University of AnbarAl- Anbar Medical Journal2706-620716220201201Origin, Causative and New Approach of Vaccine Design of COVID-19252717094810.33091/amj.2020.170948ENMothana A. KhalilDepartment of Microbiology/Virology, College of Medicine, University of Anbar, Ramadi, Anbar, IraqJournal Article20200518Coronavirus interactive disease 2019 (COVID-19) is a pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2(. It begins suddenly in December 2019 in Wuhan City, Hubei Province, China, then spread in 213 countries with 4,818,296 confirmed cases, of the 316,925 dead with 6.68% case fatality rate) until the nineteenth of May 2020). It is characterized by a mild common cold-like illness, to severe viral pneumonia leading to the acute respiratory distress syndrome that is potentially fatal https://amj.uoanbar.edu.iq/article_170948_95a217786eaff3b661a945bf766261b7.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Rh Blood Group Positive Newborn of Rh Blood Group Negative Parents, Why, and How?283017095010.33091/amj.2020.170950ENYahya EthawiDepartment of Pediatrics, Al Qassimi Hospital for Women and Children,
Ministry of Health and Prevention, Sharjah, UAEMona KahalfDepartment of Pediatrics, Al Qassimi Hospital for Women and Children,
Ministry of Health and Prevention, Sharjah, UAERola Al ZirDepartment of Pediatrics, Al Qassimi Hospital for Women and Children,
Ministry of Health and Prevention, Sharjah, UAEJournal Article20200610The proteins of Rhesus (Rh) antigens are transmembrane proteins. The main antigens are D, C,E, c, and e, which are encoded by two adjacent gene loci. The presence or absence of RhD allele ina person is typed either positive or negative, represents by a suffix (+/-) after the ABO type. Theantigenicity of Rh antigen is guarded by many factors, for example, the molecular weight of theantigen and the antigen being accessible to the antibody. Rh phenotypes can be identified by thepresence or absence of the Rh surface antigens. The Rh antigen protein represented by 2 allelesat the specific gene locus. Rh-negative positive person can be homologous have 2 RhD alleles orheterozygous having RhD and Rhd alleles. Therefore, Rh positive parents can have Rh-negativechildren if both are Rh heterozygous. At the same time, Rh negative parent can have Rh positivechildren if both parents genotypically are positive but phenotypically are negative. They will testnegative on antigenicity testing but on DNA testing they are actually RhD positive. Thus theywill give the allele to their baby. If the baby expressed the RhD antigen on the surface will bephenotypically and genotypically positive.https://amj.uoanbar.edu.iq/article_170950_bf59e716bfe4b290d2f208fc532e2474.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Effect of Antibiotic on Men with Raised Prostatic-Specific Antigen (4-10 ng/ml)313417095210.33091/amj.2020.170952ENAbdulsattar J. AliDepartment of Surgery (Urology), Al-Ramadi Teaching Hospital,
Anbar Health Directorate, Ramadi, Anbar, IraThaker ThiabDepartment of Surgery (General Surgery), Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq.Journal Article20200221<strong>Background:</strong> The managing of raised Prostate-Specific Antigen (PSA) in a range of 4 to 10 ng/ml is still controversial among urologists. In addition to prostatic cancer, benign prostatic hyperplasia, and prostatitis is established to increase PSA. PSA reduction after antibiotic therapy might detect those patients in whom biopsy can be avoided or postponed.<br /> <strong>Objectives:</strong> To evaluate the effectiveness of a 6 weeks levofloxacin course on the serum total PSA level and PSA density (PSAD) in patients with PSA 4 -10 ng/ml and ordinary digital rectal examination and ultrasonography results.<br /> <strong>Materials and Methods:</strong> The study conducted at Al-Ramadi Teaching Hospital from February 2016 to December 2019. A total of 177 men with benign prostatic hyperplasia or lower urinary tract symptoms were with a normal digital rectal examination, chronic prostatitis (Expressed prostatic secretion was done before treatment), total PSA 4-10 ng/ml, and ultrasonography findings that did not reveal a hypoechoic lesion in the prostate will be included in this study. Serum PSA and PSAD were measured before, and after treatment with a 6 weeks course of levofloxacin.<br /> <strong>Results:</strong> The age of our 177 men was ranged from 40-80 years with a mean age of 56.52 years ± 7.253. The mean prostatic size was 49.5 ± 28.5 g (range, 23-150 g). In 89 (50.2%) patients of the 177 men, total PSA has normalized to less than 4 ng/ml after antibiotics treatment. In 56 patients of 89 men had a high level of PSAD. PSAD was normalized (less than 0.15 ng/ml/cm3) after treatment in 49 patients of the 56 patients. A significant reduction in total PSA and PSAD after treatment (p <0.05). https://amj.uoanbar.edu.iq/article_170952_55ed86b3168441e84a1e5f1806a1f804.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Incidence of Hemorrhagic Complications among Patients Treated with Thrombolytic in Erbil City, Iraq353917095510.33091/amj.2020.170955ENAhmed F. HammadDepartment of Internal Medicine, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq.Imad T. AbdulhafedDepartment of Internal Medicine, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq.Abdulsalam R. AwadDepartment of Internal Medicine, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq.Journal Article20191122<strong>Background: </strong>Recombinant tissue-type plasminogen activator is an option of treatment for suspected occlusive vascular thrombi and its sequel (transmural myocardial infarction, pulmonary embolism, and ischemic stroke). The most important concern associated with those patients is the fear of hemorrhagic complications.<br /> <strong>Objectives:</strong> To evaluate the incidence and risk factors of bleeding following the use of recombinant tissue-type plasminogen activator.<br /> <strong>Materials and Methods: </strong>This prospective study was conducted in the Intensive Care Units of Roj-halat Emergency Hospital and Rizgary Teaching Hospital in Erbil city/Iraq. The duration of the study was through the period from 1<sup>st</sup> of June, 2016 to 1<sup>st</sup> of March, 2017. A convenient sample of 100 patients was selected. The patients were followed after their admission to Intensive Care Units for 24 hours after their treatment with recombinant tissue-type plasminogen activator to explore their complications.<br /> <strong>Results:</strong> Bleeding complication represented 10% of patients treated with recombinant tissue-type plasminogen activator (50% for each major and minor bleeding). There was a significant association between increased age of patients treated with recombinant tissue-type plasminogen activator and bleeding (P-value = 0. 01). Patients with a history of hypertension, diabetes, and smoking were significantly associated with a bleeding complication of recombinant tissue-type plasminogen activator (P-value <0.05).<br /> <strong>Conclusions: </strong>The incidence of bleeding among patients after treatment with recombinant tissue-type plasminogen activator in the intensive care unit was acceptable. The age, diabetes, smoking, and hypertension were risk factors for increasing the bleeding complications in subjects treated with recombinant tissue-type plasminogen.https://amj.uoanbar.edu.iq/article_170955_c923e8b479beeee0aa8720460d617813.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Does Rheumatoid Factor have any Protective Role in Patients with Lupus Nephritis404517102410.33091/amj.2020.171024ENKhamis Y. C. AL-QubaeissyRheumatology Department, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq.Talal AbdulsamadRheumatology Department, College of Medicine, University of Baghdad, Baghdad, Iraq.Ziad Al-RawiRheumatology Department, College of Medicine, University of Baghdad, Baghdad, Iraq.Sarah Tareq Abdul AzeezRheumatology Department, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq.Journal Article20191216<strong>Background</strong>: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that appears to result from an immune-regulatory disturbance caused by an interplay of genetic, hormonal, immunological, and environmental factors.<br /> <strong>Objective:</strong> To test the hypothesis that rheumatoid factor (RF) protects against lupus nephritis in Iraqi patients with SLE.<br /> <strong>Materials and Methods:</strong> Fifty-eight consecutive patients with SLE, who fulfilled the American College of Rheumatology (ACR) revised criteria for the diagnosis of SLE and attend the rheumatology unit of Baghdad Teaching Hospital during the period June 2000 to June 2001 were enrolled in the study. SLE patients divided into 2 groups (with lupus nephritis=30, without lupus nephritis =28) and a third group of control patients =30.<br /> <strong>Results:</strong> All SLE patients with and without lupus nephritis had positive antinuclear antibodies. There were no obvious differences in the positivity rate of RF in SLE patients both with and without lupus nephritis (P-Value > 0.05). The disease activity was slightly higher in those with RF positives compared to those with RF negatives. The disease activity score was significantly higher in those with lupus nephritis compared to those with no lupus nephritis (p=0.007)<br /> <strong>Conclusions</strong>: RF appears to play no significant role in the protection of renal disease in Iraqi patients with SLE. The presence of RF in SLE patients is associated with a lower disease activity score. The presence of lupusnephritis is associated with a higher disease activity score.https://amj.uoanbar.edu.iq/article_171024_1813465ba01cf37270c949de6097c091.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201The Efficiency of Intense Pulse Light in the Treatment of Hirsute Ladies464917102710.33091/amj.2020.171027ENNaeem N. AlhayaniDepartment of Dermatology, Hit General Hospital, Anbar Health Directorate, Anbar, Iraq.Jaafar S. AlkubaisiDepartment of Dermatology, Hit General Hospital, Anbar Health Directorate, Anbar, Iraq.Journal Article20200305<strong>Background:</strong> Hirsutism results in severe cosmetic and psychological problems. Many types of lasers and intense lights have been developed for the treatment of hirsute ladies. Intense pulse light (IPL) is one of the most useful broadband light for hirsutism. <br /> <strong>Objective</strong>: To evaluate the efficiency of IPL in ladies with hirsutism.<br /> <strong>Material and Methods:</strong> This prospective study was conducted at the private dermatological clinic in Hit city, Anbar province, Iraq from May 2018 to May 2019. A hirsute ladies subjected to 6 sessions of IPL were enrolled in the study. The age of the females, Fitzpatrick skin type, site, history of polycystic ovary disease, patient satisfaction, and hair reduction rate were recorded and analyzed.<br /> <strong>Results:</strong> The mean age of the enrolled 62 patients was 32.02 years ± 7.939 (range 18-51 years). The highest age group affected was 18-40 years (n = 55, 88.7 %). Most of the patients were of skin type 3 (n = 36, 58.1 %). The most common site was "upper lip, chin, and sides of the face" in 23 patients (37.2 %). Thirty-five (56.5 %) ladies were with polycystic ovary disease. Good and Excellent hair reduction rates to IPL treatment were 62.9 and 25.8 % respectively. The satisfied and very satisfied feeling of the treated ladies was 71 and 25.8 % respectively. No statistically significant difference between treatment response and age of the patient, skin type, and site (P-Value > 0.05). While there was a high statistically significant difference (P-Value = 0.000) between hair reduction in relation to patients' satisfaction and history of polycystic ovarian disease. Most patients complained from transient erythema after treatment for 1- 2 hours.<br /> <strong>Conclusions:</strong> IPL is a safe and efficient mode for facial hair removal in hirsute ladies.https://amj.uoanbar.edu.iq/article_171027_5611b1622399ad8c328c716def36d14f.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Reactive Lymphocytes in Blood Film of A COVID-19 Iraqi Patient: A Case Report505217103010.33091/amj.2020.171030ENAbdulsalam Al-AniDepartment of Pathology and Forensic Medicine/Hematology,
College of Medicine, University Of Anbar, Anbar, Iraq.Journal Article20200728Approved diagnosis of coronavirus disease 2019 (COVID-19) depends on the golden-standard ofmolecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However,hematological parameters play a pivotal role in the diagnosis and progress of the disease. This casereport of a 51-year-old COVID-19 Iraqi male patient, showed the presence of reactive lymphocytesin his peripheral blood film. Although the presence of these cells was regarded as a hallmark incertain viral infections, this was a striking feature in comparison with coronavirus family infectionsother than caused by SARS-CoV-2. This hematological finding can play a role in COVID-19diagnosis as a feasible, rapid, and cheap tool, especially in low medical resources countries.https://amj.uoanbar.edu.iq/article_171030_5da245a9bf1d7ccb9a6764c4a3e14e4c.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Ingested Fishbone Results in Sigmoid Colon Perforation535517105110.33091/amj.2020.171051ENSami M Al-RubayeDepartment of Surgery (General Surgery), Al-Muqdadiya General Hospital, Diala Health Directorate, Diala, Iraq.Journal Article20200601The unwitting swallowing of a foreign body is not uncommon and rarely causes perforation of any part of the gastrointestinal tract. We have reported in this case of a 46-year-old man who presented with a clinical picture similar to a perforated peptic ulcer. At the laparotomy exploration, the case was a perforation of the sigmoid colon by a fishbone (6 cm in length). The foreign object was removed and the perforated site was closed by the primary suturing. There were no postoperative complications. Although intestinal perforation due to an ingested foreign object is seldom to be seen, the surgeon must be aware of its occurrence and put it as one of the differential diagnosis in a case of an acute abdomen. A detailed history and computerized tomography (CT) scan are essential tools to detect intestinal foreign bodies in subjects with acute abdomen.https://amj.uoanbar.edu.iq/article_171051_9bcf3a0f9ffa4b72ca5d0cae90724589.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Median Nail Dystrophy565617105210.33091/amj.2020.171052ENAbdullah MancyDepartment of Dermatology, Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, IraqJournal Article20200313A 35-years-old housewife woman presented with fissuring and yellowish-green discoloration of the central and distal part of the left thumbnail to the Dermatology and Venereology clinic three months ago (Panel A). There was no history of trauma to the nail, no family history of the same condition, and no history of taking drugs. On examination, the left thumbnail had a longitudinal split that extended throughout the entire length of the nail plate, forming a V-shaped configuration. The color of the nail plate was changed mostly to yellowish-green. The nails of the other fingers were normal. Subungual debris and nail clipping were prepared for 10% KOH examination under the microscope but hyphae were not demonstrated. The culture was not available. Median nail dystrophy (MND) consists of longitudinal splitting in the midline of the nail. Thumb is mostly affected. It is of unknown origin, but trauma, familial cases, papilloma, and glomus tumor of the matrix and drugs like isotretinoin and ritonavir, have been reported. Due to color changes of the nail plate, we suspect that dermatophyte infection was the cause of MND. Accordingly, the patient was treated by two pulses of Itraconazole capsules, 200 mg two times per day for one week per month for two successive months. One month after treatment, few mm of a healthy nail appears at the proximal nail fold, (Panel B) and three months, about 1 cm of a normal nail with the disappearance of yellowish discoloration of the nail plate (Panel C). To our best knowledge, the fungal infection doesn't report in the literature as a cause of MND, so fungal infection might be the cause as in this case and further study on this issue is required. The patient now followed-up regularly for 6 months, the time required for the fingernail to replace itself.https://amj.uoanbar.edu.iq/article_171052_c087e9418bef1f16f11fcf6f1a9a1436.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620716220201201Toxic Erythema of Chemotherapy575717105310.33091/amj.2020.171053ENAhmed K.AhmedDepartment of Oncology, Anbar Cancer Center, Anbar Health Directorate, Ramadi, Anbar, Iraq.Journal Article20200610A 63-year-old woman with a history of stage II breast cancer (invasive ductal carcinoma) on adjuvant chemotherapy including a taxane group. A week after the 1<sup>st</sup> and 2<sup>nd</sup> cycles of docetaxel, she got a skin rash that affected both hands only. On examination, the hands were erythematous and associated with mild pain; they were dry with mild peeling of the skin; and also there was brownish discoloration of the fingernails (Panel A and B). It mildly affected the daily living activities of the patient. Within a few days, the rash was resolved by using skin emollients only and was totally disappeared after finishing chemotherapy. The condition was diagnosed as toxic erythema of chemotherapy mainly related to the docetaxel drug. The clinical presentation, the time at which the rash appears and the absence of other organ involvement can differentiate it from other conditions. Histopathological examination was not done because it is usually nonspecific. Docetaxel-related skin reaction of different grades occurs in about 50% of patients receiving this drug and it is usually reversible and resolves before the next treatment. It is usually prevented or reduced by receiving premedication with 3-days dexamethasone.https://amj.uoanbar.edu.iq/article_171053_55003861e6b40150c0dbd0e9c81e48ba.pdf