Journal of the Faculty of Medicine Baghdad

As we are living the month of Men’s Health awareness, November, we thought of touching base regarding screening for prostate cancer; an intriguing topic indeed, and the jury is out as of yet regarding whether to formalize a screening platform for prostate cancer. The fact remains that prostate cancer is one of the most common cancers in men and the fifth leading cancer-related death globally (1).
However, it remains to be determined whether mass screening is recommended for such an important health issue.
Over the past few decades, the pendulum has swung with many trials attempting to come up with the sensible conclusion as to whether screening is recommended for prostate cancer.
For screening for any medical condition to be effective according to Wilson and Jungner criteria, the condition has to constitute an important health problem with no natural history. Also, it has to have a recognizable latent or early symptomatic stage (2).
More importantly, there has to be an easy, reliable, and acceptable test for the screening along with an acceptable treatment. Speaking of which, the treatment has to be effective, especially if commenced early.
When it comes to prostate cancer, it ticks most of the boxes regarding this criteria, especially when it comes to knowing the natural history of the disease.

Background: The preterm premature rupture of the membrane is linked to various perinatal problems, including chorioamnionitis.
Objectives: To evaluate the use of serum ferritin, C-reactive protein, and procalcitonin as early indicators for predictions of subclinical intra-amniotic fluid infection.
Methods: A case-control study was conducted at Baghdad Teaching Hospital from January to October 2021. A convenient sample of 90 singleton pregnant women with a live fetus between 24 - 36 weeks of gestation were divided into three groups: Group 1 (controls) included 30 women with intact membranes and no signs of labour seen in the outpatient obstetrics clinic in Baghdad Teaching Hospital; Group 2 included 30 women with preterm premature rupture of membrane (PPROM) but without chorioamnionitis; and Group 3 included 30 women with PPROM and chorioamnionitis. The second and third groups were collected from the labour room in Baghdad Teaching Hospital.
Results: There was no significant difference in the levels of C-reactive protein between the study groups. Serum ferritin and Procalcitonin levels were normal in all of the participants, with a significant difference in the level of Procalcitonin between group 2 (PPROM with chorioamnionitis) and group 3 (PPROM without chorioamnionitis).
Conclusion: Procalcitonin might be used to detect the presence of chorioamnionitis. Serum ferritin and C-reactive protein had no role in the detection of chorioamnionitis among patients with preterm premature membrane rupture.

Background: The liver synthesizes albumin, a pivotal protein that accounts for approximately 60-65% of total plasma proteins. During ischemic attacks linked to oxidative stress, reactive oxygen species, and acidosis, albumin’s properties undergo alterations. This leads to the generation of ischemia-modified albumin, characterized by a diminished metal-binding capacity, particularly for transition metals like copper, nickel, and cobalt.
Objectives: This study aimed to assess the significance of serum albumin and ischemia-modified albumin concentrations in Iraqi individuals with hepatitis B virus
Methods: A case-control study, including 50 patients with hepatitis B recruited from a Gastroenterology hospital in the Medical City/ Baghdad/ Iraq, was conducted from January to February 2023. The patients' group included males and females, ages 18 to 77 years, with a mean value of 44 years. Meanwhile, the study group consisted of 50 sex-matched normal healthy individuals. Albumin concentration was determined in the serum samples using a Biosystems kit, and ischemia-modified albumin concentration was measured through the albumin cobalt binding test. The ischemia-modified albumin/ [albumin] ratio and ischemia-modified albumin index were then calculated.
Results: lower serum albumin concentration was measured in the patients' group, while the mean value of ischemia-modified albumin concentration in the patients' group and healthy control were 0.466 ± 0.114 absorbance unit & 0.395 ± 0.070 absorbance unit, respectively, with a statistically significant increase (P < 0.001). The ischemia-modified albumin ratio in the hepatitis B patients and control groups was 0.172 ± 0.073 and 0.117 ± 0.050, respectively, showing a significant increase (P < 0.001). Additionally, the ischemia-modified albumin index in the patients and the control groups were 0.491 ± 0.167 & 0.390 ± 0.131, respectively, with a statically significant increase (p<0.001) in the patients group. Conclusion: In the patients' group with hepatitis B, serum albumin concentration decreased, while the levels of ischemia-modified albumin, ischemia-modified albumin ratio, and ischemia-modified albumin index increased. The elevation in ischemia-modified albumin, ischemia-modified albumin ratio, and ischemia-modified albumin index was more prominent in younger patients and those with albumin concentrations less than 4g/dl. Moreover, the prevalence of hepatitis B is higher in men compared to women.

Cancer remains a leading cause of mortality and morbidity worldwide. Advances in cancer therapies—including immunotherapies (e.g., checkpoint inhibitors, gene-targeted therapies), antibody-based cancer toxins, chemotherapy, radiotherapy, and surgery—have significantly improved survival rates(1,2).However, this progress has led to a surge in the prevalence of cardiovascular disease (CVD) among cancer survivors, now recognizedas a leading cause of mortality in this population(3,4). These intersecting burdens highlight the growingneed to prevent, detect, and manage cardiovascular complications in cancer care pathways and callfor important initiativesin establishing Cardio-oncology services globally(5,6).Cardio-oncology(CO),a multidisciplinary specialty, focuses on optimising cardiovascular risk stratification, prevention, and treatment amongcancer survivors(7).The field has addressedthe cardiotoxicity associated with cancer treatments(see Table 1), such as heart failure, arrhythmias, and coronary artery disease. Baseline risk assessment and early identification of high-risk patients are central to mitigating treatment-related cardiac complicationsand ensuring uninterrupted cancer carein this population

Background: Aftershock delivery and direct current DC-cardioversion of atrial fibrillation may be immediate or delayed.
Objective: To characterise the immediate or delayed reversion of atrial fibrillation.
Methods: The study was conducted at Alhassani Heart Centre from October 2018 to February 2022. Patients diagnosed with persistent atrial fibrillation and who reverted to sinus rhythm after DC-cardioversion were included in this case series study. Some patients showed immediate conversion to sinus rhythm, while others showed delayed conversion after shock delivery. The duration of the atrial fibrillation, the ventricular rate range before the intervention, the preceding drug therapy, patient weight, and left atrial size were measured to illuminate the factors that affect the reversion format. Results: From a total of 86 patients with persistent atrial fibrillation treated with DC-cardioversion, 77 (89%) patients reverted into sinus rhythm and were included in the study. Fifty patients reverted immediately, and 27 patients reverted late. The mean ventricular rate was higher in the immediate group (138± 22) compared to 75± 18 in the delayed group. The post-conversion appearance of atrial premature beats was more in the delayed group. The left atrial size was slightly larger in the delayed group. The role of taking a preceding drug was not significant in both groups.
Conclusion: The pattern of reversion in atrial fibrillation patients undergoing DC shock is governed by the ventricular rate before the reversion and the appearance of atrial premature complexes after DC shock.

Background: Beta-oxidation of fatty acids takes place in the mitochondria to produce energy. This process is linked to the formation of free radicals. Previous researches propose that some fatty acids may be related to mitochondrial dysfunction, as they induce oxidative stress.

Objectives: To examine the correlation between follicular fluid fatty acids and relative cell-free mitochondrial DNA in the follicular fluid in women experiencing intra-cytoplasmic sperm injection (ICSI).

Methods: Fifty women subjected to ICSI participated in this cross-sectional research. Follicular fluid samples were obtained during oocyte pick-up. The samples were assessed for fatty acids, utilizing gas chromatography, and for relatively cell-free mitochondrial DNA, real-time polymerase chain reaction (PCR) was used.

Results: There was a strong significant positive correlation between follicular fluid margaric acid and follicular fluid relative to cell-free mitochondrial DNA, as the correlation coefficient was 0.869, and the P value was 0.025. In addition, a strong significant inverse correlation was noticed in women with diminished ovarian reserve between follicular fluid oleic acid and relative cell-free mitochondrial DNA in the follicular fluid, as indicated by a correlation coefficient = - 0.9 and a P value = 0.037.

Conclusion: Margaric acid correlated positively with the relative cell-free mitochondrial DNA, which might reflect mitochondrial dysfunction due to aggravation of oxidative stress. Whereas oleic acid, in women with diminished ovarian reserve, correlated negatively with relative cell-free mitochondrial DNA. However, more studies are required in this area of research.

Background: Urinary tract infections (UTIs) are one of the most common bacterial illnesses among the public and in hospital settings. A prevalent nosocomial disease is catheter-associated urinary tract infection (CAUTI). The risk of infection increases with urinary catheterization, making it easier for Escherichia coli to colonize the urinary system. Uropathogenic E. coli (UPEC) specifically adapts to survive in challenging urinary tract conditions. Treating CAUTI accurately and effectively can be difficult. An important health concern nowadays is drug-resistant bacteria.
Objectives: To assess the prevalence of swarming genes in E. coli responsible for UTIs and catheter-associated UTIs, and determine their antibiotic resistance.
Methods: A total of 143 clinical specimens of urine and catheter samples were collected from two teaching hospitals in Baghdad city between October and December 2023. The bacteria were identified, and their antimicrobial susceptibility was tested. Conventional PCR methods were used to determine the bacteria and detect swarming genes (flhC, flhD, and recA).
Results: Out of 143 samples, 44 isolates were identified as E. coli (35 isolates from UTIs and 9 isolates from catheters). These isolates exhibited varying sensitivities to antibiotics, most being multi-drug resistant (MDR). They were highly resistant to tetracycline (72.7%) and highly susceptible to imipenem (93.2%). Among these isolates, 16 were identified (12 from UTIs and 4 from catheters). All the highly swarming and multidrug-resistant E. coli isolates were found to possess the three tested swarming genes (flhC, flhD, and recA), as determined by conventional PCR.
Conclusion: Escherichia coli is more prevalent in UTIs than in catheters. The number of isolates demonstrating the ability to swarm was found to be higher in UTIs, and these isolates also exhibited the capability to swim. Most E. coli isolates are multidrug-resistant and can swarm.

Background: Inflammatory bowel disease is a chronic inflammatory condition affecting the gastrointestinal tract, encompassing two primary conditions: Crohn’s disease and ulcerative colitis. Calprotectin, a protein released by keratinocytes, phagocytes, monocytes, granulocytes, and vascular cells, plays a key role in the body’s inflammatory response. It is recognized by toll-like receptors, which trigger pathways that lead to inflammation. The chronic nature of inflammatory bowel disease presents a significant health challenge, requiring precise methods for regular assessment and monitoring of disease activity. Elevated calprotectin levels are widely recognized as a biomarker for detecting inflammation in the gastrointestinal tract, making it an essential tool in managing inflammatory bowel disease, particularly ulcerative colitis.
Objectives: To examine whether significant differences exist in the levels of interleukin-6 and calprotectin between patients with ulcerative colitis and healthy control subjects, this study analyzes and compares these inflammatory markers across both groups. suggesting that both markers could serve as potential diagnostic tools for ulcerative colitis. Furthermore, these findings highlight saliva as a non-invasive source for evaluating inflammatory markers in patients with ulcerative colitis.
Methods: The subjects included were twenty-five patients with ulcerative colitis and twenty-five healthy individuals as the control group. All of whom ranged in age from 20-55 years, and the levels of interleukin-6 (IL-6) and calprotectin in the saliva of ulcerative colitis patients were measured using the ELISA method.
Results: When compared to the control group, the current findings indicated that both (IL-6) and calprotectin levels were significantly higher in UC patients. Moreover, this study found a significant positive correlation between IL-6 levels and age in all study groups (UC and control) and between IL-6 and calprotectin in UC patients.
Conclusion: There are higher levels of IL-6 and calprotectin in the saliva of patients with UC disease, both markers could be used as diagnostic markers for UC disease

Background: Activin A (ACV-A), a member of the transforming growth factor-beta (TGF-beta) superfamily that regulates follicular growth hormone (FSH) secretion and initiates intracellular signaling pathways, is essential to reproductive regulation. ACV-A is involved in regulating cellular proliferation, differentiation, apoptosis, and homeostasis, among other biological processes. The pituitary gland, the gonads, and other organs all secrete ACV-A, which is made up of two beta A (βA) subunits.
Objectives: To compare the serum concentrations of ACV-A in women diagnosed with missed abortion (MA) or ectopic pregnancy (EP) with those of healthy controls.
Methods: The study was conducted in the gynecology departments of the Medical City - Baghdad Teaching Hospital and Al-Kut Obstetrics and Gynecology Hospital from October 2023 to January 2024. A total of 120 women aged between 18 and 45 years participated in the study; An ectopic pregnancy was diagnosed in 30 of them, 30 had a missed miscarriage, and the remaining 60 were considered a control group. ACV-A and beta-human chorionic gonadotropin (β-HCG) levels were measured by the enzyme-linked immunosorbent assay (ELIZA) method.
Results: The control group had a significantly lower mean ± SD of ACV-A (773.6 ± 130.26 pg/ml) in comparison to the EP group (1408.1 ± 219.02 pg/ml) and the MA group (1200.9 ± 199.31). In addition, patients in the ectopic group had a significantly lower mean± SD of ACV-A than patients in the missed abortion group.
Conclusion: Serum Activin A levels can be used as an indicator of ectopic pregnancy and missed abortions. A novel biomarker for evaluating women who have an ectopic pregnancy could be the level of HCG in their serum at a cutoff value of greater than 236 ng/ml.

Background: Preptin is an endocrine peptide with 34 amino acids. Conjugated with insulin, it is produced
by β-cells from the pro-insulin-like growth factor 2 E-peptide. However, in addition to insulin, pancreatic
hormone (Preptin) is released in response to elevated blood glucose levels. Preptin's primary metabolic
effect is to raise insulin synthesis, achieved through both an amplifying mechanism and a triggering route
dependent on calcium signaling.
Objectives: To determine the Preptin in patients with coronary artery disease (CAD) with and without
Type 2 diabetes mellitus (T2DM).
Methods: One hundred and twenty Iraqi participants between the ages of 40 and 60 years were enrolled
(80 patients and 40 age-sex matched controls). The study occurred between August and December 2023
at Ibn Al-Bitar Center for Cardiac Surgery in Baghdad, Iraq. The level of Preptin in patients with CAD
with and without T2DM was evaluated. The biochemical tests performed on participants included fasting
blood sugar (FBS), total cholesterol (TC), triglycerides (TG), low-density lipoproteins (LDL), and very
low-density lipoproteins (VLDL) high-density lipoproteins (HDL), blood urea, serum creatinine, and uric
acid. The waist-to-hip ratio (WHR) and body mass index (BMI) were also computed. There was a
significance level below 0.05 using the Mann-Whitney tests. A non-parametric method and Spearman's
rank coefficient were used to determine the significance of correlation for the relationship between the
two numerical variables. We determined the Preptin cut-off value by analyzing the receiver operation
characteristic (ROC) curve.
Results: The CAD cases both with and without T2DM had a significantly higher serum Preptin than the
control group. The levels of Preptin, HDL, and uric acid were significantly strongly correlated. The
Preptin ROC curve showed a clear cut-off value (>601.71, >818.10, and >694.71) with the area under the
curve (AUA) (0.973, 0.996, and 0.985) respectively when calculated in three groups: CAD without
T2DM, CAD with T2DM, and both CAD groups together compared with the controls.
Conclusion: Preptin may serve as a predictive marker for the progression of declining heart function in
people with T2DM. It also works well as a diagnostic tool to distinguish between patients with CAD and
those without.

Background: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a familial
tendency. It affects approximately 10%-20% of children and 1%-3% of adults worldwide. Chenopodium
murale is clinically proven for treating many medical conditions, such as AD, due to its easy application
and efficacy. Salvia plant has an anti-inflammatory effect on AD cases treated with phenolic compounds.
Objective: To determine the anti-inflammatory effect of the phytosterol fraction of Chenopodium murale
(CM) in comparison to Salvia frigida (SF).
Methods: This study was conducted from December 2020 to June 2021 in the Department of Pharmacology,
College of Medicine, Al Nahrain University. Fifty mice were included in the study, subdivided equally into
five subgroups [control, induction, Tacrolimus-1%, Phytosterol-3%, and Phenolic-5%]. Biological and
histological parameters were measured, and their means were compared using the independent t-test, and
the one-way ANOVA was used to estimate the mean of differences.
Results: The Tacrolimus-1% group showed a significant decrease in white blood cells, Ig-E, and
inflammation means than other groups; a significant decrease in mean epidermal thickness than the
Phytosterol-3% groups; and a significant decrease in IL-13 and erosion than the Phenolic-5% groups. The
phytosterol-3% group showed a significant decrease in the mean parakeratosis, erosion, and observational
severity (OS) score than other groups. The phenolic-5% group showed a significant decrease in the mean
epidermal thickness than other groups and a significant decrease in OS score than the Tacrolimus-1%
groups.
Conclusion: The topical applications of the phytosterol fraction of Chenopodium murale or the phenolic
compound of Salvia frigida were effective and promising in treating atopic dermatitis. While the phenolic
compound of Salvia frigida is effective, it is somewhat less than that of the phytosterol fraction of
Chenopodium murale

Background: Polycystic ovary syndrome is among the leading causes of fertility-related problems and menstrual irregularities in women of reproductive age. The granulosa cells of the developing pre-antral and antral follicles produce inhibin B, which triggers chemical responses in the ovaries. Inhibin B is most often observed in the follicular phase when levels peak early and then decline over time
Objectives: This study was designed to investigate the role of serum inhibin B and the Luteinizing Hormone / Follicle Stimulating Hormone ratio in differentiation between the different phenotypes of polycystic ovary syndrome as well as to define the predominant PCOS phenotype.
Methods: This cross-sectional research was conducted in the Department of Biochemistry, College of Medicine, University of Baghdad from November 2023 to March 2024. The study included 111 women, ranging in age from18-40 years. Among these, 91 women were diagnosed with polycystic ovary syndrome (PCOS) based on the 2003 Criteria for the Rotterdam Consensus, and the other 20 were healthy women. Investigations included serum levels of inhibin B using the Enzyme Linked Immunosorbent Assay technique, follicle Stimulating Hormone, luteinizing Hormone and prolactin using Tosoh AIA-2000 Automated Immunoassay, to calculate the LH/FSH ratio.
Results: phenotype A was observed to be the predominant PCOS phenotype, while phenotype B was the rare form. The mean ±SEM values of the inhibin B levels for the phenotypes B (26.07±0.23 pg/ml, p=<0.001), C (25.96±1.68 pg/ml, p=<0.0001), and D (37.51±2.31 pg/ml, p=<0.0001), respectively, were significantly lower than those of the control women (57.68±2.07 pg/ml). However, the mean ±SEM value of inhibin B of phenotype A (50.46±7.12 pg/ml) was comparable to that of controls. The mean value of the LH levels of phenotype A (7.12±0.76 µIU/ml) showed significantly higher numbers than those of the control women (4.59±0.38 µIU/ml, p=0.03). Furthermore, the mean values of the LH/FSH ratio were significantly elevated in phenotypes A (p=0.001) and B (p=0.04) compared to the controls.
Conclusion: Serum Inhibin B level and LH/FSH ratio can be used to distinguish between the different phenotypes of PCOS.

Background: Primary myelofibrosis is a chronic myeloproliferative neoplasm characterized by abnormal megakaryocyte proliferation and fibrosis that destroys healthy bone marrow. This results in extramedullary hematopoiesis, variable blood cell deficiencies, hepatosplenomegaly, general symptoms, progression to leukemia, and a reduced lifespan. Myelofibrosis can occur as a de novo myeloproliferative neoplastic disorder or evolve from other myeloproliferative neoplasms, including Polycythemia Vera or Essential Thrombocytosis. MicroRNAs (miRNAs) are short, non-protein-coding RNA molecules, typically 18–24 nucleotides in length. Dysregulation of miRNAs may contribute to the disease phenotype.
Objective: To investigate the expression level of MicroRNA-155-5p in patients with Primary Myelofibrosis compared to healthy controls and its correlation with common clinic-pathological factors.
Methods: twenty-eight patients with Primary Myelofibrosis and twenty healthy subjects were examined as controls. Expression analysis of MicroRNA-155-5p was performed using reverse transcription-quantitative polymerase chain reaction (qRT-PCR) on plasma isolated from peripheral blood.
Results: MicroRNA-155-5p expression was significantly upregulated in patients with Primary Myelofibrosis (P = 0.0001). However, no significant correlations were found between MicroRNA-155-5p and age, sex, Janus kinase 2 mutation status, or hematological parameters, including hemoglobin, white blood cell count, and platelet count.
Conclusion: MicroRNA-155-5p expression is not influenced by age, sex, Janus kinase 2 mutation status, or hematological parameters. Aberrant expression of MicroRNA-155-5p may contribute to the pathogenesis of Primary Myelofibrosis, warranting further research to understand the disease mechanisms better.

Background: Male infertility is a multifactorial condition influenced by various physiological and biochemical factors. Seminal fluid composition plays a crucial role in sperm function and fertilization potential. Chitotriosidase is a chitinase enzyme released by activated macrophages and is highly conserved and controlled. The notable chitinase in humans plays a significant role in the body's immunological response and is linked to inflammation, infection, tissue damage, and remodeling processes. On the other hand, malondialdehyde is a marker of lipid peroxidation, reflecting oxidative stress levels.
Objective: This study aimed to explore the correlation between malondialdehyde levels and Chitotriosidase-1in seminal fluid in Iraqi infertile males.
Methods: Ninety males aged between twenty and forty-five were included in this cross-sectional study, all diagnosed with infertility by specialists at the infertility unit of Al-Batool Teaching Hospital between February 2022 and February 2023. The participants were categorized into three groups: the Normozoospermic Group (G1), the Asthenospermia Group (G2), and the Oligozoospermic Group (G3). Seminal malondialdehyde and Chitotriosidase-1 levels were measured by competitive Enzyme-linked immunosorbent assay.
Results: The study findings showed significantly higher levels of seminal fluid Chitotriosidase-1 found in the G2 group compared to the G3 and G1 groups. The seminal fluid malondialdehyde level for G1 was significantly lower than those for G2 and G3, which revealed a significant positive correlation between seminal fluid Chitotriosidase-1 activity and malondialdehyde levels (r = 0.37, P < 0.05) in the Asthenospermia Group.
Conclusion: In the Asthenospermia Group, there is a correlation between seminal fluid Chitotriosidase-1 activity and malondialdehyde level. Novel diagnostic and therapeutic approaches for the treatment of male infertility may result from our growing understanding of the roles played by Chitotriosidase-1 and malondialdehyde in male reproductive health.

Background: Bariatric surgery (BS) is the most effective method for long-term weight loss. Rapid weight reduction after BS may contribute to the formation of gallstones.
Objectives: To assess the rate, and to identify the associated factors, of gallstone formation after laparoscopic sleeve gastrectomy.
Methods: This was a cross-sectional study among 128 patients with morbid obesity, who were treated with laparoscopic sleeve gastrectomy and followed up at two weeks, one month, six months, and one year after surgery between October 2018 and July 2020, at the Gastroenterology and Hepatology Teaching Hospital in Baghdad and the Dowaly Private Hospital. Data was collected using a structured questionnaire.
Results: The mean age of patients was 36.5±5.21 (17–54) for females and 41.6 ±3.04 (24–58) for males. Gallstone formation happened in 49 cases (38.3%). Of all males, four (36.4%) developed gallstones after (LSG), compared to 45 (38.5%) females. Sixty (46.9%) patients had a Body Mass Index (BMI) ≥40 kg/m2, of whom 29 (48.3%) developed gallstones after LSG (p = 0.031). The p-values for weight loss regarding timing and degree of loss show a significant relationship with gallstone formation after LSG (p < 0.05). Comorbid conditions were not significantly associated with the incidence of gallstone formation after LSG (p > 0.05).
Conclusions: More than a third of the cases developed gallstones after Laparoscopic Sleeve Gastrectomy. This was associated with Gross obesity prior to surgery (BMI ≥ 40 kg/m²), losing ≥25% of the original weight, and rapid weight loss during the first six months after LSG.

Background: Beta-thalassemia major is a prevalent global condition characterized by a rapid breakdown of red blood cells. Regular blood transfusions can give rise to problems such as cardiovascular disease, diabetes, osteoporosis, and renal disorders. Alpha-Klotho protein is a protein that has anti-aging properties and is involved in several functions, including reducing oxidative stress, regulating energy metabolism through several routes, and managing calcium and phosphate metabolism.
Objective: This study aimed to assess changes in calcium and phosphate levels, Alpha-Klotho protein concentration, and their associations with cardiac dysfunction in patients with Beta-thalassemia major.
Methods: The study was conducted at Al-Sadr General Hospital and Ibn Albaladi Center of Blood Diseases, Baghdad, and involved 90 participants who were grouped into three groups: Group A: 30 patients with Beta-thalassemia major and heart dysfunction; Group B:30 patients with Beta-thalassemia major without any signs of heart dysfunction; and Group C:30 healthy individuals as a control group. The indicators examined were serum levels of Alpha-klotho protein, calcium, phosphate, and Ferritin. ELISA method was used to assess serum Alpha-klotho protein, whereas serum Ca, serum phosphate, and serum Ferritin were analyzed using the Beckman Coulter AU clinical chemistry analyzers.
Results: The mean values of Serum Alpha-Klotho protein, phosphate, and Ferritin in the patients with beta-thalassemia were greater than those in the control group with P value<0.05. Patients with thalassemia had decreased levels of serum calcium compared to the control group. Additionally, a strong negative association was observed between serum calcium and phosphate levels.
Conclusion: Patients with beta-thalassaemia major have significant alterations in calcium and phosphate levels under the control of Klotho protein levels.

Background: Hypovitaminosis D can cause immunological irregularities in the development of immune thrombocytopenia.
Objectives: To identify the frequency of low levels of 25-hydroxyvitamin D in children with Immune thrombocytopenia (ITP), and to assess the effect of the disease phase and type of treatment on vitamin D level.
Methods: This case-control study was carried out on 88 children (63 had been diagnosed with immune thrombocytopenia and 25 healthy children as controls) during November 2023 and April 2024. The patients were sub-grouped according to global classification of vitamin D level into three groups: less than 10 ng/ml (n = 47), 10–20 ng/ml (n = 16), and 20-30 ng/ml (none of the patients or controls fell in this group). The cases were sub-classified according to their disease phase: Acute (n = 21), persistent (n = 24), and chronic (n = 18). The serum 25-hydroxyvitamin D level was measured using the enzyme-linked immunosorbent assay (ELISA) technique.
Results: Around 75% of ITP children had a serum 25-hydroxyvitamin D level of less than 10 ng/ml. The mean (± SEM) values of the serum 25-hydroxyvitamin D of the ITP children of acute (9.5±1.84 ng/ml) and chronic (8.0±1.13 ng/ml) phases were lower than those of controls (10.0±1.32 ng/ml, p > 0.05), but not significantly so. The mean values of 25 hydroxyvitamin D of ITP children were lower than those of the controls, irrespective of the type of treatment.
Conclusion: Vitamin D deficiency is prevalent among children with immune thrombocytopenia, particularly those in the chronic phase.

Background: Lumbar disc degeneration (LDD) is a common musculoskeletal disorder that frequently causes low back pain (LBP). In addition to the discomfort of lower back pain, it can accompany pain in one or both legs. The lumbar spine and sacrum, consisting of five vertebrae and one bone, determine the spine's balance. Microelements are essential in bone metabolism and are associated with preventing osteoporosis and alleviating musculoskeletal pain.
Objectives: To examine the correlation between lumbar spinal surgery and the concentrations of microelements, namely zinc and copper.
Methods: A case-control study was conducted in Ghazi Al-Hariri Hospital in Baghdad, Iraq, during the October 2023 to January 2024. The study included 120 participants ranging in age from 18 to 70 years. Sixty participants underwent lumbar spine surgery and were diagnosed using X-ray or MRI scans. The other 60 were healthy controls. The zinc (Zn) and copper (Cu) levels in the blood were determined using an atomic absorption spectrometer. The body mass index (BMI) was determined using the formula: BMI (kg/m2) = weight/height2.
Results: The patients had a lower mean zinc level (57.3 ± 14.56 Mmol/L) and a higher mean copper level (106.6 ± 39.41 Mmol/L) in comparison to healthy controls (96.4 ± 17.38 Mmol/L) and (61.0 ± 9.53 Mmol/L) respectively. There was a weak relationship and a significant correlation between copper and zinc (r=-0.2). A very strong relationship and a significant correlation between copper and Cu / Zn ratio (r = 0.85) while zinc had a significant very strong correlation relationship with Cu / Zn ratio (r =-0.7) in patients.
Conclusion: The present study underscores the noteworthy association between microelements (Cu, Zn) and degenerative lumbar discs underscoring the significance of pre-operative evaluation in achieving the best possible surgical results. The study has demonstrated the utility of measuring serum zinc level and copper level especially their link with lumbar disc degeneration (LDD) as markers of patients undergoing lumbar spinal surgery.

Background: Osteoporosis (OP) is a prevalent age-related condition that increases the risk of fracture and bone fragility as a result of loss of bone mass as well as micro-architectural degradation of the bone, thereby reducing the mass and strength of bone. Human β-defensin (HBD-3) is an anti-inflammatory peptide and a crucial part of the human innate immune system. Giving early therapeutic intervention for OP requires an early diagnosis.
Objectives: To evaluate the serum HBD-3 accuracy of diagnosis in patients with osteoporosis.
Methods: The study was conducted in the National Joint Center at Yarmouk Teaching Hospital in Baghdad during September - October 2023.
Eighty participants were recruited, all of whom had clinical examinations and had their bone status measured by dual-energy X-ray absorptiometry (DXA). Levels of serum HBD-3 and vitamin D3 (Vit D3) were determined by the ELISA technique. Calcium level (Ca+2) was measured using a spectrophotometer. A comparative study was conducted between forty patients with OP and 40 control. The study included females and males with an age range between (40-60) years.
Results: The serum level of HBD-3 in the OP group was significantly higher (p < 0.001) than that of the healthy controls. The area under the curve (AUC) was found to be (1.000) in the ROC curve analysis for serum HBD-3 level.
Conclusion: Serum HBD-3 can be a valuable indicator of OP in middle-aged individuals and may be a helpful biological marker for OP diagnosis.

Background: Psoriasis is an immune-mediated inflammatory disease with unknown aetiology that may
be associated with the defect in proliferation and differentiation of the keratinocytes related to
inflammatory cell infiltration. According to published reports, it is universal in occurrence; its prevalence
in different populations varies from 0.1% to 11.8%. Receiving Apremilast resulted in a strong reduction
in interleukin 17 and interleukin 23, as well as reduced expression of other inflammatory cytokines and
improvement of psoriatic lesions.
Objectives: This study aimed to assess the impact of Apremilast on levels of IL-17, IL-23, and lipids in
obese psoriatic patients.
Methods: Thirty obese patients with psoriasis were included in this prospective interventional study to
measure serum levels of lipid profile, IL-17, and IL-23, before and after receiving Apremilast treatment.
A t-test was used to compare between means.
Results: The mean age of the participants was 38 years. The most common age group was 30–40 years.
The levels of IL-17 before the administration of Apremilast were 225.55 ± 7.70 pg/mL. After six months
of treatment with Apremilast, a statistically significant reduction was seen, with the value decreasing to
183.41 ±2.33 pg/ml. IL-22 levels before the administration of Apremilast were measured to be 76.42 ±
4.03 pg/mL. After six months of treatment with Apremilast, these levels exhibited a non-significant
decrease to 67.15 ± 5.40 pg/ml. Modest alterations were noted in the lipid profile.
Conclusion: The use of Apremilast is effective in decreasing IL-17 levels, which have pro-inflammatory
effects; this leads to improvement in psoriatic lesions. Moreover, receiving Apremilast in obese psoriatic
individuals led to a reduction in TG levels and an elevation in HDL-C levels. Additionally, a rise in TC
levels and LDL-C was seen.