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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: 2010 volume:8 issue:3

Article

Article
THE VALUE OF LOCAL APPLICATION OF HYDROGEN PEROXIDE SOLUTION AT THE SITE OF WOUND AFTER MASTECTOMY FOR BREAST CARCINOMA IN REDUCING LOCAL RECURRENCE OF THE TUMOR
أهمية استعمال محلول بيروكسيد الهايدروجين موضعيا على الجرح بعد استئصال الثدي لمرضى سرطان الثدي في تقليل نسبة رجوع السرطان موضعياً.

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Background: Hydrogen peroxide is produced in normal cells of the body by peroxisomes. Cancer cells have lower respiration rates than normal cells therefore they grow better under low oxygen concentration, and introducing high oxygen levels could retard their growth or kill them. On these bases hydrogen peroxide solution had been applied locally at the site of wound after mastectomy for breast carcinoma to decrease the risk of local recurrence of the tumor. Objective: To evaluate the significance of local application of hydrogen peroxide solution at the site of wound after mastectomy for patients with breast carcinoma in reducing local recurrence of the tumor, and to observe whether it is safe or not. Patients and Methods: One hundred female patients with breast carcinoma and underwent mastectomy in Baghdad hospitals were involved in this study. Patients were divided into two identical groups each with fifty patients. Group 1, patient's wounds were treated locally by hydrogen peroxide solution after mastectomy; whereas the other group (control) did not treat with it. Patients had been followed for survival, recurrence, and complications for 15 years. Results: In group 1; there was no local recurrence, while in the control group, the local recurrence of the tumor was 14% .In group 1,the five, ten, and fifteen years survival were 60%, 14%, and 6% respectively without detectable complications; while in the control group, the 5 year survival was 24%, and no patient survive more than 7 years. Conclusion: Local application of hydrogen peroxide solution at the site of wound after mastectomy for breast carcinoma is safe and may be effective in improving survival rate and reducing local recurrence of the tumor. Key words: Breast carcinoma, local application of hydrogen peroxide solution, local recurrence.


Article
DEVELOPMENTAL CHANGES IN THE GENITAL ORGANS OF YOUNG MALE MICE ASSOCIATED WITH LICORICE EXTRACT CONSUMPTION BY MOTHERS BEFORE AND DURING GESTATION
التغيرات النمائية في الاعضاء التناسلية لذكور الفئران اليافعة المرتبطة بتناول مستخلص عرق السوس من قبل الامهات قبل واثناء الحمل.

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Background: Licorice (Glycyrrhiza glabra) is one of the most popular plants and widely consumed as a medicinal herb, which is used mainly in treatment of inflammations and improvement of reproductive performance in both females and males. Objective: To detect the effect of licorice extract consumed by pregnant females on gonadal development of their male offspring. Materials & Methods: Mature female mice(No:60), were divided into: experimental group(G,30mice), which subdivided into 3 equal subgroups: G1,G2 and G3(10 mice for each), given extract of licorice root(1gm/kg body weight),immersed in distilled water for 3 weeks before mating (G1) or for 6weeks before and during pregnancy (G2) or for 3 weeks during pregnancy time only(G3) . The other main group (C) was considered as control group subdivided as that with the experimental group but they were given distilled water only. Number and weights of male's newborn were recorded. After 40 days, weights of their bodies and testes were recorded; histological sections were prepared for the testes to detect the presence of mature sperms and to measure the diameters of semineferous tubules and thickness of their germinal walls. Results: Highly significant increase (P<0.01) in litter size of all experimental groups were recorded. Young males born from treated mothers showed significant increase (P<0.05) in weights of both body and testes, and a highly significant increase (P<0.01) in the thickness and diameters of their semineferous tubules in comparison with that born from control mothers. No significant differences were recorded between the three experimental groups. Conclusions: consuming low dose of licorice root extract by pregnant females causes a significant increase in the numbers and weights of the offspring with clear maturation features in the gonads of young males. Key words: fetal development, male gonads, pregnancy, licorice, mice.


Article
EXPRESSION OF CERTAIN ACTIVATION MARKERS, CD45RA, CD45RO AND CD11b ON THE SURFACE OF PERIPHERAL BLOOD LYMPHOCYTES ISOLATED FROM PATIENT WITH IDIOPATHIC PRETERM LABOUR
ظهور بعض من معلمات التنشيط على سطح الخلايا اللمفاوية للدم المحيطي والمعزولة من مريضات الولادات المبتسرة التلقائية مجهولة الاسباب.

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Background: preterm labor (PL) is remaining the leading cause of non-anomalous prei natal mortalities. Objective: is to determine the association of PL on the expression of certain activation markers on the surface of peripheral blood lymphocytes (PBLs). Patients and methods: Thirty patients with idiopathic pre term labour (IPL) (group A) in addition to 30 healthy pregnant women of comparable gestational age groups (group B) were enrolled in this study. Blood samples were taken from both groups and lymphocytes were separated and stained with fluorescent labeled monoclonal antibodies against CD45RA, CD45RO and CD11b. Results: results indicated that there were a significant increase in the percentage of CD45RA in group A and reduction in the percentage of both CD45RO and CD11b in the same group. Conclusions: patients with IPL have a less tendency of the activity of lymphocytes. Key words: Idiopathic premature labour, activation markers, CD45RA, CD45RO, CD11b.


Article
EVALUATION OF ANGIOGENESIS IN IDIOPATHIC MYELOFIBROSIS WITH CD31 AND CD34 BY LIGHT MICROSCOPE AND COMPUTER-AIDED IMAGE ANALYSIS SYSTEM
تقييم تكوين الأوعية الدموية في متلازمة تصلب نخاع العظم التلقائي المصبوغ بواسطة CD34 وCD31 بأستعمال المجهر الضوئي و نظام تحليل الصورة بمساعدة الحاسوب.

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Background: Myelofibrosis with myeloid metaplasia (MMM) is a clonal stem cell disease with varying degrees of fibrosis in the marrow. Vasculogenesis is the formation of new blood vessels from pre-existing vessels during adult life; it plays a critical role in neoplastic development, progression and metastasization and has been shown to be an adverse prognostic factor in many solid tumors. It is becoming increasingly evident that angiogenesis plays a key role in the pathophysiology of hematologic malignancies by estimating bone marrow microvessel density and by measuring circulating angiogenic factors. MMM is probably the disease with the more pronounced angiogenesis among Chronic Myeloproliferative Disorders. Objective: 1. Evaluation of angiogenesis in Idiopathic Myelofibrosis (IMF) via immunohistochemical staining for CD31 and CD34 and quantifying them by Computerized Image Analysis System and Light Microscope. 2. To investigate whether angiogenesis can be considered as a marker for disease activity. Methods: This cross sectional study was conducted on 31 formalin fixed paraffin embedded blocks of Idiopathic Myelofibrosis cases along with 10 age matched control cases having no abnormal bone marrow pathology, from January 2006 to June 2006. The sections from bone marrow biopsies were processed routinely and stained with Hematoxylin and Eosin (H&E) and with immunohistochemical stain for CD31 and CD34 markers. The bone marrow Microvessel Density of IMF and control case was assessed by the means of Computer Aided Image Analysis System and by visual count using light microscope. Results: This study revealed that there was a significant increase in microvessel density in IMF cases, using both the computerized method and the visual count by light microscope, with both CD31 & CD34 compared to control group (P < 0.05). Also this study showed that the increase in angiogenesis was positively correlated with the Dupreiz score prognostic system and the age of the patients. On the other hand; no significant correlation was found between angiogenesis and the following parameters: sex of the patient, Hb value, WBCs count, peripheral blood platelets count. Conclusion: This study has showed that angiogenesis was an integral component of the bone marrow stromal reaction in MMM and it was closely related to many prognostic parameters; thus bone marrow angiogenesis can be used as a tool to assess the disease activity. Key word: Idiopathic myelofibrosis, angiogenesis, Computeriz image analysis.


Article
CT -GUIDED TRANSTHORACIC BIOPSY OF SOLITARY PULMONARY NODULES USING AUTOMATIC BIOPSY GUN
اخذ الخزعات النسيجية من العقد الرئوية المنفردة باستخدام بندقيةَ الخزعة الآلية بمساعدة المفراسِ.

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Background: CT –guided percutaneous transthoracic fine needle aspiration biopsy (TFNAB) has become a widely accepted and effective minimally invasive technique for the diagnosis of a variety of intrathoracic lesions that are not readily accessible with bronchoscopy. It is generally regarded as a safe procedure with limited morbidity and extremely rare mortality. It provides high diagnostic accuracy and has a relatively low complications rate. Objectives: The aims of our study were to report our experience with regard to the accuracy & pneumothorax rate of percutaneous CT-guided biopsy of solitary pulmonary nodules using automatic biopsy gun. Patients and methods: Between January 2006 and August 2009, 54 patients (46 men and 8 women) with solitary pulmonary nodule underwent CT guided transthoracic biopsy at Al-Kadhimiya Teaching Hospital, Baghdad, Iraq. All the lesions could not be diagnosed with fiberoptic bronchoscopy. CT-guided biopsy was performed with an 18-gauge automatic biopsy gun. Chest radiography was done 2-4hr later and 24hr after biopsy for observation of pneumothorax. The overall diagnostic accuracy, pneumothorax rate, and chest tube insertion rate were determined. Diagnostic accuracy and pneumothorax rate were statistically compared according to lesion size & lesion depth (p value of less than 0.05 was considered to be significant). Results: Forty one patients (76%) diagnosed as malignant (diagnostic accuracy of 87.8%). Thirteen patients (24%) were diagnosed as benign (diagnostic accuracy of 92.3%). The overall diagnostic accuracy was 89% (48 of 54). The diagnostic accuracy did not differ with respect to the lesions size and lesions depth from the chest wall. Accurate diagnosis was made in 25 of the 29 nodules <20 mm (86%) and in 23 of the 25 nodules 20 mm (92%). Similarly accurate diagnosis was made for 36 (90%) of the 40 nodules shallower than 60 mm and for 12 (85.7%) of the 14 nodules 60 mm. Pneumothorax occurred in 23 (42%) patients. Pneumothorax occurred more frequently in small sized lesions (16 out of 29 lesions measuring <20 mm) as compared to (7 out of 25 lesions 20 mm) (P <0.05). similarly pneumothorax occurred more frequently in deeper lesions (10 out of 14 lesions 60mm in depth) as compared to (13 out of 40 lesions <60 mm in depth) (P <0.05). Only 7 (13%) patients requiring thoracostomy tube placement. Conclusions: CT- guided biopsy using automatic biopsy gun allowing a specific diagnosis for benign & probably malignant lesions. Diagnostic accuracy was not affected by the size and depth of the lesions. Deeper & small sized lesions have associated with an increased rate of pneumothorax. Keywords: solitary pulmonary nodule, CT – guided biopsy, automatic biopsy gun


Article
DETECTION OF B1 GENE OF TOXOPLASMA GONDII IN BLOOD OF PREGNANT AND ABORTIVE WOMEN INFECTED WITH THIS PARASITE
التحري عن الجينB1 في دم النساء الحوامل والمجهضات المصابات بطفيلي المقوسات الكونديه

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Background: Primary maternal infection with toxoplasmosis during gestation and its transmission to the fetus continue to be the cause of tragic yet preventable disease in offspring. Objective: This study was aimed to investigate the utility of nested PCR (nPCR) technique for detection recent infection with Toxoplasma gondii in blood of pregnant and abortive women. Methods: One hundred twenty women were included in this study with a history of single or repeated abortion and thirty women with normal pregnancy were used as a control. Blood samples were tested for specific anti-Toxoplasma IgM and IgG antibodies by an enzyme-linked immunosorbent assay (ELISA) and detection of B1 gene of T. gondii by nPCR. Results: The results indicated that 43.33% of abortive women were exposed positive for anti-Toxoplasma antibodies, 4.16% of them had IgM, 25.83% had IgG, and 13.33% had both IgM and IgG, and 56.55% had no antibodies. Subsequently, nested PCR analysis was used to detecting T. gondii DNA in blood of abortive women. It was found that 15.83%of abortive women exposed positive result for B1 gene of T. gondii, those abortive women involved 10.52% of them with IgM, 31.57%with IgG, and 26.31% with both IgM and IgG, and 31.57% of them had none anti-Toxoplasma antibodies. Conclusion: It can be concluded that nPCR assay in blood has advantage in detection of recent and active toxoplasmosis. Key Words: Toxoplasma gondii, nested PCR, toxoplasmosis.


Article
THE POSSIBLE PROTECTIVE ROLE OF BCL-2 IN RECURRENT ABORTION
الدور المحتمل لبروتين (BCL-2) في الحماية من الإجهاض المتكرر

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Background: Recurrent abortion is a worldwide problem, with undefined causes. Apoptosis could play a major role in the process. Objective: Detect the expression of Bcl-2 protein at the materno-fetal interface in patients with recurrent pregnancy loss (RPL). Methods: Immunohistochemistry analysis of Bcl-2 protein using paraffin embedded sections of curate samples obtained from 40 women divided into three groups: 24 women with recurrent abortion, 10 women with abortion for the first time, and 6 women with induced abortion. Results: The mean value of the expression of Bcl-2 protein was (57.9± 1.4), which is significantly higher than that of the second group (39± 1.9), and the third group (47.5± 2.4). Conclusion: High expression of Bcl-2 protein in women with recurrent abortion may have a protective role in preventing placental apoptosis that leads to failure of pregnancy. Keywords: Bcl-2, recurrent pregnancy loss (RPL).


Article
DOWN'S SYNDROME A NEW MATERNAL IRAQI RISK
متلازمة داون : خطر جديد للنساء العراقيات.

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Background: The occurrence of Down's syndrome is usually associated with advancing maternal age and increased parity. Objectives: This study explores the risk factor associated with the occurrence of Down's syndrome for different age groups. Methods: Blood sample from suspected Down's syndrome babies were prepared for chromosomal preparation. A hundred and fifty four blood samples from patients suspected of being Down's syndrome baby came with variable features which raise the suspicion of being Down's. Results: The study groups were 65 male and 89 female. Seventy seven (77) were the first member of the family, 68 were born for young mothers with an age between 15-34 years. Only nine were born for old mothers aged between 35-43 years. Seventy three were members of the family other than the first. Twenty six were born for mothers aged between 35-43 years, while the other 47 were born for mothers aged between 15-34 years. Chromosomal study for 4 cases revealed normal chromosomal findings. Conclusion: This study may show that young Iraqi mothers (under 35 year) carry high risk of having down's baby both in multi as well as primigravida. Key words: Down's syndrome, trisomy, primigravida, multigravida, Chromosome.


Article
CLINICAL CHARACTERISTIC AND IN –PATIENTS MORTALITY AMONG 100 PATIENTS WITH HEART FAILURE ADMITTED TO IBN SEENA CENTRAL HOSPITAL, MUKALLA, HADHRAMOUT- YEMEN
الخصائص السريرية والوفيات في المستشفى بين مائة مريض بفشل القلب ادخلوا مستشفى ابن سيناء المركزي – المكلا / حضرموت خلال الفترة من اكتوبر2007 إلى يوليو 2008.

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Background: The rate of heart failure in Hadhramout is steadily increasing. Objective: To determine the clinical characteristic and the predictors of in –hospital mortality of heart failure patients. Method: The first 100 consecutive patients with heart failure admitted to Ibn Seena central hospital in Mukalla for whom clinical history, physical examination and the basic investigations( including hemogram, blood sugar, chest X-Ray. Renal function test, serum cholesterol, electrocardiogram and echocardiogram) were performed during the period from October 2007 to June 2008. Results: In this study, we found male were more affected than female (65% versus 35%). The mean age of the patients was 57 ±12.1 years for males and 59 ±12.2 years for females. The most common underlying causes in all the patients were IHD in 52% followed by AHT 25%. IHD was more in males and AHT was more in females, while valvular heart diseases was the cause of HF in only 7%. The most common associated co-morbidities were renal dysfunction, anemia, dyslipidemia, diabetes mellitus and stroke in 43%, 41%, 35%, 25% and12% respectively. Patients of heart failure with impaired left ventricular function were 67.8%. And it was more in males than in females (52.7% &15.1%). The most common presenting symptoms was dyspnea of different classes in all of the patients and the most common sign was cardiomegaly in 89% of the patients followed by pulmonary crackles in 82%. And the most common arrhythmia were ventricular ectopic in 28% and atrial fibrillation in 21%. During the admission period 9 out of 100 patients died. The most common underlying causes were IHD, AHT and DCM and the most common co-morbidities of death were elder age of the patients, male sex, anemia, renal failure, DM, Stroke, impaired systolic ventricular function, and class IV NYHA dyspnea. Conclusion: This study revealed that HF is common in our community and it is recommended that early detection and management of the underlying etiology and associated co-morbidities could reduce the morbidity and mortality of HF Key words: Heart failure, clinical presentation, predictors, outcome. Mukalla, Yemen


Article
TREATMENT OF CONGENITAL UNDESCENDED SCAPULA WITH WOODWARD OPERATION, THE FUNCTIONAL AND COSMETIC OUTCOMES
النتائج الوظيفية و المظهرية لمعالجة عاهة عدم هبوط لوح الكتف الخِلقية بطريقة "وُود وُرد" الجراحية

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Background: Although congenitally undescended scapula (Sprengel’s deformity) reported to be rare, yet many families still seek medical help for their children. Cases with congenitally undescended scapula were collected, evaluated, and the majority subjected to surgical treatment with Woodward operation. Objective: Is to demonstrate the functional in addition to cosmetic improvements obtained with Woodward procedure used for Sprengel’s deformity. Methods: Between December 2007 and November 2009, fifteen patients with Sprengel deformity were evaluated (all have unilateral deformity) and treated surgically with Woodward procedure. The study included 9 males and 6 females, their age range from 5 to 11 years; right side is affected in 8 patients and left side in 7 patients. The preoperative grade of the deformity (according to Cavendish classification) and the maximum shoulder abduction were reported to assess severity and to be compared with the postoperative results. Results: All the patients get improvement in scapular elevation by about 2 grades and the increase in the maximum combined abduction was 20.33° in average. Two patients developed transient brachial plexus palsy. An omo-vertebral connection was found in 10 cases, in 3 cases the connection was bony, another 3 cases was cartilaginous, and 4 cases were fibrous. Conclusions: children with grade 2 and more and especially if abduction is much affected need to be treated with surgery, Woodward operation seems to be effective in handling both the cosmetic concern and the functional impairment. Keywords: Sprengel deformity, undescended scapula, Woodward.

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