IRAQI JOURNAL OF MEDICAL SCIENCES

Surgery training continues to be challenging and competitive. Training programs developed multiple strategies to select the best candidates. Applicants continue to improve their chances to join the highly ranked programs. Various skills and strategies have been adopted to optimize their application process. However, many applicants are still in need to prepare for the application process and identify the best strategy to present themselves. In this editorial, we provide practical points to consider when planning to apply and join a surgery training program.
Keywords: Surgical training, Application strategies, Surgery programs, Residency application
Citation: Tuma FL. Points of consideration in applying to surgery training programs. Iraqi JMS. 2021; 19(2): 134-136. doi: 10.22578/IJMS.19.2.1

Background: It is known that measurement of serum total sialic acid (TSA), lipid bound sialic acid (LBSA) and L-Fucose levels may be altered and associated with different types of disease included malignant tumors, therefore, the evaluation of these compounds in serum cancer patients may elucidate the possibility of using this as a diagnostic marker.
Objective: To explore the clinical application of TSA, LBSA and L-Fucose serum levels in patients with different site of nasal and para nasal sinus malignancies and compare with a group of healthy controls.
Methods: Blood samples obtained from 16 patients with nasal-paranasal sinus malignancies confirmed cases (12 males, 4 females) (age range 45-73 years) and 28 healthy individuals (18 males, 10 females) (age range 38-67 years) participated in this study. Serum TSA and LBSA levels were determined by using colorimetric methods and the serum Fucose level estimation was done based on the method as adopted by Winzler using cysteine reagent.
Results: Results showed that serum levels of TSA, LBSA and L-Fucose were significantly higher in cancer patients compared to normal healthy control (P<0.001) and more increased in patients with ethmoid and frontal sinuses cancer group.
Conclusion:Estimation of TSA, LBSA and L-Fucose is suggestive to be a reliable marker as well as can use an effective diagnostic biomarker of cancer patients.
Keywords: Sialic acid, lipid-bound sialic acid, Fucose, nasal, paranasal sinus cancer, spectrophotometer
Citation:Mohammed AK, Mahdi NR, Ahmed FS. Biochemical estimation of total sialic acid, lipid-bound sialic acid and fucose in serum patients with nasal and paranasal sinus malignancies. Iraqi JMS. 2021; 19(2): 137-146. doi: 10.22578/IJMS.19.2.2

Background: Premarital blood screening helps couples to identify potential health problems and risks for themselves and their offspring, considered a primary preventive approach for couples planning for conception and an important step towards protecting society from spread of diseases especially thalassemia, and allowing people to enjoy life.
Objective: To determine the prevalence of minor β-thalassemia, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and venereal disease research laboratory (VDRL) referred to Al-Nuaman Teaching Hospital.
Methods: The cross-sectional study as part of premarital screening in Al-Nuaman Teaching Hospital was conducted over six months from May 2017 to the end of October 2017. Total individual of 3027 underwent routine mandatory tests.
Results: Regarding HIV and VDRL cases were zero, regarding HBV was no case in August, only one case in May and June, two cases in September and October, and four cases in July, regarding HCV there was no cases in May, June and Aug., two cases in September, and October, and three cases in July, Regarding β-thalassemia minor, one couple in August and another couple in September, those two couples both male and female were thalassemia minor , while the rest either the male or female were thalassemia minor.
Conclusion: Premarital screening program is an important project in detecting asymptomatic carriers of hepatitis viral infection and thalassemia. This study showed that incidence of hepatitis B infections 0.33% were more frequent than Hepatitis C infections 0.23%, there was no cases of HIV infection detected so far, and β-thalassemia trait prevalence was 1.92%.
Keywords: Premarital, β-thalassemia, virology, screening
Citation: Hanoon BD, Sudad A. Khalf SA, Khalaf IA. Premarital screening program in Al-Nuaman Teaching Hospital. Iraqi JMS. 2021; 19(2): 147-151. doi: 10.22578/IJMS.19.2.3

Background: PTEN (phosphatase and tensin homolog) gene is located at the 10q23 region that regulates cell proliferation and survival mainly by regulating PI3K (phosphatidylinositol 3-kinase)-AKT (protein kinase B) signaling pathways. PTEN gene is one of the most frequently mutated tumor suppressor genes in human cancer. Loss of PTEN gene can cause overgrowth, proliferation, survival, and metabolism of tumor cells. In breast cancer, loss of PTEN gene is associated with the occurrence of tumor and is significantly correlated with its characteristics.
Objective: To assess the frequency of PTEN deletion or signal reduction in breast cancer in a sample of Iraqi female patients using FISH technique and its relation with clinico-pathological parameters (age, tumor size, multicentricity, histopathological types, grade, pathological stage and lymph node status).
Methods: This is a retrograde, case control study, which was conducted at the Department of Pathology and Forensic Medicine, College of Medicine, Al-Nahrain University for the period between October 2019 to November 2020. It involved 30 patients with breast cancer who underwent mastectomy and 30 patients with benign breast lesions.
Results: PTEN gene deletion or signal reduction was observed in 8 (26.67%) out 30 breast cancer patients. There was a significant relation between PTEN gene deletion (or signal reduction) and larger tumor size, higher grade, advanced pathological stage, and metastasis to more than 4 lymph nodes.
Conclusion: There was significance difference between cases and control groups regarding PTEN deletion or signal reduction. There was significant correlation between PTEN gene deletion or signal reduction and larger tumor size, higher pathological grade and advanced stage.
Keywords: PTEN gene, breast cancer, FISH technique
Citation: Al-Taie MRF, Qasim BJ. Assessment of PTEN deletion or signal reduction in breast carcinoma using FISH technique in a sample of Iraqi female patients. Iraqi JMS. 2021; 19(2): 152-162. doi: 10.22578/IJMS.19.2.4

Background: Breast cancer has been the highest-ranked malignancy among the Iraqi population since 1986. Althaea officinalis is a perennial plant and native to Iraq and Asia, Europe and United States of America.
Objective: To evaluate the cytotoxicity of Althaea officinalis extracts on AMJ13 breast cancer cell line.
Methods: The cytotoxic activity of crude, flavonoids, and phytosterols extracts were tested by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Apoptosis assay was done by Acridine orange–Ethidium bromide dual staining method.
Results: The cell line was exposed to serial concentrations of Doxorubicin and extracts from (3.125 to 100 µg/ml) in triplicate of each concentration for 72 hours exposure period. The Inhibitory concentration fifty (IC50) values for Doxorubicin, crude, flavonoids, and phytosterols were as follows: 19.52 µg/ml, 25.18 µg/ml, 39.54 µg/ml, and 47.88 µg/ml, respectively.
Conclusion: Althaea officinalis extracts have a significant cytotoxic activity and have the ability to cause apoptosis on AMJ13 breast cancer cells. Crude extract have the highest significant cytotoxic activity
Keywords: Breast cancer, AMJ13 cell line, Althaea officinalis, cytotoxicity assay, apoptosis assay
Citation: Kadhum HH, Abd AH, Al-Shammari AM. Anti-Proliferative activity of Althaea Officinalis extracts on Iraqi breast cancer cell line AMJ13. Iraqi JMS. 2021; 19(2): 163-171. doi: 10.22578/IJMS.19.2.5

Background: High prevalence of both vitamin D (vit. D) deficiency and obesity in world population as reported by many studies drown attention to establish the association and its direction between these two modifiable risk factors and their impact on health status which are still uncertain.
Objective: To measure vit. D levels among a sample of obese women, describing some factors that may contribute for vit. D values in this sample and assess the correlation between vit. D levels and body mass index (BMI).
Methods: A cross-sectional study was carried out among 100 obese women. Their age ranged between (20-50) years, during the period from 1st February to 1st August 2019. The sample was gathered from laboratory of private medical center at Palestine Street in Baghdad. vit. D was measured by (Ichroma vit D), which is a fluorescence immunoassay.
Results: The mean±SD of vit. D values of the participants were found to be (16.05±6.9) ng/ml. Only two women from the sample had sufficient vit. D level of more than 30 ng/ml, (72%) of the participants found to have insufficient vit. D level 10-29.9 ng/ml and the remaining had deficiency in vit. D level <10 ng/ml. A significant association was found between vit. D levels and the age participants and beverages drinking (P≤0.01). Indirect correlation was found between vit. D values of the participants, their BMI values, and waist/ hip ratios and was significant with the last P≤0.012.
Conclusion: No association was found between vit. D and BMI, but there is indirect correlation between vit. D and waist/hip ratio. Highest deficiency of vit. D among age group (30-39) years old and among those who were drinking carbonated beverage.
Keywords: Obese, women, vitamin D, body mass index
Citation: Abdulkader HD, Al-Saffar AJ. Assessment of vitamin D level in a sample of Iraqi obese women. Iraqi JMS. 2021; 19(2): 172-181. doi: 10.22578/IJMS.19.2.6

Background: Pelvic osteotomy is a major procedure required for lately presented with developmental dysplasia of hip (DDH) patients; one of the needed osteotomies of the pelvis in such patients is Pemberton osteotomy (P.O.).
Objective: To evaluate the clinical and radiological results of the P.O. for delayed presentation of Iraqi DDH patients.
Methods: The study was conducted at Al-Imamein Al-Kadhimein Medical City from 2014-2020. We did the osteotomy for 32 hips of 25 patients (no one of them have neuromuscular disease). Of them 28 hips were Tönnis stage IV, 4 stage III, and 2 stage II.
Results: The clinical status of all patients has improved according to modified McKay criteria, 26 of them have excellent score, 4 have good score, 2 with fair results, but no one has bad results. Radiologically, we score Severin’s classification as 62.5% with excellent, 28.1% with good, 9.4% with fair stage, and zero for bad stage. The average acetabular index corrected from 41.34⁰ into 16.17⁰. The center edge angle of wiberg reached 32.34⁰. The VCA of Lequesne became 29.66⁰. And the ACM angle became 43.33⁰. Avascular necrosis was reported as 1 hip was class I and 1 hip as class II according to Kalamchi McOwen classification.
Conclusion: Although Salter R.B. when published his article about his osteotomy discussed the P.O. as one option for pelvic osteotomies meanwhile Pemberton P.A. still not publishing his article until after 4 years even it was practiced well before that time! We found that P.O. is very useful and dependable for clinical improvement and for correcting the radiological parameters to normal values yet it is simple, safe, practical, and effective osteotomy.
Keywords: Pemberton osteotomy, delayed DDH, Tonnis classification, Severin’s classification, modified McKay classification, Kalamchi McOwen classification
Citation: Chhaily ZA, Joda AI, Hafith AA, Abbood WH. Radiological and clinical results of Pemberton osteotomy for delayed presentation of Iraqi DDH patients. Iraqi JMS. 2021; 19(2): 182-188. doi: 10.22578/IJMS.19.2.7

Background: Rheumatoid arthritis (RA) is a chronic progressive, autoimmune disease that affects about 1.5% of the community. New markers are needed for early diagnosis of RA as seronegativity in early RA remains a major limitation of both anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF).
Objective: To measure the plasma levels of the collagen triple helix, repeat containing-1 (CTHRC-1) protein in RA patients.
Methods: 103 RA patients (56 new diagnostic without treatment group and 47 patients on treatment were included in this study according to American College of Rheumatology (ACR) criteria, in addition to 25 subjects as healthy control group. CTHRC-1 level was measured by using Immunoassay System in plasma samples.
Results: The mean and SD of CTHRC1 was (49.10±6.51 ng/ml) in RA patients was significantly higher than its mean in healthy controls (6.20±2.81 ng/ml), (p value =0.002). The distribution of CTHRC1 was insignificantly associated with patient treated or not (P value 1.000, 0.273) respectively, or were the patients had positive or negative RF (P value 0.118, 1.000) respectively.
Conclusion: Using the Immunoassay System for CTHRC-1 quantification, CTHRC1 could be used as a plasma marker that can aid in the diagnosis of RA although it has no association with seropositivity with RF or treatment.
Keywords: Collagen triple helix repeat containing-1, rheumatoid arthritis, serum rheumatoid factor, anti-CCP
Citation: Alwan SA, Abdul-Ridha RA, Ali AI. Assessment of plasma level of CTHRC-I in patients with rheumatoid arthritis. Iraqi JMS. 2021; 19(2): 189-193. doi: 10.22578/IJMS.19.2.8

Background: Congenital anomalies of the kidney and the urinary tract (CAKUTs) are relatively common birth defects and account for 40-50% of the etiology of chronic kidney disease (CKD) in children worldwide.
Objective: To study the types of renal anomalies (RA) and to compare between obstructive and non-obstructive RA in relation to demographic data and complications.
Methods: A descriptive study conducted in Al Imamein Kadhimein Medical City spanning the period from the 1st of February 2020, to the 30th of July 2020. Data collected were: type of renal anomaly, age of diagnosis, family history of RA, consanguinity, clinical presentation and associated complications.
Results: In this study, 160 patients were included. Males were more affected than females 1.54:1. Most of the patients, 78 (48.8%), diagnosed were ≤5 age group. Most of the patients, 124 (77.5%), had negative family history, vesicoureteral reflux (VUR) was the commonest anomaly detected in 67 patients (41.9%), followed by renal agenesis in 24 patients (15.0%). Urinary symptoms were most common presentation in 93 patients (58.1%). A higher complication was urinary tract infection (UTI) (62.5%). Comparison between obstructive and non-obstructive RA, reveled age of diagnosis and hydronephrosis has significant difference. While family history, UTI, failure to thrive, and chronic kidney disease stages was not significant.
Conclusion: The commonest renal anomaly was VUR, the most prominent complication was UTI. Gender, age of diagnosis and hydronephrosis has significant difference between obstructive and non-obstructive RA.
Keywords: Renal, anomalies, children
Citation: Ali SH, Kadhim SA, Al-Obaidy QMAH. Comparative study between obstructive and non-obstructive renal anomalies among a Group of Iraqi children. Iraqi JMS. 2021; 19(2): 194-201. doi: 10.22578/IJMS.19.2.9

Background: Pain defines as unpleasant sensory and emotional experience associated with actual or potential tissue damage. Postoperative pain should be assessed regularly and documented carefully as it is a significant part of postoperative care. Pain scales are useful for assessment and monitoring the effectiveness of treatment. The 100 mm visual analogue scale (VAS) and the numerical rating scale (NRS) are the most commonly used one.
Objective: To compare between VAS and NRS for assessing post-operative pain in patients undergoing elective cholecystectomy.
Methods: A cross-sectional study was done in Al-Imamein Al-Kadhimein Medical City from the period of 1st of October 2019 to the 1st of March 2020. Fifty patients were enrolled in this study. All underwent elective cholecystectomy. Patient consents were obtained. Pain assessment was done when patients fully recovered and asking for pain relief and then one hour after giving analgesia.
Results: Of the 50 patients, females were 42 (84%). Laparoscopic cholecystectomy has been done for 45 (90%); 33 (66%) patients received parenteral opioid and paracetamol, the remaining 17 (34%) received only paracetamol. There were no significant correlations between most of the suggested risk factors and pain perception apart from type of medications used for pain control. There is strong correlation between NRS and VAS before and after analgesia (P< 0.01), while no observed significant effect or relation between other demographic and surgical parameters on pain score rating.
Conclusion: This study validated that both the NRS and the VAS are two comparable acute pain scores mostly used in practice. NRS, which is easy, less pain inducing and more user friendly in the post-operative period has a strong linear association with VAS, thus can be substituted for VAS in assessment of postoperative pain.
Keywords: Pain, cholecystectomy, Visual analogue scale, numerical rating scale
Citation: Abdulhassan BA. Post-cholecystectomy pain assessment using visual analogue scale and numerical rating scale. Iraqi JMS. 2021; 19(2): 202-212. doi: 10.22578/IJMS.19.2.10

Background: Chronic lymphocytic leukemia (CLL) is a malignancy of mature B cells. The genetic factors have been found to play a role in the pathogenesis of the disease. Deletions of the long arm of chromosome 13, specifically involving band 13q14 (del(13q14)) constitute the single most frequently observed cytogenetic aberration in CLL, occurring in ~55% of all cases, followed by structural abnormalities of ch 12(trisomy 12), del 11q22.3-q23.1, del 6q21-q23, del 17p13.1, and 14q.
Objective: To detect frequencies of chromosome 13q14 deletion, chromosome 11q22 deletion and trisomy 12 in in CLL patients using FISH technique, and to investigate the relation between those chromosomal abnormalities and clinical features and hematological parameters.
Methods: This cross-sectional study was conducted on fifty newly diagnosed patients with CLL. Three ml of fresh blood were taken from each patient at admission and then transfer it to FISH unit for blood preparation. Slide preparation was done by using dual color fusion gene probe. The slides were read in the second day by fluorescent microscope.
Results: Deleted chromosome 13 was found in 24 out of 50 patients, (48%). Trisomy chromosome 12 was found in 15 out of 50 patients, (30%). Deleted chromosome 11 was found in 12 out of 50 patients, (24%).
Conclusion: In a sample of Iraqi adult with CLL, the most frequent chromosomal abnormality was deletion of chromosome 13 followed by trisomy of chromosome 12 and chromosome 11 deletion.
Keywords: Chronic lymphocytic leukemia, FISH, deleted chromosome 13, trisomy chromosome 12
Citation: Hashim HH, Abdulateef SS. Detection of chromosome 13q14 deletion, chromosome 11q22 deletion and trisomy 12 in chronic lymphocytic leukemia patients. Iraqi JMS. 2021; 19(2): 213-229. doi: 10.22578/IJMS.19.2.11

Background: One of the most commonly employed medical therapies for idiopathic male infertility are antiestrogens. Tamoxifen as estrogen receptor blockers have been used as empiric treatments for male infertility, acting through blocking estrogen receptor at the hypothalamus and pituitary levels and so preventing the important negative feedback of estrogens to the pituitary and hypothalamus as a result that leading to gonadotropin releasing hormone (GnRH) stimulation and pulsatile release of luteinizing hormone (LH)/follicle-stimulating hormone (FSH).
Objective: To assess tamoxifen role in the treatment of men with primary infertility who are normogonadotropic. as it is widely prescribed drug for that purpose as well as to evaluate possible patient’s criteria for a better response to tamoxifen.
Methods: One hundred twenty-three patients with idiopathic primary infertility and normal FSH, LH, and testosterone serum levels were enrolled in this prospective study. All patients received 20 mg tamoxifen daily as a single dose for at least 3 months, and semen analysis (total sperm concentration, total number of progressive motile sperms and percentage of normal sperm morphology) as well hormones levels were evaluated, with the values being compared with those before treatment.
Results: Overall, there was no statistically-significant improvement in semen parameters 3 months after treatment (P>0.05); however, patients with pretreatment lower normal FSH level of (1.7-6.85 mIU/ml) and those with pretreatment sperm concentration of (five to ten million per ml) showed statistically significant improvement in sperm concentration after tamoxifen therapy (p=0.044 and p=0.012 respectively).
Conclusion: Tamoxifen is an acceptable treatment for idiopathic male infertility. A better response can be expected in patients with pretreatment lower normal FSH level of (1.7-6.85 miu/ml) and sperm concentration of 5-10 million per ml. It might be used as first line treatment to enhance sperm concentration, giving its availability and lower cost in comparison to other hormonal therapies.
Keywords: Male Infertility, tamoxifen, empirical treatment
Citation: Al-Anbary LA. Tamoxifen as empirical treatment in males with primary infertility and normal gonadotropic hormonal levels: A prospective study. Iraqi JMS. 2021; 19(2): 230-236. doi: 10.22578/IJMS.19.2.12