Assessment of antimicrobial drugs employed at government-operated hospitals in central and northern provinces of Iraq.

OBJECTIVE: Aim: To document the clinical patterns of antibiotic prescriptions in government hospitals, where the majority of physicians possess a degree-based training. PATIENTS AND METHODS: Materials and Methods: A Retrospective cross section study carried out between 1/7/2022 and April 2023 that enrolling 300 patients from governmental hospitals from different provinces of Central and northern Iraq. The research form contained 15 fields divided into three sections. The first section contains social information such as age, gender, field of work, Residence and education. The second part consists of diagnosis and lab. Finding. The third part related to antibiotic uses: Number of AB prescribed, duration of using, type of use, route of administration, AB interaction, dose administration of AB, indication of Ab, and Class of AB. RESULTS: Results: A total of 300 eligible patients, 165 patients (55.0%) were male and 135 (45.0%) were female, patients were <20 years ages were 117 (39.0%), 25 (8.3%) from the 20-29 years age group, 40-49 years ages were 28 (9.3%) and >50 years ages were 105 (35.0%) were which belong to the pediatric population. The 198 patients (66.0%) were used cephalosporins and 106 (53.5%) of them used alone. A 13-19% percentage of patients had used penicillin, carbapenem, anti-fungal, and aminoglycoside in combination form. CONCLUSION: Conclusions: The implementation of clinical guidelines, the provision of direct instruction, and the regular dissemination of antibiogram data have the potential to encourage a more judicious consumption of antibiotics.

Causes and management of Pica disorder among central Iraqi peoples.

OBJECTIVE: Aim: To find the causes and factors behind the Pica disorder, which helps in early diagnosis and appropriate treatments.. PATIENTS AND METHODS: Materials and Methods: A retrospective cross-section study was carried out between July 1, 2022, and April 20, 2023, enrolling 300 patients from different provinces of central and south Iraq with Pica disease whose diagnosis depended on specialized physicians according to WHO guidelines. The participants were following up for three to six months in private clinics. RESULTS: Results: 92.4% of the patients were female, and 41% of patients were under 20 years old, with low ferritin, HB, and vitamin D levels (80% of cases), and these markers showed a negative correlation with the number of Pica. Chowing of ice and clay were the common types of Pica, which represent about 30% each, while 34% of cases had multiple types, which had signs and symptoms of fever, palpitation, vomiting, abdominal pain, paleness, headaches, and hair loss. Six-month flows were better than three months. CONCLUSION: Conclusions: Pica was a disorder that could lead to behavior and emotional abnormalities that caused the patients to eat some things that were eaten by healthy people. This may be, as concluded from our results, due to reduced levels of ferritin, hemoglobin (Hb), and vitamin D that caused these psychological problems.

Parkinson's Disease and MicroRNAs: A Duel Between Inhibition and Stimulation of Apoptosis in Neuronal Cells.

Parkinson's disease (PD) is one of the most prevalent diseases of central nervous system that is caused by degeneration of the substantia nigra's dopamine-producing neurons through apoptosis. Apoptosis is regulated by initiators' and executioners' caspases both in intrinsic and extrinsic pathways, further resulting in neuronal damage. In that context, targeting apoptosis appears as a promising therapeutic approach for treating neurodegenerative diseases. Non-coding RNAs-more especially, microRNAs, or miRNAs-are a promising target for the therapy of neurodegenerative diseases because they are essential for a number of cellular processes, including signaling, apoptosis, cell proliferation, and gene regulation. It is estimated that a substantial portion of coding genes (more than 60%) are regulated by miRNAs. These small regulatory molecules can have wide-reaching consequences on cellular processes like apoptosis, both in terms of intrinsic and extrinsic pathways. Furthermore, it was recommended that a disruption in miRNA expression levels could also result in perturbation of typical apoptosis pathways, which may be a factor in certain diseases like PD. The latest research on miRNAs and their impact on neural cell injury in PD models by regulating the apoptosis pathway is summarized in this review article. Furthermore, the importance of lncRNA/circRNA-miRNA-mRNA network for regulating apoptosis pathways in PD models and treatment is explored. These results can be utilized for developing new strategies in PD treatment.

Dendritic cell-derived exosomes (Dex): Underlying the role of exosomes derived from diverse DC subtypes in cancer pathogenesis.

Exosomes are nanometric membrane vesicles of late endosomal origin that are released by most, if not all, cell types as a sophisticated means of intercellular communication. They play an essential role in the movement of materials and information between cells, transport a variety of proteins, lipids, RNA, and other vital data, and over time, they become an essential part of the drug delivery system and a marker for the early detection of many diseases. Dendritic cells have generated interest in cancer immunotherapy due to their ability to initiate and modify effective immune responses. Apart from their cytokine release and direct interactions with other cell types, DCs also emit nanovesicles, such as exosomes, that contribute to their overall activity. Numerous studies have demonstrated exosomes to mediate and regulate immune responses against cancers. Dendritic cell-derived exosomes (DCs) have attracted a lot of attention as immunotherapeutic anti-cancer treatments since it was found that they contain functional MHC-peptide complexes along with a variety of other immune-stimulating components that together enable immune cell-dependent tumor rejection. By enhancing tumor and immunosuppressive immune cells or changing a pro-inflammatory milieu to inhibit tumor advancement, exosomes generated from dendritic cells can initiate and support tumor growth. This study reviewed the immunogenicity of dendritic cell-derived exosomes and strategies for expanding their immunogenic potential as novel and effective anti-cancer therapies.

Natural killer cell-mediated immune surveillance in cancer: Role of tumor microenvironment.

In the immunological surveillance against cancer, natural killer (NK) cells are essential effectors that help eradicate altered cells. The complex interactions that occur between NK cells and the tumor microenvironment (TME) are thoroughly examined in this review. The review examines how cytokine stimulation affects NK cell activation, focusing on the dynamic modulation of NK cell function within the TME. It looks at NK cell-related biomarkers such as PD-1/PD-L1, methylation HOXA9 (Homeobox A9), Stroma AReactive Invasion Front Areas (SARIFA), and NKG2A/HLA-E, providing critical information about prognosis and treatment outcomes. The changing landscape of immunotherapies-including checkpoint inhibitors, CAR-NK cells, and cytokine-based interventions-is examined in the context of enhancing NK cell activity. The review highlights the potential pathways for precision medicine going forward, focusing on customized immunotherapies based on unique biomarker profiles and investigating combination medicines to produce more robust anti-tumor responses.

Recent progress and the emerging role of lncRNAs in cancer drug resistance; focusing on signaling pathways.

It is becoming more and more apparent that many of the genetic alterations associated with cancer are located in areas that do not encode proteins. lncRNAs are a class of RNAs that do not code for proteins but play a crucial role in maintaining cell function and regulating various cellular processes. By doing this, they have recently introduced what may be a brand-new and essential layer of biological control. These have more than 200 nucleotides and are linked to several diseases; as a result, they have become potential tools for therapeutic intervention. Emerging technologies suggest the presence of mutations on genomic loci that give rise to lncRNAs rather than proteins in a disease as complex as cancer. These lncRNAs play essential parts in gene regulation, which impacts several cellular homeostasis processes, including proliferation, survival, migration, and genomic stability. The leading cause of death in the world today is cancer. Delays in diagnosis and a lack of standard and efficient treatments are the leading causes of the high death rate. Clinically, surgery is frequently used successfully to remove cancers that have not spread, but it is less successful in treating metastatic cancer, which has a drastically lower chance of survival. Chemotherapeutic drugs are a typical therapy to treat the cancer that has spread to other organs. Drug resistance to chemotherapy, however, presents a significant challenge to achieving positive outcomes and is frequently the cause of treatment failure. A substantial barrier to progress in medical oncology is cancer drug resistance. Resistance can develop clinically either before or after cancer treatment. According to this study, lncRNAs influence drug resistance through several different methods. LncRNAs often impact drug resistance by controlling the expression of a few intermediary regulatory variables rather than by directly affecting drug resistance. Additionally, lncRNAs have a variety of roles in cancer medication resistance. Most lncRNAs induce drug resistance when overexpressed; however, other lncRNAs have inhibitory effects. This study provides an overview of the current understanding of lncRNAs, relevance to cancer, and potential therapeutic applications.

Advances in chitosan-based hydrogels for pharmaceutical and biomedical applications: A comprehensive review.

The treatment of diseases, such as cancer, is one of the most significant issues correlated with human beings health. Hydrogels (HGs) prepared from biocompatible and biodegradable materials, especially biopolymers, have been effectively employed for the sort of pharmaceutical and biomedical applications, including drug delivery systems, biosensors, and tissue engineering. Chitosan (CS), one of the most abundant bio-polysaccharide derived from chitin, is an efficient biomaterial in the prognosis, diagnosis, and treatment of diseases. CS-based HGs possess some potential advantages, like high values of bioactive encapsulation, efficient drug delivery to a target site, sustained drug release, good biocompatibility and biodegradability, high serum stability, non-immunogenicity, etc., which made them practical and useful for pharmaceutical and biomedical applications. In this review, we summarize recent achievements and advances associated with CS-based HGs for drug delivery, regenerative medicine, disease detection and therapy.

MicroRNA-155 and cancer metastasis: Regulation of invasion, migration, and epithelial-to-mesenchymal transition.

Among the leading causes of death globally has been cancer. Nearly 90% of all cancer-related fatalities are attributed to metastasis, which is the growing of additional malignant growths out of the original cancer origin. Therefore, a significant clinical need for a deeper comprehension of metastasis exists. Beginning investigations are being made on the function of microRNAs (miRNAs) in the metastatic process. Tiny non-coding RNAs called miRNAs have a crucial part in controlling the spread of cancer. Some miRNAs regulate migration, invasion, colonization, cancer stem cells' properties, the epithelial-mesenchymal transition (EMT), and the microenvironment, among other processes, to either promote or prevent metastasis. One of the most well-conserved and versatile miRNAs, miR-155 is primarily distinguished by overexpression in a variety of illnesses, including malignant tumors. It has been discovered that altered miR-155 expression is connected to a number of physiological and pathological processes, including metastasis. As a result, miR-155-mediated signaling pathways were identified as possible cancer molecular therapy targets. The current research on miR-155, which is important in controlling cancer cells' invasion, and metastasis as well as migration, will be summarized in the current work. The crucial significance of the lncRNA/circRNA-miR-155-mRNA network as a crucial regulator of carcinogenesis and a player in the regulation of signaling pathways or related genes implicated in cancer metastasis will be covered in the final section. These might provide light on the creation of fresh treatment plans for controlling cancer metastasis.

ROLE OF DIMETHYL FUMARATE (NRF2 ACTIVATOR) IN REDUCING OF CIPROFLOXACIN-INDUCED HEPATOTOXICITY IN RATS VIA THE NRF2/HO-1 PATHWAY.

OBJECTIVE: The aim: The present study aims to study the effect of DMF on ciprofloxacin-induced liver damage as assessed by liver function and liver pathology and to study this effect if it is thought to activate the Nrf2 antioxidant defense mechanism. PATIENTS AND METHODS: Materials and methods: G1 (control), G2 (ciprofloxacin group), G3 and G4 (two DMF groups rats treated with DMF 50mg and 100mg), and G5 and G6 (two DMF groups rats treated with DMF 50mg and 100mg) (two ciprofloxacin Plus DMF at 50 mg and 100 mg). The tests included study of liver function, Nrf2 analysis, and anti-oxidant enzyme analysis. RESULTS: Results: The serum blood Nrf2, HO-1, and tissue anti-oxidant enzymes all increased after ciprofloxacin treatment. The serum levels of Nrf2 and HO-1 were higher in the ciprofloxacin plus DMF groups, but anti-oxidant enzymes were lower. DMF increased Nrf2 expression in rats when ciprofloxacin caused hepatotoxicity. CONCLUSION: Conclusions: DMF lowers experimental hepatotoxicity in vivo. This effect is thought to activate the Nrf2 antioxidant defense mechanism.

The potential effect of infliximab, dimethyl fumarate (DMF), and their combination in ciprofloxacin-induced renal toxicity in male rats.

The aim of this study was to evaluate the effectiveness of infliximab and dimethyl fumarate (DMF) in reducing renal damage induced by ciprofloxacin. Forty rats were divided into five groups of eight each, with normal saline and CIP 600 mg IP administered to all animals in Groups 1 and 2 for ten days. Groups 3 and 4 were administered infliximab 7 mg/kg and DMF 30 mg/kg 24 hours before the CIP injections. Group 5 received a combination of infliximab/DMF after 24 hours of CIP. The levels of TNF-α, NF-Bp65, and IL-6 were measured, and the results showed that both infliximab and DMF had similar effects. However, the combination of infliximab and DMF had a robust anti-inflammatory and antiapoptotic impact, reducing TNF-α, NF-Bp65, IL-6, and Bcl-2 compared to the renal control group. Bcl-2 immuno-expression was lower in the ciprofloxacin group compared to the control group. DMF and infliximab had no effect on Bcl-2-positive cells, whereas infliximab increased the percentage of Bcl-2-positive cells substantially. CIP induced nephrotoxicity by increasing cytokine release and cell death signaling. Both infliximab and DMF are powerful TNF-α blockers that suppress cytokine release, preventing cell death and apoptosis caused by cytokines. Controlling inflammation and apoptosis can prevent nephrotoxicity.

USE OF INFLIXIMAB TO ATTENUATE CEREBRAL APOPTOSIS INDUCED BY CEREBRAL ISCHEMIA/REPERFUSION IN MALE RATS.

OBJECTIVE: The aim: The purpose of the research was to study the role of infiximab global cerebral ischemia-reperfusion injury. PATIENTS AND METHODS: Materials and methods: The rats were split into five groups: Sham group; Control group: occlusion of the common carotid artery for 60 minutes, and sub-sequently reperfusion for an hour without receiving any medication; Vehicle group: as the control group, but 72 hours before to the ischemia, they were given the medication 0.9 NaCl intraperitoneally (i.p); Treated group-1: as the control group, plus 3 mg/kg of IFX intraperitoneally (i.p) 72 hours prior to ischemia; Treated group-2: as the control group, plus 7 mg/kg of IFX intraperitoneally (i.p) 72 hours prior to ischemia. RESULTS: Results: Pre-treatment with IFX significantly reduced the percentage of infarct area, but in the IFX (7 mg/kg) group, the infarct area was smaller than at the low dose. The ischemia group had a significant elevated of TNF- α and caspase-3 while a significant lowered in CAT and SOD levels. The pre-treatment with IFX, the TNF- α and caspase-3 levels lowered significantly, furthermore, significantly increased CAT and SOD levels activity (P≤0.05) as compared with IR group. Among effective groups, I/R+IFX (7mg/kg) group more effective in lowering TNF- α and caspase than I/R+IFX (3mg/kg) group. CONCLUSION: Conclusions: Infiximab has neuroprotective effective due to its powerful TNF- α blocker and limit ROS release and cell death signaling which protects the neurons from injury during cerebral ischemia reperfusion.

EVALUATION OF COVID-19 VACCINES EFFICACY IN IRAQI PEOPLES.

OBJECTIVE: The aim: The present study was carried out on patients recovered from COVID-19, including those patients who have taken vaccine and those who have not. PATIENTS AND METHODS: Materials and methods: The patients were recruited via an online panel and surveyed at different regions of Iraq from June 1, 2021, to August 30, 2021. RESULTS: Results: Our results demonstrated that the highest percentage of people recommended Pfizer vaccine followed by Sinopharm, while AstraZeneca vaccine was least recommended. CONCLUSION: Conclusions: The efficacy of different vaccines differed significantly; the highest effectiveness was observed with Pfizer vaccine followed by AstraZeneca and Sinopharm with effectiveness ranging from 94%, 89%, and 74%, respectively. Further, the highest percentage of re-infected patients was observed with Sinopharm vaccine followed by Astra Zeneca and Pfizer vaccine, respectively. Also, the highest percent of re-infection with masking used was seen in the case of Sinopharm vaccine followed by AstraZeneca and Pfizer vaccine. Although, we observed that post-vaccination symptoms were lowest than pre-vaccination symptoms, the percent of asymptomatic cases post-vaccination was highest than pre-vaccination cases for all vaccines.

CORRELATION BETWEEN RS6265 SNP IN BDNF AND THE CONTEXT OF DIABETES TYPE II INVOLVEMENT IN IRAQI PATIENTS.

OBJECTIVE: The aim: In this study, we looked into the possible link between the G196A polymorphism in the BDNF gene and DM in Iraqi patients. PATIENTS AND METHODS: Materials and methods: By using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach, 100 subjects were genotyped for the G196A SNP of the BDNF gene, 50 as DM and 50 as controls, age-sex and ethnically matched healthy controls. Analysis of covariance (ANCOVA) was used to assess the association of this polymorphism, and genotype frequencies were compared between patients and healthy controls. RESULTS: Results: Our result show that patient with the AG (Val-Met) genotype had a 40%of total DM patients than those and GG (Val-Val) genotypes. Therefore, we concluded that as a future aspect of the report the work can be further extended on proteomic level wherein the corresponding change occurred due to the mutation in the protein can be further detected at structural and functional level. CONCLUSION: Conclusions: conclusion of our result was any patient with covid-19 must need to follow up for at least 1 month after recovery to notified of the post-Covid symptoms especially the male gender.

ROLE OF PRE-CESAREAN SECTION CEFOTAXIME IN AMELIORATED POST-CESAREAN COMPLICATION.

OBJECTIVE: The aim: The purpose of this study was to examine the efficacy of cefotaxime before and after skin incision in avoiding post-operative infection complications in caesarean section women, also evaluation the efficacy of cefotaxime in reducing post-caesarean section complications. PATIENTS AND METHODS: Materials and methods: We conducted 150 women who undergoing caesarean section in the Obstetrics & Gynecological Department, Babylon government from January, 2021 to March, 2021. The caesarean operations were done by using standard protocols. Each patient was examined daily and post-operative infectious. Women were randomly divided into three groups; each group contains 50 women; Group 1: (control) given normal saline 12 hr. before and after skin incision. Group 2 (pre-operation antibiotic): given single dose of cefotaxime 1 g intravenously 12 hr. before skin incision, and Group 3 (post-operation antibiotic): given single dose of cefotaxime 1 g intravenously 12 hr after operation. RESULTS: Results: The outcome measures were post-operative febrile morbidity, healing period and urinary tract infections, in addition to socioeconomic state of each woman. CONCLUSION: Conclusions: cefotaxime pre-cesarean section could ameliorate post-operative problems such as infection of surgical wound, febrile, and urinary tract infections.

GASTROINTESTINAL AND METABOLIC DISTURBANCES IN POST-COVID-19 DISEASE OUTCOMES.

OBJECTIVE: The aim: Recognizing gastrointestinal symptoms that precede COVID-19 respiratory difficulties may be crucial for effective early detection and treatment. PATIENTS AND METHODS: Materials and methods: A total of 200 individuals with the post-covid-19 symptoms for both genders in clinical private and hospital COVID-19 verified by polymerase chain reaction were tracked until they recovered. To evaluate the duration of symptoms as a predictor of COVID-19 prognosis, we proposed a link between gastrointestinal symptoms, metabolic disturbances and disease severity. Glucose disturbances were observed in 65 percent of participants, higher D-Dimer plasma levels have been found in 77 percent of participants, and ferritin plasma levels were found in 62 percent of participants. RESULTS: Results: While gastrointestinal symptoms were common, with nausea accounting for 51% of participants, an increase in appetite accounting for 76% of patients, and anal fissure accounting for 30% of participants. Both metabolic and GIT symptoms disturbances impact a large percentage of men. CONCLUSION: Conclusions: Our conclusion was any patient with covid-19 must need to follow up for at least 1 month after recovery to notified of the post-covid symptoms especially the male gender.

MENTAL HEALTH AND PSYCHOSOCIAL CONSIDERATIONS POST COVID-19 OUTBREAK.

OBJECTIVE: The aim: To determine the pandemic's impact on worldwide psychological suffering and its consequences for vulnerable groups. PATIENTS AND METHODS: Materials and methods: 200 participants (mean 66.5% males) from 6 provinces of central and southern Iraq responded to the survey for 6 months. Mental signs and symptoms were assessed using the Patient Health Questionnaire and State Trait Anxiety Inventory, respectively. Over 55% of the post-Covid respondents had depression; the male gender was higher than female gender (56% vs. 44%). About 44% of the post-Covid respondents had Nervousness, 59% of them was male. Participates had moderate level of confusion & memory loss about 73%, however, the male gender was greater suffering from it than female (72% vs. 28%). RESULTS: Results: Results show that Post Covid-19 patients have high depression, Nervousness, and memory loss, and also Male gender with Covid-19 have a severe level of depression, Nervousness, memory loss as compare with the female gender. CONCLUSION: Conclusions: Post Covid-19 patients have high depression, Nervousness, and memory loss as compared with those without covid-19 one. Patients who have a history of psychological problems inpatient with Covid-19 must be taken and treated in combination with a protocol of covid-19 management. The male gender with Covid-19 has a severe level of depression, Nervousness, memory loss as compared with the female gender.

The Nrf2 Activator (DMF) and Covid-19: Is there a Possible Role?

INTRODUCTION: COVID-19 is a new viral illness that can affect the lungs and airways with lethal consequences leading to the death of the patients. The ACE2 receptors were widely disturbed among body tissues such as lung, kidney, small intestine, heart, and others in different percent and considered a target for the nCOVID-19 virus. S-protein of the virus was binding to ACE2 receptors caused downregulation of endogenous anti-viral mediators, upregulation of NF-κB pathway, ROS and pro-apoptotic protein. Nrf2 was a transcription factor that's play a role in generation of anti-oxidant enzymes. AIM: To describe and establish role of Nrf2 activators for treatment COVID-19 positive patients. METHODS: We used method of analysis of the published papers with described studies about COVID-19 connected with pharmacological issues and aspects which are included in global fighting against COVID-19 infection, and how using DMF (Nrf2 activator) in clinical trial for nCOVID-19 produce positive effects in patients for reduce lung alveolar cells damage. RESULTS: we are found that Nrf2 activators an important medication that's have a role in reduce viral pathogenesis via inhibit virus entry through induce SPLI gene expression as well as inhibit TRMPSS2, upregulation of ACE2 that's make a competition with the virus on binding site, induce gene expression of anti-viral mediators such as RIG-1 and INFs, induce anti-oxidant enzymes, also they have a role in inhibit NF-κB pathway, inhibit both apoptosis proteins and gene expression of TLRs. CONCLUSION: We are concluded that use DMF (Nrf2 activator) in clinical trial for nCOVID-19 positive patients to reduce lung alveolar cells damage.