Diyala Journal of Medicine

Background: A novel peptide known as Elabela was recently discovered; it
functions similarly to apelin and acts through apelin receptors. This research
is to compare the characteristics and biological roles of apelin and Elabela in
patients with metabolic syndrome who are obese and those who are not.
Patients and Methods: A cross-sectional study included 90 participants, ages
20–45, whose samples were collected from Al-Yarmouk-Hospital/Al-
Karkh/Baghdad, from April–July/2024. Classified into three groups: group1
was obese metabolic syndrome patients (N=30), group 2 was metabolic
syndrome patients without obesity (N=30), and group 3 was control (N=30).
Anthropometrics and parameters were assessed for all study groups. Fasting
blood glucose levels and lipid profiles were determined using an enzymatic
process with spectrophotometric methods, while insulin, apelin, and Elabela
were evaluated by enzyme-linked immunosorbent assay.
Results: The result shows a significant difference in Body Mass Index, Waist
to Hip Ratio, Lipid profile, FBS, apelin, insulin, and HOMA-IR, while there
was no significant difference between the study groups in Elabela levels. In
addition, there is a positive correlation between apelin and BMI, FBS, and
insulin. apelin levels have a higher diagnostic value for obesity than metabolic
syndrome, respectively.
Conclusion: This study suggests that apelin and Elabela are powerful
modulators of the metabolism of adipose cell and highlights the crucial role of
apelin in MetS in both non-obese and obese MetS, as well as in clinical and
biochemical markers associated with obesity.

Background: Tonsillitis is an inflammation of the tonsils, often spreading to
the adenoids and lingual tonsils. It is influenced by immune and genetic
factors. This study aimed to evaluate the gene expression of Heat Shock Factor
1(HSF1), a protein that regulates cellular responses to stress, especially heat
stress, and to measure the concentration of epithelial-derived neutrophil-
activating protein-78, a chemokine involved in neutrophil activation and
recruitment during inflammation. The study also sought to explore the
relationship between these molecules and their roles in inflammation and
stress responses. Additionally, it aimed to isolate bacterial species responsible
for tonsillitis and assess their ability to form biofilms.
Patients and Methods: Sixty blood samples from tonsillitis patients and 30
from healthy individuals were collected, along with 200 throat swabs from
patients, between December 2023 and March 2024. Blood samples were
processed for ELISA to quantify ENA-78 and for RNA extraction to analyze
HSF1 gene expression. Bacterial cultures were grown on Congo Red Agar to
detect biofilm production.
Results: Out of 120 positive cultures, 70% were Gram positive, 23% were
Gram negative, and 7% mixed. ENA-78 levels were significantly higher in
patients (619.2±123.4) than in controls (490.1±145.8) pg/mL (P≤0.0001)
HSF1 gene expression was also significantly elevated in patients (9.913) (P₌
0.0001).
Conclusion: Gram positive bacteria, particularly Staphylococcus aureus,
were the predominant biofilm producers, while Escherichia coli was common
among Gram-negative isolates. Significant differences in ENA-78 levels and
HSF1 expression suggest their potential as diagnostic markers and targets for
immune - based therapies.

ackground: Ascaris lumbricoides remains a significant public health
concern, especially in settings with poor sanitation. Prevalence, transmission
dynamics, and knowledge at the population level can inform the
implementation of enhanced control. This study establishes the infection rate
of A. lumbricoides in the Iraqi population, investigates factors associated with
sociodemographics contributing to infection, and explores diversity in egg
morphology
Patients and Methods: A total of 110 participants were involved in this cross
sectional study. Stool samples collected from each participant were examined
microscopically for the presence of A. lumbricoides eggs. The
sociodemographic data collected include age, gender, residence, educational
status, occupation, hand-washing habits, and household size, as determined
through structured questionnaires. Associations of these variables with
infection rates were analyzed using various statistical tools. Egg morphology-
decorticated and mamillated eggs- was investigated.
Results: The overall prevalence of A. lumbricoides was 14.64%, with a higher
rate amongst rural residents, 9.09%, compared to urban people, 4.54%
(p=0.0067). The infection rates were also strongly inversely related to
education level; the highest rate was among those with no education, 7.27%
(p<0.00001). A low infection rate was significantly associated with washing
hands before meals (p<0.00001). The morphology varied, with the fertilized
eggs showing both mamillated and decorticated morphology, while the eggs
from the unfertilized females were larger, with disorganized contents
internally.
Conclusion: This study reflects that high infection burdens with A.
lumbricoides are significantly associated with sociodemographic variables,
particularly education, hygiene practices, and rural residency. The diversity
observed for egg morphology underlines further complications in the parasite's
transmission and adaptation to environments. Sanitation improvement and
extension programs may reduce the burden of infections caused by A.
lumbricoides in Iraq.

Background: MicroRNAs (miRNAs) regulate several biological pathways in
osteoporosis patients. The study aimed to estimate the correlation of miRNA
21, miRNA-422, miRNA‐142-3p, and miR-181c with osteoporosis in
premenopausal women.
Patients and Methods: This study was performed on 60 osteoporosis
premenopausal and 30 healthy women. Determination of osteocalcin (OC),
deoxypyridinoline (DPD), and bone-specific alkaline phosphatase (BAP) were
done by ELISA, and estimation of miRNA gene expression was done by using
qRT-PCR.
Results: OC, DPD, and BAP levels indicated a significant decrease in
osteoporosis women. In addition, our data showed that miRNA-21 (p=0.0001,
r=-0.5585) and miRNA-422 (p=0.0035, r=-0.3715) have a high expression and
negative correlation with BMD. Meanwhile, the miRNA-142-3p (p=0.0136,
r=0.3089) and miRNA-181c (p=0.0401, r=-0.2685) have decreased expression
and positive correlation with BMD value.
Conclusion: The results of this study indicated a clear association of miRNA
21 and miRNA-422 in osteoporosis thus they may be useful as biomarkers for
osteoporosis

Abstract
Background: Breast cancer is a complex, heterogeneous disease and the most
common malignancy among women. It is classified based on the presence of
estrogen receptors (ER), progesterone receptors (PR), and HER2. Rapid
proliferation of cancer cells increases their energy demands leading to
enhanced glycolysis and lactate accumulation. Lactate dehydrogenase (LDH)
is pivotal in this process, particularly in tumors with anaerobic metabolism.
The transcription factor c-Myc (cellular myelocytomatosis oncogene)
promotes aerobic glycolysis by increasing glucose uptake and lactate
production are a hallmark of the Warburg effect.
Objectives: This study was aimed to evaluate c-Myc expression levels in
patients with triple-positive breast cancer (TPBC) and triple-negative breast
cancer (TNBC), comparing them to healthy control.
Patients and Methods: The study included 80 women (ages 35–66): 20 with
TNBC, 20 with TPBC, and 40 individual healthy as a control, matched for age,
sex, and Body Mass Index (BMI). Serum levels of c-Myc, CA 27-29 was
measured using an ELISA sandwich technique. Additionally, lactate
dehydrogenase (LDH), glycated hemoglobin (HbA1c), liver enzymes (ALT
and AST), and lipid profiles were assessed using spectrophotometric
techniques.
Results: c-Myc levels were significantly higher in breast cancer patients (4.71
± 3.75 ng/ml) compared to controls (0.81 ± 0.44 ng/ml, p = 0.001). LDH and
CA 27-29 levels were significantly elevated (p = 0.001). Metabolic
parameters, including HbA1c%, ALT, AST, and lipid profiles (except HDL),
showed significant changes, with reduced HDL levels in cancer patients.
Notably, TNBC patients exhibited higher c-MYC and HbA1c levels compared
to TPBC patients.
Conclusion: Elevated c-Myc levels are associated with metabolic
reprogramming in breast cancer and may serve as a potential therapeutic
target. The higher c-Myc expression in TNBC correlates with its more
aggressive nature, suggesting c-Myc's role in tumor progression.

Curcumin is a traditional herbal medication, which has shown
promise in a variety of pharmacologic applications. Epidermal growth factor
an amino acid polypeptide found in saliva and other bodily fluids, which
promotes cell proliferation and renewal. Lactate dehydrogenase is classified
as altered protein markers present in saliva, and its levels showed significantly
elevated in head and neck cancer. To study the effect of curcumin oral gel on
levels of salivary epidermal growth factor and lactate dehydrogenase in head
and neck cancer patients receiving concurrent chemoradiation induced oral
mucositis.
Patients and Methods: Ninety head and neck cancer patients receiving
concurrent chemoradiation, 45 patients in each group. Saliva levels of lactate
dehydrogenase and epidermal growth factor measured by an enzyme linked
immunosorbent assay. WHO scale used to assess oral mucositis.
Results: Highly significant increase in salivary epidermal growth factor and
decrease in lactate dehydrogenase levels with less severe oral mucositis in
group treated with curcumin. Significant differences were found between the
two groups in the WHO scale at two weeks (P = 0.041) and six weeks
(P=0.02).
Conclusion: The current study concludes that curcumin oral gel can increase
epidermal growth factor and reduce lactate dehydrogenase levels in saliva, and
it may be used as an alternate treatment for oral mucositis-induced by
chemoradiation.

ackground: Birth asphyxia is a critical neonatal condition characterized by
the failure to initiate and sustain breathing at birth, often due to impaired
cerebral blood flow. Electrolyte imbalances may contribute significantly to its
morbidity and mortality.
Objectives: To assess the serum sodium, potassium, and calcium levels in
neonates with birth asphyxia of varying severities and healthy controls.
Patients and Methods: A hospital-based cross-sectional study was conducted
at Al-Batool Teaching Hospital in Diyala, Iraq, from June to September 2023.
A total of 200 term neonates were enrolled, 80 with birth asphyxia (defined by
an Apgar score <7 at 5 minutes) and 120 healthy neonates as controls. Blood
samples were collected within the first 24 hours of life, and serum levels of
sodium, potassium, and calcium were measured using standard photometric
methods.
Results: Hyponatremia (<130 mmol/L) was observed in 51.3% of asphyxiated
neonates. Hyperkalemia (>5.2 mmol/L) was found in 50% and hypocalcemia
(<2.2 mmol/L) in 55% of cases. Compared to controls, asphyxiated neonates
had significantly higher potassium levels (p < 0.05) and lower calcium levels
(p < 0.05); however, differences in sodium levels were not statistically
significant (p > 0.05). Electrolyte abnormalities were more pronounced in
neonates with altered tone, sucking, respiration, and heart rate.
Conclusion: Hyponatremia, hyperkalemia, and hypocalcemia are prevalent in
neonates with birth asphyxia and correlate with clinical severity. Early
identification and management of these disturbances are vital to improving
outcomes and reducing neonatal morbidity and mortality.

Multidrug-resistant
Pseudomonas
aeruginosa
has
epidemiological impact on human health. It poses a threat to the health systems
of the world including Iraq. Type 3 Secretion System effectors are among the
several virulence factors that this bacterium possess. Determining the
virulence profile is essential in prevention of infection. This study investigates
the frequency of the four classical Type 3 Secretion System effectors in
multidrug resistant Pseudomonas aeruginosa.
Patients and Methods: This study initially included 120 bacterial isolates
from different clinical samples which were preliminary identified as P.
aeruginosa. Out of those, 80 isolates were confirmed to be P. aeruginosa.
Antibiotic susceptibility profile was studied and the existence of exoY, exoT,
exoS and exoU was investigated by PCR.
Results: 95%, 3.75%, and 1.25% of the isolates were classified as multidrug
resistant, extensive drug resistant, and pan drug resistant, respectively. Among
the selected isolates, exoT was found in 86.7%, exoY in 76.7%, exoS in 50%
and, exoU in 30%.
Conclusion: This study highlights an increase in the emergence of multidrug
resistant profiles in clinical isolates of P. aeruginosa, besides the co-existence
of the four classical Type 3 Secretion System effectors in variable frequencies
(86.7%, 76.7%, 50%, and 30%, respectively).

Background: Zirconium is mainly composed of zirconia/silica particles.
Zircon filling material is a light-curing, radiopaque nanohybrid composite
resin designed for anterior and posterior tooth restorations with a high
inorganic filler component. One synthetic polymer that dissolves in water is
polyvinyl alcohol. Polyvinyl Alcohol's low toxicity, low propensity for protein
adhesion, and biocompatibility make it useful in a range of medical
applications. Contact lenses, eye drops, and cartilage substitutes are among the
specific applications.
Objectives: evaluate the effect of chemical mixing polyvinyl alcohol polymer
on the hardness, strength, water solubility, and water sorption properties of
zircon dental filling material.
Patients and Methods: The biocomposite was prepared by dissolving 5g of
polyvinyl alcohol in distilled water and stirring the mixture continuously for
30 minutes at 80°C. The mixture was stirred until a gel formed. Then, the
mixed Universal Restorative material with zircon fillings was exposed to
visible violet curing light for hardening, with different curing times (1, 2, 5,
10, 15, and 20 seconds). Then, we measured the strength, hardness, sorption,
and solubility of the new mixed filling.
Results: Showed an increase in the hardness and the strength of the zircon
filling materials after chemical mixing with Polyvinyl Alcohol polymer,
compared with traditional zircon material that cured without Polyvinyl
Alcohol polymer, and a decrease in the solubility and sorption of the filling
material after chemical mixing.
Conclusion: An addition of polyvinyl Alcohol polymer particles to impact
light-cure zircon dental filling material improves the impact physical and
mechanical properties of the new mixed filling material.