Diyala Journal of Medicine

Background: Technology advancement of retrograde intrarenal surgery is
important in elevating its efficiency and safety for renal and upper ureter stone
management.
Objectives: To evaluate the efficiency and safety of retrograde intrarenal
surgery with a flexible and navigable ureteral access sheath in the management
of renal and upper ureter stones.
Patients and Methods: It was a clinical prospective follow-up study carried
out in Life Private Hospital in Kalar city, Kurdistan region, Iraq, over the
period of one year, from 1st of January to 31st of December 2024. A sample
of one hundred patients underwent retrograde intrarenal surgery with a flexible
and navigable sheath. The diagnosis of stones was done by a researcher and a
Radiologist or referral from other physicians from different specialties through
abdominal ultrasound and computerized tomography scan.
Results: The preoperative clinical co-morbidities were present in 37% of
patients, commonly diabetes mellitus (18%), hypertension (12%), and heart
disease (7%). The preoperative urine culture was positive in 17% of patients.
Preoperative stent was done for 31% of patients, commonly for noncompatible
ureter (20%), pain (9%), and sepsis (2%). No stone fragments or
sepsis were reported postoperatively among the patients studied.
Conclusion: The retrograde intrarenal surgery using flexible and navigable
ureteral access sheath is an effective and safe surgical procedure in the
management of kidney and upper ureter stones.

Background: Probiotics are live microorganisms that, when consumed or
applied in sufficient amounts, bring health benefits to the host, according to
the definition by the International Scientific Association for Probiotics and
Prebiotics.
Objectives: This study aimed to explore the association between the
understanding, beliefs, and behaviors of the Malaysian adult population
regarding probiotics.
Patients and Methods: A cross-sectional study was carried out using
convenience sampling technique among the general adult population in
Malaysia, within a duration of 6 weeks during 2024, to explore how the
understanding, beliefs, and behaviors of the adult population related to
probiotics were associated with their awareness of the potential health
benefits.
Results: Among 397 adults, the mean (±SD) scores were 10.2 ± 3.5 for
knowledge, 5.1 ± 1.0 for attitude, and 6.0 ± 1.9 for practice. Overall, 32.0%
had good knowledge, 89.7% positive attitudes, and 65.7% good practices.
Most respondents (over 95%) recognized the benefits of probiotics, and 78.3%
reported prior consumption. Multivariate logistic regression showed that
Malaysian females were more likely to have good knowledge (AOR = 1.76,
95% CI: 1.14–2.70, p = 0.010). Malay ethnicity was associated with more
favorable attitudes (AOR = 4.29, 95% CI: 0.80–23.00, p = 0.049), while
Malaysian nationality was linked with lower odds of good practices (AOR =
0.69, 95% CI: 0.38–0.92, p = 0.019).
Conclusion: To gain the potential benefits of using probiotics for overall
health and well-being, more studies are needed to fully understand their
mechanisms and optimal applications. As our knowledge of microbiomes
expands, so does the potential for probiotic interventions in supporting overall
well-being

Background: For more than sixty years, a safe and potent vaccine has been
available; however, efforts to control measles through immunization are now
endangered by a startling rise in cases both at home and abroad.
Objectives: To explore epidemiological and clinical characteristics of measles
outbreak during 2023-2024 in Diyala province, Iraq.
Patients and Methods: This is a retrospective cross-sectional study that
involved registering and following up the clinical case sheets of all measles
cases admitted during the period from May 1st, 2023, to June 30th, 2024. A
total of 5418 cases were included; among which 439 laboratory-confirmed
cases. Clinical features were documented for a total of 652 cases.
Results: The majority (4612, 85.1%) of patients aged ≤10 years, followed by
those >10 -20 years of age (347, 6.4%); the difference was highly significant
(p<0.001). Additionally, 5328 (98.3%) of patients were not vaccinated versus
90 (1.7%) who were vaccinated. The difference was highly significant
(p<0.001). Patients with cough were significantly more than those without
cough (99.5% versus 0.5%, p<0.001). Similarly, patients with coryza were
significantly more than those without coryza (97.2% versus 2.8%, p<0.001).
Likewise, conjunctivitis appeared in 616 (94.5%) patients, accounting for a
significantly higher percentage compared to those without conjunctivitis
(p<0.001).
Conclusion: Unvaccinated people form an immunological gap that may act as
an inlet for large measles outbreaks. Premarital screening of women for antimeasles
IgG, adjusting the timing and number of measles vaccine doses, and
increasing vaccination coverage plus initiation of an active surveillance
system may reduce the rate of infection in the community.

Background: MicroRNAs have been concerned in modulating multiple
stages of HCV life cycles and specific miRNAs have been identified to be
deregulated during HCV infection and serve as essential mediators for the
antiviral treatment.
Objectives: To understand the role of circulating serum microRNAs (miR-
21-5p and miR-196-5p) in correlation with liver function tests and lipid
profiles as diagnostic markers in patients with different stages of hepatitis C
virus (HCV).
Patients and Methods: 150 cases—100 with the Hepatitis C virus and 50
healthy as a control group—are involved. The patients' and the control group's
serum levels of miR-21-5p and miR-196-5p were assessed using quantitative
real-time PCR (qRT-PCR), and the biochemical tests were measured using a
standard automatic biochemistry analyzer (Thermo Fisher 240 V Indiko Plus
Clinical Chemistry Analyzer, Kerala, India).
Results: Serum miR-21-5p is upregulated in patients with acute and chronic
HCV compared with the control group, while serum miR-196-5p is
upregulated in acute HCV, HCV induced liver cirrhosis and sustained
virologic response patients compared to the control group. The maximum
serum total cholesterol (TC), TG, LDL and VLDL levels were in SVR and the
minimum levels were in HCV-LC, the highest LFTs levels were in the AHC
group. MiR-196-5p was negatively correlated with TG and VLDL in AHC and
HCV-LC. The ROC curve showed the highest sensitivity and specificity for
miR-21-5p in the AHC and CHC groups, while the highest sensitivity and
specificity for miR-196-5p was in the AHC, HCV-LC, and SVR groups.
Conclusion: Increased serum miR-21-5p and miR-196-5p expression in HCV
patients implicated in lipid dysregulation within hepatocytes and monitoring
this correlation might be used as biomarker of disease progression and liver
dysfunction.

Background: The Pfizer-BioNTech vaccine has revolutionized the field of
vaccines with its approach to eliciting and modulating the immune response
against SARS-CoV-2, despite uncertainty about the duration of this response.
Objectives: The study aims to estimate the immunological effectiveness of
the Pfizer-BioNTech vaccine in eliciting anti-spike IgG antibodies and in
modulating IL-10 and IL-1β.
Patients and Methods: The Prospective Cohort study was conducted between
June 2022 and August 2023 and included 90 participants who had not
previously been infected with SARS-CoV-2 and were unvaccinated (16 male
and 74 female). Their ages ranged from 19 to 23 years. They were divided into
two groups: 45 participants in the control group and 45 participants who
received two doses of the Pfizer-BioNTech mRNA vaccine. The levels of S1-
RBD (S1 subunit contains a receptor-binding domain) anti-spike IgG
antibody, IL-10, and IL-1β were measured in the baseline group and the
vaccinated group at 1 and 4 months after the 2nd dose of vaccination using the
Enzyme-Linked Immunosorbent Assay (ELISA) method.
Results: The male-to-female ratio was 18:82, with a mean age of 21 among
vaccinated student participants. The levels of S1-RBD anti-spike IgG
antibody, IL-10, and IL-1β before and post the 2nd dose of the vaccine at 1–4
months were (nonparametric). In addition, the Mann‒Whitney test revealed a
significant difference (P< 0.001) in S1-RBD anti-spike IgG antibody and IL-
10, IL-1β levels between 1 and 4 months after the 2nd dose of vaccination.
Conclusion: The Pfizer-BioNTech vaccine induced robust immune responses,
with significant increases in S1-RBD anti-spike IgG antibody levels and in IL-
10 and IL-1β levels post-vaccination.

Background: Asthma is an allergic disorder affecting the lower respiratory
tract and causing lung problems such as wheezing, coughing, and a sensation
of chest constriction. Environmental, immunological, and genetic factors play
a crucial role in the development of hyper-responsivity and bronchial
obstruction.
Objectives: This study aimed to estimate the serum concentrations of soluble
Growth Stimulating Expression Gene 2 Protein (sST2) and to assess and
analyze the Single Nucleotide Polymorphism (SNP) of the NR3C1 gene (BclI
rs41423247) in asthmatic patients under treatment and healthy controls.
Patients and Methods: This study included 80 asthmatic patients and 40
controls. sST2 was quantified using an enzyme-linked immunosorbent assay
(ELISA). DNA was extracted from blood samples, followed by PCR
amplification using a thermocycler with a newly designed, gene-specific
primer pair targeting the NR3C1 gene. The Sanger sequencing technique
detected the BclI rs41423247 SNP.
Results: The results show a highly significant difference in sST2 levels
between asthma patients and controls (55.43±15.81 vs. 38.04±5.215,
respectively), with the highest levels observed in severe asthma patients
(60.72±21.38). According to the treatment type used, the highest sST2 levels
were seen in the G2 group, while the lowest levels were observed in the G1
group. The GC genotype of the BclI rs41423247 SNP is more common in
patients (31.25%) than in controls (10%) (P value = 0.0103, χ2 = 6.571, and
OR= 4.091).
Conclusion: The current study concluded that individuals with the BclI
rs41423247 polymorphism in the NR3C1 gene can develop asthma compared
to individuals without this defect. Furthermore, the GC genotype of the BclI
rs41423247 can affect the effectiveness of the steroid used, directly or
indirectly, by its role in glucocorticoid receptor expression. This leads to a
persistent inflammatory process associated with increased serum sST2 levels.

Background: Phenotype A also referred the classic PCOS phenotype,
represents the most severe clinical form as it encompasses all three diagnostic
features clinical and/or biochemical hyperandrogenism (HA), ovulatory
dysfunction (OD), and polycystic ovarian morphology (PCOM). it is more
commonly found in subjects identified in clinical populations.
Objectives: To investigate the hormonal changes in phenotype (A) of
polycystic ovary syndrome (PCOS).
Patients and Methods: This study was carried out at Department of
Biochemistry, College of Medicine, University of Baghdad. Investigations
included serum measurements of anti-müllerian hormone (AMH), free
testosterone, inhibin B, by using enzyme linked immunosorbent assay
(ELISA) technique, prolactin, luteinizing hormone (LH), follicle stimulating
hormone (FSH) were measured by TOSOH technique. The ratio of LH/FSH
was calculated.
Results: The mean (±SEM) value of serum free testosterone levels of
phenotype (A) PCOS was significantly higher than that of controls (p=0.001).
However, the mean (±SEM) value of AMH levels of phenotype (A) PCOS was
higher than that of control women, but did not reach the significant level
(p=0.06). The mean (±SEM) values of LH levels and LH/FSH ratio, of
phenotype (A) PCOS were significantly higher than those of control women
(p=0.03, p=0.001, respectively). In addition, significant correlations were
observed among the studied hormones in phenotype (A) PCOS.
Conclusion: Phenotype A is the predominant one of PCOS phenotypes and is
associated with highest serum AMH, free testosterone and obesity. The pattern
of hormonal changes and correlations among them may shed light on the new
pathophysiology of the phenotype A PCOS and may aid in treatment strategy.

Background: Meconium-stained amniotic fluid complicates pregnancies and
is associated with high risk of neonatal meconium aspiration syndrome. Early
detection of meconium-stained amniotic fluid is essential to prevent adverse
neonatal outcomes.
Objectives: To investigate the relationship between poor neonatal outcomes
of meconium-stained amniotic fluid and serum brain-derived neurotrophic
factor (BDNF).
Patients and Methods: A case control study was carried out in the
Department of Obstetrics and Gynecology of Azadi Teaching Hospital in
Kirkuk, Iraq from 1st of March to 31st of August 2024 on a sample of 90
pregnant women. The case group included 45 pregnant women who underwent
cesarean section due to fetal distress with meconium-stained fluid, and the
control group included 45 pregnant women who underwent cesarean section
due to fetal distress without meconium-stained liquor. The brain-derived
neurotrophic factor was assessed in mothers and neonates from umbilical vein.
Results: Mean maternal and fetal cord (brain-derived neurotrophic factor)
level was significantly lower among pregnant women with meconium-stained
liquor compared to controls (p<0.001). The maternal BDNF cutoff for
predicting meconium-stained liquor fetal distress was 1.76 ng/ml, showing an
acceptable validity finding with sensitivity 100%, specificity 95.6% and
accuracy 98.5%. The maternal and fetal brain derived neurotrophic factor
levels were positively correlated with birth weight and APGAR score at both
1 and 5 minutes in neonates from pregnancies complicated with meconiumstained
liquor.
Conclusion: Maternal and fetal cord serum brain-derived neurotrophic factors
are decreased in fetal distress with presence of meconium-stained amniotic
fluid.

Background: Rhinitis and nasal irritation are highly prevalent, significantly
impacting the quality of life for millions of patients. The high prevalence of
rhinitis in Iraq may be attributed to environmental factors, including dust
storms, pollution, and a poor air quality index. Rhinitis is a group of symptoms
that includes congestion, rhinorrhea, sneezing, and nasal itching. Rhinitis can
be divided into several groups; however, it typically refers to a group of nasal
symptoms. Three primary forms of rhinitis are known: allergic rhinitis (AR),
infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). In certain
instances, an overlapping or mixed type may exist, making it essential to
refrain from oversimplification. Because of this, it is crucial to be cautious not
to oversimplify.
Objectives: This study aims to determine the prevalence of rhinitis among a
sample of medical students and to identify possible associated factors that may
exacerbate this condition.
Patients and Methods: A cross-sectional study was conducted at a medical
college and a college of dentistry in Baghdad from February 1 to July 1, 2024.
It included 600 students randomly selected from these two colleges at all
stages of their education. Based on a questionnaire, comprehensive history,
and ARIA guidelines, the diagnosis of rhinitis was made.
Results: In this study, rhinitis was diagnosed in 29.8% of participants. The
most common nasal symptoms were sneezing (55.2%), headache (55%), nasal
obstruction (48.8%), and postnasal drip (47.5%). Medical college students and
those with a positive family history had the highest prevalence of rhinitis.
Conclusion: The prevalence of rhinitis in Iraq is relatively high, similar to
findings in the Gulf area. Substantial environmental changes and genetic
influence over the past few decades are two potential causes. This study
supports recent research indicating that allergic diseases are becoming
increasingly prevalent in modern societies

Background: Kienbock's disease, also known as avascular necrosis of the
lunate, is characterized by a sequence of lunate collapse, carpal changes, and
degeneration resulting from a combination of anatomic, vascular, and
traumatic insults. The methods of treatment of Kienbock's disease vary
according to the stage of the disease.
Objectives: Evaluate the clinical and functional outcome of the pronator
quadratus pedicled bone graft in the treatment of avascular necrosis of the
lunate bone.
Patients and Methods: A prospective case-series study was conducted at Al-
Wasity Teaching Hospital from September 1, 2023, to October 1, 2024. The
follow-up period was approximately six months for eight patients, whose ages
ranged from 22 to 36 years (mean age, 29). Five males and three females
among those patients were affected in the right hand, and three were affected
in the left hand; all affected hands were the dominant ones. They presented
with a history of vague wrist pain and restriction of wrist movement. These
patients were later diagnosed as Kienböck disease; all of them were stage two
and stage three-A. Patients were surgically treated at Al-Wasity teaching
hospital by vascularized bone graft (distal radius transfer on pronator
quadratus pedicle).
Results: The patients included in this study were followed for a period of six
months. The clinical assessment was good, as indicated by the DASH scoring
system, the Mayo scoring system, and the patient's clinical and functional
outcomes. Functional improvement in power grip strength was evident, with
the patients' mean grip strength increasing from 147.5 mmHg preoperatively
to 163.75 mmHg postoperatively. Regarding the range of motion, mean
flexion-extension preoperatively was 64.37-60.62, and postoperatively, it was
71.87-65.
Conclusion: The pronator quadratus pedicle bone graft is a beneficial
procedure for treating patients with stage two and stage three (A) Kienbock's
disease.