The Medical Journal of Basrah University

Abstract

Abstract
Background: Celiac disease is one of the most prevalent autoimmune illnesses in type 1 diabetes, Celiac disease and type 1 diabetes are immune-mediated diseases with shared risk factors, genetics like Human Leukocyte antigen, environmental variables that have a significant role in the pathophysiology of both diseases since their occurrences are growing globally.
Objective: to estimate the prevalence and the sociodemographic characteristics of celiac disease among patients with type 1 diabetes mellitus with age less than 30 years.
Methodology: A descriptive, registry-based Cross-sectional study, carried out on patients with type 1 diabetes, who were registered over 3 years period (from the first of January 2020 till the end of December 2022), in Faiha Specialized Diabetes, Endocrine, Metabolism Center in Basra. A total of 474 patients were included in the study, their ages ranged from (1-30) years.
Result: A total of 474 patients who registered over three years, their mean age was 10.33 ±5.91, majority of them were female (57%). The total prevalence of celiac disease in type one diabetes from January 2020 to the end of 2022 was 19.2%. and the incidence was highest in 2022 (26.3%) and lowest was in 2020 (13.2%). The Type 1 diabetes duration ranged from 1 to 24 years with a mean of 3.14±2.93. In most of the celiac patients, 88.2% were presented with less than five years duration of type 1 diabetes.
Conclusion: The prevalence of celiac disease among people with diabetes type 1 increased from 2020 to 2022 by about 6-7% annually. There was no significant difference between age and gender and the risk of getting celiac disease among diabetic type 1 patients in this study.

Abstract

Backgrounds: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by ovarian dysfunction, elevated androgen levels, metabolic disturbances, and hyperinsulinemia. Aim of the study: In this study, we tried to measure whether there is any correlation between serum Regucalcin (RGN) levels with Insulin Resistance (IR) and Testosterone in PCOS patients. Materials and methods: This study included 42 patients from the Al-Anbar governorate who were recruited from private clinics, along with 42 healthy individuals who served as controls. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of RGN and F. Testosterone (F.Test), while fasting serum glucose (FSG), and fasting serum insulin (FSI) were determined by enzymatic colorimetric methods.
Results: Serum level of RGN (ng/mL) was higher in controls than PCOS patients (P<0.0001), while, FSG, body mass index (BMI), F.Test, LH/FSH, homeostasis model assessment of insulin resistance (HOMA-IR), FSI were higher in PCOS than in controls. The results showed a significant negative correlation between RGN with, FSG, BMI, F. Test, LH/FSH, homeostasis model assessment of insulin resistance (HOMA-IR), FSI (P <0.0001), A non-significant negative correlation with waist/thoracic (W/T) and Rate of pluses (ROP). The studied parameters demonstrated a descending order of the area under the receiver operating characteristic (AUROC) curve: RGN (1), BMI (1), FSG (1), HOMA-IR(1), FSI (0.9977), LH/FSH (0.9819), F.Test (0.9714). The Rreceiver operating characteristic (ROC) curve indicates that RGN, BMI, FSG and HOMA-IR were excellent sensitive markers in the diagnosis of PCOS, while FSI, LH/FSH, and F.Test showed Good discriminatory efficacy between patients with PCOS and healthy individuals.
Conclusion: The study discovered a weak correlation between RGN and IR, as well as testosterone levels. This finding suggests that RGN could be a potential biomarker for detecting PCOS and a useful diagnostic tool for the disease.

Abstract

Background: Anti-tuberculosis drugs can cause harmful effects on the health of a PTB patient and thus cause harmful interference with various vital body functions. Methods: In this study, 80 PTB patients (43 men and 37 female) were randomly assigned, and 40 healthy people (21 men and 19 female) were used as the control group. The findings indicated that males (53.75%) were more likely than females (46.25%) to be infected with pulmonary tuberculosis. Results: The result of statistical analysis showed a significantly increased serum level of urea, TSB, and sodium in the PTB patients group compared to the control. The mean ±SD of serum urea, TSB, and sodium for the patient respectively were 34.14±4.19, 0.669±0.21 and 142.98±14.837. There was a significant positive correlation between serum GOT and serum GPT (r=0.573, p<0.0001) as well as serum ALP (r=0.258, p<0.0001) in PTB patients (N=80). Similarly, the correlation between serum sodium and serum potassium was positive and significant (r=0.200, p=0.021). Conclusions: Anti-tuberculosis drug-treated tuberculosis was linked with a significant increase in serum urea, TSB, and sodium and a significant decrease in serum potassium in this study. Therefore, in patients who receive anti-tuberculosis drugs, there is a chance that the increase and decrease in serum biochemical parameter levels will have an adverse influence on body functions. Objectives: In considering this, the current study's goal was to investigate the side effects of anti-tuberculosis drugs on liver and kidney functions and some electrolytes for PTB patients who take these drugs.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine-metabolic disorder affecting 6-10% of women of reproductive age. While the pathophysiology of PCOS remains complex, recent studies suggest trace elements, such as zinc, may play a significant role in its development and management.
Objectives: This study aimed to assess the relationship between serum zinc levels and the presence of PCOS among women visiting the outpatient clinics at Basrah Maternity and Children's Hospital.
Methods: A prospective case-control study was conducted from October 2023 to September 2024, involving 150 women: 50 diagnosed with PCOS and 100 healthy controls. Participants were stratified by body mass index (BMI) and serum zinc levels were measured. Statistical analyses were performed using SPSS version 26, employing Chi-square tests for categorical variables and independent t-tests for continuous variables, with a significance level set at p ≤ 0.05.
Results: The study revealed significantly lower serum zinc levels in women with PCOS compared to controls (63.8 ± 20.6 μg/dL vs. 76.8 ± 22.7 μg/dL, p = 0.002). In the PCOS group, those with obesity demonstrated even lower zinc levels (60.71 ± 3.01 μg/dL vs. 71.2 ± 5.4 μg/dL in obese controls, p = 0.024). Furthermore, elevated luteinizing hormone (LH) levels were observed in PCOS women, correlating with lower zinc levels.
Conclusions: The findings indicate a significant association between reduced serum zinc levels and the presence of PCOS, particularly in obese women. This suggests that zinc deficiency may exacerbate the hormonal imbalances characteristic of PCOS, highlighting the importance of monitoring zinc status in managing this syndrome.

Abstract

Background: In recent years, there has been a surge in scientific research focused on probiotics and their various beneficial applications. This heightened attention has led to increased awareness among scholars, government bodies, and companies operating within the pharmaceutical and food industries. Previous studies have explored the significance of probiotics, tracing their historical development and evolution.
Aims of the study: the current review aims to examine different aspects related to the advancing application of probiotics in combating a range of viral infections, particularly those affecting the respiratory syst
Methode: This investigation will delve into the intricate mechanisms by which probiotics act against viral pathogens and assess their potential as alternative therapeutic options for COVID-19.
Result: The eradication of such diseases may be achieved through direct probiotic administration or the incorporation of probiotic-rich foods into the

Abstract

Background/Aims: Urinary tract infection (UTI) is a prevalent disease of significant public health importance, affecting over 150 million individuals annually. This research aims to discover adhesion genes ZapA gene (protease) and mrpA gene (fimbriae) of P. mirabilis isolated from patients with urinary tract infection and kidney stones, and whether the presence of such virulence factors contributes to increasing its ability to evade the host's immune defences.
Materials and Methods: Two hundred and ten samples were collected from Al-Diwaniyah Teaching Hospital in Al-Diwaniyah Governorate - Iraq, during the period from July 2023 to December 2023. The bacterial isolates that were obtained from urine samples taken from patients with UTI and kidney stones were cultured purified and then diagnosed using the Vitek-2 system. Compact - Biomerieux-France. Then, the adhesion genes were investigated using PCR technology, where the ZapA gene and mrpA gene were detected.
Results: The results of the study showed that P. mirabilis was the dominant microorganism that caused urinary tract accounting for 30% of the cases, followed by Escherichia coli (24%), Klebsiella pneumoniae (20%), Staphylococcus (16%) %), and finally mixed infections represented (10%) of cases. Gene screening results showed that mrpA and ZapA genes of P. mirabilis were positive in all the relevant samples.
Conclusions: The current study concluded that P. mirabilis is the most common bacterial species that causes urinary tract infections with kidney stones. Adhesion-related genes and immune evasion genes were positive in all samples.

Background: Early pregnancy loss, occurring before 10-13 weeks, often involves an empty or nonviable gestational sac. Vitamin D deficiency is linked to higher miscarriage rates. Between 10% and 20% of diagnosed pregnancies end in loss, with true rates potentially higher.
Aims of the study: To assess if there is a relationship between serum vitamin D level and the spontaneous termination of pregnancy that occurs before reaching 10 to 13 weeks of gestational age.
Methods: A case-control study at Basrah Maternity and Child Hospital conducted from October 2023 to April 2024, involved 104 women divided into case (early pregnancy loss) and control (normal delivery) groups. Data collected included sociodemographic factors, medical history, and serum 25(OH)D levels, using the AFIAS™ Vitamin D assay.
Results: The study compared two groups of women (n = 52 each). Serum vitamin D3 levels were significantly lower in the case group (17.24 ng/ml) compared to the control group (27.74 ng/ml, p = 0.001). There was a significant statistical difference between both groups (P value = 0.05) regarding the time spent outdoors.
Conclusion: The study found a significant disparity in serum vitamin D levels in women with early pregnancy loss compared to those with normal pregnancies. Cases spent less time outdoors, reducing sun exposure and vitamin D synthesis. Despite higher average BMI in controls, they had better vitamin D levels, suggesting lifestyle and supplementation play key roles.

Abstract

Background: Vitamin D plays a crucial role in the pathogenesis of diabetes mellitus (DM) in children. Researches suggest that its deficiency is associated with an increased risk of developing Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) in children. Vitamin D helps in the regulation of insulin secretion and sensitivity, and its deficiency may contribute to improper diabetes control and increased diabetes complications in children and adolescents.
Aims: The present study was conducted to investigate the relationship between serum vitamin D levels and parameters of controls in children and adolescents with diabetes.
Methods: A cross-sectional study was conducted at Basrah Maternity and Children Hospital and Faiha Specialized Diabetes, Endocrine, and Metabolism Center. All the new and old cases who attended the study centers with DM (TIDM or T2DM) or complications of DM were included, the study period was from March 2023 to March 2024, in Basrah governorate, the southern part of Iraq. The demographic and clinical data were gathered using an organized questionnaire and medical records. HbA1c, RBS, and 25 OH cholecalciferol levels were measured. After data collection, SPSS version 26 was used for statistical analysis.
Results: The vitamin D levels among the 107 children and adolescents with type one and type two diabetes who enrolled in the study were: 62 (57.9%) had a deficiency, 25 (23.4%) had insufficiency, and 20 (18.7%) had sufficient levels. In comparison to the sufficient and insufficient group, the vitamin D deficiency group's participants were significantly older (p =0.038), and lived in rural regions 65 (60.7%). Additionally, the vitamin D deficient group had higher mean values of random blood sugar (RBS) 227.41±25.31 mg/dL and glycosylated hemoglobin (HbA1c) 7.72±0.47 % values; however, these differences did not achieve statistical significance. A negative correlation was found between the number of hospital admissions in the last year (r= -0.177), the number of diabetic keto-acidosis (DKA) in the last year (r= 0.154), the number of hypoglycemia episodes (r= -0.120), and BMI (r= -0.252) with the serum vitamin D levels. Additionally, a negative correlation was found between HbA1c values (r= -0.131) and RBS values (r= -0.260) with the serum vitamin D levels
Conclusion: This study found no significant association between serum vitamin D levels and poor diabetes control. However, the deficient group showed higher rates of poor clinical and laboratory indices.

Abstract
Background: One of the most frequent side effects in ALL patients receiving neurotoxic chemotherapeutic drugs, particularly vincristine, is chemotherapy-induced peripheral neuropathy (CIPN). The diagnosis of CIPN is usually made clinically; however, electrophysiologic studies verify the diagnosis and rule out other possibilities for the neuropathic symptoms.
Aims: The purpose of this study was to estimate the percentage of CIPN, as well as evaluate the neurophysiological alterations of peripheral neuropathy in ALL patients receiving chemotherapy.
Methods: A multicentric cross-sectional study was carried out in southern Iraq, Basrah city. Thirty-eight patients with an established ALL diagnosis were included in the study. Their clinical and electrophysiological parameters, employing nerve conduction studies and needle electromyography, have been recorded.
Results: Among ALL patients, the CIPN percentage was 26.31%. All the cases were axonal polyneuropathy; of them, 60% had pure sensory neuropathy and 40% had mixed sensory motor neuropathy. In NCS, sural nerve approached the borderline while, needle EMG demonstrated distal lower limb muscle neuropathic changes.
Conclusions: The chemotherapeutic regimen utilized for ALL induced peripheral neuropathy; the pattern was distal, symmetrical, length-dependent, axonal polyneuropathy of pure sensory, followed by mixed sensory-motor type. We recommend screening routine for early detection of PN, further study to assess pre and post treatment changes with a bigger sample size and longer follow-up.

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disease with an unknown etiology that affects 0.5–1% of people worldwide. It is characterized by hyperplasia, an overgrowth of synoviocytes, and chronic inflammation of the synovial joints. During the inflammatory phase of arthritis, many pro-inflammatory cytokines and mediators are secreted by infiltrating immune and resident joint cells, which are responsible for cartilage degradation and excessive bone remodelling. Amongst them, a β-galactoside-binding lectin, galectin-3 (Gal-3), has been reported to be highly expressed and secreted by inflamed synovium of rheumatoid arthritis. The study findings show that serum gal-3 level in patients has a high discriminating power in the diagnosis of RA patients with high sensitivity (86.70) and specificity (85.30). In addition, it has a significant correlation with Anti CCP and PLT with P values 0.017 and <0.001 respectively. However, there is no correlation with the DAS28 (CRP) level with a P value of 0.06. In conclusion, Gal-3 serum levels have a potential role as diagnostic markers in patients with RA.
Objective: The present study aims to assess the level of serum galectin-3 in rheumatoid arthritis (RA) patients as a potential serologic marker and to study their association with some disease parameters (DAS28, Anti CCP, PLT) in Aldewaniya Province.

Abstract

Background: The increased prevalence of obesity and its strong association with cardiovascular disease has resulted in exceptional awareness for obese individuals. Obesity affects the hemodynamics of the cardiovascular system in general and left ventricular diastolic function in specific. In this study, we aimed to estimate the effect of obesity on the echocardiographic left ventricular diastolic function indices.
Patients and Methods: In this case-control study, we included 113 patients from Fayhaa General Hospital in Basrah between Feb and Aug 2016. The patients who were free of diabetes mellitus, hypertension, and any history of heart diseases -structural or functional met the eligibility criteria. The patients were divided into three groups based on their BMI including; 45 patients with normal BMI as the control group, 35 overweight patients, and 33 obese patients as case groups.
Results: BMI is positively and directly correlated to both Peak A Velocity and DT, and negatively on the E/A Ratio with inverse correlation. Higher BMI is correlated with worsening diastolic function regardless of traditional risk factors for diastolic dysfunction. The increase in age of more than 45 years has a significant association with all the indices of LVDD except for DT. The study reveals that smoking resulted in a significant acute alteration in the LV diastolic function.
Conclusions: All obesity grades have unfavorable consequences on the LV diastolic function, with subclinical changes in diastolic indices (Peak E, Peak A, E/A Ratio, and DT), in individuals with no previous comorbidities, even after adjustment for (age, sex, and smoking).

Abstract

Backgrounds: Febrile convulsion is one of the common childhood clinical conditions. Children under the age of five years are more susceptible to such types of convulsions. This disorder produces anxiety among family members mostly in mothers. There is an extreme need for parents to be prepared with precise knowledge about the causes and suitable home resuscitation of febrile convulsion to reduce the under-five mortality rate.
Objectives: The objective was to evaluate the practices of mothers attending primary health care centers in Basrah regarding febrile convulsion.
Methods: The study was cross-sectional, accomplished among 210 mothers attending five PHCCs in Basrah. Data were gathered by face-to-face meeting of the mothers by the investigator, using a specially prepared questionnaire form.
Results: Nearly one-quarter of the mothers (24.8%) were illiterate, while (21%) of them had primary school education. When assessing the mothers’ practices regarding febrile convulsion, the highest correct responses were in “Observe seizure manifestations and duration” at (93.3%) followed by “Reduction of temperature” at (90.5%) then “Place the child on the soft surface” at (84.3 %). Only (5.2%) of mothers with good practices about FC, while those with poor and fair practices were (20.5%) and (74.3%), respectively.
Conclusions: According to the findings of the present study, mothers’ practice of febrile convulsion was good in only (5.2%) of mothers, there is a need for women to be informed about risk factors and suitable home practices of febrile convulsion management in children below the age of five years in Basrah, so the health care providers can give suitable health education and support plans.

Abstract

Background: Diabetes is a chronic metabolic disease of serious concern associated with a major burden on the well-being of people worldwide. Non-compliance to medications is the most challenging hurdle in managing non-communicable diseases such as diabetes.
Aim of the study: to evaluate the compliance level to anti-diabetic drugs for patients with type 2 diabetes mellitus attending al-Faihaa specialized diabetes endocrine metabolism center in Basrah, Iraq.
Method: this was a cross-sectional descriptive study carried out in Al-Faihaa Specialized Diabetes Endocrine Metabolism Center during the period from the 1st of January to the 31st of December,2021. The data were collected through direct interviews of the eligible patients using a special questionnaire form. Morisky Medication Adherence Scale (MMAS) was used to measure adherence.
Results: About two-thirds (61.9%) of the patients had a low level of compliance to anti-diabetic drugs and only 12.1% of the patients showed a high level of compliance. A significant association was found between patients' age, patients' education, duration of diabetes and their level of compliance. On the other hand, a significant independent association between the type of anti-diabetic drugs, the intake of medications for other co-morbidities and compliance level was found. Intake of other medications showed a significant inverse association with compliance level.
Conclusion: The compliance rate for anti-diabetic drugs among diabetic patients with T2DM was unsatisfactory. Patients' adherence to other elements of diabetic care (diet, exercise, self-monitoring of blood glucose), was also unsatisfactory.

Background: Spontaneous preterm labor, is the onset of labor that occurs before the 37th week of gestation and poses significant health risks for mothers and newborns. Both short (under 18 months) and long (over 59 months) inter-pregnancy intervals can increase risks, highlighting the need for tailored prevention and management strategies .
Aims of the study: To assess the influence of interpregnancy intervals on the occurrence of spontaneous preterm labor, providing insights into factors affecting gestational outcomes .
Methods: A case-control study was conducted to assess the impact of interpregnancy interval on spontaneous preterm labor risk among women delivering at two Basrah hospitals from the 1st of November 2023 to the 1st of September 2024. It included 140 cases who experienced spontaneous preterm labor and 140 controls, who had full-term deliveries, matched for age, BMI, and parity, with data collected via a structured questionnaire and routine examinations.
Results: The study included 280 women. Significant findings included irregular antenatal care in 49.3% of cases versus 28.6% of controls (p = 0.001). Previous complications like preeclampsia (p = 0.035), stillbirth (p = 0.047), and preterm labor (p = 0.001) were higher in cases. The mean inter-pregnancy interval was significantly shorter in cases (10.8 ±2.3) months compared to controls (21.3 ±5.4) months (p < 0.001).
Conclusion: Short inter-pregnancy intervals significantly increase the risk of spontaneous preterm labor, while regular antenatal care reduces it; however, sociodemographic factors, gestational diabetes mellitus and parity do not predict preterm labor risk in this population.

Abstract

Background: Cancers, including lung cancer, are often targets for tyrosine kinase inhibitors. The prevalence of EGFR mutations is known to vary by ethnicity, with higher rates in East Asian populations. Limited data exist on EGFR mutations in non-small cell lung cancer patients from Iraq.
Objective: To assess the prevalence of EGFR mutations in non-small cell lung cancer patients in Iraq and compare the mutation rates across age groups, sex, and cancer subtypes.
Methods: A cohort of 430 confirmed lung carcinoma cases from southern Iraq (2016-2023) was analyzed. DNA was extracted from paraffin-embedded samples, and EGFR mutations in exons 18, 19, 20, and 21 were detected using real-time PCR. The prevalence of EGFR mutations was stratified by age, sex, and cancer subtype.
Results: EGFR mutations were detected in 35.3% of the total cohort (152/430). The most frequent mutations were found in exon 19 (53.9%), followed by exon 21 (19.7%) and exon 18 (11.8%). Combined mutations in occurred at 9.2%. The prevalence of EGFR mutations was significantly higher in the 60-69 age group (42.1%) at p= 0.037*, followed by the 70-79 group (20.4%) and 50-59 group (18.4%). There was no significant sex difference p=0.2*, with mutation rates in males at 51.97% and females at 48.03%. Adenocarcinoma was the predominant cancer subtype (95.3%) associated with EGFR mutations.
Conclusion: EGFR mutations are prevalent in 35.3% of Iraqi lung cancer patients, a rate comparable to East Asian populations and higher than in other Middle Eastern countries. This highlights the need for further research into genetic predispositions and targeted therapies in Iraq. Understanding the high prevalence could guide treatment decisions and improve survival rates among Iraqi lung cancer patients.

Abstract

Background: Sleep is an essential biological process that significantly impacts quality of life, body functions, and homeostasis. Sleep disturbances are a common complaint among college students worldwide. Medical students, who face increased academic load and irregular schedules, are particularly affected.
Aims of the study: This study aimed to assess the association between sleep quality and academic performance. As well it tries to investigate the other contributing factors to poor sleep experiences.
Method: A cross-sectional observational study was conducted on 224 students from Al-Zahraa College of Medicine. A questionnaire included sociodemographic characteristics, sleep-affecting factors, and an assessment of the sleep quality of students by the Pittsburgh Sleep Quality Index (PSQI).
Results: A total of (224) medical students. The mean age of students was 21.61 years, and the females form 54.5% of the sample. Most of the participants had mild sleep difficulties 56.3% while only 4% had severe sleep difficulties. There is a significant association between lack of sleep and poor academic achievement as the p-value <0.05.
Conclusions: Sleep disturbances are common among medical students, as most of the participants report sleep difficulties. The study shows that there is a significant relationship between sleep quality and academic performance.