سامر طه عبيد العذراي

Background: Angiotensin Converting Enzyme Inhibitors (ACEI) commonly cause cough as a main side effect, and whether or not they cause a more substantial effect on the respiratory function remains uncertain. Aims: to assess the pulmonary function status in patients who are taking ACEI with or without cough, during the treatment time & one month after cessation of therapy. Methods: This study was conducted in Al-Sader teaching hospital in Annajaf and Al-Hamza general hospital in Diwanyia from October 2015 till October 2016. One hundred and twenty subjects were assessed and divided in the following groups: G1: 30 hypertensive patients treated with ACEI who developed cough as a side effect of ACE inhibitors, G2: 30 hypertensive patients on ACEI without cough, G3: 30 hypertensive patients treated with antihypertensive drugs other than ACEI, G4: 30 subjects without history of hypertension used as control group. Spirometric tests and blood biochemistry tests were performed for all participants at baseline and were repeated for G1 one month after discontinuation of ACE inhibitors therapy. Results: Statistical analysis of the results reveals that the FEV1, FEV%, PEF were significantly lower in G1 than G2, G3 and G4 (p<0.05) and that FVC in G1 was significantly lower than G4 (p<0.05). Following the discontinuation of ACEI therapy , spirometry was repeated and the results show that there were significant increment in FEV1, FVC, FEV% and PEF for G1 after ACEI cessation (p<0.05). Conclusions: It is not only the cough that is caused by ACEI medication in those susceptible patients but also airway hype responsiveness and some effect of ACEI may persist after one month of stopping medications.

Background: Calcifications in non–coronary cardiac and vascular locations are frequently observed in imaging modalities, including echocardiography and non–cardiac computed tomography (CT) scans. Previous studies have shown an association between extra-coronary calcification and risk factors of cardiovascular disease. This study aims to investigate the prevalence of extra-coronary calcification, and explore the association with coronary disease severity and plaque characteristics. Method: In total, 200 consecutive patients who underwent CT coronary angiography at our institution had coronary calcium score and lesion characteristics assessed by two experienced Level B readers. The CT scans were reviewed by a third blinded reader to measure the calcium score at four extra-coronary sites including the aortic valve, mitral annulus, and ascending and descending aorta. Results: The prevalence of extra-coronary calcification at any site was 53%. The prevalence of aortic valve, mitral annulus, and ascending and descending aorta calcification were 36.5%, 12%, 9%, and 35.5%, respectively. Patients with extracoronary calcium score (ECCS) >0 had a higher prevalence of coronary calcification than patients without extra-coronary calcification (42% vs 16.5%; p < 0.001). Extra-coronary calcium score correlated with coronary calcium score (r = 0.520; p < 0.001) and age (r = 0.632; p < 0.001). Patients with extracoronary calcification were more likely to have calcified plaques than patients with no extra-coronary calcification (67.9% vs 27.2%; p < 0.001). Patients with ECCS >400 had higher rates of significant coronary stenosis (>50% stenosis in ≥1 artery) than patients with ECCS ≤400 (55% vs 13.8%; p < 0.001). Conclusion: An ECCS>400 was associated with the presence of significant coronary disease. The clinical relevance of extra-coronary calcification in non–coronary imaging modalities warrants further investigation.

Background Coronaviruses are essential animal and human pathogens. Symptomatic infection spectrum varies from mild stage to critical. Numerous COVID-19 complications have been characterized. However, most doomed consequences are severe pneumonitis, ARDS, and Cytokine release syndrome. A large spectrum of laboratory markers can support the identification and follow up of COVID-19 case. Lymphopenia is similarly one of the utmost recognized hematologic abnormalities that serve as a great prognostic tool. Various particular parameters have been used to predict disease outcome, for instance neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. Objectives The study conducted to have a better understanding on the role of neutrophil-lymphocyte ratio in the determination of the prognosis of COVID-19 and to assist in predicting disease severity. Methods • A total of 96 patients within age group 18-80 years who were verified positive for the COVID-19 by PCR, and admitted to (Al-Sader Medical City) in Al-Najaf City between (July to October 2020) were enrolled in a cohort retrospective study. • Neutrophil to lymphocyte ratio was calculated via taking the absolute neutrophil count divided by the absolute lymphocyte count. Other parameters like (renal function tests, D-dimer, C-reactive protein, serum ferritin) also has been studied in relation to outcome of patients with COVID-19 Results The neutrophil-lymphocyte ratio was significantly associated with low oxygen saturation and poor outcome. A significant difference was found between two clusters in CRP, serum ferritin, and D-dimer level. In addition, age and obstructive airway disease were important clinical predictors for poor outcome Conclusion The study established that elevated NLR at admission was a useful prognostic marker linked with poor outcome in patients admitted for COVID-19 pneumonia. Other inflammatory markers, such as ferritin, CRP, and D-dimer were also associated with critical illness and increased mortality from COVID-19 disease.

Background: pituitary gland adenoma is a benign tumor. It is classified into microadenoma and macroadenoma depending on the size and invasiveness of the tumor. The tumour can manifest with a variety of clinical features including amenorrhea, infertility, obesity, diabetes, heart disease, sex hormone abnormality, and many other serious illnesses. Immunological marker's such as interleukin-6 (IL-6) and natural killer activated receptors group 2D (NKG2D) may have a role in determing the prognosis and response to treatment in patients with pituitary glands adenoma. Objectives: study aims to assess the role of circulating IL-6 & NKG2D in the prognosis of pituitary adenoma. Methods: thirty female with new diagnosis of prolactinoma (pituitary gland adenoma) were enrolled in the study. ELISA test was used to evaluate the level of IL6 and NKG2D. ELISA tests were conducted before the initiation of treatment and six months later. Results: There are significant differences in mean levels of IL-6 and NKG2D, and the anatomical type (tumor size) (-418.7& 418.9 p<0.001) of anatomical tumor (-373.72&-373.920p=0.001). In addition, there is a significant difference between the two immunological markers (IL-6 &NKG2D) (-0.305; p<0.001). the IL-6 markers significantly decreased in means on follow up (-197.8; P value=<0.0001) while the reverse occur in NKG2D, which increased in levels post-treatment compared with baseline measurement. The high expression of IL-6 positively correlated with the risk of macroadenoma (>10 microns) and poor resonse to treatment and vice versa (P<0.024). Moreover, the high expression of NKG2D significantly((P<0.005) correlated with good prognosis and increased chance for tumor response to medicine and shrinkage in size compared with low concentration. Conclusion: The higher the level of IL-6, the larger the size of adenoma (macroadenoma) and the poorer the response to treatment. On the other hand, the higher the level of NKG2D indidcate a better prognosis. Therefore, IL-6 and NKG2D correlate negatively in prolactinoma patients.

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