Objective: This study was aimed to evaluate the effect of serum leptin level on irisin level in relation to glucose homeostasis that to be associated with hormonal changes (Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), Prolactin (PRL), Testosterone (TES)) in obese and nonobese women with polycystic ovary syndrome (PCOS). Methods:Fifty women with polycystic ovaries syndrome (PCOS) and thirty-four apparently healthy control women with regular menstruation (28±2days) were included in this study both of PCOS patients and controls were divided into sub-groups according to their body mass index (BMI) into: twenty-five obese (BMI ≥30) with (BMI= 35.934±0.746) and another twenty-five non-obese polycystic ovaries syndrome women (BMI=25.074±0.456). Whereas, controls were divided as seventeen obese (BMI= 37.140±1.470) and seventeen non-obese (BMI= 25.022±0.683) healthy control women with regular menstruation with an age range (20-40 y) and BMI matching that of the patient groups. Venous blood samples were collected to measure serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, prolactin (PRL), total testosterone (TES), thyroid stimulating hormone (TSH). As well as, fasting glucose, irisin, leptin, and insulin. Besides, estimating Insulin Resistance (HOMA-IR) index, β-cell function was determined using the Homeostasis Model Assessment of β-cell function (HOMA-β).Results: Serum irisin levels were not significantly different from their corresponding controls, in both obese and non-obese PCOS patients. Whereas, serum irisin levels were elevated significantly in both obese (patients and control) as compared to non-obese (patients and controls), respectively. But, serum leptin levels were significantly elevated in obese PCOS patients as compared to their corresponding control group, nonobese control, and non-obese PCOS patients. However, serum leptin levels were not significantly different in non-obese women groups, both the PCOS and controls. The irisin/insulin ratio expressed no significant variations from its corresponding control in non-obese groups. But the obese PCOS patient's values were highly significantly different as compared to their control (p<0.01). Furthermore, irisin/insulin ratio was elevated significantly in obese control as compared to non-obese patients (p = 0.001), but not with non-obese controls (p=0.114). The leptin/insulin ratio was not significantly varied in PCOS groups from their corresponding control in non-obese (p = 0.094) but in obese PCOS patients, there was significantly different as compared to its control (p = 0.01). Furthermore, leptin to insulin ratio was not significantly different between patients groups (non-obese and obese, p=0.133), nor between the studied controls (p=0.705). Conclusion:Although serum irisin levels show no significant variation in subjects in relation to PCOS condition, it seems more to be related to BMI, since it's secreted by adipocytes. And because leptin and irisin levels would be elevated in obese subjects th...

Chronic Kidney Disease (CKD) is a public health problem and many studies support the link between kidney dysfunction and cardiovascular events.  Aldosterone has been shown for decades that a plasma aldosterone concentration is elevated in CKD. Whilst, Osteoprotegerin (OPG), after its capacity to protect bone, also osteoprotegerin is elevated in patients with chronic kidney disease (CKD), where it could predict the deterioration of kidney function, cardiovascular, vascular events and all-cause mortality. On the other hand, fibroblast growth factors (FGFs), in patients with CKD, its levels seem to increase progressively as kidney function worsens. The aim of the present study is to assess the correlations between serum osteoprotegerin, aldosterone and fibroblast growth factor-23 levels in patients with chronic kidney disease stage (II-IV) with and without cardiovascular events. The study includes fifty-nine patients with chronic kidney disease(CKD) and according to CKD-EPI /Creatinine/ 2009 equation to be allocated as stage II-IV, patients were divided into three groups: Group1 (29 patients) with chronic kidney disease(CKD) stage (II-IV) with cardiovascular events. Group2 (30 patients) with chronic kidney disease stage (II-IV) without cardiovascular event, to be compared with Group 3(23 apparently healthy subjects), age and sex matched to that of patients. Serum obtained from their blood specimens to measure; glucose, urea, creatinine, calcium, phosphate, sodium, potassium, aldosterone, FGF-23, Osteoprotergen. Data analysis showed that fasting serum glucose levels of CKD patients (with and without CV disorder) had significantly higher values as compared to the controls (76.5% and 29% respectively). Serum Aldosterone, FGF-23, OPG levels were presented with no significant variation among studied groups with CV events or those without CV events.

Recent studies have highlighted on association between anemia and the development and progression of diabetic nephropathy. There is also an increased cardiovascular risk in patients with diabetic nephropathy and a clear association between anemia and abnormal cardiac function, although most patients in the previous studies have type 2 diabetes mellitus. The present study focused on the possible variations in hematological parameters as well as hs-CRP levels in anemic type 1 and type 2 diabetics without microalbuminuria, in relation to their glycemic indices.The study groups compromised of 50 diabetic patients (25 with type 1 and 25 with type 2) who had been selected to have haemoglobin levels below the gender specific normal range with negative microalbuminurea, in comparism to two control groups of 16 and 18 healthy subjects, respectively,whom are age and sex matching of type 1 and type 2 patients.For this the patients blood specimens were taken for testing blood levels of haemoglobin, red blood cells count,reticulocyte count, Hb A1C levels; as well as fasting serum glucose, serum insulin, C-reactive protein levels.The results indicated that anemia in both types of diabetes was not related to any of the RBCindices (MCV, MCH, MCHC), results are not shown, but it s related to lowered total number of RBC as compared to their controls. Meanwhile,their was no evidence of an increased reticulocyte in the studied groups of either types of diabetes, indicating a defective erythropoiesis rate, although the selected patients were without detectable nephropathy ( − v e t e s t i n g f o r microalbuminuria). Furthermore, the reduction in RBC count was not significantly correlated with glycemic indices (FPG, FPI, Hb A1C , QUICKI). However, hs-CRP levels were significantly elevated in diabetic patients, but CRP levels were significantly correlated with fasting serum insulin in type 2 diabetics,but not in type1. Which may indicate a role for inflammation in type 2 diabetes in contribution to insulin resistance that may provide an additional risk factor for cardiovascular diseases in this type of diabetic whom have anemia as well.Abbreviations: hs-CRP = high sensitive C-reactive protein, MCV = mean corpuscular volume, MCH=mean corpuscular haemogolobin, MCHC = mean corpuscular haemogolobin conc. FPG=fasting plasma glucose, FPI = fasting plasma insulin, QUICKI = quantitative insulin sensitivity check index, Hb A1c = glycated blood haemoglobin.

Diabetic Nephropathy(DN) is a complex disease manifested by persistence microalbuminuria   occurring due to the interaction between hemodynamic and metabolic pathway that activates the local renin-angiotensin-aldosterone system resulting in a decline in renal functions. This study aimed to quantify the associations between serum aldosterone concentration and fetuin- A as a marker of calcification in type 2 diabetic patients with and without microalbuminuria from one side, and study the possible relationship between aldosterone and fetuin-A with glycemic indices, serum electrolyte, renal function and microalbuminuria and body mass index from the other side. A case-control study involved eighty-six adult subjects classified into three groups after testing urine microalbumin including thirty-two diabetics type 2 patients with positive microalbuminuria and twenty-eight diabetics type 2 patients with negative microalbuminuria and 26 healthy subjects during their visit to AL kindy specialized Center for Endocrinology and Diabetes / Baghdad. Those patients were compared to control group of 26 apparently healthy subjects, fasting blood samples was obtained from each of them in one occasion only to measure: fasting serum glucose, electrolyte, aldosterone,  fetuin-A, urea, and creatinine. In addition to glycoheamoglobin, glomerular filtration rate and body mass index. Despite the presence of microalbuminuria in  thirty-two of the studied diabetics, there was no positive correlation between aldosterone and fetuin- A, besides that no significant variations in serum aldosterone ,glomerular filtration rate(GFR) values, while both groups showed a significant increase in fasting serum glucose and glycaoheamoglobin ,significant decrease in serum sodium and chloride in comparison with the control group , significant increase was detected  in serum fetuin-A mean  values in microalbuminuric diabetics. Whereas, negative microalbuminuric diabetics measures expressed a positive correlation between both serum sodium and chloride levels and fetuin -A. The conclusion of this study diabetic patient are prone to vascular calcification (VC)  might be due to increase in aldosterone level or due to diabetic itself  from this study we can conclude microalbuminuria can occur without a decline in renal function or a change in estimated GFR ,no definite correlation occur between aldosterone and fetuin- A, fetuin- A mean values are higher in diabetic patient with microalbuminuria compared to diabetic patients without microalbuminuria and control group and this referred to uncontrolled diabetes ,aldosterone show a correlation with  weight and body mass index while fetuin- A does not show  such correlation. In general, electrolyte disturbances (hypernatremia) is more obvious in this study  , and its occurrence is due to diabetic (osmotic diuresis) or drugs, while sodium retention which is a sign of aldosterone increment does not occur.  Hypochloremia that occur in this study is due to chloride and it is in parallel with sodium level.  

Background: Diabetes patients have a higher chance of developing dyslipidemia and increased release of free fatty acids, which participate in developing insulin-resistant fat cells. On the other hand, vitamin D insufficiency is linked to the evolution of type 2 diabetes mellitus (T2DM). This study examines the impact of vitamin D serum levels on lipid profiles and insulin resistance concerning glycemic indices in obese T2DM patients. Methods: During the data collecting stage, 47 diabetes patients were chosen from the out-patient clinic. The control individuals were selected from the general population and were equivalent to the matching patients, with a total of 43 healthy participants. After an overnight fast, a venous blood sample was collected from each individual to test insulin and vitamin D3 levels using particular ELISA kits. In addition, by colorimetric test, serum was used to estimate total cholesterol, triglyceride, and high-density lipoprotein cholesterol. Aside from that, fasting serum glucose levels were measured (FSG). Results: Fasting serum glucose (FSG), homeostatic model assessment-insulin resistance (HOMA-IR), total cholesterol, and triglycerides, all of these values were significantly elevated in people with diabetes as compared to controls (p-value <0.05) when the serum level of vitamin D was markedly low. In contrast, insulin and high-density lipoprotein values had decreased significantly in the diabetic population compared to controls (p-value <0.05) and were not correlated to vitamin D levels. Conclusions: Diabetes patients had higher FSG, HOMA-IR, hemoglobin A1c (HbA1c), fasting insulin, triglycerides, total cholesterol to high-density lipoprotein cholesterol ratios (TC: HDL-C), triglyceride to high-density lipoprotein cholesterol ratios (TG: HDL-C), and low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratios (LDL-C: HDL). In obese diabetic individuals, vitamin D levels had a significant impact on total cholesterol, LDL-C, and the TC:HDL-C ratio.

Background Burnout is a work-related physical and/or emotional exhaustion among individuals working in the human service sector. This descriptive cross-sectional study aimed to estimate the prevalence of burnout among interns training in different hospitals in Riyadh, Saudi Arabia, and its relation to engaging in unethical behaviors. Results The study found a high burnout level in 135 (50%) of the interns with minimal overall engagement in unethical behaviors (5.9%). However, patient-related burnout was the only factor found with a highly significant association to engagement in unethical behaviors (P-value < 0.001). Conclusions This study demonstrated a high prevalence of burnout among interns with a significant association between patient-related burnout and the engagement in unethical behaviors. That was a worrying sign that needs further evaluation in future research, including the other risk factors, to prevent/improve burnout and to limit the unprofessional behaviors.

Background: Acinetobacter baumannii (A. baumanii) has recently emerged as a major pathogen causing nosocomial infections in patients admitted to intensive care units with a surprisingly rapid acquisition of antibiotic resistance. Objective: To study the rate of occurrence of A. baumanii in different clinical samples and to investigate the association between biofilm formation and presence of ompA and bap genes in multi-drug resistance isolates. Methods: A total of 150 clinical samples were collected from (blood, sputum, urine, wound swab) during a period from the first of October 2017 to the end of March 2018 from Al-Imamein Al-Kadhimein City, Central Teaching Hospital of Pediatrics, Welfare Children Protection in Medical City and Al-Yarmouk Teaching Hospital and tested against 14 antibiotics by disc diffusion method. Quantitative microtiter plate assay was done for detection of biofilm formation. Polymerase chain reaction (PCR) was performed to detect ompA and bap genes. Results: There were 75 A. baumanii isolated from different clinical samples as follows: 41 from blood, 13 from wound, 12 from sputum and 9 from urine. The results of antimicrobial susceptibility test showed, high rate of resistance to Aztronem (94.7%) followed by Cefotaxime (89.3%), Cefepim (86.7%), Meropinem (86.7%), Ceftriaxone (86.7%), Ceftazidime (85%), Gentamicin (85%), and Piperacillin (82.7%) respectively. Moderate - to - low rate of resistance to Ciprofloxacin (78%), Impenim (46.7%), Levofloxacin (46%), Amikacin (44%), Tigacycline (42.3%) and Colistin (44%). The detection of biofilm formation showed that (52%) of isolate produce biofilm and the prevalence of ompA gene was 86.7% while the prevalence of Bap-gene was 34.7%. Conclusion: High frequency of A. baumannii infection was observed in different hospitals in Baghdad. More than half of the isolates were biofilm producer and there is highly significant association between the presence of bap gene and the biofilm formation but not with ompA gene. Keywords: Acinetobacter baumannii, ompA, Bap, MD Citation: Talib SS, Abdulrahman TR, Ali SH. Detection of some biofilm genes related with multidrug-resistant in Acinobacter baumannii isolated from clinical isolates. Iraqi JMS. 2018; 16(4): 430-438. doi: 10.22578/IJMS.16.4.11

Background: Prostaglandin G/H Synthases (Cyclooxygenases) are enzymes that catalyze the conversion of arachidonic acid to a series of compounds endingin prostaglandins, endogenous compounds triggering many biological & physiological events in many systems including circulatory & renal systems.The normal balance between Cox-1 derived thromboxane A2 (TXA2) which acts as a platelet activator enhancing thrombosis, & the antithrombotic cardioprotective effects of prostacyclin (PGI2) which is produced through Cox-2 activity. Thus inhibition of Cox-2 derived PGI2 will exaggerate the cardiovascular effects of TXA2. Cyclooxygenase - 2 (Cox-2) inhibitors have different odds on cardiovascular risk factors through selectivity to that enzymethat could play a role in their pharmacological action.Objective: Our study includes a comparison between the effects of the purely cox-2 selective inhibitor (Celecoxib), and the relatively Cox-2 selective inhibitor(Meloxicam) on some cardiovascular risk markers in patients suffering from rheumatoid arthritis.Materials &Methods: Thirty –six patients were selected as having rheumatoid arthritis (RA) with age range of 30-60 years (48±9.72), in addition to a group ofnormal subjects (12) were included as a control group Specific biochemical investigations based on measuring highly sensitive kit for serum C – reactiveprotein (hs-CRP), serum creatine kinase( CK), serum aspartate aminotransferase(AST), serum urea, serum creatinine, and serum lipid profile.The patients were treated with celecoxib 400mg/day or with meloxicam 15mg/day for 3 months period.Results: Both drugs were able to reduce (significantly) the highly sensitive Creactive protein and increase serum total cholesterol, Low Density Lipoprotein/High Density Lipoprotein (LDL/HDL) ratio as compared pretreatment values.Both drugs have nearly the same effects on renal function presented by decreasing glomerular filtration rate (GFR) as indicated by elevating serum urea levels.Conclusion: The selectivity of COX2 inhibition is not the major character that could be correlated with cardiovascular events related to their administration.Since, meloxicam could aggravate some cardiovascular risk factors more than celecoxib does, as presented a significant increment in serum CK activity.