Background/Aim: Diabetic microvascular complications are not uncommon. This study was done to investigate the relationship between biochemical parameters of diabetes mellitus (DM) and diabetic microangiopathy and serum levels of soluble intercellular cell adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in DM. Patients and methods: The study included 35 type-1 and 25 type-2 DM patients along with 20 age- and sexmatched healthy controls. For each studied subject, thorough clinical examination and laboratory evaluation [fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides)] were performed. The serum level of C-peptide was estimated by radioimmunoassay (RIA) while levels of sICAM-1 and sVCAM-1 were determined by ELISA. Results: A significant elevation of both sICAM-1 and sVCAM-1 was detected in both type-1 and type-2 DM patients (P<0.001), with no significant difference between the two patient groups. Levels of sICAM-1 and sVCAM-1 in patients with microangiopathy were significantly (p<0.05) higher than that of patients lacking this complication. Patients with microangiopathy had older age and longer duration of DM, but there was no difference between patients with and those without microangiopathy regarding FBS, HbA1c or lipid profile. There was no significant effect of the disease duration on sICAM-1 or sVCAM-1 levels. Moreover, there was no correlation between circulating CAMs and FBS, HbA1c, cholesterol, triglyceride or C-peptide levels. Conclusion: sICAM-1 and sVCAM-1 serum levels are elevated in DM patients and may have a role in pathogenesis of diabetic microvascular complications. They may be predictors for these complications.

Background: Thyroid disease is a common disease in women of the reproductive age. This disease arises due to complex interactions between environmental and genetic factors. However, the interactions between genes and environment are yet well defined. Among the main susceptibility genes that have been identified is the HLA-DQB1 gene locus. The major environmental factors include iodine, medications, infection, smoking, and possibly stress. Aim of study: To ascertain the association between HLA-DQB1 alleles and goitrous thyroid disease in a sample of Iraqi Arab Muslims. Patients and methods: A cross sectional case-control comparative study was carried out. Patients with thyroid disorders who attended this hospital in the period from September 2013 to June 2014 for thyroidectomy were studied. HLA-DQB1genotyping was done using a panel of sequence-specific oligonucleotide probes (SSOP) using HLA-DQB1 amplification and hybridization kits (SSO HLA type DQB1 plus and Mastermix for HLA type DQB1 Amp plus) using automated method by AutoLipa-48. Results: There was an increased frequency of HLADQB1*03:01and 0601 in control group compared with patients group (P=0.005, Odds ratio=0.0164, 95% CI: 0.0009-0.2926) and (P=0.01, Odd ratio=0.1667, 95% CI: 0.0412 to 0.6750) respectively. Other alleles like HLA-DQB1* 0202, 03:02, 0501 and 06:02 were detected in the patients' group but not in controls. Conclusions: HLA alleles have an effect on development thyroid disease. HLADQB1* 0301 and 0601 is a protective in Iraqi Arab Muslims individuals.

Background and Aims: Fasting during the holy month of Ramadan is an obligatory duty for all healthy adult Muslims. Fasting can be a major challenge for adolescents with type 1 diabetes mellitus (T1DM) as they have to keep good glycemic control to avoid complications. Limited data was published regarding the safety of fasting Ramadan in adolescent patients with T1DM. We have therefore conducted this study addressing the question “Can adolescents with T1DM fast safely during the Holy month of Ramadan, without getting significant hypo/hyperglycemia?” Patients and Methods: This is an observational, prospective, single center study, conducted during Ramadan 2013. Twenty-three patients were observed (7 males, 16 females). Median age was 14 years. All of them had T1DM, and were planning to observe the fast during Ramadan. They were provided with dairies to be filled by the parents or the adolescents themselves (with parental supervision), indicating the days they fasted/didn't fast, and the reasons for not fasting e.g. hypoglycemia, hyperglycemia, menstrual period, sickness or other reasons. Patients were also asked to record the blood glucose readings and their insulin doses on daily basis. They were asked to bring their folders back to the Diabetic clinic after Ramadan. Outcome measures obtained included the percentages of the days fasted/not-fasted, the reasons for not fasting, HbA1c changes, and a comparison between patients on multiple daily injections and those on insulin pump. Moreover, we studied the relationship between the number of days not-fasted due to diabetes related issues and the HbA1c before Ramadan. Results: Patients were able to fast 79.9% of the total days eligible for fasting, while 20.1% of the days were not fasted due to either hypoglycemia (29.1%), hyperglycemia (19.4%) or other reasons (51.5%). None of the patients developed severe hypoglycemia or diabetic ketoacidosis. There was a mild increment in mean HbA1c after Ramadan (from 8.3% to 8.5%). The patients on insulin pump tended to fast more days than those taking multiple daily injections (82.8% versus 77.3% out of the total eligible days). Patients who had able to fast more days without diabetes related problems tended to have had a marginally better glycemic control before Ramadan (8.3% versus 8.7%). Conclusions: Adolescent patients with T1DM wishing to fast during the holy month of Ramadan may contemplate doing this under medical supervision. The use of insulin pump therapy may help patients to fast more easily and have better control. Adequate education and good glycemic control prior to Ramadan is associated with better outcome.

Painless rat bites in patients with diabetic neuropathy are very rare occurrence and may result in foot ulcers, amputations, or rat bite fever. Infective endocarditis complicating rat bites are extremely rare and almost exclusively a complication of rat bite fever caused by Streptobacillus moniliformis (a common microbial flora of the rat mouth). To the best of our knowledge, this is the first report of Staphylococcus aureus (another common flora of rat teeth) native valve endocarditis complicating rat bite.