Narjis A.H. Ajeel

Bio: Narjis A.H. Ajeel is an academic researcher. The author has contributed to research in topics: Cancer & Population. The author has an hindex of 6, co-authored 21 publications receiving 124 citations.

Parity is associated with increased waist circumference and other anthropometric indices of obesity.

Abstract: Background: There is growing interest in the effect of childbearing on the development of chronic medical conditions. In the present study we aim at seeing whether parity is associated with increased waist circumference (WC) and other anthropometric indices of obesity, or not, in a sample of Iraqi women. Methods: This was a cross sectional study conducted during the period from January 2006 to the end of December 2007. Subjects were women attending two primary health care centers in a rural district population in Basrah (Abu-Al-khasib district), Iraq. Results: A total of 9135 women with a mean age of 46.4±15.5 years were included in the study. The mean weight was 69.9±16.9 kg and the mean WC was 92.7±15.0 cm with 78.9% of women having WC =80 cm. The mean and the standard deviation of other anthropometric variables were 27.0±6.25 for body mass index (BMI), 0.57±0.09 for waist-to-height ratio (WHtR) and 0.89±0.08 for waist-to-hip ratio (WHpR). Body weight, WC, BMI, WHpR, and WHtR progressively and significantly increased with increasing parity (p 0.05). Conclusion: Parity was associated with increased WC and other anthropometric indices of obesity in a sample of rural Iraqi women attending two primary health care centers.

Cancer registration in Basrah 2005: preliminary results.

Abstract: Cancer is a disease which shows significant variation with time and across geographical entities. In Basrah, Iraq, despite the widespread impression that cancer is increasing, researchers are not yet able to draw clear boundaries as to the extent of cancer and its determinants. In this paper, we make a start in that direction; the aim was to measure as accurately as possible the incidence of cancer (all types) in Basrah, to assess age specific incidence rates and to map the cases across different areas of the governorate. For this purpose we compiled data on every accessible case of cancer. The cancer registry in Basrah was used as the prime source of data on newly diagnosed cancer cases, supported by three other sources: the Cancer Registration Section at the Department of Pathology and Forensic Medicine, College of Medicine, University of Basrah; the Oncology Centre at Al-Sadr Teaching Hospital; and the Oncology Ward in Basrah Maternity and Child Hospital. Other minor sources were also utilized. Information on cases from these sources was subjected to meticulous verification regarding repetition, place of residence and other potential errors. The overall incidence rate was 74.3/100,000 population with a higher rate for females (80.5/100,000) than for males (68.1/100,000). The results indicate clear increase in registered cancer cases with increasing age. The lowest incidence rate was among females aged 5-14 years (10.5/100,000) and the highest was among males aged 65 years and above (660.2/100,000). The results show no major variation in the annual incidence rates of cancer in different areas of Basrah governorate. This finding may suggest a common exposure to cancer risk factors. To reach sound conclusions about extent and determinants of cancer in Basrah, immense multi-spectrum efforts are now needed.

Epidemiology of Breast Cancer among Females in Basrah.

Abstract: Breast cancer is the most frequent cancer in females. Its incidence is higher in developed countries than in developing ones partly due to variation in risk exposure and partly due to better detection methods. Scattered evidence in Basrah, Iraq, suggests that breast cancer has been increasing at a significant pace in recent years. This study aimed to measure the current level of risk of breast cancer among females in Basrah and to describe the time trend over almost a decade of years. Data on breast cancer cases from all sources of cancer registration in Basrah governorate were compiled for the years 2005-2012. The data for each year were first checked separately for duplicate reporting of cases among various sources. Then the eight files were pooled together and checked again for any duplicate cases among years of registration. The final set of data contained 2,284 cases of breast cancer (2,213 female cases and 71 male cases). All patients were inhabitants of Basrah governorate at the time of diagnosis. Figures on the Basrah population were obtained from various sources including the Ministry of Health, Ministry of Planning and Developmental Collaboration and local household surveys. It was possible to have total population estimates for each year and by age and sex. The data were imported into SPSS (version 17) software. Age specific and year specific incidence rates were calculated. The age standardized incidence rate was also calculated using world population as the standard population to be 34.9 per 100,000 females. Age-wise, no case was reported among children aged less than 15 years and the incidence increased with advancing age reaching a peak of 123.8/100,000 females at the age range of 50-54 years. The time trend of the crude incidence rate showed only modest increased risk with passage of years and no age shift could be documented in this study. Breast cancer in females in Basrah is a significant health problem. The current incidence rate (crude, 23.7/100,000, age-standardized, 34.9/100,000) is high and justifies intensive efforts to improve early detection of cases, provide better treatment amenities and introduce long term preventive measures. Using the age standardized incidence rate as reported in this paper, it is possible to put the risk in Basrah within a regional and international context.

Work-related allergic disorders among flour mill workers

Abstract: A cross-sectional comparative study was carried out to study the prevalence of occupational allergic disorders among flour mill workers. In this study the flour mill workers from three major flour mill industries in Basrah (study group) were compared to non exposed group from diary products and pepsi cola industries (comparative group). The results showed that the prevalence of work-related allergic conditions as reported by workers and diagnosed by one of the investigators was significantly higher among the study group than that in the comparison group.

Atherosclerotic cardiovascular disease among patients with type 2 diabetes in Basrah

Abstract: AIM: To determine the frequency of atherosclerotic cardiovascular disease and its risk factors among patients with type 2 diabetes in Basrah, Iraq. METHODS: Participants in this cross-sectional study were patients who had type 2 diabetes for at least 1 year, presenting at the Al-Faiha Diabetes Endocrine and Metabolism Center in Basrah (Southern Iraq) over the period from January to December 2008. RESULTS: The series included 1079 patients (58.8% men), of whom 25.0% were smokers. The prevalence of symptomatic cardiovascular disease and hypertension was 16.0%, and 44.3% respectively. Those who were overweight or obese constituted 70.5%. Insulin was used in only 26.9% despite 56.1% having had diabetes for 6 years and more. The mean glycated hemoglobin (HbA1c) was 9.46% ± 2.0% and only 5.5% achieved the target of HbA1c of < 7%. We had 68.7% of patients with total cholesterol of ≥ 200 mg/dL, 21.5% with high density lipoprotein cholesterol of < 40 mg/dL, 84.1% with low density lipoprotein cholesterol of ≥ 100 mg/dL and 71.6% with triglyceride of ≥ 150 mg/dL. CONCLUSION: Among adults with type 2 diabetes mellitus, there was increased frequency of cardiovascular disease and its modifiable risk factors. This finding necessitated urgent work to modify these risk factors in a population based setting.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017

Abstract: Cardiovascular disease (CVD) is a common comorbidity in type 2 diabetes (T2DM). CVD’s prevalence has been growing over time. To estimate the current prevalence of CVD among adults with T2DM by reviewing literature published within the last 10 years (2007–March 2017). We searched Medline, Embase, and proceedings of major scientific meetings for original research documenting the prevalence of CVD in T2DM. CVD included stroke, myocardial infarction, angina pectoris, heart failure, ischemic heart disease, cardiovascular disease, coronary heart disease, atherosclerosis, and cardiovascular death. No restrictions were placed on country of origin or publication language. Two reviewers independently searched for articles and extracted data, adjudicating results through consensus. Data were summarized descriptively. Risk of bias was examined by applying the STROBE checklist. We analyzed data from 57 articles with 4,549,481 persons having T2DM. Europe produced the most articles (46%), followed by the Western Pacific/China (21%), and North America (13%). Overall in 4,549,481 persons with T2DM, 52.0% were male, 47.0% were obese, aged 63.6 ± 6.9 years old, with T2DM duration of 10.4 ± 3.7 years. CVD affected 32.2% overall (53 studies, N = 4,289,140); 29.1% had atherosclerosis (4 studies, N = 1153), 21.2% had coronary heart disease (42 articles, N = 3,833,200), 14.9% heart failure (14 studies, N = 601,154), 14.6% angina (4 studies, N = 354,743), 10.0% myocardial infarction (13 studies, N = 3,518,833) and 7.6% stroke (39 studies, N = 3,901,505). CVD was the cause of death in 9.9% of T2DM patients (representing 50.3% of all deaths). Risk of bias was low; 80 ± 12% of STROBE checklist items were adequately addressed. Globally, overall CVD affects approximately 32.2% of all persons with T2DM. CVD is a major cause of mortality among people with T2DM, accounting for approximately half of all deaths over the study period. Coronary artery disease and stroke were the major contributors.

Prostate cancer in Asian men

Abstract: Prostate cancer incidence and mortality in most native Asian populations have gradually increased, but are around one-third lower than in corresponding Asian-American cohorts, which are themselves lower than the rates observed in other American cohorts. Although genetic and environmental factors, particularly a Western diet, could partially explain these differences, lower exposure to PSA screening in Asian individuals might be a major contributing factor. Genetic features and diet are, however, unlikely to differ substantially within the same region of Asia, and age-stratified PSA levels in men from various Asian countries are almost identical; therefore, variation in the epidemiology of prostate cancer among native Asian populations might be attributable to differences in access to PSA testing, urology clinics, and available therapies. Conversely, the proportion of patients with metastatic prostate cancer is substantially higher even in the more developed Asian countries than in migratory Asian populations residing in Western countries and in Westerners. Consequently, the most appropriate approaches to the management of prostate cancer in Asian countries probably also differ, and therefore individualized prostate cancer screening and treatment strategies based on the epidemiological features and socioeconomic status of each country are needed.

Cancer epidemiology and control in the arab world - past, present and future.

Abstract: The Arab world, stretching from Lebanon and Syria in the north, through to Morocco in the west, Yemen in the south and Iraq in the east, is the home of more than 300 million people. Cancer is already a major problem and the lifestyle changes underlying the markedly increasing rates for diabetes mean that the burden of neoplasia will only become heavier over time, especially with increasing obesity and aging of what are now still youthful populations. The age-distributions of the affected patients in fact might also indicate cohort effects in many cases. There are a number of active registries in the region and population-based data are now available for a considerable number of countries. A body of Arab scientists is also contributing to epidemiological research into the causes of cancer and how to develop effective control programs. The present review covers the relevant PubMed literature and cancer incidence data from various sources, highlighting similarities and variation in the different cancer types, with attempts to explain disparities with reference to possible environmental factors. In males, the most prevalent cancers vary, with lung, urinary bladder or liver in first place, while for females throughout the region breast cancer is the greatest problem. In both sexes, non-Hodgkins lymphomas and leukemias are relatively frequent, along with thyroid cancer in certain female populations. Adenocarcinomas of the breast, prostate and colorectum appear to be increasing. Coordination of activities within the Arab world could bring major benefits to cancer control in the eastern Mediterranean region.