Evaluation of Serum Vitamin D level in patients with inflammatory bowel disease in Duhok Governorate Azad Saleh Mohammed Medical Journal of Babylon 2019 16(3):167-173 Background: Vitamin D deficiency is a common problem in patients with inflammatory bowel diseases (IBDs). Objectives: The aim of the current study was to measure serum Vitamin D concentrations (25 (OH) D) in patients with IBD and examine its relation to the severity of disease. Materials and Methods: This was a prospective cross-sectional study of adult patients diagnosed with IBD including ulcerative colitis and Crohn's disease compared to sex-matched controls from an outpatient clinic in a public hospital in Iraq between February 2018 and May 2018. The Vitamin D deficiency levels were assessed as below 20 ng/ml as deficient, between 20 and 30 ng/ml as insufficient, and >30 ng/ml as sufficient level. Results: Serum Vitamin D levels were measured in 145 patients including 68 patients (median age: 30.5 ± 17.25) and 77 healthy controls (median age: 52.00 ± 12.25) ranged 18–63 years. Further, the median length of disease progression was 3.0 years. Serum Vitamin D levels were significantly lower in patients (IBD or separately) compared to healthy controls. However, such significant difference was not found between patients with respect to Vitamin D and disease severity. In addition, it was confirmed that disease severity is related to Vitamin D deficiency in IBD patients. Conclusions: The current study revealed that the patients with IBD have a significantly lower level of Vitamin D compared to healthy control group. In addition, the Vitamin D deficiency is related to disease severity.

Maternal and fetal risk factors associated with hypospadias in a sample of Iraqi boys Saif H Al-Tamimi, Firas S Al-Quraishi, Aseel A Naji Medical Journal of Babylon 2019 16(3):174-178 Background: Hypospadias is one of the most common congenital anomalies among boys. The exact causes of this anomaly are not clearly defined yet. However, many of the risk factors have been identified in different ethnic groups. Objective: The objectives of this study are to evaluate the maternal- and fetal-related risk factors for hypospadias in a sample of Iraqi patients. Materials and Methods: This case–control study included 42 boys with hypospadias cases and other 42 age-matched boys free from any genital anomalies as a control group. Maternal data, including age, parity, body mass index, hypertension, diabetes mellitus (DM), the use of assisted reproduction techniques (ART), level of education, consanguinity, and residence; and infant-related factors. Logistic regression analysis was used to predict the risk of each variable through the calculation of odds ratio (OR) and its corresponding 95% of confidence interval (CI). Results: Three maternal factors were found to be associated significantly with increased risk of hypospadias. These were maternal age >33 years (OR = 3.08, 95% CI = 1.02–9.26, P = 0.045), consanguineous marriage (OR = 3.0, 95% CI = 1.02–8.8, P = 0.045), and rural residence (OR = 2.64, 95% CI = 1.04–6.73, P = 0.041). Hypertension, DM, and using ART were more frequent among mothers of cases than controls; however, the differences were not significant. For fetal-related factors, infants with low-birth weight (LBW) were more frequent among cases than controls (40.48% vs. 19.05%), with a statistically significant difference (OR = 2.89, 95% CI = 1.08–7.75, P =0.035). Of note, twins were more frequent among cases than controls; however, this difference was not statistically significant (P = 0.074). Conclusions: These results highly suggest the critical role of advanced maternal age, consanguinity, rural residence, and infant LBW, as predisposing factors for the occurrence of hypospadias among Iraqi boys.

Expression of beta-human chorionic gonadotropin as a prognostic factor in colorectal carcinoma Hameed Naeem Mosa, Esraa Abdulaal Aldujaily, Ali Jabir Duabil, Liwaa Hussein Alkelabi, Azhar Naji Alnajim, Faiza Aftan Al-Rawi Medical Journal of Babylon 2019 16(3):179-183 Background: Colorectal carcinoma (CRC) is a common malignancy in Iraq and carries a high mortality rate. It has been shown that CRCs express high level of beta-human chorionic gonadotropin (β-HCG) as detected by immunohistochemistry. Objectives: The aim of this study was to assess the expression of β-HCG in CRC and to study the association between β-HCG expression and pathological prognostic parameters. Materials and Methods: This study was carried out on 35 colonic specimens consisting of 30 CRC selected from files of Pathologic Laboratory of Al-Kadhymia Teaching Hospital and Teaching Laboratories of the Medical City, Baghdad. Paraffin blocks were cut sections stained with H and E stain and sections for streptavidin-biotin immunohistochemical staining using monoclonal antibody against β-HCG. Immunohistochemical sections were examined for positive or negative staining and positivity assessed as: occasional, focal, and diffuse tumors. Results: Of the 30 CRCs, 60% were male and 40% were female. The most common site of large bowel malignancy was the rectum 13 (43.3%). Most of the tumors were moderately-differentiated adenocarcinoma (83.3%). More than half of the cases were Stage T3, followed by Stage T2, then Stage T4, 3 cases (10%), and no case in Stage T1. Lymph node metastases were found in 19 cases (63.3%). Twelve cases (40%) of CRC show immunoreactivity to β-HCG. β-HCG expression was more frequent in the left side of the large bowel and more common in poorly-differentiated adenocarcinoma (80%). β-HCG was more positive in Stage T4, and there was significant association with lymph node metastasis. Conclusion: Expression of β-HCG in CRC is not an infrequent phenomenon, and no stain was demonstrated in benign and normal colonic specimens, while β-HCG expression associated with poor differentiation, greater local invasion, and regional lymph node metastasis.

Hematological parameters in children with type-1 diabetes Kamal Hussein Khudhur, Mouroge Hashem Al-Ani Medical Journal of Babylon 2019 16(3):184-187 Background and Objective: This study was done to investigate and compare the hematological parameters related to hemoglobin (Hb), total white blood cell (WBC) count, and platelet parameters in a case–control study of patients with diabetes with those of nondiabetic healthy persons, potentially predisposing patients with diabetes to complications. Materials and Methods: A case–control study consisted of 50 children with type I diabetes have been diagnosed since 5 years attending Laila Qasim Diabetic Center compared with another 50 nondiabetic healthy children attending Pediatric Clinic at Raparin Pediatric Hospital from October 2018 to March 2019. Investigations were done as follows: (a) both patients and controls including Hb (g/dl), total WBC count (109/L), platelet count (109/L), mean platelet volume (MPV) (fl), platelet distribution width (PDW) (fl), platelet-large cell ratio (P-LCR) (%), and (b) patients only HbA1C (%) to know their control state. Results: WBC, MPV, PDW, and P-LCR were significantly higher among children with diabetes in comparison with the control group (WBC 9.34 ± 1.56 109/L vs. 8.14 ± 1.88 109/L, P = 0.001; MPV 9.60 ± 1.13 fL vs. 8.07 ± 0.87 fL, P = 0.001; PDW 11.91 ± 1.18 fL vs. 10.03 ± 1.1 fL, P = 0.001; and P-LCR 19.34% ± 4.85% vs. 12.09% ± 4.37%, P = 0.001); Hb was significantly lower among children with diabetes in comparison with the control group (Hb 12.61 ± 0.75 g/dl vs. 12.89 ± 0.64 g/dl, P = 0.04); No significant difference was detected between the two groups regarding platelet count. Conclusion: The study revealed that hematological parameters changed as a result of diabetes mellitus, especially Hb was decreased among patients with diabetes and WBC, MPV, PDW, and P-LCR were highly elevated in type I as compared with nondiabetic participants.

Seroprevalence of toxoplasmosis in aborted women in Babylon Province, Iraq Lawhedh Jasim Mohammed, Mohammed Salih Al-Janabi Medical Journal of Babylon 2019 16(3):188-191 Background: Toxoplasmosis is considered as one of the most prevalent human parasitic infections that can be transmitted from mother to the fetus. The onset of toxoplasmosis during pregnancy has clinical complications, including spontaneous abortion, preterm labor, stillbirth, and fetal abnormalities. Objective: The aim of this study was to investigate the seroprevalence of toxoplasmosis infection in aborted women. Materials and Methods: Seventy-five sera samples were collected from the women admitted in the obstetrics and gynecology ward with abortion. The blood samples were processed appropriately and tested for Toxoplasma gondii IgM and IgG using enzyme-linked immunosorbent assay (ELISA) technique, in addition to latex agglutination test (LAT) as a screening test. Results: Seropositivity of aborted women to T. gondii was 42.6% when used LAT while 4% and 22.6% when detection of T. gondii IgM and IgG respecyively ELISA.the highest percentage of infection was found to be 18.6% in the age group of 21–25 years, in patients inhibited in rural area. Also seropositive in women with double frequent of abortion. Conclusion: ELISA test was the best method to investigate toxoplasmosis in aborted women, especially with recurrent spontaneous abortion.

S100A4 and S100A6 proteins expression promote migration of Bladder cancer cells in Zebrafish Hanaa Al-Mahmoodi, Ibtihal Alshamarti, Qais Ibraheem Al-Ismaeel, Ahmed Mohamed Salih, Hishyar Azo Najeeb, Rusul Mohammed Al-Rubaay Medical Journal of Babylon 2019 16(3):192-198 Background: Bladder cancer (BC) is one of the major causes of cancer-related mortality in the world. S100 family of small Ca-binding proteins has been implicated in the progression of different cancer types, including BC. Objective: The goal of this study is to develop a more rigorous understanding of the role of S100 proteins in BC progression and also to what extent S100s have the ability to increase the metastatic potential for BC. Methods: A selected panel of bladder cell lines (J82, T24, HT1376, and RT112) was transplanted into zebrafish embryos to investigate their migration behavior and metastatic potential. Characterizing the expression pattern of S100 proteins including (S100A4 and S100A6) in different BC cells was performed using quantitative polymerase chain reaction and Western blot. Assess the effect of S100 proteins on bladder cell migration in vivo was carried out using a zebrafish xenotransplant model. S100 proteins expression was modulated by small-interfering RNA approach. Results: High expression of mRNA and proteins levels of S100A4 and A6 were detected in T24 and J82 cell lines, which displayed the highest migration rate in zebrafish embryos. In addition, our data showed that the average migration rate of T24 cells transfected against S100A4, S100A6, and S100A4 and A6 were 17.3%, 10%, and 17.3%, respectively, which was lower than from siControl 41.9%. Likewise, the same effect of protein silencing on cell migration was observed in J82 cell lines. S100A4, S100A6, and S100A4 and A6 knockdown reduced the migration rate of J82 cells to 14.6%, 17%, and 14% compared to the control 37.8%. Furthermore, overexpressed S100A4 expression in RT112 cells significantly increased in migration ability by 29%, compared to control cells 7.3%. Conclusion: S100A4 and S100A6 play a role in BC cells invasion and migration. Silencing of these proteins affected dissemination of BC cells in zebrafish embryos highlighting their role in tumor progression.

A comparative study of diagnostic nasal endoscopy and computed tomography in chronic rhinosinusitis Rawand Kamaran Hussein, Said Mustafa Said Jaf Medical Journal of Babylon 2019 16(3):199-202 Background: Chronic rhinosinusitis (CRS) is a common condition in medical practice. It is defined as inflammation of the mucosa of nose and paranasal sinuses, the fluids within these cavities, and/or the underlying bone that has been present with or without treatment for at least 12 weeks' duration. Objective: This study aimed to determine the correlation of nasal endoscopy examination and computed tomography (CT) in the early diagnosis of CRS. Materials and Methods: The study was carried out in outpatient Department of Otorhinolaryngology, in Rizgary Teaching Hospital in Erbil. A total of 60 patients with clinical evidence of sinonasal diseases were evaluated with nasal endoscopy and computed tomographic evaluation. Patients with previous variation of paranasal sinus anatomy due to facial trauma and former sinus surgery were rejected. Patients with history of having malignant neoplasms or congenital malformations were also excluded from the study. Results: Sixty patients with chronic rhinosinusitis participated in the study. Their mean age + standard deviation was 38.18 + 10.19 years, ranging from 20 to 63 years. The median was 37.5 years. The largest proportion (41.7%) of the sample aged 30–39 years old, and only 16.7% aged ≥50 years. The main symptoms of the patients were nasal obstruction (80%), ear pressure (80%), and nasal discharge (78.3%). No significant difference was detected between the two tests regarding their findings. Conclusion: Nasal endoscopy have sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure, it may reduce unnecessary diagnostic scanning procedures.

The modified alvarado score versus alvarado score in the diagnosis of acute appendicitis Suzan Safar Sulo, Hisham Ahmad Al-Atrakchi Medical Journal of Babylon 2019 16(3):203-206 Background: Appendicitis is the most common surgical emergency presented daily to emergency surgical department. The Modified Alvarado Scoring System (MASS) is easier and applicable in the diagnosis of acute appendicitis using extra signs instead of neutrophilic left shift. Objective: The aim of this study is to compare and evaluate the diagnostic accuracy of MASS versus the Alvarado scoring system. This study was carried out in Duhok Emergency Teaching Hospital, Iraq, over the period of 12 months, from October 2017 to October 2018. Materials and Methods: A cross-sectional study including 200 patients, diagnosed with acute appendicitis by the senior surgeon on call and underwent conventional open appendicectomy. MASS were applied to all patients preoperatively by author and results of both scores compared to operative and histopathological findings of excised appendix to analyze the efficacy of both scores in the diagnosis of acute appendicitis. Results: Of 200 patients who underwent operation those with Alvarado score of 9–10 had sensitivity of 88% and specificity of 100%. Those with a score of 7–8 had sensitivity of 63% and specificity of 68%. For MASS patients with score of 9–10 had sensitivity of 96% and specificity of 100%, and those with a score of 7–8 had sensitivity of 77% and specificity of 86%. The higher the score, the sensitivity and specificity increased. Positive predictive value and accuracy of neutrophilic left shift of Alvarado were 95% and 65%, positive predictive value and accuracy of extra signs of modified Alvarado score were 97% and 84% respectively. Conclusion: Both Alvarado and MASS are fast, simple, and repeatable systems in the diagnosis of acute appendicitis. This study reveals that accuracy of MASS is higher than Alvarado score, and the rate of negative appendicectomy can be reduced using this system.

Echocardiography assessment of the left ventricular systolic function and regional wall motion abnormalities pre- and post-coronary artery bypass grafting surgery Vazheen Abdul Hameed Ismael, Mousa Haji Ahmed, Maher Mohamad Amin Taher Medical Journal of Babylon 2019 16(3):207-214 Background and Objective: Coronary artery disease is a significant global health problem and is a leading cause of disability and death. In this study, the effect of coronary artery bypass graft (CABG) surgery on left ventricular (LV) systolic functions and regional wall motion abnormalities in the 1st week and 3rd month after surgery was evaluated through echocardiographic techniques. Patients and Methods: Fifty patients who underwent elective isolated CABG at Azadi Heart Center were included and studied prospectively from November 2018 to May 2019. Transthoracic two-dimensional echocardiography was used to assess the LV-systolic function (LV ejection fraction [LVEF]) and wall motion score index (WMSI) and abnormalities. Results: Almost all patients had chest pain preoperatively, and 32% and 38% of them were in Canadian Cardiovascular Society (CCS) Class III and IV, respectively. Ninety percent had multivessel disease, and the left anterior descending was the most common vessel affected (86%), complete revascularization was done in all patients using 3–6 grafts, and left internal mammary artery was used in 48 patients (96%). There was no significant improvement in LVEF in the early postoperative period (P = 0.28). On the contrary, there was a highly significant improvement of LVEF lately postoperatively, which was improved from (49.62%–56.92%) at (P ≤ 0.001). As well, there was a substantial improvement of WMSI at lately postoperative (P = 0.026) that changed from (1.204 to 1.12). Conclusions: The present study suggests that CABG has a positive effect on LV systolic functions and regional wall motion abnormalities 3-month post-operatively as confirmed through echocardiographic techniques.

Role of intracranial ultrasonography in the evaluation of premature babies Balen Karim Salih, Abbas Abdulkadir Rabaty Medical Journal of Babylon 2019 16(3):215-219 Background and Objective: In this study, the role of intracranial ultrasonography was evaluated in detecting intracranial abnormalities in premature neonates; furthermore, some maternal risk factors were evaluated for increasing incidence of intracranial abnormalities. Materials and Methods: A prospective cross-sectional study was done on 60 preterm neonates admitted in the neonatal care unit in both Raparin pediatric teaching hospital and maternity teaching hospital over a 5-month period. Neurosonogram was carried out for all within 1 week of life, and then, a second brain ultrasound (US) scan performed for them after 1 week if the first one was abnormal and the third scan for those who were abnormal at the second visit. Results: Incidence of intracranial abnormalities by ultrasonography in preterm neonates is 13.3% in the present study. There were 50% male and 50% female neonates. Ten percent of the study sample had evidence of intraventricular bleeding, and 3.3% had ventricular dilatation. There is a significant association between maternal risk factors and incidence of intracranial abnormalities (P = 0.01), and furthermore, there is a significant association between weight and gestational age (P = 0.001). There is no significant association between US finding with each of weight, gestational age, gender, and mode of delivery. Conclusion: Neurosonogram is the best initial method of investigation for preterm babies in the evaluation of intracranial abnormalities even if clinically silent. Maternal risk factors should be taken into consideration in increasing incidence of intracranial abnormalities. It is best to perform neurosonogram studies on all preterm babies within the 1st week of birth. It is widely available, cheap, and repeatable.