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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 16 | Issue 2
Page Nos. 87-165

Online since Monday, June 17, 2019

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EDITORIAL  

Employing triple-drug therapy to expedite the process of the global elimination of filariasis p. 87
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_18_19  
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ORIGINAL ARTICLES Top

Interaction of sodium dodecyl sulfate with anticancer drug 6-mercaptopurine p. 89
Alaa A Habeeb, Falah Sh. Abed Suhail, Sami W Radhi
DOI:10.4103/MJBL.MJBL_3_19  
Background: 6-Mercaptopurine (6-MP) is used in the conventional chemotherapy of patients with acute lymphoblastic leukemia. Materials and Methods: Sodium dodecyl sulfate (SDS), an anionic surfactant that is commonly used to mimic hydrophobic binding environments such as cell membranes, micellization behavior of sodium dodecyl sulfate (anionic surfactant) has been studied in the presence of 6-MP (anticancer drug) at (1 × 10−5 M) concentrations with different time periods in micelle solution, studied at 37°C. Results: The results showed increase the absorbance values for the pharmaceutical compound (6-MP). Increase the absorbance values of pharmaceutical compounds with 1 × 10−2 critical micelle concentration values of surfactant increase of 6-MP concentrations in micelle solution, with decrease its concentrations in organic media, various thermo-dynamic parameters such as standard-free energy of micellization ΔG (0.6216 k J.mol−1), that have direct bearing on the consequences of such interactions at the molecular level have been calculated. Depend on Keq and slope values for reversible reactions. Conclusion: The above-calculated parameters were found to be sensitive toward the interactions prevailing in 6-MP–SDS–hexane-water systems. After fixed the experimental optimum conditions at pH 7.4, 37°C, and λmax 322 nm.
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Treatment of genital warts by using CO2 laser Highly accessed article p. 94
Mayyadah H Mehdi, Ali S Mahmood
DOI:10.4103/MJBL.MJBL_120_18  
Background: Genital wart is the most common viral sexually transmitted disease. In fact, its incidence is rising rapidly. It is approximated that 30%–50% of sexually active adult have human papillomavirus (HPV) infection, but only 1%–2% of them have apparent genital wart. Mostly, cervical dysplasia and cancer are associated with oncogenic HPV types. HPV types are classified into high-, intermediate-, and low-risk group. HPV Types 16 and 18 are considered as a high-risk group cancer-associated HPVs, whereas Types 6 and 11 concerned as a low risk and HPV types 31, 33, and 35 have an intermediate association with cancer. Objective: The objective of the study was designed to evaluate the activity of CO2 laser to treat genital warts of female Iraqi patients. Materials and Methods: Fifteen female patients with genital warts were involved in this study. Their age range from 22 to 49 years treated by CO2 laser at the Laser Medicine Research Clinics of Institute of Laser for Postgraduate Studies from July 2017 to end of July 2018. Application of topical lidocaine cream 10% for 30 min or local infiltration of 2% xylocaine had been performed. CO2 laser in chopped mode was used with a peak power: 151 watts and repeated time 35 s in D mode, pulse duration 1.3 ms. Treatments by vaporization of the warts were done in one session except one patient with a large number and multiple locations two sessions were done. Results: Three patients expressed mild pain during the procedure, but it could be tolerated by them. No edema or oozing observed during the 1st week. No postoperative infections or scars. Two cases of recurrence 2/15, (13.3%) after few months from treatment. Conclusion: CO2 laser vaporization is an effective and safe method for treatment of genital warts and can be done in the outpatient clinic.
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Compliance to antituberculous drugs among patients in Erbil, Kurdistan Region of Iraq p. 99
Shapol Jalal Kokha Ubed, Hamanejm H Jaff
DOI:10.4103/MJBL.MJBL_1_19  
Introduction: In Erbil, Kurdistan region of Iraq, some patients registered with tuberculosis (TB) diagnosis in Chest and Respiratory Diseases Center have interrupted treatment before completing their course, and many patients take their treatment irregularly due to different reasons. In this study, we try to determine the percentage of patients who are noncompliant to antituberculous drugs, to know the causes of noncompliance and to compare the outcome of patients taking drugs irregularly to those who take them regularly. Materials and Methods: Patients enrolled in this study were those who were diagnosed as having TB and registered in Erbil Chest and Respiratory Center during the years 2015 and 2016. Data were collected from patient forms and registers. For most patients, the causes of interruption in the course of treatment are not documented in the registers, and thus patients had been called by phone to know factors behind that. Results: Among 394 patients registered in this study, it was found that 57 patients (15%) registered to having TB have been registered as default from the treatment and 14 patients (3.55%) have interrupted their treatment because they had been wrongly diagnosed as TB. Fifteen patients (3.8%) have completed their treatment, but their follow-up was not documented. One (0.25%) of the patients completed his treatment outside Iraq. Another patient was originally from other governorates (Al-Anbar) and completed his treatment when he returned to his governorate. Two (0.5%) were non-Iraqi patients who returned to their countries and their outcome is unknown. Five (1.27%) of the patients stopped treatment due to side effects of drugs; three (0.8) of them were told by the referring doctor to stop treatment. Conclusion: Most TB-infected patients who were registered in Erbil Chest and Respiratory Diseases Center were compliant to the treatment but with occasional interruptions. Not all patients who were registered as default were really defaulters as many of those have completed their treatment, but their follow-up was not documented, and many were misdiagnosed as TB.
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Effectiveness of the modified valsalva maneuver in the emergency management of supraventricular tachycardia p. 104
Ameen M Mohammad, Mahir Sadullah Saeed, Federico Migliore
DOI:10.4103/MJBL.MJBL_8_19  
Background: The return rate of supraventricular tachycardia (SVT) to sinus rhythm by the standard Valsalva maneuver (SVM) is as low as 5%–20%. Despite the limited available data in the literature, the modified Valsalva maneuver (MVM) is promising. We tested the effectiveness of the MVM for the emergency treatment of patients with SVT. Materials and Methods: In this cohort prospective study, 93 confirmed SVT cases with mean age of 47.88 ± 15.66 years and female: male ratio (1.73) across multiple centers underwent MVM. The reversion to sinus rhythm after 1 min of the maneuver, in the first or second attempt, was considered to be a success, and other conditions were considered to be a failure. Alternative therapies were administered for nonresponders. Results: The overall success rate of the reversion of SVT to sinus rhythm by using MVM in this study is 47.3%. In addition, the rate was not affected by medical and drug histories, and the rate was not substantially different among the patients having different sociodemographics, blood pressures, and pulse rate statuses. MVM has a high cardioversion rate when used for patients with SVT. We recommend using it instead of the SVM as the first-line nonpharmacologic therapy for SVT. Conclusion: The MVM has a very reasonable cardioversion rate in the setting of emergency treatment of SVT regardless of the associated sociodemographic and medical histories of patients.
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Prevalence of hepatitis B and C in thalassemic patients and its relation with type of thalassemia, frequency of blood transfusion, and spleen status p. 108
Liqaa Mohammed Al-Sharifi, J Murtadha, A Shahad, Y Mohammed, J Sura, Z Waleed, M Raheeq, A Sura, H Ehab, M Shahad, Q Abbas
DOI:10.4103/MJBL.MJBL_6_19  
Background: Thalassemia is one of the most common inherited diseases; it is an inherited impairment of hemoglobin production, in which there is partial or complete failure of the synthesis of globin chain. Hepatitis B and hepatitis C had emerged as a major cause of end-stage liver disease. Both the viruses are transfusion-transmitted disease. Objective: The objective of the study is to assess the prevalence of hepatitis B and C viruses in thalassemic patients and its relation with type of thalassemia, blood transfusion, and spleen status. Material and Methods: A cross-sectional study was conducted on 100 multitransfused thalassemic patients for 2 months from November 1, 2016, to January 1, 2017. Test for HBsAg., HBcAb. IgG and IgM for screening of hepatitis B virus (HBV). HBcAb. by VIDAS method and confirmation by reverse transcription polymerase chain reaction for hepatitis C virus (HCV) was done. There is no family history of HBV and HCV infection nor vaccination history of the studied population. Results: Twelve (12%) patients had a positive HBcAb, while 3 (3%) had HBsAg positivity, higher percentage of HCV-infected patients (91%) received regular every 1-month blood transfusion, 50% of hepatitis C patients had splenomegaly, and 20.7% had splenectomy. Conclusion: Good and sensitive screening tests and stringent donor selection processes are required for the better control of this transfusion-transmitted infection among thalassemic patients.
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Clinical and histopathological features of ovarian cancer in Rizgary Hospital/Erbil City from 2014 to 2017 p. 112
Marwa Jabbar Hussein, Jangi Shawkat Salai
DOI:10.4103/MJBL.MJBL_117_18  
Background: Ovarian cancer is a heterogeneous disease with variations in clinical behavior and outcome. It is a group of many subtypes with distinct biological features that lead to differences in response to treatments, recurrence rates, and survival. Objective: The aim of the study is to describe the epidemiology of the diagnosed cases of ovarian cancer from 2014 to 2017 in Erbil, Iraq. Materials and Methods: This is a retrospective study, 100 ovarian cancer cases were reviewed from Rizgary Oncology Center in Erbil. Then, we compared histological types with age groups of the study as premenopausal and postmenopausal, stage of the disease, grade, and with side of tumor. Furthermore, this study includes the most important risk factors that may affect the incidence of ovarian cancer which includes menarche age, age of menopause, and with obesity. Results: The result showed that ovarian cancer occurs in old age groups with a percentage of 64%. The most common type is epithelial ovarian cancer with subtype papillary serous adenocarcinoma in 56%, with all types, the most affected site is the right one in a percent of 57%. Grade 3 is the dominant one at presentation in a percent of 49%. About staging at the time of diagnosis, Stage 4 presented in a percent of 58%, and 16% of patients were obese. Conclusion: Most common type of cancer is epithelial type of papillary serous cystadenocarcinoma histology that occur in old patients and presented in advanced stage at the time of diagnosis with poor differentiation, and the most effective treatment is total abdominal hysterectomy + bilateral salpingo-oophorectomy followed by adjuvant platinum-based chemotherapy.
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Prevalence of vitamin D deficiency in Iraqi female at reproductive age p. 119
Hayder A Hantoosh, Mayyadah H Mahdi, Ban W Imran, Ansam A Yahya
DOI:10.4103/MJBL.MJBL_9_19  
Background: Vitamin D, a fat-soluble vitamin that now is recognized as a prohormone that recently has an important role in the reproductive health. Vitamin D deficiency (VDD) had high prevalence worldwide and was estimated to affect about 50% of the population worldwide. Hypovitaminosis D related to several health problems in women such as infertility, polycystic ovarian syndrome endometriosis, and pregnancy-related complications such as preeclampsia and caesarian section. Objective: The aim of the study is to evaluate the serum level of Vitamin D in sample of Al-Hilla women at reproductive age. Materials and Methods: The total number included in the study was 500 patients. They were companions of patients visiting specialist gynecologic and obstetric private clinics in Hilla City from first of October 2017 to end of March 2018 the patients were grouped into three groups according to their age: Group 1: Patients aged (15–30) years. Group 2: Patients aged 31–40 years. Group 3: Patients aged more than 40 years and premenopausal. The data were collected which were then analyzed statistically and registered. Results: Whole sample mean serum Vitamin D level 15.85 ± 7.69 and the percentage of deficiency over all the sample was 76%. Regarding the result in each group, Group 1 include 350 patients, mean age (23.8 ± 3.96), and mean serum Vitamin D level (16.16 ± 7.69), t-test was statistically significant P < 0.05. Group 2 include 119 patients, mean age (35.2 ± 2.9), and mean serum Vitamin D level (15.14 ± 7.42), t-test was statistically significant P < 0.05. Group 3 include 31 patients, mean age (42.81 ± 1.45), and mean serum Vitamin D level (14.82 ± 7.77), t-test was statistically significant P < 0.05. Conclusion: Results of our study revealed a widespread, severe VDD in women at reproductive age with aproportion of deficiency in the whole sample of 76% and proportion of insufficiency 18% while only 7% had sufficient Vitamin D Serum level.
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Comparison of pulmonary function test between smokers and nonsmokers at Hawler Medical University, Erbil, Iraq p. 123
Media Qader Hasan, Karwan Hawez Sulaiman
DOI:10.4103/MJBL.MJBL_5_19  
Introduction: Cigarette smoking has extensive effects on pulmonary function. Pulmonary function testing is a routine procedure for the assessment and monitoring of respiratory diseases. The pulmonary functions were compared between apparently healthy smoker and nonsmoker persons in this study. Materials and Methods: This case–control study was conducted among apparently healthy smoker and nonsmoker students and staff of the university between the first of April and the end of June 2018. A total number of 131 persons were taken, in which 71 of them were nonsmokers (controls) and 60 were smokers (cases). The reference ranges for the pulmonary functions were used following the below criteria: forced vital capacity (FVC): normal (80%–120%) and reduced (<80%); FEV1 (forced expiratory volume in one second): normal (≥75) and reduced (<75); FEV1/FVC: normal ≥80 and reduced <80. Results: The study showed that smoker persons had a lower level of FVC (84.38 vs. 94.75; P = 0.026) and peak expiratory flow rate (PEFR) (67.08 vs. 84.18; P < 0.0001) compared to nonsmoker persons. Whereas, there was no significant difference in FEV1 (the first second of forced expiration) (80.42 vs. 86.86; P = 0.139) and the FEV1/FVC ratio (96.13 vs. 94.48; P = 0.589) between smokers and nonsmokers, respectively. The mean pack-year smoked by the smokers was 34.89. Conclusions: Cigarette smoking has a significant adverse effect on FVC and peak expiratory flow rate, while it was not confirmed to have an adverse effect on other pulmonary function tests.
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The benefit of prophylactic cervical cerclage in twin pregnancies p. 128
Iman Yousif Abdulmalek
DOI:10.4103/MJBL.MJBL_119_18  
Background: Despite the progress in modern obstetric practice, preterm labor is second leading cause of death in the 1st month of life and the main cause of perinatal morbidity and mortality; it remains a difficult problem to prevent, delay or even stop. It occurs in 5%–13% of all pregnancies before 37 weeks' gestation but its incidence in twin pregnancies is about 25%. Objectives: This study aimed to determine the effect of prophylactic cervical cerclage (CC) in comparison to others methods: vaginal progesterone and bed rest in prolongation of gestational age in twin pregnancies to prevent preterm labor. Materials and Methods: A retrospective descriptive study was conducted between January 2012 and September 2018, in a private obstetric antenatal care clinic in Duhok/Kurdistan Region/Iraq. It involved 150 women with twin pregnancies attending this clinic for follow-up, they divided into: Group 1 (N-86): women who received prophylactic CC; Group 2 (N-44): those who got the vaginal progesterone supplementation of 100 mg from 20 to 34 weeks of gestation; and Group 3 (N-20): those who asked for advisement of bed rest and restriction of physical activity. Results: Most of the total sample 95.3% had dichorionic placenta, the majority of them 84.7% were the result of assisted reproductive techniques. There was no statistically significant difference between the three groups in relation to maternal age, gravid, and previous preterm delivery, but there was in relation to the gestational age at delivery. In Group 1, 93% who delivered >37 weeks, whereas 16% and 10% in Group 2 and Group 3 who delivered at this gestational age, respectively. The overall perinatal survival was 91.3% and 26.6% who admitted to Neonatal Intensive Care Unit. Conclusions: The current study found that the prophylactic CC was an effective method to prolong pregnancy among women with twin pregnancies.
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Serum protein levels and albumin/globulin ratio in patients with uterus, ovary, and breast tumors compared to healthy women in Kirkuk City p. 136
Israa Ghassan Zainal, Ebaa Ghassan Zainal
DOI:10.4103/MJBL.MJBL_10_19  
Background: Gynecological cancer is one of the most serious public health problems in the world with main gynecological cancers, uterus, breast, and ovarian, causing morbidity with severe suffering and a high mortality. Objective: This study aimed to investigate the levels of the total protein (TP), albumin (Alb), globulin (Glo), and Alb/Glo ratio in the female patients with (uterus, ovary, and breast) cancer compared to healthy females. Materials and Methods: This study included 120 females with (28 uteri, 31 ovaries, and 25 breasts) cancer patients and 36 healthy control participants, with age ranges between (20 and 42) years. Results: Alb levels significantly (P ≤ 0.05) decreased in all patient samples except those with uterus cancer who showed significant increase (P ≤ 0.05) compared to healthy participants, and Glo levels significantly (P ≤ 0.05) decreased for uterus and breast cancer samples and nonsignificant (P ≤ 0.05) decrease in patients with ovary cancer compared to healthy participants; finally, the ratio of Alb./Glo. showed significant (P ≤ 0.05) decrease in all patients group except patients with breast cancer showed significant increase (P ≤ 0.05) compared to healthy participants. The results of correlation coefficient indicated that there were significant (P ≤ 0.05) positive correlations between TP and Glo for uterus and breast cancer patients and between TP and Alb for ovary cancer patients. Conclusion: The ratio of Alb/Glo was significantly (P ≤ 0.05) decreased in all patients group except patients with breast cancer who showed significant increase (P ≤ 0.05) compared to healthy participants which could be used in the diagnosis of these patients.
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Proportion of colorectal cancer proved by a histopathological study on patients who underwent colonoscopy p. 141
Nadir A. Sanad Al-Jenabi, Ali Abaid Kadhem, Hamid Fadhel Abbas
DOI:10.4103/MJBL.MJBL_22_19  
Background: Colorectal cancer is the third most common cancer in the world, and the general lifetime risk of development cancer in the United States is 6%. Many people with colon cancer experience no symptoms in the early stage of the disease. When symptoms appear, they will likely vary, depending on the cancer size and location in the large intestine. Objective: The objective of this study was to determine the proportion of colorectal cancer proved by a histopathological findings on patients who underwent colonoscopy and also to study the association of colorectal cancer with age, gender, and presenting signs. Materials and Methods: This study has been carried out at gastroenterology, and colonoscopy has been done for 366 patients with signs and symptoms of lower gastrointestinal tract infection. Out of those patients, biopsies have been taken from 320 patients. Results: Results of distribution of the patients who underwent colonoscopy by presenting signs and symptoms found that the majority (80.6%) of the patients presented with bleeding per rectum. The distribution of (320) patients by histopathological findings found that only 17.8% of patients had colorectal tumors. Conclusion: Younger age group is more involved in colon cancer and left colon was the most common site, and when symptoms occur, the tumor is locally invasive.
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Vitamin D supplementation in the first trimester of pregnancy as an intervention to protect against adverse gestational outcomes in the third trimester p. 145
Banav Najeeb Muhammed, Ardawan Fatah Ali
DOI:10.4103/MJBL.MJBL_23_19  
Background: Vitamin D deficiency (VDD) is thought to be common among pregnant women and is a widespread public health problem. Objective: The aim of this study was to know whether the correction of VDD by Vitamin D supplementation given to pregnant women in the first trimester of pregnancy can prevent the development of complications such as preeclampsia (PE), gestational diabetes mellitus (GDM), and small for gestational age (SGA) in the third trimester or not, in a sample of pregnant women. Materials and Methods: The study was an experimental design. It was carried out between December 2016 and October 2018. A total 200 healthy pregnant women were included. They were chosen randomly in the first trimester of pregnancy from the Outpatient Clinic in Duhok Governorate of Kurdistan Region, Iraq. A knowledge questionnaire was used to collect information. Blood samples were taken and analyzed for the determination of 25 hydroxyvitamin D (25[OH] D). We did routine investigations which done for every pregnant woman as a part of antenatal care in the form of complete blood count, general urine examination, random blood sugar, and ultrasound. Results: Mean serum 25[OH] D concentration before supplementation was 8.41 ± 2.48 and after supplementation was 30.96 ± 9.60. There was a reduction in the risk of GDM and SGA but no change in the risk of PE. Conclusion: Supplementation of Vitamin D to pregnant women with VDD in the first trimester may lower the risk of GDM and SGA, but its effects in the prevention of PE need further evaluation. All patients had response to the Vitamin D supplement within 8–10 weeks regardless the outcomes.
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Microbial contamination of operating theatres and intensive care units at a surgical specialty hospital in Erbil City p. 150
Soza Tharwat Baban, Payman Akram Hama Saeed, Dlovan M. F. Jalal
DOI:10.4103/MJBL.MJBL_15_19  
Background: Microbial contamination of operating theater (OT) and intensive care unit (ICU) is the most frequent cause of nosocomial infections in patients. Objectives: this study aims to evaluate the prevalence level and variety of microbial contamination in these high-risk areas in the surgical specialty hospital in Erbil city. Materials and Methods: Three sampling procedures were employed in this study, which includes swabbing, open plate, and both microbiological and biochemical investigation of water supply in these high-risk areas. Standard microbiological techniques were used for microbiological culture and identification of microbial pathogens. Results: 48.3% yielded positive microbial growth. The most common isolates were Gram-positive bacteria (83.1%), of which Staphylococcus aureus accounted for 78.6% of bacterial pathogens isolated, followed by Streptococci (33.3%) and Enterococci (28.6%). Whereas, lower rate of Gram-negative bacterial contamination (16.9%) was observed, including Escherichia coli (19%) and each of Pseudomonas aeruginosa and Proteus (4.8%). Air contamination with Aspergillus (19%) and Molds (14.3%) was observed, respectively. The highest rate of microbial contamination was observed in OT rooms (35.6%) where 50% of environmental hygiene practice was detected using infection control practice audit tool. In addition, 21.4% of positive cultures were identified in ICU rooms where only 9% of environmental hygiene was practiced. Conclusions: These findings emphasize the important role of infection control system to prevent the cross-transmission of nosocomial pathogens to cause contamination and infection in the critically ill patients.
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Molecular characteristics and clinical relevance of cytotoxin-associated genes A and E of Helicobacter pylori from Patients with gastric diseases p. 156
Ahmed L Hamad, Haidar A Shamran, Jasim Muhsin Al-Maliki, Ibrahim A Mahmood
DOI:10.4103/MJBL.MJBL_19_19  
Background: Helicobacter pylori colonizes about a half of the world's population. It possesses several genes that associated with virulence, among which are cytotoxin-associated antigen (CagA) and cytotoxin-associated gene E (CagE) genes within the cag pathogenicity island. These genes encode for proteins involved in the pathogenicity of the bacteria. Objective: This study aimed to investigate the prevalence of CagA and CagE genes among H. pylori isolates from patients with different gastric pathologies and for phylogenetic analysis of the isolated bacteria according to gene sequence. Materials and Methods: A total of 104 gastric biopsies were collected for patients suffering from different gastric pathologies. DNA was extracted from these biopsies, and a conventional polymerase chain reaction (PCR) was performed to amplify the gene fragments corresponding CagA and CagE genes using specific primers. PCR product of selected samples of positive for CagE was undergone direct sequencing. The result of sequences was aligned with reference sequences in National Center for Biotechnology Information (NCBI), and the phylogenetic tree was constructed. Results: Out of 104 isolates of H. pylori, 89/104 (85.58%) were found to have either CagA, CagE, or both genes. The frequencies of CagA, CagE, and coexistence of both genes were 71.15%, 46.15%, and 31.73%, respectively. The phylogenetic tree revealed two main clades, one of which involved isolates 6 and 9 as separated isolates and another clade involved all other isolates. The isolate 4 clustered with AY153111.1 and AP014523.1, the isolate 3 clustered with AY153124.1, the isolate 5 clustered with LC339073.1 and LC339017.1, the isolates 7 and 11 clustered with EU090726.1, the isolate 2 clustered with AB191082.1, the isolate 10 clustered very close to LC339004.1 and less close to LS483488.1, while the isolate 1 clustered with AP017334.1. Conclusion: CagA and CagE genes are highly prevalence among H. pylori isolate from gastric pathologies from Iraqi patients.
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CASE REPORT Top

Suturing of tracheomalatic rings complicating long-standing huge goiters to adjacent structures p. 163
Ahmed H. M. Al-Jenabi, Mohammed Salih Al-Janabi
DOI:10.4103/MJBL.MJBL_13_19  
Five patients selected having huge goiter compressing and deviating trachea, with criteria of tracheomalacia which were scheduled for total thyroidectomy with fixing tracheomalatic rings to adjacent structures instead of other methods used previously, with follow-up more than 1 year. We report five cases of tracheomalacia following total thyroidectomy for huge multinodular goiters which were diagnosed and managed, despite different support techniques. The surgical management of tracheomalacia is still a challenging problem. It is found that this method is superior to other methods of overcoming tracheomalacia complicating huge goiter and associated with no/nor mortality, so this simple procedure can be used as a first line of treatment of tracheomalacia complicating long-standing huge goiter.
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