Saad Abdulrahman Hussain

Scopus Publications

Parenteral Nutrition-Associated Sepsis and Extravasation in Iraqi Neonates: A Case-Series Prospective Study
Dalya Abdul Kareem Mohammed, Yasir Ibrahim Abdulridha, Mustafa Ghazi Alabbassi, and Saad Abdulrahman Hussain
Al-Rafidain University College
Background: Extravasation and sepsis are two of the many side effects linked to the use of intravascular devices during parenteral nutrition (PN). Objective: To assess the incidence of sepsis and extravasation in Iraqi neonates receiving PN in the critical care unit. Methods: From January 27, 2022, to January 15, 2023, a case-series prospective study was carried out in two tertiary neonatal intensive care units (NICUs) in Children Welfare Hospital and Baghdad Teaching Hospital, Baghdad, Iraq. The study reports the rate of sepsis and extravasations and correlates their occurrence to other neonatal features. Results: Of the 94 newborns examined, 24 patients (25.5%) experienced 35 instances of stage IV extravasation, and 34.04% of them experienced 40 episodes of sepsis in total. They have a strong and significant correlation with the newborns' body weight, treatment duration, gestational age, and postnatal age. Conclusions: The administration of PN to neonates in Iraq has been linked to severe side effects such as sepsis and extravasation.

Factors Influencing Adalimumab Treatment Response in Patients with Rheumatoid Arthritis: The Future of Clinical Expertise
Samer Imad Mohammed, Ali Lateef Jasim, Mohammad Yawuz Jamal, and Saad Abdulrahman Hussain
Al-Rafidain University College
Rheumatoid arthritis (RA) is characterized by persistent joint inflammation, which is a defining feature of this chronic inflammatory condition. Considerable advancements have been made in the field of disease-modifying anti-rheumatic medicines (DMARDs), which effectively mitigate inflammation and forestall further joint deterioration. Anti-tumor necrosis factor-alpha (TNF-α) drugs, which are a class of biological DMARDs (bDMARDs), have been efficaciously employed in the treatment of RA in recent times Adalimumab, a TNF inhibitor, has demonstrated significant efficacy in reducing disease symptoms and halting disease progression in patients with RA. However, its use is associated with major side effects and high costs. In addition, ongoing advancements in therapeutic development have resulted in the production of medications that exhibit enhanced efficacy and safety characteristics. However, further investigation is required before RA can be deemed a manageable pathology. This review presents an analysis of the utilization of adalimumab for the treatment of RA by synthesizing information from relevant literature and emphasizing its effectiveness and safety to improve overall outcomes along with potential cost reductions for patients with RA.

Targeting IL-6 Signaling Pathways for Musculoskeletal Disorders Treatment: Risks and Benefits
Aisha Muthanna Shanshal, Raghda Hisham Aljorani, and Saad Abdulrahman Hussain
Al-Rafidain University College
Pro-inflammatory mediators like IL-6 effectively mediated the majority of musculoskeletal disorders such rheumatoid arthritis (RA), osteoarthritis (OA), and tendinitis. Increased levels of IL-6 are found in the serum or synovial fluid of patients with these disorders, and these levels are correlated with the incidence and severity of the disease. IL-6 is crucial for the development of cartilage pathology, for example, by inducing a variety of pathways that are involved in the induction and spread of inflammation. The expression of anti-catabolic factors is similarly increased by IL-6, indicating a protective function. The differential impacts of IL-6 classic and trans-signaling may be the reason for this dual role of IL-6, which has so far remained poorly understood. In this article, the experimental and clinical data on the function of inhibiting IL-6 signaling in the development and progression of pathologies of the synovium, cartilage, and bones were thoroughly reviewed. By evaluating the IL-6 targeting approaches that are currently being considered in research and clinical practice, it may provide a glimpse into the future of these illnesses' treatment.

The association of metformin dose up-titration and treatment duration with adiposity, lipid profile indicators, and serum leptin levels in T2DM Iraqi patients
Zainab S. Abdulrahman, Mohammed Qasim Alatrakji, Ahmed Abood Al-Maliky, Khalid Ibrahim Hussein, and Saad Abdulrahman Hussain
University of Sarajevo Faculty of Health Sciences
Introduction: Numerous factors, including age, gender, physical inactivity, insufficient dose, noncompliance, and drug-drug interactions, may contribute to significant intraindividual variation in metformin (MET) response. This study aims to determine the effect of Met dose and treatment duration on adiposity markers and serum leptin levels in Iraqi patients with type 2 diabetes. Methods: Between October 2021 and March 2022, a cross-sectional study at the Diabetes and Endocrinology Center in Baghdad included 150 type 2 diabetes mellitus (T2DM) patients with a disease duration of more than 1 year. Clinical and physical examinations were conducted before enrollment. We measured anthropometric variables such as body mass index, waist-to-hip ratio, and visceral adiposity index. We evaluated glycated hemoglobin, leptin, C-reactive protein, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and triglycerides (TGs) in the serum. Results: Only the TC/HDL-c and TG/HDL-c ratios were significantly different after the data were arranged according to glycemic control level. Arrangement for MET doses and treatment duration, none of the evaluated parameters were significantly different (p > 0.05) between groups receiving different doses of MET for different durations, except visceral adiposity index (VAI), which shows a very slight decrease (p = 0.046) after more than 10 years of treatment. Pearson’s correlation analysis revealed a weak and significant association between waist circumference (WC) and hip circumference and MET doses, and a weak and significant association between WC, VAI, and TG levels and treatment duration. The other markers lacked a significant relationship with MET doses or duration of treatment. Conclusion: MET dose and duration of treatment were not significantly correlated with adiposity and lipid profiles in Iraqi patients with T2DM.

Cost-Effectiveness Analysis of the Culturally Developed Diabetes Self-Management Education and Support Program among Type 2 Diabetes Mellitus Patients in Iraq
SiewChin Ong, EhabMudher Mikhael, and SaadAbdulrahman Hussain
Medknow
Background: Diabetes mellitus (DM) is a chronic disease associated with a major economic burden on persons, health care systems, and countries. Diabetes self-management education and support (DSME(S)) programs are highly effective method in the management of T2DM patients. Therefore, this study aimed to determine the cost-effectiveness of the developed culturally-specific DSME(S) program regarding glycemic control, lipid profile, and body weight for Iraqi type 2 DM patients. Methods: A randomized controlled clinical trial design was used to assess the cost-effectiveness of the culturally-specific DSME(S) program from the perspective of health care providers. In the cost-effectiveness analysis (CEA), cost per patient and clinical outcomes over 6 months were compared between the intervention and control group. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per unit improvement in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high density lipoprotein- cholesterol (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body weight. Results: The effectiveness of most outcomes was better in the intervention group compared with the control group. The ICER per unit improvement in HbA1c, SBP, DBP, serum TC, and TG levels was <1 of the minimum CET compared with the control group, thus meeting the definition of being highly cost-effective. Conclusion: The currently developed DSME(S) was cost effective method to improve glycemic control, blood pressure, TC, and TG for T2DM patients in Iraq.

Evaluating Eating Disorders among Medical Students in Baghdad, Iraq
Aisha Muthanna Shanshal, Saad Abdulrahman Hussain, Mustafa Sameer Mahmoud, Maha Ali Saleh, and Omar Abdulwahid Salih
Al-Rafidain University College
Background: Eating disorders represent a psychological problem characterized by abnormal eating behaviors and related emotions and thoughts. Aim: The study aims to assess the prevalence of eating disorders among medical students in Baghdad, Iraq. Methods: A cross-sectional study was conducted in medical departments that include medicine, dentistry, and pharmacy disciplines from January 2021 to March 2021 using an English version of a structured questionnaire. About 552 medical students participated in this study. Results: The study showed that in some individuals with normal Body Mass Index values, 64.47% suffered from eating disorders as diagnosed by EAT-26 while according to SCOFF, 23.5% of normal individuals suffer from eating disorders. Overweight individuals are more likely to have eating disorders than underweight individuals. According to SCOFF, 33.44% of the overweight and 4.18% of underweight individuals scored above the cutoff value. They were likely to have eating disorders. Similarly, in accordance to EAT-26, 19.70% of the overweight individuals and 9.48% of the underweight individuals were likely to have eating disorders. Conclusion: Many Iraqi medical students are predisposed to having eating disorders, with females being more vulnerable than males. To reduce the frequency of eating disorders among Iraqi medical students, a variety of initiatives and strategies are required.

Adverse effects associated with the use of N95 mask among health-care workers at the COVID-19 care units: A cross-sectional study in Sulaimani city, Iraq
S. Hussain, N. Mahmood, Trefa M. Ali Mahmood, Neega Aras Mohammed Salih and Z. Abdulrahman

BACKGROUND: Health-care workers have to use the N95 mask as a part of the protection kit during the COVID-19 pandemic. The adverse effects of such practice are not fully elucidated. The study aims to evaluate negative impacts of N95 face masks on health-care personnel at COVID-19 care units. MATERIALS AND METHODS: One hundred and twenty-two health-care workers (aged 20–58 years) from various health-care settings in Sulaimani, Iraq, from January to August 2020, were enrolled in this prospective, cross-sectional study. The physiological variables (blood pressure, heart rate, and oxygen saturation) were recorded before putting on the N95 mask and postremoval of the mask. The incidence of adverse effects such as headache, difficulty breathing, redness, irritation, and dizziness were also reported as a number and percent at the end of the work shift. RESULTS: There was a statistically significant difference in the physiological parameters after removal of the mask compared with baseline. Only diastolic pressure was significantly lower in those working >6 h when compared to those working 1–6 h. The changes in physiological markers were poorly and nonsignificantly associated with the duration of wearing the mask. Moreover, 67.2%–70.5% of the participants complain of headaches and breathing difficulties, while 45.9%–51.6% reported signs of itching, redness, and irritation. However, health-care workers who put on the face mask >6 h showed signs of headache, breathing difficulties, and itching at the exposed areas higher than those working for 1–6 h. CONCLUSION: N95 mask negatively impacts the physiological variables of health-care providers. The adverse effects may lead to excessive exhaustion after long shifts in the intensive care unit during treatment of COVID-19 patients.

Exam-Related Anxiety Levels among Iraqi Medical Students in Baghdad City
Aisha Muthanna Shanshal, Saad Abdulrahman Hussain, Ahmed Mohamed Mahmood, Fatima Abood Zukhair, Ali Sabah Mahdi, Athraa Mohammad Mahmood, and Nabaa Mustafa Hamed
Al-Rafidain University College
Background: Exam-related anxiety is a set of responses that include excessive worry, depression, nervousness, and irrelevant thinking from an individual's experience of assessment or testing and its outcome. Aim: This study was designed to evaluate exam-related anxiety among medical students in Baghdad City. Methods: This study utilized a cross-sectional survey design and was conducted by administering an online questionnaire to medical students (medicine, dentistry, and pharmacy). Results: A total of 530 students participated in the survey; 20.8% of them came from medical colleges, 41.7% from dentistry schools, and 37.5% from pharmacy schools. Around 27.1% of the respondents reported positive test-related anxiety. Conclusion: Exam-related anxiety is frequent among Iraqi medical students in Baghdad and highlights the need for education programs to reduce this anxiety.

Association of cigarette and water-pipe smoking with increased visceral adiposity, glycemic intolerance and hematological derangement in Iraqi healthy smokers
Saad Abdulrahman Hussain, Ashwaq Nagemeldeen Abbas, Hussein Saad Abdulrahman, and Ahmed Shaalan Deab
FapUNIFESP (SciELO)
The present study aims to investigate the impacts of cigarette smoking (CS) and water-pipe smoking (WPS) on the visceral adiposity index (VAI), hematological characteristics, and glycemic tolerance in Iraqi healthy smokers. A total of 528 healthy males from different locations of Baghdad city were allocated to three groups; nonsmokers (176), cigarette smokers (178), and WP smokers (174). Baseline characteristics, anthropometric and hematological markers and were reported. Glycemic control was evaluated using the glucose tolerance test. The evidence of elevated VAI, disrupted hematological markers, and impaired glucose tolerance was significantly ( P <0.001) different compared with non-smokers and related to the duration of smoking. The impacts of WPS seem to be significantly greater than CS in certain parameters (hemoglobin, hematocrit, methemoglobin, and 2-hour glucose tolerance values). In conclusion, CS and WPS negatively impacted body fat distribution, glucose tolerance, and hematological markers. There is a positive association between the rate of smoking and obesity, glycemic intolerance in both groups.

Polyphenols as Tyrosine Kinase Inhibitors for the Treatment of Metastatic Cancers: Current and Future Perspective
Saad Hussain and Qasim Mahmood Alhadidi
Universitas Gadjah Mada
Cancer is the world's biggest cause of death as a whole. The higher cancer mortality rate is related to metastasis, which is a major stumbling block in cancer treatment. Polyphenols are a diverse set of antioxidant-rich natural compounds that are often used in cancer treatments as chemopreventives and adjuvants. To find publications that highlight the topic of this review paper, a thorough literature search was conducted in several electronic databases such as PubMed Central, Google Scholar, Scopus, and Medline. Many signaling pathways are involved in the metastatic cascade, including the tyrosine kinase pathway. Tyrosine kinases are a group of enzymes involved in the control of cancer spread. Polyphenols' true role in cancer metastasis remains unappreciated, despite a large body of research proving their antimetastatic effects. As a result, the current work lays out cancer metastasis signaling pathways, stressing the importance of tyrosine kinases in the metastatic process. Polyphenols can suppress tyrosine kinase activity, which contributes to their antimetastatic characteristics. The importance of polyphenols in preventing cancer metastasis by interfering with the tyrosine kinase signaling cascade is highlighted in this work, which could lead to the development of future antimetastatic drugs.

The Association of Metformin Doses and Length of Treatment with Glycemic Control and Serum Insulin Levels in Iraqi Patients with Type-2 Diabetes Mellitus
Zainab Saad Abdulrahman, Mohammed Qasim Alatrakji, Ahmed Abood Al-Maliky, Khalid Ibrahim Hussein, and Saad Abdulrahman Hussain
Biomedical and Pharmacology Journal Oriental Scientific Publishing Company
Numerous variables, including age, gender, physical inactivity, inadequate dose, noncompliance, and drug-drug interactions, may lead to substantial intraindividual variability in metformin (Met) response. This study aimed to determine how dosages and duration of metformin affected glycemic control and insulin levels in Iraqi patients with T2DM. A total of 153 T2DM patients with a disease duration of more than one year participated in a cross-sectional study at the Diabetes and Endocrinology Center, Baghdad from October 2021 to March 2022. As part of the study method, the patients were evaluated clinically and physically, and their body weight, waist circumference, and body mass index (BMI) were measured. Glycated hemoglobin (HbA1c), fasting glucose (FSG), insulin, creatinine, and C-reactive protein (CRP) levels were evaluated. After data correction for Met doses and length of treatment, FSG, HbA1c, insulin, creatinine, and CRP levels were not substantially different (P > 0.05) among groups taking different doses of Met for different periods. According to Pearson's correlation analysis, there was no significant relationship between Met doses and treatment duration and glycemic control or insulin levels. In conclusion, Met dose and treatment duration were not significantly correlated to glycemic control or serum insulin levels, which could be attributed to other factors.

Gingko biloba extract improves the lipid profile, inflammatory markers, leptin level and the antioxidant status of T2DM patients poorly responding to metformin: A double-blind, randomized, placebo-controlled trial
Saad Abdulrahman Hussain, Tavga Ahmed Aziz, Taha Othman Mahwi, and Zheen Aorahman Ahmed
FapUNIFESP (SciELO)
The present study aims to evaluate the effects of Ginkgo biloba (GKB) extract as “add-on” therapy with metformin on the lipid profile, inflammatory markers, leptin and the total antioxidant capacity (TAOC) of patients with type 2 diabetes mellitus (T2DM). It is a multi-center, randomized, placebo-controlled double-blinded clinical study. Sixty patients were allocated into two groups: control and treatment groups; they received orally either 120 mg starch/capsule or 120mg GKB/capsule, respectively as an adjuvant with metformin for 90 days. Blood samples were obtained at zero time and after 90 days. The blood was utilized for analysis of the lipid profile, inflammatory markers, leptin, and TAOC. The GKB extract produced a significant decrease in the levels of TG, LDL-c, and CRP, with a significant increase in HDL-c compared to baseline values. There were no significant changes reported in the placebo-treated group. It also produced a significant decrease in the concentrations of IL-6, TNF-α, and leptin compared to baseline values and placebo-treated groups with a significant increase in TAOC compared to baseline values. In conclusion, GKB extract, as an adjuvant with metformin, decreases inflammatory mediators, leptin level and improves the antioxidant status and lipid profile of T2DM patients improperly managed with metformin.

Anti-Inflammatory Activity of Gingko biloba Extract in Cotton Pellet-Induced Granuloma in Rats: A comparative Study with Prednisolone and Dexamethasone
Ahmed Azad Kareem, Tavga Ahmed Aziz, Zheen Aorahman Ahmed, Hemn Hassan Othman, and Saad Abdulrahman Hussain
College of Pharmacy University of Baghdad
The current study was designed to evaluate the anti-inflammatory effect of GKB in the rat model of granulomatous inflammation. Thirty rats were distributed into five groups: The first group served as negative control group that received distilled water (DW) only without inducting inflammation, positive control group; treated with DW with the induction of inflammation and they were assigned to cotton pellet-induced granuloma, ginkgo biloba (GKB) treated group (200mg/kg/day), dexamethasone-treated group (1mg/kg), and Prednisolone treated group (5mg/kg). All the treatments were given orally for seven consecutive days. On day eight, the rats were anesthetized and the pellets together with granulation tissue were carefully removed and made free from extraneous tissue. The weight and the percent of the exudate and granuloma were determined and samples of the tissues were sent for histopathological examination. Blood samples were collected by cardiac puncture and used for the analysis of the inflammatory markers: TNF-alfa, IL10, VCAM-1, and hs-CRP. The study revealed a significant reduction in the weight and the percent of exudate (p-value = 0.019), (17%) and granuloma (p-value = 0.013), (20%) by GKB which was comparable to that produced by prednisolone. All the treatment groups showed a significant reduction in serum TNF-?, VCAM-1, and hs-CRP concentration compared with the positive control. The histopathological finding revealed pronounced improvement. In the current study, GKB was effective in attenuating the level of inflammation by decreasing the exudate, granuloma, and inflammatory markers. The underlying mechanisms could be the inhibitory effect on the expression of the inflammatory cytokines and endothelial adhesion molecule. These findings suggest GKB as a good contender to be tested in the treatment of inflammatory diseases.

Stress-induced behavioral changes in Iraqi dentistry academics during the COVID-19 outbreak
Mustafa Al-Shaikhli, Aisha Shanshal, and Saad Hussain
University of Sarajevo Faculty of Health Sciences
Introduction: Studies of dental practitioners performed around the world demonstrate that COVID-19 pandemic negatively impacts their daily activities lives, social functions, and health-care providing duties. The aim of the study is to evaluate the pandemic-induced psychological stress and associated factors on dental academics in Iraq.Methods: We conduct an observational study using a self-administered survey to obtain data from dental academics in many colleges of dentistry within Baghdad city. A closed-ended questionnaire was utilized, to assess post-traumatic responses to particular events. The Impact of Event Scale was used to assess the level of stress in the first of two outcomes. The second depicts the effects of COVID-19 on behavioral changes.Results: A total of 108 participants from seven colleges in Bagdad responded. About 38% reported a state of severe stress, 46.3% showed moderate stress, and 13.9% complained of mild states of stress. Stress levels were found to be substantially linked to fear of infection, worries about professional responsibilities, and limited mobility.Conclusion: The pandemic stress induces psychological and behavioral changes on the Iraqi dental educators, which can never be eliminated.

Silibinin Improves the Clinical Scores of Memory Function in Patients with Mild Cognitive Impairment: A Double-Blind, Placebo-Controlled Pilot Study
Saad Abdulrahman Hussain, Zainab Saad Abdulrahman, and Wael Waleed Mustafa
Oriental Scientific Publishing Company
The aim of pharmacotherapy for moderate cognitive impairment (MCI) is to reduce the present clinical signs and delay the progression of Alzheimer's disease (AD). There is currently no viable pharmacological therapy for the treatment of AD. Early intake of nutraceuticals, on the other hand, may help to alleviate and delay MCI. The goal of this study was to see how silibinin (SIL) supplementation affected cognitive function in older people with memory problems. A total of 85 subjects with memory impairment were randomly assigned to one of two groups: SIL (n = 42) supplied with 250 mg twice daily, or placebo (n = 43) for 16 weeks. A computerized neurocognitive function test was used to assess cognitive function (CNT). When comparing the SIL group to the placebo group, the "verbal learning test index" items of the CNT were significantly improved in the SIL arm (P < 0.05). Supplementing older people with memory impairment with SIL for 16 weeks appears to have a positive impact on their state of "verbal memory." Further studies are highly recommended.

The effect of providing usual care only for control subjects on the reliability of results obtained by controlled clinical trials assessing the benefits of diabetes self-management educational programs
Ehab Mudher Mikhael, Mohamed Azmi Hassali, and Saad Hussain
Clinical Ethics SAGE Publications
Diabetes self-management (DSM) is a crucial part in the management of diabetic patients. Most randomized controlled clinical trials reported significant benefits by diabetes self-management education (DSME) on DSM behaviors and metabolic control. Although the randomized clinical trials are the gold standard method in assessing the effectiveness of any intervention, including DSME interventions, the outcomes of these studies may reflect exaggerated effects; because in most of these studies, subjects in control group receive usual (standard) care with no any DSME. The lack of such education in the control group had many drawbacks: ( 1 ) make blindness impossible; at which non blinded studies may result in false-positive findings; ( 2 ) it may be unethical to recruit patients for participation in DSME studies as control subjects, most of these studies with long periods of follow up, without any direct benefit to them during the study period; the lack of direct benefit to control subjects in any clinical trial may results in high attrition (drop-out) rate. The high attrition rate in clinical trials especially in the control group can lower the statistical power of the study results; thus, the DSME program would appear to have positive effects even if the program had no real benefit. This problem of the DSME exaggerated effects can be solved partially through providing control subjects with education about some DSM behaviors or comparing the effect of DSME through different educational approaches (for example DSME by didactic vs interactive approach).

Validation of newly developed culturally specific diabetes self-management education and support program for Iraqi type 2 diabetes mellitus patients
Journal of Education and Health Promotion

The Influence of Rheumatoid Arthritis on Work Productivity among a Sample of Iraqi Patients
Faiq Isho Gorial, Sattar Jabbar Naema, Hameed Oda Ali, and Saad Abdulrahman Hussain
Al-Rafidain University College
Background: Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that impact daily life activities. The impact on work productivity is critical because of persistent work disability. Aim: To evaluate work productivity in RA patients compared to healthy controls, and to assess the impact of socio-demographic characteristics on work productivity. Methods: This was a case-control study conducted at the Rheumatology Unit of Baghdad Teaching Hospital, Medical City during the period from August 2020 to the end of March 2021. Seventy-two patients with RA were selected and compared with 72 healthy subjects as a control group. All patients were diagnosed according to ACR/EULAR 2010 RA classification criteria. The socio-demographic and clinical features, lifestyle practices, and disease activity of the patients and controls were all recorded during interviews. A standardized Arabic version of the Workplace Activity Limitation Scale (WALS) and the Job Limitations Questionnaire were used to assess the impact of RA on work productivity (WLQ-25). Results: The vast majority of patients were females (58.1%). Positive rheumatoid factor was reported in 94.4% of the patients. The patients showed a significantly lower WALS total score and higher WLQ-25 total score median (IQR) compared with controls. Conclusion: Active RA impairs the work productivity which was influenced by CDAI score and negatively associated with the use of DMARDs.

Medication-Use Behavior of Elderly Patients in Baghdad City: A Cross-Sectional Study
Massara Salah Abbas, Marwa Jamal, Mustafa Mohammed Sabri, Zainab Abdulrahman, and Saad Abdulrahman Hussain
Al-Rafidain University College
Background: As our society ages, the incidence of chronic diseases increases, and so does drug use and polypharmacy. Aim: To evaluate the medication use behaviors of selected elderly patients who lived in Baghdad city. Methods: This cross-sectional study included 225 subjects aged >60 years who lived in Baghdad city and consumed chronically prescribed medications. Data were collected using a survey form, and the survey was conducted through face-to-face interviews. The data are presented as numbers, percentages, and averages. Results: The majority were treated through polypharmacy, using various drugs. The most commonly used drugs included those used to treat cardiovascular diseases, DM, and dyslipidemia. 74.6% did not know about the side effects of the drugs they used, and 55.6% did not read the product information leaflet (PIL) of the drugs. Also, 70.7% said that the health care personnel did not educate them about their drugs. Of the elderly who were informed about their drugs, 128 obtained the information from the physician and 91 from the pharmacist. Conclusion: The majority of the elderly subjects used more than one drug, and the main drug class used was the cardiovascular agents. they are unaware of the side effects of the prescribed agents.

Effects of SGLT2 Inhibitors on the Risks of Hypertension and Heart Failure in Diabetic Patients: A Systematic Review
Harzhin Hiwa Ali, Naza Mohammed Ali Mahmood, and Saad Abdulrahman Hussain
Al-Rafidain University College
Diabetes mellitus (DM) with uncontrolled blood sugar causes a variety of problems, including coronary artery disease, stroke, heart failure, hypertension, nephropathy, neuropathy, and retinopathy. These consequences harm the diabetic patients' lives. Many studies have shown that diabetic patients have a higher rate of heart failure and a worse prognosis than non-diabetic people. Sodium and glucose co-transporter receptor-2 (SGLT2) inhibitors are a relatively new class of anti-diabetic drugs. They not only regulate blood sugar but also have positive cardiovascular effects via a variety of mechanisms. This review intends to show that SGLT2 inhibitors, in addition to good glycemic control, possess a cardioprotective role. We conducted a literature review and identified 20 adequately powered clinical trials and animal studies in type 2 DM that investigated the cardiovascular (CV) effects of SGLT2 inhibitors (particularly heart failure and hypertension). These studies looked at the cardiovascular effects of three SGLT2 inhibitors: Empagliflozin, Canagliflozin, and Dapagliflozin. In diabetic patients, these three inhibitors of SGLT2 significantly lowered the risk of heart failure and hypertension, making them valuable therapy for lowering CV risks in high cardiovascular-risk individuals with T2DM. Finally, the use of SGLT2 inhibitors in patients without diabetes mellitus showed positive metabolic outcomes in weight and blood pressure control.

Association between Red Cell Distribution Width to Platelet Ratio and Disease Activity among Iraqi Patients with Systemic Lupus Erythematosus
Faiq Isho Gorial, Hameed Oda Ali, Sattar Jabbar Naema, and Saad Abdurahman Hussain
Al-Rafidain University College
Background: The link between red blood cell distribution width-to-platelet ratio (RPR) and disease activity in systemic lupus erythematosus (SLE) is not well understood. Aim: To investigate the association between RPR levels and disease activity in SLE. Methods: This was a case-control study conducted at Baghdad Teaching Hospital, Medical City from July 2020 to March 2021. Seventy SLE patients were compared with 70 healthy controls. The diagnosis was made using the American College of Rheumatology SLE criteria. Results: SLE patients had a mean age of 35.2±12.03 years, while controls had a mean age of 36.3±9.9 years (P=0.5). Females represent 97.1% of SLE patients and 88.6% of controls. The average disease duration was 4.98±0.05 years. The disease activity index (SLEDI) was 16.4±4.8. SLE patients had a lower platelet count than controls, and the median (IQR) of RDW was larger than that of controls. SLE patients had a greater median (IQR) of RPR than controls (0.058; 0.04-0.07 vs. 0.045; 0.039-0.053). The RPR and SLEDAI showed strong positive association. The optimal cutoff point for distinguishing SLE patients from controls was 0.0455, with 79% sensitivity and 51% specificity. The RPR was not significantly affected by sociodemographic or clinical factors. Conclusion: The RPR was positively correlated with disease activity in SLE patients, and may be a valid measure to differentiate between SLE patients and healthy controls. Sociodemographic and other clinical characteristics do not significantly affect RPR.

The Role of Polyphenols in the Treatment of Alzheimer's Disease: Curcumin as a Prototype
Reem Halim Alattiya, Farah Khalid Tarish, Lina Loai Hashim, and Saad Abdulrahman Hussain
Al-Rafidain University College
Many epidemiological studies have suggested that consuming a diet rich in polyphenols can help prevent Alzheimer's disease (AD). Based on well-known in vitro and in vivo models of cerebral Aβ amyloidosis, we examined the data on the effects of various natural polyphenols on the aggregation of amyloid-protein (Aβ). These polyphenols effectively prevent oligomerization and fibril formation of Aβ through differential binding patterns, lowering Aβ oligomer-induced synaptic and neuronal toxicity, according to in vitro investigations. Furthermore, in a transgenic mouse model fed orally with such polyphenolic compounds, soluble Aβ oligomers as well as insoluble Aβ deposits in the brain were significantly reduced. Natural polyphenols exhibit anti-amyloidogenic effects on Aβ, in addition to well-known anti-oxidative and anti-inflammatory activities, according to an updated assessment of the literature, implying their potential as therapeutic and/or preventive agents for AD treatment. To prove polyphenols' efficacy as disease-modifying agents, well-designed clinical trials or preventive treatments using various polyphenols are required.

Correlation between serum pro inflammatory cytokines and clinical scores of knee osteoarthritic patients using resveratrol as a supplementary therapy with meloxicam
B. Marouf, S. Hussain and Z. Ali

OBJECTIVE: The objective of this study was to analyze the associations between the pro-inflammatory markers with the clinical outcomes of knee osteoarthritis (OA) in patients using resveratrol as an add-on treatment with meloxicam. MATERIALS AND METHODS: This was a double-blind controlled clinical investigation, with 110 eligible patients with OA assigned randomly to receive 15 mg a day meloxicam with either resveratrol 500 mg a day or placebo for 90 days. The standard tools for assessment of pain severity and physical functions were utilized. The tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6 in the blood were evaluated. Spearman's correlation coefficient test was used to determine the significance of correlations. RESULTS: The regression analysis to determine the correlation between reductions of the inflammatory biomarkers with the amelioration of the clinical scores showed a nonsignificant weak correlation between these variables. Total clinical scores of each assessment tool that was used “Knee Injury and OA Outcome Score (KOOS) and WOMAC” displayed a weak and nonsignificant correlation with TNF-α, IL-1β blood level. The Spearman's correlation shows a relatively nonsignificant association between IL-6 levels and KOOS, WOMAC, and Visual Analog Scale scores after incorporating resveratrol as an adjuvant with meloxicam for 90 days. CONCLUSION: A weak and nonsignificant correlation between serum biomarkers and the clinical outcomes has been suggested in patients with painful knee OA treated with meloxicam and resveratrol.

Solid lipid nanoparticles delivery systems for colon cancer chemotherapy: A critical review
B. Y. Al-najjar and S. Hussain

Therapeutic approaches for targeting colon cancers are currently of significant importance important because of possible remission, reduction of cancer metastases, and increased success pf surgery or radiotherapy. Colonic drug delivery is becoming the increasingly preferred route for drug administration; however, it has many limitations that can be avoided by the use of proper carrier systems. Currently, many solid lipid nanoparticle systems (SLNs) were developed to enable the formulation of hydrophobic and poorly water-soluble drugs including those utilized as colonic drug delivery systems. They have many advantages including high bioavailability, high biocompatibility, cost-effectiveness, controlled release, physical stability, and safety, besides, avoidance of using organic solvents and capability of large-scale production and sterilization. Various studies provide important insights into the use of SLN delivery system to treat colon cancer. However, there is a general lack of data from clinical trials and further studies are recommended to evaluate SLNs in animal models.

The Development and Validation of Quality of Life Scale for Iraqi Patients with Type 2 Diabetes Mellitus
EhabM Mikhael, MohamedA Hassali, SaadA Hussain, and Nizar Shawky
Journal of Pharmacy and Bioallied Sciences Medknow
Background and Aim: The current trend for determining the effectiveness of new treatment or services provided for diabetes mellitus (DM) patients is based on assessing the improvement in both glycemic control and the patient quality of life. Many scales have been developed to assess quality of life among DM patients, but unfortunately, no one can be considered as gold standard. Therefore, this study aimed to develop and validate a brief and specific scale to assess quality of life among Iraqi type 2 DM patients. Methods: An extensive literature review was done using Google-Scholar and PubMed to find out scales that utilized to assess quality of life among DM patients. Four relevant scales, three diabetes specific and one general, were selected. The selected scales were carefully evaluated to find out domains that are commonly used to assess quality of life and then the items within the selected domains were reviewed to choose relevant and comprehensive items for Iraqi type 2 DM patients. Ten items were selected to formulate the quality of life scale for Iraqi DM patients (QOLSID). The content validity of QOLSID was established via an expert panel. For concurrent validity QOLSID was compared to glycosylated hemoglobin (HbA1C). For psychometric evaluation, a cross sectional study for 103 type 2 DM patients was conducted at the National Diabetes Center, Iraq. Test-retest reliability was measured by re-administering QOLSID to 20 patients 2-4 weeks later. Results: The internal consistency of the QOLSID was 0.727. All items had a corrected total-item correlation above 0.2. There was a negative significant correlation between QOLSID score and the HbA1C level (-0.518, P = 0.000). A significant positive correlation was obtained after re-testing (0.967, P = 0.000). Conclusion: The QOLSID is a reliable and valid instrument that can be used for assessing quality of life among Iraqi type 2 DM patients.

Saad Abdulrahman Hussain

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