Al-Kindy College Medical Journal

rtificial intelligence has demonstrated remarkable promise for diagnosing current and future diseases. The use of Artificial intelligence in disease diagnosis is anticipated to increase with advancements in this field. Artificial intelligence -driven diagnostic tools can assist clinicians in diagnosing patients more quickly and accurately by interpreting images such as computed tomography scans, magnetic resonance imaging, and X-rays. Artificial intelligence algorithms may analyze and combine patient information, symptoms, and medical background. In the future, Artificial intelligence may use the massive volumes of medical data to assist in disease prediction and prevention. Moreover, Artificial intelligence may also help diagnose complex diseases by integrating environmental, lifestyle, and genetic factors. Artificial intelligence can optimize patient care outcomes by enhancing and improving diagnostic processes. It cannot, however, replace trained medical personnel. Data security, continuing model validation, and ethical considerations must all be taken into account in future research and the application of Artificial intelligence for disease diagnosis.

Fetal growth restriction is a significant contributor to fetal morbidity and mortality. In addition, there are heightened maternal risks associated with surgical operations and their accompanying dangers. Monitoring fetal development is a crucial objective of prenatal care and effective methods for early diagnosis of Fetal growth restriction, allowing prompt management and timely intervention to improve the outcomes. Screening for Fetal growth restriction can be achieved via many modalities; it can be medical, biochemical, or radiological. Some recommended combining more than one for better outcomes. Currently, there is inconsistency about the best method of Fetal growth restriction screening.
In this review, a comprehensive evaluation of the current radiological methods used for Fetal growth restriction, including serial growth scan, Doppler velocimetry, and biophysical profile is offered. Limitations, and potential enhancements area were specifically analyzing the effectiveness. Moreover, recently developed experimental radiological techniques were presented and how to integrate them into practice to enhance follow-up performance and results.

Background: Numerous studies have demonstrated that interleukin-6 (IL-6) and serum dehydroepiandrosterone sulfate levels are negatively correlated. Low DHEA-S levels may be associated with severe disease and clinically ailing patients in the context of infectious diseases. Individuals infected with Coronavirus disease who exhibit elevated levels of IL-6 may undergo a cytokine storm, which can result in severe manifestations and a dismal prognosis.

Objectives: To examine the relationship between DHEA-S and Il-6 in patients exhibiting severe manifestations of COVID-19.

Subjects and Methods: A case-control investigation with 79 patients, ranging in age from 36 to 74 years, who were admitted to the hospital due to severe COVID-19 disease. A control group of 72 ostensibly healthy individuals was also included in the study. Using the ELISA method, the concentrations of IL-6 and DHEA-S in the serum of both groups were determined. The statistical analyses involved the application of the Pearson correlation coefficient and the T-test. None of the authors present any conflicts of interest.

Results: With a Pearson correlation coefficient (r) of -0.8349, the study revealed a highly significant negative correlation (P < 0.0001) between the mean IL-6 level (64.369 pg/ml ± 2.6237) and the mean DHEA-S level (1.2728 ng/ml ± 1.7005) in the study group. An exceptionally significant statistical disparity was also identified when IL-6 and DHEA-S levels were compared between the study and control groups.

Conclusions: In severely infected COVID-19 patients inverse correlation between the levels of IL-6 and DHEA-S indicates that DHEA-S deficiency may play a role in cytokine storm formation for these patients.

Background: Pancreatic cancer is an aggressive malignancy with high mortality rate. Many morbidities associated with Whipple\\\\&#039;s procedure that endanger patients’ life which need updated surgical techniques to lower these morbidities. The aim of this study is to determine management modalities of pancreatic cancer and surgical outcomes of adding Braun\\\\&#039;s jejunojejunostomy to Whipple\\\\&#039;s procedure for reduction of postoperative risks in Sudanese patients to reach excellent surgical practice.

Subjects and Methods: This is a prospective-cohort study conducted during the period between January 2022 and July 2023 at Ibn Sina specialized hospital, Khartoum, Sudan, on sixty-three patients diagnosed with resectable pancreatic cancer. Addition of Braun’s jejunojejunostomy to elective open Whipple’s surgery was performed.

Results: Seventy-three percent of patients diagnosed with pancreatic cancer were males with the ratio (3:1). Patients’ distribution according to age ranged between 46 and 60 years representing (41.3%). The significant reported comorbidities that associated with PC were diabetes mellitus (30.2%) and businessmen (39.7%). Most of patients were lived in rural areas (57.1%). Abdominopelvic CT-scan revealed stage (II) of pancreatic cancer in (68.2%) of patients. The predominant morbidity after addition of Braun\\\\&#039;s jejunojejunostomy was wound infections noticed in (17.5%) of patients. Moreover, other complications were categorized as follows: pulmonary infections in (6.35 %) of cases, postoperative diabetes mellitus in (4.76 %) of cases, entero-cutaneous fistula in (4.76 %) of cases, delayed gastric emptying in (3.17%) of cases, biliary leak in (3.17%) of cases, (3.17%) of cases, pancreatic fistula in one case (1.58%), gastric outlet obstruction in one case (1.58%) and postoperative GIT bleeding in one case (1.58%). Postoperative hospital stay of patients were ranged between 8-15 days for (66.7%) of cases. The mortality rate was zero.

Conclusions: To reduce the rate of lethal surgical morbidities of Whipple\\\\&#039;s procedure, we recommend addition of Braun\\\\&#039;s jejunojejunostomy as useful technique. Moreover, it will potentially help in improving the quality of surgical practice and survival outcomes of patients who diagnosed with pancreatic cancer.

Background: Meteorin-like, is an innovative adipokine, that exhibits elevated expression within adipose tissue and confers advantageous effects upon energy metabolism. Nevertheless, current research pertaining to circulating Meteorin-like levels in obesity remains limited and incongruent. Thus, the objective of this study was to assess Metrnl serum concentrations among adult individuals with pre-diabetes and newly diagnosed type 2 diabetes mellitus and examine its correlation with glucose, HbA1C, and lipid metabolism.

Subjects and Methods: The case-control study incorporated 120 subjects, who were then segregated into three distinct groups, namely control (n = 60), pre-diabetes (n = 30), and newly diagnosed type 2 diabetes mellitus patient’s (n = 30). The quantification of serum Meteorin-like concentrations was undertaken by employing an enzyme-linked immunosorbent assay.

Results: The data of the current study demonstrates a significant increase in the concentration of Meteorin-like protein in individuals with newly diagnosed type 2 diabetes mellitus patients as compared to those without the condition (p ≤ 0.001). A positive correlation between METRNL and various metabolic parameters, such as BMI, FBS, HbA1C, TC, TG, and LDL-C, was observed using the Pearson correlation coefficient. Conversely, a negative correlation was observed between METRNL and HDL-C as well as VLDL-C.

Conclusions: The present study has revealed that serum Meteorin-like levels were found to be elevated in both individuals having newly diagnosed type 2 diabetes mellitus patients and pre-diabetes. Furthermore, the association between serum Meteorin-like levels and lipid profile was observed to be dependent. These findings strongly suggest that the modification of circulating Meteorin-like levels may serve as a promising biomarker for the prognosis of type 2 diabetes mellitus.

Background: Lower gastrointestinal bleeding is one of the common problems seen worldwide, could be serious and occur at any age. Several studies conducted all over the world verified that there were variations in frequencies of etiologies of bleeding per rectum in their population, however, in the Middle East and Asia, the etiology of rectal bleeding differs from the West.

Objectives: To assess the causes of bleeding per rectum and to find if there is an association between rectal bleeding and various variables.

Subjects and methods: This was a retrospective cross-sectional study of 120 patients with bleeding per rectum for one year were studied in Al Ramadi Teaching Hospital, Ramadi City, Iraq. The patients underwent a full history and thorough physical examination. In all cases, initial digital rectal examination and proctoscopy were performed. Patients presented with a noticeable diagnosis of massive bleeding from the rectum were not included in our study.

Results: There were 84 males (64%) with male to female ratio of 2.33: 1. The median age of patients was 38 years (age ranged from 15-81 years). The main age group was ≤ 50 years (n = 95, 79.2%). The hemorrhoid was the most common cause of rectal bleeding (n = 95, 79.2%). The second cause was anal fissure which was found in 26 cases (21.65 %). Colorectal carcinoma was seen in 14 patients (11.67%), and most of them (n = 13) were above 50 years of age. There was no significant association between the rectal bleeding causes and the gender. However, there were highly significant differences between the causes and the age and bowel habits of the patients (P-value = 0.0001).

Conclusion: Hemorrhoids were the most prevalent cause of rectal bleeding. The patient's age and bowel habit might be determined the cause of bleeding per rectum.

Background: In young adults, multiple sclerosis is a prevalent chronic inflammatory demyelinating condition. It is characterized by white matter affection, but many individuals also have significant gray matter involvement. A double inversion recovery pulse pattern was recently proposed to improve the detectability of multiple sclerosis lesions.

Objectives: To evaluate the diagnostic value of double inversion recovery sequence in the detection of cortical and white matter multiple sclerosis plaques in different brain anatomical locations.

Subjects and methods: A total of 37 patients with an established diagnosis of multiple sclerosis were included in this cross-sectional study. Brain MRI was done using double inversion recovery, T2 and FLAIR sequences. The number of lesions was counted and compared in the three sequences.

Results: Dual Inversion Recovery sequence was highly significant and superior to both T2 and FLAIR sequences (P < 0.001) in depicting the lesions regardless of anatomical distribution. Dual Inversion Recovery was significantly superior to T2 (P =<0.001) and FLAIR (P =<0.001) in detecting lesions in cortical and juxtacortical. However, Dual Inversion Recovery shows less periventricular and deep white matter lesions in comparison to T2 and FLAIR sequences.

Conclusion: The Dual Inversion Recovery sequence detected more multiple sclerosis lesions in cortical, subcortical and infratentorial than the traditional T2W and FLAIR sequences. It also demonstrated greater delineation between the white matter, grey matter, and multiple sclerosis lesions, which became more easily visualized

Background: Background oral hygiene means the degree of cleanliness of the oral cavity. Good oral hygiene is necessary to prevent common oral diseases.

Objectives: to evaluate the relation of some salivary variables to oral hygiene and gingival health conditions among Iraqi boxers.

Subjects and Methods: There was a cross-sectional comparative study. The total sample consisted of 80 males, including 40 male boxing players with weights ranging from (46-60 kg) attending different sports clubs for boxers in Baghdad (study group). And 40 male school students from some schools in Baghdad (comparative groups), ages ranging from (15-16) years old. This study was conducted from January-2022 to the end of May -2022. The unstimulated salivary analysis included samples collected flow rate, pH, and Minerals (calcium and phosphate) and salivary immunoglobulin A. After that, the clinical Assessment of gingival disease, calculus and plaque were assessed.

Results: The results demonstrate that plaque and calculus are higher in the study group than in the control with a significant difference in plaque index and no significant difference in calculus. Concerning correlations, a weak negative significant correlation between flow rate and plaque index in control weakens the negative significance between Gingival index and PH, while other results are insignificant. Also, Findings show a weak negative significant correlation between plaque index and salivary IgA and a weak negative significant correlation between Gingival index and calcium and phosphorous in control.

Conclusions: In conclusion, boxer players were associated with high gingival index, calculus and plaque index compared to control groups.

Background: Assessment of communicable diseases surveillance officers is one of the important aspects of the detection of obstacles that prevent the development of surveillance system, which would certainly affect their control programs.

Objectives: To assess the Competencies of communicable diseases' surveillance officers in all Iraqi provinces

Subjects and Methods: A cross sectional study from the15th March to 30th September 2019 in which all the communicable diseases' surveillance officers (136) that are employed by Ministry of Health all over Iraq were included. A structured questionnaire developed by the researcher and filled by them. The questionnaire form gathered demographic data, service characteristics and status of competencies including basic epidemiology, biostatistics, surveillance, outbreak investigation, rapid response to health incidence and developing scientific reports.

Results: The response rate was 85.3%, about half of surveillance officers was responsible for less than 10 Primary Health Care Centre. More than half of them (55.3%) were responsible for 1-2 hospitals. Their age ranged between 21 and 62 years and the males constituted more than three quarters (78.4%) of the study sample, Diploma was the highest educational certificate. 15.6% of the sample did not attend any training activity. Cholera has been the most frequently reported incident (53.8%).

Conclusions: The surveillance system in Iraq at district level was operated mainly by low qualified and under-trained health personnel. There is inequity in distribution of workload and training sessions between surveillance officers in health offices, therefore redistribution is recommended. Supporting continuous training programs with increase incentives.

Background: One of the most well-known diabetic microvascular consequences is diabetic nephropathy, which affects 40 percent of people with diabetes mellitus type 2. It develops into end stage renal disease, and diabetes biomarkers can be used as a predictor.

Objectives: This study aimed to determine the concentration levels of serum Beta Trace Protein and serum Cystatin C in all stages of diabetic nephropathy disease.

Subjects And Methods: A Case- control study included 120 Persons (30-persons appeared healthy as control and 90 patients proved with T2DM of both gender (64 males and 56 females), split into four groups by using urinary micro-albumin and albumin to creatinine ratio (UACR) as following: group-I: includes 30persons as a healthy control (UACR < 30 mg/g creatinine). Group-II: includes 30patients with type2 DM normoalbuminuria (UACR < 30 mg/g creatinine) as a positive control. Group-III: includes 30 patients with type 2 DM microalbuminuria (UACR 30 – 300 mg/g creatinine). Group-IV: includes 30 patientsا with type 2 DM macroalbuminuria (UACR˃ 300 mg/g creatinine), all groups with ages ranges between (40-69) years. in allا groups, Beta Trace Protein and Cystatin C quantitative enzyme immunoassay (double-antibody sandwich), calculated in serum and both biomarkers using the same methods.

Results: Patients with diabetes have statistically substantially increased blood levels of Beta trace protein and Cystatin C. with macro-albuminuria groups in comparison to micro-albuminuria, normo-albuminuria and healthy control in addition, the mean for the micro-albuminuria group was greater than for the healthy control and normo-albuminuria groups.

Conclusion: A rise in blood Beta trace protein and Cystatin C levels in the early nephropathy group microalbuminuria, which may be used as a predictor for early diagnosis of diabetic nephropathy.

Background: Coronavirus Disease 2019 (COVID-19) is multisystemic disorder. It uses angiotensin converting enzyme 2 (ACE2) to gain access to human cells. The ACE2 receptor is present on cell types, one of them is pancreatic cell.

This study aimed to assess the impact of COVID 19 infection on severity of acute pancreatitis (AP).

Subjects and Methods: A prospective cohort study that was conducted at a major teaching hospital. The study group included all cases of AP with COVID 19. Medical records of randomly selected fifty cases of AP presented one year before COVID 19 pandemic with matching months of the year were considered as control. A comparison of the effect of COVID 19 on the severity of AP was done by measuring Glasgow and revised Atlanta scores.

Results: 37 cases of COVID 19 patients developed AP in this study. The serum calcium, and albumin were lower, while blood urea, sugar, and Glasgow score all were higher in cases of COVID 19 than control. Follow up, showed that 17 (19.5%) of the cases developed severe pancreatitis, 76.5% of severe cases of AP had COVID 19 on comparison to control. COVID 19 is an independent predictor for severity of AP.

Conclusions: COVID 19 is an independent predictor for severity of AP. More directed care to the cases of COVID 19 with superimposed AP, as they prone to develop severe form. Future studies to examine the effect of COVID 19 antiviral therapy on the severity of AP is recommended.

Background: Different proposed mechanisms for insulin resistance have been put forth to understand the relationship and changes in insulin resistance. Looking at the levels of insulin, the neurotransmitter gamma-aminobutyric acid, glucose transport type 4, and the newly discovered enzyme insulin regulated aminopeptidase may provide an integrated perspective on insulin resistance.

Objectives: To study the role of serum gamma-aminobutyric acid and insulin regulated aminopeptidase enzyme levels in pathogenesis of insulin resistance and translocation of glucose transport type 4 in patients with type2 diabetes mellitus and pre-diabetes ones.

Subjects and methods: Ninety individuals were divided into three age- and BMI matched groups (diabetics, prediabetics, healthy) were assessed for glycated hemoglobin (turbidometry method), fasting serum glucose (colorimetric method), serum insulin (electrochemiluminescence immunoassay method), homeostatic model assessment for insulin resistance, serum gamma-aminobutyric acid, glucose transporter type 4, and insulin regulated aminopeptidase measured by the sandwich ELISA method. The cut-off value was adopted according to the World Health Organization, individuals with their fasting serum glucose lower than 110 mg/ml, and glycated hemoglobin level not more than 5.7 % are considered healthy individuals.

Result: The mean (±SD) values of serum insulin regulated aminopeptidase, gamma-aminobutyric acid and glucose transport type 4 showed significantly lower levels with greater increases in insulin resistance, represented by the significant decrease in diabetics group who have high insulin resistance compared with pre-diabetics and healthy individuals’ groups (p < 0.05). They also significantly decrease in individuals with the pre-diabetic stage compared to healthy individuals without insulin resistance (p < 0.05). Significant negative correlations were found between HOMA-IR values and each of GABA, IRAP, and GLUT4.

Conclusion: Decreasing gamma-aminobutyric acid may promote insulin resistance and prediabetes/diabetes onset. Decreased insulin regulated aminopeptidase levels suggest a role alongside glucose transport type 4 in glucose uptake, allowing screening for prediabetes risk.

Primary Non-Hodgkin’s Lymphoma (NHL) of the thyroid gland is a rare disease comprising of 2.5 - 5% of all thyroid malignancies. It has the female preponderance, found mostly in 6th or 7th decade. The most common sub type is diffuse large B cell lymphoma (DLBCL). Ultrasonography of the neck and thyroid gland along with Fine Needle Aspiration Cytology (FNAC) are essential tools for early diagnosis of this disease. The main treatment of choice is chemotherapy following this radiotherapy. The prognosis of the patients mainly depended upon the size and grade of tumor, stage of disease and patient’s age. In this study, we report a case of a 73-year-old women rapidly growing neck mass deteriorated quickly within 10 days. The thyroid gland invades and compresses the trachea led to succumb early.

The musculocutaneous nerve is important in the upper extremity because it provides motor innervation to the musculature of the anterior arm region and sensory innervation to the skin on the lateral side of the forearm region. During the dissection of approximately 74 aged male cadaver for the 2021-2022 academic year at the Department of Anatomy, Faculty of Medicine, International University of Africa, Sudan. Considerable variation was present; the musculocutaneous nerve was observed to be absent in both upper extremities. The median nerve replaces the musculocutaneous nerve innervation’s role on both sides except for the coracobrachialis muscle on the right side. A direct branch from the lateral cord innervated it. Reporting these variations has a critical impact on many surgical and clinical procedures.

As dedicated readers of Al-Kindy College Medical Journal, we are writing to highlight a critical and profoundly concerning matter that requires urgent research attention: the alarming surge in suicidal ideation among users of Iraqi crystal methamphetamine. Expert psychiatrists at Baghdad Medical City and Ibn-Rushd Psychiatry Teaching Hospital have observed this worrisome trend. In tandem, previous studies regarding suicidal ideation among Iraqi medical students have revealed an unexpectedly high prevalence (64.9%). The escalating global trend in amphetamine-type stimulant (ATS) abuse and the distinct challenges posed by crystal meth addiction necessitate comprehensive investigation into the resultant psychological toll.
According to the World Drug Report 2022, amphetamines' popularity and use, including methamphetamine, have surged globally, ranking as the second most commonly abused illicit substance after cannabis. This rise in ATS abuse has not spared Iraq, where illicit methamphetamine and captagon use have dramatically increased, notably in Al-Basrah governorate. The transition from opioid-related overdose deaths to the abuse of stimulants like methamphetamine signifies the urgency for novel strategies to monitor and combat this growing public health concern. As methamphetamine misuse becomes more prevalent, it is imperative to prioritize research that explores the mental health consequences of its abuse.