Baghdad Teaching Hospital Research Articles

Protective Health Behaviors among Critical Care Nurses Concerning Pressure Ulcer Prevention for Hospitalized Patients at Baghdad Teaching Hospitals

Background: Pressure ulcers remain a serious complication for immobile patients and a burden for healthcare professionals. Objectives: To assess health behavior prevention among critical care nurses regarding pressure ulcer prevention for hospitalized patients and to find out the relationship between critical care nurses health behavior prevention and sociodemographic variables. Methods: A cross-sectional design study was carried out in critical care units at three teaching hospitals. The study period extended from November 1, 2022, to January 28, 2023. Non-probability purposive sampling, whose target population was 100 nurses who work in critical care units in Baghdad, Iraq. The data were collected using a self-administered questionnaire. The data was collected from November 10th through December 23rd, 2022. Study instruments consist of two parts. First, the demographic sheet included sociodemographic information about the participants. The second part includes nurses’ attitudes toward the pressure ulcer prevention instrument (APuP). The collected data was analyzed using SPSS version 26. Results: Findings of the current study showed nearly three-quarters (74%) of critical care nurses had positive health behaviors regarding pressure ulcer prevention based on a total mean score of 2.26. Conclusion: This study concluded that the critical care units’ nurses surveyed in this study demonstrate an acceptable level of knowledge regarding pressure ulcer prevention and treatment. Continuing education or in-service training should be provided to enhance critical care units’ nurses’ practices and positive health behaviors about pressure ulcer prevention.

Carbapenem Resistance Mechanisms in Acinetobacter baumannii: Spotlight on OXA Genes

Acinetobacter baumannii is a highly problematic bacterium due to its multidrug-resistant nature and ability to rapidly develop resistance. Carbapenem-resistant A. baumannii (CRAB) is particularly concerning, recognized as a top priority pathogen by the World Health Organization (WHO). In this study, we aimed to assess the susceptibility of A. baumannii to antibiotics and characterize the presence of specific carbapenem resistance genes using PCR analysis. The study was conducted as a cross-sectional investigation at Al-Sader Medical City and Baghdad Teaching Hospitals between October 2022 and February 2023. A total of 59 A.baumannii isolates were collected from patients. To ensure accuracy in diagnosis, the isolates underwent thorough processing using morphological techniques, biochemical tests, and Vitek2 systems. The susceptibility of the isolates to 24 antibiotics was evaluated using the Kirby-Bauer method. Additionally, DNA extraction and PCR analysis were performed to detect the presence of carbapenem resistance genes. The study included analysis of 59 specimens collected from patients, including sputum, wound swabs, blood, and inguinal swabs. The majority of the isolates were obtained from in-patients, demonstrating a significant difference compared to outpatients. Among the studied isolates, the most prevalent carbapenem resistance gene detected was blaOXA51, present in 97% of the isolates. This highlights the substantial presence of blaOXA-mediated carbapenem resistance among A. baumannii strains in our study population. Furthermore, our findings revealed alarmingly high resistance rates against the majority of antibiotics commonly used to treat A. baumannii infections. Approximately 95% of the isolates were classified as extensively drug-resistant, indicating resistance to multiple classes of antibiotics. This poses significant challenges in terms of effective treatment options and emphasizes the urgent need for alternative strategies to manage A. baumannii infections.

Comparative Assessment of the Immunological Significance of Semaphorin 5A and Anti-Cyclic Citrullinated Peptide Antibodies in Iraqi Patients with Rheumatoid Arthritis

The objective of this research was to assess the predictive potential of Semaphorin 5A in comparison to Anti-Cyclic Citrullinated Peptide antibodies for forecasting disease progression and treatment responses among Iraqi patients with Rheumatoid Arthritis (RA). Conducted as a case-control study, the investigation encompassed a total of 150 participants, comprising 100 RA patients and 50 healthy individuals. The study took place at Baghdad Teaching Hospital over the period from November 2021 to February 2022. Enrolled participants were selected based on the 2010 criteria established by the American College of Rheumatology. The levels of biomarkers were assessed using the enzyme-linked immunosorbent assay (ELISA) method. The findings demonstrated a noteworthy elevation in the levels of both ACCP and Semaphorin 5A among RA patients compared to the control group (p<0.001). Furthermore, these levels were found to be higher in individuals with active disease as opposed to those with inactive disease. In both active and inactive disease states, the levels of both ACCP and Semaphorin 5A remained considerably higher compared to the levels observed in the healthy control group (p<0.001). In patients who had not undergone treatment, the levels of both ACCP and Semaphorin 5A exhibited considerably greater significance compared to those who received Methotrexate or etanercept (p<0.001). A noteworthy and positive correlation was observed between ACCP and Semaphorin 5A, with a correlation coefficient of 0.476 (p<0.001). The sensitivity for ACCP and Semaphorin 5A was determined to be 72% and 83% respectively, while the specificity values were 98% and 76%. The study's conclusion highlighted the promising prognostic potential of both ACCP and Semaphorin 5A, establishing them as potential biomarkers for distinguishing between Rheumatoid Arthritis patients and healthy individuals. Predict disease activity and response to methotrexate or etanercept. Active disease patients and without treatments patients ACCP and Semaphorin5A levels were higher than inactive and received treatments (methotrexate or etanercept).

Serum level of certain cytokines associated with psoriasis progression in Iraqi patients

Introduction and Aim: Psoriasis is a skin ailment that typically affects the scalp, lower back, knees, elbows, and results in flaky skin patches. The purpose of this study was to compare cytokines, leptin, and adiponectin levels, as well as several physiological characteristics, in psoriasis patients with and without treatment to levels in healthy people in Iraq. Materials and Methods: The study included 310 subjects, males and females aged (25-65) years. The patients were attending a dermatology consultant at Al-Yarmouk Teaching Hospital in Baghdad. Blood samples were collected by venipuncture from all individuals. The Sandwich ELISA was used to estimate serum levels of IL-2, IL-8, IL-22, TNF-alpha, IFN-gamma, ADP and Leptin. Results: Patients with psoriasis had considerably decreased lymphocyte and RBC counts while having significantly higher neutrophil, platelet, NLR, and PLR counts. WBC mean values in females and males among control groups were 7.16 ± 3.09x 103/µl and 8.6 ±3.62 x103/µl respectively. In psoriasis patients the WBC counts varied from 3.69 x103/µl to 12.8 x103/µl with a mean of 7.27 x 103/µl in female patients and from 6.47 x 103/µl to 13.62 x103/µl in males. Serum levels of cytokines, leptin and adiponectin were significantly higher in Group I patients, while in Group II it was almost like levels in the control group. Conclusion: Smoking is a risk factor for psoriasis. Lymphocytes, erythrocytes, and hemoglobin levels are decreased in patients with psoriasis, while platelets and cytokines are elevated, signifying a relationship between these immunological parameters and development and severity of psoriasis disease.

257 Postoperative Pain, Analgesic Choices, and Ileus: A Snapshot From a Teaching Hospital in a Developing Country

Abstract Aim In this study, we looked at the severity of postoperative pain, the type of analgesics used to control the pain, and the incidence of POI at Baghdad Teaching Hospital. We hypothesized that we would find an association between the type of analgesia used and POI. Method This observational study was conducted among 100 patients who were residents at the general surgery wards of Baghdad Teaching Hospital. A structured questionnaire was employed focusing on types of analgesics, degree of pain control, and the presence of ileus. Results Sixty-nine percent of patients received a combination of opioids and non-opioids. Moderate-to-severe pain was the most commonly reported category on pain scales. More than half of the patients (57%) were found to have POI during their hospital stay and there was a statistically significant association between the type of analgesia and POI development ( p = 0.001). Conclusions A mix of analgesics (opioids and non-opioids) was the most common regimen at our centre. The majority of the surgical inpatients reported having moderate-to-severe pain on both pain scales used in this study. Ileus incidence following abdominal surgeries (61%) was significantly higher than the reported incidence worldwide (10-30%). Postoperative ileus has multifactorial causes, one of which is the use of opioids for pain control. Considering the high incidence of ileus in our center and the association we found between the use of opioids and ileus, further studies should look at the doses of opioids used and whether alternative analgesic methods might result in less ileus.

The Role of CX3CL1-CX3CR1 Axis, C3, C4 & ESR Abs in pathogenicity of Iraqi patients with SLE

Background: Systematic Lupus erythematosus (SLE) has been described as a chronic inflammatory illness where chemokines play an essential role in its pathogenesis CX3CL1and CX3CR1 are chemokines that described their crucial role in immune response in SLE patients. Aim of the study: To evaluate the serum level of CX3CL1- CX3CR1, C3, C4 & ESR Abs in SLE patients without treatment and compare their level with those under treatment (hydroxychloroquine,predeslone 5-20mg, D3). Patients collecting and Methods: 120 females with SLE and healthy, with ages ranging between 20-40 years, were involved in this investigation from Medical City (Consultant of Arthritis, Consultant of Dermatology, Lobby of Hematology and Arthritis)/ Baghdad Teaching Hospital and from Al-Imameen Al-Kazimeen Teaching Hospital from August 26 to October 18, 2021. The samples included 80females with SLE (40 females as early diagnosed patients (G2) without treatment, 40 females as patients that received treatment subjects (hydroxychloroquine, predeslone 5-20mg, D3) (G3), while the control group included 40 healthy females (G1). Five mL of venous blood were obtained from patients and healthy females for measuring C3, C4, ESR and serum levels of CX3CL1 and CX3CR1, which were measured using the ELISA method. Results: Our findings demonstrated a significant increase in the serum levels of CX3CL1, CX3CR1, and ESR. Also, there were significant decreases in serum levels of C3 and C4 in SLE patients (with and without treatment) compared to the control group, and a significant difference was detected between SLE patients without treatment and patients receiving treatment. Conclusion: Based on our results, CX3CL1 and CX3CR1 chemokines may have a role in the pathogenesis of SLE as they are increased in SLE patients. In addition, serum CX3CL1 levels can be used as an independent biomarker of SLE activity. Furthermore, low levels of c3 and c4 and high levels of ESR are considered diagnostic indicators of SLE disease in people. Keywords: Systemic lupus erythematosus, CX3CL1; CX3CR1. C3,C4

Unmasking the Resistance: Detecting Carbapenem Genes in Acinetobacter baumannii Isolated from some Hospitals in Najaf and Baghdad

Acinetobacter baumannii is a multidrug-resistant bacterium associated with nosocomial infections and known for its ability to develop resistance rapidly. Carbapenem-resistant A. baumannii (CRAB) is a top priority pathogen according to the World Health Organization (WHO). We focused on evaluating the susceptibility of A. baumannii to antibiotics, detecting carbapenemase enzymes using the modified Hodge test, and characterizing the presence of specific carbapenem resistance genes using PCR analysis.This cross-sectional study took place at Al-Sader Medical City and Baghdad Teaching Hospitals from October 2022 to February 2023. It involved 59 A. baumannii isolates collected from patients. The isolates were obtained and processed for accurate diagnosis using morphological techniques, biochemical tests, and Vitek2 systems. The Kirby-Bauer method was employed to assess the susceptibility of the isolates to 24 antibiotics. DNA extraction and PCR analysis were conducted to detect carbapenem resistance genes, 59 specimens from patients, including sputum, wound swabs, blood, and inguinal swabs were analyzed. The majority of isolates were from in-patients, showing a significant difference compared to outpatients. Our finding revealed that among the studied isolates, blaSPM was the most prevalent gene, detected in 50% of the isolates. This indicates a significant presence of blaSPM-mediated carbapenem resistance among A. baumannii strains in our study population.Furthermore, our findings demonstrated alarmingly high resistance rates against the majority of antibiotics commonly prescribed to treat A. baumannii infections. A striking 95% of the isolates were classified as extensively drug-resistant, indicating resistance to multiple classes of antibiotics. This poses significant challenges for effective treatment options and underscores the urgent need for alternative strategies in managing A. baumannii infections.

Effect of Using Midazolam and Propofol in Low Doses for Intraoperative Nausea and Vomiting Prevention in Pregnant Women Underwent Cesarean Section under Regional Anesthesia

Aim: To investigate if and how severe intraoperative nausea and vomiting occur following elective cesarean sections performed under spinal anesthesia using sub-hypnotic dosages of midazolam and propofol.
 Study Design: Clinical trial.
 Methodology: The current study was conducted at the Gynecology and Obstetrics Department of a Teaching Hospital in Baghdad, Iraq. The study included 90 full-term pregnant women with single viable fetuses who underwent elective C/S by spinal anesthesia and were randomly assigned to one of three groups: group A included 30 women who received propofol, group B included 30 women who received midazolam, and Group C included 30 women who received placebo. The Bellville scoring score was used to assess nausea and vomiting. The Richmond Agitation Sedation Score (RASS) was used to assess sedation intraoperatively.
 Results: Patients in group C had the highest prevalence of nausea and vomiting (56.7%), which was significantly different from groups A (16.7%, P=0.001) and B (13.3%, P=0.001); however, there was no statistically significant difference between groups A and B (P= 0.717). The group B patients had the highest prevalence of drowsiness (20%), which was substantially different from group C (3.3%, P=0.044), whereas there were no statistically significant differences between groups A and B (P= 0.278) or A and C (P= 0.3).
 Conclusion: Low doses of midazolam or propofol administered after cesarean section (after the umbilical cord has been clamped) can lessen intraoperative nausea and vomiting without significantly lowering blood pressure or heart rate, with midazolam being more effective than propofol in this regard.

Correlation between Neonatal Outcomes and Maternal Anemia among Attending Pregnant Women in Al-Elwiya Maternity Teaching Hospital.

Anemia in pregnancy can considerably elevate the maternal mortality risk and can negatively distress the development of fetus. To assess the association between neonatal outcomes and maternal anemia (MA) among pregnant women (PW). The present work is a clinical prospective one performed at Al-Elwiya Maternity Teaching Hospital in Baghdad from January 1, 2022 to June 30, 2022. Current study selected 120 term PW with anemia admitted to hospital for caesarian section. Data were collected as a questionnaire. The data were directly taken from PW. The acquired data from anemic PW were distributed as followings: Age of anemic PW, which was classified into two groups; 25-29 years and 30-35 years. The gestational age of anemic PW, which was categorized into three groups; 37th week, 38th week, and 39th week of gestation. Anemia characteristics were studied, which included hemoglobin level (Hb) and packed cell volume test (PCV), which were done by taking 5 ml blood from each PW for s. ferritin, s.iron, Hb level, and blood film in laboratory of Al-Elwiya Maternity Teaching Hospital. The Hb helped in detecting anemic PW joined this study, as Hb was <10.5 g/dl at third trimester. Mean gestational age (GA) of anemic PW was 37.5 ± 0.5 weeks; 58.3% of them were at 37th week, 39.2% of them were at 38th week, and 2.5% of them were at 39th week GA. So, the mean Hb of anemic PW was 8.6 ± 1.3 mg/dl, and the mean PCV was 28.6 ± 3.6%. Anemia was classified into mild (20%) and moderate (72.5%); also, mean ultrasound fetal head circumference (HC) among PW with mild anemia was 32.3 cm and for PW with moderate anemia was 32.1 cm, and mean ultrasound fetal abdominal circumference (AC) for PW with mild anemia was 31.3 cm and with moderate anemia was 31 cm, and validity results of MCA/UA-PI ratio regarding severe anemia of anemic were as follows: sensitivity (81.8%), specificity (79.8%), +ve predictive value (29%), -ve predictive value (97.8%), and accuracy (80%). The gestational mean age (GA) of anaemic PW was 37.50.5 weeks; 58.3% of them were in the 37th week and 39.2% were in the 38th week. Thus, the mean ultrasound foetal head circumference (HC) was 32.3 cm for PW with mild anemia and 32.1 cm for those with moderate anaemia. The mean ultrasound foetal abdominal circumference (AC) was 31.3 cm for those with mild anaemia and 31 cm for those with moderate anaemia, but 30 cm for those with severe anaemia, with no discernible difference. The following were the MCA/UA-PI ratio's validity findings for severe anaemia of anaemic: sensitivity (81.8%) and specificity (79.8%).

The Relationship between Levels of Serum Vit. D and Kidney Function in Diabetic Nephropathy Iraqi Patient

Background: According to several animal and human studies, Vitamin D appears to play a substantial role in the development of diabetic nephropathy, However, the possibility of vitamin D's Reno protective impact and influence on the reversal of already-existing renal damage remains speculative. Vitamin D deficiency and insufficiency are ubiquitous worldwide and have been linked to a variety of pathophysiological conditions, including diabetes, allergies, autoimmune illnesses, pregnancy difficulties, and, more recently, worse COVID-19 clinical outcomes. From a translational perspective, the goal of this review is to look into the potential function of vitamin D in the development of diabetic kidney diseases Aim of the study: to evaluate the role of vit. D on renal function in patients with DMT1. Patient and Method: The total number of study participants was 120, divided into three groups: Group A: Included 40 patients have DM with NP (stage1, stage 2, stage 3a), Group B included 40 patients who had DM without NP, and group C included 40 healthy participants (control). Samples were taken from the Diabetic control clinic of Endocrinology and Diabetes Center/Al-Kindy Hospital, Baghdad Teaching Hospital/ Medical City, and Al-Shaheed Al-Sadder General Hospital during the period from October 2021 to March 2022. Result: Statistically significant weak positive correlations were detected between vitamin D and GFR (r= 0.321, P= 0.001); while a significant moderate negative correlation was seen between vitamin D and HbA1c (r= -0.494, P= 0.001) and weak negative correlation was seen with B. Urea (r= -0.2, P= 0.028). No statistically significant correlations were detected between vitamin D and all of age, DM duration, and s. creatinine. Conclusion: Our data suggest a correlation between reduced levels of vitamin D3 and diabetes nephropathy and it may be a potential predictor for both the occurrence and severity of diabetic nephropathy

Effect of small-interfering RNA (As1974) and HFq-binding proteins on resistance gene and host microRNA (miR-30C) expression in Pseudomonas aeruginosa-infected patients from Iraq

Abstract Background: MicroRNAs (miRNAs) are a class of small RNAs encoded by the genome that regulate the production of cellular mRNAs that include either incomplete or complete miRNA-binding sites. Objectives: To evaluate the impact of sRNA (As1974) and HFq-binding proteins on the expression of resistance gene and host miRNA (miR-30C) in Iraqi urinary tract infections (UTIs) patients infected with Pseudomonas aeruginosa. Materials and Methods: Patients with UTIs from Baghdad, Iraq’s Baghdad Teaching Hospital, Ghazi Hariri Hospital, Central Laboratories in Medical City, and Al-Yarmouk Hospital were recruited during June 2022 and October 2022 to provide 200 clinical samples. Results: Out of 200 patients with UTIs, only 56 (38.14%) were diagnosed as P. aeruginosa from positive urine samples. Urine samples were analyzed for HFQ gene expression, and the results showed that HFQ is overexpressed in P. aeruginosa-resistant samples compared to sensitive clinical samples, as measured by fold change after normalization with housekeeping gene 16sRNA by folding (21.4971.241 vs. 1.92142 0.04598). Furthermore, normalization of As1974 gene expression in urine samples using 16sRNA revealed a downregulation of As1974 in resistance, with a fold change of 0.66220.0465 versus 2.0121.0243. The miR-30 gene was shown to be downregulated in urine and blood samples (1.360.34, 0.478210.03678) as compared to those of healthy subjects. Conclusions: All ages were susceptible to the UTIs, also females suffered from UTIs more than males. A significant over expression of HFQ-binding protein in P. aeruginosa compared to sensitive clinical samples. Downregulation of As1974 in resistance.

Evaluation of Nurses’ Practices and Perceived Barriers Related to Pain Assessment in Critically Ill Patients at Baghdad Teaching Hospitals

Introduction: Inadequate pain assessment and management is a problem in hospitalized patients that impairs their wellbeing. Intensive care unit nurses’ pain practices are affected by several barriers and enablers. Objectives: The objectives of this study were to determine the level of nurses’ practices and perceived barriers related to pain assessment in critically ill patients. Methodology: A cross-sectional design study was used. Purposive sampling technique was employed, including 100 nurses recruited from 8 intensive care units in Baghdad city, Iraq. The study was conducted from September 1st to October 20th, 2022. The pain assessment and management for critically ill patients survey was used to collect data. Descriptive statistics, Spearman correlation, and chi-square tests were used to analyze the data. Results: The findings of the current study indicate that nearly half (49%) of the respondents were in the age group of 28-37 years old, with a mean age of 33.73 ± 7.045 years. Three-quarters of the respondents were males and the rest were female. The majority (63%) of the respondents held a bachelor’s degree in nursing. More than three-quarters (76%) of the respondents were married. The majority (31%) of the respondents had 6-10 years of service experience in nursing, and most of them had 1-5 years of experience as a nurse in the intensive care unit. Finally, a high percentage of nurses had training courses about pain assessment and management. Conclusions: This study allowed us to recognize the nurse’s practices and the barriers to effective pain assessment and management. The analysis showed that critical care nurses had an acceptable practice level related to pain assessment and management in critically ill patients. Insufficient numbers of nursing staff, workload, and poor communication were identified as common factors that negatively influenced effective pain management.

Assessment of Risk Factors of Chronic Kidney Disease among Patients Attending Medical City Complex

Chronic kidney disease is a worldwide health problem that is defined as structural abnormalities or progressive or permanent loss of renal function for 3 months or more, which is usually associated with a decrease in glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 or persistent proteinuria, which can lead to end-stage renal disease (ESRD) or kidney failure. To assess the risk factors leading to chronic kidney disease among the patients between cases and controls in the Medical City Complex. The study was conducted in hospitals of the medical city complex (Baghdad Teaching Hospital, Nursing Home Private Hospital, Ghazy Al-Hariri Hospital for Surgical Specialist, and kidney diseases and Transplant Center) in Baghdad, Iraq, and was designed as a case-control. There were 300 participants (150 cases and 150 controls). Data was collected over five months. The findings show that the highest percentage (20%) was within the age group 50–59 years old in the case study group, with a mean age of patients and controls of 47.71 ± 17.42 and 48.54 ± 17.43 years, respectively, and there were significant sociodemographic risk factors for CKD with gender and residency (p. value &lt; 0.05). There was a significant link between medical history and the outcome of this investigation (p. value &lt; 0.05 and OR &gt; 1) All of the risk factors for CKD were hypertension, acute kidney disease, HCV infection, hyperlipidemia, renal stones, anemia, and cardiovascular disease. alcohol consumption had a significant difference with CKD (p. value =0.004). Increased intake of antihypertensive medical drugs also increases the risk of CKD (p. value =0.000). There is a significant association between patients' gender and residence, the patients with hypertension, AKI, HCV infection, hyperlipidemia, renal stones, anemia, and CVD had a significant relationship with CKD. The risk of CKD is increased in people who have had alcoholism and also in patients who have taken antihypertensive medication, The study recommends educating people about the risk factors of CKD, encouraging them to adopt a healthy diet, and healthy lifestyle, and encouraging alcohol cessation through special programs. The GFR test and other routine clinical tests must be performed regularly to monitor the change in kidney functions.

Molecular detection of mononucleotide biomarkers of microsatellite instability in sporadic colorectal carcinoma patients with clinicopathological correlation

Objectives: To identify the frequency and types of microsatellite instability among a group of sporadic CRC patients and to correlate the findings with clinicopathological characteristics.&#x0D; Methods: During an 8-month period, all patients with sporadic CRC who attended to two teaching hospitals in Baghdad, Iraq were recruited to this cross-sectional study regardless of age, sex, ethnicity, or tumor characteristics. Demographic, clinical, and histopathological features were recorded. DNA was extracted from FFPE-blocks of the resected tumors and normal tissues. PCR amplification of five microsatellite mononucleotide repeat loci (BAT25, BAT26, NR-21, NR-24, and MONO-27) and 2 pentanucleotide repeat control markers (Penta C and Penta D) was performed to determine the MSI status. Capillary electrophoresis and Genetic Analyzer 3500 (Applied Biosystem, Japan) were used to separate and examine the products. Data were analyzed by Genescan software (Promega, USA). Instability of two or more loci is considered MSI-H.&#x0D; Result: In this study, ages of the 45 recruited patients ranged between 20-80 years, with a mean±SD of 55±12.3 years; of them, 31(68.9%) were ≥50 years; 25 (55.6%) were males. Rectal bleeding was the most frequent presenting feature [22 (48.9%)] patients; 23 (51.1%) of CRCs were located at recto-sigmoid region, 29 (64.4%) were T3 tumors, 34(75.5%) were non-mucinous adenocarcinoma, 39(86.7%) were moderately differentiated, 17 (37.8%) patients had stage III tumors; and 25 (55.5%) had lymphovascular invasion. MSI-H was seen in 5/45 (11.1%) patients; 3(60%) of them were ≥50 years, 4(80%) were males, 3(60%) were smokers, 2 (40%) presented with intestinal obstruction and altered bowel habits each; 4(80%) had T3 tumors, 3(60%) had mucinous adenocarcinomas [p=0.004], 2(40%) had stage II tumor and stage III each.&#x0D; Conclusion: The frequency of MSI-H among the recruited patients with CRC was 5/45 (11.1%) and it was significantly associated with mucinous adenocarcinoma subtype. NR-24 and NR-21 were the most prevalent instable markers.

A case series of gyrus rectus arteriovenous malformation: Clinical characteristics, angioarchitecture, microsurgical treatment, and outcome.

Gyrus rectus arteriovenous malformation (AVM) is one of the intricate pathologies that can lead to gyrus rectus hematoma. However, there is a paucity of research on this topic. This case series aims to delineate the characteristics of gyrus rectus AVMs, their outcomes, and treatment strategies. We enrolled five cases of gyrus rectus AVM that presented to the Neurosurgery Teaching Hospital in Baghdad, Iraq. Patients with the presence of gyrus rectus AVM were analyzed according to the demographic data, clinical status, radiological imaging, and outcome. Of the total cases enrolled, all five cases were ruptured at the presentation. Most of the AVMs had arterial feeders from the anterior cerebral artery (80%) and superficial venous drainage through the anterior third of the superior sagittal sinus occurred in four cases (80%). Two of the cases were classified as Spetzler-Martin grade 1 AVMs, two were grade 2, and one was grade 3. With regard to the modified Rankin Score (mRS), four of them had a score of 0 after observation for 30, 18, 26, and 12 months, respectively, while one patient had an mRS score of 1 after 28 months of observation. All five cases presented with seizure and were all treated by surgical resection. To the best of our knowledge, this is the second report documenting the features of gyrus rectus AVMs and the first one from Iraq. Further, research into gyrus rectus AVMs is required to help better characterize and enhance our knowledge on the outcomes of such lesions.

Tooth wear in relation to physical salivary characteristics among gastroesophageal reflux disease

Background: Gastroesophageal reflux disease, is a quite prevalent gastrointestinal disease, among which gastric content (excluding the air) returns into the oral cavity. Many 0ral manifestations related t0 this disease include tooth wear, dental caries also changes in salivary flow rate and pH. This study was conducted among gastroesophageal reflux disease patients in order to assess tooth wear in relation to salivary flow rate and pH among these patients and the effect of gastroesophageal reflux disease duration on this relation. Materials and methods: One hundred patients participate in this cross-sectional study for both genders and having an age range of 20-40 years old, patients had been endoscopically identified as having gastroesophageal reflux disease using the classification of Los Angeles (LA), who were attending the Gastroenterology and Hepatology Teaching Hospital in Baghdad. and divided into two groups: group A with grade severity mucosal breakage not longer than 5 mm and Group B with grade severity mucosal breakage more than 5 mm long, Smith and Knight (1984) tooth wear index criteria were used for the assessment of tooth wear. For measurement of salivary flow rate and pH, saliva sample (unstimulated) had been collected. Results: Of the entire sample (90%) were having tooth wear. Tooth wear was higher in grade B severity than in grade A severity among patients with gastroesophageal reflux disease duration of two years or less, while it was higher in grade A than in grade B among patients with a duration of more than two years but all these results were statistically non-significant. Salivary flow rate and pH showed a non-significant reduction with increasing gastroesophageal reflux disease severity for both of groups concerning disease duration. The correlation of total tooth wear with salivary flow rate and pH was a significantly weak negative correlation in grade A, while a nonsignificant weak negative correlation in grade B. Conclusions: The findings of the present study concluded that patients with gastroesophageal reflux disease recorded a high occurrence of tooth wear and there was a negative correlation of tooth wear with salivary flow rate and pH among patients with gastroesophageal reflux disease.

Role of genetic variation in Toll like receptor-5 with rheumatoid arthritis pathogenicity in Iraqi patient

Background: Rheumatoid Arthritis (RA) is a persistent inflammatory condition characterized by the immune system’s improper attack of bodily tissues. Rheumatoid arthritis is a chronic autoimmune disorder that impacts the synovial membrane of joints, leading to an inflammatory response characterized by painful swelling. Over time, this condition can progress to the erosion of bone tissue and the development of joint deformities. Aim: characterized the primary objective of the present study was to evaluate the impact of certain variations in the TLR5 gene (namely, rs2072493 and rs45508499) on the severity of Rheumatoid Arthritis among patients from Iraq. Materials and methods: Approximately similar samples from apparently healthy individuals are enrolled as control. The patients attended from April to June 2022 at the Baghdad teaching hospital / medical city /Baghdad / Iraq. It was based on a clinical examination . The single nucleotide polymorphisms (rs2072493 T/A, C, and rs45508499A/G) are examined using the Tetra ARAMS technique. All (SNPs) from the control person are analyzed in the Chi-square test. Results: The analysis revealed a significant association between the rs45508499 polymorphism and the trait of interest. However, no significant association was observed for the rs2072493 polymorphism. Conclusion: The current investigation showed that the presence of TLR5 polymorphism at rs4550899 was associated with RA but rs2072493 was not associated with any effect on the susceptibility to Rheumatoid arthritis .

Using the ABCD2 Scale and Other Risk Factors to Predict the Risk of Permanent Stroke after Temporary Stroke.

A temporary ischemic attack (TIA) is described as an immediate loss of localized cerebral and ocular function that lasts for 24 hours and is thought to be caused by embolic or coagulant vascular disease after thorough evaluation. Objective: our study examined the role of ABCD2 alongside additional risk variables in the capacity to predict the development of TIA to stroke. Methods: Cross-sectional research was conducted over a 12-month period, from 12 January 2021 to 24 September 2022, at the emergency department of Baghdad Teaching Hospital, Medical City Complex, which is Baghdad, Iraq. The Department of Emergency Medicine at Baghdad Teaching Hospital and the Emergency Medicine Council on the Arab Board approved the study protocol, which includes a questionnaire for gathering information about the population of interest (name, age, occupation, address, medical condition, smoking, drug use, weight gain, symptoms and signs, examinations, and all medical records) and the outcomes that were considered. The selection of patients was based on the criteria for inclusion and exclusion that were determined. Before including any patients in the study, verbal agreement was acquired from each one of them. Results: In this study, 150 stroke patients were included, of whom 94 (62.7%) had no subsequent transient ischemic attack (TIA), and 56 (37.3%) did. According to the study, stroke struck 30 TIA patients (53.6%) in less than a week as opposed to 26 (46.4%) in a period of seven days or more (P 0.001). Conclusion: Stroke is more likely to occur in TIA patients who have ABCD2 values of greater than three during seven days of the TIA. In this study, we discovered a strong relationship between weight and a high ABCD2 score as opposed to a low score. The number of antihypertensive medications has also been linked to a high ABCD2 score, which is independently linked to an increased likelihood of stroke post-TIA.

Pharmacist Intervention to Address Drug Related Problems in Patients with Decompensated Liver Cirrhosis

Background: Patients with decompensated cirrhosis are often given therapeutic and prophylactic drugs. Polypharmacy raises both the likelihood of prescription errors and the complications associated with drugs. Clinical pharmacists are excellent at recognizing, addressing, and preventing clinically significant drug-related problems. Objectives: Identification types of pharmacist interventions to address drug-related problems in patients with decompensated cirrhosis and assess the acceptance/implementation of these recommendations. And identify patient factors associated with accepting pharmacist recommendations. Subjects and Methods: Prospective, interventional, clinical study for 80 hospitalized decompensated cirrhosis patients was conducted at Baghdad Teaching Hospital and lasted for four months, from the first of December 2021 until the last of March 2022. The study involved two phases, the first one was observational to identify drug-related problems and classify them according to the Pharmaceutical Care Network Europe classification version 9.1, and the second phase was interventional to increase the awareness of patients and health care providers about those problems and to propose a proper solution for each one. Results: The most frequent pharmacist intervention was proposed to the prescriber (54.7%), followed by speaking to the caregiver (37.7%). Acceptance and full implementation were highly observed in 71.1% of the intervention. There is a significant association between occurring ascites and bleeding in patients and accepting/implementing pharmacist recommendations Conclusions: Patients with decompensated liver cirrhosis have a significant prevalence of drug-related problems. Clinical pharmacists are excellent at recognizing drug-related problems and reducing their incidence, and their interventions were well accepted.

A novel Link of Serum IL-39 Levels in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory condition causing joint pain and stiffness, with often debilitating and life-limiting consequences. Recently, a new B-cell secreted cytokine, IL-39, was identified in mice. The most up-to-date research indicates that although IL-39 is expressed in murine models of lupus and has a role in mediating the inflammatory response in this context, there is no solid, replicated evidence of the existence of IL-39 in humans. This study aimed to clarify the existence and role of IL-39 in the human body and to elucidate whether it plays a role in rheumatoid arthritis. Accordingly, serum samples were collected from 66 patients with rheumatoid arthritis who were under therapy and from 66 healthy controls attending the Baghdad Teaching Hospital Rheumatology Unit. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of IL-39. Our results showed that mean ages of RA patients were 46.48 ± 10.17 years, and for healthy controls 44.97 ± 11.658 years. The results revealed that serum IL-39 levels were significantly lower in RA patients (p = 0.016) (4.95 ± 1.1001) compared to healthy controls (5.55 ± 1.762). Corresponding sensitivity of IL-39 was 56.1%and specificity was 60.6% at cutoff values of ≤ 4.99 ng/ml. In Conclusion, IL-39 is found in humans but is downregulated in rheumatoid arthritis patients. This suggests either that IL-39 can have both pro- or anti-inflammatory functions based on the underlying disease or that the role of IL-39 is masked by the effects of treatment.