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Background. The safety and efficacy of combination tablets of metformin plus sulfonylurea or plus dipeptidyl peptidase-4 inhibitors have not been studied previously. This study aimed to compare the efficacy and safety of Gliconorm versus Sitavia plus among patients with type 2 diabetes mellitus who fast Ramadan. Methods. This was an open-label study conducted from 1 May 2018 till 1 July 2018. People with type 2 diabetes mellitus who were drug-naive or on metformin only, with HbA1c < 10 % were included. The participants were divided into two groups. The first group was given Gliconorm (glibenclamide 5 mg + metformin 1000 mg), while the second group was given Sitavia plus (sitagliptin 50 mg + metformin 1000 mg) imme-diately after Iftar. Glycated hemoglobin (HbA1c) was measured before and after Ramadan. Several home recordings of blood glucose were collected. In addition, patients were asked to report any hypoglycemic or severe hyperglycemic episodes. Results. A total of 34 participants (18 women) (19 in the first group and 15 in the second group) were involved the study. The mean age was 49.6 ± 9.3 years. HbA1c reduced from 8.7 % (72 mmol/mol) to 7.6 % (60 mmol/mol) and from 8.7% (72 mmol/mol) to 7.7 % (61 mmol/mol) in the first and second group, respectively (p < 0.0001). Only one patient in the first group experienced one episode of hypoglycemia and hyperglycemia. Conclusion. Both medications seem to be safe and effective during Ramadan fasting.

Background: People from our region need a higher dose of vitamin D to maintain their serum 25(OH)D levels at concentrations greater than 20 ng/mL. This study aimed to obtain real data on vitamin D status in Basrah. Methods: Retrospective data analysis of patients seen over 2 years from May 2017 to the end of May 2019 at the Faiha Specialized Diabetes, Endocrine and Metabolism Centre (FDEMC) in Basrah, a tertiary referring center of southern Iraq. Results: The cohort included 3692 persons. Vitamin D deficiency was evident among 62.5% of the studied persons (66.5% of women and 48.7% of men). Univariate analysis for factors associated with vitamin D deficiency found it was significantly associated with female sex (OR, 2.095; 95% CI, 1.793 to 2.448; P

Background: Thyroid function tests are mandatory in clinical practice because symptoms and signs are not reliable to discriminate between various types of thyroid disease. Aim: The aim of this study was to determine assay-specific reference range for serum free T4, total T4, total T3 and TSH among healthy non-pregnant adult cohort for Roche® platforms in Basrah (Southern Iraq) from single laboratory in a tertiary center using indirect approach of the available data. Methods: A Cross sectional study for non-pregnant adults 19 years and above. Sera were analyzed by using cobs e411 for thyroid functions tests. Results: Total enrolled persons were 10,078. The 95% reference intervals for TSH were 0.20-6.50 μIU/mL, which increased with age though not linear, for free T4 were 0.8-1.70 ng/dL, for total T4 were 3.78-15.33 μg/dL, and for total T3 were 0.80-2.50 ng/mL. Colcusion: Cobs e411(Roche® analytical platform) analyzer reference range for thyroid function cannot be applied for Iraqi population .

Background Premixed insulin and basal insulin plus short-acting insulin regimens may be of value for treating individuals with type 2 diabetes (T2DM) who are fasting during Ramadan due to simplicity and better compliance. The objective of this study was to compare the effectiveness of human premixed insulin to basal plus short-acting insulin regimens in the management of fasting individuals with T2DM during Ramadan. Methods We conducted a prospective observational study in Basrah (southern Iraq) on 30 individuals with T2DM who fast during Ramadan. The enrolled patients were assigned into two groups at random: one group received a human premixed insulin regimen, the other received a basal plus short-acting insulin regimen. A baseline clinical and biochemical analysis was gathered for all patients at recruitment two weeks before fasting and within four weeks after the end of fasting. Patients were assessed twice during fasting month for insulin dose adjustment and documentation for any hyperglycemia or hypoglycemia. Results Fourteen patients were assigned to the premixed group, and 16 patients were assigned to the basal plus short-acting insulin group. The mean patient age was 53 ± 8 years, and the mean T2DM duration was 9.3 ± 4.2 years. The two groups were matched by age, body mass index, and glycated hemoglobin (HbA1c). There was no significant difference between the initial and final mean HbA1c in both groups. However, there was more non-significant HbA1c reduction in the premixed group as compared to the basal plus short-acting insulin group. The number of hypoglycemic events and weight changes among the two groups was not significant. Conclusions Both human premixed and basal plus short-acting insulin regimens are equally useful for glycemic control for patients with T2DM who choose to fast in observance of the month-long holiday of Ramadan.

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. Keywords: Glucose; Fasting; Duration of Therapy; Diabetes Mellitus; Iraq.

Background: Weight gain is one of the most important hypothyroidism-related concerns among patients with hypothyroidism. However, not as expected, thyroxine replacement does not necessarily result in body weight (BWT) reduction among those patients. The study aimed to assess the patterns of BWT changes through time in patients with hypothyroidism. Method: A retrospective database study from Faiha Specialized Diabetes, Endocrine, and Metabolism Center. A total of 346 adult patients with hypothyroidism, 192 newly diagnosed and 154 known, who had 1 visit every 3 months, 5 visits per one year. From those patients, 116 new and 69 known had completd 9 visits per two years. Each visit involved thyroid-stimulating hormone (TSH) and BWT measurements. Patients with chronic liver or renal disease, diabetes mellitus, thyroid cancer, or other malignancies, pregnancy, and on steroid or hormonal therapies were excluded. The patients were further subdivided based on average TSH levels into controlled (TSH≤4.2 μIU/mL) and uncontrolled TSH>4.2 μIU/mL. Repeated measures ANOVA with a Greenhouse-Geisser correction and Post hoc tests using the Bonferroni correction were used to evaluate BWT changes through the study. Results: Both newly diagnosed and known hypothyroidism, over one and two years, in patients with average TSH>4.2 μIU/mL, BWT increased significantly through visits. For newly diagnosed over one year, (F(2.41, 321.60) = 3.28, p = 0.03), and mean BWT increase = 1.4 ± 0.38 kg from 3rd to 12th month visits, (p = 0.004). For newly diagnosed over two years, (F(3.10, 263.89) = 9.08, P < 0.0005), mean BWT increase = 3.02 ± 0.77 kg from 3rd to 24th month visits, (p = 0.007). And for known hypothyroidism over one year, (F(2.56, 187.47) = 7.11, p = 0.0003), mean BWT increase = 1.97 ± 0.64 kg at 12th month visit, and over two years, (F(2.35, 77.56) = 4.67, P = 0.009), mean BWT increase = 3.78 ± 1.26 kg at 24th month visit. While in all other patients with average TSH≤4.2 μIU/mL, the BWT changed non-significantly through visits. For newly diagnosed patients over one year and two years (p = 0.10, 0.34 respectively), and known patients over one year and two years (p = 0.47, 0.34 respectively). Conclusion: In contrary to what is believed, adequate treatment with thyroxine does not associate with weight reduction. Instead, either the patient kept on the same weight or continued to gain more weight.

Background: Data on thyroid disease epidemiology in the Middle East are scanty and anecdotal. This study aimed to assess the pattern of thyroid disease seen in Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah,Southern Iraq. Methods Retrospective observational study of database retrieval from the FDEMC a tertiary care Center in Basrah for the period of September 2008 to January 2019. Included all adults non pregnant 18 years or older. Results Total enrolled patients 17878; of them 4174(23.3%) men and 13705(76.7 %) women. There were 2229(12.5%) patients with hypothyroidism (83.0% women), with subclinical hypothyroidism observed in 364 out of 2229 with hypothyroidism(16.3%). We found 1087 (6.1%) patients with hyperthyroidism (67.7% women) and subclinical hyperthyroidism observed in 92 of 1087 hyperthyroidism (8.4%). Thyroid nodularity was seen in 944 (5.2%) patients (807 women in 85.5%). Thyroidectomy was done in 776(4.3%). Differentiated thyroid cancer was seen in 77 (0.4%). Conclusion: Hypothyroidism was double that of hyperthyroidism. Cross-sectional community-based study can give more information on the epidemiology of thyroid disease in Iraq.Iodine status needed studded in the future. Keywords: Hyperthyroidism, hypothyroidism,autoimmune thyroid disease, Iraq.

Background Fasting the month of Ramadan should be achieved by every pubescent Muslim unless they have an excuse. Fasting involves complete abstinence of oral intake throughout daytime. Patients who have hypothyroidism usually require levothyroxine (L-thyroxine) replacement, which is typically given on an empty stomach away from meals. Taking L-thyroxine replacement without feeding is challenging during the nighttime of Ramadan, in addition to being prohibited during daytime. Objectives This study aimed to determine the best time of L-thyroxine intake during Ramadan. Methods Fifty patients who were taking L-thyroxine treatment for primary hypothyroidism were involved in this prospective study for three months including the fasting and pre-fasting months. The patients were divided into three groups with different times of L-thyroxine intake. In the group one (pre-iftar), the patients were asked to take L-thyroxine at the time of iftar (the sunset meal) but to delay any oral intake for at least 30 minutes. In the group two (post-iftar), the patients were asked to take L-thyroxine two hours after iftar. The patients in the last group (pre-suhoor) were asked not to eat in the last two hours before suhoor (the predawn meal) and to take L-thyroxine tablet one hour prior to suhoor. Results When thyroid stimulating hormone (TSH) levels were compared before and after Ramadan, there were no significant differences neither within each group nor among all the study groups. Moreover, the frequencies of the TSH control after Ramadan showed no significant differences within each of the study groups (P = 0.18, 0.75, 1.0 for pre-suhoor, pre-iftar, and post-iftar respectively). Similarly, comparison among the groups of the study showed no significant differences regardless of whether the patients had controlled or uncontrolled TSH prior to Ramadan (P = 0.75 and 0.67, respectively). In the patients with controlled TSH before Ramadan, 8 out of 10 (pre-suhoor), 8 out of 12 (pre-iftar), and 4 out of 6 (post-iftar) maintained their control after Ramadan. While in the patients with uncontrolled TSH before Ramadan, 7 out of 10 (pre-suhoor), 6 out of 8 (pre-iftar), and 2 out of 4 (post-iftar) achieved controlled TSH after Ramadan. Conclusions No significant differences in TSH control were observed in patients taking L-thyroxine at pre-iftar, post-iftar, or pre-suhoor time in Ramadan.

Background: Adrenal disorders is rare life-threatening conditions needed high awareness for earlier diagnosis. The aim of this study is to see the pattern and spectrum of adrenal disorders in Southern Iraq. Methods: Retrospective electronic database analysis of Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah, the largest tertiary referring Center in the Southern Iraq. Only adults 18 years and above analysed. Results: The total referred patients for presumed adrenal disorders were 5064(6%) of 83473 new patients seen over 11 years for the period of August 2008 to August 2019.The commonest adrenal disease were due to glucocorticoids misuse in 2407/5064 (47.5%),followed by adrenal endocrine hypertension in 883/5064 (17.4%),than adrenal insufficiency in 340/5064 (6.7%), hirsutism in 264/5064 (5.2%), hypopituitarism 85/5064 (1.6%) and congenital adrenal hyperplasia in 78/5064 (1.5%).Rare causes of adrenal disorder were primary aldosteronism in 30/5064 (0.5%), Addison disease in 26/5064 (0.5%), pheochromocytoma in 19/5064 (0.4%), autoimmune polyendocrine syndromes in 19/5064 (0.4%), ACTH independent Cushing syndrome in 17(0.3%), ACTH dependent Cushing syndrome in 4(0.07%), subclinical Cushing syndrome in 4(0.07%), ectopic ACTH syndrome in 1(0.01%), adrenal cyst in 9(0.1%), adrenal myelolipoma in 5(0.09%), adrenocortical carcinoma in 3(0.05%),and paraganglioma in 2(0.04%).One of the paraganglioma were secretory. Patients characteristics for those with glucocorticoids misuse showed that female forming the bulk of cases in 1708/2407 (70.9%), and mean age of 39.5±12.3 years. Urban constitutes 1306/2407 (54.3%),and 629/2407 (26.1%) were illiterates. There were 706/2407 (29.3%) with established type 2 diabetes mellitus(with all the risks of loss of glycemic control) and glucocorticoids misuse causes 105/2407 (4.3%) incident diabetes. Conclusion: Glucocorticoids misuse constituted the bulk of referral for adrenal disorders in Basrah. A lot of work needed to reduce the prevalence of this new high-risk iatrogenic disease.

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.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.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 (HbA1c7%) was achieved by 13.8% of patients. Multivariate analysis revealed55 years of age, female gender,3 years duration of diabetes, HbA1c10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI25 kg/mUsing 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.

The conventional method for detecting blood abnormality is time consuming and lacks the high level of accuracy. In this paper a MATLAB based solution has been suggested to tackle the problem of time consumption and accuracy. Three types of blood abnormality have been covered here, namely, anemia which is characterized by low count of red blood cells (RBCs), Leukemia which is depicted by increasing the number of white blood cells (WBCs), and sickle cell blood disorder which is caused by a deformation in the shape of red cells. The algorithm has been tested on different images of blood smears and noticed to give an acceptable level of accuracy. Image processing techniques has been used here to detect the different types of blood constituents. Unlike many other researches, this research includes the blood sickling disorder which is epidemic in certain regions of the world, and offers a more accuracy than other algorithms through the use of detaching overlapped cells strategy.

Background: Thyroid function test results of healthy pregnant women differ from those of healthy non-pregnant women. This study aimed to determine trimester-specific reference ranges for total tetraiodothyronin (T4), free T4, total triiodothyronin (T3) and thyroid stimulation hormone (TSH) using electrochemiluminescence techniques from apparently healthy pregnant women in Basrah. Material and Methods: A cross sectional study was conducted between January 2014 and June 2015. The total enrolled pregnant women were 893. Clinical examination, estimation of free T4, total T4, total T3, TSH, and anti-thyroid peroxidase (anti-TPO) using electrochemiluminescence technique done for each. Results: Trimester specific normal range of TSH in μIU/mL was 0.04–3.77, 0.30–3.21 and 0.60–4.50 μIU/mL respectively, for each trimester. For FreeT4, the trimester specific reference range was 0.8–1.53, 0.7–1.20 and 0.7–1.20 ng/dL for each trimester, respectively. The reference range for total T4 for the first, second and third trimester was 7.31–15.00, 8.92–17.38, and 7.98–17.70 μg/dL, respectively. Furthermore, last trimester specific reference range for total T3 was 0.90–2.51, 1.99–2.87 and 1.20–2.70 ng/mL, respectively. Conclusion: Using this thyroid function study, we established for first time trimester-specific reference ranges for each thyroid function test and thyroid antibody status for the first time in Iraq. The reference ranges are different from all previous studies outside Iraq and the reference kit range from the method we used.

Background:Pituitary disorders spectrum includes a wide variety of diseases.This study aimed at a comprehensive description of such disorders for patients from Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq).Methods: Retrospective data analysis of FDEMC for the period from January 2012 through June 2017. We included all patients with pituitary disorders who have MRI pituitary.Results: The pituitary disorders were more common among women. Those with macroadenoma were older than those with microadenoma with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disorders in this registry (67.2%). Growth hormone secreting adenoma were the commonest adenoma seen in 41.0% followed by clinically non-functioning pituitary adenoma(NFPA)in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4 % of growth hormone secreting adenoma, 61.2% in NFPA and 62.0% of prolactinoma (of them six were giant prolactinoma)Conclusion: Pituitary adenoma constituted the bulk of pituitary disorders in Basrah, growth hormone secreting adenoma is the commonest adenoma followed by NFPA and prolactinoma due to referral bias. A change in practice of pituitary adenoma treatment is needed.

Background: Sellar and parasellar region lesions spectrum includes a wide variety of diseases. This study aimed at providing a comprehensive overview of such lesions in patients from Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq).Methods:Retrospective data analysis from FDEMC for the period January 2012 through June 2017. We included all patients with sellar and parasellar region lesions who received a MRI scan on their pituitary regionResults:The total enrolled patients were 232 (84 men and 148 women),with age range 15-75 years.Pituitary disease and adenoma were more common among women. Those with macroadenoma were older than those with microadenoma, with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disease in this setting (67.2%). Growth hormone secreting adenoma were the most common adenoma seen in 41.0%, followed by clinically non-functioning pituitary adenoma (NFPA) in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4% of growth hormone secreting adenoma (acromegaly), 61.2% in NFPA and 62.0% of prolactinom a(of them six were giant prolactinoma).Conclusion: Pituitary adenoma constituted the bulk of sellar and parasellar region lesions, growth hormone secreting adenoma is the the most common adenoma followed by NFPA and prolactinoma due to referral bias. A change in practice of adenoma treatment is needed.