Diyala Journal of Medicine

Abstract
Background: A common metabolic disorder during pregnancy is gestational
diabetes mellitus (GDM). It is linked to insulin resistance and impaired
glucose tolerance. The role of neudesin, a regulatory peptide hormone
involved in glucose metabolism, as a potential biomarker for GDM remains
unclear.
Objectives: To assess Neudesin's predictive value for GDM and evaluate its
correlation with insulin resistance indices and glycemic indicators.
Patients and Methods: This case-control study was conducted in Baghdad,
Iraq, from January to July 2025 at the Department of Chemistry, College of
Science for Women, University of Baghdad, in collaboration with the
Department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital.
Eighty healthy controls and 120 women with GDM were included. Serum
Neudesin, fasting blood glucose (FBG), insulin, HOMA-IR, HbA1c, TyG
index, and TyG-BMI index were evaluated.
Results: Women with GDM had significantly higher serum Neudesin levels
compared to controls (2.372 ± 0.36 ng/mL vs. 0.919 ± 0.156 ng/mL, p<0.001).
Neudesin levels were positively correlated with BMI, FBG, HbA1c, insulin,
HOMA-IR, and TyG indices (p<0.001). Logistic regression identified
neudesin as an independent predictor for GDM. ROC analysis showed high
diagnostic accuracy (AUC = 0.986), with a cut-off value of 1 1185 ng/ml,
which yielded 100% sensitivity and 86.7% specificity.
Conclusion: Circulating neudesin concentrations are markedly higher in
individuals with GDM and show a strong correlation with the degree of insulin
resistance and poor glycemic control. Neudesin may serve as a promising
diagnostic biomarker and potential target for early identification and
management of GDM.

Background: Pruritus is a common and bothersome symptom of chronic
kidney disease (CKD). According to the most recent epidemiologic data, about
40% of patients with end-stage renal disease (ESRD) experience moderate to
severe pruritus. The reason for uremic pruritus remains poorly understood, but
recent studies suggest a strong association with the inflammatory process and
elevated white blood cell (WBCs).
Objectives: This study aims to investigate the correlation between uremic
pruritus (UP) and differential leukocyte levels in patients with CKD
undergoing dialysis (Hemodialysis patients), and to examine the potential role
of inflammation in the severity of pruritus.
Patients and Methods: A study was conducted at Ibn Sina Dialysis Center,
Diyala Governorate, Iraq. The study involved 150 hemodialysis (HD) patients,
divided into two groups: 75 patients with UP and 75 without UP. The control
group consisted of 26 healthy individuals. Out of 226 HD patients at the
Dialysis Center, those under 20 years old, as well as patients with hepatitis C
or hepatitis B, were excluded. From each patient and control in this study, 3
ml of venous blood was collected before dialysis, placed in an ethylene
diamine tetraacetic acid (EDTA) tube for leukocyte differential count, and
analyzed at the educational laboratory of Baqubah Teaching Hospital.
Results: The results showed that 33.8% of HD patients had uremic pruritus
and had a significantly higher eosinophil level when compared with patients
without UP and controls. While basophil and neutrophil showed no significant
difference in patients with UP and without UP when compared with the
control. When compared to patients without UP, HD patients with UP had
higher lymphocyte counts; however, there was no discernible difference
between the control group, hemodialysis patients with UP, and patients
without UP.
Conclusion: It was shown that eosinophils may play an essential role in the
pathogenesis of UP by inducing and secreting materials that exacerbate its
severity. Lymphocytes can also play a role in the pathogenesis of UP by
secreting cytokines.

Background: Ureteroscopic fragmentation and extraction of ureteric stones is
one of the most efficient minimal invasive treatment modalities. One of the
drawbacks of this procedure, which occurs mainly during the fragmentation
of upper ureteric stones, is the migration of proximal stones.
Objectives: To study the efficacy and safety of the Stone cone in preventing
proximal stone migration during ureteroscopic pneumatic lithotripsy.
Patients and Methods: A retrospective data set of forty patients (25 male and
15 female), with symptomatic upper ureteral stones of greater than 7 mm in
size, was collected from patients’ records. Patients were allocated into two
equal groups: Group A (interventional group) underwent ureteroscopic
pneumatic fragmentation using a stone cone, and Group B (control group)
underwent ureteroscopic fragmentation without using a stone cone. The data
on pre-operative patients, the stones dealt with, and the results of the procedure
in both groups were all stated.
Results: Pre-treatment patients and stone data (including patient age, gender,
stone size, opacity, laterality, duration of symptoms, and degree of
pelvicalyceal system dilatation) were comparable in both groups, with no
statistically significant difference. The mean stone size was 12.7 mm in group
A and 12.5 mm in group B. Stone migration occurred in 0 % in group A and
35% in group B (p=0.004), which led to a stone-free rate of 90% in group A
and 60% in group B (p=0.028). Complications were minimal and comparable
in both groups, and they were all amenable to conservative treatment.
Conclusion: Use of a stone cone as a ureteric occlusive device was reasonably
safe, helped prevent proximal stone migration, and led to statistically
significant improvement in stone-free rate during pneumatic lithotripsy.

Background: Pentraxin-3 (PTX3) is an important component of the innate
immune system, playing a significant role in the inflammatory process and
tissue damage. Assessing its levels in different clinical conditions may offer
insights into its diagnostic and prognostic significance.
Objectives: This study aims to evaluate whether PTX3 levels are elevated in
ischemic stroke patients with PCOS and whether increased PTX3 is linked to
greater stroke risk and worse outcomes.
Patients and Methods: A case-control study was conducted in the neurology
and obstetrics & gynecology clinics at Azadi Teaching Hospital in Kirkuk
starting from 1st February 2023 to 1st March 2024. Women diagnosed with
polycystic ovarian syndrome (PCOS) according to Rotterdam criteria were
divided into three groups: the first group had PCOS with stroke, while the
second group had PCOS without stroke; and the third group was considered
an age matching control group with age ranges between 18 and 50 years.
Blood samples were withdrawn in the morning to determine the levels of
PTX3, C-reactive protein (CRP), triglyceride/ high density lipoprotein
(TG/HDL) ratio, and homeostatic model assessment for insulin resistance
(HOMA-IR) and measured in all studied groups.
Results: The level of PTX3 was significantly higher in patients with PCOS
with stroke group (5.717 ± 1.172 ng/mL) than those without Stroke (3.665 ±
1.085 ng/mL) and Control (2.377 ± 0.740 ng/mL) groups (p < 0.001).
Pentraxin3 levels positively correlated with stroke severity (r = 0.42, p <
0.001), while there was no significant correlation with CRP, TG/HDL Ratio,
and HOMA-IR.
Conclusion: Pentraxin-3 levels are markedly higher in PCOS patients who
have had an ischemic stroke, and the level is in proportion to the severity of
the stroke. This means that PTX3 could potentially be used as a biomarker for
risk assessment.

Background: Obesity and metabolic disorders are increasingly prevalent
public health concerns. Excess adiposity, particularly visceral fat, is associated
with metabolic dysfunction, whereas regional fat depots, such as gynoid fat,
may confer protective benefits on skeletal integrity.
Objectives: This study aimed to examine the intricate relationship between
biometric profiles, biochemical markers, body fat distribution, and bone
health.
Patients and Methods: Data were obtained from the National Health and
Nutrition Examination Survey (NHANES), including adult participants with
complete measurements on body composition (total, visceral, and
subcutaneous fat; BMI; waist circumference), biochemical markers (lipid
profiles, fasting glucose, insulin, hormonal regulators), and bone health
metrics (bone mineral density and content via DXA). Correlation and
multivariate regression analyses were conducted to identify predictors among
demographic, biometric, and biochemical variables. Machine learning
techniques, specifically Random Forest Regression, were employed to
enhance predictive modeling of fat indices and bone health outcomes.
Results: BMI and waist circumference emerged as robust predictors of total
and visceral fat, with significant gender and age disparities noted. Women
exhibited higher total and subcutaneous fat, whereas men demonstrated
increased visceral fat. Biochemical markers, notably insulin and glucose,
correlated strongly with adiposity indices. Furthermore, bone health was
positively associated with BMI and specific biomarkers (testosterone,
Creatinine phosphokinase (CPK) and negatively associated with Sex
Hormone-Binding Globulin (SHBG) and Alkaline Phosphatases (ALP).
Moderate to high predictive accuracy was observed for the machine learning
models, confirming the supporting role of predictive analytics in
understanding these relationships.
Conclusion: The combination of anthropometric measures, biochemical
markers, fat and bone density, and machine learning offers a comprehensive
understanding of their correlation. Such insights can inform the design of
targeted clinical decision-making strategies and highlight the feasibility of
using simple, non-invasive measurements to assess metabolic and skeletal
risks.

Abstract
Background: Accurate blood cell classification is essential for diagnosing and monitoring blood disorders. Manual blood evaluation is cumbersome and subject to disagreement among specialists, which can negatively impact diagnostic reliability.
Objectives: This study aims to develop an automated deep learning framework for accurate classification of major blood cell types, especially basophils, red blood cells, and bone marrow cells, to enhance the accuracy and efficiency of clinical diagnosis.
Patients and Methods: A set of publicly available, high-resolution blood smear images obtained from a specific patient cohort with distinct genetic properties was analyzed, with standardized preprocessing applied to address variance. Multiple AI-based classification strategies were developed, and all models were evaluated on an independent test set using overall accuracy, precision, recall, and F1 score.
Results: Wavelet scattering combined with an SVM delivered the strongest overall performance, surpassing both the custom CNN and ResNet variants. It achieved a near-perfect separation of basophils and erythroblasts and only occasional confusion with myeloblasts. These results highlight the sensitivity of the wavelet scattering method to subtle morphological differences in blood cells.
Conclusion: This study highlights how machine learning-based image analysis techniques can reliably and accurately classify blood cells, reducing the need for the subjective manual interpretation that characterizes traditional microscopy. There is potential for increasing the accuracy of early diagnosis and simplifying patient treatment plans for hematological disorders by integrating these automated systems into standard clinical practice.

Background: Rheumatoid arthritis (RA) is an autoimmune disease marked by
complex causes and ongoing joint inflammation. Recently, more efforts have
been directed at finding new non-invasive prognostic biomarkers for RA,
which can help in disease monitoring.
Objectives: To investigate the circulatory levels of IL-20 and IL-23 in RA
patients relative to healthy volunteers and to evaluate their correlation with
disease activity. Additionally, to explore the association between IL-20
genetic polymorphism and RA susceptibility.
Patients and Methods: The study comprised a total of 85 individuals with
RA and 45 healthy subjects. IL-20 and IL-23 concentrations were measured
using ELISA, and disease activity was assessed using the DAS-28 score. The
IL-20 rs2981573 polymorphism was genotyped using Amplification
Refractory Mutation System-Polymerase Chain Reaction.
Results: The study found that RA participants exhibited significantly elevated
serum IL-23 levels compared to controls (P = 0.0347), while IL-20 levels did
not differ (P = 0.6354). Correlations between IL-20 and IL-23 with DAS-28
were significant (P = 0.0021 and P = 0.0030, respectively). Regarding the IL-
20 gene polymorphism, no significant association was found between the
rs2981573 gene polymorphism and RA susceptibility
Conclusion: This study demonstrated that IL-23 levels were significantly
higher in RA patients and may have diagnostic value. Although IL-20 levels
were not significantly different between groups, both cytokines showed a
positive correlation with disease activity and could be valuable markers.
Furthermore, the IL-20 gene polymorphism showed no association with
rheumatoid arthritis susceptibility

Abstract
Background: The most frequent oral mucosal lesion is recurrent aphthous
stomatitis. It first appears in childhood or adolescence and is evident as many
tiny, recurrent, or ovoid ulcers with yellow floors and erythematous haloes. A
widespread viral infection, herpes labialis, is characterized by recurrent
vesicular lesions, frequently on the lips and perioral tissue.
Objectives: To find the prevalence of oral aphthous stomatitis and recurrent
herpes labialis among dental students of Bilad Alrafidain University.
Patients and Methods: A cross-sectional study was conducted among 187
dental students of Bilad Alrafidain University, who are in the fourth and fifth
stages of the dental department. The data were collected using questionnaires.
Questionnaires required two sections. The first section restricted personal
information. The second section involved questions related to aphthous ulcers
and recurrent herpes labialis, including the duration and site of the ulcer after
examination.
Results: In the present study, the number of students with aphthous ulcers in
the fourth stage is 13 (14.1%), and in the fifth stage, 24 (25.3%), with a highly
statistically significant difference. Out of 187 students, 10 (10.9%) had
recurrent herpes labialis in the fourth stage, while 15 (15.8%) were in the fifth
stage, indicating a highly significant statistical relationship. The number of
students with recurrent aphthous stomatitis and recurrent herpes labialis in the
fifth stage is 24 (25.3%) and 15 (15.8%), respectively, which is higher than in
the fourth stage, where the numbers are 13 (14.1%) and 10 (10.9%),
respectively, indicating a significant relationship.
Conclusion: Recurrent aphthous stomatitis is a lesion with a higher
prevalence in females than in males. Stress during the period of academic
examinations is one of the reasons for recurrent eruption of aphthous
stomatitis and reactivation of recurrent herpes labialis.

Background: Type 2 diabetes mellitus is a chronic metabolic illness that
significantly increases the probability of cardiovascular disorders among
individuals with type 2 diabetes. Oxidative stress represents a central
pathophysiological connection between type 2 diabetes mellitus and
cardiovascular complications. Hyperglycemia in type 2 diabetes mellitus
elevates oxidative stress through multiple pathways, including the production
of advanced glycation end products and methylglyoxal, which interact with
their receptor advanced glycation end product (sRAGE). These processes
enhance the generation of reactive oxygen species, which leads to lipid
peroxidation with malondialdehyde serving as a biomarker.
Objectives: To investigate the levels of methylglyoxal, sRAGEs, and
malondialdehyde in type 2 diabetes patients with and without cardiovascular
risk factors.
Patients and Methods: The cross-sectional study involved eighty patients
with type 2 diabetes diagnosed with and without cardiovascular risk factors.
The study used high-performance liquid chromatography (HPLC) to measure
serum methylglyoxal and an ELISA kit (Sun Long Biotech, China) to measure
serum sRAGE. Malondialdehyde levels were assessed by spectrophotometry.
Moreover, measured parameters included FBS, HbA1c, CRP, and lipid profile
by the Cobas system using a kit from Roche, Germany.
Results: Type 2 diabetes patients with cardiovascular risk factors had
significantly higher serum methylglyoxal, sRAGE, and malondialdehyde
compared to those without CV risk factors. Furthermore, fasting blood
glucose, HbA1c, lipid profile, and CRP are higher in diabetes with CV risk
factors compared to those without.
Conclusion: The patients with type 2 diabetes and cardiovascular risk factors
showed an increase in methylglyoxal, sRAGE, and Malondialdehyde, which
are considered useful biomarkers for the indication of T2DM with
cardiovascular risk.

Background: Hyperthyroidism is associated with increased oxidative stress and alterations in enzymatic and non-enzymatic antioxidant systems. Methionine adenosyltransferase (MAT) plays a key role in cellular metabolism and may be involved in redox homeostasis in thyroid disorders.
Objectives: This study aimed to evaluate the levels of MAT and investigate its association with selected enzymatic and non-enzymatic oxidative stress markers in patients with hyperthyroidism.
Patients and Methods: A total of 90 blood serum samples were collected from patients with hyperthyroidism and compared with 50 healthy controls. Enzymatic markers measured included methionine sulfoxide reductase A (MsrA), thioredoxin (Trx), catalase (Cat), myeloperoxidase (MPO), lactoperoxidase (LP), xanthine oxidase (XO), glutathione S-transferase (GST), and senescence marker protein-30 (SMP-30). Non-enzymatic markers included glutathione (GSH), uric acid (UA), albumin (Alb), malondialdehyde (MDA), and peroxynitrite (ONOO⁻).
Results: Compared to healthy controls, patients with hyperthyroidism showed a significant increase in MAT, Cat, XO, GST, Trx, and LP levels, while SMP-30 was significantly decreased. Among non-enzymatic parameters, MDA and ONOO⁻ were significantly elevated, and albumin levels were decreased. No significant changes were found in the remaining markers. MAT showed a direct correlation with SMP-30, MPO, MsrA, UA, ONOO⁻, and Alb, and an inverse relationship with Cat, XO, and GSH. No correlation was observed between MAT and GST, LP, or Trx.
Conclusion: The findings suggest a strong association between MAT activity and oxidative stress in patients with hyperthyroidism. The observed changes point to metabolic imbalances and compromised antioxidant defense mechanisms in these patients.