PhD Dissertation Defense at the College of Medicine, University of Babylon
The College of Medicine at the University of Babylon hosted the defense of a PhD dissertation entitled “Investigating the Association Between Immune Exhaustion Factors and Chronic Suppurative Otitis Media,” submitted by PhD candidate and researcher Intidhar Naim Kareem.
The defense was attended by the Associate Dean for Scientific Affairs, Assistant Professor Dr. Ashraf Mohammed Ali Hussein.
The dissertation was examined by a specialized scientific committee comprising:
• Prof. Dr. Lamis Abdul-Razzaq Abdul-Latif, College of Medicine, University of Babylon — Chair
• Prof. Dr. Safaa Sahib Naji, College of Medicine, University of Babylon — Member
• Prof. Dr. Haider Shukhair Abais, College of Biotechnology, Al-Qasim Green University — Member
• Prof. Dr. Zaytoon Abdul-Ridha Akhayoush, College of Medicine, University of Babylon — Member
• Prof. Dr. Lubna Abdul-Azim Al-Bayati, DNA Research Center, University of Babylon — Member
• Prof. Dr. Mohammed Abdul-Kadhim Hassan, College of Medicine, University of Babylon — Supervisor and Member
• Prof. Dr. Safaa Hussein Abbas, College of Medicine, University of Babylon — Supervisor and Member
This case-control study investigated the microbiological, molecular, and immunological aspects of chronic suppurative otitis media (CSOM). It included 100 participants: 50 patients and 50 healthy individuals serving as a control group. The study was conducted in cooperation between the College of Medicine and the Ear, Nose, and Throat Unit at Al-Diwaniyah General Hospital.
The clinical samples revealed that Staphylococcus aureus was the most prevalent bacterial pathogen, accounting for 44% of isolates, followed by Pseudomonas aeruginosa at 14%. These were identified as the principal bacterial causes of the disease in Iraq, in agreement with findings reported in the international literature.
Molecular examination of the Staphylococcus aureus isolates demonstrated the presence of the antibiotic-resistance gene mecA in 100% of the isolates, in addition to considerable variation in virulence genes. Sequence analysis of the 16S rRNA gene also revealed clear genetic differences between the Iraqi isolates and previously reported clinical isolates from France, South Korea, and Egypt, suggesting the presence of regional and strain-specific genetic adaptations.
Using real-time polymerase chain reaction (RT-PCR), the study detected a high prevalence of viral nucleic acids in patient samples. Coronaviruses were identified in 80% of the samples, rhinovirus in 20%, and adenovirus in 12%.
Enzyme-linked immunosorbent assay (ELISA) findings showed a highly significant increase in the concentrations and expression levels of adaptive immune checkpoint molecules and innate immune sensors, including CTLA-4, PD-L1, CD28, and TLR9, among patients compared with healthy controls. These findings indicate persistent immune regulation and chronic stimulation of the inflammatory response.
The study concluded that there is a strong association between combined bacterial and viral infections and the stimulation of chronic inflammation and immune exhaustion within the middle-ear environment. This creates an immunosuppressive microenvironment and localized immune inhibition that impair tissue and epithelial repair. These mechanisms may explain the persistence of the disease, the failure to eliminate causative pathogens, and its progression into a chronic condition