Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 2 2025 07 09 64 72 Hussein Abed Dakhil Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq Suhail Najm Alareer Hayder Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq. Hussein Saleh Abdul Mohsen Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq Adam Norrie Hussein Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq Mustafa Sattar Sjil Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq. Hassan Khayon Mhlhel Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq Ayat Muhammad Touma Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq Maha Hussein Ali Department of Radiology Technologies, College of Health & Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Iraq 2025 01 04 2025 02 07 Multidetector Computed Tomography (MDCT) imaging is a noninvasive tool that does not necessitate sedation and allows accurate assessment of the variceal site and size. Patients experience better tolerance when using MDCT than upper GI endoscopy (EGD). The present study aimed to assess the efficacy of MDCT in evaluating esophageal varices. We conducted a thorough search of international databases (Web of Science, PubMed, Embase, and Scopus) and extracted studies using the appropriate keywords to investigate the efficacy of MDCT in evaluating esophageal varices. The collected data were analyzed using the random and fixed-effects model and STATA (version 15). 17 articles aligned with the inclusion criteria, published between 2008 and 2022, were included in the study. The pooled data of 15 articles on MDCT sensitivity and specificity were 0.87 and 0.82, with 95% CI of 0.85-0.89 and 0.81-0.84, respectively. The meta-analysis of the data from fourteen articles showed a pooled PPV of 0.85 and a pooled NPV of 0.84, with 95% CI of 0.83-0.87 and 0.82-0.85, respectively. Also, our meta-analysis of eight surveys that reported accuracy revealed a high pooled accuracy of 0.92 (95% CI: 0.90-0.93), underscoring the reliability of MDCT in evaluating esophageal varices. These findings strongly suggest that MDCT holds considerable potential as a valuable diagnostic tool for clinicians managing patients with liver cirrhosis and suspected esophageal varices, paving the way for more effective patient care. https://acta.tums.ac.ir/index.php/acta/article/view/11449

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 2 2025 07 09 73 82 Abbas Abed Noor Al-Owaidi Department of Biology, College of Sciences, University of Babylon, Babylon, Hillah, 51001, Iraq. Mohammed Abdullah Jebor Department of Biology, College of Sciences, University of Babylon, Babylon, Hillah, 51001, Iraq 2025 01 05 2025 04 10 The employment of L-Methioninase (L-Met), an enzyme degrading L-methionine, as a possible anticancer therapy has been provided that it selectively destroys cancer cells, which require methionine to grow. Many tumor tissues have a limited capacity for methionine production and depend on exogenous supplies of this amino acid. Therefore, they could be selectively attacked by methioninase-based treatment. The present study was carried out to investigate the effect of L-Met on cancer cells, especially colorectal cancer (HCT-116) and renal cell carcinoma (A498), and its potential as a therapeutic agent. Various techniques, such as ammonium sulfate precipitation, dialysis, ion-exchange chromatography, and gel filtration chromatography, were employed in this study for enzyme purification of L-Met. Cytotoxicity testing was performed against HCT-116 and A498 cells in the range of 25-200 µg/mL concentration by the MTT assay for viable cell quantification, Total Nuclear Intensity (TNI), and Cell Membrane Permeability (CMP). The statistical analysis was done using one-way ANOVA and Dunnett's multiple comparisons test to compare multiple groups. The optimal temperature for enzyme activity was 37° C, with pH 7 offering the best enzyme stability. Further investigation into incubation time revealed that a 48-hour period maximized enzyme yield. The enzyme was purified using a combination of ammonium sulfate precipitation, ion-exchange chromatography, and gel filtration, achieving a 4.6-fold increase in purity. Characterization of the purified enzyme revealed a molecular weight of approximately 55 kDa, with optimal activity at pH 7 and 37°C. The enzyme demonstrated strong potential for therapeutic applications, showing dose-dependent cytotoxicity against colorectal cancer (HCT-116) and renal cancer (A498) cell lines, with significant inhibitory effects at concentrations as low as 25 µg/mL for colorectal cancer cells. The study highlights the potential of P. aeruginosa-derived L-Met showed strong activity in colorectal cancer, while activity in renal cell carcinoma was lower or inconclusive. https://acta.tums.ac.ir/index.php/acta/article/view/11461

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 2 2025 07 09 83 97 Abbas Abed Noor Al-Owaidi Department of Biology, College of Sciences, University of Babylon, Babylon, Hillah, 51001, Iraq Mohammed Abdullah Jebor Department of Biology, College of Sciences, University of Babylon, Babylon, Hillah, 51001, Iraq 2025 01 05 2025 02 03 L-methioninase (L-Met), a methionine-degrading enzyme, has shown potential for anticancer therapy. Many tumor tissues have a limited ability to produce methionine and depend on external sources; hence, these tumors can be targeted by methionine-based treatments. The present study was conducted to investigate the effects of L-Met on cancer cells, particularly hepatocellular carcinoma (HepG2) and pancreatic carcinoma (PANC-1), and to evaluate its viability as a therapeutic agent. Various techniques, including ammonium sulfate precipitation, dialysis, ion-exchange chromatography, and gel filtration chromatography, were employed to purify the enzyme L-Met. A cytotoxicity test was conducted against HepG2 and PANC-1 cells (at 25-200 µg/mL concentrations), using the MTT to evaluate cell viability, total nuclear intensity (TNI), and cell membrane permeability (CMP). Statistical analysis was done using one-way ANOVA and Dunnett's multiple comparisons test to compare study groups. L-Met displayed dose-dependent growth inhibition of the specified cell lines. The PANC-1 cell line exhibited an IC50 of 64.68 µg/mL, indicating a higher sensitivity to L-Met compared to WRL 68 normal cells, which had an IC50 of 214.0 µg/mL. Regarding HepG2, an even lower IC₅₀ of 66.44 µg/mL was observed, further confirming the selective targeting of cancer cells by L-Met. Treatment with L-Met at a 200 µg/mL concentration significantly decreased TNI and CMP levels in both the PANC-1 and HepG2 cell lines, indicating increased cytotoxicity and compromised membrane integrity. Additionally, L-Met reduced matrix metalloproteinase activities in both cancer cell lines, a critical factor in metastasis. Our study demonstrates the dose-dependent cytotoxic effects of L-Met on methionine-dependent tumor cells, specifically HepG2 and PANC-1. These findings highlight the need for optimized L-Met dosing strategies in cancer treatment, particularly for methionine-dependent malignancies, paving the way for its potential use in targeted cancer therapy. https://acta.tums.ac.ir/index.php/acta/article/view/11460

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 2 2025 07 09 98 105 Kawa A. Mahmood Department of Clinical Science, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 2025 01 05 2025 02 07 Diffusion-weighted imaging (DWI) and the calculation of the Apparent Diffusion Coefficient (ADC) provide valuable functional information at the molecular level, which can aid in distinguishing hepatic lesions. This study aims to assess the role of MRI DWI and ADC values in differentiating between hepatic hemangiomas and colorectal liver metastases (CRLMs), focusing on lesion size and potential to reduce reliance on liver biopsy. In this prospective observational study conducted from January 2019 to February 2020 at Hiwa Cancer Hospital, 61 patients with newly diagnosed colorectal cancer (CRC) and suspicious liver lesions underwent abdominal MRI. Lesions were characterized using DWI with two b-values (b=50 and b=800 sec/mm²), and ADC values were calculated for both hemangiomas and metastases. The histopathological diagnosis of CRLM was confirmed for all cases. The study excluded larger or necrotic lesions and focused on lesion size influencing ADC values and ratios. Statistical analysis was performed using SPSS version 25. Hemangiomas demonstrated significantly higher ADC values and ADC ratios than metastases, particularly in smaller lesions (≤21.5 mm), with a P<0.001. In lesions >21.5 mm, while ADC values were less pronounced, ADC ratios remained significantly higher for hemangiomas (P=0.02). ADC values in left lobe lesions were slightly higher than those in the right lobe, although this difference did not reach statistical significance.  MRI DWI with ADC measurement is valuable for differentiating hepatic hemangiomas from colorectal liver metastases, especially in smaller lesions. The significantly higher ADC values and ratios in hemangiomas can help avoid unnecessary biopsies and reduce the risk of metastasis seeding, which is particularly crucial in patients with resectable liver metastases. https://acta.tums.ac.ir/index.php/acta/article/view/11458

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 2 2025 07 09 106 112 Gaziza Hassan Marouf Public Health Laboratory-Sulaymaniyah, General Directorate of Health, Sulaymaniyah, Ministry of Health, Kurdistan Region, Iraq. Hisham Arif Getta Department of Clinical Science, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq Ahmed Farhan Shallal Department of Medical Laboratory Science, College of Science, University of Raparin, Kurdistan Region, Iraq. Aveen M. Raouf Abdulqader Department of Medical Microbiology, College of Health Science, Cihan University Sulaymaniyah, Kurdistan Region, Iraq. 2025 01 05 2025 07 09 Iron deficiency is frequent in female athletes due to greater turnover of red blood cells during exercise. Also, female athletes are considered to be at a greater risk of iron disturbance, which may lead to iron deficiency anemia or latent iron deficiency. Therefore, the study aimed to determine the frequency of iron deficiency in female athletes in Sulaymaniyah city. A total of 140 healthy habitual female athletes were screened for eligibility. One hundred and twenty were eligible and participated in the current study. Sampling was collected based on a stratified sampling method. Blood samples were taken from the participants in 23 Sports centers based on socioeconomic distribution. The parameters included complete blood counts (CBC), serum ferritin, serum iron, total iron-binding capacity (TIBC), and unsaturated iron binding capacity (UIBC). Of the participants, 25 (20.8%) had low ferritin levels (<10 ng/ml), indicating iron deficiency, while 95 (79.2%) had normal ferritin levels (10-291 ng/ml). Only 16 (13.3%) participants had been exercising for 6-12 years, and about half of them exhibited iron deficiency anemia. A significant difference was found in iron deficiency across exercise duration groups (P<0.05). No significant relationship was observed between menstrual patterns and iron deficiency (P>0.05), nor between BMI categories and iron deficiency (P=0.487). Despite 40% of athletes taking supplements, 25% remained iron-depleted, whereas only 15% of non-supplement users had iron deficiency. The high prevalence of iron deficiency, both with and without anemia, among female athletes highlight the urgent need for implementing regular screening programs. Such initiatives are essential to mitigate the negative effects of iron deficiency on overall health and athletic performance, ensuring that athletes receive timely intervention to maintain optimal iron status. https://acta.tums.ac.ir/index.php/acta/article/view/11459

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 2 2025 07 09 113 119 Suhail Najm Alareer Hayder Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq Ahmed Mohamedbaqer Easa Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq. Basman Radhi Majeed Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq Nabeel Naeem Hasan Almaalei Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq Reda Elsaman Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq M.M Abou Halaka Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq Raad Ajeel Bustan Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq Hussein Abed Dakhil Department of Radiology, College of Health and Medical Technology, Al-Ayen Iraqi University, An Nasiriyah, Iraq 2025 01 04 2025 02 07 The study aimed to assess the diagnostic accuracy of high-resolution computed tomography (HRCT) in evaluating mastoid involvement in patients with chronic suppurative otitis media (CSOM) in southern Iraq. This multicenter study was conducted in three medical centers across southern Iraq from September 2023 to February 2024. A total of 120 patients diagnosed with attico-antral CSOM, scheduled for mastoidectomy across three medical centers, underwent HRCT scanning and subsequent intraoperative evaluation. The research compared HRCT findings with intraoperative results across various parameters, including soft tissue lesions, mastoid pneumatization, and erosion of the scutum, tegmen plate, sinus plate, ossicular chain, facial canal, and lateral semicircular canal (LSCC). The study found that HRCT and intraoperative findings showed good agreement in assessing soft tissue involvement in the mastoid, attic, middle ear, Eustachian tube, and facial recess (P>0.05). Mastoid pneumatization also noted a strong agreement (P=0.75). However, significant discrepancies were observed in scutum erosion (P=0.047), sinus plate positioning (P=0.036), and ossicular status, with HRCT being less sensitive for detecting stapes erosion (P=0.013). For facial canal erosion, no significant differences were observed (P=0.58), while HRCT identified fewer cases of LSCC erosion compared to intraoperative findings, though the difference was not statistically significant. The results demonstrate that while HRCT is a reliable tool for assessing most aspects of middle ear involvement in CSOM, certain areas such as scutum erosion and stapes erosion require careful intraoperative evaluation for comprehensive diagnosis and management. https://acta.tums.ac.ir/index.php/acta/article/view/11448

Tehran University of Medical Sciences https://acta.tums.ac.ir/index.php/acta/article/view/11513 https://acta.tums.ac.ir/index.php/acta/article/download/11513/6054

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 12098 12098 Mohammed Abd Al-Hussein Khalil Department of Chemistry and Biochemistry, Faculty of Medicine, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq. Qabas Abdulsamad Thanoon Department of Basic Sciences, Faculty of Dentistry, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq. Ammar Yasir Abdulrahman Department of Basic Sciences, Faculty of Dentistry, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq 2026 04 27 2026 05 14 Rheumatoid arthritis (RA) defined as a chronic inflammatory disease characterized by painull inflammation of small joints additionally to cardiac disease, probably due to shared pathophysiological pathways and dyslipidemia. The main goal of the presented study is to evaluate the role of the ApoE polymorphisms in Iraqi RA patients and their association with lipid profiles, total ApoE levels, and disease severity markers, including galectin-3 and anti-CCP. A case-control study included 90 RA patients and 90 gender- and healthy controls aged 21 to 70 years with BMI ranging from 18 to 27 kg/m². Fasting serum lipid profiles were analyzed colorimetrically. Total ApoE, ApoE isoforms, anti-CCP, and galectin-3 were quantified by ELISA. Genomic DNA was used to perform ApoE genotyping for the ε2, ε3, and ε4 alleles. RA patients had significantly lower total ApoE levels and markedly higher levels of total cholesterol, LDL, galectin-3, and anti-CCP than controls (P<0.001). The ApoE ε2 allele correlated with reduced cholesterol and LDL-c levels and higher total ApoE levels. In contrast, the ApoE ε4 allele was associated with more severe dyslipidemia, including higher cholesterol and LDL-c levels, as well as increased inflammatory markers, including galectin-3 and anti-CCP, compared with carriers of either ε2 or ε3. ApoE polymorphisms, specifically the ε4 allele, together with elevated galectin-3 levels, are associated with exacerbated dyslipidemia and systemic inflammation in RA, suggesting their potential utility as combined biomarkers for identifying patients with a heightened atherogenic profile who may warrant cardiovascular risk assessment. https://acta.tums.ac.ir/index.php/acta/article/view/12098 https://acta.tums.ac.ir/index.php/acta/article/download/12098/6059

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 309 316 Atessa Pakfetrat Department of Oral and Maxillofacial Diseases, Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Mahdi Talebi Department of Family Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Taghi Shakeri Department of Epidemiology and Biostatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Reza Shakiba Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Mahdi Rivandi Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Ala Ghazi Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 01 25 2025 11 10 This study was conducted with the aim of investigating the pattern of smoking and its relationship with chronic pain in patients with atypical facial pain (AFP). This descriptive cross-sectional study was conducted on patients with AFP referred to the Oral and Maxillofacial Medicine department of Mashhad Dental faculty. Patients whose disease was confirmed through clinical and psychiatric examinations, and standard diagnostic criteria were included in the study. The information based on the designed checklist includes demographic characteristics, pain characteristics, and information related to tobacco use was extracted and recorded. Out of 77 patients included in the study, 23 were smokers and 54 were non-smokers. The most common site of pain in the smoking group was the face and, in the non-smoking group was the mandible. The most reported pain type was sharp pain in both groups. In non-smokers, a history of mental stress at the same time as the onset of pain was reported in 56% of people, and in the population of smokers, it was reported in 73% of people. In both groups, most people reported that pain does not affect sleep patterns. No significant difference was observed between the smoking and non-smoking groups in terms of pain intensity. According to the findings of present study, Smoking does not play a role in the pain intensity and sleep pattern of people with AFP, and other factors such as economic status, stress, anxiety, and smoking compounds may be effective, which should be investigated in future studies. https://acta.tums.ac.ir/index.php/acta/article/view/11500 https://acta.tums.ac.ir/index.php/acta/article/download/11500/6058

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 317 328 Ali Najeh Al-Awwady Department of Surgery, College of Medicine, Jabir ibn Hayyan University for Medical and Pharmaceutical Sciences, Al-Najaf, Iraq 2026 04 26 2026 05 16 Septoplasty is a common otolaryngological procedure in which a bloodless surgical field is critical for safe and accurate surgery. Deliberate hypotension is widely used to minimise intra-operative bleeding and optimise visibility, but the relative haemodynamic stability, blood-conservation efficacy, and postoperative nausea and vomiting (PONV) profile of total intravenous anaesthesia (TIVA) compared with combined intravenous–inhalational techniques in septoplasty are not fully established. This study aimed to compare propofol–remifentanil TIVA with a combined intravenous–inhalational technique (isoflurane plus metoprolol and glyceryl trinitrate) in patients undergoing septoplasty, with regard to haemodynamic stability, intra-operative blood loss, and PONV. A prospective, single-centre, parallel-arm, open-label randomised clinical trial was conducted at Al-Najaf Teaching Hospital, Iraq, between December 2022 and October 2023, and is reported in accordance with the CONSORT 2010 statement. Forty patients aged 16–50 years (ASA physical status I–II) were randomly allocated 1:1 by an independent biostatistician using a computer-generated block-randomisation sequence (block size 4). Allocation was concealed in sequentially numbered, opaque, sealed envelopes, which were opened only after enrolment and immediately before induction. Patients were assigned to combined intravenous–inhalational anaesthesia (Group A, n=20) or TIVA with propofol and remifentanil (Group B, n=20). The pre-specified primary endpoint was the proportion of patients achieving and maintaining the deliberate-hypotension target (MAP 50-65 mmHg) for ≥90% of the intra-operative period. Secondary endpoints were intra-operative blood loss, PONV incidence within 24 h, operative time, and recovery profile. Heart rate, systolic and diastolic blood pressure, MAP, intra-operative blood loss, and PONV up to 24 h after surgery were recorded. Both groups achieved the deliberate-hypotension target within five minutes of induction and maintained stable haemodynamics throughout surgery. Intra-operative blood loss did not differ significantly between groups (TIVA 119.0±14.10 mL vs combined 121.5±14.60 mL; P=0.548). PONV occurred in 25% of TIVA patients and 35% of combined-anaesthesia patients (P=0.503); no episodes of vomiting were recorded in either group within 24 h. Female sex was significantly associated with PONV (P=0.014). Operative time and recovery profiles were similar between the two groups. Both TIVA and combined intravenous–inhalational anaesthesia, when titrated to identical haemodynamic targets, showed no statistically significant differences in haemodynamic stability, intra-operative blood loss, or PONV outcomes during septoplasty. Because the study was not designed or powered as a formal equivalence or non-inferiority trial, these findings should be interpreted as hypothesis-generating rather than as proof of clinical equivalence. Either technique may be selected on the basis of patient-specific factors, drug availability, and clinician preference. https://acta.tums.ac.ir/index.php/acta/article/view/12097 https://acta.tums.ac.ir/index.php/acta/article/download/12097/6057

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 11416 11416 Amir Mir Mohammad Sadeghi Cardiovascular Surgery Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Mohaddeseh Behjati Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Bashir Najafabadian Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran Keyvan Shirneshan Pathology Research Center, Dr. Ali Shariati Hospital, Isfahan, Iran Mohsen Mir Mohammad Sadeghi Cardiovascular Surgery Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 2024 12 15 2025