Vol 24, No 3 (2020)

Background and objective: Human identification and anthropological evaluation of mass graves are the key step towards scientific documentation and achieving justice. This study aimed to investigate the exhumation, anthropological evaluation, and individual victim identification of a mass grave in Busaya in Samawa governorate.

Methods: The investigation included excavation of the graves and identification of the victims. The field study was started after taking testimonies and witnesses for locating the site of graves. The sites were determined, which were excavated according to the scientific standard procedures. Gender determination and age and stature estimation were performed on the remnant skeletons in the laboratory of the medico-legal institute in Erbil.

Results: The grave included 93 bodies, 66 (71%) were males, 24 (26%) were possibly males, while the others were not identified because of degradations of the bones. The results of age estimation reported that the number of young bodies under 20 years old were five cases (5.4%), while 53 cases (57%) were young bodies between 20-29 years. The rest were more than 30 years old, except for eight cases that could not be identified. The results of stature revealed that more than half of cases had stature more than 166 cm, while only six cases were less than 155 cm. All the remained bones were recorded in detail for more documentation.

Conclusion: These findings described the anthropological evaluation of a large Barzanian mass graves in Busaya desert in the south region in Iraq. The majority (or all) of the victims were males and young people.

Background and objectives: Rheumatoid arthritis is an autoimmune and inflammatory disease that influences many tissues and organs. Inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, anti-cyclic citrullinated protein, rheumatoid factor, and 14-3-3η protein have been found to play an important role in both the diagnosis and progression of rheumatoid arthritis. This study aimed to elucidate the effect of anti-rheumatoid medication, as mono- and combined therapy, on these inflammatory mediators.

Methods: A cross-sectional study was performed at Hawler Medical University, College of Pharmacy, Erbil, Iraq. Forty-two patients of both genders with rheumatoid arthritis participated in the study as group I. Forty-four age–gender matched adults (with no rheumatoid arthritis) were included as a comparison group or group II. Serum levels of biomarkers were determined by enzyme linked immune sorbent assay.

Results: There was a statistically significant (P <0.05) increased level of serum anti-cyclic citrullinated peptide, 14-3-3η protein, erythrocyte sedimentation rate, C-reactive protein, and rheumatic factor levels in group I compared with group II. The serum level of the anti-cyclic citrullinated peptide significantly decreased in rheumatoid patients treated with combined therapy compared with mono remedy. However, the mean of body mass index, age, and gender of group I was non-significantly different from group II (P >0.05).

Conclusion: Therapeutic regimen of mono or combined therapy played a role in changing levels of inflammatory markers. Anti-cyclic citrullinated protein significantly decreased with the combined therapy in comparison with the monotherapy regimen.

Background and objectives: Most benign prostatic hyperplasia patients do not present obvious indicators for surgical intervention, so most of these patients are treated initially with medical therapy. This study aimed to compare the incidence of acute urinary retention after treatment with monotherapy with the incidence after combination therapy and determine the need for surgery in both methods.

Methods: This is a retrospective study of the medical records of 248 benign prostatic hyperplasia patients who had attended Rizgary Teaching Hospital from May 2012 to June 2017. These patients were divided into two groups of 138 and 110 patients who have been treated by 0.4 mg tamsulosin capsule once daily and 0.4 mg tamsulosin capsule plus 5mg finasteride tablet once daily, respectively. Benign prostatic hyperplasia outcomes (acute urinary retention, benign prostatic hyperplasia related surgery) were compared between these two groups according to prostate volume and serum prostate specific antigen.

Results: The combined treatment had significantly reduced the incidence of acute urinary retention and benign prostatic hyperplasia related surgery than monotherapy (P = 0.006 and 0.044, respectively). Similarly, when prostate volume and prostate specific antigen were above the cutoff value, both acute urinary retention and benign prostatic hyperplasia related surgery were lower in the combination therapy group than the monotherapy group.

Conclusion: Combined therapy (0.4 mg tamsulosin plus 5mg finasteride) was significantly superior to 0.4 mg tamsulosin alone in the reduction of the incidence of acute urinary retention and benign prostatic hyperplasia related surgery among benign prostatic hyperplasia patients.

Background and objective: Orally disintegrating film is a solid dosage form made as an alternative for tablets for pediatric and geriatric patients who have difficulty in swallowing. These formulations are designed to dissolve in the mouth rapidly upon contact with saliva. This study aimed to prepare a thin oro-dispersible film base that can withstand handling in which a drug can be incorporated to provide a new dosage form.

Methods: The solvent casting method was used to prepare the films, in which the ingredients were mixed, dissolved, and cast in a Petri dish. Then, they were left to dry in the oven overnight. Different concentrations of each of the two polymers alone and combined in different ratios were compared using different concentrations of plasticizer.

Results: Successful, transparent films were prepared from gelatin and glycerin. A combination of 70% gelatin and 30% sodium carboxymethyl cellulose with glycerin formed an acceptable film having white color. The film forming capacity of sodium carboxymethyl cellulose alone was not good. All films were tearing and not well formed. All films that contain polyethylene glycol were brittle. Both superdisintegrants reduced the disintegration time for both films, but kyron was more effective than sodium starch glycolate.

Conclusion: A successful oral film was prepared using different types of polymers, which is suitable for incorporating a potent drug to form a new dosage form that is easily portable and does not require water for swallowing.

Background and objective: Oligohydramnios is defined as an amniotic fluid index less than 5^th centile for gestation. It presents a threat to the fetus and has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores, and congenital abnormalities. It is associated with perinatal morbidity and mortality and maternal morbidity in a significant number of cases. Therefore, early detection of oligohydramnios and its management is important. This study aimed to determine the perinatal and maternal outcomes in oligohydramnios.

Methods: This retrospective cohort study was carried out at the Maternity Teaching Hospital in Erbil from March 2018 to March 2019. A total of 300 patients were recruited, including 150 pregnant women with oligohydramnios and 150 with normal amniotic fluid index.

Results: There was a significant difference between the oligohydramnios group and the comparison group in relation to parity and gestational age. Oligohydramnios was more among primigravids. The rate of cesarean section was higher in oligohydramnios group compared to the comparison group. Intrauterine growth retardation among oligohydramnios group was 13%. Oligohydramnios was associated with birth weight <2500 gm (21.3%).

Conclusion: Antepartum diagnosis of severe oligohydramnios at term was associated with an increased cesarean section rate, a higher rate of admission of neonatal care unit, and low birth weight. Therefore, antepartum oligohydramnios is associated with increased perinatal morbidity and mortality.

Background and objective: Patients on blood transfusion may develop complications related to iron overload and the effects of chelating agents (drugs), which adversely affect the liver in thalassemia, which is a genetic blood disorder of hemoglobin synthesis that causes severe anemia. This study aimed to assess the effect of deferasirox and deferoxamine drugs on liver enzyme activities (aspartate transaminase, alanine transaminase, and alkaline phosphatase), and serum ferritin level in β_thalassemic patients.

Methods: This study was carried out in Erbil city from October 2017 to February 2018. Blood specimens were collected in Hawler thalassemia center and Raparin hospital. The samples included 105 individuals; 70 β-thalassemic patients (35 treated by deferasirox as group A and 35 treated by deferoxamine as group B), and 35 healthy individuals (control group C).

Results: The serum aspartate transaminase and alkaline phosphatase activities in β-thalassemic patients were higher than that of controls. The serum alanine transaminase activity in the patients' groups showed non-significant elevation than that of controls. The serum ferritin level in the patients was significantly higher than that of controls.

Conclusion: Our finding showed that both deferasirox and deferoxamine drugs affect liver enzymes and increase ferritin level.

Background and objective: There are different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. This study aimed to compare the surgical outcome of the conventional extended incision with the limited mid palmar one.

Methods: The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into two groups: Group 1 was patients operated on by the conventional extended incision, Group 2 with a limited mid palmar incision.

Results: The patients included were 79 with 89 hands. The age mean was 41 years. Group 1 included 47, and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities, and return to work). However, the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications that occurred for the cases of Group 2 was about a third of that occurred for Group 1. The highly significant difference was in the scar tenderness in the third month of the post-operative period.

Conclusion: The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, earlier use of the hand in daily life activities, and return to work in a shorter period.

Background and objective: Delivering a malpositioned and malpresenting fetus remains uncertainty, despite advances in obstetric practice. This study aimed to determine the mode of delivery and neonatal outcome in cases of fetal malposition and malpresentation.

Results: The total rate of malposition and malpresentation was 4.8%. Most women (87.3%) delivered by cesarean section, 25% of the neonates were admitted to the neonatal intensive care unit, where 69.3% of these infants stayed for seven days. There were three early neonatal deaths (1.0%), all of them were in occipito-posterior, or occipito-transverse position and were delivered abdominally. Among occipito-posterior and occipito-transverse deliveries, 2.2% ended with the death of the fetus (P = 0.360). An Apgar score of 7 was recorded after 5 minutes for 97.7% of the infants. Around 11% of the women had postpartum hemorrhage.

Conclusion: Fetal malpresentation and malposition are not uncommon during labor, and most cases are delivered by cesarean section. Neonatal morbidity and mortality are dependent on the type of presentation and the mode of delivery.

Background and objective: Coronary artery disease is a chronic inflammatory disease in which many risk factors and inflammatory mediators, including macrophage migration inhibitory factor, are involved. This study aimed to estimate macrophage migration inhibitory factor level in coronary artery disease patients in regard to age, gender, and smoking.

Methods: A total of 138 coronary artery disease patients and 38 coronary artery disease free control subjects were admitted to surgical specialty hospital-cardiac center in Erbil city, Iraq between January and December 2017. Plasma macrophage migration inhibitory factor concentration was measured by enzyme linked immunosorbent assay.

Results: Patients and controls were categorized into subgroups according to age (<55 and ≥55 years), gender (women and men), and smoking status (smokers and non-smokers). Macrophage migration inhibitory factor level in every coronary artery disease subgroup (age, gender, and smokers) patients increased significantly compared to the same control subgroups (P <0.05). Macrophage migration inhibitory factor level showed a higher level in coronary artery disease patients subgroups (≥55 years, female, smokers) compared to their corresponding coronary artery disease subgroups (<55 years, male, and non smokers). Macrophage migration inhibitory factor demonstrated a significant positive correlation with fibrinogen and high sensitivity C-reactive protein, insignificant positive correlation with age, total cholesterol, low density lipoprotein, and insignificant negative correlation with high density lipoprotein-cholesterol (P >0.05).

Conclusion: This study demonstrated the diagnostic value of macrophage migration inhibitory factor elevation in coronary artery disease patients if compared with coronary artery disease free subjects, meanwhile suggesting that age, gender, and smoking had no direct role in macrophage migration inhibitory factor elevation considering their secondary minor contributions in macrophage migration inhibitory factor circulation.

Background and objective: Low aqueous solubility of active pharmaceutical ingredients has an effect on both formulation development and bioavailability. Nimodipine is an antihypertensive agent with low oral bioavailability, which might be attributed to the extremely poor water solubility. This study aimed to increase the solubility of nimodipine in water using hydrotropes and solid dispersion technology to increase dissolution rate compared to the marketed drug product.

Methods: Solubility of nimodipine was determined separately in sodium acetate, sodium citrate, sodium benzoate, and niacinamide solutions at a concentration of 10, 20, 30, and 40% w/v using distilled water as a solvent. The highest solubility was obtained in 40% sodium benzoate solution. Mixed concentrations of hydrotropic agents were used in ratio 1:3 (niacinamide: sodium benzoate). Fourier-transform infrared spectroscopy was used to exclude any drug-hydrotropes interaction. The dissolution rate of nimodipine from solid dispersion and physical mixture were studied using USP type II dissolution test apparatus in acetate buffer (pH 4.5) as a dissolution media.

Results: Hydrotropic solid dispersion of nimodipine with a blend (30% sodium benzoate and 10% niacinamide) increased the dissolution rate of the drug by 1.5 folds compared to the marketed conventional nimodipine tablet. Fourier-transform infrared analysis did not show any physicochemical interaction between drug and carriers in solid dispersion formulation.

Conclusion: The hydrotrop is a novel and safe compound. It is a successful way to enhance the solubility of poorly aqueous soluble drugs. Immediate dissolution of practically insoluble drug nimodipine in dissolution media indicates that it has a great potential to solubilize the drug in biological fluids. Thus, a considerable improvement in bioavailability and onset of action of the drug can be predictable. Adding of a hydrotropic agent with nimodipine in solid dispersion increased the dissolution rate of the drug compared to the marketed conventional nimodipine tablet

Background and objective: Vitamin D deficiency appears to be related to the development of diabetes mellitus type 2 and metabolic syndrome. This study aimed to assess the association between the level of 25-hydroxy vitamin D{25(OH)D₃ and the glycemic control in patients with type 2 diabetes.

Methods: This case-control study involved 240 participants divided into two groups, 119 patients with type 2 diabetic mellitus and 120 healthy individuals as a control group. The study was conducted in Layla Qassim Diabetic Center in Erbil from March 2018 to March 2019. The data were collected from all the cases, including history and physical examination, using a specially designed questionnaire. From all cases, blood was taken, and samples were sent to the laboratory for serum vitamin D3 level estimation.

Results: From the total of 240 participants, the mean age of cases was 54.04 ± 10.56 years and of controls was 53.12 ± 9.84 years. The mean serum vitamin D3 level of the cases was 9.21 ± 5.69ng/ml, and it was non-significantly (P = 0.3) higher than the control (8.61±4.57)ng/ml. Both groups were within the vitamin D deficient range. Vitamin D level was non-significantly deficient in 84 (70.6%) of diabetic patients compared to 89(73.6%) of control. There was a non-significant difference in vitamin D level in poorly controlled diabetic patients compared to well-controlled diabetic patients (P = 0.584).

Conclusion: No significant association was detected between vitamin D level and glycemic control.

Background and objective: Pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. Pancreatitis is a condition characterized by inflammation of the pancreas. When the digestive enzymes are activated before they are released into the small intestine, they begin attacking the pancreas, and pancreatic damage happens. This study aimed to evaluate the association between pancreatic lipase, gamma-glutamyl transferase, and acute pancreatitis in patients living in Erbil city.

Methods: The present study was carried out at the College of Medicine, Hawler Medical University from December 2017 to July 2018. A total of 35 patients with acute pancreatitis and 25 healthy controls were investigated. Examinations of serum pancreatic lipase and gamma glutamyl transferase were carried out spectrophotometrically for both groups using commercial diagnostics kits.

Results: The results showed that the mean level of serum pancreatic lipase in patients with pancreatitis was significantly higher (P <0.01)compared to normal healthy control. The mean serum gamma glutamyl transferase was higher in patients with acute pancreatitis when compared to the reference group but not statistically significant.

Conclusion: In the frame of this work, we delineate that pancreatic diseases had a significant effect on pancreatic enzymes reflected by a significant increase in serum lipase, whereas the level of gamma glutamyl transferase increased marginally.