Al- Anbar Medical Journal

The 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.

Background: The managing of raised Prostate-Specific Antigen (PSA) in a range of 4 to 10 ng/mlis 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 detectthose patients in whom biopsy can be avoided or postponed.Objectives: To evaluate the effectiveness of a 6 weeks levofloxacin course on the serum totalPSA level and PSA density (PSAD) in patients with PSA 4−10 ng/ml and ordinary digital rectalexamination and ultrasonography results.Materials and methods: The study conducted at Al-Ramadi Teaching Hospital from February2016 to December 2019. A total of 177 men with benign prostatic hyperplasia or lower urinary tractsymptoms were with a normal digital rectal examination, chronic prostatitis (Expressed prostaticsecretion was done before treatment), total PSA 4−10 ng/ml, and ultrasonography findings thatdid not reveal a hypoechoic lesion in the prostate will be included in this study. Serum PSA andPSAD were measured before, and after treatment with a 6 weeks course of levofloxacin.Results: 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%) patientsof the 177 men, total PSA has normalized to less than 4 ng/ml after antibiotics treatment. In 56patients 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 PSADafter treatment (p<0.05).Conclusion: A 6 weeks course of levofloxacin reduced the total PSA and PSAD to normal levelsin significant patients with lower urinary tract symptoms due to benign prostatic hyperplasiaand chronic prostatitis with a normal digital rectal examination and ultrasonographic findings.Therefore, this option of treatment might have a benefit in reducing the number of prostatic biopsies.

Background: Recombinant tissue-type plasminogen activator is an option of treatment forsuspected occlusive vascular thrombi and its sequel (transmural myocardial infarction, pulmonaryembolism, and ischemic stroke). The most important concern associated with those patients is thefear of hemorrhagic complications.Objectives: To evaluate the incidence and risk factors of bleeding following the use of recombinanttissue-type plasminogen activator.Materials and methods: This prospective study was conducted in the Intensive Care Units ofRoj-halat Emergency Hospital and Rizgary Teaching Hospital in Erbil city, Iraq. The durationof the study was through the period from 1st of June, 2016 to 1st of March, 2017. A convenientsample of 100 patients was selected. The patients were followed after their admission to IntensiveCare Units for 24 hours after their treatment with recombinant tissue-type plasminogen activatorto explore their complications.Results: Bleeding complication represented 10% of patients treated with recombinant tissue-typeplasminogen activator (50% for each major and minor bleeding). There was a significant associationbetween increased age of patients treated with recombinant tissue-type plasminogen activatorand bleeding (P-value = 0.01). Patients with a history of hypertension, diabetes, and smokingwere significantly associated with a bleeding complication of recombinant tissue-type plasminogenactivator (P-value <0.05).Conclusion: The incidence of bleeding among patients after treatment with recombinant tissuetype 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 treatedwith recombinant tissue-type plasminogen.

Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that appearsto result from an immune-regulatory disturbance caused by an interplay of genetic, hormonal,immunological, and environmental factors.Objectives: To test the hypothesis that rheumatoid factor (RF) protects against lupus nephritisin Iraqi patients with SLE.Materials and methods: Fifty-eight consecutive patients with SLE, who fulfilled the AmericanCollege 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 enrolledin the study. SLE patients divided into 2 groups (with lupus nephritis=30, without lupus nephritis=28) and a third group of control patients =30.Results: 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 andwithout lupus nephritis (P-Value > 0.05). The disease activity was slightly higher in those withRF positives compared to those with RF negatives. The disease activity score was significantlyhigher in those with lupus nephritis compared to those with no lupus nephritis (p=0.007) .Conclusion: RF appears to play no significant role in the protection of renal disease in Iraqipatients with SLE. The presence of RF in SLE patients is associated with a lower disease activityscore. The presence of lupus nephritis is associated with a higher disease activity score.

Background: Hirsutism results in severe cosmetic and psychological problems. Many types oflasers 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.Objectives: To evaluate the efficiency of IPL in ladies with hirsutism.Materials and methods: This prospective study was conducted at the private dermatologicalclinic in Hit city, Anbar province, Iraq from May 2018 to May 2019. A hirsute ladies subjected to6 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 andanalyzed.Results: 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 ofskin 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 andExcellent hair reduction rates to IPL treatment were 62.9 and 25.8% respectively. The satisfied andvery satisfied feeling of the treated ladies was 71 and 25.8% respectively. No statistically significantdifference 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 hairreduction in relation to patients’ satisfaction and history of polycystic ovarian disease. Mostpatients complained from transient erythema after treatment for 1- 2 hours.Conclusion: IPL is a safe and efficient mode for facial hair removal in hirsute ladies.

Approved 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.

The unwitting swallowing of a foreign body is not uncommon and rarely causes perforation of anypart of the gastrointestinal tract. We have reported in this case of a 46-year-old man who presentedwith a clinical picture similar to a perforated peptic ulcer. At the laparotomy exploration, thecase was a perforation of the sigmoid colon by a fishbone (6 cm in length). The foreign object wasremoved and the perforated site was closed by the primary suturing. There were no postoperativecomplications. Although intestinal perforation due to an ingested foreign object is seldom to beseen, the surgeon must be aware of its occurrence and put it as one of the differential diagnosisin a case of an acute abdomen. A detailed history and computerized tomography (CT) scan areessential tools to detect intestinal foreign bodies in subjects with acute abdomen.