أحمد نصير محمد قفطان

Background Type 2 diabetes mellitus (T2DM) is a significant global health burden due to rising incidence, cardiovascular complications, and multifactorial etiology involving genetic and environmental factors. One of the most common SNPs (single-nucleotide polymorphisms) is rs12255372 within the TCF7L2 gene, which has been shown to have a substantial impact on the risk of developing T2D. Objective The purpose of this study was to investigate the relationship between the polymorphism rs12255372 of the TCF7L2 gene and T2DM in the Middle Euphrates region of Iraq. Methods The study consisted of 300 individuals, comprising 150 T2DM patients and 150 healthy age and sex matched controls. Biochemical parameters (FBS, HbA1c, lipid profile, insulin) and genetic data were obtained from blood samples. Genotyping for the rs12255372 polymorphism was performed using the PCR-TETRA ARM method. Statistical analysis conducted included Hardy–Weinberg Equilibrium, logistic regression, multivariate analysis of covariance (MANCOVA), and Bayesian statistics, which were applied to validate genotype-metabolic trait associations and support the robustness of observed findings. Results A considerable association was noted between rs12255372 and T2DM under all of the tested genetic models: codominant, dominant, recessive, and additive. Carriers of the T allele (both GT and TT genotypes) had a significantly greater risk of acquiring T2DM (adjusted OR for GT: 2.67, TT: 6.34; p < 0.0001). T allele prevalence was markedly higher among diabetics, thus confirming its status as a potential genetic risk factor. The polymorphism was also associated with worsening glycemic control, exacerbated dyslipidemia, and higher insulin resistance. MANCOVA confirmed that rs12255372 genotypes significantly influenced metabolic trait variation. Conclusion The polymorphism rs12255372 within the TCF7L2 gene is strongly associated with T2DM predisposition and adverse metabolic traits among Middle Euphrates residents. This SNP may serve as a genetic risk marker for T2DM and contribute to risk stratification efforts. Its identification could support early intervention strategies when integrated with other genetic and lifestyle factors.

With the release of ChatGPT at the end of 2022, a new era of thinking and technology use has begun. Artificial intelligence models (AIs) like Gemini (Bard), Copilot (Bing), and ChatGPT-3.5 have the potential to impact every aspect of our lives, including laboratory data interpretation. To assess the accuracy of ChatGPT-3.5, Copilot, and Gemini responses in evaluating biochemical data. Ten simulated patients' biochemical laboratory data, including serum urea, creatinine, glucose, cholesterol, triglycerides, low-density lipoprotein (LDL-c), and high-density lipoprotein (HDL-c), in addition to HbA1c, were interpreted by three AIs: Copilot, Gemini, and ChatGPT-3.5, followed by evaluation with three raters. The study was carried out using two approaches. The first encompassed all biochemical data. The second contained only kidney function data. The first approach indicated Copilot to have the highest level of accuracy, followed by Gemini and ChatGPT-3.5. Friedman and Dunn's post-hoc test revealed that Copilot had the highest mean rank; the pairwise comparisons revealed significant differences for Copilot vs. ChatGPT-3.5 (P = 0.002) and Gemini (P = 0.008). The second approach exhibited Copilot to have the highest accuracy of performance. The Friedman test with Dunn's post-hoc analysis showed Copilot to have the highest mean rank. The Wilcoxon Signed-Rank Test demonstrated an indistinguishable response (P = 0.5) of Copilot when all laboratory data were applied vs. the application of only kidney function data. Copilot is more accurate in interpreting biochemical data than Gemini and ChatGPT-3.5. Its consistent responses across different data subsets highlight its reliability in this context.

Background: Since December 2019. millions of people in the world have been affected with the novel Coronavirus disease-2019 (COVID-19) pandemic, and high economic impact has affect many countries especially low socioeconomic one like Iraq due to the high cost and limited availability of RT-PCR for diagnosis of COVID-19, so there should be predictive low cost easily available laboratory tests that can be used before proceeding to the high cost techniques. Objective: In this retrospective study we aimed to evaluate the diagnostic accuracy of CRP, ferritin, LDH and D-dimer in predicting positive cases of COVID-19 in Iraq. Methods: It is a retrospective observational cohort study based on STARD guidelines to determine the diagnostic accuracy of (CRP, LDH, ferritin and D dimer) for COVID-19 of electronic medical records of private medical center in Najaf city, at which 566 individuals were recruited. The investigated subjects were either in close contact with previously COVID-19 positive patients or have one or more symptoms of COVID-19. They were categorized into 2 groups, 205 subjects diagnosed with RT-PCR as COVID-19 negative, and 361 COVID-19 positive patients, results of study variables of the cohort were recruited from the medical records. Results: Combining of these parameters had the following findings: CRP + ferritin; AUC: 0.77 with 55% sensitivity and 97% specificity, Ferritin + LDH; AUC: 0.83 with 65% sensitivity and 92% specificity, CRP+LDH; AUC: 0.78 with 56% sensitivity and 98% specificity, CRP + LDH + ferritin; AUC: 0.85, with 73% sensitivity and 88% specificity, CRP + LDH + ferritin + D dimer; AUC: 0.85 75% sensitivity and 87% specificity. Conclusion: Combination of routine laboratory biomarkers (CRP, LDH and ferritin ±D dimer) can be used to predict the diagnosis of COVID-19 with an accepted sensitivity and specificity before proceeding to definitive diagnosis by RT-PCR.

Background: Disorders of thyroid gland are common in general population, and it’s the most common affecting the endocrine system after diabetes mellitus. Thyroid function regulates a wide range of metabolic parameters, as well as affects some cardiovascular disease risk factors. Fructosamine is produced by a reaction between albumin (protein) and glucose; it is used to monitor patients with diabetes for short-term glycemic changes. H-FABP is present in the cytoplasm of cardiac myocytes, and delivers fatty acids into these cells. It has been shown to increase in myocardial injury. Lipoprotein LP(a) is consist of a special apolipoprotein called apoprotein (a), and it’s recognized as a cardiovascular disease independent risk factor. Objective: To study whether certain metabolic and cardiovascular markers (fructosamine, H-FABP and lipoprotein (a) are changed in hypothyroid patients. Methods: The current study included 280 overt hypothyroid, 272 with subclinical hypothyroidism compared with 270 healthy individuals of matched age and gender. For all subjects serum (TSH, T4, T3, FBS, HbA1c, fructosamine, triglycerides, cholesterol, lipoprotein (a), and Heart-type Fatty Acid-Binding Protein (H-FABP)) was measured. Results: Serum fructosamine level significantly elevated (p value <0.05) in patient with hypothyroidism when compared with control group, and no significant change between subclinical and control groups. There is no significant change in serum H-FABP between study subjects. There is significant increase in lipoprotein (a) in patient with hypothyroidism and those with subclinical group when compared with control group. Conclusion: Serum fructosamine and level is significantly changed in patients with overt hypothyroidism when compared with euthyroid subjects. Also, we conclude that hypothyroidism increase risk of cardiovascular diseases by changing non-traditional marker such as lipoprotein (a), and no effect on H-FABP concentration.

SUMMARY. Ischemia reperfusion injury (IRI) was a major issue with high mortality rate; more in critically ill, renal IRI is a common complication in circumstances such as partial nephrectomies and renal transplantation. Renal IRI activate an inflammatory response within the kidney tissue by synthesis of proinflammatory cytokines such as IL-1β and MCP-1. P2X7 receptor is a cation channel stimulated by extracellular ATP at high concentrations. Chloroquine is an anti-malarial agent and reports demonstrated that chloroquine suppress production of proinflammatory cytokine. Trolox, a water-soluble analogue of vitamin E, is a strong scavenger of frees radicals and has higher antioxidant activity in relation to vitamin E. The purpose of this study was to test the acute outcomes of a single-dose i.p. chloroquine and trolox administered in the experimental model of IRI in mice. The procedure would include certain histological and biochemical markers of renal function and reperfusion injury. Thirty Swiss albino adult male mice (12 weeks age, 25-45 g weight) were randomized to five groups, n = 6 for each group: IRI (control) group, sham group, vehicle (normal saline) group, chloroquine treated group, and trolox treated group. Mice undergo to bilateral renal ischemia (half an hour) followed by 2 hours reperfusion. Chloroquine was injected in doses of 0.3 mg/kg and trolox at dose 10 mg/kg administered i.p. 30 min before IRI. Selected biochemical and morphological markers then followed in the sham group and mice undergo IRI and administered with saline, chloroquine or trolox which include: 1) ELISA: IL-1β, MCP-1 estimation in both serum and homogenization of frozen kidney tissues and P2X7, 2) Serum urea and creatinine, and 3) histopathologic analysis. Renal IRI causes significant (p < 0.05) increase in both serum and tissue level of IL-1β, MCP-1 and serum level of P2X7, urea and creatinine, also cause significant tissue damage when compared with sham group. Pretreatment with chloroquine and trolox causes significant (p < 0.05) reduction in both serum and tissue level of IL-1β, MCP-1 and serum level of P2X7, urea and creatinine, and also cause significant reversal of tissue damage when compared with IRI group. In conclusion, pretreatment with chloroquine and trolox in mice model cause significant attenuation of renal IRI.

Background: Type two diabetes mellitus (Type II DM) in Iraq is exceeding and exhibited a large demand on health care systems. Many studies have explained polymorphism within the promoter adiponectin gene like -11391G>A (rs17300539) is associated with (Type II DM) and this polymorphism can cause changes in body mass index (BMI), blood glucose level insulin sensitivity and lipid profile. Methods: The current study included 400 Type II DM patients and 400 apparently healthy control subjects. Genotyping of rs17300539 polymorphism was performed by PCR–RFLP technique by using restriction enzyme (MspI) then agarose gel electrophoresis. Results: The analysis of the genotype distribution of rs17300539 emphasized significant differences among Type II DM group after comparison with the control subjects under the codominant and dominant models. The homozygous genotype (AA) and heterozygous (GA) genotype of rs17300539 was significantly (OR = 2.52, CI 95%:1.04–6.12, P = 0.04) (OR = 2.27, CI 95%; 1.62–3.19, P = 0.001) respectively, raised the risk of Type II DM by two folds, as compared to the wild type (GG) after adjustment for age, gender and BMI. Conclusion: Adiponectin gene polymorphism of promoter gene location rs17300539 was implicated in the development of Type II DM. this polymorphism also affect the metabolic changes in diabetic patients.

Background: Diabetes mellitus is a significant global health issue. Polymorphisms of Vitamin D receptor gene such as rs 2228570 could be linked with type 2 DM. Methods: A case-control analysis was performed on 400 patients and 400 controls. This research was conducted in Iraqi patients for the correlation between (rs2228570) and (rs7975232) with T2DM. After extraction of DNA, FokI and ApaI are used as restriction enzymes in the RFLP method to detect these two polymorphisms. Insulin level, serum 25 hydroxyvitamin D, HDL, TG, VLDL, and total cholesterol were measured. BMI has been calculated in all subjects. The odds ratio for type 2 DM risk was calculated. Results: The ff, Ff and f allele of rs 2228570 was significantly associated with an increased risk of developing T2DM [OR = 4.30, p = 0.000], [OR = 3.12, p = 0.001] and [OR = 3.24, p = 0.000] respectively. The SNP is correlated with T2DM in the various inheritance models, dominant [OR = 4.0, p = 0.001] and recessive [OR = 2.90 p = 0.000]. Under codominant pattern revealed that the (BMI, insulin level and 25 hydroxyvitamin D) analyzed showed significant differences among genotypes in patients group. There were no significant differences between all genetic models and alleles frequencies of the ApaI (rs 7975232) and the risk of T2DM (p > 0.05). ApaI AA genotype was associated with a higher HDL level (p < 0.05). Conclusion: Our results revealed that the FokI rs2228570 SNP increases the risk of T2DM, and it is associated with low levels of vitamin D, while no significant between the risk of T2DM and ApaI rs 7975232 genotype.

Clinical algorithms are used by health care providers and medical student for clinical decision making and teaching, this book illustrate algorithms and note boxes in subjects of clinical chemistry.

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A pilot study of the assessment of adiponectin gene SNP (rs266729) in Iraqi T2DM patients • This SNP significantly increased the risk of T2DM. • It significantly directed the changes of plasma levels of insulin and HDL

Keywords: TCF7L2 rs7903146 Polymorphism RFLP diabetes Iraq