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
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.
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
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.
A Global Misuse of Semaglutide for Cosmetic Weight Loss in Non-diabetic Young Population, an FDA Public Database and Google Trends Data Analysis
Background: in a world full of aesthetic trends and a pervasive focus on physical appearance, often driven by celebrities and social media influencers. The misuse of medications and increased demand on aesthetic surgeries have been documented and become increasingly concerning. Recently, the use of GLP-1 analog medications for aesthetic weight management, particularly Semaglutide (brand name Ozempic and Wegovy) has gained increasing popularity among the public on these platforms. Subjects and Methods: Our study aimed to investigate the potential for Semaglutide misuse, particularly Ozempic based on FAERS database and Google Trends tool. We also explored the potential adverse events associated with Semaglutide medication's misuse. Results: Our findings showed a surge in Semaglutide medication (Ozempic) for weight loss as opposed to T2DM treatment worldwide. Moreover, Ozempic popularity for weight loss outweighs the popularity of Wegovy, which was approved for weight management indications in obese patients with at least one weight-related comorbidity. Furthermore, our results demonstrated an annual increase in the number of Semaglutide-related AERs on FAERS from January 2018 to September 2024, including a rise in death related AERs. A wide verity of Semaglutide related AERs have been documented, including both serious and non-serious outcomes, with death being the most serious outcome reported. Current results have also documented a worldwide shortage in Semaglutide medications, particularly Ozempic and Wegovy, due to increased demand and off-label use of these medications. Conclusion: collectively, our findings provide clear evidence of Ozempic and Wegovy misuse outside their approved indications to achieve aesthetic weight goals among young non-diabetic individuals. This misuse is often driven by media platforms without stressing on the potential adverse events and ethical concerns associated with the misuse of these medications.
The Impact of Personalized Medicine on Enhancing Quality of Life in Chronic Diseases Management
Personalized Medicine represents a recent revolution in healthcare practice, focusing on tailoring different therapies to be precise for a specific individual; this is aided by exploring the number of genetic predispositions and lifestyle choices that fit each individual. In this article, the authors utilize and gather recent literature and opinions to discuss the impact of personalized medicine on chronic disease management and patient quality of life. Additional attention is paid to limits and possible ethical issues. Chronic diseases such as Hypertension, Diabetes, and chronic kidney diseases adversely affect multiple health indicators, including Quality of Life (QoL) and well-being. This will have additional impacts on physical and mental health that require further mitigations and to deal with more ongoing mental health. Personalized medicine is a revolutionary step that could be used to manage chronic disease by improving patients' QoL through tailored treatments. However, it is crucial to handle equity, ethics, and infrastructure issues.
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Hepatitis B virus infection in pregnant women in Baghdad
Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy.
Copyright (c) 2013 http://creativecommons.org/licenses/by/4.0
Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy. Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy. Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy. Background: Globally, hepatitis B is one of the most common infectious diseases. Estimates indicate that at least 2 billion people have been infected with the hepatitis B virus (HBV), with more than 378 million people being chronic carriers. Those individuals at higher risk for acquiring HBV and transmitting disease like pregnant women should be screened for hepatitis B surface antigen (HBsAg) to prevent transmission by vaccination and operation. Aim of study: The aim of this study was to determine the prevalence of HBsAg and its associated parameters in pregnant women who referred to antenatal clinic in Baghdad Province. Methods: The 234 apparently healthy pregnant women and their families, husbands and children were selected as study subjects from among those who had attained prenatal care clinic in Baghdad province between 2010 to 2012. Serological test was done for HBV using ELISA test (Dialab REF:Z00360,LOT2052-2). Results: Of these, 234 cases were brought into the study. Their age were ranged from 16-42 years old. Based on a different parameters , women positive for HBV and their children were negative constitute the highest percentage 85.4% and lowest one was pregnant women who lived with positive family history of HBV were 8.9%. Conclusions: The seroprevalence of HBsAg was of moderate severity according to WHO. This finding would suggest for the introduction of routine screening for HBV to all pregnant women during the antenatal period, and that “at birth dose” vaccination is given to new born babies of mothers found to be HBsAg positive so as to reduce and prevent the spread of infection. However more data is required from larger studies to support the findings so that ultimately this can be recommended as a policy.
A Cautionary Perspective on Artificial Intelligence and Novel Imaging Technologies in Patient Selection for Retrograde Intrarenal Surgery
The advancement of retrograde intrarenal surgery (RIRS) has been accompanied by the evolution of many promising tools that aim at improving patient selection and predicting surgery outcomes in terms of stone fragmentation and expected complications. The incorporation of artificial intelligence (AI) into the advanced imaging technologies such as dual-energy CT scan (DECT), three-dimensional (3D) reconstruction, and radiomics resulted in a number of clinical tools and algorithms forwarded to surgeons to use in their daily practice. This commentary critically examines these clinical algorithms, highlighting the absence of prospective validation, the potential for overreliance, and the possible limitations of their clinical applicability. AI-driven predictive models often rely on retrospective, uniform datasets taken from a single center, with evident interpretability concerns. Similarly, DECT and 3D reconstructions might provide detailed information about the anatomy of the renal collecting system and stone composition, but they do not account for real-time surgical dynamics. Radiomics, in the other hand, provides excellent insights into stone behavior, but their reproducibility and clinical relevance are still to be tested. The take-home message of this commentary is that conventional CT metrics—such as stone size and density—continue to outperform novel techniques in reliability and accessibility, and the adoption of emerging technologies in RIRS must be cautious, ethically sound, and evidence-based, reinforcing the primacy of clinical judgment in urologic care.
Applying the Principles of Sustainability to Diabetes Care in Low Resources Settings: Reduce, Reuse, Recycle
\ Background: Sustainability in healthcare is a relatively new concept that aims to integrate environmental, financial, and social factors. Diabetes care in low socioeconomic communities relies on disposable medical supplies, leading to increased waste. This study aims to propose the application of the (reduce, reuse and recycle) framework in diabetes care to enhance sustainability Subjects and Methods: This study used a mixed-methods approach, including both a literature review and a pilot survey. The literature review included fifty studies focusing on sustainable healthcare practices. A survey was conducted among fifty healthcare professionals and fifty patients to assess their baseline knowledge about practices related to sustainability in healthcare. Results were analyzed to assess similarities or differences between high and low socioeconomic communities Results: The survey revealed that 63% of patients thought treatment costs was the primary barrier to sustainability, while 50% of healthcare providers pointed to limited resources. Both groups emphasized the need for government support and education to enhance sustainability efforts. Reusable insulin pens and eco-friendly packaging were the most viable solutions. Conclusions: Applying sustainability to diabetes care can reduce both environmental and economic burdens. This is particularly challenging in low-resource settings, where cost and infrastructure limitations persist. Policy reforms, education, and innovation to reduce waste is essential to achieve a sustainable healthcare system.
Radiographic Assessment of the Critical Shoulder Angle, the Lateral Acromion Angle and the Acromial Index in a Sample of Normal Adult Individuals: A Cross-Sectional Analytical Study
Background: Several radiological parameters used to assess the shoulder joint; among these, the critical shoulder angle (CSA), acromion index (AI), and lateral acromion angle (LAA) are widely used. Objectives: the primary objective of our study was to establish a reference value for these parameters among healthy Iraqi adults, and secondly to explore the influence of some anthropometric parameters on these shoulder parameters. Materials and Methods: the CSA, AI, and LAA were measured for all participants using AP radiographs of the shoulder joints on both sides, the anthropometric parameters were also recorded. The data were tabulated and statistically analyzed. Results: the study shows no statistically significant differences in the measurements of CSA, AI, or LAA between males and females and also no differences between right and left sides. There was a weak correlation between the CSA measures and all anthropometric parameters, while there was a strong positive correlation between AI measures both age and body weight. Conversely, the LAA showed significant negative correlations with age and BMI. Interestingly we found that age was a major predictor of both AI and LAA, while weight and BMI were predictors CSA. Conclusion: The findings of our study suggest that critical shoulder angle is relatively constant shoulder parameters among individuals, however acromial index and the lateral acromial angle vary with age and BMI, and this may affect the biomechanics of the shoulder.
The Correlation of Expression of P16Ink4a and CD31 Immunohistochemical Stains in Invasive Squamous Cell Carcinoma of the Cervix and its Precursors
Background: Squamous cell carcinoma of the cervix (SCC) and its precursors squamous intraepithelial lesions (SIL) remain a major global health burden. The tumor suppressor protein P16(Ink4a), a surrogate marker for high-risk human papilloma virus (HPV) infection, and CD31, an angiogenesis marker reflecting microvessel density (MVD), play critical roles in tumor progression. Objective: This study aimed to assess the immunohistochemical (IHC) expression of P16(Ink4a) and CD31 in SIL and SCC and assess their correlation with disease severity. Subjects and Methods: A cross-sectional study was conducted on 77 archived cervical biopsies (17 low-grade SIL [LSIL], 24 high-grade SIL [HSIL], and 36 SCC cases) from archival materials of two Baghdad hospitals (Medical City, The Teaching Hospital and Medical City of Al-Imamain AL-Kadhimein) (2018–2022). IHC staining for P16(Ink4a) (scored by intensity/distribution) and CD31 (for MVD quantification) was conducted. Statistical analysis used SPSS v26, with significance set at p < 0.05. Results: P16(Ink4a) expression significantly increased from LSIL (35.3%) to HSIL (70.8%) and SCC (91.7%) (p < 0.001), with the highest scores in SCC (30.6%). MVD also rose with cervical lesion severity (p < 0.001), with means of 4.37 (LSIL), 13.11 (HSIL), and 52.81 (SCC). Poorly differentiated SCC showed the highest MVD (67.34). A strong positive correlation was found between P16(Ink4a) and MVD (p < 0.001). Conclusions: Both P16(Ink4a) and CD31 (MVD) expression correlate strongly with cervical lesion severity, suggesting their potential as biomarkers for disease progression. Further studies are warranted to validate their prognostic utility in cervical cancer management.
Omega-3 Supplementation is Effective in Reducing Interleukin-6 Levels After Physical Exercise: A Systematic Review
Not only does physical exercise improve health, it can also trigger inflammation. Therefore, supplementation after exercise is necessary to reduce it. Omega 3 is one of the nutrients that can potentially reduce inflammation. The fundamental however, the mechanism is not well known. This study examined how omega-3 supplementation while exercise affected IL-6 levels, an inflammatory biomarker. Our systematic review analysis examined interleukin 6, inflammation, and omega 3 papers from Pubmed, Web of Science, and Science Direct during the previous five years. This systematic review assessed nine eligible papers. This research assessed standard operating procedures using PRISMA. Taking omega-3 supplements while working out has been shown to reduce IL-6 levels. IL-6 is reduced by omega-3 supplementation during exercise. So, this can be a recommendation for sportsmen in routine consumption to prevent inflammation during exercise.
A Bibliometric Analysis of Global Research on Dementia and its Cognitive Function
Introduction: Dementia is a neurocognitive disease manifested by progressive and global declination in cognition. However, there is a lack of visualization analysis on research in the field of dementia and cognitive function. To evaluate the impact and compare the scholarly work output and productivity among organizations, bibliometrics was used. Material and methods Literature related to dementia and cognitive function were searched from Scopus database. In the area of dementia bibliometrics was used to analyze the leading authors, the journals with higher citation, higher collaboration between the countries, and keywords. Scopus analysis and Biblioshiny R-package were used in the analysis of country collaboration and global cited documents. Results: Total 1753 articles were identified from Scopus database and among these 425 articles were included in the study on basis of inclusion criteria. United states, China and Japan has the highest productivity and China, USA, Australia, Canada and Indonesia and has strong collaboration. The research hotspots in this field focused on Dementia and its impact on cognitive function. According to Lotka’s Law the studies in the field of dementia is limited and need to be conducted further. Conclusion: Dementia is a major public health issues in India and this study has thrown light on all articles which has manifested the current trends and important areas of research on dementia. After an intensive analysis the study concluded that there is still a gap in international collaboration among leading countries. In India dementia can be a research gray area and focus of future attention.
Uric Acid as a Predictor of the Severity of Preeclampsia: A Cross-Sectional Study in Sidi Bel Abbes, Algeria
Background: Preeclampsia is a pregnancy complication characterized by elevated blood pressure and organ failure, endangering the health of both the fetus and the mother. The research aimed to examine the predictive value of uric acid levels on outcomes in preeclamptic pregnant women. Subjects and Methods: The study consisted of 151 preeclamptic pregnant women, categorized into two groups: 99 with severe preeclampsia (SPG) and 52 with moderate preeclampsia (MPG). The researchers compared uric acid levels between groups and looked at LDH, ASAT, and ALAT biomarkers. The study employed Receiver Operating Characteristic (ROC) curve analysis to evaluate the predictive capacity of uric acid levels regarding outcomes. Results: The study revealed that women with severe preeclampsia exhibited markedly elevated uric acid levels (p = 0.003). The cohort with severe preeclampsia encountered more pronounced feto-maternal complications at a statistically significant level (p ≤ 0.001). The ROC curve analysis indicated that uric acid levels exhibited a moderate capacity to predict the severity and complications of preeclampsia, with diagnostic accuracy rates of 0.691 (p≤0.001) and 0.635 (p=0.007), respectively. The predictive value of uric acid was demonstrated to be inferior to that of the other biomarkers in the study. Conclusions: While elevated uric acid levels are associated with preeclampsia severity, they may not be as strong a predictor of adverse outcomes as other biomarkers such as ASAT, ALAT, and LDH.
The Role of Brain-Derived Neurotrophic Factor in Different Psychiatric Disorders and Neurodegenerative Diseases
Brain-derived neurotrophic factor is a widely studied neurotrophins found throughout the mammalian central nervous system. These neurotrophins regulate numerous aspects of neuronal and oligodendroglia development and function, including axonal growth, synaptic plasticity, differentiation, proliferation, survival, and apoptosis. Brain-derived neurotrophic factors have a significant impact on neurodegenerative disorders, synaptic plasticity, and the formation and maintenance of a normal brain circuit. Precise regulation of Brain-derived neurotrophic factor concentrations, including their controlled release at the transcriptional and translational levels, is essential for the correct functioning of the central nervous system. This review provides a summary of the role of Brain-derived neurotrophic factor in various neurological and mental disorders. In addition, to its role in memory recognition by increasing neuronal proliferation and survival in the perirhinal cortex, a vital area for recognizing objects in memory.
Effect of Vitamin D3 on Colonization Genes Expression of Haemophilus influenzae Isolated from Children with Otitis Media Associated with Temporomandibular Joint Pain
Background: Acute otitis media (AOM) is the middle ear inflammation caused by various microorganisms, including bacteria. Haemophilus influenzae is a common bacterium that causes this inflammatory condition. This study aimed to determine the role of cholecalciferol (D3) in the expression of colonization genes in H. influenzae isolated from children with otitis media, which is associated with temporomandibular joint pain. Subjects and Methods: A total of 160 ear swabs and blood samples were collected from children with recurrent acute otitis media (AOM) for culture and sensitivity tests. The number of patients with pain in the TMJ was recorded, whether by pressure on the joint area or during mouth opening. Vitamin D3 was measured using an Enzyme-Linked Immunosorbent Assay. The minimum inhibitory and bactericidal concentrations of vitamin D3 were identified. Quantitative real-time PCR was used to evaluate the impact of this vitamin on the expression of pilA, hmw1, and hmw2. Results: This study showed that H. influenzae caused 28.12 % of AOM, and this inflammation occurred in 30.6% of children aged 1-2 years. Interestingly, 14.38 % of AOM patients had TMJ pain, while 85.62 % did not. Vitamin D3 levels in AOM patients were lower than those in normal children. The current study demonstrated that the expression of colonization genes in H. influenzae, the most common bacterium causing AOM, is upregulated in the absence of vitamin D3. However, these genes' expressions are downregulated in the presence of this vitamin. Conclusions: This study demonstrated that vitamin D3 inhibited the colonization gene expression of H. influenzae and altered the expression of these genes, suggesting therapeutic roles in infection prevention.
Al-Kindy College Medical Journal: An Audit of Publications for One Decade (2015-2024)
The Al-Kindy College Medical Journal (KCMJ) is an Iraqi scholarly journal published by the Al-Kindy College of Medicine, University of Baghdad. It was officially founded in 2004. It is a peer-reviewed journal, published in both online and printed forms. It has a mission to offer a publication platform that mirrors recent knowledge and findings in the field of medicine and medical sciences. It publishes various types of articles, including editorial, review article, research article, brief report, case report, and letter to editor. It accepts articles in the English language. It was biannually published till 2021 when it started to launch three issues per year. The journal is registered with numerous partners, including Iraqi Academic Scientific Journals (IASJ), CrossRef, Google Scholar, Researchgate, Scopus, Open Access Scholarly Publishing Association (OASPA), Committee on Publication Ethics (COPE), Directory of Open Access Journals (DOAJ), and Digital Object Identifier (DOI) System. The journal is archived by Clockss and Repository of the University of Baghdad. All articles published in the journal are freely available for everyone to read and access. Globally, a publication audit is usually exercised as it is regarded as an indispensable tool to evaluate the scientific progress of a particular academic journal in terms of achieving higher quality, attaining wider visibility, attracting more or better researchers/authors, getting recognition, expanding journal's dissemination, increasing the number of subscriptions, and planning for the future development.
Comparative Analysis of Short-Term Outcomes in Thoracoscopic Minimally Invasive Versus Traditional Mitral Valve Replacement: Randomized Clinical Trial Study
Background: The standard approach for mitral valve surgery was a sternotomy, but with the new trends, mitral valve surgery can now be performed with right mini thoracotomy incision. Minimally invasive mitral valve surgery has demonstrated superior cosmetic outcomes, less surgical trauma, shortened intensive care unit and hospital stays, cost effectiveness, and faster recovery, while the efficacy is comparable to conventional sternotomy. Objective: The aim of this research is to investigate the short-term outcomes of thoracoscopic minimally invasive mitral valve replacement in comparison with the conventional technique. Subjects and Methods: This study included 100 patients with isolated mitral valve disease, who were randomly divided into two equal groups. Group A underwent a right anterolateral video-assisted mini-thoracotomy, while Group B was approached via a conventional median sternotomy. Results: The minimally invasive group had significantly longer total operative time (291.3±48.89 min vs. 227.68±49.18 min, p = 0.001). However, Group A demonstrated better post-operative outcomes, including shorter ICU stay (2.1±1.07 vs. 3.82±1.49 days, p = 0.002), shorter extubation time (4.24±1.12 vs. 8.45±4.55 hours, p = 0.0001), reduced post-operative blood loss (271.7±107.09 ml vs. 449.2±230.93 ml, p < 0.0001). Post-operative pain scores were significantly lower in Group A (VAS 3.84±1.53 vs. 7.58±1.62, p < 0.0001), and hospital stay was shorter (7.22±1.37 vs. 11.21±3.53 days, p < 0.0001). Conclusions: Minimally invasive mitral valve surgery can be a safe and effective alternative to traditional MVS in patients with mitral valve disease.
Thoracoscopic Minimally Invasive Mitral Valve Surgery
Obesity-Induced Mechanisms in Colorectal Cancer Development: A Narrative Review
Obesity is a significant risk factor for colorectal cancer (CRC), influencing its development through multiple biological pathways. Elevated levels of insulin, insulin-like growth factor-1 (IGF-1), leptin, resistin, and inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) contribute to colonic cell proliferation and tumor formation. Additionally, obesity-induced hormonal imbalances, including decreased adiponectin and ghrelin, further increase CRC risk. Changes in gut microbiota due to obesity also play a role in carcinogenesis, highlighting the complex interplay between metabolic, inflammatory, and microbial factors. This review explores the pathophysiological mechanisms linking obesity to CRC, emphasizing its role as a modifiable risk factor. Insulin resistance, chronic inflammation, oxidative stress, and dysregulated adipokine secretion are key contributors to CRC progression in obese individuals. By analyzing molecular and epidemiological evidence, this review underscores the importance of early CRC screening for obese individuals, along with lifestyle modifications such as weight loss, dietary improvements, and increased physical activity. Furthermore, microbiome-targeted interventions, including probiotics and prebiotics, may help counteract obesity-driven dysbiosis and reduce CRC risk. Emerging biomarkers and therapeutic targets offer potential for developing obesity-specific CRC treatments. Given the rising global burden of CRC, integrating preventive healthcare strategies, public health initiatives, and clinical interventions is essential for reducing its incidence and improving patient outcomes. Addressing obesity through targeted preventive measures can significantly lower CRC-related morbidity and mortality, making it a crucial aspect of cancer prevention and management
An Epidemiological Review of the Impact of COVID-19 on Achilles Tendon Rupture Injuries, Experience from a Large London District General Hospital
Background: During the lockdown for COVID-19, hospitals experienced a reduction in the number of trauma admissions related to high energy, sport, and occupational injuries. As lockdown measures began to ease, hospitals experienced a high admission rate of patients presenting with Achilles Tendon Rupture [ATR]. However, in the post-pandemic phase, the number of cases reduced. The aim of this paper is to report changes in incidence and identify changes in demographics, mechanism of injury, and Achilles Tendon Rupture management pre- and post-pandemic. Subjects and Methods: We undertook a review during six different time periods of our Achilles Tendon Rupture patients, the time periods included: pre-pandemic, during the first after the first lockdown, during the second lockdown, after the second lockdown and the post-pandemic period. Patient’s demographics, mechanism of injury, past medical history, the use of steroids and patient management, Achilles tendon Total Rupture Score (ATRS) were all included. Results: One hundred and sixty-three patients were included in the study. During the second lockdown [1st January 2021- 11th April 2021], the average age of patients was significantly lower than any other group [p <0.005]. 40% of patients after the first lockdown [August 2020- December 2020] were treated surgically and this was significant [p-value <0.005], during all other time periods; the vast majority of patients were treated conservatively. For the entire cohort, 71.78% of patients were treated conservatively, whilst the other 28.22% were treated surgically. There was no statistical difference in the Achilles Tendon Rupture Score-based [p-value - 0.729] when comparing the management of Achilles Tendon Rupture, at least 8 months post-treatment. Conclusions: During each national lockdown, there was a decrease in the number of patients who presented with Achilles Tendon Rupture to hospital. Following the second lockdown, the number of patients who presented with ATR has significantly increased. However, in the post-pandemic phase, the number of cases decreased again. The study also found no significant difference in long-term outcomes as measured by the Achilles Tendon Rupture Score (ATRS), regardless of treatment approach. these findings suggest that the pandemic had a transient but marked impact on Achilles Tendon Rupture incidence, and further research is needed to explore the underlying mechanisms of this pattern, as well as the long-term outcomes and potential preventive strategies for Achilles Tendon Rupture in the post-pandemic era.
Assessment of VDR Gene Polymorphism (FokI) in Epithelial Ovarian Cancer Using PCR-RFLP Method
Background: Epithelial ovarian cancer (EOC) has been associated with genetic variations in the vitamin D receptor (VDR) gene among women in different geographical locations. Due to inadequate detection methods, many cases are diagnosed at advanced stages. Vitamin D deficiency and the FokI gene polymorphism in the VDR gene are known to increase cancer risk. The current study aimed to evaluate the correlation between the VDR gene polymorphism (FokI) and epithelial ovarian cancer risk Subjects and Methods: A prospective case-control study with 160 participants comprised 80 patients with epithelial ovarian cancer and 80 controls without the disease. FokI genotyping was observed using the PCR-RFLP technique, which allows for the precise identification of genetic variants in the VDR gene. Additionally, vitamin D levels were assessed through chemiluminescence immunoassay, providing quantitative data on vitamin D status. Results: Serum vitamin D levels showed no clear association with ovarian cancer risk across tertiles (p > 0.05). Genetic analysis identified significant genotype distributions in cases versus controls, with the CC genotype associated with reduced risk (OR = 0.5238, 95% CI: 0.042 - 0.5238) and the CT genotype with increased risk (OR = 1.9091, 95% CI: 0.047 - 1.9091) of ovarian cancer. Conclusions: Findings underscore the multifaceted nature of ovarian cancer etiology, suggesting that CT genotype in FOK1 gene increases the risk of ovarian cancer
A Comparative Study between Intravenous Lidocaine (0.5%) and Prilocaine (0.5%) in Intravenous Regional Anesthesia (Bier’s Block)
Background: Bier’s block is a reliable, straightforward, and safe technique for anesthetizing upper limb. This study aimed to compare between the effectivity of IV Lidocaine (0.5%) and IV Prilocaine (0.5%) in Bier’s block in terms of onset and recovery time of sensory and motor block, tourniquet tolerance, vital signs during and after surgery, and the need for intraoperative analgesia. Subjects and Methods: This study was conducted at Erbil Teaching Hospital and Emergency Hospital, from the period of May 2021 to October 2021. In this prospective, randomized, double-blind study, two groups of 25 patients were prepared for hand operation. Patients in group A were given IV Lidocaine (0.5%) while patients in group B were given IV Prilocaine (0.5%). Sensory and motor block and their recovery times, tourniquet pain, intra-operative analgesic needs, vital signs, and visual analog scale (VAS) scores were recorded. Results: No significant difference was found in the onset of sensory and motor block in both Lidocaine (5.5±1.6 min) and Prilocaine (5.9±1.6 min) groups (p-value=0.319), while the recovery of sensory block after releasing tourniquet was significantly shorter in Prilocaine group (7.4±1.4 min vs. 5.4±0.8 min) (p-value=0.003). The VAS score of Prilocaine group during and after surgery was significantly higher, with more patients receiving analgesia (5 vs. 2). Conclusions: Both IV Lidocaine (0.5%) and IV Prilocaine (0.5%) appeared to be effective local anesthetics in Bier’s block of distal upper extremity, intraoperatively and postoperatively. IV Lidocaine (0.5%) provided greater analgesia, while IV Prilocaine (0.5%) exhibited quicker sensory block recovery after tourniquet cuff release.
Immunohistochemical-Based Detection of Human Cytomegalovirus in Brain Tissues from a Group of Iraqi Patients with Glioblastoma Multiforme and WHO Grade II Astrocytoma
Background: Human Cytomegalovirus (HCMV) nucleic acids and proteins are frequently detected in brain tumors, especially high-grade gliomas in adults and children. Despite conflicting data, further investigation into HCMV's role in gliomas is warranted. Objective: This study aimed to determine the frequency of HCMV proteins in tissues from patients at the Specialized Surgeries Hospital in Baghdad diagnosed with glioblastoma multiforme (GBM) and grade 2 astrocytoma. Subjects and Methods: Ninety-three (93) tissue samples were collected from patients aged 8-75 years: 46 samples from GBM surgeries and 27 from astrocytoma surgeries. An additional 20 samples collected from non-tumor neurosurgical patients such as (Eosinophilic granuloma and reactive gliosis) aged 21-71 years were included as a control group. Immunohistochemistry (IHC) was used to detect immediate early and early HCMV proteins. Results: Of the 73 glioma tissues, 38 (52.1%) showed positive IHC signals for HCMV. In GBM tissues, 28 out of 46 (59.9%) were positive, while in astrocytoma tissues, 10 out of 27 (38.4%) were positive. Only 1 out of 20 control tissues (5%) showed HCMV positivity. Within the GBM group, low, moderate, and high IHC scores were observed in 57.1%, 28.6%, and 14.3% of cases, respectively. In the astrocytoma group, scores were low in 60%, moderate in 30%, and high in 10%. Significant statistical differences were noted when comparing GBM and astrocytoma to the control group and comparing GBM to astrocytoma Conclusions: The study revealed a high prevalence of HCMV in glioma samples, supporting its potential role in glioma development, particularly in GBM pathogenesis and possibly carcinogenesis.
A Revolutionary Road Map for Obesity Management and Beyond: Tirzepatide as a Dual-Acting Insulinotropic Polypeptide
Tirzepatide is a revolutionary and promising medication with a high impact in the treatment of Obesity and T2DM with their complications. Its efficacy was proven through different trials in achieving favorable weight loss and a significant reduction in glycemic index. It also treated a large diversity of related co-morbidities, including fatty liver, cardiovascular disease, dyslipidemia, and more. Tirzepatide is well tolerated, has a good safety profile, and is highly reliable and suitable for use in a population.
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Screening and Evaluation of Osteoporotic Biomarkers in Smoking Individuals in Basrah City, Iraq
Background: Prolonged cigarette smoking leads to significant bone loss, an independent risk factor for osteoporosis. Currently, there are no effective prevention procedures for this, and the exact mechanisms affecting bone metabolism remain unclear. Objectives: This study aims to (1) identify the differences in measured osteoporotic biomarkers among smokers, which are categorized based on the duration and smoking intensity, (2) identify a statistical correlation between variables and smoking intensity, (3) discuss the possibility of employing the appearance of pain sensations in healthy smokers as a reliable indicator of osteoporosis. Subjects and Methods: A study involved 200 males in Basrah city, aged 20-60 years, who were categorized into long-term heavy smokers (LTHS), long-term light smokers (LTLS), short-term current smokers (STCS), and non-smokers (control). A self-reported questionnaire was used to collect baseline data and smoking history. Serum levels of bone-specific alkaline phosphatase (BALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), interleukin 6 (IL-6), osteocalcin (OC), Dickkopf-1 (DKK-1), osteoprotegerin (OPG), and Receptor activator of nuclear factor kappa-B ligand (RANKL) biomarkers were measured using an ELISA technique. Results: statistical analysis for mean age 32± 8 years demonstrated a statistically significant relationship (P<0.05) in education levels, employment status, and type of diet among smoker groups. The prevalence of pain symptoms and pain severity showed (P<0.0001) among smoker groups compared to the control group. Among smokers, IL-6, vitamin D, BALP, OC, DKK-1, OPG, and PTH levels were statistically significant. The RANKL/OPG ratio shows significant differences in LTHS and LTLS. Conclusions: The Basra community's smoking status is influenced by education, employment state, and dietary profile. The high prevalence of smoking and its negative health effects significantly on osteoporotic biomarkers, and pain prevalence is positively correlated with smoking intensity.
Pregnant Mothers’ Knowledge, Attitude, and Practice Towards Prevention of Iron Deficiency Anemia in Georgia
Background: Anemia in pregnancy is a serious global health challenge, particularly affecting developing countries. Objectives: This study aimed to explore pregnant women's attitudes and perceptions regarding preventing iron deficiency anemia (IDA). Subjects and Methods: A qualitative research method was used to survey pregnant women with IDA and physicians through in-depth interviews. The target sample consisted of 9 gynecologists and 26 pregnant women, selected through purposive sampling from three maternity hospitals in Tbilisi (Georgia). Results: The majority of pregnant women (n=22; 84.6%) had some knowledge about IDA and correctly identified its symptoms. However, despite high awareness, most lacked adequate knowledge about the causes and risk factors of IDA. While pregnant women were aware of healthy eating practices, they did not follow a proper diet. Obstacles to healthy eating included limited financial access to food as well as cultural and religious barriers. Although respondents had some knowledge about iron-rich foods, they were generally unaware of the need to take iron supplements for prevention. The majority of pregnant women (n=21; 80.8%) received little information about anemia from their family physicians, indicating a limited role of family doctors in IDA prevention during pregnancy. Conclusions: Although pregnant women possess knowledge and positive attitudes towards IDA prevention, their practices remain insufficient. The findings suggest a weak connection between knowledge of IDA prevention and healthy behavior, contributing significantly to anemia prevalence. To address this issue, it is essential to promote proper nutritional counseling for pregnant women during antenatal care, with a focus on strengthening family doctors' involvement. Additionally, awareness should be increased among women of reproductive age and adolescent girls.