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IRAQI JOURNAL OF MEDICAL SCIENCES

المجلة العراقية للعلوم الطبية

ISSN: 16816579
Publisher: Al-Nahrain University
Faculty: Medicine
Language: English

This journal is Open Access

About

Iraqi Journal of Medical Sciences
Aims and Scope
Iraqi Journal of Medical Sciences is published by College of Medicine, Al-Nahrain University. It is a quarterly multidisciplinary medical journal since 2000 . High quality papers written in English, dealing with aspects of clinical, academic or investigative medicine or research will be welcomed. Emphasis is placed on matters relating to medicine in Iraq in particular and the Middle East in general, though articles are welcomed from anywhere in the world.
Iraqi Journal of Medical Sciences publishes original articles, case reports, and letters to the editor, editorials, investigative medicine, and review articles. They include forensic medicine, history of medicine, medical ethics, and religious aspects of medicine, and other selected topics.
عنوان المجلة :
College of Medicine
Baghdad, Iraq
Tel and Fax: + 964-1-5224368
P. O. Box 14222, Baghdad, Iraq.
E-mail: iraqijms@colmed-alnahrain.edu.iq

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iraqi_jms_alnahrain@yahoo.com

iraqijms@colmed-alnahrain.edu.iq

http://www.colmed-alnahrain.edu.iq

Table of content: 2009 volume:7 issue:2

Article
EDITORIAL: NEWBORN SCREENING FOR INBORN ERRORS OF METABOLISM (IEM)

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Abstract

Keywords


Article
MINERAL HOMEOSTASIS IN PREECLAMPSIA
توازن المعادن لدى الحوامل المصابات بارتفاع ضغط الدم (قبل الشنج)

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Background: Preeclampsia is a form of high blood pressure manifested during pregnancy, it is a common major complication causing significant morbidity and mortality; however, its etiology is unknown. Moreover, data on mineral homeostasis and on cation pattern during pregnancy are conflicting. Also, the status of ionized calcium and magnesium during pregnancy and its complication preeclampsia have not been described adequately. Objective: to demonstrate the pattern of minerals during preeclampsia with respect to normal pregnancy. Subject and methods: the present study is a cross-sectional case-control study includes measurement of minerals (calcium and magnesium) in 60 patients with preeclampsia. They are classified into two groups according to gestational age: o Preeclamptics in the second trimester G1: (n=30). o Preeclamptics in the third trimester G2: (n=30,). The results are compared with 60 apparently healthy pregnants controls. They are classified according to gestational age into two groups: o Pregnants in the second trimester G3: (n=30). o Pregnants in the third trimester G4: (n=30). Results: show that serum corrected calcium and serum magnesium are significantly reduced in preeclamptics when compared with normal pregnants. In addition, there was a reduction in free calcium and free magnesium that was accompanied by a significant high elevation of the ratio between ionized calcium to ionized magnesium. Conclusion: preeclamptics (in different gestational age groups) have altered mineral status when compared with healthy pregnants matched with their age and gestational age. Key words: preeclampsia, calcium, magnesium.


Article
EXTRACTION AND PURIFICATION OF TWO OUTER MEMBRANE PROTEINS (PORINS) FROM KLEBSIELLA PNEUMONIAE LOCAL ISOLATE
استخلاص وتنقية بروتينات الغشاء الخارجي من عزله محليه لبكتريا الـ Klebsiella pneumoniae

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Background: The porins are present in large amounts in the outer membrane of gram negative bacteria and form water-filled channels that permit the diffusion of small hydrophilic solutes across the outer membrane. Porins are generally divided into two classes: nonspecific porins (e.g., OmpC and OmpF), which permit the general diffusion of small polar molecules (600 Da), and specific porins (e.g., LamB), which facilitate the diffusion of specific substrates. Objective: To purify and characterize outer membrane proteins (porins) from a local isolate of Klebsiella pneumoniae. Materials and methods: An identified local isolate of Klebsiella pneumoniae was used as a primary source for the isolation and purification of porins. Outer membrane protein (porins) was purified and characterized and the contaminating lipopolysaccharides (LPS) were detected by thiobarbituric acid assay. Results: The final preparation contained porins in a concentration of 3.2 mg/ml. The results of electrophoretic separation revealed that porins appeared as two distinct bands with molecular weights of porins were estimated to be 35 and 36 kDa, respectively. Conclusions: Porins were expressed by the local isolate of Klebsiella pneumoniae with molecular weights highly similar to that of porins preparations produced by other gram negative bacteria and Klebsiella pneumoniae expressed two types of porins under standard laboratory conditions. Keywords: Porins, Thiobarbituric acid, Gel filtration chromatography, Ketodeoxyoctinate.


Article
EVALUATION OF THE ROLE OF ERYTHROCYTE DEFORMATION ON ERYTHROCYTES AGGREGATION AND SEDIMENTATION RATE USING HE-NE LASER SCATTERING
تقييم دور تغير شكل كريات الدم الحمراء في معدل تجمع وترسب كريات الدم الحمراء باستخدام أشعة الليزر

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Background: The erythrocyte aggregation is an important physiological phenomenon in the circulation of blood. It is a basic characteristic of normal blood that plays a major role in the cardiovascular system, especialy in the microcirculation. Objective: To evaluate the role of deformability of red blood cells on the aggregation and sedimentation of red blood cells. Subjects & Method: The present study was carried out on thirty two healthy subjects. Laser scattering method was employed for this study. From scattered light intensity, profiles continuously obtained during aggregation and sedimentation of the aggregated erythrocytes. Different values of erythrocyte deformability were determined and evaluate their effects on each phase of the erythrocyte aggregation and sedimentation, rouleaux formation, one- dimensional aggregate and three- dimensional aggregate formation. Results: Deformability values are expressed in term of rigidity index, the difference between medium and high rigidity index significantly decreased the rate of aggregation and the rate of three dimensional aggregate sedimentation. Conclusion: Variation of the values of erythrocyte deformability from low to medium and from medium to high showed different effects on aggregation and sedimentation stages. Keywords: Erythrocyte aggregation, sedimentation rate, deformability, laser light.


Article
CYSTINURIA IN A GROUP OF CHILDREN IN IRAQ
السستينيوريا لدى مجموعة من الاطفال في العراق

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Background: Cystinuria is an autosomal recessive defect in reabsorptive transport of Cystine and dibasic amino acids. Increased urinary excretion of Cystine, the least soluble of all amino acids, results in formation of stones. Objectives: we report our experience with management of cystinuria in a group of Iraqi children. Patients and Methods: from 1999 to 2006, all children with cystinuria were evaluated, treated and followed in Al – Kadhimiya Teaching Hospital. Results: Twenty three patients with cystinuria having calculi (16 males, 7 females) were treated. Their age ranged from 10 months to 18 years. Associated hyperuricosuria was recorded in 30.5%, hypercalciuria in 13% and hyperoxaluria in 4.3%. Follow up period ranged from 1 – 88 months. Nine patients were treated with increased oral fluids and alkalis only. D–Penicillamine therapy was given to 13 patients. Side effect to penicillamine was noticed in 4 patients (22.2%). Captopril was given to 4 patients. Extracorporeal shock wave lithotripsy (ESWL) was performed in 8 patients, and 18 patients underwent open surgical procedures. The stone free rate was 55.6% with fluids and alkali alone, 58.3% with D–Penicillamine, 0% with Captopril and 50% with ESWL. Combined treatments were required in 45% of patients. Stone recurrence rate was 70%. Conclusion: Oral fluids and alkali was most successful when used in patients with mild disease. D–Penicillamine and ESWL had nearly equal rate of successful results. Keywords: cystinuria, chlidren, calculi, urolithiasis


Article
CD30 MOLECULE EXPRESSION IN SERA AND ON T CELLS OF TROPHOBLAST TISSUE FROM WOMEN WITH RECURRENT SPONTANIOUS ABORTION
التعبير عن المعلم CD30فى مصول وعلى الخلايا التائيه فى نسيج المشيمه الماخوذ من مريضات الاجهاض التلقائى المتكرر

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Background: Immune responses during pregnancy show a distinct shift towards Th2-type reactions occurs, especially at the feto-maternal interface. CD30 has been described as being preferentially expressed, and released, by human T cells producing the Th2-type cytokines. Objective: To determine the level of soluble CD30 (sCD30) in serum and in the trophoblasts of patients with recurrent spontaneous abortion (RSA). Materials and methods: A total of sixty one women attending the Obstetrics department in al- kadhimiya hospital, age range from (23.9 - 28.5years), were enrolled in the current study and were further classified into three categories: Group A: 35 women included cases with recurrent spontaneous abortion, group B: 16 women included non- recurrent spontaneous abortion (non-RSA): group C: 10 women was Control (successful pregnancy). From each subject blood sample and placental tissues were collected and serum was seperated for the estimation of soluble CD30 (sCD 30) levels using ELISA method and trophoblasts tissues (an image for the local microenvironment) were screened to determine the levels of CD30 using immunohistochemistry. Results: Trophoblast expression of CD30 and sCD30, showed a highly significant increased values for both patients groups (p<0.001) when compared with control group. Conclusion: It is likely that there may be an association between normal pregnancy and CD30 density on the cell surface. Key words: recurrent spontaneous abortion, CD30, mmunohistochemistry, ELISA


Article
PATTERN OF MYCOBACTERIUM TUBERCULOSIS DRUG RESISTANCE IN PREVIOUSLY TREATED CASES IN IRAQ
طبيعة الممانعة الدوائية لعصيات التدرن عند المرضى المعالجين سابقًا في العراق

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Background: The resistance of certain Mycobacterium tuberculosis strains to anti-tuberculosis drugs is not a new phenomenon. It is man-made amplification of natural phenomenon. Objectives: 1- To provide scientifically based information on the burden of Mycobacterium tuberculosis drug resistance in Iraq. 2- To compare the pattern of this resistance in Iraq with that in the other countries. Methods: A total 411 patients with pulmonary tuberculosis who have already received at least one month of anti-tuberculosis therapy were selected. Sputum cultures and drug sensitivity tests for Mycobacterium tuberculosis were arranged. Results: Resistance to rifampicin, isoniazid, streptomycin and ethambutol was noted in 52 (24.4%), 22 (10.3%), 21 (9.9%) and 8 (3.8%) of isolates respectively. Multidrug and four-drug resistance was found in 52 (24.4%) and 24 (11.3%) respectively. Rifampicin resistance in any form was noted in 146 (68.5%). Conclusion: The magnitude of Mycobacterium tuberculosis drug resistance in Iraq found to be relatively high. Key wards: tuberculosis; antituberculous drugs resistance; multidrug resistance; drug resistance


Article
IMMUNOPHENOTYPHING OF PERIPHERAL BLOOD LYMPHOCYTES TO PERSON EXPOSED TO ELECTROMAGNETIC FIELDS
دراسة التنميط المناعي للخلايا اللمفاوية في الدم المحيطي للأشخاص المتعرضين للمجال الكهرومغناطيسي

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Background: There is considerabl evidence relating electromagnetic fields (EMFs) exposure to reduce immune system competence .and these changes associated with cell growth control, differentiation and proliferation of cells of immune system, trans membrane signaling cascades, gap junction communication, immune system action. Objective: to investigate the Phenotyping of peripheral blood lymphocytes of volunteer’s exposed at least 10 years to electromagnetic fields (EMFs) induced by transmission power lines in their residential area , Subjects and methods: fourty five volunteer’s aged between 25 and 65 Years, exposed for at least 10 years to electromagnetic fields (EMFs) induced by transmission power lines in their residential area and Fifteen male of similar age unexposed, away from the transmission power lines as a control group were used in this study . The electromagnetic fields (EMFs) (with range of 50 Hz) beside the homes of the volunteer’s. This study carried out in three different are as of Baghdad included (Al –Bladyat, Hay Al-Adel and Al-Dorra cities) , The groups of this study were divided into three sub- groups according to the distance away from the towers of transmission power lines (1) range: from 1 to 25 meter (2) from 25 to 50 meter (3) from 50 to 75 meter . Phenotyping of peripheral blood lymphocytes had been done by direct immunofluorescent microscopy using anti –CD 3(for T-cells detection), anti-CD4 (for T- helper-cells), anti CD8 (for T-cytotoxic/suppressor cells), anti CD21 (for B-cells) and anti CD56 (for natural killer cells). Results: A statistically significant reduction of PBL percentage bearing CD3,CD4,CD19,CD56(P<0.01) between the exposed volunteers and control ;.except CD8 which showed no significant different between these groups . the mean percentage of CD4+/CD8+ ratio in exposed volunteers groups was significantly (P<0.01) lowered in comparison to control group . Conclusion: We postulated that the chronic exposure to electromagnetic fields from power lines caused suppression in immune system. Keywords: Electromagnetic felid, CD4, CD8, CD21, CD56, Lymphocytes, phenotyping


Article
ULTRA STRUCTURAL STUDY OF CARBOXYLESTER HYDROLASES ACTIVITY IN THE INTERNEURON OF THE MAMMALIAN SPINAL CORD
دراسة كيمانسجية لخلايا بين العصبونات في الحبل الشوكي في اللبائن

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Background: Neurosciences mainly focused on the enzymatic pattern of the neurons, however, in this study the demonstration of certain carboxylaser hydrolases (Alph naphthyl butyrate esterases) activity in the Intrinsic spinal networks neurons (central pattern generator) was performed. Objective: Interneurons or Renshow cells assume autoinhibitor functions, which dampens the a-motoneurons through negative feedback circuit, in addition to that they receive an input from higher centers through which it modify reflex responses to peripheral stimuli by facilitating or inhibiting different populations of interneurons, however, this issue modulates the performance of specific movement performed by a-motoneurons. Materials and methods: α – naphthyl butyrate used as a broad spectrum substrate in treating minced tissue block of gray matter of the spinal cord in the Rabbit prior to their traetment with the usual way to be examined lateron with the electron microscopy . Result: Reactivity was clearly evident in a form of deep stained granules in the nuclear matrix ,mitochondera and ,RER , and in certain prenuclear region ,however, the reactivity was varied in the mitochondrea in different neurons examined. Conclusion: Recently the term, central pattern generators was used, which address the Intrinsic spinal networks of interneurones that control the timing and pattern of the muscle activity underlying locomotion in mammals,however the effect of the higher centers that modulates the type & tone of movement through those neurons elucidate function which was varied from excitatory-inhibitory, flexor-extensor. The reactivity of those enzymes and their different isoformes that might have an effect on the molecular and genetic pattern of neurotransmitres were discussed in this study . Keywords: Interneurons,Central pattern generator, Alpha naphthyl butyrate,esterase, Spinal cord


Article
A STUDY FOR THE CORRELATION BETWEEN EOSINOPHIL DERIVED NEUROTOXIN (EDN) AND ASTHMA
دراسة العلاقه بين الذيفان العصبى المستخلص من خلايا الحمضات و الربو القصبى

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Background: Eosinophil Derived Neurotoxin (EDN) has been used to assess eosinophil cells activity and to monitor inflammation in asthmatic patients. Objective: Study the correlation between Eosinophil Derived Neurotoxin (EDN) and asthma. Materials and methods: Eosinophil Derived Neurotoxin (EDN) was extracted from eosinophils taken from patients with eosinophilic leukemia.This extract was conducted to study its biological effects (Gordon phenomena) and detection of antibodies against it in urine samples of diagnosed asthmatic patients. Results: One of the two tested rabbits with the extracted EDN test material showed the signs and symptoms of Gordon phenomenon during the second day after injection and continued to show complete paralysis within the fifth day .Patients urine results showed that it contained a higher values of END than the control subjects urine . Conclusion: Results revealed that EDN is a product that can be used as a monitor for asthma. Key words: EDN, asthma, ELISA.


Article
NERVE CONDUCTION STUDIES IN HEALTHY IRAQIS: NORMATIVE DATA
دراسة التوصيل العصبي للعراقيين الأصحاء: بيانات طبيعية

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Background: Nerve conduction studies as part of the peripheral neurophysiologic examination are an extension of the clinical history and examination. They can be extremely useful both in localizing lesions and determining the pathological processes. Objective: To establish the normal electrophysiological data for the facial nerve and commonly tested nerves of the upper and lower limbs in healthy Iraqis and to compare with those data published in the literature. Methods: Nerve conduction studies were performed in the upper and lower limbs of 11,437 carefully screened healthy individuals between the ages of 2 months and 89 years using a standardized technique. Results: The data were separately analyzed for different age groups. In the age group less than 10 years, the sensory and motor nerve conduction velocities were progressively increasing with increasing age until adult values were reached. Later, in the adulthood, the conduction velocity of all tested nerves decreased with age and this is pronounced in both lower and upper limbs. Conclusion: Normative conduction parameters of the facial nerve and peripheral nerves in the upper and lower limbs were established for the EMG laboratory in Iraq. The overall mean sensory and motor nerve conduction parameters for the tested nerves compared favorably with the existing literature data. Keywords: Upper limbs, Lower limbs, Nerves, Conduction Velocity, Iraqis


Article
ENDOSCOPIC SINUS SURGERY VERSUS CONVENTIONAL METHOD IN MANAGEMENT OF NASO-ETHMOIDAL POLYPS AND THEIR ASSOCIATED INTRANASAL ABNORMALITIES
جراحة الجيوب الناظورية بالمقارنة مع الطرق التقليدية في علاج الزوائد اللحمية للأنف والجيوب الغربالية مع الأختلالات الأنفية المصاحبة

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Background: This is a prospective and comparative clinical study, implemented in department of Otolaryngology –Sulaimani Teaching Hospital, from Aug. 1st 2006 to Nov. 1st 2007. Objectives: This study was carried out to compare the influences and outcomes of endoscopic sinus surgery versus conventional intranasal method in management of patients with nasal polyps, which is the most common intranasal swelling. Methods: The sample of the study includes 50 patients’ aged 12-75 yeas old that are managed for nasal polyp, thirty patients managed by conventional method and twenty patients were managed by endoscopic sinus surgery.Patients are observed postoperatively by symptomatic score and endoscopically Results: Endoscopic sinus surgery resulted in better improvement in symptoms, better treatment of other associated sinonasal pathologies, less complication rate,and less recurrence rate than conventional polyoectomy.On the other hand endoscopic sinus surgery is more technically demanding and needs more operative time than the conventional way. Conclusion: We concluded from the study that Endoscopic Sinus surgery is better than conventional intranasal polypectomy, as endoscopy provides approximate field of vision and illumination, good access, hidden pathology are revealed and managed, and complication, recurrent rate are less. Keywords: nasal polyp, conventional polypectomy, endoscopic sinus surgery


Article
PULMONARY HYPERTENSION IN PATIENTS WITH CHRONIC RENAL FAILURE
فرط ضغط الدم الرئوي عند المصابين بالعجز الكلوي المزمن

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Background: Pulmonary hypertension (PH) comprises a group of clinical and pathophysiological entities with similar features but a variety of underlying causes. Many etiologies causing PH have been reported, and one of the background disease seen with patients with PH is chronic renal failure (CRF). Objective: To evaluate the prevalence of pulmonary hypertension in patient with chronic renal failure in predialysis state and in uremic patients undergoing hemodialysis Patients and methods: One hundred patients had complaining chronic renal failure. 50 patients on conservative treatment and 50 patients on hemodialysis evaluated clinically and by echocardiography for the presence of pulmonary hypertension Results: The prevalence of pulmonary hypertension >35 mmHg was found in 33% of patients with chronic renal failure. the patients with pulmonary hypertension had significantly lower albumin and arteriovenous fistula and long duration of dialysis Conclusion: This study demonstrated that 42% of patients with chronic renal failure receiving regular hemodialysis have pulmonary hypertension and 24% of patients with chronic renal failure in predialysis have pulmonary hypertension. The presence of pulmonary hypertension was related to the low level of albumin, presence of arteriovenous fistula and long duration of hemodialysis. Keywords: Pulmonary hypertension, hemodialysis, predialysis, echocardiography.


Article
MORPHOMETRIC STUDY ON THE Ag-NOR CHANGES IN SKELETAL MUSCLE RESIDENT CELLS WITH AGING
دراسة علم الشكل(مورفومتريه) للتغيرات في صبغه نترات الفضة في الخلايا القاطنة في العضلات الهيكلية مع التقدم بالعمر

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Background: Aging is the deterioration of mature organism resulting from time dependent irreversible changes. The effects of aging on skeletal muscle cells have not been much-elucidated using Ag-NOR analysis. Objectives: This study aims to demonstrate the effects of aging on Ag-NOR in morphometric & counting aspects. Materials and methods: The Extensor digitorum longus muscle of forty Albino male rats with age ranging from 27 days up 18 month were studied. Paraffin blocks were performed & sectioned. Ag –Nor stained sections were de-waxed, rehydrted, developer solution was used. Morphometric Analysis of the Ag-NOR stained nuclei through using a soft wear GLI (Global lab image 2) with a microscope connected to PC Unit, a software used to analyze the picture that seen through the microscope, nuclear area, nuclear perimeter, and roundness were calculated,& counting of the number of Ag-NOR stained nucleoli per stained cells. Results: In neonate age group, the nuclei have high affinity to the stain. High proportion of nuclei can be recognized, with the higher count of Ag-NORs per cells. • In adult age groups the affinity to the stain is reduced, the nucleus appears to have smaller count of Ag-NORs per cells. • In old age group the staining intensity seem to be highly reduced, the nucleus seem to have single, rounded Ag-NOR. Conclusion: A significance differences is seen in Ag NORs in cells of skeletal muscle fibers with aging demonstrated by counting and morphometric method of Ag-NOR analysis. Key words: Skeletal muscle, Ag NOR. Morphometry.


Article
TRACE ELEMENTS HOMEOSTASIS IN PREECLAMPSIA
توازن العناصر الضئيلة لدى الحوامل المصابات بارتفاع ضغط الدم (قبل الشنج)

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Background: Preeclampsia is a form of high blood pressure with proteinuria manifested during pregnancy, it is a common major complication causing significant morbidity and mortality; however, its etiology is unknown. Moreover, data on mineral and trace elements homeostasis and on cation pattern during pregnancy are conflicting. Also, the status of ionized calcium and magnesium during pregnancy and its complication, preeclampsia, has not been described adequately. Objective: to demonstrate the pattern of minerals and trace elements during preeclampsia with respect to normal pregnancy. Subject and methods: the present study is a cross-sectional case-control study included measurement of minerals (calcium and magnesium) in 60 patients with preeclampsia. They were classified into two groups according to the gestational age: o Preeclamptics in the second trimester G1: (n=30). o Preeclamptics in the third trimester G2: (n=30,). The results are compared with 60 apparently healthy pregnant controls. They were classified according to the gestational age into two groups: o Pregnants in the second trimester G3: (n=30). o Pregnants in the third trimester G4: (n=30). Results: show that serum corrected calcium, serum magnesium and serum zinc were significantly reduced accompanied by significant high serum copper in pre-eclamptics when compared with that of normal pregnancy. Conclusion : preeclamptics (in different gestational age groups) altered mineral and trace element status when compared with healthy pregnants matched with their age and gestational age. All preeclamptics had certain factors that reduce vasodilation, enhance vasospasm and trigger oxidative stress supported by the finding of low level of ionized magnesium (which is essential for maintenance of vascular tone), low ionized calcium level (which is essential for the synthesis of endothelial-derived NO), high copper level (which generates highly reactive oxygen species) and low zinc level (which is essential for antioxidant function). K ey words: preeclampsia, calcium, magnesium, zinc, copper.


Article
INCIDENTAL INTRACRANIAL TUMOR: A CASE REPORT
ورم الجوف القحفي التصادفي "تقرير حالة "

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This is a case report of 30 years lady referred by the investigation authority to the medico-legal institute in Baghdad as a car accident victim for postmortem examination. A prior autopsy history with her relatives was negative. During autopsy a large intracranial tumor was discovered at the base of the brain. Histopathological examination revealed the diagnosis of meningioma. Keywords: Intracranial tumor, meningioma, autopsy, brain tumor.

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