ACTA MEDICA IRANICA

Diagnostic Performance of Multidetector Computed Tomography in the Evaluation of Esophageal Varices: A Meta-Analysis Study

Hussein Abed Dakhil — 2025-06-28

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.

Evaluation of L-Methioninase as a Targeted Anticancer Agent in Colorectal Cancer and Renal Cell Carcinoma

Abbas Abed Noor Al-Owaidi — 2025-06-28

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.

L-Methioninase as a Selective Anticancer Agent: Dose-Dependent Cytotoxicity and Metastasis Suppression in Methionine-Dependent Tumor Cells

Abbas Abed Noor Al-Owaidi — 2025-06-28

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.

Non-Invasive Differentiation of Liver Hemangiomas and Colorectal Metastases: The Role of Apparent Diffusion Coefficient in Reducing Unnecessary Liver Biopsies

Kawa A. Mahmood — 2025-06-28

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.

Prevalence and Risk Factors of Iron Deficiency Among Female Athletes in Sulaymaniyah District, Kurdistan Region of Iraq

Gaziza Hassan Marouf — 2025-06-28

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.

Evaluating Mastoid Involvement in Chronic Suppurative Otitis Media: Diagnostic Accuracy of High-Resolution Computed Tomography in Southern Iraq

Suhail Najm Alareer Hayder — 2025-06-28

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.

Assessment of LI-RADS Efficacy in the Classification of Hepatocellular Carcinoma and Benign Liver Nodules Using DCE-MRI Features and ADC MRI

Suhail Najm Alareer Hayder — 2025-06-28

The Liver Imaging Reporting and Data System (LI-RADS) is a widely utilized tool for classifying liver lesions, particularly in patients at risk for hepatocellular carcinoma (HCC). This study aims to assess the efficacy of LI-RADS in distinguishing between HCC and benign liver nodules by leveraging dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) features and apparent diffusion coefficient (ADC) values derived from MRI. Between October 2023 and March 2024, 43 patients with suspected HCC underwent MRI evaluation, including DCE-MRI and DWI sequences. The diagnostic performance of various MRI sequences was analyzed, focusing on their ability to differentiate HCC from benign lesions. The diagnostic efficacy of DCE-MRI and ADC in differentiation was evaluated using statistical analyses, such as t-tests and receiver operating characteristic (ROC) curve analysis. SPSS VER 16 was used to analyze the collected data. The study findings reveal that the DCE-MRI arterial phase demonstrated perfect diagnostic accuracy with an area under the curve (AUC) of 1.00, achieving 100% sensitivity and specificity. T2-weighted imaging also exhibited diagnostic solid performance, with an AUC of 0.801, while ADC values from DWI sequences showed limited efficacy in differentiating HCC from benign lesions (AUC=0.512). These findings indicate that DCE-MRI significantly enhances the accuracy of LI-RADS in classifying HCC versus benign liver nodules. This study highlights the importance of incorporating advanced imaging features into LI-RADS to improve the diagnostic precision of liver lesion evaluation in clinical practice.

Impact of COVID-19 and Its Vaccine on Menstrual Cycle Among Medical Staff in Sulaimani Maternity Teaching Hospital

Rozhan Yassin Khalil — 2025-06-28

Despite extensive research on the effects of the COVID-19 pandemic and its vaccine, detailed reports specifically addressing their impact on the menstrual cycle and the female reproductive system have been lacking. The present study aimed to assess the impact of the COVID-19 virus and its vaccines on the menstrual cycle pattern among Sulaimani Maternity Teaching Hospital medical staff. This cross-sectional study was conducted among female healthcare workers at Sulaimani Maternity Teaching Hospital who contracted COVID-19 or received the COVID-19 vaccine. Demographic data were collected through direct interviews, while clinical information was obtained through medical history reviews, clinical examinations, and relevant investigations. A total of 143 participants were recruited out of an initial 195 candidates, all meeting the study’s inclusion criteria. Data analyses were performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 21. The participants’ ages ranged from 20 to 35 years, with over half (60.8%) being married. Among the study participants, 93% had contracted COVID-19, and 72% had received the COVID-19 vaccine. Among the women who had contracted COVID-19, 30.1% reported experiencing menstrual irregularities, with the most common being oligomenorrhea (54.83%). Following vaccination, 8.4% of participants experienced menstrual changes, primarily intermenstrual spotting (58.33%) and oligomenorrhea (25%). However, no significant associations were found between the severity of COVID-19 infection, vaccination status, and menstrual irregularities, with P of 0.773 and 0.676, respectively. Furthermore, thyroid dysfunction was observed in 70% of the women who experienced prolonged menstrual irregularities, suggesting a potential endocrine-related factor contributing to these changes. COVID-19 infection and vaccination were associated with transient menstrual irregularities in some women. These changes were generally short-lived and not significantly linked to the severity of infection or vaccine type.

Clinical and Laboratory Predictors of COVID-19 Severity: Identifying Key Biomarkers for Risk Stratification and Patient Outcomes

Yasir Haider Al-Mawlah — 2025-06-28

Identifying clinical and laboratory markers associated with COVID-19 severity can aid in risk stratification and management. This study investigates the correlation between demographic, clinical, and laboratory parameters with disease severity and patient outcomes. This study encompassed all COVID-19 patients admitted to hospitals in Thi-Qar, Iraq, from January 2020 to February 2022. A total of 148 COVID-19 patients were evaluated. Two skilled chest radiologists separately examined all Computed Tomography (CT) scans. Key variables, including age, diastolic blood pressure, respiratory rate, Oxygen saturation (O₂ Sat), white blood cell count (WBC), blood urea nitrogen (BUN), potassium (K), albumin (Alb), creatine phosphokinase (CPK), C-reactive protein (CRP), and lactate dehydrogenase (LDH). Data analysis was conducted using SPSS version 23. The variables of age, diastolic blood pressure, respiratory rate, O₂ Sat, WBC, BUN, K, Alb, CPK, CRP, and LDH were significantly associated with the severity of the disease. The results found strong correlations between clinical and laboratory variables and CT severity scores, with oxygen saturation demonstrating a negative correlation with CT severity in both discharged (-0.41, P<0.001) and expired (-0.344, P=0.003) patients. WBC and absolute neutrophil count (ANC) were positively correlated with CT severity in both patient groups, while LDH and CRP exhibited strong positive correlations with CT severity in both discharged and expired patients. Additionally, serum albumin showed a negative correlation with CT severity in discharged patients, and potassium had a positive correlation in the discharged group. In expired patients, total bilirubin exhibited a negative correlation with CT severity. Comorbidities such as ischemic heart disease and cancer also significantly influenced patient outcomes. Our study identifies the significant role of clinical and laboratory parameters in predicting COVID-19 severity, highlighting the importance of early detection and intervention.

Novel Risk Factors for Placenta Accreta Spectrum in Women Without Prior Cesarean Section: Insights From a Case-Control Study

Maryam Bakir Mahmood — 2025-06-28

Placenta accreta spectrum (PAS) is a significant contributor to maternal morbidity and mortality, often complicating pregnancies due to abnormal placental attachment. While cesarean section (CS) remains the most recognized risk factor, nearly one-third of PAS cases occur in women without a history of CS. Identifying risk factors in these women is critical for improving early detection and management. This study aims to investigate maternal characteristics and risk factors associated with PAS in women without a history of CS, focusing on surgical histories and other potential predictors. A case-control study was conducted at the Maternity Teaching Hospital in Sulaimania, Kurdistan Region, Iraq. The study included 120 pregnant women diagnosed with placenta previa: 60 with PAS (cases) and 60 without PAS (controls). Women with a history of CS or uterine surgery were excluded. Data on maternal age, body mass index (BMI), parity, uterine surgical history, and other clinical factors were analyzed. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors. Significant risk factors for PAS included previous uterine myomectomy by laparotomy (OR 65.23, 95% CI: 7.85-541.72, P<0.0001), uterine septum excision (OR 9.45, 95% CI: 1.10-81.23, P=0.022), and a history of multiple endometrial biopsies (OR 3.92, 95% CI: 1.03-14.93, P=0.045). Repeated uterine curettage also emerged as a significant predictor (OR 3.78, 95% CI: 1.05-13.59, P=0.042). Conversely, traditional risk factors such as multiparity, gestational hypertension, and diabetes mellitus were not significantly associated with PAS in this cohort. Our study highlights uterine myomectomy, septum excision, repeated biopsies, and curettage as significant risk factors for PAS in women without a history of CS. These findings emphasize the importance of careful monitoring and risk assessment in such patients to improve early detection and management of PAS.