Al-Qadisiyah Medical Journal

Background: Despite the total absence of symptoms from patients with confirmed recovery (negative PCR), significant number of patients continues to suffer from symptoms for a long period of time. Actually 55 long term effects have been reported by a recent meta-analysis. There is generally poverty in Iraqi literatures dealing with the problem of long term post-COVID manifestation despite the clinical experience of such problem in Iraq.
Aim of study: The current study was designed and conducted in order to evaluate post-COVID-19 long term clinical manifestation in a sample of Iraqi patients.
Patients and methods: The current cross sectional study was carried out in Al-Diwaniyah Province, Iraq in the department of Medicine/ Al-Diwaniyah Teaching hospital in addition to a private clinic of medicine form April 2021 to January 2022. Ethical consideration included verbal consent being obtained from each participant, the explanation of the objectives behind such study for all enrolled patients and approval being issued by the ethical approval committee belonging to the teaching hospital.
Results: The most common long term post COVID-19 symptom was fatigue which was recorded in 120 (80.0 %), followed by shortness of breath in 78 (52.0 %), dry irritant cough in 48 (32.0 %) and then chest pain in 24 (16.0 %). These long term manifestations were significantly more encountered in severe cases than in mild to moderate cases (p < 0.05). It was commonly to see patients with more than one symptom and most frequently fatigue with other symptom.
Conclusion: The most common long term post COVID-19 symptoms in order of frequency were fatigue, shortness of breath, dry irritant cough and chest pain.

The objective of study is to evaluate the salivary levels of (MMP-9) in polycystic ovarian syndrome women with inflammation of periodontium in comparison to healthy control. The present study included a total of 85 subjects with an age range of 20 to 40 years. The current study included a control group (n = 10), patients suffering from periodontitis (n = 25), patients suffering from polycystic ovary syndrome (PCOS) (n= 25) and patients suffering from combined pathologies periodontitis and PCOS (n = 25). The median value of plaque index (PI) was highest in periodontitis group followed by combined group then by PCOS group and lastly by groups (p< 0.001). The results showed that control and PCOS groups had the lowest bleeding on probing median level, but it was significantly lower than that of periodontitis and combined groups (p< 0.001). On the other hand, the level in the PCOS group was significantly lower than that of periodontitis and combined groups (p< 0.001). The median level of PPD of periodontitis group was significantly lower in periodontitis group than that of combined group (p< 0.001). Intra-group comparison revealed that the median levels of MMP-9 in descending order was as following: combined group then PCOS then periodontitis and lastly control group. Kruskal Wallis test demonstrated high significance difference (p < 0.001). PCOS is associated with more severe periodontal inflammation and tissue destruction in comparison with non-PCOS women. Salivary matrix metalloproteinase-9 is useful in predicting periodontitis in women with or without PCOS.

Diabetes in pregnant woman, is a common medical complication which can lead to significant neonatal morbidities by causing infant hypoglycemia. The aim of this work is to study the neonatal hypoglycemia in IDMs in a tertiary care hospital. A cross‑sectional study was done in postnatal ward in Al Qadisiyah Maternity and Children hospital from February to August 2020. All IDMs delivered during this period who admitted to postnatal ward were included in this study. The results were compared between the normoglycemic and hypoglycemic IDMs and also between gestational diabetic mothers (GDM) and pre‑GDM in hypoglycemic group using Chi‑square test and Fisher’s exact test. The total number of IDMs who included in this study was 100 cases. Hypoglycemia occur in 74% of IDMs. 44% infants of GDM and 63% infants of pre‑GDM developed hypoglycemia, i.e. it was more in infants of pre‑GDM. Large for gestational age (LGA) were strongly associated with hypoglycemia (P = 0.0001, highly significant). 80.8% of hypoglycemic IDMs developed hypoglycemia during the first 6 h of age (P‑value 0.00001, highly significant) and most of them (41.8%) developed it at 2 h of age. So that, early diagnosis and appropriate treatment for this critical problem are needed.

Antibiotic abuse and misuse, as well as societal and economic factors, have increased the growth of antibiotic-resistant bacteria in recent decades, rendering the medical treatment ineffective. Antimicrobial resistance kills at least 700,000 people per year around the world. Thus , the aim of present study was to evaluate the use cell wall lysis protein (endolysin) and determine if they could replace or enhancing the action of some of the current antibiotics used in treating some bacterial infections.
Different cӏinical specimens had been coӏlected from patients and used to isolate and identify the bacterial isolates by using cultural , biochemical tests API systems and vitek-2 system followed by testing their resistance to antibiotics using antibiotic susceptibility test ,then estimation the gene expression of efflux pump resistance genes in three groups include tested against antibiotic alone ,tested against endolysin alone ,and against combination of antibiotic with prepared endolysin using real-time PCR.
The resuӏts of antimicrobial activity of synthetic phage encoded endolysin (1 mg/ml) against MDR Enterobacter-spp and Pseudomonas-spp showed high efficient(p˂0.05) on the expression of efflux pump genes .On the other hand the activity of endolysin along with antibiotic showed a significant(p˂0.05) decrease in the expression of efflux pump genes. The results of gene expression for efflux pump resistance genes of Pseudomonas aeruginosa and Enterobacter cloacae gave high decrease in the expression when using endolysin, and when using endolysin with antibiotic compared with control isolates
The synthetic endolysin revealed a significant effect as antimicrobial agent against MDR isolates and the effect of combination therapy of endolysin and antibiotic was synergistic effect and the expression of efflux pump genes were significantly decrease.

Legionella pneumophila gram-negative, aerobic bacilli that do not form spores, are capsule-free, and possess the enzymes catalase and oxidase ,belong to genus legionella which single genus in legonellacea family the genus legionella consist of 53 spices and 70 serogroup. Legionella ubiquite and inhabits nature water such as rivers and lacks and artificial water also moist soil. infection occur when human inhaled aerosol contained pathogen or aspiration .Person to person not transmitted after inhaled bacteria invade alveolar macrophage and other cells such as monocytes by process know coiling phagocytosis. The current study aimed to detect Legionella pneumophila and identification of DNA sequencing with Studying the phylogenetic tree . Sixty samples of sputum were obtained from qRT - PCR confirmed COVID-19 patients .DNA extracted using a specific kit, and PCR product for 16SrRNA gene were sequenced in Macrogen Company of korea ,Sample were sent through Company of Iraq biotechnology . From sixty patients investigated for COVID-19 infection ,it was found that460( 6.6 %) had co-infection with legionella pneumophila where local legionella pneumophila strains were diagnosis that recorded under accession number ID; ON399095, ON399096 ON399097and ON399098with NCBI-Blast legionella pneumophila by using (MEGA X program).

Background: Folate deficiency has been found in Beta-thalassemia major (β-TM). However, its impact with mitochondria DNA damage status has not been addressed. The study aimed to investigate the serum folic acid in β-TM patients and to determine an association between serum FA deficiency and mitochondria DNA damage.
Methods: A total of 80 patients who were diagnosed with β-TM patients were enrolled in the study and divided into two groups:45 β-TM who were not receiving folic acid (FA)and 35 β-TM who were receiving folic acid 5 mg/day (β-TM +FA), 40 healthy subjects were consider as control. A blood sample (5 ml) was taken from all study groups. 1 ml was used for the complete blood count (CBC) Neutrophils/lymphocytes ratio analysis and mtDNA damage by conventional PCR. Serum was separated from other 4 ml of blood by centrifugation for folic acid analysis by immunochromatographic assay. serum Ferritin was measured by an enzyme-linked fluorescence immunoassay.
Results: the results were demonstrated a significant decrease in serum folic acid (P < 0.05) in both patient’s groups as compared with control (P<0.05). Serum ferritin levels increased significantly in both patient groups as compared with control. The results of conventional PCR for mtDNA damage showed mtDNA damage in β-TM compared to control.
Conclusion: The folic acid deficiency and iron overload due to repeated blood transfusion in patients with β-TM may cause more mtDNA damage.

background
Dilated cardiomyopathy (DCM) is characterized by a dilated left ventricle with systolic dysfunction that is not caused by ischemic or valvular heart disease.
Left atrial (LA) size is a predictor of adverse cardiovascular outcome both in the general population and in selected clinical conditions. The left atrium modulates left ventricular filling through three components: a reservoir phase during systole, a conduit phase during diastole and an active contractile component during late diastole. During diastole the LA is directly exposed to the left ventricular (LV) cavity pressure. With progressive impairment of LV diastolic function, and the consequent increase in LV end-diastolic pressure, the LA increases in size with a reduction of both the LA passive emptying and conduit functions, with a compensatory increase of the active LA emptying, at least in the first stages of LV diastolic dysfunction.
Methods
The study included 50 patients with the diagnosis of DCM (NYHA class I to IV and normal sinus rhythm) and 10 healthy control subjects. Two-dimensional (2D) conventional echocardiography was performed to assess LV dimensions, volumes, ejection fraction (EF), fractional shortening (FS), wall thickness, LA diameter, LA area, Mitral annular plane systolic excursion (MAPSE). Mitral E-wave (E) and A-wave (A) velocities, as well as their ratio (E/A), E’ wave and E/E’ ratio were measured. LA volumes including maximum (at the end of systole), minimum (at the end of diastole) and pre A LA volumes (before atrial contraction) were measured using the modified Simpson method. LA emptying volume (LAEV) and emptying fraction (LAEF), passive emptying volume (LAPEV) and passive emptying fraction (LAPEF) and active emptying volume (LAAEV) and active emptying fraction (LAAEF) were calculated in apical four-chamber view. We measured the peak LA strain, and strain rate during systole and late diastole using speckle tracking echocardiography in both apical four-chamber and apical two-chamber views.
Results
Patients with DCM showed a significant increase in LA volumes (Maximum, Minimum and Pre-A volumes) compared with the control group. LAEV and LAEF (reservoir function), LAPEV and LAPEF (conduit function) were significantly lower in patients with DCM compared to normal subjects. No significant difference was observed in LAAEV and LAAEF (pump function) between patients and controls. LA strain and LA strain rate and late diastolic strain rate values were decreased in patients with DCM. A negative correlation between LA strain measured in septal, lateral, anterior, and inferior walls and NYH class was observed. Only LAEV and LAEF (reservoir function) was correlated with NYHA class.
Conclusion
In patients with DCM, LA volumes, LA reservoir, Conduit, and pump functions were significantly reduced. Atrial myocardial deformation properties, assessed by strain and strain rate imaging, are abnormal in patients with DCM. The severity of
HF symptoms correlated positively with the LA reservoir function and negatively with the LA strain parameters. These findings suggest that LA systolic and diastolic dysfunction assessed either by conventional echocardiography or speckle tracking imaging could be related to reduced functional capacity in patients with DCM.

The reactive signaling molecule sphingosine-1-phosphate (S1P) plays a vital function in many biological processes that encompass cell development. In addition, it has been linked to bone resorption and formation. Based on its biological effects on osteoclastic and osteoblastic cells and immune cells, S1P has recently been discovered as a mediator and biomarker in inflammatory bone disorders such as osteoporosis and inflammatory osteolysis. Sphingosine-1-phosphate (S1P) may play a role in developing periodontitis, an inflammatory disorder that destroys bone. This study aims to evaluate the salivary level of S1P in periodontitis. The study sample consisted of 70 participants, both males and females. It was divided into three groups: the first group, the Healthy Control group (20 Subjects); the second group, Periodontitis Stage II (25 Subjects); and the third group, Periodontitis Stage III (25 Subjects). Clinical periodontal characteristics were evaluated after entire, unstimulated saliva samples were collected from all individuals (plaque index, probing pocket depth, bleeding on probing, and clinical attachment level). As a biomarker, the amount of S1P in the saliva was measured using an enzyme-linked immunosorbent assay (ELISA). This study demonstrated a statistically significant correlation between higher mean S1P levels and higher periodontitis severity. The study demonstrated that the salivary S1P level could help to monitor periodontal disease progression.

Background:
Paranasal sinus diseases are one of the communest causes of patients visit to an Otolaryngologist. The symptoms are multiple and nonspecific, while inspection is often limited as sinuses cannot be examined directly. Anterior rhinoscopy gives little information about middle meatus and osteomeatal unit.
Objective: The study is carried out with an objective to compare the CT scan findings and diagnostic endoscopic findings with operative nasal endoscopy findings in patients with chronic rhinosinusits.
Methods: A cross sectional study dealt with 36 patients with chronic rhinosinusitis not responding to routine medical lines of treatment were selected and operated after being thoroughly investigated by means of CT scan and nasal endoscopy. All patients underwent bilateral surgery, a total of 72 events were carried out. Verdicts of both the CT scan as well as analytic nasal endoscopy were correlated with operative findings.
Results: In the current study, a high association was found between both the modalities of assessment i.e CT scan and operative nasal endoscopy. Indicative nasal endoscopy is found to be highly specific investigatory modality with mean specificity (87.5%), while it’s mean sensitivity(79.5%).Whereas CT-scan was highly sensitive (92.5%), while it’s specificity was (84.18%).
Conclusion : Both nasal endoscopy and CT-scan are objective measures that can increase the accuracy of chronic rhinosinusitis diagnosis. The use of symptoms, CT-scan, and nasal endoscopy may prove to be the most accurate approach for reaching the diagnosis of chronic rhinosinusitis.

Background: Type 1 diabetes mellitus(T1D) is due to β-cells destruction, usually leading to absolute insulin deficiency.T1D is the most common type of diabetes mellitus in children. The occurrence of T1D has been increasing worldwide. The International Diabetes Federation (IDF) has announced that there are 78,000 children in the world develop T1D every year. As of 2017, an estimated 1.1 million of children and adolescents have T1D worldwide, and 132.6 hundred of newly diagnosed cases are reported each year. Methods: Overall, 51 samples were collected from patients both genders .The patients composed of (51), (23) of them are males and (28) females with age range 2-12 years old, were seen in Endocrinology and Diabetes Center in Samawa.Those sample were diagnosed clinically by HBA1C to Diagnosis of the type diabetic by cobas c111 and evaluate vitamin- D by cobas e411 technique in diabetic patients. Further, groups consist of 50 samples were collected from apparently healthy individuals (25 males and 25 female) without any history of chronic disease. Result: There was no significant difference in mean age between patients group and control group, 8.43 ± 3.13 years versus 8.12 ±2.69 years, respectively (p = 0.594). The proportion of males with type 1 diabetes mellitus was 45.1 % while that of girls was 54.9 % and there was no significant difference in frequency distribution according to gender between type 1 diabetes mellitus group and control group (p = 0.622). There was no significant difference in mean age between boys and girls with type 1 DM (p = 0.785). The mean HbA1c% of patients with type 1 diabetes mellitus was significantly higher than that of control group, 9.75 ±0.80 % versus 4.64 ±0.40 %, respectively (p < 0.001). The mean serum vitamin –D in our study was significantly lower in patients with type 1 DM in comparison with control group, 11.14 ±4.65 ng/ml versus 17.16 ±6.39 ng/ml, respectively (p < 0.001). Diabetic patients with vitamin deficiency (< 20 ng/ml) accounted for 94.1 %, while control subjects accounted for 64 %, therefore, the prevalence rate of vitamin D deficiency in patients with type DM is higher than that in control group significantly (p < 0.001).

Background: Pseudomonas aeruginosa is an opportunistic human pathogen cause most healthcare-associated infections and is considered a paradigm of antibiotic resistance.
Objective: The present study aimed to determine the antibiogram profile of multidrug-resistant isolates of P. aeruginosa isolates collected from Baghdad hospitals.
Methods: In a cross-sectional manner, P. aeruginosa isolates were collected from various clinical samples between December 2021 to June 2022. were defined as those resistant to at least one anti-pseudomonal agent in three or more classes. The Kirby-Bauer disk diffusion method tested one hundred isolates of P. aeruginosa for susceptibility to 24 anti-pseudomonal agents. Multiple-resistant isolates.
Results: The results showed that out of 2000 specimens, 100 isolates of P. aeruginosa were recovered and accounted for 5% of hospitalized infection isolates. The results showed high resistance against most antipseudomonal drugs. The results showed high resistance against Amikacine 77%, Ciprofloxacin 65%, Gentamicin 80%, Meropenem 82%, Levofloxacin 77%, Ofloxacin 78%, Tobramycin 80%
Conclusion: the present study proved that P. aeruginosa isolated had carbapenem-resistant genes that strongly correlated with antibiotic resistance according to phenotypic and genotypic characterization.