Al-Qadisiah Medical Journal

Objective : Coronary artery disease is increasing and accounts for a high proportion among others diseases. In Iraq various studies have been reported that the polymorphism of vitamin D receptor VDR-Fok I gene like rs 2228570 are associated with CAD patients.
Aim: This study was aimed to investi¬gate the association between the SNP of VDR Fok I (rs2228570) gene with various anthropometric and biochemical parameters as a risk for CAD in Iraqi population.
Methods and Materials : The current case - control study consisted of 300 samples , 150 of them were obtained from CAD patients who underwent the angiography department – heart centre – Al-Hussein Teaching Hospital, Al-Hussein Medical City / Holy Kerbala - Iraq and another 150 healthy control samples. Phenotypic data included body mass index (BMI), levels of fasting blood sugar (FBS), lipid profile, and blood urea, serum creatinine. Genotyping of rs2228570 polymorphism was carried out by PCR–RFLP method. DNA was extracted from genomic whole blood and genotyping was achieved with specific primers to amplify fragments for digestion with restriction enzymes. The enzyme Fok I was used for the digestion of VDR gene product followed by electrophoresis on agarose gel. Various statistical analyses were applied to analyse the data.
Result: Digestion of VDR – Fok I gene product (PCR-product ) exhibited an amplicon size of 273 bp, when this amplicon digested with Fok I enzyme, it gives three genotypes indicated one (273bp), two (75 bp + 198 bp) and three (75 bp + 198 bp + 273 bp ) bands for those with wild type (TT), homozygous (CC) and heterozygous (TC) genotypes respectively. Genotype frequencies of rs2228570 polymorphism were found to be consistent with Hardy–Weinberg equilibrium with allele frequencies of TT wild genotype (33.3%), TC heterozygous genotype (46.7%), and CC homozygous genotype (20%) in cases of CAD group while 66.7%, 30 % and 3.3 % for wild, heterozygous, and homozygous in the control group respectively. The homozygous genotype (CC) was significantly (OR= 7.25, CI 2.74-19.20 , P<0.001 ) increased the risk of CAD seven and quarter folds with respect to those of the wild type (TT) after adjustment for age, sex and BMI, while the TC genotype significantly (OR = 2.04, CI 95% ; 1.27-3.28 , P<0.001) raised the risk of CAD by two folds. Co-dominant genotypes of rs2228570 polymorphism exhibited significant association with anthropometric and biochemical parameters such as BMI, and lipid profile among patients groups as compared with control groups.
Conclusion: The obtained results improved that the gene polymorphism of VDR-Fok I was associated with high risk for development and progression of CAD and exhibited a significant association with increased BMI and lipid profile of coronary artery diseases of Iraqi population.

Treatment of trigeminal neurolagia by percutaneous retrogasserian glycerol rhizotomy was assessed in a series of 45 patients during the period from May 2008 through June 2012 with a follow up period ranging from 2 to 24 months postoperatively. All patients enrolled in the present study were considered medical failures before the procedure. Achievement of substantial pain relief was reported in 42 patients (93.3 %) and no further medical treatment was needed. Outcome also included reduction in facial sensation in 30 patients (66.7 %) and recurrence in 4 patients (8.9 %). Failure of treatment was seen in 3 patients (6.7 %).
Conclusion: percutaneous retrogasserian glycerol rhizotomy offers safe and reliable relief of pain in patients with trigeminal neuralgia; low recurrence rate and long lasting reduction in facial sensations are the major disadvantages; nonetheless, it is by far, in our opinion, the method of choice in elderly particularly high risk patients.

Antibiotic therapies can not affect only on the pathogenic bacteria, but also commensal microorganisms in the humans gut, which might serve as a reservoir of antimicrobial resistance genes. fecal Escherichia coli (E. coli) is often considered as a good indicator for selection pressure imposed by antimicrobial use. The goal of this study was to determine genotyping groups of commonsal E. coli and investigate the frequency of integrons class 2 and antibiotic resistance among them. So detect the association of integron class2 with antibiotic resistance (single and multiple drug resistance) that may be transport horizontally in bacterial populations. In this study 301isolates of commonsal E. coli were isolated from stools obtained from healthy individuals with age from 1to 80 years. All isolates were tested for their susceptibility against 16 antimicrobial agents and subjected to conventional polymerase chain reactions (PCR) for detection integrons and multiplex PCR for genotyping analysis. Present results showed that group B2 represent the majority of the collected isolates (63%) followed by group A (23%) and D (14%) but no strains were found to belong to group B1. Also results revealed that 10% of isolates have integron class 2 that mainly related to genotypic group B2. High resistance observed for most antibiotics especially ampicilln, amoxcillin, lincomycin, cephalexin while resistance to amikacin and gentamicin was less common. Antibiotic resistance mainly appeared in integron positive isolates. In conclusion, high prevalence of antibiotic resistance especially among integron class 2 positive isolates that

BACKGROUND:
The addition of the long acting insulin glargine (Lantus) to the regimen of multiple oral hypoglycemic drugs in patients with uncontrolled type 2 diabetes mellitus has long been studied in terms of efficacy (e.g. HbA1c reduction) and safety ( e.g.incidence of hypoglycemia).
OBJECTIVES:
The aim of this study was to assess 1) effectiveness in controlling hyperglycemia 2) safety in terms of the incidence of hypoglycemia, after the addition of a single dose of insulin glargine to the previous regimen of oral hypoglycemic drugs in patients with uncontrolled type 2 diabetes.
PATIENTS AND METHODS:
200 patients with long standing (5-10 years) type 2 diabetes mellitus uncontrolled by multiple oral hypoglycemic drugs (HbA1c 9.5-13%) attending the diabetes center in Diwaniya, were selected to add a single titrated dose of insulin Glargine to their oral regimen and followed for 6 months to evaluate their glycemic control (as defined by HbA1c and FPG) and safety regarding the incidence of moderate and severe hypoglycemia.
RESULTS:
After 6 months, ,109 patients Of total 200 patients (54.5%) achieved both targets, HbA1c reduction (> 7 %) and fasting plasma glucose (> 130mg/dl), among them only 3 patients (2.7%) developed severe hypoglycemia and 17 patients (15.5%) developed mild to moderate hypoglycemia.64 patients (32%) achieved HbA1c between ( 7 - 7.5% ) ,among them only 8 patients(12.5%) developed mild hypoglycemia. of the total 200 patients ,20 patients (10%) had their HbA1c between (7.5 – 8%) with only 2 patients among them (10%) had mild hypoglycemia. only 7 patients of the total 200 (3.5%( had HbA1c > 8% without hypoglycemia.

Background : CA 15-3 is the commonest tumor marker for breast cancer. Elevated serum levels of this marker was shown to be a predictor of disease recurrence in patients with localized breast cancer. This study aimed to determine the sensitivity of serum CA 15-3 level in the detection of breast cancer recurrence in relation to the molecular subtype of breast cancer, type of recurrence and the number and sites of distant metastasis.
Methods : Retrospective observational study of patients with localized breast cancer followed until relapse. Serum level of CA 15-3 at first documentation of relapse was compared between patients in respect to the molecular subtype of breast cancer, type of recurrence and the number and sites of metastasis.
Results : Elevation of CA 15-3 were found in 56% of patients at relapse. Only 6% of patients with locoregional relapse shows elevation of this marker compared with 62% of patients with distant metastasis. Elevation of CA 15-3 were more sensitive for detection of relapse in patients with luminal subtype (62%) than in patients with HER2 enriched (45%) and triple negative (35%) breast cancers. The test was more sensitive in patients with bone (69%), lung (65%) and liver (62%) metastasis than in patients with brain metastasis (25%).
Conclusions : CA 15-3 is a relatively sensitive marker for detection of breast cancer recurrence. However, this sensitivity may be hampered in patients with isolated locoregional relapses and in patients with HER2 enriched and triple negative breast cancers

Background: The INSURE method (Intubation- SURfactant- Extubation) is increasingly being used to treat the respiratory distress syndrome in preterm infants and associated with declining the necessity for mechanical ventilation and reducing it is associated adverse events.
Objectives: To evaluate the effectiveness of surfactant therapy using INSURE method in the management of respiratory distress syndrome and to identify the risk factors associated with its failure.
Patients and methods: A retrospective descriptive cross sectional study was conducted in neonatal intensive care unit in Al- Yarmook Teaching Hospital, Baghdad, Iraq from April through October 2014. All preterm neonates (Gestational age 24- 34 weeks) with clinical signs and chest X- ray findings suggestive of respiratory distress syndrome and received surfactant by INSURE method were enrolled in this study and allocated into INSURE success and INSURE failure group depending whether they need re- intubation and mechanical ventilation or not.
Results: The total number of neonates enrolled in this study was one hundred five; of whom number of males was 60 patients (57.1%) compared with 45 females (42.9%). The INSURE method was successful in 71 neonates (67.6%). The mean birth weight and gestational age in the failure group were 1135(± 296) grams and 28.47(± 2.402) weeks respectively, and were significantly lower than the success group (1426(± 327) grams and 30.5(± 1.969) weeks respectively. This study also showed that the INSURE method was successful in 36 among 42 (85.7%) neonates with gestational age > 30 weeks while succeed in 35 among 63(55.6 %) neonates with gestational age ≤ 30 weeks. The Apgar scores at 5 min where significantly lower in the failure group up in comparison with success group (the Apgar score between 4- 6 was present in 31.4% of success group where as 68.6% of failure group). Severe respiratory distress syndrome was significantly more common in the failure group (75.7%) than in the success group (24.3%).
Severe radiological finding on CXR was significantly more common in the failure group than in success group (83.9% vs. 16.1%). The need for second dose of surfactant was significantly more common in failure group than in success group (81.1% vs. 18.9%). This study showed that the more prolonged CPAP (continuous positive airway pressure) treatment after surfactant administration, the more the INSURE method failed. Sepsis, recurrent apnea and pneumothorax were significantly more common in the failure group.
Conclusion: INSURE method is very effective method in the management of respiratory distress syndrome. It is associated with decrease the need for mechanical ventilation and decline in the neonatal mortality rate. There is an increased risk of failure of this method among those preterm neonates with low birth weight, lower gestational age, lower Apgar score, severe respiratory distress syndrome with severe radiological findings on CXR and with prolonged CPAP treatment duration after surfactant administration. Complications during the course of treatment such as Sepsis, recurrent apnea and pneumothorax may adversely affect the INSURE method success.

AIH so far thought to be an auto-immune disease. One of the genetic predisposing factors is thought to be HLA-DR3 and DR4 genes. The present study aimed at investigation the frequencies of HLA-DR3, DR4 and HLA-B27 genes among the Real-time PCR were used for the HLA-genes. The age of the patients were ranged from 7- 69 years in AIH group and from 8-67 years in healthy controls group. On the context of genotyping of HLA- genes, DR3, DR4, and B27 were found to be differed in their frequencies significantly among AIH patients that creating high etiological fraction of 0.504, 0.583, and 0.129 respectively compared to healthy controls, with odd ratio (OR) 7.35 for DR3, high OR 8.0 for DR4 and 2.23 for B27. The frequencies of these genes in AIH patients, highly significant differed between patient group, for DR3 compared to healthy group which 58.3% and 16% respectively, and very high significantly differed between patient group for DR4 compared to healthy group which 66.7% and 20% respectively, while no significant differed between patient group compared to healthy group for B27 which 23.3% and 12% respectively.

Back ground:

Laparoscopy became used as a surgical procedure for the removal of gallbladder by Lukichev in

1983 and Muhe in 1985. Those procedures gained little attention and popularity till the well acknowledged laparoscopic cholycystectomy which was performed by the French gynecologist Mouret in 1987.
Aims of the study:

To evaluate the rate of conversion of laparoscopic cholecystectomy into open surgery and its predisposing factors.
Patients and methods: A total number of 1077 patients undergoing elective laparoscopic cholecystectomy were enrolled in the presents study. The sample was composed of 932 females and 145 males and their age ranged from 9-86 years. The study was conducted in Al-Dewaniyiah teaching hospital from January 2015 through December 2015.
Results: The occurrence of disease in female patients was significantly higher than that of male patients (P<0.001). The conversion rate of laparoscopic cholycystectomy into open surgery was reported in 13 out of 1077 (1.2%). The conversion was reported only in the following intervals:
30-39 years (0.7%), 40-49 years (1.6%), 50-59 years (3.5%) and 60-69% (0.8%). The rate of conversion was significantly higher in males than females (P<0.001).
Conclusions: Conversion rate is acceptable in view with available data. Risks for conversion included: Male gender, advanced age, dense adhesion, diabetes, CBD injury and Cholecystoduodenal fistula.

Zinc has a role in normal growth and development during pregnancy, childhood, and is needed for the proper sense of taste and smell. Studies on animals, adolescents and low birth weight neonates showed that oral zinc salt intake decreased serum bilirubin level, probably through inhibition of the bilirubin enterohepatic circulation.
Objective :
To study the effect of serum zinc level of the newborn and their mothers on neonatal jaundice.
Patient and methods
A case control study included a total 130, 65 with jaundice and 65 healthy neonates with their mothers. The study was carried out from May to October 2016 at ALhussein hospital for children in Al-Diwanyia city. For all neonates serum zinc, total serum bilirubin, hematocrit, blood group typing and Rhesus were carried out. Serum zinc for the mothers also was measured .
Results :
Serum zinc in jaundiced neonates was significantly lower than non jaundiced neonates (P<0.05). One hundred and nine mothers out of 130 mothers have low serum zinc. In multipara, zinc deficiency was more frequent in the mothers of both groups and P value (0.69).There was no significant difference was in mean serum zinc level when gestational age was taken into consideration (full term versus pre-term) (P>0.05).
Conclusions :
This study showed that serum concentration of zinc in neonates with jaundice was significantly lower than that in healthy control.

This study aimed for determination of serum hepcidin level and its association with ‎iron ‎state in pregnant women with and without anemia. ‏This study comprises ‎86 pregnant women divided into two groups, the first ‎group comprises 49 pregnant women without iron deficiency ‎anemia‎, the second group comprises 37 pregnant women with iron ‎deficiency anemia. ‎Blood was drawn from all pregnant women for determination of serum ferritin and hepcidin concentrations. The results establish a significant decrease in serum ferritin ‎and hepcidin concentrations in pregnant women with anemia as paralleled with pregnant women without anemia. The outcomes of linear regression analysis demonstrate a significant positive association between serum ferritin ‎and hepcidin concentrations in both study groups. In conclusion, measurement of serum hepcidin level is an important parameter for ‎evaluation the iron state in pregnant women. ‎

Background: Human respiratory syncytial virus( RSV) is the major etiological agent of respiratory tract illness particularly in children, and it provokes allergic and asthma exacerbation, so, the respiratory tract epithelial cell are stimulated and produce several chemokines such as MDC and TARC that play a major role in asthma attack.
Objective: To identify human genetic groups of RSV from children with respiratory tract infection and establish the relationship between RSV and allergy exaggeration through determination of the host gene expression (TARC and MDC) which are induced by RSV infection.

Methods: Patients suffering from respiratory tract illness (RTI), from several days to fourteen years old of both sexes were enrolled in this study. A nasopharyngeal swabs (NP) were taken from patients and subjected to molecular detection of RSV and gene expression of TARC and MDC were done for positive samples with RSV.

Results: Out of 230 children suffering from respiratory tract infection, 8 (8%) and 14 (14%) were detected with RSV type A and B respectively, and all epithelial cells of patients who have infected with RSV express TARC and MDC which are known to have an essential role in severity and hyper-responsiveness of allergy.
Conclusion: Measurement of host gene expression such as TARC and MDC revealed increased level of these genes in asthmatic patients, in children infected by RSV. Both genes may play an essential role in severity and hyper-responsiveness of allergy.

The study is designed to clarify the influence of induced diabetes mellitus on maternal rats and their fetus at different stages (14, 16, and 18) days of gestation. Diabetes mellitus was induce in (75) female's rats (Rattus norvegicus) before mating by streptozotocin (60 mg/kg of animal body weight) one dose intrapersonal injection, all animals were isolated and divided into two groups (non-diabetic and diabetic group), each group (36) female, also each group subdivided into two groups, health females group as control and the subgroup that treated with n-butanolic extract of celery seeds (60 mg/kg of body weight daily). While, the diabetic group had been subdivided into two groups too, one of them had been treated with celery seeds extraction, but another one had diabetes mellitus without treated, each of the four groups contains (18) females which had been separated as three equal groups (6) at each period (14, 16, and 18) days of gestation. There were many macroscopic observations reported by the current study, include the still birth in addition to differences in size between the fetuses which was tend to increased (macrosomia) in the diabetic groups resulted from hyperglycemic mothers, furthermore there are a difference in the number of fetuses in the horns of uterus. Molecular study of (Sox17, Pax6, Insulin1, Insulin2, and Glucagon genes) in the tissues of (pancreas of mothers, placentas, and fetuses) was refer to the decrease in the level of gene expression in diabetic groups but there are a great increased of it in the groups that treated with celery seeds extract, for all genes of all tissues and in all stages of gestation. It has been concluded that there is an effect of the extract at the genetic level in the tissues studied