IRAQI JOURNAL OF MEDICAL SCIENCES

Vitamin D, an evolutionarily conserved molecule essential for diverse life forms ranging from phytoplankton to mammals, plays a critical role in health beyond its classical functions. It promotes osteoclast differentiation indirectly via receptor activator of nuclear factor κB (RANKL) upregulation, facilitating intestinal calcium absorption, promoting renal calcium reabsorption, and stimulating the mineralization of the bone collagen matrix, thereby regulating calcium and bone homeostasis. Significantly, immune cells, including B lymphocytes, T lymphocytes, and antigen presenting cells express the vitamin D receptor (VDR) and possess the enzymatic to activate vitamin D. This locally produced vitamin D exert autocrine and paracrine immunomodulatory effects. Adequate vitamin D status influences both innate and adaptive immune responses, while deficiency is epidemiologically associated with increased susceptibility to infection and heightened risk of autoimmunity. Consequently, the immunomodulatory benefits of vitamin D supplementation in deficient individuals with autoimmune diseases extend beyond the regulation of calcium and bone metabolism.
Keywords Vitamin D, immune system, bone health, calcium absorption, autoimmunity

Background: Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder characterized by chronic hyperglycemia due to insulin resistance and impaired insulin secretion. Prediabetes, an intermediary condition where blood glucose levels are elevated but not yet diagnostic for diabetes, poses a significant risk for progression to T2DM. Neudesin (NENF), a neurotrophic factor with known roles in adipocyte differentiation and myoblast inhibition, has emerged as a potential biomarker for metabolic dysregulation.
Objective: To evaluate serum NENF levels in individuals with prediabetes and T2DM, and establish a diagnostic cutoff value with optimal sensitivity and specificity to distinguish diabetic and prediabetic patients from healthy individuals.
Methods: A total of 120 Iraqi individuals aged 28–66 years participated in this study, including 30 patients with T2DM, 30 individuals with prediabetes, and 60 healthy controls. Serum levels of NENF were determined using a commercially available enzyme-linked immunosorbent assay kit, body mass index was calculated from participant height and weight, fasting blood glucose and glycated hemoglobin were measured using standard enzymatic colorimetric methods.
Results: The findings revealed significantly higher serum NENF levels in T2DM patients compared to prediabetic and control groups (P <0.001). Mean NENF concentrations were 651.61±184.08 ng/ml in healthy controls, 745.56±231.23 ng/ml in prediabetic individuals, and 1034.78±496.45 ng/ml in T2DM patients.
Conclusion: Elevated NENF levels are associated with T2DM and prediabetes, suggesting its potential as a sensitive and precise biomarker for early detection, screening, and monitoring of metabolic dysregulation.
Keywords: Type 2 diabetes mellitus, neudesin, prediabetes, metabolic dysregulation

Background: Toxoplasma gondii (T. gondii) is known to manipulate host immune responses to establish a persistent infection. This manipulation involves modulation of immune regulatory pathways, including those mediated by checkpoint molecules like programmed cell death protein 1 (PD-1). The parasite employs various strategies to evade host immune surveillance and promote its survival within the host organism.
Objective: This study aimed to determine of the levels of PD-1 during acute T. gondii infection by enzyme linked immunosorbent assay (ELISA).
Methods: In this case control study, samples were collected from 350 women suspected Tox with an age range from (18-48) years. According to the presence of anti-T. gondii (IgM) in serum of women using ELISA technique, the women were divided into 2 groups, group 1 with positive IgM, and group 2 with negative IgM. Serum levels PD-1 were measured in both groups.
Results: The results showed a significant higher level serological biomarker (PD-1) in T. gondii IgM patients than in controls (p value 0.0001). Also, there was a significant variation of PD-1 level according to clinical history (p value 0.004), highest in those with delayed pregnancy, and lowest in those with cervical lymphadenopathy.
Conclusion: There is a significant higher level serological biomarker (PD-1) in T. gondii IgM patients than in controls. Also, there is a significant variation of PD-1 level according to clinical history
Keywords: Toxoplasmosis, IgM, PD-1.

Background: Coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has had a massive negative impact of the healthcare systems worldwide, most obvious in its acute stage, but subtler chronic sequelae are being recognized. Sarcopenia, a progressive loss of muscle mass and strength, is believed to be both a risk factor and a complication of acute COVID-19 in various settings.
Objective: To assess sarcopenia frequency following COVID-19 infection in a sample of Iraqi patients and to study the effect of various patient-related and infection-related factors on its development.
Methods: An observational cross-sectional study, conducted at Baghdad Teaching Hospital in Baghdad, Iraq, from December 2021 until June 2022. A convenience sample of polymerase chain reaction -confirmed COVID-19 infection survivors who were otherwise apparently healthy was recruited, patients’ data were collected by direct questioning with measurements of muscle mass through whole body dual-energy x-ray absorptiometry scan, muscle strength via a hand-held dynamometer and physical performance assessment by 4 meters walking speed to determine sarcopenia category.
Results: The study involved 68 participants (mean age 37.3±11 years). Severe COVID-19 occurred in 12 (17.6%), while 56 (82.4%) had non-severe infection. Sarcopenia was present in 6% (4 patients), probable sarcopenia in 12% (8 patients), with no severe cases. Significant associations were found between sarcopenia and BMI <25 (p=0.023), and between steroid use and probable sarcopenia (p=0.013).
Conclusion: This study shows how common sarcopenia and probable sarcopenia are following COVID-19, 6% and 12% respectively. Having a BMI within the normal range increases the risk of developing sarcopenia and corticosteroid use increases the risk of developing probable sarcopenia.
Keywords: COVID-19, sarcopenia, post-COVID.

Background: It is important for college teachers to have awareness about knee osteoarthritis (OA) so that they can provide appropriate support and accommodation for themselves and their students with this condition.
Objective: To assess the awareness level, the risk factors for OA and find the association between the awareness level and some factors.
Methods: A cross-sectional study carried out at Baghdad, Iraq from January 2023 until January 2024 in 8 different colleges to assess risks for knee OA and the awareness level for a sample of 225 college teachers.
Results: The mean age of participants was 42.1±10.6 years, 124 (55.1%) of them were males, 132 (58.7%) had PhD degrees and 42% of subject had knee pain. The most frequent risk factor was standing for more than two hours per day with 178 (79.1%) subjects. There were 114 (50.7%) college teachers in this study who showed a good total awareness score. In this study, the most notable scores pertained to the domains of prevention (83.1% correct) and disability (72.4% correct). In the current study, better awareness was observed in PhD holders. Good awareness levels were more likely to among participants with previous joint injury or disease (odd’s ratio = 2.544), and those who walks >3 km/day (odd’s ratio = 3.256).
Conclusion: The study highlights standing for extensive periods as a key risk factor for knee OA among college teachers, with 42% reporting knee pain. Awareness was notably better among teachers with PhDs, who participated in lighter physical activities, or walked more than 3 km daily. Surprisingly, individuals with physical habits like frequent stair climbing and heavy weightlifting had lesser OA awareness. Additionally, there\'s a noted link between higher OA awareness and having a history of joint issues or regularly walking long distances.
Keywords: Preventive factors, knee osteoarthritis, awareness

Background: Vitamin D is a fat-soluble vitamin that played an important role in bone metabolism (mineralization). It was considered a prohormone and had important role in the optimal function of many organ systems and may be a risk modifying factor for many chronic diseases.
Objective: To assess the level of vitamin D in preterm neonates and its relation with different neonatal and maternal factors.
Methods: A cross sectional study conducted at the Neonatal Intensive Care Unit (NICU) in Al-Imamein Al-Kadhimein Medical City, in Baghdad during a period from 1st of march 2022 to 1st of October 2022, seventy preterm neonate admitted to NICU were included and divided into groups according to their gender, gestational age, cause of admission and maternal factors such as gravidity, maternal health and supplementation with vit D or not during pregnancy, and the neonatal serum vitamin D level was measured to assess its relationship with these different neonatal and maternal factors.
Results: Among the total number of 70 preterm neonate included in current study, number of females were 33 (47.2%), males were 37 (52.8%). Vitamin D level in preterm neonates was significantly low in the group in whom mother did not take vitamin D supplement during pregnancy (mean 8.56) versus (11.54) in neonates whom their mothers supplemented with vitamin D during pregnancy. Regarding the maternal health, there was no significant association with neonatal vitamin D (p = 0.08), there were no significant association between maternal parity and neonatal vitamin D deficiency (p = 0.091). Regarding the neonatal factors there were no significant association between vitamin D level and the gender (p = 0.47), gestational age (p = 0.2) and cause of admission of the preterm neonates to neonatal intensive care unit (p = 0.478).
Conclusion: There was significant relation between neonatal serum vitamin D level and maternal use of vitamin D supplement during pregnancy. No significant relation between serum vitamin D and neonatal gender, gestational age, cause of neonatal admission, maternal health and gravidity.
Keywords: Preterm, gestational age, vitamin D.

Background: Tobacco smoke contains thousands of chemical compounds, many of which are toxic and capable of inducing oxidative stress and inflammation. Interleukin (IL)-6 and IL-10 are cytokines crucial for immune regulation, inflammation, and hematopoiesis, produced by several cells.
Objective: To evaluate the effects of traditional and electronic smoking on salivary IL-6 and IL-10 to estimate the risks on oral immunity.
Methods: Ninety male students were enrolled in the study. The participants were divided into 3 groups: traditional cigarette smokers, electronic cigarette (e-cigarette) smokers and non-smokers matched in terms of age 18-25 years. Unstimulated saliva was collected from the participants, and the concentrations of cytokines were assessed by the enzyme-linked immunosorbent assay test. Bleeding on probing (BOP), plaque and calculus indices (PI and CI), salivary PH, and flow rate were measured and calculated.
Results: Results showed a significant increase in salivary IL-6 of traditional and electronic cigarette smokers compared to the nonsmoker group (p = 0.041) and a downregulation of salivary IL-10 in traditional and e-cigarette smokers compared to nonsmokers' group (p = 0.011). BOP showed no significant difference among the three groups (p = 0.164), however PI and CI were significantly higher in cigarette smokers compared to non-smokers and e-cigarette users with p value = 0.003, 0.002 respectively. Salivary pH levels differed significantly among groups, with non-smokers showing the highest pH, followed by e-cigarette users and cigarette smokers (p <0.001). Saliva flow rate (SFR) was also significantly higher in non-smokers (mean = 0.55 ml/min) compared to both cigarette smokers and e-cigarette users (p = 0.024).
Conclusion: Both traditional cigarette smoking and e-cigarette use were associated with increased salivary IL-6, reduced IL-10, lower salivary pH and flow rate, indicating altered oral immune responses. Traditional smokers also showed higher plaque and calculus indices than non-smokers.
Keywords: Cytokine, IL-6, IL-10, saliva, smoking

Background Type 2 diabetes mellitus (T2DM) is characterized by difficulties of insulin utilization or synthesis. MicroRNAs (miRs), family has a basic role in control of glucose level in blood.
Objective To estimate the serum expression of miR-126 as a candidate biomarker for early detection of T2DM.
Methods This study included 50 newly diagnosed T2DM patients ranging from 25 to 70 years old, as well as 50 apparently healthy volunteers as a control group. The expression of miR-126 was estimated by using quantitative real-time polymerase chain reactions (RT-qPCR).
Results The expression level (fold change) of miR-126 in serum was significantly lower in patients (7.59) than control group (26.68). p value 0.031. The miR-126 expression was comparable between obese and no obese patients p value 0.844.
Conclusion Current data suggest that circulating miR-126 may represent a promising biomarker for the early detection of T2DM.
Keywords T2DM, miR-126, RT-qPCR.

Background: Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, is a heterogeneous endocrine disorder that affects approximately 4-8% of women of reproductive age.
Objective: To study the effect of Cressa cretica (C. cretica) leaves extract on induced PCOS in rat model, to evaluate the effect of C. cretica leaves extract on lipid profile and histopathological picture of rat's ovary and to compare the effect of C. cretica leaves extract with that of metformin.
Methods: Thirty-six apparently healthy female rats weighing (180–200g) at 3-5 weeks of age divided into 6 groups, 6 rats for each. Five groups were administrated with 0.4 ml of oral Letrozole (5.3 mg/kg) daily for 21 days to induce PCOS, followed by a dose of Metformin (500 mg/kg/day) for one group, high dose C. cretica (400 mg/kg/day) for 2nd group, low dose C. cretica (300 mg/kg/day) for 3rd group and combination of (200 mg/kg/day) from C. cretica with (250 mg/kg/day) from Metformin for forth group, the treatment received for 30 days. Other 2 groups, one left without any treatment, and one did not receive any drug (control). Serum samples were taken from each rat to measure the lipid profile, and histopathology of the ovary was done after sacrificing the rats at the end of study.
Results: C. cretica treated groups showed lower level of lipid profile except that for high-density lipoprotein where it was elevated in comparison to induction group. Ovulation is restored in the C. cretica treated group.
Conclusion: C. cretica treated groups observed better results in comparison with Metformin in improvement of PCOS symptoms in female rats.
Keywords: Cressa cretica, leaves, PCOS, Female rats, lipid profile.

Background: The progression of chronic kidney disease (CKD) and the development of complications are facilitated by oxidative stress, which is a progressive condition. 8-Isoprostane, a byproduct of lipid peroxidation, has the potential to serve as a biomarker that reflects kidney function and oxidative stress levels.
Objective: To investigate the role of 8-Isoprostane as a biomarker in CKD progression.
Methods: A case-control study was conducted involving 120 children aged 6-18 years who were divided into three groups: CKD patients requiring dialysis, CKD patients not requiring dialysis, and healthy controls. Serum 8-Isoprostane levels were tested using enzyme-linked immunosorbent assay, and their ability to diagnose was assessed with statistical methods and Receiver Operating Characteristic (ROC) analysis.
Results: 8-Isoprostane levels were significantly elevated in CKD patients requiring hemodialysis compared to non-hemodialysis patients and controls (p <0.001). ROC analysis confirmed its strong diagnostic accuracy, with a sensitivity of 100% and specificity of 100% in distinguishing between CKD patients and controls and a sensitivity of 90% and specificity of 90% in distinguishing between CKD patients with and without hemodialysis.
Conclusion: 8-Isoprostane is a reliable biomarker for assessing oxidative stress and CKD progression. Regular monitoring can aid in early diagnosis, better disease management, and targeted interventions.
Keywords: 8-Isoprostane, Chronic Kidney Disease (CKD), Oxidative Stress Biomarker.

Background: Using microorganisms such as Ralstonia mannitolilytica (R. mannitolilytica), to create selenium nanoparticles (SeNPs) offers a promising path for Grammy advancement. Antibiotic resistance poses a formidable challenge, particularly against multidrug-resistant (MDR) bacteria. The employment of supernatant as a cost-effective and straightforward approach enhances the efficacy of SeNPs biosynthesis.
Objective: To explore the biosynthesis of SeNPs by R. mannitolilytica with the aim of achieving cost-effective and environmentally friendly production methods while ensuring novel morphological characteristics of SeNPs furthermore evaluated of antimicrobial and toxicity.
Methods: Preparation SeNPs by biological method (Biosynthesis). Ultraviolet-visible spectrophotometer (UV–Vis), energy dispersive of X-ray spectroscopy (EDX), atomic force microscopic (AFM), X-ray diffraction (XRD), Zeta potential analysis (ZP); these methods were used to characterize the physical properties. The well diffusion assay and minimum inhibitory concentration (MIC) of 16 μg/ml were also assessed.
Results: This study successfully demonstrates the biosynthesis of stable, spherical SeNPs with a crystalline structure and an average diameter of ~56.8 nm, as confirmed by XRD, TEM, and UV–Vis spectroscopy (λmax = 236 nm). The SeNPs exhibited favorable colloidal stability (ZP = −22.47 mV) and broad-spectrum, dose-dependent antimicrobial activity against both Gram-positive and Gram-negative pathogens. Maximum inhibitory effects were observed at 64 µg/ml, underscoring their potent biocidal efficacy.
Conclusion: The biological technique employed in this study is appropriate for producing SeNPs with significant antibacterial properties against MDR pathogens and no toxicity to cell line tissue, provided that the product is homogeneous and the particle size is controlled.
Keywords: Ralstonia mannitolilytica, selenium nanoparticles, inhibition zone

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication challenges, repetitive behaviors, and restricted interests. The etiology is elusive, but it is believed to involve genetic, environmental, and viral factors. The Herpes simplex virus (HSV) has gained attention for its potential role in ASD. In Iraq, the unique socio-clinical environment may provide insights into how these factors collectively contribute to ASD risk.
Objective: To explore how socio-clinical factors, non-genetic viral infections, and their interactions influence the clinical features and susceptibility to ASD.
Methods: A cross-sectional study was conducted at the National Autism Centre, Child Welfare Hospital in Baghdad, involving 400 autistic children aged 2 to 14 years. Participants were assessed using diagnostic and statistical manual of mental disorders fifth edition (DSM-5) criteria, along with neurological and psychological evaluations. Social and clinical factors included parental age, family history of autism, history of prenatal drug usage, history of comorbidity, perinatal factors, postnatal factors, and family history of other neuropsychiatric disorders. Serological testing for HSV types 1 and 2 (IgG) was also performed.
Results: The age of participants ranged from 2 to 14 years, with a mean age of 7.3±2.9 years. The sex distribution revealed that males constituted 72% of the participants, while females made up 28%. Serological testing for HSV types 1 and 2 showed that 60.5% of participants tested positive for HSV-1 (IgG). The study reveals significant associations between autism severity, advanced parental age, a positive autism family history, attention-deficit hyperactivity disorder, and epilepsy. Perinatal factors like neonatal hypoxia and preterm delivery are linked to HSV-1 positive cases and severe autism, while postnatal factors do not.
Conclusion: The study results indicate that several parentals, perinatal, and postnatal factors significantly affect the severity of autism spectrum disorder among patients with HSV-1 infection, but these associations do not hold for patients with HSV-2 infection. This suggests a possible interaction between HSV-1 infection and these factors in influencing ASD severity.
Keywords: HSV-1, HSV-2, autism spectrum disorder, autism risk, Socio-clinical factors.

Background: Pilonidal sinus (PNS) is an inflammatory condition in the natal cleft above the coccyx. Its treatment is highly variable and can include observation and hair removal, incision and drainage, or excision with sometimes complex surgical reconstruction, however, the usual treatment for PNS abscesses is incision and drainage.
Objective: To evaluate the safety and effectiveness of a 1470 nm diode laser in treating PNS abscesses.
Methods: This prospective study involved 12 patients with PNS abscesses between June 2023 and June 2024 in a private clinic. The patients were aged 15 to 32 years, using local anesthesia during the procedures. The procedure includes drainage of pus and cleansing the interior of the sinus from hair, granulation tissue, and debris, followed by laser irradiation; patients reported any complications via a survey questionnaire.
Results: All patients tolerated the procedure under local anesthesia, with no major complications during the early postoperative period. Sinus pits closed within 12-22 days. The procedure duration ranged from 25 to 38 minutes. Moderate pain was experienced by 75% of patients, and 25% had mild pain. Serous discharges for 2–3 days was present in 58.4% of patients. Sixty-six % of patients returned to work after two days, while 34% returned after three days. Overall, 83% of patients were satisfied with the results, while 17% were dissatisfied due to pain.
Conclusion: Drainage of pus from PNS abscess is followed by a 1470 nm diode laser is a safe and effective procedure. It results in minimal postoperative complications. Patients return to work faster than with traditional surgical methods, though recovery is slightly slower than SiLaT alone.
Keywords: 1470 nm, pilonidal sinus abscess, pilonidotomy, pilonidoplasty.

Background: Hepatitis B virus (HBV) vaccination is known as the best way to prevent the spread of the Hepatitis B virus in hemodialysis centers.
Objective: To study the effectiveness of the Euvax B vaccine in end-stage kidney disease (ESKD) Iraqi patients on hemodialysis already not responded to a series of doses of HBV vaccination before, using a different route of administration.
Methods: Forty-six ESKD patients on hemodialysis who did not respond to previous intramuscular HBV vaccination (defined as patients who had a series of intramuscular HBV vaccination doses and anti-hepatitis B virus surface antibody <10 IU/ml) were chosen. All 46 patients started on a new regimen of 4 doses of intramuscular recombinant HBV vaccination (Euvax B) 40 µg (double the regular dose for the non-dialysis population) at 0, 1, 2, and 6 months’ interval. The immune response has been studied after 2 and 4 doses. Patients who did not respond to all four doses had started intradermal vaccination of a 5 µg weekly dose for 8 weeks.
Results: Twenty-seven ESKD patients had responded to 2 doses of intramuscular doses (59%), while (70%) developed a response after completing 4 doses (P 0.001). Intramuscular injections are more effective with patients on hemodialysis for less than two years (P 0.02). Fourteen patients (who did not respond to Intramuscular doses) started on Intradermal administration of Euvax B, and nine patients (64%) responded to it.
Conclusion: Starting four doses of intramuscular HBV vaccination is effective and gives better outcomes if it is done in the early years of hemodialysis. Moreover, the intradermal route of administration of Euvax B is also effective for those who have not responded to intramuscular vaccination cycles.
Keywords: Hepatitis B vaccination, ESKD, Euvax B, hemodialysis, non-responders, intradermal route

Spexin is an adipokine and neuropeptide that is extensively expressed in a number of tissues and organs, like the pancreas, fat, small intestine, liver, stomach, and other endocrine tissues to perform a variety of functions such as glucose and lipid metabolism. Spexin might be a biomarker for insulin resistance, diabetes, and obesity, where it is a potent adipose cell metabolism regulator that improves insulin sensitivity in diabetes and obesity by inhibiting adipogenesis, promoting adipose tissue browning and lipolysis, increasing body thermogenesis and energy expenditure. An updated explanation of spexin and mechanism action of this peptide as an efficient treatment to prevent obesity and diabetes were the aims of this review.
Keywords Insulin, lipid, metabolic effect, obesity, Spexin, resistance, T2DM

Background Osteoporosis (OP) is a common bone illness that affects people worldwide and is characterized by reduced bone mineral density (BMD) and deteriorated bone tissues, making the bones fragile. Type 2 diabetes mellitus (T2DM) characterized by hyperglycemia, accounts for about 90% of all diabetes cases worldwide. Osteocalcin (OC) is a small bone-specific non-collagen protein produced by osteoblasts and it is a sensitive marker of bone formation. A small proportion of OC is released into the circulation and plays a role in fat and glucose metabolism.
Objective To Evaluate of the serum level of OC in T2DM patient with and without OC, healthy people and to investigate their ability to differentiate between the studied groups.
Methods This observational case-control study involved 120 adult patients between (30-70) years old of both sexes (male and female), divided into four groups (30 patients with OP), (30 patients with T2DM), (30 patients with OP and T2DM (OPDM)) and (30 healthy people). This study was conducted in the Department of Chemistry and Biochemistry at the College of Medicine at Al-Nahrain University in conjunction with the X-ray department in Al-Imamein Al-Kadhimein Medical City in the period from November 2023 to March 2024. The practical part was done in a private laboratory.
Results The median serum levels of OC were significantly higher in the T2DM, OP, and OPDM groups. OC showed promise as a biomarker for diagnosing both OP and T2DM, either alone or combined (OPDM). It demonstrates good differentiation between these conditions and the healthy control group with area under the curve values ranging from 0.886 to 0.976. OC offers high sensitivity (90% accuracy in identifying OPDM and DM), its specificity is moderate (83.3% accuracy in excluding OPDM and DM).
Conclusion OC may have the potential to be used as an indicator of metabolic derangement in OP and T2DM. Also, it may be used as a biomarker for diagnosing patients with OP.
Keywords Osteoporosis, type 2 diabetes mellitus, osteocalcin, bone mineral density.

Background Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with significant maternal and fetal risks. Dietary habits and metabolic risk factors play an important role in its development.
Objective To investigate the association between dietary patterns and GDM, and to assess related maternal risk factors and pregnancy outcomes in pregnant women.
Methods A cross-sectional study was conducted among 100 pregnant women attending antenatal care clinics in Baghdad City from December 2022 to January 2024. Data were collected using structured interviews, medical records, Food Frequency Questionnaire (FFQ), and 75-g oral glucose tolerance test (OGTT).
Results The prevalence of GDM was 40%. Higher prevalence was observed among women aged ≥35 years with a positive family history of diabetes. GDM was associated with higher rates of pregnancy-induced hypertension (60%) and macrosomia (22%). A strong positive correlation was observed between high-carbohydrate dietary patterns and OGTT levels (r = 0.938, p <0.01). Maternal age, pre-pregnancy body mass index (BMI), and family history of diabetes were significantly associated with GDM.
Conclusion GDM is highly prevalent and strongly associated with maternal age, obesity, family history of diabetes, and dietary patterns. Early screening and nutritional interventions are essential to reduce adverse maternal and fetal outcomes.
Keywords Gestational diabetes mellitus, OGTT, dietary patterns, pregnancy outcomes, BMI.

Background Pleural effusion (PE) is an abnormal buildup of fluid in the pleural space that typically results from excessive fluid production and/or reduced lymphatic absorption. It is still difficult to distinguish between benign and malignant exudative PE in clinical settings. Matrix metalloproteinase-9 (MMP-9) is linked to tumor aggressiveness and the potential for metastasis. It also plays a part in chronic inflammation. Numerous studies have shown that MMP-9 may be a useful marker to distinguish between benign and malignant exudative PE.
Objective To assess the diagnostic utility of tissue inhibitor of metalloproteinase-1 (TIMP-1) and MMP-9 in separating benign from malignant exudative PEs.
Methods A case-control study comprised 60 patients with malignant PEs and 60 patients with benign PEs who visited Al-Imamein Al-Kadhimein Medical City. All patients were examined and asked about their medical history, and they had measured the serum level of MMP-9 and TIMP-1 as markers for differentiation between benign and malignant exudative pleural effusion. It was determined by using quantitative sandwich (ELISA) technique.
Results The levels of MMP-9 and TIMP-1 in the serum of patients with malignant PE are higher than in benign PE, with a sensitivity of MMP-9 and TIMP-1 (60% and 56.67%), specificity (93.33% and 95%), AUC (0.774 and 0.782) and the optimal cutoff value was >11.784 ng/ml and 1089.19 pg/ml) respectively with p-value ˂0.001.
Conclusion MMP-9 and TIMP-1 might be valuable markers in differentiating benign from malignant PEs.
Keywords Exudative pleural effusion, lactate dehydrogenase, matrix metalloproteinase-9, tissue inhibitor metalloproteinase-1.

Background Bladder cancer (BC) is the tenth most prevalent cancer worldwide. The fibroblast growth factor receptor 3 (FGFR3) controls essential signaling pathways that govern several cellular processes, including proliferation and migration. Cytokeratin-19 (CYFRA21-1) is a protein belonging to the intermediate filament family that serves as an essential component of the cellular cytoskeleton. Although FGFR3 and CYFRA21-1 have been reported as prognostic factor in several malignancies, their association with muscle-invasive bladder cancers (MIBC) and non-muscle-invasive bladder cancers (NMIBC) has not yet been well-studied.
Objective To determine the association of FGFR3 and CYFRA21-1 levels with MIBC and NMIBC in a sample of the Iraqi population.
Methods This case-control study involved 40 NMIBC and 40 MIBC participants. The serum levels of FGFR3 and CYFRA21-1 were determined using the enzyme-linked immunosorbent assay (ELISA) technique.
Results In the MIBC patients' group, smoking was significantly more prevalent than in the NMIBC group. FGFR3 levels were significantly higher in NMIBC groups. While CYFRA21-1 significantly increased in MIBC groups. According to the logistic regression model, CYFRA21-1 levels are associated with an increased risk of developing MIBC disease by nearly 2-fold (odd ratio: 1.44, 95% confidence interval: 1.31-1.57, p value <0.001).
Conclusion CYFRA21-1 levels were associated with the development of MIBC and could be used as a predictive marker for the development of the disease in a sample of the Iraqi population.
Keywords Muscle invasive bladder cancer; non-muscle invasive bladder cancer; fibroblast growth factor 3 receptor; CYFRA21-1.

Background Early detection of renal stress in patients with inflammatory bowel disease (IBD) is crucial to prevent progression to overt kidney injury. The tissue inhibitor of metalloproteinases-2 (TIMP-2) * insulin-like growth factor binding protein 7 (IGFBP7) index has been proposed as a sensitive, non-invasive biomarker for subclinical renal involvement.
Objective To assess the utility of the TIMP-2 * IGFBP7 index as a marker of renal stress by comparing its levels between patients with IBD and healthy controls.
Methods A case-control study was conducted at the Department of Chemistry and Biochemistry, College of Medicine, Al-Nahrain University from December 2024 to March 2025, including 60 patients with IBD and 60 age- and sex-matched healthy individuals. Disease activity was assessed using the Mayo Score for ulcerative colitis and the Crohn’s disease activity index for Crohn’s disease. Serum levels of TIMP-2 and IGFBP7 were measured and compared between groups. Receiver operating characteristic analysis was performed to evaluate discriminative power.
Results TIMP-2 * IGFBP7 index was significantly higher in patients (0.207 ± 0.1166) compared to controls (0.16 ± 0.11, p = 0.0185). TIMP-2 alone showed a significant elevation, while IGFBP7 index did not differ between groups. Receiver operating characteristic analysis indicated moderate discriminative ability (area under curve = 0. 0.59). Patients with active disease demonstrated higher index levels than those in remission, suggesting a potential association with ongoing intestinal inflammation.
Conclusion The TIMP-2 * IGFBP7 index is non-invasive marker of early renal stress in patients with IBD. However, its moderate discriminative performance suggests that it should be interpreted in conjunction with other clinical and laboratory parameters.
Keywords Inflammatory bowel disease, subclinical kidney injury, tissue inhibitor of metalloproteinases-2, insulin-like growth factor binding protein 7, index

The tumor microenvironment is an ecological system made by malignant tumor cells. Important processes related to tumor development and survival are regulated by the tumor microenvironment. Lymphoma, especially the Hodgkin subtype, is one of many malignant tumors in which, many studies focused on the pathological role of tumor microenvironment components because Classic Hodgkin Lymphoma is characterized by a large number of reactive, non-neoplastic cells with few (<1%) malignant Reed-Sternberg cells in the tumor microenvironment. This narrative review will focus on the cellular composition of the Hodgkin lymphoma tumor microenvironment and their pathological interaction, which contributes to the pathogenesis of Hodgkin lymphoma, as well as various cytokines and chemokines secreted with characteristic immunohistochemistry. Lastly, this review will discuss the clinical relevance of the tumor microenvironment by illustrating drugs targeting the tumor microenvironment and their mechanism of action.
Keywords Hodgkin lymphoma, immunohistochemistry, Reed-Sternberg cells, tumor microenvironment

Background Retrograde intrarenal surgery (RIRS) has been expanded and now it is a common endourologic procedure used for treating renal stones with high success rates and is considered a safe and optimal treatment modality for renal stones of different sizes.
Objective To evaluate the safety and efficiency of RIRS technique without using ureteric access sheath in treating 1-2 cm renal stones.
Methods An observational study conducted at Al-Imamein Al-Kadhimein Medical City and Al-Salama Private Hospital for 21 patients (17 males and 4 female) who had 1-2 cm renal stones burden. All patients were presented 2 weeks prior to RIRS operation. Flexible ureterorenoscopy (f-URS) was performed under general or spinal anesthesia using laser lithotripsy. The patients were followed by ultrasound 1 month post-operatively to assess stone free rate.
Results The mean age of patients was 42.1±17.2 years (range 19-71 years). Males comprised the majority of cases (80.9%). The mean stone size was 1.5±0.35 cm with mean density of 854.7±232.3 Hounsfield units. The mean preoperative stent duration and operative time was 3.1±2.1 weeks and 54.1±14.6 minutes, respectively. The vast majority of patients (95.2%) were discharged from hospital within 24 hours after the procedure. After 1 month of follow up, success, as defined by no stone or clinically-insignificant stone fragment ≤4 mm, was achieved in 19 patients (90.5%), while residual stone fragment >4 mm was observed in two patients (9.5%). As high as 95.2% had only minor complications (grade I & II) in the form of transient hematuria (85.7%), transient fever relieved by antipyretics (19%). Two patients (9.5%) had urinary tract infection and 1 patient needed intervention under general anesthesia for ureteric stent replacement.
Conclusion The sheathless RIRS is an effective and safe procedure for management of 1-2 cm renal stones.
Keywords Sheathless retrograde intrarenal surgery, renal stone.