Background: the patient’s perceptions about hypertension play an important role to reach the best control of this chronic disease. However, many hypertensive patients particularly the elderly present with uncontrolled blood pressure, which is a leading factor for mortality. Patient's knowledge and modifications of life style can contributes in the controlling of hypertension and preventing their long-term complications. Methods: Cross-sectional study, data from 212 hypertensive patients was collected from medical outpatient clinics in Baghdad along period of more than one year. Level of knowledge, attitude, perceptions and practice about hypertension were assessed using questionnaire sheet prepared for this purpose. Results: There were 212 hypertensive patients, 138 (65.1%) were women and 47 (34.9%) were men. Mean ± standard deviation age of patients was 56.56 ± 9.58 years. Most of the patients had completed high school (n = 179, 84.43%), and nearly half of them were have a job as average (n = 114, 53.8%).  In general, more than half of participants revealed good knowledge, attitude and perception about elevated blood pressure, but unfortunately there are still a cogent percent of Iraqi patients present with poor knowledge and practice regarding to risk factors of hypertension, benefits of life style modifications mainly exercise, and taking healthy diet. Patient's knowledge, attitude, perception & practice were positively related to the educational level of hypertensive patients. Conclusion: This study demonstrated a non-convincing knowledge, attitude and perception and poor practice about hypertension in patients with elevated blood pressure in the study population. More efforts should be made to educate patients about the acquaintance of hypertension and the suitable individual way of treatment.   Keywords: Hypertension, Patient’s knowledge, perception, attitude, practice.

Helicobacter pylori (H. Pylori) is one of the most common infectious human pathogens. H. pylori could induce inflammation, that causes illnesses and disorders of upper gastrointestinal which including peptic ulcer diseases, dyspepsia, gastroesophageal reflux disease and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. It is important to use a better tolerated and greatly effective eradication regimen. In this study, 75 newly diagnosed adult patients with H. pylori infection were included and completed the study, they were allocated into three groups with three different treatment regimens for H. pylori eradications; Group A (25 patients) received oral standard clarithromycin-based triple therapy for 14 days. Group B (25 patients) received oral bismuth based-quadruple therapy for 10 days. Group C (25 patients) received oral moxifloxacin-based triple therapy for 14 days. The results reported in this study indicated a significant higher eradication rate of Group B and Group C (84% and 80%, respectively) of patients with H. pylori infections compared to that of Group A (52%). The incidence of adverse effects were appeared as 72%, 64% and 24% of patients in group A, B and C respectively. The use of moxifloxacin triple regimen for H. pylori eradication, present with eradication efficacy parallel to that of quadruple regimen which were significantly higher compared to that of clarithromycin triple regimen. Also moxifloxacin triple therapy is more tolerable and does not increase the incidence of overall adverse effects compared to other regimens used in this study.

The most prevalent chronic complication of diabetes mellitus is diabetic neuropathy. The pathogenesis of diabetic neuropathy is exacerbated by hyperglycemia-induced oxidative stress, which causes nerves to deteriorate in a programmed manner. Many clinical trials depend on supplement in an attempt to improve neuropathy symptoms such as (pain & tingling) and patient quality of life, one of them is Coenzyme Q10 which is reported to have an anti-inflammatory and antioxidant effects, and was totally nontoxic and non-reported side effects. This study aimed to evaluate using a Coenzyme Q10 supplement as an adjuvant therapy to gabapentin to improve the clinical symptoms of diabetic neuropathy in relation to its anti-inflammatory and antioxidant effects. This open-label interventional study involved 33 diabetic neuropathy patients divided into two groups: group (1) 16 patients were given 300 mg of gabapentin once a day at evening, plus group (2) 17 patients received 300 mg of gabapentin once a day in the evening plus Coenzyme Q10 200mg once daily. Pre- and post-3 months of treatment, blood samples used to measure metabolic, anti-inflammatory and antioxidant biomarkers (fasting blood glucose, glycated hemoglobin, tumor necrosis factor-α, Iinterleukin-6 & Superoxide dismutase) , as well as the Michigan neuropathy screening instrument for  assessment of clinical symptoms. After 3 months of Coenzyme Q10 use, the results showed that the group 2 produced a highly significant change in glycated hemoglobin & fasting blood glucose levels. Meanwhile, there is no significant change in glycated hemoglobin & fasting blood glucose values in patients receiving just gabapentin. Moreover, results showed highly significant differences in Michigan neuropathy screening instrument, tumor necrosis factor-α, iinterleukin-6 & superoxide dismutase between the study groups at the completion of the research. Finally, addition of Coenzyme Q10 to gabapentin for diabetic neuropathy patients result in improving the glycemic control & symptoms of the diabetic neuropathy, as well as decreasing effects of the inflammation in addition to oxidative stress after three months of treatment.

Diabetic neuropathy (DN) is the most common chronic complication of diabetes mellitus. Hyperglycemia-induced oxidative stress induces programmed cell death of nerves, which contributes to the pathology of Diabetic neuropathy. Many clinical trials depend on supplement, in an attempt to improve neuropathy symptoms such as (pain &   tingling) and patient quality of life, one of them is alpha-lipoic acid (ALA). Alpha-lipoic acid is a potent anti-inflammatory and antioxidant with insulin-mimetic activity, it has been shown to improve clinical symptoms in experimental Diabetic neuropathy and protect peripheral nerves from ischemia, in addition to stimulate the nerve growth factor and promote fiber regeneration. This study is aimed to evaluate the effect of Alpha-lipoic acid supplement as adjuvant therapy to gabapentin in patients with diabetic neuropathy, which can reflect by the improvement in nerve conduction velocity (NCV) a test was conducted to assess the severity of iabetic neuropathy and clinical symptoms. A prospective randomized- open-label interventional study for 3 months include 33 DN patients, aged (18-69) years were divided into two groups; group A  include 16 patients received gabapentin 300 mg once daily at night, and group B include 17 patients received gabapentin 300 mg once daily at night plus alpha-lipoic acid 600mg once daily. Pre and post 3 months of treatment, blood samples used to measure metabolic biomarkers (FBG, HbA1c), in addition to Nerve conduction velocity. The results showed that, the intervention group produced a highly significant change in HbA1c & no significant change in FBG levels after 3months of Alpha-lipoic acid supplementation. Meanwhile, there is no significant change in HbA1c & FBG levels in patients treated with gabapentin alone. Moreover, results showed highly significant improvement (P˂0.01) in Nerve conduction velocity for two groups at the end of the study. Addition of Alpha-lipoic acid to gabapentin in diabetic neuropathy patients result to improve the glycemic control & Nerve conduction velocity.  after three months of treatment.

Hyperphosphatemia is a serious biochemical abnormality that affected almost patients undergoing maintenance hemodialysis and has independent association with high risk of mortality due to cardiovascular diseases. The mechanism linking hyperphosphatemia to cardiovascular mortality is vascular calcification that it is promoted by elevated serum phosphorus level. The control of hyperphosphatemia remains a major challenge. All currently phosphate binders have requirement for dosing with each meals that contributed to high pill burden and reduce patient compliance. Calcium-based binders preferred to be avoided due to their high risk of vascular classification, while the expensiveness of non-calcium based binder represent their major drawbacks. Niacin; a naturally occurring water-soluble vitamin and the first used antidyslipidemic drug, has been demonstrated to show therapeutic potential for hyperphosphatemia treatment in hemodialysis patients. It decreases phosphorus absorption in the GIT, thereby lowering serum phosphorus level. This study is designed to evaluate the efficacy of niacin as adjuvant therapy to sevelamer carbonate (as a phosphate binder) in hemodialysis patients. This prospective, randomized clinical trial was conducted among patients with hyperphosphatemia. Seventy nine patients were enrolled in this study; only 39 patients completed the study. Thirty nine patients were assigned randomly into two groups; group (1) 19 patients treated with sevelamer alone (2400mg/day), group (2) 20 patients treated with a combination of sevelamer (2400mg/day) and niacin (1000 mg/day) for 2 months . Clinical outcomes (Pi, Ca, Ca x P product) serum levels were evaluated at time of enrolment, after 1 month and after 2 month of treatment. Results of this study showed that the patients who administered orally niacin as adjuvant to sevelamer had the superiority over using sevelamer alone in the reduction of both serum phosphorus level and (Ca x P) product level (-30% and -37%) respectively after 2 months of treatment in respect to baseline levels. Meanwhile, there was no statistically significant difference observed in serum calcium level. Administration of niacin for hemodialysis patients is an effective strategy for reducing the serum levels of inorganic phosphorus and calcium-phosphorus product which subsequently reduce risks of cardiovascular diseases associated with hyperphosphatemia.