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PubMed2024

High yield of monogenic short stature in children from Kurdistan, Iraq: A genetic testing algorithm for consanguineous families.

PURPOSE: Genetic testing in consanguineous families advances the general comprehension of pathophysiological pathways. However, short stature (SS) genetics remain unexplored in a defined consanguineous cohort. This study examines a unique pediatric cohort from Sulaimani, Iraq, aiming to inspire a genetic testing algorithm for similar populations. METHODS: Among 280 SS referrals from 2018-2020, 64 children met inclusion criteria (from consanguineous families; height ≤ -2.25 SD), 51 provided informed consent (30 females; 31 syndromic SS) and underwent investigation, primarily via exome sequencing. Prioritized variants were evaluated by the American College of Medical Genetics and Genomics standards. A comparative analysis was conducted by juxtaposing our findings against published gene panels for SS. RESULTS: A genetic cause of SS was elucidated in 31 of 51 (61%) participants. Pathogenic variants were found in genes involved in the GH-IGF-1 axis (GHR and SOX3), thyroid axis (TSHR), growth plate (CTSK, COL1A2, COL10A1, DYM, FN1, LTBP3, MMP13, NPR2, and SHOX), signal transduction (PTPN11), DNA/RNA replication (DNAJC21, GZF1, and LIG4), cytoskeletal structure (CCDC8, FLNA, and PCNT), transmembrane transport (SLC34A3 and SLC7A7), enzyme coding (CYP27B1, GALNS, and GNPTG), and ciliogenesis (CFAP410). Two additional participants had Silver-Russell syndrome and 1 had del22q.11.21. Syndromic SS was predictive in identifying a monogenic condition. Using a gene panel would yield positive results in only 10% to 33% of cases. CONCLUSION: A tailored testing strategy is essential to increase diagnostic yield in children with SS from consanguineous populations.

Humans↗
PubMed2004

Cutaneous leishmaniasis in soldiers returning from deployment to Iraq.

Cutaneous leishmaniasis is becoming a frequently encountered problem in soldiers returning from deployments to areas in Southwest Asia. Two cases of cutaneous leishmaniasis diagnosed at a military treatment facility in soldiers returning from Iraq are presented. Diagnostic considerations and procedures are reviewed as are the histopathologic findings and treatment options.

Adult↗
PubMed2007

Pediatric trauma: experience of a combat support hospital in Iraq.

BACKGROUND/PURPOSE: The mission of the combat support hospital (CSH) is to evaluate and treat combatants injured during war operations. The 31st CSH in Balad and Baghdad, Iraq, during Operation Iraqi Freedom 2 also treated many injured civilians, including children. The purpose of this article is to report the experience of the 31st CSH treating pediatric trauma patients. METHODS: A retrospective review of a comprehensive patient database collected in theater was conducted. RESULTS: From January 1 to December 31, 2004, we treated 99 patients 17 years and younger. The average age of these patients was 10.6 years. Nine died of their wounds. The mean injury severity score was 11.6. Forty-one sustained gunshot wounds, 13 acquired fragment wounds (55% penetrating), and 22 were injured by improvised explosive devices (22%). Seventy-three patients required a total of 191 operations: 18 celiotomies, 8 craniotomies, 23 skeletal fixations, and 75 wound washout/debridements, among others. Predictors of mortality included admission Glasgow Coma Score less than 4 and admission pH less than 7.1. CONCLUSIONS: The primary mission of the CSH in theater remains unchanged, but its role is evolving. With this study, we can begin to understand the needs of wounded children in urban conflict and help guide training and resource allocation in the future.

Adolescent↗
PubMed2004

The deployment of an intensive care facility with a military field hospital to the 2003 conflict in Iraq.

The deployment of an intensive care unit with a forward British military field hospital to the conflict in Iraq in March 2003 is described. The 10 bedded unit treated 47 patients in the first month of activity. Thirty seven were adults and 10 were children. Forty two (89%) were trauma patients, mostly related to the conflict. Sixty eight percent of patients were ventilated and mortality to discharge was 6%. Mean bed occupancy was five beds and the mean duration of patient stay was 3.3 days. The difficulties of the working environment are described including the problems of a desert climate and close proximity to a conflict. Several critical incidents occurred including total power failure, extreme ambient temperatures and gas attack alarms. Despite these challenges, the facility attempted to provide a standard of intensive care similar to that seen in UK practice.

Adult↗
PubMed1999

Neuro-Behcet's disease in Iraq: a study of 40 patients.

Behcet's disease (BD) is a chronic, multisystemic disorder with variable prevalence in different geographical areas. Neurological manifestations (neuro-Behcet's disease, NBD) are well recognized. We studied 40 Iraqi patients with NBD from a neurological unit in a large teaching hospital, all fulfilling the International Study group criteria for the diagnosis of BD. There were 37 males and three females. Thirty-nine were Arab Muslims and one was a Kurd Muslim. Mean age at neurological presentation was 29+/-7.6 years (range 18-50 years). Fifteen out of 23 tested patients (65%) had a positive pathergy test and seven out of 13 tested (54%) had HLA-B5(51). A classification into three reasonably clear distinctive main patterns of neurological presentation is proposed. First: a parenchymal CNS pattern (the commonest) - 26 patients (65%), which included three relatively common forms: brain stem syndrome (10 patients), diffuse form (predominantly with pseudobulbar signs) (nine patients) and cerebral stroke-like form (five patients); and two less common forms: psychiatric and myelopathy (one patient each). Second: intracranial hypertension (IH) (with papilledema) - 11 patients (27.5%). Third: meningitis-like pattern - three patients (7. 5%). This classification has clinical, etiopathological, therapeutic and prognostic implications. In conclusion, NBD is not uncommon in Iraq, and it affects predominately Arab Muslims. BD should be routinely looked for in adult patient, especially males, in their third and fourth decades who present with IH and papilledema, brain stem syndrome, pseudobulbar palsy, stroke, meningitis or myelopathy.

Adolescent↗
PubMed2003

Minimal debridement or simple wound closure as the only surgical treatment in war victims with low-velocity penetrating head injuries. Indications and management protocol based upon more than 8 years follow-up of 99 cases from Iran-Iraq conflict.

BACKGROUND: During military conflicts, surviving victims traditionally underwent large enough craniectomy or craniotomy to achieve extensive debridement of the in-driven bone, shell fragments, and debris. Meanwhile, the completely as well as the partially devitalized adjacent brain tissue would also be debrided. This might have led to additional neurologic deficit or lesser degree of recovery of functions. METHOD: We studied the efficacy and safety of much more limited or even absence of surgical intervention in a selected group of wartime head-wounded patients. Among 1,150 war victims with penetrating head wounds referred to two major centers affiliated with Tehran University of Medical Sciences during the 8-year period spanning the Iran-Iraq conflict, there were 191 head-wounded patients who underwent either no surgical intervention or a very limited debridement. We have attempted to follow up as closely as possible for more than 8 years. Ninety-nine of them fulfilled the criteria to be included in this series. Close follow-up for development of cerebral infections, functional recovery, or development of new neurologic deficits and epilepsy were performed. At least 3 contrast-enhanced CT scans were taken for each patient. All patients were victims of the battle-field areas with low- to moderate-velocity missile or shell fragment injury. The Glasgow Coma Scale (GCS) scores of the patients were between 8-14 when visited by the first attending neurosurgery staff. The factors considered to be effective in the outcome analysis were the entry point, the number of the in-driven bone fragments, the retained shell fragments, the brain compartments affected, and the paranasal sinus or skull base involvement with or without cerebrospinal fluid (CSF) fistula. RESULTS: There were 13 unilobar, 44 bilobar, 4 trilobar, 38 transventricular, and 3 skull base lesions. The number of retained metal fragments varied between 1 to 6. The number of retained bone fragments varied between 1 to 5 in 73 victims and more than five chips in other cases. The outcome was good (back to work) in 90 patients and poor (severely disabled) in 4. Five patients died because of severity of brain damage and meningitis. The effect of the different enumerated variables upon the outcome was measured using chi(2) and Fisher exact test, which was nonsignificant for all of the variables except for the orbitofacial entry point of injury (p = 0.00006). CONCLUSION: This study seems to indicate that not only is reoperation for retained bone or shell fragments unnecessary, but surgeons having modern neuroradiological instruments available to detect the proper explanation for changes in GCS of the patients may decide not to proceed with any surgical intervention in a good number of patients. As a result of the "no surgical treatment protocol," one can preserve cerebral tissue without exposing the patient to undue risk of seizures, infection, or death by leaving behind some or all the in-driven bone and shell fragments.

Brain Injuries↗
PubMed2002

Long-term effects of chemical weapons on respiratory tract in Iraq-Iran war victims living in Babol (North of Iran).

In the Iraq-Iran war (1981-1989), extensive use of chemical weapons such as mustard gas caused high mortality, morbidity, injuries, and chronic side effects in vital organs, especially the respiratory tract. This study was performed to evaluate the long-term effects on respiratory tract of victims. Two hundred and twenty victims were referred from the Mostazafan and Janbazan Foundation of Babol from 1994 to 1998. Complete histories, physical examinations, chest X-rays, and PFTs were performed. Nearly all the victims complained of cough, dyspnea, and suffocation. Hemoptysis was found in 6 victims. In 4 patients, respiratory distress with use of accessory muscles was observed. Two-thirds of the subjects had wheezing and coarse rale. For the other third, physical examination revealed no abnormal finding. Radiographic findings were mostly normal. Spirometry revealed an obstructive pattern in all patients and PFT revealed mostly normal and restrictive patterns. The shortlist time from exposure to study was 7 years and the longest was 13 years. Most patients reported mustard gas exposure and a few of them did not know what type of gas exposure they had. The clinical evaluations, radiography, and PFTs revealed that the most prevalent effects of chemical weapons on respiratory tract were chronic obstructive lung disease, presenting as many types of obstructive involvement.

Adult↗
PubMed1997

Management of maxillofacial injuries in the Iran-Iraq War.

PURPOSE: This study discusses types of maxillofacial injury, their treatment, and complications encountered in the Iran-Iraq war. PATIENTS AND METHODS: During 1981 to 1986, 210 casualties were treated with 250 operations in Mostafa-Khomeini hospital in Tehran. Their records were analyzed retrospectively. The operations were mostly reconstructive and consisted of methods adopted because of available instruments of that time. RESULTS: Mandibular defects were the most prominent kind of injury (43.2%), and approximately two thirds of them needed tracheostomy. Ophthalmic injuries represented 20% of midfacial injuries. Osteomyelitis was a common complication of primary phases of treatment. CONCLUSION: The inability to evacuate and promptly treat patients with gunshot wounds can result in complications, especially infections, that make the later phases of treatment difficult.

Adolescent↗
PubMed1976

One hundred cases of mandibular fractures in children in Iraq.

A survey of 476 cases of mandibular fractures in Iraq revealed that 100 cases (21%) occurred in children under the age of 13 years. Twice as many fractures were seen in the 6- to 13-year-old group than in the 0- to 5-year-old group. The male to female ratio was 2/1. The site distribution in descending order of frequency was canine region, condyle, angle body and symphysis. Of the 33 condylar fractures, only two showed signs of deviation and ankylosis. Most of these fractures were treated by simple methods of fixation.

Adolescent↗
PubMed1999

Prevalence of Sarcocystis spp. in meat-producing animals in Iraq.

The prevalence of Sarcocystis spp. infection was investigated in 605 sheep, 826 goats, 1080 cattle, 580 water buffaloes and 36 camels slaughtered from 1992 to 1996 in the Baghdad area (Iraq) using naked eye examination for macroscopic sarcocysts, and peptic digestion, muscle squash, squeezing methods and indirect fluorescent antibody test (IFAT) for microscopic types. The intestinal stages of the parasite were also studied in dogs experimentally fed with tissues containing microscopic cysts. The percentage prevalence of macroscopic cysts were 4.1, 33.6, 0.2, 15.6 and 0, and of the microscopic type, 97.0, 97.4, 97.8, 82.9 and 91.6 for the above-mentioned hosts, respectively. Among the different organs examined, macroscopic cysts were found to be highest in the oesophagus and the lowest in the heart. Peptic digestion method gave the highest rate (93.3%) followed by indirect fluorescent antibody test (IFAT) (88.6%), squeezing (81.3%), and muscle squash (81.2%). Each infected dog shed a total of about 150-200 million sporocysts. Histologically, developmental stages of the parasite were detected in the small intestinal mucosa of the dogs on Days 7 and 13 post-infection.

Animals↗
PubMed1990

Otomycosis: a common problem in north Iraq.

Otomycosis is a common disease in North Iraq. Of the 219 cases diagnosed clinically in Mosul Teaching Hospital seen during a 15 month period, 179 were due to fungus infection. The disease was more frequently encountered in young adults whose age was range from 16-30 years. The incidence of the disease was significantly higher in females (65.4 per cent), mainly housewives, than in males. Aspergillus species were the dominant isolated fungi (92.1 per cent).

Adolescent↗
PubMed1983

Seasonal fluctuations and hypobiosis of gastro-intestinal nematodes of Awassi lambs in Iraq.

The results of an epidemiological study involving the estimation of worm counts of gastro-intestinal nematodes of lambs, during the period December 1978 to November 1979, in the Baghdad area are reported. Ostertagia spp. and Trichostrongylus spp. were the most abundant nematodes in the weaned lambs used in this study. Ostertagia spp. infection was present throughout the period of observation, the level of infection being the highest during early summer (May-June). Trichostrongylus spp. infection, however, reached a peak during July-August. In the tracer lambs the maximum population of Ostertagia spp. was found during February-March, while that of Trichostrongylus spp. could be observed only after mid-June. Other nematodes encountered were Haemonchus contortus and Trichuris sp. but they were only present in small numbers. The proportion of inhibited larvae of Ostertagia spp. was markedly high during the dry summer months. Little inhibition was noticed during autumn and the early winter months. It appears that if the seasonal inhibition of Ostertagia spp. in Iraq is brought about by an environmental stimulus acting upon pre-parasitic larval stages, that stimulus cannot be chilling or falling temperatures, as observed in temperate northern zones.

Abomasum↗
PubMed2005

Seasonal variation in Sarcocystis species infections in goats in northern Iraq.

We investigated the prevalence of sarcocystosis in 826 goats slaughtered in the winter season from November to April in northern Iraq. The prevalence of macrocysts was on average 34%, with only 20% infected animals in November, but 46% in February. The infection rate in 1-, 3- and 6-year-old goats was 4%, 48%, and 83%, respectively. The highest specificity of infection was in the oesophagus (99%) and the lowest in the diaphragm (3%). Grossly, we identified 2 forms of macroscopic sarcocysts, fat and thin, with different morphological characteristics. The prevalence of microcysts was 97% and no effects of age, sex and seasonal variations were observed. Development of microcysts in the small intestine of dogs and cats has also been investigated. The pre-patent period in experimentally infected dogs was 12-14 days and the patent period lasted 64-66 days. A dog shed about 155 million sporocysts, but no sporocysts were shed by cats that had been fed the same infected tissues, thus identifying the microcysts as Sarcocystis capracanis.

Age Factors↗
PubMed2001

Exocellular enzyme activity of dermatophytes and other fungi isolated from ruminants in Southern Iraq.

Sixteen fungal species were isolated from 182 specimens collected from four ruminants (buffalo, camel, cattle and sheep) in Southern Iraq. Fungi represented by five species of dermatophytes and eleven species of other fungi were screened for the activity of four enzymes: keratinase. proteinase, lipase and amylase. Keratinase was found to be produced by all of the dermatophytes and non-dermatophytes, except for Paecillomyces variottii and Scytalidium lignicola. However, high keratinase activity was expressed by the dermatophytic species particularly by Trichophyton mentagrophytes var. erinacei and Microsporum gypseum. Three dermatophytes viz. M. gypseum, T verrucosum and T. mentagrophytes var. nodulare were capable of producing protease, lipase and amylase. Although, T. mentagrophytes var. erinacei showed high protease activity, it did not produce lipase and amylase. On the contrary most of the non-dermatophytic species revealed protease and lipase activities higher than the dermatophytes. The Curvularia spp. isolates showed the highest protease and amylase activity, while Aspergillus parasiticus revealed the highest activity of lipase andamylase. No correlation was observed between enzyme activity and the growth rate of the examined fungi.

Animals↗
PubMed2003

Description of Pomphorhynchus spindletruncatus n. sp. (Acanthocephala: Pomphorhynchidae) from freshwater fishes in northern Iraq, with the erection of a new pomphorhynchid genus, Pyriproboscis n. g., and keys to genera of the Pomphorhynchidae and the species of Pomphorhynchus Monticelli, 1905.

The status of species of Pomphorhynchus Monticelli, 1905 is examined and 23 species are recognised as valid. These include P. spindletruncatus n. sp., which is described herein from two species of freshwater fishes in northern Iraq, Aspius vorax Heckel and Barbus xanthopterus (Heckel) (Cyprinidae). Only one other species, P. yunnanensis Wang, 1981, has a spindle-shaped trunk similar to that of P. spindletruncatus, but is distinguished from it by a distinctly different proboscis armature. A key separating the new taxon from other species of Pomphorhynchus is included. P. heronensis Pichelin, 1997 is reassigned to a new pomphorhynchid genus, Pyriproboscis n. g., based on its unique proboscis shape and armature, short proboscis receptacle and tubular cement glands. A key to the genera of the Pomphorhynchidae is also included.

Acanthocephala↗
PubMed2003

A new tapeworm, Postgangesia inarmata n. sp. (Eucestoda: Proteocephalidea: Gangesiinae), parasitic in Silurus glanis (Siluriformes) from Iraq and some comments on the Gangesiinae Mola, 1929.

We describe a new species of cestode belonging to Postgangesia Akhmerov, 1969 (Proteocephalidea: Gangesiinae) from the catfish Silurus glanis Linnaeus in Iraq. This is the second species known from this genus, and a redescription of the type-species, P. orientalis Akhmerov, 1969 (emend.), as well as a differential diagnosis are provided. The new species is characterised by the arrangement of its vitelline follicles, and various meristic and metrical characters. The systematic position of Postgangesia is discussed on the basis of both scolex and strobilar characters and arguments are presented for its placement within the Gangesiinae together with Electrotaenia Nybelin,1942, Gangesia Woodland,1924, Silurotaenia Nybelin, 1942 and Vermaia Nybelin, 1942. Finally, we illustrate and discuss some particular structures found in these taxa, especially in relation to the apical organs of the scolex.

Animals↗
PubMed2004

Military dentists in Iraq.

Earlier this year, together with thousands of British troops, military dentists belonging to the Defence Dental Agency were deployed on operations in Iraq. Here, three dentists recount their stories and experiences of their time in the conflict and give us an insight into day to day dentistry on the frontline.

Humans↗
PubMed1999

Characteristics of dermatophytoses in Basrah, Iraq.

A total of 1199 clinical specimens were collected from 1144 patients clinically diagnosed as cases of superficial cutaneous mycoses in Basrah (Iraq). The collected specimens were examined for the etiologic agents of dermatophytoses by direct microscopy and culture. A total of 237 isolates representing eight species of dermatophytes as a causative agents of skin and nails infections were isolated. Among the tinea infections, tinea corporis and tinea cruris were the most common types of dermatophytoses revealed in this study.

Adolescent↗