سامر نعمة ياسين الفتلاوي

This study aimed to detect the incidence, etiology, risk factors, and severity of nosocomial diarrhea among adult inpatients in a medical ward in Iraq. The study was conducted among patients admitted to the medical ward from June 1, 2019, to January 31, 2020, in AL-Sader medical city. The surveillance for nosocomial diarrhea was performed by monitoring every patient in the ward 3 times/week. 1050 patients were admitted to the medical ward in AL-Sader medical city. Of these, 52 patients (mean age 58±12.91 years, range 32 to 80) developed new-onset diarrhea during hospitalization. There was a significant relationship between the severity of diarrhea and age, residence, antibiotic use, including number and duration of antibiotics, immunosuppressive agents (steroids/chemotherapy), duration of hospital stay, level of consciousness, and enema use. Nosocomial diarrhea is a significant clinical problem that complicates about 5% of all admission in the medical ward. Various microorganisms account for nosocomial diarrhea, including E. histolytica, G. lamblia, and Candida. Several risk factors associated with the severe form of nosocomial diarrhea include old age, antibiotic use, immunosuppressive use, and length of hospital stay.

Background: Celiac disease is characterized by small intestinal malabsorption of nutrients after the ingestion of wheat gluten or related proteins from rye and barley, villus atrophy of the small intestinal mucosa, prompt clinical and histologic improvement following strict adherence to a gluten-free diet, and relapse when gluten is retaken. Aim of the Study: Evaluation of patients seeking gastroenterology and hepatology teaching hospital/medical city/Baghdad with suspected celiac disease regarding serological investigation, histological findings and genetic testing, to determine sensitivity, specificity, positive predictive value and negative predictive value for every test. Patients and Method: The study is a cross sectional descriptive analytic study conducted at the teaching hospital of gastroenterology and hepatology/Baghdad/Iraq during a period from the 1st of February 2018 to the 1st of April 2019. After thorough history and Clinical examination patients with suspected celiac disease were sent for serological investigation (TTG IgA and IgG), (antigliadin IgA and IgG), all patients were sent for endoscopic examination for duodenal biopsies with subsequent histological assessment. Patients who failed to be confirmed (positive serology and negative histology or vice versa) were sent either for HLA genotyping or for IgG Deaminated gliadin peptide. Sensitivity & specificity were measured for each test. Results: A total of 140 suspected celiac disease patients involved in this study. Mean age was 18.9 years and ranged from 2 years to 60 years. Male represented 36.4% of the cases while female represented 63.6%. Only 19 patients show positive family history of celiac disease (13.6 %). Regarding associated autoimmune diseases, the majority (111 patients) have no associated diseases (79.3%) while the other patients who have associations most of them show positive association with type 1 DM (16.4%). Fifty patients (35.7%) presented with short stature, (25.7%) came with diarrhea. The other symptoms vary between bloating and distention, unexplained anemia and weight loss. Constipation was seen in one patient. tTG IgA and tTG IgG showed high sensitivity, specificity, positive predictive value and negative predictive value while antigliadin antibody failed to show these significant results.Conclusion: The use of serologic markers in celiac is easy, direct, noninvasive and reliable and could be benefit in the diagnosis and monitoring of the disease. More specifically, both the tTG-IgA/IgG are very good markers in the diagnostis of CD. This study confirmed the high specificity and sensitivity of tTG, and the low results of AGA, but celiac serology does not replace the biopsy in the diagnosis but is useful as an assistant for diagnosis.

Background: Calprotectin is consisting of a protein binding zinc and calcium mainly found in Neutrophils. It is generally associated with inflammation. Elevated fecal Calprotectin can be detected when there is gastric or colorectal malignancy, or when there is an inflammation such as in inflammatory bowel disease (Crohn's disease and ulcerative colitis). Objectives: To assess the role of fecal Calprotectin as an indicator for inflammatory bowel disease and malignancy in chronic diarrhea. Methodology: Cross-sectional study conducted in Al-Sadr Teaching Hospital from January till the end of March 2020, and included (100) patients with chronic diarrhea who underwent fecal Calprotectin test and colonoscopy. Results: Mean age of participants was (36.61 ± 13.09) years, with equal gender distribution. Comparison of fecal Calprotectin level among colonoscopy findings was performed using ANOVA test. There was significant association between the two variables (FCP and colonoscopy finding), P-value < 0.001. In Crohn's disease, fecal Calprotectin level was significantly higher than that of normal group, with a mean difference of (44.53) µg/g, P-value < 0.001. Similarly, ulcerative colitis had significantly higher fecal Calprotectin level than normal group with mean difference of (54.29) µg/g, P-value < 0.001. Conclusions: This study concludes that the level of fecal Calprotectin increases significantly in patients with inflammatory bowel disease and colon malignancy, and can be used to predict the abnormal findings in colonoscopy. However, this indicator cannot discriminate between ulcerative colitis and Crohn's disease.

Abstract Background: This is a study of liver function tests in type two diabetic patients reveal that abnormal tests are not uncommon encounter in those in whom their diabetes is poorly controlled and it is regarded as a predictor for nonalcoholic fatty liver disease. Aim of this study: To study the correlation between liver transaminases (alanine aminotransferase and aspartate aminotransferase) and non-alcoholic fatty liver disease in type two diabetic patients. Patients and methods: In this cross sectional study conducted at diabetic and endocrine centre in A-Sadr medical city in Najaf, from February 2014 to March 2015 , a total of 120 type 2 diabetic patients were included (Male 39 and Female 81). Several different factors were studied like age, sex, type of treatment, body mass index and control of diabetes by measuring glycated hemoglobin. Liver transaminases (alanine aminotransferase and aspartate aminotransferase) was done to all those patients and the results are compared with these different factors that mention above. Ultrasonography was done to all the patients searching for any signs of non-alcoholic fatty liver disease like increase in liver size or echogenicity and compared with these factors. Results: Raised Alanine aminotransferase and Aspartate aminotransferase were noted in 20.8% and 16.6% respectively. The mean values of Alanine aminotransferase and Aspartate aminotransferase had no significant correlation with age, sex , mode of therapy or type of diabetes. Values of Alanine aminotransferase and Aspartate aminotransferase were also significantly higher with increasing Body Mass Index. Hepatomegaly, increased liver echogenicity are associated significantly with elevated Alanine aminotransferase and Aspartate aminotransferase values. Conclusion: There was significant correlation between increase level of ALT & AST and the U/S evidence of NAFLD in type 2 diabetic patients. Significant correlation was also found between increase BMI and raise level of liver transaminase ALT & AST ) as there was significant association between control of DM and liver transaminase level.