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Background Hypertriglyceridemia (HTG) is one of the major modifiable risk factors for the development of several metabolic diseases. Determining the factors associated with HTG is an important step for increasing awareness of the problem and proper planning of health programs for HTG prevention. This study aimed to determine the conditions associated with HTG in adult patients in Basrah, Iraq. Methodology This retrospective study was conducted at Faiha Specialized Diabetes Endocrine and Metabolism Center (FDEMC) in Basra, southern Iraq, in January 2024. The data were retrieved from the center database of 37,133 subjects registered from 2008 to 2023 (16,284, 43.8% males and 20,849, 56.2% females) who attended the FDEMC in Basra due to different reasons. Results The most common causes of HTG were type 2 diabetes mellitus (T2DM) (29,799, 80%), obesity (19,914, 53.63%), and smoking (7,309, 12.68%). The age group of 18-45 years displayed higher triglyceride (TG) levels (281.1 ± 210.1 mg/dL) than other age groups. Furthermore, male patients had higher TG levels than females (288.0 ± 196.3 mg/dL vs. 268.9 ± 165.9 mg/dL). Regarding body mass index, overweight and obese patients had higher mean TG levels (284.4 ± 182.1 mg/dL and 281.7 ± 184.6 mg/dL, respectively). Current and ex-smokers had higher TG levels (305.1 ± 212.2 mg/dL and 283.4 ± 161.3 mg/dL, respectively) than non-smokers (272.5 ± 175.4 mg/dL). Moderate HTG was the most common category encountered in 24,137 patients (65%), followed by mild HTG (12,705, 34.2%). Very few patients had severe (264, 7%) or very severe HTG (27, 0.07%). Male patients had more frequent severe and very severe HTG than females. Conclusions The most common conditions associated with HTG were T2DM, obesity, and smoking. Smoker males were prone to severe and very severe HTG.
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BACKGROUND: The diagnosis of Grave's disease (GD) poses a challenge. Thyrotropin-receptor antibodies (TRAb) are the key diagnostic feature of GD, as the American and European Thyroid Associations suggested. AIM OF THE STUDY: This study aims to find a cut-off level of TRAb in GD in Basrah. METHODS: This is a retrospective study that included 617 patients with hyperthyroidism (530 GD and 87 non-Grave's disease (NGD) (thyroiditis or subclinical hyperthyroidism)). The candidates were patients presenting with hyperthyroidism who were referred for TRAb assay, while patients with thyroid carcinoma or nodular thyroid disease, pregnant ladies, and patients who were treated were excluded. RESULTS: The manufacturer cut-off value of 1.75 IU/L had a sensitivity of 88.1%, specificity of 72.4%, positive predictive value (PPV) of 95.1%, and negative predictive value (NPV) of 50.0%. Our data analysis through receiver operating characteristic (ROC) statistics revealed that the optimum cut-off point with the highest total sensitivity and specificity was determined to be 3.95 IU/L, as it had a sensitivity of 76.9%, specificity of 98.8%, PPV of 99.7%, NPV of 41.3%. CONCLUSION: For a more accurate diagnosis of GD, the findings of the present study support the implementation of a higher TRAb cut-off value (3.95 IU/L) than that predefined by the manufacturer (1.75 IU/L).
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Background Graves' disease (GD) is an autoimmune disease, with thyrotropin receptor antibodies (TRAbs) being the most important cause in the pathogenesis. The aim of this study is to assess the clinical significance of anti-TPO Abs in GD. Methods A retrospective study was conducted at the Faiha specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah during the period between December 2021 and December 2022. A total of 141 patients with GD were involved in this study, and of them, 97 (68.8%) were women. They were divided into two groups: patients with positive and negative anti-TPO Abs groups. Results Positive anti-TPO Abs were seen in 83 patients (58.9%) with GD. Pretreatment-free thyroxine level (ng/dL) was higher in the anti-TPO Abs positive GD patients than in those with negative antibodies (3.7±0.2 versus 3.0±0.2 with a p=0.021). Similarly, higher TRAb titers (IU/ml) at baseline were also seen in patients with positive anti-TPO Abs (9.8±0.7 versus 6.8±0.8) with a p=0.008. Giraffe appearance on thyroid ultrasound was more common in the group with positive anti-TPO Abs as compared to patients with negative anti-TPO Abs: 20 (87.0%) versus 3 (13.0%) with a p=0.005. A higher anti-TPO Abs titer (IU/mL) was associated with a baseline TRAb level of more than 6.4 IU/mL, and giraffe appearance on thyroid ultrasound (206.5±20.0 p-value<0.0001 and 228.0±35.3 p value=0.007, respectively). Conclusion A positive anti-TPO Abs in GD is associated with a high TRAb titer and free T4 level at baseline, as well as a giraffe appearance on thyroid ultrasound.
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Background Hypogonadotropic hypogonadism is an important cause of male infertility and loss of secondary sexual characteristics. Gonadotropin replacement is mandatory for sexual function, bone health, and normal psychological status. This study is to compare the effectiveness of different gonadotropin therapy modalities in the management of male hypogonadism. Methods A randomized open-label prospective study of 51 patients attended the Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) with hypogonadotropic hypogonadism, divided randomly into three groups. The first group was treated with human chorionic gonadotropin (hCG) alone, the second group was treated with a combination of both hCG and human menopausal gonadotropin (HMG), while the third group started with hCG alone then followed by combination therapy after six months. Results All modalities of therapy result in a significant increase in mean testicular volume although no clinically significant difference between the groups, but the combination group had the highest increment. The increment in serum testosterone level was statistically significant among the different groups of treatment (p-value < 0.0001). When comparing groups, a higher mean maximum testosterone level (710.4±102.7 ng/dL) was obtained with the combination group followed by the sequential group, with mean maximum testosterone levels (636.0±68.6 ng/dL) (p-value = 0.031). Factors negatively affecting testosterone level include BMI > 30 kg/m2, initial testicular volume < 5 mL, and duration of therapy < 13 months. Conclusions Induction of puberty using recombinant hCG alone is sufficient to induce secondary sexual characteristics, while for fertility issues combination from the start or sequential therapy has better for spermatogenesis. There was no effect of prior exogenous testosterone treatment on final spermatogenesis.
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Objectives: This study aimed to evaluate whether a shorter fasting duration of five to six hours can be used as an alternative to the usually recommended eight hours for fasting glucose measurement. Methods: This one-month observational, cross-sectional study was conducted during Ramadan (May to June) 2019. It included those attending Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, Iraq; all individuals ate a pre-dawn meal (suhoor) followed by a complete fast for many hours. Two fasting serum glucose (FSG) venous samples were taken; the first was taken five to six hours and the second eight hours after the pre-dawn meal. Participants were divided into two groups: individuals with type 2 diabetes mellitus (T2DM) and those with a normal glucose level. T2DM patients were further subdivided into three groups: those without treatment, those on oral antidiabetic drugs (OAD) and those using insulin and OAD. Results: A total of 200 individuals participated in this study. There was no significant difference found between the mean FSG levels in the first and second samples for those without T2DM (104.5 ± 21.4 mg/dL versus 104.8 ± 12.6 mg/dL; P = 0.80) as well as those with T2DM (235.0 ± 107.0 mg/dL versus 230.0 ± 105.0 mg/dL; P = 0.20). Untreated T2DM patients had non-significant FSG readings for the two samples (194.0 ± 151.5 mg/dL versus 193.9 ± 128.9 mg/dL; P = 0.90). Patients on insulin and OAD showed a similar pattern of FSG (268.0 ± 111.0 mg/dL versus 269.0 ± 114.0 mg/dL). However, the two FSG samples were found to be significantly different among patients on OAD (220.0 ± 78.0 mg/dL versus 207.0 ± 77.0 mg/dL; P = 0.01). Conclusion: The fasting duration of five to six hours can give a comparable measurement of FSG as that obtained after eight hours.
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Diabetes Mellitus Tipo 2 , Glucemia , Estudios Transversales , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Ayuno/metabolismo , Humanos , IslamismoRESUMEN
Background Conservative clothing like niqab and hijab may affect the wearer's vitamin D metabolic parameters even in predominantly sunny areas of the world (i.e., areas with adequate sunlight exposure throughout the year). Our objective was to evaluate the effect of wearing the niqab or hijab on different vitamin D3 metabolic parameters in a sample of premenopausal women from Basrah. Methodology This was a cross-sectional observational study on premenopausal women who wore a niqab (n = 64), with a comparable age-matched group of women who wore the hijab (n = 60). Biochemical evaluation of the vitamin D3 metabolic profile involved 25-hydroxycholecalciferol (25-OH)-vitamin D, corrected serum calcium, parathyroid hormone (PTH), phosphorus, and alkaline phosphatase estimation. Statistical comparison of these parameters was made using the independent sample t-test and Mann-Whitney-U test. Results The two groups of women were age- and weight-matched, with a median age of 39 and median body mass index (BMI) of 31.8 kg/m2. Overall, age, marital status, and BMI of women in both groups had no significant relationship with the vitamin D3 metabolic parameters (low 25-OH-vitamin D, low corrected calcium, and high PTH). The subgroup analysis for women wearing the niqab showed the same results. Conclusions Wearing niqab or hijab in premenopausal women was not associated with any significant statistical relationship or difference in vitamin D3 metabolic parameters. Conservative dress styles like niqab and hijab are practical barriers to sun exposure and contribute to suboptimal vitamin D levels, affecting subsequent metabolic pathways. Healthcare professionals should advise women who wear niqab or hijab to increase their vitamin D3 levels through culturally appropriate alternative mechanisms.
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BACKGROUND: This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period. METHODS: A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months. RESULTS: Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m2 and presence of hypertension were associated with a decreased risk of poor glycemic control. CONCLUSION: Using data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.