Al- Anbar Medical Journal

No Abstract

Background: Vitamin D deficiency is common among Iraqi females and has been linked to various diseases. Although associated with lower weight, there is no evidence that it causes weight gain in young females.
Objective: To determine the prevalence of Vitamin D deficiency among female university students and explore its association with obesity, sun exposure, dietary habits, and physical activity.
Materials and Methods: A cross-sectional study was conducted at the University of Kerbala (April–May 2024) on 200 female students. Serum 25-hydroxyvitamin D was measured, and data were analysed using nonparametric tests and Spearman’s correlation, with significance set at a P-value < 0.05.
Results: Serum 25-hydroxyvitamin D levels indicated sufficiency in 22.5% and deficiency in 64% of participants. The mean body mass index (BMI) of students was 25.38 ± 5.60 kg/m². Vitamin D levels differed significantly across colleges (P-value = 0.036), with engineering students showing the lowest values. No association was found between vitamin D and BMI (P-value > 0.05). However, sun exposure and a healthy diet were positively correlated with higher vitamin D levels (P-value < 0.05).
Conclusion: Over 60% of participants had vitamin D deficiency. No significant correlation was found between high BMI and vitamin D status. Implementing educational programs promoting outdoor activity, sun exposure, and a vitamin D-rich diet is recommended.

Background: Thyroid dysfunction and type I diabetes mellitus (TIDM) often coexist. Many studies reported a higher prevalence of thyroid diseases among patients with diabetes. However, there is no local relevant study on this subject.
Objective: To determine the prevalence of thyroid diseases among children with TIDM at Al-Ramadi Teaching Hospital for Maternity and Childhood.
Materials and Methods: A cross-sectional study was conducted at Al-Ramadi Teaching Hospital for Maternity and Children from October 1, 2022, to May 1, 2023. Children aged 2-16 years of both sexes with TIDM who attended the hospital for any complaints were enrolled. All patients were screened for thyroid dysfunction.
Results: Of 190 children with TIDM, 25 (13.2%) had thyroid disorders. Children with thyroid dysfunction had significantly higher rates of parental consanguinity, diabetic ketoacidosis, hospital admissions, and chest infections (P-value < 0.05). Children with thyroid disorders had a significantly higher rate of positive anti-thyroid peroxidase and antithyroglobulin antibodies (P-value < 0.05). Glycated hemoglobin levels were significantly higher in children with thyroid dysfunction than in those with normal thyroid function. Glycated hemoglobin levels were significantly correlated with thyroid-stimulating hormone (P-value < 0.05).
Conclusion: Thyroid dysfunction is a common comorbidity in children with TIDM. Affected patients exhibit a higher rate of diabetic ketoacidosis, hospital admission, and chest infection.

Background: Lack of sleep is harmful to your mental and physical health. Multiple studies have shown that insulin sensitivity and glucose metabolic regulation are both negatively impacted by inadequate sleep.
Objectives: To determine whether there is a correlation between the amount and quality of sleep and blood sugar levels in those who suffer from type 2 diabetes mellitus.
Materials and Methods: At the National Centre for Diabetes in Baghdad, 224 people with type 2 diabetes who had been on anti-diabetic medication for at least a year participated in a 13-month cross-sectional study from February 2024 to February 2025. The Pittsburgh Sleep Quality Index was used to evaluate the prior month's sleep length and quality. Other information gathered included demographics, lifestyle variables, co-morbidities, length of diabetes, treatment compliance, and hemoglobin A1c levels.
Results: Most patients (80.8%) had poor sleep quality, and 68.3% had poorly managed type 2 diabetes mellitus. The results showed that low quality sleep (P = 0.001) and inadequate total nighttime sleep (P = 0.002) were two independent risk factors for inadequate glycemic management. In addition, the Pittsburgh Sleep Quality Index showed a somewhat positive connection with HbA1c levels, suggesting that greater levels of HbA1c were linked to worse sleep quality. However, there was a small but statistically significant negative connection between HbA1c levels, and the amount of time people slept (P-value = 0.001 and 0.002, respectively), indicating that less sleep is associated with worse glycemic management.
Conclusion: There is a substantial correlation between insufficient glycemic control and poor sleep quality/length, both of which have a major influence on the management of type 2 diabetes mellitus.

Background: Natalizumab is a well-established therapy for multiple sclerosis (MS) that carries a risk of dev progressive multifocal leukoencephalopathy (PML) linked to John Cunningham virus (JCV). While JCV seroconversion has been well studied in the western hemisphere, data from the Middle east, including Iraq, are limited.
Objective: To assess JCV seroconversion rates and associated risk factors among Iraqi MS patients treated with Natalizumab.
Materials and Methods: a retrospective cohort study included patients with MS who were followed at the MS Clinic of Baghdad Medical City between January 2015 and December 2023. Data were collected from 290 patients and included demographics, treatment duration, prior exposure to other disease-modifying therapies (DMTs), and JCV antibody index values. The JCV antibody status was assessed every six months using a two-step enzyme-linked immunosorbent assay (ELISA).
Results: In this sample, 18% (n = 52) exhibited persistent JCV seroconversion, corresponding to an annual conversion rate of 5.2%. The seroconversion rate was 25.4% in males and 15.5% in females; which was just short of reaching statistical significance (P-value = 0.06). No significant association was observed between seroconversion and age, treatment duration, or prior exposure to DMTs (P-value > 0.05). Notably, the highest seroconversion rate (20%) was observed in patients who had previously received treatment with interferon-β derivatives. Importantly, no cases of PML were identified during the study period.
Conclusion: JCV seroconversion in Iraqi patients on natalizumab was 18% (annual 5.2%), with no significant risk factors identified. JCV monitoring remains crucial, and no cases of PML were detected.

Background: Hashimoto’s thyroiditis (HT) is a common autoimmune disease, especially in females. While hypothyroidism is a recognized complication, emerging evidence links HT to metabolic disturbances and increased cardiovascular risk. However, the broader systemic effects in untreated patients remain insufficiently clarified.
Objectives: To assess the metabolic and cardiovascular risk profiles among women with HT, with a special emphasis on lipid parameters, insulin resistance (IR), and inflammation.
Materials and Methods: This case-control study included 100 women: 50 patients with Hashimoto’s Thyroiditis (25 newly diagnosed and untreated, and 25 receiving thyroid hormone replacement therapy) and 50 age-matched healthy controls. Anthropometric measures, glycemic status, lipid profile, and inflammatory markers were assessed. The evaluated indices included HOMA-IR, triglyceride/HDL-C ratio, LDL-C/HDL-C ratio, Atherogenic Index of Plasma, Lipid Comprehensive Index, and high-sensitivity C-reactive protein.
Results: Patients with HT had significantly greater body mass index, fasting glucose, fasting triglyceride, LDL-C, IR, and markers of inflammation than controls (all P values < 0.001). Atherogenic risk, as measured by both AIP and LCI, was significantly elevated in greater than 90% of patients with HT, with the highest burden among untreated patients. While thyroid hormone therapy produced a degree of improvement, a number of cardiometabolic risk factors persisted at elevated levels.
Conclusion: Female patients with HT frequently exhibit adverse metabolic and cardiovascular alterations, likely driven by chronic inflammation and thyroid dysfunction. Early screening and comprehensive management are essential, particularly for newly diagnosed and untreated women with HT.

Background: Multiple sclerosis (MS) is one of the common causes of disability in young adults. Despite the increasing prevalence and growing burden of MS, aspects such as auditory pathway involvement remain under-researched.
Objectives: To evaluate the most common auditory complaints among patients with MS, determine the most frequently affected pure tone audiometric frequencies, and assess the integrity of the peripheral auditory pathway using transient evoked otoacoustic emissions (TEOAE).
Materials and Methods: A case-control study was conducted involving 60 MS patients and 60 age- and sex matched healthy controls. All participants underwent neurological examination, ear, nose, and throat examination, tympanometry, pure tone audiometry (PTA), auditory brainstem response (ABR), and TEOAE testing.
Results: The most common auditory symptoms among MS patients included hyperacusis (65%), speech discrimination difficulties (53.3%), tinnitus (48.3%), and hearing loss (35%). MS patients had elevated pure tone audiometry thresholds (P-value < 0.05) at all frequencies except 250, 1000, and 2000 Hz, with notable influence from sex, but not from disease duration or treatment type, significantly prolonged wave III, wave V and interpeak latencies in MS ears compared to controls (P-value < 0.05), and significant differences in TEOAE signal-to-noise ratio between study groups at 2000, 3000, and 4000 Hz frequencies (P-values of 0.016, 0.0001, 0.0001 respectively).
Conclusion: Hyperacusis, speech discrimination difficulties, tinnitus, and hearing loss appear to be among the most frequently reported auditory complaints in MS patients. The disease tends to affect all audiometric frequencies, with a particular predilection for high and low frequencies. The peripheral auditory pathway appears to be subtly affected, particularly at the high frequencies, highlighting the need for routine audiological testing in this population.

Background: The distribution of hepatitis B virus (HBV) genotypes and viral mutations significantly influences disease progression in HBeAg-negative chronic hepatitis B (CHB), particularly in endemic regions where molecular epidemiological data are limited.
Objectives: To assess the molecular epidemiology of HBV in Iraqi patients with HBeAg-negative chronic hepatitis B, focusing on genotype prevalence, key precore (G1896A, G1898A) and basal core promoter (A1762T, G1764A) mutations, and their prognostic significance for advanced hepatic disease.
Materials and Methods: This cross-sectional study enrolled 150 HBeAg-negative CHB patients at Baghdad Teaching Hospital, Baghdad, Iraq, from January to April 2025. HBV genotyping and mutation analysis were performed using polymerase chain reaction-Sanger sequencing. Hepatic fibrosis was assessed using transient elastography, which employs established fibrosis staging (F0-F4) with specific cutoff values. Fibrosis stages were classified as: F0-F1 (<7.0 kPa), F2 (7.0-9.4 kPa), F3 (9.5-12.4 kPa), and F4 (≥12.5 kPa).
Results: Genotype D predominated (85.3%), exhibiting significantly elevated viral loads compared to non-D genotypes (4.9±1.3 vs. 4.3±1.0 log I. U/mL, P-value = 0.02). G1896A mutation prevalence reached 54.7% overall, with marked elevation in genotype D patients (61.7% vs. 20.0% in genotype C, P-value = 0.004). Advanced fibrosis (F3-F4) was observed in 36.7% of patients, with G1896A mutation (OR=3.1, 95% CI: 1.4-6.9) and BCP mutations (OR=4.3, 95% CI: 1.9-9.8) serving as independent predictors. Laboratory parameters, including albumin levels <3.5 g/dL and platelet counts <150×10³/μL, demonstrated strong associations with the development of cirrhosis.
Conclusion: HBV genotype D and associated precore mutations are significant predictors of severe clinical outcomes in Iraqi HBeAg-negative CHB patients, supporting integrated molecular diagnostics for enhanced risk stratification in resource-limited settings.

Hemothorax is uncommon complication of central venous catheterization. Although it often develops immediately after the procedure, it is very rare after removal of the central catheter. A 33-year-old female patient is scheduled for septoplasty under general anesthesia. Before the start of surgery, she developed hypotension (70/50 mmHg) and desaturation (PO2 down to 85%). The provisional diagnosis was anaphylaxis. A central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) by the Seldinger technique with ultrasound guidance. The patient improved after hemodynamic correction for 24 hours. A few minutes after removal of the catheter in the intensive care unit, the patient developed acute chest pain and dyspnea. Chest X-ray and computed tomography revealed a massive right-sided hemothorax requiring urgent chest tube insertion with evacuation of two liters of blood. The patient improved clinically, the chest tube was removed after 3 days, and she was discharged in stable condition. Although massive hemothorax is very rarely reported after CVC removal, all cases with IJV catheter removal should be carefully monitored for an appropriate period.

After blunt abdominal trauma, severe injuries to the duodenum are rare but can be serious. As the duodenum lies retroperitoneally, perforation may not cause noticeable symptoms, leading to delayed diagnosis. Isolated duodenal perforation (IDP) is difficult to diagnose due to nonspecific symptoms. Early detection with a computed tomography (CT) scan is fundamental to saving lives. In prior studies, approximately 100 cases of IDP in children have been reported. The present study highlights the high index of clinical suspicion, along with the crucial role of the CT scan in detecting this injury. A 7-year-old boy arrived with worsening right abdominal pain, fever, and vomiting 9 days after a road traffic accident. Upon admission, leukocytosis (28.44 ×10³/µL) and plain abdominal X-ray findings revealed retroperitoneal free air and suspected bowel perforation. Exploratory laparotomy confirmed a 3 cm duodenal perforation, repaired by two-layer duodenorrhaphy and omental patch. Postoperative recovery was successful with multidisciplinary care. Therefore, isolated duodenal perforation warrants a high degree of suspicion in pediatric patients with blunt trauma. Early contrast CT and prompt surgical intervention are crucial to reduce morbidity and mortality.