IRAQI JOURNAL OF MEDICAL SCIENCES

The newly discovered coronavirus (Severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) is the causative agent of the ongoing pandemic. Broad arrangement has been done to minimize virus spreading among population and to control the worldwide outbreak. Expanded biosafety measure specifically with respect to the work require using SARS-CoV-2 in laboratory (lab.) and a special consideration should be taken to protect researcher and lab. worker during handling of specimens. Therefore, the aim of this review is to help the scientists, researchers, lab. staff and biosafety specialists to respond to the current coronavirus disease (COVID-19) through discussion of effective biosafety practices that can prevent laboratory acquired infections and to lessen the spread of infection into community and environment.
Keywords: Coronavirus, COVID-19, biosafety, research, laboratories
Citation: Al-Shuwaikh AM, Al-Shwaikh RM, Hanna DB. SARS-CoV-2 and biosafety in laboratory. Iraqi JMS. 2021; 19(1): 1-9. doi: 10.22578/IJMS.19.1.1

Background: Morbidity after thyroid surgery related to injuries to parathyroid, recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN), mostly due to unawareness of the anatomical variations and lack of meticulous dissection added to that patient comorbidity and type of goiter.
Objective: To assess the incidence of nerves injuries (RLN and EBSLN) and evaluation of the risk factors for nerves injuries.
Methods: A prospective study included 250 patients admitted to the General Surgical Unit at Al-Imamein Al-kadhimein Medical City from the first of October 2014 to the end of October 2017. Evaluation of nerves injuries (RLN and EBSLN) with regard to thyroid pathology, types of resection, age and gender. Thyroidectomies were done by different surgical teams. Patients with recurrent goiter, prior cervical surgery and preexisting vocal cord paralysis were excluded. Vocal cords assessment was done preoperatively, intraoperatively at time of extubation and postoperatively. Patients with injury to the RLN were managed accordingly and followed up by serial examination for 6-12 month, while patients with symptoms of EBSLN injuries were followed depending just on clinical feature due to lack of diagnostic facilities.
Results: There were 78 (31.2%), 172 (68.8%) male and females subsequently. The age range was (18-70) years and mean±SD was (44±11.9). Multinodular goiter was the main presentation in (168 patients), while thyroiditis was the least (6 patients). Injury to RLN was reported in 8 (3.2%) patients, 3 had unilateral and 5 had bilateral. Permanent damage documented in 2 patients. There was a significant RLN injury association with malignancy and total thyroidectomy. EBSLN injury have been reported in 55 patients (22%), it was transient in 43 patients and permanent in 12 patients.
Conclusion: Nerve damage after thyroidectomy is not uncommon and affect significantly on quality of life. Careful dissection and awareness of anatomical variation is essential. Majority of injuries were transient and recovered spontaneously. Immediate intervention is not recommended unless airway compromisation ensure.
Keywords: RLN, EBSLN, thyroidectomy
Citation:Jaber SMA, Abdulhassan BA, Hussien HK, Al-Helfy SH. Patterns of laryngeal nerves injuries following thyroid surgery in Al-Imamein Al-Kadhmein Medical City. Iraqi JMS. 2021; 19(1): 10-17. doi: 10.22578/IJMS.19.1.2

Background: Hepatitis B virus (HBV) is a serious public health problem worldwide and major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC).
Objective: To assess the association of the role hepatitis B x antigen (HBxAg) in chronic HBV; active and inactive patients, and complicated patients.
Methods: Ninety blood samples from patients who had chronic HBV were enrolled in this study. Serum samples were screened by enzyme linked immunosorbent assay (ELISA) technique for the detection of HBxAg. Viral nucleic acid was extracted from these 90 samples, and plasma HBV viral load was investigated by real time-polymerase chain reaction (RT-PCR).
Results: The overall prevalence of HBxAg was 26.7% with a significantly higher prevalence in active than inactive patients.
Conclusion: The high HBxAg prevalence rates in active chronic patients raise the possibility of increasing risk of disease progression.
Keywords: Hepatitis B virus (HBV), hepatitis B X antigen (HBxAg), hepatocellular carcinoma (HCC)
Citation: Mahdi AF, Al-Khezrachi AH, Shamran HA, Al-Obaidi AB. Evaluation of HBx antigen in patients with chronic hepatitis B virus infection. Iraqi JMS. 2021; 19(1): 18-23. doi: 10.22578/IJMS.19.1.3

Background: The appendiceal disease is one of the most common reasons for emergency hospital admission, and appendectomy is one of the most frequently performed emergency procedures. Obstruction of the appendiceal lumen is the usual cause of acute appendicitis. However, in elderly patients, it may also be due to a neoplasm of appendix, cecum, or even colorectal carcinoma and appendicitis can be its first manifestation. Of all the gastrointestinal tract malignancies, colorectal carcinoma is the most common one.
Objective: To find the incidence of the carcinoma of colon in patients above 40 years of age who underwent appendectomy.
Methods: Two groups of patients studied from Sulaimani Teaching Hospital and Kurdistan Center for Gastroenterology and Hepatology. Both groups underwent colonoscopy and one group only had appendectomy. Non-appendectomized group used as control. A 213 patients from a total of 545 patients studied from October 1st, 2018 to September 30th, 2019.
Results: More than half of the patients (54%) had normal colonoscopy, others showed internal hemorrhoid (15.5%), polyp (15%), sigmoid mass (0.9%), rectosigmoid mass (0.5%) and gastrointestinal stromal tumor (0.5%). Histopathology results were tubular adenoma with low-grade dysplasia (36.4%), hyperplastic polyps (34.1%), adenocarcinoma (2.3%), and familial adenomatous polyposis (2.3%).
Conclusion: The incidence of colorectal carcinoma is 4.76% in the studied group whom underwent appendectomy after 40 years of age.
Keywords: Acute appendicitis, adenocarcinoma, colonoscopy, colorectal cancer, mucinous neoplasm of appendix, appendectomy.
Citation: Faraj FH, Abdulla AA, Abdulqader GMR, Mardan ME, Mohammed SA, Mahmood MMS, Hussein SA, Shareef WOH. Incidence of colorectal carcinoma in patients undergoing appendectomy after age of 40 years in Sulaimani Teaching Hospital. Iraqi JMS. 2021; 19(1): 24-32. doi: 10.22578/IJMS.19.1.4

Background:Helicobacter pylori (H. pylori) infection had been criticized for many deleterious effects and had been amalgamated to iron deficiency by many authors, frequently based on correlative rather than direct relationship studies and often opposed by others.
Objective: To evaluate the role of H. pylori infection in the etiology of iron deficiency anemia and to study the impact of the bacterial eradication on the response to iron therapy.
Methods:The current study represents an interventional prospective study and involved 52 non-pregnant females with iron deficiency anemia. All patients were tested for the presence of active H. pylori infection by stool antigen test and they followed after one month of iron therapy. Patients with positive H. pylori infection followed for another month after eradication of H. pylori and iron therapy.
Results: Fifteen patients (28.85%) were positive for H. pylori. Hematological and biochemical data were not different among both groups (H. pylori positive and negative) at presentation despite significant better response among H. pylori negative individuals. Continuation of iron therapy after eradication of H. pylori infection improve the response to therapy significantly.
Conclusion: Eradication of H. pylori enhances the response to iron therapy significantly.
Keywords: Iron deficiency anemia, H. pylori, iron therapy, eradication
Citation:Eissa AA, Mirza SS. The relevance of Helicobacter pylori Infection to iron deficiency anemia in Duhok City. Iraqi JMS. 2021; 19(1): 33-38. doi: 10.22578/IJMS.19.1.5

Background: Delayed recovery from anesthesia is one of the important challenges that face anesthesiologist. The time of delayed recovery from anesthesia is related to anesthetic agent, patient, duration and type of surgery.
Objective: To determine the factors from the patients and other things related to delayed recovery after giving anesthesia.
Methods: A total of 286 patients were observed in Shar Medical Hospital and Cardiac Center in Sulaimani city, Iraq between November 2019 and March 2020. Post-operative evaluation and observation were collected for delayed and normal recovery after anesthesia. P value less than 0.05 means significant relationship were obtained between variables.
Results: From the 286 patients, 180 (62.94%) were male, in which 66 of them were have delayed recovery and significant relation was found p=0.005. Most of the patients were >50 years-old 126 (44.05%) and there was significant relation between age and delayed recovery of consciousness p=0.01. Delayed recovery was found among overweight more frequently than the underweight and normal weight (51 from 73 for overweight, 33 from 45 and 7 from 168, respectively). Also, significant relationship was found p=0.001.
Conclusion: Old age, male, obese patients and cigarette smokers, diabetes mellitus, cerebrovascular accident, history of myocardial infarction, hyperlipidemia, and neurological diseases are high risk factors for delayed recovery.
Keywords: Anesthesia, delayed recovery, post-operative care, risk factors
Citation: Karim SB. Factors related to delayed recovery after anesthesia. Iraqi JMS. 2021; 19(1): 39-48. doi: 10.22578/IJMS.19.1.6

Background: Epilepsy is a common disorder of brain that is not well controlled via drugs available for it. Gephyrin, a well-known inhibitory synaptic regulator, has a role in epilepsy. Additionally, significant development of oxidative stresses tends to be involved in epileptic seizure pathophysiology that giving rise to neuronal cell death. Zizyphus spina christi is a vastly available Iraqi tree and its leaves have several beneficial effects on central nervous system level.
Objective: To investigate the possible neuroprotective effect of crude Zizyphus spina christi extract in kindling model induced.
Methods: The removed brains of forty albino male mice from four separate groups were exposed to immunohistochemical test for gephyrin, glutathione, and NeuN expressions.
Results: The data found that pretreatment with Zizyphus spina christi crude extract shows highly significant difference (P value <0.001) in immunohistochemical scores for all studied parameters as compared with those being of pentylenetetrazole-kindled group.
Conclusion: These findings suggest that crude Zizyphus spina christi extract of leaves is effective in protection against kindling that induced via pentylenetetrazole when applied orally for male mice.
Keywords: Gephyrin; glutathione; kindling; NeuN; pentylenetetrazole; Zizyphus spina christi
Citation: Al-Humaidhi AM, Abd AH, Ghazi HF. Zizyphus spina christi effect on pentylenetetrazole-induced kindling. Iraqi JMS. 2021; 19(1): 49-55. doi: 10.22578/IJMS.19.1.7

Background: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV-2) cases are being frequently reported nowadays and the objective of this clinical case report is to highlight its unique presentation as acute icteric sever hepatitis.
Case report: A 28-year-old female patient presented with 3 days history of fever, abdominal pain, nausea, vomiting and jaundice. Lab investigations revealed positive COVID-19 reverse transcription-polymerase chain reaction test along with picture suggestive of acute severe hepatitis (Aspartate aminotransferase; 2772 U/L (N: <32), Alanine transaminase; 2522 U/L (N: <33), Alkaline phosphatase; 172 U/L (N: 35-104), direct bilirubin 4.2 mg/dl (N: 0-0.3)). The patient was admitted, monitored and started on supportive therapy for 5 days and was discharged well for outpatient follow-up.
Conclusion: Requesting liver function test for COVID-19 patients who presents with gastrointestinal symptoms is a crucial decision that can guide us with the management of the case since many drugs used in the treatment of the new SARS‐CoV-2 infection are hepatotoxic and should therefore be used with caution.
Keywords: Hepatitis, COVID-19, SARS‐CoV‐2, COVID-19 hepatitis, icteric hepatitis
Citation: Al-Hasnawi DH, Kareem AM. Acute severe icteric hepatitis caused by the novel Corona virus: A case report. Iraqi JMS. 2021; 19(1): 56-59. doi: 10.22578/IJMS.19.1.8

Background: Cervical radiculopathy (CR) is a pathological procedure that encompasses root of the cervical nerve. Cervical disc herniation, accompanied by cervical spondylosis, is among the most common causes of radiculopathy. Clinical neurophysiology is a medical field focused mainly on assessing activity in the nervous system and muscles being an expansion of neurological assessment, using particular same anatomical localization criteria as clinical testing.
Objective: To evaluate the sensitivity and specificity of conduction time of the intraspinal segment of peripheral motor neurons in the diagnosis of CR using cervical root magnetic stimulation and conventional electromyography (EMG) study.
Methods: Fifty patients (15 males and 35 females) aged 46.02±9.76 years with reported CR were subjected to an electrophysiological examination and control group consisted of 50 (36 females and 14 males) healthy volunteers aged 36.24±12.09 years. Analysis of sensory and motor nerve conduction, conventional needle EMG test, and motor evoked potentials (MEPs) for all (recording abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB), deltoid muscles) was conducted to determine the peripheral nerves, muscles, sensory and motor pathways. The motor evoked potential (MEP) parameters studied for the median, ulnar musculocutaneous and axillary nerves include latency of the spinal root {peripheral motor conduction time} (PMCT).
Results: During direct cervical root stimulation, the PMCT of the median nerve shows the highest specificity (59%) than that of the ulnar nerve (57%), while the intraspinal latency shows the same specificity for both nerves (57%). In comparison, PMCT by kimura formula recording ADM during direct stimulation of the cervical root have the highest sensitivity (56%) than that of PMCT by kimura formula recording APB. Additionally, the recording of direct cervical root stimulation amplitude after deltoid muscle showed the highest specificity and sensitivity (57.0%, 58.0% respectively). On the other hand, PMCT shows the highest specificity and sensitivity while the BB muscle is recoded (62.0%, 49.0%).
Conclusion: Overall, the current motor evoked potential study shows abnormalities in less than 60% of patients with cervical radiculopathy relative to conventional EMG needle study abnormalities that reached 90%. The intraspinal latency of the median and ulnar show low sensitivity and specificity.
Keywords: Cervical radiculopathy, electromyography, motor evoked potentials
Citation: Abdulhameed AK, Kaddori HG. Cervical intraspinal conduction time by magnetic root stimulation versus conventional electromyography in the diagnosis of cervical radiculopathy. Iraqi JMS. 2021; 19(1): 60-71. doi: 10.22578/IJMS.19.1.9

Background: Post-traumatic stress disorder (PTSD) before adulthood has long-lasting effects on school performance among students, thus, early recognition and treatment are vital.
Objective: To identify the effect of war trauma among secondary school students, test the rate of PTSD among students, and investigate the relationship between exposure to war trauma and effect on school performance.
Methods: Total 108 (third intermediate class) students of both sex at two secondary schools. They screened by modified war trauma Questionnaire scale (CRIES-13) to diagnose PTSD and used impact on school performance scale.
Results: The percentage of students who had >11 and above traumatic events during the preceding seven years was 38.9%. PTSD rate is 27.8% (above the cutoff point of 17 on children revised impact of events scale-13). PTSD rate is higher in females (63.3%) than 36.7% of males. The rate of impact on school performance is 43.5% (above the cutoff point of 21). The rate of impact on school performance is 83.3% among students with PTSD.
Conclusion: The exposure to war trauma increases risk of PTSD among school children, number of traumatic events are high among adolescents, rate of PTSD is high in relation to events and higher in females than male and effect on school performance is high among students with PTSD.
Keywords: Children, PTSD, school performance
Citation: Hussein HS, Jaber OA, Alwan YS. Post-traumatic stress disorder and school performance among adolescents' students in Baghdad. Iraqi JMS. 2021; 19(1): 72-81. doi: 10.22578/IJMS.19.1.10

Background: Atrial flutter is a common arrhythmia in structurally normal or abnormal heart. The electrocardiographic features of it can be mistaken for sinus tachycardia or supraventricular tachycardia. By careful electrocardiogram (ECG) inspection or by electrophysiological study differentiating atrial flutter can be reliably done.
Objective: To differentiate atrial flutter from supraventricular tachycardia and sinus tachycardia.
Methods: Twenty-one patients, ten females and eleven males, collected over 6 years at the author’s practice in Sulaymaniyah, diagnosed as sinus tachycardia or supraventricular tachycardia and then found to be in atrial flutter were included in this study. The atrial flutter differentiated by careful inspection of the 12 leads ECG or with electrophysiological study.
Results: Ten patients were misdiagnosed as sinus tachycardia and eleven patients as supraventricular tachycardia. Eleven diagnosed by careful ECG inspection and ten by electrophysiological study where ablation therapy was done in 8 patients. In 13 patients, drug therapy was applied where 4 reverted to sinus rhythm and in 6 patients reverted by synchronized DC shock. Two failed to revert to sinus rhythm.
Conclusion: Differentiating atrial flutter from sinus tachycardia and supraventricular tachycardia is essential for management strategy decision.
Keywords: Atrial flutter, misdiagnosis, sinus tachycardia, supraventricular tachycardia
Citation: Alhamdi AT. Atrial flutter, the commonly misdiagnosed arrhythmia as supraventricular tachycardia or sinus tachycardia. Iraqi JMS. 2021; 19(1): 82-89. doi: 10.22578/IJMS.19.1.11

Background: Acute bacterial rhinosinusitis occurs commonly as a sequel to a viral upper respiratory tract infection. Spread of infection outside the sinuses to the surrounding brain and orbit results in complicated sinusitis. Complications are more common in children than adults due to anatomical and immunological factors.
Objective: To identify the correlation of orbital manifestations with computed tomography (CT) scan findings in diagnosing and classifying the disease, the efficacy of various treatment modalities and the outcome of these complications in children.
Methods: A prospective study of 16 patients who presented with orbital swelling and features of acute rhinosinusitis was conducted in the Otorhinolaryngology Department at Al-Imamein Al-Kadhimein Medical City from April 2014 to October 2015. A full history, ear, nose and throat (ENT) examination including naso-endoscopic examination (if possible), ophthalmological assessment and CT scan of nose and paranasal sinuses were done. Patients were classified to have either pre-or postseptal infection depending on CT findings. All patients were admitted to the ENT ward, received intravenous broad-spectrum antibiotics and supportive measures and kept under close observation with monitoring of ophthalmological manifestations and vital signs. Some patients responded to medical treatment and others required surgical intervention. All patients after recovery were discharged home on oral antibiotics for 2 weeks and followed up monthly for a total duration of 3 months.
Results: The majority of patients were males (62.5%). Mean ages of patients was 8.9±2.9 years with a range (4 to 15) year. Preseptal cellulitis was more common (62.5% vs. 37.5%). Impaired visual acuity, impaired extraocular movement and proptosis were significantly associated with postseptal infections as the P values were 0.01, 0.003 and 0.003 respectively. Preseptal cellulitis responded well to medical treatment. Postseptal abscesses required surgical drainage using an external, endoscopic or combined approach. 94% of patients had complete recovery without any sequel.
Conclusion: Orbital manifestations are strongly correlated with CT findings. Medical treatment is very effective for preseptal infection. The choice of surgical approach for managing postseptal infection will depend upon, the site and extension of the abscess and the state of the nasal cavity. Early and accurate management can reduce morbidity and mortality.
Keywords: Orbital complications of sinusitis, pediatric rhinosinusitis, ethmoiditis
Citation: Al-Hassani JMK. outcome of orbital complications of acute rhinosinusitis in children. Iraqi JMS. 2021; 19(1): 90-98. doi: 10.22578/IJMS.19.1.12

Background: The blood of blood donors is screening for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection by enzyme immunoassay (EIA) in the National Center of Blood Bank in Baghdad. The residual risk of EIA negative samples is not estimated till now in Iraq.
Objective: To detect HBV, HCV and HIV viruses within seronegative plasma of blood donors by a commercially available multiplex nucleic acid amplification tests (NAT) with mini-pooling system.
Methods: One thousand (1000) blood donors were screened by EIA revealed negative results then NAT was performed on pools of samples, each pool contain ten seronegative plasmas (MP10) i.e., 100 minipools.
Results: The detected positive minipools 10 seronegative plasmas by NAT for HBV, HCV and HIV were 3 MP10.
Conclusion: The use of NAT appeared to be sensitive and reliable to detect occult HBV and overcome the seroconversion problem related with HCV and HIV within seronegative plasmas of blood donors. Therefore, the implementation of NAT with mini-pooling in addition to serological tests for routine blood donor screening will improve and ensure the safety of blood transfusion in Iraq.
Keywords: Blood transfusion, widow period, multiplexes PCR
Citation: Majid GS, Abdulamir AS, Ahmed AM, Aufi IM, Abdullah OI. The using of multiplex RT-qPCR for pooled samples to detect hepatitis B virus, hepatitis C virus, human immunodeficiency virus within Iraqi blood donors. Iraqi JMS. 2021; 19(1): 99-106. doi: 10.22578/IJMS.19.1.13

COVID-19 patients suffer from the lack of curative therapy. Hence, there is an urgent need to try repurposed old drugs on COVID-19. Randomized controlled study on 70 COVID-19 patients (48 mild-moderate, 11 severe, and 11 critical patients) treated with 200 µg/kg PO of Ivermectin per day for 2-3 days along with 100 mg PO doxycycline twice per day for 5-10 days plus standard therapy; the second arm is 70 COVID-19 patients (48 mild-moderate and 22 severe and zero critical patients) on standard therapy, which is (vitamin C, D, and zinc, azithromycin, dexamethasone and oxygen supply if needed). The time to recovery, the progression of the disease, and the mortality rate were the outcome-assessing parameters. Among all patients and among severe patients, 3/70 (4.28%) and 1/11 (9%), respectively progressed to a more advanced stage of the disease in the Ivermectin-Doxycycline group versus 7/70 (10%) and 7/22 (31.81%), respectively in the control group (P>0.05). The mortality rate was 0/48 (0%), 0/11 (0%), and 2/11 (18.2%) in mild-moderate, severe, and critical COVID-19 patients, respectively in Ivermectin-Doxycycline group versus 0/48 (0%), and 6/22 (27.27%) in mild-moderate and severe COVID-19 patients, respectively in standard therapy group (p=0.052). Moreover, the mean time to recovery was 6.34, 20.27, and 24.13 days in mild-moderate, severe, and critical COVID-19 patients, respectively in Ivermectin-Doxycycline group versus 13.66 and 24.25 days in mild-moderate and severe COVID-19 patients, respectively in standard therapy group (P<0.01). It is concluded that Ivermectin with doxycycline reduced the time to recovery, the percentage of patients progress to more advanced stage of disease, and reduced mortality rate in severe patients from 22.72% to 0%.
Keywords: Ivermectin, Doxycycline, COVID-19, Coronavirus, SARS-CoV-2
Citation: Hashim HA, Maulood MF, Ali CL, Rasheed AM, Fatak DF, Kabah KK, Abdulamir AS. Controlled randomized clinical trial on using ivermectin with doxycycline for treating COVID-19 patients in Baghdad, Iraq Iraqi JMS. 2021; 19(1): 107-115. doi: 10.22578/IJMS.19.1.14

Background: The fibroblast growth factor receptors (FGFRs) family includes five tyrosine kinase receptors, which play an important role in many cellular mechanisms including proliferation, migration and survival. Deregulations in the genes that coding for these receptors, mainly the FGFR3 gene, had been reported in patients with urothelial carcinoma of the urinary bladder.
Objective: To estimate the frequency of FGFR3 gene amplification in patients with urothelial carcinoma of the urinary bladder and its relation to some clinico-pathological parameters of the tumor.
Methods: The present retrospective study included 30 paraffin blocks of urothelial carcinoma tissue (trans-urethral resection of bladder tumor (TURBT)), and 10 samples of normal bladder tissue (control group). Sections were taken from each paraffin block for studying FGFR3 gene amplification by fluorescent in situ hybridization (FISH) technique.
Results: FGFR3 gene was shown to be amplified in 4 (13.3%) out of 30 urothelial carcinoma cases. There was significant relation between FGFR3 gene amplification and tumor’s pathological stage (p=0.037). FGFR3 gene wasn’t statistically correlated with the patient’s age, gender, tumor’s grade or the lympho-vascular permeation.
Conclusion: FGFR3 gene amplification was detected in 13.3% of urothelial carcinoma of the urinary bladder cases, which may reflect its role in carcinogenesis process. This amplification was statically correlated to tumor’s pathological stage suggesting its relation to tumor progression.
Keywords: FGFR3, FISH, TURBT, urothelial carcinoma, gene amplification
Citation: Al-Marashi MA, Qasim BJ. Fibroblast Growth Factor Receptor 3 (FGFR3) gene amplification in patients with urothelial carcinoma of the urinary bladder.Iraqi JMS. 2021; 19(1): 116-125. doi: 10.22578/IJMS.19.1.15

Background: Rheumatoid arthritis (RA) is a systemic chronic, inflammatory disease that may affect many tissues and organs.
Objective: To investigate effectiveness and safety of Low-level-laser-therapy (LLLT) in management of early onset RA compared to symptomatic non-steroidal anti-inflammatory drugs (NSAIDS) therapy.
Methods: A convenient selection 3 arms single blinded trial conducted in Al-Saraj Center for Rheumatoid Diseases in Baghdad during period between January-May 2017. Thirty-four patients with RA onset below one year were recruited. Disease activity score (DAS28) formula with American College of Rheumatology criteria (ACR20), erythrocyte sedimentation rate (ESR), visual analogue scale (VAS), complete blood count (CBC), C-reactive protein (CRP), rheumatoid factor (RF) were measured. Patients were divided into three groups: group 1 (n=12) received LLLT, group 2 (n=12) received placebo laser and naproxen and group 3 (n=10) received only naproxen. Primary outcomes measured were disease activity using DAS28 score, clinical improvement using ACR20 and pain assessment using VAS. Secondary outcomes measured were remission ACR50 and 70 and inflammatory indicators.
Results: LLLT group has shown significant decrease of DAS28 (P=0.02), morning stiffness duration (p=0.05), number of tender joints (p=0.03), number of swelling joints (p=0.04), and VAS (p=0.01) compared to baseline whereas placebo laser group with naproxen and naproxen only group showed only significant reduction in duration of morning stiffness(P=0.04) and (p=0.048) respectively. There was marginal lowering of ESR (P=0.06) in LLLT group but no changes in CRP, RF. There were no reported side effects of LLLT use.
Conclusion: Laser therapy is better than NSAIDS in controlling RA symptoms with no associated side effects. Therefore, it is recommended as first-line therapy in early onset RA.
Keywords: laser, Low level laser therapy, rheumatoid arthritis, NSAIDS, ESR, Nerve root
Citation: Al-Saraj MJA, Al-Ethary ZY, Al-Attar ZI. the effect of low level laser therapy on early onset rheumatoid arthritis patients. Iraq Iraqi JMS. 2021; 19(1): 126-133. doi: 10.22578/IJMS.19.1.16