This paper aims to develop appropriate solutions for each of the causes for the change orders, which help to manage the cost risk in road projects in Iraq. The literature was reviewed in detail, and the objectives were implemented by using a questionnaire that was distributed to specialists in the public sector to survey all possible causes for exceeding the cost of road projects. As a result, 35 causes were identified for a large number of change orders in road projects and their classification into four axes: design, implementation, financial, and other causes. The results of the questionnaire were analyzed using the relative importance index (RII). As a result, the main causes of the change orders were the variations in design and the quantities of work. The main effect was found to be an increase in the cost of the project. Finally, solutions were collected for each of the factors causing the change order through personal interviews with professionals and consultants.

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This study was carried out at Baghdad hospital in, for the period from November 2018 to July 2019. The study included (151) aborted obese women whose ages ranged between (18–41) years with positive Toxoplasma gondii infection. They were divided into two groups according to the body mass index (BMI) value: Group 1: consisted of 61 women with BMI less than 30, Group 2: consisted of (90) women with BMI greater than 30. The control group included (52) healthy volunteer women aged 19–41 years with negative Toxoplasma for comparison of the results. The case and controls were matched for age and gender. Serum samples were tested for fasting blood sugar, insulin, IgG, and IgM of Toxoplasma, Leptin, and Adiponectin as well as insulin resistance index. The results showed that the age factor was not significant between group 1 and group 2 when compared with the healthy group, and there was no significant change between group 2 comparing to group1. In this study, the result of BMI showed substantial increase in group 1, while highly marked increase in group 2 when both groups were compared with the control group. Finally, the levels of Toxoplasma IgG and IgM antibodies showed a highly significant increase in the two patient groups in comparison with the control group. An increase in mean value of leptin concentration was noticeable in group 1 and group 2 with a highly significant difference when compared with the control group. No significant difference was found in the levels of fasting blood glucose in Group 1 and Group 2 compared to the control group. Also, a significant difference in HOMA-IR and QUICK- IR was observed in the patient groups once associated control group. Data revealed a considerable difference with the glucose/insulin ratio in group 1, but a highly significant was noticed in group 2 when compared with the control group. HOMA-AD results showed a significant difference in Group 1 and a highly significant decrease in Group 2.

Background: Patients with rheumatoid arthritis show predominance of metabolic disorder characterized by overweight, central obesity, dyslipidemia, and impaired glucose tolerance, specifically, few studies have explained insulin resistance in this disease.Objective: The aim of the present study is to examine insulin resistance and the risk of developing diabetes mellitus in middle age Iraqi women with early rheumatoid arthritis.Patients and methods: This work involved seventy female with early rheumatoid arthritis. Who was attending to the National Diabetic Center (NDC) of Al-Mustansiriya University and 35 healthy subjects as a control group. From all subjects blood sample was drawn in fasting state to measure the biochemical parameters which including plasma glucose level and fasting insulin concentrations. Other measurements (RF and anti-CCP) were made by routine methods. Homeostasis model of assessment insulin resistance (HOMA-IR) by using the formula HOMA model Insulin sensitivity was calculated in RA patients and healthy control.Results: Results revealed a highly significant in the level of the rheumatoid factor (RF), anti-CCP and fasting insulin, and HOMA-IR when compared the patient group with the control group. While a significant increase in the level of FBG in the RA group than the control group. Also, there was a positive correlation with high significance among, Anti-CCP, and RF with HOMA-IR in the rheumatoid arthritis group. Conclusions: This study shows that patient with rheumatoid arthritis have abnormal insulin secretion with a high value of IR than a group of healthy control and these patients may be at risk of diabetic mellitus.

Background: Patients with rheumatoid arthritis show predominance of metabolic disorder characterized by overweight, central obesity, dyslipidemia, and impaired glucose tolerance, specifically, few studies have explained insulin resistance in this disease.Objective: The aim of the present study is to examine insulin resistance and the risk of developing diabetes mellitus in middle age Iraqi women with early rheumatoid arthritis.Patients and methods: This work involved seventy female with early rheumatoid arthritis. Who was attending to the National Diabetic Center (NDC) of Al-Mustansiriya University and 35 healthy subjects as a control group. From all subjects blood sample was drawn in fasting state to measure the biochemical parameters which including plasma glucose level and fasting insulin concentrations. Other measurements (RF and anti-CCP) were made by routine methods. Homeostasis model of assessment insulin resistance (HOMA-IR) by using the formula HOMA model Insulin sensitivity was calculated in RA patients and healthy control.Results: Results revealed a highly significant in the level of the rheumatoid factor (RF), anti-CCP and fasting insulin, and HOMA-IR when compared the patient group with the control group. While a significant increase in the level of FBG in the RA group than the control group. Also, there was a positive correlation with high significance among, Anti-CCP, and RF with HOMA-IR in the rheumatoid arthritis group. Conclusions: This study shows that patient with rheumatoid arthritis have abnormal insulin secretion with a high value of IR than a group of healthy control and these patients may be at risk of diabetic mellitus.  عوامل الخطر والتشخيص المبكر لداء السكري للنساء حديثات الاصابة بألتهاب المفاصل الروماتويدي محمد حسن علي  د.عـبير جبـار حسن أيناس جبار حسن  الخلاصة: خلفية البحث:يكون المرضى الذين يعانون من التهاب المفاصل الروماتويدي عرضة للاصابة بمتلازمة التمثيل بالغذائي والعوامل المرتبطة بها مثل زيادة الوزن، وقلة دهون الدم أو ضعف تحمل الجلوكوز، وهناك بعض الدراسات بينت ان هولاء المرضى يكونون معرضون لمقاومة الانسولين . الهدف: صممت هذه الدراسة لفحص مقاومة الانسولين وخطر الإصابة بداء السكري عند النساء العراقيات المصابات حديثا بالتهاب المفاصل الروماتويدي. طرق العمل: شملت الدراسة سبعين أنثى مصابات حديثا بالتهاب المفاصل الروماتويدي و 35 من النساء المتطوعات كمجموعة ضابطة. تم سحب عينة الدم من الجميع في حالة الصيام لقياس المعلمات البيوكيميائية بما في ذلك مستوى الجلوكوز ، تركيزالأنسولين وقياسات أخرى مثل (RF and anti-CCP). وايضا تم حساب المقاومة للانسولين (HOMA-IR). النتائج أظهرت النتائج وجود زيادة معنوية في مستوى العامل الروماتويدي (RF) وتركيز الانسولين مقاومة الانسولين (HOMA-IR) عند مقارنة مجموعة المرضى مع مجموعة السيطرة. في حين أن زيادة كبيرة في مستوى السكر الصائم  في مجموعة المرضى مقارنة بالمجموعة الضابطة. أيضا كان هناك علاقة إيجابية  مؤثرة بين، Anti-CCP, and RF  و HOMA-IR في مجموعة مرضى التهاب المفاصل الروماتويدي. الاستنتاجات: اظهرت نتائج هذه الدراسة أن المرضى بالتهاب المفاصل الروماتويدي يكون لديهم إفراز الأنسولين غير طبيعي وبالتالي تظهر لديهم مقاومة للانسولين ويكونون عرضة لخطر الاصابة بمرض السكري. الكلمات المفتاحية: مقاومة الانسولين,  داء السكري, التهاب المفاصل الروماتويدي.