Vol 24, No 1 (2020)

Background and objective: Nesfatin-1 is a newly described peptide, derived from nucleobindin2. Nesfatin-1 suppresses food intake and it is involved in regulating insulin secretion. The aim of this study was to compare serum levels of Nesfatin-1 in patients having type 2 diabetes and non-diabetic subjects.

Methods: This cross-sectional study included 90 participants; 64 patients with type 2 diabetes mellitus (32 males and 32 females) and 26 control subjects (13 males and 13 female). Body mass index, fasting serum level of glucose, fasting serum level of insulin, and glycated hemoglobin were estimated. Homeostasis model assessment of insulin resistance was calculated. Nesfatin-1 level was measured using enzyme-linked immune-sorbent assay kit. The data was analyzed using Graphpad prism 7.04 for windows.

Results: Type 2 diabetes patients aged from 33-78 years and the control group aged from 32-75 years. Nesfatin-1 level in the diabetic group was significantly lower than controls. The median interquartile range (IQR) of Nesfatin-1 was 0.765 (0.4-1.173) in diabetes and 1.02 (0.775-1.458) in controls. The diabetes group has significantly higher homeostasis model assessment of insulin resistance compared with non-diabetics. Serum Nesfatin-1 was correlated negatively with body mass index, fasting serum glucose, fasting serum insulin, glycatedhemoglobin, and homeostasis assessment of insulin resistance.

Conclusion: Serum Nesfatin-1 level is negatively correlated with fasting serum glucose, fasting serum insulin, and glycated hemoglobin. This association supports the role of Nesfatin-1 in increased insulin resistance in patients with type 2 diabetes.

Background and objective: This study aimed to evaluate the effect of adding postoperative antibiotics in reducing the incidence of symptomatic urinary tract infections following ureteroscopic stone treatment beyond the recommended preoperative dose.

Methods: This prospective comparative study was conducted between March and November 2017. A total of 80 patients with preoperative negative urine cultures who underwent ureteroscopy were randomly allocated. All the patients received a single dose antibiotic before the induction of anesthesia, and a group of them also received postoperative antibiotics. The rate of symptomatic urinary tract infection was compared between the patients who received only preoperative antibiotics (group 1) and those who received pre- and postoperative antibiotics (group 2).

Results: Eighty patients underwent ureteroscopy for stone treatment. The time to follow up was 4±2 weeks from ureteroscopy. Eleven (13.8%) patients in total developed urinary tract infections postoperatively, including five (12.5%) from group 1 and six (15%) from group 2, P = 0.74. In group 1, four patients presented with cystitis and one with sepsis; those patients with infections in group 2 presented with pyelonephritis (n=2) and cystitis (n=4). Risk factors such as preoperative stenting, nephrostomy tubes, and Foleys catheters did not differ between groups.

Conclusion: The postoperative symptomatic urinary tract infection rate in this study (13.8%) is in agreement with previous reports. This study suggests that a single preoperative dose of antibiotics is sufficient, and additional postoperative antibiotics do not decrease infection rates after ureteroscopic stone treatment.

Background and objective: Double-J ureteral stent is widely used in endourologic surgery. However, it might cause some annoying side effects. This study aimed to evaluate the effect of two different doses of solifenacin (5mg, 10mg) on double-J stent-related symptoms after uncomplicated ureteroscopic lithotripsy.

Methods: This study involved 120 patients. A total of 80 patients undergoing double-J ureteral stent insertion after ureteroscopic lithotripsy were involved in this study and provided with solifenacin postoperatively; 40 patients received 5mg and another 40 patients received 10mg. Another 40 age- and sex-matched patients without solifenacin therapy (received placebo) were enrolled as a placebo group. All patients completed the modified-form of the Ureteral Symptom Score Questionnaire to evaluate the lower urinary tract symptoms, hematuria and stent-related body pain two weeks following the operation. The severity of stent-related symptoms was compared between the three groups.

Results: The mean age was 45.4 years in the 5 mg solifenacin group, 48.2 years in the 10 mg solifenacin group, and 46.8 years in the placebo group. Compared to the placebo group, both solifenacin groups had significantly lower total symptom score, urgency, and urge incontinence scores. Solifenacin groups had significantly less urethral, abdominal and flank pain and hematuria scores. There was no statistically significant difference between the two solifenacin groups of 5mg and 10mg. The solifenacin groups versus the placebo group showed significant benefits in lower urinary tract symptoms, hematuria, and stent-related pain in both genders. Ten subjects encountered minor adverse events in solifenacin groups (8 in the 10 mg group and 2 in the 5 mg group), which was mostly dry mouth and constipation.

Conclusion: Postoperative solifenacin was effective and well-tolerated in patients undergoing ureteroscopic lithotripsy and double-J stent indwelling irrespective of genders, particularly for the treatment of stent-related body pain, hematuria and the lower urinary tract symptoms.

Background and objective: Flexor tendon injuries of the hand are common, especially in zone II. Various pharmacologic agents have been used to improve the outcome of primary tendon repair. One must select an option that accomplishes an excellent total active movement of the repaired tendon. This study aimed to find out the effect of hyaluronic acid injections in the restoration of normal gliding and power of the repaired tendon.

Methods: An interventional study of 47 cases of zone II flexor tendon injury managed from May 2017 to May 2018. The data were assembled in a questionnaire. Standardized photographs for pre-, intra-, and postoperative were taken. Hyaluronic acid injections were used in selected cases.

Results: Sharp injury (34 cases, equal to 72%) was found to be the commonest mechanism of flexor tendon injury. Male predominance was noticed (38 cases out of 47) due to their working nature. The hyaluronic acid injection was delivered to selected cases (10 cases, equal to 21%) based on preoperative evaluation. Eighty percent of repairs regained total active movement uneventfully. Few complications happened which responded to conservative management. The P value of total active movement in relation to hyaluronic acid injection was 0.036, which is considered statistically significant.

Conclusion: This study shows that intraoperative injection of high molecular weight of hyaluronic acid improves the outcome of flexor tendon repair, presumably by decreasing the chance of adhesion.

Background and objective: Acute lower respiratory tract infection is one of the major causes of mortality and morbidity in children under five years of age, with many etiologies suggested to be among its predisposing risk factors. Research has suggested that iron and vitamin D deficiencies may contribute to the vulnerability of acute respiratory infection among young children. This study aimed to assess the correlation between iron and vitamin D3 levels with acute lower respiratory tract infection.

Methods: The present study is a hospital-based case-control study conducted over a period of six months at Rapareen Teaching Hospital for Pediatrics in Erbil, Iraq. A total of 100 infants, 50 cases with and 50 controls without chest infection, aged four months to one year, attending the outpatient department, participated in the study.

Results: A statistically significant correlation was detected between vitamin D level and acute lower respiratory tract infection (P = 0.029). Combined iron and vitamin D deficiency in cases compared to the control group was statistically significant (P = 0.004). Iron level alone and presence of anemia between cases and control were statistically not significant (P = 0.197 and P = 0.216, respectively).

Conclusion: The study shows a significant correlation between vitamin D deficiency with increased susceptibility to acute lower respiratory tract infection. It was also found that combined deficiencies of Hb with vitamin D and iron with vitamin D significantly correlated with susceptibility to acute lower respiratory tract infection. It is concluded that treating these deficiencies may decrease the liability of this type of infection in infants.

Background and objective: Abdominal ultrasound can provide an effective, non-invasive, fast, inexpensive, and safe procedure with no risk of radiation to patients. Accordingly, this study aimed to assess the role of ultrasonography in differentiating causes of right iliac fossa pain among patients admitted to emergency hospitals in Erbil City.

Methods: In this cross-sectional study, 120 patients with acute abdominal pain and tenderness of right lower quadrant (iliac fossa) region, clinically suspected to have acute appendicitis admitted to the emergency hospitals in Erbil city were included in the study, from April 2011 to February 2012. The data was collected through a direct interview of patients, followed by a sonographic examination.

Results: The prevalence of true positive sonographic examination was 60.8%, with only 30% true negative findings. Around 69% of the cases had acute appendicitis, followed by ovarian cyst and right ureteric stone (11.1% and 7.4%, respectively). The sensitivity of sonographic examination in identifying appendicitis was 90.1%, the specificity was 92.3%. The positive predictive was 96%, while the negative predictive value was 81.8%. Sonographic characteristics of the positive patients with appendicitis showed that 58.0% of the patients had swollen appendix, and a diameter of 7.1- 8 mm was the most imaging finding. Also, appendicitis was significantly (P = 0.02) more common (58%) in males, and negative appendectomy was prevalent among females.

Conclusion: Appendicitis was the major cause of the right iliac fossa pain. Abdominal ultrasound was a reliable method in the diagnosis of the majority of patients with right iliac fossa pain and can decrease the rate of negative appendectomy.

Background and objective: Vitamin D has been associated with decreased risk of several cancers, including breast cancer, and its deficiency has been associated with poor prognosis. This study evaluated vitamin D level in breast cancer patients at diagnosis and investigated its association with various breast cancer prognostic criteria, especially the intrinsic molecular subtypes.

Methods: Using a prospective population-based, case-control and case series, study in Erbil city during 1^st October 2017 and 31^st March 2018, we evaluated vitamin D status in 50 breast cancer patients in correlation with 100 normal healthy controls. We examined various clinicopathological and immunohistochemical features of breast cancer to determine the prognostic effect of plasma 25-hydroxyvitamin D levels at diagnosis.

Results: The mean patient’s age was 51.1±10.7 years. The mean plasma 5-hydroxyvitamin D concentration was 8.138 ±7.5 and 16.7±12.06ng/mL in the breast cancer patients and controls, respectively (P <0.001). Vitamin D deficiency was associated with positive breast cancer risk (Odds Ratio (OR), 4.1; 95% confidence interval (CI), 1.68–10). The risk was greater in premenopausal (OR=7.5; 95%CI =1.60-35.23) than postmenopausal women (OR=2.7; 95%CI =0.87- 8.49). The mean serum level of 5-hydroxyvitamin D decreased significantly with the increasing stage in premenopausal (P = 0.055) and HER2/neu +ve immunoexpression (P = 0.008), especially in postmenopausal (P = 0.035). Regarding the molecular subtypes, HER2/neu enriched type showed the lowest mean 5-hydroxyvitamin D with a significant statistical association in premenopausal (P = 0.033).

Conclusion: These results add to a growing body of evidence that vitamin D deficiency associated with breast cancer risk and prognosis. Well-designed clinical trials are highly needed to determine whether vitamin D supplementation is effective for breast cancer chemoprevention and prognosis improvement if occur.

Keywords: Breast cancer; Molecular types; Vitamin D.

Genetic variations between individuals usually leads to differences in the drug response as it could affect both pharmacokinetic and pharmacodynamic processes. An example of mutation of genes that affect drug targets (pharmacodynamic) is VKORC1 gene that codes for active sites of the enzyme vitamin K epoxide reductase that is responsible for activation vitamin K. A famous example of mutation affecting pharmacodynamic properties of medicine is the anticancer agent irinotecan. Bone marrow suppression is a well known side effect for this medicine. In many cases, this adverse drug reaction appears to be very severe compared to the majority of the individuals, and that is possibly due to a mutation of a gene called UDP-GT 1A1.Identifying exact genes could be helpful in better targeting of medicines in the future, Pharmacogenetic testing and individualized medicine widens the window of therapy for better treatment approaches, it helps us to reduce both rate of toxicity and the dose of the drug, so it saves both lives and economically efficient that is why it worth funding by drug authorities in order for improving better and economically efficient clinical practice in the future.

Background and objective: The development of new antimicrobial drugs is still demanded as there is increasing resistance of microorganisms to currently available antimicrobial drugs and searches for safer nonsteroidal anti-inflammatory agents with greater cyclooxygenase COX II selectivity is challenging. The new series of 2-substituted-2,3-dihydro-1H-perimidine (4a-j) that are close analogs to Naproxen 5, might inhibit COX II enzyme in a similar manner to naproxen 5. This study aimed to synthesize some new heterocyclic compounds for enhancing biological activity.

Methods: 1,8-Diaminonaphthalene 2 was condensed with a variety of aldehydes and ketones 3 to afford a new series of 2-substituted-2,3-dihydro-1H-perimidines4a-j using a suitable synthetic strategy. All the synthesized 2,3-dihydro-1H-perimidine compounds 4a-jwere screened for their invitro antimicrobial activities against two identifiable strains using the agar diffusion method. At the same time, the synthesized pyrimidine derivatives 4a-were evaluated for their COX inhibition activity. Supplementary to these, the constitutions of the newly synthesized 2,3-dihydro-1H-perimidines 4a-j had been confirmed on the basis of their IR, ¹H- and ¹³C-NMR spectral data.

Results: The synthesized 2-substituted-2,3-dihydro-1H-perimidine compounds 4a-j exhibited promising antibacterial activity against Escherichia coli microorganism, while none of the synthesized derivatives 4a-jshowed likely result against Staphylococcus aureus strain. In addition, compound 4b had the most potent anti-inflammatory activity with an inhibition rate of 47% at 1000 nM.

Conclusion: The synthesized products4a-j possessed antibacterial activity (towards Escherichia coli microorganism; however, compounds 4c,4e, and 4j took the highest activity) and anti-inflammatory activity (compound 4b showed the highest inhibition rate).

Background and objective: Women with polycystic ovary syndrome serve as a model to estimate the functions of insulin resistance and chronic hyperinsulinemia on serum level of insulin resistance markers. This study aimed to determine the association of the serum visfatin, resistin levels with insulin resistance in patients with polycystic ovary syndrome, and its correlations with various parameters.

Methods: This case-control study was performed at the College of Pharmacy, Hawler Medical University in the period between May 2017 and July 2018. It included 100 patients and 100 age matched healthy control group was also enrolled for comparing purposes.

Results: Patients had significantly elevated serum visfatin ( 2.46 vs. 1.08 ng/ml), resistin (3.87 vs. 2.46ng/ml), and insulin (17.22 vs. 8.1 µlU/ml) levels than controls. They also had significant elevations in insulin resistance (2.41 vs. 1.92) and β insulin function (94.45 vs. 86.98). There was no significant variation in insulin sensitivity (88.77 vs. 92.08).

Conclusion: There was an association between resistin, visfatin, and polycystic ovary syndrome-related insulin resistance. Many recent proteins are now considered as potential new markers of insulin resistance in polycystic ovary syndrome. There was a strong connection between visfatin and resistin with insulin resistance in polycystic ovary syndrome pathophysiology.

Background and objective: Patient with unilateral nasal pathology is common in clinical practice. A careful history followed by complete otolaryngology examination is mandatory and diagnostic nasal endoscopy by either flexible or by using endoscope. This study aimed to assess patients presented with the unilateral sinonasal disease, regarding clinical features, CT scan findings, and histopathological results.

Methods: A prospective study was completed on 90 patients with unilateral sinonasal disease. The study was conducted at the Otolaryngology Department, Rizgary Teaching Hospital, Erbil city, Iraq, from February 2017 to July 2018. Regarding the pathological result, patients were categorized into two main groups of inflammatory and neoplastic. A biopsy was taken for histopathological confirmation from the patients with nasal mass either under local or under general anesthesia. The patients had been assessed clinically and radiologically.

Results: Chronic rhinosinusitis was found to be the commonest cause of unilateral sinonasal disease followed by antrochoanal Polyp, benign tumor, fungal sinusitis and then malignant tumor in that order. Male gender and right side were predominant. The purulent nasal discharge was the commonest symptom under inflammatory conditions, while nasal bleeding, dental and orbital complained were the main symptoms in neoplastic diseases. Calcifications were noted on CT scan, mainly in patients with fungal sinusitis. Bony erosion and destruction were detected in the malignant tumor.

Conclusion: Chronic rhinosinusitis was the most common cause of unilateral nasal and paranasal disease. Comprehensive evaluations of patient age, presenting symptoms, naso- endoscopic examination, and CT finding help in the diagnosis of unilateral sinus disease. However, histopathological confirmation remains the gold standard for final diagnosis.

Background and objective: Neck pain is one of the most common symptoms in the general population; several work-related and individual factors have been verified as being related to neck pain. This study aimed to determine the pathologic MRI findings of patients presented with neck pain and assess its association with some probable risk factors for cervical spine lesions.

Methods: This descriptive cross-sectional study involved a convenient sample of 100 patients with neck pain referred to the radiology department of Rizgary teaching hospital in Erbil for Magnetic Resonance Imaging examination of the cervical spine from June 2013 to February 2014.

Results: The age of the patients ranged from 21 to 70 years, with a mean age ± SD of 40.19 ±10.44 years. Around 42% of patients were between 30-39 years, and 60% were females. Clinical symptoms of the patients revealed that51.6% had radicular pain with cervical MR images abnormalities in 59% of the patients. The most common degenerative abnormality on MRI was disc bugle, which accounted for 37.3 % of total degenerative changes. MRI findings were most common at the C5/C6 level. A significant association was found between the cervical MRI abnormalities and the occupation and practicing neck (P = 0.03 and 0.001, respectively). However, no association was found with age, gender, BMI, and smoking habits of the patients. Also, there was a highly significant (P = 0.001) association between radicular pain, with disc bulge and disc protrusion.

Conclusion: MRI is a useful investigation tool for diagnosing different clinical conditions among patients with cervical pain. Considering the diagnostic accuracy and cost-effectiveness, it is the key diagnostic tool for early detection of the degenerative changes and initiating appropriate treatment.

Background and objective: Vitamin K is a fat-soluble vitamin that plays an important role in the coagulation pathways of living organisms. A popular application of vitamin K has been used to help in the extravascular removal of blood from the skin. The aim of the present study was to test the wound healing effect of vitamin K and some common wound dressing agents available in Erbil city clinical settings such; the moist exposed burn ointment (MEBO) and the Cica silver spray to test their combination with vitamin K injections.

Methods: Six groups of albino rats were used (6 rats in each group). Group M received Mebo ointment, Group Creceived Cica silver spray, Group K received Vitamin K injection, Group MK received Mebo ointment+vitamin K injection.Group CK received Cica silver spray +vitamin K Group, and Group N received no- treatment. The duration of the experiments was as 7, 14, and 21 days post wound surgery.The percentage of wound contraction was measured, and the blood serum was collected to test the level of transforming growth factor β (TGFβ) and platelet-derived growth factor (PDGF).

Results: Data presented in our study showed that the best wound contraction percentage(99%) was obtained by the MK treated rats compared to the control group. Similar results were obtained fromTGFβ and PDGF data in which MK group showed a significant increase in the levels of these growth factors.

Conclusion: The wound healing process is supposed to be due to an increase of TGFβ, PDGF, and enhanced fibroblast proliferation and neovascularization of tissues.

Background and objective: Extracts of Fumaria species have been traditionally used for the treatment of some skin diseases, rheumatism, stomach ache, fever, and male infertility mainly because of the presence of isoquinoline alkaloids. On the other side, fluoxetine is used as an antidepressant induce sexual dysfunction and a decrease in sperm concentration, motility, and morphology. The present investigation dealt with the study of the protective role played by the Fumaria officinalis extract against the selective serotonin reuptake inhibitor (SSRI) induced testicular toxicity in the rat. Therefore, the purpose of this work was to determine the benefits of Fumaria officinalis extract in animals treated with fluoxetine.

Methods: Thirty six male rats were divided into three following groups, control group, fluoxetine (20 mg/kg/day) treated-group, and the same dose of Fluoxetine plus Fumaria officinalis extract (150 mg/kg/day) as a third group. Drugs and extract were administered orally for 30 days. Sections of testes were stained by Haematoxylin and Eosin.

Results: Fluoxetine has caused several structural changes in the rat testis such as vacuolation within germinal epithelium of seminiferous tubules, decrease the diameter of these tubules and decrease number of sertoli and germinal cells. Treating the fluoxetine exposed rats with Fumaria officinalis extract has shown to ameliorate the above histological changes.

Conclusion: Fumaria officinalis extract can protect testis from histological alterations caused by the toxicity of the fluoxetine.

Background and objective: Cancer is a major health problem that threatens the life of many peoples with an increasing need for anticancer therapy. The present work aimed to investigate the effectiveness of using sonophotodynamic modality (exposure of infra-red laser as photodynamic) and to the ultrasound as sonodynamic modality in combination with nano-chlorophyll, for cancer therapy through histopathological assessment in Ehrlich ascites carcinoma cell implanted to mice as experimental animals.

Methods: A total of 120 male mice were randomly assigned to 12 treatment groups. Ehrlich ascites carcinoma cell was inoculated subcutaneously in all the experimental mice. When the tumor had grown to about 10 mm in diameter at day 10 after inoculation, treatments were started. Experimental groups were investigated histopathologically two weeks after treatments.

Results: The histological evaluation revealed that tumors from various treated groups of mice bearing the tumor showed different percentages of necrosis and tumor proliferation based on the type of treatment. Tumor excised from mice receiving sonophotodynamic with nano-Chlorophyll treatment showed a significant increase of necrosis about 15 – 25% compared to other groups without nano-chlorophyll as a sensitizer. The group of mice subjected to the combination of photodynamic and sonodynamic therapy in the presence of nano-Chlorophyll, showed large foci distinct necrosis areas 95% of large distinct foci of necrosis in the tumor and no tumor proliferation.

Conclusion: The anti-tumor activity of nano-chlorophyll in combination with sonophotodynamic therapy for Ehrlich ascites carcinoma in mice was effective.

Background and objective: Non-steroidal anti-inflammatory drugs (such as diclofenac1) had been widely prescribed for the treatment of different types of pain; however, they are not devoid of adverse effects. Therefore, synthesis of new bio-isosteric analogs4a-e of diclofenac1 with greater COX II selectivity and less gastrointestinal side effect is demanded. This study aimed to evaluate the acute toxicity and gastroprotective activity of the bio-isosteric derivative of diclofenac against ethanol-induced gastric ulceration in rats.

Methods: 2-Cumaranone 2 had been utilized to prepare amides 3a-e then after the bio-isosteric derivatives 4a-esynthesized from them then used to study the biological activity by testing whether high doses of the prototype compound 4c are toxic or not on albino mice and measuring the gastroprotective effect on albino rats. Rats were divided into four groups. Group 1 orally administered with Tween 20; group 2 was orally administered with 20 mg/kg esomeprazole; groups 3 and 4 received 100 and 200 mg/kg of the compound, respectively. Absolute ethanol was given orally to the groups, and rats were sacrificed after one hour.

Results: Few diarylethers 4a-ebio-isosteric to diclofenac had been prepared and fully characterized (including ¹HNMR, ¹³CNMR, and IR spectroscopy). Serum biochemical parameters were reported to be normal. Hematological analysis of kidney and liver did not elicit any remarkable changes in the treated group compared to the control group. Thus, the 50% oral lethal dose (LD₅₀) for the male and female mice was greater than 5 g/kg body weight. Anti-ulcer data showed a gastroprotective effect of the bio-isosteric diclofenac derivative 4c and presented the ulcer area inhibition, low stomach pH, and preserve the mucous content.

Conclusion: Many bio-isosteric derivatives of diclofenac had been prepared with good yields. The synthesized derivative4c showed no toxicity, and the gastroprotective effect may possibly be due to the preservation of gastric wall mucus.

Background and objective: Cutaneous leishmaniasis is an endemic disease in Iraq, mainly in central and southern regions. The disease is, however, lower or rare in Kurdistan region of Iraq; which is situated to the north of the country. After the summer of 2014, there was a massive displacement of population to Kurdistan, mainly from the central region. The aim of this work was to investigate the outbreak reported by Duhok preventive health department among internally displaced persons from Ninewa to Duhok governorate between 2015-2017.

Methods: A cross sectional study design was conducted on the records of internally displaced persons from Nineveh governorate who were diagnosed clinically as cutaneous leishmaniasis by Duhok health authority. Information regarding age, gender, occupation, places of current residency, expected vector exposure, displacement date and status, number of lesions, and date of onset.

Results: A total of 451cases were reported during the study period. The mean age was 22.7±17.1 years, and about 69% of cases were in the age group of 5-44 years. The mean number and SD of lesions was 3.6 (±4.2), with a range of 1-35lesions. Three quarter of patients were off camps during diagnosis. Cases were mainly encountered in autumn. All, except 17, have suspected vector exposure outside Duhok governorate. No significant variation was noted regarding gender, age, occupation, urban/rural residency, and displacement status.

Conclusion: A significant outbreak has occurred in Duhok, an area not known to be endemic with the disease. Close surveillance and strict preventive measures are highly recommended.