IRAQI JOURNAL OF MEDICAL SCIENCES

Vitamin K2 (Menaquinone) stands out from other members of the vitamin K family due to its unique molecular structure. It is primarily found in meat and dairy products or converted from K1 in the gut. The conversion process of K1 to K2 in animal tissues, along with the role of intestinal bacteria in K2 production, is crucial for maintaining adequate levels. Extensive research has highlighted the importance of vitamin K2 in promoting bone health, preventing arterial calcification, and enhancing cardiovascular health. Additionally, vitamin K2 supports fertility and growth, and is associated with reducing the risk of cardiovascular diseases and certain cancers.
Keywords: Vitamin K2, bone, osteocalcin, calcification
Citation: Ahmed MH, Hashim ZH. Role of vitamin K2 in human body: A mini review. Iraqi JMS. 2024; 22(2): 188-193. doi: 10.22578/IJMS.22.2.1

Background: The pathogenic risk caused by the Leishmania donovani (L. donovani) parasite has long been known, and it has become necessary to find a suitable treatment other than traditional medications and their many side effects, among the best medicines in China, Artemisinin (ART) is not only an anti-inflammatory medicine, but also an anti-allergy medicine and and antibiotics.
Objective: To investigate the effect of the ART in inhibiting the activity of the L. donovani parasite through studying its impact on alanine transaminase (ALT), aspartate transaminase (AST), cholesterol (CL) and triglyceride (TG).
Methods: The ART drug was compared with Pentostam drug (the traditional drug used in the treatment of leishmaniasis), a concentration of 20 mg/ml (0.01 ml/ day) of the ART was prepared and was tested in vivo by observation the levels of liver enzyme ALT, AST, CL and TG in serum of infected mice and comparing with control positive group after 7, 14 and 21 days of treatment.
Results: The results showed that there were statistically significant differences between the groups treated with ART drug and Pentostam compared to the positive control group, in addition to the statistical differences between these groups over the three weeks. The AST and ALT values increased in positive control mice over the three weeks, while they returned to normal levels in mice treated with ART drug and Pentostam. As for the CL value, it decreased significantly and statistically significantly in the group of positive control mice. As for the treated groups, there were also statistical differences during the three weeks. While the TG value had statistical differences between the different groups for one week, the TG value for the same group was not affected much.
Conclusion: The results indicate the 20 mg/ml of ART had the approximately same positive effects of Pentostam in returning ALT, AST, CL and TG to normal level in mice infested with L. donovani promastigotes parasite.
Keywords: Leishmania donovani, Artemisinine, ALT, AST, CL, TG
Citation: Ali ZA, Majeed HA. Antiparasitic effect of Artemisinin drug on alanine transaminase, aspartate transaminase, cholesterol and triglyceride in infected mice with Leishmania donovani. Iraqi JMS. 2024; 22(2): 194-202. doi: 10.22578/IJMS.22.2.2

Background: Medical students experience the transition between preclinical and clinical training as a stressful period, as preparedness for practice as new doctors is associated with patient safety issues.
Objective: To explore medical students/graduates' perception regarding methods of assessments, feedback, support and new responsibilities.
Methods: A cross-sectional analysis was carried out online using google form sent to all medical colleges of Iraq during March-May 2023 on stagiaire and first year graduates to inquire about their opinions regarding their clinical training.
Results: From 250 responses received from different universities, 37.3% of students found the educational sessions are most useful for training, 14.1% found they are not useful and 5.6% don’t attend the educational sessions. Majority of Al-Nahrain students have adapted new responsibilities (60%), most of them have chosen group members as their main supporters (46%) and most of them have suggested skill labs as a method for improvement in future sessions.
Conclusion: The majority of the students found that the educational sessions and skill lab are the most useful tools for preparedness and clinical training.
Keywords: Clinical training, medical education, stagiaire, skill lab
Citation: Mohammed LK. Perception of stagiaires and freshly graduates regarding clinical training of the final year medical college. Iraqi JMS. 2024; 22(2): 203-211. doi: 10.22578/IJMS.22.2.3

Background: Type 1 diabetes mellitus (T1DM) is a complex disease that is caused by a combination of genetic and environmental factors. One of environmental factor that has been linked to T1DM is Parvovirus B19 (B19V), a virus that can infect erythroid progenitor cell. Studies have assumed that people with T1DM are more likely to have been infected with B19V, which suggest that B19V may play a role in the development of T1DM.
Objective: To detect B19V IgG in patients with T1DM.
Methods: A total of 50 children with newly diagnosed T1DM and 50 non-diabetic children were recruited as controls. B19V was detected using enzyme linked immunosorbent assay (ELISA) technique.
Results: B19V infections had been detected in T1DM patients and control group with exposure rate 6% and 10% respectively. However, results were statistically not-significant.
Conclusion: Current study concluded that B19V infection might not be considered as a risk factor for T1DM.
Keywords: Parvovirus B19, T1DM, ELISA
Citation: Khudair EA, Al-Shuwaikh AM, Abdoun DS. Detection of Human Parvovirus B19 IgG in a group of Iraqi children with newly onset type 1 diabetes mellitus. Iraqi JMS. 2024; 22(2): 212-216. doi: 10.22578/IJMS.22.2.4

Background: Visual impairment in diabetic retinopathy (DR) due to diabetic macular edema (DME) is common and disabling for increasing diabetic population all over the world. Varieties of anti-vascular endothelial growth factors (VEGF) had been developed to manage this problem.
Objective: To observe and compare the short-term effect of intravitreal Bevacizumab (Avastin) and Aflibercept (Eylea) in patients with DME.
Methods: A retrospective cross-sectional study was conducted to assess 40 eyes of 25 patients, 20 eyes received intravitreal Bevacizumab (1.25 mg in 0.05 ml) and the other 20 eyes received intravitreal Aflibercept (2 mg in 0.05 ml) as a line in treatment of diabetic macular edema from January 2022 to February 2024 in Dar-Alsalam Private Eye Hospital in Baghdad – Iraq. A baseline visual acuity (VA) and optical coherence tomography (OCT) were performed in the week prior to the 1st intravitreal injection and were repeated one month after the 3rd intravitreal injection.
Results: The study sample involved 40 eyes of 25 patients, 15 of them were males and 10 were females and their ages ranged from 40-77 years (mean age 62.8 years). For Aflibercept group, the VA in log MAR (Mean±SD) showed a highly significant improvement from (0.5±0.39) to (0.31±0.38) after injection. In Bevacizumab group, the mean macular thickness significantly decreased from (458.92±107.1 µm) to (316.0±67.81 µm).
Conclusion: Bevacizumab is more effective in decreasing macular thickness while Aflibercept is better in improving VA when treating diabetic macular edema.
Keywords: Diabetic retinopathy, diabetic macular edema, Bevacizumab, Aflibercept
Citation: Mahdi HA. Treatment outcomes of primary Bevacizumab injection versus primary Aflibercept injection in diabetic macular edema. Iraqi JMS. 2024; 22(2): 217-220. doi: 10.22578/IJMS.22.2.5

Background: Type 2 diabetes mellitus (T2DM) causes multiple complications in various body systems.
Objective: To look into the effect of the duration of T2DM on the filling phase of the urination process.
Methods: One hundred and twenty patients with T2DM and filling (storage) symptoms participated in this cross-sectional study. Each patient\'s full history was recorded. A full urodynamic test was done. According to T2DM duration, participants were categorized into two groups; short duration (1-10 years) and long duration (>10 years). The patients answered the questionnaire about their symptoms (nocturia, frequency, urge incontinence, and urgency). Then the patients underwent a full urodynamic study and the filling phase parameters were recorded (bladder compliance, bladder capacity, first sensation, normal desire, and strong desire). The association between demographic and clinical parameters and urodynamic study outcomes was investigated.
Results: According to subjective symptoms, there was a significant difference between the two groups in term of nocturia (P = 0.001) and no significant difference in other subjective terms. According to urodynamic test findings, there was a significant difference between the two groups in terms of bladder compliance, bladder capacity, first sensation, normal desire, and strong desire (P <0.001) for all mentioned parameters.
Conclusion: The longer duration of T2DM has a negative impact on the process of urine storage function.
Keywords: Urodynamic test, urgency, urge incontinence, frequency, nocturia, bladder compliance, bladder capacity, first sensation, normal desire, strong desire
Citation: Abdul-Hussain MA, Mahmood IA, Alquraishi FS. Clinical and urodynamic evaluation of filling phase in type 2 diabetic patients. Iraqi JMS. 2024; 22(2): 221-228. doi: 10.22578/IJMS.22.2.6

Background: Despite the recognition of myocardial ischemia as a unique clinical condition, there is still substantial debate on the suitable screening protocols for individuals who are at high risk for cardiac insult.
Objective: To examine effectiveness of already used medical diagnostic tests in identifying myocardial ischemia in type 2 diabetic individuals.
Methods: Case control research included 50 type 2 diabetic patients and a control group of 50 healthy volunteers. All participants were investigated using: exercise treadmill test (TMT), 24-hour Holter monitoring, echocardiography, electrocardiography (ECG), lipid profile, HbA1c, renal function test, and complete blood picture.
Results: Myocardial ischemia was more common in males (54%), with no statistical difference in body mass index (BMI). Regarding presence of atherogenic risk factors, there was a statistically significant difference in hypertension, smoking but no statistically significant difference in hyperlipidemia. Using test combination was better than using one test alone in early diagnosis of myocardial ischemia. Concordance between TMT and Holter monitoring was the highest one in comparison to other combinations of tests.
Conclusion:Diabetes mellitus itself was the major cause of ischemic heart disease rather than the other atherogenic risk factors. The combination of the three non-invasive tests in detection of myocardial ischemia give the best results, but if only two of them to be done, then it is better to select the combination with best agreement. TMT has the greatest role when combined with another test in detection of myocardial ischemia, while echocardiography has the weakest role in this regard.
Keywords:Myocardial ischemia, diabetes mellitus, treadmill test, echocardiography, Holter monitoring
Citation:Yousif ZY, Al-Hashimi AF, Hamid MB. Standard tests usefulness in diagnosing myocardial ischemia, alone or with combination in type 2 diabetic patients. Iraqi JMS. 2024; 22(2): 229-238. doi: 10.22578/IJMS.22.2.7

Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition primarily affecting women of reproductive age. The prevalence of PCOS is 3 to 10%. According to the pathogenesis of PCOS; obesity, hyperandrogenemia, insulin resistance (IR), hormonal imbalances and metabolic dysregulation are patterns of PCOS. Vitamin D deficiency may be associated with PCOS and it has been shown that low vitamin D levels may worsen PCOS symptoms.
Objective: To prove the role of vitamin D deficiency in pathogenesis of PCOS.
Methods:A case control study with a sample size of (80) women. The females included in this study were single or married but not pregnant. They were divided in to 2 groups: 40 females having PCOS and 40 females without PCOS. Parameters measured were total serum testosterone, serum prolactin level and vitamin D level by i-chroma, also body mass index (BMI) (kg/m2) and waist-hip ratio (WHR).
Results: In PCOS group, (97.5%) of patients had low vitamin D levels, which is significantly higher than those of the control group who only (65%) of them had low vitamin D level. Also, PCOS group had significantly higher serum prolactin and serum testosterone than control group. The percentage of PCOS patients with irregular menstrual cycle was 80%, and with hirsutism was 57%, while with acanthosis was 42%.
Conclusion: There is a relationship between vitamin D status and a variety of PCOS symptoms, emphasizing the possible contribution of vitamin D deficiency to symptom severity.
Keywords: Polycystic ovary syndrome, vitamin D, serum prolactin, serum total testosterone.
Citation: Abow FH, Alsarraf ZH, Ali HJ. The role of vitamin D deficiency in Pathogenesis of PCOS: A case-control study among females in Mosul city. Iraqi JMS. 2024; 22(2): 239-251. doi: 10.22578/IJMS.22.2.8

Background: Diabetes-related nephropathy DN is a form of renal impairment that affects 40 % of DM patients. It is a permanent state that leads to inflammation and affects a large number of diabetes patients worldwide. Netrin-1 (NTN-1) is a protein that belongs to a group of proteins called neuronal guidance proteins and has a significant impact on the regulation of inflammation by impacting the migration of cells.
Objective: To assess the relation of serum NTN-1 level with the early detection of nephropathy in type 2 diabetes mellitus (T2DM) patients.
Methods: A total of 88 individuals were enrolled in this cross-sectional study, and subdivided into three groups: normoalbuminuria, microalbuminuria, and macroalbuminuria. Serum NTN-1 was measured by using an enzyme-linked immunosorbent test (ELISA).
Results: The DN patients had significantly different serum levels of NTN-1; the macroalbuminuria group had the greatest value (1127.73±407.93 pg/ml). The prediction of DN was determined by ROC curve analysis to have 88% sensitivity and 63% specificity for serum netrin-1 at a cutoff point of 686.5 pg/ml with an AUC of 0.642 (P = 0.08).
Conclusion: There is a progressive increase in serum NTN-1 levels with the severity of albuminuria in T2DM patients.
Keywords: Netrin-1; Biomarkers, diabetic nephropathy, type 2 diabetes mellitus, albuminuria
Citation: Abdulfattah SW, Abdulsattar SA, Rahmah AM. Serum Netrin-1 level in type 2 diabetic nephropathy. Iraqi JMS. 2024; 22(2): 252-258. doi: 10.22578/IJMS.22.2.9

Background: Helicobacter pylori (H. pylori) a spiral-shaped bacterium that infects roughly half the world’s population, leading to the development of severe complications such as peptic ulcer diseases, gastric cancer, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Cytotoxin associated gene A (CagA) and α-subunit of urease (UreA) are two of the major virulence factors of H. pylori, and each of them has a distinct entry pathway and pathogenic mechanism during bacterial infection.
Objective: To investigate the relationship of UreA and CagA with the clinical and histopathological finding in patient with different gastro-duodenal diseases.
Methods: This is a cross-sectional study included a total of 194 specimens of gastric tissue biopsy (GTB) from patients diagnosed with different gastro-duodenal diseases in period from march 2022 to August 2022. In addition, a histopathologically normal GTBs were obtained from patients. Direct molecular identification of H. pylori Ure A and CagA.
Results: The results showed that 162/194 (83.5%) of specimens were positive for H. pylori UreA and 35/194 (18.0%) of specimens were positive for CagA. The association of positivity to H. pylori and oesophagogastroduodenoscopy (OGD) finding was statistically not significant as P-value = 0.079, except for congested mucosa, which was statistically significant as P-value 0.033. The association of positivity to CagA and OGD finding was statistically not significant, P-value = 0.107, except of nodular gastritis which was statistically significant, P-value= 0.001. The association of positivity to cagA with histopathological finding was statistically not significant, P-value= 0.639.
Conclusion: The association between UreA and CagA with the OGD and histopathological finding required more investigations. There is association between UreA and congested mucosa, while CagA is associated with nodular gastritis.
Keywords: Helicopacter pylori, UreA, CagA, conventional PCR
Citation: Mohammed AA, Ghadhban JM. Association between Helicobacter pylori virulence genes UreA and CagA with histopathological changes in gastroduodenal disease. Iraqi JMS. 2024; 22(2): 259-267. doi: 10.22578/IJMS.22.2.10

Background: A novel coronavirus causing corona virus 2019 (COVID-19) disease, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was a serious cause of respiratory failure, cytokine release syndrome or myocarditis. The immune checkpoint blockade (ICB), cytotoxic T-lymphocyte associated proteins 4 (CTLA-4) and programmed cell death protein 1 / programmed death-ligand 1(PD-1)/PD-L1) axis, has been a recognized standard of treatment in various cancers and in the prevention of several viral infections.
Objective: To evaluate soluble immune checkpoint levels (PD-1, PDL-1 and CTLA-4) in SARS-Cov-2 patients.
Methods: This cross-sectional study included 90 patients with confirmatory SARS-CoV-2 test by polymerase chain reaction (PCR), as they were seeking for treatment at Medical City in Baghdad's Teaching Hospital (BTH). Patients with SARS-Cov-2 were divided into two groups: first group were those with severe SARS-CoV-2 symptoms lowest oxygen saturation (less than 90% O2 saturation) and the second group are those with mild-moderate SARS-CoV-2 symptoms. The three ml of venous blood were taken from each patient to evaluate the levels of soluble PDL-1, PD-1, and CTLA-4 by using enzyme linked immunological sorbent test (ELISA).
Results: Data regarding serum level of CTLA-4, PD-1 and PD-L1 in mild-moderate and severe covid-19 patients were found to be abnormally distributed. The median serum level of CTLA-4, PD-1 and PD-L1 in mild-moderate groups was much lower than that of severe cases with highly significant differences. Age demonstrated a positive significant correlation with each of CTLA-4, PD-1 and PD-L1. Soluble CTLA-4 had a positive significant correlation with each of PD-1 and PD-L1. Finally, PD-1 had a positive significant correlation with PD-L1.
Conclusion: Soluble immune checkpoint markers are significantly increased in patients with severe covid-19 cases and soluble immune checkpoint markers are positively significant correlated with age.
Keywords: Immune checkpoint, CTLA-4, PD1, PDL-1, SARS-C0v-2, COVID-19
Citation: Talib AL, Kadhim HS. The role of soluble immune checkpoint in SARS-CoV-2 Iraqi patients. Iraqi JMS. 2024; 22(2): 268-273. doi: 10.22578/IJMS.22.2.11

Background: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that is characterized by the presence of autoantibodies and joint inflammation, which consequently leads to articular cartilage damage. Due to the tumor necrosis factor-alpha (TNF-α) crucial role in the pathogenesis of RA, TNF-α inhibitors have revolutionized this disease treatment.
Objective: To evaluate the influence of the single nucleotide polymorphism (SNP) of TNF-α on the response to etanercept in RA patients.
Methods: The study comprised of 60 RA patients and 25 healthy individuals. The age range of the participants was between 20 and 69 years. DNA sequencing was carried out by using conventional polymerase chain reaction (PCR) and sequencing. The blood samples were taken from the RA patients at the baseline before the administration of anti TNF-α therapy. The level of TNF-α in the sera was measured using an enzyme-linked immunosorbent assay (ELISA).
Results: The TNF-α-308 G/G genotype was the most prevalent in Iraqi RA patients (78%), while there was no significant difference of TNF-α-308 G/A between responders and non-responder group. TNF-α -308 G/G or G/A genotype have no influence on the response to etanercept. The results indicate that the level of TNF-α was significantly different (P <0.05) between RA patients (190.82±12.23 SEM pg/ml) and the control group (106.62± 4.15 SEM pg/ml), while there was no significant difference of the level of TNF-α between responders (188.53 ±15.81 SEM pg/ml) and non-responders (194.25±19.45 SEM pg/ml).
Conclusion: The level of TNF-α was elevated in RA patients in comparison to healthy individuals. The level of TNF-α at baseline have no influence in the response to etanercept in RA patients. TNF-α-308 G/G or G/A gene polymorphism has no influence on the response to etanercept.
Keywords: Rheumatoid arthritis; TNF-α; Etanercept, TNFR, ELISA, PCR.
Citation: Abbas BF, Mohammad NA, Naif HM. The influence of single nucleotide polymorphism of tumor necrosis factor alpha gene on the response to etanercept in Iraqi rheumatoid arthritis patients. Iraqi JMS. 2024; 22(2): 274-282. doi: 10.22578/IJMS.22.2.12

Background: Calprotectin is a heterodimeric compound belonging to the S100 family, it is mostly produced in leukocytes and is implicated in various human disorders, including tumors and autoimmune diseases.
Objective: To evaluate the usefulness of calprotectin serum level as a valid target for monitoring progression of rheumatoid arthritis (RA) disease and response to tumor necrosis factor-alpha (TNF-α) inhibitor therapy (Infliximab).
Methods: This case-control study comprised 150 participants, consisting of 50 healthy individuals and 100 patients with RA on anti-TNF-α (Infliximab) therapy (50 responders and 50 non-responders). The concentration of calprotectin in the serum was determined using the enzyme-linked immunosorbent assay.
Results: The clinical disease activity index revealed a substantial distinction between patients, specifically responders and non-responders (P <0.001). The study's findings revealed 68% of the patients who responded to treatment were positive for rheumatoid factor (RF), whereas 88% of the non-responders were seropositive. Furthermore, non-responders' patients exhibited a greater presence of anti-citrullinated protein antibodies. According to this study, RA patients who test positive for anti-citrullinated protein antibodies exhibit a diminished response to anti-TNF-α therapy. The serum levels of calprotectin were markedly elevated in non-responder patients compared to both responders and the control group (P <0.001).
Conclusion: Calprotectin serum level may reflect an effective target for monitoring progression of RA disease and response to anti-TNF-α therapy.
Keywords: Calprotectin, rheumatoid arthritis, TNF inhibitor
Citation: Jassim HH, Abbas AA, Alosami MH. The emerging role of calprotectin in disease activity and response to treatment among Iraqi patients with rheumatoid arthritis. Iraqi JMS. 2024; 22(2): 283-290. doi: 10.22578/IJMS.22.2.13

Background: Brain magnetic resonance imaging (MRI) is one of the most important investigations in epilepsy, which can detect any structural abnormality such as infarctions, gliosis, tumors and other different abnormalities.
Objective : To investigate types of structural brain lesions and its relation to their seizure semiology.
Methods: This is a retrospective cross-sectional study involving 352 patients. Collected data were taken from patient’s files in epilepsy clinic between 2016-2021. Sequences were used according to MRI epilepsy protocols.
Results: Files of 352 patients were reviewed, males 222 (63.1 %) while the rest were females (36.9 %), mean age of patients was 30.69 years ± 11.011 and mainly from the age group 18-30 years old (57.1%). Regarding the clinical diagnosis of seizure 210 (59.65%) to have focal type seizures and 142 (40.35%) of the patients with generalized types. One-third of seizure subtypes was a generalized tonic-clonic seizure (32.1%), followed by focal aware seizure (19.3%), focal to bilateral tonic-clonic (15.6%). Regarding MRI findings, (62%) of the patients had a normal study, temporal lobe pathology 32 (9.1%) patients, gliosis 21 (6%) patients, generalized brain atrophy was 15 (4.3%) patients, nonspecific white matter lesion was 10 (2.8%) patients, cerebrovascular insult was (2.8%).
Conclusion: The commonest MRI findings in epileptic patients was normal scan, followed by mesial temporal lobe lesions, gliosis, nonspecific white matter lesions, brain atrophy and cerebrovascular insults.
Keywords: Epilepsy, MRI, seizure, tonic-clonic
Citation: Obaid HH, Jabbar BH, Salman BH. Magnetic resonance imaging and its benefit in epilepsy and seizure disorders diagnosis. Iraqi JMS. 2024; 22(2): 291-297. doi: 10.22578/IJMS.22.2.14

Background: Vitiligo is a common condition, highly distributed in Iraq and in the world. It is an acquired disorder of the skin and mucous membranes. It may appear at any age; cases have been reported as early as 6 weeks after birth. Segmental vitiligo often occurs in a dermatomal pattern, This observation led to a neural hypothesis that proposes certain chemical mediators released from nerve endings may cause decreased melanin production, elevated neuropeptide levels have been demonstrated in skin affected by vitiligo.
Objective: To shed light on some demographic parameter and detect the association between vitiligo and Catechol-O-Methyltransferase (COMT) gene polymorphisms in a sample of Iraqi population.
Methods:This case-control study was performed to detect the polymorphism of COMT 158 G/A by polymerase chain reaction restriction length polymorphism trial in 110 individuals of two groups of peoples, the first group represent the patients and the other group was apparently healthy as control, with age range from 3-62 years. Ninety-six Iraqi vitiligo patient were selected from vitiligo patients attended the Consulting Clinic of Al-Mussyab Hospital and private clinic of dermatology in Al-Mussyab City during the period from the beginning of June 2014 till ending of September 2014. Approximately 2 ml of blood samples were collected from all individuals in ethylenediaminetetraacetic acid (EDTA) anticoagulant tubes with aseptic technique and kept in -20°C.
Results: The demographic study revealed that the disease was appeared in females 59 (61.46%) more than that in males 37 (38.54%) with a highly significant difference (P ≤0.01) and the ratio of females to males was 1.59: 1. The mean age of the patient group was 20.67±13.36 years with age range 3-62, the highest number of patients affected by vitiligo was found in the age range 10-19 years with a highly significant difference (P <0.01). The most frequent vitiligo type was segmental followed by generalized, mucosal, acrofacial, then focal type, lately, the universal type with a highly significant difference (P <0.01). In this study, psychological factors were seen in 85% of cases, 10% nutrition may act as triggering factor in these cases, and 5% unknown cause, the result of this study count no differences in COMT polymorphism between vitiligo patients and the control persons.
Conclusion: There was no significant association between vitiligo and COMT 158 G/A polymorphisms in the Iraqi people.
Keywords: Vitiligo, Catechol O-methyl transferase gene, polymerase chain reaction
Citation: Al-Hamadani HQ, Al-Thwani AN. Relationship between Catechol-O-Methyltransferase polymorphism and vitiligo in a sample of Iraqi peoples Iraqi JMS. 2024; 22(2): 298-307. doi: 10.22578/IJMS.22.2.15

Background: Cryptosporidium spp. and Rotavirus are recognized as important causes of acute gastroenteritis in children worldwide.
Objective: To determine the frequency of Cryptosporidium spp. and Rotavirus in children under five years with diarrhea.
Methods: This cross-sectional study included 100 stool samples collected from children complaining from diarrhea with age ranged between 1-60 months. Samples were collected from Al-Imamein Al-Kadhimein Medical City, Al-Kadhimiya Children Hospital and Central Child Teaching Hospital in Baghdad during the period from December 2021 to May 2021. Conventional polymerase chain reaction was used to detect Cryptosporidium spp. while enzyme-linked immunosorbent assay was used to detect Rotavirus.
Results: The rate of Cryptosporidium infection was 39% and the rate of Rotavirus infection was 20.43%. Co-infection Cryptosporidium and Rotavirus found in seven patients.
Conclusion: Infection with Cryptosporidium may facilitate with infection with Rotavirus.
Keywords: Gastroenteritis, Cryptosporidium, Rotavirus, co-infection
Citation: Shayyal FK, Al-Marsomy HD, Ali SH. Detection of Cryptosporidium spp. co-infection with Rotavirus in children under five years with diarrhea. Iraqi JMS. 2024; 22(2): 308-313. doi: 10.22578/IJMS.22.2.16

Background: Physical activity is a crucial determinant of cardiovascular health and metabolic well-being.
Objective: To investigate the association between physical activity levels and various cardiometabolic risk factors in a sample of adults.
Methods: A cross-sectional study was conducted on 140 adults, with complete data available for analysis. The participants' physical activity levels were categorized as high or low. Several cardiometabolic risk factors, including age, sex, smoking status, alcohol consumption, food style, body mass index (BMI), blood pressure, glycated hemoglobin, cholesterol levels, triglycerides, high-density lipoprotein, low-density lipoprotein, very-low-density lipoprotein, waist circumference and uroguanylin (UGN) were assessed. Chi-square tests and t-tests were conducted to examine the significance of associations between physical activity levels and each risk factor.
Results: The study found that physical activity levels were significantly associated with younger age (P <0.001), lower body mass index (BMI) (P <0.001), lower systolic blood pressure (P = 0.036), lower diastolic blood pressure (P = 0.036), smaller waist circumference (P <0.001), lower cholesterol (P <0.001), lower triglyceride (P = 0.004), lower low-density lipoprotein (P = 0.003), lower very low-density lipoprotein (p = 0.005), lower obesity prevalence (P <0.001). However, no significant associations were observed for sex, smoking, alcohol consumption, food style or UGN and glycated hemoglobin (HbA1c).
Conclusion: The physical activity levels are significantly associated with various cardiometabolic risk factors; especially lipid profile parameters and lower obesity prevalence, emphasizing the importance of regular physical activity in maintaining cardiovascular health and metabolic balance in adults.
Keywords: Physical activity, cardiometabolic risk factors, adults, BMI, cholesterol, triglycerides, HDL, LDL, VLDL, HbA1c, Uroguanylin
Citation: Mohammed FA, Baban RS, Jasim MA. Association of physical activity levels with cardiometabolic risk factors in a sample of Iraqi adults. Iraqi JMS. 2024; 22(2): 314-319. doi: 10.22578/IJMS.22.2.17

Background:The hepatitis B virus (HBV), are the primary causative agents of blood borne infectious disease. Cirrhosis and hepatocellular cancer are potential complications of chronic hepatitis. The quantitative HB surface antigen (qHBsAg) assessment can provide clinicians with more precise information. This can be especially useful for predicting treatment response, sustained virological response, disease progression, and other clinical situations, and laboratory-developed methods are not standardized. Persisting the HBV is caused by intrahepatic covalently closed circular DNA (cccDNA).
Objective: To find out the relation between the degree of liver fibrosis and the levels of HBsAg and HBeAg and the usefulness of these two markers in prognosis of chronic hepatitis.
Methods:Eighty-nine patients with chronic HBV infection took part in a cross-sectional study Gastrointestinal Tract Hospital in Medical City in Baghdad during a period from the first of September 2022 to the end of January 2023. Those patients were >18 years old with and without prior or current anti-HBV therapy and those patients were subjected to fibroscan to monitor liver fibrosis. qHBsAg and HBV (DNA) were taken from the medical records of those who recruited according to the specialist decision. Measuring the blood levels of HBsAg by using quantitative enzyme-linked immunosorbent assay (ELISA). Determining the HBeAG status by qualitative ELISA.
Results: Fibroscan results showed that 47% had no fibrosis and the remaining 53% had different ranges of fibrosis, qHBsAg was directly correlated non significantly associated with DNA, age (P >0.05). Regarding HbeAg status (94.4% were negative, and 5.6% were positive). HBeAg was found to be associated with the staging of fibrosis (P <0.01); about 1 (2.4% F0 was HBeAg positive), 0 (0% F1) HBeAg positive), 1 (9.1% F2 HBeAg positive), 3 (27.3% F3 HBeAg positive), and, 0 (0% F4 HBeAg is positive).
Conclusion: qHBsAg can be used as a biomarker for liver fibrosis and hepatitis B. HBeAg may be unrelated to the liver fibrosis to determine its clinical implications. The age was non-significantly associated with qHBsAg. qHBsAg levels are a reliable indicator of the immune system's ability to control HBV.
Keywords: Chronic HBV, Fibroscan, HBsAg, HBeAg
Citation: Al-Hamadani EA, Abdulamir AS. Quantitative hepatitis B surface antigen as biomarker for the evaluation of liver fibrosis in chronic hepatitis B patients. Iraqi JMS. 2024; 22(2): 320-329. doi: 10.22578/IJMS.22.2.18

Background: Adult bone strength and shape are physiologically maintained in large part by thyroid hormones. Thus, there exists a correlation between thyroid diseases and bony outcomes.
Objective: To assess the level of type I collagen cross-linked C-terminal telopeptide in Iraqi patients with thyroid disorders and its relationship to other biochemical markers.
Methods: Eighty Iraqi thyroid disease patients (40 with hypothyroidism and 40 with hyperthyroidism) were included in this study, aged between 30 and 65 years. Patients were chosen from the Baghdad Teaching Hospital in the Medical City Complex. The 40 individuals in the healthy control group (20 males and 20 females) ranged in age from 30 to 55 years.
Results: Among the three study groups, there was a highly significant decrease in vitamin D3 in hypothyroidism and hyperthyroidism compared to control. A statistically significant increase in alkaline phosphatase levels was seen among the study groups (hypothyroidism, hyperthyroidism, and control); however, no statistically significant differences were seen between phosphate and calcium levels. There was a highly significant rise in C-terminal telopeptide (CTX-1) between the groups with hypothyroidism and hyperthyroidism and the control group; similarly, the hyperthyroidism group showed a highly significant increase in CTX-1.
Conclusion: There was a substantial increase in type I collagen cross-linked C-terminal telopeptide in hypothyroidism and hyperthyroidism compared to control. This rise could be interpreted as a predictive marker of osteoporosis in thyroid disease.
Keywords: CTX-1, hypothyroidism, thyroid hormone, type I collagen cross-linked C-terminal telopeptide, osteoporosis
Citation: Ghadban AH, Tahir NT, Jawad RS. Type I collagen cross-linked C-terminal telopeptide as a predictor marker of osteoporosis in Iraqi thyroid diseases patients. Iraqi JMS. 2024; 22(2): 330-338. doi: 10.22578/IJMS.22.2.19

Background: All-natural killer (NK) cells are crucial to the natural body immune system showcasing the capability to target and also remove cancer cells.
Objective: This study concentrates on maximizing NK cell activation with sugar society contrasting it versus conventional cytokine excitement techniques, to improve their anticancer efficiency.
Methods: This examination used a speculative layout for sugar society activation, including the incubation of NK cells with sugar tool and succeeding examination of their activation performance via circulation cytometry along with Western blot evaluation. NK cell cytotoxicity was analyzed making use of circulation cytometry to gauge CD69 expression as well as novel adhesion molecule as pens for activation and also maturation specifically. Real-time polymerase chain reaction was used to quantify genetics expression degrees of activation pens (CD16 and CD56) as well as cytotoxic elements (Granzyme B Perforin) while Western blot evaluation took a look at the healthy protein expression pertaining to NK cells task.
Results: The research located considerable upregulation in the expression of NK cell activation as well as cytotoxicity genetics (CD16, CD56, Granzyme B and Perforin) post-glucose society, with P values <0.001 showing boosted -feature versus lump cells. Circulation cytometry evaluation exposed a rise in CD69+ NK cells along with enhanced cytolytic capabilities post-glucose activation. Western blot evaluation revealed a critical decrease in Calcineurin A expression complying with siRNA coupled with Calcineurin prevention therapies recommending a concentrated strategy to enhance NK cell-mediated cytotoxicity.
Conclusion: Glucose society arises as an effective technique for NK cells activation going beyond conventional cytokine-based excitement in advertising NK cell preparedness as well as cytotoxic capacities versus cancer cells. This technique might improve the effectiveness of NK cell-based treatments in cancer cell therapy highlighting the requirement for more research studies right into enhanced activation methods.
Keywords: Natural killer cells, cancer immunotherapy, glucose culture activation, cytokine stimulation, cytotoxicity gene expression.
Citation: Fahad HM. Enhancing natural killer cells immunotherapy in solid tumors: In vitro study. Iraqi JMS. 2024; 22(2): 339-356. doi: 10.22578/IJMS.22.2.20

Background: The stem cells have been reported in umbilical cord blood (UCB), the Wharton\'s jelly, and in other perivascular mesenchymal areas within the cord. Two types of stem cells that have been identified in UCB are haemopoietic stem cells (HSCs), which are blood-forming, and mesenchymal stem cells (MSCs), which are supposedly pluripotent. Stem cells within the umbilical cord other than those in cord blood have been broadly termed umbilical cord matrix stem cells (UCMSCs).
Objective: To analyze the histological and histomorphometric changes in early term and postdate human umbilical cord (HUC).
Methods: Fifty samples of the HUC were collected from normal vaginal delivery and were divided into 25 UC as normal early term and 25 UC as normal postdate labor. The age of pregnant women was (18-30 years), whose mother had normal pregnancy and normal vaginal delivery. The UC were fixed in 10% formaldehyde for paraffin blocks preparation. Transverse sections were placed on standard glass slides for hematoxylin and eosin staining.
Results: The mean±SD of the length in postdate UC was 58.76±4.72 cm, significantly more than in early term UC (46.12±2.65 cm, P <0.001). The diameter of postdate UC was 0.61±0.12 cm, more than in early term UC (0.55±0.04 cm, P <0.02). The artery diameter in postdate UC was 504.45±44.97 pixel/µm², compared to 422.23±52.82 pixel/µm² in early term UC (P <0.001). The vein diameter in postdate UC was 612.20±62.54 pixel/µm², less than in early term UC (712.84±64.11 pixel/µm², P <0.001). The MSCs thickness in postdate UC was 40.18±15.22 pixel/µm², more than in early term UC (29.05±7.10 pixel/µm², P <0.002).
Conclusion: In early gestation, oxidative stress likely increases vessel diameters, such as the umbilical vein, to enhance blood return to the fetus. As the gestational period progresses, the growth of smooth muscle walls results in thicker arterial walls and larger diameters in postdate compared to early term.
Keywords: Stem cells, oxidative stress, term of gestation, blood of human umbilical cord
Citation: Abed AS, Jaafar HA, Al-Rawaf SA. A comparative study of morphological changes in mesenchymal stem cells between early term and postdate human umbilical cord. Iraqi JMS. 2024; 22(2): 357-368. doi: 10.22578/IJMS.22.2.21

Background: The Klebsiella pneumoniae (K. pneumoniae) is part of the healthy human microbiome, providing a potential reservoir for infection. It is most prevalent in healthcare settings and it is a significant nosocomial pathogen, leading to infections among hospitalized patients.
Objective: To investigate the prevalence of multidrug resistance (MDR), extensively drug resistance (XDR) and pan-drug resistance (PDR) patterns among K. pneumoniae with their importance in mixed type isolates.
Methods: This study is a cross-sectional investigation that included a total of 132 K. pneumoniae isolates, isolated from different infections collected from bacteriology laboratories located in six government hospitals in Baghdad. The Vitek2 system confirmed the bacterial and antibiotic susceptibilities.
Results: The results showed that 106/132 (80.3%) of the isolates were pure K. pneumoniae, and 26/132 (19.7%) were mixed type isolates (K. pneumoniae plus other bacteria). It was found that the isolates were most resistant to beta-lactamase drugs and sulfonamide, such as Ticarcillin (97%), Piperacillin (92%), Ceftazidime (90%), Ticarcillin/Clavulanic acid (83%), Azatreonem (86%), and Trimethoprim/Sulfamethoxazole (86%). The antibiotic susceptibility patterns showed that 40/132 (30.3%) had possible XDR, 30/132 (22.7%) had MDR, and 16/132 (12.1%) had possible PDR. In the present study, burn infections followed by respiratory secretions revealed isolates with higher antibiotic resistance.
Conclusion: The study revealed that high incidence of XDR and MDR patterns compared to previous studies conducted in Iraq in recent years. The co-existence of two or more bacterial species may lead to syntrophic interactions. The emergence of antibiotic-resistant strains among mixed strains has increased the severity of polymicrobial infection.
Keywords: Klebsiella pneumoniae, antibiotics susceptibility patterns, poly-microbial infections.
Citation: Fouad NA, Totl KJ. Antibiotic resistance in Klebsiella Pneumoniae and its impact in mixed type isolates. Iraqi JMS. 2024; 22(2): 369-376. doi: 10.22578/IJMS.22.2.22

Background: Vaccine development is not an easy task but is a top priority to restore normalcy for Coronavirus-19 disease (COVID-19) and achieve the herd immunity.
Objective: To compare the level and duration of humeral versus cellular immune response in vaccinated individuals at one and 8 months after second dose of three different vaccines to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), namely Pfizer, AstraZeneca, and Sinopharm vaccines.
Methods: The level of neutralizing antibodies and the peripheral mononuclear cells proliferation (PBMC) activity and in vitro IFN-γ release by the S1 spike protein-stimulated T cells were monitored using isotype- and species- free competitive blocking ELISA, microculture tetrazolium assay (MTT) proliferation assay and an ELISA technique for the assessment of IFN-γ level in a cell culture supernatant, respectively.
Results: PBMC proliferation percentage and the concentration of the in vitro IFN-γ release were remarkably higher in 8 months than in 1-month post-2nd dose vaccination groups of the three vaccines studied in this study (P <0.0001). For the PBMC proliferation percentage, AstraZeneca vaccine induced much higher proliferation percentage than Pfizer and Sinopharm (P <0.01), which both showed very close PBMC proliferation (P >0.05).
Conclusion: AstraZeneca showed superior effect on inducing robust cellular immunity followed by Pfizer vaccine, while Sinopharm showed minimal cellular immune response induction. And for all vaccines, the cellular immunity increased with time over 8 months after vaccination. Moreover, Pfizer vaccine proved to be of highest and most durable neutralizing anti-RBD IgG antibodies and followed with Sinopharm and AstraZeneca vaccines.
Keywords: COVID-19, SARS-CoV-2, RBD, vaccine, neutralizing antibodies (nABs)
Citation: Jawad FMM, Abdulamir AS. A comparative study of the effectiveness of Pfizer-BioNTech (BNT162b2), AstraZeneca (ChAdOx1nCoV-19) and Sinopharm (BBIBP-CorV) vaccines in eliciting cell mediated and humoral immunity in a sample of vaccinated population from Iraq. Iraqi JMS. 2024; 22(2): 377-394. doi: 10.22578/IJMS.22.2.23

Background: Diabetic nephropathy (DN) is a serious consequence of diabetes that can result in end-stage renal failure. The development of this condition is characterized by the activation of inflammatory pathways, in which pyroptosis, a specific type of programmed cell death, plays a vital role. Gasdermin D plays a crucial role in the process of pyroptosis, which is becoming more and more associated with DN. Elevated glucose levels and advanced glycation end-products stimulate the nucleotide-binding oligomerization domain - like receptor protein 3 inflammasome, resulting in the activation of caspase-1 and pyroptosis in different types of kidney cells.
Objective: To investigate the role of pyroptosis in DN by evaluation of serum Gasdermin D level and biochemical parameters.
Methods: This study was case-control study that had 160 individuals divided into three groups including 40 individuals with DN, 40 individuals with type 2 diabetes mellitus (T2DM), and 80 individuals as control group. The parameters total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), very low-density lipoprotein-cholesterol (VLDL-C), low-density lipoprotein-cholesterol (LDL-C), random blood sugar (RBS), glycated hemoglobin (HbA1c%), urea, and creatinine, GSDMD and IL-18) were examined in this study.
Results: The study revealed a strong association between DN and the control group in all investigated parameters. The comparison between DM and the control group did not yield a statistically significant result for GFR, whereas other parameters did reveal significant results. The link between DN and DM is found to be substantial in terms of urea, creatinine, GFR, GSDMD, and IL-18. However, the remaining parameters also exhibit significant results.
Conclusion: The significant result in all parameters shown in comparison between DN and control group due to elevated levels of parameters in DN patients. The non-significant result in (GFR) in comparison between DM and control group while other parameter shown significant result due to elevated levels of parameters in DM patients.
Keywords: GSDMD, IL-18, DN, T2DM, pyroptosis
Citation: Al-Tu’ma AF, Al-Wasiti EAR, Al-Saegh RM. Evaluation The serum level of Gasdermin D in relation to pyroptosis in diabetic nephropathy. Iraqi JMS. 2024; 22(2): 395-406. doi: 10.22578/IJMS.22.2.24

Background: Ventricular septal rupture (VSR) is a rare but catastrophic complication of acute myocardial infarction (MI), usually leading to congestive heart failure and cardiogenic shock with high mortality.
Objective: To study the clinical profile and outcomes of the VSR complicating acute MI in tertiary center in Baghdad.
Methods:This is a single center retrospective study recruited patients who were admitted to Ibn Al-Bitar Cardiac Center from September 2016 to February 2020 who were diagnosed with acute MI and admitted to this facility then MI course complicated by VSR as well as patients who were referred for surgical intervention from other hospitals where have been diagnosed of VSR.
Results: A total 22 patient admitted with AMI complicated by VSR, 14 patients were male (64%), 8 patients were female (36%), 14 patients were hypertensive (64%). Sixteen patients developed anterior ST elevation myocardial infarction (STEMI) (72%) and 6 with inferior STEMI (28%). Eight patients had surgery, two of them during index hospitalization and the other 6 patients as elective scheduled procedures. Twelve patients (54%) died during hospitalization, all of them were in cardiogenic shock at presentation.
Conclusion: VSR complicating acute MI is a catastrophic mechanical complication that carries high in-hospital mortality, need high index of suspension and aggressive medical support with early surgical intervention.
Keywords: Ventricular septal rupture, myocardial infarction mechanical complication
Citation: Bairam AR, Shuailah MA, Dakhil ZA, Alwan AH. Ventricular septal rupture post myocardial infarction: Baseline characteristics and in-hospital outcomes. Iraqi JMS. 2024; 22(2): 407-413. doi: 10.22578/IJMS.22.2.25

Background: Helicobacter pylori (H. pylori), is a Gram-negative bacterium that colonizes the human stomach. Persistence of H. pylori infection may lead to various gastrointestinal pathologies such as gastric cancer.
Objective: To investigate the correlation between H. pylori antigen in stool and antibody with serum interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α).
Methods: The participants were assigned into patients and controls, for both groups, rapid urease test, H. pylori stool antigen test, Anti-H. pylori IgA, and IgG, serum Il-6, and serum TNF-α were measured.
Results: The mean serum levels of the IgA, IgG, IL-6, and TNF-α for the patients were as follows: 32.56±0.51 U/ml, 18.37±0.39 U/ml, 71.05±1.09 pg/ml, 54.72±1.01 pg/ml, respectively, while those of the controls were: 7.97±0.35 U/ml, 2.09±0.21 U/ml, 11.69±0.50 pg/ml, 3.76±0.23 pg/ml, respectively. The comparisons of all four markers showed very highly statistically significant difference between patients and controls (P <0.001). The mean serum concentrations of the IgG showed a highly statistically significant difference (P <0.001), while all other comparisons indicated no statistically significant difference (P = 0.76, P = 0.76, P = 0.70) for the IgA, IL-6, and TNF-α comparisons, respectively.
Conclusion: Infection with H. pylori can significantly alter the diagnostic markers and the markers commonly used to determine post-infection inflammatory response thus those markers can be utilized to diagnose and/or follow up infection progress.
Keywords: H. pylori, IgA, IgG, IL-6, TNF-α
Citation: Ali MR. Correlation between Helicobacter pylori infection and the level of serum inflammatory markers. Iraqi JMS. 2024; 22(2): 414-421. doi: 10.22578/IJMS.22.2.26

The chest wall hydatidosis is a rare location of primary hydatid cyst. This is a 29-old female, multipara presented with a right anterior chest wall painless swelling below the clavicle deep to the pectoralis major muscle). Investigations confirm that this is a chest wall cystic lesion most likely hydatid cyst and it is the only one, no other organ involved. Patient prepared for surgery, the cyst completely removed successfully under general anesthesia and the histological examination confirm a hydatid cyst of the chest wall).
Keywords: Chest wall cyst, hydatid cyst.
Citation: Mohialdeen SA. Unique location of the chest wall hydatid cyst: A case report. Iraqi JMS. 2024; 22(2): 422-426. doi: 10.22578/IJMS.22.2.27