Babcock University Medical Journal

Effect of gut microbiota modulation with probiotics on inflammatory markers in the letrozole-induced polycystic ovary syndrome rat model

2026-06-07T13:14:52+01:00

Objective: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with chronic low-grade inflammation. This study aimed to evaluate whether probiotic supplementation (Lactobacillus and Bifidobacterium) could restore serum interleukin‑10 (IL‑10) and tumour necrosis factor‑alpha (TNF‑α) levels in a letrozole‑induced PCOS rat model, compared with metformin.

Methods: Twenty‑eight female albino Wistar rats were randomly divided into four groups (n=7 each): control (normal diet), PCOS model (letrozole 1 mg/kg plus high‑fat diet for 21 days), metformin (300 mg/kg/day for 28 days after induction), and probiotic (1×10⁹ CFU/day of Lactobacillus and Bifidobacterium for 28 days after induction). Serum IL‑10 was measured by ELISA, and TNF‑α by CLIA. Data were analysed using one‑way ANOVA with Bonferroni post‑hoc test.

Results: PCOS induction significantly decreased IL‑10 by 32.98% (p<0.001) and increased TNF‑α by 46.33% (p<0.001) compared with controls. Probiotic treatment significantly raised IL‑10 by 27.51% (p<0.001) relative to the model group, but IL‑10 remained 14.54% lower than in controls (p=0.003). Probiotics reduced TNF‑α by only 4.69% (p=1.000), which was not statistically significant. Metformin increased IL‑10 by 36.88% (p<0.001) and reduced TNF‑α by 7.71% (p=1.000) compared with the model group.

Conclusion: Probiotic supplementation partially improves the anti‑inflammatory IL‑10 but does not significantly reduce TNF‑α in this PCOS model. Probiotics alone are insufficient to reverse the inflammatory profile of PCOS fully.

Neuregulin-4 as a novel target of dapagliflozin in high-fat diet-induced fatty liver disease in rats

2026-06-09T08:13:08+01:00

Objective: The present study aimed to evaluate the hepatoprotective effects of dapagliflozin in a rat model of high-fat/high-fructose diet-induced fatty liver disease and to investigate its association with Neuregulin-4 (NRG4) expression.

Methods: Forty adult male Wistar albino rats were randomly allocated into five groups (n = 8 each): control, high-fat/high-fructose diet (HFD), pioglitazone-treated (10 mg/kg/day + HFD), dapagliflozin-treated (1 mg/kg/day + HFD), and vehicle-treated (1% DMSO + HFD). Pioglitazone and dapagliflozin were administered orally for 14 days before induction and continued throughout the 8-week induction period. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured, while hepatic malondialdehyde (MDA), reduced glutathione (GSH), and NRG4 levels were determined using ELISA-based methods. Histopathological and fibrosis assessments were performed using hematoxylin and eosin and Masson's trichrome staining.

Results: The HFD group demonstrated significant hepatic injury, characterised by increased serum ALT, AST, and hepatic MDA levels, together with reduced GSH and NRG4 levels compared with the control group. Treatment with dapagliflozin significantly improved liver enzyme profiles, attenuated oxidative stress, restored antioxidant status, and increased hepatic NRG4 levels. Histopathological examination revealed a marked reduction in hepatic steatosis and fibrosis in dapagliflozin-treated rats, with effects comparable to those observed with pioglitazone treatment.

Conclusion: Dapagliflozin administration was associated with improvement of biochemical, oxidative stress, and histopathological alterations induced by a high-fat/high-fructose diet in rats. The findings are consistent with a potential role of NRG4 in the hepatoprotective effects of dapagliflozin; however, further mechanistic studies are required to clarify the underlying molecular pathways.

Thymol attenuates carboplatin-induced nephrotoxicity in male rats by suppressing oxidative stress and NF-κB-mediated inflammation: A biochemical and histopathological study

2026-06-09T20:31:42+01:00

Objective: Carboplatin, a platinum-based chemotherapeutic agent, often causes dose‑limiting nephrotoxicity. Thymol, a natural monoterpene phenol, has antioxidant and anti‑inflammatory properties. This study aimed to determine whether thymol protects against carboplatin‑induced kidney injury in male rats.

Methods: Fifty adult male albino rats were randomly divided into five groups (n=10 each): control (distilled water), olive oil (vehicle), thymol alone (40 mg/kg/day orally), carboplatin alone (50 mg/kg single intraperitoneal), and carboplatin plus thymol (same doses, thymol started 24 hours after carboplatin). After three months, serum renal function markers, oxidative stress indices (malondialdehyde [MDA], 8‑hydroxy‑2′‑deoxyguanosine [8‑OHdG]), circulating Nrf2, antioxidant enzymes (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx], reduced glutathione [GSH]), pro‑inflammatory cytokines (NF‑κB p65, TNF‑α, IL‑6, IL‑1β), and renal histopathology were assessed. Data were analysed by one‑way ANOVA with Tukey’s post hoc test (p<0.05).

Results: Carboplatin significantly increased serum creatinine, urea, and uric acid; elevated MDA, 8‑OHdG, and circulating Nrf2; depleted SOD, CAT, GSH, and GPx; and raised NF‑κB, TNF‑α, IL‑6, and IL‑1β (p<0.05). Renal histology showed tubular degeneration, vascular congestion, and inflammatory infiltration. Co‑administration of thymol reversed most of these changes towards control values and markedly improved histological architecture.

Conclusion: Thymol attenuates carboplatin‑induced nephrotoxicity in male rats, likely by reducing oxidative damage and suppressing inflammatory signalling. These findings support further investigation of thymol as a potential adjunct to platinum‑based chemotherapy.

Role of Pregnancy-Associated Plasma Proteins (PAPP A and PAPP A2) and Insulin-Like Growth Factor-Binding Proteins in Children with Idiopathic Short Stature

2026-06-10T18:19:41+01:00

Background: Idiopathic short stature (ISS) is a poorly understood growth disorder in children who have normal growth hormone secretion but remain significantly shorter than their peers. This review synthesises current evidence on the roles of pregnancy‑associated plasma proteins (PAPP‑A and PAPP‑A2) and insulin‑like growth factor-binding proteins (IGFBPs) in the pathophysiology of ISS, and evaluates their potential as diagnostic biomarkers and therapeutic targets.

Main Body: We performed a narrative review of peer‑reviewed literature published up to 2024, focusing on the biochemical regulation of the growth hormone–insulin‑like growth factor (GH–IGF) axis, with special emphasis on PAPP‑A, PAPP‑A2, and IGFBPs. Genetic, diagnostic, and treatment studies in children with ISS were also examined.

PAPP‑A and PAPP‑A2 are metalloproteinases that cleave IGFBP‑3 and IGFBP‑5, thereby increasing free IGF‑1 bioavailability and promoting chondrocyte proliferation and linear bone growth. Disrupted activity of these proteins leads to relative IGF‑1 resistance and impaired growth. Several genetic variants in the GH–IGF axis (GHR, IGFALS) and in growth‑plate regulators (SHOX, NPR2, FGFR3, ACAN) have been identified in ISS children, although routine testing for PAPP‑A/A2 is not yet standard. GH therapy remains the only FDA‑approved treatment for ISS, but its efficacy is variable and long‑term safety data are limited.

Conclusion: PAPP‑A, PAPP‑A2, and IGFBPs are key modulators of IGF bioavailability. Their measurement may improve diagnostic accuracy in ISS and open avenues for targeted therapy. Future research should focus on standardised assays and clinical trials of PAPP‑A/A2 modulators.

Comparative diagnostic and predictive utilities of N-Terminal Pro-B-Type natriuretic peptide and copeptin in assessing heart failure and systolic dysfunction severity

2026-05-08T14:07:37+01:00

Objective: To evaluate and compare the diagnostic and predictive capacities of N-terminal pro-B-type natriuretic peptide (NT proBNP) and copeptin in heart failure (HF), and to determine their respective associations with the severity of systolic dysfunction.

Methods: A case-control study enrolled 60 patients with diagnosed HF and 60 healthy controls. Serum NT proBNP and copeptin were quantified using enzyme-linked immunosorbent assays. Diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. Binary and ordinal logistic regression models identified independent predictors of HF and its severity.

Results: Both biomarkers showed good diagnostic accuracy. NT proBNP yielded an area under the curve (AUC) of 0.87 (specificity 99.0%, sensitivity 64.0%), while copeptin produced an AUC of 0.84 (sensitivity 81.9%, specificity 74.0%). Binary logistic regression confirmed both markers as significant independent predictors of HF (NT proBNP: odds ratio [OR] 3.23, p=0.007; copeptin: OR 2.33, p=0.001). Ordinal logistic regression revealed that only NT proBNP maintained a statistically significant association with the severity of systolic dysfunction (OR 2.12, p=0.001), whereas copeptin did not (OR 0.99, p=0.87).

Conclusions: NT proBNP and copeptin provide complementary diagnostic information. NT proBNP correlates strongly with cardiac dysfunction severity, whereas copeptin offers enhanced sensitivity to neurohormonal stress. A multimarker strategy may optimise clinical evaluation in HF.

Folic acid, folate receptor autoantibodies, glutathione and vitamin D3 as biomarkers of cerebral folate deficiency in children with autism spectrum disorder: A case‑control study from Iraq

2026-05-11T08:14:26+01:00

Objective: To assess serum levels of vitamin D3, folic acid and reduced glutathione in children with autism spectrum disorder (ASD) in relation to the presence of folate receptor alpha (FOLR1) autoantibodies, and to explore associations with ASD severity.

Methods: A case‑control study was conducted between October 2025 and January 2026 at the QAR Autism Rehabilitation Centre and Alshatra General Hospital in Thi Qar, Iraq. The study included 60 children with ASD diagnosed according to DSM‑5 criteria and 60 age‑ and sex‑matched healthy controls. Serum anti‑FOLR1 IgG, vitamin D3, folic acid and reduced glutathione were measured by ELISA and automated chemistry. ASD severity was categorised using the Childhood Autism Rating Scale (CARS). Comparisons between seropositive and seronegative ASD children were performed with Mann–Whitney U and chi‑square tests.

Results: Among the 60 ASD children, 46 (76.7%) were positive for anti‑FOLR1 IgG. Compared with seronegative ASD children, seropositive children had significantly lower levels of vitamin D3 (median 13.74 vs 29.20 ng/mL, p=0.002), folic acid (median 9.94 vs 21.50 ng/mL, p=0.002) and reduced glutathione (median 0.83 vs 2.15 μmol/L, p<0.001). Anti‑FOLR1 positivity was strongly associated with greater ASD severity (severe: 63.0% in seropositive vs 14.3% in seronegative, p=0.002).

Conclusion: The presence of FOLR1 autoantibodies in children with ASD is associated with marked depletion of vitamin D3, folic acid and glutathione, and with more severe clinical presentation. These findings support the existence of a distinct metabolic‑immunological subtype of ASD that may benefit from targeted biomarker‑guided interventions.

Prevalence of tinea capitis in Nnewi and its correlation with haemoglobin genotype, blood group and haematological parameters

2026-04-12T23:57:00+01:00

Objective: This study aimed to assess the prevalence of Tinea capitis and determine its correlation with haemoglobin genotype, blood group, and haematological parameters among pupils presenting with clinical features of the infection.

Method: Scalp scrapings and hair shafts were collected from 131 pupils with clinical features to check for dermatophytes. Blood samples (2mls) were collected from them and 131 randomly selected pupils without clinical features to check the haemoglobin genotype, blood group and haematological parameters and the level of significance was calculated. Ethical approval was obtained, and permission was obtained from the Anambra State Universal Basic Education Board. Pupils whose parents/guardians consented were recruited for the study. Samples were analysed using standard procedures.

Results: Percentage of dermatophyte growth detected was 22.1%. The prevalence of haemoglobin genotype AA was 70% and AS; 29.8%, with M. audouinii more predominant (9.2%). Blood group O occurred more (53.4%), followed by B; 24.4% and A (22.1%). The male gender had a higher prevalence (60.3%) as compared to the female (39.7%). Two isolates (1.5%) of M. canis occurred among the male group in haemoglobin genotype AA and blood group A. The Packed cell volume was significantly lower (P<0.05) in pupils with clinical features of tinea capitis, while total white blood cell count, neutrophil count, lymphocyte count, basophil count and monocyte count were significantly higher (P<0.05).

Conclusion: The study revealed that tinea capitis still affects primary School pupils in Nnewi, mostly in the age group 7-9 years, irrespective of the haemoglobin genotype or blood group.

Evaluation of serum dipeptidyl-peptidase-like protein 6 (dppx) levels in patients with epilepsy: a case control study from Al Diwaniyah governorate, Iraq

2026-05-15T22:54:22+01:00

Objective: To compare serum DPPX levels between epilepsy patients and healthy controls, evaluate its diagnostic performance via ROC analysis, and assess associations with disease duration.

Methods: A hospital-based case-control study (Nov 2025–Mar 2026) included 50 epilepsy patients (18–75 years, both sexes, ≥1 year of aware/impaired awareness seizures) and 50 age-/sex-matched healthy controls. Exclusion criteria: diabetes, chronic diseases, autoimmune disorders, cancer, pregnancy, lactation. Serum DPPX measured by ELISA. Statistical analysis used SPSS v26 (t-test, chi-square, ROC). Significance: p≤0.05.

Results: Mean age was similar between patients (33.24±8.31 years) and controls (32.18±7.11 years; p=0.681). Serum DPPX was significantly lower in epilepsy patients (47.02±4.33 vs. 83.68±7.38 ng/mL; p=0.001). ROC analysis yielded an optimal cut-off <46.69 ng/mL (AUC=0.721, 95% CI: 0.623–0.819; p=0.001), sensitivity 70.0%, specificity 74.0%, PPV 72.9%, NPV 71.2%. No significant DPPX difference between disease duration ≤10 years (45.16±6.48 ng/mL) and >10 years (48.49±5.92 ng/mL; p=0.707).

Conclusion: Serum DPPX is significantly reduced in epilepsy patients, showing modest discriminatory value that remains stable across disease duration. It may serve as a potential adjunct biomarker. Larger prospective studies with epilepsy subtype stratification are warranted.

Matrix metalloproteinase-2 and inflammatory indices as discriminatory biomarkers for coronary artery ectasia versus stenosis: A cross-sectional study

2026-05-15T10:20:29+01:00

Objective: To evaluate serum matrix metalloproteinase-2 (MMP-2), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and lipid profiles for discriminating coronary artery ectasia (CAE) from coronary artery stenosis (CAS) and healthy controls.

Methods: This cross-sectional study enrolled 120 participants (40 with angiographically confirmed CAE, 40 with CAS, and 40 healthy controls) between November 2024 and March 2025. Serum MMP-2 was measured using an enzyme-linked immunosorbent assay. Lipid profiles and complete blood counts were determined using automated analysers. Group comparisons employed Kruskal–Wallis H tests with Bonferroni correction. Receiver operating characteristic (ROC) curve analysis assessed diagnostic performance.

Results: MMP-2 levels were significantly elevated in CAE (73.48 ± 7.65 ng/mL) compared to CAS (38.49 ± 4.40 ng/mL) and controls (15.01 ± 4.70 ng/mL) (p < 0.001 for all pairwise comparisons). ROC analysis demonstrated excellent discrimination (area under the curve = 1.000) for distinguishing CAE from both CAS and controls, though this finding requires validation in larger cohorts. The CAE group exhibited the most severe atherogenic dyslipidaemia, with the highest total cholesterol, triglycerides, and lowest high-density lipoprotein cholesterol. Inflammatory indices (NLR, PLR, RDW) were significantly higher in CAE than in CAS and controls (p < 0.001), indicating a pronounced neutrophil-dominant inflammatory milieu in ectatic disease.

Conclusion: Marked MMP-2 elevation combined with severe dyslipidaemia and amplified inflammatory indices distinguishes CAE from CAS, suggesting that excessive proteolytic and inflammatory pathways drive pathological vascular dilation in coronary artery ectasia.

Association between biofilm-related genes and phenotypic formation capacity in Streptococcus mutans isolated from the oral cavity

2026-05-15T22:51:22+01:00

Objective: To investigate the relationship between the presence of four key biofilm-associated genes (gtfB, gbpA, comDE, atpH) and phenotypic biofilm formation capacity in clinical oral isolates of Streptococcus mutans.

Methods: Three hundred clinical samples (saliva, dental plaque, and dental caries specimens) were collected from patients attending dental clinics in Nasiriyah, Iraq, between November 2025 and February 2026. S. mutans was isolated using selective media and identified by biochemical tests and 16S rRNA PCR. Biofilm formation capacity was assessed using the microtiter plate method. PCR was employed to detect the presence of gtfB, gbpA, comDE, and atpH genes. Statistical analysis was performed using Fisher's exact test.

Results: Thirty-six (12%) isolates were confirmed as S. mutans. Phenotypically, 31 isolates (86.1%) produced biofilms: 11 (30.5%) strong, 9 (25%) moderate, and 11 (30.5%) weak biofilm formers. Genotypically, gtfB was present in all 36 isolates (100%), while comDE, atpH, and gbpA were found in 35 (97.2%), 34 (94.4%), and 31 (86.1%) isolates, respectively. No statistically significant association was observed between the presence of any tested gene and biofilm formation strength (p > 0.05 for all comparisons).

Conclusion: Biofilm-associated genes are highly prevalent among oral S. mutans isolates, yet their mere presence does not predict phenotypic biofilm strength. This discrepancy suggests that post-transcriptional regulation, allelic variations, or alternative pathways critically modulate biofilm formation.

Effect of latanoprost versus fixed-combination timolol-dorzolamide on intraocular pressure in a sample of people from Kerbala city in Iraq

2026-04-27T20:37:51+01:00

Objective: Aqueous humour pressure on the internal surface area of the anterior part of the eye is termed the intraocular pressure (IOP). The balance between aqueous secretion and drainage determines the intraocular pressure. Several drugs treat glaucoma by lowering the IOP, decreasing aqueous secretion, or increasing drainage. It is reported that latanoprost, a prostaglandin agonist, enhances uveoscleral drainage. In addition, timolol and dorzolamide decrease IOP by secretion reduction and can be used as a fixed combination (DTFC). This study aimed to compare the efficacy of latanoprost 0.005% once daily versus fixed-combination timolol (0.5%) and dorzolamide (2%) twice daily in reducing intraocular pressure (IOP) among people in Kerbala city with glaucoma or ocular hypertension.

Methods: A randomised controlled study enrolled 100 patients (200 eyes) with glaucoma or ocular hypertension, equally divided into two groups. Group A received timolol/dorzolamide twice daily, and Group B received latanoprost once daily for three months. IOP was measured using air-puff tonometry pre- and post-intervention. Data were analysed using an independent samples t-test.

Results: Baseline IOP was similar between groups (24.43±8.83 mmHg vs 26.12±7.23 mmHg; p=0.056). Post-intervention, latanoprost achieved greater mean IOP reduction (26.2%) compared to timolol/dorzolamide (21.6%; p=0.002).

Conclusion: Latanoprost demonstrated statistically greater IOP reduction than fixed-combination timolol-dorzolamide over three months. Further studies with larger sample sizes and longer follow-up are warranted.

Influence of casp8 -652 6n (rs3834129) polymorphism on oxidative stress biomarkers in patients with myocardial infarction

2026-05-18T15:54:40+01:00

Objective: This study aimed to evaluate the association between the CASP8 -652 6N insertion/deletion (rs3834129) polymorphism and oxidative stress biomarkers, malondialdehyde (MDA), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and total antioxidant capacity (TAC), in Iraqi patients with MI.

Methods: A case-control study enrolled 60 MI patients and 30 age- and sex-matched healthy controls. Serum levels of MDA, 8-OHdG, and TAC were measured using enzyme-linked immunosorbent assay (ELISA). Genotyping of the CASP8 rs3834129 polymorphism was performed using amplification-refractory mutation system polymerase chain reaction (ARMS-PCR). Statistical analyses included independent t-tests, one-way ANOVA, Pearson correlation, and receiver operating characteristic (ROC) curve analysis.

Results: MI patients exhibited significantly higher MDA (23.9±6.8 vs. 10.4±3.9 nmol/ml, P<0.001) and TAC (0.072±0.001 vs. 0.034±0.002 mmol/l, P=0.025) concentrations compared to controls, while 8-OHdG showed a non-significant elevation (142.3±14.5 vs. 107.9±8.2 ng/ml, P=0.137). Age correlated positively with both 8-OHdG (r=0.625, P<0.001) and MDA (r=0.406, P=0.001). The CASP8 Ins/Ins genotype was more frequent among patients (90% vs. 73.3%, P=0.04), and the Ins allele frequency was significantly higher in patients (0.95 vs. 0.87, P=0.049, odds ratio=3.873). The Ins/Del genotype was associated with significantly higher TAC (P < 0.001) and lower MDA (P < 0.001) in patients than in controls.

Conclusion: Oxidative stress is markedly elevated in MI patients, with MDA serving as a robust biomarker. The CASP8 Ins/Ins genotype and Ins allele may increase MI susceptibility, while the Ins/Del genotype appears protective by enhancing antioxidant capacity. These findings suggest potential genetic markers for MI risk stratification.

Association between pro- and anti-inflammatory cytokines (IL-6, IL-10), hypothyroidism, and glomerular filtration rate in chronic kidney disease

2026-05-18T16:00:03+01:00

Objective: Hypothyroidism and chronic kidney disease (CKD) frequently coexist and may potentiate systemic inflammation, but the cytokine dynamics underlying this interaction remain poorly understood. This study assessed the relationship between pro‑inflammatory (IL‑6) and anti‑inflammatory (IL‑10) cytokines, hypothyroidism, and estimated glomerular filtration rate (eGFR) in patients with chronic kidney failure.

Methods: A case‑control study was conducted at two tertiary hospitals in Thi‑Qar, Iraq, involving 100 male participants divided into four equal groups (n=25 each): isolated hypothyroidism, isolated CKD, combined hypothyroidism+CKD, and healthy controls. Serum IL‑6, IL‑10, anti‑thyroid peroxidase (anti‑TPO), thyroid‑stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), urea, creatinine, and eGFR were measured using electrochemiluminescence immunoassay.

Results: Compared with controls, all patient groups exhibited a pro‑inflammatory shift characterised by elevated IL‑6 (highest in combined group: 41.42±18.44 vs 14.51±3.66 pg/mL, p<0.001) and reduced IL‑10 (lowest in CKD: 4.91±3.23 vs 8.02±2.23 pg/mL, p<0.001). The combined group showed the most severe thyroid dysfunction (TSH: 17.14±13.19 mIU/L; FT3: 1.37±0.23 pmol/L) and the strongest inverse correlation between IL‑6 and eGFR (r=‑0.68, p=0.0001).

Conclusion: Co‑existing hypothyroidism and CKD produce a synergistic pro‑inflammatory state with marked cytokine imbalance and aggravated renal‑thyroid crosstalk. Integrated management targeting inflammatory pathways may improve outcomes in this high‑risk population.

Association between bone morphogenetic protein 2 and interleukin 6 in patients with acute coronary syndrome

2026-05-18T17:16:13+01:00

Objective: To investigate the association between serum concentrations of bone morphogenetic protein 2 (BMP2) and interleukin‑6 (IL‑6) in patients diagnosed with acute coronary syndrome (ACS).

Methods: A case‑control study was conducted at Merjan Teaching Hospital, Iraq, from November 2025 to February 2026. The study included 60 patients with ACS and 60 healthy controls. Serum BMP2 and IL‑6 levels were measured using enzyme‑linked immunosorbent assay (ELISA).

Results: ACS patients had significantly higher serum BMP2 (2.53±1.0 ng/L vs. 1.55±0.37 ng/L; p<0.0001) and IL‑6 (74.7±27.5 ng/mL vs. 48±10.3 ng/mL; p<0.0001) compared to controls. Receiver operating characteristic (ROC) analysis showed excellent diagnostic performance for BMP2 (area under the curve, AUC=0.86) and IL‑6 (AUC=0.88). IL‑6 levels differed significantly across ACS subtypes (p=0.0008), being highest in unstable angina (UA), whereas BMP2 levels showed no significant variation (p=0.61).

Conclusions: Elevated BMP2 and IL‑6 are strongly associated with ACS and reflect the interplay of inflammation and vascular dysfunction. Their high diagnostic accuracy supports their potential as clinical tools for risk stratification, although BMP2 does not differentiate between ACS subtypes.

Factors affecting rotator cuff tendon healing after arthroscopic repair augmented with platelet-rich fibrin in large rotator cuff tears: A prognostic study

2026-05-21T23:07:37+01:00

Objective: To identify preoperative prognostic factors associated with tendon-to-bone healing after arthroscopic repair of large rotator cuff tears augmented with platelet-rich fibrin (PRF).

Methods: A prospective study enrolled patients with large rotator cuff tears (3–5 cm) who underwent arthroscopic suture‑bridge repair with PRF augmentation. Preoperative clinical data, MRI findings, and intraoperative factors were analysed against 6‑month postoperative MRI tendon integrity (Sugaya classification). Univariate and multivariate logistic regression identified independent predictors.

Results: Of 60 patients, 15 (25.0%) had a retear at 6 months. Univariate analysis showed that age, infraspinatus fatty infiltration grade 2, supraspinatus occupation ratio, infraspinatus occupation ratio, acromiohumeral distance, and inferoglenohumeral distance were significantly associated with retear. In multivariate analysis, only the supraspinatus occupation ratio remained an independent protective factor (OR = 0.70 per 1% increase; 95% CI: 0.51–0.94; p = 0.018). The model’s small event number (15 retears) limits precision; findings are exploratory.

Conclusion: Preoperative supraspinatus occupation ratio on MRI is an independent prognostic factor for tendon healing after arthroscopic PRF‑augmented repair of large rotator cuff tears. Larger validation studies are needed.

Serum dipeptidyl peptidase-4 as an adjunctive biomarker in diabetic kidney disease: A multicentre case-control study from Iraq

2026-05-28T22:09:17+01:00

Objective: Conventional renal indices for diabetic kidney disease (DKD) have limitations. This study compared serum dipeptidyl peptidase-4 (DPP-4) levels among Iraqi adults with type 2 diabetes mellitus (T2DM) with DKD, T2DM without DKD, and healthy controls, and evaluated its association with DKD.

Methods: This multicentre case-control study (November 2025 - April 2026) enrolled 171 participants: T2DM with DKD (n=51), T2DM without DKD (n=60), and healthy controls (n=60). DKD was classified using KDIGO 2024 criteria (eGFR by CKD-EPI 2021, UACR). Serum DPP-4 was quantified by ELISA. Logistic regression and ROC analysis were performed.

Results: Serum DPP-4 showed stepwise elevation (controls 203.6±44.4, T2DM 502.6±93.1, DKD 587.2±97.6 ng/mL; all P<0.001). DPP-4 correlated with creatinine (ρ=+0.374), eGFR (ρ=−0.405), CKD stage (ρ=+0.437), and albuminuria (ρ=+0.429). Per 100 ng/mL increase, DPP-4 was independently associated with DKD (aOR 3.00, 95% CI 1.00–8.03; P=0.044), alongside hypertension and diabetes duration. ROC-AUC was 0.779 (cutoff >554 ng/mL; sensitivity 80%, specificity 75%). SGLT-2 inhibitor association with DPP-4 was attenuated after adjustment (P=0.089).

Conclusion: Serum DPP-4 was independently associated with DKD and showed modest discriminative ability. It may serve as an adjunctive biomarker in Iraqi patients but should not replace standard indices.

Sociodemographic predictors of modifiable cardiovascular risk factors among medical students in the University of Calabar, Cross River State, Nigeria

2026-05-20T19:42:10+01:00

Objectives: The study aimed to determine the prevalence and sociodemographic predictors of modifiable cardiovascular risk factors among clinical medical students at the University of Calabar.

Methods: A descriptive cross-sectional study was conducted among 4th to 6th year medical students selected by the stratified random sampling method. The study population was stratified by academic level (years 4–6), with proportionate allocation used to recruit 94, 138, and 79 students from each level, respectively. Data were collected using a semi-structured, interviewer-administered questionnaire adapted from the WHO STEP-wise approach and analysed with SPSS version 25 at a 5% significance level and 95% confidence interval. Associations were assessed using Chi-square tests. Multivariate logistic regression was used to identify independent predictors of modifiable cardiovascular risk factors.

Results: There were 311 participants comprising 163(52.4%) females and 148(47.6%) males. The overall mean age was 24.6±5.8 years. The prevalence of modifiable cardiovascular risk factors was 58.8%. Statistically significant associations were observed between the presence of cardiovascular risk factors and age (p=0.039), academic level (p<0.001), tribe (p<0.001), and religion (p=0.048). Multivariate logistic regression analysis identified older age, 5th year of study and ethnicity as predictors of cardiovascular risk.

Conclusion: Integrating cardiovascular health promotion into the medical curriculum, alongside regular health screening and targeted behavioural interventions, is recommended to reduce modifiable cardiovascular risk factors among students.

Assessment of the prevalence and types of substance abuse among undergraduate students in selected universities in Ogun State, Nigeria

2026-05-02T13:33:47+01:00

Objective: This study examined the prevalence and patterns of substance use among undergraduates at three universities in Ogun State, Nigeria: the Federal University of Agriculture, Abeokuta; Olabisi Onabanjo University, Ago-Iwoye; and Babcock University, Ilisan-Remo.

Method: A quantitative, descriptive cross-sectional survey design was employed, utilising a multi-stage sampling technique to select participants. The study targeted students aged 15–25 years who were available and willing to participate during the data collection period. Data analysis included Pearson’s chi-square (χ²) test to evaluate the significance of differences in frequency distributions.

Results: Results indicated widespread substance use, with alcohol (86.5%), cigarettes/tobacco (85.5%), and illicit drugs such as cocaine, heroin, morphine, and marijuana (78%) being the most commonly consumed. Motivations for substance use included coping with stress (79%), enhancing confidence and strength (78.5%), peer influence (68.5%), and recreational enjoyment (31%). The negative impacts of substance use were notable, including reduced academic performance (86.5%), increased cravings (85.5%), depressive symptoms (84%), feelings of euphoria (81.5%), and a perceived ability to overcome personal problems (79.5%). Furthermore, substance abuse contributed to interpersonal conflicts (41.5%) and disrupted sleep patterns (46%).

Conclusion: The findings highlight the high prevalence of substance abuse, particularly alcohol and tobacco, among university students. The study recommends developing and implementing targeted intervention programs to help students reduce and ultimately cease substance use, thereby improving their academic, mental, and physical well-being.

Association between nursing workload and quality of nurses’ performance in pediatric and neonatal units in Mosul hospitals

2026-05-23T04:59:39+01:00

Objective: The study aimed to examine the association between nursing workload and nurses’ performance quality in pediatric and neonatal units in Mosul governmental hospitals.

Methods: A descriptive cross-sectional design was used, involving 207 nurses working in neonatal intensive care units, emergency units, and medical, surgical, and premature infant wards in Mosul teaching hospitals. Data were collected using a structured, self-administered questionnaire developed by the researcher. Statistical analysis was performed using SPSS version 27. Ethical approval was obtained before data collection, and confidentiality was maintained throughout the study.

Results: The results showed that 57% of participants were female and 43% were male. Most nurses (60%) were under 30 years old, while 27% were aged 30-40 years. Overall nursing performance quality was found to be high based on the Relative Importance Index. Many nurses reported that increased workload negatively affected their performance, particularly in pediatric and neonatal settings.

Conclusion: The study found that nursing documentation quality achieved the highest score, whereas workflow scored the lowest. The findings demonstrate a generally high level of nursing performance quality and indicate an association between nursing workload and the quality of nursing performance.

Association of serum GDF15 levels with polycystic ovary syndrome and metformin therapy: A cross-sectional study

2026-06-01T00:27:52+01:00

Objective: To evaluate serum Growth Differentiation Factor 15 (GDF15) levels in women with polycystic ovary syndrome (PCOS) and to assess the association between metformin therapy and GDF15 concentrations.

Methods: This cross‑sectional study included 130 participants: 40 healthy controls, 45 PCOS patients not receiving metformin, and 45 PCOS patients receiving metformin for at least six months. Serum levels of fasting blood glucose, insulin, luteinizing hormone (LH), follicle‑stimulating hormone (FSH), testosterone, and GDF15 were measured. Insulin resistance was estimated using the homeostatic model assessment (HOMA‑IR). Group comparisons were performed using one‑way ANOVA with post‑hoc tests.

Results: GDF15 levels were significantly different across groups (F=39.408, p<0.001). Post‑hoc analysis showed that PCOS patients not on metformin had higher GDF15 levels (889±189 pg/mL) than healthy controls (690±125 pg/mL, p=0.003). Notably, PCOS patients on metformin showed the highest GDF15 levels (984±152 pg/mL), significantly higher than both untreated PCOS patients (p<0.05) and controls (p<0.001). HOMA‑IR, fasting glucose, insulin, and testosterone were also significantly elevated in PCOS groups compared with controls (all p<0.001).

Conclusion: Serum GDF15 levels are elevated in PCOS and are further elevated in association with metformin therapy. GDF15 may serve as a marker of metabolic stress in PCOS and a potential indicator of metformin exposure or response. Longitudinal studies are needed to establish causality.

Dissociation of inflammatory and endothelial axes from insulin resistance in classic polycystic ovary syndrome: A BMI-matched case-control study from Iraq

2026-05-31T23:38:15+01:00

Objective: To test whether the inflammatory marker lipocalin‑2 and the endothelial marker vasorin carry information independent of insulin resistance severity in classic polycystic ovary syndrome (PCOS) phenotypes A/B.

Methods: This BMI‑matched case–control study recruited 60 women with classic PCOS (Rotterdam phenotypes A/B) and 60 non‑PCOS controls (18–40 years) from Iraqi hospitals. Fasting glucose, triglycerides, total testosterone, sex hormone‑binding globulin, lipocalin‑2 (ELISA) and vasorin (ELISA) were measured. Insulin resistance was estimated using the triglyceride–glucose (TyG) index. Analyses included Spearman correlations, multiple linear and logistic regression, and within‑PCOS TyG tertile stratification.

Results: PCOS cases had higher TyG index, lipocalin‑2 (731.1±196.8 vs 489.2±144.1 ng/L, p<0.0001) and lower vasorin (median 92.81 vs 115.20 pg/mL, p=0.003) despite similar BMI (p=0.064). Lipocalin‑2 correlated strongly with TyG (rₛ=0.787, p<0.0001) and remained an independent predictor of PCOS status (OR 1.014, 95%CI 1.009–1.020). Vasorin correlated modestly with TyG (rₛ=0.391, p=0.002) and did not independently predict TyG (p=0.176), but retained an inverse association with PCOS after adjustment for lipocalin‑2 (OR 0.944, 95%CI 0.915–0.968). Within PCOS, vasorin showed a non‑monotonic U‑shaped trajectory across TyG tertiles (p=0.004), whereas lipocalin‑2 increased monotonically.

Conclusions: Lipocalin‑2 is tightly coupled to insulin resistance yet independently associated with PCOS. Vasorin is dissociated from insulin resistance severity, supporting the view that endothelial alterations in PCOS are partly independent of metabolic dysfunction. Routine laboratory TyG and lipocalin‑2 offer pragmatic triage, but all cut‑offs require external validation.

Dysregulation of adipokines and inflammatory biomarkers in patients with metabolic syndrome and chronic kidney disease: A case-control study

2026-05-31T23:40:46+01:00

Objective: Metabolic syndrome (MS) frequently coexists with chronic kidney disease (CKD), yet the integrated role of adipokines and inflammatory markers in this dual condition remains poorly defined. This study aimed to compare circulating levels of key adipokines (adiponectin, leptin, resistin), the inflammatory cytokine TNF-α, and parathyroid hormone (PTH) between patients with MS-CKD and healthy controls, and to evaluate their diagnostic utility.

Methods: A case–control study enrolled 60 patients with confirmed MS-CKD and 60 age- and sex-matched healthy controls. Fasting blood samples were analysed for glycaemic indices (FBS, HbA1c, insulin, HOMA-IR), renal function (urea, creatinine, eGFR, albumin–creatinine ratio), lipid profile, liver enzymes, electrolytes, and minerals. Adiponectin, leptin, resistin, TNF-α, and PTH were measured using ELISA or chemiluminescence. Statistical comparisons used independent t‑tests and receiver operating characteristic (ROC) curve analysis.

Results: MS-CKD patients showed severe metabolic dysregulation (FBS 241.4±30.4 vs 92.7±7.8 mg/dL; HOMA-IR 3.54±0.68 vs 0.99±0.2; both p<0.001) and advanced renal impairment (eGFR 16.6±3.1 vs 108.7±12.1 mL/min/1.73 m²; urea 137.6±15.2 vs 23.2±3.0 mg/dL; both p<0.001). Adiponectin was lower (3.45±1.85 vs 5.12±2.15 mg/L), while leptin, resistin, TNF-α, and PTH were significantly higher in patients (all p<0.001). ROC analysis revealed excellent diagnostic performance for resistin (AUC=0.98) and TNF-α (AUC=0.95).

Conclusions: MS-CKD is characterised by profound adipokine imbalance and systemic inflammation. Resistin and TNF-α show strong potential as non‑invasive biomarkers for identifying MS‑CKD, supporting their clinical utility in risk stratification.

Prevalence and associated factors of umbilical hernia among Nigerian post-neonatal infants: A prospective cross-sectional study

2026-05-28T22:22:25+01:00

Objectives: To determine the prevalence and associated factors of umbilical hernia development in Nigerian infants aged 1–12 months. Umbilical hernias are disproportionately common among populations of African descent and may present as surgical emergencies. Identifying modifiable risk factors is therefore essential, particularly in Black populations, to inform preventive strategies and reduce associated morbidity.

Methods: A prospective cross-sectional study was conducted at two tertiary centres in Southwestern Nigeria. Consecutive infants attending outpatient and immunisation clinics were enrolled. Sociodemographic characteristics, cord care practices, and relevant clinical variables were assessed. Descriptive and inferential analyses were performed, and predictors of umbilical hernia development were identified.

Results: A total of 159 babies were evaluated with M: F-1:1. Umbilical hernias were recorded in 27 (17%). 158 (99.4%) of infants had 70% alcohol for cord care. The mean duration of cord separation was 7.74±3.46 days. The risk of umbilical hernia occurrence increased in those with umbilical stump infections (p=0.03), (OR=5.85; CI:4.15-8.25) and those with a positive family history of umbilical hernia (p<0.001) (OR=13.29, CI:4.57-38.64)

Conclusion: We found a 17% prevalence rate of umbilical hernia, which is relatively low in an African population. Umbilical stump infection (omphalitis) and positive family history of umbilical hernia are factors associated with the occurrence of umbilical hernia development in Nigerian post-neonatal infants.

Common sleep disorders and their sociodemographic and clinical determinants among patients attending a primary care clinic in Ilorin, North Central Nigeria

2026-05-12T10:49:02+01:00

Objective: This study set out to determine the prevalence of common sleep disorders among the study population and the sociodemographic and clinical factors associated with them.

Methods: This cross-sectional study was conducted over three months at outpatient clinics, University of Ilorin Teaching Hospital, North Central Nigeria. Data were collected from 405 respondents using the Global Sleep Assessment Questionnaire to screen for sleep disorders. The questionnaire was interviewer-administered, and data were analysed using the SPSS 23 Statistical package.

Result: In this study, insomnia (55.6%) was found to be the most common type of sleep disorder and was more prevalent among older age groups. Pain (OR=2.8, CI=1.9-4.3), (OR=1.6, CI= 1.0-2.4), and diabetes mellitus (OR=2.2, CI= 1.1-4.1), (OR=2.1, CI=1.1-3.9) were significant predictors of insomnia. and obstructive sleep apnoea, respectively. On the other hand, male gender (OR=2.2, CI=1.5- 3.5), diabetes mellitus (OR=2.1, CI=1.1- 3.9), and hypertension (OR=1.5, CI=1.0- 2.3) were predictors of excessive daytime sleepiness.

Conclusion: Sleep disorders are common among outpatients, with insomnia as the leading cause. Pain, diabetes, and hypertension are major predictors of these sleep disorders. Patients with these conditions should be screened for sleep disorders to provide comprehensive treatment. Proper management of pain, hypertension, and diabetes may reduce the occurrence of sleep disorders.

Problems associated with the introduction of complementary foods to breastfed infants in Ibadan North Local Government Area, Ibadan

2026-05-12T12:28:20+01:00

Objective: This study examined the challenges encountered during the introduction of complementary foods, whether these challenges are unique to exclusively breastfed infants, and the coping strategies employed by mothers.

Methods: A multi-stage sampling technique was used to select 200 mothers attending selected primary health centers in Ibadan North Local Government. A pretested semi-structured interviewer-administered questionnaire was distributed to the mothers, and three focus group discussion sessions were conducted with 21 mothers to enhance, as well as clarify the quantitative results generated. Quantitative data was analysed using descriptive statistics and Chi-square test at p=0.05, while qualitative data was analysed thematically.

Results: Findings from this study revealed that one of the major challenges mothers experience during introduction of complementary foods is food refusal, as seen in 27.5% of respondents. Though infants who were exclusively breastfed refused foods for longer periods, there was no statistically significant difference in food refusal between exclusively breastfed and non-exclusively breastfed infants (X² = 6.893; P =0.075). Other challenges are time constraints and maintaining good hygiene. Mothers employed positive coping strategies like singing to engage the child’s attention and negative coping strategies like force-feeding to ensure the child eats.

Conclusion: Food refusal was reported in both exclusively and non-exclusively breastfed infants. However, exclusively breastfed infants refused food for longer periods.

A comparative evaluation of the efficacy and safety of clonidine and atomoxetine combined with behavioural interventions in children with autism spectrum disorder and comorbid attention-deficit/hyperactivity disorder

2026-06-04T07:21:20+01:00

Objective: To compare the clinical efficacy and safety of atomoxetine versus clonidine, each combined with structured behavioural interventions, in children aged 6–12 years with autism spectrum disorder (ASD) and comorbid attention-deficit/hyperactivity disorder (ADHD).

Methods: A retrospective observational cohort study was conducted at the Imam Al-Hussein Institute for Children with Autism in Najaf, Iraq, between October 2025 and March 2026. Sixty-two children were allocated to two equal groups: atomoxetine plus behavioural intervention (n=31) or clonidine plus behavioural intervention (n=31). Outcomes were measured using DSM‑5 criteria and Conners’ Rating Scales at baseline and three follow‑up intervals (1–3, 3–6, and 6–12 months). Data were analysed using two‑way repeated‑measures ANOVA, Bonferroni post‑hoc tests, and chi‑square tests.

Results: The atomoxetine group showed significantly greater mean symptom improvement than the clonidine group (mean improvement score –13.4 vs. –9.5; p=0.0011), with effects emerging after 3 months and increasing over time. Adverse effects were more frequent in the clonidine group, notably sedation (70.9% vs. 9.6%), irritability (45% vs. 12.9%), and fatigue (61.2% vs. 16.4%). Atomoxetine was associated with mild appetite loss (35%) and gastrointestinal symptoms (29%).

Conclusion: Atomoxetine combined with behavioural intervention demonstrated superior and more sustained clinical improvement and a more favourable safety profile than clonidine in this observational cohort. However, owing to the non‑randomised design and baseline imbalances, these findings should be viewed as hypothesis‑generating. Randomised controlled trials are needed to confirm superiority.

Assessment of malnutrition risk and its association with diabetes complications in hospitalised adult patients attending Marjan Teaching Hospital

2026-06-03T20:29:48+01:00

Objective: Malnutrition is common among hospitalised diabetic patients and may worsen clinical outcomes. This study assessed the prevalence of malnutrition risk using the Malnutrition Universal Screening Tool (MUST) and examined its association with diabetes‑related complications among hospitalised adults at Marjan Teaching Hospital, Iraq.

Methods: A hospital‑based analytical cross‑sectional study enrolled 200 adult patients with diabetes mellitus. Malnutrition risk was categorised using MUST (low=0, medium=1, high≥2). Associations with diabetes complications were analysed using chi‑square tests and multivariable logistic regression, adjusting for age, sex, diabetes duration, body mass index (BMI), HbA1c, and length of stay.

Results: Overall, 71.5% of patients were at low malnutrition risk, 14% at medium risk, and 14.5% at high risk. The prevalence of at least one diabetes‑related complication was 86.5%. MUST risk category was significantly associated with the presence of complications (p=0.046). Compared with the low‑risk group, medium‑risk (adjusted OR 0.34, 95% CI 0.11–0.96, p=0.042) and high‑risk (adjusted OR 0.39, 95% CI 0.14–1.08, p=0.071) patients had lower adjusted odds of complications. Insulin therapy and fair glycaemic control (HbA1c 7‑9%) were associated with higher malnutrition risk in unadjusted analyses.

Conclusion: Nearly 30% of hospitalised diabetic patients were at medium or high risk of malnutrition. Routine MUST screening is recommended to enable early nutritional intervention, particularly in resource‑limited settings.

Pilot 16s rRNA-based salivary microbiome profiling reveals candidate microbial signatures in autoimmune and immunocompromised patients: An exploratory study from Iraq

2026-06-05T21:33:22+01:00

Objective: Immune system disorders may disrupt the oral microbiome, but data from Middle Eastern populations remain scarce. This pilot study aimed to characterise salivary bacterial composition in autoimmune and immunocompromised patients compared with healthy controls and to identify potential disease-associated microbial signatures using 16S rRNA metagenomic sequencing.

Methods: A comparative cross-sectional pilot study was conducted in Ninewa Governorate, Iraq. Saliva samples from 15 participants (five autoimmune patients, five immunocompromised patients, and five healthy controls) underwent bacterial DNA extraction, 16S rRNA gene amplification, and metagenomic sequencing. Relative abundances were compared using Kruskal–Wallis and Mann–Whitney U tests with false discovery rate (FDR) correction. Linear discriminant analysis effect size (LEfSe) identified candidate discriminatory taxa.

Results: The control group showed higher abundance of commensal taxa, particularly Unclassified streptococcus, Salivarius-vestibularis, and Odontolyticus. Autoimmune and immunocompromised groups exhibited increased levels of Nigrescens, Macacae-mucosa-sicca, Fusobacterium nucleatum, and Parainfluenzae. However, no taxon remained statistically significant after FDR correction (q > 0.05). LEfSe analysis identified Nigrescens (LDA = 5.12) and Macacae-mucosa-sicca (LDA = 4.40) as the strongest discriminatory candidates.

Conclusions: This pilot study reveals preliminary compositional differences in salivary microbiomes associated with immune dysfunction. The candidate microbial signatures, particularly Nigrescens and Macacae-mucosa-sicca, warrant validation in larger, adequately powered cohorts before clinical application.

Expression of Glycolytic Enzymes (GLUT1, HK-2, PKM2, LDH-A) and their association with Tumour Stage and Clinicopathological Characteristics in Prostate Cancer Patients

2026-06-05T21:35:17+01:00

Objective: This study evaluated serum levels of glycolytic enzymes (GLUT1, HK-2, PKM2, LDH-A) in prostate cancer patients before and after treatment, compared with healthy controls, and assessed their diagnostic performance.

Methods: A longitudinal study enrolled 30 men with untreated stage II prostate cancer, the same 30 men after therapeutic intervention, and 60 healthy controls. Serum GLUT1, HK-2, PKM2, LDH-A, lactate, and fasting blood glucose were measured using ELISA and standard biochemical methods. One‑way ANOVA with post‑hoc tests compared groups; paired t‑tests compared pre‑ and post‑treatment values. Receiver operating characteristic (ROC) analysis evaluated diagnostic accuracy.

Results: All biomarkers were significantly elevated in pre‑treatment patients compared with post‑treatment and control groups (p < 0.0001). Pre‑treatment means were: GLUT1 1.93 ± 0.87 ng/mL, PKM2 250.7 ± 125.7 pg/mL, HK‑2 1715 ± 64 pg/mL, LDH‑A 1.276 ± 0.603 ng/mL. After treatment, levels declined significantly. GLUT1 showed the highest diagnostic accuracy (AUC = 0.98, sensitivity 98.0%, specificity 93.0%), followed by LDH‑A (AUC = 0.97, sensitivity 91.6%, specificity 90.0%). PKM2 and HK‑2 had lower but significant AUCs (0.88 and 0.89, respectively).

Conclusion: Serum GLUT1 and LDH‑A are promising diagnostic and monitoring biomarkers for prostate cancer. Their decline after treatment suggests utility in assessing therapeutic response.

Expression of glycolytic enzymes (GLUT1, HK2, PKM2, LDH-A) and their association with tumour stage and clinicopathological characteristics in breast cancer patients

2026-06-05T21:37:14+01:00

Objective: Cancer cells reprogramme their metabolism toward aerobic glycolysis (Warburg effect), a process driven by key enzymes and transporters. This study evaluated serum levels of glucose transporter 1 (GLUT1), hexokinase 2 (HK2), pyruvate kinase M2 (PKM2), and lactate dehydrogenase A (LDH-A) in breast cancer patients before and after chemotherapy, and assessed their diagnostic performance.

Methods: A case–control study enrolled 120 women (30 untreated breast cancer, 30 post‑chemotherapy, and 60 age‑matched healthy controls) in Thi‑Qar, Iraq. Serum biomarkers were quantified using enzyme‑linked immunosorbent assays. Fasting blood glucose and lactate were measured enzymatically. Statistical analyses included ANOVA with Tukey’s post hoc test, Pearson correlation, receiver operating characteristic (ROC) curves, and Cohen’s d effect size. In silico validation used TCGA and GEO datasets.

Results: Pre‑treatment patients showed significantly elevated lactate, FBS, LDH‑A, GLUT1, and PKM2 compared with post‑treatment and control groups (p < 0.001). Post‑chemotherapy levels decreased but remained above controls for most markers except HK2, which was unexpectedly higher in controls. PKM2 and LDH‑A demonstrated excellent diagnostic accuracy (AUCs of 0.98 and 0.97, respectively). Correlation analysis revealed a positive association between PKM2 and FBS (r = 0.572, p = 0.001). Effect sizes were large for LDH‑A and PKM2.

Conclusion: Serum PKM2 and LDH‑A are promising non‑invasive diagnostic biomarkers for breast cancer and may help monitor treatment response, despite the unexpected behaviour of HK2, which warrants further investigation.

Association between oxidative stress markers and antioxidant vitamins C and D in Iraqi women with breast cancer: A cross-sectional study

2026-06-06T10:04:39+01:00

Objective: To evaluate the relationship between oxidative stress (measured by malondialdehyde, MDA) and antioxidant vitamins C and D in the incidence and progression of breast cancer among Iraqi women.

Methods: This cross‑sectional study was conducted at Kirkuk Oncology Centre from December 2025 to March 2026. It included 90 women with histologically confirmed breast cancer (stages I–IV) and 45 age‑matched healthy controls. Fasting serum samples were analysed for MDA, superoxide dismutase (SOD), glutathione peroxidase (GPx), vitamin C and vitamin D using ELISA and the Roche Cobas system.

Results: Breast cancer patients had significantly lower mean vitamin C (1.00 ± 0.20 vs. 1.32 ± 0.23 mg/dL, p<0.001) and vitamin D (13.19 ± 4.35 vs. 23.26 ± 5.18 IU/L, p<0.001) levels than controls, and significantly higher MDA (26.27 ± 6.34 vs. 18.20 ± 5.76 ng/mL, p<0.001). Vitamin D levels decreased progressively from stage I (14.9 ± 4.1) to stage IV (10.37 ± 3.85) (p=0.006). A moderate negative correlation was observed between vitamin D and MDA (r = –0.45, p=0.009). Vitamin C levels did not differ significantly across cancer stages.

Conclusion: Elevated oxidative stress and reduced antioxidant vitamins C and D are associated with breast cancer in Iraqi women. Vitamin D shows an inverse relationship with cancer stage, suggesting a possible role in disease progression. Prospective studies are needed to establish causality.

Evaluation of Leptin, Adiponectin, and the Leptin/Adiponectin Ratio as Diagnostic Biomarkers for Metabolic Syndrome

2026-06-09T20:27:06+01:00

Objective: To evaluate serum leptin, adiponectin, and the leptin/adiponectin (L/A) ratio as diagnostic biomarkers for Metabolic Syndrome (MetS) in an Iraqi adult population and to determine optimal cutoff values using receiver operating characteristic (ROC) curve analysis.

Methods: This case-control study enrolled 90 adults (45 MetS cases diagnosed by IDF 2005 criteria and 45 age- and sex-matched healthy controls) from Al-Zahraa General Hospital, Wasit, Iraq, between November 2024 and January 2025. Serum leptin and adiponectin were measured by enzyme-linked immunosorbent assay. Anthropometric and biochemical parameters were assessed under standardised conditions. ROC analysis evaluated diagnostic accuracy, with sensitivity, specificity, area under the curve (AUC), and 95% confidence intervals calculated.

Results: Leptin was significantly elevated in MetS patients compared to controls (9.37 ± 1.77 vs. 2.07 ± 2.06 ng/mL; P < 0.001), while adiponectin was significantly reduced (5.35 ± 2.81 vs. 10.17 ± 7.14 µg/mL; P < 0.001). The L/A ratio was markedly higher in cases (2.07 ± 0.81 vs. 0.18 ± 0.08; P < 0.001). ROC analysis revealed AUC values of 0.981 (95% CI: 0.959–1.000) for leptin, 0.843 (95% CI: 0.757–0.929) for adiponectin, and 1.000 (95% CI: 1.000–1.000) for the L/A ratio. At a cutoff >0.52, the L/A ratio achieved 100% sensitivity and 100% specificity.

Conclusion: The L/A ratio demonstrated excellent discriminative ability for MetS, outperforming either adipokine alone. This composite biomarker holds promise for screening and risk stratification, though validation in larger, independent cohorts is warranted.

Diagnostic performance of serum hepcidin, soluble transferrin receptor, and heme oxygenase-1 in metabolic-dysfunction-associated steatotic liver disease and steatohepatitis

2026-06-11T19:44:30+01:00

Objective: Iron dysregulation and oxidative stress are central to the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progression to steatohepatitis (MASH). This study evaluated the diagnostic utility of serum hepcidin, soluble transferrin receptor (sTfR), and heme oxygenase-1 (HO-1) in patients with MASLD and MASH.

Methods: A case–control study enrolled 120 adults aged 30–60 years, divided equally into simple steatosis (MASLD), MASH (assessed by FibroScan), and matched healthy controls. Serum hepcidin, sTfR, and HO-1 were quantified using sandwich ELISA. Diagnostic accuracy was assessed with receiver operating characteristic (ROC) curves, and independent associations were examined using Firth penalised logistic regression adjusted for age, body mass index (BMI), HbA1c, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).

Results: Hepcidin, sTfR, and HO-1 concentrations increased stepwise from controls to MASLD and MASH (all p < 0.001). For discriminating MASLD from controls, sTfR and HO-1 achieved areas under the curve (AUC) of 1.000 and 0.986, respectively. For differentiating MASH from controls, HO-1 (AUC = 1.000) and sTfR (AUC = 0.999) showed excellent performance. Multivariable analysis confirmed sTfR as an independent predictor of the MASLD spectrum after adjusting for metabolic risk factors.

Conclusions: Hepcidin, sTfR, and HO-1 are promising non-invasive biomarkers for MASLD and MASH, reflecting underlying iron dysregulation. However, the near-perfect diagnostic accuracy observed in this single-centre discovery cohort requires external validation before clinical application.

Antibacterial and antibiofilm synergy of silver-selenium core-shell nanoparticles with meropenem against multidrug-resistant Klebsiella pneumoniae isolated from catheter-related urinary tract infections

2026-06-09T08:16:48+01:00

Objective: To evaluate the antibacterial and antibiofilm efficacy of cold plasma‑synthesised silver‑selenium (Ag@Se) core–shell nanoparticles, alone and in combination with meropenem, against multidrug‑resistant Klebsiella pneumoniae isolates from catheter‑associated urinary tract infections.

Methods: Ag@Se nanoparticles were synthesised using an atmospheric cold plasma jet system. Characterisation was performed by UV‑Vis spectroscopy, X‑ray diffraction (XRD) and transmission electron microscopy (TEM). Cytotoxicity was assessed on rat embryo fibroblast (REF) cells. Among 200 urine samples, 67 K. pneumoniae isolates were identified; 30 were multidrug‑resistant, and five highly resistant isolates with strong biofilm formation were selected for synergy testing using checkerboard assays. Biofilm formation was quantified by crystal violet microtiter plate method.

Results: XRD confirmed a face‑centred cubic silver core; TEM showed core–shell structures of ~100 nm. Ag@Se nanoparticles exhibited low cytotoxicity (maximum growth inhibition 23.3 % at 48 h, 100 µg/mL). Against the five selected isolates, Ag@Se alone achieved 50–65 % growth inhibition. Combination with meropenem increased inhibition to 60–70 %. Synergy was confirmed by isobologram and combination index analyses.

Conclusion: Plasma‑synthesised Ag@Se nanoparticles enhance meropenem activity against MDR K. pneumoniae and show acceptable biocompatibility, offering a promising nano‑antibiotic strategy for biofilm‑associated urinary tract infections.

Antibiotic resistance patterns and associated genetic determinants among clinical isolates of Pseudomonas aeruginosa from a tertiary hospital in southern Iraq

2026-06-13T18:46:05+01:00

Objective: To evaluate antibiotic resistance patterns and investigate the distribution of the carbapenemase‑associated gene blaOXA‑23 and the biofilm‑associated gene algD among clinical isolates of Pseudomonas aeruginosa recovered from patients at a tertiary hospital in Southern Iraq.

Methods: A cross‑sectional study was conducted from November 2025 to April 2026 at Al‑Nasiriyah Teaching Hospital. A total of 120 P. aeruginosa isolates were collected from clinical specimens (burned tissue, sputum, urine, bronchoalveolar lavage, and others). Antimicrobial susceptibility was tested against 14 agents using the VITEK 2 system. Isolates were categorised as non‑MDR, MDR, XDR, and pandrug‑resistant (PDR). PCR was used to detect blaOXA‑23 and algD. Statistical analysis included chi‑square tests, with Cramér’s V for effect sizes.

Results: PDR isolates were most prevalent (33.3%), followed by XDR (24.2%), non‑MDR (23.3%), and MDR (19.2%). Burned tissue yielded the highest proportion of PDR (n=18). Resistance rates were alarmingly high for ceftazidime (78.3%), cefotaxime (73.3%), and carbapenems (≈50%). algD alone was detected in 42.5% of isolates, blaOXA‑23 alone in 15.8%, and co‑occurrence in 22.5%. Significant associations were found between resistance patterns and specimen type (p<0.01, Cramér’s V=0.31), hospitalisation status (p<0.01, V=0.36), and age group (p<0.05, V=0.24).

Conclusions: The high prevalence of MDR, XDR and PDR P. aeruginosa in clinical samples underscores the urgent need for integrated surveillance. The co‑occurrence of blaOXA‑23 and algD in highly resistant isolates suggests a synergistic interplay between carbapenemase activity and biofilm‑mediated protection.

Diagnostic and endocrine-metabolic significance of serum kallistatin and vasorin in women with polycystic ovary syndrome from Southern Iraq

2026-06-14T12:54:37+01:00

Objective: Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogeneous metabolic and reproductive features. Novel circulating biomarkers may improve phenotypic characterization. This study aimed to compare serum kallistatin and vasorin levels between women with PCOS and healthy controls and to examine their associations with body mass index (BMI), insulin resistance (IR), and reproductive hormones.

Methods: This case‑control study enrolled 120 women aged 18–45 years from Southern Iraq: 60 diagnosed with PCOS by Rotterdam criteria and 60 healthy controls. Serum kallistatin and vasorin were measured by enzyme‑linked immunosorbent assay. Metabolic and hormonal parameters were assessed using automated biochemical and electrochemiluminescence immunoassays. Statistical analyses included independent t‑tests, Mann–Whitney U tests, Spearman correlations, and receiver operating characteristic (ROC) curve analysis.

Results: Women with PCOS had significantly higher serum kallistatin (3.37 ± 0.85 vs. 2.13 ± 0.96 ng/mL, p < 0.001) and lower serum vasorin (62.72 ± 9.86 vs. 94.92 ± 10.31 pg/mL, p < 0.001) than controls. Kallistatin was significantly higher in those with elevated BMI (3.55 ± 0.82 vs. 2.77 ± 0.67 ng/mL, p = 0.003) and with high IR (3.62 ± 0.85 vs. 2.72 ± 0.40 ng/mL, p < 0.001). Vasorin showed no significant association with BMI or IR but was lower in women with high testosterone (60.27 ± 9.82 vs. 63.53 ± 9.84 pg/mL, p = 0.006). ROC analysis yielded areas under the curve of 0.829 for kallistatin and 0.988 for vasorin.

Conclusions: Serum kallistatin and vasorin are altered in PCOS and show distinct association patterns: kallistatin with metabolic features (obesity, insulin resistance) and vasorin with androgen status. These findings support further investigation of both molecules as adjunctive biomarkers, pending validation in independent cohorts.

Combined assessment of serum netrin-1 and GDF-15 across albuminuria stages in type 2 diabetes

2026-06-16T07:25:25+01:00

Objective: The urinary albumin-to-creatinine ratio (uACR) has limited sensitivity for early structural changes in diabetic kidney disease (DKD), prompting interest in novel circulating biomarkers. This cross-sectional study evaluated the combined diagnostic association of serum Netrin-1 and Growth Differentiation Factor-15 (GDF-15) across albuminuria stages in type 2 diabetes mellitus (T2DM).

Methods: Sixty T2DM patients (stratified by albuminuria: normo-, micro-, and macroalbuminuria, n=20 each) and 60 age- and BMI-matched healthy controls were enrolled. Serum Netrin-1 and GDF-15 were quantified by sandwich ELISA. Estimated glomerular filtration rate (eGFR) was calculated using the race-free CKD-EPI 2021 equation. ROC analysis and multivariable logistic regression were performed.

Results: Netrin-1 and GDF-15 were significantly elevated in T2DM versus controls (p=0.004 and p=0.001, respectively). Netrin-1 peaked in microalbuminuria (495.2±102.7 pg/mL) while GDF-15 was highest in macroalbuminuria (406.6±106.8 ng/L; ANOVA p=0.020 and p=0.041). Single-marker AUCs: Netrin-1 0.725 (95%CI:0.635-0.816), GDF-15 0.708 (95%CI:0.615-0.800); combined model AUC 0.743 (95%CI:0.655-0.831; p=0.032 vs GDF-15 alone). In adjusted analysis, only eGFR (aOR=0.945 per mL/min/1.73m², p<0.001) and BMI (aOR=1.195 per kg/m², p=0.023) independently predicted T2DM status; biomarker associations attenuated to non-significance.

Conclusion: Serum Netrin-1 and GDF-15 show stage-specific patterns across albuminuria in T2DM but provide only modest incremental diagnostic value over conventional renal indices. These findings are hypothesis-generating; longitudinal studies with hard renal endpoints are required to establish clinical utility.

Internalised stigma and self-esteem among adult outpatients with major depressive disorder: A cross-sectional correlational study

2026-09-29T22:42:21+01:00

Objective: The study aimed to evaluate the internalised stigma and self-esteem in adult outpatients with major depressive disorder (MDD) attending a psychiatric outpatient clinic in Iraq, and to explore the relationship between these variables.

Methods: A cross-sectional correlational study among 120 adults with MDD who attended psychiatric outpatient clinics of Azadi Teaching Hospital in Kirkuk, Iraq. All participants filled out a sociodemographic and clinical questionnaire, the Internalised Stigma of Mental Illness Scale (ISMI), and the Rosenberg Self-Esteem Scale (RSES). Data were analysed using descriptive statistics, Pearson's correlation coefficient and simple linear regression.

Results: The overall mean ISMI score was 2.90 (SD = 0.42), with the highest scores for stereotype endorsement (M = 3.16) and alienation (M = 3.14) and the lowest for stigma resistance (M = 2.19). The overall mean RSES score was 2.29 (SD = 0.38). There was a negative correlation between internalised stigma and self-esteem (r = −0.338, p < 0.001). Self-esteem was statistically associated with internalised stigma (β = −0.338, t = −3.897, p < 0.001), explaining 11.4% of the variance (R² = 0.114) in simple linear regression.

Conclusions: In this single-centre sample of adults with MDD, internalised stigma and self-esteem were inversely related. Since the study is a cross-sectional design, the association observed cannot be considered a causal relationship. The results provide a basis for consideration of the psychosocial aspects of routine psychiatric care (stigma and self-esteem) and for further longitudinal and multicentre research to establish temporal relationships and to determine potentially modifiable factors.

Changes in intraocular pressure and topical anti-glaucoma medication burden after phacoemulsification in medically controlled pseudoexfoliation glaucoma: A prospective cohort study

2026-10-05T18:54:29+01:00

Objective: To describe short-term changes in intraocular pressure (IOP) and topical antiglaucoma medication burden following uneventful phacoemulsification in selected eyes with medically controlled pseudoexfoliation glaucoma (PXG).

Methods: This prospective single-arm before-and-after cohort study enrolled 30 patients with 30 eyes with medically controlled PXG and visually significant cataract who underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation at two tertiary eye hospitals in Baghdad, Iraq, between April 2024 and April 2025. IOP was measured by Goldmann applanation tonometry preoperatively and at 1 week, 1 month, and 4 months postoperatively. Topical antiglaucoma medication burden was recorded before surgery and after postoperative stabilisation. Data were summarised descriptively using means, standard deviations, frequencies, and percentages.

Results: Mean IOP decreased from 19.9 ± 2.4 mmHg preoperatively to 15.5 ± 3.2 mmHg at 1 week, 15.4 ± 2.9 mmHg at 1 month, and 14.8 ± 2.7 mmHg at 4 months. The corresponding mean absolute reductions from baseline were 4.4 ± 3.6, 4.5 ± 3.0, and 5.1 ± 2.6 mmHg, respectively. Mean topical antiglaucoma medication use decreased from 2.00 ± 1.15 to 1.43 ± 1.25 medications after postoperative stabilisation, and 9 patients (30.0%) required no topical antiglaucoma medication at that assessment.

Conclusions: In this small, selected, uncontrolled cohort, phacoemulsification was followed by lower mean IOP and reduced topical antiglaucoma medication burden over four months. Because the study had no comparator group and perioperative medication regimens were modified, these findings should be interpreted as descriptive postoperative associations rather than evidence of a causal treatment effect.

Association of red cell distribution width and platelet distribution width with angiographic severity of coronary artery disease in patients with stable angina: a cross-sectional study

2026-10-14T22:13:10+01:00

Objective: To assess the associations of red cell distribution width-standard deviation (RDW-SD) and platelet distribution width (PDW) with angiographic coronary artery disease (CAD) severity, using the Gensini score, in adults undergoing coronary angiography for stable angina.

Methods: This single-centre cross-sectional study recruited 65 consecutive adults who underwent coronary angiography for stable angina at Mosul Cardiac Centre, Iraq, between January and August 2025. A Gensini score ≥32 defined severe CAD. Clinical and laboratory measurements, including RDW-SD and PDW, were compared by severity. Spearman correlation, logistic regression and receiver operating characteristic (ROC) analyses were performed.

Results: Severe CAD occurred in 29/65 patients (44.6%); 36 (55.4%) had mild-to-moderate disease. RDW-SD was higher in severe CAD (45.85 ± 6.36 fL) than in mild-to-moderate disease (42.41 ± 3.25 fL; p = 0.003). RDW-SD correlated with Gensini score (rs = 0.358; p = 0.003) and remained associated after adjustment (adjusted OR, 1.320 per unit; 95% CI, 1.055–1.651; p = 0.015). RDW-SD AUC was 0.710 (95% CI, 0.582–0.837). PDW did not differ (15.60 ± 1.50 vs 15.80 ± 1.30 fL; p = 0.452) and showed poor discrimination (AUC, 0.430). Severe CAD also had higher fasting glucose and white blood cell count.

Conclusions: In this single-centre study of stable angina, RDW-SD was related to the severity of CAD as defined by Gensini but not PDW in this sample. The discrimination of RDW-SD was limited-to-moderate. The preliminary results of this study need to be confirmed in a larger population before use in the clinic.