IRAQI JOURNAL OF MEDICAL SCIENCES

Opportunistic viral infections make an important threat to renal transplant recipients (RTRs), and with the use of more intense newly-developed immunosuppressive drugs; the risk of renal allograft loss due to reactivation of these viruses considerably increased. At the top priority of these viruses, human cytomegalovirus and other herpes viruses in addition to polyomavirus, reactivation of these viruses in these chronically immunosuppressed RTRs can lead to renal impairment and subsequently loss, unless early detected and properly treated.
Keywords: kidney transplantation, viral infections
Citation: Al-Obaidi AB, Jasim MB, Hussein MR, Kadhim HS, Habib MA. Opportunistic viral infections after kidney transplantation: A review. Iraqi JMS. 2020; 18(2): 79-93. doi: 10.22578/IJMS.18.2.1

Background: Spirometry is a physiological procedure used as a diagnostic tool for disease diagnosis; e.g. obstructive pulmonary diseases such as asthma or chronic obstructive pulmonary disease (COPD). The bronchodilator test is a method of measuring lung capacity changes following inhalation of a short-acting bronchodilator drug that dilates the airway, this test helps to diagnose, evaluate and differentiate asthma from COPD.
Objective: To evaluate the role of forced expiratory volume in third second (FEV3) as an alternative for forced vital capacity (FVC) in assessing bronchodilator response in patients with chronic obstructive airway diseases.
Methods: The study a case-control, comparative study done from November 2018 to November 2019. The cases involved divided into 2 groups; patients group included (80) patients with chronic obstructed pulmonary diseases (asthma and COPD) and control group included (160) apparently healthy peoples aged and sex matched. Lung function was measured using a standard protocol and electronic table spirometry. Bronchodilator test was done for each patient with chronic obstructed defect on spirometer.
Results: There was no significant difference between (FVC), FVC% and (FEV3), FEV3% respectively before bronchodilator and there was no significant difference after bronchodilator in patients. There was no significant difference between FEV1/FVC, FEV1/FVC % and FEV1/ FEV3, FEV1/FEV3% respectively before bronchodilator and there was no significant difference after bronchodilator in patients.
Conclusion: FEV3 can be used as an alternative to FVC in patients with chronic obstructive airway diseases for assessing bronchodilator response.
Keywords: Spirometry, Bronchodilator test, FVC%, FEV3%, FEV1/FVC%, FEV1/FEV3%
Citation: Jizar AY, Hashim ZH, Jasim AH. Role of forced expiratory volume in third second (FEV3) as an alternative to forced vital capacity (FVC) in assessing bronchodilator response in patients with chronic obstructive airway diseases. Iraqi JMS. 2020; 18(2): 94-100. doi: 10.22578/IJMS.18.2.2

Background: Chronic hepatitis B (CHB) infection is associated with the depletion of T cells, resulting in weak or absent virus specific T cells reactivity, which is described as ‘exhaustion’. This exhaustion is characterized by impaired cytokine production and sustained expression of multiple coinhibitory molecules. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) is one of many coinhibitory molecules that can attenuate T cell activation by inhibiting stimulation and transmitting inhibitory signals to T cells.
Objective: To explore the effect of CTLA-4+49A/G single nucleotide polymorphism (SNP) on the progression CHB in Iraqi patients.
Methods: Blood serum and genomic DNA was isolated from 90 patients with CHB. Tetra-Primer Amplification Refractory System-Polymerase Chain Reaction (ARMS-PCR) was used for amplification and genotyping of CTLA-4 gene using specific primers, and plasma hepatitis B virus (HBV) viral load was investigated by real time PCR, in addition to estimate the hepatitis B e antigen (HBeAg) and anti-HBe by enzyme-linked immunosorbent assay (ELISA).
Results: AA genotype was more frequent among uncomplicated than complicated CHB (44.83% versus 28.12%) with a significant difference (OR= 0.315, 95%CI=1.0-0.99, p= 0.048).
Conclusion: These data strongly suggested the persistence role of CTLA-4+49 polymorphism against HBV among Iraqi patients.
Keywords: CTLA 4, SNP, ARMS-PCR
Citation: Mahdi YS, Kadhim HS. Evaluation of cytotoxic T-lymphocyte Antigen-4 (+49A/G) gene polymorphism in chronic hepatitis B virus infection. Iraqi JMS. 2020; 18(2): 101-109. doi: 10.22578/IJMS.18.2.3

Background: Febrile seizures are prevalent in children aged between 6 months and 5 years with an incidence of 2-5%. Iron deficiency is the most common hematologic disease of infancy and childhood with a period of incidence that coincides with the time of febrile seizures. Although the most common manifestation of iron deficiency is anemia, it is frequently the source of a neurologic disorders in pediatrics, including developmental delay, seizure, stroke, breath-holding episodes, pseudo tumor cerebri, and cranial nerve palsies.
Objective: To investigate the association between iron deficiency and febrile seizures.
Methods: Two groups (80 for each) of 6 months to 5 years old febrile children were subjected to the study between 1st of Oct. 2017 to 1st of Oct. 2018. The first group, cases, included children with febrile seizures admitted to the Pediatric Ward in Al-Imamein Al-Kadhimein Medical City, whereas the control group, included febrile children, visited the hospital during the same period for febrile illness. History was taken, physical examination was done. Blood count indices, serum iron, total iron binding capacity and serum ferritin were estimated. Lumber puncture was done in some of the patients. Statistical Analysis was done using t-test and Chi-square test (x2), P-value was considered significant if less than 0.05. Percentages and Odds ratio were estimated. A prevalence of 20-25% among cases is considered clinically relevant.
Results: Both groups were comparable for age and gender (17.5±8.81) and (17.6±8.54) months, male: female ratio was (1.75:1 and 1.2:1). Family history of febrile seizure were seen in 25% and 13.75% respectively. Simple febrile seizure was found in (72.5%). The blood indices were lower in patients than the control group and statistically have significant difference in hemoglobin, hematocrit, mean corpuscular volume, serum iron and serum ferritin level with a P-value less than 0.05. A total of 36 (45%) of the cases had iron deficiency, compared to 12 (15 %) of control respectively with P-value less than 0.05.
Conclusion: Iron deficiency was more frequent among children with febrile seizure than those with febrile illness alone. The results suggest that iron deficiency may be a risk factor for febrile seizure.
Keywords: Febrile seizure, infants, children, iron deficiency anemia
Citation: Shaheed AH, Abbas SA. The association between iron deficiency and febrile seizures in children below 5 years. Iraqi JMS. 2020; 18(2): 110-116. doi: 10.22578/IJMS.18.2.4

Background: Hypertension is a major cardiovascular problem across the globe. Electrolytes like magnesium are linked with the pathophysiology of essential hypertension by various studies.
Objective: To evaluate the serum magnesium in patients with essential hypertension compared to healthy control.
Methods: A case-control study recruited 45 patients with essential hypertension and 45 matched healthy control. The study was conducted in the Medical Outpatient Clinic in the Medical City Teaching Complex, Baghdad, from July 2016 to November 2016. Serum magnesium measured by Atomic Absorption Spectrophotometers (AAS).
Results: Serum magnesium was significantly lower in patients with essential hypertension when compared to healthy control. Female had lowest serum Mg in the patients’ group. Mg was low in obese hypertensive patients. Serum Mg tends to be lower with longer duration of hypertensin ( r value-0.227) but it didn’t reach statistical significance (p value 0.133).
Conclusion: Serum magnesium levels were found to be low in hypertensive patients when compared with normotensive persons.
Keywords: Hypertension, magnesium
Citation: Athab AK, Al-Taee HA, Ali AS. Serum magnesium in a sample of iraqi adults with essential hypertension. Iraqi JMS. 2020; 18(2): 117-122. doi: 10.22578/IJMS.18.2.5

Background: Subtrochanteric fractures account for approximately 10-30% of all hip fractures, affecting persons of all ages and should be internally fixed to reduce the morbidity and mortality by early rehabilitation and mobilization. A dynamic condylar screw (DCS) and a 95° angle blade plate (BP) provide a good choice for fixation of subtrochanteric fractures so it is a matter of debate that which one is the best fixation in such fractures.
Objective: To evaluate the surgical treatment of subtrochanteric fracture of femur using DCS versus a 95° BP.
Methods: Prospective comparative study of 40 patients conducted in Al-Imamein Al-Kadhimein Medical City from November 2015 to November 2017. Twenty patients treated with open reduction and internal fixation by using DCS and other twenty patients treated with open reduction and internal fixation by using a 95° BP. The mode of injury, site and type of fracture, age of patients, operating time, and blood loss, union rate, complication of implants, functional results were compared between the groups.
Results:Out of 40 patients, there were 26 (65%) male, right side affected in 24 (60%) patients. Mechanism of injury was trivial trauma observed in 28 (70%) patients. According to a Russell-Taylors classification, majority of fractures are type IB that observed in 16 (40%) patients. Majority of the patients, 27 (67.5%), started full weight bearing at 14 weeks. There was no significant mean age difference between the two groups (p=0.7). The mean operation time of DCS (83±4.3 min) was lower significantly than of 95° BP (p<0.001). Mean blood loss from DCS variety (365±63 cc) was lower significantly than of 95° BP (p=0007). Infection occurred less frequently significantly in patients who treated by DCS than those treated by 95° BP (p=0.03). There was no association between types of open reduction and internal fixation treatment variety and functional result according to the modified Harris hip score (p=0.52).
Conclusion: DCS better than 95ᵒ BP because of its technically easier, possibility to correct reduction even after insertion, less perioperative complication and earlier weight bearing.
Keywords: Subtrochanteric fractures of femur, dynamic condylar screw, 95ᵒ BP
Citation: Joda AI, Chhaily ZA, Abd Ali AS, Rahee LS. Is dynamic condylar screw better than (95°) blade plate in management of subtrochanteric fracture of femur? Iraqi JMS. 2020; 18(2): 123-129. doi: 10.22578/IJMS.18.2.6

Background: The use of immunosuppressive medications remains the most important challenge in renal transplantation because of the activation of many infections mainly viruses. The study was designed to evaluate the frequency of Torque teno virus (TTV) viremia among renal transplant recipients (RTR).
Objective: To detect TTV in a sample of Iraqi RTR, and its association with renal functions.
Methods: This cross-sectional study included 80 serum samples collected from RTR and subjected for TTV detection by real-time polymerase chain reaction (RT-PCR).
Results: Qualitative RT-PCR run gave positive results for TTV in 45 out of 80 (56.25%) RTR, the results showed non-significant association between TTV and allograft rejection (p=0.26).
Conclusion: TTV seems not associated with post transplantation renal impairment and/or kidney rejection.
Keywords: Torque teno virus, renal transplantation, RTR
Citation: Taher NM, Hussein MR, Al-Obaidi AB, Kadhim HS. The possible role of Torque teno virus in kidney allograft recipients in a sample of Iraqi patients. Iraqi JMS. 2020; 18(2): 130-137. doi: 10.22578/IJMS.18.2.7

Background: Incisional hernia (IH) after abdominal surgery is a well-known complication and its incidence continues to be 10-15% after laparotomy. The repair of IH has always been a challenge to the surgeon. Various operative techniques for the repair of IH are in practice; however, the management is not standardized. The sublay technique has been reported to be quite effective, with low recurrence rates and minimal complications.
Objective: To assess the advantage and complications of sublay mesh repair of IH in comparison to onlay mesh repair.
Methods: Prospective study of 63 patients undergoing repair of IH from 1st January 2013 to 1st February 2015 done in General Surgical Unit of Al-Imamein Al-kadhmein Medical City. 42 cases of IH were managed by onlay mesh repair and 21 cases of IH were managed by sublay mesh repair.
Results: Post-operative complications like seroma and wound infection were comparable in both groups. In sublay group seroma formation was one patient (4.76%). Wound infection was in one patient (4.76%). No septic mesh was removed in the series. In onlay group, seroma formation was in 9 patients (21.42%); most of seroma occur in large IH repair, wound infection was in 2 patients (4.76%) and one septic mesh was removed. In sublay recurrence rate was 0%, in onlay recurrence rate was in one patient (4.76%).
Conclusion: Sublay mesh although it is more time consuming and technically more difficult, however, it carries low recurrence rate and few postoperative wound complication.
Keywords: Sublay, onlay, Mesh Repair, Incisional Hernia
Citation: Hasan YA, Al-Helfy SHA, Jabur RT. Is sublay mesh repair for incisional hernia better than conventional onlay mesh repair? Iraqi JMS. 2020; 18(2): 138-144. doi: 10.22578/IJMS.18.2.8.

Background: The anabolic effect of physical exercise on osseous tissue is related to mechanical effort, leading to the osteogenic response by causing dynamic changes, which stimulate osteocytes through fluid shifts in their canalicular network. They produce signaling molecules that regulate bone formation and absorption by osteoblast and osteoclasts.
Objective: To study the effect of 8-week exercise training programs on the histomorphometry of male rat femur bone including weight, length, thickness and the bone formation biomarker (osteocalcin).
Methods: The study was done in the labs of College of Medicine, Al-Nahrain University, from September 2019 to February 2020. A thirty adult healthy male rat (albino rat), were selected and divided into three groups; the group (A) of rats with exercise training programs of treadmill running, for 8 weeks. The control group, (B) were kept under free movements without exercise. The group (C) was kept under restricted movements in small cages. Tail blood sample were obtained twice from all animals; at zero day and after 8 weeks, for measurement of osteocalcin. Then after 8 weeks all animals were sacrificed and dissected for extraction of femoral bone for measuring bone length, weight, thickness and bone ultrastructure under light microscope by staining with hematoxylin and eosin.
Results: The osteocalcin, femoral bone weight, length, thickness, haversian thickness and lamellar thickness showed significant increase in value of group A in comparison to group B and group C which show a significant decrease in femoral bone thickness, haversian thickness, lamellar thickness, and osteocalcin level.
Conclusion: Exercise training has an anabolic effect on bone, in contrast to restriction movement that cause catabolic effect on bone. Osteocalcin increases with exercise and could be used as a marker in monitoring the exercise program therapy.
Keywords: Femoral bone weight, length, thickness, haversian thickness, lamellar thickness, osteocalcin
Citation: Musleh AM, Hashim ZH, Jaafar HA. Effect of 8-week exercise program on bone biomarker osteocalcin and bone histomorphometry features in male rats. Iraqi JMS. 2020; 18(2): 145-154. doi: 10.22578/IJMS.18.2.9.

Background: Ulcerative colitis is a chronic refractory inflammatory disease affecting the colon. Several drugs have been developed for it, nevertheless, there are limitations in the therapy due to the inadequate responses and significant undesirable effects. Therefore, novel safer drugs with more therapeutic efficacy are needed.
Objective: To investigate the potential anti-inflammatory effects and histological outcome of artemisinin in acetic acid-induced ulcerative colitis in rats.
Methods: Rats with colitis were received either artemisinin 100 mg/kg or sulfasalazine 100 mg/kg orally for 7 days. Macroscopical and microscopical assessment, the measurement of the colonic cytokines (tumor necrosis factor-alpha (TNF-α) and interleukin-4 (IL-4)), myeloperoxidase (MPO), and E-Selectin.
Results: Both macroscopical lesion area and histological colonic damage induced by acetic acid were significantly reduced by artemisinin and sulfasalazine accompanied by attenuation of the elevated colonic TNF-α, IL-4, MPO activity and E-Selectin.
Conclusion: Artemisinin had an effective role in experimental colitis in rats through anti-inflammatory and antioxidant actions.
Keywords: Acetic acid, artemisinin, oxidative stress, E-Selectin, ulcerative colitis, IL-4
Citation: Abdullah HR, Abd AH, Qasim BJ. Artemisinin attenuates inflammation in rats with ulcerative colitis through inhibition of inflammatory biomarkers, oxidative stress and adhesion molecules. Iraqi JMS. 2020; 18(2): 155-163. doi: 10.22578/IJMS.18.2.10