IRAQI JOURNAL OF MEDICAL SCIENCES

Conflict of interest (COI) in peer review journals is a serious issue that earn more attention than it currently receives. COI can influence reviewers' or editors' decisions in favor of or against a project. There is no universal description of COI in the medical and scientific world; it is generally defined as a set of situations, in which a major professional interest is overly influenced by a secondary one(s) authors, editors, and reviewers may all be subject to COI. The majority of COI discussion in scientific papers has centered on the impact that authors' financial and nonfinancial (i.e., personal or professional) circumstances have the impact that personal (or professional) interests can have on research integrity.
Keywords: Conflict of interest, authors, editors, reviewers, budget
Citation: Hassan JS. Conflict of interest. Iraqi JMS. 2022; 20(1): 1-2. doi: 10.22578/IJMS.20.1.1

Background: Multiple sclerosis (MS) is a disease affecting the central nervous system (CNS), with inflammation and demyelination of nerves, eventually resulting in nerve damage and disabilities. The risk of developing MS enlarged by infectious mononucleosis, which is caused by delayed primary infection by Epstein-Barr Virus (EBV). Early reports consistently demonstrated an increased antibody response in MS patients versus healthy subjects towards different EBV antigens, including the EBV nuclear antigen-1 (EBNA-1). In Iraq, number of researchers found that the EBV have a possible role at some point in the course of the disease, others reported that the EBV pathogenesis have an important role in the triggering of MS disease.
Objective: To compare the sero-prevalence of EBV nuclear antigen-1 antibody (EBNA-1 IgG) among the Iraqi MS patients and controls and find out whether there is a relation between disease severity and EBNA-1 IgG titer.
Methods: This case-control study conducted on 120 MS patients aged between 13-42 years, and 120 apparently healthy age- and sex-matched volunteers as controls. Three ml of whole blood were collected from all MS patients and controls and put in gel tubes. The blood samples were centrifuged at 5000 RPM for 5 minutes to get serum from the gel tubes. Serum was preserved in (-20ºC), and then used for enzyme-linked immunosorbent assay (ELISA). The ELISA study was performed using ELISAs kits (Abnova /Taiwan) for EBNA-1 IgG antibodies measurement.
Results: EBNA-1 IgG was positive in 51.7% (62/120) of MS patients and 39.2% (47/120) of controls, (P=0.035). The median of EBNA-1 IgG level of MS patients and controls were 81.08 U/ml, and 67.73 U/ml, respectively (P=0.043). And EBNA-1IgG was significantly higher in younger age groups. Patients with the first-line and second-line treatment showed no significant differences in EBNA-1 IgG levels, while the median level in patients without treatment (newly diagnosed) and those who were at early years of the disease was higher.
Conclusion: EBNA-1 antibody could play a triggering role in MS because it is significantly higher in MS patients than in controls, especially at younger age groups, early stages of the disease and in female patients.
Keywords: Multiple sclerosis, EBV, EBNA-1 IgG, ELISA
Citation: Ali ZA, Al-Obaidi AB, Almashta SA. The potential role of Epstein-Barr Virus Nuclear Antigen-1 (EBNA-1) in multiple sclerosis. Iraqi JMS. 2022; 20(1): 3-10. doi: 10.22578/IJMS.20.1.2

Background: Patients on long-term hemodialysis are at a higher risk of contracting blood transmitted infections because of their weakened immune systems and frequent interaction with blood, blood products, equipment, and contaminated surfaces. This making them an important population to study the clinical and epidemiological consequences of newly discovered infections like torque teno virus (TTV).
Objective: To investigate the frequency of TTV in patients undergoing hemodialysis by molecular method and to find out any association with risk factors and liver function tests.
Methods: This cross-sectional study conducted on (100) patients whom attending Hemodialysis Unit at Al-Imamein Al-Kadhimein Medical City in Baghdad, Iraq. The sample of the study consist of (58) males and (42) females, their mean age is (49.97±4.97 SD) years, (50) with viral hepatitis, while (50) without viral hepatitis, for a period from November 2020 to March 2021. Nested polymerase chain reaction (PCR) was used to detect TTV-DNA. TTV genogroup was determined by Sanger sequencing and phylogenetic tree construction.
Results: TTV DNA was detected in 81% (81 out of 100) of hemodialysis patients, respectively. However, no significant association was found between demographic data, clinical characteristics and risk factors with TTV infection.
Conclusion: This study showed high prevalence of TTV in hemodialysis patients but didn't play a role in liver injury among these patients. Also, based on phylogenetic analysis of the untranslated region (UTR), genogroup-3 was found to be the most prevalent in hemodialysis patients.
Keywords: Torque teno virus, hemodialysis, risk factors, liver function, sequencing, phylogenetic tree
Citation: Ali HM, Al-Shuwaikh AM, Manuti K. Molecular and phylogenetic detection of Torque Teno Virus (TTV) among hemodialysis patients: A single center study. Iraqi JMS. 2022; 20(1): 11-25. doi: 10.22578/IJMS.20.1.3

Background: Benign prostate hyperplasia (BPH) can be treated with endoscopic urological procedures, which includes both laser ablation of prostate and transurethral resection of the prostate (TURP).
Objective: To determine the advantages and disadvantages of using diode laser procedure in treating patients with BPH in contrast to TURP treatment.
Methods: In a prospective non-randomized study at a single center, 40 patients presenting with symptoms of lower urinary tract symptoms attributable to BPH between the ages of 50 to 90 years were enrolled from November 2014 to June 2015. TURP was used in Group A, and transurethral laser ablation of prostate (TULAP) was used in Group B. Outcomes, including International Prostate Symptom Score (IPSS) and higher maximum flow rate (Qmax) were compared at 3 months.
Results: At 3 months, patients treated with TULAP had a significantly Qmax than those treated with TURP (p<0.001). There was a significantly lower hospital stay for BPH patients treated with the TULAP technique (p<0.001). Patients treated with the TULAP procedure had a significantly shorter catheter time (p=0.001). There was a non-significant difference in procedure time between the two methods (p=0.2). There was a significant increase in prostate-specific antigen (PSA) among those treated with the TURP technique (p=0.01).
Conclusion: Lower urinary tract problems induced by BPH can be successfully treated by diode laser ablation of prostate. Our findings suggest that diode laser is reliable and efficient when patients are carefully chosen for surgery.
Keywords: BPH, Ablation of Prostate, TULAP, TURP
Citation: Sami AKM, Bajalan DH. Diode laser ablation of prostate versus monopolar transurethral electro-resection of prostate for treating symptomatic BPH: A prospective study. Iraqi JMS. 2022; 20(1): 26-34. doi: 10.22578/IJMS.20.1.4

The emergence of multidrug-resistant (MDR) Mycobacterium tuberculosis (Mtb) strains, identified as resistant to at least isoniazid and rifampin, these two drugs form the backbone of the first line drug which is used for tuberculosis (TB) treatment, unresponsive has hampered TB control. As a result of the nearly universal calculation of with half a million new cases of MDR/first line drug TB per year, it is important to keep the database up to date awareness of the processes that contribute to the emergence of MDR Mtb. This resistance is produced for a variety of reasons, including genetic, microbiological factors, non-adherence to treatment by patients and/or failures in therapy administration by some referrer medical centre for TB. This review offers a detailed summary of genetic mechanisms that lead to resistant to first line drug therapy used in management of TB as well as up-to-date information on some new aspects lead to such problem.
Keywords: Mycobacterium tuberculosis, first line drug, anti-TB treatment, World Health Organization, isoniazid and rifampin
Citation: Hassan JS, Al-Tamimi BJ, Abdulrahman TR, Jamal QW. Resistance mechanisms to first line drug in Mycobacterium tuberculosis: A review. Iraqi JMS. 2022; 20(1): 35-43. doi: 10.22578/IJMS.20.1.5

Background: The etiologies of mental disorders involve interactions among genetic, developmental, social, and environmental risk factors. An association between blood cadmium and depression was recently reported in young adults.
Objective: To determine the prevalence of elevated blood cadmium level and to evaluate its association with depressive symptoms among adult Iraqi workers.
Methods: A comparative cross-sectional study that conducted in two industries in Baghdad. It included 200 young adult male and female workers in the batteries factory (100 participants) who were exposed directly or indirectly to cadmium and in the textile factory (100 participants) unrelated to direct cadmium exposure. Blood sample was taken for measurement of blood cadmium level. Patient Health Questionnaire-9 was used to measure the symptoms of depression.
Results: Mean of blood cadmium level was significantly higher in participants who had depressive symptoms than that in those who didn’t have; in those with moderate to severe symptoms than that in those who had mild symptoms. Blood cadmium >0.21 µg/dl is predictive for risk of development of depressive symptoms. Statistically significant weak positive correlations were detected between blood Cd with total PHQ9 score, no. of cigarettes/day, duration of work in batteries factory and in textile factory.
Conclusion: Elevation of blood cadmium level among sample of adult Iraqi workers especially in batteries factory is a significant health problem. Cadmium neurotoxicity may be a contributing factor for adverse mental health outcomes, even at levels generally considered to pose low or no risk.
Keywords: Depression, mental illness, health, cadmium, workers, Iraq
Citation: Al-Samaraee MF, Sahib AAA. Blood cadmium level and its association with depressive symptoms in a sample of Iraqi workers. Iraqi JMS. 2022; 20(1): 44-50. doi: 10.22578/IJMS.20.1.6

Background: Acne vulgaris is a common skin disease, which is a significant health problem among adolescents and young adults. It affects 85-100% of people at some point in their lives, and it usually begins at puberty. Acne can persist into the 30s and beyond.
Objective: To evaluate the risk factors for development of acne vulgaris among Mosul University students in Mosul- Iraq.
Methods: A case-control study conducted to 300 persons (150 cases and 150 controls) aged 18-35 years selected randomly among Mosul University students who attended university primary health care that located inside Mosul University, Iraq, during the sixth month period from august 2019 to January 2020.
Results: Of the acne vulgaris cases (150 cases) that included in the study, 45 % are males and 55% are females, those with age group 18-23 years has 1.8 risk for developing of acne, always stress has 2.7 risk, female cases with irregular cycle have 58 times risk. 53% of female & 46% of male have acne on their face and male patients have 35 risk for acne on their shoulder, oily skin has 3 times risk, two and more members in family with acne have 4 risk followed by 3 times risk of one family member with acne, student’s mobile use has about 2 times risk for developing of acne.
Conclusion: There were several significant factors associated with acne formation in the study, which play a role in acne formation including age, psychological status, menstrual cycle irregularity, site of appearance of acne, nature of the skin, family history, using student's mobile.
Keywords: Acne vulgaris, risk factors, university students
Citation: Khaleel FF. Risk factors of acne vulgaris among Mosul University Students from Iraq. Iraqi JMS. 2022; 20(1): 51-58. doi: 10.22578/IJMS.20.1.7

Background: Gestational diabetes mellitus (GDM) is a common and serious maternal complication, in which hyperglycemia develops at any time during pregnancy due to progressive insulin resistance. It affects about 14% of pregnancies worldwide. There are many adverse effects of GDM that compromise the fetus and neonate.
Objective: To compare neonatal outcomes according to type of treatment for GDM.
Methods: A prospective study conducted at the Department of Pediatrics, (Neonatal Intensive Care Unit; NICU) and Obstetric in Al-Imamein Al-Kadhimein Medical City in Baghdad during a period from 1st of march 2019 to 1st of January 2020. The study included 100 neonates delivered by mothers with GDM, divided in to four groups according to their mothers' therapy; (diet group: 18 neonates, metformin group: 36, insulin group: 26, mixed group: 20).
Results: Neonates in metformin group had a higher chance of having normal birth weight comparing with others, but neonates in insulin group have higher percent of prematurity, macrosomia, large for gestational age or small for gestational age, hypoglycemia and jaundice among others. No significant statistical difference between metformin and insulin, in mode of delivery, Apgar score, respiratory distress syndrome, hypocalcaemia, anomalies, and NICU admission but can occur more in insulin group.
Conclusion: Metformin was able to reduce the risk of neonatal complications, therefore, it can be a good alternative for insulin in the treatment of GDM.
Keywords: Gestational diabetes mellitus, macrosomia, metformin, insulin
Citation: Rashed GM, Al-Omrani AA, Mohmmed ZA, Al-Bahadle AJ. Neonatal outcomes in gestational diabetes mellitus. Iraqi JMS. 2022; 20(1): 59-67. doi: 10.22578/IJMS.20.1.8

Background: Hearing loss (HL) is one of the commonest and neglected childhood disabilities. According to the World Health Organization (WHO), most of childhood hearing impairment is preventable. Studies showed that 31% of hearing impairment cases are caused by prenatal and postnatal infections, 17% are birth-related causes, 4% are ototoxic medications and about 8% related to other causes such as maternal substance abuse.
Objective: To review factors associated with HL in a sample of children attending the Medical City Hospital in the Pediatrics Outpatient Clinic and Auditory Clinic; including congenital, early, or late onset and to investigate risk factors associated with HL.
Methods: A cross sectional study, included children <15 years with hearing loss attending the Medical City Hospital in the Pediatrics Outpatient Clinic and Auditory Clinic during the period from the 1st of July 2021 till the 30th of October 2021.
Results: One hundred and one children with HL; 65.3% of them were males, 71.3% were preschoolers, 60.4% of them had family history of deafness, Severe deafness was found among 45.5% of children. Management was by Cochlear implantation for 60.4% of them and hearing aid for the rest. Causes of deafness were unknown in 39.6% of children, congenital among in 37.6%, acquired in 15.8% and mixed causes in 6.9%.
Conclusion: Hearing impairment is severe deafness in most of the children included in this study. Family history, congenital infections and otitis media were the major causes of hearing impairment. Finally, cochlear implant was the management of choice in the majority of these children.
Keywords: Hearing loss, cochlear implant, otitis media
Citation: Qasim MF, AbdulKareem MN, Issa MA. characteristics and factors associated with hearing loss (deafness) in children attending the Medical City Hospital, Baghdad, Iraq. Iraqi JMS. 2022; 20(1): 68-76. doi: 10.22578/IJMS.20.1.9

Azithromycin is a semi-synthetic macrolide antibiotic of the azalide groups. It inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit of the bacterial 70S ribosome. It inhibits peptidyl transferase activity and interferes with amino acid translocation during the process of translation. Its effect may be bacteriostatic or bactericidal depending on the organism and the drug concentration. Azithromycin is one of the famous and important antibiotics agents and the determination methods of azithromycin in this article were tabulated with lots of chemical and instrumental methods that used in different parameters. Different high performance chromatographic methods have been reviewed in this paper.
Keywords: Azithromycin, HPLC
Citation: Taqi RMM, Hammoudy SR, Hamzah MJ. Review of HPLC methods for determination of azithromycin in different samples. Iraqi JMS. 2022; 20(1): 77-82. doi: 10.22578/IJMS.20.1.10

Background:Very late antigen 4 (VLA4) integrin facilitates the immune cells migration to central nervous system (CNS) through blood brain barrier (BBB), so the polymorphism in this gene may be considered as genetic risk factor for multiple sclerosis (MS) occurrence. It may interact with the responsiveness level of Natalizumab.
Objective:To show if VLA4 single nucleotide gene polymorphism (SNP) (C-269-A) considered as genetic predisposition factor for MS and if have a role in Natalizumab (Tysabri) drug non-responsiveness.
Methods: Sixty-six (66) person with MS and 60 healthy persons involved in this study, their ages were range from 14 to 67 years. They attended to seek treatment in the MS outpatient’s clinic, at Baghdad Teaching Hospital, Medical City Complex from December 2018 to March 2020. Patient were divided into two group; resistant group (34) and response group (32). The VLA-4 SNP polymorphism investigated by sequence specific primer polymerase chain reaction (SSP-PCR) technique.
Results: The VLA4 gene SSP-PCR genotyping revealed no significant differences between patients and control group also between responder patients and non-responder to Natalizumab.
Conclusion: VLA-4 polymorphisms at the level of SNP at positions 269 (C/A) have no role in MS susceptibility or Natalizumab responsiveness.
Keywords: MS, Natalizumab, VLA-4
Citation: Khaliel AH, Abbas AA, Hatem AO, Abdulamir AS. The impact of Very Late Antigen 4 polymorphism on drug responsiveness in patients with multiple sclerosis initiation. Iraqi JMS. 2022; 20(1): 83-89. doi: 10.22578/IJMS.20.1.11

Background: Refineries are exposed to different types of air pollutants, among them, polycyclic aromatic hydrocarbons (PAHs), they are a group of over hundred different kinds of hazardous organic chemicals (pollutants), which are formed primarily during the incomplete burning of oil, gas and coal. PAHs are metabolized in different organs of human body especially in the liver leading to generation of mutagenic metabolites, of them, the reactive oxygen species, which damage DNA by binding with guanine base leading to formation of 8-hydroxyguanine. The 8-oxo-guanine DNA glycosylase (hOGG1 rs1052133) gene, is a regulatory gene binds with 8-oxo-DG in the DNA to initiate base excision repair (BER) pathway.
Objective: To investigate the role of (hOGG1 rs1052133) gene polymorphism in single nucleotide polymorphism repair.
Methods: One hundred sixty-eight (168) subjects were participated in this study. They were they divided into three groups (country side, office workers and field workers). PAHs were analyzed in all participant by Gas Chromatography Coupled with a Mass Spectrophotometry GC/MS. SNP for hOGG1 and gene expression were detecting by real time polymerase chain reaction and quantitative polymerase chain reaction for each subject respectively.
Results: PAH were detected in blood serum of refineries workers and not detected in country side participants. The level of hOGG1 gene expression was higher in GG genotype than GC and CC genotype.
Conclusion: Refineries worker are at high risk of developing malignant transformation and serious disease due to high level of PAH compared to other population. hOGG1 plays an important role in DNA repair following DNA mutation.
Keywords: Poly cyclic aromatic hydrocarbons, HOGGI, gene expression
Citation: Al-Ani RH, Al-Wasiti EA, Shukur AS. Study the Effects of (8-oxo-Guanine DNA Glycosylase 1 rs1052133) Polymorphism on Gene Expression as a Predisposing Factor for DNA Mutation in Midland Refineries Company-Dura Refinery Workers. Iraqi JMS. 2022; 20(1): 90-97. doi: 10.22578/IJMS.20.1.12

Background: The postoperative pain remains the most prevalent complaint after laparoscopic cholecystectomy for cholelithiasis, which may lead to prolong hospital stay.
Objective: To evaluate the effect of wound infiltration and intraperitoneal instillation of Bupivacaine for relief the postoperative pain (within first 24 hours) in patient undergoing laparoscopic cholecystectomy.
Methods: A randomized study included 60 patients having symptomatic gallstones attending Al-Yarmouk Teaching Hospital, Department of Surgery, Baghdad, Iraq, during the period from December 2018 to December 2019; for elective laparoscopic cholecystectomy. Patients were divided into two equal groups; in group (A), intraperitoneal 10 ml bupivacaine (0.5%) was given for postoperative pain relief, while group (B) was not given this local anesthesia. The postoperative pain was assessed by Visual Analogue Scale score at fixed time intervals starting 1, 2, 4, 6 hrs then 12, 18 and 24 hrs postoperatively.
Results: In group A, 33.3% (n=10) of patients had abdominal pain that needed additional analgesia, while 66.6% (n= 20) of patients, they didn’t need additional analgesia. In group B, 93.3% (n=28) of patients had pain and needed additional analgesia, whereas 6.6% (n=2) of patients, they didn’t need additional analgesia. The incidence of shoulder pain was 10% (n=3) in group A and 20% (n=6) in group B.
Conclusion: The wound infiltration and intraperitoneal instillation of local anesthesia significantly reduces abdominal pain (first 12 hrs), also reduces the need for post-operative additional analgesia, while local anesthesia had no significant effect on shoulder tip pain, post operatively.
Keywords: Laparoscopic cholecystectomy, local anesthesia, post operative pain
Citation: Malallah ZZ, Al-Mafrachi KKR. The use of local anesthesia for relief of postoperative pain after laparoscopic cholecystectomy. Iraqi JMS. 2022; 20(1): 98-105. doi: 10.22578/IJMS.20.1.13

Background: Vascular endothelial growth factor (VEGF) is an essential factor for angiogenesis and plays important role in placental development.
Objective: To investigate the association between VEGF single nucleotide polymorphisms (SNPs) +936 Cytosine/Thymine (C/T) and -634 Guanine/Cytosine (G/C) and preeclampsia risk.
Methods: A total of 50 cases of pregnant women with preeclampsia and 50 healthy pregnant women (as a control) were involved in this case control study. Blood samples were collected form each woman and the Deoxyribonucleic acid (DNA) was extracted. Amplification of VEGF gene was done by conventional polymerase chain reaction (PCR) and then detection of SNPs-634 G/C and +936 C/T were carried out by restriction fragment length polymorphism PCR (PCR-RFLP).
Results: The frequency of different genotypes of VEGF SNPs +936 C/T &-634 G/C are in accordance with Hardy Weinberg equilibrium. VEGF polymorphism +936 C/T appeared in 3 genotypes after digestion with restriction enzymes Cytosine Cytosine (CC), Cytosine Thymine (C/T) & Thymine Thymine (TT). VEGF SNP -634 G/C appeared in 3 genotypes after digestion with restriction enzymes; those were Guanine Guanine (GG), Guanine Cytosine (GC) and CC. The heterozygous genotype CT of polymorphism +936 C/T was more frequent among preeclamptic patients than the controls (26% versus 16%). Likewise, TT genotype was more frequent among preeclamptic patients (8% versus 2%) with no significant differences. At the allelic level, the difference was more prominent. The frequency of mutant allele (T allele) was much more frequent in preeclamptic patients than controls (21% versus 10%) with a statistically significant difference (p=0.049). Although CC genotype of polymorphism -634 G/C was more frequent among preeclamptic patients than controls (14% versus 10%), the difference was not significant (p=0.704). Likewise, there were no significant differences in allele frequency.
Conclusion: The study suggested that the mutant T allele of VEGF +936 C/T polymorphism was associated with increased preeclampsia risk and disease development.
Keywords: Vascular endothelial growth factor, polymorphisms, preeclampsia
Citation: Khaleel MF, Al-Moayad HA. Association between vascular endothelial growth factor gene polymorphisms and the risk of preeclampsia in Iraqi pregnant women. Iraqi JMS. 2022; 20(1): 106-112. doi: 10.22578/IJMS.20.1.14

Background: Internal fixation is gold standard in treatment of intertrochanteric fractures, but in patients with anesthesia or surgical hazards the external fixation should be explored as a safe approach to reduce operative time and complications risk.
Objective: To assess the outcome of external fixation of an intertrochanteric fracture is in elderly patients with co-morbidities.
Methods: Twenty-eight elderly patients with non-pathological fractures, closed, who were 65 years old or older, unsuited for surgery for a long period, and had chronic uncontrolled medical problems such as hypertension, diabetes mellitus, or heart disease were included in the study. Criteria for exclusion include reverse obliquity fractures, dementia, pathological fractures and prior hip fractures. Those patients treated with percutaneous external fixation under image intensifier from 2015 to 2020 in Ibn Sina Training Hospital in Baghdad.
Results: At 1-year follow-up, 80% returned to pre-fracture ambulatory status. Average time to fixator removal was 12 weeks. There were no cases of pin loosening, breakage, or penetration of femoral head. All patients were evaluated clinically and radiologically for 24 months except 3 patients, 2 died 6 months’ post-operative due to causes unrelated to the surgery, and 1 lost follow up 3 months after surgery. Excellent and good results were found in 8 patients. The time of radiological union and fixator removal about 12 weeks. Pin tract infection occurred in most of the patients. Varus malalignment occurred in 20% of patients. Shortening ranged from 0 to 3 cm.
Conclusion: External fixation of intertrochanteric fractures in elderly high-risk patients is a dependable, successful, and safe therapeutic option.
Keywords: Intertrochanteric fracture, external fixator, elderly patient
Citation: Alsudany FKI, Alhamashi AHS, Al-Abbody HHT, Ismael HA. Treatment intertrochanteric fracture of femur in elderly by external fixation: prospective case-series study; Ibn-Sina Training Hospital, Baghdad. Iraqi JMS. 2022; 20(1): 113-120. doi: 10.22578/IJMS.20.1.15

Background: Klebsiella pneumoniae (K. pneumoniae) is an important pathogen in hospital and community-acquired urinary tract infections (HAUTI and CAUTI). It is showing a high resistance towards many antibiotics
Objective: This study aims to estimate the percentage of K. pneumoniae in HAUTIs and CAUTIs, antibiotic resistance, extended spectrum bata lactamase (ESBL), and detect the beta lactamase K. pneumoniae carbapenemases (bla KPC) resistance gene and presence of mutation in this gene.
Methods: A total of 200 urine samples were collected randomly; K. pneumoniae was cultured and isolated on MacConkey agar, antibiotic sensitivity testing and ESBL detection were performed by Vitek 2 system, then DNA was extracted, polymerase chain reaction and sequencing for KPC gene were done.
Results: There was 7% (14 isolates) of K. pneumoniae (50%) HAUTI and (50%) CAUTI. ESBL was positive in 3 isolates (21.43%). Percentage of positive bla KPC gene was 42.8%. KPC gene sequencing showed high rate of mutation in positive isolates reaching to 50 different nucleotides.
Conclusion: This work has increased the knowledge on K. pneumoniae causing HAUTI and CAUTI in Iraqi patients.
Keywords: Klebsiella pneumoniae, hospital acquired urinary tract infection, community acquired urinary tract infection, ESBL, bla KPC gene.
Citation: Nasser HH, Abdulrahman TR, Malik AS. Klebsiella pneumoniae in hospital acquired and community acquired urinary tract infections in an Iraqi cohort: Frequency, antibiotic susceptibility and the percentage of bla KPC resistance gene. Iraqi JMS. 2022; 20(1): 121-131. doi: 10.22578/IJMS.20.1.16

Background: Coxsackievirus B is a virus may cause type 1 diabetes. There are links between Coxsackievirus B infections and type 1 diabetes. The presence of autoantibodies in pancreatic beta cells has been linked to the development of type 1 diabetes following Coxsackievirus B infection.
Objective: To detect autoantibodies in patients with type 1 diabetes. Also, to find if there is an association between pancreatic beta cell autoantibodies and Coxsackievirus-B IgG.
Methods: This study was done from January to March 2021, it included two groups of 75 children; their ages ranged from one month to fifteen years. Children with type 1 diabetes were admitted to the diabetic and endocrine glands center in Thi-Qar governorate, whereas children without diabetes (control group) were admitted to Bint Al-Huda Children's Hospital in Nasiriyah/Thi-Qar. Venous blood was taken from each person for estimation of random blood sugar, serum fructosamine, and HbA1c in the laboratory of the diabetic and endocrine glands center. Pancreatic beta cell autoantibodies and anti-Coxsackievirus-B IgG was detected by enzyme-linked immunosorbent assay. The statistical analyses were done using SPSS 25. The study population P-values below 0.05 to be statistically significant. The study was authorized by Al-Nahrain University's Institutional Review Board and parental consent was taken.
Results: The patients had significantly greater levels of random blood sugar, fructosamine, and HbA1c than healthy controls. Anti-islet antigen, anti-islet cell, anti-glutamic acid decarboxylase, and anti-Coxsackievirus-B IgG antibody titers were greater in patients than controls. The majority of autoantibodies tested correlated with Coxsackievirus-B IgG antibodies.
Conclusion: Anti-Coxsackievirus-B IgG antibody positivity was associated with autoantibodies related to type 1 diabetes mellitus.
Keywords: Coxsackievirus B, type 1 diabetes, autoantibodies
Citation: Hassan HG, Al-Shuwaikh AM, Al-Auqili RKD. Association of Anti-Coxsackie Virus-B IgG with autoantibodies related to type 1 diabetes mellitus. Iraqi JMS. 2022; 20(1): 132-138. doi: 10.22578/IJMS.20.1.17

Background: Thalassemias are a group of genetically transmitted blood diseases characterized by defects in the production of α- or β-chains of hemoglobin called α-thalassemia and β-thalassemia, respectively. One of the common features of β-thalassemia is ineffective erythropoiesis because of the imbalance of globin chain production, which result in increased apoptosis during erythroblast maturation.
Objective: To evaluate the ß/α globin mRNA ratio in patients with ß-thalassemia syndrome and to correlate the ß/α ratio with hematological and clinical condition of the patients.
Methods: Thirty-five patient samples were collected from Thalassemia Centre of Ibn Al-Balady Hospital; 18 patients with β-thalassemia major and 17 patients with β-thalassemia intermedia. The patients were randomly selected regarding sex, whereas their age ranged from 3 to 17 years. Along with those samples, twenty control leftover samples that were the remaining of samples collected for laboratory investigation, were taken from Al-Kadhimiya Pediatric Hospital, and were age and sex matched with the patients group. The α and β globin chain ration were calculated by the real-time reverse transcription-polymerase chain reaction (qRT-PCR). The β/α -globin mRNA ratio of the samples was measured by the 2−ΔΔCT method.
Results: Analysis of the β-globin/α-globin mRNA ratio showed that disease severity increased with a reduction of the ratio. There was a highly significant difference in α level, ß level and ß/α ratio among studied groups with a p value of (p < 0.001). The highest level was in control group, followed by that in β-thalassemia intermedia and the lowest was in β-thalassemia major.
Conclusion: The severity of ß/α globin chain imbalance showed a significant and negative correlation with the mean corpuscular volume and there was no significant correlation between the ß/α ratio and markers of erythropoiesis in ß-thalassemia major and ß-thalassemia intermedia patients. The ß/α ratio was a good tool for diagnosis in ß-thalassemia major and ß-thalassemia intermedia as compared to control group with high sensitivity and specificity. A ß-chain gene expression was the lowest in ß-thalassemia major followed by ß-thalassemia intermedia as compared to control group.
Keywords: Thalassemia, ß/α -globin mRNA ratio
Citation: Yousif MH, Al-Mamoori HS. The Correlation of β/α mRNA Ratio with Clinical and Hematological Parameters in Patients with β-thalassemia Syndrome. Iraqi JMS. 2022; 20(1): 139-145. doi: 10.22578/IJMS.20.1.18

Background: Forearm bone fracture is a commonly encountered fracture. The inception of locking compression plate (LCP) has revolutionized fracture management. With their dramatic success for articular fractures, there is a speculation that they might be more appropriate for diaphyseal fractures as well.
Objective: To compare internal fixation of closed, middle third forearm fractures with LCP and limited contact dynamic compression plate (LC-DCP) in adults with respect to union rate, implant failure, functional outcome, and infection rate.
Methods: Twenty-two patients with closed, middle third fractures of both the forearm bones were involved in this prospective, randomized, controlled study, which took place between February 2019 to January 2021. They were segregated into two groups based on open reduction and internal fixation with LCP (n=11) and with LC-DCP (n=11). Postoperative follow-up intervals of 1, 2, 6 weeks and 3, 6 months. The patients were assessed for implant failure, fracture union and function outcome of Andersons’ criteria to assess union, forearm rotation, and wrist flexion-extension, and disabilities of the arm, shoulder and hand (DASH) score for patient related outcome at the latest follow up.
Results: The mean age of the patients was 30.9 years (range 19-47 years) with mean follow up about of 2 years. The union rate in LCP group was (100%) whereas in LC-DCP was (81.8%), the p value was (0.4), which is not statistically significant. The p value for Quick DASH score and Anderson’ criteria were (0.8 and 0.43), respectively which is also not statistically significant. No incidence of implant failure in both groups.
Conclusion: Although LCP is an effective treatment alternative and may have a subtle edge over LC-DCP in the management of these fractures, their supremacy could not be certified. We deduce that surgical planning and expertise rather than the choice of implant are more pivotal for outstanding results.
Keywords: Limited contact dynamic compression plate, locking compression plate, closed, middle third fractures, both bones of forearm
Citation: Chhaily ZA, Joda AI, Abd Ali AS, Ali ZH. Is locked compression plate better than limited contact dynamic compression plate in treatment of closed middle third radius and ulnar fractures in adults: A short-term comparative study. Iraqi JMS. 2022; 20(1): 146-153. doi: 10.22578/IJMS.20.1.19