Projections to 2035 used join point-derived trend parameters applied to UN World Population Prospects 2024. Results: In 2023, Iraq recorded 4,866 new BC cases, 1,848 deaths, and 48,433 DALYs, increases of 482.9%, 329.6%, and 349.6%, respectively, from 1990. The age-standardized incidence rate (ASIR) rose from 10.52 to 19.15 per 100,000 compared to a global fall from 7.25 to 6.30 per 100,000. Iraq's ASIR in 2023 was 3.0 times the global average; its age-standardized mortality rate was 3.4 times the global figure; and its age-standardized DALY rate was 3.7 times the global figure. Female rates rose proportionally faster (AAPC: +2.35% vs +1.94%). Smoking contributed 33.6% of DALYs in 2023, down from 36.9% in 1990, while the contribution of hyperglycemia rose from 8.3% to 12.6%. Approximately 8,400 BC cases are projected by 2035. Conclusions: Iraq carries an increasingly disproportionate bladder cancer burden compared to global rates, with significantly rising age-standardized rates in contrast to the declining global trend. Two modifiable risk factors should be prioritized in future targeted intervention: smoking and hyperglycemia.
Effect of Protective Nasal Dressing on the Incidence and Severity of Nasal Injury in Preterm Infants Receiving Continuous Positive Airway Pressure: A Randomized Controlled Trial
Background: Continuous positive airway pressure-associated nasal injury persists as one of the most prevalent complications observed among preterm infants receiving non-invasive respiratory support in neonatal intensive care units. This study aims to evaluate the effect of the hydrocolloid protective nasal dressing on nasal injury for premature infants undergoing continuous positive airway pressure. Subjects and Methods: A randomized controlled trial was conducted during three months, from 14 February to 16 May 2026, in the neonatal intensive care units of two teaching hospitals affiliated with the Maysan Health Department in Iraq. 80 preterm infants with gestational ages between 26 and 36 weeks who required at a minimum 72 hours of CPAP intervention were consecutively recruited and randomly allocated into intervention and control groups. Infants in the intervention group received a hydrocolloid protective nasal dressing along with routine care, whereas the control group received routine care only. Nasal injury was assessed using the nasal injury assessment score chart over a 72-hour follow-up period. Results: Infants receiving hydrocolloid protective dressing showed a significantly reduced incidence and severity of nasal injury related to CPAP at 27.5% compared with 100% in the control group. The intervention also delayed the onset and progression of tissue injury, while maintaining skin integrity throughout the intervention period. No cases of CPAP failure requiring airway intubation were observed in each group. Conclusions: The nasal protective dressing evaluated in this study is a safe and effective intervention for reducing the incidence of nasal injuries among preterm infants receiving continuous positive airway pressure.
From Polycystic Ovary Syndrome to Polyendocrine Metabolic Ovarian Syndrome: A Paradigm Shift in Understanding a Complex Endocrine–Metabolic Disorder
This editorial highlights the transition from Polycystic Ovary Syndrome to Polyendocrine Metabolic Ovarian Syndrome and its implications for disease classification, patient care, and future research.
Strengthening Data Systems and HMIS: A Pathway to Effective Family Planning in Pakistan
The relationship of social dynamics, cultural norms, and deficiencies in the structural health system influences the environment of family planning in Pakistan, which can subsequently result in low contraceptive acceptance. This letter to the editor discusses the capacity of existing data infrastructure and the Health Management Information System (HMIS) for the service delivery of reproductive health in Pakistan. It emphasizes the essential requirement for enhanced data collection and analysis to guide policy and practice, with the ultimate goal of increasing contraceptive utilization and reproductive health outcomes.
health management information systems (HMIS)
Universal Newborn Screening for Congenital Hypothyroidism at a District-Level Tertiary Care Center in South India: A Prospective Observational Study
Background: Congenital hypothyroidism (CH) is one of the main preventable conditions causing intellectual disabilities and delayed neurodevelopment in childhood. Although screening programs are established in several countries, district-level epidemiological data from India remain limited. Subjects and Methods: This prospective observational study was conducted between September 2022 and February 2024 at a district-level tertiary care teaching hospital in South India. A total of 1551 consecutive live-born neonates underwent screening using heel-prick dried blood spot thyroid-stimulating hormone (TSH) estimation performed between 48 and 72 hours of life. Neonates with screening TSH values greater than 20 mIU/L were recalled for confirmatory venous thyroid function testing. Infants diagnosed with congenital hypothyroidism received levothyroxine therapy and were followed for six months. Results: Among 1551 screened neonates, 18 infants (1.16%) had elevated screening TSH values and underwent confirmatory evaluation. Congenital hypothyroidism was confirmed in three infants, corresponding to an incidence of 0.19% (1:517 live births or 1.9 per 1000 live births; 95% confidence interval 0.4–5.6 per 1000 live births). All diagnosed infants started treatment within the first two weeks of life. Thyroid function was stable on medication, and there were no problems with development according to chronological age at six months' follow-up. Conclusions: The results show that universal newborn screening resulted in a higher prevalence of CH among others when compared with a number of earlier regional reports. Early detection made it possible to start treatment promptly even without clinical symptoms. Thus, there is a possibility to expand newborn screening programs for all districts and regions.
Flipped Classroom: A Pedagogical Approach for Undergraduate Medical Education in India
Background: The flipped classroom educational model reverses the role of the traditional format of a classroom lecture from group learning to individual learning, and the educator guides students in the application of knowledge and building concepts. The objective is to evaluate the perception of students in a flipped teaching model versus didactic /traditional classroom model. The purpose was to assess the ability of the educator to enhance the academic achievement of students. Subjects and Methods: The current study was conducted for a period of six months, in which second-phase medical undergraduates participated. Informed / ethical consent was taken before the study was initiated. A total of 133 students out of 150 participated in the study. Two groups were formed, one had a traditional class, and the other had a flipped class. Pre-test and post-test in the form of a questionnaire were conducted before starting and after completion of the class, and the perceptions of students were assessed. Result: Out of 150 students, only 133 participated in the study, 65 were in the flipped classroom space, and 68 were in the traditional model. The baseline performance of both groups was the same (mean difference 0.37, 95% CI: -0.35 to 1.10, p = 0.31). Post-intervention, both groups showed improvement, but the flipped classroom group demonstrated significantly greater gain. Conclusion: The implementation of a new teaching model depends upon its acceptance, dynamism, logistics, understanding, and better outcomes. The innovative method (flipped) was found to be a more effective teaching-learning, thought-provoking model with enhanced students’ engagement in learning and perception.
Should Reno-Protective Protocols Be Routine in Extracorporeal Shockwave Lithotripsy?
For decades, extracorporeal shockwave lithotripsy (ESWL) has been considered a first-line and non-invasive treatment for kidney stones, especially small and medium-sized stones located in the upper pole and renal pelvis. However, this procedure is not without collateral damage to kidney tissue, with both acute and chronic side effects. Shear stress and cavitation forces generated by shockwaves to fragment stones do not discriminate between stones and renal parenchyma. When they release their energy into the renal parenchyma, shockwaves cause microvascular damage, vasospasm, ischemia-reperfusion injury, oxidative stress, and an inflammatory cascade that might end with fibrosis and nephron loss. These detrimental side effects would be more evident in patients requiring multiple treatment sessions and those with solitary or pre-damaged kidneys. Although population-level data on long-term systemic effects like hypertension and diabetes are equivocal, imaging, biomarkers, and histopathology consistently demonstrate ESWL-related subclinical renal injury, questioning the traditional “treat and assess” trend.​ Given the clear pathophysiological rationale and growing supportive evidence, reno-protective protocols should be an integral component of modern ESWL practice, at least for high-risk groups such as patients with solitary kidneys, pre-existing renal damage, children, and patients with recurrent stones requiring repeated treatment sessions.
Innovative Approach to Unilateral Laminotomy for Bilateral Decompression: Overcoming Challenges with Minimal Resources in Iraq
Background: Unilateral laminotomy for a bilateral decompression procedure for lumbar spinal stenosis has been increasingly accepted as an effective and safe alternative to conventional open decompression techniques. This approach aims to reduce postoperative instability by maintaining both facet joints, the neural arch, and the muscles of the contralateral side. Methods: Seventy patients were included in this study. All underwent unilateral laminotomy for bilateral decompression of the lumbar spinal canal through unilateral interlaminar fenestration without using advanced surgical equipment. Patient demographics and clinical characteristics were reviewed. Results: The patients in the current study comprised 51 females and 19 males, with a mean age of 47.46 ± 10.52 years. Out of the total number of patients, 67.1% (n=47) had involvement in a single spinal level, 22.9% (n=16) had involvement in two levels, and 10% (n=7) had involvement in three levels. An excellent outcome after surgery was 61.4%. Good and fair outcomes after surgery were observed in 27.1% and 8.6% of the patients, respectively. Only two patients (2.9%) showed no improvement after the surgery. Conclusions: The lumbar 'over-the-top' unilateral laminotomy for bilateral decompression, performed without advanced surgical equipment, was feasible and associated with favorable clinical outcomes and substantial pain improvement.
unilateral laminotomy bilateral decompression
Al-Kindy College Medical Journal: Benchmarks to Streamline the Desk's Workflow and Harvest New Milestones
This editorial outlines key strategic benchmarks to enhance editorial workflow, publication quality, journal visibility, and scientific impact.
The Role of Simulated Laparoscopic Assessment for Trainee Progression and Certification
The Joint Committee on Surgical Training (JCST) and the Royal Colleges of Surgery oversee the surgical training for surgical specialties. To join higher general surgery training for the full six years, trainees have to complete the Royal Colleges’ membership exams (MRCS) and satisfactorily complete the core surgical training for two years. After completing 6 years of higher surgical training and the Royal Colleges’ fellowship exam (FRCS), trainees are awarded the certificate of completion of training (CCT).
2025 Triumphs and Setbacks: Endovascular Neurosurgery Perspective
In 2025, the field of stroke and carotid artery disease experienced a new update, with the publication of two landmark randomized trials that represent contrasting examples of setback and triumph within endovascular neurosurgery. The MeVO trials proved no superiority of mechanical thrombectomy over best medical therapy for acute ischemic stroke caused by distal- and medium-vessel occlusions. The CREST-2 trials demonstrated a significant reduction in stroke when carotid artery stenting is added to medical therapy. These trials illustrate how recent evidence has simultaneously challenged and reaffirmed the role of neurointerventional therapy.
Application of Artificial Intelligence in Diagnosing Autism Spectrum Disorder based on Structural Brain MRI using EfficientNet-B0 and Convolutional Block Attention Model
Background: Autism spectrum disorder is a progressive neurological disorder that affects 1 in 60 children; early detection is vital for disease control and to prevent further progression. The latest diagnostic criteria for autism spectrum disorder, based on assessing behavior, are often time-consuming, costly, and necessitate a specialist. Aim: This study proposes a model that helps clinicians diagnose autism spectrum disorder based on MRI neuroimaging. Subjects and Methods: This retrospective diagnostic modeling study proposes a deep learning framework that combines EfficientNet-B0 with a Convolutional Block Attention Model and advanced data augmentation strategies for diagnosing autism spectrum disorder. The model was trained on the mid-slice axial T1-weighted MRI scan that belongs to the ABIDE II KKI_1 dataset. Results: The experimental results of the proposed model achieve an accuracy of 95.37%, with recall, precision, and F1-score all exceeding 93%, with better performance compared with traditional architectures such as SqueezeNet and ResNet50. Conclusions: The study approach achieves a high level of accuracy, sensitivity, and specificity; thus, it may be viewed as a valuable computer-aided diagnostic tool in autism spectrum disorder detection.
Artificial Intelligence in Medical Education: Balancing Emerging Opportunities with Real-World Limitations
The integration of Artificial Intelligence into medical education is a newly emerging and promising strategy that transforms the outlook of the learning process. This continuously evolving technology influences various aspects of medical education, including curriculum design, learning, and assessment. This editorial will discuss how AI is reshaping all aspects of medical education, highlighting challenges and issues, including bias, data governance, and excessive dependence on technology that may be encountered.
Copyright (c) 2025 AL-Kindy College Medical Journal http://creativecommons.org/licenses/by/4.0
Complex Brucellosis with Cervical Spine Abscess and Orchitis: A Case Report Highlighting Diagnostic and Management Challenges in Iraq
Brucellosis, a significant zoonotic infection, is characterized by protean manifestations that can make timely diagnosis difficult. This case report details a severe and atypical presentation of brucellosis in a 41-year-old male from a rural area in Kirkuk, Iraq, a region where the disease is endemic. The patient presented with a one-month history of debilitating upper back pain, fever, and constitutional symptoms. His condition was complicated by the formation of large para-vertebral and epidural abscesses in the cervical spine. For which he was treated with empirical antibiotics, but his symptoms persisted, and he subsequently developed acute brucellar orchitis. The diagnosis was ultimately established through serological testing, as blood cultures remained negative. This case underscores the critical importance of including brucellosis in the differential diagnosis for patients from endemic areas presenting with complex, multisystemic inflammatory conditions, particularly severe osteoarticular infections and genitourinary involvement. The patient responded well to a prolonged, multidrug antibrucellar regimen, resulting in a favorable outcome.
The ErbB Receptors and Associated Key Signalling Proteins in Cancer
Cancer is a disease of almost all multicellular organisms, in which communication between cells plays a crucial role in the life and development of that organism. The ErbB family of tyrosine kinase receptors plays a fundamental part in signal transmission, controlling cell proliferation and survival. Signalling outputs of the ErbB receptors are tightly controlled under normal physiological conditions. However, genomic amplification, overexpression or mutational activation of these receptors and their signalling proteins is a common cause of cancer. This narrative review provides an overview of the structure, activation, and modes by which these receptors are dysregulated in oncogenesis. The critical downstream signalling pathways of RAS/RAF/MEK/ERK governing proliferation and PI3K/AKT/mTOR controlling survival are detailed. We discuss the development of ErbB-targeted therapies with emphasis on monoclonal antibodies and tyrosine kinase inhibitors and address the major challenge of therapy resistance. Next-generation tyrosine kinase inhibitors and combination therapies aimed at overcoming treatment failures are also outlined.
Assessment of Sexually Transmitted Infections Surveillance System in Iraq
Background: Sexually transmitted infections (STIs) continue to pose significant public health challenges worldwide. This study aimed to assess the STI surveillance system in Iraq, including the Kurdistan Region, to identify gaps and areas for improvement. Subjects and Methods: A cross-sectional study was conducted from March 12 to October 1, 2023. A total of 116 health facilities (HFs), including HIV control sections, Primary Health Care Centers (PHCCs), and hospitals, across 20 Directorates of Health (DOH) were included in the assessment. A structured questionnaire was developed by the researchers and administered through interviews. The questionnaire collected demographic, surveillance data, and service characteristics. Results: The study assessed 116 HFs, comprising 345 units (surveillance, clinic, and laboratory (Lab)). Most peripheral-level surveillance units faced significant shortages in logistical resources. The timely submission of STI reports to the next health level was below the 85% target across all health levels. HIV control sections investigated 35% of reported cases, of which 35% had complete data. Data cleaning processes were completed by 11% of PHCCs and 0% of hospitals. National STI guidelines were in 50% of PHCCs and 35% of hospitals. The percentage of diagnosed cases meeting the definitions was 36% in PHCCs and 30% in hospitals. STI records were found in 80% of PHCCs and 45% of hospitals. Syphilis testing was available in 47% of PHCCs and 29% of hospitals. Conclusions: The STIs surveillance system at both peripheral and intermediate levels is inadequately managed, with significant gaps in resource allocation, training, and data management.
Effect of Psychosocial Intervention on Motivation and Coping Strategies Among Patients with Substance Use Disorder
Background: Substance or drug abuse is a significant public health issue, commonly impacts adolescents and young adults of both genders, and is the 4th leading cause of youth- related crime and disability. Objective: This study was conducted to evaluate the effect of psychosocial intervention on the level of motivation and coping strategies among patients with substance use disorder. Subjects and Methods: A quasi-experimental pre-test post-test control group design was adopted among 92 patients with substance use disorder (45 in the experimental group and 47 in the control group), selected using a purposive sampling technique. Pre- and post-tests were done for both groups using the Personal Drug Use Questionnaire SOCRATE 8D & brief cope questionnaire. Psychosocial intervention was given only to the experimental group. Descriptive and inferential statistics were employed to evaluate the effect using SPSS version 21 at a 0.05 level of significance. Results: The study results reveal that in the experimental group, 24.4% of subjects had a very high level of motivation, and in post-intervention, it increased to 86.7%, which is very high in comparison to the control group (34%). In response to coping, in the experimental pre-test group, 20% had poor coping, whereas in the control group, 19% had poor coping; after the intervention, all subjects developed good coping in both the experimental and control groups. Hence, it is suggestive that psychosocial intervention has a positive impact on the level of motivation and coping among patients with substance use disorder. The experimental group showed significant enhancements in the level of motivation and coping strategies in comparison to the control group following the intervention. Psychosocial intervention showed statistically significant differences in level of motivation (t (90) = 7.39, p < 0.001; Cohen’s d = 1.54) and coping (t(90) = 9.04, p < 0.001; Cohen’s d = 1.88), indicating very large effect sizes. No significant association was found between outcome variables and selected socio-demographic characteristics. Conclusions: The psychosocial intervention was effective in improving motivation and coping strategies among patients with substance use disorders.
Early Laboratory Biomarkers as Risk Factors for Alzheimer's Disease: A Systematic Review and Meta-analysis
The timely diagnosis of Alzheimer's disease is of paramount importance to support the timely intervention and effective risk management strategies. Biomarkers have become powerful tools for predicting the risk of Alzheimer's disease. The objective of this systematic review and meta-analysis is to examine the prognostic utility of early laboratory biomarkers in Alzheimer's disease, how integrated into risk assessment models, and the gaps in modern studies. An extensive search was conducted in databases such as PubMed, Scopus, and Web of Science to retrieve peer-reviewed articles published since 2014. There were 26 empirical studies that met the determined inclusion criteria and were aimed at the investigation of tau protein, amyloid-beta (Ab42), phosphorylated tau (p-tau), neurofilament light chain (NfL), Apolipoprotein E (ApoE), α-synuclein, Triggering Receptor Expressed on Myeloid cells 2 (TREM2), and other inflammatory markers (CRP, TNF-α, IL-6). High tau (effect size 2.10, 95% CI, I2 = 52%), and p-tau (1.95, I2 = 48%), and a decrease in Ab42 (1.75, I2 = 45%), were each found to have a consistent positive relation with an increased risk of Alzheimer's disease. ApoE e4 (2.50, I2 = 60%), plasma neurofilament light chain (1.60, I2 = 37%), and C-reactive protein (1.30, I2 = 25%) are genetic biomarkers that show significant predictive values. Pre-initial lab biomarkers have a strong correlation with Alzheimer's Disease risk as well and can be used extensively to prognosticate Alzheimer's Disease. Nevertheless, additional studies are needed to elucidate their role in the development of Alzheimer's disease and to develop effective preventive measures.
Comment on: “Neuropathic Cystinosis: A Rare Case Report”
This letter to the editor provides commentary on a previously published case and highlights additional diagnostic and genetic considerations in cystinosis.
Renal Health Status in Individuals Living in Camps of Duhok, Kurdistan Region – Iraq
Background: Internally displaced persons (IDPs) living in camps often face substandard living conditions that may adversely affect renal health. This study aimed to assess and compare the renal function biomarkers between IDPs residing in camps and healthy individuals living outside camps in Duhok, Kurdistan Region, Iraq. Subjects and Methods: A cross-sectional study was conducted involving 300 participants (150 IDPs and 150 controls), aged 18–65 years. Individuals with chronic diseases, smokers, alcohol consumers, or other potential confounders (such as pregnancy, recent acute illness, use of nephrotoxic medications, or history of kidney surgery) were excluded. Blood and urine samples were collected to evaluate serum albumin, creatinine, and urea, urine albumin and creatinine, albumin/creatinine ratio (ACR), and microscopic urine examination. The estimated glomerular filtration rate (eGFR) was calculated. The data were analyzed across demographic variables, including age, gender, body mass index, drinking water amount, and biochemical parameters. Results: IDPs exhibited significantly lower serum albumin and creatinine levels and higher ACR compared to controls (p < 0.05). No significant differences were found in urea or eGFR. Microalbuminuria prevalence was higher in IDPs (5.3%) than in controls (2%), and this difference was statistically significant (p = 0.006). ACR was elevated in the IDPs across all subgroups. Microscopic urine examination revealed uric acid crystals in the IDP group; these crystals were not observed in the control participants. Most participants were classified as CKD stage 1 or 2; comparisons at stages 3a and 3b were limited due to small sample sizes. Conclusions: IDPs living in camps showed early signs of renal dysfunction, with altered albumin, creatinine, and ACR levels. These findings underscore the need for improved renal health surveillance and targeted interventions focused on hydration, nutrition, and living conditions in displacement settings.
Age-Related Variations in Tumor Suppressor Genes and Hormone Receptor Expression in Breast Cancer Patients
Background: This study investigated the immunohistochemical expression of hormone receptors (ER, PR, HER2, Ki-67) and tumor suppressor genes (PTEN, p53) in women with breast cancer from Erbil, Iraq, focusing on how these expressions relate to patient age. Subjects and Methods: Between April and October 2024, 120 female breast cancer patients took part in a cross-sectional study. Immunohistochemical analysis was performed to evaluate the expression of PTEN, p53, ER, PR, HER2, and Ki-67. Results: Age was significantly positively correlated with PTEN loss, which was shown in 86.7% of patients (p < 0.001). Additionally, there was a positive connection between age and the expression of ER and PR (χ² = 26.67 for ER and 15.59 for PR). There was less correlation between HER2 positive and age. 34.2% of tumors had P53 expressions, which were unrelated to age. All tumors were discovered to contain Ki-67, indicating that active proliferation is taking place. Furthermore, there were notable variations in the expression levels of PTEN, P53, ER, PR, Ki-67, and HER2 according to tumor grade, which is a sign of the biology and aggressiveness of the tumor. Conclusions: While P53 expression does not significantly change with patient age, PTEN, ER, PR, and HER2 expression do. Ki-67 universal expression indicates that tumor proliferation is high in this population. Tumor aggressiveness and biology variations are highlighted by the variance in important biomarker expression by tumor grade.
Time-Adjusted Immune Indices: A Circadian Perspective on Neutrophil-to-Lymphocyte Ratio in Immunotherapy
Immune indices such as the neutrophil-to-lymphocyte ratio (NLR) are widely used to monitor patients on immune checkpoint inhibitors, yet their interpretation rarely consider time-of-day biology. This perspective proposes a circadian framework in which sampling time and treatment timing shape baseline values, short-term fluctuations, and prognostic thresholds. Drawing on clinical observations across lungs, renal, and other tumors, I outline how morning versus afternoon therapy and corticosteroid administration may differentially modulate NLR trajectories and toxicity and introduce practical steps for time-adjusted reporting: record clock time, analyze intra-patient trends, and compare like-for-like time windows. Integrating chronobiology into routine hematologic
Assessment of Interleukin-30 in Iraqi Female Patients with Hashimoto’s Thyroiditis
Background: Hashimoto’s thyroiditis is a chronic lymphocytic autoimmune thyroid disease that results in gradual destruction of the thyroid gland. Interleukin-30 (IL-30) is one of the interleukins that controls inflammatory response since it enhances T-reg cells' suppressive function and induces IL-10 production. The aim of this study was to assess the serum level of IL-30 as an indicator for understanding the pathology of this autoimmune disorder. Subjects and Methods: A single-center, case-control study was carried out on Hashimoto’s Thyroiditis patients who were admitted to the department of medicine at Al-Yarmook Teaching Hospital and Baghdad Teaching Hospital, Baghdad, Iraq, between January 2024 and June 2024. Serum levels of thyroid-stimulating hormone (TSH), antithyroglobulin antibody (anti-TG Abs), antithyroid peroxidase antibody (TPO Ab), and IL-30 were measured in control (n=21) and patient (n=40) groups, all are determined by sandwich enzyme-linked immunosorbent assay (ELISA) kits. Results: Serum TSH, TPO Ab, and TG Ab are significantly higher in the patient group (p<0.0001), whereas serum IL-30 decreases significantly (p<0.0001). There was a significant correlation between serum IL-30 and serum TPO Abs levels (p=0.001), while there was a negative correlation between the severity of hypothyroidism and serum IL-30 (P<0.05). Conclusion: Serum IL-30 level is associated with the pathogenesis of autoimmune thyroiditis. There is a negative correlation between serum IL-30 and the degree of hypothyroidism. Moreover, a decrease in serum IL-30 level can be considered a predictor for autoimmune thyroiditis.
Serum Copeptin in Acromegaly with and Without Diabetes: A Comparative Cross‑Sectional Study
Background: Copeptin serves as a stable substitute marker for vasopressin and is emerging as a biomarker in endocrine disorders. Given the complex metabolic interactions in acromegaly and the role of growth hormone in fluid balance, this study examined copeptin levels in patients with acromegaly and diabetes mellitus, non-diabetic acromegaly, and healthy controls. Objectives: To compare serum copeptin concentrations among acromegalic patients with diabetes, acromegalic patients without diabetes, and healthy controls. Subjects and Methods: This is a comparative cross-sectional study that included 176 participants: acromegalic patients with diabetes, acromegalic patients without diabetes, and healthy controls. Serum copeptin was measured using a standardized ELISA method. A comprehensive biochemical profile was also assessed, including growth hormone, insulin-like growth factor-1, fasting glucose, glycated hemoglobin, and lipid parameters. One-way ANOVA with post-hoc least significant difference testing was used to analyze group differences. The study was conducted at the National Diabetes Center (Baghdad, Iraq) with fasting samples collected between November 2024 and March 2025. Results: Mean copeptin concentrations demonstrated a statistically significant variation between the groups (p = 0.012). Non-diabetic acromegalic patients exhibited the highest copeptin levels (72.6 ± 59.3 pmol/L), followed by diabetic acromegalic patients (57.3 ± 49.2 pmol/L) and control subjects (48.0 ± 25.7 pmol/L). Post-hoc analysis indicated a substantial elevation in copeptin levels among non-diabetic acromegalic patients compared to controls (p = 0.003; Cohen’s d = -0.45, 95% CI: -0.85 to -0.05), indicating a small-to-medium effect size. Copeptin demonstrated a positive correlation with growth hormone (r = 0.443, p = 0.003) and insulin-like growth factor-1 (r = 0.333, p = 0.027), while it correlated negatively with triglycerides (r = -0.326, p = 0.031) and VLDL (r = -0.332, p = 0.028). Conclusions: Serum copeptin levels were significantly higher in non-diabetic acromegalic patients than in controls, while diabetic acromegalic patients were not significantly different from controls.
Colocolic Intussusception: A Case Report of an Uncommon Manifestation of Peutz-Jeghers Syndrome
Peutz-Jeghers syndrome is a rare genetic disorder resulting from defects in signaling pathway regulation, marked by gastrointestinal hamartomas and mucocutaneous pigmentation. This condition can lead to complications such as intussusception, with colocolic intussusception being particularly rare. We present the case of a 30-year-old female who exhibited acute on chronic abdominal pain and progressive distension, along with digital and perioral hyperpigmentation. Unfortunately, her diagnosis of Peutz-Jeghers syndrome was delayed until she developed intestinal obstruction. Imaging revealed large bowel obstruction with proximal bowel dilatation, prompting a left hemicolectomy and end-to-end colocolic anastomosis. The patient experienced an uneventful postoperative recovery and remained symptom-free during follow-up. This case highlights the rarity of colocolic intussusception as a manifestation of Peutz-Jeghers syndrome and emphasizes the importance of early recognition and intervention to prevent bowel obstruction and the need for extensive surgical procedures.
Multivariate Regression Modeling of Health Inequities: The Role of Social Determinants of Health
Background: Health inequities remain a worldwide public health problem, and the populations that are affected disproportionately are the vulnerable populations, so it is related to income disparities, education disparities, employment disparities, housing disparities, and healthcare disparities. These differences are substantially engraved in the social determinants of health and cannot be solved without some thoughtful data-oriented means to study these effects on the variety of groups of people and in different nations. Objective: to evaluate the impact of various social factors on health outcomes under a multivariate regression model and seek to find common global trends that cause health inequity. Subjects and Methods: A merged cross-section was made with publicly available data on health, covering various countries, whose national health surveys and databases consisted of the World Health Organization, the World Bank, and so on. Among the main variables to be analyzed, the researchers focused on the household income, educational level, employment, living conditions (quality of housing), and accessibility to healthcare services. Linear and logistic regression techniques (in a multivariate framework) were used to determine the relationship with health outcomes, including self-reported health status and prevalence of non-communicable diseases. Adjustment was done on age, gender, and urban-rural classification. Statistical significance was determined by p-values, adjusted R2, and Akaike Information Criterion. Results: The results demonstrated a similar trend in every country: low-income earners and lowly educated people registered dismal health conditions and a high prevalence of chronic diseases. These disparities were further propagated by poor access to medical treatment and poor housing. The multivariate model accounted to 64.8 percent of the variation in health outcomes at a global level with the factors that exerted the greatest influence being education (0.38, p < 0.001) and access to healthcare (0.31, p = 0.003). Conclusions: This global comparison highlights the profound impact of social determinants on populations worldwide. Multivariate statistical modeling proves highly valuable in identifying and quantifying these associations, providing evidence that can inform international health policies aimed at reducing inequities and promoting health equity across all nations.
The Effectiveness of Physical Exercise in Preventing Postpartum Depression: A Systematic Review of Randomized Controlled Trials (2019–2024)
Background: Postpartum Depression (PPD) affects 13-19% of moms following childbirth. Globally, around 350,000 maternal deaths occurred in 2022, with depression accounting for 22% of all postpartum deaths. Exercise is increasingly being examined as a preventive intervention. Objective: To determine the effectiveness of exercise, specifically its type, intensity, and duration in reducing postpartum depression. Subjects and Methods: A systematic review was conducted in accordance with the PRISMA standards. Searches for (postpartum AND exercise) or (physical activity AND lessened postpartum depression) yielded 11 suitable studies. Data were retrieved on activity features and PPD outcomes, which were predominantly evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Results: Aerobic exercise was the most constant and successful intervention. Women who engaged in moderate-intensity aerobic exercise (30-45 minutes, 3-5 times per week) had significantly lower depression symptoms than controls (standardized mean difference [SMD] = -0.42; 95% CI: -0.65 to -0.19; p < 0.001). Exercise interventions were also linked to a 32% lower chance of having PPD (risk ratio [RR] = 0.68; 95% CI: 0.52 to 0.85). Subgroup analyses suggested greater benefits when exercise was initiated during pregnancy and continued postpartum. Conclusions: Structured physical exercise can be considered a safe, low-cost adjunct to prevent the occurrence of Postpartum Depression in mother psychological well-being through enhanced endorphin release and body image perception. Integration of exercise into maternal health programs may substantially reduce the burden of postpartum depression.