IRAQI JOURNAL OF MEDICAL SCIENCES

More than 200 chemical compounds have been identified and isolated from Annona muricata fruits and the most important such as alkaloids, phenols and acetogenins. Number of investigations have interested for this plant including antidiabetic, anticancer, anticonvulsant, anti-arthritic, anti-parasitic, antimalarial, analgesic hypotensive, anti-inflammatory and enhancing of immune system in addition to its content of high form antioxidants, which are vital to human health. Because these it the World Health Organization recommends the minimum consumption of fruit 120 kg/person/year.
Keywords: Annona muricata, oxidation, health, cytotoxic activity, phytochemicals and traditional medicine
Citation: Jassim HS. A review on different benefit for Annona muricata fruits as antioxidant. Iraqi JMS. 2020; 18(1): 1-3. doi: 10.22578/IJMS.18.1.1

Background:Systemic lupus erythematosus is a chronic, systemic, idiopathic autoimmune disease. One of the suggested environmental factors that lead to development of systemic lupus erythematosus is infection with Epstein-Barr virus.
Objective: First, detection and quantification of Epstein-Barr virus in peripheral blood of systemic lupus erythematosus patients compared to control. Second, estimation of mRNA level of latent and lytic genes and compare them with control groups.
Methods: This a case-control study conducted on systemic lupus erythematosus patients during the period from (December 2018 to March 2019). A total of 40 patients were involved in this study. Blood samples were taken from Baghdad Teaching Hospital of Medical City. On the other hand, 40 blood samples were collected from apparently healthy subjects, as control samples from blood donor center in Al-Imamein Al-kadhimein Medical City.
Results: Eleven of forty (27.5%) of systemic lupus erythematosus patients were positive with Epstein-Barr virus at mean viral load 815.72 copy/ml with (P value 0.59). And the rate of Epstein-Barr virus detection in blood of patients group was highest in severe cases rather than in less severe ones. Only 2/40 (5%) of control subjects were positive with Epstein-Barr virus at much lower mean viral load, 64.75 copy/ml (P Value 0.34). The expression of the latent genes in patients versus control groups, was 100% versus 77.5% for EBNA-2, 50% versus 15% for EBNA-3C, 82.5% versus 97.5% for late membrane protein -1, and 85% versus 75% for EA/D, respectively. EBNA-2 expression showed significant direct proportional correlation with viral load.
Conclusion: Increased rate of Epstein-Barr virus DNA detection in systemic lupus erythematosus group compared to control group and higher rate of viral DNA detection within severe cases might indicate a possible defect in controlling viral infection and increased number of latent infected cell in systemic lupus erythematosus. Also increased positive EBNA-2 and EBNA-3C expression in systemic lupus erythematosus group rather than in control group indicates that these Epstein-Barr virus proteins might have ability to disrupt the normal immune system, and might trigger and/or promote the autoimmune status.
Keywords: EBV, SLE, EBNA-2, EBNA-3C, LMP-1, EA/D
Citation: Abdullah ZF, Abdulamir AS, Gorial FI. The possible role of Epstein Barr virus and its latent proteins in systemic lupus erythematosus patients. Iraqi JMS. 2020; 18(1): 4-11. doi: 10.22578/IJMS.18.1.2

Background: Renal cysts are a heterogonous group of cystic renal diseases that present in approximately 40% of the patients undergoing imaging.
Objective: To describe the role of the radiological imaging methods for the diagnosis of adult renal cystic diseases and their management.
Methods: A descriptive study carried out for 218 patients of renal cystic diseases in adults in two Private Hospitals in Aden Province during the period from February 2006 to December 2014, diagnosed by ultrasonography, contrasted urography and computerized tomography determined the age, gender, frequency, and complications and type of treatment.
Results: Autosomal dominant polycystic kidney disease (ADPKD) presented in 96 patients (44%), simple renal cysts 90 (41%), medullary sponge kidney 25 (11%), localized cystic renal disease (LCRD) six (3%) and adult multilocular cystic nephroma one (1%). Ultrasound correctly interpreted 179 patients (82%), nonvisualized 25 (11%), and inconclusive 13 (7%) contrasted urography correctly interpreted 176 (76%), nonvisualized 13 (6%) and inconclusive 19 (9%) and computerized tomography (CT) scan 199 patients (91%), six (3%) and 13 (6%) respectively. Complications occurred in 65 patients (68%) of ADPKD, 23 (25%) of simple renal cysts, 15 (60%) of medullary sponge kidney (MSK) and three patients (50%) of LCRD. Conservative treatment performed in 171 (78%) and surgical intervention in 47 patients (22%).
Conclusion: The commonest renal cystic disease is adult dominant polycystic kidney. Ultrasound is inconclusive for renal cystic masses. CT scan is the effective imaging study for localized and multifocal renal cystic diseases, complications and associated pathology. The frequent complications occur in adult dominant polycystic kidney disease and medullary sponge kidney.
Keywords: Adults, renal cystic diseases, imaging, management
Citation: Akares SA, Bahomil AA. Radiological imaging diagnosis of adult renal cystic diseases and management. Iraqi JMS. 2020; 18(1): 12-20. doi: 10.22578/IJMS.18.1.3

Background: Drowning is a main universal community health problem. In medico-legal practice, the autopsy diagnosis of drowning presents one of the major problems especially when there is delay in recovering the victim from water.
Objective: To gather the autopsy findings with the serology test "Surfactant-associated protein A" (SP-A) procedures to reach more accurate diagnosis of drowning and to clarify the significance of serology test (SP-A) procedures.
Methods: This study was performed at Medico-legal Directorate (MLD) in Baghdad for (12) months within the period from 1/1/2018 to 31/12/2018. Full proper autopsy including external and internal examination of the body for all cases was performed, after obtaining complete medico-legal history, in addition to serology test (SP-A) procedures to determine the cause of the death as due to drowning.
Results: The study included (60) cases, (52) males and (8) females with their ages ranged between (15-44 years old) for male, while ages ranged between (1-44 years old) for females. Drowning was the cause of death in all cases. The most important result of this study is that the serum SP-A concentration showed increment alongside with period that had been passed since the event of drowning. The highest value was (1042.167 ng /L) after 48 hours from the event.
Conclusion: The concentration of SP-A increases with increasing duration of immersion in water and an important marker in the diagnosis of drowning together with the autopsy findings.
Keywords: Medico-legal study, SP-A, drowning
Citation: Hussein HN, Hashim NG, Abdulla MA. Surfactant Protein Type-A in diagnosis of drowning cases. Iraqi JMS. 2020; 18(1): 21-28. doi: 10.22578/IJMS.18.1.4

Background: The underlying pathology of the vast majority of diabetic polyneuropathies is axonal degeneration. F wave study is one of the most sensitive indices of the severity of neuropathy.
Objective: To test the validity of different F wave parameters including F minimum latency, F wave index and F Jitter in the diagnosis of diabetic axonal peripheral neuropathy.
Methods: Eighty type 2 diabetics aged 52.57±5.62 years with disease duration of 1 to 18 years and 90 aged-matched healthy volunteers serve as the control group. Both groups were submitted to medical history, clinical neurological examination, and electrophysiological tests of both upper and lower limbs.
Results: Tibial and ulnar F wave latencies were significantly prolonged in diabetic patients (p < 0.001). Tibial F index for male patients shows significantly lower value as compared to the control group. Ulnar F wave latency was 76.7% sensitive and 89.3% specific in female patients while tibial F wave latency was 80% sensitive and 81.3% specific in male patients.
Conclusion: F wave is a precise parameter in detecting diabetic axonal peripheral neuropathy. Minimal F-wave latency is more sensitive than both F index and F Jitter in the diagnosis of axonal neuropathy in diabetic patients.
Keywords: DM, Axonal neuropathy, Ulnar, Tibial, F-wave latency, F-jitter, F-index
Citation: Yaqoub ZA, Kaddor HG, Hamdan FB. The validity of different F wave parameters in the diagnosis of diabetic axonal polyneuropathy. Iraqi JMS. 2020; 18(1): 29-38. doi: 10.22578/IJMS.18.1.5

Background: Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine. Measles transmitted via droplets from the nose, mouth or throat of infected persons.
Objective: To evaluate the immune response to measles infection among immunized school aged children, and to detect the cluster of differentiation 46 single nucleotide polymorphism (CD46 SNP) in association with the immune response.
Methods: The current study is a cross sectional study including 158 hospitalized patients were previously vaccinated with two doses of measles-mumps-rubella vaccine. The ages of patients were 5-10 years school aged children. All samples were collected from blood collection unit in Al-Imamein Al-Kadhimein Medical city during the period from December 2018 to April 2019. The detection was based on the presence of IgG Antibody to measles. The positive results were considered according to enzyme linked immunosorbant assay and conventional polymerase chain reaction to detect CD46 SNP.
Results: Among those 158 subjects' male children count for 62% and female children were 38%. Forty-one (41) immunized children (with mean age 7.98±1.92 years) were low immune response to measles vaccine (MV). On the other hand, only two cases (with mean age 5.50±0.71 years) were negative to measles virus vaccine.
Conclusion: Ensuring two doses of MV give protective immune response to MV may declines with aging. CD46 cellular receptor gene SNP (rs7144) may play role in reduction in immune response to MV.
Keywords: Measles, MMR, CD46, SNP, Iraq
Citation: Al-Gburi SAJ, Kadhim HS, Ghazi HF. Association of CD46 Cellular Receptor Gene SNP in measles vaccine response. Iraqi JMS. 2020; 18(1): 39-46. doi: 10.22578/IJMS.18.1.6

Background:Bell’s palsy (BP) is an acute, generally unilateral, paralysis or weakness of facial musculature consistent with peripheral facial nerve dysfunction; different factors suspected to contribute to the development of BP including herpesviruses.
Objective:To detect human herpes virus 6 (HHV-6) in the saliva samples of patients in the early presentation of BP.
Methods: A case-control study included saliva samples taken from 50 patients with BP and 50 apparently healthy controls without any neurological deficit, viral DNA was extracted from the saliva and then subjected for quantitative real time polymerase chain reaction (PCR) for detection of HHV-6 viral load (VL) in saliva.
Results: HHV-6 DNA was positive in 22 (44%) out of the 50 patients, and in 12 (24%) of the controls (p=0.028), with a significantly higher mean viral load in patients than control (p=0.002), in addition, 70% of HHV-6 positive patients had severe grades with a significantly higher VL (p=0.007) and (0.015), respectively.
Conclusion: HHV-6 could play an important role in the development of BP and HHV-6 might have a neuro-pathological effect in severe cases of BP.
Keywords: HHV-6, Bell's palsy, Saliva, real time PCR
Citation: Rhaif RH, Al-Obaidi AB, Al-Khazrajee AK. The potential role of Human Herpes Virus-6 in idiopathic facial nerve paralysis. Iraqi JMS. 2020; 18(1): 47-51. doi: 10.22578/IJMS.18.1.7

Background: Mycobacterium tuberculosis (Mtb) is the major causal pathogen of human tuberculosis (TB). Autophagy is a highly conserved cytosolic pathway influencing the immune responses and the elimination of intracellular pathogens including Mtb.
Objective: To evaluate the effect of Mtb on autophagy flux with autophagy related genes of LC3I and LC3II, beside the evaluation of serum interferon-gamma (IFN-γ) level in patients with pulmonary TB.
Methods: A total of 50 blood samples were collected from patients with pulmonary TB, besides 30 as healthy control. The real-time polymerase chain reaction (PCR) method was determined the measuring of mRNA expression of autophagy-related genes of LC3I and LC3II. Serum IFN-γ protein concentration was measured using sandwich Enzyme Linked ImmunoSorbant assay.
Results: The present study showed an increasing in LC3-I level in newly-diagnosed pulmonary TB patients rather than in the control group despite statistically non-significant P˃0.05, while LC3-II showed decreasing in all pulmonary TB groups but statistically non-significant P˃0.05. Autophagy flux ratio of LC3-I and LC3-II genes showed a statistically significant decrease in pulmonary TB groups especially in newly- diagnosed (p value=0.02) rather than control groups. Moreover, the study of the serum level of IFN-γ showed an increase in the level of IFN-γ with p=0.0001 in pulmonary TB patients in comparison with the control group. In addition, the correlation between autophagy-related genes and IFN-γ have been shown a positive significant correlation (p value =0.013) in the multidrug-resistant (MDR) TB group.
Conclusion: Autophagy flux ratio showed a statistically significant decrease in pulmonary TB groups particularly in newly-diagnosed TB patients rather than control groups, this indicates the different modulation factors that may affect the process of autophagy. The only positive correlation within biomarkers of the present study has been shown that LC3-II is a dependent factor on IFN-γ in MDR group.
Keywords: Pulmonary tuberculosis, autophagy flux, LC3-I, LC3-II, diagnosis, IFN-γ
Citation: Wahwah SA, Abdulrahman TR, Mankhi AA. Evaluation of autophagy flux LC3 gene expression and serum IFN-???? in pulmonary tuberculosis patients. Iraqi JMS. 2020; 18(1): 52-60. doi: 10.22578/IJMS.18.1.8

Background: Polycystic ovary syndrome (PCOS) is that the commonest reproductive endocrine disorder among women of reproductive age, affecting high of population worldwide. It’s the most typical multisystem endocrinopathy having diverse etiopathogenesis in women, causing menstrual irregularities, hirsutism and anovulatory infertility.
Objective: To determine the effect of Glucomannan, Amorphophallus konjac supplementation on body weight, body mass index (BMI), Insulin level, insulin resistance indexes, fasting glucose level, luteinizing hormone (LH) level, testosterone, sex hormone binding globulin (SHBG) and lipid profile in over weight and obese women patients with PCOS.
Methods: Thirty obese and overweight women with PCOS, mean BMI = 32 kg/m2 with mean age = 29 yr were enrolled in the study. They were received Glucomannan in a dose of 2300 mg daily) for three months. The parameters were measured before and after three months of treatment are BMI, fasting plasma glucose, serum insulin levels, Insulin resistance indexes; homeostasis model assessment of β-cell function (HOMA-B), homeostasis model assessment of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI), lipid profile; serum cholesterol, triglycerides, very low density lipoprotein (VLDL-C), low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C), LH, testosterone and SHBG.
Results: Glucomannan shows highly significant decrease in weight, glucose, insulin level, HOMAB, HOMAIR, QUICKI, testosterone, LH, serum cholesterol, triglycerides, VLDL-C and LDL-C and highly significant increase in HDL-C and SHBG concentrations, no effect on BMI.
Conclusion: Glucomannan was effective in management of patients with PCOS through their ability to decrease the glucose, insulin levels, insulin resistance indexes, lipid profile, testosterone and LH and increase the HDL-C and SHBG.
Keywords: PCOS, Glucomannan, obese, overweight, SHBG
Citation: Hussein ES, Abu-Raghif AR, Almuaid HA. Amorphophallus konjac and polycystic ovary syndrome. Iraqi JMS. 2020; 18(1): 61-69. doi: 10.22578/IJMS.18.1.9

Background: Silent myocardial ischemia (SMI) is a major clinical entity. SMI is highly prevalent and occurs more commonly in patients with diabetes. It is a predictor of mortality.
Objective: To assess SMIs in type 2 diabetic patients with atherogenic risk factors using exercise stress test (EST) and to evaluate its applicability as a screening test.
Methods: The study was conducted on sixty-three type 2 diabetic symptomless patients (37 male, 26 female patients), and without resting electrocardiographic (ECG) signs of ischemia. Patients were divided into 2 groups; Group I: patients with one or none of the atherogenic risk factors and Group II: patients with 2 or more of the atherogenic risk factors or peripheral vascular disease (PVD) alone. EST was carried out for all patients. Ischemia was diagnosed by ECG. Other tests were carried out as echocardiography, ultrasound Doppler of carotid arteries.
Results: Only 57/63 (90.5%) patients had a diagnostic EST; 11 (19.3%) tested to be positive and 46 (80.7%) tested to be negative. ECG indicated ischemic features in 10 patients with positive EST. Ultrasound Doppler showed PVD in 3 out of 41 patients. Using multivariate analysis, there was a significant association of positive EST with PVD, hyperlipidemia, smoking, and hypertension.
Conclusion: As the number of the atherogenic risk factors in diabetic patients increase, the incidence of SMI increases. Therefore, EST is applicable and practicable for screening of SMI in type 2 diabetic patients with 2 or more atherogenic risk factors.
Keywords: Silent Myocardial ischemia, Exercise Stress test, Diabetes mellitus.
Citation: Al-Ethary ZY, Alrikabi MB. Screening of silent myocardial ischemia in type 2 diabetic patients with additional atherogenic risk factors; the applicability of exercise stress test. Iraqi JMS. 2020; 18(1): 70-78. doi: 10.22578/IJMS.18.1.10