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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:Hirsutism is a distressing medical problem for women. Most of hirsutism in women is associated with excess androgen, and most cases have PCOS as an underlying cause.Which androgen to be used to evaluate clinical or biochemical hyperandrogenism in women with PCOS is still debated.There are a small number of studies that evaluated androgens in women with PCOS having hirsutism with conflicting results. The Objective of this study was to determine which androgen predict hirsutism in women with polycystic ovary syndrome (PCOS). Patients and Methods:A case-control study was done in Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), Basrah, Iraq. A total of 130 women with PCOS (based on Rotterdam criteria) and 70 healthy controls of comparable age (16-40 years) were investigated for androgens (total testosterone, free testosterone, DHEA-S) using Electrochemiluminescence technology assay; excess hair was examined according to the modified Ferriman-Gallwey (mFG) score and a cut-off value of 8 defined hirsutism. Results: In the three groups of women, the first (n=100) included PCOS with hirsutism, the second (n=30) PCOS without hirsutism, and the third (n=70) women without PCOS or hirsutism as healthy control, hirsutism was seen in about 77 % of PCOS women mostly of moderate severity; High TT, FT, DHEA-S, and overall androgens were seen in 69%, 76%, 37%, and 99% respectively of our PCOS women with hirsutism. No correlation was found between TT, FT, and DHEA-S and the mFG score. Conclusions: This study provides evidence that presence of hirsutism in women with PCOS was associated with a higher level of biochemical hyperandrogenism than seen in PCOS without hirsutism; however, there was no correlation between the studied androgens and mFG score.

Introduction Validation assesses the acceptability, responsiveness, interpretability, and quality of any questionnaire in any specific population. This is done by correlation matrix evaluation of the proposed test tool with a previously well-validated assessment tool. The study objective is the dual-center assessment of the construct validity of the first health-related quality of life questionnaires for married and unmarried women with polycystic ovary syndrome (PCOS), i.e., PCOSQoL-47 and PCOSQoL-42, respectively. Materials and methods At two centers in Iraq, we enrolled 406 married women and 362 unmarried women with PCOS to test for the construct validity of PCOSQoL-47 and PCOSQoL-42, respectively, from August 2019-August 2020 (after obtaining full results of reliability testing in our previous work). We used the comparable domains from the multiculturally validated questionnaire (World Health Organization Quality of Life [WHOQOL-BREF]) as a comparator to assess the construct validity of the domains of the final highly reliable questionnaire drafts of PCOSQoL-47 and PCOSQoL-42 which were obtained from our previous work. The enrolled women will respond to WHOQOL-BREF and either PCOSQoL-47 or PCOSQoL-42, according to their marital status. Pearson's parametric correlational coefficient compared the total scores of the matched domains in one of our questionnaires and WHOQOL-BREF at p≤0.05. Values more than 0.3 denoted an important correlation between our test questionnaires and the well-validated WHOQOL-BREF questionnaire. The inter-rater reliability between our questionnaires and the comparator was calculated by Cronbach's alpha level, inter-item, and intra-class correlations coefficients matrix. Results We obtained a good respondent-to-item ratio of approximately 9:1 for both questionnaires. We had a good response for the domains of our questionnaires and WHOQOL-BREF. The coping domain at PCOSQoL-42 showed the highest Pearson's coefficient value of (0.708), which indicates a strong and significant correlation between the two constructs at (p0.5. The PCOSQoL-42 and PCOSQoL-47 showed high inter-rater reliability levels in measuring the requested construct or concept when we used Cronbach's alpha and inter-item correlation matrix assessment. Conclusion The individualized PCOSQoL-47 and PCOSQoL-42 for married and unmarried women with PCOS, respectively, represent the first reliable and valid HRQoL assessment tools for assessing the health-related quality of life (HRQoL) in those women with PCOS who use Arabic as a first or native language and address the sexual function as a separate domain.

Introduction: Colorectal carcinoma is commonest cancer of gastrointestinal tract. It is represent third cancer in man worldwide beyond lung and prostate cancers. It is fourth cancer in woman beyond breast, lung and uterus cancers. Deaths from colorectal cancer are more in compare with other GIT cancers. Objective: The aim is prove epidemiological and clinical data of colorectal cancer. Method: Our study conducted in Misan Province, Iraq. The data collected from 2013 to 2016. Seventy one patients that found have colorectal cancer. Gender, age, residency, site of cancer, family history, past history, year of onset, smoking history, alcohol intake, presentation, staging and histopathology pattern are get. Results: Prevalence of colon and rectum carcinoma is 3.75%. The most age group affected was 51–60 years as 30.99%. The gender and residency of patients have no effect on cancer percent. Obesity, Family history, cigarette smoking and alcohol consumption risk factors. In 42.25% of patients had family history of cancer. Conclusion: Most common site of colorectal carcinoma left colon, which present in 61.97%. There is increase in new cases detection of colorectal carcinoma from 2013 to 2016. Advanced stages cancer were most common stages description as IIIA, IIIB, IIIC and IV in 12.67%, 16.90%, 19.72% and 15.49%. The common histopathological pattern is differentiated adenocarcinoma as 53.52%. Resumo: Introdução: O carcinoma colorretal é o câncer mais comum do trato gastrointestinal. É o terceiro tipo de câncer mais observado no sexo masculino mundialmente, atrás dos cânceres de pulmão e próstata. É o quarto câncer mais observado no sexo feminino, atrás dos cânceres de mama, pulmão e útero. As mortes por câncer colorretal são mais comuns comparadas a outros cânceres do TGI. Objetivo: O objetivo do estudo é comprovar dados epidemiológicos e clínicos do câncer colorretal. Métodos: Nosso estudo foi conduzido na província de Misan, no Iraque. Os dados foram coletados de 2013 a 2016. Setenta e um pacientes apresentaram câncer colorretal. Sexo, idade, local de residência, local do câncer, história familiar, história pregressa, ano de início, história de tabagismo, etilismo, apresentação, estadiamento e padrão histopatológico foram obtidos. Resultados: A prevalência de carcinoma de cólon e reto é de 3,75%. A faixa etária mais afetada foi de 51 a 60 anos, com 30,99%. O gênero e o local de residência dos pacientes não afetam a porcentagem de ocorrência do câncer. Obesidade, antecedentes familiares, tabagismo e consumo de álcool são fatores de risco. 42,25% dos pacientes tinha história familiar de câncer. Conclusão: O local mais comum de carcinoma colorretal é o cólon esquerdo, com 61,97%. Houve aumento na detecção de novos casos de carcinoma colorretal de 2013 a 2016. Os estágios avançados de câncer mais comuns foram IIIA, IIIB, IIIC e IV em 12,67%, 16,90%, 19,72% e 15,49% dos casos. O padrão histopatológico comum é o adenocarcinoma diferenciado, em 53,52% dos casos. Keywords: Colorectal carcinoma, Misan, Epidemiology, Palavras-chave: Carcinoma colorretal, Misan, Epidemiologia

Background and objective We lack a reliable and validated health-related quality of life (HRQoL) questionnaire to measure the negative impact of polycystic ovary syndrome (PCOS) on the various aspects of the lives of Arabic women, which addresses sexuality in married women only. Hence, we aimed to develop two separate, simple, reliable, validated, and easily interpretable HRQoL questionnaires in Arabic for married and unmarried women with PCOS for effective QoL evaluation. Materials and methods The development and reliability analysis of the Polycystic Ovary Syndrome Quality of Life (PCOSQoL)-47 and PCOSQoL-42 involved two quantitative and qualitative phases. Phase 1 included retrieval of 158 items from 584 PubMed articles, item reduction, Arabic translation, content and face validity testing, creation of a five-domain draft (53 items for married and 45 items for unmarried women), with no sexuality domain for unmarried women. Phase 2 involved test-retest reliability, which involved using the Spearman's correlation, Wilcoxon nonparametric signed-rank, and internal consistency using Cronbach's-alpha, inter-item, and intraclass correlation (ICC) coefficients, as well as creating a second draft (47 items for married and 42 items for unmarried women). Results The content validity indices testing by 26 healthcare experts decreased the item pool to 57 items for married and 45 items for unmarried women. Face validity by another 30 experts and 30 women from each group resulted in a further reduction to 53 items for married and 45 items for unmarried women, to be tested in a pilot study, which included another 30 women from each group. Test-retest reliability analysis by 195 married and 173 unmarried women revealed significantly excellent redundancy, reliability, and stability of items (highly significant Cronbach's alpha and ICC by internal consistency testing), and reduced the item pool to 47 items for married and 42 items for unmarried women. Conclusions Both questionnaires were found to be highly reliable for the HRQoL evaluation among both married and unmarried Arabic women with different phenotypes of PCOS.

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.

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: 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.

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: Colorectal carcinoma is commonest cancer of GIT. It is represent third cancer in man worldwide beyond lung and prostate cancers. It is fourth cancer in woman beyond breast, lung and uterus cancers. Deaths from colorectal cancer is more in compare with other GIT cancers. The study aimed to determine epidemiological and clinical data of colorectal cancer in Misan province.Methods: Our study conducted in Misan province, Iraq. The data were collected from 2013 to 2016. Seventy one patients that found have colorectal cancer. An epidemiological, clinical and descriptive study perform which included frequency of gender, age, residency, site of cancer, family history, past history, year of onset, smoking history, alcohol intake, presentation of cancer at time of diagnosis, staging and histopathology pattern in relation to colorectal cancer.Results: Overall prevalence of colon and rectum carcinoma is 3.75%. The most age group affected was 51-60 years as 30.99%. The gender and residency of patients have no effect on cancer percent. Obesity, Family history, cigarette smoking and alcohol consumption represented risk factors for colorectal cancer. In 42.25% of patients had family history of cancer. Most common site of colorectal carcinoma was left colon, which present in 61.97%. Conclusion: There was slight increase in new cases detection of colorectal carcinoma from 2013 to 2016. Advanced stages of colorectal cancer were most common stages description as stage IIIA, IIIB, IIIC and stage IV in 12.67%, 16.90%, 19.72% and 15.49% respectively. The common histopathological pattern of colorectal cancer was moderately differentiated adenocarcinoma as 53.52%.

Background: Lymphomas represent a biologically and clinically heterogeneous group of neoplasms. They have historically and clinically been divided into two groups, Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). This study aimed to identify patterns in lymphomas in Misan city, Iraq, and evaluate the characteristics of this disease. Methods: A retrospective, observational, single-center study was conducted at Al-Shifaa Oncology Center, Al-Sadder Teaching Hospital, Misan city, Iraq, between 1 April 2016 and 30 April 2018. A total of 80 Misanian participants (48 (60%) men and 32 (40%) women) who had lymphoma were involved in this study. The sources of information were patient files, histopathology reports, and patients’ oncologist reports. Results: The mean age (±SD) of participants was 36 ±12.8 years. The male to female ratio was 1.5:1. NHL cases were three times more prevalent than HL. The most frequent stage at presentation was stage IV, in 34 (42.5%) participants. The classical subtypes of HL were present in 14 (70%) of HL cases. The diffuse large B-cell lymphoma (DLBCL) subtype was the most common NHL subtype, being recorded for 44 (73.3%) of participants. Conclusion: Lymphomas were more frequent in men. NHL was more common than HL; one HL case was diagnosed for every three NHL cases. The most common histopathology of HL was mixed cellularity, while DLBCL was the most common subtype of NHL. Most cases presented at an advanced stage, resulting in a late diagnosis.