IRAQI JOURNAL OF MEDICAL SCIENCES

Currently, the evaluation and treatment of chronic inflammatory diseases relies on specific clinical signs accompanied with single or multiple marker(s) for that disease. Despite that, these diseases share a common innate immune mechanism involved upregulation of “Inflammasome” that have been proved in its implication in the pathologic mechanism (s) and direct irreversible conversion of pro-interleukin 1β and pro-interleukin 18 into active IL-1b and active IL-18 contributing in disease progression and tissue damage, suggesting a common theranostic target to reduce inflammatory mechanism.
Keywords: NLRP3, inflammasome, theranostic marker
Citation:Ghazi HF. NLRP3 Inflammasome: a promising theranostic target in inflammatory diseases. Iraqi JMS. 2018; Vol. 16(1): 1-3. doi: 10.22578/IJMS.16.1.1

Background: Genital herpes simplex infection is a viral infection caused by the herpes simplex virus (HSV) type 1 or 2. This disease transmitted during close skin or mucus membranes contact with an infected person who is shedding the virus. Infections that are commonly spread by sex, especially vaginal intercourse, anal sex and oral sex.
Objective: For detection of HSV by immunological and molecular methods.
Methods:Two hundred (200) samples were collected from females attending the Gynecology Outpatient Department in the Al-Imamein Al-Kadhimein Medical City and Baghdad Teaching Hospital during the period from May 2014 to April 2015. Based on availability of full clinical information about each patient, high vaginal swabs were taken from females at different ages (15-54 years) representing patients group complaining of abnormal vaginal discharge with or without other symptoms. The Statistical Analysis System- SAS program was used to study the effect of difference factors in study parameters. Chi-square test was used to significant comparison between percentages in this study.
Results: Each of the vaginal swabs collected were examined, was preserved at -20 °C for DNA extracts were analyzed. In RT-PCR, the rate of infection was in women with HSV, those with age group (25-34) years and (35-44) years were 50%.
Conclusion: HSV infections were detected in genital tract infection in women; molecular methods are considered the gold standard for diagnosis, given the excellent sensitivities, specificities, rapid and accurate laboratory diagnosis of HSV.
Keywords: Genital herpes, diagnosis, immunological, molecular study
Citation: Ali MK, Hathal HD, Almoayed HA. Prevalence and diagnosis of genital herpes by immunological and molecular study. Iraqi JMS. 2018; Vol. 16(1): 4-7. doi: 10.22578/IJMS.16.1.2

Background:Listeria monocytogenes (L. monocytogenes) is a Gram-positive, facultative intracellular bacterial pathogen that can cause a severe invasive disease (listeriosis) mainly in pregnant women. Based on genetic content, L. monocytogenes can be divided into 3 lineages I, II and III. Several molecular methods have been developed to assist in the characterization of L. monocytogenes, macrorestriction analysis by pulse-field gel electrophoresis (PFGE) is one of the most used methods for the genotyping of L. monocytogenes.
Objective:To determine the predominant genotype of L. monocytogenes isolated from clinical cases in a group of aborted Iraqi women.
Methods: A study was designed and included 15 clinical isolates of L. monocytogenes and one isolate from locally made cheese. The PFGE protocol was performed as described by Graves and Swaminathan. Briefly, bacterial suspensions adjusted to optical density of 1.3 at 610 nm were embedded in 1.2% Sea Kem Gold agarose plugs. The lysed, washed five times and a 2 mm thick piece was cut, equilibrated and digested with 200 μl of AscI enzyme master mix at 37 °C for 2 h. The macrorestriction fragments were separated by electrophoresis on a CHEF-DRIIBIO-RAD. Images were analyzed with the software Bio Numerics Gel Compar II version 6.6.11 (Applied Maths).
Results: All L. monocytogenes isolates displayed AscI digestion profiles after incubation with the enzyme, about 6-12 majorfragments of 30 to 675 kb were obtained, sixteen isolates have been used in this study, however, 11 different AscI profiles were encountered, the distribution of the isolates according to the restriction profiles showed that two profiles were the most predominant A, A2 with a percentage of similarity of 100%.

Conclusion:L. monocytogenes genotyping showed profiles that can be well used in tracing down infection source and outbreak of this bacterium. PFGE represents a great discrimination and reproducibility method for molecular sub-typing of L. monocytogenes and it is considered the gold standard.
Keywords:Listeria monocytogenes, genotyping, placenta, aborted women, pulse field gel electrophoresis
Citation: Qassim KW, AL Attraqchi AAF, Khatab YI. Genotyping of Listeria Monocytogenes in Iraqi women with spontaneous abortion using pulse field gel electrophoresis. Iraqi JMS. 2018; Vol. 16(1): 8-13. doi: 10.22578/IJMS.16.1.3

Background:Parkinson’s disease (PD) is a neurodegenerative condition of the central nervous system, which is accompanied by the impairment of the cortico-subcortical excitation and inhibition systems. It is characterized by motor and non-motor symptoms, having both hypokinetic and hyperkinetic features.
Objective:To investigate the integrity of the central motor pathways by studying the motor evoked potential (MEP) latencies, amplitudes and central conduction time (CMCT) of the median nerve in patients with PD as compared to healthy controls.
Methods:Twenty-five patients with documented PD were studied; with a mean age of (63.16±5.49 years) as compared to 25 age and sex matched apparently healthy controls. All subjects were instructed about the examination and informed consent was provided. Transcranial magnetic stimulation TMS-MEP study of the right median nerve was done. Cortical and cervical latencies and amplitudes of the MEP study were determined. The responses were recorded with both relaxed and slightly contracted target muscle. CMCT calculation was done by subtraction of the latency of peripheral segment of the motor pathway (spinal motor root to muscle) from that of the entire motor pathway (motor cortex to muscle) or by calculation of the CMCT with the F-wave method.
Results:The means of the cortical latencies of PD patients during relaxation and facilitation states were lower than controls; and the differences were significant for both (P=0.03 and 0.02; respectively). In both relaxed and facilitation states, the means of CMCT in PD patients were lower than in control and the difference was significant during contraction (P=0.02), and near statistical significance during relaxation (P=0.08). CMCT calculations by the estimation of F wave and distal motor latency (DML) were equivocal between relaxation and facilitation states. Nevertheless, the differences were not statistically significant (P=0.45; P=0.62; respectively). The means of the MEP amplitude of PD patients were lower than controls (4.21±1.94 versus 4.28± 1.84 mV; respectively). Nevertheless, the differences were not significant (P=0.89).
Conclusion:Single-pulse TMS is a valuable study to investigate central motor dysfunction in PD. CMCT measurement of the median nerve or any nerve in the upper limb is a potential marker for the evaluation of the severity of PD; especially in the facilitated state.
Keywords:Parkinson’s disease, TMS, MEP, CL, CMCT
Citation:Ahmed HR, Al-Hashimi AF. Motor evoked potential in patients with Parkinson’s Disease: a transcranial magnetic stimulation study. Iraqi JMS. 2018; Vol. 16(1): 14-21. doi: 10.22578/IJMS.16.1.4

Background:Mental disorders in old age are frequent.
Objective:To determine the diagnostic pattern of mental disorders in elderly patients aged ≥ 60 years, attending the Old Age Psychiatry Unit, Ibn-Rushed Psychiatric Teaching Hospital, Baghdad, Iraq.
Methods:A retrospective study to all attendees to the Old Age Psychiatry Unit between January 2009 and November 2011 was carried out. Data collected included diagnoses, comorbid disorders, treatment received, and socio demographic characteristics.
Results:Analysis of 907 patients was done; the mean age 68 ± 6.3 years, 67.5% age range 60 – 69 years, 70% married, 50% without income (unemployed and housewives), 52% illiterate, and 98.5% live with their families. Depression was 46.9%, schizophrenia 23.2%, and 20.7% dementia. 48% of clients had comorbid illness. All patients had at least one pharmacological medication. Diagnoses high statistical significant association with gender (P=0.000), marital status (P=0.001), occupation (P=0.000), and education level (P=0.000).
Conclusion:Mental disorders in old age are frequent. Many old age people were with limited access to mental health services. Mental health services must be designed to meet the needs of older people at all points of the mental health continuum.
Keywords:Pattern, determinants, elderly, psychiatry, Iraq
Citation:Al Abbudi SJR, Ezzat KI. Pattern and determinants of psychogeriatric disorders among the attendees of Old Age Psychiatric Unit, Baghdad, Iraq. Iraqi JMS. 2018; Vol. 16(1): 22-29. doi: 10.22578/IJMS.16.1.5

Background:Hepatitis C virus (HCV) is an important human pathogen affecting 120-170 million individuals in the world. Identification of the causative virus genotype is of a significance to both clinical practices and predict the likelihood to therapy response.
Objective:To determine the distribution of HCV genotypes/subtypes and its association with response to therapy among newly diagnosed HCV patients.
Methods:Fifty patients with confirmed anti-HCV antibodies were included in this study for HCV genotyping in association with response to therapy. Blood samples from patients were subjected to RNA extraction and reverse transcription step; viral load of HCV was measured by polymerase chain reaction (PCR) at time zero, 3 months and 6 months of dual therapy. Response to therapy was measured as a decrease in viral load (2 log or more) and was described as: good (median log is zero after 6 months of therapy), moderate (median log declines more than 2 log but not zero after 6 months of therapy), poor (median log does not decline or decline less than 2 log after 6 months of therapy).
Results:Two genotypes of HCV were detected, genotype 4 was the predominant (27/50, 54%) followed by genotype 1 (23/50, 46%). For HCV subtypes, subtype 1a was of highest percentage (28%) followed by 4e (24%), 1b (18%), 4a (14%), 4b (12%), and 4e (4%).The results revealed a significant association between HCV subtypes, but not genotypes, with response to therapy. HCV subtype 1a followed by 4a showed the highest rate of response 85.7% and 71.4%, respectively, while interestingly HCV subtype 4d showed no response and 1b showed poor response 11.11%.
Conclusion:HCV subtypes of great importance in predicting success to HCV therapy and it is believed this would affect the newly emerging directly acting drugs as well.
Keywords:HCV, genotypes, response to therapy
Citation:Abdulhassan LJ, Abdulamir AS, Alkhalidi NM, Alwaysi SA. Frequency of hepatitis C virus genotypes /subtypes association with response to therapy in a sample of HCV infected Iraqi patients. Iraq. Iraqi JMS. 2018; Vol. 16(1): 30-40. doi: 10.22578/IJMS.16.1.6

Background:The vertebrate limb bud develops as an outgrowth of mesoderm, which forms all their elements (muscles, nerves, vessels, bone, cartilage, and tendon). Myogenic precursor cells are seen at E11.5 mouse embryo, when the first nerve fascicles begin to enter the limb. The first signs of musculature masses are seen at E12.5 in both fore and hind limb buds. Apoptosis or programmed cell death is essential in the development of the limbs. In vertebrate, the developing limb morphogenesis depends on the appropriate spatial and temporal balance between cell death and cell proliferation.
Objective:To perform comprehensive analysis of the proximo-distal pattern of cell death, evaluated by (TUNEL test) in cross sections of mouse limbs during prenatal development after onset of primary myogenesis.
Methods:Fifteen pregnant female mice (Musmusculus) were divided into three groups according to the days of pregnancy into day (14, 16 and 19), only two embryos were taken from each mouse. All the limb buds were involved in this study. Paraffin embedded histological cross-sections of the limb buds were prepared, histological staining (using H&E stain) and TUNEL test labeling were done. Assessment of the number of apoptotic cells in the limb bud mesenchyme was done by counting these cells.
Results:The H&E stained sections of the limb buds showed less amounts of mesenchymal tissues in older embryos (day 19). The TUNEL stain showed active apoptotic changes at proximal parts of the limb buds at gestational day 19, while the distal parts of the limbs buds showed active apoptotic changes at the early days (day 14). The evaluation of TUNEL test reaction in the proximal regions showed statistical significant increase of apoptotic cells in day 19 compared to day 14 (p = 0.001 for both). The mean number of apoptotic cells in the proximal regions were statistically significant (p = 0.001) between day 16 and day 19. While the mean number of apoptotic cells of distal regions of the limb buds was higher at day 14 compared to that of day 16 and day 19. These differences between day 14 and day 16 were statistically significant and between day 16 and day 19 while statistically non-significant between day 14 and day 19. Comparison of mean number of apoptotic cells between proximal and distal regions in all the three groups showed a statistically significant higher mean number of apoptotic cells in the distal regions compared to proximal region (p = 0.001). The mean number of the apoptotic cells in both regions (proximal and distal) of the limb buds revealed statistically significant differences between day 16 and day 19 (p = 0.001).
Conclusion:Apoptosis was higher in all parts of the developing limbs during day 19, and that could be associated with degenerative changes occurring at the apical ectodermal ridge. Moreover, apoptosis was higher in the distal part of the limb bud and this may be due to more differentiation of the distal parts than in the proximal part of the limb bud.
Keywords:Development, limb bud, mouse, embryo, TUNEL, apoptosis, mesenchyme
Citation:Al-Musawi DML, Mubarak HJ. Mesenchymal Cell death in mouse limb bud after the onset of primary myogenesis. Iraqi JMS. 2018; Vol. 16(1): 41-50. doi: 10.22578/IJMS.16.1.7

Background:Single nucleotide polymorphisms in the promoter regions of genes encoding for some interleukins may associate with occurrence of asthma.
Objective:To investigate the association of single nucleotide polymorphisms of interleukin-4 (IL-4) (C-590T) and asthma.
Methods:Forty-five patients with asthma and 40 apparently healthy subjects (represent the control group) were enrolled in this study. Blood samples were collected from both patients and controls. DNA was extracted from blood samples and gene fragments corresponding to IL-4 C-590T were amplified with specific primers using conventional PCR technique.
Results:The heterozygote genotypes of IL-4 C-590T (CT) showed significant association with asthma (OR = 3.922, 95% CI= 1.153-13.339, P = 0.028).
Conclusion:These results suggest the significance of IL-4 C-590T polymorphism as a risk factor for asthma.
Keywords:Asthma, interleukin-4, polymorphism
Citation:Gaidan, Abbas AA, Hassan MA, Hashim HM. Interleukin-4 single nucleotide polymorphism C-590T polymorphisms in relation to asthma. Iraqi JMS. 2018; Vol. 16(1): 51-56. doi: 10.22578/IJMS.16.1.8

Background:Pseudoexfoliation syndrome is a common disorder with a wide range of ophthalmic presentation and risks. Corneal endotheliopathy is one of these presentations.
Objective:To evaluate corneal endothelial cell morphology, density and function in eyes with pseudoexfoliation syndrome.
Methods:120 eyes of sixty patients with clinically evident unilateral pseudoexfoliation were examined with non-contact specular microscopy (SP-3000P) Topcon Corporation. Central corneal thickness (T), cell density (CD), and percentage of cell hexagonality (HEX%) were measured and the values of the affected eyes were compared to those of the fellow normal eyes. Corneas with CD less than 2000/mm2 or HEX% <50% were considered as at-risk corneas for decompensation. The pseudoexfoliated eyes were subdivided into three groups according to the density of the pseudoexfoliated material (those with deposits on the lens capsule alone, on the pupil margin alone or on both) and the morphometric values of endothelial cells in each group were studied. Statistical analysis was performed using a 2-tailed Student t-test and the Chi square test, P value <0.05 was considered significant.
Results:Significant increase in central corneal thickness (500.25±28.95 micron vs 493.18±28.59 micron) and reduction in endothelial cell density (2307.5±272.3 vs 2480.2±289.9 cell/mm2) with a non- significant decrease in cell hexagonality (51.78±8.9 vs 53.48±6.2 %) was noticed in eyes affected by pseudoexfoliation syndrome as compared to the contralateral normal eyes. The changes were noticed more when the severity of the condition increases as reflected by the density of the pseudoexfoliated material. At risk corneas were found more frequently in eyes with pseudoexfoliation based on both endothelial cell density and cell hexagonality.
Conclusion:Pseudoexfoliation syndrome is a cause of corneal endotheliopathy and a risk for corneal decompensation. More endothelial cell changes are found in eyes with advanced pseudoexfoliation. Extra care and more meticulous handling is required while operating upon eyes with pseudoexfoliation to reduce the risk for corneal decompensation.
Keywords:Pseudoexfoliation, corneal endothelium, endotheliopathy, decompensation.
Citation:Kareem AA, Neamah GAT. Corneal endotheliopathy in pseudoexfoliation syndrome. Iraqi JMS. 2018; Vol. 16(1): 57-65. doi: 10.22578/IJMS.16.1.9

Background:Type 2 diabetes (T2D) is frequently encountered among younger ages during last decades in both developed and developing countries largely contributed to the increasing degree and prevalence of obesity in such ages.
Objective:To determine the frequency of T2D in patients younger than 40 years at Northern Iraq.
Methods:Retrospectively a total of 9331 patients were studied consisted of 3471 males and 5860 females with diabetes mellitus (DM) at two settings in Northern Iraq in a period from January 2009 – January 2015. Demographic measurements and clinical evaluation were performed for all patients. The diagnosis of DM and its types was depended on the clinical background and confirmed by plasma glucose level measurement. The data from all patients were assessed and statistically analyzed.
Results:T2D contributed by 8704 (93.3%) of total number of study sample. The mean values for body weight and body mass index for T2D were higher than those of T1D patients (78.0±14.2, and 30.93±5.42 vs. 56.1±22.6 and 23.72±6.89) respectively. The female to male ratio in T2D was approximately 1.73:1.00. Out of 8704 patients with T2D, almost 2134 (24.52%) patients were ≤ 39 years of age.
Conclusion:Type 2 diabetes appears to be seen more frequently in younger age groups in Northern Iraqi society in parallel to increased rate of obesity particularly in adolescent and children.
Keywords:Diabetes in young, obesity and diabetes, type 2 diabetes.
Citation:Alhabbo DJ, Saeed ID, Khalaf YA. Frequency of type 2 diabetes in young age groups in Northern Iraq. Iraqi JMS. 2018; Vol. 16(1): 66-73. doi: 10.22578/IJMS.16.1.10

Background:Elastography has been attracting attention as a new non-invasive diagnostic tool with the potential to improve breast masses characterization.
Objective:To assess the value of incorporating strain elastography into the ultrasound Breast Imaging Reporting and Data System (BIRADS) System to differentiate benign from malignant breast masses.
Methods:Fifty-six women with 61 solid breast masses were enrolled in this study. Ultrasound was performed and the mass was given an US BIRADS category. Elastographic examination was performed and each lesion was assigned an Elasticity Score (ES) according to the Tsukuba scoring system. Strain Ratios (SRs) were calculated from a tumor adjusted Region of Interest (ROI) and a reference ROI in the fatty tissue. The US BIRADS was modified according to the elasticity criteria. Sensitivity, specificity, area under the curve (AUC) and cutoff values were calculated for US BIRADS, ES, SR and the modified BIRADS method using (ROC) curve analysis.
Results:The final results were based on 61 masses, 25 benign and 36 malignant. The sensitivity and specificity were respectively (97% and 80%) for US BIRADS, (86.1% and 84%) for ES, (94.44% and 84%) for SR, and (97% and 84%) for the modified BIRADS.
Conclusion:Combining elastography with conventional ultrasound yielded better diagnostic performance with improved specificity.
Keywords:Elastography, breast masses, elasticity, strain ratio, modified BIRADS
Citation:Tawfeeq RHA, Khalel EA, Al-Waely NKN. Combining strain elastography findings with ultrasound BIRADS system to discriminate between benign and malignant solid breast masses. Iraqi JMS. 2018; Vol. 16(1): 74-83. doi: 10.22578/IJMS.16.1.11

Background:The salivary gland pleomorphic adenoma (PA) is a benign epithelial neoplasm, histologically characterized by a great diversity of morphological aspects. It is the most common neoplasm of salivary gland origin.
Objective:Studying the histopathological characteristics of PA with special attention to the various morphological features of the epithelial cells and stromal components of this neoplasm.
Methods:Hematoxylin and Eosin (H&E) stained tissue sections of 120 cases of PA were reviewed. The tumors were classified according to their histological subtypes as described by Seifert et al. The epithelial components were analyzed considering the type of cells and the morphological pattern. The stromal components were analyzed according to the presence of myxoid, hyaline, chondroid or calcified tissue.
Results:This study revealed that most of the tumors were located in the parotid gland (44%). Myxoid or stroma-rich was the most frequent histological subtype (43%). Plasmacytoid cells were the most commonly seen epithelial component (100%), followed by cuboidal cells in (80%) of the cases. Trabecular pattern was the predominant epithelial morphological pattern (90 %), and the myxoid component was the most frequent stromal component (80%).
Conclusion:PA of the salivary glands demonstrates a wide variety of cells, stromal components, and morphological characteristics. Since it is the most frequent salivary gland neoplasm that can resemble other salivary gland tumors, the knowledge about these variations is essential for a correct diagnosis.
Keywords:Histopathology, pleomorphic adenoma, salivary gland neoplasms
Citation:Sarkis SA, Al-Drobie BF, MajeedGH, Al-Marzooq TJM.Histopathological characteristics of pleomorphic adenoma; a retrospective analysis of 120 cases. Iraqi JMS. 2018; Vol. 16(1): 84-91. doi: 10.22578/IJMS.16.1.12

Background:Hypocalcemia is a major post-operative complication of total thyroidectomy, causing severe symptoms and increasing hospitalization time. The primary cause is secondary hypoparathyroidism following damage to or devascularization of one or more parathyroid gland during surgery.
Objective:To identify the occurrence rate of post-operative hypocalcemia as an indicator of parathyroid gland function and its relation to the type of the surgical procedure of thyroidectomy whether it’s a subtotal or total thyroidectomy.
Methods:One hundred and ninety patients with total and subtotal thyroidectomy were selected in this study (144 females and 46 males). The patients were divided into 2 groups, group 1 (95 patients) represent the patients with total thyroidectomy, and group 2 (95 patients) represent the patients with subtotal thyroidectomy. Serum calcium and parathyroid hormone were done pre-operatively and post-operatively for all patients with a follow-up for serum calcium for 6 months.
Results:Of the total number serum calcium levels decreased from pre-operative levels in 156 patients (82%), but still within normal range (2.1-2.6 mmol/L). The overall incidence of transient hypocalcemia was 22 % (42 patients), 35 patients belong to group 1 and 7 patients to group 2, and that of permanent hypocalcemia (hypocalcemia persisted at the 6 months assessment) was 2.6 % (5 patients), 4 patients belong to group 1 and one patient to group 2. Most of the patients with hypocalcemia were asymptomatic 19.4% (n=37) and did not require calcium supplementation. Symptomatic hypocalcemia occurred in 5.2 % (n =10) patients. It was found that the overall incidence of hypocalcemia after thyroidectomy was 24.7 % (22% transient and 2.6% permanent).
Conclusion:It could be concluded that, insuring the integrity of parathyroid glands is important to avoid post-thyroidectomy hypocalcemia. If incidental removal or devascularization of the parathyroid glands is noted, parathyroid auto-transplantation should be done.
Keywords:Post-operative hypocalcemia, total thyroidectomy, subtotal thyroidectomy.
Citation:Naji RE. Post-operative hypocalcemia among ongoing patients after total and subtotal thyroidectomy. Iraqi JMS. 2018; Vol. 16(1): 92-99. doi: 10.22578/IJMS.16.1.13

Background:Osteoarthritis (OA) is a degenerative joint disease caused by gradual loss of cartilage. Telmisartan is an angiotensin II receptor antagonist, and act as a partial agonist on the nuclear peroxisome proliferator-activated receptor-gamma (PPAR-γ), that has been reported to exert anti-inflammatory effects.
Objective:To evaluate the potential anti-inflammatory effect of telmisartan in patients with knee OA.
Methods:Forty-two patients with painful knee OA were allocated into 2 groups, group (1): patients treated with naproxen tablets (500 mg/12 hr), telmisartan tablets (40 mg/day) and omeprazole (20 mg/day) for 3 months, while group (2): patients treated with naproxen tablets (500 mg/12 hr) and omeprazole (20 mg/day) for 3 months. The serum levels of IL-1β, high-sensitivity C-reactive protein (hs-CRP), TNF-α and erythrocyte sedimentation rate (ESR) were measured before and after 3 months of treatment.
Results:Telmisartan when used in combination with naproxen resulted in significant decrease in serum levels of IL-1β and hs-CRP, higher than that produced by naproxen when used alone. The mean TNF-α level and ESR was decreased non-significantly in both study groups.
Conclusion:Administration of telmisartan as an adjuvant therapy to naproxen in knee OA patients produced a significant decrease in the serum levels of IL-1β and hs-CRP, though no clear effect on TNF-α and ESR was noticed after 3 months treatment. Accordingly, many promising preventive strategies emerged from the available results since telmisartan relatively reduce the inflammatory burden in OA patients. The dose and duration of telmisartan treatment in this study did not indicate a risk of hypotension.
Keywords:Telmisartan, naproxen, osteoarthritis, cytokines
Citation:Hmood SA, Mohammed MM, Kamal YM, Jasim NA. Evaluation of the anti-inflammatory effect of telmisartan as an adjuvant therapy to NSAID in the management of knee osteoarthritis; a clinical prospective study. Iraqi JMS. 2018; Vol. 16(1): 100-110. doi: 10.22578/IJMS.16.1.14