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Papers by Khesar Hussein Khalil

Dohuk medical journal, Dec 31, 2018

Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq... more Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq, colorectal cancer was the seventh top cancers, whereas in Kurdistan, it was the fourth most common cancer for both males and females. Although the methods of the diagnosis and therapy have been improved, only about 50% of the patients who resected the tumor died from disease within 5 years, due to distant metastasis. The study was carried out to determine the frequency of histopathological types of colorectal cancer, and to evaluate the correlation between colorectal cancer regarding the grade, stage, with different histological finding which include desmoplastic reaction, lymphocytic infiltration, foamy macrophages, necrosis, intraglandular necrosis, and calcification. Subject and Methods: This study includes (108) patients diagnosed with colorectal cancer. Cases were collected during the period January 2015-December 2017 from the histopathological department at Central Public Health Laboratory and other private labs in Duhok city. Clinical information were obtained from the available histopathological reports. Paraffin embedded blocks were sectioned and stained with immunohistochemistry markers; Ki67 and VEGF then processed automatically according to protocols supplied by the antibody manufacturer. Results: Patients age ranged from18-83 years with a mean of 54.42 years. The peak ages of the patients were between 60-69 years. Male: female ratio was 1.5:1. The commonest tumor location was (recto-sigmoidal region); rectum was (42.6 %) and sigmoid colon was(22.2%).Conventional adenocarcinoma was the predominant type 86(79.6%), majority of cases were moderately differentiated adenocarcinoma constituting85.2%. Stage III was the highest stage constituting 56(51.9%), followed by stage II which constitute 37(34.3%).The local invasion of the mucosa and other layers of colonic wall were associated with desmoplasia and collagen fiber remodeling. Infiltration of foamy macrophages decreased in number in relation to higher grade. Intraglandular necrosis showed significant correlation with tumor invasiveness, lymph node metastasis and grade. The frequency of both markers Ki67 and VEGF were 77 and 75 respectively. Ki67 immunoreactivity revealed significant relationship with tumor grade (P=0.014), whereas VEGF had significant relationship with TNM stage (P = 0.019), as well as the local invasion to the colorectal wall (P 0.009). Conclusions: Moderate differentiated adenocarcinoma (85.2%) and stage III (51.9%) were the most frequent diagnosed cases with colorectal cancer. Macrophages infiltration was conversely related with grading of colorectal cancer. Histopathological changes like desmoplastic reaction and intraglandular necrosis were common findings in colorectal cancer and they were in concordance correlation with stage and grade.Ki67 had relationship with tumor grade, whereas VEGF correlate with tumor invasion.

Capparis spinosa is one of the most aromatic plants growing in wild in the dry regions around the... more Capparis spinosa is one of the most aromatic plants growing in wild in the dry regions around the west or central Asia and the Mediterranean basin, and reports to contain a wide range of phytochemical constituents. The present study evaluates the cytotoxic effects of aqueous, methanolic crude extracts and secondary metabolites extracts polyphenolic, rutin, and alkaloids of mature fruit of C. spinosa on Human larynx carcinoma (Hep-2) and Human cervix adenocarcinoma (HeLa) tumor cell lines in vitro. The present study also includes the investigation of the effect of polyphenol mature fruit extracts on mitotic index (M.I.) of HeLa tumor cell line. The effect of (aqueous and methanol) crude extracts and secondary metabolites extracts (polyphenol, rutin, and alkaloids) of mature fruits of C. spinosa on Hep-2 and HeLa tumor cell lines have been showed highly significant difference (P≤ 0.0001) or (P ≤ 0.01) among all types of extracts, and among all concentrations for each extract in two periods 24 and 48 hrs of the treatment. However the study reveals that the effective extracts against the proliferation of tested cell line were polyphenol extracts with concentration 10000 µg/ml in Hep-2 cells after 24 and 48 hrs. and with concentrations 10000 and 5000 µg/ml in HeLa cell line after 48 hrs. Polyphenolic extract showed a cytotoxicity concentration 50% (CC50%) 6400 and 6800 µg/ml on Hep-2 tumor cell line after 24 and 48 hrs. of treatment, respectively. The CC50% of HeLa cells was 7100µg/ml after 48 hrs. Other extracts; aqueous, methanolic crude extracts and secondary metabolites extracts (rutin and alkaloids) of mature fruit of C. spinosa caused less inhibition activity on the growth of Hep-2 and HeLa tumor cell lines. The CC50% for all these extracts were more than 10000 µg/ml. The result of present study shows that non significant difference of polyphenol mature fruit extracts effect on the type of tumor cell line either HeLa or Hep-2 cell lines. The cytogenetic study on HeLa cell line shows that polyphenol mature fruit extract has antimitotic index against tested cell line. Some of structural and numerical chromosomal aberrations were observed in both treated and untreated groups. Structural chromosomal aberrations include: ring chromosome (R. Ch.), dicentric chromosome (D. C.Ch.), chromatid gap and symmetrical interchange of chromosome as well as pulverization in treated group with higher concentrations 3550and 1775 µg/ml of extract. Numerical chromosomal aberrations include: octoploidy, euploidy and aneuploidy.

International Journal of Research in Medical Sciences, 2015

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in... more Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age. Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori) and (4.7% without H. pylori). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%). Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference.

Baghdad Science Journal, 2020

Neuroendocrine differentiation has been mentioned in many cancers of non-neuroendocrinal organs, ... more Neuroendocrine differentiation has been mentioned in many cancers of non-neuroendocrinal organs, involving the gastrointestinal tract. In contrast, the correlation of focally diffused neuroendocrine differentiation in colorectal adenocarcinoma with neuroendocrine cell hyperplasia has not been somewhat reported. The objective of this research is to study the relationship between neuroendocrine cell hyperplasia and neuroendocrine differentiation in colorectal adenocarcinoma and to find the correlation of neuroendocrine differentiation and VEGF expression with clinicopathological parameters of colorectal adenocarcinoma. Methods employed in the current study were including eighty-one patients with colorectal cancer. Formalin fixed paraffin embedded blocks were sectioned and stained with immunohistochemical markers; Chromogranin A and VEGF; and processed automatically according to protocols supplied by the antibody manufacturer. Results show that neuroendocrine cell hyperplasia in the mucosa nearby tumor comprised (42%) and it was associated with neuroendocrine differentiation. Neuroendocrine differentiation and vascular endothelial growth factor were positive in 48.1% and 63% respectively. Neuroendocrine differentiation did not show a relation with clinicopathological parameters with the exception of tumor that metastasizes to other tissues and organs. The association of VEGF with the same factors had significant impact with tumor stage, degree of local invasion and lymph node metastasis. Other histological changes revealed that only desmoplastic reaction had significant difference in relation to neuroendocrine differentiation. This study reached the conclusion that neuroendocrine cell hyperplasia is positively correlated with neuroendocrine differentiation and it has strong linkage in pathogenesis of colorectal adenocarcinoma. Neuroendocrine differentiation and VEGF expression are greatly correlated with progression and invasion of tumor to other tissues and organs, and this can be represented as an important parameter for poor prognosis of colorectal adenocarcinoma.

Duhok Medical Journal, 2018

Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq... more Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq, colorectal cancer was the seventh top cancers, whereas in Kurdistan, it was the fourth most common cancer for both males and females. Although the methods of the diagnosis and therapy have been improved, only about 50% of the patients who resected the tumor died from disease within 5 years, due to distant metastasis. The study was carried out to determine the frequency of histopathological types of colorectal cancer, and to evaluate the correlation between colorectal cancer regarding the grade, stage, with different histological finding which include desmoplastic reaction, lymphocytic infiltration, foamy macrophages, necrosis, intraglandular necrosis, and calcification. Subject and Methods: This study includes (108) patients diagnosed with colorectal cancer. Cases were collected during the period January 2015-December 2017 from the histopathological department at Central Public Health Laboratory and other private labs in Duhok city. Clinical information were obtained from the available histopathological reports. Paraffin embedded blocks were sectioned and stained with immunohistochemistry markers; Ki67 and VEGF then processed automatically according to protocols supplied by the antibody manufacturer. Results: Patients age ranged from18-83 years with a mean of 54.42 years. The peak ages of the patients were between 60-69 years. Male: female ratio was 1.5:1. The commonest tumor location was (recto-sigmoidal region); rectum was (42.6 %) and sigmoid colon was(22.2%).Conventional adenocarcinoma was the predominant type 86(79.6%), majority of cases were moderately differentiated adenocarcinoma constituting85.2%. Stage III was the highest stage constituting 56(51.9%), followed by stage II which constitute 37(34.3%).The local invasion of the mucosa and other layers of colonic wall were associated with desmoplasia and collagen fiber remodeling. Infiltration of foamy macrophages decreased in number in relation to higher grade. Intraglandular necrosis showed significant correlation with tumor invasiveness, lymph node metastasis and grade. The frequency of both markers Ki67 and VEGF were 77 and 75 respectively. Ki67 immunoreactivity revealed significant relationship with tumor grade (P=0.014), whereas VEGF had significant relationship with TNM stage (P = 0.019), as well as the local invasion to the colorectal wall (P 0.009). Conclusions: Moderate differentiated adenocarcinoma (85.2%) and stage III (51.9%) were the most frequent diagnosed cases with colorectal cancer. Macrophages infiltration was conversely related with grading of colorectal cancer. Histopathological changes like desmoplastic reaction and intraglandular necrosis were common findings in colorectal cancer and they were in concordance correlation with stage and grade.Ki67 had relationship with tumor grade, whereas VEGF correlate with tumor invasion.

International Journal of Research in Medical Sciences, 2015

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in... more Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age. Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori) and (4.7% without H. pylori). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%). Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference.

Dohuk medical journal, Dec 31, 2018

Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq... more Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq, colorectal cancer was the seventh top cancers, whereas in Kurdistan, it was the fourth most common cancer for both males and females. Although the methods of the diagnosis and therapy have been improved, only about 50% of the patients who resected the tumor died from disease within 5 years, due to distant metastasis. The study was carried out to determine the frequency of histopathological types of colorectal cancer, and to evaluate the correlation between colorectal cancer regarding the grade, stage, with different histological finding which include desmoplastic reaction, lymphocytic infiltration, foamy macrophages, necrosis, intraglandular necrosis, and calcification. Subject and Methods: This study includes (108) patients diagnosed with colorectal cancer. Cases were collected during the period January 2015-December 2017 from the histopathological department at Central Public Health Laboratory and other private labs in Duhok city. Clinical information were obtained from the available histopathological reports. Paraffin embedded blocks were sectioned and stained with immunohistochemistry markers; Ki67 and VEGF then processed automatically according to protocols supplied by the antibody manufacturer. Results: Patients age ranged from18-83 years with a mean of 54.42 years. The peak ages of the patients were between 60-69 years. Male: female ratio was 1.5:1. The commonest tumor location was (recto-sigmoidal region); rectum was (42.6 %) and sigmoid colon was(22.2%).Conventional adenocarcinoma was the predominant type 86(79.6%), majority of cases were moderately differentiated adenocarcinoma constituting85.2%. Stage III was the highest stage constituting 56(51.9%), followed by stage II which constitute 37(34.3%).The local invasion of the mucosa and other layers of colonic wall were associated with desmoplasia and collagen fiber remodeling. Infiltration of foamy macrophages decreased in number in relation to higher grade. Intraglandular necrosis showed significant correlation with tumor invasiveness, lymph node metastasis and grade. The frequency of both markers Ki67 and VEGF were 77 and 75 respectively. Ki67 immunoreactivity revealed significant relationship with tumor grade (P=0.014), whereas VEGF had significant relationship with TNM stage (P = 0.019), as well as the local invasion to the colorectal wall (P 0.009). Conclusions: Moderate differentiated adenocarcinoma (85.2%) and stage III (51.9%) were the most frequent diagnosed cases with colorectal cancer. Macrophages infiltration was conversely related with grading of colorectal cancer. Histopathological changes like desmoplastic reaction and intraglandular necrosis were common findings in colorectal cancer and they were in concordance correlation with stage and grade.Ki67 had relationship with tumor grade, whereas VEGF correlate with tumor invasion.

Capparis spinosa is one of the most aromatic plants growing in wild in the dry regions around the... more Capparis spinosa is one of the most aromatic plants growing in wild in the dry regions around the west or central Asia and the Mediterranean basin, and reports to contain a wide range of phytochemical constituents. The present study evaluates the cytotoxic effects of aqueous, methanolic crude extracts and secondary metabolites extracts polyphenolic, rutin, and alkaloids of mature fruit of C. spinosa on Human larynx carcinoma (Hep-2) and Human cervix adenocarcinoma (HeLa) tumor cell lines in vitro. The present study also includes the investigation of the effect of polyphenol mature fruit extracts on mitotic index (M.I.) of HeLa tumor cell line. The effect of (aqueous and methanol) crude extracts and secondary metabolites extracts (polyphenol, rutin, and alkaloids) of mature fruits of C. spinosa on Hep-2 and HeLa tumor cell lines have been showed highly significant difference (P≤ 0.0001) or (P ≤ 0.01) among all types of extracts, and among all concentrations for each extract in two periods 24 and 48 hrs of the treatment. However the study reveals that the effective extracts against the proliferation of tested cell line were polyphenol extracts with concentration 10000 µg/ml in Hep-2 cells after 24 and 48 hrs. and with concentrations 10000 and 5000 µg/ml in HeLa cell line after 48 hrs. Polyphenolic extract showed a cytotoxicity concentration 50% (CC50%) 6400 and 6800 µg/ml on Hep-2 tumor cell line after 24 and 48 hrs. of treatment, respectively. The CC50% of HeLa cells was 7100µg/ml after 48 hrs. Other extracts; aqueous, methanolic crude extracts and secondary metabolites extracts (rutin and alkaloids) of mature fruit of C. spinosa caused less inhibition activity on the growth of Hep-2 and HeLa tumor cell lines. The CC50% for all these extracts were more than 10000 µg/ml. The result of present study shows that non significant difference of polyphenol mature fruit extracts effect on the type of tumor cell line either HeLa or Hep-2 cell lines. The cytogenetic study on HeLa cell line shows that polyphenol mature fruit extract has antimitotic index against tested cell line. Some of structural and numerical chromosomal aberrations were observed in both treated and untreated groups. Structural chromosomal aberrations include: ring chromosome (R. Ch.), dicentric chromosome (D. C.Ch.), chromatid gap and symmetrical interchange of chromosome as well as pulverization in treated group with higher concentrations 3550and 1775 µg/ml of extract. Numerical chromosomal aberrations include: octoploidy, euploidy and aneuploidy.

International Journal of Research in Medical Sciences, 2015

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in... more Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age. Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori) and (4.7% without H. pylori). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%). Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference.

Baghdad Science Journal, 2020

Neuroendocrine differentiation has been mentioned in many cancers of non-neuroendocrinal organs, ... more Neuroendocrine differentiation has been mentioned in many cancers of non-neuroendocrinal organs, involving the gastrointestinal tract. In contrast, the correlation of focally diffused neuroendocrine differentiation in colorectal adenocarcinoma with neuroendocrine cell hyperplasia has not been somewhat reported. The objective of this research is to study the relationship between neuroendocrine cell hyperplasia and neuroendocrine differentiation in colorectal adenocarcinoma and to find the correlation of neuroendocrine differentiation and VEGF expression with clinicopathological parameters of colorectal adenocarcinoma. Methods employed in the current study were including eighty-one patients with colorectal cancer. Formalin fixed paraffin embedded blocks were sectioned and stained with immunohistochemical markers; Chromogranin A and VEGF; and processed automatically according to protocols supplied by the antibody manufacturer. Results show that neuroendocrine cell hyperplasia in the mucosa nearby tumor comprised (42%) and it was associated with neuroendocrine differentiation. Neuroendocrine differentiation and vascular endothelial growth factor were positive in 48.1% and 63% respectively. Neuroendocrine differentiation did not show a relation with clinicopathological parameters with the exception of tumor that metastasizes to other tissues and organs. The association of VEGF with the same factors had significant impact with tumor stage, degree of local invasion and lymph node metastasis. Other histological changes revealed that only desmoplastic reaction had significant difference in relation to neuroendocrine differentiation. This study reached the conclusion that neuroendocrine cell hyperplasia is positively correlated with neuroendocrine differentiation and it has strong linkage in pathogenesis of colorectal adenocarcinoma. Neuroendocrine differentiation and VEGF expression are greatly correlated with progression and invasion of tumor to other tissues and organs, and this can be represented as an important parameter for poor prognosis of colorectal adenocarcinoma.

Duhok Medical Journal, 2018

Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq... more Background: Colorectal cancer is the most common gastrointestinal tract cancer worldwide. In Iraq, colorectal cancer was the seventh top cancers, whereas in Kurdistan, it was the fourth most common cancer for both males and females. Although the methods of the diagnosis and therapy have been improved, only about 50% of the patients who resected the tumor died from disease within 5 years, due to distant metastasis. The study was carried out to determine the frequency of histopathological types of colorectal cancer, and to evaluate the correlation between colorectal cancer regarding the grade, stage, with different histological finding which include desmoplastic reaction, lymphocytic infiltration, foamy macrophages, necrosis, intraglandular necrosis, and calcification. Subject and Methods: This study includes (108) patients diagnosed with colorectal cancer. Cases were collected during the period January 2015-December 2017 from the histopathological department at Central Public Health Laboratory and other private labs in Duhok city. Clinical information were obtained from the available histopathological reports. Paraffin embedded blocks were sectioned and stained with immunohistochemistry markers; Ki67 and VEGF then processed automatically according to protocols supplied by the antibody manufacturer. Results: Patients age ranged from18-83 years with a mean of 54.42 years. The peak ages of the patients were between 60-69 years. Male: female ratio was 1.5:1. The commonest tumor location was (recto-sigmoidal region); rectum was (42.6 %) and sigmoid colon was(22.2%).Conventional adenocarcinoma was the predominant type 86(79.6%), majority of cases were moderately differentiated adenocarcinoma constituting85.2%. Stage III was the highest stage constituting 56(51.9%), followed by stage II which constitute 37(34.3%).The local invasion of the mucosa and other layers of colonic wall were associated with desmoplasia and collagen fiber remodeling. Infiltration of foamy macrophages decreased in number in relation to higher grade. Intraglandular necrosis showed significant correlation with tumor invasiveness, lymph node metastasis and grade. The frequency of both markers Ki67 and VEGF were 77 and 75 respectively. Ki67 immunoreactivity revealed significant relationship with tumor grade (P=0.014), whereas VEGF had significant relationship with TNM stage (P = 0.019), as well as the local invasion to the colorectal wall (P 0.009). Conclusions: Moderate differentiated adenocarcinoma (85.2%) and stage III (51.9%) were the most frequent diagnosed cases with colorectal cancer. Macrophages infiltration was conversely related with grading of colorectal cancer. Histopathological changes like desmoplastic reaction and intraglandular necrosis were common findings in colorectal cancer and they were in concordance correlation with stage and grade.Ki67 had relationship with tumor grade, whereas VEGF correlate with tumor invasion.

International Journal of Research in Medical Sciences, 2015

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in... more Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age. Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori) and (4.7% without H. pylori). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%). Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference.