Journal of the Faculty of Medicine Baghdad

Background: Neonates who are admitted to hospitals will need various drugs. The use of unlicensed or off-label drugs without scientific evidence makes this exposure unsafe.
Aim of study: We aimed to assess the use of drugs for neonates based on the British National Formulary for Children and IBM Micromedex Neofax.
Patients and methods: This is a descriptive study which reviewed the clinical files of enrolled neonates who have stayed in the hospital for more than 24 hours and received at least one drug. It was conducted in the neonatal care unit of the Children Welfare Teaching Hospital/ Medical City Complex in Baghdad during the period from 1st of January to 30th of June/2018. The data was entered on a predesigned format and analyzed by using the appropriate statistical methods.
Results: A total number of 1079 neonates were admitted to the NCU during the study period, of whom 967 were included in the current study with 597 (61.7%) males and 370 (38.3%) females. There were 424 (43.8%) preterm, 496 (51.3%) term and post term neonates, and 47 (4.9%) neonates with unknown gestational age. Different classes of drugs were used with a total of 56 drugs, of which 33.9% were unlicensed and 66.1% were off-label. Accordingly, 42.5% of the neonates received unlicensed drugs and almost all patients received at least one off-label drug. Major risk factors for such use include mechanical ventilation, male sex and prolonged hospitalization.
Conclusions: In hospitalized neonates, drugs were more frequently prescribed as an off-label rather than unlicensed. Almost all neonates were exposed to off-label formulations.

Background: The demographic characteristics of Iraqi patients with metabolic syndrome (MS) and presenting with acute coronary syndrome (ACS) have been scarcely studied before.
Aim of the studyTo study the socio-demographic characteristics of a group of Iraqi patients with MS presenting with ACS. Patients and Methods: A convenience sample of 150 cases presenting with ACS and admitted to the coronary care unit (CCU) of Al-Yarmouk Teaching Hospital in Baghdad from mid-January through July 2011 were included in the current cross-sectional study. The data needed for the study was collected through a direct interview to fill a questionnaire for all cases carried out by a consultant physician.
Results: Of all the 150 ACS cases included in the study, 69.3% had MS. The prevalence of MS among males was 63.8%, and among females was 78.6%. The most frequently seen age group was 50-59 years. Gender differences in MS patients were statistically significant regarding Residence (Urban: 63.3% M, 84.1% F), educational level (illiteracy: 15% M, 52.3% F, high education: 25% M, 4.5% F), and employment (Employed: 50% M, 22.7% F). Males with MS and ACS had more myocardial infarction (MI) (80%) than unstable angina, compared to females (41% MI), with statistically significant associations.
Conclusion: The prevalence of MS in Iraqi ACS cases is high, and among them, MI was significantly higher in Males

Background: Differentiating flow gaps associated with hypoplastic transverse sinus from venous thrombosis
is a diagnostic challenge in brain magnetic resonance imaging with venography.
Objective: To assess the clinical benefit of anatomical signs to anticipate the side of the dominant transverse
sinus.
Patients and Methods: A total of 100 patients underwent brain magnetic resonance imaging with venography
at the radiology department /medical city and were retrospectively reviewed for the direction of superior
sagittal sinus flow void, inclination of sulcus for the superior sagittal sinus, angulation of the posterior falx
and direction of occipital lobe bending in axial non-contrast T1 weighted image, then compare these findings
with a side of the dominant transverse sinus in magnetic resonance venography.
Results: Inclination of sulcus for superior sagittal sinus and superior sagittal sinus flow void direction toward
the right side had high positive predictive values (95.5%) and (93.2 %) in proper matching with the right
transverse sinus dominance, respectively. Right-sided angulation of the posterior flax and rightward direction
of the occipital lobe had a positive predictive value of (90.9 %) in predicting transverse sinus dominance.
Conclusion: The side of dominant transverse sinus can be anticipated by reviewing anatomical signs in T1
weighted image, which may help to differentiate hypoplastic transverse sinus from venous thrombosis that
aid in better interpretation of brain MRI- MRV examinations

Background: Bone mineral density has been assessed using Dual-Energy X-Ray Absorptiometry. Bone mineral density is measured according to the results of the Dual-Energy X-Ray Absorptiometry examination of the vertebral column and pelvis. Although diabetes mellitus type II (DM) is known to affect bone mineral density, at the present time this particular relationship is not clear.
Aim of the study: The aim of the current study was to evaluate the effects of type II diabetes mellitus on bone mineral density of the upper and lower limbs as well as gender differences.
Patients and Methods: This study involved 165 patients complaining of bone pain (85 males and 80 females), 85 patients of who suffered from diabetes, involving both genders. In addition, 90 apparently healthy volunteers had been studied and were considered to constitute the control group. All individuals (255) were studied regarding their bone mineral density via Dual-Energy X-Ray Absorptiometry for all parts of the body.
Results: The Dual-Energy X-Ray Absorptiometry exam revealed highly statistically significant differences between the sides of the body in the same person. In addition, there were significant differences in bone mineral density between females and males, as well as between the control and patient groups with type II diabetes mellitus.
Conclusion: Our results indicated that the bone mineral density of women was less than that in men in all cases (normal, osteoporosis, and diabetes mellitus type II (DM) with osteoporosis). Other results obtained from this research revealed that diabetes mellitus type II (DM) can be considered to be one of the major causes of osteoporosis in the general population

Background: health insurance system covers medical expenses by a third party. The Iraqi Health Insurance
Law (IHIL) has been approved in 2021. Most insured patients should pay a co-insurance of 25% for
prescriptions, lab tests, X-rays, and medical dental services and pay 10% of the physician visit fees.
Aim of the study: The aims of study were to explore the physicians' insights toward the impact of the
prospective implementation of the Iraqi Health Insurance Program (IHIP) on patients, healthcare providers
(HCPs) and services, and to identify the potential challenges facing its implementation.
Method: This is a qualitative study based on semi-structured face-to-face interviews with specialist
physicians from different disciplines (Internal medicine, family medicine, cardiology, orthopedic, oncology,
gynecology, general surgery, pediatrics and dentistry). The interview guide included open-ended questions
about the impact of the IHIP on patients and HCPs at three levels: quality of services, costs, and frequency of
visits. Potential challenges were also discussed. Interviews were conducted in six provinces from April 19th
to August 31, 2022. Thematic analysis was used to analyze the interview findings and generate themes and
subthemes.
Results: The study recruited 26 physicians till the saturation point has been reached. Only sixteen of the
participants were aware of the IHIP. Most participants believed that the program could enhance patient health
and would increase the income of HCPs in the private sector. They also expected that patients would use
private-sector services more frequently. Additionally, the implementation of the health insurance can improve
the quality of healthcare services and reduce the financial burden regarding private sector fees. The potential
challenges of the program implementation include mismanagement, provision of comprehensive medical
services to insured people, overuse of the plan by the insured patients, convincing non-governmental
employees to join the health insurance plan and potential delays in the reimbursement to HCPs.
Conclusions: The study indicated several main themes and subthemes of physicians’ insight regarding the
national health insurance. The IHIP has several potential advantages, but at the same time, it can face several
technical challenges. Thus, the program should be well studied before being implemented, and it needs to be
piloted at a small scale before national implementation. Electronic health system must be adopted to facilitate
transferring data to health insurance authority. Hiring international experts to help managing the medical
claims is pivotal to avoid delaying in the processing. Finally, the Health Insurance Authority (HIA) needs to
raise the awareness of HCPs and people about the national health insurance plan.

Background: One of the most frequent bacterial infections is urinary tract infections, both in
public and in medical settings. It is vital to employ new techniques to overcome drug resistant
bacteria, which has emerged as one of the major health issues facing the world. Medicinal plants
(Medicago sativa) are recognized as one of the most abundant sources of antibiotics in this
regard.
Aim of the study: To evaluate the antibacterial effect of the fraction of ethyl acetate of Medicago
Sativa extract against Escherichia coli isolated from urine samples of patients with urinary tract
infections.
Materials and methods: In the current study, 85 urine samples were taken from patients
attending one of the teaching hospitals in the Medical City complex in Baghdad. The study was
conducted between December 2021 and May 2022. The urine samples were cultured using semiquantitative culture techniques, and conventional microbiological methods were employed to
identify the bacteria. The method of Kirby-Bauer Disk diffusion was used to determine the
susceptibility to antibiotics. The antibacterial effect of Medicago Sativa was tested by preparing
Medicago sativa crude extract in 85% ethanol in the Soxhlet apparatus. The extract is then
fractionated into ethyl acetate fraction, then the effectiveness against uropathogenic E. coli was
tested at different concentrations (25mg/ml, 50mg/ml and 75mg/ml).
Result: Of the 85 UTI patients from whom the urine samples were taken, 60% were females and
40% were males. The majority of the cases were under 40 years old (56.7%). All isolates showed
complete meropenem sensitivity. The extracts from Medicago Sativa showed significant
antibacterial activity against E. coli.
Conclusion: Medicago sativa extracts have an excellent opportunity as an antibacterial agent to
uropathogenic E. coli, according to the findings of the current investigation.

Background: Metabolic syndrome is a complex series of metabolic defects, characterized by high levels of
serum glucose, hypertension, abdominal obesity, and dyslipidemia. The high mobility group AT-hook1, an
architectural transcript factor, affects the homeostasis of glucose. No previous studies have been performed
to examine whether HMGA1 can be secreted into the extracellular milieu.
Aim of the study: this case-control study aimed to examine whether HMGA1 secretes into the extracellular
milieu and compares its serum level in two groups of metabolic syndrome (with and without diabetes) and a
control group composed of apparently healthy individuals of Iraqi population with different nationalities.
Patients and Methods: Sixty-one patients with metabolic syndrome and thirty healthy Iraqi participants
included in this study. Serum HMGA1 concentrations were determined by enzyme linked immuno sorbent
assay (ELISA). Lipid profile, serum (glucose and insulin), HbA1c, systolic/diastolic blood pressure, body
mass index, and waist circumference were also measured. The statistical analysis was done using IBM SPSS
software for Windows version 26.0.
Results: Significant difference in HMGA1 level was seen (P = 0.000), between metabolic syndrome with
diabetes, metabolic syndrome without diabetes and control group. Higher concentrations were seen in
metabolic syndrome patients with diabetes followed by metabolic syndrome patients without diabetes and
then the control group, and no significant difference was seen in the serum level based on nationality.
Significant positive correlation was found between HMGA1 and fasting blood glucose (p=0.001) as well as
between HMGA1 and HbA1c (p= 0.015) in patients with metabolic syndrome. Moreover there was a
significant association between HMGA1 levels and the risk of metabolic syndrome. The risk of metabolic
syndrome was found to be increased by a high HMGA1 level, odds ratio (OR), 0.411 (95% CI, 0.208-0.813).
Conclusions: This case-control study found that circulating HMGA1 concentration was significantly higher
in Mets mainly in those with T2DM. Also, the high concentration of HMGA1 was found to present a
significant risk of metabolic syndrome regardless of whether diabetes is present or not. Besides HMGA1
serum level was positively correlated with parameters of diabetes including HbA1c and FBG.

Background: Hypertension with smoking is a chronic medical condition that impacts the humans’ health.
It has been proved that it could be a significant risk factor for different disorders like brain damage, the
lungs disease and has been related to the growth of oral diseases. However, there are few and conflicting
research on its effect on salivary electrolytes concentrations.
Aim of the study: To assess the effect of hypertension with and without smoking on electrolyte
concentrations in saliva and to identify its effect on normal oral balance.
Methods: A total number of 90 subjects included, which is comprised of (49) (54.4 %) males subjects and
(41) (45.6 %) females subjects in the gender. They were divided into three groups, G1, G2 and G3 groups.
Group 1 comprised 30 subjects of hypertension with smoking, Group 2 comprised 30 subjects of
hypertension without smoking and Group 3 comprised 30 subjects of healthy non-smoking controls.
Results: Findings displayed a highly significant difference in concentration of calcium in saliva and there
was no significant difference in potassium and sodium for the three groups. There was a significant
difference of calcium in saliva concentration for all study group with respect to P-Value (0.000).
Conclusion: The salivary calcium concentration in the saliva can be affected by hypertension with smoking
and the increase in salivary calcium levels might be a risk factor for development of periodontal diseases.

Background: Luliconazole, a newer class of imidazole anti-fungal agent, is very effective against
several species of fungi, especially dermatophytes. It has very low aqueous solubility acting as barrier.
for topical delivery and limiting its dermal availability.
Aim of the study: This study aimed to formulate luliconazole oil/water nanoemulsion by the aqueous
titration method.
Methods: Solubility study resulted in selecting peppermint oil, tween 80 and transcutol p as oil phase,
surfactant and cosurfactant respectively, although pseudoternary phase diagram construct nanoemulsion
area for picking formulations. Fifteen o/w nanoemulsion formulations prepared and characterised for
droplet size, polydispersity index, pH values, percent transmittance, luliconazole content. Among
formulations, eight preparations introduced to enhance the viscosity of prepared nanoemulsion by
combining 0.5% carbopol 934 as gelling agent.
Results: The selected preparations demonstrated homogeneous nanoemulgels with pH values
appropriate for skin application and accepted luliconazole content. Viscosity results manifested nonnewtonian pseudo plastic behavior with shear-thinning viscosity profile. In vitro release studies revealed.
dissimilar release profile (f2˂50) than that of pure luliconazole dispersion. The results revealed that the
formula NG-1 with oil: Smix(2:1): water (15:40:43.5) ratio containing 1% drug and 0.5% carbopol 934
was the optimized formula with excellent spread ability.
Conclusion: The study concluded that nanoemulsion-based gel is contemplated an encouraging and
proceed technique for the topical preparation and upgrade solubility, dissolution rate and permeability.
of insufficient water-soluble drugs across the skin

Background: Toxoplasmosis is a common zoonotic disease affecting one-third of the world population with
potentially serious health implications.
Aim of the study: To find the prevalence and risk factors of Toxoplasma gondii infection among females in
Al-Anbar, Iraq.
Methodology: Over an eight-month period from (1
st November 2021 to 30th June 2022), 200 females visiting
private veterinary clinics in Al-Anbar (92 owned cats) participated in this prospective study. Age and
residency were recorded. Blood samples were collected from all females and subjected first to the Toxoplasma
Latex Agglutination test (TLAT). Samples of cat feces were collected from 57 (62%) pet and 35 (38%) stray
cats and subjected first to direct microscopy looking for Toxoplasma oocysts. Blood and fecal samples were
then tested by nested polymerase chain reaction (n-PCR) and real-time PCR. Results were then statistically
analyzed.
Results: Rates of human toxoplasmosis were (n=48, 24%), (n=60, 30%), and (n=77, 38.5%) with TLAT, nPCR, and RT-PCR tests respectively. Likewise, rates of cat toxoplasmosis were (n=7, 7.6%), (n=55, 60%),
and (n=80, 87.0%) with TLAT, n-PCR, and RT-PCR tests respectively. Results of the latex test revealed that
females >40 had a high rate of infection (45.8%) compared with those aged 31-40 years (33.8%) and those
aged 21-30 years (13.0%) (P≤0.01). City resident females had a lower infection rate compared to village
residents (29.7% vs. 55.4%).
Conclusions: Toxoplasmosis was more prevalent in females >40 from rural areas but wasn’t related to contact
with cats. Real-time PCR provided a better diagnostic yield

Background:-Streptococcus pyogenes is an exclusively human pathogen. This bacterial species is
responsible for a large variety of infections.
Objective: This review identified published articles on the risk factors, prevention and control strategies
for streptococcus diseases.
Material and methods: A systematic search was carried out to identify papers published on the Web of
Science, PubMed, Scopus, and Google Scholar electronic databases in an attempt to provide basic
information about Streptococcus infections, potential risks for their spread, and treatment and prevention
strategies.
Results: The more common methods for Streptococcus pyogenes transmission are through respiratory
droplets, skin lesions brought on by Streptococcus pyogenes contact with infected objects or devices.
Another potential mode is foodborne transmission but more research is needed to determine this infection
route. Native communities, and those of low socio-economic status worldwide were found particularly
susceptible to Streptococcus diseases, as well as children, older adults and those with impaired immune
system. Those groups are susceptible to Streptococcus pyogenes infections and their complications with
higher infectious rates in educational institutions, hospitals, over-crowding and the continuous increase
in social contact. The importance of improving living conditions and personal and hand hygiene is one of
the techniques in the management and prevention of Streptococcus pyogenes infections. Infection control
methods must be highlighted with greater precision.
Conclusion: Prevention and control measures should target the improvement of living conditions, and
personal and hand hygiene. Adherence to infection prevention and control practices should be emphasized
in high-risk settings.

Background: Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine illnesses affecting reproductive - age women. L-carnitine has important roles in oxidative stress, energy production, and glucose metabolism. It affects insulin resistance as decreased plasma carnitine level has been well reported in type II diabetes mellitus. Hence, it means L-carnitine may reduce insulin resistance which is found in PCO disease.
Aim of the study: This study aims to measure the level of L-carnitine and insulin resistance in both obese and non- obese patients with PCOS.
Patients and Methods: Sixty women within the reproductive age with PCOS (30 obese and 30 non- obese) were recruited from the Gynecology and Obstetrics Outpatient Clinic in Baghdad Teaching Hospital from June 2016 to June 2017. The data collected for each case included: Height, weight, waist circumference, blood pressure, obstetrical, medical, and medication history as well as ultrasound results. A physical examination was done to evaluate the clinical signs of hyperandrogenism. Biochemical measurements included fasting blood sugar, leutinizing hormone, follicular stimulating hormone, Testosterone and lipid profile were measured together with total L-carnitine (using L-Carnitine Assay Kit Sigma-Aldrich Co.). Insulin resistance was diagnosed according to National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III). PCOS is diagnosed according to the Rotterdam criteria.
Results: This study revealed that insulin resistance (IR) was present in 51.7% of PCOS patients, which was higher in obese PCOS patients (73.3%) than in non-obese (30%). Age of patients, serum cholesterol, LH, and FSH were not related to IR. High mean BMI, waist circumference, FBS, and triglyceride were significantly associated with IR (p < 0.05), while low serum HDL and L-Carnitine were associated with IR (p < 0.05). The mean serum total L-carnitine in this study was 34.03μmol/L. Obese women had lower carnitine levels than non-obese women and low serum L-Carnitine was associated with IR. Serum triglyceride, FBS and testosterone were correlated negatively with serum L-carnitine (p < 0.05) and serum HDL correlated positively with serum L-carnitine (p value = 0.001).
Conclusions: The mean value of serum total L-carnitine among the non-obese PCOS women was higher than among the obese ones. Low serum L-carnitine is associated with insulin resistance