Baghdad Teaching Hospital Research Articles

Characterization And Antimicrobial Activity of Copper Oxide Nanoparticles Synthesized by Crocus Sativus Extract

This study aimed to evaluate the antimicrobial activity of green synthesized copper-oxide nanoparticles (CuO-NPs) using Crocus sativus. The microorganisms were supplied from Baghdad Teaching Hospital. Using C. sativus, CuO nanoparticles were synthesized in a green manner, and their properties were assessed using UV-visible spectroscopy at the peak of 260 nm. Atomic force microscopy (AFM) was used to measure the particles' size and form, and x-ray technology was used to more precisely quantify their dimensions. diffraction (XRD). The biomolecule and functional group were determined by Fourier transform infrared spectroscopy (FTIR). Different concentrations of nanoparticles (50, 75, and 100 ?g/ml) were subjected to the well diffusion method for antibacterial activity testing. The findings indicated that the CuO-NPs had a spherical form and a 0.154 nm size. The average diameters of the AFM pictures were found to be 11.89 nm, 2.62 nm, and 24.55 nm. The following growth zone inhibition values for the various bacteria species used were revealed by the nanoparticles' antimicrobial activity results: Staphylococcus aureus 18 mm, Staphylococcus epidermidis 18 mm, Klebsiella ssp 15 mm, Candida albican 18 mm, and Escherichia coli 17mm.

Echocardiographic Assessment of Left Ventricular Systolic Function in Lymphoma Patient After Initial Dose of Chemotherapy in Baghdad Teaching Hospital

Despite cancer therapeutics-related cardiac dysfunction (CTRCD) can be initially asymptomatic, if not detected and properly managed, it may progress to severe and irreversible heart failure. Therefore, identification of high-risk patients and early detection of subclinical myocardial dysfunction are fundamental tasks for the management of cancer patients undergoing chemotherapy, involving both cardiologists and oncologists. LVEF has low sensitivity for the detection of small changes in LV function. LVEF calculated by conventional 2DE often fails to detect small changes in LV contractility because of several factors. These factors include LV geometric assumptions, inadequate visualization of the true LV apex, lack of consideration of subtle regional wall motion abnormalities, and inherent variability of the measurement. Accordingly, strategies using newer echocardiographic technology, such as STE-derived strain imaging for the early detection of subclinical LV systolic dysfunction. GLS being the most robust and reproducible among the myocardial strain parameters, this parameter has raised the interest of the investigators to detect early and subclinical myocardial dysfunction in patients at risk of CTCRD

Parenteral Nutrition-Associated Sepsis and Extravasation in Iraqi Neonates: Case-Series Prospective Study

Background: Extravasation and sepsis are two of the many side effects linked to the use of intravascular devices during parenteral nutrition (PN). Objective: To assess the incidence of sepsis and extravasation in Iraqi neonates receiving PN in the critical care unit. Methods: From January 27, 2022, to January 15, 2023, a case-series prospective study was carried out in two tertiary neonatal intensive care units (NICUs) in Children Welfare Hospital and Baghdad Teaching Hospital, Baghdad, Iraq. The study reports the rate of sepsis and extravasations and correlates their occurrence to other neonatal features. Results: Of the 94 newborns examined, 24 patients (25.5%) experienced 35 instances of stage IV extravasation, and 34.04% of them experienced 40 episodes of sepsis in total. They have a strong and significant correlation with the newborns' body weight, treatment duration, gestational age, and postnatal age. Conclusions: The administration of PN to neonates in Iraq has been linked to severe side effects such as sepsis and extravasation.

The Role of Tumor Necrosis Factor Alpha in Adolescent Iraqi Children Infected with Toxoplasmasis

Toxoplasmosis affects various biochemical markers, which has garnered attention recently. Toxoplasmosis biochemical marker values were the focus of this study. To evaluate the infection-related marker TNF alpha, TNF-α regulates inflammation, anti-tumor responses, and homeostasis via interacting with TNF-R1 and TNF-R2. TNF-α has a vital function in treating T. gondii by regulating hematopoietic stem and progenitor cell development. Despite therapeutic usage of anti-TNF-α medications, adverse effects such lymph proliferative disorders have been known to occur. This also suggests that one major mechanism by which cytokines operate is by inhibiting parasite invasion. TNF-α has the ability to directly influence the proliferation of intracellular parasites to different extents. The study included one hundred patients with toxoplasmosis, aged between eighteen and thirty years old. Among them, seventy had confirmed cases of infection, with forty samples from both male and female patients, while the remaining thirty samples were taken from healthy individuals serving as a control group. Baghdad Teaching Hospital, Al-Yarmouk Teaching Hospital, and many outpatient clinics will treat patients from different Iraqi governorates from November 2022 and October 2023. Additionally, we utilized the ELISA technique to determine the quantity of TNF-alpha present. With this study, there were no significant changes in blood levels of TNF-α between the control group and teens of different ages and genders, according to the results. The mean ±SE values of the level in healthy teens (80.57 ±5.27) and T. gondii patients (123.59 ±4.35, 158.85 ±10.26) were not statistically different. The findings indicated that the mean values for healthy teenagers were 66.02 ±5.89 and 87.84 ±3.24, respectively. There was no significant gender difference, with mean values of 149.65 ±11.98 and 133.25 ±3.96, respectively. Patients with toxoplasmosis exhibited substantially higher TNF-α levels than the control group (P ≤0.01). The average ± SE TNF-alpha levels in teenagers infected with T. gondii were 136.86 ±5.96, whereas the control group had 87.84 ±3.24. Our research suggests that Toxoplasma gondii have the capability to exert effect on certain indicators, such as TNF-alpha. The findings indicate that adolescents are prone to a significant prevalence of toxoplasmosis diagnoses. Consequently, prioritizing health education for those with a heightened susceptibility to developing the disease is imperative.

The Association between Refractive Errors and Congenital Ptosis

Abstract Background: Children with congenital ptosis need to be carefully assessed for refractive errors and visual function to identify and treat amblyopia which occurs in 20% of congenital ptosis, small amount of which is attributed to ptotic eyelid occluding the pupil. Objectives: The objective is to determine the frequency of refractive errors and its associations among children with congenital ptosis. Patients and Methods: Case–control study of 60 patients with congenital ptosis (79 eyes) and 60 patients without ptosis (control group) (72 eyes). Conducted in Ibn Al-Haithem Eye Teaching Hospital in Baghdad from April 2020 to May 2021. The main outcome measures were relative congenital ptosis, presence, and types of refractive errors. Results: Significant association was obtained between children with ptosis and average spherical and cylinder refractory error. Among 60 cases (79 eyes) of congenital ptosis, refractive errors were present in 26 eyes (32.9%) with the astigmatisms as the most common refractive errors (18.9%), followed by hypermetropia (8.9%) and myopia (5.1%). Conclusions: Children with congenital ptosis in our environment have greater refractive errors, early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.

Effect of Enoxaparin on D-dimer levels in hospitalized Corona Virus patients with a comparison of its level in patients with comorbid conditions.

Aim: The main goal is to assess the levels of comorbid diseases and examine the changes in D-dimer in hospitalized patients before and following SC enoxaparin medication. Material and Methods: At the Al-Yarmouk Teaching Hospital in Baghdad, Iraq, from October 2022 to May 2023, 86 patients who were hospitalized and had severe to critical COVID-19 infections provided data for a retrospective analysis. Results: The medical records of all COVID-19 patients who were hospitalized and whose D-dimer level was greater than 0.5 mg/l and who were given enoxaparin (40 mg subcutaneously) were reviewed with the requisite authorization from the relevant authorities. The D-dimer level was assessed following therapy on the day of admission and day five after commencing enoxaparin. An examination of 86 case records revealed that persons with COVID-19 had significantly decreased D-dimer levels after taking subcutaneous enoxaparin (p-value<0.0001). The comorbidities (diabetes mellitus, hypertension) of patients who received the drug were compared. Conclusions: Enoxaparin and other anticoagulants were utilized to treat the coagulopathy brought on by COVID-19. Low molecular weight heparin enoxaparin has demonstrated positive outcomes in the management of VTE. A decrease in D-dimer level is anticipated when COVID-19 patients are treated with subcutaneous enoxaparin, partly because decreased coagulation results in lower fibrin formation.

Association between Tissue Polypeptide Specific Antigen and Vascular Endothelial Growth Factor in Colorectal Cancer Patients and their Relation with P53 Expression and Global DNA Methylation

Background: Colorectal cancer is a high risk disease with rapidly progression medical problems and high mortality rate. Tissue polypeptide specific antigen can be classified as biomarker candidates in colorectal cancer and other kinds of cancer. Vascular endothelial-derived growth factor has a curial role in the formation of new blood vessels. DNA methylation may decrease invasiveness of cancer. Objectives: This study was designed to measure the potential role of some serological biomarkers in the progression of colorectal cancer as well as their relations to P53 expression, global 5-methylcytosine. Patients and Methods: This study involved of 60 patients with colorectal cancer who attended Oncology Teaching Hospital in Baghdad, Iraq and compared with 30 apparently healthy volunteers. All participants were checked for serological biomarker levels using an enzyme-linked immunosorbent assay. Also, DNA and RNA extracted and the levels of 5-methylcytosine and P53 expression were evaluated. The SPSS version 24.0 program was used for all statistical analysis done in this study. Results: The analysis of serological biomarker data has shown that the mean of tissue polypeptide specific antigen and vascular endothelial growth factor was significantly higher for patients with colorectal cancer, while it was lower for control subjects (356.4 ± 16.9, 139.75 ± 7.31) and (1127.82±65.41, 388.93±35.86), respectively. Also, a significant positive relation between tissue polypeptide specific antigen and vascular endothelial growth factor in the tumor area was significantly associated with control (P≤ 0.001). However, there was significant correlation in the levels of P53 expression and global DNA methylation between studied groups as well as tissue polypeptide specific antigen and vascular endothelial growth factor (P ≥ 0.05). Conclusion: The serological biomarkers include tissue polypeptide specific antigen and vascular endothelial growth factor and they play a critical role in the development of colorectal cancer. Serum vascular endothelial growth factor is useful in distinguishing colorectal cancer from healthy controls, whereas tissue polypeptide specific antigen is an independent prognostic factor for colorectal cancer proliferation. Received: Mar. 2023 Accepted: Jun 2023 Published: Oct.2023

Role of tissue inhibitor of matrix metalloproteinase-1 in Iraqi patients with acute myeloid leukemia

Abstract: BACKGROUND: Leukemia is characterized by an uncontrolled expansion or proliferation of hematopoietic cells that are unable to develop appropriately into mature blood cells. Tissue inhibitor of metalloproteinases (TIMP) is glycoprotein with 28 Da Molecular weight. It has proteolytic and proliferative activity show pleiotropic effects in the bone marrow regulates cell responsible for survival and growth also healthy hematopoietic progenitor cells and involve in cancer progression. OBJECTIVES: The aim of this study was to measure TIMP in Iraqi acute myeloid leukemia patients as well as the correlation between tissue inhibitor of matrix metalloproteinase-1 and blast cells. PATIENTS MATERIALS AND METHODS: The study involved 50 patients from Iraqi National Hematology Center/Al-Mustansiriyah University and Baghdad Teaching Hospital with acute myeloid leukemia and 50 control participants who were physically similar. The patients’ ages ranged from 20 to 70 years. Tissue inhibitor of matrix metalloproteinase concentration in plasma was measured using a sandwich enzyme immunoassay approach that is quantitative. RESULTS: The present study demonstrates a statistically significant increase in the level of tissue inhibitor of matrix metalloproteinase-1 patients with acute myeloid leukemia. The level of TIMP-1 in serum AML patients was 443.7 ± 0.3 pg/mL while in healthy control serum was 149.5 ± 0.088 pg/mL. The current result showed a positive significant correlation between TIMP-1 level and blast Cells percentage (r = 0.495; P = 0.031), while the correlation between leukocytes number and platelets number was insignificant (r = 0.388; P = 0.078, r = −0.444; P = 0.155). CONCLUSION: TIMP-1 levels increased in the CML patient compared with healthy control also there was a significant correlation between TIMP-1 and Blast cell level while no correlation between level of TIMP-1 and number of leukocytes and platelets. The level of TIMP in patients untreated and undergoing chemotherapy does not change.

Incidence of QT interval prolongation during arsenic trioxide-based therapy in a sample of Iraqi adult patients with acute promyelocytic leukemia (a single-center experience)

Abstract: BACKGROUND: Arsenic trioxide (ATO) regimen is now the standard of care for acute promyelocytic leukemia (APL). The complete remission and possible cure are reported to be 50%–80% of APL patients. Prolongation of the QT interval has been consistently observed in clinical trials with ATO, which is known to have a direct effect on cardiac repolarization with the recommendations for management include electrocardiogram (ECG) monitoring, discontinuation of drugs that prolong the QT interval, and careful repletion of serum potassium and magnesium. OBJECTIVES: To study the incidence and clinical consequences of QT prolongation in a sample of Iraqi APL patients treated with ATO. PATIENTS AND METHODS: A prospective, cross-sectional study was conducted on 24 adult patients with newly diagnosed APL at Baghdad Teaching Hospital. ECG was performed at baseline and twice weekly till the end of induction treatment course. Corrected QT interval was calculated based on Bazett and Fridericia formulas (QTc interval of more than 500 ms is considered dangerous): Serum potassium, calcium, and magnesium levels were also measured simultaneously. RESULTS: The mean QT at baseline was 424 ± 18 ms and 402 ± 15 ms by Bazett and Fridericia, respectively, and at the end of induction, the mean QT was 436 ± 20 ms and 418 ± 20 ms by Bazett and Fridericia, respectively. The rate of developing prolonged QT was 62.5% by Bazet, in which 15 patients developed prolonged QT (at any time point). The comparison between prolonged and dangerous QT groups by Bazet showed significant difference, in which QT-related complications were associated with dangerous QT (&gt;500 ms) prolongation significantly, while Fridrica method did not label these patients as having dangerous QT prolongation. The change in QT started as early as 1 week after treatment, the comparison between baseline QT and QT at week 1 showed that there was significant increase in QT. The electrolytes analysis and comparison with baseline results for potassium, magnesium, and calcium showed that there were no significant differences over time for tested electrolytes. CONCLUSION: Bazett formula is useful to monitor Iraqi patients with APL who are treated with ATO for the detection of dangerous prolongation of QT.

Correlation of Serum levels of Chromium, Copper, and Manganese with the Glucose levels in Type 2 Diabetes Mellitus in Iraq

Correlation of Serum levels of Chromium, Copper, and Manganese with the Glucose levels in Type 2 Diabetes Mellitus in Ira Background: The metabolism of many trace elements such as chromium, copper, and manganese were reported to be altered in type 2 diabetes militates. This element may have specific roles in the pathogenesis and progress of this disease. Objectives: To evaluate the serum levels of copper, chromium, and manganese in type 2 diabetic patients in Iraq. Patients and Methods: This case-control study included 100 type 2 diabetic patients, 35-60 years old, with high BMI as cases, and 100 non-diabetic subjects as controls who were healthy volunteers not suffering from type 2 diabetes (staff and student). The data was collected from October 2022 until January 2023. The cases were seen in the Diabetes Consultation Unit / Baghdad Teaching Hospital / Medical City. Serum chromium, copper, and manganese were measured using atomic absorption. ELISA was used to test for insulin. spectrophotometry to measure glucose and HPLC was used to measure whole-blood HbA1c. Insulin resistance was calculated using the semi-empirical formula: HOMA-IR = glucose * insulin / 405 (glucose in mg/dl). To test for the difference between means of numerical data across several parameters, ANOVA tests were utilized. Pearson’s. correlation was used to test the correlation between variables. Results: Diabetics had higher HbA1c, serum copper (P value&lt;0.01), and blood glucose than healthy controls. Compared to controls, diabetics had lower serum chromium (P value&lt;0.01) and manganese (P value &lt; 0.01). In diabetics, chromium and manganese are highly negatively correlated with insulin resistance. Copper levels increase with increasing insulin resistance. Insulin levels were greater in type 2 diabetics (18.6 ± 4.1mlU/L) than in the control (6.2 ± 1.3) (p &lt;0.01). Conclusions: Serum copper was high while serum chromium and manganese were low in type 2 diabetics. that indicates that these elements may have a role in the occurrence and development of type 2 diabetes. Received: May, 2023 Accepted: Oct., 2023 Published: Jan., 2024

Investigating nutritional status and body composition in geriatric outpatient clinics in Baghdad teaching hospital: Unveiling the importance of muscle screening

Investigating nutritional status and body composition in geriatric outpatient clinics in Baghdad teaching hospital: Unveiling the importance of muscle screening

Study the effect of urokinase-type plasminogen activator (UPA) and some biochemical parameters in Iraqi hemodialysis patients with type 2 diabetes

Abstract The most common cause of end-stage renal disease (ESRD) and leading ultimately to hemodialysis (HD) is type 2 diabetes mellitus (T2DM). The current study aims to assess the role of serum urokinase plasminogen activator (UPA) levels among Iraqi hemodialysis patients with ESRD with type 2 diabetes. The study encompassed 50 patients aged 40–74 years (35 males and 15 females), admitted to the Iraqi dialysis center at Baghdad Teaching Hospital, Al-Hayat Center at Al-Karama Teaching Hospital, and Hamida Al-Misfah Dialysis Center in Imam Al-Kadhimin Medical City for the period from October 2022 to February 2023. Were diagnosed based on previous medical reports, and laboratory tests by a consultant nephrologist. UPA, Blood. Urea, Creatinine, fasting serum glucose (FSG), HbA1c, Insulin, HOMA-IR, and lipid profile levels were determined. The present study showed a significant increase in serum UPA levels in HD patients in ESRD with T2DM compared to control. In addition, there was an important negative correlation between UPA and Hb1AC, FSG, and a positive correlation with VLDL-C and TG in HD patients in ESRD with T2DM patients. This study demonstrates increased UPA serum levels in HD in ESRD with T2DM patients and associated with FSG, Hb1AC, TG, and VLDL this shows that it can be considered a good marker for the development of diabetes complications, the most important of which is diabetic kidney disease (DKD).

Detection of active human cytomegalovirus in patients with multiple myeloma

Abstract: BACKGROUND: Human cytomegalovirus (HCMV) infection is ubiquitous and successfully reactivated in patients with immune dysfunction as in patient with multiple myeloma (MM), causing a wide range of life-threatening diseases. Early detection of HCMV and significant advances in MM management has amended patient outcomes and prolonged survival rates. OBJECTIVES: The aim of the study was to estimate the frequency of active HCMV in MM patients. MATERIALS AND METHODS: This is a case–control study involved 50 MM patients attending Hematology Center, Baghdad Teaching Hospital; 25 of them were newly diagnosed and 25 on treatment compared to 50 of apparently healthy control. HCMV-viral load was measured using a real-time polymerase chain reaction (RT-PCR). RESULTS: Active HCMV was detected in 8 patients out of 50 (16%); 6/25 (24%) in newly diagnosed and 2/25 (8%) on treatment and had autologous bone marrow transplant with mean ± standard deviation of 910 × 1010 ± 210 × 1010, and 32,000 × 1010 ± 1500 × 1010 IU/mL, respectively. HCMV viremia is equally detected in both remission and relapsed cases. CONCLUSION: RT-PCR detected a significant number of MM patients infected by cytomegalovirus compared to healthy individuals. Further studies are needed to verify if this finding has a relation to etiology or disease progression.

Age-related dynamics in acute myeloid leukemia: Implications for prognosis, risk stratification, and treatment response

Abstract: BACKGROUND: Acute myeloid leukemia (AML) is a complex, heterogeneous disease driven by acquired somatic mutations. The presence of specific mutations advances stratification, treatment, and prognosis. Linear accumulation of mutations over time is a crucial factor in cancer development, particularly among elderly patients. Our recent study on gene rearrangement in AML revealed a significant association between age and adverse risk cases. AIM: The aim of this study was to examine the distribution of age, molecular characteristics, risk stratification, and treatment response based on age among patients with de novo AML in Iraq. PATIENTS AND METHODS: A prospective cohort study enrolled 115 Iraqi adult patients diagnosed with de novo AML using morphology and flow cytometry from December 2020 to May 2022. The Leukemia Q-Fusion Screening Kit, employing multiplex reverse transcription–real-time quantitative polymerase chain reaction with 30 gene rearrangements, was employed for the identification of gene rearrangement. The patients received care and follow-up at the Hematology Unit of Baghdad Teaching Hospital in Medical City. Ethical approval from the College of Medicine’s Ethical Committee at the University of Baghdad was secured before commencing the research, ensuring adherence to ethical standards throughout the study. RESULTS: The age distribution exhibited a bimodal pattern, with a mean of 45.1 ± 17.5 years, ranging from 18 to 84 years, and a median of 46 years. A total of 39.1% of patients were diagnosed with AML before the age of 35 years, while 43% were diagnosed after the age of 51 years. AML patients with RARA mutations, RUNX1::RUNX1T1 alterations, and NPM1 mutations were predominantly observed in younger individuals, as well as those diagnosed with AML defined by differentiation. Conversely, KMT2A rearrangements were more prevalent among older age groups, with a statistically significant difference in the distribution of AML classifications according to the World Health Organization (WHO) by age categories (P = 0.001). The risk stratification based on age and response assessment showed a notable higher risk profile observed among elderly patients that was associated with adverse risk and poorer response and mortality (P &lt; 0.05). The prediction of treatment response accuracy rate was improved by adding age to the WHO classification and ELN 2022 risk stratification (73.5%–87.9%). CONCLUSION: Age significantly influences AML prognosis and treatment response. Incorporating age into risk stratification improves accuracy. Tailored approaches considering age are vital for optimizing AML management and outcomes.

Prevalence of Anxiety and Depression Symptoms among Post Bariatric Surgery Patients in Baghdad-Iraq

J. Fac. Med. Baghdad 2023. Vol 65, No. 4 Background: Obesity is a major public health concern and is on the rise worldwide. Numerous studies revealed that the best method for treating morbid obesity is bariatric surgery, which has indicated its effectiveness in controlling weight. Published studies reported that patients who had undergone bariatric surgery may have psychiatric illnesses when compared to other obese individuals with similar preoperative characteristics. Objectives: Estimate the rates of anxiety and depression among post-operative bariatric surgery patients. Methods: A cross-sectional study on 61 patients was conducted at the bariatric clinic in the Gastroenterology and Hepatology Baghdad teaching hospital and the Private Nursing Home Hospital in Medical city, Baghdad-Iraq from 1st of April to the 30th of December 2021. Generalized Anxiety Assessment – 7 (GAD-7) Scale, and Patient Health Questionnaire – 9 (PHQ-9) scale were applied to assess these conditions. Results: The prevalence of depression among the studied patients was 32.8%, while the prevalence of anxiety was 44.3%. Marital status, diabetes mellitus, post-operative BMI, and past psychiatric history were significantly associated with depression, P value &lt; 0.05. Chronic diseases (diabetes mellitus and hypertension), post-operative BMI,nd psychiatric history were significantly associated with anxiety, P value&lt;0.05. Conclusions: Anxiety was found to be more common than depression among patients who underwent bariatric surgery. Variables predicting both depression and anxiety were diabetes mellitus, post-operative severe obesity, and a history of psychiatric disorders before surgery. Received May. 2023 Accepted July 2023 Published Jan. 2023

Prevalence and Contributed Factors for Varicose Veins in Intensive Care Unit Nurses at Baghdad Teaching Hospitals

Background: Varicose vein (VV) is a common problem that mostly occurs in legs. This medical condition can influence the quality of life and working condition of nurses. Aim of the study: To estimate the prevalence of lower limbs varicosity and its associated risk factors among nurses. Methods: This a cross-sectional descriptive study was carried out among 100 nurses working Baghdad Teaching Hospital, Surgical Specialties Hospital, and Al- Kidney Teaching Hospital, Baghdad, Iraq from January 1st to May 10th, 2022. The participants were recruited in the study using systematic random sampling. The Occupational Sitting and Physical Activity and Aberdeen Varicose Vein Questionnaires were used for data gathering. Results: The prevalence of varicose veins was estimated to be (48%) of the sample. There are a significant association between (age, prolonged standing, body mass index and varicose vein. Conclusion: The prevalence of VV among the nurses working in Baghdad teaching hospitals was high, and many factors showed a significant relation with this problem. Nurses should be informed about preventive measures and treatments for this medical condition.

Comparative Study Between Intramedullary Nail and Minimally Invasive Plate Osteosynthesis in Tibial Shaft Fracture

Background: Casting, open plate fixation, minimally invasive plate osteosynthesis, intramedullary nailing, and external fixation are some treatment options for tibial fractures. The aim of treatment is anatomical alignment with sufficient stability to permit early motion. The least invasive and most popular techniques are intramedullary nailing, external fixation, and minimally invasive plate osteosynthesis. Aim of Study: To compare the clinical and functional outcome between Intramedullary nailing and external fixation and minimally invasive plate osteosynthesis in treating tibial shaft fracture. Patients and Methods: A randomized clinical trial study was conducted at Al-Yarmouk Teaching Hospital and other private hospitals in Baghdad, Iraq, during a period of 17 months from September 2020 to January 2022, including a period of one year for follow-up. Patients were selected according to certain inclusion criteria and divided into two groups, each with 20 patients. IMN was treated by intramedullary nailing, and the MIPO group was treated by minimally invasive plate osteosynthesis. Patients were followed up radiologically and clinically using the JETTS Lower Extremity Trauma Scale score. Result: The difference was significant (P&lt; 0.05) regarding partial and full weight bearing, union time, and return to work. Ankle stiffness, implant irritation, and knee pain revealed significant differences. Conclusion: Intramedullary nailing and external fixation and minimally invasive plate osteosynthesis are effective methods for the treatment of extra-articular tibial shaft fracture. They provided rigid fixation, preventing major complications and good functional and anatomical outcomes.

The Impact of Practicing Exercise and Risk Factors Categorize in Osteoporotic Concerning Postmenopausal Women (Analytical study using binary logistic regression)

Background: Osteoporosis is an illness that may be categorized as a "silent pandemic" because of its worldwide incidence. The essential characteristics of osteoporosis are bone mass reduction and degeneration in bone tissue's micro-architecture. Postmenopausal osteoporosis (PMO) seems to be the most prevalent skeletal disorder. Objective: To study investigates the influence of practicing exercise and physical activity as the most critical contributing factors of osteoporosis in postmenopausal women. Patients and Methods: A cross-sectional survey was conducted at Baghdad Teaching Hospital from July 1, 2021, to December 31, 2021. Data were collected directly through interviews using a special questionnaire. One hundred and fifty postmenopausal women with osteoporosis participated in this study. A rheumatologist clinically diagnosed all participants using a bone density screening (DEXA). Results: the current study's results indicate the prevalence of osteoporosis among postmenopausal women, with a higher percentage of 69.3% in the age group (≥50 years). 60.7% of all participants were overweight and obese according to body mass index (BMI). Calcium deficiency was found in 87.3% of the subjects, more than two third (76%) of them were not practicing exercises, and 86.7% suffered from vitamin D deficiency. Reclassifying the actual and wrong percentile demonstrates the accurate percentile (overall percentage = 78.7), 32 individuals were wrongly classified, and the probability of total error was reported at around 21.3%. The most important finding was that postmenopausal women with osteoporosis who exercised and participated in physical activity regularly were 13.7 times in better health than those who did not exercise. Conclusion: Exercising and physical activity lower risk factors for postmenopausal women. It is becoming more necessary to reconsider the importance of performing exercises in maintaining and enhancing postmenopausal women's health. Keywords: Risk Factors, Osteoporosis, Postmenopausal, Practicing Exercises.

The Impact of Practicing Exercise and Risk Factors Categorize in Osteoporotic Concerning Postmenopausal Women (Analytical study using binary logistic regression)

Background: Osteoporosis is an illness that may be categorized as a "silent pandemic" because of its worldwide incidence. The essential characteristics of osteoporosis are bone mass reduction and degeneration in bone tissue's micro-architecture. Postmenopausal osteoporosis (PMO) seems to be the most prevalent skeletal disorder.&#x0D; Objective: To study investigates the influence of practicing exercise and physical activity as the most critical contributing factors of osteoporosis in postmenopausal women.&#x0D; Patients and Methods: A cross-sectional survey was conducted at Baghdad Teaching Hospital from July 1, 2021, to December 31, 2021. Data were collected directly through interviews using a special questionnaire. One hundred and fifty postmenopausal women with osteoporosis participated in this study. A rheumatologist clinically diagnosed all participants using a bone density screening (DEXA).&#x0D; Results: the current study's results indicate the prevalence of osteoporosis among postmenopausal women, with a higher percentage of 69.3% in the age group (≥50 years). 60.7% of all participants were overweight and obese according to body mass index (BMI). Calcium deficiency was found in 87.3% of the subjects, more than two third (76%) of them were not practicing exercises, and 86.7% suffered from vitamin D deficiency. Reclassifying the actual and wrong percentile demonstrates the accurate percentile (overall percentage = 78.7), 32 individuals were wrongly classified, and the probability of total error was reported at around 21.3%. The most important finding was that postmenopausal women with osteoporosis who exercised and participated in physical activity regularly were 13.7 times in better health than those who did not exercise.&#x0D; Conclusion: Exercising and physical activity lower risk factors for postmenopausal women. It is becoming more necessary to reconsider the importance of performing exercises in maintaining and enhancing postmenopausal women's health.

Effects of Vitamin D3 level on the gene expression of Immune checkpoint Cytotoxic T-lymphocytes antigen-4 in Iraqi patients with rheumatoid arthritis

Background: Rheumatoid arthritis is chronic autoimmune inflammatory disease that affects synovium, rheumatoid arthritis. Antigen presentation cells (APCs) link B7-1 and B7-2 with cytotoxic T-lymphocyte related protein-4 (CTLA-4), the member of the immunoglobulin superfamily, that causes T-regulatory cells to cause APCs to produce an inhibitory signal to autoreactive T cells (Treg). This study looked at the effects of vitamin D3(Vit-D3) on the expression of the CTLA-4 gene in whole blood taken from RA patients.Methods: The case control study was conducted on 100RA patients acute and remission stages of the disease depending on DAS-28 and CDAI with respect to the level of vitamin D3. The cases and samples were obtained from Baghdad Teaching Hospital, Baghdad, Iraq from Jun 2022 to January 2023. In addition,45 healthy subjects were enrolled in this study. Standardized gene expression at a level of a reference gene (GAPDH) and enumerated by the ∆Ct-value and fold change (2-∆∆Ct) method using qPCR. The ESR was measured in all subjects and serum CTLA-4, anti-cyclic citrullinated peptide (ACCP), RF was measured using ELISA techniques. The D3 level was assessed using immunofluorescent technique.Results: Significantly increased ESR and serum CTLA-4 levels, ACCP, CRP, RF in RA patients compared to controls (p≤0.05), respectively. The vitamin D3 was significantly reduced in acute cases and substantial raised in remission case compared to the controls (p≤0.05) fold change of gene expression was dramatically elevated in patients excepts in acute male cases compared to 1. There was a significant positive correlation between vitamin D3 and CTLA-4 expression.Conclusion: The current study showed that Vit-D3 up-regulates CTLA-4 gene expression as the defensive mechanism in contradiction of a severity of a disease and possible therapeutic targets through the action of Treg population and immunotolerance.