International Journal of Nutrology

The effectiveness of an educational program in improving nurses knowledge of blood transfusion safety: a cross-sectional study

2026-07-16T23:21:24+00:00

Introduction: Blood transfusion is a safe and life-saving medical procedure in which blood or its components (red blood cells, platelets, and plasma) are transferred from a healthy donor into the patient's bloodstream using an intravenous catheter. This method is used to replace blood lost due to injuries or surgery, or to treat severe anemia and chronic diseases such as cancer and thalassemia. Objective: To assess the efficacy of a proposed educational program on nurses’ knowledge of blood transfusion safety and identify the relationships between the demographic characteristics and their knowledge level. Design: A cross-sectional study was employed, utilizing a quantitative research methodology. The study was conducted between 19/11/2025 and 1/2/2026 to fulfill the predefined objectives. Methods: A convenience sample of nurses administering blood transfusions at Tarmia General Hospital was gathered. Data were gathered utilizing a structured questionnaire developed in accordance with WHO guidelines, encompassing demographic characteristics and associated variables, alongside knowledge pertaining to patient preparation, pre-transfusion responsibilities, post-transfusion protocols, and the management of blood transfusion reactions. The tool had multiple-choice questions scored as (1) for correct replies and (0) for wrong responses. Reliability was evaluated with the Kuder–Richardson Formula-20 for internal consistency. Pre-Period = 50.3409, Post-Period = 65.2919. Data were evaluated employing descriptive statistics, including observed frequencies, percentages, mean scores, standard deviations, and relative sufficiency (RS%), alongside the Binomial test, One-sample Chi-Square test, One-Sample Kolmogorov-Smirnov test, McNemar test. Results: Knowledge increased from 49.8% to 79.3% in the post-test, and the average score also improved. Demographic characteristics and cognitive improvements were not substantially associated (p>0.05). Conclusion: The introduction of an educational program has markedly enhanced nurses' knowledge across all examined areas, whereas minor correlations have been identified with nurses' sociodemographic factors and some associated variables.

From antimicrobial resistance to disability: a One Health framework linking pandrug-resistant infections to amputation and irreversible functional decline

2026-07-16T10:56:40+00:00

Introduction: Antimicrobial resistance (AMR) has become one of the greatest challenges of the 21st century to global health. The impact of AMR is usually assessed in terms of morbidity, mortality, and cost of health care, but irreversible disability is significantly underrecognized. Multidrug-resistant (MDR) pathogens, extensively drug-resistant (XDR) and especially pandrug-resistant (PDR) pathogens often cause therapeutic failure, chronic infection, progressive destruction of tissue and permanent impairment in function. Objective: The objective of this review was to reframe AMR in a disability-focused and One Health perspective, by examining the link between resistant infections and amputation, long term functional decline, and disability. Methods: A narrative integrative review was performed with recent literature from clinical, microbiology, public health and One Health publications. The review is targeted at high-risk infections such as diabetic foot infections, infections associated with trauma, burn wounds, osteomyelitis and chronic soft tissue infections. Results: Available data has shown that there exists a link between resistant infections and delayed effective therapy, chronic infection with biofilm, necrosis of tissue, recurrence of surgical intervention and loss of the limb. PDR pathogens mark the ultimate point of therapeutic exhaustion of antimicrobial agents—often the last resort is surgical containment. The burden of disability due to AMR is especially high in LMICs due to delayed diagnosis, poor antimicrobial stewardship, limited access to newer antimicrobials, and lack of adequate rehabilitation services. Conclusion: AMR should no longer be considered solely a cause of death, but also as a leading cause of irreversible disability and long-term burden on society. The inclusion of disability prevention, functional preservation, rehabilitation and One Health in AMR frameworks is essential to future global strategies for health.

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Integrating artificial intelligence and One Health approaches for virtual screening and antimicrobial resistance prediction

2026-07-16T10:50:28+00:00

Introduction: Antimicrobial resistance (AMR) has become a global health threat affecting human, animal, and environmental health. Artificial intelligence (AI) techniques, including machine learning (ML) and deep learning, have demonstrated significant potential in enhancing antimicrobial resistance prediction, antimicrobial discovery, and One Health surveillance systems. Objective: The purpose of this review was to evaluate the use of artificial intelligence and One Health approaches in virtual screening, antimicrobial resistance prediction, and antimicrobial stewardship, and to explore their potential applications in global antimicrobial resistance management. Methods: A narrative review was conducted on recent literature covering the application of AI in antimicrobial resistance prediction, drug discovery, machine learning algorithms, and One Health surveillance systems. Clinical, veterinary, environmental, and public health studies relevant to the topic were reviewed and synthesized. Results: The available evidence showed that AI can enhance resistance prediction, identify resistance-associated mutations, facilitate virtual screening of antimicrobial compounds, and support the discovery of novel therapeutic agents. AI models can also integrate clinical, veterinary, genomic, and environmental data, strengthening One Health surveillance and antimicrobial stewardship efforts. However, data quality, transparency, ethical considerations, and interoperability remain significant challenges. Conclusion: AI has the potential to be a powerful tool in combating antimicrobial resistance within a One Health framework. To fully realize the benefits of AI for antimicrobial resistance prediction, antimicrobial discovery, and global surveillance programs, improved data integration, ethical governance, and interdisciplinary collaboration are essential.

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Evaluating the level of awareness regarding ovarian cancer signs and risks among women in Kirkuk: a cross-sectional study

2026-07-16T01:13:37+00:00

Introduction: Ovarian cancer is a malignant type of illness, the misinterpretation of the symptomatic ovarian cancer average in women and their physicians might cause a subsequent misdiagnosis of the illness. Objective: Aim of the research was to find out the level of awareness of the symptoms and risk factors of ovarian cancer among women visiting teaching hospital in Kirkuk city. Methods: This study is quantitative descriptive (cross-sectional) design. The data collection was performed using a constructed questionnaire of purposive (non-probability) sample of (200) women visiting at outpatient and inpatients in the Teaching Hospitals in Kirkuk City. Results: The average of the subjects under assessment was (33.16). Juvenile cases were divided into the following groups of Married (66.5%) and house wife (66%). most cases (33%) had high level of education. The cases with adequate economic condition were 57 percent and (72%) percent of cases were urban dwelling. A statistically significant association was observed between Awareness of the risk factors of ovarian cancer in relation to age (p-value = 0.000) and educational level (p-value=0.013), also statistically significant difference was observed between awareness of the symptoms of the ovarian cancer in related to age (p-value = 0.024), Educational level (p-value=0.043) and Economic status (p=0.003). The good awareness (61%) of the participants toward risk factors of the ovarian cancer is more than the poor awareness of the risk factor, while the good awareness (49%) of the participants toward the symptoms is less than the poor awareness (51%) of the ovarian cancer symptoms. Conclusion: The general awareness of the symptoms of ovarian cancer in this study was low.

Nurses’ knowledge regarding postoperative pain management at Tikrit Teaching Hospital: a cross-sectional study

2026-07-15T15:12:50+00:00

Introduction: Postoperative pain (POP) is a common and expected experience after surgery. If not adequately controlled, many complications will occur. Objective: This study assessed nurses’ knowledge of postoperative pain at the Tikrit teaching hospital. Methods: A cross-sectional study (November 2025-May 2026) included 100 nurses working in surgical units, selected through purposive sampling. Data were collected using a questionnaire covering sociodemographic data and nurses' knowledge about POP management. Analysis by SPSS v25. Results: The results showed that 71% of the sample were males, 81% were between 21 and 29 years old, 77% had diplomas in nursing, 92% were nurses, not midwives, 80% of the sample had 1-5 years of working experience, and 64% of the sample had 1-5 years of experience in surgical units. The nurses respond correctly to 9 questions at a moderate level of knowledge. Conclusion: The nurses have limited knowledge regarding postoperative pain management. Tthereis a need for POP management training. The questionnaire is suitable for both genders.

Ameliorating effects of topical lornoxicam on acne-like lesions induced by Cutibacterium acnes and testosterone in mice: a randomized controlled animal study

2026-07-14T04:43:20+00:00

Introduction: Alternative therapeutic approaches are required for acne vulgaris, as current treatments, such as antibiotics, are less effective due to antimicrobial resistance and side effects. Objective: It was to evaluate the efficacy of lornoxicam gel as a non-antibiotic treatment, an acne mouse model was established using C. acnes and testosterone. Methods: Thirty untreated male albino BALB/c mice weighing 25-35 grams and aged 6-8 weeks were randomly divided into five groups (n = 6 per group). After a one-week acclimatization period, acne induction was initiated by applying the testosterone solution topically once daily for 14 days. On day 15, C. acnes was injected intradermally into the dorsal skin, while topical testosterone application continued to the end of the experiment. On day 17, Lornoxicam gel (0.5%) was applied once daily for one week. Clindamycin gel was applied to the standard group. H&E staining was used to evaluate histopathological changes, and ELISA was used to measure the levels of inflammatory mediators (TNF-α, IL-1β, and IL-8) in skin homogenates. Results: Lornoxicam treatment significantly reduced clinical lesion scores, histological damage, and pro-inflammatory cytokine levels compared with the untreated induction group (p<0.001). Conclusion: Topical lornoxicam markedly improves acne-like lesions, indicating new therapeutic possibilities for acne management. Further testing is required to determine its clinical significance, including Phase I/II human clinical trials to assess efficacy, safety, and appropriate dose regimens in various patient populations with moderate-to-severe inflammatory acne.

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Iron status and its clinical implications in women with diabetes and thyroid disorder: a cross-sectional study

2026-07-13T15:53:59+00:00

Introduction: Thyroid dysfunction and Type 2 Diabetes Mellitus are intimately linked to iron status. Because iron plays a crucial role in the synthesis and action of insulin as well as in the generation of thyroid hormone through its involvement in important enzymatic activities, maintaining appropriate iron levels is vital for correct metabolic function. Objective: This study aimed to assess iron status in women with Type 2 Diabetes Mellitus and thyroid dysfunction. Methods: Ninety participants were collected from the National Diabetes Center (NDC) at Mustansiriyah University. Results: They were divided into three groups: G1: (30) hypothyroidism patients with T2DM, G2: (30) hyperthyroidism patients with T2DM, and G3: (30) healthy controls there was a strong positive correlation between iron vs FBS and positive correlation with iron and HbA1c, TT4, and serum ferritin levels in hypothyroidism patients, while A strong negative Correlation between iron level and TSH in hypothyroidism patients. Conclusion: A strong positive correlation between iron vs FBS and positive correlation with iron vs HbA1c, TSH and serum ferritin levels in hyperthyroidism patients, while A negative Correlation between iron level and TT4 in hyperthyroidism patients. Conclusion, iron metabolism, glycemic management, and thyroid hormone regulation are closely related. Monitoring and controlling iron levels may be crucial to improving clinical outcomes for individuals with thyroid dysfunction since changes in iron status may contribute to metabolic dysregulation in both hypothyroid and hyperthyroid states.

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Nutrology of probiotics and nutrients in cancer patients: a systematic review

2026-07-10T01:12:38+00:00

Introduction: In the scenario of immunomodulation by regulatory T cells (Tregs), studies show that the increase in Bifidobacterium probiotics, in addition to colonizing the intestine, alters the intestinal microbiota, activating Treg cells, which produces anti-tumor effects. Objective: This was to establish, through a systematic review study, the main clinical studies that show the positive effects of probiotics and nutrients in stimulating regulatory T cells in cancer patients, to enable immunotherapy for the control, reduction, or even elimination of cancer cells. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from April to May 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 141 articles were found. A total of 40 articles were fully assessed and 31 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 24 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=67.8%>50%. It was concluded that probiotics, together with intestinal microbiota, have been increasingly proposed to improve immune checkpoint blockade treatments against cancer by activating Treg cells. Oral administration of butyrate, propionate, and acetate, individually or in combination, led to an increase in the number of Treg cells in the colon. Also, all-trans retinoic acid (atRA), a bioactive form of vitamin A, stimulates Treg cells in the human intestine.

Main clinical studies on the impact of nutrition on oral and endodontic health: a systematic review

2026-07-09T15:39:04+00:00

Introduction: In the context of endodontics, oral and periodontal diseases are predictors of various problems, primarily tooth loss in adults. Inflammatory processes are caused by bacteria, genetic factors, lifestyle, and nutrition. Periodontitis can cause alterations and severe damage to oral health and well-being. Numerous clinical and experimental studies highlight a strong association between periodontitis and certain systemic diseases. Objective: It was to conduct a systematic review presenting key clinical studies on the impact of nutrition on oral and endodontic health. Methods: The PRISMA guidelines for systematic reviews were followed. The search was conducted from February to May 2026 across the Scopus, PubMed, Science Direct, SciELO, and Google Scholar databases. Study quality was assessed using the GRADE instrument, and risk of bias was analysed according to the Cochrane tool. Results and Conclusion: A total of 135 articles were identified; 50 were evaluated in full, and 40 were included in this systematic review. Based on the Cochrane risk-of-bias tool, the overall assessment revealed 9 studies with a high risk of bias, while 5 studies failed to meet GRADE and AMSTAR-2 standards. Most studies lacked homogeneity in their results (X² = 75.2% > 50%). This review concluded that nutritional science is essential for oral and endodontic health. Nutrient deficiencies can affect oral health status. Nutritional science addresses nutritional needs and helps prevent diseases associated with a poor diet. A nutrient-deficient diet can accelerate the progression of oral cavity diseases by disrupting tissue homeostasis, reducing resistance to microbial biofilms, and impairing tissue healing, thereby compromising endodontic health and, consequently, systemic health.

Evaluation of the relationship between pediatric patients with mosaic down syndrome and hypothyroidism and treatment with honey: a cross-sectional study

2026-07-04T20:16:20+00:00

Introduction: Down syndrome is are three chromosome copies (trisomy) from chromosome 21 in the somatic cells of a person. People may have Mosaic Down syndrome, which is a combination of two types of cells, meaning that they are two cell lines of one fertilized cell (zygote). Some cells contain 46 chromosomes, indicating that they are normal cells, while other cells contain 47 chromosomes; cells with 47 chromosomes contain an extra chromosome 21. Objective: The relationship between Mosaic Down syndrome and thyroid gland shape and between Mosaic Down syndrome and thyroid gland hormones T3, T4 and TSH, and effect of honey on those with hypothyroidism. Methods: Karyotyping was performed for 20 males in childhood who were 10 years old, and all of them had Mosaic Down syndrome. The levels of thyroid hormones (T3, T4, TSH) were measured and 6 controls were included, patients were fed honey to observe the effect of honey on the concentration of thyroid hormones in the blood. Results: The highest percentage of thyroid hormones (57, 0.75, 0.35), (T3, T4, TSH) in the sample in which the lowest percentage of mosaicism was 8.16%, and the lowest percentage of thyroid hormones was recorded (9, 0.01, undetectable), (T3, T4, TSH) in the sample that had the highest percentage of mosaicism (32.25%). The rate of decrease in thyroid hormone levels increases further as the percentage of mosaicism increases, the percentage of sister chromatids exchanged in the group with mosaic Down syndrome was (62.46 ±6.12) compared to the percentage of exchanges in the control group (41.61 ± 4.84), honey was highly effective in raising thyroid hormone levels. Conclusion: All patients with Mosaic Down syndrome have hypothyroidism, and the rate of decline in thyroid hormones increases further as the percentage of mosaicism increases, the higher the degree of mosaicism, the greater the rate of sister chromatid exchange, there were significant differences; honey raised the level of thyroid hormones in patients.

Development model of sports service management for elderly: a cross-sectional study

2026-06-18T14:23:58+00:00

Introduction: China faces severe population aging, and institutional elderly sports service is critical for healthy aging. Objective: This study targets fourteen elderly institutions in Kunming to explore sports service management bottlenecks. Methods: Mixed-method design including seventy-eight semi-structured interviews and 580 valid questionnaires. Structural Equation Model (SEM) with Smart PLS 4.0 was adopted to test four-dimensional environmental factors (government, economy, society, technology). Results: Significant gaps exist between public, public-built-private and fully private institutions. Social environment (β=0.36) and government policy (β=0.30) are the top positive driving factors, while technology application is the primary weakness. Unbalanced fiscal allocation, insufficient cross-department collaboration and industry integration barriers restrict service quality. Conclusions: A "classified policy + four-dimensional synergy" development model is constructed. Differentiated governance, industrial integration and age-friendly intelligent transformation are proposed to optimize sports services for elderly institutions in southwest ethnic regions.

Phytochemical screening and pharmacological activities of various fractions derived from Ephedra foeminea Forssk aerial parts

2026-06-16T19:09:36+00:00

Obesity is a major risk of chronic diseases such as metabolic syndrome, cardiovascular diseases and type-2 diabetes mellitus. These diseases are the leading causes of death worldwide. Therefore, it is necessary to search for anti-obesity therapeutics. This study aimed to investigate, in vitro, the anti-obesity effect of Ephedra foeminea Forssk. for the first time. To achieve our aim, acetone, hexane, aqueous and methanol fractions were derived from E. foeminea. It appeared that the four fractions had strong inhibitory effect against the activity of α-amylase enzyme with IC50 value range 13-15 μg/mL. Methanol fraction possessed the strongest inhibitory effect on glucosidase (IC50 117.5 μg/mL) and lipase enzymes activities (IC50 24.5 μg/mL). Furthermore, methanol fraction possessed the strongest antioxidant activity (IC50 14.5 μg/mL) and had no cytotoxic effect. This indicates that methanol fraction is a potential and safe source of therapeutically active compounds with anti-obesity and anti-diabetic potency.

Antioxidant, antimicrobial, and cytotoxic properties of four different fractions derived from the bulbs of Urginea maritima L.

2026-06-16T14:26:25+00:00

Introduction: Urginea maritima L. (U. maritima) has been utilized in traditional medicine, but in many cases, it is not based on scientific evidence due to limited studies, particularly in Palestine. Objective: This study aimed to assess the antioxidant, antimicrobial, and cytotoxic properties of four solvents fractions extracted from U. maritima bulbs collected from Palestine for the first time. Methods: The DPPH method was used to quantify antioxidant activity. Antimicrobial activity was tested employing the broth microdilution method. Anti-proliferative activity was evaluated utilizing colorimetric methods. Results: The DPPH free radical scavenging assay revealed that the U. maritima aqueous and methanol fractions demonstrated no antioxidant properties. In contrast, acetone and hexane fractions exhibited significant activity with IC₅₀ values of 24 and 10.33 μg/mL, respectively. Acetone and hexane fractions had a broader spectrum of antimicrobial activity (ranging from 0.8 to 6.3 mg/mL) compared to aqueous and methanol fractions. Aqueous fractions reduced cell viability by 50% within 24-48 h. Methanol and acetone fractions reduced cell viability by 40% after 4 and 24 h (p-value <0.0001), while prolonged exposure to methanol, acetone, and hexane fractions for 48 hresulted in a substantial decrease in cell viability by 70% to 90% (p-value <0.0001). Conclusion: Our findings have revealed that acetone and hexane fractions exhibited strong antioxidant, cytotoxic, and antimicrobial activities compared to the aqueous and methanol fractions. These observations offer significant insights into the potential therapeutic applications of U. maritima in combatting oxidative stress, microbial infections, and perhaps cancer. Further in vivo investigations are necessary to validate these findings in the future.

Evaluating the link between static foot alignment and dynamic plantar loading in type 2 diabetes: a cross-sectional study

2026-06-10T13:39:53+00:00

Introduction: In type 2 diabetes mellitus (T2DM), elevated cumulative plantar loading contributes to ulcer risk, especially in patients with neuropathy. Static foot posture may influence plantar load distribution, but evidence remains limited. Objective: This study aimed to examine the association between FPI-6 and PTI during walking in adults with T2DM attending outpatient services at RSUD Dr. Soetomo, Surabaya. Methods: A cross-sectional study was conducted in May–July 2025 at RSUD Dr. Soetomo, enrolling 33 adults with T2DM (no dropouts). Foot posture was assessed using the FPI-6, and plantar pressure-time integral (PTI) was recorded with an in-shoe pressure system (Pedar-X) during walking; participants completed 20 steps while cadence was maintained with a metronome. Normality testing used the Shapiro–Wilk test; correlation used Pearson when assumptions were met. Results: Most participants had neutral foot posture (right 82.4%; left 70.6%). The mean PTI was highest in the forefoot, followed by the hindfoot. Correlation between total FPI and PTI was not significant for hindfoot or forefoot (all p > 0.05). Conclusion: Static foot posture (FPI-6) was not associated with dynamic cumulative plantar loading (PTI) in this T2DM cohort. These findings support the use of a combined risk assessment strategy (neuropathy, deformity, joint motion, and dynamic plantar pressure) rather than relying on static posture alone.

Early detection of hearing impairment in neonates with dual/multiple toxoplasma, rubella, cytomegalovirus infections: a cross-sectional study

2026-06-10T13:25:21+00:00

Introduction: Hearing impairment is often associated with pregnancy infections such as Toxoplasma, Rubella, Cytomegalovirus (TORCH). Objective: To determine the prevalence of hearing impairment using Otoacoustic Emissions (OAE) and to analyze the associated risk factors in neonates with dual/multiple TORCH infections. Methods: This cross-sectional study was conducted from September to November 2019. Infants admitted to the intermediate room during the study period were included in the study and underwent OAE testing to evaluate for hearing impairment. Infants with OAE refer tested with TORC examination. Prevalence of hearing impairment with dual/multiple TORC infections was calculated, and the Odds Ratio for specific risk factors was measured using Fisher’s exact test. Results: Over the period, 50 babies were screened. Forty-three babies (86%) presented with normal hearing on OAE testing. Seven babies (14%) responded to OAE referral. Out of 7 infants, one infant classified as OAE refer had early discharge, and the six of them underwent TORC examination. Of the 6 infants, 5 had dual or multiple TORCH infections. By univariate analysis, the highest risk factor for hearing impairment and dual/multiple TORC infection was the premature rupture of membranes, OR 41; 95% CI 3,65–46,03. Correlation between dual/multiple TORC infection and hearing impairment was statistically significant, p = 0.001, R = 0.826. Conclusion: The incidence of hearing impairment among neonates in our study is almost similar to that in the previous study. Eighty percent of them had dual/multiple TORC infections. The premature rupture of the membrane is the commonly associated risk factor in this study.

Major clinical considerations of nutrients and supplements in the treatment of periodontitis for dental implant success: a scoping review

2026-06-09T11:23:36+00:00

Introduction: With Brånemark's concept of osseointegration in 1960, dental implants have seen significant advancements, particularly in the structural and functional connection between bone and the implant surface. One of the main predictors influencing osseointegration is bone quality fostered by nutrients and the absence of periodontitis. Objective: This study aimed to analyze the clinical considerations of nutrients and supplements in the treatment of periodontitis for dental implant success. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from March to April 2026 in the Web of Science, Scopus, Embase, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneity in their results, with X²=83.5%>50%. A total of 101 articles were found and submitted for eligibility analysis, with 13 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. It was concluded that probiotic and prebiotic nutraceuticals, polyunsaturated fatty acids, and vitamins A, B, C, D, and E are the most commonly used in dentistry. Evidence suggests a positive relationship between adequate vitamin D levels and early osseointegration of dental implants. Regarding marginal bone changes and peri-implant soft tissue outcomes, the findings were consistent but statistically heterogeneous, with several studies indicating greater bone loss, thinner gingival phenotypes, or a more pro-inflammatory peri-implant environment in the presence of vitamin D deficiency.

Effect of cytokinin on growth parameters, yield, and medicinally active compounds of roselle (Hibiscus sabdariffa L.) under water stress conditions

2026-06-03T22:08:33+00:00

Introduction: Water stress significantly limits the agricultural and medicinal potential of roselle (Hibiscus sabdariffa L.). Exogenous plant growth regulators, such as cytokinins, may mitigate these adverse environmental effects and enhance overall plant productivity. Objective: To investigate the impact of cytokinin application and varying water stress levels on the vegetative growth, yield, and medicinally active compounds of roselle. Methods: A factorial field experiment using a Randomized Complete Block Design (RCBD) with three replications was conducted during the spring season of 2025 in Al-Mussaib, Iraq. Treatments consisted of three cytokinin levels (0, 50, and 100 mg L⁻¹) and four water stress levels (25%, 50%, 75%, and 100% of field capacity). Data were statistically analyzed using the Least Significant Difference (LSD) test. Results: The application of 100 mg L⁻¹ cytokinin significantly maximized plant height (95.08 cm), branches (9.20 plant⁻¹), leaves (106.70 plant⁻¹), capsules (38.83 plant⁻¹), and calyces’ dry weight (9.30 g). It also peaked the concentrations of vitamin C, quercetin, hibiscetin, and gossypetin. Similarly, irrigation at 75% field capacity produced the highest mean values for the same traits. Crucially, the interaction between 100 mg L⁻¹ cytokinin and 75% field capacity recorded the absolute highest values across all studied morphological, yield, and phytochemical parameters. Conclusions: Applying 100 mg L⁻¹ of cytokinin optimally enhances the growth, yield, and phytochemical composition of Hibiscus sabdariffa L., particularly when combined with

moderate water management (75% field capacity). This combination provides an effective agronomic strategy for cultivating this medicinal crop under constrained water conditions.

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Clinical studies on the interrelationship between gut microbiota and oral health for systemic homeostasis: a systematic review

2026-05-29T18:13:30+00:00

Introduction: The oral microbiota has shown important actions in the physical and mental health of human beings. Oral diseases related to oral dysbiosis are studied, as well as systemic degenerative inflammatory diseases. Objective: It was to present and discuss the main considerations and results of clinical studies on the interrelationship between gut microbiota and oral health for systemic homeostasis. Methods: The PRISMA Guidelines were followed. The search was conducted from January to February 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X2=67.5% > 50%. A total of 112 articles were found and submitted for eligibility analysis, with 18 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that there are distinct causal relationships between the microbiota and acute and chronic gingivitis. Oral microbiota dysbiosis not only induces local inflammation and exacerbates inflammation associated with metabolic diseases, but can also trigger systemic inflammation, leading to metabolic and neuropsychiatric disorders. Clinical studies have shown the effectiveness of anti-inflammatory treatments of the gut and oral microbiota in reducing periodontal disease and cognitive decline. The integration of advanced microbiome analysis and neuroimaging techniques may help to elucidate the mechanisms linking gut health, systemic inflammation, and cognitive function.

Midwives practices regarding standardized guidelines for prevention of postpartum hemorrhage: a cross-sectional analysis

2026-05-26T08:36:07+00:00

Introduction: Postpartum Hemorrhage is still one of the greatest dangerous and significant problems that can happen during birth. Most Postpartum Hemorrhage cases can be prevented and managed with prompt intervention and standardized protocols. Objective: The research aim was to assess midwives’ level of practice regarding standardized guidelines for prevention of postpartum hemorrhage. Methods: To achieve the study's objectives, a descriptive crosssectional design was adopted. two tools were used to collect data. The first instrument was a selfadministered structured questionnaire that included questions about the demographic characteristics of midwives, and the second instrument was Observational Checklist for assess midwives' practices regarding guidelines for prevention of postpartum hemorrhage: It was an adopted from the World Health Organization's (WHO) guidelines updated in 2023, and The Iraqi Ministry of Health's guidelines for prevention of primary postpartum hemorrhage (PPH). The questionnaire was tested by professionals and showed good reliability (Cronbach alpha= 0.82). SPSS version 25 was used to code, input, and analyses questionnaire data. The chi-square test explored category variable relationships. Significant results had a p-value below 0.05. Results: the current findings reveal that (89.8%) of midwives had moderate practices in the prevention of postpartum hemorrhage (PPH) throughout 3rd stage of labor and immediate postpartum period. While (10.2%) had poor practices and (0.0%) had good practices, also its found that there was no correlation between the sociodemographic factors and the total level of midwives’ practice. Conclusion: The current study concluded that most midwives demonstrated a moderate level of practice regarding standardized guidelines for postpartum hemorrhage prevention during 3rd stage of labour and immediate post-partum period. To bridge these gaps, a monitoring system should be designed and implemented to regularly assess obstetric nurses' practices to ensure best practices and identify area for improvement.

Role of herbal bioactive compounds in the prevention of dental caries and periodontal diseases: a narrative review

2026-05-23T11:51:14+00:00

Introduction: Dental caries and periodontal diseases remain two of the most prevalent chronic non-communicable conditions worldwide, with substantial impact on systemic health and public health expenditure. Although fluoride, mechanical biofilm control, and chlorhexidine remain cornerstones of prevention, concerns regarding antimicrobial resistance, dysbiosis, staining, and altered taste have stimulated interest in herbal bioactive compounds as complementary agents. Objective: To critically synthesize current evidence on the role of herbal bioactive compounds, including polyphenols, flavonoids, terpenoids, alkaloids, and essential oils — in the prevention of dental caries and periodontal diseases, with attention to mechanisms of action, clinical efficacy, safety, and translational nutrological perspectives. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library covering literature published between January 2000 and December 2025. In vitro studies, animal experiments, randomized controlled trials, systematic reviews, and meta-analyses published in English were eligible. Results: Multiple herbal bioactives demonstrate antibacterial, antibiofilm, anti-inflammatory, antioxidant, and matrix-stabilizing properties relevant to oral disease prevention. Camellia sinensis catechins (especially EGCG), curcumin, propolis flavonoids, pomegranate ellagitannins, grape-seed proanthocyanidins, Salvadora persica derivatives, Azadirachta indica extracts, aloe vera polysaccharides, and Glycyrrhiza glabra isoflavans show consistent activity against key cariogenic and periodontal pathogens. Clinical trials suggest that herbal mouthrinses, gels, and dentifrices achieve plaque and gingivitis reductions comparable to chlorhexidine, with fewer adverse effects. Conclusion: Herbal bioactive compounds represent a scientifically promising adjunct to conventional oral preventive strategies. However, methodological heterogeneity, lack of standardized formulations, and limited long-term safety data preclude their unqualified recommendation as monotherapies. Future research should prioritize adequately powered randomized controlled trials with standardized phytochemical preparations and integration with nutrological frameworks.

Graphical Abstract

Comparison of cesarean section rates and Robson Group 5 proportions before and after non clinical intervention (focus group discussion) at Jombang District Hospital

2026-05-21T13:45:19+00:00

Introduction: Global cesarean section (CS) rates continue rising without corresponding maternal/neonatal mortality reductions. WHO recommends 10-15% ideal rates, yet Indonesia reports 17.6% (Riskesdas 2018) to 36% (BPJS 2019). Jombang District Hospital showed 38.9% CS rate in 2023, predominantly Robson Group 5 (16.9%). Objective: To compare CS rates and Robson Group 5 proportions before and after interventions at Jombang District Hospital in 2024, and evaluate management changes for women with prior CS history. Methods: Quasi-experimental study compared a pre-intervention period (January-June 2024: n=1,341) and a post-intervention period (July-December 2024: n=1,142) across a total of 2,483 deliveries. Hospital delivery records were analyzed utilizing the Robson classification. Chi-square tests assessed differences in CS proportions with a significance level of p<0.05. Results: The overall CS rate was 44.8% (1,113/2,483), increasing nonsignificantly from 43.3% to 46.6% (p=0.113). Robson Group 5 CS rates remained persistently high, shifting from 92.0% pre-intervention to 93.5% post-intervention (p=0.624). Vaginal birth after cesarean (VBAC) success was limited to 8-12%. Conclusion: Non-clinical focus group discussions among healthcare providers failed to reduce CS rates, highlighting the limitations of single-component interventions. Multifaceted strategies are essential, including mandatory second opinions for elective CS, standardized VBAC protocols, and intensive antenatal education.

Serum p-Tau217 and apolipoprotein E as potential biomarkers for Alzheimer's disease severity: a case-control study

2026-05-20T22:10:08+00:00

Introduction: Alzheimer's disease (AD) is a chronic neurodegenerative illness characterised by aberrant protein accumulation and progressive cognitive decline. One of the most researched blood indicators of tau pathology is phosphorylated tau 217 (p-tau217), and apolipoprotein E (ApoE) is essential for lipid metabolism, amyloid removal, and neuronal maintenance. The severity of AD may be correlated with changes in these biomarkers. Objective: To compare serum levels of p-tau217 and ApoE in individuals with different severities of Alzheimer's Disease. Methods: The present case–control study consisted of 156 subjects aged between 55 and 85 years:106 patients with ad (and balanced frequency matched to healthy controls on age, international classification of diseases t63 diagnosis). The DSM-5 criteria classified the patients as mild (n = 12), moderate (n = 50), or severe (n = 44). Using the sandwich enzyme-linked immunosorbent assay (ELISA), the levels of circulating ApoE and p-tau217 were determined. The receiver operating characteristics (ROC) curve examination, Spearman's correlation, and the Kruskal-Wallis test were used in the statistical studies. Results: The mean serum p-tau217 and ApoE level were 165 ± 84.2 pg/mL and 75.5 ± 55.6 ng/mL, respectively. While serum p-tau217 significantly increased with severity of disease, ApoE levels decreased. We found a significant positive association of p-tau217 (p<0.001) and a negative association of ApoE (p<0.001) with disease severity by DSM-5 criteria. ROC analysis showed high diagnostic accuracy of CSF p-tau217 (AUC=0.916, sensitivity: 87.18%, specificity: 90.00%) and ApoE (AUC=0.992, sensitivity: 100.00%, specificity:98.00%). Conclusion: Increased serum p-tau217 and decreased ApoE levels were significantly associated with greater AD severity. Both biomarkers may serve as complementary noninvasive indicators of disease severity in Alzheimer’s disease.

Objectives: The study objective is to reveal biochemical way to diagnose and know Alzheimer's patients biochemically instead of using traditional

Methods that used to diagnosis as an example using: Electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI) and brain biopsy.

Methods: A case control research design was applied to current study, 156 individuals and thy were as follows: 12 with mild symptoms ,50 with moderate,44 with sever progression and 50 apparently as healthy control with an age range of 55 to 85 years were included. Samples were collected in accordance with the consultant's diagnosis; disease severity was categorized according to DSM-5(Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) staging, which was then demonstrated by laboratory tests. A Human p-tau217 (Phospho Tau 217) Catalogue No.: EH5067 Revision: V4.0 Size: 48T/96T ELISA Kit was used and rang test was (7.813-500pg/ml) which tested by instrument (human reader).

Results: The baseline serum biomarkers analysis of whole Study Participants showed that the mean tau level was 165 ± 84.2 pg/mL, Tau levels increased markedly with disease severity, rising from 86.33 ± 34.40 pg/mL in the control group to 265.72 ± 50.91 pg/mL in the severe group. DSM-5 score also showed a strong positive correlation with Tau concentration, suggesting that higher clinical severity was associated with increased Tau levels. Tau showed very strong negative correlations with ApoE, the correlations' findings indicated that this effect size is substantial up to assay. ApoE demonstrated a mean value of 75.5 ± 55.6 ng/mL. of whole Study Participants. ApoE levels showed a pronounced and significant reduction across disease stages, with the lowest mean value observed in the severe group. While DSM-5 score also showed a negative association with ApoE was strong and significant.

Conclusion: Serum Tau levels increased markedly with disease severity, indicating that Tau may serve as a reliable marker of progressive neuronal injury and neurodegeneration in Alzheimer’s disease. ApoE levels declined substantially with increasing disease severity and showed the highest diagnostic accuracy among the studied biomarkers, indicating its strong potential as a predictive biomarker for Alzheimer’s disease progression.

Education and training needs for enhancing rural women’s participation in sustainable farming systems in Iraq: a cross-sectional study

2026-05-10T13:11:06+00:00

Introduction: Strengthening rural women’s participation in sustainable farming is essential for Iraq’s agricultural development, yet their specific educational and training requirements remain insufficiently defined to guide effective programming. Objective: The study assessed the education and training requirements needed to strengthen rural women’s participation in sustainable farming systems in Iraq. Methods: A cross-sectional descriptive survey design was adopted. Using purposive selection and proportional allocation, 150 respondents were drawn from ministries, research institutions, and development organizations involved in women-in-agriculture and agricultural extension programming. Data were collected via interview-administered structured questionnaires and analyzed using means (x̄), percentages, and rank order. Results: The most critical needs identified were specialized educational programmes (x̄ = 4.54; 90.00%), field schools (x̄ = 4.54; 89.06%), and knowledge-sharing platforms (x̄ = 4.43; 88.66%). Preferred delivery modalities focused on participatory and accessible formats, particularly local learning platforms and follow-up support. Key extension agendas included training in organic farming, waste recycling, soil/water management (x̄ = 4.40; 88.13%), and the integration of sustainability concepts into rural curricula (x̄ = 4.33; 86.66%). Conclusions: Participation of rural women in sustainable agriculture in Iraq is contingent upon the provision of locally accessible, practice-oriented, and continuous extension education tailored to their specific technical needs.

Graphical Abstract

A systematic review on marine-derived fucoidan as a nutritional therapeutic in periodontal disease

2026-05-09T18:18:38+00:00

Introduction: Fucoidan is a naturally occurring sulfated polysaccharide derived from brown seaweeds such as Fucus vesiculosus, Laminaria japonica, and Undaria pinnatifida. As a nutritive agent, fucoidan modulates tsystemic health through its bioactive components that influence metabolic, immune, and cellular functions. Its anti-inflammatory properties have a promising role in mitigating chronic low-grade inflammation, which underlies many systemic and oral diseases. Fucoidan is recently reported to possess significant antibacterial activity and the evidence regarding its use for periodontal diseases is scattered. Objective: Critical evaluation of the efficacy of fucoidan on periodontal pathogens using the existing evidence. Methods: Literature search was done on PubMed, Cochrane, Scopus, etc, according to PRISMA guidelines. Relevant articles were collected and evidence was tabulated. Results: The collected evidence indicated that fucoidan shows multifaceted therapeutic potential regarding periodontal diseases through multiple mechanisms like modulation of microbial virulence, reduction of inflammation, and boosting host–pathogen balance. Conclusion: Fucoidan exhibited promising antimicrobial, antibiofilm, and anti-inflammatory properties against periodontal pathogens.

Stratified lipidomic, inflammatory, and oxidative-stress phenotyping of Helicobacter pylori infection: study group distinguishing CagA- positive strains in Iraqi adult

2026-05-09T15:12:10+00:00

Introduction: Helicobacter pylori is increasingly implicated in extragastric metabolic and atherogenic disease, but human data integrating advanced lipidomics, oxidative-stress biology, and high-density lipoprotein (HDL) functional assessment in a CagA-stratified design remain scarce, particularly in the Middle East. Objective: To characterize variations in lipid metabolism across stages of H. pylori exposure, distinguishing virulent CagA-positive strains, and to identify the biological pathways mediating this relationship. Methods. In this STROBE-compliant case– control study (Al-Nasiriyah General/Turkish Hospital, Dhi Qar, Iraq; September 2025–February 2026), 230 adults aged 18–60 years were assigned to four pre-specified groups: H. pylori-naïve controls (n=60), past H. pylori exposure (n=50), active CagA-negative infection (n=60), and active CagA-positive infection (n=60), based on ¹³C-urea breath testing, stool antigen testing, and anti-H. pylori/anti-CagA serology. Conventional and advanced lipoproteins, apolipoproteins, atherogenic indices, inflammatory cytokines, oxidative-stress and antioxidant markers, HDL-functional enzymes, adipokines, insulin axis, one-carbon biomarkers, and an untargeted serum lipidomic panel were measured. Multivariable linear regression, ROC analysis with bootstrap-validated LASSO modeling, and bootstrap mediation analyses were performed. Results: A monotonic gradient (Control → Past-HP → CagA− → CagA+) was observed for atherogenic, inflammatory, and oxidative biomarkers, with reciprocal declines in apolipoprotein A-I, paraoxonase-1, lecithin– cholesterol acyltransferase, adiponectin, and antioxidant capacity. After adjustment for age, sex, BMI, smoking, diet, physical activity, and inflammation, CagA+ infection was independently associated with elevated oxidized LDL, ApoB/ApoA-I ratio, atherogenic index of plasma, and reduced PON1 activity (all P<0.001). Lipidomics revealed elevated saturated ceramides and lyso-phosphatidylcholines with depleted sphingosine-1-phosphate. Oxidative-stress index and inflammation partially mediated the H. pylori–lipid associations. Conclusion: H. pylori infection, particularly with CagA+ strains, is independently associated with an adverse lipid metabolic, lipidomic, and HDL-functional phenotype mediated in part by inflammation and oxidative stress.

Graphical Abstract

Micronutrient supplementation and cognitive aging in Brazil: evidence, challenges, and policy directions

2026-05-07T14:57:32+00:00

Introduction: Brazil is undergoing rapid population aging, with individuals aged 60 and above comprising 15.6% of the population in 2023. This demographic shift poses significant publichealth challenges, particularly the rising prevalence of cognitive decline, compounded by widespread micronutrient deficiencies. Objective: To synthesize evidence on the relationship between micronutrient status, supplementation, and cognitive decline in older Brazilian population, and to identify barriers to implementing nutritional strategies into public health and clinical practice. Methods: A narrative review was conducted using data from national surveys, regional studies, clinical trials and reviews. Literature searches were performed in PubMed, MEDLINE, and Embase using Brazil-specific terms related to micronutrients, cognitive health, and aging. Results: Deficiencies in vitamins B-complex, D, E, and minerals such as magnesium, zinc, and selenium are prevalent among older Brazilians, with some inadequacy rates exceeding 60–80%. These deficiencies are mechanistically linked to cognitive decline via oxidative stress, neuroinflammation, and elevated homocysteine levels. Evidence from clinical trials, notably COSMOS, and the 2025 Latin American Consensus Statement supports multivitamin and mineral supplementation (MVMs) as an effective strategy to improve memory and cognition. However, key barriers include lack of age-specific dietary reference values, national supplementation guidelines, and systematic integration of nutrition into geriatric care. Conclusions: Addressing micronutrient deficiencies through targeted supplementation and nutrition policy reforms represents a practical, evidence-based approach to promote cognitive resilience and healthy aging in Brazil.

Evaluation of serum IL-39 levels as a potential risk marker in type 2 diabetic patients: a case-control study

2026-05-06T22:28:29+00:00

Introduction: Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disorder characterised by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action, or both, leading to long-term damage of multiple organ systems, including the kidneys, retina, nervous system, heart, and blood vessels. Interleukin-39 (IL-39) is a novel heterodimeric member of the IL-12 cytokine family that may participate in the pathogenesis of human inflammatory disorders. Because T2DM is characterised by chronic low-grade inflammation, IL-39 may be a relevant cytokine whose pathogenic involvement in the disease warrants investigation. Objective: The present study aimed to evaluate the role of serum interleukin-39 in patients with type 2 diabetes mellitus. Materials and Methods: A case-control study was conducted in which serum IL-39 levels were measured in 45 patients with type 2 diabetes mellitus (T2DM) and 45 age- and sex-matched healthy controls. Biochemical measurements included fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), total cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL), measured using spectrophotometric enzymatic colorimetric methods. Serum IL-39 was quantified using an enzyme-linked immunosorbent

assay (ELISA) kit. Results: The mean serum IL-39 level was significantly higher in patients than in controls (11.21 ± 2.38 ng/mL vs. 7.42 ± 1.76 ng/mL; p < 0.001). Serum IL-39 showed a significant positive correlation with FPG (r = 0.298, P = 0.005), HbA1c (r = 0.499, p < 0.001), and body-mass index, and a significant negative correlation with HDL (r = –0.367, p < 0.001). Receiver-operating-characteristic (ROC) curve analysis of serum IL-39 yielded a cut-off value of 8.975 ng/mL, an area under the curve of 0.904, sensitivity of 0.844, specificity of 0.820, and p < 0.001. Conclusion: Serum IL-39 levels were significantly elevated in patients with T2DM and correlated positively with markers of glycaemic control. ROC analysis demonstrated excellent diagnostic performance of IL-39 in distinguishing T2DM patients from healthy controls. These findings suggest that IL-39 may serve as a potential novel biomarker for T2DM.

Graphical Abstract

Immunomodulatory effects of Lactobacillus acidophilus as a probiotic and aqueous Punica granatum peel extract on immune responses in BALB/c mice infected with experimentally induced Escherichia coli diarrhea

2026-05-01T23:21:57+00:00

Diarrheal disease caused by Escherichia coli is a major cause of disease worldwide. The mutations that bacteria undergo lead to antibiotic resistance, necessitating the development of evidence-based treatment alternatives. This research investigates the immunomodulatory effects of Lactobacillus acidophilus as a probiotic and pomegranate peel aqueous extract (PPE) from the pomegranate plant (Punica granatum L.), individually and in combination, on certain innate and adaptive immunity markers in experimentally infected BALB/c mice with E. coli-induced diarrhea. 40 male BALB/c mice (6–8 weeks old, weighing 20–25 g) were randomly assigned to five groups (8 mice per group): negative control (G1), positive control infected with E. coli only (G2), E. coli with Lactobacillus acidophilus (109 CFU/day) (G3), E. coli with pomegranate peel extract (200 mg/kg/day) (G4), and E.coli with the Mix therapy (G5). All treatments were administered orally for 21 days. The concentrations of cytokines (IL-6, TNF-α, IFN-γ, IL-10), immunoglobulins (IgG, IgM, IgA), splenic lymphocyte subsets (CD4+, CD8+, and natural killer cells), and the phagocytic index of phagocytes were measured at the end of the experiment. A significant decrease in the levels of the pro-inflammatory cytokines IL-6, TNF-α, and IFN-γ was observed in group G5 compared to group G2 (p ≤ 0.05), while IL-10 did not show a statistically significant difference between the two groups. Serum IgG and CD4+ T cell levels returned to normal significantly in group G5 (p ≤ 0.05), while IgM, IgA, CD8+ T cell levels, the CD4+/CD8+ ratio, and the frequency of natural killer cells remained largely unchanged. The phagocytosis index was also significantly higher in group G5 compared to group G2 (p ≤ 0.05). The synergistic action of L. acidophilus and the aqueous PPE extract demonstrated statistically significant immunomodulatory activity, suggesting its potential as an alternative treatment in the management of E. coli-induced diarrhea.

The role of vitamin and mineral deficiencies in rheumatoid arthritis: insights from a comparative study

2026-05-01T16:32:16+00:00

Introduction: The exact etiology of Rheumatoid arthritis (RA)is unknown, although it occurs due to a complex interplay between genetic, and environmental/ hormonal factors. Objective: The aim of this study was to examine for a possible relationship between RA and malnutrition, focusing on vitamins (D, A, B12) and trace elements (zinc, copper). This section will review the potential impact of these limitations on the progress and therapy targeting disease modifying in RA. Methods: The study comprised 1500 participants; among which there were 1200 patients diagnosed to be having RA based on the four treatment regimens criteria, i.e., biological therapy, chemotherapy and bio-chemotherapy only (with known disease severity), along with taking of these medications for at least the last three months, while the other set included healthy individuals (n =300). Serum levels of ACPA, vitamins (B, A, and D3), zinc and copper were measured using ELISA kits. Results: High ACPA in patients were found compared to the healthy (decreased after treatment, suggesting a relatively lower level), low vitamin D and A concentration, (larger) variations at vit B12, Zn, and Cu compared to controls. Deficiencies in vitamin B12, zinc and copper were significantly corrected by biological agents, chemotherapy, and bio-chemotheraphy while the latter's still higher among RA patients. These findings support the importance of addressing malnutrition, for example by supplementation or diet modification, as part of care in RA to possibly improve treatment response and quality of life. Conclusion: Deficiencies and imbalances in nutrients, primarily vitamins, and trace elements are significant in the management and development of RA disease

Outcomes of total hip arthroplasty for chronic hip diseases in Iraqi patients: a five-year prospective study of functional recovery and improving quality of life

2026-04-29T02:18:52+00:00

Introduction: Chronic hip diseases — hip osteoarthritis, avascular necrosis of the femoral head and the sequelae of osteoporotic femoral-neck fractures — are leading causes of pain and functional disability. Total hip arthroplasty (THA) is established as the principal intervention for these chronic diseases, with improving quality of life as its goal. Iraqi data are limited. Objective: To assess the functional and pain outcomes of primary THA performed for chronic hip diseases in an Iraqi cohort and identify baseline factors associated with improving quality of life. Methods: Prospective observational study (2019–2023) in four hospitals in Al-Najaf, Iraq. Sixty-four consecutive adults aged ≥40 years (ASA I–II) undergoing primary THA were enrolled. The Harris Hip Score (HHS) was recorded preoperatively and at 3 weeks, 3, 6 and 12 months. Predictors of the 12-month HHS were modelled by multivariable linear regression. Sample-size adequacy was confirmed by post-hoc power analysis (G*Power 3.1.9.7; α = 0.05, two-tailed; achieved power ≥ 0.80 for the primary association). STROCSS 2021 reporting was followed. Results: Mean age was 60.9 ± 13.1 years (70.3% ≥60 years); 53.1% women; 82.8% overweight or obese. Indications were avascular necrosis (40.6%), femoral-neck fracture (31.3%), hip osteoarthritis (25.0%) and intertrochanteric fracture (3.1%). The HHS rose from 43.2 ± 8.3 preoperatively to 92.1 ± 6.3 at 12 months (P < 0.001), with 92.2% of patients achieving good or excellent outcome — substantial improving quality of life. Body mass index was the only baseline variable independently associated with the outcome (standardised β = −0.327, P = 0.002). Complications were limited (leg-length discrepancy 7.8%, heterotopic ossification 4.7%, dislocation 4.7%, one superficial infection); no revision or mortality occurred. Conclusions: Primary THA is highly effective for chronic hip diseases in Iraqi patients, producing durable, clinically important improving quality of life. Body mass index emerges as a modifiable nutrological target whose optimisation may further enhance outcomes.