Hospitals In Baghdad Research Articles

Prevalence of Keratoconus and Keratoconus Suspect among a sample of Iraqi Children with Refractive Errors: A Cross-Sectional Study

Background: Keratoconus (KC) is a chronic, bilateral, non-inflammatory degenerative condition with severe consequences. Objective: To assess the prevalence of KC and Keratoconus Suspect (KCS) in a pediatric population with astigmatic error ≥1 diopter (D) and non-axial myopia. Methods: Between March and October 2022, a cross-sectional study was done with a group of 6–18-year-old kids with an astigmatic error of ≥1 D or non-axial myopia who went to the pediatric ophthalmology clinic at Ibn Al-Haitham Teaching Eye Hospital in Baghdad, Iraq, for regular checkups. All patients got a thorough eye examination and corneal imaging using the Corneal Tomography System (CSO) Sirius equipment and Scheimpflug technology. Results: The majority of patients were females aged 110–14 years (55%). The frequencies of KC and SKC were 13.5 and 119.6%, respectively. The proportion of KC was substantially higher for those above the age of 14. Patients with KC exhibited considerably larger cylinder and axis measurements. Participants with inferior cones and an asymmetric Bow Tie exhibited greater rates of KC (51.2% and 29.4%, respectively). Except for Pachy-Thin and corneal volume mean values, all other metrics were considerably greater in KC and KCS patients than in control patients. Conclusions: The high prevalence of KC and KCS emphasizes the importance of this issue and the necessity for a systematic strategy for screening in pediatric age groups with refractive error.

Synergistic Effect of Purified Protease Enzyme with Antibiotics on Pathogenic S. Aureus In-Vitro and In-Vivo

Objective: The goal of this study is the detection of the P. aeruginosa isolate for production the protease, the optimal conditions for produce, extraction, purification and characterization of the enzyme and study the synergistic effect of protease with antibiotics on S. aureus. Method: Among (110) isolates from clinical sources, only (74) isolates identified as P. aeruginosa isolated from Baghdad hospitals. Detection of the optimal isolate for production the protease enzyme and the optimal conditions its produce, purification of enzyme by using ammonium sulfate, ion exchange chromatography and gel filtration, enzyme characterization of PH and temperature activity and stability, the study of synergistic effect of protease with antibiotics on S. aureus. Results: The optimal conditions to produce protease is pH (8), (37) ºC, (BHI) broth, and during (48 hrs.). The precipitation saturation ratio (80%). Ion- exchanges (DEAE and CM) Cellulose and Gel filtration have specific activity ((121.25), (161.6), (660.53)) units/ mg)) respectively. The characterization done by pH and temperature activity purified protease was active in (138.51units/ ml) at pH (8), and stable in pH (8), the temperature for protease activity is (158.21 units/ ml) at (37) ºC. The synergistic effect of purified protease with antibiotics on S.aureus in- vitro,was detected using the agar diffusion method, the effectiveness of the prepared hydrogel types, the results showed S.aureus was more sensitive isolate to prepare (Gel & Protease & Ceftriaxone) the diameter of the inhibition zone reached (44 mm) ,the synergistic effect we noticed when using a (Gel & Ceftriaxone & Protease) healing was observed in time (five days) with wound healing without effect. Conclusion: In this study, it was discovered that mixing (protease + hydrogel + Ceftriaxone) accelerates the wound healing without leaving traces.

Molecular diagnosis of E.coliO157:H7 Which Isolated from Children with Diarrhea by using Multiplex PCR

A total of 96 stool samples were collected from children with bloody diarrhea from two hospitals in Baghdad. All samples were surveyed and examined for the presence of the Escherichia coli O157:H7 and differentiate it from other Non -Sorbitol Fermenting Escherichia coli (NSF E. coli). The Bacterial isolates were identifed by using morphological diagnostic methods, Samples were cultured on liquid enrichment medium, incubated at 37C? for 24 hrs, and then cultured on Cefixime Tellurite -Sorbitol MacConkey Agar (CT- SMAC). 32 non-sorbitol fermenting bacterial isolates were obtained of which 11 were identified as Escherichia coli by using traditional biochemical tests and API20E diagnostic system without differentiation between serotype O157:H7 and other NSF E. coli isolates . Four special biochemical tests were done for serotype O157:H7 differentiation from other NSF bacteria. Only 3 isolates belonging to the serotype O157:H7 were obtained . Latex agglutination test for O157 and H7 showed that the 3 isolates gave positive results with both tests. The Bacterial isolates were identifed by using Multiplex Polymerase Chain Reaction (MPCR) technology for the presence or absence of 4 genes (Stx1, Stx2, hlyA and eaeA) that encode for main virulence factors to diagnose E. coli O157:H7 isolated By using specific primers in MPCR . The result showed that one E. coli O157:H7 isolates contain all 4 genes , other isolates contain 3 genes: Stx2, hlyA & eaeA.

Detection of BRCA1and BRCA2 mutation for Breast Cancer in Sample of Iraqi Women above 40 Years

Breast cancer is the commonest cancer affecting women worldwide. Different studies have dealt with the etiological factors of that cancer aiming to find a way for early diagnosis and satisfactory therapy. The present study clarified the relationship between genetic polymorphisms of BRCA1 & BRCA2 genes and some etiological risk factors among breast cancer patients in Iraq. This investigation was carried out on 25 patients (all were females) who were diagnosed as breast cancer patients attended AL-Kadhemya Teaching Hospital in Baghdad and 10 apparently healthy women were used as a control, all women (patients and control) aged above 40 years. The Wizard Promega kit was used for DNA isolation from breast patients and normal individuals. By this method suitable quantities of DNA approximately (50 µl) with purity ranged from (1.7-1.9) were obtained from 100-200µg of fresh biopsy which had been taken from women breast patients. The extracted DNA was successfully used in amplification of BRCA1 & BRCA2 genes by PCR and some mutation were detected. The outcome of genetic analysis indicated that the percentage of 185delAG mutation was 16 (4 patients) whereas, the percentage of 5382insC mutation was 32 (8patients) in BRCA1 gene and the third mutation 6174delT in BRCA2 present in 3 patients only (12%). The study demonstrated that the frequency of BRCA1 mutation (48%) was higher than BRCA2 (12%) in this sample of Iraqi women with breast cancer.

Exogenous Insulin Effect on the Initiation of Breast Cancer in Type 2 Diabetes Mellitus Patients

Background: Growing evidence has indicated that women with type 2 diabetes mellitus are at an increased risk of developing breast cancer. However, as a major adjuvant treatment, the influence of hormone therapy such as exogenous insulin on type 2 diabetes mellitus in primary breast-cancer remains controversial. Objective: To explore the relationship between different types of hypoglycemic medications for diabetes and the factors that may contribute to the initiation of breast cancer. Methods: The study included 80 blood samples taken from 80 females recruited from Ibn Al-Bitar Center for Cardiac Surgery Hospital in Baghdad, Iraq, between November 2022 and February 2023. They were within the age range of 40 to 70 years. They were divided into three groups according to the treatment strategy and duration of disease as follows: Group 1: (20) patients who take insulin only, Group 2: (20) patients who take metformin with insulin, and G 3: (40) patients on metformin only for less than one year. An enzymatic oxidation technique was used to test the following biochemical parameters for all research groups: Total cholesterol, triglycerides, fasting blood glucose, and high-density lipoprotein cholesterol. Using the Friedewald formula, the very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol were determined. Using an enzymatic process, Insulin levels and Insulin like growth factor-1(IGF-1), Estrogen receptor alpha (ERα) levels, and breast cancer susceptibility protein 1 (BRCA1) were measured with an enzyme-linked immunosorbent assay (ELISA). Glycated hemoglobin (HbA1c) level was measured with a sandwich immunodetection method. Finally, The Homeostasis Model Assessment for insulin resistance (HOMA-IR) was calculated according to the specific formula. Results: The values for HbA1C%, FBS, and lipid profile showed non-significant differences when compared between study groups. While BRCA-1, estrogen receptor alpha (ERα), insulin, insulin growth factor IGF-1, and HOMA IR All showed significant differences among all groups. Conclusion: Taking metformin only for less than one year seemed to contribute to higher levels of BRCA-1.

The Role of Arginase and some Parameters in Diabetic Type 2 Patients with and without Retinopathy

Background: Oxidative stress plays a major role in the pathogenesis of diabetes mellitus by damaging cellular organelles and enzymes in blood such as arginase1, insulin and glutathione s-transferase; increasing lipid peroxidation such as malondialdehyde and increasing insulin resistance which can lead to diabetic complications such as diabetic retinopathy. Objectives: To explore the relationship of oxidative stress to the development of diabetic retinopathy by measuring the levels of Arginase1, the activity of glutathione s-transferase enzyme, and the levels of malondialdehyde as a secondary product of lipid peroxidation (biomarker for oxidative stress). Patients and MethodsThis study was conducted from November 2022 to January 2023 at the Ibn Al-Haitham Teaching Eye Hospital in Baghdad, the University of Baghdad / Department of Chemistry and the National Diabetes Centre for Treatment and Research at Al-Mustansyrriah University. This study was conducted on 120 subjects distributed as follows: 40 non-diabetic obese controls, 40 type 2 diabetics with no retinopathy, and 40 type 2 diabetic retinopathy patients, between 30 and 65 years of age. All groups were subjected to tests: measuring fasting blood glucose (FBG), HbA1c, lipid profile (cholesterol, triglycerides, HDL- cholesterol, LDL- cholesterol, and VLDL cholesterol), serum total arginase1, malondialdehyde glutathione s -transferase, body mass index (BMI), and waist-to-hip ratio. Results: Mean arginase1 levels were significantly higher in diabetic patients than in diabetic retinopathy and control groups (p ≤ 0.05). The mean xidative stress marker malondialdehyde concentration was significantly higher in diabetic retinopathy patients than in type 2 diabetics and the control group (P ≤ 0.05). The mean glutathione s-transferase activity in diabetic retinopathy patients was significantly higher than in the control group and type 2 diabetics (P ≤ 0.05). Conclusion: There is a relationship between oxidative stress and the development of diabetic retinopathy, where the levels of arginase1 and malondialdehyde increased and the activity of glutathione s –transferase enzyme increased as a result of oxidative stress and inflammation associated with complications of type 2 diabetes.

Health and Environmental Risk Assessment of Heavy Metals Contamination from Medical Wastes Ash of Baghdad Hospitals

Abstract One of the complex problems that many countries suffer from is how to deal with medical waste because of its harmful and devastating effects on humans and the environment. Hospitals around the world use and consume many different products. These products are composed of various materials, and many of them contain heavy metals in their production and manufacturing, which are ultimately emitted into the environment, posing a major danger and risk to human health. This work focused on assessing the contamination levels of medical waste ash after the incineration process. Ash samples were collected from major hospitals in the capital, Baghdad. The health risks resulting from heavy metal pollution were calculated. Medical waste ash was collected at different times from three major hospitals within the capital, Baghdad, and tested for contamination with heavy metals. To measure the bottom ash samples, X-ray spectroscopy (XRF) technology was used to determine heavy metal concentrations. The results showed the presence of more than twenty elements in the ash of medical waste, including the heavy metals found in Baghdad hospitals. Work was done on eight of these heavy metals due to their high concentrations. These selected elements are considered highly toxic and dangerous if exposed to them, including zinc (Zn), lead (Pb), arsenic (As), cobalt (Co), and copper. (Cu), nickel (Ni), chromium (Cr), and mercury (Hg). To evaluate the health risks of this pollution. All of these elements are a major problem if exposed to them. The amount of contamination was calculated using the contamination factor (CF). The results showed that the percentage of As, Cd, Hg, Zn, Pb, and Cu was very high. Meanwhile, the concentrations of Co and Ni were moderate values in medical waste ash. Adult health risks were calculated using the non-cancer health risk ratio (HL). The calculated values show values higher than the safe level in Imam Ali Central Hospital, indicating a potential high health risk. Meanwhile, other hospitals (Sheikh Zayed and Dhari Al Fayyad) recorded risk values below the safe level, indicating no health risks. The health risk assessment indicated that there are three main routes of human exposure: “ingestion, inhalation, and skin contact.” The cancer risk index (Risk) was also calculated. The values obtained were within the acceptable range. An analysis of the metal pollution index was also conducted, and it was found that heavy metals pose a non-cancerous risk. But the harmful effects of pollution from ash disposal have been particularly serious because they may contain high concentrations of heavy metals.

Isolation and Diagnosis of Acinetobacter baumannii Isolates from Patients with Meningitis in Child Protection Hospital in Baghdad

Environmental contamination has been estimated to account for up to 20% of all hospital-acquired illnesses. Acinetobacter baumannii has recently become the predominant pathogen, posing a significant risk to human health. In present study, two hundred fifteen CSF samples were collected from children between the ages of new born to 14 years who were visiting child protection hospital in Baghdad. For the period from first of Oct 2023 to the end of Jan 2024, and the samples were sent for diagnosis. Isolates were identified after culturing them on MacConkey agar, blood agar, and mannitol salt agar. A number of biochemical tests were performed to detect Acinetobacter baumannii bacteria. The results indicated a negative oxidase reaction, a positive catalase reaction, a negative indole reaction, a negative methyl red reaction, a negative Voges-Proskauer reaction, and a positive citrate reaction, which were performed for the samples and for final diagnosis the Vitek-2 Compact system was used. After cultivation and diagnosis, 7 isolates of Acinetobacter baumannii were obtained out of 40 samples that showed positive culture results with bacterial growth.

Assessment Outcomes Effect of Apolipoprotein E4 Allele on Cardiovascular Diseases

The apolipoprotein E4 allele is a genetic risk factor that has a negative impact on the quality of life of people with cardiovascular disease. Our current study aimed to evaluate the effect of apolipoprotein E4 allele in cardiovascular patients (n=85). A total of 85 elderly patients with cardiovascular disease were enrolled in the study, which was conducted at hospitals in Baghdad, Iraq, between 18 January 2022 and 27 October 2023. Comprehensive cardiovascular examinations were performed on each patient, including blood pressure, heart rate, and other vital sign measurements. APOE genotype analysis was conducted to evaluate the impact on the patients. Additionally, questionnaires were administered to assess the quality of life of patients with cardiovascular disease. In terms of clinical outcomes, chest pain was identified as the most prevalent symptom among patients, with a total of 38 cases. Additionally, the E3/E4 genotype of the APOE gene was observed in 41.18% of patients, which was associated with an increase in serum lipid-lipoprotein levels in terms of SBP (145.39 ± 27.46) mmHg and DBP (87.89 ± The mean values for the variables were as follows: glucose (3.11 ± 1.12) mg/dL, triglycerides (224 ± 46.25) mg/dL, LDL-C (167.29 ± 12.92) mg/dL, and HDL-C (14.82 ± 3.82) mg/dL. The adverse findings revealed that 23 cases involved heart attacks, and 30 cases involved strokes. Patients with CVD who carried the apolipoprotein E4 allele exhibited negative impacts on their quality of life, as evidenced by the following scores: physical functioning (46.38 ± 14.26), energy/fatigue (53.25 ± 12.29), and emotional problems (62.10 ± 10.29). In general, patients with the apolipoprotein E4 allele exhibit elevated levels of lipid profiles, which signify an elevated risk of severe complications in patients with cardiovascular disease.

Immunohistochemical investigation of SOX2 expression in Iraqi patients with high-grade glioma

Background. Gliomas, particularly high-grade gliomas, are aggressive brain tumors with poor prognosis. Sex-determining region Y-box 2 (SOX2) is a transcription factor responsible for stem cell maintenance and differentiation and has been implicated in glioma progression and recurrence. The present study investigated SOX2 expression in Iraqi patients with high-grade glioma and assessed its potential as a diagnostic and prognostic biomarker. Methods. Sixty-four paraffin-embedded samples from the Neurological Hospital in Baghdad were analyzed, including 34 high-grade glioma cases (21 males and 13 females) and 13 benign controls (10 males and 3 females). Immunohistochemical staining for SOX2 was performed, and staining levels were categorized using a scoring system. Statistical analyses were conducted to evaluate differences in SOX2 expression between genders and between patient and control groups. Results. There were highly significant differences in SOX2 expression between patients and controls (p ≤0.01). However, no significant difference was observed between male and female patients (p ≤0.01). Additionally, there were significant differences in SOX2 expression distribution between genders, with p-values of 0.0022 for males and 0.0061 for females. The highest distribution percentages for males were at scores 2 and 3, with values of 38.10 and 47.62%, respectively. In contrast, females had distribution ratios only at scores 2 and 3, with values of 30.77 and 69.23%, respectively. Conclusion. SOX2 is highly expressed in high-grade gliomas, supporting its potential as a diagnostic and prognostic marker. Future studies with larger cohorts and detailed sex-specific analyses are needed to elucidate SOX2's role in glioma pathogenesis and its potential as a therapeutic target.

Effect of Growth Conditions on Hemolysin Production from Clinical Isolates of <i>Escherichia Coli</i>

Background: Escherichia coli belongs to the Enterobacteriaceae family and is found in the digestive systems of humans and various animals as normal flora. Objective: This study aims to identify the optimal conditions necessary for the synthesis of hemolysin by E. coli isolated from a variety of clinical contexts. Methods: A total of 120 specimens were collected from different clinical sources in Baghdad Hospitals. Screening for hemolysin production was done by plate and Spectrophotometric methods. Furthermore, many conditions for producing hemolysin from clinical E. coli isolates were investigated including temperature, pH, incubation time, inoculum size, culture medium, and aeration. Results: Six isolates of E. coli exhibited hemolysin production. Optimal conditions for hemolysin production were determined: the temperature was 37 °C with an optical density of 0.931, the pH was 7 with an optical density of 0.976, the incubation period was 24 hours with an optical density of 0.885, 1% inoculum resulting in an optical density of 0.558, brain heart infusion as the best medium with an optical density of 1.697, and a shaker method showing superior results (optical density of 1.235) compared to static aeration (optical density of 0.988). Conclusions: This study identified the optimal conditions necessary for the synthesis of hemolysin by E. coli. By understanding these optimal conditions, researchers may be better equipped to develop strategies for managing and controlling the spread of these pathogenic bacteria.

The Role of Serum Level of Col2a1 and Hyaluoronic Acid in Diagnosis of Knee Osteoarthritis

Osteoarthritis (OA) is a complex condition in which affected tissues experience changes in metabolism, structure, biochemistry, and function. This condition arises when chondrocytes fail to balance the synthesis and degradation of extracellular components like proteoglycans and collagens, leading to inflammation of the synovial membrane and joint capsule. Aim of the study: This study was designed to evaluate the serum levels of Type II Collagen alpha 1 (coll2a1) and Hyaluronic Acid (HA) in diagnosis of early stage of knee osteoarthritis in Iraqi patients Subjects and Methods: This case- control study was carried out at Department of Biochemistry, College of Medicine, University of Baghdad and at Rheumatology Department , Baghdad Hospital / Medical City, during the period from September 2022 to March 2023. It included ninety volunteer males and females subdivided into subgroups: Group 1consisted of 50 patients who have had early stages of knee osteoarthritis (KOA) and group 2 involved 40 apparently healthy subjects who served as control group. The diagnosis of KOA was made by a consultant rheumatologist using American College of Rheumatology (ACR) criteria. Moreover, patients were sub- classified according to their BMI (normal weight, overweight and obese) and KOA severity (grad1 and grad 2). Investigations included serum measurements of Human serum coll2a1( type II collagen alpha I) and Human serum HA (Hyaluronic Acid) in all patients and controls by ELISA technique. Results: The mean (±SD) values of Coll2a1, HA, of KOA patients were significantly higher than those of controls (for all, p <0.01). There was significant positive correlation between. The mean value of serum hyaluronic acid was significantly increased in grad 2 KOA when compared with grad 1 KOA patients (p < 0.004). The results found that fibulin-3 has the highest receiver operator characteristic (ROC) and area under curve (AUC=89.2% ) at cutoff (7.50 ng/ml) with sensitivity 80.0 and specificity 80.0 in diagnosis of KOA. Also, serum Coll2a1 has high diagnostic utility (AUC=88.6%) at cutoff (286.00 pg/ml) with sensitivity 82.0 and specificity 80.0 . Conclusion: Assessing non-invasive serum levels of coll2a1 (with a cutoff of 286.00 pg/ml) offers a new biochemical marker for diagnosing the early stages of knee osteoarthritis (KOA) potentially before changes become visible on X-rays. Additionally, measuring serum hyaluronic acid levels could serve as an indicator of disease severity, helping to differentiate between various grades of KOA.

A profile of emergency departments in Baghdad hospitals.

To assess the structure as well as availability of essential equipment and medicine at emergency departments in Baghdad hospitals. The descriptive, cross-sectional study was conducted from March to June 2021 after approval from the ethics review committee pf the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised emergency departments of general and teaching hospitals in the city. Evaluations were done using the World Health Organisation checklist and the guidelines of the Australasian College for Emergency Medicine related to Emergency Department Design. Of the 26 secondary care hospitals in Baghdad, 13(50%) were evaluated. Triage was not available in 8(62%) hospitals, resuscitation room in 10(77%) and waiting room in all the 13(100%). An obvious shortage of medicines and vaccines was noted in 11(85%) hospitals. Coronary care unit and intensive care unit were not close to the emergency department in 7(54%) hospitals, and liaison psychiatry and social work links were not available in all 13(100%) hospitals. There is a need to improve service delivery at emergency departments functioning at hospitals in Baghdad.

Prevalence of breakthrough COVID-19 infection among healthcare workers in Baghdad.

To determine the prevalence and severity of breakthrough coronavirus disease-2019 infection among health workers, and to assess health workers' post-vaccination adherence to preventive guidelines. The cross-sectional study was conducted from December 2021 to March 2022 at 2 major hospitals in Baghdad, Iraq, and comprised physicians, pharmacists, dentists and paramedical staff present at time of data collection. The participants were classified according to vaccination status with history of infection. Unvaccinated meant infected before vaccination; partially vaccinated meant infected after the first dose; and fully vaccinated meant breakthrough infection after the second dose. Data was analysed using SPSS 28. Of the 506 participants aged 20-59 years, 327(64.6%) were females, 247(48.8%) were physicians, 72(14.2%) were smokers, and 21(4.1%) had asthma. All the 506(100%) participants had been infected after vaccination; 430(85%) after the second dose, and 76(15%) after the first dose. In 445(88.6%) cases, the infection was mild to moderate, while admission was required in 21(4.1%). With respect to adherence to preventive guidelines, 229(45.3%) subjects were always wearing masks before the vaccination, but 119(23.7%) continued doing that after receiving the second dose of the vaccine. The majority of the participants had fallen victim to breakthrough coronavirus disease-2019 infection. Adherence to preventive guidelines was found to be reduced after the second dose of the vaccination.

The Impact of Maternal Smoking on Perinatal Complications in Iraq

Smoking is negatively associated with birth outcomes for Iraqi pregnant women, with the fetus being at risk of stillbirth, neonatal death, and severe complications. The present study aims to investigate and enrol the clinical outcomes of perinatal complications among Iraqi smokers who are pregnant. A total of 63 pregnant Iraqi women, aged between 25 and 45 years, who had given birth in maternity hospitals in Baghdad, Iraq, were recruited between March 2023 and April 2024. The study enrolled the women's intrapartum outcomes, their daily cigarette use, and the dose of cigarettes they consumed during pregnancy. The clinical data pertaining to both the women and the fetuses were determined in terms of complications, pain, obstetric outcomes, and quality of life assessment. The study revealed that women in the 25–30 age group were the most prevalent participants, with 24 cases. The daily cigarette consumption was classified into four categories: <10 cigarettes per day (29 cases), ≥ 10 cigarettes per day (20 cases), and ≥20 cigarettes per day (14 cases). A total of 14 cases were identified, with gestational age in ≥ 37 weeks representing 53.97% of the total patient population. The mode of delivery was predominantly caesarean section (28.57%), while the remaining 71.43% underwent vaginal delivery. Low birth weight was identified as a risk factor. Of the total number of cases, ten were identified as having perinatal complications, representing a rate of 41.27% among all patients. Additionally, 22 cases were classified as having a birth weight of less than 2500 g. There were four instances of stillbirth. Pregnancy outcomes perinatal ones are adversely affected by cigarette smoking based on the dosages.

The Association between the Response to Rituximab with Sociodemographic Data and Disease Characteristics Among a Sample of Iraqi Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Rituximab (RTX), a monoclonal antibody with anti-CD20 action, is now used as a treatment. Even with proper RTX use, some patients showed variations in response. Objective: To assess the association of different sociodemographic data and disease characteristics with RTX responsiveness in RA patients. Methods: A cross-sectional study was conducted in the Specialized Center of Rheumatology at Baghdad Teaching Hospital in Baghdad, Iraq. The study included 90 RA patients who received a 1000mg RTX intravenous infusion for at least six months. The collected sociodemographic data included age, gender, smoking status, body mass index (BMI), disease characteristics such as co-morbidities, and the use of previous biological agents. The activity of RA was assessed by the 28-joint Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI). Results: Upon measuring the DAS28, the enrolled patients were divided into RTX responders (50 patients) and RTX non-responders (40 patients). Patients with a family history of RA were significantly higher in the RTX responders (21% versus 2% in the non-responders group). The responders had a significantly longer RA duration (p=0.030).The mean of CDAI and DAS28 were significantly higher in patients with no family history of RA than in those with a family history of RA. Conclusions: Disease duration, family history, and the use of previous biological agents could be considered as possible predictors of response to RTX, thereby saving time and treatment costs.

Genetic diversity, virulence profiles, and antimicrobial resistance of Salmonella enterica serovar Typhi isolated from typhoid fever patients in Baghdad, Iraq

Typhoid fever is an important health issue in developing countries, and the pathogenicity of Salmonella enterica serovar Typhi (S. ser. Typhi) depends on the presence of different virulence factors. Therefore, this study aimed to investigate the spread of virulence genes among S. Typhi isolates from patients with typhoid fever in Baghdad, Iraq. Sixty S. Typhi isolates were collected from several hospitals in Baghdad and identified using VITEK-II and confirmed by polymerase chain reaction (PCR) to detect the 16S rRNA gene. After testing their susceptibility to different antimicrobials (via the disk diffusion method), we found the highest resistance rates (100 %) were to ampicillin, piperacillin, cefotaxime, and ceftriaxone. The highest sensitivity rates (100 %) were to ertapenem, imipenem, meropenem, and sulfamethoxazole/trimethoprim. The presence of genes encoding for virulence in S. Typhi isolates was tested by conventional PCR. The results showed that out of 60 isolates, 59 (98.3 %), 59 (98.3 %), 58 (96.7 %), and 60 (100 %) were positive for viaB, staA, cdtB, and orfL genes, respectively. The sequencing of PCR products (viaB, staA, cdtB, and orfL genes) was carried out at the Macrogen Company (Seoul, Korea). The sequences were compared with nucleotide sequences in the BLAST GenBank database, and data obtained from the sequencing of these virulence genes were submitted to GenBank under different accession numbers. A phylogenetic analysis of the 16S rRNA gene sequence found a high similarity between local sequences and the closely related sequences of genes in GenBank. The presence of the viaB, staA, cdtB, and orfL virulence genes in nearly all of the isolates under examination suggests that they play an important role in the pathogenicity of local isolates.

Analysis of the partial sequencing of clbA, clbB and clbQ in Escherichia coli isolates that produce colibactin and multilocus sequence typing

Colibactin, is a cyclomodulin expressed from polyketide synthase (pk) genomic islands. These bacterial toxins interfere with the eukaryotic cell cycle and induce DNA damage. The aim of the present study was to investigate the prevalence of colibactin production among E. coli strains recovered from different infections, determine the similarity of clb nucleotide sequences, and identify genotype of isolates using multilocus sequence typing(MLST). This was a prospective, cross-sectional study conducted from January 2022 to February 2023. A total of 117 clinical isolates were obtained from various sample types collected from outpatients and inpatients recruited to the Department of Bacteriology Labs in different hospitals in Baghdad, Iraq. clbA/clbR, clbB and clbP/clbQ were detected via conventional PCR, and partial sequencing of amplicons was performed via Sanger sequencing. For select isolates, MLST genotyping was performed. The most common phylogenetic group was B2 (61/106; 57.54%). Among the E. coli strains, 27/106 (25.47%) were clb + ve, and the most common type was clbB (13/27; 48.14%). Analysis of the partial sequencing of clb among the strains revealed high molecular similarity. Genotyping of 37 selected E. coli strains via MLST revealed 28 different genotypes. There was a high prevalence of colibactin production in phylogroup B2, and it seems that the clb + ve strains had conserved molecular structures. There was high genetic diversity among the strains tested.

Detection of fim H and UDP virulence-associated genes in patients with MDR Klebsiella pneumoniae isolates from Baghdad hospitals

Klebsiella pneumoniae is a gram-negative, encapsulated, and lactose-fermenting bacterium related to hospital-acquired infections that can cause various diseases. The current study aimed to detect the presence of the virulence-associated genes fim H and UDP among multiple drug-resistant K. pneumoniae isolates obtained from different sources using polymerase chain reaction (PCR) to determine their association with antibiotic resistance. Ninety K. pneumoniae isolates were obtained from 210 different clinical samples collected from various sources (urine, sputum, wound swabs, blood, and burns) from patients of both genders in Baghdad hospitals between March 2022 and July 2022. Bacterial identification was based on selective and differential media, followed by seven biochemical tests, the Vitek-2 system, and molecular identification tests were performed using 16S rRNA. The antibiotic susceptibility of isolates to 13 antibiotics was assessed by the disk diffusion method on Mueller–Hinton agar. The results showed that 100% of the isolates were resistant to vancomycin. Otherwise, colistin had the lowest resistance rate (25.55%). The virulence genes fim H and UDP (uge) were detected by multiplex polymerase chain reaction (PCR) in multidrug-resistant (MDR) isolates. The most prevalent gene was fim H (88%) followed by UDP (80%). The virulence genes were highly prevalent among MDR K. pneumoniae isolates. The resistance rate to colistin was 25.55%, making it the most effective antibiotic used in the current study. Vancomycin, on the other hand, had a high resistance value. Multidrug resistant isolates were found to be associated with the presence of virulence genes.

Accuracy of community pharmacy blood pressure measurement: a cross-sectional study

Background: Recently, community pharmacy blood pressure measurement has gained popularity as it is easily accessible and cost-effective out-of-office method especially for blood pressure monitoring. However, it’s practical applicability and clinical value has not been fully studied. This study aimed to evaluate the accuracy of community pharmacy blood pressure measurement. Methods: Study participants were adults (390) who measured their blood pressure at different community pharmacies and came to the emergency departments (for confirmation of their blood pressure reading on the same day) of eight major hospitals in Baghdad, Iraq 2024. Participants were directly interviewed and blood pressure measured according to guidelines. Results: The mean age was (44.8±14.2) years of whom (58.7%) were males. The sensitivity was (85.1%), specificity (9.1%), positive and negative predictive values (22.9%, 65.9%), respectively. Paired t test showed significant difference between both systolic and diastolic blood pressure measurements in pharmacies (156.4±21.7 and 91.9±14.2, respectively) and hospital (122.7±15.4 and 77.4±9.50, respectively) (p<0.001). Pearson’s correlation test showed that there was mild positive correlation between measurements in hospital with body mass index (BMI) (r=0.20, p=0.005 and r=0.22, p<0.005, respectively). Conclusions: Community pharmacy blood pressure measurement lack accuracy. Further detailed studies are needed.