Triiodothyronine/Free Thyroxine Ratio as a Criterion for the Differentiation Between Graves' Disease and Subacute Thyroiditis.

BACKGROUND: Graves' disease (GD) and subacute thyroiditis (SAT) are important causes of thyrotoxicosis. The differentiation between these diseases is of great value because it will affect the management plan of either of them. The study aimed to assess the triiodothyronine/free thyroxine (T3/fT4) ratio as a criterion for the differentiation of hyperthyroidism due to GD and SAT. METHOD: A retrospective study with database retrieval was conducted at Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah, southern Iraq. Patients attending the center who presented with thyrotoxicosis due to GD and SAT from January 2010 to January 2024 were included in the analysis that was conducted from October 2023 to February 2024. For comparison between GD and SAT, the baseline thyroid-stimulating hormone (TSH), fT4 and T3 were used to calculate the fT4 ratio (fT4 level (ng/dL)/1.7 ng/dL), T3 ratio (T3 level (ng/dL)/200 ng/dL), and T3/fT4 ratio (T3 level (ng/dL)/fT4 (ng/dL)). RESULTS: As compared to SAT, patients with GD had a significantly lower TSH and higher T3, T3 ratio, and T3/fT4 ratio. A T3/fT4 ratio with a cutoff equal to or more than 25 had 95% sensitivity and 18.1% specificity for GD with 94.4% positive predictive value. Raising the cutoff to equal or more than 100 results in the reduction of sensitivity to 32.7% but with 100% specificity and positive predictive value. CONCLUSION: The T3/fT4 ratio presents as a valuable diagnostic tool in differentiating GD from SAT, with potential applications in refining the diagnostic approach to hyperthyroidism.

Gastrointestinal Endoscopic Outcome in Late Adolescent Women With Iron-Deficiency Anemia in Basrah-Iraq: A Multicenter Study.

Background Iron deficiency anemia (IDA) in late adolescent women has multiple pathophysiologies. Silent blood loss, celiac disease (CD), malignancies, and other gastrointestinal (GI) lesions receive much attention during IDA management. There is no consensus about endoscopic screening. Our study evaluates factors affecting GI endoscopic diagnosis for the etiology of IDA in late adolescent women. Materials and Methods We conducted an observational, multicenter retrospective analysis of 192 adolescent women with IDA admitted for GI endoscopic diagnosis from 2006 to 2016. Baseline measurements included hemoglobin, serum ferritin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation. We collected demographic characteristics, duration of hospital stay, the degree of severity of anemia, and endoscopic findings. Results The mean age was 19±1 years (range 17 to 21 years), with mildly to moderately severe IDA. Patients received esophagogastroduodenoscopy (EGD, n=178) or colonoscopy (n=14). The mean hospital stay was 2.0±1.0 days. We found negative endoscopies (n=74), CD (n=85), gastric ulcer (n=19), malignancy (n=2), inflammatory bowel disease (n=1), and other nonsignificant endoscopic findings (n=11). We found no correlation between the duration of the hospital stay with the severity of IDA, no significant association between GI symptoms of the patients with endoscopic findings, and a significant but weak association between GI symptoms and serum ferritin. Conclusions In late adolescent women with IDA who have significant GI endoscopic lesions, the GI symptoms are of limited value in guiding the endoscopic diagnostic approach for evaluation of IDA.

Do Gastrointestinal Symptoms Affect the Endoscopic Outcome in Anemic Premenopausal Women Due to Iron Deficiency: A Multicenter Study From Basrah-Iraq.

BACKGROUND AND OBJECTIVES: The most common cause for iron deficiency anemia (IDA) in women before menopause is menstrual blood loss. The persistence of digestive symptoms despite iron supplementation is the only indication for gastrointestinal (GI) endoscopy in premenopausal women (PW) with IDA. We evaluated how the GI symptomatology manifestation affects the GI endoscopy diagnostic outcome in this cohort. MATERIALS AND METHODS: This is an observational, multicenter retrospective evaluation of 245 PW admitted for GI endoscopic diagnosis for the etiology of IDA from 2006 to 2016. Baseline measurements included hemoglobin, iron status tests, and red blood corpuscle morphological evaluation. We evaluated the relationships of different endoscopic findings to the severity of IDA, different demographic characteristics, and hospitalization duration. RESULTS: The mean age was 40±7 years. The duration of hospitalization was neither associated with age nor the IDA severity. The IDA was mild to moderate. More than 53% (n=131) had either a negative study or nonspecific inflammatory changes. Around 16% (n=39) had GI malignancies. There was a significant association between initial GI symptoms with endoscopic GI finding and GI malignancy diagnosis in particular. The relationship loses its power during further assessment by general univariate analysis. CONCLUSION: A considerable percentage of anemic PW due to iron deficiency has an endoscopically-diagnosed pathology for IDA determined during GI endoscopy. The GI symptoms' phenotypes were unrelated to the endoscopically-diagnosed GI lesion location, even if they were malignant. Therefore, the determination of IDA severity must be thoroughly and individually determined.

Basrah Preliminary Experience With COVID-19: A Report on 6404 Patients.

BACKGROUND: The first case of coronavirus disease 2019 (COVID-19) reported in Basrah was in early March 2020. This study aimed at assessing some of the characteristics of patients with COVID-19 in Basrah during the period from March 4th to September 8th, 2020. METHODS: Retrospective analysis of the University of Basrah database on COVID-19. All patients with positive COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test during the study period were enrolled. RESULTS: Of 6404 patients included (males 54.8% and females 45.2%), healthcare workers constituted 11.4%. Physicians represented 16.1% of health care workers. The mean age was 39±16.7 years, those aged 61 years or more constituted 9.8%. The case fatality rate was 3% (males 55.2% and females 44.8%). No deaths were reported in adolescents or children. The highest death rate was among those aged 61 years or more. CONCLUSION: The situation of COVID-19 infection in Basrah, Iraq is evolving similar to other countries. Studies are needed to assess the influence of associated comorbidities, results of treatment regimens used and variables associated with high mortality.

Efficacy of Gastrointestinal Endoscopy in 398 Patients With Iron Deficiency Anemia Who Lack Gastrointestinal Symptoms: Basrah Experience.

Introduction The diagnosis of iron deficiency anemia (IDA) relies heavily on symptom presentation, and patients lacking typical gastrointestinal (GI) symptoms represent a diagnostic challenge. IDA may be the initial manifestation of underlying pathology. This study sought to evaluate the effectiveness of different GI endoscopic studies in patients with IDA who lack GI symptoms. Methods We conducted an observational, multicenter retrospective analysis of 398 asymptomatic IDA patients admitted for GI endoscopic diagnosis from 2006 to 2016. Baseline measurements included hemoglobin, serum ferritin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation. We analyzed demographic characteristics, duration of hospital stay, the degree of severity of anemia, and endoscopic findings. Results The mean age of the study population was 52±9 years (range, 23 to 85 years), and 53% were men. Most patients were older than 45 years (n=353, 89%) with mild to moderate IDA. Patients underwent esophagogastroduodenoscopy (EGD, n=102), colonoscopy (n=271), or bidirectional endoscopy (n=25). The mean hospital stay was 2.72±1.66 days. The most common EGD results were atrophic gastritis (n=31), peptic ulcer (n=25), and negative findings (n=25). The most common colonoscopic results were negative findings (n=118), nonspecific colonic inflammatory changes (n=117), and non-bleeding hemorrhoids (n=29). We found no significant association between any endoscopic findings and age, gender, the severity of anemia, and length of hospitalization. Conclusions The presence of symptoms is of limited value in guiding diagnostic procedures concerning GI etiologies. Asymptomatic patients with IDA patients should receive an endoscopic examination irrespective of iron parameters, age, or gender for potentially treatable pathologies, especially for patients with suspected malignancies.

Kidney stones in children and teenagers in the central coast region of Tunisia.

OBJECTIVE: Since 1980s, the clinical and biological characteristics of urolithiasis in Tunisian children have continuously evolved. This retrospective study defines the current status of urolithiasis among children and adolescents in Tunisia. METHODS: We retrospectively reviewed the records of 310 children and adolescents (age: 3 months - 19 years) between 2003 and 2010, holding urolithiasis. A first-line metabolic, urine and plasma work-up was performed in all patients. Physical and chemical analysis of the stones was performed respectively by stereomicroscopy and infrared spectroscopy. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. FINDINGS: Our study shows a male predominance of urolithiasis with a sex ratio of 1.5. Stones were located in the upper urinary tract in 70.7% of cases. Calcium oxalate was the predominant constituent in 52.6% of stones. There was an increasing prevalence of calcium oxalate stones according to age in both genders (48.6% in infants vs 68.5% in teenagers (P<0.01)). Struvite was more frequent in patients aged 2-9 years (P<0.02) and significantly more prevalent in boys than in girls (P<0.001). Ammonium urate stones were observed in 14.2% and were more frequent in infants. CONCLUSION: Our results emphasize a high percentage of calcium oxalate stones and a low percentage of struvite stones. The persistence of urate stones reflects the particular eating habits and the infectious risk factors. The patient's age is an important factor that must be taken into account during etiopathogenic work-up.

Renal amyloidosis complicating bladder carcinoma associated with supra renal insufficiency.

A 61-year-old white man was admitted for evaluation of hematuria. His medical history revealed endoscopic resection of bladder carcinoma 10 years earlier. A diagnosis of relapse of this carcinoma was made. Few months later, he developed low blood pressure and the nephrotic syndrome. Examination of a renal biopsy specimen showed amyloid deposits. Results of immunofluorescence were positive for AA protein. Furthermore, laboratory tests demonstrated suprarenal insufficiency probably due to amyloidosis. A diagnosis of bladder carcinoma- induced amyloidosis of the kidneys and suprarenal glands was made since no other identifiable cause for AA amyloidosis was found.