International Journal of Nutrology

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.

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.

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.

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.

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.

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.

Serum hBD-2, IL-36γ, CCL20/MIP-3α, and soluble FGL-2 as innate-immune biomarkers in Iraqi patients with plaque psoriasis: a case-control study with diagnostic-performance evaluation

2026-04-26T19:51:35+00:00

Introduction: Plaque psoriasis is driven by an IL-23/IL-17–centred axis in which keratinocyte-derived innate mediators amplify and sustain cutaneous inflammation. Circulating biomarkers that capture this axis in Iraqi patients are poorly characterised. Objective: To compare serum human β-defensin-2 (hBD-2), interleukin-36γ (IL-36γ), CCL20/MIP-3α, and soluble fibrinogen-like protein 2 (sFGL-2) between adults with plaque psoriasis and matched healthy controls, and to evaluate their diagnostic performance. Methods: This case–control study enrolled 45 patients with clinically diagnosed plaque psoriasis and 45 age- and sex-matched healthy controls at Marjan Teaching Hospital, Babylon Governorate, Iraq (October 2025 – March 2026). Serum biomarkers were quantified by sandwich ELISA. Group comparisons, Pearson correlation, ROC analysis, and logistic regression were performed. Results: hBD-2, IL-36γ, and CCL20 were significantly higher in patients than controls (all p < 0.05); sFGL-2 showed a non-significant trend. Strong positive correlations were observed between hBD-2 and the other three mediators. IL-36γ had the best diagnostic performance (AUC = 0.714, p = 0.001). All four biomarkers were associated with psoriasis in univariate logistic regression, with attenuation in multivariable models consistent with shared pathway regulation. Conclusion: A coordinated innate-immune serum signature is present in Iraqi plaque-psoriasis patients; IL-36γ showed the most promising diagnostic utility, although these findings are hypothesis-generating and require validation before clinical use.

Graphical Abstract

Functional Molecular Biomarkers in the Identification of Probiotic Strains

2026-04-23T08:00:06+00:00

Identification of novel probiotic strain candidates based on sequence information of currently available probiotic strains and their key biomarkers requires comprehensive functional evaluation to establish their contributions to human health. Potential functional molecular biomarkers play a vital role in facilitating the discovery of new probiotic strains through sequence similarity analyses, remarkably within metagenomic datasets and unexplored microbial “dark matter”. It is critical to evaluate probiotic properties beyond taxonomical identifications by including the most important functional, metabolic, antibacterial and immunological features, as well as by using them as a marker for selection of probiotics. This review highlighted some key molecular biomarkers of probiotics, but also considered challenges like lack of standardization and in vitro and in vivo data, and discussed potential for further use. Probiotic screening by molecular markers in combination with bioinformatic search technology, which might represent future development direction toward the generation of next-generation probiotic strains.

Potential of nutraceutical fucoidan against periodontal pathogens: a novel molecular docking study

2026-04-20T17:09:01+00:00

Introduction: Fucoidan from seaweed has gained significant attention due to its diverse therapeutic properties. Its antibacterial potential in periodontitis needs exploration. Objective: This paper aims to explore the suitability of fucoidan to treat periodontitis by molecular docking methods. Methods: Molecular docking of fucoidan was done with targets from Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans. Binding energy, inhibition constant, number of hydrogen bonds, aminoacid residues involved in H-Bond were identified. Control docking was done with chlorhexidine and compared. Results: Docking of Porphyromonas gingivalis enzyme, gingipain K (Kgp) with fucoidan had an inhibition constant of -6.83, ODP from T. denticola with fucoidan had binding energy of -4.52, anti-CRISPR protein AcrIF9 with fucoidan had a binding energy of 4.81 and Tannerella forsythia potempin E with Fucoidan had a binding energy of -3.09 all expresssed as kcal/mol. Respective inhibition constants were 67.3 µM, 485.11µM, 295.72 µM and 5.47 mM. All binding energies ranged from -3 to -6 range suitable for inhibition of their targets. Conclusion: Inhibition constant for targets from T. denticola and A. actinomycetemcomitans had highest values indicating that fucoidan inhibits T. denticola and A. actinomycetemcomitans more significantly than P. gingivalis and T. forsythia.

Interactive effects of quail strain and dietary arginine on the chemical composition of the breast and thigh meat

2026-04-05T22:10:13+00:00

This study was conducted to evaluate the interactive effects of quail strain and dietary L-arginine levels on the chemical composition of breast and thigh meat. A total of 270 one-day-old Japanese quail chicks from three strains (white, brown, and grey) were randomly assigned to a 3×3 factorial experimental design. The birds were fed diets supplemented with three levels of L-arginine (0%, 5%, and 10%) for a period of 35 days. The results indicated that dietary L-arginine significantly influenced the chemical composition of the meat. In breast meat, the 10% arginine group showed a significantly higher fat content (1.977%) compared to the 0% and 5% groups. Ash and carbohydrate contents in the breast were also significantly affected by arginine levels (p≤0.05). In thigh meat, the 5% arginine level resulted in the highest protein content (25.542%), while the 10% level was associated with the highest fat (19.401%) and ash (0.43%) contents. In contrast, the quail strain did not significantly affect the chemical features of either breast or thigh meat, including moisture, fat, ash, protein, and carbohydrate levels. These findings suggest that nutritional intervention through arginine supplementation is a more dominant factor in determining meat quality than genetic strain under uniform environmental conditions. The study concludes that optimizing arginine levels, specifically at moderate concentrations, is essential for enhancing the nutritional value and production efficiency of Japanese quail.

Graphical Abstract

A prospective clinical study on metabolomic profiling for early detection of response to nutritional interventions in pediatric obesity

2026-04-03T10:39:58+00:00

Introduction: Obesity in children is a significant health issue, exposing children to the risk of metabolic and insulin resistance and long-term cardiometabolic complications. It is essential to detect and identify the responses to nutritional interventions at the earliest possible time to provide effective and personalized treatments. The overall evaluation of small-molecule metabolites in biological samples, termed metabolomics profiling, could be applicable in the characterization of real-time biological biochemical responses related to pediatric obesity and nutritional intervention. Objective: This research aimed to determine how metabolomics could serve to detect early biological metabolic changes to scientific dietary interventions in children by exploiting lipid, carbohydrate, and amino acid metabolism biomarkers. Methods: As its look at the use of metabolomic markers in methods that define clinical response measures (e.g., clinical, anthropometric), it also shows that the distinctive molecular responses that are discovered by the metabolomics can forecast individual reactions to dietary interventions, which allow the reaction to occur within effective and precise time frames. Results: It was observed that it is possible to engage in metabolomic-guided nutritional planning at the pediatric level, a transition between evidence-based nutrition and personalized nutrition. It also evaluated the possibility of applying metabolomics in clinical practice to assist the establishment of treatment efficacy, metabolic health optimization, and prevention of the development of obesity-related problems. Conclusion: In general, metabolomic profiling is a new method of pediatric nutrition with practical implications to stimulate early diagnosis, personalized therapy, and better treatment outcomes in childhood obesity.

A randomized controlled trial on the efficacy of intermittent fasting and mediterranean diet on visceral adiposity and gut microbiota in overweight adults

2026-04-03T03:00:38+00:00

Introduction: Obesity, particularly visceral adiposity, is a considerable risk factor for metabolic diseases, including insulin resistance, dyslipidemia, and chronic inflammation. A growing body of evidence suggests that the gut microbiota is influenced by food and plays a role in energy homeostasis and systemic metabolism, with dysbiosis typically observed in individuals with excess weight. Nutritional strategies of intermittent fasting (IF) and the Mediterranean diet (MD) have each been independently shown to help reduce adiposity and alter gut microbiota composition. However, there remains a dearth of research on the effects of IF and the MD when combined. Objective: The purpose of this study was to assess the effectiveness of a combination of IF and MD intervention for visceral fat loss, and for the dietary intervention to modify gut microbiota. Methods: A total of 60 participants were recruited into a 12-week human intervention study, along with longitudinal assessment of dietary intake and compliance. Visceral adiposity was measured using imaging-based techniques, and gut microbiota profiles were analysed using 16S rRNA sequencing. Results: As a result of the intervention, there were considerable reductions in visceral fat, increased microbial diversity, and enrichment of some beneficial bacterial taxa that are linked to better metabolic health. Conclusion: The data demonstrate that the time-restricted feeding in combination with the Mediterranean diet is an experimental dietary approach resulting in a decrease of visceral fat mass and restoration of the microbiota toward a healthy one. It also provides a required evidence-based structure for therapeutic nutrition in the treatment of metabolic complications induced by obesity.

Major relevances of nutrological therapy and gut microbiota in neurodegenerative diseases: a systematic review

2026-04-02T14:12:42+00:00

Introduction: Critical patients, both due to brain injury and neurodegenerative diseases, have an increased risk of developing nutritional malnutrition due to complex problems and deleterious effects of diseases on protein and energy metabolism, resulting in metabolic dysregulation, hypercatabolic state and depletion of energy reserves energy. Objective: It was to carry out a systematic review to externalize and discuss the main findings on the effects of enteral nutritional therapy, as well as on the action of the gut microbiota in patients with brain injuries or neurodegenerative diseases. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to May 2025 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: A total of 108 articles were found, and 20 articles were evaluated in full, and 08 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 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=88.9%>50%. Enteral nutrition supplemented with probiotics effectively decreases the risk of mortality, gastrointestinal complications, and infection, and shortens the length of stay in the intensive care unit, therefore, it should be widely adopted for the management of these patients. Nasal inspiratory pressure during a sniff at baseline is an early indicator of disease progression and therefore the need for enteral nutrition in amyotrophic lateral sclerosis. Furthermore, problems with tolerance, diarrhea, and abdominal distension decreased between the 3 and 6-month visits in patients who received home enteral nutrition.

Metabolic actions of the gut microbiota in obesity: a systematic review

2026-04-01T16:00:52+00:00

Introduction: Obesity is a multifactorial disease that is difficult to manage and causes several comorbidities, such as physiological and mental disorders, diabetes, stroke, and depression. Worldwide, more than 2.3 billion people are overweight or obese. The gut microbiota interacts with several organs, including the brain, and can regulate metabolism, adiposity, homeostasis, energy balance, and central signaling of appetite and food reward. Objective: To explore and describe the metabolic actions of the gut microbiota and probiotics in the management of patients with obesity. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from August to November 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 125 articles were found. A total of 32 articles were fully evaluated, and 21 were included and developed in this systematic review. Using the Cochrane risk of bias tool, the overall assessment resulted in 23 studies with a high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneous results, with X²=74.8%>50%. It was concluded that bidirectional signaling occurs within the gut-brain axis in the pathophysiology of obesity, mediated by metabolic, endocrine, neural, and immune system mechanisms. Fecal microbiota transplantation and supplementation with probiotics and prebiotics may be potential treatments for obesity. Diet is a determining factor for healthy colonization of the gut microbiota. Studies in obese humans also found a lower proportion of Bacteroidetes compared to those in normal-weight individuals. After weight loss, the proportion of Firmicutes is reduced and becomes more similar to that of lean individuals. Inulin supplementation can significantly promote intestinal bacterial diversity and improve gut microbiota dysbiosis in obese patients. Low-carb diets and time-restricted feeding are effective in weight management and produce profound changes in the gut microbiome and metabolome, in addition to caloric restriction.

Randomized controlled clinical study on proteomic analysis of skeletal muscle adaptations to high-protein nutrition in post-bariatric surgery patients with obesity

2026-03-31T14:58:36+00:00

Introduction: Bariatric surgery can cause complicated metabolic and physiological changes in some patients, leading to a significant amount of loss of lean mass. The preservation of skeletal muscle mass is important for metabolic health, functional performance, and long-term weight maintenance. Proteomics provides detailed information on muscle tissue molecular responses, but can be best utilized when coupled with intentional nutritional interventions such as high-protein diets. Objective: The intent of the present study was to examine skeletal muscle proteomic responses to bariatric surgery in obese males and females using a high-protein nutrition intervention. Methods: Patients with obesity after bariatric surgery followed a standardized high-protein nutritional intervention (≥ 1.5g protein per kg per day). Muscle biopsies were taken at baseline (pre-treatment) and 12 weeks post-surgery. Muscle biopsies were taken, proteins extracted, digested, and analyzed by LC-MS-MS (label-free quantification). It used bioinformatic applications to perform differential quantitative analysis of protein expression, pathway enrichment, and functional annotation of differentially expressed proteins. Results and Conclusion: High protein nutrition resulted in upregulation of proteins associated with mitochondrial function, oxidative phosphorylation, and translation, while demonstrating downregulation of proteins representing catabolic and inflammatory pathways. Also, many of the proteomic adaptations identified were supportive of improved muscle remodelling (i.e., improved structural contractile proteins and regulators of protein synthesis). High protein nutritional support after bariatric intervention promotes advantageous skeletal muscle proteomic remodelling, which promotes retention of lean mass and recovery of metabolic status. The data also demonstrated that high-protein nutrition, after bariatric surgery, was associated with positive molecular adaptations.

Major clinical approaches to palliative care and nutrology in dentistry: a systematic review

2026-03-26T22:14:09+00:00

Introduction: Poor oral health is a common and neglected concern in palliative care (PC), negatively impacting patients' quality of life. There is a significant gap in the knowledge and practices of primary care physicians regarding oral health due to various barriers, with few documented support strategies in this area, as well as an information gap on the nutritional aspects that complement palliative practices in oral care. Objective: It was to carry out a concise systematic review in order to present the main clinical approaches to palliative care in dentistry, as well as showing the associated nutritional importance. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from December 2025 to January 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 homogeneity in their results, with X²=77.8%>50%. A total of 136 articles were found and submitted for eligibility analysis, with 12 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 33 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that early palliative care intervention can be effective in reducing psychological suffering and improving the quality of life of critically ill dental patients. Dentists can play a key role in linking tertiary and community care to promote patient well-being. Weight loss and impaired oral intake were associated with psychosocial distress affecting patients and caregivers. Future research is needed to explore the experiences of patients, caregivers, and healthcare professionals regarding nutrition and to evaluate the effectiveness of alternative nutritional strategies.

Barriers encountered by nurses while caring of mechanically ventilated adult patients: a cross-sectional study

2026-03-26T19:06:58+00:00

Introduction: Mechanical ventilation (MV) is a critical and frequently used intervention in intensive care units (ICUs), with up to 70% of ICU patients requiring it. The rates of invasive mechanical ventilation range from 29.1% to nearly 90% in some studies, particularly during the COVID-19 pandemic, with associated mortality rates exceeding 35% to 50%. Providing care for mechanically ventilated adult patients is a complex and high-risk nursing responsibility. Objective: This study aimed to identify the primary barriers encountered by nurses when caring for mechanically ventilated adult patients and to examine how these barriers relate to their demographic and professional characteristics. Methods: A descriptive cross-sectional study was conducted in the Respiratory Care Units (RCUs) of Kirkuk and Azadi Teaching Hospitals to identify barriers encountered by ICU nurses caring for mechanically ventilated adult patients. The study included 93 nurses with at least six months of RCU experience, recruited using a convenience sampling technique. Sample size adequacy was justified using a single-proportion formula at 95% confidence and 5% margin of error. Data were collected via a structured, self-administered questionnaire covering demographics, staffing/ workload, knowledge/training, equipment/ resources, and communication/emotional barriers, measured on a 5-point Likert scale. The questionnaire was validated by experts and piloted (Cronbach’s alpha = 0.87). Ethical approval was obtained, and participants provided informed consent with confidentiality ensured. Data were analyzed using SPSS 26.0, employing descriptive statistics, t-tests, and ANOVA, with p < 0.05 considered statistically significant. Results: The majority of participants were female (62.4%) and aged 30–39 years (43.0%). The most prominent barriers identified were staffing shortages (mean = 4.2), lack of formal ventilator training (mean = 4.1), stress and burnout (mean = 4.1), and equipment shortages (mean = 3.9). Overall mean scores for staffing/workload, knowledge/training, equipment/resources, and communication/ emotional barriers were 3.77, 3.86, 3.71, and 3.82, respectively. No statistically significant relationships were observed between demographic variables and perceived barriers (p > 0.05). Conclusion: ICU nurses face multiple, interconnected barriers when caring for mechanically ventilated adult patients, including inadequate staffing, insufficient knowledge, limited availability of equipment, and work-related psychological stress. Organizational interventions such as improving staffing levels, providing formal training, ensuring resource availability, and supporting nurses’ well-being are essential to enhance the quality of patient care.

Graphical abstract

Prevalence of complications for type 2 diabetes mellitus among patients visiting the diabetes clinic at azadi teaching hospital: a cross-sectional study

2026-03-26T18:57:42+00:00

Diabetes mellitus, commonly referred to as DM, is a chronic illness that can no longer develop or be transmitted as an epidemic. The research study aims to ascertain the frequency of type 2 diabetes mellitus complications among patients attending the diabetes clinic of Azadi Teaching Hospital. Azadi Teaching Hospital Kirkuk City was conducted the cross-sectional descriptive research. Purposively sampling (non- probability) of 118 samples was done. A strong relationship was found in the current study between the length of diabetes and number of problems. Having a disease for a long period of time is linked with more hypertension, cardiovascular disease, and ischemic heart disease rates, with DM consequences being a particularly important one. More research involving more people will get more accurate results.

Graphical Abstract

Major approaches to parenteral nutrology therapy in the intensive care unit: a systematic review

2026-03-24T11:40:34+00:00

Introduction: In the context of parenteral nutrition, critically ill patients are associated with a state of catabolic stress and a systemic inflammatory response. Patients admitted to intensive care units (ICU) have a prevalence of malnutrition greater than 35%. Objective: It was to carry out a systematic review to list the main approaches to macro and micronutrients in parenteral therapy in intensive care units. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from June to July 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: 115 articles were found. A total of 45 articles were evaluated and 25 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 32 studies that did not meet GRADE. It was concluded that several clinical studies critically analyzed the evolution and changes that marked the development of parenteral nutrition in intensive care units. Standard solutions of crystalline amino acids, although devoid of side effects, remain incomplete about their composition (e.g., glutamine). Lipid emulsions have evolved a lot and are now included in bi- and tri-compartmented feeding bags, allowing true total parenteral nutrition, as long as daily micronutrients are prescribed. The question of exact individual energy, macro and micronutrient needs has not yet been resolved. Many complications attributed to total parenteral nutrition are the consequence of under- or overfeeding. The historical concept of hyperalimentation is the main cause, along with the use of fixed weight-based predictive equations (incorrect in 70% of critically ill patients).

Effect of some natural plants’ extract for P38 downregulation on breast cancer

2026-03-24T06:29:42+00:00

Introduction: Breast cancer is the most common cancer diagnosis and the leading cause of death for women worldwide. A multitude of women favor alternative therapies to address their ailments, mitigate pharmaceutical adverse effects, or postpone illness progression. Objective: This study investigates the application of economical, environmentally sustainable ethanol-extracted Fenugreek and green tea in treating breast cancer. Methods: The impact of these plant extracts on MCF-7 cells was evaluated utilizing MTT, qRT-PCR, and ELISA methodologies. The findings indicated that Fenugreek extract inflicted cellular damage. Similar to green tea, Fenugreek elevated LDH levels in cells. Fenugreek extracts induced apoptosis in MCF-7 cells more than green tea extracts. Results: Fenugreek extracts promote dendritic cell maturation by modulating the JNK, p38 MAPK, and NF-κB pathways, resulting in elevated IL-1β, IL-6, IL-8, and TNF-α levels. One of the initial RAS/RAF/MEK/ERK-associated breast tumors is associated with Raf-1 expression. In MCF-7, P38 and Raf1 exhibited down-regulation, whereas TNFα, IL1β, IL6, and IL8 shown up-regulation. Conclusion: There are no significant effects from green tea extract. Ultimately, fenugreek extract decreased apoptosis and pro-inflammatory cytokines.

Nutritional aspects and waiting time for surgery in cobb angle worsening in young patients with scoliosis: a systematic review

2026-03-18T11:31:52+00:00

Introduction: The prevalence of scoliosis varies geographically and ethnically, and it is most frequently diagnosed in adolescence, typically between the ages of 10 and 18. The impact of the use of calcium and vitamin D in patients with idiopathic scoliosis appears to be promising, reducing the incidence and prevalence of cases. Studies on the natural progression of scoliosis indicate that untreated patients may experience significant worsening of the condition. Objective: It was to analyze the nutritional aspects and waiting time in Cobb Angle worsening in young patients with scoliosis. Methods: The PRISMA systematic review guidelines were followed. Randomized clinical trials, prospective studies, and retrospective studies were included in the analysis. The literature search was conducted from January to March 2026 and was based on Web of Science, Scopus, Embase, PubMed, Lilacs, Ebsco, Scielo, and Google Scholar, covering scientific articles from various periods to the present. Results and Conclusion: A total of 119 articles were submitted to eligibility analysis, with 18 final studies selected with 3,778 participants selected for this systematic review (scoliosis and nutritional deficiency, n=07, and scoliosis, waiting times, and the progression of Cobb angle, n=11). According to the GRADE instrument, most studies for scoliosis and nutritional deficiency showed homogeneity in their results, with X²=77.1%>50%, and X²=68.4>50% for scoliosis, waiting times, and the progression of Cobb angle. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet the GRADE and AMSTAR-2 criteria. Figures 2 and 3 present the results of the risk of bias of the studies with symmetrical behavior, suggesting a low risk of bias. It was concluded that patients undergoing scoliosis surgery experience prolonged waiting times, which may contribute to the progression of the deformity, including an increase in the Cobb angle. Strategies to reduce this waiting time may lead to improved clinical outcomes and fewer complications. Studies show that individuals on the waiting list for adolescent idiopathic scoliosis surgery experience worsening of the spinal deformity, increased treatment costs, and may negatively impact patients' quality of life. Increased waiting times for surgery negatively impact the quality of life of scoliosis patients. The positive correlation between vitamin D and calcium, together with the negative correlation with the Cobb angle, is further proof that patients with idiopathic scoliosis should be regularly investigated for these pathologies.

Correlation between vitamin D3 level and frequency of vestibular migraine attacks: a prospective cross-sectional study

2026-03-17T21:57:57+00:00

Introduction: Vestibular migraine (VM) is considered to be the second most common cause of vertigo and most common cause of spontaneous episodic vertigo. Keeping in mind the global health burden of low vitamin D level and its effect on pain and balance. Objective: This study aiming at determining the effect of vitamin D on VM. Methods: A prospective, cross-sectional study conducted in Basrah hearing and balance center with 37 patients diagnosed with VM. Female to male ratio were 4.3:1. Mean age of 37.622 +/- 14.36 years. Results: It was found a significant relation between the frequency of VM attacks and the level of vitamin D as patients with low or sub optimal level have more frequent attacks than those with normal vitamin D level (p-value = 0.0012). Conclusion: These findings suggest that assessment of vitamin D level may be important in patients suffering from vestibular migraine. Vitamin D supplementation may serve as a simple and cost-effective adjunct in the management of these patients.

Oral administration of Bacillus acidophilus lactic acid bacteria and copper oxide nanoparticles to mice with induced diarrhea- causing serotype of E.coli in Samarra-Saladin -Iraq

2026-03-12T12:03:51+00:00

L. acidophilus bacteria are found in foods and are used in pharmaceuticals to supplement the natural gut flora associated with human digestive health. They also possess excellent therapeutic properties, attributed to their biological activity. These bacteria produce serotypes that inhibit the growth of pathogenic bacteria and adhere to epithelial cells, preventing intestinal pathogens from attaching to them through a process called competitive exclusion. In this study, L. acidophilus strains were isolated and identified from local yogurt, and the efficacy of the isolated strains' metabolites against the diarrheal serotype of Escherichia coli was investigated. Additionally, some L. acidophilus strains were examined for their probiotic properties. The research was conducted in the laboratories of the Department of Biological Sciences and the Central Laboratories at Samarra University from September 1, 2025, to November 1, 2025. In this study, one of the L. acidophilus strains was obtained from lactic acid bacteria. The study results showed that the metabolites of the studied strains exhibited good inhibitory activity against the diarrheal serotype of E. coli. Regarding the probiotic assay, the results confirmed the ability of all strains to adhere to epithelial cells. The group treated with a combination of pathogenic bacteria and copper oxide nanoparticles (G2) showed a significantly higher level of IL-8 (9.78±3.45 pg/mL), which is considerably higher than G1, suggesting that the nanoparticles may have stimulated a level of inflammatory stress or an immune response. The control group (G3: pathogenic bacteria only) recorded the highest mean IL-8 (12.21 ± 3.09 pg/mL). In comparison, the presence of gut microbiota (G1) appeared to have a modulating effect on the IL-8 response to pathogenic infections, resulting in a marked decrease in its mean concentration (4.54±0.99 pg/mL) compared to the control group (G3) (p<0.05). Interestingly, the group treated with pathogenic bacteria and copper oxide nanoparticles (G2) exhibited an exceptionally high mean IL-6 (63.5 ± 22.28 pg/mL), significantly higher than the mean of both the control group (G3: 18.13 ± 9.49 pg/mL) and the gut microbiota group (G1: 9.52 ± 4.11 pg/mL). Copper oxide nanoparticles not only directly and effectively affect bacteria but also influence the host's immune system. The large increase in IL-6 may be due to the recognition of nanoparticles as foreign bodies, causing phagocytic cells to activate and release pro-inflammatory cytokines in an attempt to remove the particles.

Distribution of the iucD virulence gene among clinical Escherichia coli isolates in Iraq and evaluation of magnesium oxide nanoparticles as an antibacterial agent

2026-03-12T06:59:48+00:00

Escherichia coli (E. coli) multidrug resistance is one of the most serious reasons for urinary tract and burn wound infections. In this context, the iucD virulence gene and the antibacterial and antibiofilm activity of magnesium oxide (MgO) nanoparticles were studied in 20 E. coli isolates from 50 Babylon patients in Iraq. High resistance to ampicillin and tetracycline, moderate susceptibility to ciprofloxacin and gentamicin, but full susceptibility to imipenem was shown by antimicrobial susceptibilty testing. iucD gene was detected only in three (10%) isolates, representing a marked variability of virulence. The nanoparticles were analyzed by FE-SEM, XRD, FTIR and EDS techniques for spherical morphology of crystalline white particles well dispersed in the matrix. The nanoparticles showed concentration-dependent antibacterial activity with inhibition zones of 17 mm and 13 mm for 2 mg/mL and at 1 mg/mL, respectively, as well as significantly reducing the biofilm formation. These findings indicate that MgO nanoparticles can be used as a potential experimental antibacterial and antibiofilm therapeutic strategy against MDR and biofilm formers of E. coli. Although not aimed to the direct treatment of burn infections in humans, this study also fits into sustainable health research set forward towards UN Sustainable Development Goal 3 (Good Health and Well-being) as it represents an approach to seek novel strategies for fighting antimicrobial resistance or achieving better infection control.

Quality of life and psychological aspects for disabled people: an observational cross-sectional study

2026-03-09T09:53:35+00:00

Introduction: Disability is used to describe a broad range of disabilities, activity constraints, or participation limitations, disability arises from the combine of health conditions with contextual factors–environmental and personal factors. Objective: This study aimed to assess Quality of life and psychological aspects for disabled people, and Find Out the Relationship between Quality of Life and Psychological Aspects with Demographical Characteristic and Find-Out the Correlation between Psychological Aspects with Quality of Life for disabled People. Methods: A descriptive correlational study was conducted in two Rehabilitation Centers for Disabled and Physiotherapy at Hilla City/Babylon Province (Babylon Specialized center for medical rehabilitation, Babylon Center for Artificial Limbs and Medical Supports) during the period from September, 12, 2024 to April, 20, 2025. The study sample consisted of 155 physical disabled people who were selected according to the non-probability (convenience) sampling method. Data from interviews method were examined through both descriptive and inferential methods. statistics. Results: The research's findings are significant, revealing that 68.7% of participants' quality of life was moderate. with mean with mean 46.25 (Min- Max 23-69), and 56% had moderate psychological aspects (depression, anxiety and stress) with mean=57.56 (Min- Max 21 - 84). These findings underscore the importance of this research. Also, it was found highly significant statistical negative direction correlations between Psychological Aspects with Quality of Life for physical disabled People at p<0.05. Quality of life were also significantly associated with demographic variables such as age, income and type of disability at p˂0.05. Psychological aspects (depression, anxiety and stress) were linked to age, Occupation status and income at p˂0.05. Conclusion: The quality of life for individuals with disabilities was found to be moderate. The Depression Anxiety Stress (Psychological Aspects) with disabilities was found to be moderate. There were statistically significant negative direction relationships between Psychological Aspects with Quality of Life for physical disabled People. Accordingly, the study recommended to improve accessibility and support for individuals with physical disabilities by establish dedicated psychological therapy clinics within healthcare centers, specifically designed to provide mental health services to individuals with disabilities. Efforts should also be made to raise public awareness and foster greater acceptance and social inclusion of individuals with impairments.

Therapeutic effects of Melissa officinalis extract on hippocampal oxidative stress and body weight in a valproic acid-induced autism model in albino rats

2026-03-09T09:25:46+00:00

Autism spectrum disorder (ASD) is an autistic neurodevelopmental disorder where humans have social communication problems, limited interests, and repetitive behaviors and the prevalence is growing in the world. This paper examined the therapeutic impact of Melissa officinalis alcoholic extract on body weight variation and signs of oxidative stress in an autism model induced by valproic acid (VPA) on male rats. Pregnant Wistar rats were injected with VPA (600mg/kg, subcutaneously) or saline on gestation day 12.5, and the male offspring were injected with Melissa officinalis extract (100mg/kg, orally) or vehicle on postnatal day 35 to 82. The body weights were analyzed after every week and the biomarkers of oxidative stress in the hippocampal were measured biochemically in the four experimental groups (n=5/group). The experimental VPA dosage has a significant effect on the body weight, causing a 71 percent weight gain on average of 246.88±2.50 g at week 7 over baseline of 144.15±3.83 g in controls. Exposure to VPA caused severe oxidative stress in the hippocampal which included reduction of superoxide dismutase activity (41% vs. 44.826±1.320 U/mL) reduced levels of reduced glutathione (17% vs. 15.346±0.366 ug/l) and an increase in malondialdehyde concentration (70% vs. 26.602±2.313 mmol/L). Melissa officinalis extract treatment was significant in improving the conditions of oxidative stress by replacing the activity of superoxide dismutase up to 88% of the levels of control (39.638±1.987 U/mL), returning glutathione concentrations (14.698±0.264 µg/L) to normal level, and lowering the amount of lipid peroxidation by 27% (32.934±3.883 mmol/L), yet exhibited slight effic The above findings indicate that Melissa officinalis extract has strong neuroprotective actions against oxidative stress induced by VPA due to its increased antioxidant enzyme activity and abated lipid peroxidation, which can be used as a complementary medicine in the management of oxidative stress-related pathology of autism spectrum disorders.

Creatine and body composition in individuals with obesity: a brief review

2026-03-07T00:40:18+00:00

Obesity represents a global public health challenge, characterized by excessive body fat accumulation, associated with comorbidities such as type 2 diabetes and sarcopenic obesity. Effective intervention requires body composition modulation, prioritizing fat mass loss and the preservation of Fat-Free Mass (FFM), which is essential for metabolism and insulin sensitivity. In this context, the present study, a Systematic Literature Review, aimed to analyze the impact of creatine (Cr) supplementation, combined with resistance training, on body composition modulation in individuals with obesity. The search was conducted in the PubMed, SciELO, and Google Scholar databases, filtering for high-quality studies (RCTs and Meta-Analyses) from the last ten years. Creatine was identified as a "gold standard" supplement with dual mechanisms of action: (1) energetic, optimizing the ATP-PCr system to increase strength and training intensity, and (2) anabolic, promoting cell volumization and positively influencing protein synthesis pathways (mTOR) to combat catabolism. Literature findings in clinical populations, such as sarcopenic elderly, suggest that creatine is promising in preserving FFM and increasing strength without inducing fat mass gain. It is concluded that creatine supplementation is a safe and effective adjunct strategy to enhance resistance training in individuals with obesity, optimizing body composition and improving metabolic and functional prognosis.

Evaluation of post-stroke complications and prevention measures among patients at kirkuk city hospitals: an observational cross-sectional study

2026-03-06T05:24:27+00:00

Stroke is one of the leading causes of mortality and long-term disability worldwide, accounting for millions of new cases annually and representing a major global health burden. Post-stroke complications may significantly impede recovery and increase the risk of death. This study aimed to evaluate post-stroke complications and preventive measures among patients in hospitals in Kirkuk City. A descriptive cross-sectional study was conducted at Azadi Teaching Hospital in Kirkuk City. A total of 155 patients were randomly selected. Data were analyzed to assess differences in post-stroke complication prevention scores according to gender, residence, and educational level. The findings showed that prevention scores varied significantly by gender and area of residence. Male patients demonstrated higher average ranks compared to females. Similarly, urban participants achieved better preventive evaluation scores than rural patients. Educational level was also significantly associated with prevention measures. The study concluded that demographic factors influence post-stroke prevention outcomes. These findings highlight the importance of targeted educational and preventive strategies. Further large-scale cohort studies are recommended.

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Challenges to diabetes self-management among patients with type2 diabetes: a cross-sectional study

2026-03-06T05:18:00+00:00

Introduction: Type 2 Diabetes Mellitus (T2DM) is a major global public health problem, affecting more than 537 million adults worldwide, with projections reaching 783 million by 2045. Effective self-management is essential to prevent complications; however, patients often face multiple barriers. Objective: To assess the challenges of diabetes self-management among patients with Type 2 Diabetes Mellitus in Kirkuk City, Iraq. Methods: A cross-sectional study was conducted in the outpatient clinics of Kirkuk City, Iraq, to assess challenges in diabetes self-management among adult patients with Type 2 Diabetes Mellitus (T2DM). A total of 336 patients were recruited using a convenience sampling technique, with sample size justified via standard formulas for population proportions at 95% confidence and 5% margin of error. Data were collected through a structured, validated, and reliable questionnaire covering demographics, clinical characteristics, and five domains of self-management (knowledge, medication adherence, diet, physical activity, and psychosocial challenges). Face-to-face interviews were conducted individually, with written informed consent obtained from all participants. Ethical approval was secured from the College of Nursing, Kirkuk University, and confidentiality and anonymity were ensured. Data were analyzed using SPSS 26.0, employing descriptive statistics, independent t-tests, and one-way ANOVA, with p < 0.05 considered statistically significant. Results: The mean age of participants was 51.9 ± 10.1 years, with females slightly predominating (52.4%). Overall knowledge of diabetes self-management was moderate (mean score = 3.46). Patients experienced moderate challenges related to medication adherence (mean = 2.94), dietary management (mean = 3.28), physical activity (mean = 3.15), and psychological and social factors (mean = 3.33). The most prominent barriers included dietary restrictions, lack of motivation for physical activity, medication costs, and psychological stress. Conclusion: Most participants were middle-aged to older adults, predominantly female and married, with moderate knowledge and self-management abilities. Challenges in medication adherence, lifestyle behaviors, and psychosocial aspects were evident and significantly associated with demographic factors, highlighting the need for tailored interventions.

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