Examining the role of salivary IL-2 and IL-22 in recurrent aphthous stomatitis: a diagnostic approach

Background: Recurrent aphthous stomatitis (RAS) is a prevalent inflammatory condition, that manifests as mouth ulcers. This study aims to evaluate IL-2 and IL-22 levels in saliva samples of individuals with recurrent aphthous stomatitis (RAS) compared to healthy volunteers. Methods: A case-control study was conducted between April 1st and September 30th, 2023, at the Dental Center of New Baquba, Diyala, Iraq. Saliva samples were collected from 40 patients diagnosed with recurrent aphthous stomatitis and 40 healthy controls. IL-2 and IL-22 levels were assessed in both groups using enzyme-linked immunosorbent assay (ELISA). Statistical analysis, employing paired sample ‘t’ test, was conducted with a significance threshold below. Results: In the case group, the mean age was 53.4 years (SD=1.58), ranging from 26 to 81 years, while in the control group, it was 47.18 years (SD=1.55), ranging from 24 to 78 years. Females predominated in both groups, comprising 62.5% in cases and 52.2% in controls. Most aphthous ulcers (77.5%) were found in the buccal mucosa, with minor aphthous ulcers being the most common (67.5%). Results from paired-samples t-tests revealed significantly higher levels of IL-2 in RAS cases (M=62.090, SD=20.242) compared to controls (M=36.366, SD=14.596), (t(39)=7.101, p < 0.001). Similarly, IL-22 levels were significantly elevated in RAS cases (M=106.537, SD=44.112) compared to controls (M=73.399, SD=32.852), (t(39)=3.553, p=0.001). These results suggest a potential association between RAS and increased IL-2 and IL-22 levels, indicating their involvement in RAS pathophysiology. Conclusion: In summary, females showed a significant predominance in RAS cases. Significant differences were observed in IL-2 and IL-22 levels between case and control groups

Postoperative satisfaction and perception among laparoscopic cholecystectomy patients in Diyala Province, Iraq

Background: Over the past two decades, laparoscopic surgeries have significantly progressed, and surpassing traditional surgical methods across multiple medical fields. This study aims to assess the patients’ satisfaction and the related factors toward the laparoscopic cholecystectomy in Iraq.   Methods: A cross-sectional study was conducted from April 2023 to 30th March 2024 at the Alkalis General Hospital and Al Hayat Private Hospital, Diyala province, Iraq. Semi-structured questionnaire was recruited to collect the pre and post operative data from patients. Statistical analysis was carried out using SPSS-21, with significance set at p < 0.05. Results: Data of 157 patients with mean age (+ Standard Deviation) of 47.57 (SD +12.80) were analyzed. Most of them (53.5%) were females, operated in public hospitals (52.2%), unemployed (51.6%), and earned less than USD 400 (60.5%). The majority of patients expressed high overall satisfaction with the laparoscopic cholecystectomy procedure (42.7% being strongly satisfied and 38.9% satisfied). In the multiple logistic regression, the patients who were operated in private hospital (OR = 4.506, 95% CI: 1.394 to 14-577; P-value= 0.012), with monthly income exceeds USD 400 (OR = 4.887, 95% CI: 1.531 to 15.601; P-value=0.007), involved in the choosing of surgery technique (OR = 5.596, 95% CI: 1.425 to 21.982; P-value=0.014), and those recommend laparoscopic cholecystectomy for others (OR = 9.100, 95% CI: 1.425 to 21.982; P-value=0.001), had the highest odds ratios. The Hosmer and Lemeshow test indicated a good fit (p = 0.552). Conclusion: Patient satisfaction is high especially among high income patients operated in private hospital however, the perception of postoperative outcomes remains important areas of focus, particularly in regions with unique healthcare challenges like Iraq

Prevalence and antimicrobial susceptibility characterization of Escherichia coli isolated from the intestines of freshwater fish from the Mindu dam in Morogoro, Tanzania

Background: The Mindu dam, an open system, serves as a microbial reservoir, housing uropathogenic microorganisms like Escherichia coli. Morogoro municipality relies on the dam for water and fish. This study aimed to assess the antimicrobial susceptibility of Escherichia coli isolated from fish and water in Mindu dam.    Methods: In May 2019, a cross-sectional study was conducted in Morogoro municipality. Selected antimicrobials, including ampicillin, tetracycline, cefoxitin, erythromycin, trimethoprim, gentamicin, enrofloxacin, and nalidixic acid, were tested using the disc diffusion method. E. coli ATCC 25922 served as a positive control for quality assurance during bacterial isolation. The potential source of antimicrobial contamination was identified through the multiple antibiotic resistance index. Results: Out of 148 samples, E. coli was found in 24, none in water. E. coli showed high resistance (≥50.0%) to erythromycin (62.5%), nalidixic acid (79.2%), and ampicillin (75%). Additionally, 58.0% of isolates displayed multi-drug resistance across antimicrobial classes, with a multiple antibiotic resistance index ranging from 0.00 to 0.75. Conclusion: Antimicrobial-resistant E. coli in the food chain may heighten the spread of complex urinary tract infections in the municipality. It underscores the necessity for robust municipal surveillance of antimicrobial resistance and effective antimicrobial stewardship for enhanced infection prevention and control

Topical corticosteroids in the treatment of acute sunburn: a systematic review

Background: Acute sunburn is a prevalent dermatological issue, particularly affecting individuals with fair skin types I-III. It is characterized by erythema, edema, and discomfort due to ultraviolet (UV) radiation exposure. Topical corticosteroids are commonly used for their anti-inflammatory properties, but their efficacy in sunburn treatment is debated due to limited high-quality evidence from randomized controlled trials (RCTs). This study aims to assess the efficacy of topical corticosteroids in relieving symptoms and inflammation of sunburn.  Methods: A systematic review was conducted by searching PubMed, Web of Science, ProQuest, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published up to April 30, 2024. Keywords included combinations of terms related to corticosteroids, topical application, and sunburn. Studies were selected based on PRISMA 2020 guidelines, focusing on adult patients treated with topical corticosteroids compared to placebo. Data extraction and quality assessment were independently performed by two researchers using the Cochrane Collaboration’s Risk of Bias tool. Results: The review included six RCTs with a total of 339 participants, aged 18-68 years, conducted in Europe and the USA. Various topical corticosteroids were studied, including methylprednisolone aceponate, hydrocortisone 17-butyrate, and hydrocortisone-21-acetate. Treatment durations ranged from single applications to twice daily for seven days. The results demonstrated that prolonged treatment with topical corticosteroids significantly reduced sunburn symptoms such as erythema and pain. When applied for seven days, treated areas showed lower sunburn reaction scores and reduced inflammation compared to untreated areas. Early application of corticosteroids, particularly within 6 hours post-exposure, was more effective than later applications. Histological analyses supported these findings, showing improvements in epidermal thickness and reduced dermal inflammation in treated areas. Conclusion: Topical corticosteroids can effectively alleviate acute sunburn symptoms and aid skin recovery by targeting inflammatory pathways. Their efficacy is enhanced with prolonged and early application. Further research is needed to optimize treatment protocols and assess long-term effects to fully realize the therapeutic potential of corticosteroid therapy in managing acute sunburn

Insights into substance abuse knowledge and attitudes among high school students in Anbar Province, Iraq

Background: The high prevalence of substance use among children and adolescents has become a major global public health concern. This study aims to explore adolescents' knowledge and attitudes toward substance abuse.  Methods: A cross-sectional study was conducted from January 2nd to February 15th, 2023 in Ramadi City, Anbar Province, Iraq. Students from eight high schools participated, selected through a multistage sampling approach. The bivariate analysis included independent sample t-tests and one-way ANOVA. Furthermore, a multivariable linear regression analysis was employed to predict factors influencing knowledge and attitudes. Statistical analyses were performed using SPSS version 16. Results: The study included 415 students, with a mean age of 16.7 (±9.3) years, with a majority being male (52.8%). Accuracy rates for knowledge and attitude were 79.6% and 70.2%, respectively. About 79.3% of participants were familiar with terms related to drug abuse in Iraq. Regression analysis showed that higher knowledge scores were linked with male gender and a household income exceeding IQD 600,000 monthly (95% CI:1.311 to 2.923; P <0.001; and 95% CI:1.072 to 2.331; P =0.001), respectively. Attitudes toward drug abuse prevention were influenced by male participants and students with employed fathers (95% CI:1.245 to 4.302; P=0.025; and 95% CI: 2.073 to 6.737; P=0.032), respectively. Conclusion: In conclusion, most of the students had sufficient knowledge and a constructive attitude toward drug use. Male gender, high income, and employed fathers were the main predictors

Clinical spectrum of demyelinating disease of central nervous system and frequency of anti AQP4 and anti MOG among them: one-year single-center retrospective study

Background: Inflammatory demyelinating diseases of the central nervous system (CNS) are autoimmune conditions leading to significant neurological disability in adults. Recent classifications include myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) and neuromyelitis optica spectrum disorder (NMOSD) which pose diagnostic challenges due to overlapping clinical and radiological features. This study aimed to assess the clinical spectrum among adults and children diagnosed with CNS demyelinating diseases and to find the proportion of MOG and/or aquaporin-4 (AQP4) autoantibodies amongst them. Methods: This single-center, retrospective study examined 20 patients diagnosed with CNS demyelinating disorders between March, 2023 and February, 2024. Data pertaining to demographics, disease types, CSF analysis, MRI findings, treatment modalities, and serological profiles for anti-AQP4 and anti-MOG antibodies were collected from hospital records and evaluated. Results: Among 20 patients [median age, 34 years (IQR, 18.75); males (n=10) and females (n=10)], acute transverse myelitis (TM) was the most common demyelinating disorder at onset (60%) followed by optic neuritis (ON) (20%). CSF analysis found elevated protein levels in 53% and pleocytosis in 33% of patients. MRI findings revealed longitudinal extensive involvement in 52% of patients, predominantly affecting the cervical and dorsal spine. Serological testing identified 15% positive for anti-AQP4 and 10% for anti-MOG antibodies. MOG+ patients were significantly younger than AQP4+ patients (mean age 16.5 vs. 36.66 years, p=0.016). Both MOG+ patients were male, with 50% presenting with acute TM and 50% with acute disseminated encephalomyelitis. Among AQP4+ patients, the male-to-female ratio was 1:2, with 66.66% presenting with acute TM and 33.33% with ON. Conclusion: CNS demyelinating disorders primarily affect younger individuals, with TM as the most common initial disorder and extensive spinal involvement in cervical and dorsal regions. Serological testing identified three patients with anti-AQP4 and two with anti-MOG antibodies, providing valuable insights into the clinical spectrum of these disorders through cell-based assays

The experiences of adult children caring for a parent with Korsakoff’s syndrome

Background: Korsakoff’s syndrome (KS) is a debilitating psychoneurological disorder that can occur in adults with alcohol use disorder (AUD). People with KS experience a sudden onset of symptoms including confabulation, anterograde and retrograde amnesias, apathy, issues with vision and gait, and lack of insight. Frequently an adult child of the parent with alcohol-induced KS becomes the caregiver, regardless of the status or quality of the relationship with their parent. While there is a rich literature base in the areas of adult children of parents with AUD and caregiving, there are no studies that have explored the experiences of adult children caring for a parent with alcohol-induced KS. This study aimed to explore the experiences of adult children who provide care for a parent or parental figure suffering from alcohol-induced Korsakoff syndrome (KS). Method: This study used a generic qualitative approach with thematic analysis using both in person and web-based video interview methods and field notes to address this gap in the literature. Eight individuals participated in the study, men (n=2) and women (n=6), with participants ranging in age from 31 to 43 years (average age 37 years). Results: Five themes emerged: addiction and the adult child, experiencing caregiver burden, experiencing a variety of emotions, professional healthcare experiences, and observations of symptoms. These themes emerged over seven anchor events in their caregiving experiences: interactions with their parent pre-diagnosis, parent’s medical emergency, hospitalization, diagnosis, housing, legal, and financial. Conclusion: The results provide a foundation for future research in the areas of KS, caregiving, and adult children of parents with AUD. They also provide a basis to inform the development of interventions with this population and demonstrate a need for more awareness of KS among healthcare professionals.

Breaking the silence: navigating adolescent knowledge, attitude, and perception on substance abuse in Diyala Province, Iraq

Background: Drug use often leads to a range of health risks, social complications, and involvement in criminal behavior. This study aims to investigate adolescents' understanding, opinions, and perspectives on substance abuse.  Methods: Between October and December 2023, a cross-sectional study was undertaken in Diyala Province, Iraq. High school students were sampled using a multistage sampling technique. Bivariate analysis utilized independent sample t-tests and one-way analysis of variance (ANOVA). Additionally, a multivariable linear regression analysis was performed to predict factors associated with knowledge, attitudes, and perceptions. All statistical analyses were carried out using SPSS version 16. Results: The study encompassed 365 students, with a mean age (SD) of 17.5 (+ 8.2), predominantly male (57.3%). Overall accuracy rates for knowledge, attitude, and perception stood at 87.1%, 86.7%, and 88.7%, respectively. Approximately 5.2% of the sample reported cannabis (hashish) use. Regression analysis revealed significant associations between higher knowledge scores and male gender (p=0.002, 95% CI:0.341, 0.729), urban residency (p<0.0001, 95% CI:1.165, 4.524), and monthly income > US$400 (p >0.0001, 95% CI:0.907, 1573). Attitudes toward drug abuse prevention were influenced by male gender and highly educated parental backgrounds (p<0.001, 95% CI:1.412, 5.223; p=0.002, 95% CI: 2.160, 4.881; p=0.007, 95% CI:1.810, 5.690). Perception scores were significantly associated with male gender (p=0.001, 95% CI: 0.430, 0.691), students from smaller families (p=0.013, 95% CI:2.201, 5.003), and those in the sixth class (p=0.021, 95% CI:1.423, 4.202). Conclusion: While adolescents demonstrate a solid understanding of societal norms and consequences associated with substance abuse, there may still be areas where perceptions can be refined and aligned more closely with the realities of drug abuse

The impact of water vapor thermal therapy of the prostate (rezūm) on sexual functions: a narrative review

Background: Senile prostate enlargement is an age-related condition. Many sexually active patients fear formal prostate surgeries owing to their negative impact on sexual performance. Minimally invasive procedures, including prostate water vapor thermal therapy (Rezūm®), were devised to make ends meet. This study aims to present a comprehensive narrative synthesis about the impact of prostate water vapor therapy on sexual functions.  Methods: A narrative literature review was performed in May 2023, using MEDLINE, Cochrane Library, Ovid-Embase, Scopus, Science Direct, and Google Scholar; for the MeSH term “rezum AND sexual functions”. Selected reports were published articles from 2018 to date (the last 5 years). Only open-access journals in English were analyzed. Efforts were made to focus on the 2 main domains of sexual functions; erection and ejaculation. Results: As per the concise MeSH term “rezum AND sexual functions”, a score of 207 hits appeared on the initial search. After eliminating duplicate and irrelevant papers, only 7 articles fulfilled the inclusion criteria and were subjected to analysis. The analyzed articles were critically appraised to point out the studies` strengths and limitations. The gathered data were found to be consistent with one another as no outliers were detected. Conclusion: Water vapor thermal therapy of the prostate showed satisfying preservation of erectile function with minimal ejaculatory dysfunction

Surgical decision-making: key factors influencing the shift from laparoscopic to open cholecystectomy

Background: Recognizing the preoperatively and intraoperatively factors can aid surgeons in making timely decisions to shift from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). This study aims to identify the main factors leading to LC conversion to OC among Iraqi patients. Methods: One-year prospective research was performed using cross-sectional design between 1st April, 2023, and 3oth March, 2024, at Alkalis General Public Hospital and Al Hayat Private Hospital, Diyala, Iraq. Pre and intraoperative data were collected from the planned LC surgeries including demographics, medical history, laboratory and Ultrasound findings. Descriptive and bivariate analysis was carried out to compare variables between patients undergoing LC and those requiring conversion to OC. Results: Out of 172 LC patients (mean age 48.28±12.62), 52.9% were female, 55.8% obese, 50.6% aged 49+, 23.3% diabetic, and 19.8% had emergency cholecystectomy; 15 (8.7%) required conversion to open surgery. The conversion group was mainly men (66.7% vs. 46.5%, P = 0.001) and older (73.3% vs. 48.4% aged 49+, P = 0.003). Obesity (60.0% vs. 55.4%, P = 0.005) and diabetes (53.3% vs. 20.4%, P < 0.001) were more common. Public hospital referrals were higher (86.7% vs. 52.2%, P < 0.001). Elevated total bilirubin, direct bilirubin, and alkaline phosphatase levels were significant predictors of conversion to OC. Adhesions in Calot's triangle (20.0% vs. 13.4%, P = 0.021) were more common in the conversion group, along with unclear anatomy, thick gallbladder wall, bleeding, stone and bile spillage, and cystic duct injury. Conclusion: In conclusion, out of 172 LC patients, 15 (8.7%) required conversion to open surgery, predominantly older men with higher obesity, diabetes, and elevated bilirubin and alkaline phosphatase levels, and more adhesions in Calot's triangle