The diagnosis of iron deficiency anemia (IDA) relies heavily on symptom presentation, and patients lacking typical gastrointestinal (GI) symptoms represent a diagnostic challenge. IDA may be the initial manifestation of underlying pathology. This study sought to evaluate the effectiveness of different GI endoscopic studies in patients with IDA who lack GI symptoms. Methods We conducted an observational, multicenter retrospective analysis of 398 asymptomatic IDA patients admitted for GI endoscopic diagnosis from 2006 to 2016. Baseline measurements included hemoglobin, serum ferritin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation. We analyzed demographic characteristics, duration of hospital stay, the degree of severity of anemia, and endoscopic findings. Results The mean age of the study population was 52±9 years (range, 23 to 85 years), and 53% were men. Most patients were older than 45 years (n=353, 89%) with mild to moderate IDA. Patients underwent esophagogastroduodenoscopy (EGD, n=102), colonoscopy (n=271), or bidirectional endoscopy (n=25). The mean hospital stay was 2.72±1.66 days. The most common EGD results were atrophic gastritis (n=31), peptic ulcer (n=25), and negative findings (n=25). The most common colonoscopic results were negative findings (n=118), nonspecific colonic inflammatory changes (n=117), and non-bleeding hemorrhoids (n=29). We found no significant association between any endoscopic findings and age, gender, the severity of anemia, and length of hospitalization. Conclusions The presence of symptoms is of limited value in guiding diagnostic procedures concerning GI etiologies. Asymptomatic patients with IDA patients should receive an endoscopic examination irrespective of iron parameters, age, or gender for potentially treatable pathologies, especially for patients with suspected malignancies.

Introduction Validation assesses the acceptability, responsiveness, interpretability, and quality of any questionnaire in any specific population. This is done by correlation matrix evaluation of the proposed test tool with a previously well-validated assessment tool. The study objective is the dual-center assessment of the construct validity of the first health-related quality of life questionnaires for married and unmarried women with polycystic ovary syndrome (PCOS), i.e., PCOSQoL-47 and PCOSQoL-42, respectively. Materials and methods At two centers in Iraq, we enrolled 406 married women and 362 unmarried women with PCOS to test for the construct validity of PCOSQoL-47 and PCOSQoL-42, respectively, from August 2019-August 2020 (after obtaining full results of reliability testing in our previous work). We used the comparable domains from the multiculturally validated questionnaire (World Health Organization Quality of Life [WHOQOL-BREF]) as a comparator to assess the construct validity of the domains of the final highly reliable questionnaire drafts of PCOSQoL-47 and PCOSQoL-42 which were obtained from our previous work. The enrolled women will respond to WHOQOL-BREF and either PCOSQoL-47 or PCOSQoL-42, according to their marital status. Pearson's parametric correlational coefficient compared the total scores of the matched domains in one of our questionnaires and WHOQOL-BREF at p≤0.05. Values more than 0.3 denoted an important correlation between our test questionnaires and the well-validated WHOQOL-BREF questionnaire. The inter-rater reliability between our questionnaires and the comparator was calculated by Cronbach's alpha level, inter-item, and intra-class correlations coefficients matrix. Results We obtained a good respondent-to-item ratio of approximately 9:1 for both questionnaires. We had a good response for the domains of our questionnaires and WHOQOL-BREF. The coping domain at PCOSQoL-42 showed the highest Pearson's coefficient value of (0.708), which indicates a strong and significant correlation between the two constructs at (p<0.001). Other domains of the PCOSQoL-42 showed moderate significant correlation coefficient values. The psychological and emotional status domain of PCOSQoL-47 showed a weak yet significant correlation with its corresponding domain of the WHOHRQOL-BREF. The other domains of the PCOSQoL-47 showed moderate significant correlation coefficient values >0.5. The PCOSQoL-42 and PCOSQoL-47 showed high inter-rater reliability levels in measuring the requested construct or concept when we used Cronbach's alpha and inter-item correlation matrix assessment. Conclusion The individualized PCOSQoL-47 and PCOSQoL-42 for married and unmarried women with PCOS, respectively, represent the first reliable and valid HRQoL assessment tools for assessing the health-related quality of life (HRQoL) in those women with PCOS who use Arabic as a first or native language and address the sexual function as a separate domain...

Background and objectiveWe lack a reliable and validated health-related quality of life (HRQoL) questionnaire to measure the negative impact of polycystic ovary syndrome (PCOS) on the various aspects of the lives of Arabic women, which addresses sexuality in married women only. Hence, we aimed to develop two separate, simple, reliable, validated, and easily interpretable HRQoL questionnaires in Arabic for married and unmarried women with PCOS for effective QoL evaluation. Materials and methodsThe development and reliability analysis of the Polycystic Ovary Syndrome Quality of Life (PCOSQoL)-47 and PCOSQoL-42 involved two quantitative and qualitative phases. Phase 1 included retrieval of 158 items from 584 PubMed articles, item reduction, Arabic translation, content and face validity testing, creation of a five-domain draft (53 items for married and 45 items for unmarried women), with no sexuality domain for unmarried women. Phase 2 involved test-retest reliability, which involved using the Spearman's correlation, Wilcoxon nonparametric signed-rank, and internal consistency using Cronbach's-alpha, inter-item, and intraclass correlation (ICC) coefficients, as well as creating a second draft (47 items for married and 42 items for unmarried women). ResultsThe content validity indices testing by 26 healthcare experts decreased the item pool to 57 items for married and 45 items for unmarried women. Face validity by another 30 experts and 30 women from each group resulted in a further reduction to 53 items for married and 45 items for unmarried women, to be tested in a pilot study, which included another 30 women from each group. Test-retest reliability analysis by 195 married and 173 unmarried women revealed significantly excellent redundancy, reliability, and stability of items (highly significant Cronbach's alpha and ICC by internal consistency testing), and reduced the item pool to 47 items for married and 42 items for unmarried women. ConclusionsBoth questionnaires were found to be highly reliable for the HRQoL evaluation among both married and unmarried Arabic women with different phenotypes of PCOS.

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) or (Müllerian Agenesis) represents uterovaginal aplasia or hypoplasia of unknown etiology in young women with usual 46, XX karyotype, and normal secondary sexual characteristics. We report a 15-year-old adolescent woman with primary amenorrhea, and normal pubertal secondary sexual characteristics, normal hormonal workup, and clinical examination. Abdominopelvic magnetic resonance imaging (MRI) revealed cervical and uterine agenesis, with the absence of the proximal thirds of the vagina. Both kidneys are fused in the right iliac fossa with oval lobulated appearance, picture of crossed fused ectopia. The ovaries are normal and located bilaterally. The diagnosis of MRKHS type 2 was confirmed based on clinical, biochemical, and radiological findings. The correct clinical and radiological diagnosis of MRKHS by MRI is crucial for the next steps in long-term management.   Keywords: Müllerian Agenesis, Uterovaginal malformations.

Background: The classic celiac disease (CD) presentation in individuals with iron deficiency anemia (IDA) has been changed given the large percentage of subtle or asymptomatic cases. The study objective was to assess the predictive factors influencing the diagnosis and severity of villous atrophy in individuals with CD and IDA referred for a diagnostic endoscopy. Methods: This was a retrospective observational, cross-sectional analysis of the medical records of 499 individuals with IDA in 2 centers in Basrah, Iraq, who referred for possible diagnosis of CD within 10 years (2006-2016). The relationship of the severity of anemia, demographic characteristics, symptomatology, and celiac serological results on the final diagnostic endoscopic evaluation was evaluated using a univariate analysis, at a P value ≤ 0.05. The study adopted the Marsh classification for celiac disease diagnosis where Marsh type 3 represents the definite celiac disease. Results: The definite diagnosis was seen in 44.5% of the cohort (n = 222), with asymptomatic cases representing 22.5% of cases (n = 50). The mean age was (27 ± 11) years, with significant association to (female gender, age ≤45 years, positive celiac serology, and severity of anemia). After adjustment of the variables, the Marsh type was significantly correlated with positive celiac serology, low hemoglobin, and presence of gastrointestinal symptoms. Conclusion: The positive celiac serology, low hemoglobin <9 g/L, and the presence of gastrointestinal symptoms are strong predictors of the severity of villous atrophy (Marsh type).