Background: Breast cancer is the most frequently diagnosed malignancy and the second leading cause of mortality among women in Iraq forming 23% of cancer related deaths. The low survival from the disease is a direct consequence to the advanced stages at diagnoses. Aim: To document the composite stage of breast cancer among Iraqi patients at the time of diagnosis; correlating the observed findings with other clinical and pathological parameters at presentation. Patients and Methods: A retrospective study enrolling the clinical and pathological characteristics of 603 Iraqi female patients diagnosed with breast cancer. The composite stage of breast cancer was determined according to UICC TNM Classification System of Breast Cancer and the American Joint Committee on Cancer Staging. The studied parameters comprised age of the patient, stage of the disease, marital and educational status, history of lactation and hormonal intake (for a minimum period of 6 months), family history of breast or any other cancer, the effected breast side, hormone (Estrogen and Progesterone) receptor (ER, PR) and Her2 contents of the primary cancer. Statistical analysis was performed to correlate the recorded composite stages at diagnosis with the corresponding clinical and pathological data utilizing SPSS version 16.0 statistical program. Results: Out of 603 patients, seven (1.2%) had ductal carcinoma in situ (Stage 0). Stages I, II and III and IV were documented in 9.5%, 47.1%, 33.2% and 9.1% of the patients at the time of diagnoses. Overall 70.8% of patients presented in the age group (40-59 years), 79.3% were married and 32.2% were highly educated. History of lactation, hormonal intake, family breast cancer and contralateral breast involvement was observed in 73.4%, 26.5%, 20.2% and 6.5% respectively. No correlation was elicited between the stage of breast cancer and the age of the patients, history of lactation or contralateral breast involvement. On the other hand, significant associations were demonstrated with respect to the marital and educational status, history of hormonal intake and breast cancer in the family. Immuno-histochemical evaluation revealed ER+PR+Her2+ (Triple Positive/Luminal B), ER-PR-Her2- (Triple Negative), ER+PR+Her2- (Luminal A) and ER-PR-Her2+ (Her2) subtypes in 13.4%, 11.8%, 48.2% and 9.8% of the examined breast samples respectively. When correlating the composite stage at diagnosing breast cancer with the corresponding subtypes the relationship was highly significant at p<0.01. Conclusions and Recommendations: The study reports a regression in Stage IV breast cancer at the time of initial presentation among Iraqi patients specifically in those with family history of the disease; pointing out to the fruitful outputs of initiating the National Program for Early Detection of Breast Cancer in the country. Further professional efforts, endorsed by practical policy decisions, are recommended to down stage breast cancer through promoting evidence based protocol guidelines and adopting comprehensive well designed diagnostic, screening and cancer control strategies.
There is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient
... Show MoreThe calculation of potential earth's surface solar radiation is imperative for analyzing the atmosphere-vegetation-soil interaction process. Therefore, many schemes were introduced with direct (using net radiometer) or indirect (using air temperature or air plus soil temperatures) formulas. Three combinations of factors are known to control the Rn value; the astronomical based factors which determine the general spatial distribution of Rn values, the climatological factors which determine the assigned spatial variation of those values, and the topographical factors that influence climatological factors rates ( i.e. have indirect effects on Rn values).
For Iraq, the ecosystem in
... Show MoreThe work involves synthesis of new quinolin-2-one Schiff bases (XIII)a,b and (XIV)a,b, pyrazoles (XI)a,b and pyrazolines (XII)a,b derivatives containing isoxazoline or pyrimidine cycle starting with chalcones. 3-Aminoacetophenone was reacted with 4-bromobenzaldehyde or 4-N,N-dimethyl aminobenzaldehyde in basic medium to give chalcones (I)a,b by Claisen-Schemidt reaction. These chalcons were reacted with hydroxylamine hydrochloride or with thiourea in basic medium to form isoxazolines (II)a,b or pyrimidine-2-thion (III)a,b ,respectively.Also the pyrimidine-2-thiones (III)a,b and isoxazolines (II)a,b reacted with 4-or 3-substituted benzaldehyde and coumarin to form Schiff bases (IV)a-f (V)a-f and quinoline derivatives (VII)a-d(VIII)a-d, re
... Show MoreThis study develops a systematic density functional theory alongside on-site Coulomb interaction correction (DFT + U) and ab initio atomistic thermodynamics approachs for ternary (or mixed transitional metal oxides), expressed in three reservoirs. As a case study, among notable multiple metal oxides, synthesized CoCu2O3 exhibits favourable properties towards applications in solar, thermal and catalytic processes. This progressive contribution applies DFT + U and atomistic thermodynamic approaches to examine the structure and relative stability of CoCu2O3 surfaces. Twenty-five surfaces along the [001], [010], [100], [011], [101], [110] and [111] low-Miller-indices, with varying surface-termination configurations were selected in this study.
... Show MoreAim: To evaluate the cytotoxic activity of newly synthesized a series of novel HDAC inhibitors comprising sulfonamide as zinc binding group and Isatin derivatives as cap group joined by mono amide linker as required to act as HDAC inhibitors. Materials and Methods: The utilization of sulfonamide as zinc binding group joined by N-alkylation reaction with ethyl-bromo hexanoate as linker group that joined by amide reaction with Isatin derivatives as cap groups which known to possess antitumor activity in the designed of new histone deacetylase inhibitors and using the docking and MTT assay to evaluate the compounds. Results: Four compounds have been synthesized and characterized successfully by ART-FTIR, NMR and ESI-Ms. the compounds w
... Show MoreIn this study, dead and live anaerobic biomass was used in biosorption of Pb(II), Cr(III) and Cd(II) ions from a synthetic wastewater. The biosorption was investigated by batch adsorption experiments. It was found that, the biosorption capacities were significantly affected by biosorbent dosage. The process follows Langmuir isotherm (regression coefficient 0.995, 0.99 and 0.987 for Pb(II), Cr(III) and Cd(II) ions, respectively, onto dead anaerobic biomass) model with uniform distribution over the biomass surface. The experimental uptake capacity was 51.56, 29.2 and 28 mg/g for Pb(II), Cr(III) and Cd(II), respectively, onto dead anaerobic biomass, compared with 35, 13.6 and 11.8 mg/g for Pb(II), Cr(III) and Cd(II), respectively, onto live
... Show MoreA novel series of mixed-ligand complexes of the type, [ML1(L2)3]Clx [M= Cr(III), Fe(III), Co(II),Ni(II), Cu(II), Cd(II) and Hg(II), n = 2, 3], was synthesized using Schiff base (HL1) as main ligand, nicotinamide (L2) as secondary ligand, and the corresponding metal ions in 1:3:1 molar ratio. The main ligand, HL1 was prepared by the interaction of ampicillin drug and 4-chlorobenzophenone. The synthesized mixed ligand complexes were characterized by elemental analysis, UV-Vis, FT-IR,1H-NMR,13C-NMR and TG/DTG studies. In the mixed-ligand complexes, the Schiff base ligand, HL1 showed coordination to the central metal ion in tridentate manner via azomethine nitrogen, β-lactam ring oxygen and deprotonated carboxylic oxygen atoms, whereas the sec
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