Journal of the Faculty of Medicine Baghdad

Background: Co-microbial infection occupies a big portion of the urinary tract infections (UTI), especially in the elderly. Such infections are hidden, because of the dominance of one species over the other species.
Objectives: This study aims to detect polymicrobial urinary tract infections in middle-aged and elderly patients using both culture-based and molecular methods. It also investigates the presence of aminoglycoside resistance genes, specifically armA and rmtG, to improve diagnostic precision and support targeted therapeutic decisions.
Methods: In the current study, 100 clinical samples of urine were collected from middle-aged and elderly patients suffering from urinary tract infections. The study was conducted in two hospitals in Baghdad between October 2023 and April 2024. The age of patients was 45+ years equally divided between males and females. These samples were cultured on selective and differential culture media. The grown isolates were further purified and identified using the Vitek system. The antibiotic susceptibility test was done to evaluate the antibiotic resistance pattern. Bacterial DNA was extracted and specific primers were designated for this study, to amplify the resistance coding genes armA and rmtG by the polymerase chain reaction (PCR) technique.
Results: Klebsiella pneumoniae and Escherichia coli were the co-existing microbes causing UTI in middle-aged and elderly patients. Significant gender differences were found in the co-infection rates and antibiotic susceptibility tests and genetic analysis identified resistance genes armA and rmtG. These co-microbes were resistant to aminoglycoside antibiotics. Both K. pneumoniae and E. coli carried the armA gene, while the rmtG gene was predominant in K. pneumoniae only. K. pneumoniae and E. coli were found in 42% of the samples. The armA gene was detected in 46% of isolates (10/15 E. coli, 4/15 K. pneumoniae), while the rmtG gene was detected in 26.6% of K. pneumoniae isolates and not found in E. coli
Conclusion: This study highlights the occurrence of polymicrobial urinary tract infections among middle-aged and elderly patients, especially females. The detection of resistance genes underscores the importance of molecular diagnostics and gender-specific treatment strategies in managing UTIs.

Background: Retinopathy of Prematurity (ROP) is a preventable cause of childhood blindness. The global incidence of ROP is increasing though the contributing factors differ between developed and developing countries.
Objectives: This study aimed to determine the prevalence of ROP and to identify associated risk factors among preterm neonates admitted to the neonatal intensive care units of three hospitals within the Baghdad Medical City complex.
Methods: A prospective study was conducted from January first 2019 to January first 2020 in the neonatal intensive care units (NICUs) of Medical City Hospitals in Baghdad: Children Welfare Teaching Hospital, Baghdad Teaching Hospital, and a Private Nursing Home. Inclusion criteria were gestational age (GA) <34 weeks and/or birth weight (BW) <2000g; unstable infants exceeding these criteria were also included. All eligible infants underwent retinal examinations by an ophthalmologist at 4-6 weeks of age using RetCam imaging.
Results: Eighty-nine infants were included. The mean GA was 31.1±1.9 weeks and mean BW was 1333.2±254.7 grams. The incidence of ROP was 20 (22.5%). A highly significant association was found between ROP and lower GA, lower BW, blood transfusion, intraventricular hemorrhage, mechanical ventilation, necrotizing enterocolitis, and sepsis. No significant association was found with gender or multiple pregnancy.
Conclusions: The prevalence of ROP was significant. Key risk factors were gestational age less than 32 weeks of gestation, birthweight less than 1250g, and clinical complications. The findings underscore the critical need for stringent ROP screening protocols and optimized neonatal care strategies including minimizing transfusions, enhancing infection control, and improving respiratory management, to reduce ROP-related morbidity.

Background: Hemophilia B is an X-linked recessive disorder caused by mutations in the F9 gene, causing bleeding tendency predominantly in males. The mutational spectrum of the F9 gene has not been adequately studied in Iraq.
Objectives: To detect the disease-causing variants of exons 6, 7, and 8 and immediate introns of F9 gene using Sanger sequencing among Iraqi hemophilia B patients and to correlate them with phenotypes.
Methods: Forty Iraqi hemophilia B patients were recruited for this cross-sectional study from The Hereditary Bleeding Disorder Ward in the Children Welfare Teaching Hospital, Medical City, Baghdad, between November 2021 and April 2022 using a consecutive sampling technique. Peripheral blood samples were used for sequencing exons 6, 7, and 8, which encode catalytic serine protease (SP), linker, and activation peptide domains and immediate introns of the F9 gene using Sanger sequencing.
Results: Nineteen (47.5%) patients had positive conclusive results. Fifteen unique variants were detected; 12 (80%) of them were disease-causing. Nine variants were located in the SP, one in the linker domain, and two in the splice site of intron 6. The most common pathogenic variant was the c.572G>A (p.Arg191His) on the linker domain as seen in six patients, while c.880C>T (p.Arg294Ter) and c.1358G>T (p.Trp453Leu) were the most common pathogenic variants of the SP domain as seen in two patients each. The vast majority were point mutations that are generally similar to the reported phenotype.
Conclusion: Molecular profiling of F9 gene in the current cohort confirms 12 disease-causing variants, making molecular diagnosis and genetic counseling of hemophilia B possible. It explained the discrepancy between FIX level and clinical course, and variable severity among family members. Integrating genetic data into national registries will expand the molecular database for important health conditions in Iraq, improving healthcare provision through genetic counseling, prevention, and prenatal diagnosis.

Background: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental conditions that arise from a complex interplay of genetic, biological, and environmental factors. Essential metal elements (EMEs), including copper, zinc, iron, and calcium, support brain development, support neuronal communication, and maintain normal metabolic activity. Any increase or decrease in these elements may play a role in the development of ASD and ADHD.
Objectives: The study aimed to investigate the relationship between serum levels of zinc, copper, iron, and calcium with ASD and ADHD. Moreover, to compare these levels among children with ASD, ADHD, combined ASD plus ADHD, and healthy controls.
Methods: A case-control study was carried out at the College of Medicine, University of Baghdad, between March and September 2025. In total, 200 children aged 2–15 years were included and divided into four groups: Controls (n = 40), ADHD (n = 30), ASD (n = 57), and ASD + ADHD (n = 73). Five ml of venous blood from each child was dispensed into a gel tube to estimate zinc, copper, iron, and calcium. Assessment of inorganic elements zinc and copper was performed by Flam atomic absorption spectrometry (FAAS) while iron and calcium was performed by spectrophotometer.
Results: Serum zinc levels were significantly lower in all patient groups compared with the controls. Copper levels were significantly higher, particularly in the ADHD and ASD + ADHD groups. Serum calcium showed no significant differences among the groups. Serum iron levels were significantly reduced only in ADHD group.
Conclusion: Reduced zinc and iron levels, together with elevated copper, may contribute to neurodevelopmental disturbances in ASD and ADHD. Monitoring and correcting trace-element imbalance could support better clinical outcomes in affected children.

Background: Triple-negative breast carcinoma has an aggressive nature, poor prognosis, with high recurrence rates and metastasis. It has a poor response to targeted therapies, leaving a restricted number of efficient treatments, including chemotherapy and radiotherapy. Some types of triple-negative breast carcinoma are considered immunogenic types, which mean that these tumors may be susceptible targets to a new line of treatment known as immunotherapy. Several biomarkers have been discovered to determine patients who could be eligible candidates to receive immunotherapies. One of these biomarkers is the programmed death receptor 1 (PD1)/ programmed death ligand 1 (PD-L1) overexpression.
Objectives: To assess the expression status of the PD-L1 protein in a group of triple-negative breast carcinoma patients, and its correlation with the clinicopathological parameters.
Methods: The study was conducted from October 2024 to April 2025. A cross-sectional study involved 53 patients, who were diagnosed as triple-negative invasive ductal breast carcinoma. The formalin-fixed paraffin-embedded blocks were retrieved from the archives department of the histopathological laboratories in the Medical City Complex hospitals, Baghdad, Iraq. The clinical data of these patients were reviewed, and the blocks were sectioned, prepared, and stained with monoclonal anti-PD-L1 antibody.

Results: The majority of the cases (45 patients, 84.9%) had negative expression of PD-L1 protein, while eight patients (15.1%) had positive expression of PD-L1 protein. A non-significant correlation was found between the PD-L1 protein expression and the clinicopathological parameters.
Conclusion: The vast majority of the studied cases had a negative expression of PD-L1 protein. It seemed that the correlation between PD-L1 expression status and the studied clinicopathological parameters was not significant.

Background: Psoriasis, a common chronic autoimmune dermatological disease, is identified by scaling and inflammation seen in the skin. Both environmental and genetic factors contribute to its pathogenesis.
Objectives: To examine changes in albumin and C-reactive protein levels and their ratios, and the effect of Etanercept treatment on these indicators in the serum of Iraqi Psoriasis patients compared to healthy individuals.
Methods: A total of 100 Psoriatic patients were enrolled in the study and matched with healthy individuals (n=93) attending the Department of Venereology and Dermatology at Baghdad Teaching Hospital from November 2024 to April 2025. The levels of C-reactive protein and albumin, as well as their ratio in these patients, were compared with those of the control group. Furthermore, the effects of the biologic treatment were followed up for these parameters using 30 patients, before receiving any treatment, and after three months of Etanercept treatment.
Results: The serum level of albumin showed a highly significant decrease, with a highly significant increase in the concentrations of both serum C-reactive protein and the CRP/albumin ratio in the patient group compared to the control group, respectively. Furthermore, the three-month treatment with Etanercept induced a substantial difference in the albumin levels, and a very notable decrease in both C-reactive protein concentration and CRP/albumin ratio.
Conclusion: Psoriasis is a disease that affects the albumin and C-reactive protein levels, as well as their ratio. In the interim, using Etanercept for three months as biotherapy revealed alterations in the measured levels, achieving concentrations nearly similar to those of normal healthy individuals.

Background: Multidrug resistance bacteria is rapidly spreading globally and has created an urgent need for alternative antimicrobial strategies to combat these bacteria. Green nanotechnology is an eco-friendly way of synthesizing Bioactive Nanoparticles with enhanced antimicrobial activities compared to conventional methods.
Objectives: The purpose of this study was to \"green\" synthesize magnesium oxide nanoparticles (MgO NPs) from an alcohol extract of Camellia sinensis (tea plant) and evaluate their antibacterial and anti-biofilm activity against clinical multidrug resistance bacterial isolates.
Methods: Magnesium Oxide nanoparticles were synthesized utilizing an alcohol extract of Camellia sinensis as a reducing/stabilizing agent. The synthesized MgO NPs were characterized by UV–Vis Spectroscopy, FTIR, XRD, SEM, AFM, EDX, AAS, and Zeta Potential analyses. The antibacterial activity of the MgO NPs was determined using minimum inhibitory concentration (MIC) determinations while their anti-biofilm activity was assessed by a microtiter plate crystal violet assay against clinical MDR Enterococcus faecalis and Klebsiella pneumoniae isolates. Data were expressed as mean ± SD.
Results: According to the study, MgO nanoparticles that were created by biosynthetic means had an average particle size range of 52-104 nm (SEM) and had evidence of nanoscale surface roughness from AFM. They also showed high colloidal stability with zeta potentials of -44.61 mV. MgO nanoparticles exhibited very strong (dose-dependent antibacterial effect on both E. faecalis and K. pneumoniae with a MIC value of 12.5 µg/ml, and significantly reduced biofilm formation by 95.45-100% at sub-MIC concentrations.
Conclusion: Green-synthesized magnesium oxide (MgO) nanoparticles using extracts from Camellia sinensis, have very good anti-bacterial and anti-biofilm activities against multi-drug resistant (MDR) pathogens, and support the theorized use of green-synthesized MgO nanoparticles as an eco-friendly antimicrobial agent to reduce biofilm-related infections.

Background: As the number of caesarean deliveries has escalated over the last 50 years, Placenta Accreta Spectrum is now emerging as a more frequent pregnancy- related issue. The incidence of this problem is increasing, with recent estimates indicating an approximate 1/333 to 1/533 deliveries. Recent studies reveal that YKL-40 (also known as Chitinase-3-like protein 1 which is a secreted glycoprotein that is approximately 40kDa in size) may be involved in angiogenesis, cell proliferation and differentiation as well as extracellular matrix remodeling, and other inflammatory processes.
Objectives: To evaluate the association between maternal serum YKL-40 levels and the severity of Placenta Accreta Spectrum.
Methods: A case - control study was conducted in the Department of Obstetrics and Gynecology at Baghdad Teaching Hospital, Baghdad, from June 1, 2023, to June 1, 2024. It included 97 pregnant women with singleton pregnancy in the third trimester, having a diagnosis of Placenta Accreta Spectrum (37 patients), and those with normally sited placenta admitted for delivery either by vaginal or caesarean section (60 controls). The serum YKL40 biomarker was investigated in both groups.
Results: The mean level of the YKL-40 was significantly higher in patients diagnosed with placenta accreta spectrum than in those with a normal placenta. As the cut-off point for the YKL-40 is 112.68 pg/ml, a YKL-40 level > 112.68 pg/ml was associated with placenta accreta spectrum.
Conclusion: Serum YKL-40 appears to be a promising biomarker associated with the presence and clinical severity of Placenta Accreta Spectrum in the third trimester. While its role as a primary diagnostic tool is limited by the availability of imaging techniques at this stage of pregnancy, it shows a significant correlation with the depth of placental invasion.

Background: Allergies, as prevalent conditions, significantly impact individuals' health and quality of life. The criticality of accurate diagnosis cannot be overstated, as it is the cornerstone for effective management and treatment, underscoring the gravity of the medical professionals’ work.
Objectives: This review aims to provide a comprehensive evaluation of laboratory markers used to diagnose different types of allergies, including food, respiratory, skin, and drug allergies.
Methods: The review analyzed and synthesized data from current literature on essential diagnostic tools such as skin prick tests, specific IgE blood tests, and component-resolved diagnostics. Studies comparing these diagnostic methods' efficacy, specificity, and limitations were discussed.
Results: Skin prick tests remain widely used for diagnosing immediate-type allergies but may have limitations in detecting all allergens. Specific IgE blood tests offer a more detailed assessment of allergen-specific responses, although they can be influenced by factors such as patient age and coexisting conditions. Component-resolved diagnostics provide enhanced precision by identifying specific allergenic components, potentially improving diagnostic accuracy and guiding targeted immunotherapy.
Conclusions: The review underscores the effectiveness of existing diagnostic tools while also highlighting their variability depending on the type of allergy and patient characteristics. The future of allergy diagnosis lies in the integration of advanced technologies, such as component-resolved diagnostics, into clinical practice. This need for further research should instill a sense of urgency and emphasize the importance of efforts to enhance patient outcomes and optimize allergy management strategies.