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Aalborg Academy Journal of Medical Sciences

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1 Quality improvement of health care in Iraq , Abdulghani Alsamarai, MD, MGUM, Ph D. Editor –in – Chief Aalborg Academy Journal of Medical Sciences Chairman of the Scientific Bureau – International Union of Arab Academics. Member of Asian Council for editors. Alaa Bashir, Editorial Director, Aalborg Academy Journal of Medical Sciences.
Iraqi health care experts documented that hundreds of patients die each year because of hospitals failures to adhere consistently to standard procedures of safe and effective medical care. The routine hospital care improvement is public health imperative. High quality health care [safe, effective, patient – centered, timely, equitable and efficient] is should be provided for all population. Unfortunately, the growing literature and health care professions documents a serious problem in health care delivery in Iraq, for example: Unnecessary surgery: Such as increased numbers of cesarean section with time; increasing numbers of operation for appendectomy (most of them in is later found to be normal).; High morbidity and mortality following surgery.; Inappropriate use of medications.; Inadequate prevention of diseases.; Avoidable exacerbation of chronic conditions, Malpractice, lack of accreditation and licensing system, malpractice in private pharmacy, drugs irrational use, absence of referral system, short consultation time, no consistent medical record system, no clinical standards in health care providing, fail to maintain sanitation in public health care services, non existence of quality control programs in hospital and health care centers, and non effective diseases prevention and control programs [1-3]. All of the above examples of problems in health care delivery are due to loss of supervision that was previously performed by collaborative activities of Ministry of Health, Ministry of Higher Education, Iraqi Medical Syndicate, Dentist and Pharmacist Syndicates. However, on national ground, some physicians and surgeons are trying their effort to improve the quality of patients care through clinical and managerial changes in the processes of care. Health care practices have always evolved, but mostly in a scattershot way. Globally, in recent years, health care providers have initiated new methods, some of which were modelled first in a manufacturing to make ongoing improvements more systematic, data – guided and efficient [4,5]. Quality improvement [QI] facing problems of ethical issue, because attempts to improve health care may inadvertently cause harm, waste scare resources or affect some patients unfairly. Furthermore, some activities using QI methods have been categorized as research that uses patients as subjects, which brings activities under the ethical and regulatory requirements governing human subject’s research [6]. Putting improvement activities under research regulations can precipitate substantial delays, costs, and conflicts [7-10]. MOH in collaboration with WHO and US Agency for International Development [USAID], proposed a National Healthcare Quality Improvement Program [N-QIP], USAID Primary Health Care Project in Iraq [PHCPI], Training Model Primary Providers [TMPP] led by RTI. Additionally, other programs and practices performed by many Non-governmental Organizations to improve the quality of health care delivery and standards. Collectively, all the MOH, WHO, USAID, NGOs, and private practices and programs not show a quality improvement in health care in Iraq. Up to 2016 healthcare facilities, equipment and professionals are in critical short supply that have led to increased mortality rates in all area [3]. WHY? There is no improvement in the health care quality in Iraq? The health care situation in Iraq deteriorated as a part of national decline in whole services in the country as an outcomes of leadership and financial corruption. The International Union of Arab Academics convened a group of scientists to address the ethical issues associated with QI methods in health care. The committee members are clinician leaders, experienced clinical trials experts, and ethicists. The project committee addressed the following questions: What is the definition of quality improvement? Should all QI activities need ethical approval and informed consent? What ethical requirements should QI activities meet? What arrangement do we need to ensure the ethical conduct of QI? Quality improvement is defined as systematic, data guided activities designed to bring about immediate improvements in health care delivery in particular setting [11]. QI is intrinsic parts of good clinical care, in which data from clinicians own setting guide them in improving their practice. However, QI assumes that the quality and safety are largely characteristics of systems and its methods enable workers to gain insight about their systems relationships and functions [11]. Organizations that accredit the education and certify the competence of health care professionals have come to require practitioners to be competent in improving their own practices [12, 13]. But their practice for improvement must not be away from guidelines for management of diseases. Over time, successful QI transforms organizational culture so that everyone has the requisite skills. An effective way to promote QI is to conduct evaluative research on programs designed to implement standard practices for the safety and care of hospitalized patients [14]. Such research, however, poses an apparent ethical conundrum: it is often impossible to obtain informed consent from patients enrolled in QI research programs because interventions must be routinely adopted for entire hospitals or hospital units [14]. Suppose that the research involve patients setting in ICU, emergency unit, or emergency surgical interventions, the patients have no opportunity to decide whether or not to participate or able to decide to give informed consent or not. The question arises here is it ethical to conduct such research without informed consent? Informed consent is meant to protect people from exposure to research risks that they have not agreed to accept, as well as to respect their autonomy. In the above hospital settings none of the QI interventions were experimental and not have increased the risk of hospital acquired infection. In addition, in these hospital units the QI activities could be performed without research, in such case the general consent to treatment by the patients or their families would have covered these interventions. Thus, there are no reasonable or ethical grounds for any patient to object to being included in the study without his or her consent. Ethical requirements [15] for the protection of human participants in QI activities are: i. Social or scientific value. ii. Scientific validity.  iii. Fair participant selection. iv. Favourable risk – benefit ratio. v. Respect for participants. vi. Informed consent. vii. Independence review. The characteristics that to be used in the construction of guidelines for categorizing QI activities as overlapping with human subjects research are11: a. Testing of issues that go beyond current knowledge based on science and experience, such as new treatments. b. Random allocation of patients into different intervention groups to enhance confidence in differences that might be obscured by non random selection. c. Deliberately delayed or ineffective feedback of data from monitoring the implementation of changes, especially if this is done to avoid biasing the interpretation of data. d. Involvement in key project roles of researchers who have no ongoing commitment to improvement of the local care situation, even if others in the team do have professional commitments to it. e. Funding, sponsorship, or substantial participants by parties outside the clinical setting or organization in which the activity takes place. The global recommendations for implementing accountability for the ethical conduct of QI are summarized as follow [16, 17]: A. Clarify professional and organizational responsibility for QI. B. Clarify patient’s responsibility for QI. C. Develop guidance on QI methodology and dissemination of QI results. D. Develop new models of internal management and supervision of QI and of QI - human subjects research overlap projects. E. Develop and expand external accountability for QI. The effective approach to overcome the above mentioned national problems and an effective way to promote quality improvement in health care are: 1. Any doctor should provide health care according to his specialty. Not acting by the Computer doctor approach, i.e. WORKING LIKE CARS MECHANIC, which is mean that he knows everything. 2. Control of the private sector of health care delivery. 3. Conduction of evaluative research on programs designed to implement standard practices for safety and care of patients, at least the hospitalized one for the first step. 4. Development of Human Research protection Committee within each governorate. This committee must be headed by an academic specialist, Medical association and society representative, and experts in the disciplines of surgery, medicine, gynaecology, paediatrics, community medicine, clinical pharmacology, dentist, and expert in pharmacy. The responsibility of this committee is to supervise the impact of research on human subjects, in order to achieve protection for the society. 5. Development of Institutional Review Board. This board to establish in each college and reach regional health authority. The member of the board should be specialist in their field and with Ph D or equivalent degree. 6. Implement research program from neutral individuals to evaluate the quality of health care in each governorate. This is to be the responsibility of the governorate mayor. 7. Activate surgical pathology weekly conference. 8. Activate mortality meeting. 9. Activate death conference for each case without any exemption. 10. Stick to medical ethics regulation. 11. Provide health care according to guidelines. 12. Iraqi Medical Association must get more and more supervision for medical practice. 13. Development of specialty and subspecialty societies on national and regional grounds. 14. Iraqi Medical, Dentist, and pharmacist Syndicates should act as professional body and not a political or social organization.  
2 Comparison of Antibiotic Sensitivity between Extended Spectrum Beta Lactamase Producers and ESBL Negative Escherichia coli Clinical Isolates. , Abdulghani Mohamed Alsamarai , Shler Khorshed Ali, Tikrit University College of Medicine, Tikrit, Iraq. Aalborg Academy of Science, Denmark. College of Education, Kirkuk Education Authority, Kirkuk, Iraq.
Background: Recurrent urinary tract infection [UTI] and treatment failure were common challenges in the control of UTI in Iraqi community. Objective: To determine the difference in antibiogram and multidrug resistance between ESBL positive and negative E. coli clinical isolates. Materials and methods: prospective cross-sectional study was conducted during the period from 1st of June 2015 to the end of January 2016. The study population was 563 women, of them 425 [75.5%] were outpatients, and 138 [24.5%] were inpatients. Their age range was between 18 and 80 years, with a mean age of 33.59±15.29 years. Urine samples were immediately cultured on blood agar and MacConkey agar by spread plate technique. Bacterial colonies with different morphology were selected, purified and identified according to their biochemical characteristics using conventional standard methods. Results: The rate of resistance was higher in ESBL positive as compared to ESBL negative producers E. coli isolates for all tested antibiotics. A high rate of resistance was demonstrated by most of the tested antibiotics. A low resistance rate in both ESBL positive and negative E. coli were demonstrated against amikacin, imipenem and nitrofurantoin. ESBL producer E. coli isolates were resistant to ≥5 of MDR in 98% of isolates [92/94], while the corresponding value was 71% [29/41], while MDR to ≥7 was 56% [53/94] in ESBL producer and 17% [7/41] in ESBL none producer E. coli. Conclusion: ESBL producing was of significant influence on the emergence of resistance in E. coli clinical isolates. Key words: ESBL, E. coli, Antibiotic resistance, UTI.
3 Novel Natural Disinfectants for Contaminated Cosmetic Application Tools , Amera M. Al-Rawi, * Shababa A. Bahjat , May A. A. Al-Allaf Department of Biology, College of Science , Environmental Research Center , Mosul University/Iraq.
Background: Makeup can get contaminated by inadequate preservative capacities, poor handling procedures during manufacturing and in use contamination. Makeup application tools like tweezers, scissors, and a variety of brushes and sponges are also a potential breeding ground for bacteria. Bacterial growth can occur when these tools are shared or used for a prolonged period of time without washing. Aim: The present study attempted to find a novel, effective, economic and easy to use natural disinfectants that can be effective in inhibiting bacterial contaminants from cosmetic application tools. Materials and Methods: A total of 35 multiuse tools (10 brushes and 15 face sponges) were collected from University Girls' Dormitory/ University of Mosul. Two concentrations (1,5, and 10%) of Aluminum potassium sulfate ( alum) and sodium bicarbonate ( baking soda) were evaluated for the first time for antimicrobial activity. Results: Microbial analysis showed that brushes harbored more bacterial contamination than sponges. The most prevalent pathogenic bacteria were found to belong to the genera Staphylococcus, Bacillus, Proteus, Klebsiella and other lactose and non-lactose fermenters. Results showed that both compounds were effective in inhibiting growth of all bacterial isolates over a 24 hr. treatment period especially at higher concentrations (10%). Conclusion: This study demonstrated the feasibility of alum used in debridement removing activity and a disinfecting agent based on antimicrobial activity against facultative anaerobic bacterial isolates which are best representing sponge and brush contaminants An advantage of NaHCO3 and alum over other antimicrobial agents is its safety, availability , ease and low cost. Key words: Alum, Sodium bicarbonate, disinfection, cosmetic application tools
4 Evaluation of Interleukin- 5 in Mild and Moderate Asthmatic Patients Following Corticosteroid Therapy , Moheeb A. Salih ABMS, Raed Hussein Alnuaemi M Sc. Department of Medicine and Biochemistry, Tikrit University College of Medicine, Tikrit, Iraq. Correspondence author: Moheeb A. Salih, Department of Medicine, Tikrit University College of Medicine, Tikrit, Iraq.
Background: Asthma is a very common chronic disease in Iraqi community. Involving the respiratory system in which the airways occasionally constrict, become inflamed, and are lined with excessive amounts of mucus often in response to one or more triggers. Aim: this study was conducted to determine the role of interleukin 5 as asthmatic biomarker in Iraqi community in order to target the trait. Patients and Methods: Serum level of interleukin-5 [SIL-5] which is one of the inflammatory markers in asthma was estimated in 90 persons including those with asthma on steroid therapy (35 patients) and those without steroid (35 patients) therapy and the healthy control group (20 persons). Results: The mean level of SIL-5 was high in moderate asthmatic patients without steroid in their treatment protocol (16.56 pg/ml), while it was less in mild asthmatic patients without steroid therapy. SIL-5 mean values were lower in mild and moderate asthmatic patients who receive steroid therapy (3.94 pg/ml, 4.10 pg/ml respectively). While it was least in the control healthy group (3.32 pg/ml). Conclusion: serum IL-5 is predictive biomarkers for asthma severity and treatment response monitoring in Iraqi subjects with asthma. Key Words: Asthma, IL-5, Steroid therapy, Inflammatory marker.
5 Relevance of IL-4, IL-5 and IL-6 in Women withToxoplasmosis in Erbil. , Sawsan M. Al-Sorchee, Nasir I. Khatab, Cihan University, College of Science, Biology Department, Salah-Aldeen University, College of Education, Biology Department.
Background: Toxoplasmosis is a common infection in women with child bearing age and may attribute to bad obstetric outcomes. Aim: This study was conducted to evaluate IL-4, IL-5 and IL-6 levels in women with toxoplasmosis and their relevance to this infection. Materials and Methods: Sixty eight women were included in this study with a history of abortion (single or repeated). They were referred to by physicians from different hospitals and private laboratories in Erbil/ Kurdistan region of Iraq from March 2010 until March 2011 for the detection of antitoxoplasma antibodies and 30 healthy women were selected as control. Venous blood samples were collected from these women; serum was obtained for ELISA test for the detection of anti- toxoplasma IgG and IgM. Levels of IL-4, IL-5 and IL-6 in these women were also detected. Results: Fifty one women (75%) who had a single or repeated abortion were infected with Toxoplasmosis and had positive ELISA tests. From those, eleven (21.6%) had IgM, twenty five (49%) had IgG and fifteen (29.4%) had both IgM and IgG. The levels of IL-4, IL-5 and IL-6 were significantly high compared to the control. Conclusion: Cellular immune response was highly involved during acute and chronic Toxoplasmosis.
6 CASE REPORT: Permanent skin hyperpigmented lesion as a consequence of drug allergy. , Abdulghani Mohamad Alsamarai, Tikrit University College of Medicine, Tikrit, Iraq. Amina Hamed Ahmad Alobaidi, Kirkuk University College of Veterinary, Kirkuk, Iraq.
Povidone solution for topical application is an antiseptic that used in the prevention of wound infection the reported side effects of topical application of povidone mainly was irritation. We report a case of oval hyperpigmented (brown) permanent lesion following topical application of povidone as treatment for an erythematous oval lesion around the umbilicus in a 6 year old boy.
7 THESIS ABSTRACTS: Studying the Birth Outcome in Tikrit Teaching Hospital , Areej Muthana Noaman M.B.Ch.B.
Background : A successful birth outcome is defined as the birth of a healthy baby to a healthy mother. While relatively low in industrialized world, maternal and fetal morbidity and mortality and neonatal deaths occur disproportionately in developing countries. Aim of the Study: To assess birth outcome and identify some risk factors affecting it for achieving favorable birth outcome in Tikrit Teaching Hospital. Objectives of the study :The study was conducted to : 1. Describe the sociodemographic background for the study subjects including maternal age, occupation, education, and smoking habit and their effect on birth outcome. 2. Recognize the extent and the factors which determine the perinatal mortality and morbidity. 3. Measure the frequency of birth outcome among delivered pregnant mothers in Tikrit Teaching Hospital . 4. Identify the effect of antenatal care, residency and mode of delivery on birth outcome. 5. Assess the effect of parity, birth spacing and medical and family history on birth outcome. 6. Find out the effect of fetal factors (including: number of fetuses, and their gender) on the birth outcome. 7. Recognize the benefit of Apgar score and its relationship with birth weight and birth outcome. Study design: The current work represents a cross sectional study, which included ( 714 ) pregnant women who gave birth in the delivery room in Tikrit Teaching Hospital in Tikrit city, for the period extended from the first of February to the end of July ( 2007 ) . This study was carried out in an attempt to study the birth outcome in Tikrit Teaching Hospital. A direct interview was done with every included delivered mother and a physical examination was conducted only for their newborn babies. Results: The outcome of ( 714 ) deliveries was evaluated and to be set as either favorable or unfavorable, it was found that the frequency of favorable outcome was 512 (71.7%) , while those who have unfavorable outcome (defined as having one or more of the following conditions : stillbirth , preterm, birth asphyxia , gross congenital anomaly, birth trauma or low birth weight) , was 202 (28.3 %) .
8 Psoriasis: Tumor Necrosis Factor –α, Interleukin 18, C Reactive Protein Polymorphism , and Osteopontin Role. , Ibrahim Mohamed Abed. Ph D Theses conducted in Tikrit University College of Medicine [TUCOM], Iraq in 2012.
Background: Psoriasis is a common chronic skin disorder with prevalence of 2.7% in Iraqi community. Many factors affect the prevalence of psoriasis which include genetic, environmental, infectious, immunological, biochemical, endocrinological and psychological. Psoriasis is a chronic inflammatory disease with unknown exact pathogenesis, which may be started as skin condition that subsequently associated with systemic complications. The recurrent proliferative inflammatory processes in subject with psoriasis may lead to abnormal lipid metabolism and associated with cardiovascular diseases. Gene polymorphisms represent either a protective or risk factors for development of psoriasis and cardiovascular disease. Aim of the Study: The aim of the present study is to provide a picture about the association between psoriasis and atherosclerosis.
9 Breast Cancer in Iraq: A Review , Nemah H. Aljubori; MB.Ch B; PhD; LS3Clin.Pathol. Babylon University College of Medicine (BUCM), Babylon, Iraq
Globally, breast cancer is the most common cancer among women, comprising 23% of the 1.1 million female cancers that are newly diagnosed each year. In Iraq, breast cancer is the commonest type of female malignancy, ac- counting for approximately one-third of the registered female cancers according to the latest Iraqi Cancer Registry [4]. This shows that the breast is the leading cancer site among the Iraqi population in general, surpassing even bronchogenic cancer. As proposed by the World Health Organization, early detection and screening, especially when combined with adequate therapy, offers the most immediate hope for a reduction in breast cancer mortality. The incidence of breast cancer increased in Iraq in recent years, indication a significant health problem. Actions are needed on the national level for better estimate of the problem.
10 Book Review: Title: District Laboratory Practice in Tropical Countries , Mohamed Alsamarai  
11 Association of Human Cytomegalovirus and Epstein-Barr Virus with Breast Cancer , Abdulghani Mohamed Alsamarai, Department of Medicine, Tikrit University College of Medicine, Iraq. Aalborg Academy of Sciences College of Medicine [AA-FOM], Denmark. Correspondence Author: Prof. Dr. Abdulghani Alsamarai, Department of Medicine, Tikrit University College of Medicine, Iraq. Aalborg Academy of Sciences College of Medicine, Denmark.
Breast cancer forms the most common cancer in women worldwide [1,2] and in Arab countries [3]. Breast cancer accounts for about 1/3 of the registered female cancer in Iraq [4] and with incidence rate of 31.1/ 100 000 in Iraqi women , while it was 18.4 for Iran, 22.4 for Saudi Arabia, 23.0 for Syria, 28.3 for Turkey, 47.0 for Jordan, and 47.7 for Kuwait [5,6]. Recent study in Iraq reported a trend for breast cancer to affect younger age group [7]. This study shows that the highest frequency of breast cancer (32.4%) was in women with age of 21-30 years. Unfortunately, 79.7% of breast cancer cases were in women with age of ≤ 40 years. In addition, 14.9% of breast cancer cases were in women with age of 16-18 years and 52.7% were in those with age of ≤ 30 years. This age shift pattern of breast cancer in Iraqi women was not consistent with previous studies in Iraq [6-12], Arab countries and globally [13,14]. The peak frequency of our study was 21-30 years, while previous studies in Iraq [15-21] indicated that breast cancer frequency peak was in fifth decade of life, in Asian countries in 40-50 years and it was 60-70 years in Western countries [22]. The mean age of women with breast cancer in our recent study was 30.6 ±11.5 years and was not agreed to previous studies in Iraq [6,15-25], Arab countries [13,26] and globally [27]. Thus breast cancer diagnosis age was a decade earlier than previous Iraqi and Arab countries studies and two decade earlier than Western countries [7].
12 Lipid Profile in Patients with Asthma and Allergic Rhinitis , Adnan Hassan Alwan1 , Amina Hamed Ahmed Alobaidi2 , Diyala Health Authority1 , Kirkuk University College of Veterinary Medicine2 . Correspondence author: Amina Hamed Alobaidi, Kirkuk University College of Veterinary Medicine
Background: Asthma is a chronic inflammatory disease of the respiratory airways; its prevalence has increased worldwide. The disease may be associated with metabolic changes that could be either induced by treatment or may be due to inflammatory process. Aim: To clarify the status of lipid profile in Iraqi patients with asthma and allergic rhinitis. Patients and Methods: The study was performed on asthmatic patients (190), allergic rhinitis patients (110) and healthy control subjects (48). Age of subjects included were from 16-60 year, with a mean of 34.34 ±11.58 . At time of study inclusion, they all underwent full clinical examination after full history taking, pulmonary function tests, measuring body mass index and blood sampling. Results: Serum cholesterol was significantly higher in asthmatic with over weight (mean 219.93±60.02 mg/dl, P< 0.001), asthmatic with metabolic syndrome (mean 290.08±90.95 mg/dl, P<0.001), allergic rhinitis with overweight patients (mean 233.69±81.59mg/dl P< 0.001) than in control subjects (mean 145.95±36.52 mg/dl). It was of no significant difference in asthma with normal weight patients (mean 139.09±50.36 mg/dl, P-value 0.4291) and allergic rhinitis with normal weight patients (mean 155.81±49 mg/dl, P-value 0.2610) than in control subjects. Serum triglycerides was significantly higher in asthma with normal weight patients (mean 109.65±33.75 mg/dl, P-value 0.0123), asthma with over weight (mean 184.02±60.11 mg/dl, P<0.001), asthma with metabolic syndrome (mean 222.82±65.12 mg/dl, P<0.001) and allergic rhinitis with overweight patients (mean 173.62±54.27 mg/dl, P<0.001) than of control subjects (mean 92.63±35.37 mg/dl). It was of no significant difference in allergic rhinitis with normal weight patients (mean 101.56±36.29 mg/dl, P-value 0.2340) than of control subjects. High density lipoprotein-cholesterol was significantly lower in asthma with overweight group (mean 33.32±4.82 mg/dl, P<0.001), asthma with metabolic syndrome (mean 36.03±3.51 mg/dl, P<0.001), allergic rhinitis with over weight (mean 35.82±4.84mg/dl, P<0.001) than in control healthy group (mean 40.28±6.05mg/dl). It was of no significant difference between asthma with normal weight patients (mean 42.92±10.56 mg/dl, P-value 0.1215), allergic rhinitis with normal weight (mean 41.45±4.44 mg/dl, P-value 0.2600) than control subjects. Low density lipoprotein-cholesterol was significantly higher in asthma with over weight (mean 151.31±63.53 mg/dl. P<0.001); asthma with metabolic syndrome (mean 181.15±88.27 mg/dl, P<0.001); allergic rhinitis with normal weight (mean 108.42±38.05 mg/dl, P<0.01); allergic rhinitis with over weight (mean 163.49±80.92 mg/dl, P<0.001). IJMS May 2018; 1(2):9-24 10 It was significantly lower in asthma with normal weight patients (mean 68.76±32.66 mg/dl. P<0.05) than in control subjects (mean 85.84±39.39 mg/dl). Conclusion: Asthma and / or allergic rhinitis in Iraqi population were associated with dyslipidemia, whether in the presence of metabolic syndrome, or the patients were with normal or abnormal weight. Key words: Asthma, Allergic rhinitis, dyslipidemia, cholesterol, Triglycerides, HDL, LDL, VLDL, Iraq.
13 Study of Pathogenic Bacterial Isolates from Patients with Skin Infections and their susceptibility to Antibiotics in Some Hospitals in Taiz City-Yemen , Al-Jendy, A.S.1 *,Al-Ofairi, B.A.2 *,Al-Ganady, M.H.3 1Department of Medical laboratory technology - Al-Ma’afer CommunityCollege –TaizYemen. 2Department of Biology- Microbiology, Faculty of Science, Sana’a University-Yemen. 3Department of Clinical laboratory analysis, Institute of health - Taiz –Yemen. *Corresponding Author: Ahmed Abdulla Salem Al-Jendy, Department of Medical Laboratory Technology, Al-Ma’afer Community College , Taiz-Yemen.
Background: Skin and soft tissue infections (SSTIs) are commonly encountered in clinical practice, the spectrum of the causative bacterial agent changes constantly and so does their antibiotics. Aim: This study was carried out to investigate the incidence of different aerobic bacteria isolates. Materials and methods: Samples were collected from patients with skin infections at a local Hospital in Taiz City, Yemen. A cross-sectional study was conducted during the period between January to December 2014. A pus specimens were collected aseptically from 130 cases of skin and soft tissue infections in the sterile condition and cultured on blood agar, MacConkey agar and mannitol-salt agar media. After growing and staining of bacteria by gram stain, bacteria were cultured in differentiated media, strains that were isolated, undergo antibiotic susceptibility test by Kirby-Bauer disc diffusion method. Results: From a total of 130 swabs collected, 89 (68. 5%) were with bacterial growth : gram positive bacteria form [57 (64%)], while gram negative bacteria were [32 (36%)], common aerobic bacterial pathogens were: S. aureus[30 (33.7%)], S. epidermidis [18 (20.2%)], P. aeruginosa [14 (15.9%)], S. pyogenes [9 (10.1%)], E. coli [8 (8.9%)], K. Pneumoniae [6 (6.7%)], P. mirabilis [4 (4.5%)]. These results showed that in vitro antibiotic susceptibility tests among gram positive cocci susceptibility was highest to Vancomycin, Fusidic acid (except S. pyogenes) and Ciprofloxacin. Among gram negative bacilli Gentamycin, Chloramphenicol and Ciprofloxacin susceptibility was high, however, all Escherichia coli isolates were resistant to Penicillin, Ampicillin, and Tetracycline. Additionally, all Proteus mirabilis isolates were resistant to Erythromycin and Penicillin. Conclusion: This study indicated that the multi drug resistance (MDR) of bacterial organisms were alarming for increase in skin infections . Keyword: Pathogenic bacteria, Skin and soft tissue infections, Antibiotic resistance, Taiz City, Yemen.
14 Molecular Characterisation of ESBL producer E. coli , Abdulghani M. Alsamarai, Tikrit University College of Medicine Shler Ali Khorshed, College of Education, Kirkuk Education Authority. Imad Jihad Weli, Kirkuk General Hospital, Kirkuk Health Authority. Correspondence author: Shler Ali Khorshed, Open College of Education, Kirkuk Education Authority
Background: Antibiotic resistance emerged as clinical problem challenge the effective treatment of infections. Virulence factor may play an important role in the influence of antimicrobial resistance. Objective: To determine the frequency of resistance gene in E. coli clinical isolates from women with urinary tract infection. Materials and Methods: Fifteen E.coli clinical isolates were tested by PCR to determine their molecular characterization. Results: The bla CTX –M gene was not detected in 6.7% out of the tested 15 E. coli clinical isolates from women with urinary tract infection. However, bla OXA gene was detected in all E. coli tested clinical isolates from pregnant women, female student and diabetic women with urinary tract infection. While bla TEM gene and bla SHV gene were not detected in 33.3% and 40% out of the tested E. coli clinical isolates respectively. Conclusions: Four types of ESBL genes were detected, and shows new trend of distribution, which indicated the predominance of OXA and CTX-M genes. Key words: Urinary tract infection, Resistance, PCR, , CTX, OXA, OXA, SHV.
15 CASE REPORT: Trichotillomania , Abdulghani Mohamed Ali, Department of Medicine, Tikrit University College of Medicine, Tikrit, Iraq. Address correspondence: Prof. Abdulghani Alsamarai, College of Medicine, Tikrit University, P O Box 45, Alyarmook ST, Tikrit, Iraq.
Trichotillomania is an anxiety disorder characterized by persistent and excessive pulling of one's own hair, resulting in a noticeable hair loss. The understanding about the disorder is still not very clear. Hair pulling can occur on any part of the body where hair grows. The most common area of hair pulling is the scalp, followed less commonly by the eyebrows, eyelashes, and pubic region. Here I report a case of Trichotillomania in a 16 years old girl. Key Words: Trichotillomania, Hair loss, Anxiety.
16 THESIS ABSTRACT: Evaluation of the Predictive Value of Ghrelin and Adiponectin as Biomarkers in Type 2 Diabetes Millitus. , Chero Ghazi This is a diploma thesis conducted in Tikrit University College of Science , In 2018, under the supervision of Assistant Prof. Dr. Amina Hamed Alobaidi, Kirkuk University College of Veterinary Medicine, Kirkuk. Iraq.
Background: Type 2 diabetes mellitus [DM] is the most pervasive diabetic disorder, as the fourth major cause of mortality worldwide and form 80% - 90% of all cases of diabetes mellitus. Aim: This study aims at evaluating the role of ghrelin and adiponectin level in patients with type 2 diabetes mellitus as biomarkers. Material and method: A case - control study was conducted and included 65 patients with type 2 diabetes mellitus (18 males and 47 female) and 50 apparently healthy controls (18 male and 32 female). Fasting serum samples were obtained and used for the measurement of serum glucose by enzymatic colorimetric method using Randox diagnostic kits (UK), lipid profile enzymatic colorimetric method using Biolabo diagnostic kits (France).Serum adiponectin and serum ghrelin by using ELISA method of mybiosource, glycated haemoglobin (HbA1c) by Nycocard method. Result: Fasting serum glucose, HbA1c, total cholesterol, triglyceride, CHO/HDL, LDL/HDL, NHDL/HDL and serum low density lipoprotein showed significant increase (p<0.05) in diabetic patients when compared to control group. High density lipoprotein cholesterol and serum ghrelin levels showed significant decrease in diabetic patients (p<0.05) as compared to control but serum adiponectin decreased in patients in relation to control but statistically no significant. Conclusion: Serum ghrelin demonstrated significantly lower levels in diabetic patients as compared to control, while slightly difference in serum adiponectin levels in type 2 DM patients as compared to control. Key words: diabetes, lipid profile, ghrelin, adiponectin, CHO/HDL, LDL/HDL, NHDL/HDL.
17 Molecular Epidemiology and Characterisation of Extended Spectrum Beta Lactamase Producing E. coli in Female Patients with Urinary Tract Infection , Shler Ali Khorshed Ph D Thesis Tikrit University College of Science
Background: Urinary tract infections form the common community and hospital acquired- infection in Iraq, with impact on health care delivery. The emergence of antimicrobial resistance which increased in its prevalence with time attributed the treatment failure and recurrent infection. Aim: The aim of this study was determine the prevalence of extended spectrum beta lactamase and ESBL resistance genes of E. coli in female in Kirkuk city
18 MEDICAL EDUCATION: Problem based learning (PBL) in Organic Chemistry , Ferah G. Al-Salihi1 , Amina H. Ahmad Alobaidi2 1Department of Biochemistry, College of Science, Tikrit University, Tikrit, Iraq. 2Kirkuk University College of Veterinary Medicine, Kirkuk, Iraq
Background: PBL appears to answer many concerns regarding educational methods, encourages students to look for new solutions to relevant problems using available knowledge and resources. The process expands students' critical thinking and problem solving skills while enhancing their creative capabilities Objective: To develop a PBL modules for teaching of organic chemistry. Methods: This module was developed for implementation in the curriculum of Chemistry Departments in Colleges of Sciences and Education. This is an innovations to be developed for increasing the wide-ranging abilities of students. A series of strategies which are involved in PBL, concept mapping and online communications, are suggested and discussed in terms of encouraging studentcentered learning. Key words: PBL, Chemistry, Learning, Education.
19 BOOK REVIEW: Environmental Modelling An Introduction , Mohamed Almustafa Alsamarai, Department of Pathological Investigations, Samara University College of Applied Sciences,
The focus on modelling in practice encourages the reader to think like a researcher, and consider how modelling can be used to probe questions of interest • Clear, articulate writing style gives clarity to an often daunting subject • Case studies demonstrate the use of modelling in practice, to give the reader a real insight into the application of modelling in real situations • Numerous end of chapter problems and web-based tasks encourage the student to engage with the subject more deeply, to build a better understanding of the concepts presented
20 LEADING ARTICLE: Bad Obstetric History: Etiology and Risk Factors , Abdulghani Mohamed Alsamarai, Editor-in-Chief, International Journal of Medical Sciences.
As the Iraqi health care system has evolved, people have had to take a more effective role in the care they receive. [1]. Fortunately, taking more responsibility for understanding community health care and individuals communicating with their doctor can help extend society healthy years. Preventive medicine is one area of health care in which all consumers can exercise more dependability and control. Getting regular screening tests for common health problems is a simple and effective first stage. Screening tests can give the community and health care providers the information needed to recognize health risks and take preventive measures before they become more severe problems [2]. Screening tests include self-checks, clinical exams, non-laboratory tests (such as imaging tests), and laboratory tests. The focus here is on laboratory screening tests. Getting routine tests performed even though you have no signs can help discover problems early and help you profit from easier and more active treatment. It can sometimes even prevent disease.
21 REVIEW ARTICLE: Maternal Infections Associated with Bad Obstetric Outcome: Toxoplasmosis and Rubella. , Abdulghani Mohamed Alsamarai, Editor-in-Chief, International Journal of Medical Sciences. Tikrit University College of Medicine. Hala Majeed Hassan, Tikrit University College of Veterinary Medicine, Tikrit, Iraq.  
Toxoplasmosis is caused by infection with the obligated intracellular protozoan parasite Toxoplasma gondii. It is one of the most prevalent chronic infections affecting one third of the world's human population [1]. The prevalence of T. gondii infection varies among different geographical regions. The infection is characterized by non-specific signs with the consequent formation of cysts that may stay in latent form in many organs [2]. Primary infection is usually subclinical but in some patient's cervical lymphoadenopathy or ocular disease can be present [3]. There are four groups of individuals in whom the diagnosis of toxoplasmosis is most critical: pregnant women who obtain their infection during gestation, fetuses and newborns who are congenitally infected, immune compromised patients, and those with chorioretinitis [4]. Although these infections are usually either asymptomatic or associated with self-limited signs in adults [e.g., fever, malaise, and lymphoadenopathy], infections in pregnant women can cause severe health problems in the fetus if the parasites are transmitted [i.e., congenital toxoplasmosis] and cause severe sequelae in the infant including mental retardation, blindness, and epilepsy
22 ORIGINAL ARTICLES: Toxoplasmosis Seropositivity and Male Sex Hormones , *Mustafa Riadh Hussien, ** Adel T. M. Al-Saeed, *** Souzan H. Eassa *Microbiology Department, College of Nursing, IRAQ, University of Duhok. ** Microbiology Department, College of Medicine, IRAQ, University of Duhok. ***College of Medicine, IRAQ, University of Duhok.
Background: Toxoplasmosis is a cosmopolitan disease with acute and chronic infections, caused by the obligate intracellular protozoan parasite Toxoplasma gondii that can infect a variety of cells in almost all warm blooded animals including humans. Aim: The study aimed to determine the seroprevalence of T. gondii infection among males in Duhok city. Materials and methods: Using ELISA (IgG and IgM), the relationship between toxoplasmosis and reproductive hormones including testosterone, free testosterone, and follicle stimulating hormone (FSH) levels and its association with male sterility were also investigated. Results: 22.98% of male samples appeared to be affected by T. gondii infection. The mean concentrations of the male reproductive hormones were 6.15±1.03 ng/ml (total testosterone), 14.81±4.71pg/ml (Free Testosterone), 4.84±2.20 IU/ml (Folliclestimulating hormone), 0.54±0.22 (IgM), and 0.62±0.75 (IgG). A significant difference was found in the samples in terms of infertility (p<0.0001), while p-values for testosterone (P>0.05), free testosterone (P>0.05) and follicle-stimulating hormone (P>0.05), were non-significant. Conclusion: The present study showed a high rate of T. gondii among males in Duhok city with significant difference (P<0.05) in infertility between T. gondii seropositive and seronegative samples. Keywords: Toxoplasmosis, Acute and Chronic infection, Male Sex Hormones
23 Risk Factors in Diabetes and Pregnant Women with Urinary Tract Infections Compared to Younger Aged Female. , Abdulghani Mohamed Alsamarai1 , Shler Ali Khorshed2 1Tikrit University College of Medicine. 2Essential College of Education, Kirkuk Education Authority. Correspondence author: Prof Abdulghani Alsamarai, Tikrit University College of Medicine
Background: Urinary tract infection is common with health impact in women and characterised by failure to treatment and recurrent episodes. Aim: This study was conducted to determine the risk factors for the development of urinary tract infection in diabetic and pregnant women in comparison to student female. Materials and methods: A prospective cross-sectional study conducted during the period from 1st of June 2015 to the end of January 2016. The population included in the study are 563 women, of them 425 were outpatients, and 138 were inpatients. Their age range between 18 and 80 years, with a mean age of 33.59±15.29 years. Urine samples collected and cultured on blood agar and MacConkey agar by spread plate technique. Bacterial colonies with different morphology were selected, purified and identified according to their biochemical characteristics using conventional standard methods. Results: In diabetic women, there were no significant difference in mean age and BMI values between culture positive and culture negative groups. However, pus cell mean scale was significantly higher [P=0.000] in women with urinary tract infection [1.76±1.25] than in those with negative culture [0.69±1.00]. In pregnant women, BMI mean value was significantly [P=0.013] lower in pregnant women with UTI [26.14] as compared to those without infection [26.99]. Pus cell scale mean value was significantly [P=0.000] higher in pregnant women with UTI [1.55] than women with negative UTI [0.85]. While there was no significant difference in mean age between UTI positive and negative pregnant women. In female student, there was a significant difference between UTI infected and non-infected in mean age [P=0.041] and pus cell scale [P=0.000]. However, BMI was not significantly different between infected and non-infected female student. Other risk factors association are variables in the 3 groups when analysed using X2 , while AUC and OR show different trends of association between risk factors and UTI. Conclusion: BMI, pus cell scale, child number, delivery method, operation history and hospital setting were significantly associated with culture positivity in the 3 studied groups as determined by AUC. While OR confirmed association with pus sale scale in the 3 groups. Key words: UTI, Pregnancy, student, risk factor.
24 Adiponectin hormone and Measurements of Plasma Membrane Voltage in Isolated Adipocytes of Control and Diabetic Patients. , Mohammed F. Alkotobe1 , Nabaa Saad Ibadi2 . Alkitab University College, Department of Pharmacology, Alton- kobry, , Kirkuk, Iraq. 1 Physiology Department, Tikrit Univ .College of Medicine Tikrit, Iraq2 . Correspondence author: Mohammed F. Alkotobe, Alkitab University College - Department of Pharmacology. Alton-kobry, Kirkuk, Iraq.
Background: Diabetes is one of the most important and social-economic problem worldwide and characterized by serious metabolic, vascular and neurologic complications. Aim: To isolate adipocytes in diabetic patients and estimate the electrical potential difference (membrane potential) of isolated adipocytes. Methods: Biopsy of lipid tissue of diabetic patients were taken In Bin-Sina hospital and then adipocytes were isolated in laboratory of College of Science, Baghdad University.. Results: The Adiponectin mean serum value was significantly (P<0.001) higher in diabetic patients (15.60 ± 1.73 g/ml) as compared to controls (5.80 ± 1.22 g/ml). While the measurement of isolated adipocytes current was significantly (P<0.001) different in diabetic patients (-30.4 ± 4 mV) from that in controls ( -61 ± 5mV). Conclusion: Adipocytes plasma membrane voltage was with significant difference in diabetic patients as compared to controls and this reflect the inflammatory changes at cellular level in diabetes. Key words: Diabetes, Adiponectin, Adipocytes, plasma membrane voltage.
25 Genotyping and Antifungal Vulnerability of Candida albicans Isolated from Cancer Patients in Dewaniyeh Governorate. , Radhi F. Shlash1 and Adnan H. Al-Hamadani2 1Departement of Internal Medicine, Faculty of Medicine, Al-Qadisiyah University. 2Department of Microbiology, Faculty of Medicine, Al-Qadisiyah University.
Background: Candida infections are one of the major causes of morbidity in cancer patients. Aim: To determine the genotype and antifungal susceptibility of C. albicans isolated from cancer patients and compared with that from healthy individuals. Materials and methods: Oral swabs collected from cancer patients and healthy subjects were screened for the occurrence of C. albicans. Isolates were identified to species level by the conventional mycological methods. Genotypes were determined with use of 25S rDNA PCR analysis. Susceptibility testing was performed using HiCombo MIC technique. Results: Phenotypic examination showed that oral C. albicans was detected in 90% of cancer patients and 50% of healthy controls. PCR shows that the isolates of A, B, C and T genotypes, among which genotype A C. albicans was the predominant genotype. Genotype A C. albicans recognized the entirely isolates in healthy group. Isolates were most sensitive to amphotericin B. Occurrence of resistance to amphotericin B was the lowest followed by itraconazole. However, the isolates demonstrated a high rate of resistance to ketoconazole and fluconazole. Conclusion: Based on these results, 25S rDNA have been shown to be a useful criterion for distinguishing among various isolates of C. albicans. Amphotericin B is effective antifungal agents that can be used against isolates. Key words: Candida albicans; PCR; Cancer, Itaraconazole, Amphotericin B; Ketokonazole; 25S rDNA; Antifungal agents.
26 Therapeutic efficacy of some extracts of hot pepper fruits (Capsicum annuum) and Sumac seeds (Rhus coriaria) on the growth of some isolated dermatophytes species , Sarah Omran Rasheed, Abdul-Ghani Mohammed Ali, Firas Shawqi AbdulRazzaq. Department of Life Sciences, College of Science, Tikrit University, Tikrit, Iraq Correspondence author: Sarah Omran Rasheed, Tikrit University College of Science, Microbiology Department
Background: Fungal infections are one of the common skin diseases with difficulty in their treatment approach. The present efficient drugs for fungal infection are limited. Aim: To determine the therapeutic efficacy of plant extracts as alternative antifungal agents. Materials and methods: 100 clinical samples [68 from female and 32 from male] were collected during the period from March to July 2017 from subjects attending Dermatology Clinic in Salah Uldean General Hospital. Fungal infection was diagnosed with using KOH wet preparation. Fungal species identified by using conventional approach. The active ingredients existing in the plant extracts were detected and analyzed through qualitative and quantitative detection technique of chemical compounds using a high performance liquid chromatographic device (HPLC). Agar diffusion method was used to determine antifungal activity of plant extracts. Results: Direct microscopic examination showed that there were (75%) positive samples, while culture shows (67%) positive samples. The isolated dermatophytes belong to Epidermophyoton, Microsporum, and Trichophyton genus. The predominant dermatophytes were T. rubrum (25%) species. The highest frequency of infection was in the age group of 11-20 years. The sensitivity of the tested fungi to the aqueous and alcoholic plant extracts varies. Alcoholic extract of the hot pepper plant was more effective as antifungal than the aqueous extract of the same plant. However, aqueous hot pepper extracts was more effective against T. mentagrophyte than that of alcoholic extract. Additionally, alcoholic Sumac extract shows higher efficacy that aqueous extract. Conclusion: Hot pepper and Sumac extracts show antifungal activity against Microsporum canis, Trichophyton rubrum and T. mentagrophyte. Key words: Antifungal, Dermatophytes, Hot pepper, Sumac, Trichophyton, Epidermophyton, and Microsporum.
27 THESIS ABSTRACT: Psoriasis: Paraoxonase and Lipoprotein (a) Role , Tafaoel Jaber Hamed Departments of Biochemistry and Medicine. Tikrit University College of Medicine Tikrit Iraq This is an M Sc thesis conducted in Tikrit University College of Medicine , In 2015, under the supervision of Assistant Prof. Dr. Amina Hamed Alobaidi, Kirkuk University College of Veterinary Medicine, Kirkuk. Iraq.
Background: Psoriasis is a common chronic skin disorder with prevalence of 2.7% in Iraqi community. Psoriasis is a skin disease that it's prevalence affected by many factors which include genetic, environmental, infectious, immunological, biochemical, endocrinological and psychological. Psoriasis is a chronic inflammatory disease with unknown exact pathogenesis, which may be started as skin condition that subsequently associated with systemic complications. The recurrent proliferative inflammatory processes in subject with psoriasis may lead to abnormal lipid metabolism and associated with cardiovascular diseases Aim: This study aims at determining some biochemical parameters of psoriasis .
28 Genotypes of Hepatitis C Virus in United Arab Emirates: Their Relationship with Age, Gender, Nationality, and the Severity of Liver Disease with Viral Load , Seham Abdelwahed Hafez Koura, Egypt. This is a Ph D thesis conducted in Lahaye International University College of Applied Medical Sciences, Lahaye
Background: Hepatitis C virus (HCV) is a major global public health problem with estimate of 3% chronicity. The prevalence of HCV in Eastern Mediterranean Region was variable with a range of 1% to 14.9%. HCV infection was found to be endemic in Arab World as different studies confirmed such endemicity. Arabian Peninsula region HCV prevalence was reported as low (1-1.9) in Oman, Saudi Arabia, Kuwait, and Bahrain, while it was moderate in Yemen (2.0-2.9), high in UAE (3.0-3.9), and very high in Qatar (>4).
29 Community- Based Education: Tikrit University College of Medicine Experience. PART ONE: Concept and Rationale of Community –Based Education. , Amina Hamed Ahmed Alobaidi, Kirkuk University, Kirkuk, Iraq
Tikrit University College of Medicine [TUCOM] is a community based college incorporating PBL and it is the first and only medical school in Iraq to introduce an innovative curriculum [1]. TUCOM/CBE programme constitutes a community based curriculum including an acceptable balance of community based activities through out of the educational settings [6 years of study] [2]. CBE is one of the most powerful and important teaching and learning strategy that allows students to study the sources, nature and magnitude of health and related problems [3]. In CBE, the community plays an important role in determining its own health needs, health problems and to overcome such problems. Furthermore, the students encouraged to learn from the community and assist them to attain their educational objectives [4]. Furthermore, well planning and well implementation of CBE are the important factors that driven the outcome of such innovative education method [5]. Recently, Worley [5] perform analysis of CBE and proposed a model for the key relationship in which student must be an active participant to facilitate high quality learning. He provided evidence for “the role of clinical, institutional, social and interpersonal relationships in providing a framework for describing quality in CBME curricula- the 4R model”
30 Problem Based Learning in Teaching Chemistry: Proposed Module for Teaching Analytical Chemistry. , *Amina H.A. Al-Obaidi, **Ferah G. Al-Salihi , ***Seham T. Amine *College of Medicine, Tikrit University **College of Education for Women, Tikrit University ***College of Science, Tikrit University
Problem based learning [PBL] approach for 3rd year students in the department of Chemistry, College of Science in the analytical chemistry course. The activities involved cover the area of analytical chemistry and students must use their judgment in order to come to an acceptable conclusion. It is possible to compare this course with a conventional parallel course and to monitor the longer-term effects of students’ approaches to studying.
31 BOOK REVIEW: Social Research Methods Third Edition , Mohamed AlMoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq.
This book provide an essential information for social research methods, with deep coverage of quantitative and qualitative research methods. The text presents a nontechnical approach to the range of tools for the analysis of quantitative data avoiding mathematical formulae, preferring instead to focus on how to choose a method of analysis and interpret the findings. It is an excellent reference for undergraduate and postgraduate students and step by step guide for all types of research methods and statistical analysis such as SPSS.
32 LEADING ARTICLE: Misuses and side effects of steroids derivatives. , Nemah H. Aljubori; MB.Ch B; PhD; LS3Clinical Pathology. Editor for Basic Sciences, International Journal Medical Sciences Babylon University College of Medicine (BUCM), Babylon, Iraq
The term Steroid, denotes any of a class of natural or synthetic organic compounds characterized by a molecular structure of 17 carbon atoms arranged in four rings [1]. Steroids are important in biology, chemistry, and medicine [2]. They are classified into two major categories; the catabolic and the anabolic steroids. The catabolic steroids include corticosterone cortisone and aldosterone. The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone [3].
33 REVIEW ARTICLE: Maternal Infections Associated with Bad Obstetric Outcome: Cytomegalovirus and Herpes Simplex Virus. , Mohamed Almoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq. Hala Majeed Hassan, Tikrit University College of Veterinary Medicine, Tikrit. Correspondence author: Mohamed Almoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq. 
Introduction. Cytomegalovirus (CMV) infection is with global distribution and range of 30-100% [1, 2]. CMV infection is the most common congenital viral infection worldwide [3]. The sign of congenital CMV infection encountered most frequently is hearing loss, which wills 12.6% of congenitally infected newborns and congenital CMV infection form 10-20% as a cause of total hearing loss in children [4]. About 10% of the live-born infants with congenital CMV infection are symptomatic at birth. Where as an additional 10% of the infected newborns will develop permanent sequelae in the following years. [5] Among children with bilateral profound hearing loss, the hearing incapacity is attributable to congenital CMV infection in one out of five patients. This makes CMV the leading cause of non genetic congenital hearing impairment [6]. Asymptomatic CMV infection at birth may develop hearing loss in adolescent age [4]. In spite of the detailed knowledge about the epidemiology and pathogenesis of CMV infections in pregnant women, this infection stays largely unknown to the majority of women in the United States .Few, if any pregnant women are routinely screened for CMV infections during pregnancy. Questions surrounding the suitability of serologic screening for CMV during pregnancy are important because over 90% of primary maternal CMV infections during pregnancy are asymptomatic and may remain asymptomatic in the fetus. Israel and eight European countries (France, Belgium, Spain, Italy, Germany, Austria, Portugal, and the Netherlands) routinely screen the majority of pregnant women serologically for CMV This routine serologic screening occurs without the recommendations or guidelines of any governmental agency, authority, or a professional medical society [7].
34 ORIGINAL ARTICLES: Determination of some Antibiotic Resistances genes by Polymerase Chain Reaction of Lactic Acid Bacteria Isolates from Local Dairy Products , Zainab M. ALzubaidy, Department of Biology, Diyala University College of Science [DUCOS], Diyala, Iraq. Khanda O. Khthir, Department of Food Technology, College of Agriculture, University of Salahadeen, Erbil, Iraq. Rozgar Kamal, Department of Food Technology, College of Agriculture, University of Salahadeen, Erbil, Iraq. Correspondence author: Zainab M. Alzubaidy, Department of Biology, College of Science, Diyala University.
Background: This study sheds light on the current resistance situation in local dairy product associated microorganisms Like Lactic Acid Bacteria (LAB) and will provide a basis for further experiments concerning gene transferability. Objective: Isolation of Lactic Acid Bacteria (LAB) from local dairy products that have resistance phenotypes to antibiotics, and detection by PCR presence of certain known antibiotic resistance genes. Materials and methods: This study was conducted during the period from 1st of September 2016 to the end of January 2017. Two hundred samples from local dairy products were collected as 50 samples from each raw milk, sour-milk, yogurt, cream and soft cheese. All isolates were identified according to biochemical characters, antimicrobial sensitivity test and MIC of the isolates was done by the Kirby–Bauer disc diffusion and micro dilution methods respectively. PCR amplification genes associated with resistance to β-lactam antibiotics (bla Z) gene, erythromycin (ermB), genes, and tetracycline ribosomal protection proteins (tet M), were done by PCR. Results: The results showed that the most common bacteria presents in all dairy source samples were Lactobacillus as followed:75(31.9%), 40(17%), 30(12.7%) and 90(38.2%) in yogurt, white cheese, cream and sour milk respectively. Lactococcus isolates was appeared as 20(36.3%) and 15(27.27%) in yogurt and creams respectively IJMS January 2019;2(1):12-28;ISSNe 2522-7836 13 and 10(18.1%) in each of white cheese and sour milk. Streptococcus was found as 45(40.9%) in white cheese and 30(27.2%) in yogurt, while in cream and sour milk was found as 27(24.5%) and 8(7.2%) respectively, whereas the total number of Lactococcus and Pediococcus were 55(12.6%) and 36(8.25%) respectively. The physiological characters and phenotypic identification was found that out of the 436 LAB isolates; Lactobacillus isolates were the dominant genus appeared followed by Streptococcus species. Isolates of LAB demonstrated different profiles of antibiotic resistance, all Lb. delbrukii, Lb. plantarum and Lb. fermentum were resistance to penicillin G, while showed a variable susceptibility rates to other antibiotics. The detection of tet M and erm B and bla Z resistance genes in LAB isolates showed that some isolates harbor tet M and/or erm B and bla Z genes. Twenty isolates of Lactobacillus delbrukii showed the presence of tet M and erm B and 17 isolates harbor bla Z genes corresponding to their resistance phenotypes. As well as 10 isolates of Lb. plantarum showed these gens in some of them as follow; five of the ten possessed the resistance tet M gen and 4 isolates have erm B while 8 isolates showed the penicillin G resistance gen. From the ten isolates of Lb. fermentum; only 4 isolates harbor tet M gene and 5 isolates possessed erm B gens while 9 isolates had the resistance gens bla Z. The isolates Pedicoccus sp. and Lc. lactis showed only presence of tet M gens in 8 and 7 isolates respectively. On the other hand Strep. thermophilus (20 isolates); the band of the detected gens appeared in 18 isolates for tet M and 15 for the erm B, but a β-lactamase gene detected in only 4 of these resistant isolates. Leu. mesntroids (10 isolates) showed 6 and 4 isolates possessed bla Z and tet M gen respectively but only one isolates showed to possessing the gene erm B. Conclusion: This study had established that wide varieties of LAB the most common bacteria presents in all local dairy source samples were lactobacillus species which show high resistance properties to amoxicillin and ampicillin. Lactococcus lactis isolates showed resistance to tetracycline and all Leuconostoc cremoris isolates showed sensitivity to all tested antibiotics except, some isolates resisted to tetracycline and chloramphenicol. While Leuconostoc mesntroids had variable resistance to tetracycline, chloramphenicol, erythromycin, vancomycin, amoxicillin, ampicillin and penicillin G. All Streptococcus thermophilus isolates were resisting to tetracycline. The genes tet M, erm B and bla Z were detected in Lactic acid bacterial isolates. Key word: LAB, Antibiotics resistance, tet M, erm B, bla Z genes.
35 The Antibacterial Effect of Silver and Zinc Oxide Nanoparticles against Intracellular Brucella melitensis , Zainab M. Alzubaidy, Department of Biology, Diyala University College of Science [DUCOS], Diyala, Iraq. Narin Mohammed Amin, Salahadeen University College of Agriculture, Erbil, Iraq. Mahabad Sabah, Salahadeen University College of Agriculture, Erbil, Iraq. Correspondence author: Zainab M. Alzubaidy, Department of Biology, College of Science, Diyala University.
Background: Brucellosis is a zoonotic disease of worldwide importance among animal and humans. The most important virulence factor of Brucella melitensis is related to intra-macrophage survival. On the other hand, the side effects of the current brucellosis treatment regime, it is necessary to find out new antimicrobial agents to treat the disease. Objective: To Isolate Brucella melitensis from local white cheese and raw milk by culture method with identification using PCR and determination of their susceptibility to classical antibiotics and silver and zinc oxide nanoparticles. Materials and methods: A total of 150 local soft cheese and raw milk samples collected from different local markets in Erbil city and were examined for the presence of Brucella melitensis during a period of (6) months (November 2015 to April 2016).Selective media; such as, Brucella agar were used for the isolation, and identified according to standard biochemical tests and confirmed by PCR.Antibiotic susceptibility test determined by Kirby-Bauer disk diffusion method and the antimicrobial activity of silver and zinc oxide nanoparticles were carried out in Muller–Hinton agar with 1% sheep’s blood by well diffusion method. Five mm diameter wells were prepared and loaded with Ag(20 nm size) and ZnO (20 nm size) nanoparticles dilutions, finally the combination of ampicillin/ cloxacillin with the nanoparticles were tested against isolates of Brucella melitensis. Results: Out of the 150 food samples, 53(35.33%) were contaminated; 21(28%) of the total samples of local soft cheese and 32(42.6%) of raw milk was contaminated with Brucella melitensis. Twenty isolates were identified according to standard biochemical tests, and confirmed by PCR for detection of pure Brucella genomic DNA in PCR. Brucella-specific primer BgF/BgR, were evaluated for detection of pure Brucella genomic DNA, provided bands on agarose gel corresponding to a 208 base pair product when compared to molecular ladder, the specific primer IS711were detected IJMS January 2019;2(1): 29-42;ISSNe 2522-7836 30 for Brucella melitensis, and achieved by given bands on agarose electrophoresis corresponding to 731 base pair from the total isolates. Seventeen from 20 isolates were found positive for Brucella with BgR/BgF primers and 15 isolates were positive for IS711 primer. The sensitivity to antibioticsshowed that the resistance to ampicillin and ceftazidime were (85%), for aampicillin/cloxacillin was (45%), and for imipenem and piperacillin were 80% and 90% respectively. The inhibition zone of ZnO-NP against Brucella melitenisis ranged between 10-20 mm when the concentration was 10-1000 ppm. While the inhibition zone of Ag NP was 11.5-24.5 mm. Combination of amoxicillin/ cloxacillin with nanoparticles show a synergistic effect as demonstrated by the increase of inhibition zone to 20 mm fir ZnO-NP and 23 mm for AgNP nanoparticles. Conclusion: Brucella melitensis contaminate local white soft cheese and raw milk and showed variable sensitivity to antibiotics and some isolates were resistant to ampicillin/ cloxacillin, ceftazidime, imipenem, piperacillin, and trimethoprimsulphamethoxazole. The present study data show that silver and zinc oxide nanoparticles inhibit the growth of Brucella melitensis. The combination of silver nanoparticles and ampicillin/ cloxacillin showed a synergistic effect. Key word: Brucella melitensis, BgF/BgR, IS711 gene, Ag and ZnO Nanoparticles
36 Association of Interleukin-6, Interleukin-17 and Angiopoietin in Different Infections, Thyroid Stimulating Hormone, Demographic and Socioeconomic Characteristics in Women with Bad Obstetric History, Kirkuk, Iraq. , Abdulghani Mohamed Alsamarai, Tikrit University College of Medicine, Tikrit, Iraq [TUCOM]. Hala Mohamed Majeed, Tikrit University College of Veterinary Medicine, Tikrit, Iraq [TUCOVM]. Amina Hamed Alobaidi, Kirkuk University College of Veterinary Medicine, Kirkuk, Iraq [KUCOVM].  
Background: Bad obstetric history [BOH] is associated with microbiological infections and abnormal immunological responses. Study design: Descriptive Case Control Study. Aim: to determine the association of interleukin-6 (IL-6), interleukin-17 (IL-17) and angiopoietin with infectivity inn female within Bad obstetric history, in Kirkuk city, Iraq. Materials and method: The study included 547 Bad obstetric histories within Bad obstetric history and 291 female with normal pregnancy outcome. The test performed to detect IL-6, IL-17 and angiopoietin in 60 women with BOH, of them 20 were pregnant and 20 were non-pregnant at time of enrolment in the study. In addition, 20 female with inevitable abortion be included in the study. Also thee study included 28 women with normal pregnancy as control and 14 of them were pregnant and 14 were non-pregnant. Serological study carried out to determine IL-6, IL-17 and Angiopoietin using ELISA kits. Results: IL-17 significantly lower in parvovirus 19 acute infection. Angiopoietin was significantly lower in Toxoplasma gondii infected women, while IL-6 was significantly higher in acute rubella infection as compared to non-infected. Angiopoietin was significantly higher in women with positive TPO autoantibodies. Smoking, animal exposure and low haemoglobin (<11) were associated with decrease in IL-6, while IL-17 was significantly higher in women with history of animal exposure. Conclusion: IL-6, IL-17 and angiopoietin may be influenced by infections in women with BOH, however, this need to be evaluated in a large scale study. Key Words: BOH, IL-6, IL-17, Angiopoietin, women.
37 Molecular Diagnosis of TORCH Infection of Pregnant Women in Iraq. , Anmar Ahmed Al-Taie, Department of Biology, College of Science, Mosul University, Mosul, Iraq. Basima A. Abdullah, Department of Biology, College of Science, University of Mosul, Iraq. Mozahim Y. Al-Attar, Department of Microbiology, College of Veterinary Medicine, University of Mosul, Mosul, Iraq. Correspondence author: Anmar Ahmed Al-Taie, Department of Biology, College of Science, Mosul University, Mosul, Iraq.
Background: TORCH complex (Toxoplasma gondii, others, Rubella virus, Cytomegalovirus, and Herpes simplex virus) infections in pregnant women may attribute to bad obstetric outcomes. Objective: To investigate the role of TORCH as an etiology of bad obstetric outcome using a molecular technique. Materials and Methods: The samples were collected from women with Bad Obstetric History attending clinics in Mosul and Baghdad hospitals in Iraq over a period from (15/4/2013) to (1/6/2014) and from (1/5/2017) to (1/11/2017). The women included in the study were with mean age of (26±6.1) years and a range of 22 to 39 years. Blood samples, throat and cervical swabs were collected from 300 women ELISA positive seroprevalence of TORCH for PCR testing. Results: DNA and RNA were extracted and Real-Time PCR indicates negative results for T.gondii, Rubella and HSV I&II, but were CMV positive in only four samples represented (1.3%) from total 300 positive samples in ELISA tests. Conclusion: ELISA test is considered as a preliminary and screening test for TORCH infections. Real Time PCR is an essential tool in the research laboratory. It has engendered wider acceptance than the conventional PCR due to its improved rapidity, sensitivity, reproducibility and the reduced risk of carry-over contamination. Keywords: TORCH, ELISA for TORCH, Real-Time PCR, Bad obstetric history.
38 CASE REPORT: Hands hypopigmentation , Abdulghani Mohamed Ali, Department of Medicine, Tikrit University College of Medicine, Tikrit, Iraq. Address correspondence: Prof. Abdulghani Alsamarai, College of Medicine, Tikrit University, P O Box 45, Alyarmook ST, Tikrit, Iraq.
Hypopigmentation is a common dermatologic problem of multiple aetiologies. This health problem is associated with social and psychological impact on the patient and his filmily. Here I report a case of hands hypopigmentation in a year's old, adult male. Key Words: Hypopigmentation, Skin, Loss of color, Anxiety.
39 THESIS ABSTRACT: Susceptibility to Mumps Infections in Tikrit City: A Comparative Study , Dandan Abdulwahed Bado Al-Salami, This is a diploma dissertation that was conducted in Tikrit University College of Science , in 2018, under the supervision of Assistant Prof. Dr. Hala Mohamed Majeed, Tikrit University College of Veterinary Medicine, Tikrit, Iraq [TUCOVM].
Background: Immunization has a promising future. We are entering a new era in which it is expected that the number of available vaccines will double. Immunization services are increasingly used to deliver other important health interventions, making them a strong pillar of health systems. There are still millions of people who do not benefit from the protection that vaccination provides. They are at risk of life-threatening illness every day. In Iraq there are still thousands of children who do not complete all their doses and hence not fully protected. Aim: This study aiming to illustrate the mumps immunological status in adults and children in Tikrit city. Materials and methods: A Cross-sectional prospective study conducted in Tikrit Teaching Hospital and Primary Health Care Centers. The study population included adults and children from both gender. The adult's population group is recruited from university students, while the children are recruited from 6th primary, 1st, 2nd and 3rd secondary schools. The sample size is 100 subjects in each adult and children groups [50 subject males and 50 females]. Thus a minimum of 200 subjects to be included in the study. A pre-designed questionnaire is used for gathering data from each individual included in the study. A verbal informed consent taken from each individual before enrolment in the program. Data on vaccination was taken directly from each individual or vaccination cards if available. ELISA was used for determination of IgG for mumps diseases in central research Laboratory and Tikrit Laboratory’s. The tests were performed according to manufacturer instructions. Results: The mean value of optical density was with predictive value for mumps antibodies concentration. The mumps antibodies mean serum value was lower in adult subjects as compared to child group. This finding indicated that immune response to mumps decreased with time and contributes to resurgence of mumps in community. Thus the frequency of mumps none immune status was higher in adults as compared to child. Additionally, mumps immune response with high titer was significantly lower in adults than in children. The high titer rate was two times more in children than in adults. These figures indicated that IgG mumps antibody concentration confirmed the possibility of immune reduction with age and explain the outbreak of the disease in vaccinated subjects. Thus the present study finding may gave an explanation for the high rate of reported cases in Iraq in 2016 as compared to previous years. However, the war conflict may act as another factor that disturbs the vaccination program performance.
40 Determination of the Activity of the Green Synthesized Silver Nanoparticles Against Multidrug Resistant Bacteria Isolated from Children with Diarrhea under Five Years. , Shahad Maath Altikriti, This is a M Sc thesis that was conducted in Tikrit University College of Science, Tikrit, Iraq, in 2018, under the supervision of Assistant professor Dr. Mohamed Nadhir, Tikrit University College of Education for Pure Sciences, Tikrit, Iraq.
Background: Bacterial resistance to wide range of antibiotics increased dramatically in the last decade. The most serious of such resistant is the multidrug resistance that leads to failure of treatment and increase in morbidity and mortality. Aim: To evaluate the synergistic inhibition of combination of nano particles with antibiotics against multidrug resistant bacteria
41 Risk Assessment for TORCH Complex Infection, Human Papilloma Virus and Parvovirus B19 Infection in Women with Bad Obstetric History. , Hala Mohamed Majeed, Tikrit University College of Veterinary Medicine, Tikrit, Iraq [TUCOVM]. This is a Ph D thesis conducted in Tikrit University College of Science, 2015, under the supervision of Professor Dr. Abdulghani Mohamed Alsamarai, Tikrit University College of Medicine, Tikrit, Iraq [TUCOM].
Background: Maternal infection can lead to adverse pregnancy outcomes, which are initially in apparent or asymptomatic and thus difficult to diagnose on clinical grounds. Basic epidemiological data concerning Toxoplasma. gondii, rubella, cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2), Parvovirus and human papilloma virus (HPV) is necessary for health planners and care providers. The present study updates and extends the earlier studies perfo
42 Community- Based Education: Tikrit University College of Medicine Experience. PART TWO: Community Based Education Programme in Tikrit University College of Medicine: current situation and proposal for change , Amina Hamed Ahmad Alobaidi, Kirkuk University, Kirkuk, Iraq
Tikrit University College of Medicine [TUCOM] has tried since foundation to implement relevant curriculum, which is both community- oriented as well as community –based [1]. Partners involved in CBME: In community-based learning activities the active partners include students, staff and community [2]. However, the development of CBLA program is influenced by economic and political factors in local national levels and these two factors affected badly the education in Iraq after 2003. TUCOM/CBME programme was designed before the first batch of student joined the college. Its development, implementation and sustainability faced a lot of challenges. The partners involved in TUCOM/CBME programme are heterogeneous and this heterogeneity does affect the program implementation. However, all the partners share a common set of values such as quality, equity, relevance, and cost effectiveness, as well as certain vision of future health services delivery [2].
43 BOOKS REVIEW: Lennette's Laboratory Diagnosis of Viral Infections 4th Edition , Mohamed Almoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq.
Comment: Well written extensive textbook for laboratory diagnosis of human viral diseases. The book provided an important illustrations, algorithms and tables that enhance the understanding of viral infections in human being. The book serve as reference textbook for virologists, epidemiologists, infectious diseases specialists and microbiologists. Additionally, it is a reference book for medical, dental, nursing, phamarmacist, and laboratory investigator students.
44 LEADING ARTICLE: Challenges Facing Postgraduate Studies in Iraqi Universities , Nemah H. Aljubori; MB.Ch B; PhD; LS3Clinical Pathology. Editor for Basic Sciences, International Journal Medical Sciences Babylon University College of Medicine (BUCM), Babylon, Iraq.
There is hardly any doubt about the fact that the reality of postgraduate studies in Iraq is suffering from many serious problems, which may represent a warning sign of serious harmful scientific consequences in the future [1]. The reality that must be understood by all is that the future of any country's development depends on the success or failure of this sector of the higher education (i.e, scientific research), because it provides the specialized and academic capacities necessary to build the country, and the achievements of researches and scientific innovations that are employed in the process of technological development in various fields [2,3]. For that reason, any complacency in the reform and development of this sector will greatly damage the march of development and construction in any country, and Iraq is not an exception.
45 REVIEW ARTICLE: Seroepidemiology of Toxoplasma gondii, Rubella, Cytomegalovirus and Herpes Simplex Virus Type -2 in Women with Abnormal Pregnancy Outcomes: A Review , Mohamed Almoustafa Alsamarai, Laboratory Investigation Department. Bayan Bahauldean Faraj, Kirkuk Health Authority, Kirkuk, Iraq Correspondence author: Mohamed Almoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq.
Background: The role of T. gondii, rubella, cytomegalovirus and herpes simplex virus type -2 was not fully understood as the range of Seroepidemiology of these agents was with a wide range. The reported studies results were affected by study design and patients selection criteria. Aim: To determine the role of ToRCH agents on pregnancy outcomes Materials and methods: Published articles on the role of ToRCH agents in women with bad obstetrics history retrieved from Google and reviewed. For T. gondii 19 global studies and 36 Arab countries were reviewed, while for rubella 24 global studies and 16 Arab countries were included. In addition, 19 global and 18 Arab countries for CMV, while 14 HSV-2 global and 6 Arab countries studies were reviewed. Results: T. gondii IgG and IgM seroprevalence range in global studies were 5.33% - 91.2% and 1.2% - 84.4% respectively. While the corresponding values in Arab countries studies was 6.8% - 81.5% and 0.79% and 58.1% respectively. Rubella IgG seroprevalence range was 3.6% - 91.2% in global studies and 1.05% - 93.3% in Arab countries studies. Additionally, rubella IgM seroprevalence was 1.2% - 98.4% in global studies and 1.5% - 62.3% in Arab countries studies. CMV IgG seroprevalence range was 8.3% - 99.4% in global studies and 4.8% - 97.8% in Arab countries studies. While CMV IgM seroprevalence range in global studies was 0% - 81.1% and 0% - 65% in Arab countries studies. HSV-2 IgG seroprevalence range was 6.66% - 97.6% in global studies and 29.1% - 60.6% in Arab countries studies. While HSV-2 IgM seroprevalence range was 0% - 76.2% in global studies and 3.1% - 73.9% in Arab countries studies. Conclusions: This review indicated that IgG and IgM seroprevalence ranges for ToRCH agents in global, Arab countries and Iraqi studies were with a wide range and indicated that ranges were affected by sample size of study population. IJMS May 2019;2(2):5-17;ISSNe 2522-7836 6 Key words: T. gondii, Cytomegalovirus, Rubella, Herpes simplex virus, Global, Arab countries, Bad obstetrics history, Bad obstetrics outcome.
46 ORIGINAL ARTICLES: Detection of Semen on the Underwear of Females Involved in Sexual Assaults by Using Prostate Specific Antigen (PSA) Kit and its Medicolegal Significance , Alaa Alaloosh, Department of Biology, College of Science, University of Babylon. Nemah H. Aljubori*, MB.Ch B; PhD; LS3Clinical Pathology. Editor for Basic Sciences, International Journal Medical Sciences Babylon University College of Medicine (BUCM), Babylon, Iraq
Background: Detection of semen in forensic cases, mostly sexual assault or abuse, is critical for evidence collection. As the number of rape cases is increasing day by day, there is a need for detection of semen, even if present in small quantity, no matter how old the stains are presence of semen is the most reliable marker for the investigation in cases of rape, sodomy, sexual murder etc. rapid detection of semen is an important factor in confirming sexual assaults. Aim: To detect semen in the underwear of suspected women who were involved in sexual assault by using two rapid methods; the Ultra Violet Forensic Light Source (UV FLS), and detection of Prostate Specific Antigen (PSA). Material and methods: The study included 74 female cases of suspected sexual assault. The underwear of these cases were submitted to light screening by UV FLS, and then examined for the presence of prostate specific antigen as confirmatory test for the presence of semen. Result; the majority of cases were under 30 years age. All cases were positive for UV light, (20.3%) of the underwear of these females showed positive results for PSA; the highest frequency was in the age group (21-30) years. Conclusions: though the PSA test is highly sensitive and specific for semen detection, yet they are not conclusive as to the source of semen, and therefore, further test for DNA print is very necessary to determine the source of semen on the underwear of suspected women. Key words: Semen, Underwear, Prostate specific antigen (PSA), Forensic Light Source (FLS), Sexual assault.
47 Genotypes of Hepatitis C Virus in United Arab Emirates: Their Relationship with Age, Gender and Nationality , Seham Abdelwahed Hafez Koura, AlAin University of Science and Technology, Abu Dhabi, United Arab Emirates. Abdulghani Mohamed Alsamarai, Aalborg Academy College of Medicine, Denmark. Tikrit University College of Medicine, Tikrit, Iraq [TUCOM]. Salim Awadh, Consultant physician, Gastroenterologist and Hepatologist, United Arab Emirates. Corresponding author: Seham Abdelwahed Hafez Koura, AlAin University of Science and Technology, Abu Dhabi, United Arab of Emirates.
Background: Hepatitis C virus (HCV) is a major global public health problem with estimate of 3% chronicity. The prevalence of HCV in Eastern Mediterranean Region was variable with a range of 1% to 14.9%. HCV infection was found to be endemic in Arab World as different studies confirmed such endemicity. Arabian Peninsula region HCV prevalence was reported as low (1-1.9%) in Oman, Saudi Arabia, Kuwait, and Bahrain, while it was moderate in Yemen (2.0-2.9%), high in UAE (3.0-3.9%), and very high in Qatar (>4%). Aim: To study sero-molecular epidemiology of HCV in UAE genotypes among the patients who have HCV positive antibodies and differentiate them according to their nationality in United Arab Emirates. Patients and methods: The study was conducted from June 2013 to December 2017 at the Medical as well as Infectious Diseases clinics at Khalifa Hospital Abu Dhabi, UAE. The patients with positive screening test for HCV antibodies referred from other clinics and peripheral health centers were included in the study. The study was designed to include patient's demographics, clinical information including the various risk factors for the transmission of HCV and laboratory data which included serum HCV RNA levels, HCV Genotypes and Liver function test (LFTs). A blood sample of each patient was collected and the confirmation of HCV was done by Western blot. The confirmed cases were further tested for HCV RNA levels by polymerase chain reaction and subsequently HCV-RNA positive patients were genotyped by selective hybridization of amplicons to HCV genotype-specific oligonucleotides. Results: A total of 193 patients included in the study with a mean age of 44.23 years and 76.68% of them were male, with M/F ratio of 3/1. The highest frequency was in Egyptian (60.10%), followed by UAE (18.13%) and 21.76% in others. The predominant genotype was 4 (67.93%), type 1 form 16.85%, and type 3 form 15.22%. Gender with significant influence on HCV genotype (P=0.001). HCV type 1 was higher in female (40.48%) than in male (9.86%), while type 3 was higher in male IJMS May 2019;2(2):25-44; ISSNe 2522-7837 26 (17.61%) than in female (7.14%), also type 4 was more frequent in male (72.54%) than in female (52.28%). HCV genotype 4 was the predominant types in Egyptian (97.35%), while type 1 in UAE citizen (68.57%), and type 3 in others (63.89%). Age was not with significant influence on genotype frequency, however, gender, nationality, and disease severity was with significant association between HCV genotype and age, gender and nationality (X 2 =179.01; P=0.001). Female gender was with negative association with type 3 genotype and female with relative risk to infection with type 4 genotype11 times to infection with type 3 genotype. There is no observed Egyptian with type 3 genotype infection in our study cohort. Conclusion: HCV more predominant in Egyptian than in UAE. However, Egyptian has a significant negative correlation [OR=0.085, P=0.006] with type 1, while UAE are with significant positive correlation with genotype 1 after excluding the effect of gender. Furthermore, Egyptian is 11 times susceptible for genotype4 than for genotype1, while the Emirati are 10 times susceptible for genotype1 than for genotype4. However, the genotype frequency distribution indicated that HCV infection in Emirati was with significant association with type 1 (OR=10.246; p=0.003), while OR was 0.085 in Egyptian and thus the hypothesis that presumed the increase in prevalence of HCV in Emirati was excluded. In addition, type 3 genotype was with 0% frequency in Egyptian, while it forms 63.89% as a cause of HCV infection in other nationality and thus this finding is strong evidence that exclude Egyptian a cause for increase of hepatitis C in Emirati. Key words: Hepatitis, HCV, Genotype, Nationality, United Arab Emirates, Egyptian.
48 Colorimetric Determination of Paracetamol Using 9-Chloroacridine Reagent: Application to Pharmaceutical Formulations , Firas Hassan Awad, Department of Pathological Analysis, Al-Qalam University College, Kirkuk, Iraq.
Background: The majority of reported spectrophotometric methods for determination of paracetamol are depended on hydrolysis of the compound and applying oxidative coupling and diazotization coupling methods leading to the determination of produced p-aminophenol by different reagents. In addition to using of other methods such as Schiff bases formation, oxidation reaction and charge transfer complex formation reactions. However, some of these methods either not sensitive, carried on organic medium or suffered from interferences. Other analytical techniques have been also used for determination of paracetamol, such as HPLC, voltammetry, chemiluminescence in addition to the titrimetric method. These methods needed of highly sophisticated instruments. Aim: To develop a simple and accurate method for determination of acetaminophen in pharmaceutical formulations. Materials and methods: The method is based on the reaction between the hydrolyzed paracetamol and 9-chloroacridine reagent (9-CA). Results: The spectra of the product show maximum absorption at 436 nm. Beer’s law is obeyed in the concentration range of 0.25-11 μg/ml with molar absorptivity value 5.3×103 L/ mol. cm. The average recovery percentage (Rec%) is 99.27% and relative standard deviation (RSD) is ≤2.82 %. In addition, the stability constant has been determined and the reaction mechanism is proposed. Conclusion: A simple, sensitive and accurate spectrophotometric method is developed for the quantitative determination of paracetamol. The method has been applied successfully for the assay of paracetamol in pharmaceutical formulations. Keywords: Acetaminophen, Paracetamol; 9-Chloroacridine; Spectrophotometry
49 Obesity Association with the Mode of Delivery , Bayan Bahauldean Faraj, Kirkuk Health Authority, Kirkuk, Iraq. Amina Hamed Alobaidi, Kirkuk University College of Veterinary Medicine, Kirkuk, Iraq [KUCOVM]. Isra Hashim Abduljabar, Tikrit University College of Medicine [TUCOM]. Correspondence author: Bayan Bahauldean Faraj, Kirkuk Health Authority, Kirkuk, Iraq.
Back ground: Obesity is an epidemic not only in developed countries but also in the developing world. Furthermore, obesity is becoming an increasingly common problem, both in general population and in women of the reproductive age. There is a growing body of evidence suggesting that obese pregnant women are at greater risk of a number of maternal and fetal complications of pregnancy. Objective: To study the influence of BMI on the mood of delivery, fetal body weight and post labour complications. Patients and methods: A cross sectional study was conducted at Daquk and Kirkuk general Hospital in Kirkuk governorate. The study was carried out over 60 days extended from 15th of May to 15th of July2015. The study enrolled a total of 81 nulliparous women in labour, with single tone fetus with vertex presentation. The demographic and clinical characteristics were gathered using a questionnaire and obstetrical examination performed for all included patients. Results: There were no women of this study participant with BMI of less than 20, while the predominant BMI in our study cohort was the 25 – 29.9. A 27.2% of the total rate of cesarean section (30.9%) is with BMI of ≥25. The obesity rate was more in urban. Post date (>42 wk) with a highest rate in women with BMI of ≥ 25. In addition, 69.1% (56/81) were delivered with vaginal delivery and 30.9% (25/81) were delivered by CS. Obesity do influence development of complications during pregnancy with risk of more than 8 times. The total percentage of CS (52%) with foetal complication which are the indication for cesarean section. The preterm labor was about 5 times in women with BMI of ≥25; the same pattern was demonstrated for post date. OR not confirmed presence of association between normal BMI and vaginal delivery. The highest post vaginal delivery complication rate was in women with BMI of ≥25, episiotomy was the most frequent one. Cesarean section, underweight and overweight fetus, preterm term labour and post date were more predominant in women with BMI of ≥25. More than halve of post date delivery was in women with BMI <25. Conclusion: obese and overweight women were with higher rate of cesarean section, preterm labour, postdate, and post vaginal delivery complications, however, these findings need to be confirmed in a large scale study. Key words: Obesity, BMI, cesarean section, preterm, postdate, vaginal delivery complications.
50 Practicing Tobacco Smoking Habit among Students of Technical Institute of Mosul, 2018 , Rafah F. Ali, Nineva Health Directorate, Mosul, Iraq. Riyadh A. Jerjes, Nineva Health Directorate, Mosul, Iraq. Correspondence author: Rafah F. Ali, Nineva Health Directorate, Mosul, Iraq.
Aim: To determine the frequency of practicing tobacco smoking among students. Materials and methods: The study was conducted on a sample of 2000 subjects from the second stage students at the Technical Institute / Mosul for the study of smoking. The information gathered using a predesigned questionnaire. Results: The results show that approximately, the age of students between 21-23 years represents approximately 65% of the sample size and almost equally among males and females, 75% of them from the governorate center. The percentage of non-smokers was 72% and this percentage was reduced to approximately 50% if females were excluded from the study, while the daily smokers and smokers were divided between 15 and 13% respectively. Approximately 23% of smokers tried smoking after the age of 15 years, and the daily smoking rate for the last 30 days of study was 11.5%. As for hookah smoking, non-smokers were relatively high at more than 78%. More than 95 percent said smoking was harmful to public health. In terms of smoking prevention guidelines, both through health institutions and the media, the rates were 32 and 59%, respectively. Conclusion: This study indicated that tobacco smoking practiced in 28% of the studied study cohort and 15.1% are daily smoking. Key words: College students, Smoking, Hookah, Tobacco.
51 Measuring the level of physical activity among students of Technical Institute of Mosul 2018 , Rafah F. Ali, Nineva Health Directorate, Mosul, Iraq. Riyadh A. Jerjes, Nineva Health Directorate, Mosul, Iraq.
Background: Because of the importance of physical activity, countries , organizations and even researchers try to construct standards to compare results with and study physical activity continuously. Aim: To establish whether or not Iraqi students participate in enough physical activity to gain health benefit. Materials and methods: The study was conducted on a sample of 2000 subjects from the second-year students at the Technical Institute/Mosul for the study of physical activity. The information gathered using a predesigned questionnaire. Results: The age group (21-23) year was the most frequent in the study cohort forming 58.8% of the total sample size. Male and female percent was close, giving 50.3% and 49.7% respectively. Of the total, 77.3% were from urban area, while 22.7% were from rural areas and majority (86.5%) of the sample were single. Non-smokers form 78.3% of the studied sample, which gives the good indicator. It was found that approximately 26% of the effort is high for 1 and 2 days and the time of the high activity / minute concentrated at 30 and 60 minutes and 22.5%. In the same context, the frequency of a moderate effort (1 and 2 days) was the highest and form approximately 31% as well as for the time of moderate activity/min. More than 75% were walking during (5 and 7 days) per week. Walking time/min was about 60, 30, 20, 120 and 36.1, 19.1, 9.5 and 7.2%, respectively. Conclusion: The prevalence of physical activity among students was high and more among female students . Key words: Students , Physical activity , Harm reduction .
52 THESIS ABSTRACT: Effect of Leptin and its Association with Steroid Hormones and Lipid Profile in Diabetic Subjects. , Sura Zahim Hussain Alsamarai, Tikrit Teaching Hospital, Salahuldean Health Authority, Tikrit, Salahuldean Governorate, Iraq. A Ph D thesis conducted in Tikrit University College of Science, 2012, under the supervision of Professor Dr. Abdulmonem Hamad Alsamarai, Samara University College of Education [SUCOE], and Samara, Iraq.
Background: Diabetic mellitus is a chronic non curable disease with high prevalence globally. The disease associated with inflammatory responses and metabolic changes and subsequently these responses lead to a multiple organ complications. However, these complications development may be prevented through good diabetic control. Biochemical changes monitoring is the main effective approach in such control program. Aim: To determine the role of leptin, steroid hormones, and lipid profile in the pathogenesis of diabetes mellitus and clarify their uses in disease control program. Materials and methods: Serum samples collected from 220 individuals, 100 of these individuals were normal and 120 cases were diabetic patients admitted to Tikrit Teaching Hospital in Tikrit city from January 2010 to June 2011. The study population age ranged from (12-70) years. Patients and controls had hormonal assay of Leptin, LH, FSH, PRL, Estrogen, Progesterone, Testosterone, Cortisol, Glucose and Lipid profile, these samples were divided into four groups of diabetic patients and controls. Group 1 (Diabetic ketoacidosis in pubertal age), Group 2 (Poorly controlled D.M in adult age), Group 3 (Postmenopausal D.M women & men) and Group 4 (Gestational diabetes mellitus) the fifth group (control group) subdivided into four groups each one included with each group of diabetic patients. Results: Leptin increased progressively with aging in diabetic patients as compared with controls and in female in comparison with male. It increased extensively in three trimesters of gestational diabetic women more than control. LH and FSH decreased in diabetic patients to a lesser degree than control in all groups, while Prolactin also decreased in diabetic patients in all age groups except in male of group one and female of groups one and two.
53 Anatomical and Topographical Study in Different Age Groups of Human Paranasal Sinuses: by Gross Anatomy and Computerized Tomographic Imaging , Mohamed Ahmed AbdAlla, Tikrit University College of Medicine [TUCOM], Department of Anatomy. A Ph D thesis conducted in Tikrit University College of Medicine, 2011, under the supervision of Professor Dr. Abduljabar Jamil Mahdi, Department of Anatomy, Tikrit University College of Medicine [TUCOM], Tikrit, Iraq.
Background: Paranasal sinuses are group of four paired air-filled spaces in the bones of the face adjacent to the nasal cavity that are lined with mucous membrane and continuous with the lining of the nasal cavities These sinuses are named (maxillary, ethmoid, frontal and sphenoid sinuses) according to the facial bones within which they are located.
54 Community- Based Education: Tikrit University College of Medicine Experience. PART THREE: Community Based Education Programme in Tikrit University College of Medicine: proposal for change. , Amina Hamed Alobaidi, Kirkuk University College of Veterinary Medicine, Kirkuk, Iraq [KUCOVM].
Change management in order to introduce innovative approach [CBLA] into our health profession education. The aim of CBME is to produce graduates who are responsive to the health needs of their community [1]. TUCOM has been developed through a collaborative process aimed at building faculty ownership and ongoing sustainability. The result is a capability-based program that features early clinical experience and small group teaching, which offer students considerable flexibility and achieves a high degree of alignment between graduates outcomes, learning activities and assessment.
55 BOOKS REVIEW: Community Based Education in Health Professions: Global Perspectives , Mohamed Almoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq.
Purpose of the book The book introduction explain the purpose of the book which is the need for documenting experiences from different parts of the world that describe the ways of planning and implementing community based education. A 27 contributors were invited from 6 health profession education institutions from all over the globe [3 from Bangladesh; 12 from Brazil; 2 from Egypt; 3 from India;2 from Pakistan; 5 from South Africa]. The chosen institutions represented different styles of implementing community based education and were invited to tell their stories and learnt lessons. These case studies may contribute to a generalized approach for planning and implementing CBE, taking in consideration local circumstances.
56 LEADING ARTICLE Health Risks Related to Depleted Uranium Contamination in Iraq , Souad N. Al-Azzawi, Associate Professor in Environmental Engineering
Introduction To assess any population’s health risks related to radioactive isotopes like depleted Uranium (DU) munitions we need to know several factors - where they have been used, type and mass of the radioactive radionuclides dispersed, contaminated residential areas, and the mechanism of internal and external exposure to the human body. The US and UK armed forces used Depleted Uranium (DU) munitions for the first time in recent history during the First Gulf War in 1991. The weapons were extensively used close to populated areas in Southern Iraq like Basra and its vicinity. About one million bullets, projectiles and missiles were fired along the “Highway of Death” leading from Kuwait City to Basra, then up to Nasiriya, and other Iraqi cities in 1991
57 MINI REVIEW: Leishmaniasis in North Western Yemen , Nabil M Mogalli, Biology Department, Hajjah University.
luding Yemen. Information and knowledge on the ecology and epidemiology of leishmaniasis is very important for disease control. This knowledge could be focused on detection and identification of the parasite and the vector(s), as well as identification of reservoir host(s). The leishmaniasis is widespread in Yemen and it is the most prevalent skin infectious disease. There is a clear increase in the number of cases, which is worrying in Yemen. Reports were taken from Yemen Ministry of Public Health and Population web site (2007- 2012) showing increased leishmaniasis from 1009 cases in 2007 to 2475 in 2012. In spite of this no fully documented reports for leishmaniasis are available in Yemen. Although there have been a few previous reports. Cutaneous leishmaniasis (CL) is widespread in Yemen, but its extent has not been fully documented. Key words: Leishmaniasis, Cutaneous leishmaniasis, CL, Yemen. Developing Countries.
58 REVIEW ARTICLE: Conventional and Nano- Antibodies and Their Future Uses , Awatif Hameed Issa, Department of Pathological Analyses, College of Science, Basrah University. AbdAlAllah Abd Alhesin, College of Pharmacy, Basrah University. Rana Shather Aljabery, Paediatric Hospital, Basrah Health Authority, Ministry of Health. Correspondence author: Awatif Hameed Issa, Department of Pathological Analyses, College of Science, Basrah University.
duced exclusively from plasma cells. The natural structure is glycoprotein also called immune protein because their function is defence by specialization. The main functions of antibodies are opsonisation, neutralization, agglutination, precipitation and complement activation “fixation”. Conventional antibodies consists of two heavy chains and two light chains and can divided into five Classes, based on diversity in the amino acid sequences in the constant region of heavy chains. Also antibodies can be classified into three different classes including polyclonal, monoclonal and recombinant antibodies dependent on immunotechnology applications. In addition to conventional antibodies in 1993 Hamers-Casterman et al, discover antibodies contain only two heavy chains, and produce from few animal species. These review abductors on these types of antibodies and the extent of independent thinking to be used in the treatment of incurable disease such as cancers. Keywords: Antibodies; Immune protein; Light chain, Heavy chain; Conventional antibodies; Nano-antibodies.
59 Post-mortem Serum Level of Uric Acid: A Biochemical Marker for Estimation of Post-mortem Interval , Hamdi Mohammed Al Khfagi, BSc Biology, P G Diploma, Forensic Medicine. Nemah H. Aljubori; MB.Ch B; PhD; LS3 Clinical Pathology. Editor for Basic Sciences, International Journal Medical Sciences Babylon University College of Medicine (BUCOM), Babylon, Iraq. Correspondence author: Nemah H. Aljubori; Babylon University College of Medicine (BUCOM), Babylon, Iraq.
Background Time since death is a key standard in most investigations of murders and un-witnessed deaths, as well as hospital deaths, and still a challenge for forensic scientists. Post-mortem biochemical profiles of various body fluids produced from cell degradation can give an insight into the altering metabolic environment of the cadaver. These profiles may offer valuable information concerning the estimation of time since death, if the appropriate post-mortem biochemical markers are chosen, thoroughly studied and carefully documented. Aim: To determine Post-mortem Interval (PMI) by using post-mortem serum uric acid level as a biochemical marker in the early post-mortem stages. Material and Methods: The study included 16 autopsy cases, whom time of death and cause of death were known, 10 ml of blood were drawn directly from the heart, and the Uric Acid (UA) serum level for each case was measured by colourimetric method. The results of readings of serum UA were plotted against time interval and statistically analysed by X2 test in order to determine the correlation between time after death and UA level. The results of readings were also analysed in relation to age, gender, and cause of death. Results: There was no significant correlation between serum UA level and the time after death, nor between them and cause of death, gender, and age. Conclusion; Serum uric acid level is a poor post-mortem marker for estimating the time of death. Keywords: Uric acid, post-mortem, time after death.
60 Protective Effects of Turmeric Extracts Against CCl4 -Induced Liver Injury in Rats , Firdaws A. AL-Mashhadani, Deparetment of Medical Laboratory Techniques, College of Medical Technology, AL-Kitab University, Kirkuk, Iraq. Essam Salim Rasheed, Department of Medical Laboratory Techniques, College of Medical Technology, AL-Kitab University, Kirkuk, Iraq. Nazdar Nabee Wasman, Department of Food Technology, Agriculture College, Salahaddin University, Erbil, Iraq. Corresponding author: Firdaws A. AL-Mashhadani, Dep. Of Medical Lab. Techniques, College of medical technology, AL-Kitab University, Kirkuk, Iraq.
Background: This study highlights the effect of turmeric extracts on CCl4-induced liver injury by follow up the hematological and biochemical parameter in treated rat group. Objective: Estimate the antioxidant activity of Curcumin and its hepatic protective activity, also to assign the oxidative stress, and antioxidant markers and some hematological parameters in CCl4 treated rat groups. Besides that, this study aims to evaluate the effect of curcumin extract against various pathogenic bacteria growth. Materials and methods: three groups of rats were used, each group having ten albino rats. The first group represent the control group, which received a normal diet and intraperitoneal injection with oil (0.5 ml/kg b.w. (body weight)). The second group represented the CCl4 1ml/kg b.w. (1:1 in olive oil) model. The third group received CCl4 1 ml/kg body weight (1:1 in olive oil) and turmeric 200 mg dissolved in water and given to rates by gavage for four weeks (March to April 2015). Results: The model produced oxidative stress and arising in the level of AST, ALP (Aspartate aminotransferase, Alanine aminotransferase respectively), and direct bilirubin and lowering GSH (glutathione), liver SOD (superoxide dismutase) levels. The treated group showed a significant lowering of AST, ALT, ALP (alkaline phosphatase), direct bilirubin and increasing GSH, liver SOD levels. Also ameliorated inflammation caused by CCl4 treatment via decreasing WBC (White Blood Cells), RBC (Red Blood Cells), and PLT (Platelets). These results referred to a good evidence, that is, turmeric could be used as a source of antioxidant, hepatic protective activities and a good antibiotic agent against some pathogenic bacteria. The watery extracts of Turmeric powder with different concentrations in ml inhibited the growth of the pathogenic E. coli, Staphylococcus aureus, Bacillus subtillus. Conclusions: Turmeric extracts was protective against oxidative damage in CCl4 induced liver injury in rats. Additionally, the alcoholic turmeric extract was with higher antimicrobial activity than watery extract. Keywords: Turmeric, CCl4 – Induced liver injury
61 Antifungal Activity of Nine Plant Oils Against Local Rhodotorula Species and Scytalidium dimidiatum , Salah Mahdi Al-Bader, Knowledge University, College of Science, Pathological Analysis Department. Erbil, Iraq.
Background: Although there is a development in the production of new antimicrobial agents, however, the new antifungal agents development still limited. One of the approach to overcome such obstacle is to use plants products as antifungal agents. Aims: The study was conducted to demonstrate the antifungal activity of pharmaceutical crude oils of nine medicinal plants on Rhodotorula species and Scytalidium dimidiatum. Materials and methods: Local fungal isolates of Rhodotorula species (yeast) and Scytalidium dimidiatum (filamentous) were isolated from sheep wool in Erbil city. Pure cultures were prepared on Sabouraud's dextrose agar (SDA). SDA supplemented with 1% (v/v) of plant oils was used for primary screening of oils antifungal activity. Macroscopic characteristics of yeast cultures and radial growth of mold were screened for the primary determination of the oils effectiveness. The tested oils include that of Zingiber officinale (Ginger), Sisymbrium officinale (Hedge), Peganum harmala (Harmel), Rosmarinus officinalis (Rosemary), Pimpinella anisum (Anise), Cuminum cyminum (Cumin), Salvia officinalis (Sage), Linum usitatissimum (Flax), and Allium sativum (Garlic). Results: Oils of R. officinalis, A. sativum and S. officinale exhibited the highest antifungal activity on Rhodotorula species and S. dimidiatum. The rest treatments except Z. officinalis showed a moderate antifungal effect. While Z. officinalis not demonstrated antifungal activity. The minimum inhibition concentration (MIC test) of garlic, rosemary, and hedge oils showed that garlic was the only treatment that inhibited the growth of tested isolates in all concentrations, while the rosemary and hedge oils showed a diverse activity levels. Conclusions: The effectiveness of the tested oils on fungal isolated demonstrated variable antifungal activities and the effectiveness was higher on the yeast growth rather than on filamentous fungi. Additionally, Rodotorula species was more sensitive to the tested oils S. dimidiatum. Key words: Rhodotorula, Scytalidium, plant's oils, antifungal, Iraq.
62 CASE REPORT: Unexpected Noninvasive Procedure in the Treatment of Bronchobiliary Fistula (BBF): Case Report , Wadhah Mahdi Saleem Albadir, Department of Anesthesia, College of Medical Technology, Alkitab University, Kirkuk, Iraq.
Introduction Bronchobiliary fistula is an abnormal connection between the bronchial tree and biliary tract and it is one of the rare diseases [1], but with high morbidity and mortality [2]. BBF is either congenital [3] or acquired [4]. Acquired BBF may be a consequence of local infections (amoebic liver abscess, complicated liver hydatid disease or pyogenic hepatic abscess), neoplasm, biliary tract obstruction, and trauma [5-62]. In a systematic review of 68 cases, Liao et al [4], 2011, reported that BBF cause was tumors (32.3%; 19.1% primary tumors; 13.2% metastatic tumors), followed by biliary stenosis (18%), cholangiolithiasis (13%), hepatic hydatidosis (12%), trauma (10%), multiple primary or single primary disease (6% for each) and chronic pancreatitis (3%). In 2012 Cao et al [1], reported a case in 48 years old male with hepatocellular carcinoma. In 2015, Dai et al [63] reported a case of BBF in a 65-year-old male with a hepatic abscess. In 70- year- old male, 2016, Hay et al [64] reported that BBF was developed following hepatectomy of a recurrent hepatocellular carcinoma. Other cases of BBF was reported [65], 2016, in 77 year old female with hepatocellular carcinoma; in 2017, in 55 year old female with hydatid cyst [66]; In 2018, a 70-year-old male after pacreaticoduodenectomy [67], a 61-year-old male after radiofrequency ablation for HCC [68] and in 53-year-old female with breast cancer that was metastasized to liver [69]. While in 2015, BBF case reported in 3.5-year-old child after liver abscess rupture [70]. In Iraq, one review [71], in 2014, 14 cases of BBF were reported for the period from 2004 to 2010, four of them are with previous surgery to liver or right pulmonary hydatid cyst and 10 cases were with lower thoracic or penetrating abdominal injuries. Although the first case of BBF was reported by Peacock in 1850 [55], however, the incidence of BBF still a rare clinical condition.
63 THESIS ABSTRACT: Association between Microbial Infections and HßD-3 Gene Expression in Oral Cavity of Children with Leukemia , Hanan Salman Makii Al-Amri, An M Sc dissertation conducted in Basrah University College of Science (BUCOS), 2017, under the supervision of Professor Dr. Awatif Hamed Al-Issa and Professor Dr. Abdulla Hamad Al- Sadoon
Background: Malignant diseases epidemiological studies illustrated an increase in the prevalence and incidence of cancer in Iraqi population. The increase in the incidence and prevalence of malignant diseases are mainly attributed to environmental pollution due to using of depleted uranium in recent Gulf wars. Aim: To determine the microbial infection frequency and its association with HßD-3 Gene Expression in Oral Cavity of Children with Leukemia. Materials and methods: The study was conducted in Basrah Pediatric Hospital during the period between August 2016 and June 2017. The study included testing of 50 samples collected from 25 children with leukemia. Microbial diagnosis achieved by conventional methods and molecular test.
64 THESIS ABSTRACT: Causative Agents of Diarrhea in Erbil Children and the Effect of Some Plant Extracts on Bacterial Isolates , Sawsan Mohammed Abdullah Al-Sorchee, B Sc, M Sc, Ph D. A Ph D thesis conducted in Baghdad University College of Education (Ibn Al-Haitham), 2009, under the supervision of Assistant Professor Dr. Intisar Mahmood Juma and Assistant Professor Dr. Abbas Abdul Kadir Rabat.
Background: In developing countries including Iraq diarrhea in children still represent a major health problem. Children diarrhea is with multiple etiology and causative agents varied geographically.
65 THESIS ABSTRACT: Study of Herd Immunity Associated with Tuberculosis Infections in Basra Province, South of Iraq , Mazin Saleem Salman, A Ph D thesis conducted in Basrah University College of Science (BUCOS), 2016, under the supervision of Professor Dr. Awatif Hamed Al-Issa.
Background: In Iraq, tuberculosis is a real problem worth to be studied carefully to determine all its dimensions.
66 MEDICAL EDUCATION: Medical Education Development in the Arab Region Suez Canal University Role and experience , Wagdy Talaat, MD, PhD, FHPE Professor and Founding Head, Medical Education Department Faculty of Medicine, Suez Canal University Faculty, FAIMER, Philadelphia, USA. Consultant, EMRO/WHO in Medical Education and Accreditation Co-Director, Joint Master of Health Professions Education between Maastricht and Suez Canal Universities  
Although education of medical sciences had started in Egypt in the early 19th century (Kasr Al-Eini - Cairo University- is the oldest Arab Medical School; established in 1827) using the apprenticeship model of teaching learning, yet introducing new educational strategies in the late seventies of the 20th century by Suez Canal University in Egypt and Gezira University in Sudan, then Tikrit University in Iraq had made a huge difference in perceiving "Medical Education" as an academic science that should be taught and learned independently by both under and postgraduate students. The Suez Canal Faculty of Medicine (FOM/SCU) was the first to adopt an Integrated, Student-Centered, Problem-Based and Community-Based curriculum since its inauguration in 1978 [1].
67 BOOK REVIEW: Psoriasis: Role of Tumor Necrosis Factor-α, Interleukin-18, C Reactive Protein and Osteopontin.1 st Edition. , Mohamed Almoustafa Alsamarai, Laboratory Investigation Department, Samara University College of Applied Sciences (SUCOAS), Samara, Iraq.
Purpose of the book The book presented an experimental works on a biomarkers that may play a role in the pathogenesis of psoriasis. The authors mission was to document the biochemical changes occurred during the disease course which may attributed to cardiovascular diseases. Additionally, they study the role of genetic in the pathogenesis of psoriasis.