Journal of the Faculty of Medicine Baghdad

coexists frequently with viral meningitis and is the most prevalent kind of encephalitis.
Objectives: To throw light on viral encephalitis, its types, epidemiology, symptoms and complications.
Results: Although it can affect people of all ages, viral infections are the most prevalent cause of viral encephalitis, which is typically seen in young children and old people. Arboviruses, rhabdoviruses, enteroviruses, herpesviruses, retroviruses, orthomyxoviruses, orthopneumoviruses, and coronaviruses are just a few of the viruses that have been known to cause encephalitis.
Conclusion: As new viruses emerge, diagnostic techniques advance, or we learn more about the pathophysiology of the disease, viral encephalitis has become a more serious public health concern.

Background: Gastroschisis and omphalocele are the most common congenital defects of the anterior abdominal wall which need urgent and prompt intervention post-operative time outcomes of gastroschisis and omphalocele differ between different countries, especially between developed and developing countries.
Objectives: Is to determine the early outcome of patients born with gastroschisis and omomphalocele
Patients and Methods: An analytical study including 30 patients (11 gastroschisis and 19 omphaloceles) were treated in Erbil city during 2015 -2018. Patients with associated bladder and cloacal exstrophies were excluded.
Results: Female to male ratio was 1.3:1, and the mean age at presentation was 11.7 hours. The Mean weight was 2.86 kg. The Majority of patients25 (83.3%) were term. In Nineteen cases (63.3%)were delivered vaginally (9 gastroschisis and 10comphalocele), prenatally diagnosis was done in 9(30%). The Mean size of the defect was 3.7cm, and the content was mixed in 7(23.3%). Primary repair has performed in 18(60%), a silo in 8(26.7%), and 4(13.3%) treated none surgically (all were omphalocele). Operations have been done within 24 hours of arrival in 16(61.5%). Associated anomalies have been found in 11(57.9%) patients with omphaloceles and only 2(18.2%) patients with gastroschisis. The mean period of hospital stays was6 days. Mortality among the gastroschisis patients were 8(72%), but only 4(21.1%) for omphalocele patients.
Conclusion: Gastrochisis and omphalocele constitute a considerable part of neonatal surgical problems and their management is still challenging. Omphalocele cases were more likely to have associated congenital anomalies and gastroschisis, if the associated anomalies were confined to the gastrointestinal tract. There was a high mortality rate, especially in patients with gastroschisis and ruptured omphalocele due to a lack of intensive care units, facilities, and trained personnel to look after such high-risk patients

Background: Echocardiography has an important role to follow up patients with Iatrogenic atrial septal defect (IASD) and after Catheter ablation during electro-physiological study.
Objectives: evaluating the impact of non-invasive Transthoracic Echocardiography (TTE) parameters (LAVI, LVEF, ASD size and E/e`) post radiofrequency ablation of left atrial arrhythmia.
Patients and methods: for the evaluation of the atrial septal defect, a transthoracic echocardiography (TTE) was used in patients who underwent left atrial arrhythmia ablation, enrolled in prospective study in the Iraqi center for cardiac diseases, in cooperation with university of Baghdad /college of medicine
Results: The outcomes of the present study were assessed according to Transthoracic Echocardiographic parameters with a median period of follow up of six months post-radiofrequency procedure for each patient. The mean of age was (36.28±10.34 years), females were 24 (51.1%) while males were 23 (48.9%), with no structured heart diseases and normal LV function with mean EF (64.68± ,5.23%) and the mean LA diameter (35.75±,2.92mm). Iatrogenic atrial septal defects (IASDs) were detected by TTE in all patients with range from (2-5) mm with mean of (3.47±0.92). Also we noticed that patients with smaller ASD size had higher LVEF than those who had larger ASD size with (P=0.007), while there was no significant association between ASD size with left atrial volume index (LAVI) and E/e`.
Conclusions: Non-invasive Transthoracic Echocardiography (TTE) study that was used post atrial septostomy for monitoring the closure of residual atrial septal defect is useful and applicable. And may be used in daily practise post atrial septostomy procedure and recommended rather than the use of invasive Transoesophageal Echocardiography (TEE).

Background: five clinical phases were described in patients with chronic (HBV) infection: HBeAg- positive
HBV infection, HBeAg- positive chronic HB, HBeAg negative HBV infection, HBeAg-negative CHB and
occult HBV infection.
Aim: This study aimed to determine the incidence of the unclassified phase (gray zone) in chronic hepatitis
B patients and its significant in the clinical practice.
Patients and methods: The study was conducted retrospectively on 109 patients' who have HBsAg positive
for more than 6 months. The data recorded include; HbeAg and anti-HBe Ab, ultrasound of the abdomen,
HBV DNA load and alanine aminotransferase (ALT), accordingly; we classify the patients to known clinical
phases. Patients who were unfit one of these phases considered to be in the gray zone and subsequently sent
for liver fibroscan to determine the fibrosis stage.
Results: The mean age of our patients was 34.25 (±13.93) years with 54.12% being males. The mean viral
load was 5,885,490 IU/ml and mean ALT was 56.22 (±89.88) U/L. eight patients (7.3%) were in the
HBeAg+ve HBV infection, 13 patients (11.9%) were in HBeAg+ve CHB . Thirty four patients (31.1%) were
in the HBeAg-ve HBV infection and 23 (21.1%) were in HBeAg-ve CHB phase, both were showed a higher
occurrence with age> 35 years. Thirty one (28.4%) further patients failed to identify with any of the four
phases (normal ALT with HBV load > 2000 IU/ml), this group also showed significant relation to age above
35 years and 12 patients (38.8%) had significant fibrosis on fibroscan.
Conclusions: A considerable number of patients with chronic HBV infection have persistently normal ALT
levels, despite elevated levels of viral load; this is known as the "grey zone" phase. These patients merit close
follow up with short-interval measurement of liver enzymes, liver fibroscan and biopsy may be considered.

Background: Preterm labor and related prematurity are predisposing factors that increase perinatal morbidity
and mortality. Acute phase reactants are inflammatory markers which are positive and negative reactants
explained by the reaction of reactants to the subclinical infection that are commonly associated with preterm
labor.
Objectives: To assess the role of acute phase reactants in pregnant women with preterm delivery.
Patients and method: A case control study conducted in Gynecological Department of Baghdad Teaching
Hospital from 1st February 2021 to 30th October 2021, on one hundred pregnant women with gestational age
(28weeks - 36weeks+6days) who attended outpatient clinic; fifty pregnant women with established preterm
labor as case group and fifty pregnant women with no signs and symptoms of preterm labor as control group.
Data was collected using structured questionnaire included demographic features, and biochemical parameters
(serum ferritin (ng/ml), albumin (gm/dl), fibrinogen (mg/dl), and calcium (mg/dl) .
Results: Mean±SD serum ferritin in control group was (46.2 ± 16.2 ng/ml) while in case group (52.47 ±
11.6ng/ml) with significant difference between both groups (P=0.03), mean±SD serum albumin in control group
(3.18 ± 0.31 ng/ml) while in case group (2.92 ± 0.39) with highly significant difference between both groups
(P<0.001). Validity test of serum ferritin at cutoff ≥ 52.7 (ng/ml) in case group was as follows: Sensitivity
(94%), specificity (90%), negative predictive value (94%), positive predictive value (90%) and the accuracy
was (92%). The validity test of serum albumin at cutoff ≤ 3.06 (gm/dl) to detect the preterm labor as follows:
Sensitivity (78%), specificity (86%), negative predictive value (78%), positive predictive value (83%) and the
accuracy was (84%). Mean±SD serum fibrinogen in control group was (400.9 ± 38.1) while in case group was
(410.7 ± 51.2) with no significant difference between both groups (P=0.1). Mean±SD serum calcium in control
group was (8.1 ± 0.7) while in case group was (7.92 ± 0.5) with no significant difference between both groups
(P=0.1).
Conclusion: serum ferritin and albumin can be used in prediction of preterm labor in 3rd trimester.

Background: One of the most important prognostic indicators in cancer is the lymph node dissection.
Lymphadenectomy considered as a risk factor for deep vein thrombosis in patients with gynecological
malignancy who underwent surgery. D-dimer was used to detect deep vein thrombosis, thus, it’s important
to predict complications of post-operative Lymphadenectomy.
Objective: To predict the risk of deep venous thrombosis by used serum D-dimer and wells score after
pelvic lymphadenectomy in gynecological cancer.
Patients and method: A cross sectional study conducted in Obstetrics and Gynecology/ ward in medical
city, from 1
st
, January 2021 to 30th
, Dec. 2021. A total number of 45 (22 endometrial, 12 ovarian and 11
cervical cancers).
Results: The mean±SD level of pre-operative D-dimer in patients with endometrial cancer was
(423.2±123.9) while the mean±SD post-operative level was (987±125.1), the mean±SD level of preoperative D-dimer in patients with ovarian cancer was (602±320.7) while the post-operative was (901.5±
412), mean±SD level of pre-operative D-dimer in patients with cervical cancer was (339±157) while the
postoperative was (1214±327), and the mean±SD level of pre-operative D-dimer in all gynecological
cancers was (541±167) while the post-operative was (1016±302). The mean±SD of wells score of those
who are likely to developed DVT (n=7) in pre-operative was (2.3±0.02) while for those who are unlikely
to develop deep vein thrombosis (n=38) was (2.03±0.4) with statistically significant difference (p=0.04)
while highly significant difference found in pre- and post-operatively between the group of deep vein
thrombosis (p˂0.001).
Conclusion: Highly significant increase of post-operative D-dimer in all gynecological cancer patients.

Background: Hypertension is a chronic illness that affects one billion people both in high and low-income countries and is the most common risk factor for death throughout the world. It is also responsible
for stroke, ischemic heart disease, heart and kidney failure in addition to its huge effect on the economy.
Like many developing countries, Iraq is undergoing a transitional epidemiological period with increasing
burden of hypertension and its contributing risk factors e.g. unhealthy diet, physical inactivity, obesity,
hyperglycemias, hypercholesterolemia, and smoking. In spite of the availability of a screening program
for the early detection of hypertension in primary health care centres (PHCCs) little data on hypertension
control is available.
Objectives: Assessing blood pressure control rate among Iraqi adults 18 years and older, and identifying
the related determinants.
Patients and Methods: The study is derived from the second round of Non-Communicable Diseases Risk
Factors STEPS survey Iraq 2016. A cross-sectional survey was performed on households from all Iraqi
governorates excluding three governorates suffering instability. A Multi-stage cluster sampling technique
for a sample of 4120 Iraqi adults was used. Interviews were held from the first week of November for 20
days using Arabic and Kurdish translated versions of STEPS questionnaire. A total of 4071 residents
participated.
Results: the prevalence of hypertension/ high blood pressure was 35.6%. Only 7.9% were under
medication and controlled with an evident sex-based difference in favour of women (9.3% vs. 6.6%
respectively). Uncontrolled blood pressure increased with age (t=7.4 p=<0.001), and declined with years
of education (t= -3.3 p=0.01). It was significant among subjects with hyper-triglycerides (X²= 4.07 p=
0.044), consumption of salty processed food (X²= 7.35 p= 0.007). Blood pressure was not controlled
among those reported being currently on medication (X²= 22.4 p= < 0.001).
Conclusions: Blood pressure control rate is low among Iraqi adults on medical and lifestyle management.
Further assessment and strengthening of clinical practice on hypertension management is recommended.

Background: Rheumatoid arthritis (RA) is an inflammatory disease of unknown etiology characterized
by joint inflammation and the presence of autoantibodies, mostly Anti-cyclic citrullinated peptide
antibody (ACCP) which are released when the body loses its ability to distinguish between self and
foreign molecules. Serum amyloid A2 (SAA2) is an acute phase protein produced in response to
inflammatory conditions including RA.
Objectives: To investigate the prognostic ability of SAA2 in comparison with ACCP and the prediction
of disease activity and response to treatment by Methotrexate and Etanercept in Iraqi RA patients.
Patients and methods: A case control study, on a total of 150 individuals; 100 patients and 50 healthy
controls. The study was carried out between November 2021 to February 2022 in Baghdad Teaching
Hospital. The patients were recruited according to the American College of Rheumatology 2010 criteria.
The biomarkers’ levels were measured by enzyme-linked immunosorbent assay.
Results: The levels of ACCP and SAA2 in RA patients were significantly higher compared to healthy
controls (p<0.001), and were higher among patients with active disease than those with inactive disease,
with the levels being higher in both categories than the healthy controls (p<0.00). Highly significant
ACCP levels were found in patients without treatment than those who have received treatment
(methotrexate or etanercept) (p<0.00). SAA2 level in patients without treatment were not significantly
different from those of patients who have received methotrexate (p>0.05) but significantly from those
who have received etanercept (p≤0.02). A significant positive correlation was found between ACCP and
SAA2 (r=0.553, p<0.001), with the sensitivity being (72%, 97%) and the specificity being (98%, 84%)
respectively.
Conclusion: ACCP and SAA2 have promising prognostic ability and disease activity prediction of RA
with response to treatment (Methotrexate, Etanercept)

:
Background: Cytokines have an essential contribution to the inflammatory response and the
development of chronic inflammation. Therefore, they have a pivotal role in the pathogenesis of
rheumatoid arthritis. Interleukins are closely related to rheumatoid arthritis, and the exact role of some
interleukins in the pathogenesis of rheumatoid arthritis is not yet known, such as IL-35, which has
suppressive activity, particularly in cancer and autoimmune diseases. As well as IL-39, which promotes
inflammatory responses and the activation of immune cells. Therefore, the aim of current study was to
evaluate the levels of interleukins 35 and 39 and their ratio in rheumatoid arthritis patients in Iraq.
Methods: ELISA was used to measure the levels of interleukins in the blood of 56 patients with
rheumatoid arthritis and 44 healthy volunteers who were enrolled in the study from November 2021 to
March 2022. The level of interleukins was statistically analyzed using the computer program Statistical
Package for Social Sciences (version 14).
Results: The serum levels of IL-39 in the rheumatoid arthritis patient groups were significantly higher
than in the control group (p = 0.043). In contrast, the level of IL-35 was slightly higher in rheumatoid
arthritis patients but not by significantly different values (p = 0.055). The cytokine ratio, IL-39/IL-35,
was the same for the groups, and there were no significant differences when comparing patients to controls
(14.30 ± 1.47 vs. 13.18 ± 0.71). In addition, IL-39 concentration levels were significantly higher in
rheumatoid arthritis patients under therapy than in rheumatoid arthritis patients with a first diagnosis and
without therapy.
Conclusion: Rheumatoid arthritis has been associated with an increased level of IL-35 and IL-39, so
assessment of the levels of these cytokines may be helpful in confirming rheumatoid arthritis activity

ackground: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is caused coronavirus disease
2019 (COVID-19) affecting people worldwide. The angiotensin converting enzyme2 (ACE2) represents a
receptor of SARS-CoV-2 on the infected host cell. Apelin or its receptor agonists suppress the production of
angiotensin-converting enzyme (ACE) and angiotensin II (Ang-II) and is characterized by a protective effect
against SARS-CoV-2.
Objective: The study aims to assess the serum level of Elabela biomarker as an early detector for Acute
Kidney Injury (AKI) in patients with COVID-19.
Cases and Methods: This is a case-control study which included 45 hospitalized adult patients in multiple
centers (public hospitals) receiving COVID-19 cases in Baghdad. These cases had a positive real-time or
reverse transcription polymerase chain reaction (RT-PCR) of nasal/oropharyngeal swabs. Excluded from the
study were those with a negative PCR and comorbidities and 43 apparently healthy adult subjects as controls.
The age range of the cases and controls was (20 to 60) years
Result: There are no a statistically significant differences between the two groups in terms of age and gender
distribution. Statistically significant differences were found in terms of eGFR, S. Creatinine, D. dimer,
NEU×103
/µL, LYM×103
/µL and ELA biomarker. Significant negative correlations were found between
Elabela with D. dimer and NEU×103
/µL, and between eGFR with S. creatinine, D. Dimer, and NUT×103
/µL.
Conclusion: The Elabela biomarker can be used for the early detection of acute kidney injury in COVID-19
patients.

Background: Infertility is recognized as the incapability of infertile couples to become pregnant following
one year of unsafe intercourse, with male factors accounting for roughly half of the documented instances.
Several reasons of male infertility factors have been reported; however, the actual cause in the majority of
cases remains unknown.
Objective: To study prospectively the outcome of N-acetylcysteine on semen parameters in males with
oligoasthenoteratozoospermia.
Patient and methods: A total 45 patients with idiopathic oligoasthenoteratozoospermia have received Nacetyl cysteine (NAC) for 12 weeks, their seminal fluid parameters were measured at the baseline and after
12 weeks.
Results: The results showed that after 3 months of NAC treatment, the motility was statistically significantly
higher than pre-NAC baseline, with no statistically significant differences in both count and morphology.
Conclusion: These results confirmed that NAC has a positive effect in improving motility in infertile men
and thus resulting in better spermatogenesis and sperm function

Background: Colorectal cancer (CRC) is the third most prevalent cancer worldwide with 1.80 million new
cases and 862,000 deaths in 2018. Depending on the stage, upfront surgery is the main form of treatment,
followed by adjuvant chemotherapy. Many drugs were approved by the U.S. Food and Drug Administration
for the treatment of CRC, one of which is Capecitabine. During cancer treatment, patient-reported symptoms
and quality of life parameters can provide additional information to evaluate and compare the efficacy and
toxicity of the treatments. Despite the importance of this issue, there is no published data that evaluates this
vital parameter in Iraqi patients receiving anti-cancer drugs, in general, or those on Capecitabine, in particular.
Objective: To evaluate the relationship between quality of life in capecitabine-treated colorectal cancer
patients and their sociodemographic characteristics as well as drug-related adverse effects.
Methods: A cross-sectional, open-label study was conducted at Al-Amal and Oncology Teaching Hospitals
in Baghdad during the period from November 2021 to June 2022. A convenient sampling method was adopted
to enrol patients in the current study. Quality of life assessment was performed using the European
Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30). Microsoft Excel
2019 and the Statistical Package for the Social Sciences (SPSS, Version 25) were used for data entry and
analysis. The descriptive analysis focused on frequencies and percentages. Continuous variables were
presented as (mean ± Standard Deviation). Categorical data were presented as proportions and the Chi-squared
test was used to study the associations between variables. The level of significance was considered at P≤0.05.
Results: A total of 102 patients were enrolled in the current study. Generalized fatigue was the most common
adverse event (63.7%) of participants. Only 6.9% of participants had abnormal renal function tests. Some
capecitabine-treated patients had good quality of life, others did not.
Conclusion: The quality of life of capecitabine-treated colorectal cancer patients seems to be sensitive to their
sociodemographic characteristics and adverse effects of the drug

Background: The prevalence of multidrug-resistant bacteria and their contribution to increased morbidity
and mortality due to the difficult-to-treat diseases caused by these bacteria, has demonstrated a need to
develop and use alternative antimicrobial agents to control multidrug-resistant bacteria. There has been a
growing interest in medicinal plants and herbs and their extracts for the discovery of new natural
therapeutic alternatives. Therefore, this current study aimed to know the antibacterial activity of aqueous
and alcoholic extracts of the Sumac (Rhus coriaria L) fruits against multidrug-resistant clinical bacterial
isolates and the effect of these extracts on biofilm production as an important virulence factor.
Materials and Methods: The Sumac (Rhus coriaria L) plant was selected for this study, and aqueous
and alcoholic extracts were prepared from its fruits. They were tested against four multi-antibiotic
resistant bacterial isolates that produce biofilms (Gram-positive and Gram-negative), namely
Staphylococcus aureus, Enterococcus faecalis, Acinetobacter baumannii, and Pseudomonas aeruginosa
which were isolated from Iraqi patients with wounds and burns in Medical City hospitals.
Results: The current study proved that the aqueous and alcoholic extract of Sumac ( Rhus coriaria L )
fruit is effective as an antibacterial and anti-biofilm against the studied multidrug-resistant bacterial
isolates at all tested concentrations with significant differences. The study also showed that the alcoholic
extract is more effective as an anti-bacterial and anti-biofilm than the aqueous extract of the Sumac.
Conclusion: The current study provides valuable results for the use of extracts of medicinal plants and
herbs, including sumac extracts, to treat pathogenic bacteria that have become more resistant to
antibiotics. These plant extracts also contain natural compounds that can be used without causing any
harmful effects on patients

Background: Anemia is a serious global public health problem that particularly affects pregnant women.
Objectives: The objectives of the study were to find out the prevalence of anemia and its associated risk
factors among supplemented and non-supplemented pregnant women.
Cases and methods: Six hundred and forty-one blood samples were collected through simple random
sampling from pregnant women and controls. The collected data from the participants included age,
education, residence, and obstetrical related factors, and blood samples were taken for blood tests.
Results: One hundred and sixty-four (74.2%) and 73 (34.9%) of non-supplemented and supplemented
pregnant women respectively were found to be anemic. Age of pregnant women, gestational age, high
gravidity, employment status, level of education, body mass index, daily activity, and blood pressure were
significantly associated with anemia in the supplemented group. However, in the non-supplemented group
only gestational age and high gravidity factors were significantly associated with anemia. There were
significant differences between the rate of anemia among supplemented and non-supplemented pregnant
women in all factors except birth intervals. The frequencies of low serum ferritin level among nonsupplemented and supplemented anemic pregnant women were 137 (83.5%) and 45 (61.6%) respectively.
Conclusion: The prevalence of anemia was very high among non-supplemented compared to
supplemented pregnant women in Sulaimani city in Kurdistan-Iraq. The risk factors that were associated
with anemia were: Age of pregnant women, gestational age, high gravidity, employment status, level of
education, body mass index, daily activity, and blood pressure.

Background: The most typical consequence of diabetes mellitus is diabetic retinopathy. An important part
of the etiology of diabetes and diabetic retinopathy is played by oxidative stress. Malondialdehyde is a
dialdehyde that is moderately toxic and is frequently used as a marker for oxidative stress as well as lipid
peroxidation.
Objectives: To assess the serum malondialdehyde levels in diabetic patients with and those without
retinopathy and to compare these levels to controls .In additions to, investigate the relationship between serum
malondialdehyde level and long glycemic control, the glycated hemoglobin (HbA1c).
Patients and Methods: This case-control study included (120) individuals from 40 to 70 years of age. They
were divided into three groups: Group 1: 40 type 2diabetic patients with retinopathy, Group 2 :40 type 2
diabetic patients without retinopathy, and Group 3 40 controls .The biochemical testes included fasting blood
glucose measured by Cobas c 311 systems, glycated hemoglobinHbA1c measured by Cobas c 111 systems,
and serum malondialdehyde (MDA) measured by enzyme linked immunosorbent assay (ELISA).
Results: A higer mean value of (MDA) was found serum diabetic patients with and without retinopathy as
compared to control (p=0.0001). As well as a significantly higher mean value of serum (MDA) in diabetic
patients with retinopathy as compared to those without (p=0.0001).A significant positive correlation was
found between serum(MDA) and HbA1C in diabetic patient with retinopathy group (r=0.931,p=0.0001) .
Conclusion: Higher serum levels of malondialdehyde is an indicator of increased lipid peroxidation that may
be involved in pathogeneses of retinopathy in uncontrolled type 2 diabetic patients.