IRAQI JOURNAL OF MEDICAL SCIENCES

Training and competency certification for the specialty of general surgery in North America have many similarities and some differences between the two countries (Canada & USA). The work and learning environment in both countries are very similar leading to many similarities in training and certification. Accreditation of the training centers and structured residency programs with carefully designed curriculum are the core requirements for specialization. The difference is in the accrediting and supervising institutions. Similarly, is the certification process. The Royal College of Physicians and Surgeons of Canada is responsible for both accrediting training centers and conducting the certification exams. While in the US, more than one organization is involved in the two processes. This variation may lead to different standards and quality of training. This difference is difficult to evaluate.
Keywords:Surgery, Training, Qualification, North America
Citation:Faiz Tuma. Surgical training and qualification in North America: review and comparison. Iraqi JMS. 2017; Vol. 15(2): 106-107. doi: 10.22578/IJMS.15.2.1

Background:John Cunningham virus (JCV) is one of the important viruses in immunocompromised patients. High JC viruria is seen in kidney allograft recipients; some of them with a polyomavirus associated nephropathy (PVAN) just like BK polyomavirus but to a lesser extent.
Objective:To detect JCV viruria in a sample of Iraqi renal transplant recipients, and its association with renal function.
Methods:A prospective study enrolled 71 renal transplant recipients (RTR) and 20 normal donors (ND) as controls. Urine samples were collected from all RTR and ND. Viral DNA was extracted from 1 ml urine samples, and then, JC virus DNA was detected and measured by Taqman quantitative real-time PCR.
Results:Out of 71 RTRs, 31 (43.66%), and 2 out of the 20 (10%) controls had positive JC viruria. The mean JCV viruria was 6.8 x104, and 1.04x103 copies/ml for RTRs and controls respectively.
Conclusion:There is a relatively high prevalence of JCV viruria in Iraqi RTR patients.
Keywords:JC virus, renal transplantation, urine, real-time PCR.
Citation:Mervit B. Jasim, Ali J.H. Al-Saedi, Mustafa R. Hussein, Asmaa B. Al-Obaidi, Haider S. Kadhim. High prevalence of John Cunningham viruria in renal transplant recipients. Iraqi JMS. 2017; Vol. 15(2): 108-115. doi: 10.22578/IJMS.15.2.2

Background:Dexamethasone is a glucocorticoid as a member of the steroidal anti-inflammatory and immunosuppressant. It has well documented effects on skeletal structures osseous and cartilaginous, commonly used to treat or control diseases.
Objective:To evaluate by histomorphometric study the effects of dexamethasone on the embryogenesis of long bones in chick embryos.
Methods:Forty-eight fertile chick eggs of Gallus gallus domesticus, were used. The eggs were divided into 2 groups; control and treated groups of 24 eggs each, these groups were subdivided into 4 subgroups (n=6 eggs). On day 10 of incubation, the control group was injected with 25 µl of distilled water while the treated group was injected with 25 µl of distilled water contained 8 µg dexamethasone. In the next days (11, 12, 13, and 14 of incubation), 12 chick embryos were sacrificed in each day. A computer-assisted morphometric/ image analysis (Motic Image Plus version 2.0ML), was used to measure length, area, perimeter of tibiae, and the area and perimeter of the perichondral osseous collar of cross section in mid-diaphyseal zone of these bones.
Results:These bones of chick embryos treated with dexamethasone, suffered shortening and retardation in length, weight, area and perimeter throughout the period of this study, decline area and perimeter to the perichondral osseous collar in the mid-diaphyseal zone.
Conclusion:Dexamethasone given at day 10 of incubation caused tibial bones growth retardation at development stages 11, 12, 13, and 14-days; this was observed in the measured parameters: bone length, area, perimeter and weight.
Keywords:Bones, chick-embryo, dexamethasone, histomorphometry
Citation:Wathiq Q.S. Ali, Mohammad O. Selman, Insaf J. Al-Hasson, Imad M. Al-Ani, Anam R. Al-Salihi. The Effects of dexamethasone on tibia development of local chick-embryo. I: computer-assisted morphometric study. Iraqi JMS. 2017; Vol. 15(2): 116-128. doi: 10.22578/IJMS.15.2.3

n ki-67 in benign, pre-malignant and malignant prostatic lesions.
Methods:A cross section study of 115 paraffin embedded prostatic tissue blocks, 76 cases were benign prostatic hyperplasia (BPH), 9 cases were high grade-prostatic intraepithelial neoplasia (HG-PI N), and 30 cases were prostatic carcinoma (PCa). Sections from each block were prepared for immunohistochemical staining of ki-67.
Results:Ki-67, semi-quantiative evaluation, revealed that the majority of BPH (88.2%) and HG-PIN (66.7%) presented weak positivity (+), on other hand, the majority of PCa (60.0%) presented moderate positivity (++), and 16.7% showed intense positivity (+++). For prostatic carcinoma (PCa), no significant association had found between Ki-67 and serum tPSA level, while a significant association with Gleason grade was found, the higher grade (≥7), the more intense positive immunolabeling for Ki-67.
Conclusion:Significant differences between ki-67 immunolabeling and histological type of prostatic lesions, between BPH and HG-PIN, and prostatic carcinoma, which may have potential to evolve to malignancy.
Keywords:BPH, HG-PIN, Ki-67, prostatic carcinoma, tPSA
Citation:Inas A. Rasheed, Alaa G. Hussein, Mohanad M. AbdulGhany. Ki-67 Immunohistohemical expression in prostatic lesions. Iraqi JMS. 2017; Vol. 15(2): 129-134. doi: 10.22578/IJMS.15.2.4

Background: Epstein-Barr virus (EBV) is one of the most common latent viruses inside the humans' B-lymphocytes and it has been documented as a causative agent of many cancers. The virus may be transmitted when infected blood transfused to immunocompromised as well as immunocompetent individuals.
Objective: To estimate the prevalence of EBV among apparently healthy blood donors by enzyme-linked immunosorbent assay (ELISA) and by quantitative real time polymerase chain reaction (RT-PCR).
Methods: Four hundred fifty (450) blood donors were enrolled in this study. Plasma samples were screened by ELISA technique for detection of EBV viral capsid antigen (VCA-IgG). DNA extracted from 50 representative samples of these 450, and plasma EBV viral load was investigated by RT-PCR.
Results: The overall sero-prevalence of EBV IgG was 79.8%, with a significantly higher prevalence among females than males. RT-PCR results were negative for all of the 50 representative samples.
Conclusion: The high EBV sero-prevalence rates among Iraqi subjects raise the possibility of increasing the risk of EBV-associated malignant diseases.
Keywords: Epstein-Barr virus, seroprevalence, VCA-IgG, real-time PCR, blood donors
Citation: Amjad Q. Redha, Asmaa B. Al-Obaidi, Haider F. Ghazi, Haider S. Kadhim. Sero-prevalence and plasma viral load of Epstein Barr virus among Iraqi blood donors. Iraqi JMS. 2017; Vol. 15(2): 135-142. doi: 10.22578/IJMS.15.2.5

Background: Obesity and rapid weight loss induced by weight-reducing surgery are well recognized as a risk factor for the development of gallbladder stones. There is no standard policy whether to perform prophylactic cholecystectomy at the time of the bariatric operation or to give postoperative treatment to decrease the risk.
Objective: To evaluate the incidence and risk factors of gallstone formation post-bariatric surgery. The results may help to decide how to deal with and follow up patients with post-bariatric surgery.
Methods: A total of 120 patients who underwent weight-reducing operations were recruited for this study. Several factors expected to influence gallstone formation were recorded such as body mass index and excessive weight loss. Study population was followed up for 12 months postoperatively. Ultrasonography examination was performed for those who developed symptoms suggesting gallstone formation.
Results: Twenty-six (21.7%) patients were found to develop gallstones. Of the studied risk factors, the percentage of excess weight loss, family history and carrying allele A of the variant rs670 were significant for predicting development of gallstone post-bariatric procedures.
Conclusion: Based on the results of this study, it is reasonable to put an index for the risk of developing gallstone following bariatric surgery, and according to this index, the surgeon could decide whether to perform concomitant cholecystectomy along with the bariatric procedure or do not.
Keywords: Bariatric surgery, cholelithiasis, single nucleotide polymorphism
Citation: Sajid H.A. Al-Helfy, Qasim S. Almayah, Risala H. Allami. Cholelithiasis following bariatric surgery: a new approach to deal with. Iraqi JMS. 2017; Vol. 15(2): 143-150. doi: 10.22578/IJMS.15.2.6

Background:Dermatoglyphic is the study of epidermal ridge configuration on finger tips, palms and soles. Leprosy is an infectious disease due to Mycobacterium Leprae. Few report of dermatoglyphic patterns studies in patients with leprosy have shown that fingerprint patterns were also affected in leprosy.
Objective: To identify the effect role of leprosy on of fingerprint patterns.
Methods: A prospective case control study on 50 patients complaining from leprosy and 50 control group was conducted within 11 months period in order to study the patient fingerprint patterns.
Results: In this study, male (74%) consisted high rate than female (26%) and majority of patients at age group ≥ 54 years old. The whorls and loop patterns were high in control group than cases with 36.3% and 48.9% respectively, while arch pattern was high in case group than control with 29.6% in case group. Arch patterns were high in little, ring and thumb fingers, while loop patterns were high in ring, index and thumb fingers than control one.
Conclusion: The findings of this study were suggestive that there was an increase in the loop and arch patterns of individuals with leprosy and this was highly significant when compared to the control group in which the whorls pattern was higher, and to identify the patients with leprosy also to find if there are possible risk for future infection with leprosy by study the patterns of finger print.
Keywords: Dermatoglyphic, fingerprints, leprosy.
Citation: Nagi A. Abdulla, Salwa O. Bahalah, Maysa S. Alnoban, AbdulBaset A. AlQbaty. Study of finger print patterns in leprosy. Iraqi JMS. 2017; Vol. 15(2): 151-158. doi: 10.22578/IJMS.15.2.7

Background: Endometriosis is described by the existence of endometrial tissue outside the uterine cavity. Infertility is one of clinical manifestation of endometriosis shown by the difference of fecundity.
Objective: To compare the serum levels of TNF-α and IL-17 in fertile and infertile endometriosis patients.
Methods: This study was conducted on 55 women patients with endometriosis (30 infertile women and 25 fertile women) and twenty apparently healthy controls. The technique used to reveal serum level of TNF-α and IL-17 was Enzyme-linked immune sorbent assay (ELISA).
Results: This study revealed significant increase (p<0.05) in serum levels of TNF-α in infertile patients other than that fertile. On the other hand, there were no significant differences (p>0.05) between controls and each group of patients. Moreover, there were significant increase (p<0.05) in IL-17 levels in infertile patients than that fertile patients and controls, while there were no significant differences (p>0.05) between fertile patients and controls.
Conclusion: The current results indicate that TNF-α and IL-17 might play a crucial role in endometriosis-related infertility.
Keywords: Endometriosis, TNF-α, IL-17.
Citation: Vean S.A. Al-Azawy. Levels of tumor necrosis factor alpha and interleukin-17 in fertile and infertile women with endometriosis. Iraqi JMS. 2017; Vol. 15(2): 159-164 . doi: 10.22578/IJMS.15.2.8

Background: Fetal blood flow through the umbilical cord vessels associated with abnormal coiling of the cord can have serious deleterious effects on the health of the fetus and newborn. Matrix metallopeptidase-9 (MMP-9) is a class of enzymes that are involved in the degradation of the extracellular matrix collagen and other proteins.
Objective: To investigate the profile of MMP-9 immunohistochemical reactivity in the umbilical cord with variable coiling indices.
Methods: In this study, 60 umbilical cords with inclusion criteria (full term newborns with normal perinatal outcome whose mothers were normal) collected from labor rooms of Ibn Al-Balady Hospital in Baghdad. The cords were used for immunohistochemistry matrix metaloprotenase-9 study.
Results: The results of Immunohistochemical study showed variability in mesenchymal tissue reactivity among the three groups of the umbilical cords in different regions (sub amniotic region, perivascular region and central region) of the umbilical cords. The results obtained were evaluated by using the Aprio image scope analysis software.
Conclusion: The immunohistochemical reactivity could indicate that the MMP-9 localization has role in degradation of collagen and proteins to maintain a harmless perivascular pressure in association with hypercoiling and hypocoiling of the cord and that could preserve the normal vascular blood flow to a certain limit.
Keywords: Umbilical cords, human, coiling index, matrix metalloprotienase-9, normal pregnancy, immunohitochemistry.
Citation: Hiba A. Abdul Sattar, Hayder J. Mubarak. The profile of matrix metalloproteinase-9 in relation to coiling index of human umbilical cord. Iraqi JMS. 2017; Vol. 15(2): 165-174 . doi: 10.22578/IJMS.15.2.9

Background: von Willebrand disease (VWD) is the most common, genetically, hereditary and clinically heterogeneous bleeding disorder caused by qualitative or quantitative defects in von Willebrand factor (VWF) that leads to imperfect VWF interaction between platelets and injured blood vessel wall which deteriorate primary hemostasis.
Objective: To assess the role of collagen binding assay in the classification of VMD.
Methods: A cross sectional study was conducted on 52 suspected known patients with VWD with no consideration to their age or gender who attended the National Center of Hematology. They were submitted to von Willebrand factor antigen (VWF:Ag), factor VIII (FVIII), ristocetin co factor assay (VWF:RCo), ristocetin induced platelet aggregation (RIPA), and collagen binding assay (VWF:CB) at the same center.
Results: The patients mean age was 14.42 ±1.64 years, median 10 years, and range of 1-40 years. More than half of cases below 10 years with M:F ratio 1:1.26. Two out of 9 cases of subtype I was diagnosed as subtype II, 4 out of 7 cases of subtype II sub classified as subtype2M and the rest 3 cases sub classified as 2A, 11 out of 36 of subtype III diagnosed as 8 cases for subtype I, and 3 cases for subtype II.
Conclusion: VWF:CB assay is an important and effective supplementary test, in addition to three test panel FVIII, VWF:Ag, VWF:RCo, and multimere analysis, for sub classification of VWD. VWF:CB assay has a role in reclassified VWD patients with highly variable clinical presentation and laboratory values. Type III VWD is most frequent diagnosed type among symptomatic patients due to high consanguinity rate which detected earlier with severe bleeding tendency.
Keywords: Von Willebrand disease, collagen binding assay, VWF:RCo.
Citation: Suha K. Jabbar, Subh S. Al-Mudallal, Zeyad A. Shabeeb, Yusra G. Al-Obaidy, Hind S. Al-Mamoori. The role of collagen binding assay in classification of von Willebrand disease. Iraqi JMS. 2017; Vol. 15(2): 175-180. doi: 10.22578/IJMS.15.2.10

Background: Surgical sphincterotomy (SS) has been the most commonly used treatment for chronic anal fissure (CAF). Although effective, it is associated with gas and or fecal incontinence in (0-20%) inter-sphincteric Botulinum Toxin A (BTXA) injection is a non-surgical technique that may be used as an option under certain circumstances for treatment of such condition.
Objective: To verify the effectiveness of the BTXA injection in relieving symptoms and healing of chronic anal fissures.
Methods: Thirty patients with CAF were treated by BTXA 1 U/kg injected into the inter-sphincteric plane; as an outpatient procedure, patients were re-evaluated after 1 week, and then every 2 weeks until the fissure healed or surgery was required. The patients were followed up for one year by regular attachment through phone call or visit, to evaluate the effects of treatment. Results, complications and follow up were recorded.
Results: In 25 patients (83%), the pain was disappeared after the first week; 20 patients (66%) presented with a complete healing of the fissure in a period ranging between 1 to 3 months. Gas incontinence was reported in 2 patients (6%) and solved spontaneously. No major complications were found, in 3 cases (10%) surgery was needed later on.
Conclusion: Since it avoids the greater risk of incontinence associated with SS, and it can be done as outpatient procedure without admission or general anesthesia. We recommend the use of BTXA as the first therapeutic approach for patients with chronic anal fissure.
Keywords: Botulinum Toxin A, anal fissure.
Citation: Nashwan Q. Mahgoob, Muhammed M. kamal. Inter sphincteric botulinum toxin A injection for the management of chronic anal fissure. Iraqi JMS. 2017; Vol. 15(2): 181-187. doi: 10.22578/IJMS.15.2.11

Background: Circumcision and its complications are one of the most common cases that pediatric surgeons facing in their practice. There are many techniques that have been described to perform it either by the free hand operative methods or with the use of special devices.
Objective: To evaluate the results of using Gomco clamp for circumcision as a preliminary experience in Iraq.
Methods: A total of 120 babies were subjected to circumcision by this device during the period from April 2014 - November 2015; their age ranges from 7 days - 11 months and they were divided into 3 groups: neonates, infants 1-3 months, infants 4-11 month. By using three different sizes of the clamp, the procedure was performed under local anesthesia in the majority of cases in a form of subcutaneous ring block with aid of sedatives while general anesthesia was given to those cases of coincidental circumcision with other operations. The outcomes of the procedure were assessed after one-month period of follow up.
Results: 12.5% of cases were neonates; the average duration of the procedure was 20 minutes. A total complication rate of 9.16% was recorded (11 cases out of 120. The lowest rate of complication (6.6%) was seen in neonates, while the group of infants older than 4 months had the highest complication rate (10%). The most frequent complication recorded was bleeding (36.3% of all complication rate) followed by excess skin, infection, meatitis, epidermal inclusion cyst, no other complications were recorded.
Conclusion: Circumcision by Gomco clamp is a safe and simple method with good functional and cosmetic results if performed during neonatal period and early infancy. Choosing the suitable size of the clamp, adequate training and good postoperative care will minimize most of the complications.
Keywords: Circumcision, Gomco clamp, neonate, infant, complications.
Citation: Ali E. Joda. Gomco clamp circumcision in neonates and infants: a preliminary experience in Iraq. Iraqi JMS. 2017; Vol. 15(2): 188-197. doi: 10.22578/IJMS.15.2.12

Background: Umbilical cord coiling index plays a role in predicting the pregnancy outcome and risk of low birth weight. Endothelin-1 binding sites exist on placental stem villi vessels and trophoblastic layer of the villi. Endothelin-1 is involved in regulation of the feto-placental circulation and specific trophoblastic functions.
Objective: To investigate the profile of anti-endothelin-1 antibody expression in the human normal placental villi in relation to the coiling indices of the umbilical cords attached to these placentas.
Methods: Normal human placentas were collected with inclusion criteria (full term newborns with normal perinatal outcome whose mothers were normal), and classified according to their umbilical cord coiling index into three groups: (N, H, and H), endothelin-1 marker used to investigate the localization of the endothelin-1 in the placental villi of each group.
Results: There was a difference between the mean positivity percentage of endothelin-1 immunohistochemical reactivity in normocoiled group in comparison with hypercoiled group and hypocoiled group. There is a difference between the mean number of terminal villi in the three groups and in the perimeter of blood vessels.
Conclusion: The pattern of endothelin-1 reactivity is associated with vasodilatation of the villous vascular bed to maximize the exchange function of the placenta as a physiological response to overcome the sequel of obstruction of umbilical vessels in both types of abnormal coiled cords during pregnancy.
Keywords: Placental villi, umbilical cord, coiling index, normal pregnancy, endothelin-1, immunhistochemistry.
Citation: Hayder J. Mubarak, Sarah A. Ahmed. Histomorphometric and endothelin-1 immunohistochemical study of human placental villi correlated with umbilical cord coiling index. Iraqi JMS. 2017; Vol. 15(2): 198-205. doi: 10.22578/IJMS.15.2.13

Background: Renal cancer is the 13th most common malignancy globally. Cancer stem cells display progenitor cell properties such as self-renewal and ability to re-establish tumors that explain the tumor of origin. Aldehyde dehydrogenase 1 (ALDH1) has been known as a general marker of both normal stem cells and cancer stem cells.
Objective: To evaluate the immunohistochemical (IHC) expression of cancer stem cell markers ALDH1 in renal cell carcinomas (RCCs).
Methods: A study was designed that included 70 paraffin blocks of renal cell carcinoma tissues obtained from patients who underwent nephrectomy. The control group included 30 samples of normal renal tissue of autopsy cases from the Forensic Medicine Institute. From each two sections of 5 µm thickness were taken, one section was stained with Hematoxylin and Eosin (H&E) and the other section was immunohistochemically stained for ALDH1A1 (an isoform of ALDH1 that is expressed in the renal epithelium).
Results: The difference in the IHC expression of ALDH1 is highly significant between RCC cases and control group (p<0.001). ALDH1 expression was increased in high tumor grade of RCC cases (p= 0.007) and also its high expression was noted in advanced tumor stage (p= 0.002), and with tumor size >4cm (p=0.023). RCC cases with renal vein invasion revealed high expression of ALDH1 (p=0.003), also ALDH1 expression increased in cases with perinephric fat invasion (p=0.014).
Conclusion: ALDH1 showed higher expression in RCC tissues than normal renal tissues and it is associated with clinicopathological variables (tumor grade, tumor size, tumor stage, renal vein invasion, and perinephric fat invasion). This may reflect the role of ALDH1 in disease progression and poor prognosis of RCC.
Keywords: Renal cell carcinoma, cancer stem cell marker, ALDH1, immunohistochemistry.
Citation: Ahmed M. Hassan, Ban J. Qasim, Zaidoon A. Musa. Immunohistochemical expression of Aldehyde Dehydrogenase 1 (ALDH1) in renal cell carcinomas. Iraqi JMS. 2017; Vol. 15(2): 206-213. doi: 10.22578/IJMS.15.2.14