Diyala Journal of Medicine

Background: Biofilm development in P. aeruginosa is a complicated
mechanism controlled by several genetic factors, among which quorum
sensing (QS) plays a pivotal role.
Objectives: Investigating the Impact of Quorum-sensing Systems genes (rhlI,
rhlR, lasI, and lasR) on biofilm-mediated antibiotic resistance in
Pseudomonas aeruginosa.
Patients and Methods: A total of 30 Pseudomonas aeruginosa isolates were
collected from four major referral hospitals in Baghdad, including Al-Imamian
Al-Kadhimiyain Medical City and the Iraq Medical City complex (comprising
Baghdad Teaching Hospital, Burns Hospital, and Ghazy Al-Hariri Hospital
for Surgical Specialties). Antibiotic susceptibility testing and minimum
inhibitory concentration (MIC) determination were evaluated. Quantitative
microtiter plate assays were used to study the biofilm formation ability.
Conventional PCR was used to detect quorum-sensing genes using specific
primer pairs after DNA extraction.
Results: Of the 30 Pseudomonas aeruginosa isolates,43% were identified as
extensively drug-resistant (XDR), while 17% were classified as multidrugresistant
(MDR). The highest level of antibiotic resistance was observed
against levofloxacin (60%). Formation of Biofilms was detected in 93.33% of
the isolates, with varying strength. The occurrence of quorum-sensing genes
among the isolates was as follows: lasI (96.67%), lasR (76.67%), rhlI
(93.33%), and rhlR (63.33%).
Conclusion: The quorum-sensing genes lasI and rhlI were consistently
noticed in all isolates that formed moderate to strong biofilms. Additionally, a
correlation was observed between the existence of lasR and rhlR genes and
resistance to fluoroquinolones and aminoglycosides.

Background: Autism is a neurodegenerative disease associated with
alterations in the metabolism of iron in the central nervous system. There is
evidence that children with autism have distinct iron-related proteins in their
serum, and the SNPs p.H63D and p.C282Y have been found to be significantly
correlated with a number of neurological illnesses.
Objectives: To determine the impact of p.H63D and p.C282Y polymorphisms
associated with iron status on autism in Iraqi children.
Patients and Methods: The study was conducted from June 2023 to January
2024, involving 30 individuals with autism and 30 controls, with ages ranging
from 4 to14 years. After extracting the DNA, specific sequence amplification
and restriction enzymes digestion were used to investigate the genotyping of
p.H63D and p.C282Y as well as TIBC, iron, transferrin, and ferritin, which
were measured using an autoanalyzer.
Results: Our findings showed the mean serum
iron(70.68±20.21μg/dL),ferritin(32.11±9.15μg/dL) and transferrin
(13.59±1.45(g/L))levels of autistic children were significantly lower than the
mean of the control group(90.22±22.11,79.9±20.65,25.75± 3.69 respectively)
p-value<0.05, and that an elevated risk of autism in the presence of
homozygous H/H(83.3%)at p.H63D and C/C (100%) homozygote of
p.C282Y, and the polymorphisms was substantially correlated with decreased
serum transferrin levels (odd ratio =1.20 ,p-value=0.01(with H/H),1.18 ,pvalue=
0.02 with C/C).
Conclusion: The decreased serum transferrin levels were associated with a
higher incidence of autism that is associated with the presence of p.H63D and
p.C282Y polymorphisms. Low levels of iron, ferritin, and transferrin in autism
patients can lead to cognitive and physical problems, which may increase the
risk of developing autism symptoms.

Background: Mechanical back pain is a common condition that severely
affects daily functioning and the quality of life. It often manifests as pain,
stiffness, and limited movement, resulting in a functional handicap for affected
individuals.
Objectives: Comparing the results of active rehabilitation with functional
disability and with follow-up patients who had mechanical low back pain.
Patients and Methods: an experimental study in which 159 participants with
mechanical back pain were selected from physiotherapy clinics to participate
in this exploratory investigation. Group 1 received physiotherapy exercises,
Group 2 received physiotherapy modalities, such as Transcutaneous Electrical
Nerve Stimulation, ultrasound, infrared radiation, and short-wave diathermy,
and Group 3 received a mix of exercises and modalities. Participants were
randomly divided into three groups. Ten sessions of treatment were given to
everyone. The Oswestry Impairment Index (ODI) was used to measure
functional impairment and pain levels both before and after treatment.
Results: The analysis revealed statistically significant differences among the
three therapeutic intervention groups in pain intensity and functional disability
before and after treatment (p < 0.001). At baseline, participants in the Physical
Therapy Modalities group presented with the highest levels of pain and
disability. Following five treatment sessions, the Therapeutic Exercise and
Physiotherapy Modalities Combined group showed the greatest reduction in
pain intensity, with a post-intervention mean rank of 66.25, indicating
significant clinical improvement. In contrast, the Therapeutic Exercise group
achieved the most notable reduction in overall pain score, with a mean rank of
58.85, reflecting its specific effectiveness in pain perception. Regarding
functional disability, the combined group again demonstrated the greatest
improvement, suggesting that integrating exercise with physical modalities
offers broader therapeutic benefits. These findings underscore the varying
impact of each intervention, with the combined approach showing the most
consistent improvement across both pain and functional outcomes.
Conclusion: This study has determined the effectiveness of physical therapy
in reducing functional impairment in patients with mechanical back pain. The
results indicated that the greatest improvement in pain reduction and
functional mobility was achieved when physiotherapy exercises were
combined with modalities such as Transcutaneous Electrical Nerve
Stimulation, ultrasound, and infrared radiation.

Background: Enterobacter cloacae is a gram-negative bacteria characterized
by being a rod, motile, facultative anaerobic bacteria, possess many virulence
factors that play an important role in the prevalence of this bacteria such as
biofilm, sedrophore, and fimbriae.
Objectives: this study aims to investigate some biofilm genes that contribute
to cause disease and antibiotic resistance.
Patients and Methods: This study was conducted on 300 samples involving
102 samples from hospitalized and 198 samples from non- hospitalized patient
and this study was carried out from November 2023 to March 2024 in Diyala,
Iraq.
Results: This study revealed the presence of biofilm genes in E. cloacae
bacteria, isolated from different cases (wound infection, UTI, burn infection
and patients with blood bacteremia
Conclusion: An alarming rate of drug resistance E. cloacae is on the rise,
Bacterial factor including biofilms, fimbriae and molecular mechanism are in
association with E. cloacae. Study shows up to 80-100 of clinical E. cloacae
isolates may carry CsgA and CsgD.

Background: Acromegaly is a rare endocrine disorder, with an annual
incidence of 4 cases per million and a prevalence of 40 cases per million. The
condition results from a pituitary adenoma that secretes growth hormone.
Objectives: The objective of this study is to assess β-arrestin levels in patients
with acromegaly, comparing those with and without diabetes mellitus with a
control group.
Patients and Methods: This is a case-control study involving 100 patients
with acromegaly registered at the National Diabetes Center, Mustansiriyah
University, and 76 controls. All recruited participants have given oral consent
to participate in the study, which was conducted from February to August
2024.
Results: the age distribution differences were not statistically significant
(p=0.156). The gender distribution showed 47 females and 53 males in the
acromegaly group. The β-arrestin level was higher among patients compared
to controls, and showed the highest level in acromegaly and DM (16.86 ± 6.35
ng/ml), followed by acromegaly without DM (11.12 ± 4.78ng/ml), controls
with DM (6.62 ± 2.83 ng/ml), and controls without DM (2.93 ± 0.98 ng/ml).
Conclusion: High prevalence of diabetes among female patients with
acromegaly. Elevated serum levels of β-arrestin were observed in patients with
acromegaly, with higher levels noted in those with diabetes mellitus compared
to non-diabetic acromegaly patients and control groups.

Background: The key features of polycystic ovary syndrome (PCOS) are
oligo-anovulation, hyperandrogenism, and polycystic ovaries. Elevated
plasma prolidase activity is closely related to the pathophysiology of PCOS,
in which increased ovarian stromal volume and atretic follicles may be
accompanied by changes in extracellular matrix remodeling.
Objectives: Assessment of plasma prolidase levels in PCOS and to compare
these levels between its different phenotypes as a marker for diagnosis and
prognosis of the syndrome.
Patients and Methods: A case–control study included 44 women who were
diagnosed with PCOS, and 48 healthy, ovulatory women. Plasma prolidase
levels were measured and compared between the two groups and across
different PCOS phenotypes.
Results: The mean prolidase level was significantly higher in PCOS (103.8 ±
82 ng/ml) than in controls (8.4 ± 4.1 ng/ml), the cut-off value (>31 ng/ml) was
found to be 81.82% sensitive, 93.75% specific as a predictor of PCOS. The
mean prolidase levels were higher in the PCOS group with ≥20 antral follicles;
a positive correlation was found between prolidase level and the number of
antral follicles in PCOS. Additionally, the mean prolidase levels varied
significantly among the different PCOS phenotypes, with the polycystic ovary.
hyperandrogenism oligo-anovulation (PHO) phenotype found to have the
highest level.
Conclusion: Plasma prolidase has a potential to serve as a useful, inexpensive
and easily assessable marker for the diagnosis of PCOS. Its levels were
directrly correlated with the number of antral follicles in PCOS women,
suggesting that it can be used as a tool to replase ultrasound imaging. Proidase
levels vary significantly among the different PCOS phenotypes, so it could be
used for monitoring the disease.

Background: Klebsiella pneumoniae is a major pathogen in urinary tract
infections (UTIs), with its virulence influenced by specific capsular serotypes
and strain types.
Objectives: This study aims to investigate the association between virulence
factors and capsular serotypes in classical (cKp) and hypervirulent (hvKp) K.
pneumoniae isolates from UTIs.
Patients and Methods: A total of 280 urine samples were collected from
patients at Medical City Hospital in Baghdad, Iraq, between November 2023
and May 2024. Polymerase chain reaction (PCR) was used for molecular
identification and capsular serotyping. Virulence factors assessed included
biofilm formation, hemolytic activity, serum resistance, and siderophore
production.
Results: Among 41 classical cKp, 19 were identified as serotypes K1 or K2,
while the remaining 22 belonged to other serotypes. Of the 21 hypervirulent
hvkp, 18 were associated with serotypes K1, K2, K20, or K54. All isolates
exhibited biofilm formation with no significant difference between cKp and
hvKp. However, hvKp strains demonstrated significantly higher hemolytic
activity, particularly in K1 and K2 serotypes, although differences between K1
and K2 within hvKp were not statistically significant. Serum resistance was
significantly greater in hvKp strains (p > 0.05), with K2 showing higher
resistance than K1 in both groups. Siderophore production was also
significantly elevated in hvKp, with K1 strains exhibiting the highest levels.
Conclusion: Capsular serotyping may offer valuable insights for clinical
diagnostics and therapeutic decision-making in UTIs caused by K.
pneumoniae.

Background: Type 2 diabetes mellitus (T2DM) is characterized by insulin
deficiency and resistance. This study evaluated serum interleukin‑33 (IL‑33)
and its soluble receptor (sST2), plus two IL‑33 gene polymorphisms
(rs7044343, rs1929992), for association with T2DM in Iraqi patients.
Patients and Methods: In this case–control study, 120 T2DM patients and 80
age and sex matched healthy controls were used. Fasting blood glucose and
glycated hemoglobin (HbA1c) confirmed diabetic status. Serum IL 33 and
sST2 concentrations were measured by ELISA. Genotyping of IL 33
rs7044343 and rs1929992 was performed via PCR–RFLP. Allele and
genotype frequencies were compared using χ² tests; associations were
expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Statistical
significance was set at p < 0.05.
Results: Compared to controls, T2DM patients showed significantly higher
serum IL 33 (mean ± SD: 43.2 ± 12.7 vs 28.5 ± 9.3 pg/mL, p < 0.001) and sST2
(56.8 ± 14.1 vs 34.7 ± 10.5 ng/mL, p < 0.001). The IL 33 rs1929992 variant
exhibited no significant difference between groups (p = 0.30). In contrast, the
rs7044343 AA genotype was more frequent in T2DM patients than controls
(AA = 34% vs 18%; OR = 2.35, 95% CI 1.22–4.52, p = 0.010), while the CC
genotype conferred a protective effect (CC = 22% vs 38%; OR = 0.48,
95% CI 0.26–0.89, p = 0.018).
Conclusion: Elevated IL 33 and sST2 levels, together with the rs7044343 AA
genotype, are associated with increased susceptibility to T2DM in Iraqi
patients. These findings support IL 33 pathway involvement in T2DM
pathogenesis.

Background: Myocardial infarction and oxidative stress drive the damage to
myocardial tissue, culminating in cell necrosis. The study measured IMA,
TAC, DPPH, total protein, and serum albumin in patients with MI.
Objectives: To analyze and diagnose the usefulness of IMA concentration in
patients with potential MI signs within six hours.
Patients and Methods: During the period from September 2024 to February
2025, eighty individuals diagnosed with myocardial infarction (MI) who were
admitted to Baquba Teaching Hospital in Iraq were enrolled in this study. In
addition, twenty healthy individuals were included as a control group. IMA
was measured using an ELISA kit, while serum TAC, DPPH, total protein,
and albumin were measured spectrophotometrically.
Results: The MI group showed a significantly elevated serum IMA
concentration compared to healthy controls (p < 0.001). Patients with MI
showed lower antioxidant activity and reduced levels of antioxidant
molecules. There was no apparent association between serum IMA and DPPH,
TAC, total protein, or serum albumin. However, positive correlations emerged
between TAC and DPPH (0.678, p < 0.001), total protein and serum albumin
(0.640, p < 0.001), and TAC and serum albumin (0.575, p < 0.001).
Conclusion: The aim of the study was to elucidate the crucial role of
measuring IMA, TAC, DPPH, total protein, and serum albumin in patients
with MI, alongside other oxidative stress indicators, to guide the development
of targeted antioxidant treatments for early diagnosis.

Background: Breast cancer remains one of the leading causes of morbidity
and mortality among women worldwide, with incidence rates steadily
increasing over the past decades. Despite significant advances in early
detection and treatment modalities, identifying reliable biomarkers that can
predict disease onset, progression, and patient outcomes remains a major
clinical challenge. Among the various biological factors under investigation,
vitamin D and calcium homeostasis have attracted considerable attention due
to their critical roles in cell growth, differentiation, and immune regulation.
Objectives: Vitamin D, parathyroid hormone (PTH), estrogen, alkaline
phosphatase, correlation levels between the parameters measured, and the
receiver operating characteristic curve (ROC) were all examined in this study,
which aims to shed light on the role of vitamin D in the development of breast
cancer and its relationship to some parameters.
Patients and Methods: The patients were divided into three groups. The
control group was G1; patients diagnosed early and receiving chemotherapy
were G2; and patients receiving surgery or chemotherapy were G3.
Results: This study showed that, compared to the control group, the breast
cancer groups had lower vitamin D levels, with statistically significant Pvalues
for G1 and G2 for vitamin D and PTH, respectively. The fact that
groups of people with breast cancer had significantly low vitamin D levels and
high levels of parathyroid hormone supports the idea that vitamin D can fight
cancer. Receiver operating characteristic (ROC) curve analysis underscored
the diagnostic potential of vitamin D and PTH, both of which demonstrated
excellent sensitivity and specificity.
Conclusion: Vitamin D and PTH were found to be factors that lead to tumor
progression in breast cancer patients in this study. The idea that low vitamin
D levels and high parathyroid hormone support the idea that vitamin D fights
cancer.