European Journal of Medical and Health Research
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Anti-Carbamylated Protein Antibodies as Biomarkers in RA, SLE, and Primary Sjögren's Syndrome: Clinical Relevance and Diagnostic Utility
Full text linkBackground: Anti-carbamylated protein antibodies (Anti-CarPA) have been discovered to be useful as biomarkers for diagnosing systemic rheumatic disorders (RDs) and monitoring of disease activity. Nonetheless, they lack complete profiles on their occurrence, their value in the diagnosis, and clinical correlations in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and primary Sjögren syndrome (pSS).Objective: In this study, the prevalence, diagnostic abilities, and clinical correlates of anti-CarPA in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and primary Sjögren syndrome (pSS) patients were investigated and determined as opposed to healthy controls (HC).Methods: One hundred and thirty-one cases were employed in this retrospective study (40 with RA, 40 with SLE, 11 patients with pSS, and 40 healthy people were also used, and were matched with age and sex). The current international classification criteria were used in the diagnosis of all the patients (ACR/EULAR in RA and SLICC in SLE). The enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of serum anti-CarPA. The performance of the diagnosis was evaluated through sensitivity and specificity analysis. Connections with clinical and laboratory indicators of the disease activity were established.Results: There was elevated serum Anti-CarPA concentration in RA (30.3 ± 22.9 ng/mL; p < 0.001), SLE (18.1 ± 11.1 ng/mL; p = 0.005), and pSS (14.6 ± 5.6 ng/mL; p = 0.005) when set alongside healthy control (3.2 ± 0.6 ng/mL). In RA, the Anti-CarPA positivity was correlated significantly with increased DAS28 scores (p = 0.041), rheumatoid factor detection (p = 0.003), and the volume of white blood cells (p = 0.045). The Anti-CarPA positivity was linked with a higher ESR (p = 0.002) and SLEDAI-2K (p = 0.025) in SLE. While in pSS patients, the anti-CarPA levels were also found to be significantly linked to elevated platelet counts (p = 0.001). Anti-CarPA sensitivity were 74.2 and 75.8 % in RA, 72.0 and 88.5 % in SLE, and 71.9 and 75.0 % in pSS, respectively.Conclusion: Anti-CarPA antibodies are important in the diagnosis as well as in clinical evaluation of RA, SLE, and pSS. It is indicated by their close bonds to disease-related activity parameters and good diagnostic selectivity that they could be used as supporting biomarkers in the early detection of systemic rheumatic illnesses, their administration, and patient stratification
Integrative Approaches to Subfertility: A Case Report on Combined Ayurvedic Interventions with Intra Urethral Uttar Vasti (IUUV)
Full text linkSub-fertility is a multifactorial condition requiring a comprehensive and personalized approach to treatment. This case report documented the successful conception of a couple following an integrative therapeutic regimen that combined Ayurvedic and modern medical approaches. The male partner was diagnosed asthenoteratozoospermia, the female partner presented with multiple issues including polycystic ovarian syndrome (PCOS), uterine fibroid, hormonal imbalances and both underwent a meticulously tailored treatment plan. The male partner received Ayurvedic therapies, including intraurethral uttar vasti, alongside modern supplements like Coenzyme Q10 and L-carnitine etc. The female partner treatment incorporated hormonal modulation and Ayurvedic formulations, emphasizing follicular maturity and insulin sensitivity. The synergistic effects of these treatments led to a marked improvement in sperm parameters, follicular development, and endometrial thickness, culminating in a confirmed pregnancy. This case underscores the potential of integrative medicine in managing complex subfertility cases and achieving positive outcomes
Comparing Toxicities between 18 Gy in 2 Fractions vs 21 Gy in 3 Fractions of Brachytherapy after Concurrent Chemoradiotherapy in Locally Advanced Carcinoma Cervix
Full text linkBackground: Cervical cancer remains a major global health issue, particularly in low- and middle-income countries, where late-stage diagnosis is a common phenomenon. For patients with locally advanced cervical carcinoma (LACC), concurrent chemoradiotherapy (CCRT) followed by high-dose-rate (HDR) brachytherapy is the standard treatment modality. Aim: This study aimed to compare early toxicity outcomes of two HDR brachytherapy regimens—18 Gy in 2 fractions versus 21 Gy in 3 fractions—administered after CCRT in patients with LACC. Methods: A quasi-experimental study was conducted at the National Institute of Cancer Research and Hospital (NICRH), Dhaka, between July 2023 and December 2024. A total of 66 histopathologically confirmed LACC patients were enrolled and divided equally into two arms: Arm A: 18 Gy in 2 fractions and Arm B: 21 Gy in 3 fractions. All patients received external beam radiation therapy (EBRT) at 50 Gy in 25 fractions over 5 weeks with concurrent weekly cisplatin (40 mg/m²), followed by HDR brachytherapy per their assigned arm. Early toxicities were assessed at 6-, 12- and 24-weeks post-treatment using CTCAE v5.0. Data analysis was performed using SPSS version 27, with statistical significance set at p < 0.05. Findings: Most patients were aged 30–50 years and from low socio-economic backgrounds, contributing to delayed diagnosis. Acute toxicity profiles were largely comparable between the two arms. At 12 weeks, anemia was absent in 96.9% of Arm A and 100% of Arm B; at 6 weeks, Grade II proctitis was reported in 9.1% (Arm A) and 6.0% (Arm B); at 12 weeks, skin toxicity occurred in 6.1% of patients in both arms and at 24 weeks, Grade I vaginal dryness was noted in 9.1% (Arm A) and 12.1% (Arm B). No statistically significant differences were found in hematological, gastrointestinal, genitourinary, dermatological, or vaginal toxicities between the two regimens. Conclusion: The 18 Gy in 2 fractions HDR brachytherapy regimen demonstrated comparable early toxicity outcomes to the 21 Gy in 3 fractions schedule, with the added advantage of shorter treatment duration. This makes it a viable, resource-efficient option for managing LACC in low-resource settings. Further large-scale studies with long-term follow-up are warranted to assess late toxicities, loco-regional control, and survival outcomes
Oncotype DX Recurrence Score in HER2-Negative, ER/PR-Positive Breast Cancer: A Preliminary Study and the First Iraqi Experience
Full text linkIntroduction: The Oncotype DX recurrence score (RS) is a key determinant in guiding chemotherapy decisions for hormone receptor-positive, HER2-negative breast cancer patients. This study examines RS distribution, its correlation with clinical variables, and its impact on treatment recommendations in an Iraqi cohort. Methods: a total of 383 patients with classified in to tow age group <50 years (107) and ≥50 years (276), mean, and Standard deviations were calculated for each age group. An independent samples t-test and chi square test was used test if there was significant difference in mean of RS between these independent groups <50 vs. ≥50 years. Results: A retrospective cohort analysis was conducted using patient records from oncology clinics. Patients were stratified into two age groups (<50 and ≥50), and Recurrence Scores (RS) were classified into low (0–10), intermediate (11–25), and high (≥26) categories. Statistical analyses included descriptive statistics, Conclusion: RS plays a critical role in chemotherapy decision-making for HER2-negative, ER/PR-positive breast cancer. Younger patients demonstrate higher recurrence scores, underscoring the need for personalized treatment strategies in Iraq. These findings contribute to regional oncology research by refining recurrence risk assessments and supporting evidence-based precision medicine approaches
Postpartum Ovarian Vein Thrombosis: Case Report and Literature Review
No full textBackground: Postpartum ovarian vein thrombosis (POVT) is a rare but potentially severe complication. Its nonspecific clinical presentation may mimic other abdominal emergencies, delay diagnosis and increase the risk of serious complications, including extension to the inferior vena cava and pulmonary embolism. Case Report: We report a case of a 28-year-old woman, second gestation and primiparous in her first delivery, who presented with acute right iliac fossa pain and fever on postpartum day 13 following a cesarean section. Laboratory findings showed leukocytosis and elevated C-reactive protein. Initial ultrasound was unremarkable, while contrast-enhanced abdominopelvic CT confirmed thrombosis of the right ovarian vein. The patient was treated with therapeutic anticoagulation (enoxaparin 1 mg/kg twice daily), resulting in complete resolution of symptoms within 48 hours. Thrombophilia workup was negative. Conclusion: Postpartum ovarian vein thrombosis can be presented with a misleading clinical picture. Prompt clinical suspicion and imaging are essential. Early anticoagulation prevents thrombus extension and pulmonary embolism, reducing the risk of severe complications
Vulvar Squamous Cell Carcinoma in a Virologically Suppressed Person Living with HIV: A Case Report and Narrative Review
No full textBackground: Vulvar squamous cell carcinoma (VSCC) has historically affected post-menopausal women, yet regions with high HIV prevalence now report a demographic shift toward younger patients and more locally advanced disease at presentation. Even under durable virologic suppression on antiretroviral therapy (ART), persons living with HIV (PLWH) appear to retain a residual risk of HPV-driven anogenital malignancies—the so-called "HAART paradox." Case presentation: We report a 48-year-old woman living with HIV, virologically suppressed for 7 years on an integrase inhibitorbased ART regimen (dolutegravir), with stable CD4+ count (450/μL), who presented with a painful exophytic vulvar mass and pruritus. Biopsy confirmed moderately differentiated, basaloid-type VSCC with diffuse p16 overexpression; tumor HPV DNA testing identified HPV-16. Pelvic MRI showed a 4.3 × 2.1 cm vulvar tumor with contiguous invasion of the lower left vaginal wall and suspicious inguinal nodes. FIGO 2021 staging was IIIA. Multidisciplinary management comprised total vulvectomy with bilateral inguino-femoral lymphadenectomy followed by conformal external-beam radiotherapy (45 Gy to vulvo-vaginal and nodal volumes with boost to 65 Gy) and concurrent weekly cisplatin (40 mg/m2). ART was continued; primary Pneumocystis prophylaxis with trimethoprimsulfamethoxazole was initiated. Toxicities included grade-3 febrile neutropenia (managed with short hospitalization and G-CSF) and grade-2 vulvo-vaginal mucositis. The patient achieved a complete clinical response at 3 months and a radiologic complete response at 6 months; no recurrence was observed at 18-month follow-up with sustained HIV suppression. Narrative review: A targeted narrative review of the literature highlights: younger age at VSCC diagnosis among PLWH versus HIV-negative women; near-universal association with high-risk HPV—predominantly HPV-16—and frequent basaloid/warty histology; advanced stage at presentation despite virologic suppression; and comparable locoregional cancer control with standard-of-care surgery and chemoradiation when delivered within multidisciplinary pathways, though overall survival may be attenuated by treatment toxicities, opportunistic infections, and HIV-related comorbidities. Conclusions: This case underscores that durable HIV virologic suppression does not eliminate HPV-mediated VSCC risk or preclude locally advanced presentations. Standard oncologic protocols (surgery plus concurrent chemoradiation) remain appropriate, provided that ART is optimized, drug- drug interactions are proactively managed, and infection prophylaxis is tailored. Vigilant vulvar examination and early biopsy in PLWH—irrespective of age or viral load—are essential to reduce delays and improve outcomes
Diagnostic Significance of HER2 Expression in Breast Carcinoma: A Histological perspective
No full textBackground: Breast carcinoma is the most prevalent malignancy among women worldwide and a major cause of cancer mortality. The human epidermal growth factor receptor-2 (HER2) is a key biomarker in breast cancer, linked to tumor aggressiveness, poor differentiation, and response to targeted therapy. Assessing HER2 expression and its correlation with clinicopathological parameters provides essential diagnostic and prognostic information. Objective: To evaluate the diagnostic and histopathological significance of HER2 expression in breast carcinoma and determine its association with hormone receptor status, tumor grade, lymph-node metastasis, and clinical stage. Methods: A cross-sectional study was conducted on 102 paraffin-embedded breast-carcinoma samples collected at an Iraqi tertiary hospital between January 2023 to December 2025. Tumor type, grade, and stage were assessed histologically. Immunohistochemistry for HER2, estrogen receptor (ER), and progesterone receptor (PR) was performed following ASCO/CAP 2018 guidelines. Statistical analysis was done using SPSS v25; p ≤ 0.05 was considered significant. Results: The mean patient age was 51 ± 10 years. HER2 overexpression (+3) was detected in 59.8% of cases. A significant inverse relationship existed between HER2 expression and both ER and PR status (p = 0.0001). HER2 positivity correlated significantly with lymph-node metastasis (p = 0.023) and high tumor grade (p = 0.0001), but not with tumor stage (p = 0.2). Most tumors were invasive ductal carcinoma NOS (95.1%). Conclusion: HER2 overexpression is significantly associated with hormone receptor negativity, lymph-node metastasis, and higher histological grade, identifying a biologically aggressive breast cancer subset. Routine HER2 evaluation is crucial for accurate diagnosis, prognostic stratification, and guiding targeted therapy among Iraqi breast cancer patients
Epidemiology and Risk Factors of Recurrent Shoulder Dislocation Among Young Athletes in Iraq
No full textRecurrent shoulder dislocation (RSD) is an orthopedic issue that is substantially prevalent among youth athletes and has a high rate of morbidity and potential for future long-term disability. To determine the epidemiology and risk factors for RSD among young Iraqi athletes, 285 athletes aged 16-35 years who experienced RSD and presented to a Private Hospital over two years (January 2022 - December 2023) were examined in this cross-sectional study. Information regarding demographic characteristics, clinical presentation, sports participation, and potential risk factors was collected via standardized questionnaires and clinical evaluations. Using multivariate logistic regression analysis, independent predictors were determined. The mean age of study participants was 24.3 ± 6.5 years, with 78.9% being male. The results demonstrate that participation in contact sports is a statistically significant predictor of developing RSD (OR: 3.42, 95% CI: 2.15-5.44), along with prior shoulder injury (OR: 4.78, 95% CI: 2.89-7.91) and increased generalised ligamentous laxity (OR: 2.94, 95% CI: 1.67-5.18). The overall recurrence rate for RSD was determined to be 62.1% within two years of the initial shoulder dislocation. Young athletes who sustain their first dislocation at an earlier age have a decreased risk of recurrence compared to older athletes (r = -0.547, p < 0.001). Findings of this study provide new insights into the epidemiology of RSD in the Iraqi youth athlete population and the need for identifying risk factors early to implement preventative measures and develop appropriate management strategies
Epiploic Appendagitis of the Transverse Colon: A Rare Localization of a Benign and Frequently Misdiagnosed Condition
No full textAppendagitis, a rare cause of acute abdominal pain, is an isolated inflammation of the omental appendix that often goes unrecognized. It is mainly diagnosed radiologically, thereby avoiding unnecessary surgery. We reported the case of a diabetic patient with appendagitis of the transverse colon, an exceptional location, which responded favorably to medical treatment
Artificial Intelligence Technology in Health Settings: Perception and Attitude of Nursing Interns
No full textIntroduction: Information technology and artificial intelligence (AI) are becoming increasingly prevalent in a variety of enterprises and societal areas. Purpose: This research study aimed to assess the perceptions and attitudes toward using artificial intelligence technology in health settings among nursing interns practicing in selected hospital, Eastern Region, Saudi Arabia. Methodology: A descriptive cross-sectional study was conducted among 98 nursing interns following convenient sampling technique. Data was collected after obtaining consent from all subjects via google survey link. The tool included demographic variables and a questionnaire on attitudes and perceptions of artificial intelligence. Results: The study found that 46 interns had a low perception of AI, 39 had a moderate perception, and 13 had a high perception. In terms of attitudes, 63 interns had a low level of attitude towards AI, 20 had a moderate attitude, and 16 had a high attitude. A moderate, significant correlation between perception and attitudes towards AI was observed at the P<0.01 level. Conclusion; The study concludes that there was a significant association between the perceptions and attitudes of intern students. These findings provide nurse educators valuable insights for developing instructional plans and materials to facilitate effective integration of AI in nursing practice and education