IRAQI JOURNAL OF MEDICAL SCIENCES

Medicinal fungi are those fungi, which produce medically significant metabolites or can be induced to produce such metabolites using biotechnology. The range of medically active compounds that have been identified include antibiotics, anti-cancer drugs, cholesterol inhibitors, psychotropic drugs, immunosuppressants and even fungicides. Although initial discoveries centered on simple molds of the type that cause spoilage of food, later work identified useful compounds across a wide range of fungi.
Keywords:Medicinal, fungi
Citation:Al-Attraqchi AAF. Medicinal fungi. Iraqi JMS. 2019; 17(1): 1-3. doi: 10.22578/IJMS.17.1.1

Background: Otitis media is a group of complex inflammatory disorders affecting the middle ear, which can be acute or chronic. Otitis externa is an inflammation on the skin of the external auditory canal usually associated with secondary bacterial and/or fungal infection of macerated skin and subcutaneous cellular tissue.
Objective: To investigate the effect of ginger extracts on fungal isolates from patients suffering from otitis.
Methods:Two hundred patients suffering from suppurative otitis media and externa who attended to ENT Department, Al-Imamein Al-Kadhimein Medical City enrolled in this study from November 2016 to the end of April 2017, included patients all age groups with discharging ear. All specimens were transported to the laboratory for processing and investigations at the same day. The powder of ginger rhizomes soaked with the solvent and left in a shaking water bath at 40 °C for 24 hours, and then filtered using Whatmann's filter paper No.1 for clear extract. Each extract was concentrated using a rotary evaporator with vacuum to get the final crude extract; after the procedure of ginger extract was done, this extract was taken and tested for bacterial and fungal isolates from patients with otitis.
Results:Results revealed that acute otitis media consisted of about 96 (48%), while chronic suppurative otitis media about 75 (37.5%). Otitis externa was less common infection among the other types of otitis 29(14.50%). The most fungal isolates were Candida parapsilosis. In addition, there is a significant effect of (chloroform, methanol, and aqueous) extract of ginger on pathogenic fungi.
Conclusion:Ginger extracts have been showed evident zones of inhibition effect on pathogenic fungi by chloroform more than ethanol, with less effect by aqueous extract.
Keywords: Otitis externa, otitis media, ginger extract
Citation: Al-Attraqchi AAF, Sahib HB, Al-Hasseni JMK, Mohammed MM. The vitro study effect of ginger extracts on fungal isolated from a suppurative otitis media and externa. Iraqi JMS. 2019; 17(1): 4-11. doi: 10.22578/IJMS.17.1.2

Background: Hodgkin lymphoma (HL) is a highly curable malignancy. It is a unique neoplasm, in which the malignant cell is the Reed-Stenberg cell (RSC); it constitutes approximately 40% of all lymphomas that present during childhood.
Objective: To obtain local data on the pattern of childhood and adolescent HL in our community at presentation and then compare it with the international figure.
Methods: Eighty-five patients with newly diagnosed pediatric HL were admitted to Hiwa Hematology/Oncology Hospital in Sulaimaniya province of Iraqi Kurdistan were included in this study, they were studied prospectively from March 2006 to March 2014. The patients staged by Ann Arbor Staging system and categories into three risk group depending on the Stage and Number of Nodal Sites and the presence of Bulky Disease. Data analyzed using SPSS software; version 13 and P-value obtained by Chi-square test.
Results: The median age at diagnosis was about 13.7 years with peak age of incidence was between 15-18 year and with male predominance. Most common site of the primary tumor was cervical lymph nodes; nodular sclerosis was the most common histopathological subtype and the majorities were presented in stage IIA.
Conclusion: The stage in this study was age dependent but neither there was relation between the site of the primary tumor and the risk categories nor relation between risk categories and sex.
Keywords: Hodgkin lymphoma, stage, sex distribution, risk category
Citation: Abdallah BK, Rashid NG, Tawfiq SA. Pediatric Hodgkin lymphoma in Iraq-KRG-Sulaimani. Iraqi JMS. 2019; 17(1): 12-17. doi: 10.22578/IJMS.17.1.3.

Background: Neurotrophic keratopathy as a consequence of laser retinal photocoagulation is not uncommon problem but unfortunately and unfortunately it is not well evaluated in Iraq as well as the world.
Objective: To estimate the incidence of neurotrophic keratophathy in association with diode endolaser retinal photocoagulation.
Methods: This cross-sectional descriptive study was conducted in vitreoretinal clinic at Ibn-Alhaithum Teaching Eye Hospital in Baghdad. Patients were selected during a period from April 2013 to January 2014, all patients were examined by slit- lamp microscope, and condensing lens + 78 Diopter for dilated fundus examination and cotton wisp to assess corneal sensation. Positive cases documented by anterior segment photograph.
Results: The study sample consisted of 108 vitrectomizd eyes of 108 patients, their ages ranged between 5-65 years old with mean of (35.5 years), 42 of them were females and 66 of them were males. By follow up of those patients; 13 of their eyes (12%) developed neurotrophic keratopathy. It had been found that 61.5% of those eyes manifested as stage II, while 30.8% presented as stage I and only 7.7% presented as stage III.
Conclusion: Diode endolaser retinal photocoagulation may be an unrecognized reason for neurotrophic keratopathy
Keywords: neurotrophic keratophathy, diode endolaser retinal photocoagulation, pars plana vitrectomy, diode laser 810 nm
Citation: Al-Quraishi NKM, Mohammad AA, Mahdi HA. Incidence of neurotrophic keratopathy in association with diode endolaser retinal photocoagulation. Iraqi JMS. 2019; 17(1): 18-23. doi: 10.22578/IJMS.17.1.4

Background: Chronic kidney disease (CKD) is a long-term health condition that in many cases is preventable. Many people do not know they have kidney disease, because up to 90% of kidney function can be lost before symptoms are evident. Fortunately, simple tests performed by a general practitioner can identify most cases of CKD when the disease is in its early stages, enabling treatment to prevent or slow progress.
Objective: To evaluate the risk factors for the development of CKD.
Methods: A case-control study conducted to 300 persons (150 cases and 150 controls) selected from Medical Wards, Dialysis Kidney Unit and in Outpatient Clinic at Ibn Sina Teaching Hospital in Mosul City.
Results: Diabetes mellitus (DM) had 12.9 folds risk for developing of CKD and both type 1 and type 2 D.M. had significant role for developing CKD. Diabetic patients for (> 15 years) had 29.8 times risk for development of CKD. Hypertension (HT) had 3.5 folds risk for CKD and those having HT more than 15 years had 12.9 times risk for CKD. Cardiovascular disease (CVD) had 13.6 folds risk for CKD and having more than one type of CVD had 37 times risk for CKD than heart failure, ischemic heart disease. Family history of renal diseases had 7.1 times risk for CKD and there was statistically significant role of having family history of CKD that had more than 22 times risk for CKD. Statistically significant role of having proteinuria with 383 times risk for CKD.
Conclusion: There are many risk factors significantly contributing to the development of CKD in Mosul especially DM, HT, CVD, family history of renal disease, family history of chronic diseases, and from this study it has been concluded that proteinuria plays a major role for the development and progress of CKD.
Keywords: Chronic kidney disease, risk factors
Citation: Khaleel FF, Hussain SS, Hmood AH. Risk factors of chronic kidney disease among patients attending Ibn Sina Teaching Hospital in Mosul City. Iraqi JMS. 2019; 17(1): 24-31. doi: 10.22578/IJMS.17.1.5

Background: Preterm labor is a major obstetrics problem because it associated with high morbidity and mortality to the born baby. Many studies were done to study different aspects of its risk factors, diagnosis and treatment to decrease its incidence, bad sequel to the fetus and recurrence.
Objective: To evaluate the role of progesterone in lowering CRH level in plasma of patient with preterm labor.
Methods: This study is a case control study. Forty-five pregnant women with preterm labor were included in the study and basal plasma Corticotropin releasing hormone (CRH) level was done for each patient. All patients were given oral tocolytic drug, with an initial bolus of 20 mg Nifedipine followed by 10 mg three times daily. They received betamethasone injection (12 mg) 24 hours after hospitalization. Then after stabilization of each patient with random selection, 25 patients were included in group (1) and were given progesterone injection. Twenty patients were included in group (2) or control group because no progesterone injection was given to them. After 24 hours of admission to the hospital, plasma CRH level was measured for both groups with evaluation of the outcome of each patient with preterm labor.
Results: Progesterone is more effective in lowering CRH level in patients with preterm labor. In study of 45 cases of preterm labor, the mean CRH level of group (1) decreased from 33.41 ng/ml to 22.12 ng/ml, while the mean level of it in group (2) increased from 27.44 ng/ml to 28.54 ng/ml.
Conclusion: Progesterone treatment is effective in lowering CRH level in patients with preterm labor. This would have a positive effect in prolonging the pregnancy period in these patients.
Keywords: Preterm labor, progesterone, CRH
Citation; Yaseen EM, Abd AF. Effect of progesterone in lowering maternal plasma corticotropin-releasing hormone in patients with preterm labor. Iraqi JMS. 2019; 17(1): 32-42. doi: 10.22578/IJMS.17.1.6

Background: Several lines of evidence have suggested the presence of new hepatitis agents, in addition to established hepatitis viruses A-E. Torque Teno virus (TTV) was more prevalent in patients with hepatitis, so it was thought to have hepatotropic properties.
Objective: To detect TTV Ag in apparently healthy blood donors and patients infected with chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) by enzyme linked immunosorbent assay (ELISA) technique. Also, to find out any possible association between the study population demographic data and TTV status.
Methods: This study was conducted from the beginning of November, 2017 to the end of March, 2018. Serum samples were collected from 50 patients who had chronic hepatitis HBV or HCV and attended to Gastroenterology and Hepatology Teaching Hospital. Also, sera were collected from a total 43 healthy blood donors from the Blood Donation Center in Al-Imamein Al-Kadhimein Medical City. The clinical characteristics of both patients and controls such as alanine transaminase (ALT), aspartate transaminase (AST), hepatitis C virus antibody (HCV-Ab), hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) were obtained from hospital records. Serum samples were tested by ELISA technique for detection of TTV Ag.
Results: TTV was detected in 89.2% (33 out of 37) of the HBV-positive patients and in 30.8% (4 out of 13) of the HCV-positive patients versus 23.3% of the healthy blood donor (10 out of 43). Results of this study showed that the prevalence of TTV in HBV patients is significantly higher than HCV patients and healthy blood donors. Concerning risk factors, it was found that there was statistically significant relationship between TTV positivity and mean level of ALT but results indicated that the presence of TTV was not associated with AST, sex, age and history of transfusion, surgery and tattooing.
Conclusion: TTV may play a role in hepatitis and its presence was associated with biochemical signs of liver disease, and among patients infected with chronic HBV or HCV.
Keywords: Torque Teno virus, hepatitis B virus, hepatitis C virus, healthy blood donors
Citation: khudair EA, Al-Shuwaikh AMA, Farhan NM. Detection of TTV antigen in patients with hepatitis HBV and HCV. Iraqi JMS. 2019; 17(1): 43-49. doi: 10.22578/IJMS.17.1.7

Background: Blood preservation and the development of sterile collection sets made possible the developments in blood components preparation, storage and transfusion that we have in today's blood banks and transfusion services.
Objective: To investigate the effects of gamma irradiation, ascorbic acid and the combined effect of both on the lifespan of erythrocytes through determining red blood cells hemolysis for conserving it as long as possible without any change in erythrocytes biophysical properties.
Methods: The blood was drawn from 10 healthy (5 males and 5 females) volunteers. Sample has been irradiated using 137Cs source. Different concentrations of ascorbic acid were used as an anti-oxidative agent for erythrocytes in blood suspension samples. A spectrometer was used for recording the data.
Results: The results showed that 25% of RBCs hemolysis occurred after irradiation with 5Gy of gamma ray during 5th week of storage time while in un-irradiated sample 33.8% of RBCs hemolysis occurred during the 5th week. 25% of RBCs hemolysis for 10 μM of ascorbic acid concentration started after 7th week while for control started after 4th week. The minimum rates of RBCs hemolysis observed in the samples which pre-treated with (7 and 10) μM concentrations of ascorbic acid then irradiated with 1 Gy.
Conclusion: The results indicated that irradiation of human blood with a certain doses of gamma ray, treated with small concentration of ascorbic acid or both, the two factors together can protect the blood from hemolysis for a longer time and the minimum rate of red blood cells hemolysis was observed for 10 μM ascorbic acid concentration then irradiation to 1 Gy of gamma ray.
Keywords; Gamma ray, ascorbic acid, blood storage, red blood cells, oxidative damage
Citation: Faraj KA, Abdullah SH, Muhammad SF. Effects of different doses of gamma rays and ascorbic acid concentration on human RBCs for conservation purpose. Iraqi JMS. 2019; 17(1): 50-56. doi: 10.22578/IJMS.17.1.8

Background: The microbial infections are major cause in abortion, of which viruses appear to be the most frequently involved pathogens. Human Herpes Virus-6 (HHV-6) has been implicated in cases of poor pregnancy outcome.
Objective: Detection and quantification of HHV-6 viral load along with titer of IgM and IgG in endometrial epithelial cells of women with unexplained miscarriage (cases group) compared to the decidual endometrial tissue in women with full term conception (the control group).
Methods: A total of 90 samples, 45 were taken by curettage from miscarriage women at first and second trimesters of pregnancy and 45 were taken from women with full term pregnancy during caesarian operation. HHV-6 DNA was extracted from uterus lining tissue samples, and then it was detected and measured by real time qPCR; in addition, 3 ml of blood were collected from each subject for detection of HHV-6 IgM and IgG antibodies.
Results: HHV-6 DNA was detected in uterus lining tissue of 20% of abortion and 22.22% of controls (P value=0.79). The median viral load of HHV-6 per 106 of uterine cells in abortion group was 15, while for control group was 13 (P=0.54). HHV-6 load increased with increased number of previous abortions, and it increased with presence of recurrent abortion history. It showed significant differences in the median of HHV-6 DNA load between recurrent abortion and non-recurrent abortion groups (P value =0.033). Positive anti-HHV-6 IgM serum antibodies in HHV-6 DNA detected and no-detected subjects were 0%, and 9.85% respectively; the positive anti-HHV-6 IgG serum antibodies in detected HHV-6 DNA were 100%, while 83% in HHV-6 DNA non-detected subjects. The combination of positive/negative results of the anti-HHV-6 IgG and IgM serum antibodies in HHV-6 DNA detected versus non-detected group showed 100% of HHV-6 DNA detected were positive for IgG and negative for IgM, versus 73% in non-detected group.
Conclusion: HHV-6 might associated with unexplained miscarriage. HHV-6 infection might increase with increased number of previous abortions, and increased with presence of recurrent abortion history.
Keywords: Human Herpes Virus 6A, Miscarriage
Citation; Dosh HS, Abdulamir AS, Abdul-Razzaq SH. Association of Human Herpes Virus 6A infection in endometrial epithelial cells with miscarriage. Iraqi JMS. 2019; 17(1): 57-65. doi: 10.22578/IJMS.17.1.9

Background: β-Thalassemia occurs in higher frequency in the Mediterranean area and the Middle East.
Classically serum ferritin and liver biopsy have been needed to monitor patient\'s response to
chelation therapy. Magnetic resonance imaging (MRI) has been proved effective in detecting and
quantifying iron in the heart and liver.
Objective: To assess the value of MRI T2* procedure in assessment of hepatic (LIC) serum ferritin level and
MRI T2* of liver and myocardium in patients with BTM.
Methods: A cross -sectional study was conducted at Al-Imamein Al-Kadhimein Medical City in Baghdad, from
September 2016 to September 2017, 45 patients with BTM were collected from the Thalassemia
center in Ibn AL-Baldy Hospital. Hepatic and myocardial T2* MRI results were taken from the file
records of the patients from the same center.The results of hepatitis B and C and serum ferritin
were taken from the file records.
Results: The total number of patients was 60, 15 patients were excluded because of heart failure and
hepatitis B and C, the mean age was (19.95±6.85 years), male: female ratio equal to 1:1. Fifty-one
patients (85%) were on Deferasirox and 19 patients (31.76%) were splenectomized. Serum ferritin
ranged between (1009-10600 ng/l). Liver T2* MRI ranged from (0.5-17 ms) with a mean of
(3.66±3.13 ms). Mild-moderate severity found in the majority, 18 cases (40%), 13 cases (28.9%)
respectively, with strong inverse correlation between liver MRI and serum ferritin level.
Myocardial T2* MRI ranged from (1.88-33.2ms)with amean of (13.16±7.81ms). Moderate-severe
degree of severity in the majority, 12 cases (26.67%), 19 cases (42.22%) respectively, with
significant inverse correlation between serum ferritin and myocardial MRI. There is no positive
correlation between myocardial T2* MRI nor liver T2* MRI with mean age of the patients.
Conclusion: The study shows that MRI is an accurate and non-invasive method to assess iron overload in liver
and heart in β-thalassemia patients with regular transfusion.
Keywords: β-Thalassemia major, blood transfusion, serum ferritin, cardiac MRI, hepatic MRI
Citation: Yaseen AK, Abbas SS, Abdulhadi AMA. Correlation between cardiac and hepatic T2* MRI
and serum ferritin level in patients with transfusion dependent β-thalassemia major. Iraqi
JMS. 2019; 17(1): 66-73. doi: 10.22578/IJMS.17.1.10

Background: Human Bocavirus (hBoV) has recently been identified as a causative agent of acute respiratory infection (ARI)
in infant and young children. However, there is little information about its frequency and importance as a
cause of lower respiratory tract infection (LRTI) in Iraq.
Objective: To assess the frequency of hBoV and co-infection rate in infants and young children with LRTI.
Methods: Nasopharyngeal/throat swabs were collected during the peak winter months from 100 hospitalized infants
and young children less than 5 years of age with LRTI in Baghdad, Iraq. Five viruses were investigated by
Multiplex Real-Time Polymerase Chain Reaction (RT-PCR).
Results: It was found that 71 (71%) had a viral infection either single or mixed. Six out of 100 samples (6%) were hBoV
positive, 10 (10%) were parainfluenza virus positive, 12 (12%) tested positive for adenovirus, 58 (58%) were
rhinovirus positive and none of the samples gave positive results for coronavirus. Sixteen samples showed
mixed infection with rhinovirus, eight of these (8%) with parainfluenza virus, 6 (6%) with adenovirus, and 2
(2%) with hBoV. There were no significant differences between the viral infected and non-infected patients
with respect to age, gender, crowding status, gestational age, diagnosis at presenting and hospital stay (the
average stay of viral-infected patients in the hospital was three days). In contrast, exposure to smoking was
significantly more associated with viral-infected children than virus-free children (80% vs. 44.83%, P<0.001).
In addition, viral-infected children showed significantly less proportion for need for intensive care unit than
virus-free children (15.5% vs. 79.31%, P<0.001). Breastfeeding was found to have significant adverse
association with viral infection (P<0.001). About one-third of viral-infected children had a medical history
involving a disease other than respiratory infection (P<0.001). Finally, viral-infected children were reported
to have longer period of illness before hospital admission (6.32±5.49 days) than virus-free children (6.32±5.49
days vs. 3.38±2.37 days, P<0.01).
Conclusion: More than two third of children with respiratory tract infection have been viral infection either single or
mixed. Multiplex RT-PCR has the potential for clinical use in the rapid and differential detection of viral
infection.
Keywords :Viral respiratory tract infection, Children, Multiplex Real Time PCR
Citation: Rasheed ZS, Al-Shuwaikh AMA, Issa KR. Multiplex RT-PCR based detection of Human Bocavirus and
other respiratory viruses in infants and young children with lower respiratory tract infection. Iraqi JMS.
2019; 17(1): 74-82. doi: 10.22578/IJMS.17.1.11

Background: Circumventricular organs (CVOs) are specialized structures border the brain ventricles and lack the
blood-brain barrier. These CVOs are lined by specialized ependymal cells (ECs) called tanycyte. The
sulcus medianus organum (SMO) locates at the floor of the 4th ventricle at the rostral part of the
sulcus medianus (SM).
Objective: To explore the expression of the monocarboxylate transporter 1 and monocarboxylate transporter
4 (MCT1 & MCT4) in the tanycytes of the median eminence (ME) and tanycyte-like cells of the SMO
to add a functional evidence for describing the SMO as another CVOs and to start a roadmap for
the citing the SMO specifically as a sensory or a secretory CVO.
Methods: Ten adult male rats (Rattus norvegicus albinus), aged 3-6 months with 300±50 g, were used to
study the histological characteristics of ECs in ME and SMO with Hematoxylin & Eosin and to
explore the immunohistochemical expression of MCT1 & MCT4 in ME and SMO.
Results :The ependymal cells were arranged in in 2-3 layers in the depth of SMO region and single layer in
the ME region as seen with H&E stains. Immunohistochemical expression of MCT1 & MCT4 using
Aperioscope image analysis in tanycytes of the ME is higher than that in tanycyte-like cells of the
SMO with significant differences between the two regions as proved by t-test.
Conclusion: the SMO has different structural and functional properties compared to ME suggesting that the
SMO may be a sensory CVO.
Keywords: Circumventricular organs, tanycytes, sulcus medianus organum, median eminence
Citation :Jawad HF, Al-Kaabi MA, Al-Salihi AR. Immunohistochemical expression of monocarboxylate
transporter 1&4 in tanycyte–like cells of the sulcus medianus organum. Iraqi JMS. 2019; 17(1):
83-99. doi: 10.22578/IJMS.17.1.12