Baghdad Teaching Hospital Research Articles

Study of Irisin Level Hormone and Some Biochemical Parameters in Iraqi Diabetic Type 2 without Hypothyroidism

This case-control study's purpose is to investigate serum irisin. levels and their role in people with type 2 diabetes mellitus (T2DM) who don't have hypothyroidism. A total of 60 patients with T2DM were chosen as the) case group (based on the grounds for inclusion and exclusion, and a 1:1 ratio was determined based on the patients' inclusion rate. This cohort, which was created at the Medical City / Baghdad Teaching Hospital, consisted of adults aged 30 to 60. The control group consisted of 60 healthy volunteers of the same gender and age. Clinical data on the participants was collected in order to determine their medical history, BMI, fasting blood glucose (FBS), hemoglobin (HbA1c), insulin, and serum lipid levels. An enzyme-linked immunosorbent test was used to measure the amount of irisin in the blood (ELISA). The data was analyzed using SPSS 23.0 software. only one variable. The amount of irisin in the T2DM group was substantially higher than in the control group (12.77±2.236 ng /mL and 4.121±0.308 ng /mL, respectively, according to single factor analysis. BMI, fasting blood sugar (FBS), HbA1c, insulin, total cholesterol (TC), and triglyceride (TG) levels were all higher with statistically significant differences, the T2DM group outperformed the control group. Keywords: Irisin; Type 2 diabetic mellitus

Assessment of osteoprotegerin as bone marker in chronic kidney disease patients

Chronic kidney disease is a chronic impairment in the structure or function of the kidney. (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3 months.Renal osteodystrophy is a change in bone morphology in CKD patients, and it is one marker of the skeletal component of the systemic condition of chronic kidney disease mineral bone disease (CKD-MBD) that can be quantified using histomorphometry on bone biopsies chronic kidney disease mineral bone disease (CKD-MBD) defines a complex syndrome of renal osteodystrophy, mineral disorders and cardiovascular disease in patients with chronic kidney disease. The study was a case –control design which conducted in Dialysis Unit in AL-Mahmoodia General Hospital and ALyarmook Teaching Hospital in Baghdad. This study was carried out in private laboratories between September 2021to march 2022. In this investigation,the total subjects were 90, the patient group was Consist of 45 Hemodialysis (HD) (CKD) ( 18 males and 27 females).

A Case-control Study to Determine Metalloproteinase-12 and Lysyl Oxidase Levels in Iraqi women with Osteoporosis

The current study aimed to ascertain the levels of matrix metalloproteinase-12 (MMP-12) and Lysyl oxidase (LOX) in osteoporosis patients and their correlation with alkaline phosphatase (ALP), magnesium (Mg), vitamin D (Vit D), calcium (Ca), phosphorus (P), and T-score %. 110 participants recruited from Baghdad Teaching Hospital, Iraq, were enrolled in this study from November 2019 to March 2020). The participants were divided into two groups: Group 1 comprised 60 osteoporotic women and group 2 consisted of 50 healthy women. (MMP and LOX) were estimated using a quantitative enzyme-linked immunosorbent assay (ELISA. The results showed significant differences in serum LOX, age, ALP, Mg, and T-score %, while no significant differences in serum MMP-12, Vit D, Ca, P, and body mass index (BMI) were noticed in osteoporosis patients as compared to the control group. The correlation analysis showed a significant correlation of T-score with Vit D and MMP12 in osteoporosis patients, when a t-test was conducted with the two participant groups. Moreover, no significant correlation was found between the T-score result and LOX, Mg, Ca, and P, which indicated that the relation was not linear because the change in the variables neither increased nor decreased systematically compared to the T-score. LOX, ALP, and Mg were significantly associated with osteoporosis patients, while MMP12 and Vit D were found to affect the density of the bone. Therefore, the studied parameters may be used in the form of a bone mineral density decline index.

Risk factors for iron-deficiency anemia in infants aged 6-12month old

Background: Even though the frequency of iron deficient anemia has declined in the last years, It has been the most prevalent nutritional deficit in the world. Objective: To evaluate the prevalence and etiology due to iron shortage anemia in 6- to 12-month-old babies. Patients and method: This study is a hospitalized-based study performed in a central teaching hospital in Baghdad, from 1st March 2021 to 1st February 2022, to assess the incidence also underlying causes of IDA in infants between six months and 12m of age. full history was taken from the mothers, an assessment of nutritional status done to all cases. Infants (n=133) had their mean corpuscular volume, hemoglobin, Evaluation of serum ferritin, serum iron, also total iron-binding capability. Anemia was defined as hemoglobin levels below 10.5 g/L, serum ferritin levels below 12µg/L, then iron deficiency as ferritin levels also mean corpuscular volume below 74 fL, respectively, or serum iron below 9µmol/l and TIBC more than 50µmol/l. Results: Iron deficiency prevalence was 27,3 percent and iron deficiency anemia prevalence were 24,2 percent. Less than 3000 grams at birth was the most significant risk factor for iron insufficiency (P<0.0001).

Investigation of the potential association between the levels of global DNA methylation, vitamin B12 and type 2 diabetes in Iraqi patients

Type 2 diabetes mellitus (T2DM) is an epidemic metabolic disorder that has life threatening health complications if left undetected and untreated. Understanding its molecular landscape alterations, especially DNA methylation that regulates the genome transcription activity, would aid with the prevention and management of this disease. This study was set to investigate the global DNA methylations (assessed by measuring 5mC level), along with other disease-related clinical features, including body mass index (BMI) and serum vitamin B12, in T2DM patients in comparison to healthy controls. One hundred subjects (70 T2DM patients and 30 healthy controls) who attended Baghdad Teaching Hospital/ Department of Consulting Clinic - Endocrinology and Diabetes Consultant and the National Diabetes Center, Al-Mustansiriyah University, Baghdad, Iraq. Global DNA methylation levels were assessed using Methyl flash ™ Global DNA methylation (5-mC) ELISA Easy Kits. The results showed significant increase (P=0.0018) in the 5mC level of T2DM patients in comparison to the healthy subjects (0.578±0.208 vs. 0.422±0.110, respectively).

Impact of An Instructional Program on Hypothyroidism Patients’ Knowledge Toward Physical Exercise and Activity Daily Livings

ABSTRACT: Background: The effect of physical exercise on hypothyroidism exists argumentative and require more ferrets. Poor knowledge of the patients with hypothyroidism regarding physical exercise and Activity Daily Livings (ADLs) can change in their lifestyle, deteriorate symptoms and complications. Objective: The main objective of the present research is to evaluate the effectiveness of an instructional program on hypothyroidism patients’ knowledge toward physical exercise and ADLs. Methodology: one group study (pretest– posttest) a pre experimental design study was used to conduct this study at Baghdad teaching hospitals from 2th March, 2021 to 30th Jun, 2021. A purposive sampling non probability was applied to select 50 patients with hypothyroidism were coming to Baghdad teaching hospitals. The validity of the questionnaire was verified by 20 experts. The reliability was determined the knowledge questionnaire by using (test and retest) approach. Statistics were used to analyze the results of the study using (SPSS) version (22). Results: Statistically significant differences found between the scores of the patients’ knowledge in two levels of measurements (pre- test and post-test) at (p<0.01), where the statistical global mean of score (GMS) for knowledge of patients regarding the physical exercise in pre-test was (0.195), while GMS . becomes (0.880) in post-test. Furthermore, there is no relationship among age, gender and level of education variables and hypothyroidism patients’ knowledge toward physical exercise and ADLs at (p>0.05) in pre and posttest. Conclusion: Poor knowledge of hypothyroidism patients’ toward physical exercise and Activity Daily Livings (ADLs) in (pretest) and clear improvement in their knowledge of the patients after applying the instructional program in (posttest) and there is no relationship between Socio- Demographic variables(Age, Gender and Level of education) with knowledge of hypothyroidism patients’ regard to physical exercise and ADLs. Recommendations: The study recommends conduct further large cross- sectional studies on big populations to develop the knowledge of the patients and achieving the well-being of the society. Keywords: Instructional program, Hypothyroidism, Knowledge, Exercise, Activity Daily Livings.

Comprehensive global collaboration in the care of 1182 pediatric oncology patients over 12 years: The Iraqi-Italian experience.

Iraq's health care system has gradually declined after several decades of wars, terrorism, and UN economic sanctions. The Oncology Unit at Children's Welfare Teaching Hospital (CWTH) in Baghdad was lacking basic facilities and support. To address this shortcoming, a humanitarian and educational partnership was established between CWTH and Sapienza University of Rome (SUR). We investigated the outcomes of 80 online and 16 onsite educational sessions and 142 teleconsultation sessions from 2006 to 2014. We also determined the outcomes of pathology reviews by SUR of 1216 tissue specimens submitted by CWTH from 2007 until 2019 for second opinions. The primary outcomes were discordance, concordance, and changes among clinical diagnoses and pathology review findings. The measures included the frequency of teleconsultation and tele-education sessions, the topics discussed in these sessions, and the number of pathology samples requiring second opinions. A total of 500 cases were discussed via teleconsultations during the study period. The median patient age was 7 years (range, 24 days to 16·4 years), and the cases comprised 79 benign tumors, 299 leukemias, 120 lymphomas, and 97 solid tumors. The teleconsultation sessions yielded 27 diagnostic changes, 123 confirmed diagnoses, and 13 equivocal impacts. The pathology reviews by SUR were concordant for 996 (81·9%) cases, discordant for 186 (15·3%), and inconclusive for 34 (2·8%). The major cause of discordance was inadequate immunohistochemical staining. The percentage of discordance markedly decreased over time (from 40% to 10%). The cause of the improvement is multifactorial: training of two CWTH pathologists at SUR, better immunohistochemical staining, and the ongoing clinical and pathologic telemedicine activities. The partnership yielded 12 publications, six posters, and three oral presentations by CWTH investigators. The exchange of knowledge and expertise across continental boundaries meaningfully improved the diagnoses and management of pediatric cancer at CWTH.

SHORT TERM EVALUATION OF LEFT VENTRICULAR FUNCTION FOLLOWING DUAL CHAMBER PACEMAKER A SPECKLE TRACKING STUDY

Objective: Background:In 2012 the consensus issued by both the American College of Cardiology & Foundation Heart Rhythm Society Recommend the use of Dual Chamber Pace maker instead of Single chamber pace maker for patients with Sinus Node dysfunction. Restoration of atrioventricular synchrony in patient with sinus node dysfunction or Atrioventricular block representing a new era in electrical therapy. the focus on normal physiology led to the nearly universal application of dual-chamber pacing to restore atrioventricular (AV) synchrony in patients with sinus rhythm. Design and method: Speckle tracking was used to evaluate the percent of ventricular deformation before and 3months follow upafter dual chamber implantation, this study included 28 patients with Sinus node dysfunction or Heart Failure-LBBB. This prospective observational study was carried out on patients of medical city, Baghdad Teaching Hospital, cardiology & Echocardiography Higher Education (Diploma) center from November 2016 to July 2017. Results: No statistical difference was noted between both gender groups in regard to main risk factors.Four methods were used to evaluate ventricular function synchrony (Ejection Fraction %, Global longitudinal stain, intraventricular synchrony using septal to posterior wall motion delay, interventricular Mechanical delay by Pulse wave), Global EF evaluated by Simpson biplane method remained the same in all patients after 3-month follow-up (P = NS). Global longitudinal strain (GLS) significantly decreased in all patients. Inter-ventricular dyssynchrony evaluation revealed no significant change after 3 months. Conclusions: Global longitudinal strain and Left Ventricular dessynchrony assessment enables us to detect early signs of LV dysfunction in Subjects with dual chamber pacemaker.

DNA Analysis of qacE Gene in Pseudomonas Aeruginosa Isolated from Iraqi Patient

Pseudomonas aeruginosa is an opportunistic pathogen that can cause different infections such as nosocomial bacterial infection, Urinary tract infection, Meningitis, Eye infection, Otitis Media, Respiratory infections, and Pneumonia, especially in people with Cystic fibrosis, Bone and joints infection, gastrointestinal infection, Skin infection and soft tissue inflammation. Resistance of P. aeruginosa to antibiotics and disinfectants is a major problem all over the world due to the random and unrestricted use of antibiotics. This resistance is also likely to occur due to several reasons, including the production of beta-lactamase enzymes and the lack of permeability of their cell wall, possibility of it containing resistance genes and the occurrence of genetic mutations leading to the development of resistance to antiseptics and causing failure in treating infections that caused by P. aeruginosa. This study aims to detect and sequence analysis of qacE gene in P. aeruginosa that responds to the resistance of Quaternary ammonium compounds and detect the mutations in this sequence and detection protein synthesis in this gene. A hundred swabs were collected from patients with burns and wounds infection from many Hospital in Baghdad including Al- Kindi Teaching Hospital, Al-Yarmouk Teaching Hospital, Baghdad Teaching Hospital, National Centre for Educational Laboratories, Al-Shahid Ghazi Hariri Specialist Specialized Burns Centre (Medical City), and Al-Zaafarania General Hospital during the period October 2017 for the end of December 2017.The current study detected 69 isolates of P. aeruginosa from wound 68.6% (24/35) and burn samples 69.2% (45/65). The study was investigated QacE gene in 97.1% that responses of P. aeruginosa resistance to Quaternary ammonium compounds. The sequencing analysis for QacE genes were determined and the results appeared multiple mutations including Missense mutations, insertion mutations and several silent mutations, some mutations effected in the translation of protein while others not affected. This study also included the analysis of phylogenetic tree of QacE gene and the results showed that the tree consisted of only one species which is P. aeruginosa, and the isolates in this study did not deviate of this bacteria even if their mutations were more than 22.

The Clinical Impact of Seropositivity on Treatment Response in Patients with Rheumatoid Arthritis Treated with Etanercept: A Real-World Iraqi Experience.

PurposeTo assess the clinical impact of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA)’s seropositivity on treatment response in patients with rheumatoid arthritis (RA) treated with etanercept.Patients and MethodsA retrospective analysis of patients with RA registered in Baghdad Teaching Hospital Registry from May 2012 to August 2019 was conducted. Patients aged ≥18 years, meeting the ACR/EULAR 2010 criteria for RA, being treated with etanercept, and followed up at ≥1 year after etanercept initiation were included; patients who received any other biologics for RA were excluded. Patients were classified as seropositive (RF- and ACPA-positive), seronegative (RF- and ACPA-negative), RF-positive, RF-negative, ACPA-positive, and ACPA-negative. The primary outcomes included Clinical Disease Activity Index (CDAI) and Disease Activity Score 28 (DAS28) which were measured at one year after treatment initiation.ResultsAt baseline, a total of 1318 (88.3%) patients were seropositive; 1122 (75.2%) and 1054 (70.6%) patients were RF- and ACPA-positive, respectively. Baseline mean CDAI scores were significantly (P = 0.001) higher among seropositive patients compared with seronegative patients. The baseline mean DAS28 score was also significantly higher in ACPA-positive group compared with the ACPA-negative group (P = 0.021). At baseline, the number of patients who had high CDAI scores was significantly higher among the seropositive, RF-positive, and ACPA-positive groups (P = 0.001, P = 0.001, and P = 0.002, respectively). After one year of treatment with etanercept, among seropositive versus seronegative and ACPA-positive versus ACPA-negative groups, there was a significant improvement in terms of the mean CDAI score (P = 0.004 and P = 0.017, respectively) and CDAI response (P = 0.011 and P = 0.048, respectively). At one year, the proportion of patients among the seropositive versus seronegative group who reached remission were 566 (42.9%) versus 78 (44.6%) and 642 (47.3%) versus 83 (47.4%), for CDAI and DAS28 response, respectively.ConclusionThe results imply that seropositivity and ACPA-positivity may influence the treatment response in patients with RA, who were treated with etanercept.

Effects of Long-Term Treatment with Different Types of Anti-Epileptic Drugs on Vitamin D2 and Osteoprotegrin Serum Levels in Iraqi Patients

Epilepsy is a chronic neurological illness had been described as repeated seizures associated with abnormal neurological activities in the brain. Epilepsy affects nearly fifty million people worldwide, with 85 percent of them living in developing countries. Vitamin D2 (VD2) is ergocalciferol (made from ergosterol). Genetic disorders related to vitamin D metabolism are dysfunction of generally loss osteoid mineralization the leading cause to bone disorders including: rickets or osteomalacia. Osteoprotegerin (OPG) is an osteoclastogenesis inhibitory factor (OCIF), OPG has essential role in bone metabolism and bone mass level. The aim of the present study is to investigate the effects of long-term treatment with anti-epileptic drugs (old Vs new antiepileptics) on vitamin D2 and osteoprotegrin levels among Iraqi epileptic patients. The study included fifty-one epileptic outpatients, whom attending the Consultant Clinic of Baghdad Teaching Hospital at the Medical City –Complex for the period from October/2021 to December/2021. The selected patients were on antiepileptic drugs for more than 2years, hence were grouped according to their antiepileptic therapy into: Group-1: 24 epileptic patients on old antiepileptic drugs (Carbamazepine or Valproate). Group-2: 27 epileptic patients on new antiepileptic drugs (Levetiracetam), to be compared with Group-3: 28 apparently healthy control subjects, with age and sex matching to that of patients. Serum was obtained from their blood specimens to measure: serum VD2 and OPG concentrations among the study groups participants, using specific ELISA Kits. Data analysis revealed that the mean vitamin D2 levels were not significantly different between group -1 (old antiepileptic drugs) and group-2 (new antiepileptic drugs), whereas, both of the patients groups expressed significantly lower values than the control group. However, serum osteoprotegrin levels were significantly elevated in group-1 compared to group-2. Furthermore, both of the epileptic patients groups had significantly higher values compared to the healthy subjects group. Keywords: Osteomalacia, antiepileptic drugs, Vitamin D2, Osteoprotegrin.

Comparison between the effects of older versus newer generations of antiepileptic drugs on bone metabolism in adult Iraqi patients: an observational study

Background: Metabolic bone disorder is a significant endocrine system disorder that encompasses any disorder that alters the natural skeleton's mineralization process. Epilepsy is a prevalent central nervous system disorder that can cause biochemical abnormalities involving bone metabolism in the epileptic patients. The present study aimed to investigate the effects of chronic use of older compared to the newer generations of antiepileptic drugs on bone metabolism-related biomarkers. Methods: The study included fifty-one epileptic outpatients who attended the Consultation Clinic of Baghdad Teaching Hospital at the Medical City Complex from October/2021 to December/2021. The selected patients were on antiepileptic drugs for more than 2 years, hence were grouped according to their antiepileptic therapy into: Group-1: 24 epileptic patients on old antiepileptic drugs (Carbamazepine or Valproate). Group-2: 27 epileptic patients on new antiepileptic drugs (Levetiracetam), compared with Group-3: 28 healthy control subjects. Serum was obtained from their blood specimens to measure: calcium and inorganic phosphate by colorimetric assays, parathyroid hormone, and level of bone alkaline phosphatase activity. Results: Data analysis revealed that the median value of serum parathyroid hormone levels was significantly elevated in the epileptic patients' groups compared to the healthy control group. However, group-2 (new generation antiepileptic drugs) presented higher values. Whereas serum calcium and inorganic phosphate levels showed non-significant variation for all the studied groups. Furthermore, serum bone alkaline phosphatase activity exhibited significantly higher values in the patients compared to the healthy subjects group, with more significant elevation among those on old generation antiepileptic drugs (Carbamazepine or Valproate). Conclusion: Epileptic individuals who had been on AEDs for more than two years had increased parathyroid hormone levels, which were boosted by the newer antiepileptic drug Levetiracetam. Furthermore, BAP serum levels were considerably greater in epileptic patients than in healthy control participants, with larger values generated by older antiepileptic medications.

Effect of Enterobacter cloacae toxin on immune cells isolated from Leukemia patients

Toxin extract affects Neutrophils and macrophages, which are phagocytic cells. A total of (180) samples, (50) urine and (130) peripheral blood have been obtained from leukemia patients referred to Medical city/ Baghdad Teaching Hospital/ Hematology center; all patients enrolled in this study were diagnosed by the physician according to clinical presentation and laboratory findings as leukemic patients. Investigate the role of Enterobacter cloacae toxins on phagocytic activity/THP-1cells and epithelial line/HBL-100 cells. THP-1 and HBL-100 cells have been kept in RPMI-1640 that have been supplemented by (10%) of the fetal bovine serum (100µg/mL) of the streptomycin and 100units/mL of the penicillin. The cells have been passaged with the use of the Trypsin-EDTA that has been re-seeded at a confluence of 80% twice every week, and then it has been incubated afterward at a temperature of (37C°). The results of toxin extract from Enterobacter cloacae revealed that (22) fraction/toxins were taken from (11) bacterial samples; these toxins were separated by gel electrophoresis for protein. (18) samples were positive results for gel electrophoresis of protein according to molecular weight: (13.3 KD for α-hemolysin), (70.5 KD for thiol), (75 KD for enterotoxin). This study demonstrates the cytotoxic activity of E. cloacae toxin by using tissue culture through their effect on suppressing the growth of "THP-1 cells" and HBL-100 cells". Keywords. Tissue culture; Toxin; THP-1 cells; HBL-100 cells; Enterobacter cloacae; Leukemia patients.

Role of CXCL9-CXCR3 AXIS, ANA & DS-DNA ABS in Pathogenicity of SLE in Iraqi Patients

Background: Systematic Lupus erythematosus (SLE) has been described as a chronic inflammatory illness where chemokines play an important role in its pathogenesis. CXCL9 and CXCR3 are chemokines that described their crucial role in immune response in SLE patients. Aim of the study: To evaluate the serum level of CXCL9- CXCr3 , ANA, ds-DNA Abs in SLE patients without treatment and compare their level with those under treatment (hydroxychloroquin ,predeslone5-20mg ,D3) Patients collecting and Methods: 180 females with SLE and healthy, with ages ranged between 20-40 years, were involved in this investigation from Medical City (Consultant of Arthritis, Consultant of Dermatology, Lobby of Hematology and Arthritis)/ Baghdad Teaching Hospital and from Al-Imameen Al-Kazimeen Teaching Hospital from August 26 to October 18, 2021. The samples were included 120 females with SLE (60 females as an early diagnosed patients (G2) without treatment, 60 females as patients that received treatment subjects (hydroxychloroquin ,predeslone5-20mg ,D3) (G3) , while the control group included 60 healthy females (G1). Five mL of venous blood were obtained from patients and healthy females for measuring ANA, dsDNA and serum levels of CXCL9 and CXCR3 which were measured using ELISA method. Results: Our findings demonstrated a significant increases in the serum levels of CXCL9, CXCR3, ANS and dsDNA in SLE patients (with and without treatment) in comparison to control group as well as a significant difference was detected between SLE patients without treatment and patients those receiving treatment. Conclusion: Based on our findings, CXCL9 and CXCR3 chemokines may have a role in the pathogenesis of SLE as they are increased in SLE patients. In addition, serum CXCL9 levels can be used as an independent biomarker of SLE activity. Interestingly, high levels of ANA and dsDNA are considered as a diagnostic indicator of SLE disease in the patients. Keywords: Systemic lupus erythematosus, CXCL9; CXCR3. ANA, dsDNA

Evaluation of Cytotoxic T-Lymphocyte Antigen 4 Polymorphism and Soluble Immune Checkpoint Level Among A Sample of Sars-Cov-2 Iraqi Patients

Objective: To Evaluate the Roley of Cytotoxic T-Lymphocytek antigen 4 Polymorphism and soluble immune checkpoint level (PD-1,PDL-1 and CTLA-4 ) in SARS-Cov-2 patients. Methods: Fromt October 2020 to April 2021, the currentk study was conducted in Baghdad-Iraq. Ninety patients with Confirmatory SARS-Cov-2 by PCR were inclusion in the study, and they were seeking treatment at Medical City in Baghdad's Teaching Hospital (BTH). Patients with SARS-Cov-2 were divided into two groups: those with Sever SARS-Cov-2 symptom and those with mild - moderate SARS-Cov-2 symptoms (cross sectional study. Patients with another form of autoimmune illness, malignant, diabetes, under the age of 18 and pregnant women were excluded. Results: Data regarding serum level of CTLA-4f, PD-1j and PD-L1 in mild-moderate and severe covid19 patients were found to be non-normally distributed. The median serum level of CTLA-4, PD-1 and PD-L1 mild-moderate groups were much lower than that of severe cases with highly significant differences. Age demonstrated a positive significant correlation with each of CTLA-4 (r= 0.281, p= 0.007), PD-1 (r= 0.282, p= 0.007) and PD-L1 (r= 0.219, p= 0.039). Soluble CTLA-4 had a positive significant correlation with each of PD-1 (r=0.714, p<0.001) and PD-L1 (r= 0.602, p<0.001). Allele specific of CTLA-4(+49G/A) PCR was used for gene amplification and genotyping under Gel electrophoresis of PCR products revealed that this SNP had three genotypes in mild/moderate and severe cases of COVID-19. These were GG, GA and AA. The wild homozygous genotype (AA) was more frequent among severe group than mild-moderate group with a significant difference. Conclusion: Soluble Immune checkpoint markers are significantly increased in patients with covoid-19 in severe cases and soluble immune checkpoint markers are positively significant correlation with age and The genotyping CTLA-4(+49G/A) gene SNP (AG and GG by allele specific PCR) was significantly higher in mild-moderate covid-19 cases in which may indicate that this SNP mostly protective with good prognosis. Keywords: Immune checkpoint, CTLA-4, PD1, PDL-1 and COVID-19.

ASSOCIATION BETWEEN POLYMORPHISM IN CYTOTOXIC T LYMPHOCYTE ANTIGEN -4 GENE AND THE RISK OF RHEUMATOID ARITHRITIS IN IRAQI PATIENTS

CTLA4 is well known that it is expressed in activated T-lymphocyte, and can be distinguished in cancer phenomena as well as many chronic diseases. This study was designed aiming to find a correlation between CTLA-4 and Rheumatoid Arthritis (RA). This research was carried out at Baghdad Teaching Hospital, Medical City, Baghdad, Iraq. In this study, 245 patients diagnosed with rheumatoid arthritis and 188 healthy volunteers' individuals (control group) were selected randomly. The diagnosis of the RA to both patients group and healthy individuals were characterized according to a certain protocols. The sequence of four (JO31, CT60, +49, and MH30 genotypes) were carried out using PCR-DGGE. The polymorphisms (SNPs) were genotyped for the control and the patients and the distribution of the genotypes was carried out according to HWE (P<0.05) for the two groups. The effect of two alleles on the susceptibility of RA, were investigated thoroughly, and there was a major association between the CT60, +49 alleles with the risk of RA (OR 1.43, 95%Cl (1.14-1.89), and the P-value 0.004 for CT60), while for +49 it was (OR 1.38, 95%Cl (1.04-1.77) and the P-value 0.009). There is a significant correlation between CTLA-4 genes and Rheumatoid Arthritis (RA) and both CT60 and +49 can be the main reason for RA, while JO31 and MH30 are not associated with CTLA-4.

Effectiveness of educational program on nurses practice about ovarian cancer in Baghdad City Hospitals

Background: The most severe gynecologic cancer with the greatest fatality rate is ovarian cancer(Zohre, M.,etal,2019). therefore enriching nurses knowledge about ovarian cancer very essential in order to improve nurses services for women with this dangerously diffused type of cancer. Objectives : To evaluate nurse's practice about ovarian cancer in Baghdad city hospitals ,To determine the effectiveness of Educational program on nurses practices about ovarian cancer. To identify the relationship between the nurses knowledge and their demographic characteristics ( age , educational level , socioeconomic status, years of experience ). Methods : A quasi-experimental,(two groups pretest –posttest ) control group and study design is carried out in order to achieve objectives of the study by using the evaluation approach and implementation of education program at (Baghdad teaching hospital, oncology teaching hospital, Alyarmok teaching hospital).from to 7 September to 18 December, Non- probability a purposive of (72) of nurses (36) study group and (36) control group has been selected for the present study from three teaching Hospitals in Baghdad City from to 7 September to 18 December. The data collection tool contains (57) multiple- choice questions of nurses practice about ovarian cancer.

Congenital anomalies and early neonatal mortality: A tertiary hospital study.

Background: The prevalence of congenital anomalies at birth is underestimated in developing countries due to the unavailability of perinatal diagnostic tests or accurate medical records. The prevalence of congenital defects may help to establish a baseline, track changes over time, and uncover etiological clues.
 Objectives: This study aims to evaluate the prevalence and types of major congenital anomalies in one of the main referral tertiary centers in Baghdad, highlighting the parent and neonatal characteristics and assessing the mortality rate in this group of patients.
 Patients and Methods: A prospective cohort study was conducted in Baghdad Teaching Hospital during the period between May 2017 and May 2018. Total deliveries were 6553, all live neonates with congenital anomalies were included regardless of their gestational age or birth weight. The patient's hospital notes were reviewed for the patient's characteristics, parentage, maternal chronic disease, and drug history, and other study parameters. The early neonatal outcome was assessed within 7 days of the delivery.
 Results: The prevalence of congenital malformations was 21.5 per 1000 birth with the highest frequent anomaly affecting the nervous system (41.1%) followed by multiple syndromic malformations (12.8%) and digestive system (11.3%). The mean maternal age was 27.8 (±7.8) ranging from 14-47. The rate of diseased mothers was 18.4%, only half of them were on regular medications. Out of a total of 399 early neonatal death during the study period, death due to congenital malformations constituted 19.8%. Congenitally deformed patients died at a rate of 56%, which was significantly associated with gestational age and neonatal birth weight.
 Conclusion: The prevalence of congenital abnormalities has increased in the same hospital over the last decade. Mortality rate of these patients is high and associated with gestational age and birth weight. It is critical to test for congenital malformations early in pregnancy, particularly for high-risk parents with advanced age, consanguinity, and history of congenital anomalies.

Distribution of numerous histopathological kinds of surface ovarian cancers

Introduction: Ovarian tumor considered one of the most common tumors affected the females, it represent the 6th tumor overall (4%), and 2nd most usual tumor in females international (23%). Worldwide each year, ≥225,000 women were diagnosed, and 140,000 women die from the disease. The aim of the study is to determine various histopathological and morphological variants of ovarian tumors, their size and site, age distribution, and their association with histopathological diagnosis. Method: In the cross-sectional study, histopathological reports of 285 patients who underwent surgery for removing epithelial ovarian mass and sent for pathology laboratory were collected from the archive of the teaching laboratories of Baghdad teaching hospital and Al-IMMAMAIN ALKADHIMAIN teaching hospital in Baghdad/Iraq in the period from January 2019 to October 2021. The histopathology reports were including the age and gender of the patients, site of the surgical procedure, size of the biopsy, the histopathological diagnosis, papillary growth and the stage of the malignant tumors. All the biopsied materials were fixed in 10% formalin solution, undergo routine tissue processes, were embedded into paraffin blocks, and stained with hematoxylin and eosin stains.

Relationship between juvenile idiopathic arthritis and periodontal diseases

Background: Juvenile idiopathic arthritis (JIA) is an arthritis of unknown etiology that begins before the 16th birthday and persists for at least six weeks with other known conditions excluded. In JIA, there is a destructive inflammatory process in the border between bone and connective tissue of the joint similar to the inflammatory process of the supporting tissue around the tooth in periodontitis. Objective: To emphasize the role of a pedo-dentist in the multidisciplinary management of JIA (to treat this detrimental disease before it becomes irreversible). Patients and Methods: A case-control study was conducted among JIA patients at Baghdad Teaching Hospital, Rheumatology Unit and private rheumatology clinic during the period September 2020 to May 2021. Twenty Iraqi patients diagnosed with JIA by rheumatologist (after fulfilling International League of Associations for Rheumatology (ILAR) criteria), compared with 20 healthy control individuals matched age. All patients were sent to specialized pediatric dental clinic in Baghdad where dental examination was applied. The examinations were conducted by two certified specialist pedo-dentist to indices Dental findings (dmf-s/DMF-S), Gingival inflammation (GI), Plaque index (PI). The surfaces of Ramfjord teeth were examined with diagnostic instruments (mirror and periodontal probe) and scored for all indices. Results: According to joint numbers involved, the polyarticular manner was the most common in 40% of patients, followed by oligoarticular in 35% of patients, and systematic manner in 20% of patients. In addition, one case presented with enthesitis related arthritis. The mean of gingival index (GI) in patients’ group (0.88±0.623) was higher than that of control group (0.61±0.53), without any significant difference (p=0.0545). However, the plaque index (PI) results showed high statistically significant difference (p=0.0162), similarly, the dmfs demonstrated a high significant difference (p=0.026) between patient and control groups. The DMFs was statistically significant (p=0.015), CRP level in relation to the indices, all indices have a significant high level association level (≥5mg/L) over normal level of CRP (<5 mg/L), effect of Prednisolone was statistically significant for GI (p=0.0245), and dmfs (p=0.0015). However, it was not significantly different in the value of PI (p=0.098), and DMFs (p=0.0627). In our study DMARDs (MTX) had a direct effect on GI and PI with a statistically significant difference (p=0.0164), and (p=0.017), respectively. Finally, the role of MTX on dmfs and DMFs was not significant. Conclusions: The indices used in this study to evaluate oral health in JIA children were GI has no significant difference compared to healthy children; PI was significantly higher compared to healthy children; the dmfs/DMFS both showed significantly higher compared to healthy children. The high CRP level has a significant association with GI, PI and dmfs, but no significant association with DMFs. Regarding the JIA treatment, Prednisolone has significantly modified all indices (in particular GI and DMFs), NSAIDs has significantly modified PI only, DMARDs (MTX) had direct effect on GI and PI, but no role on dmfs and no significant effect on DMFs.