IRAQI JOURNAL OF MEDICAL SCIENCES

Tissue biopsy has been the mainstay in tumor diagnosis for centuries. But due to its invasiveness and the heterogeneity of tumors there was a need for an alternative or adjuvant techniques to diagnose and assess tumors. Liquid biopsy is emerging as a new technique that will open the way for the diagnosis, tumor characterization, assess disease prognosis and individualize treatment options in cancer patients.
Keywords: Biopsy, CTC, ctDNA
Citation: Mahdi AK. Liquid biopsy - A new prospect. Iraqi JMS. 2018; 16(4): 353-356. doi: 10.22578/IJMS.16.4.1

Background: Phage therapy is a potential alternative treatment for infections caused by many bacterial species such as Acinetobacter baumannii (A. baumannii), a significant nosocomial pathogen, has evolved resistance to almost all conventional antimicrobial drugs in poor hygiene and conflicts areas like Iraq.
Objective: Isolate and apply bacteriophages as alternative therapeutic agents against extensively drug-resistant (XDR) and pan-drug-resistant A. baumannii and evaluation extracted native endolysin activity.
Methods: Twenty-three bacterial samples were collected in Al-Imamein Al-kadhimein Medical City hospital. Phages were isolated from different regions in Baghdad city including (soil, sewage, irrigation channels). Native endolysin was extracted from highly lytic phage that produced halo-like appearance around inhibition zone.
Results: Out of 50 isolates, 23 isolates (46%) of XDR, pan-drug resistant (PDR) A. baumanii have been isolated from patients with various infections. 136 lytic phages specific to A. baumanii were isolated. Each bacterial isolate was sensitive to at least one lytic phage. Phage cocktails were formulated and were shown remarkably minimize the bacterial resistance to individual lytic phages. In addition, the endolysin native activity of lytic phages specific to A. baumanii evaluated in this study revealed a potent antibacterial activity (> 1 log) reduction of bacterial density in just one hour of endolysin treatment.
Conclusion:Phage therapy assessed in this study was shown ability to efficiently solve the problems of “superbug” bacteria by lysing effectively most XDR, PDR bacteria in vitro. And, phage cocktails were shown to be superior over single-phage preparations in treating A. baumanii with much less resistance rate to therapeutic phages. Furthermore, intrinsic activity of native endolysin revealed promising results to tackling superbug pathogens.
Keywords: Phage, Phage cocktails, Acinetobacter, native endolysin, extensively drug-resistant (XDR), and pan-drug resistant (PDR)
Citation: Jasim HN, Abdul-Ameer AS. Phage cocktails against highly multi-drug resistant Acinetobacter baumanii. Iraqi JMS. 2018; 16(4): 357-371. doi: 10.22578/IJMS.16.4.2

Background: Cycloplegia abolishes the accommodative power by causing paralysis of ciliary muscle by anticholinergic drugs, which will inhibit stimulation of both ciliary muscle and sphincter pupillae causing cycloplegia and mydriasis. Atropine is widely used in cycloplegic refraction despite its potential toxicity.
Objective:To evaluate the possible role of two hours atropinization versus three days atropinization on the cycloplegic outcome in children.
Methods: This is a clinical interventional study that included fifty children aged two to seven years' old who attended Ibn Alhaitham Teaching Hospital from October 2012 to March 2013; manual refraction was done for each child after 120 minutes of two drops atropine 1% five minutes apart and refraction was repeated after three days of twice daily atropine 1% administration by the parents. T-test was used for means comparison.
Results: Fifty patients (26 males, mean age 3.89 ± 1.3) were included in the study. Spherical equivalent results obtained after three days atropinization (M = 4.2, SD = 1.85) were significantly higher than those obtained after two hours atropinization (M = 3.84, SD = 1.64) (t(49) = - 6.60, p < 0.05).
Conclusion: Two hour atropinization was inferior to the standard three days atropinization as it has less cycloplegic effect and so it cannot be recommended based on the current evidence.
Keywords: Atropine, cycloplegia, atropinization, refraction
Citation: Mohamad AA, Mahdi HA, Younis MS. The comparison between the effect of two hours atropinization versus three days atropinization on the cycloplegic outcome in children. Iraqi JMS. 2018; 16(4): 372-377. doi: 10.22578/IJMS.16.4.3

Background: The administration of antibiotics is of great value in the therapy of infections of male genital tract, which may have an effect on fertility. Antibiotics are generally prescribed for a variety of infections. A number of patients requiring assisted conception occasionally show evidence of reproductive tract infections. While fluoroquinolones being excessively prescribed in the treatment of male genital tract infections, too little information concerning their outcome on fertility are present.
Objective: To estimate ciprofloxacin effects on sperm function parameters in addition to inspect whether ciprofloxacin can affect the integrity of sperm DNA.
Methods: In the present study, 48 male adult rats were enrolled. The animals were randomly allocated into six groups; four ciprofloxacin treated groups, which were treated with either (40 mg/kg/day) or (80 mg/kg/day) of ciprofloxacin and 2 control groups. For each dose, the treatment maintained for either 14 days or 28 days. At the end of each duration of treatment, certain epididymal sperm function parameters: sperm morphological normality, sperm concentration and sperm motility were analyzed together with sperm DNA integrity analysis.
Results: A significant reduction in sperm concentration, motility and percentage of morphologically normal sperm (in a dose dependent manner) was observed when ciprofloxacin administered for 28 days. The level of DNA fragmentation was significantly elevated with a significant reduction in sperm chromatin quality in ciprofloxacin treated groups whereas serum testosterone level was not significantly affected.
Conclusion: Ciprofloxacin can adversely influence fertility parameters in male rat.
Keywords: Fertility, Ciprofloxacin, Sperm DNA
Citation: Abd AH, Al-Dujaily SS, Al-Saray DA. Effects of ciprofloxacin on male fertility parameters and sperm DNA integrity in rats. Iraqi JMS. 2018; 16(4): 378-384. doi: 10.22578/IJMS.16.4.4

Background: The improvements in instruments and technique of percutaneous nephrolithotomy (PCNL) in the last 3 decades have led to expansion in its indications to include even the large and complex renal stone cases.
Objective: To determine the efficacy and safety of PCNL in relation to stone complexity.
Methods: In this prospective, clinical, interventional study, 51 patients with symptomatic renal stones of different sizes and locations, were admitted in our Urology Unit, fully evaluated and treated by our team with PCNL. For all the patient’s data collected were: age, gender, body mass index (BMI), previous renal surgery, pre-operative stone number, stone size, stone position, stone opacity, surgical approach, operative time, stone clearance rate, postoperative residual stones and complications, hospital stay and adjuvant therapy. By using different statistical methods, correlations were made to elicit the impact of stone size, stone position, stone opacity, BMI and previous renal surgery, operative time, stone free rate, complication rate and the need for auxiliary procedures.
Results: In this study, the 51 included patients were 31 males and 20 females with a mean age 40.3 year. All the stones treated were over 2 cm in their longest diameter, with 58.8% of them were ≥ 3 cm, and mean stone size was 4.2±0.99 cm. The most prevalent site of stone was the lower calyx (39.2%), followed by (37.3%) as partial staghorn, while complete staghorn calculi constituted (11.8%). The final success rate of treatment was 86.3%. (60.8%) of the cases found to be stone free at immediate postoperative period. Auxiliary procedures were used in (27.5%) patients, to improve the stone clearance. Residual stones were ultimately remained in only (7.8%). Complications occurred in 11 patients (21.6 %).
Conclusion: PCNL though demanding, is an effective and reasonably safe procedure for the treatment of different renal stone burdens. Size and position of stones in the calyceal system and past renal surgery were the main determinants of operative time, stone clearance, complication rate and the need for auxiliary procedures.
Keywords: Renal stone, PCNL, stone complexity, stone free rate, complications
Citation: Al-Azzawi IS, Mohammed Zaki AW, Jwaid HI, Salih SL, Al-Obaidi AA. The efficacy and safety of percutaneous nephrolithotomy in correlation with different renal stone burdens. Iraqi JMS. 2018; 16(4): 385-392. doi: 10.22578/IJMS.16.4.5

Background: Prediabetes is determined on the bases of glycemic parameters, which are above normal but below diabetic thresholds. Prediabetes is associated with the presence of insulin resistance and β-cells dysfunction. N-acetyl cysteine (NAC), as a safe and inexpensive medication, is commercially accessible since long-time ago. This drug is not found in natural sources, although cysteine is present in some meals like chicken and turkey meats, garlic, yogurt, and eggs. NAC prevents apoptosis and oxygen related genotoxicity in endothelial cells by increasing intracellular levels of glutathione and decreasing mitochondrial membrane depolarization reaction.
Objective: To evaluate the effects of NAC administration on glucose homeostasis parameters in prediabetic patients.
Methods: This study included, 25 patients treated with dietary control and life style modifications for 12 weeks, 25 patients treated with NAC (600 mg) oral tablets twice daily plus dietary control and life style modifications for 12 weeks. Other 20 in addition to 50 patients to have an idea about the normal values of study parameters and in order to assess how much the drug used in the study were able to normalize the abnormal parameters.
Results: NAC demonstrated a significant decrease in the fasting blood sugar, HbA1c, fasting Insulin and insulin resistance at the end of 12 weeks (P<0.05) compared with baseline measurements.
Conclusion: The results of the study showed that N-acetyl cysteine has an effective effect on glycemic control.
Keywords: Prediabetes , N-acetyl cysteine , glycemic control
Citation: Abu Raghif AR, Yaseen YA, Dawood MH. Effects of N-Acetyl-Cysteine (NAC) administration on glucose homeostasis parameters in prediabetic patients. Iraqi JMS. 2018; 16(4): 393-399. doi: 10.22578/IJMS.16.4.6

Background: Many studies defined the association between vitamin D and breast cancer. The relation between human epidermal growth factor receptor 2 (Her2/nue), estrogen or progesterone receptors and vitamin D in breast cancer patients was not clear, since few studies was conducted.
Objective: To find out the association of deficiency of vitamin D and breast cancer. The effect of Her2/neu, estrogen, and progesterone receptors on vitamin D in the breast cancer patients was also studied.
Methods: Forty patients with benign breast lump as a control group and 40 patients with breast cancer early diagnosed were included in the study. Blood samples (5 mL) were taken from the control and patient groups and analyzed for serum 25-hydroxyvitamin D by using chemiluminescent immunoassay technology. Serum cancer antigen (CA15-3) was measured by using monoclonal antibodies against CA15-3. HER2/neu, estrogen and progesterone receptors were determined in breast cancer patients by immunochemical method.
Results: Serum vitamin D in the breast cancer patients before surgery was significantly lower (p ≤ 0.05) than that in the control group. Preoperatively, serum CA15-3 in Her2/neu positive patients was significantly (p ≤ 0.05) higher than that in Her2/neu negative patients. Postoperatively, serum CA15-3 in Her2/neu positive patients was not significantly different from that in Her2/neu negative patients. Serum vitamin D, after surgery, in Her2/neu positive patients was not significantly different from that in Her2/neu negative patients. Serum vitamin D was not significantly different in estrogen and progesterone positive patients from that in estrogen and progesterone negative patients, respectively.
Conclusion: Severe deficiency of vitamin D was noticed in breast cancer patients in Iraq, and mild deficiency in benign subjects. Serum CA15-3 was higher in positive Her2/neu than negative patients before operation. Her2/neu, estrogen and progesterone positive receptors have no effect on serum vitamin D level in breast cancer patients.
Keywords: Vitamin D, breast cancer, CA15-3, Her2/neu
Citation: Al-Saigh THT. Deficiency of serum 25-hydroxyvitamin D in patients with breast cancer in Iraq. Iraqi JMS. 2018; 16(4): 400-404. doi: 10.22578/IJMS.16.4.7

Background: Persistent infection with multidrug resistant Pseudomonas aeruginosa (P. aeruginosa) represents a real problem for health care providers. Bacteriophage lytic enzymes or lysins are highly evolved molecules that have been specifically developed by phages to quickly and efficiently allow their progeny to be released from the host bacterium while destructing that bacterium.
Objective: Isolation of endolysin from P. aeruginosa bacteriophages, and administering them systematically in vivo lab animal and measuring their therapeutic efficacy as well as evaluation of their biosafety.
Methods: This study was performed from March 2015 – August 2017, during which 50 bacteriological samples of P. aeruginosa were collected, and examined for their antibiogram, then bacteriophage cocktails were done for 5 resistant strains of them. Endolysins were extracted from their corresponding bacteriophages and characterized. The enzymatic and antibacterial activities as well in vivo therapeutic efficiency of these enzymes were investigated.
Results: This study showed that the extracted endolysin from these bacteriophages was effective in treating laboratory mice from bacteremia with P. aeruginosa and saving their lives when injected intraperitoneal.
Conclusion: Endolysin can be extracted directly from their bacteriophages and used effectively in proper doses to treat bacteremia in mice.
Keywords: Pseudomonas aeruginosa, bacteriophage, endolysin, MDR
Citation: Ali MR, Kadhim SR, Abdulamir AS. Extraction, purification and therapeutic use of bacteriophage endolysin against multi-drug resistant Pseudomonas aeruginosa: An in-vitro and in-vivo study. Iraqi JMS. 2018; 16(4): 405-412. doi: 10.22578/IJMS.16.4.8

Background: It is not clear on which level of estimated glomerular filtration rate to start dialysis until now.
Objective: To compare between patient groups according to estimated glomerular filtration rate at dialysis initiation.
Methods: Eighty-seven Patients are selected randomly from a list of patients admitted for dialysis (Hemodialysis or Peritoneal dialysis) at Northern General Hospital - Sheffield Kidney Institute from 1st of January to 31st of December 2000. Patients have been categorized into two groups. First group includes 45 patients started dialysis with glomerular filtration rate less than 5 ml/min/1.73m2. Second group includes 42 patients started dialysis with glomerular filtration rate from 5-10 ml/min/1.73m2. Patients have been followed up for five years retrospectively until 31st December 2005.
Results: The study showed males are the predominant gender. White Caucasian patients are majority of patients. The mean age is 56 years. About half of patients are middle aged (45-65 years) and are overweight or obese. This study shows no difference between patients who started dialysis early (estimated glomerular filtration rate 5-10 ml/min/1.73m2) versus late (estimated glomerular filtration rate below 5 ml/min/1.73m2) in term of mortality and morbidity throughout five years of follow up.
Conclusion: This study showed no justification to decide on time to initiate dialysis based solely on estimated glomerular filtration rate level.
Keywords: Chronic kidney disease, estimated glomerular filtration rate, hemodialysis, peritoneal dialysis, end stage renal disease, renal replacement therapy
Citation: Al-Joher JAA. Comparing dialysis patients according to estimated glomerular filtration rate at dialysis initiation and five years outcome. Iraqi JMS. 2018; 16(4): 413-423. doi: 10.22578/IJMS.16.4.9

Background: Hodgkin lymphoma (HL) is a malignant process involving the lympho-reticular system that accounts for 6% of childhood cancers. Infectious agents may be involved, such as human herpes virus 6, cytomegalovirus, and Epstein-Barr virus (EBV). Infection with EBV confers a 4-fold higher risk of developing HL.
Objective: To have an idea about the mode of presentation, pathological subtypes, treatment applied and outcome in one center in our country.
Methods: A retrospective study was done whereby twenty cases were collected from the Pediatric Oncology Clinic in Al-Imamein AL-Kadhimein Medical City over a period of ten years from the first of January 2007 – end of December 2016. Information was taken from the patient’s records in the Pediatric Oncology Clinic including age at presentation, sex, physical finding, histopathological subtypes, staging , treatment applied and outcome.
Results: Among the studied group, 14 cases (70%) were males and 6 cases (30%) were females, male: female ratio equal to 2.3:1, rang of age was between 5-12 years with a peak age at presentation was between 5-7 years, 12 cases (60%). The initial presentation was an enlarged cervical lymph node in 19 of them (95%), histopathologically, most of the patients had mixed cellularity subtype, 9 cases (45%), stage II and stage III comprise the majority of cases 9 cases (45%), 6 cases (30%) respectively, B symptoms were reported in 7 cases (35%). Chemotherapy was the mainstay of treatment with good response and remission, 17 cases (85%). Three cases refractory to treatment (15%) with no response, no death was reported.
Conclusion: Male predominance was noticed with younger age group at presentation. The majority presented with enlarged cervical lymph node. Although mixed cellularity was encountered in most of the patients, the response to chemotherapy was good. Rituximab can be used along with chemotherapy for refractory cases and for lymphocyte predominant Hodgkin lymphoma.
Keywords: Hodgkin Disease , Children
Citation: Abbas SA, Ali RH. Hodgkin disease in Children. Iraqi JMS. 2018; 16(4): 424-429. doi: 10.22578/IJMS.16.4.10

Background: Acinetobacter baumannii (A. baumanii) has recently emerged as a major pathogen causing nosocomial infections in patients admitted to intensive care units with a surprisingly rapid acquisition of antibiotic resistance.
Objective: To study the rate of occurrence of A. baumanii in different clinical samples and to investigate the association between biofilm formation and presence of ompA and bap genes in multi-drug resistance isolates.
Methods: A total of 150 clinical samples were collected from (blood, sputum, urine, wound swab) during a period from the first of October 2017 to the end of March 2018 from Al-Imamein Al-Kadhimein City, Central Teaching Hospital of Pediatrics, Welfare Children Protection in Medical City and Al-Yarmouk Teaching Hospital and tested against 14 antibiotics by disc diffusion method. Quantitative microtiter plate assay was done for detection of biofilm formation. Polymerase chain reaction (PCR) was performed to detect ompA and bap genes.
Results: There were 75 A. baumanii isolated from different clinical samples as follows: 41 from blood, 13 from wound, 12 from sputum and 9 from urine. The results of antimicrobial susceptibility test showed, high rate of resistance to Aztronem (94.7%) followed by Cefotaxime (89.3%), Cefepim (86.7%), Meropinem (86.7%), Ceftriaxone (86.7%), Ceftazidime (85%), Gentamicin (85%), and Piperacillin (82.7%) respectively. Moderate - to - low rate of resistance to Ciprofloxacin (78%), Impenim (46.7%), Levofloxacin (46%), Amikacin (44%), Tigacycline (42.3%) and Colistin (44%). The detection of biofilm formation showed that (52%) of isolate produce biofilm and the prevalence of ompA gene was 86.7% while the prevalence of Bap-gene was 34.7%.
Conclusion: High frequency of A. baumannii infection was observed in different hospitals in Baghdad. More than half of the isolates were biofilm producer and there is highly significant association between the presence of bap gene and the biofilm formation but not with ompA gene.
Keywords: Acinetobacter baumannii, ompA, Bap, MD
Citation: Talib SS, Abdulrahman TR, Ali SH. Detection of some biofilm genes related with multidrug-resistant in Acinobacter baumannii isolated from clinical isolates. Iraqi JMS. 2018; 16(4): 430-438. doi: 10.22578/IJMS.16.4.11