Multiple sclerosis in the Levant: a regional consensus statement.

The epidemiology of multiple sclerosis (MS) is rapidly changing in many parts of the world. In a geographic area that was previously associated with low prevalence, recent studies showing high prevalence and fast rising incidence of MS in the Levant countries led us neurologists of this region to meet in a consensus panel, in order to share our latest findings in terms of MS epidemiology and consent on MS management in the Levant. Twelve neurologists and MS experts representing various countries of the Levant (Lebanon, Syria, Jordan and Iraq) have met in Beirut on the 17(th) of February 2013, shared their latest epidemiological findings, discussed recent MS aspects in the region, and drafted a consensus on MS management relevant to this geographic area.

Expert opinion on the pharmacological management of multiple sclerosis in women of childbearing age in Iraq.

Background: Multiple sclerosis (MS) is often diagnosed in women of childbearing age (WCBA), with a mean age of onset of 30 years. Women with MS have long been cautioned to carefully plan their pregnancies and, traditionally, disease-modifying therapies (DMTs) have not been recommended for use in patients engaged in family planning. In 2020, the United States Food and Drug Administration (FDA) approved a label update for interferon beta (IFN ß) by adding new safety data on pregnancy and breastfeeding. Because current management guidelines do not yet reflect the recent label update, a panel of neurology experts from Iraq decided to discuss the potential need for changes in treatment strategies in Iraq. Methods: A panel of experts consisting of 8 neurologists from Iraq and one international neurology expert from Germany convened to develop an expert opinion that would provide practical guidance for the pharmacological management of WCBA with MS in Iraq. They considered the latest label update and relevant published literature, along with local clinical practice and available resources. Results: Interferon and Glatiramer acetate have no evidence of harm during pregnancy. IFN ß can be continued safely through pregnancy. Switching treatment during pregnancy is generally not recommended. Short-term intravenous methylprednisolone can be used to treat disabling relapses. Conclusion: Given the complexity of managing MS in pregnant women, it is the opinion of the expert panel that family planning should be discussed early in the disease course, planned pregnancy should be encouraged, and open communication with patient for her treatment decisions is paramount. Patients who are engaged in family planning are no longer discouraged from treatment with some of the currently available DMTs.

Association of Chlamydia pneumoniae serology and ischemic stroke.

BACKGROUND: Stroke is one of the major causes of morbidity and mortality throughout the world. Reports about the role of Chlamydia pneumoniae infection in the development of atherosclerosis have been reported in many studies. The aim of the study was to evaluate the association between Chlamydia pneumoniae infection and ischemic stroke. METHODS: We evaluated 50 patients with ischemic stroke (32 males and 18 females) and 40 control subjects (22 males and 18 females). They were age- and sex-matched. All enrolled subjects underwent an enzyme-linked immunosorbent assay (ELISA) serologic test for IgG and IgA antibodies for Chlamydia pneumoniae. RESULTS: Eighteen (36%) patients with ischemic stroke have positive IgA, in comparison with 6 (15%) among the control group (OR 3.18; CI 1.12-9.04; P = 0.03). This translates into the fact that there was a more than three-fold risk of developing ischemic stroke in those with Chlamydia pneumoniae infection compared to those who without. The IgG seropositivity was increased in patients with ischemic stroke, but it did not reach statistical significance (OR = 2.32; CI = 0.97-5.58; P = 0.078). CONCLUSIONS: Chronic Chlamydia pneumoniae infection demonstrated by positive IgA-type antibody can be considered a significant risk for ischemic stroke.

Hypertension as a risk factor: is it different in ischemic stroke and acute myocardial infarction comparative cross-sectional study?

Objective. To assess differences in age of onset, hypertension duration, type of drug, treatment compliance, and salt-free diet compliance between patients with stroke and myocardial infarction. Patients and Methods. The study was conducted in 3 hospitals in Baghdad between June 2010 and June 2011. First group includes 81 stroke patients (36 females and 45 males), age ranges between (33-82 years). Second group includes 110 myocardial infarction patients (46 females and 64 males), ages ranges from (23-76 years). Results. Salt-free diet noncompliance was seen in 69% and 62% of Myocardial infarction and stroke groups, respectively. Silent hypertension was seen in 6.3% and 19.7% of myocardial infarction and stroke groups, respectively. Noncompliant on antihypertensive therapy was seen in 61%, 71%, and 48% of the total, myocardial infarction, and stroke groups, respectively. The drug type was 24% angiotensin converting enzyme inhibitor, 18.8% combined drugs, 16.2% Beta Blocker, 11% angiotensin 11 receptor blocker, 10.4% calcium channel blocker and 7.3% diuretic. In stroke group, the commonest drug was 23% angiotensin converting inhibitor and the least (5%) was angiotensin receptor blocker. In myocardial infarction group, the commonest drug was 25% Angiotensin Converting Inhibitor and the least (8%) was diuretic. Discussion and Conclusion. Silent hypertension was high in Iraq. Salt-free diet noncompliance was high in both groups; drug noncompliance was significantly higher in patients with myocardial infarction. Angiotensin 11 receptor blocker use was associated significantly with myocardial infarction more than in stroke.

Surgical-outcome and Complication Differences between Frontal and Posterior Parietal Ventriculo-peritoneal Shunts in Iraqi.

Background: Hydrocephalus, an abnormal expansion of cerebral ventricles caused by the accumulation of cerebrospinal fluid (CSF), is estimated to occur in about 3 of 1,000 live births. With a peak age of less than 10 years, hydrocephalus is more common in males than in females and is caused by brain tumours, central nervous system (CNS) infections and many other congenital malformations. Ventriculo-peritoneal (VP) shunts are basic diversionary CSF flow-channel neurosurgical procedures that are associated with a significant failure rate and a number of complications. The use of either frontal or posterior parietal VP shunts is selected based on the determined sites of insertion. Objectives: The aim of this study was to assess the differences in the complications and number of tappings between frontal and posterior parietal VP shunts. Patients and Methods: A prospective study was conducted on 113 patients with hydrocephalus of various aetiologies who were treated at a surgical specialties hospital in Baghdad between January 2010 and January 2013. The purpose of the study, which followed each patient for 6 months after surgery, was to determine the differences between 43 patients treated with frontal VP shunts and 70 patients treated with posterior parietal VP shunts with respect to the following factors: number of tappings to access the ventricle, steps of subcutaneous tunnelling, duration[.6] of procedure , complication rates and incidents of revision. A Codman & Shurtleff programmable shunt was used in both groups; no antibiotic-impregnated shunts were used. Results and Discussion: The mortality rate was 1.76%; 31.85% of all shunted patients experienced post-operative complications. Of a total 113 patients, 22 patients (31.42%) with posterior parietal VP shunts developed complications, and 14 patients (32.55%) with frontal VP shunts developed complications. Revisions were required in 25.7% of the patients with posterior parietal VP shunts and in 20.9% of the patients with frontal VP shunts. The most frequent complication was upper-end obstruction, which occurred in two patients (4.65%) after the frontal VP shunt procedure and in eight patients (11.42%) after posterior parietal VP shunt procedure. The wide difference in the number of occurrences of this complication clearly demonstrates that the frontal approach as a method of choice in applying a ventricular catheter. Other complications were also recorded (e.g. lower-end obstruction, infection, seizure, tube and valve exposure and subcutaneous collection. Conclusion: Age, gender and the cause of hydrocephalus were found to have no relation to the development of shunt complications. Upper-end obstruction, valve exposure and required revisions were more common in patients with posterior parietal VP shunts, while lower-end obstruction, infection and seizures were more common in patients with frontal VP shunts. However, these differences were not statistically significant.

Frequency of HLA-DRB1 in Iraqi Patients with Guillain-Barre Syndrome.

Background: Genetic backgrounds play an important role in susceptibility to and protection against Guillain Barré Syndrome. Certain human leukocyte antigens have been found to be associated with Guillain Barré Syndrome. Aim of Study: This study aimed to study the relationship between the susceptibility of HLA Class II "DRBI" allele's frequencies in a sample of Iraqi's patients with Guillain Barré Syndrome compared with a healthy control group using PCR-SSOP method. Patients and Methods: Thirty consecutive Iraqi Arab Muslim patients with Guillain-Barre syndrome admitted in the Neurological Department in neurosciences Hospital between September-2012 to June-2013 were assessed for HLA genotyping for HLADRB1. A control group consisted from thirty healthy volunteers among the staff of Al-Kindy College of Medicine that did not have any neurological disorders whether recent or previously and had negative family history for this diseases or other neurological disorders. HLA genotyping for HLADRB1 was performed for each patient and for the control persons using the PCR with sequence-specific oligoneucleotide primers. Allele frequencies were compared across groups. Results: There was a significant higher rate of DRB1*03:01 frequencies in patients with GBS compared with healthy controls (p=0.007, Odds ratio=5.687, 95% CI: 1.59-20.33)Conclusions: HLA-DRB1*03:01 may have association with susceptibility to Guillain- Barre syndrome.