Mustansiriya Medical Journal

Alzheimer’s disease (AD) and major depression (MD) are frequent diseases with a significant impact on the quality of life, and epidemiological
studies show a correlation between early depressive episodes and AD. Although apparently different, they nonetheless maintain significant
similarities, such as the common genetic substrate, involvement of similar structures, and a number of common pathogenetic hypotheses. This
in‑depth literature review aims at highlighting possible linkages between the two diseases: A chronic inflammatory process that selectively
alters the blood–brain barrier in certain regions can be hypothesized.

Background:
Vagus nerve stimulation has been broadly known as one of treatment lines for refractory epilepsy, especially in poor applicants for resection surgeries or in whom resection has failed. Its use for different seizure-types control is increasing.

Aims:
We aimed to assess the efficacy of Vagal nerve stimulation (VNS) therapy outcome predictive aspects utilizing subgroup analysis.

Materials and Methods:
From 2008 until 2016, 183/190 refractory epilepsy cases with specific inclusion criteria were selected. All underwent pre- and postimplantation assessment of response utilizing Engel criteria and Chalfont seizure severity scoring system for 2 years. Descriptive and statistical data analysis was accomplished for the data of age at epilepsy start and VNS insertion, seizures nature, device stimulation parameters, and peri-surgical antiepileptic medicines.

Results:
At 12 months follow-up period (29.5%), patients were assigned to a Class I and II outcome (representing very good seizure outcome) especially among patients with G. T. C seizure. 38.8% had a “worthwhile” improvement and consigned as Class III outcome mostly among P. S. G patients. The response was better at 24 months’ follow-up period. Patients <10 years of age with pre surgery mean duration of epilepsy of 10 (+5) years and mean age at onset of epilepsy of 7 (+5) years showed better response. Mean seizure frequency reduction was 69.8% (+18).

Conclusions:
Stimulation parameters needed was lower for class I and II with significant reduction of required anti-epileptic drugs (AED). Our study may help to provide response predictive characteristics.

Background:
This study investigated the potential role of ivabradine (Nebivolol and Atenolol) in the attenuation of doxorubicin induced cardiotoxicity in mice. So we will seek the role of nebivolol and atenolol in reducing cardiotoxicity induced by doxorubicin in this experimental study.

Aims:
To investigate the potential roles of nebivolol and atenolol in the attenuation of doxorubicin (DXR)-induced cardiotoxicity in mice.

Materials and Methods:
A total of 42 Swiss-Albino male and female mice were used, which were divided into six equal groups: A negative control, a group 1 not received any agents, group 2 (DXR group) received a single dose of DXR 15 mg/kg, treated group 3 was pretreated with nebivolol 15 mg/kg plus DXR. Treated group 4 was pretreated with nebivolol 30 mg/kg plus DXR. Treated group 5 was pretreated with Atenolol 45 mg/kg plus DXR, and treated group 6 was pretreated with atenolol 90 mg/kg plus DXR. The duration of the study was 10 days. Inflammatory biomarkers including tumor necrosis factor-alpha (TNF-α), lactate dehydrogenase (LDH), malondialdehyde (MDA), and cardiac troponin (cTn-I) serum levels were measured. SPSS version 28.00 was used for data analysis.

Results:
TNF-α, LDH, MDA, and cTn-I serum levels were higher in the DXR-treated mice as compared to the control (P < 0.05). Nebivolol and atenolol produced a dose-dependent effect in the reduction of TNF-α, LDH, MDA, and cTn-I serum levels as compared to the DXR-treated mice (P < 0.05).

Conclusion:
Atenolol and nebivolol were effective agents in the mitigation of DXR-induced cardiotoxicity by their anti-inflammatory effects of both atenolol and nebivolol and antioxidant effects of nebivolol. Atenolol and nebivolol illustrated a dose-dependent effect in the attenuation of DXR-induced cardiotoxicity through inhibition of lipid peroxidation and cardiomyocyte injury.

Background:
Hepatitis C virus (HCV) has the ability to change cellular messenger RNA transcription and translation by stimulating the synthesis of cellular microRNAs (miRNAs) that impair immune response and facilitate viral reproduction. One of the most important members of the immune response against HCV is nuclear factor-kappa B (NF-κB), which is regulated by cellular miRNAs.

Aims:
we aimed to investigate the correlation of NF-κB serum level with circulatory miRNA-221 (miR-221) fold change in HCV-exposed individuals.

Materials and Methods:
Serum level of NF-κB in 88 samples (22 patients with persistent HCV infection, 22 individuals with spontaneous HCV virus clearance, 22 individuals treated with direct-acting antivirals (DAAs) drugs, and 22 uninfected apparently healthy blood donors as control) was measured by enzyme-linked immunosorbent assay. Reverse transcriptase–polymerase chain reaction was used to quantify the expression fold of circulatory miR-221.

Results:
The results showed that there was a significant decrease in the mean level of NF-κB at P < 0.000 among HCV-exposed patients (2.0058 ng/ml) as compared to the control group (2.9841 ng/ml). The mean fold change of miR-221 was significantly upregulated about six more times among HCV-exposed patients (mean = 6.3545) compared to the control group (mean = 1.1864). Furthermore, the mean ± standard deviation of miR-221 fold change in patients with persistent HCV infection was significantly higher compared to patients cured after DAA therapy (P = 0.048), there was a weak negative correlation (r = −0.246, P = 0.021) between NF-κB serum level and miR-221 folding level.

Conclusion:
HCV infection disrupts NF-κB activation, resulting in dysregulation of miR-221 that persists long after the virus has been cleared. Thus, quantification of serum NF-κB and miR-221in HCV-exposed patients could be used as noninvasive prognostic marker during long-term follow-up. Furthermore, a miRNAs profile analysis can help distinguish HCV-exposed from healthy individuals.

Background:
constrictive pericarditis may cause scarring and consequent loss of the normal elasticity of the pericardial sac. It is caused by idiopathic, viral, following cardiac surgery, radiation, connective tissue disorder, postinfectious (tuberculous or purulent pericarditis), or miscellaneous causes (malignancy, trauma, drug-induced, asbestosis, sarcoidosis, and uremic pericarditis). It is mostly presented by shortness of breath (SOB) due to right-sided failure. Surgical procedure is the cornerstone of management by doing pericardiectomy.

Aim of the Study:
This study aimed to review the surgical management of constrictive pericarditis and its surgical outcome.

Materials and Methods:
A retrospective study involved 13 patients with constrictive pericarditis in the Iraqi-cardiac surgery center in Iraqi-Cardiac Surgery Center in Baghdad Medical Complex and Ibn Al-Bitar center for cardiac surgery from 2011 to 2015. Eight (61.5%) of them were female, and the rest (38.5%) were male. Their ages ranged between 10 and 32 years old (the mean age was 21 years). The data were collected from the medical records of the patients.

Results:
The majority of patients were in the age group of 20–29 years (46.1%). The youngest was 10 years old. Dyspnea on exertion was the most presenting feature (61.5%). In the electrocardiogram, atrial fibrillation was found in three patients (23.2%), and a chest X-ray showed calcium deposition at the pericardium in eight patients (61.5%). Cardiac catheterization (right-sided) and transthoracic echo study also demonstrated the findings of the disease. None of the patients needed the by-pass machine. The biopsy results revealed that tuberculosis (TB) was the most frequent cause of pericarditis.

Conclusion:
Pericardiectomy is a useful surgical procedure to treat constructive pericarditis, and it was beneficial to all patients in this study, with improvement in their functional capacity. Another finding of significance is that despite intensive vaccination and the use of anti-TB drugs in our country, TB is still an important cause of constrictive pericarditis.

Background:
The pathogenesis of pulmonary hypertension (PHT) associated with renal failure is complex. It includes metabolic and hormonal changes, high cardiac output due to arteriovenous fistula (AVF), anemia, and other factors.

Objectives:
The objective is to identify PHT frequency and associated factors in patients on hemodialysis (HD) compared to patients, not on HD.

Methods:
A cross-sectional study was conducted at Ibn Sena teaching hospital/Mosul and included 100 diabetic males with end-stage renal disease on HD (Group 1) compared to 96 diabetic males (of similar age) with chronic kidney disease but not on HD (Group 2) to assess the pulmonary artery pressure using Doppler echocardiogram. Patients with other causes of PHT such as heart failure and chronic lung disease were excluded from the study.

Results:
42 (42%) of patients in Group 1 had PHT and 12 (12.5%) patients in Group 2. There were statistically significant differences between patients with and without PHT regarding ejection fraction (EF), but no significant differences regarding age, duration of dialysis, hemoglobin (Hb), and vascular access type in both groups.

Conclusions:
EF had a relationship with PHT, whereas the duration of dialysis, age of patients, Hb, and dialysis access type had no relationship to PHT.

Recommendations:
More studies are needed in our country regarding PHT in patients with variable stages of renal disease with larger sample sizes and different designs with the inclusion of data and parameters that were missing in our study such as duration of AVF creation.

Background:
Thyrotoxicosis is a clinical status due to hypersecretion of thyroid hormones by diffuse goiter (Grave’s disease [GD]), multinodular goiter, single toxic adenoma, and pituitary adenoma secreting thyroid-stimulating hormone (TSH) rarely. GD: It is diffuse toxic goiter (GD) or (Basedow disease) it is a triad of: Diffuse toxic goiter, hyperthyroidism, and exophthalmos (proptosis).

Aims:
1. Positivity of TRAb and TPO in thyrotoxic subjects. 2. Correlation of the titer of these antibodies with the clinical status of the patients. 3. Correlation between TRAb and TPO titer. 4. To find out if TPO titer on enrollment has any correlation with the clinical status of the patients.

Methods:
A cross-sectional study conducted in the National Diabetes Center–Mustansiriyah University in the period from November 2021 to April 2022 where 93 patients with GD are enrolled to check their thyroid status and check some biochemical variables in their sera as thyrotropin receptor antibody (TRAB), thyroid peroxidase (TPO) antibody, TSH, and free thyroxine (FT4). 44.6% are women and 35.7% are men, at the time of recreuitment 49.4% are toxic while the remaining 58.6% are euthyroid being on anti thyroid drugs. 87 persons are recruited as normal euthyroid, they are sex and age-matched, the control TRAb were negative.

Results:
GD patients are as follows: 54 (58.06%) euthyroid and 39 (41.94%) toxic at the time of recruitment. Eighty-two percent of toxic patients have goiter and 74.07% of euthyroid GD patients have goiter. Ophthalmopathy is found in (64.1% of toxic GD patients and 42.59% of euthyroid GD patients. TPO median in the control, toxic, and euthyroid GD patients is (22.76%), (75%) and (63.5%) (highest among toxic GD patients) (P < 0.001). TSH in the control group has a mean of (2.18 ± 1.72) and a median of (1.89). The TRAb is the highest in toxic GD patients, followed by euthyroid GD patients and the least in the control, its mean is (9.98 ± 8.42), (7.24 ± 7.8) and (0.93 ± 0.15), respectively. It is recommended to conduct a longitudinal study in which patients with GD are checked at variables times in the course of illness (remission and relapse) studying these biochemical and immunological markers in these variable states of thyroid function.

Conclusion:
Ninety-three thyrotoxic patients, 39 are toxic and 54 are euthyroid on arrival. Eye sings are more in toxic patients, goiter and eye signs are predictor of GD, TRAb is the highest among toxic patients, TPO are higher among GD patients versus the control.

Background:
Toxoplasmosis is a disease caused by an obligatory intracellular protozoan parasite (Toxoplasma gondii). Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is a protein receptor that acts as an immunological checkpoint and reduces immune responses.

Aims:
The present study aimed to evaluate the expression of CTLA-4 protein in women with different toxoplasmosis stages and observed its role in the occurrence of abortion.

Materials and Methods:
Anti-Toxoplasma immunoglobulin M (IgM) and IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA) test in the sera of 116 patients with toxoplasmosis (46 aborted infected groups, 35 pregnant infected groups, and 35 married infected groups). Furthermore, this test was done for 70 control samples (35 aborted women without toxoplasmosis infection and 35 healthy women). As a final point, all samples were examined to measure the level of CTLA-4 using ELISA kits (MyBioSource. Com., Ltd., USA).

Results:
Results showed that a higher level of CTLA-4 was seen in the aborted women group 34 (73.9%) than in other infected groups, and the highest CTLA-4 levels were seen in IgG positive, 20 (43.47%) of 46 in the same group, than other types of antibodies. Furthermore, the highest concentration (948.2 ± 269.4 ng/ml) was indicated in the same group and type of antibodies, with a cutoff value of 597.0 ng/ml (71.7% sensitivity and 97.1% specificity).

Conclusions:
It can be concluded that the CTLA-4 level can be used as a predicted and supported factor for the occurrence of abortion in women infected with toxoplasmosis, especially in the chronic type of the disease (IgG-positive) with a cutoff value of 597.0 ng/ml with 71.7% sensitivity and 97.1% specificity.

Objective:
The objective of this study is to evaluate metformin proposed protective effect against the development of osteoarthritis (OA) in rats.

Materials and Methods:
A total of 40 male Sprague–Dawley rats were included, divided into four groups: negative control (n = 10), positive control (OA induced by monoiodoacetate [MIA]) (n = 10), metformin 200mg/kg group (n = 10) preinduction of OA, and metformin 200 mg/kg group (n = 10) postinduction of OA. Serum C-telopeptide type II collagen (CTX-II), inflammatory biomarkers were evaluated for each group. For data analysis, SPSS version 26.00 was used.

Results:
Metformin-treated groups showed a significant reduction in inflammatory biomarkers and CTX-II serum levels compared with OA group (P < 0.05). Pretreatment with 200 mg/kg metformin imparted extra cartilage protective effect and further decreased inflammatory cytokines compared to posttreated (P < 0.05).

Conclusion:
Metformin produced a beneficial protective effect in experimental OA in rats. It attenuates the inflammatory reactions progression by preventing the release of pro-inflammatory cytokines in rats with experimental OA. Furthermore, metformin reduced cartilage degradation evidenced by lowering CTX-II serum levels experimental OA in rats.

Background:
Nasal polyps are a common condition. Their etiology remains unclear. Surgical treatment has been refined significantly over the past 20 years with the advent of endoscopic sinus surgery.

Objectives:
The objective of this study was to assess the efficacy of functional endoscopic sinus surgery in an adult patient with sinonasal polyposis, by measuring the improvement in symptoms during 6 months of follow-up. Furthermore, record complications and recurrence of nasal polyps.

Patients and Methods:
A prospective study was conducted between November 2018 to January 2021, which included (39) patients whom attended the Outpatient Otorhinolaryngological Department of AL-Karkh General Hospital and AL-Yarmouk Teaching Hospital and suffered from sinonasal polyposis. This study included patients above 18 years (of either sex) with bilateral nasal polyposis and whom medical treatment failed. Those patients were evaluated by history taking, clinical examination, and computer tomography scan of the nose and paranasal sinuses. All patients had functional endoscopic sinus surgery and visual analog scale assessments was done (both pre- and postoperatively), which followed up for up to 24 weeks.

Results:
About 79.5% of the patient get improvement in nasal blockage and (66.7%) for hyposmia, (90.5%) for nasal discharge, and (80%) for both headache and postnasal drip associated with significant improvement of symptoms score 24 weeks postoperative to preoperative score for nasal block, hyposmia, nasal discharge, and facial pain, except postnasal drip showed no significant difference. The most frequent complication was a recurrence of polyps, followed by synechiae and minor epistaxis. No major complication was recorded.

Conclusion:
Endoscopic sinus surgery for sinonasal polyposis is an efficient surgical procedure for nasal polyposis, because it provides an approximate field of vision and illumination, good access, and is associated mostly with minor complications.

Background:
Osteoarthritis (OA) is considered an attractive research issue; as it is the most common musculoskeletal progressive condition with no cure yet.

Aims:
To evaluate effect of celecoxib alone or in combination of sitagliptin in monoiodo acetate rat model of OA.

Methods:
A total of 40 Sprague-Dawley male rats were divided into 4 groups, negative control (n=10), positive control group (OA induced by monoiodoacetate (MIA)) (n=10), celecoxib 50mg/kg (n=10), and celecoxib 50mg/kg plus sitagliptin 20mg/kg group (n=10). Serum levels of inflammatory biomarkers and serum CTX-II were assessed for all groups. Data were analyzed statistically by SPSS version 28.00.

Results:
group treated with celecoxib showed a significant reduction in the inflammatory biomarkers and CTX-II serum levels compared with the OA group (P<0.01). A significant reduction in CTX-II level in combination treated group relative to celecoxib treated group.

Conclusion:
Celecoxib imparted anti-inflammatory and cartilage protective effect in OA induced rat model. Sitagliptin combination with celecoxib added an extra cartilage protective effect by reducing cartilage degradation evident by lowering CTX-II serum levels.

Background:
A recently discovered lipolytic adipokine called zinc-α2-glycoprotein (ZAG) has been linked to the control of lipid and glucose metabolism in a variety of metabolic diseases. Studies in vivo and in vitro indicate that thyroid hormones (THs) increase the production of ZAG in hepatocytes. Yet, there is little information on how TH might interact with ZAG in a human hyperthyroidism or hypothyroidism model. This study aimed to assess the effect of THs on serum ZAG and its relation to lipid disorder in Iraqi women, who have recently been diagnosed with thyroid dysfunction.

Materials and Methods:
A case–control study was performed at the Department of Chemistry and Biochemistry/Medicine College in cooperation with National Diabetes Center/University of Mustansiriyah from January 2021 to February 2022. One hundred thirty-two samples were included in this study, all participants are women aged between 21 and 54 years, which were divided into three groups: (44) subjects serve as a control group, (44) patients with newly diagnosed hyperthyroidism, and (44) patients with newly diagnosed hypothyroidism.

Results:
The results of the current study had shown that the levels of serum ZAG elevated in the patients who have been newly diagnosed with hyperthyroidism (P ≤ 0.001) and decreased in patients with hypothyroidism (P ≤ 0.001) when compared with control. Patients with hyperthyroidism have low levels of cholesterol, triglycerides (TG), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL), while patients with hypothyroidism have higher levels of cholesterol, TG, HDL, and VLDL. Nonetheless, there were no significant correlations between the ZAG and TH with lipid profile in both hyperthyroidism and hypothyroidism.

Conclusion:
ZAG levels were elevated in patients with hyperthyroidism and decreased in patients with hypothyroidism. There is no correlation between the ZAG and TH with lipid profile in both hyperthyroidism and hypothyroidism.

Background:
Infection with Helicobacter pylori is typically contracted in early childhood and is associated with a variety of upper gastrointestinal disorders. There is still little local information available on infection epidemiology. This study was performed to determine the antibodies of seroprevalence of H. pylori in people, with their relation to age and gender.

Methods:
A retrospective epidemiologic survey was conducted in different polyclinics in Tripoli from January 2021 to December 2021 to determine the seroprevalence of H. pylori infection. A total of 707 participants (452 males and 255 females, with mean age of 39 ± 19.3 years) were included in this study. For the detection of H. pylori, enzyme-linked immunosorbent assay kits were utilized. In contrast, the absence of both antibodies (IgG and IgA) resulted in the designation of an H. pylori-negative status. Anti-H pylori immunoglobulin (Ig) G/IgA ≥30 enzyme immune units were classified as H. pylori positive. Chi-square test was used to analyze the obtained data.

Results:
The overall positive seropositive samples among the study participants were 122 (17.2%). The seropositivity was high 42 (34.4%) among the age group 30 <40 years, compared with the other age groups. There was no significant difference between male and female cases regarding the seropositive samples.

Conclusion:
Seroprevalence of H. pylori infection shows a drop comparing to previously local reports. Nationwide epidemiological research is necessary for determining the seroprevalence of H. pylori in Libya.

Background:
The measurements of the sphenoid and ethmoid sinuses (ESs) are essential in forensic investigations and during endoscopic sinus and skull base surgeries. This study aimed at assessing the dimensions of these sinuses and elucidating their role in sex determination.

Materials and Methods:
This retrospective assessment was conducted using brain-computed tomographic images stored in the Department of Radiology in a Tertiary hospital in Delta State, Nigeria. After institutional ethical approval, images of 292 patients (115 females and 177 males) aged >20 years, were used to measure the dimensions of the ethmoid and sphenoid sinuses (SSs) bilaterally. These were analyzed and summarized using descriptive statistics. Their association with gender, side, or age was assessed using inferential statistics and considered statistically significant at P < 0.05. Discriminant function analysis of the sinus measurements was conducted to evaluate their accuracy in correct sex prediction.

Results:
Both sphenoid and ESs showed significant sexual dimorphism. The ESs showed significant asymmetry (P < 0.05). The anterior width of the left ES (79.8%) was the best sex-discriminating variable. The combination of the left sinus dimensions was more accurate (74.3%, 85.3%) than the right sinuses (72.6%, 81.2%) in sex allocation. Using the bilateral ES dimensions yielded a higher accuracy (89.0%) than using bilateral SS parameters (80.1%).

Conclusion:
The sphenoid and ESs may be used in predicting the sex of an unknown skull bone recovered within the studied population with acceptable accuracy levels

Background:
The objective of our study is to investigate the relationship between ligament hyperlaxity and adolescent idiopathic scoliosis (AIS) within other risk factors.

Materials and Methods:
We conducted a matched case–control study in adolescents aged 9–15 years. We matched the age and sex of adolescents with AIS to their healthy controls. The AIS is defined by a Cobb angle of 10° and the ligament hyperlaxity is defined by a Beighton score ≥4. The two parameters were identified blindly. Other risk factors for AIS were analyzed. The multivariate analysis by simple logistic regression was carried out.

Results:
We analyzed 430 adolescents, among them 215 subjects with AIS were paired with 215 healthy controls. The sex ratio (female/male) is 1.46. Scoliotics showed a significantly higher rate of joint hyperlaxity than controls, P < 0.003 (61.4% vs. 46.5%) with an odds ratio (Orb) of 1.83 confidence interval (CI) (1.25–2.68). The multivariate analysis by logistic regression revealed three predictors of AIS which are ligament hyperlaxity ORa = 1.82 CI (1.23–2.69) P < 0.003, the existence of similar cases in the ORa family = 1.94 (1.24–3.03) P < 0.002 and a trunk growth spurt ≥4 cm/6 months ORa = 1.62 (1.09–2.4) P < 0.02.

Conclusion:
There is a potential relationship between ligament hyperlaxity and the occurrence of idiopathic scoliosis in adolescents. Two other predictors were detected, similar cases of scoliosis in the family and the trunk growth spurt.

Objectives:
Bacterial biofilms can increase the survival of bacteria through providing resistance to conventional disinfectants as well as antibiotics, thus biofilm considered a serious risk to human health with hug loss. Consequently, novel approaches to deal with bacterial biofilms are required. Viruses that may eradicate bacteria are known as bacteriophages, they are also known as “bacteria eaters.” Due to their activity on bacteria, bacteriophages are distinct from other organisms and do not pose a threat to human. Consequently, they are regarded as secure substitutes for antibiotics in the management of bacterial infections.

Aim of the Study:
In this study, we report the full genome sequencing of bacteriophage, namely BAG1 that targeting an endodontic clinical strain of Enterococcus faecalis (K3). Furthermore, we evaluate it killing efficiency to eliminate E. faecalis in both planktonic media and dentine slabs.

Materials and Methods:
We used the previously isolated endodontic E. faecalis clinical strain, namely K3 and enterococcus bacteriophage BAG1 in this study by spotting on the double layer agar technique. DNA extracted proceeded with NORGEN phage DNA isolation kit. Phage full genome sequencing was performed using Illumina nova Seq 600, 150 bp PE. In addition, the killing capacity of BAG1 phage against E. faecalis K3 was measured by infecting 5 × 106E. faecalis with BAG1 phage at multiplicity of infection of 0.1. Furthermore, the biofilm fraction and the number of E. faecalis colony-forming unit in planktonic media were measured after infecting 24 dentine slabs with K3 bacteria and BAG1 phage. SYTO® 9 green LIVE/DEAD® BacLight Bacterial Viability Kits were used to visualize K3 biofilm on dentine slabs using fluorescent microscope.

Results:
Full Genome Organization of BAG1 phage was circular composed of 68 open reading frame with GC percentage of 34.56%. An efficient killer reflecting by completely eliminating K3 strain within 180 min in killing test. In addition, the result revealed that BAG1 highly significant to eliminate K3 bacteria in both planktonic broth and biofilm fraction obtained from dentine slabs infection with the endodontic K3 clinical strain.

Conclusion:
Our results support that anti E. faecalis bacteriophage BAG1 significantly eliminate biofilm of E. faecalis K3 on dentine slabs with a lytic properties due to the absence of lysogenic genes which make it a suitable substitute to adjunctive anti E. faecalis therapy.

Background:
Despite opinions regarding safety and efficacy of COVID-19 vaccines in pregnancy, they are approved for pregnant women. However, little is known about attitudes and perception of pregnant women toward COVID-19 vaccination.

Objective:
To find out COVID-19 vaccine acceptance, its predictors, and perceptions, among pregnant women attending antenatal clinic in a tertiary care hospital of India.

Methodology:
A descriptive cross-sectional study was conducted among 180 pregnant women during 2021 using a predesigned, pretested questionnaire consisting of vaccination, obstetric history, and perception about COVID-19 vaccination. Those who took at least one dose of vaccine was considered vaccine acceptor. Chi-square test was performed to check association with independent variables for vaccine-acceptors and nonacceptors.

Results:
About 126 (70%) women were vaccine-acceptors and 54 (30%) were nonacceptors. Higher proportion of vaccine-acceptors were noted among those aged >20 years (P = 0.003), with previous pregnancy loss (83.3%) and problem in conceiving (71.4%), working mothers (72.7%), lower socioeconomic status (71.1%), and lower literacy (71.2%). Favorable attitudes toward COVID vaccine were present in most of the participants (72.8%). 74.6% of vaccine acceptors and 61.1% nonacceptors agreed to take vaccine on recommendation of health-care provider (P = 0.009). Significantly higher proportion of acceptors (43.7%) agreed to recommend another mother to take vaccine than nonacceptors (24.1%) (P=- 0.044). Significantly higher proportion of acceptors (84.9%) agreed to get vaccinated with precautionary dose if vaccination camp is organized (P = 0.039).

Conclusion:
A high level of vaccine acceptance was seen mostly because of the trust on health-care providers. Targeted efforts are required for health-care workers and public regarding vaccine literacy.

Background:
Gastric diseases are commonly caused by Helicobacter pylori, by colonizing the mucosa of the gastric epithelium in more than half of the population worldwide. It has the ability for adhering to gastric epithelium, with an important aspect of the pathogenicity of the microorganism facilitating the transport of certain proteins such as CagA, sialic acid-binding adhesion (SabA), and outer inflammatory protein (Oip) into that epithelium. The LGR5 are markers that were recognized as cancer stem cells marker that have prognostic value in some disorders such as gastric cancers (GCs), metaplasia, and inflammation of gastric mucosa. This study aimed for determining the association between expression of LGR5 in patients with gastric diseases and the presence of some virulence genes (CagA, SabA and Oip).

Patients, Material and Methods:
For the 140 patients enrolled H. pylori virulence factors including (CagA, SabA and Oip) was detected using Multiplex real-time polymerase chain reaction, while LGR5 expressions were carried out via immunohistochemistry.

Results:
SabA and Oip was significant difference with gastric disease such as GC, gastric metaplasia and gastritis with and without H. pylori. While no significant difference Cag gene with gastric disease due to all patient have Cag gene. LGR5 stem cell marker expression has significant difference with GC and gastric metaplasia.

Conclusion:
There was a significant increase in H. pylori Ag (SabA and Oip) expression among patients with gastric disease compared to the apparently normal individuals this might be able to be that H. pylori as one of the risk factor for developing cancer. However, no significant between H. pylori Cag Ag expression among patients with gastric disease due to all the patients infected with H. pylori has Cag gene (100%). It is suggested that LGR5 may play an important role in gastric carcinoma formation and may be used as a potential marker for the progression in patients with gastric disease.

Background:
The bacteria Helicobacter pylori (Hp) has supposed to confirm an oncogenic consequence with the evolution of malignancy events in stomach, effectiveness of Hp consider a top risk factor of gastric-diffuse large B-cell lymphoma (DLBCL).

Aims:
the aim of this study was to observe the correlation between virulence factors, especially cytotoxin association gene A (CagA) and the progress of gastric DLBCL.

Materials and Methods:
Biopsy samples (50) involved in this study (28 were men, and 22 women, with a mean age up to 57.64 years), among gastric-DLBCL patients, with (25) control (were 14 men and 11 women) without DLBCL, tested at Medical City Teaching Hospital and Teaching Laboratories, study conducted from January 1st to September 30, 2022. Diagnosis was by molecular methods included DNA extraction for Hp by STR-Format kit (BIORON Diagnostics GmbHm In den Rauhweiden 20,67354 Germany), and “real-time polymerase chain reaction” methods using the (ABI PRISM 7700) Sequence Detection System, also applied the primers and probes, for Hp-CagA.

Results:
The mean of age was 55.7 ± 2 in DLBCL, while in control were 61.82 + 6, CagA +ve 66.66 + 2. In gastric DLBCL, the red blood cell count, white blood cell count, platelets count, and hemoglobin were all decline in DLBCL, not in the control group, lactate dehydrogenase levels in gastric DLBCL patients were rise (322 U/L), while less in control, while albumin (322g/dl) was less in gastric DLBCL patients. Hp 16S rRNA was detected relating to CagA variety, 66% (33/50) were CagA positive with highly significant in 23 patients with DLBCL (P = 0.004), and 10 in control patients. CagA gene expression was highly expression in gastric DLBCL patients with range up to (+), 8 (++), and 12 (+++), while in the control group was 5 (+), 2 (++), and 3 (+++), respectively.

Conclusions:
This present study fixed high frequency of CagA gene in gastric DLBCL patients. Moreover, confirmed this gene is significantly associated with gastric DLBCL in patients with Hp. Moreover, genotype EPIYA-ABC motif is related with the high risk of gastric DLBCL.

Background:
Polycythemia vera (PV) and essential thrombocythemia (ET) are a part of the BCR-ABL1-negative myeloproliferative neoplasms (MPNs) that harbor mutation in Janus kinase 2 (JAK2), CALR, or MPL gene.

Objectives:
The objective of this study was to investigate the impact of JAK2 and CALR mutations on the clinical course and hematological phenotype of ET patients and to evaluate the biological and clinical features of ET and PV sharing the same type of mutation in JAK2V617F.

Materials and Methods:
This was a cross-sectional study that included 94 patients diagnosed with MPN, of them 47 had PV and 47 had ET. JAK2V617F mutation was assessed using either allele-specific PCR or JAK-2 quantitative real-time PCR kit. JAK2-negative patients were further assessed for the existence of CALR mutations using SNP biotechnology MPN screening kit.

Results:
JAK2 mutation was identified in 29 ET patients, whereas CALR mutations were confirmed in 18 patients. JAK2-mutated ET patients were significantly older than those with CALR mutations. Seventy-six were reported to have a mutation in JAKV617F, of them 47 were diagnosed as PV and 29 as ET. JAK2V617F-mutated PV patients had significantly higher levels of hemoglobin, hematocrit, and WBC than JAK2-mutated ET patients. On the other hand, JAK2-mutated PV patients exhibited lower platelet count than ET harboring the same mutation.

Conclusion:
JAK2-mutated ET represents a distinct clinical entity that has a hematological and clinical phenotype ranging between JAK2-mutated PV and CALR-mutated ET. The analysis of the mutational status is essential in discriminating subtypes of MPN and confirming the diagnosis in ET and PV patients.

Background:
Caudal septal repair is hard to confront in otolaryngology and plastic surgeon, due to cartilage memory. It causes nasal obstruction or esthetical problems to the nasal base and columella. Although different modalities have been described for the treatment of this abnormality, these techniques not only improve the function but also preserve or improve the appearance of the nose.

Objective:
The objective was to discuss the different surgical conservative procedures that can be used to treat alterations of the caudal septum and change the position of the cartilage in the midline and find which is the best.

Patients and Methods:
A descriptive study was conducted on 40 patients who aged 20–40 years, had attended the Otolaryngology Outpatient Clinic in Al Karama Teaching Hospital, Baghdad, Iraq, between October 2016 and March 2020, and with a history of obstructed nose; conservative nasal septal surgery was done for them depending on the severity.

Results:
Regarding the result of the type of surgery, the patients were satisfied with their esthetic and functional perfection; patients with preoperative nasal obstruction reported improved breathing. In scoring technique with (NOSE) score pre and postoparative results were 58.21 and 22.66, in reshaping technique were 60.66 and 17.21 as a pre and postoparative results and in batten graft the results were 62.34 and 20.26 as a pre and postoparative results alternatively. Reshaping and batten graft techniques are better results than the scoring technique.

Conclusion:
The study outcomes that the approaches for improvement of caudal septal deviation are safe and effective. The approach of surgery will depend on the severity of the deviation.

Background:
Lead is a highly toxic metal and a very strong poison. Most of the time, lead poisoning builds up slowly. It follows repeated exposures to small quantities of lead. Signs of repeated lead include high blood pressure, numbness or tingling in the extremities, memory loss, anemia, and kidney dysfunction.

Objectives:
The objectives of the study were to measure the blood lead level (BLL) among sample of adult patients attending Baghdad Teaching Hospital aged ≥30 years old and to find if there is any association between BLL and renal impairment.

Subjects and Methods:
Across sectional study was conducted from January 2 to May 31, 2022. Sample involved selection of adults of both sexes who attend Baghdad Teaching Hospital outpatient clinic for nonrenal medical problems. Inclusion criteria include adults aged ≥30 years old, with no history of drugs that change creatinine level and not malnourished. Glomerular filtration rate (GFR) was measured for all participants according to the Cockcroft equation depending on serum creatinine, age, gender, weight, height, and body mass index. Blood sample was taken for measure lead level in toxicology center in Baghdad medical city using whole blood samples not <2.5 ml for each participant, and the collection of data was taken by interview using especial questionnaire. Verbal consent was taken as ethical issue from each participant in the study.

Results:
A total of 239 participants were involved in this study. The mean BLL was 23.57 μg/dl. BLL for all was ranged between the values 17 μg/dl and 33 μg/dl for both sexes. The study showed a significant association between BLL and GFR rate.

Conclusions:
BLL was higher than normal cut point used in the study which is 10 μg/dl. About one-third of participants had risk of kidney disease with GFR (60–90) ml/min/1.73 m2; they were considered asymptomatic renal impairment.

Background:
Studies found a link between visceral obesity and insulin resistance (IR). Numerous attempts made to discover a link between fat lipotoxicity and IR by measuring waist circumference (WC) or body mass index (BMI). This study investigates the relationship between body adiposity index [BAI], a body shape index [ABSI], BMI, waist-to-hip ratio [WHR], TGI-WC = Triglyceride glucose index-× WC, and TGI-BMI = Triglyceride glucose index-BMI. Homeostatic model assessment of IR (HOMA-IR) is utilized to examine the significance of those indices in the target population with obesity-linked IR in Iraq.

Objective:
The aim is to identify the most relevant obesity index by examining the relationship between multiple obesity indices and IR in obese healthy individuals.

Design and Methods:
100 obese and nonobese patients’ height, weight, and hip circumference were taken. Triglycerides (TGs), glycated hemoglobin (HbA1c), serum insulin, and fasting plasma glucose were obtained to calculate HOMA-IR, TGI-WC, and TGI-BMI.

Results:
Healthy adults 18–50 years were divided (obese and not-obese), clinical features were averaged, and standard errors of the mean calculated. Results for the first obese group were blood pressure [BP] = 114 ± 2/75 ± 9, HbA1c=5.76 ± 0.09, TG = 175.26 ± 3.66, fasting blood glucose [FBG] = 111.84 ± 1.57, WC = 106.62 ± 1.68, BMI = 32.02 ± 0.69, while those for the second group were BP = 111 ± 8/70 ± 6, HbA1c = 4.41 ± 0.06, TG = 96.36 ± 2.02, FBG = 82.40 ± 1.48, WC = 83.76 ± 0.85, and BMI = 22.84 ± 0.22. The relationships between obesity indices were analyzed with HOMA-IR being judged to be IR when it acquired a score value of ≥ 2. The Pearson’s correlation coefficient® used to represent was WHR: r = 0.58, P = 0.0001, ABSI: r = 0.44, P = 0.04, BAI: r = 0.50, P = 0.02, TGI-WC: r = 0.89, P = 0.0001, and TGI-BMI: r = 0.74, P = 0.74.

Conclusion:
All of the obesity and lipid-related indices investigated were positively correlated with IR. The use of TGI-WC is recommended since it is straightforward to calculate using accessible laboratory tests; it showed the highest (Pearson’s) coefficient (r = 0.89; P = 0.0001).

Background:
The carrying angle (CA) is an acute angle occurring between the longitudinal axis of the upper arm and that of the extended and supinated forearm. CA allows swinging of the upper limb without hitting the pelvis. It appears to be larger in females than in males and also shows some variation to anthropometric parameters. Knowledge of CAs is valuable for orthopedic surgeons and biomedical engineers as well as for forensic specialists and anthropologists.

Aims:
The aim of the study is to evaluate the normal range of CA among Iraqi population.

Materials and Methods:
The CAs of the right and the left upper limbs was measured by a clinical goniometer in 200 medical students. Analysis for differences was performed according to gender, laterality, height, weight, and hip circumference (HC).

Results:
The mean right CA in men was 9° and in women was 10.75°, while the mean left CA was 8.76° in men and 10.51° in women. The mean CA in females is significantly larger than in males. The mean CA of the right elbow was greater than that of the left. The mean CA shows a positive correlation with the individual height, weight, and HC.

Conclusion:
The study fortifies the knowledge of the standard range of CA of the elbow in a study population of apparently healthy Iraqi medical students and tries to make a reference value to be used for orthopedic surgeons, biomedical engineers as well as for forensic specialists and anthropologists.

Objective:
Kidney stones are crystalline concrete that often develops inside the kidneys. Urinary tract problems are getting worse and worse for human health. The risk of end-stage kidney failure has been associated with increase the level of a new biomarker (like xanthine oxidase) to assess severity of kidney injury.

Methods:
The eighty patients, who attended the government clinics in Yarmouk Teaching Hospital, and the forty healthy people were used as a control group. Colorimetric assays were used to assess serum xanthine oxidase (XO) and other biochemical parameters. Using an enzyme-linked immunosorbent assay was determined.

Results:
The mean serum XO activity (8.8525 IU/L) was significantly greater than the corresponding values for the controls (6.5825 IU/L). Patients with kidney stones showed abnormal activity of uric acid levels in 78.33% of cases, while XO activity showed highly sensitive (70%) and high specificity (79%). XO has been found to be an excellent biomarker for detecting damage of the kidney in people suffering from kidney stones.

Introduction:
The exaggerated cardiovascular response (hyper-reaction) to the cold pressor test (CPT) can predict whether hypertension will develop later on. The study aims to assess the profile blood pressure (BP) and heart rate (HR) changes during CPT and the recovery from the pressor stimulus.

Subjects and Methods:
Thirty-four participants were asked to immerse their left hand in chilly water for 2 min, and the pressor response in terms of BP and HR changes during the ice-cold water immersion test and for 3 min (at 1-min interval) after the cessation of the test was recorded. The result of BP changes was expressed as a mean BP (MBP). The volunteer responses to CPT were classified as hyper-reactants if the change in BP (∆systolic BP/∆diastolic BP) was ≥22/18 mm.

Results:
The MBP of the systolic hyper-reactor (SHR) and diastolic hyper-reactor (DHR) volunteers was sustained at significantly high levels (by 20% and 25%, respectively) for a longer time (3 min) after the end of CPT relative to normal reactors (NRs). There was no change in MBP upon CPT in NR within the DHR group. The same general behavior was observed with heart rate in both groups (i.e. SHR and DHR).

Conclusion:
The hyper-reactors are characterized by an exaggerated increase in MBP and HR and a longer time for the MBP and HR to return to their baseline levels.

Background:
Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Besides the skin and peripheral nerves, it also involves many internal organs. Testicular involvement is mainly seen in leprosy. Hypogonadism in males with leprosy can occur due the involvement of testis.

Aim:
The aim was to evaluate the gonadal function impairment in males with leprosy and to analyze the relation of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone to the activity, duration, and disease classification in Central India.

Patients and Methods:
This was a prospective observational pilot study. We evaluated 30 patients of leprosy. They were subjected to careful history taking, dermatological and genital examination, assessment of FSH, LH, and testosterone levels, and slit skin smear for acid-fast bacilli. Diagnosis of leprosy was confirmed histopathologically. The collected data were encoded and entered electronically in a computer excel worksheet 2010 version. The statistical analysis was performed using SPSS version 17.0 for Windows. Pearson correlation coefficient was used to establish relationship between different variables. P ≤ 0.05 was considered statistically significant.

Results:
A positive correlation was found between FSH and LH hormones which was highly significant, whereas there was a negative correlation between testosterone and FSH and LH levels. There was a positive correlation between age, duration of disease, and reaction in leprosy with those of FSH and LH levels. There was a positive correlation between disease activity bacillary index (BI) and FSH, LH and a negative correlation between BI and testosterone.

Conclusion:
It is recommended that lepromatous leprosy patients should be routinely screened for hypogonadism using FSH, LH, and testosterone levels.

Reconstruction of severe bone loss and large skeletal defects using biologic materials with autograft or allograft and using tumor endoprostheses (megaprostheses) helped orthopedic surgeons as well as patients in the sparing of limbs. Several types of megaprostheses have been described in the literature for oncological indications with unpredictable outcomes and complication rates. We review single-centered experience of three nononcological cases to assess the safety of using megaprostheses in patients with severe bone loss without malignant disease. In addition, a literature review on the previous use of megaprostheses as treatment modality, their outcome, and complications was done until August 2022. All the participants were found to be good candidates for megaprostheses implants after their refusal of amputation. Their infections were eradicated before the implants, and also, the range of movement and improvements are satisfactory. In addition, according to the literature compared to the alternative of amputation, this operation has proven to be life-altering and revolutionary for many patients. We believe that megaprostheses might be a good limb salvage alternative in patients with significant bone loss and massive skeletal deformities, even in nononcological situations. Future studies should focus on ways to improve the material and design of the megaprostheses and study the long-term complications and survival rate of the implants.