Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

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Table of content: 2011 volume:10 issue:1

Article
Prevalence, Morphology and Chemical Composition of Gallstones in 150 Cholecystectomised Patients

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ABSTRACT:: BACKGROUND: Gallstones are a major cause of morbidity worldwide, and cholecystectomy is the most commonly performed abdominal surgery in medicine. Gallstone-induced complications have a limited and overlapping pattern of clinical presentation. In this article, morphology, composition of gallstones as well as diagnosis and therapeutic options employed in their management are reviewed. OBJECTIVE: The study is to defin the different types of gallstones,and to identify their characteristics and chemical coemposition in 150 patients PATIENTS AND METHODS: A retrospective study was performed on one hundred and fifty patients who were subjected to cholecystectomy during the period from January 1992 to January 2007, in the gastro-enterology & hepatology center and Al-Mustansyria Private Hospital in Baghdad by one consultant surgeon. RESULTS: The female: male ratio was 4:1 and the peak age group was that between 41-50 years. Thirteen percent of patients required explorations of the common bile duct (CBD), 72.7% of them were jaundiced, and 27.3% of those who had CBD exploration were not jaundiced. Ninety point seven percent of cholecystectomies were performed for calculus cholecystitis and 9.3% were for acalculus cholecystitis. Of the 136 patients with calculus cholecystitis, 19.9% had a solitary stone, and 32.4% had 2-10 stones; the highest number of stones was 250. Forty nine percent of stones were less than one centimeter in size; with the biggest stone being 4.5 cm in size. Unlike what is expected of "mixed stones ", they were not more than 30.9% of cases, while "cholesterol stones "constituting 40.4% of cases." pigment stones" constituted only 8.8% of stones; with "combined stones" constituting 17.6% of cases. CONCLUSION: There is an increased prevalence of gallstones in females and the frequency of gallstones increases with age in both sexes. In this article, there has been recognized three types of gallstones, cholesterol, mixed and pigment (black and brown) stones. The cholesterol stones account for more than 40% (the highest percentage of gallstones in the study).

Keywords

gallstones


Article
Relationship Between Serum Levels of TSH and Cholesterol with Types of Gallstones

Authors: Hassan H. Yousif
Pages: 7-12
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ABSTRACT : BACKGROUND : For decades there has been a discussion whether thyroid disorders could cause gallstone disease . Particularly, there are several explanations for a possible relation between hypothyroidism and gallstone disease , these explanations include the known link between thyroid failure and disturbances of lipid metabolism that may consecutively lead to a change of the composition of the bile , motility of biliary tract and it's effect on sphincter of Oddi . OBJECTIVE: To show the relation between serum levels of thyroid stimulating hormone (TSH) and cholesterol and types of gallstone . PATIENT AND METHOD : A prospective analysis of 150 cases with cholecystectomy , were studied in Al _ Sadar teaching hospital in AL _ Najaf goverment between 1st of January 2008 till end of December 2008 , for each studied patient with gall stone serum was taken for measuring the levels of TSH and cholesterol , stone was taken after cholecystectomy and sent for chemical analysis. RESULTS : There was a remarkable gender difference with predominance of female gender as it constitutes 132 (88%) versus 18 (12%) males . Abnormal high levels of serum TSH and cholesterol were reported in 12 cases ( 8% ) and in 15 cases (10% ) respectively . Types of gallstones , were cholesterol stones in 95 cases (63%) , pigmented stone in 33 cases (22 %) and mixed stone in 22 cases (15%) . CONCLUSION : There was relationship between high serum levels of TSH and cholesterol with types of gallstones

Keywords

TSH --- gallstone --- cholesterol


Article
Self Expandable Metallic Stents in Malignant Biliary Obstruction: Safety and Efficacy

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ABSTRACT: BACKGROUND: Endoscopic stenting has become widely accepted procedure for the relief of jaundice in patients with malignant biliary obstruction. It may offer lower morbidity and mortality, shorter hospitalization, and diminished overall cost compared with surgical or radiological approaches. OBJECTIVE: To assess the efficacy of the self expendable metallic stents in treatment of the patients with biliary stricture due to malignant tumors, and to compare this efficacy between proximal and distal obstruction. PATIENTS AND METHODS: SEMS were deployed during endocopic retrograde cholangiopancreatography (ERCP) in a total of 41patients with malignant biliary obstruction (proximal or distal) . Clinical success was defined as the improvement of the laboratory data and a decrease of the bilirary dilatation by follow up ultrasound imaging. Stent dysfunction was defined as recurrence of jaundice or cholangitis, is confirmed by ERCP or simply by elevated cholestatic parameters and treated by insertion of a plastic stent or second metallic stent inside the old one. RESULTS: Stent placement was achieved in 38 of 41 patients (92.7%) with malignant bile duct obstruction. SEMS was failed to be placed in 3 patients (1 with pancreatic cancer and 2 with proximal cholangiocarcinoma).Clinical improvement was seen in 36 of 38 patients (94.7%). In 4 patients (10.5%) cholangitis had developed.The overall stent patency time was 37.88 + 18.59 weeks (range 16-76 week). Analysis in subgroup of patients classified according to the site of obstruction (34with distal and 7 with proximal biliary obstruction).The overall success (technical and clinical) was significantly higher in the distal group (33/34, 97.1%) than in the proximal group (3/7, 42.9%); p-value was 0.02. CONCLUSION: SEMS implantation is a feasible , palliative method for inoperable malignant biliary obstruction. The clinical and the technical success of biliary drainage by SEMS is better achieved in distal than in proximal tumors with hilar infiltration by the tumor


Article
Urethral Strictures Associated with the Management of Non Muscle Invasive Bladder Carcinoma

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ABSTRACT: BACKGROUND: Carcinoma of Bladder is a common urological tumor. Urethral strictures with different grades are frequently seen in patients with non muscle invasive bladder cancer . OBJECTIVE: To elicit the incidence of urethral strictures, their severity and correlation with different factors in patients managed for non muscle invasive bladder tumor. PATIENTS AND METHODS: In a prospective study from January 2008 to January 2010 ,we followed 98 patients with superficial bladder tumor ,they were all male their age ranged from 38-76 years, all patients diagnosed endoscopically and histologically staged as superficial bladder tumor (excluding invasive bladder tumor),we follow those patients with a history regarding any change in urinary stream then urethrocystoscopically during a period of 1-2 years, we classify urethral strictures that was urethroscopically diagnosed as mild, moderate and sever. For each urethral stricture case we state the site and severity of the stricture, the number of preceding cystoscopies, duration of TURBT procedure and number of preceding chemotherapy sessions , the type of chemotherapy used and method of treatment required in each case. RESULTS: During the period of the study , a total of 23 urethral strictures (23.5%) were identified. They were all in the bulbar urethra, they were mild in 10 patients (43.5%), Moderate in 6 patients (26.1%) and sever in 7 patients (30.4%) and 14 patients with urethral stricture had also B.P.H(60.9%). Prior to the occurrence of stricture; urethrocystocopy was done once in 55.5% of cases , twice in 26.1% and 3 or more in 17.4%. Duration of TURBT procedure was≤20 mints in 30.4% and > 20 mints in 69.6%. Intravesical chemotherapy sessions were 0-3 in 17.4% of patients, 6 in 43.5% and more than 6 in 39.1%. The type of chemotherapeutic agent used was Doxorubicin in 56.5% of patients Mitomycin-c- in 26.1% and both of them (through multiple courses) in 13%. CONCLUSION: Urethral stricture associated with the management of non muscle invasive bladder tumors is a common and important clinical problem that need to be considered and avoided as far as possible ,Factors that may had a positive impact on the incidence of stricture were : B.P.H , duration of TURBT procedure, the number of intravesical chemotherapy sessions(6 and more) and doxorubicin instillation.


Article
The Role of Tadalafil in Lower Ureteric Stone Expulsion

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ABSTRACT: BACKGROUND: The Recent Studies have reported outstanding results concerning medical expulsive therapy (MET) for distal ureterolithiasis in terms of stone expulsion and control of colic pain. While ureteral intracorporeal lithotripsy and extracorporeal shock wave lithotripsy are recognized to be effective. OBJECTIVE: To evaluate the role of phosphodiesterase 5 inhibitor (tadalafil) 10mg in conservative therapy for patients with lower ureteral stones. PATIENTS AND METHODS: From December 2009 to October 2010, 60 consecutive symptomatic patients with juxtavesical unilateral lower ureterolithiasis from the urologic consultation department in Baghdad Medical City were enrolled in this randomized prospective placebo controlled study (pilot study). Patients were randomly divided into two groups, group 1 (n=30) and group 2 (n=30). Group 1 was given tadalafil 10mg. Group 2 was given placebo. Tadalafil 10mg or placebo was administered once daily. The treatment duration was until stone expulsion or 14 days. During this period, all patients were evaluated weekly by US and serum creatinine level, and were asked whether they experienced acute colic pain, to score the intensity of pain according to a visual analog scale, whether the calculus passed spontaneously, the day and time of stone expulsion, number of analgesic use, and any drug side effects. RESULTS: The mean stone size was 7.91mm for treatment group and 7.55mm for placebo group (p> 0.05) .The stone expulsion rate was 93% for treatment group and 67% for placebo group (P<0.05). Mean expulsion time was 5.5 days for treatment group and 8.84 days for placebo group (P=0.001). Mean VAS was 3.9 for treatment group and 7.9 for placebo group (P<0.0001). Mean number of indomethacin suppositories used was 1.33 for treatment group and 7.9 for placebo group (P<0.05). The univariate analysis using Cox proportional hazard model revealed that only therapy and stone size proved to be significantly predictive factors of stone expulsion (P<0.0001 and 0.001) respectively, while gender and age did not have any predictive value. Although side-effects occurred more in patients who were given tadalafil 10mg, no significant side-effect was detected so as to require exclusion of a patient from the study. CONCLUSION: Medical Expulsive Therapy (MET) for lower ureterolithiasis with tadalafil during conservative treatment period is safe and effective as demonstrated by the absence of serious side effects and increased stone expulsion rate with early time. Also MET with tadalafil 10mg affords an outstanding control of pain for patients while waiting for stone expulsion.


Article
Histopathological and Immunohistochemical Study of Giant Cell Granuloma of the Jaw and Giant Cell Tumor of Long Bones (Comparative Study)

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ABSTRACT: BACKGROUND: Central giant cell granuloma (CGCG) and peripheral giant cell granuloma (PGCG) are tumor like lesions that affect jaw bones, while giant cell tumor (osteoclastoma) is a tumor that affects the long bones (e.g. tubular bones). Its affection of the jaw bones is a matter of debate. Both are very similar in their histopathological features while they vary in their clinical behavior. GCT shows a more aggressive behavior than GCG. OBJECTIVE: To evaluate the expression of (Proliferating cell nuclear antigen) and (P53) in peripheral and central giant cell lesion of the jaw and giant cell tumor of long bones with correlation to histopathological parameters. METHODS: A total of 17 (GCT), 15 (CGCG) and 16 (PGCG) cases where enrolled in this study. Immunohistochemical staining with PCNA and P53 monoclonal antibody was performed. RESULTS: A non-significant difference in proliferative activities was recorded among different histological giant cell lesion subtypes. Giant cell granuloma expressed the same proliferative potential to that of giant cell tumor, moreover PCNA expression was not statistically correlated to different histopathological paramters of lesion subtype. On the other hand. The anti-apoptotic potential of giant cell granuloma which expressed by anti P53 monoclonal antibody was the same of that of giant cell tumor. CONCLUSION: Results of this study proved that the biological behavior namely P53 and PCNA activities was comparable between giant cell lesions and giant cell tumor. This suggest that these two conditions may act as one disease entity with a spectrum of clinical behavior, possibly due to certain differences in anatomical location which by itself affect its biological behavior. This hypothesis needs further verification concerning the clonality of the lesion to be accepted or refused


Article
Evaluation of the Complement (C3) in Patients with Acute Coronary Syndrome

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ABSTRACT: BACKGROUND: To evaluate complement activation (C3) levels in all forms of acute coronary syndrome (ACS) and to find whether there is any significant changes in C3 concentration at the 1st and 4th day after admission and its relation to clinical outcome. OBJECTIVE: Comparing the degree of complement activation (C3 level) between ACS and stable pectoris.To know whether there is any significant difference between the level C3 at first and fourth day. Any correlation between CRP and C3 in patients with ACS. PATIENT AND METHODS: 129 subjects (94 male and 35 female) age range (41-72 years, mean age 57 ± 10.6) were admitted in this study over the period of Feb 2009-Jan 2010 categorized into three groups; 76 patients with acute coronary syndrome (group A), 25 patients with stable angina (group B) and 28 healthy control (group C). Full clinical, biochemical, electrocardiographic and echocardiographic studies liveredone. All patients were followed to the fourth day of admission, Blood samples from peripheral veins were collected centrifuged and Serum C3 levels were measured using immunokit based on single immunodiffusion. RESULTS: The sample of patients was (129) subjects (94 male 72.9%) and (35 female 27.1%). Troponin (I) was positive in 35.7% and negative in 64.3% of the study sample (p. value 0.0005). C-reactive protein (CRP) was significantly correlated with different groups (p. value 0.0004).the same with diabetes mellitus (p. value 0.0003) but not in hypertensive and smokers (p. value 0.486 and 0. 368 respectively).C3levels was significant in correlation to clinical status in both STEMI and NSYEMI 1st and 4th day. Correlation between C3 and C-reactive protein level was insignificant with different groups. CONCLUSION: C3 levels was significantly elevated in correlation between ACS compared to patient with stable angina and healthy control subjects. Also C3 level was significant at the fourth day of admission in patients with NSTEMI in correlation to its level at the first day. However no significance associations between C3 levels and CRP in different studied groups


Article
Predictors of In-Hospital Mortality After Acute Myocardial Infarction

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ABSTRACT: BACKGROUND: Acute myocardial infarction remains a major cause of adult mortality. A steady decline in the mortality rate appears to be due to a fall in the incidence of acute myocardial infarction, a fall in the case fatality rate, identifying those patients who are at increased risk, and more aggressive prophylactic cardiovascular treatments to prevent it from occurring. OBJECTIVE: To identify, patients who have higher risk of in-hospital mortality after the first acute myocardial infarction. PATIENTS AND METHODS: The hospital mortality for the first acute myocardial infarction (AMI) was evaluated for 112 patients who were admitted to the coronary care unit in Baghdad Teaching Hospital during a total period of six months duration, between March and Sept. 2001. For each patient, history, clinical examination, electrocardiograms, fasting venous plasma glucose were done. RESULTS: Total mortality was 16.1%. The following factors were associated with higher in-hospital mortality: advanced age (more than 65 years), females, diabetic, and clinically evident heart failure. Other variables were not associated with increase or decrease in mortality: hypertension, smoking, admission heart rate, bundle branch block, previous angina pectoris, and the site of the infarction. CONCLUSION: Certain groups of patients tend to have higher mortality; patients older than 60 years, females, diabetic and patients with clinical heart failure. Other factors didn’t affect survival; location of the AMI, the presence of bundle branch block, hypertension, angina pectoris, smoking and the high heart rate on admission.


Article
Risk Factors of Small for Gestational Age Newborn Babies

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ABSTRACT: BACKGROUND: The most common definition of Small for gestational age (SGA) newborns refers to a birth weight below the 10th percentile for gestational age. Intrauterine growth retardation(IUGR) may be caused by maternal, placental, or fetal factors. However, no underlying etiology can be identified in at least 40 % of SGA infants. OBJECTIVE: To evaluate the risk factors of SGA births in a sample of Iraqi term newborns. PATIENTS& METHODS: A case control study extended over eight months from Dec. first 2007 to July 31st, 2008 . In this study, 100 SGA newborns &100 control newborns evaluated within the first day of life. This study was performed in delivery rooms &neonatal special care birth unit in Baghdad Teaching Hospital in Medical City . Data were collected by direct interview of the mothers. Data included different variables related to mothers & neonates. RESULTS: There was a significant relationship between SGA births & maternal urinary tract infections (OR=5.231, P<0.0001) & with antepartum hemorrhage (8.6 time risk ,0R=8.609, P=0.0349). The majority of SGA newborns(15%) occurred in multiple pregnancies (OR=17.471, P=0.0003). SGA newborns were more common among non employed mothers (OR=2.100, P=0.0355). Also SGA newborns had significant relationships with mothers not attended antenatal care (OR=3.648, P=0.0001),those with maternal history of SGA births (OR=15.474, P<0.0001) , those mothers with anemia (OR=5.532, P<0.0001) & lastly with mothers suffering from hypertension (OR=8.877, P<0.0001). CONCLUSION: There was significant relationship between SGA births and :Multiple pregnancies& maternal history of SGA births, mothers suffering from hypertension& maternal history of APH and maternal anemia& UTI, mother not attended antenatal clinic & with no employment.


Article
ABSTRACT: BACKGROUND: The most common definition of Small for gestational age (SGA) newborns refers to a birth weight below the 10th percentile for gestational age. Intrauterine growth retardation(IUGR) may be caused by maternal, placental, or fetal factors. However, no underlying etiology can be identified in at least 40 % of SGA infants. OBJECTIVE: To evaluate the risk factors of SGA births in a sample of Iraqi term newborns. PATIENTS& METHODS: A case control study extended over eight months from Dec. first 2007 to July 31st, 2008 . In this study, 100 SGA newborns &100 control newborns evaluated within the first day of life. This study was performed in delivery rooms &neonatal special care birth unit in Baghdad Teaching Hospital in Medical City . Data were collected by direct interview of the mothers. Data included different variables related to mothers & neonates. RESULTS: There was a significant relationship between SGA births & maternal urinary tract infections (OR=5.231, P<0.0001) & with antepartum hemorrhage (8.6 time risk ,0R=8.609, P=0.0349). The majority of SGA newborns(15%) occurred in multiple pregnancies (OR=17.471, P=0.0003). SGA newborns were more common among non employed mothers (OR=2.100, P=0.0355). Also SGA newborns had significant relationships with mothers not attended antenatal care (OR=3.648, P=0.0001),those with maternal history of SGA births (OR=15.474, P<0.0001) , those mothers with anemia (OR=5.532, P<0.0001) & lastly with mothers suffering from hypertension (OR=8.877, P<0.0001). CONCLUSION: There was significant relationship between SGA births and :Multiple pregnancies& maternal history of SGA births, mothers suffering from hypertension& maternal history of APH and maternal anemia& UTI, mother not attended antenatal clinic & with no employment.

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ABSTRACT: BACKGROUND: Pre-labour rupture of the membrane is a common clinical problem, and the assessment of the woman with possible membrane rupture is management issue faced in every day practice. When premature rupture of membrane (PROM) occurs, the fetus loses the relative isolation and protection afforded within the amniotic cavity. OBJECTIVE: To evaluate the reliability of vaginal washing fluid Beta-human chorionic gonadotropin for the detection of premature rupture of membrane and to determine a cut-off value. METHOD: A prospective case-study includes 79 pregnant women subdividing into three groups (groupA: 20 pregnant women with confirmed premature rupture of membranes, group B: 19 pregnant women with suspected premature rupture of membranes, group C: apparently healthy pregnant women without any complaint) for which speculum examination for amniotic pooling, nitrazine paper test, measurement of vaginal washing fluid Beta-human chorionic gonadotropin were performed. RESULTS: There was significant differences in mean vaginal washing fluid β-HCG concentration among the three groups (p= 0.000), being higher in group A than the other two groups and the time interval between sampling and delivery was significantly shorter among patient in group A than group B and C. CONCLUSION: Vaginal fluid β-HCG determination is reliable, simple and rapid test for the detection of PROM.


Article
Ultrasonographically Observed Grade III Placenta at 36 Weeks’ Gestation: Maternal and Fetal Outcomes

Authors: Lilyan W. Sersam
Pages: 67-72
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ABSTRACT: BACKGROUND: Current ultrasound assessment of placental calcification relies on Grannum grading. The ultrasonographic appearance of grade III placental maturation, if it occurs before 37 weeks, may signify placental dysfunction and is found to be associated with development of pre-eclampsia and low birth weight. OBJECTIVE: To look at the prevalence of a grade III placenta at 36 weeks’ gestation in a low-risk obstetric population, and to explore the association between premature aging observed ultrasonographically and pregnancy outcome. METHODS: Scans were performed at 36 weeks’ gestation in 591 low-risk pregnant women to determine placental maturity. The prevalence of grade III placenta at 36 weeks’ gestation was determined. Follow-up was performed for the group of women demonstrating a grade III placenta in comparison to those not demonstrating a grade III placenta for determining pregnancy outcome. RESULTS: The prevalence of grade III placenta at 36 weeks’ gestation was 3.9%. A grade III placenta at 36 weeks’ gestation was significantly associated with young maternal age P = 0.01. The Grannum grade III of the placenta at 36 weeks’ gestation was statistically associated with increased risk for development of proteinuric pregnancy-induced hypertention (PIH) later in pregnancy (RR 4.94; 95% CI 1.15-21.26), P = 0.021. Women demonstrating a grade III placenta at 36 weeks’ gestation had a significant high risk of induction of labour for suspected fetal compromise (RR 4.7; 95% CI 1.76-12.59), P = 0.001. The risk for delivering a baby with a weight <10th centile at birth was significantly higher in women with grade III placentas in comparison to those with grades 0-II (RR 3.19; 95% CI 1.23-8.27), P = 0.017. CONCLUSION: In a low-risk obstetric population, ultrasound detection of Grannum grade III placenta at 36 weeks’ gestation helps to identify at risk pregnancy. It appears to predict subsequent development of proteinuric PIH and may help in identifying the growth-restricted baby

Keywords

ultrasound --- grade III --- placenta --- outcomes


Article
Variation of Glucose Concentration During Different Phases of Menstrual Cycle

Authors: Maysaa Jalal Majeed
Pages: 73-77
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ABSTRACT: BACKGROUND: A woman's menstrual cycle (and accompanying hormonal changes) can cause variations in blood glucose levels. Many women may note an increase in their blood glucose after ovulation, which then decreases once menstruation starts. These changes are caused by the hormones estrogen and progesterone, which occur at higher levels before period. They influence insulin in causing blood glucose to rise. It is important to test blood glucose levels during this cycle to be certain that blood sugar variations are attributed to menstruation. OBJECTIVE: To study the effect of sex hormones (testosterone, estradiol and progesterone) on the level of glucose; as well as it may shed light on suitable dose of diabetic treatment during different phases of menstrual cycle. SUBJECTS & METHODS: This study included 50 healthy female with regular menstrual cycle aged 25-40 years (control group) and 25 diabetic type2 (well controlled) female with regular menstrual cycle aged 30-40 years. Serum fasting glucose and sex hormones (testosterone, progesterone and estradiol ) were evaluated in these two groups of patients and controls during follicular and luteal phases of sexual cycle. Colorimetric method was used in the serum glucose concentration determination, Enzyme Linked Immune Sorbent assay (ELISA) was used in the determining sex hormones level. RESULTS: The results of the present revealed significant increase in mean (+SD) values of serum glucose (p<0.05) and serum progesterone levels (p<0.05) with significant decrease of serum estradiol mean (+SD) values (p<0.01) in lateual phase than follicular phase of menstrual cycle of healthy women. Similar findings were found in diabetic women who have regular menstrual cycle .Serum glucose and serum progesterone showed significant increase ,while serum estradiol showed significant decrease in the luteal phase compared with follicular phase . No significant difference was found serum testosterone level in the above studied groups between the phases. It was found that 22% of healthy women with regular menstrual cycle showed elevation in their serum glucose concentration during the luteal phase of their sexual cycle. CONCLUSION: The study revealed that blood glucose level changes along the period of menstrual cycle , due to the interaction between the hormones that control menstruation (estrogen and progesterone ) and the insulin hormone


Article
Status of Total L-Carnitine Level in the Seminal Plasma of Iraqi Infertile and Fertile Men: Correlation Study with Semen Quality

Authors: Zainab N.H. Anbar
Pages: 78-80
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ABSRACT: BACKGROUND: Carnitine is highly concentrated in the epididymis and Spermatozoa, where it may serve as an intramitochondrial vehicle for theAcyl group, a substrate of energy production. This study is aimed to determine any correlation between male infertility and semen quality with Concentration of L- carnitine in human seminal plasma. OBJECTIVE: This case-control study performed at the Institute of Embryo Research and Infertility, University of Al-Naharin, Baghdad. Semen samples of 40 infertile men (azoospermia, n=12, oligoasthenozoospermia, n=16, teratozoospermia, n=12) and 12 fertile men controls were collected. METHODS: The level of total L- carnitine in seminal plasma was determined by high performance liquid chromatography and the results correlated with sperm parameters as sperm count, motility and morphology. RESULTS: The level of L-carnitine was significantly reduced in infertile male groups; azoospermia, oligoasthenozoospermia and teratozoospermia in comparison with that of fertile male controls (P< 0.045, P< 0.023 and P< 0.04; respectively). There was a borderline significant positive correlation between the seminal L-carnitine and the sperm count in fertile group(r=0.63, P< 0.51). CONCLUSION: The results of this study indicated the significance of determination of seminal plasma L-carnitine in evaluation of infertility in men and the importance of recognition of those infertile male who are benefit from administration of carnitine supplement.


Article
Analysis of DNA Damage and Oxidative Stress in Human Spermatozoa and Some Biochemical Changes in Seminal Plasma and their Correlation with Semen Quality of Infertile Men

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ABSTRACT: BACKGROUND: Numerous studies have shown the presence of DNA strand breaks in human ejaculated spermatozoa. The nature of this nuclear anomaly and its relationship to patient etiology is however poorly understood. OBJECTIVE: This study was done to investigate the relationship between nuclear DNA damage, assessed using the TUNEL assay and a number of biochemical parameters including zinc level, copper level, and the malondialdehyde (MDA) level as an indicator of the lipid peroxidation and also the standard general seminal fluid examination. MATERIAL AND METHODS: In this study 100 seminal samples were tested. Seventy five infertile patients aged (30.33±5.96) and 25 normal people aged (29.84±6.434) were included as a control. All tests were done to all the samples except the DNA fragmentation which was done to 60 samples only (45 patients and 15 normal). RESULTS: A positive relationship between DNA damage level and infertility was found. Also there were higher levels of MDA level and DNA damage in spermatozoa of infertile patients (P=0.001). We found also absence of difference in the copper level between the two groups. Regarding seminal zinc level we found that there was a low zinc level in infertile patients (P=0.001). Non-significant correlations between zinc level and the percentage of DNA fragmentation and the MDA levels were obtained. CONCLUSION: This study suggested that sperm DNA analysis might be better discriminator between infertile and fertile men than standard semen analysis also oxidative stress and sperm DNA damage contributed to sperms dysfunction. The infertile samples associated with high levels of oxidative stress and low seminal zinc levels.


Article
Nicotine Dependence among a Group of Iraqi Schizophrenic Patients

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ABSTRACT: BACKGROUND: Substance dependence frequently co-occurs with psychiatric morbidities. Among substances, nicotine found to be the commonest substance of abuse among schizophrenic patients. OBJECTIVE: To assess the association of nicotine dependence with Schizophrenia. METHOD: 112 schizophrenic patients and 374 non-schizophrenic patients were invited to answer a standard clinical/demographic questionnaire and a questionnaire on nicotine dependence (modified Fagerstrom Tolerance Questionnaire (mFTQ)). RESULTS: The rate of nicotine dependence was significantly higher among schizophrenic patients (44.64%) than non-schizophrenic patients (23.52%) (P < 0.000). Male smokers outnumbered female smoker (P < 0.000) in both groups. Male gender was a significant predictor for smoking among both groups of patients (OR = 55.878; P = 0.000 for schizophrenic patients; OR = 9.489; P = 0.000 for non-schizophrenic patients). Increase in age was significant predictor for nicotine smoking in general (OR = 1.032; P = 0.001), and among the schizophrenic group (OR = 1.116; P = 0.000), whereas, it was not a significant predictor for nicotine smoking among non-schizophrenic patients (OR = 1.014; P = 0.185). Whole sample patients start nicotine smoking before their psychiatric disorders onset (3.3 and 7.7 years earlier respectively) (P = 0.01). Both groups were highly nicotine dependents (mean mFTQ = 9.92 for schizophrenic patients; mean mFTQ = 8.54 for non-schizophrenic patients) (P = 0.02). CONCLUSION: The rate and severity of nicotine dependence were higher among patients with schizophrenia than non-schizophrenic patients. Gender and age were significant predictors for nicotine smoking in whole psychiatric patients. Both groups started their smoking habit before their psychiatric morbidity onsets.

Keywords

schizophrenia --- nicotine --- dependence


Article
Psychological Study in Women with Premenstrual Dysphoric Disorder

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ABSTRACT: BACKGROUND: Premenstrual dysphoric disorder (PMDD) is a somatopsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle. It affects about 3% to 8% of women in their reproductive years. The symptoms of this disorder are primarily affective. The disturbance markedly interferes with work, school or with usual social activities and relationships with others. OBJECTIVE: Are to determine the prevalence and the sociodemographic factors in relation to PMDD and to find out the characteristic features of premenstrual symptoms and their impact on daily living. METHOD: 145 women aged between 18 and 55 years with regular menstrual cycles who met the diagnostic criteria of PMDD out of 1792, were assessed regarding their premenstrual symptoms using the Premenstrual Symptoms Screening Tool (PSST). The study was conducted in 1st August 2009 until 31thDecember 2009. RESULTS: The study revealed that 8.1% of women met the diagnostic criteria of PMDD. It was found more common among younger females 36.5% (18-25years of age), the majority of them were married (71%). CONCLUSION: PMDD is relatively common in women especially younger age group


Article
Lipid Peroxidation and Oxidative Stress in Patients with Fibromyalgia Syndrome

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ABSTRACT: BACK GROUND: Fibromyalgia (FMS) is a common, chronic widespread pain syndrome usually associated with other somatic and psychologic symptoms including fatigue, sleep disturbances, cognitive difficulties Oxidative stress means an alteration in the delicate balance between free radicals and the scavenging capacity of antioxidant enzymes in favor of free radical in the body system. OBJECTIVE: To evaluate and compare the antioxidants and lipid peroxidation in patients with fibromyalgia and healthy control. PATIENTS AND METHOD; The study has included sixty patients with FMS (40 females and 20 males) and thirty healthy subjects. The subjects were selected from people attending the out patients clinic in Medical City- Baghdad Teaching Hospital- Rheumatology& Rehabilitation Consultation Unit. Laboratory parameters included: uric acid,albumin,caeruloplasmin,total thaiol,malondiaaldehyde(MDA) and peroxinitrate(ONOO¯ ). RESULTS: MDA and uric acid levels in serum of patients with fibromyalgia were significantly higher than in the control group. While the levels of ONOO¯ GSH,CP,albumin in serum of patients with fibromyalgia were significantly lower than in healthy control. CONCLUSION: oxidative stress may have a role in the pathophysiology of fibromyalgia syndrome.

Keywords

lipidperoxide --- ONOO¯ --- GSH --- CP --- uricacid --- albumin --- fibromyalgia.


Article
Determination of Anti-Cyclic Citrullinated Peptide (ACCP) and C-Reactive Protein (C-RP) Concentrations in Serum of Patients with Fibromyalgia Syndrome (FMS)

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ABSTRACT: BACKGROUND: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal syndrome; almost invariably, symptoms persist at 5- and 10-year follow-ups. The degree of functional impairment is similar to that seen in patients with moderate to severe rheumatoid arthritis. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, in the early disease process, with the ability to identify patients who are likely to have severe disease and irreversible damage. CRP is a member of the class of acute-phase reactants that its levels rise dramatically during inflammatory processes occurring in the body. OBJECTIVE: the main objective of this study is to determine the frequency of anti CCP- in patients with FM and the association of anti-CCP level with C-RP. PATIENTS & METHODS: This study included 60 patients with FMS according to the ACR 1990 criteria. Their age range was 20-60 years. These patients were then matched by age and sex to 30 healthy control persons with mean age 42.81 ± 2.16 years. RESULTS: The mean values of ACCP antibodies concentration in serum of patients with FMS were no significant difference as compared to the level in serum of healthy controls (p>0.05), while the mean values of C-RP concentration in serum of patients with FMS were significantly increased than the level in serum of healthy control (p< 0.05). CONCLUSION: It is clear from this study that there is no relationship between the levels of ACCP concentration and FMS while C-RP concentration in patients with FMS may be a good indicator to evaluate this disease.

Keywords

ACCP --- C-RP --- FMS


Article
The Frequency of Some Deramatoses Related to Increase Solar Radiation Exposure in Sulaimania City

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Abstract

ABSTRACT: BACKGROUND: Various skin disorders are related to increase solar radiation exposure. These diseases mainly increase in spring and summer months among general population due to an increase to sun light exposure and an increase intensity of ultravaiolet radiation (UVR). OBJECTIVE: This study was done to evaluate different skin diseases related to study the frequency of the skin diseases related to increase exposure to UV light in Sulaimania city. METHODS: This is a selective prospective study; the data collected during the period of the January 2006 to September 2007 in Dermatology Department in Consulting Clinic in Sulaimania city, 391 cases were collected in both sexes whose ages ranged between 5 and 73 years with a mean age of 39 years. Full history and thorough physical examination was done for all patients. RESULTS: Three hundred ninety one patients were included in this study ; they were 190 (48.6%) males and 201 (51.4%) females, there ages ranged between 5-73 years with a mean age of 39 years. Sunburn 116 (29.7%) patients was the commonest condition seen, acne like eruption 84 (21.4%) patients, drug photosensitivity: 74 (18.9%) patients, Polymorphous light eruption: 32 (8.1%) patients, Chronic actinic dermatitis: 24 (6.1%) patients, Lichenoid dermatitis: 21 (5.3%) patients, Actinic prurigo like polymorphic light eruption 18 (4.6%) patients, .Lichen planus actinicus: 15 (3.9%) patients, Solar urticaria: 5 (1.2%) patients, Porokeratoses: 2 (0.6%) patients, The number of the cases variable during the months from no cases in January and February to the highest numbers during the summer months with a top (149) patients, in August. CONCLUSION: To best of our knowledge this is first study done about UVR exposure in Sulaimania city. There are various dermatoses related to increase UVR exposure, as the UV index increases, the number of cases increases. The highest number of cases occurs in summer (especially in July and August), because in summer the UV index reaches its higher levels and the outdoor activities increase with inadequate protective measures in Sulaimania without regular used of sunscreen. We recommend strict use of sunscreen for males and females especially summer times and avoid going out in specific times of the day especially in summer. We recommend future studies about tumors, photoaging, DNA repair-defective disorders and dermatoses aggravated by solar exposure like porphyria, SLE, pellagra, rosacea.


Article
Comparative study on the Effect of Antibiotics and Non Antibiotics Therapy (Phytotherapy) on Some Bacteria Isolated from Urinary Tract Infection

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ABSRACT: BACKGROUND: Phytotherapy is an alternative for antibiotics therapy in these days since resistance to many antibiotics used in treatment are increasing along with high cost of some antibiotics and side effect on patients. Punica granatum and Vaccinium macrocarpon have antimicrobial properties. this paper suggest that P. granatum and Vaccinium macrocarpon may be more effective than some antibiotics used in the treatment of some Gram negative urinary tract pathogens. OBJECTIVE: Punica granatum juice, cranberry juice and antibiotics were used to investigate the antimicrobial activity by using well diffusion method. MATERIALS & METHODS: A total of four different urinary tract causing pathogens collected from patients with urinary tract infection (UTI). RESULT: The result indicate that extract obtained from Punica granatum pericarp exhibited antimicrobial activity against all organisms almost similar to the effect of cranberry which is not grown in Iraq and that Punica granatum and Vaccinium macrocarpon are more effective than some antibiotics used in the treatment of urinary tract infection. CONCLUSION: The antibacterial activity of crude extract of P. granatum against urinary tract causing organisms is reported for the first time and it showed similarity with the effect of cranberry juice that are not found or imported to the local market. Further phytochemical elucidations are required to determine the nature of compound(s) responsible for the antibacterial effects. This study is generally considered an effective approach in the discovery of new antibacterial agents from P. granatum.


Article
Increase serum IL-8 Level in Iraqi Patients with Helicobacter Pylori CagA Genotype Infection

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ABSTRACT: BACKGROUND: More than half of all humans are colonized in their stomachs by Helicobacter pylori . That carriage was nearly universal among adults in developing countries suggests that in earlier times most humans carried these organisms.H. pylori was an important human pathogen that causes gastritis and is strongly associated with gastric ulcers, gastric adenocarcinomas, and mucosa-associated lymphoid tissue lymphomas. In response to H. pylori, interleukin-8 (IL-8) was secreted from host cells to attract components of the innate and adaptive immune systems to the site of infection.CagA+ cells induce higher levels of the proinflammatory IL-8 cytokine. That such effects are specific for CagA island genes had been shown by our study. OBJECTIVE: To determine the role of incidence of H.pylori CagA positive strain in induce higher level of the proinflammatory cytokine IL-8. METHODS: One hundred and fifty(150) Patients attended the Endoscopic Unit at"Gastroenterology and Hepatology Teaching Hospital/ Baghdad Medical City"were included in this study with ages range from 18 years to 65 years . The source of specimens to undergo oesophageal gastroduodenoscopy (OGD) collected from April 2009 to end of March 2010 were eligible for this study.Two types biopsy of samples for histopathology to detect H.pylori and detection of CagA gene by In Situ hybridization(ISH) and blood samples for estimation of serum IL-8 level by ELISA. RESULTS: There was a significant increase in IL-8 serum levels that P<0.05 due to the significant increase of Cag A in H.pylori positive strains. CONCLUSION: Our study revealed that increased in CagA expression in H.pylori positive strains and induced higher levels of the proinflammatory cytokines

Keywords

h.pylori --- IL-8 --- cag A.


Article
The Effect of Age on Clinical and Radiological Presentation in Patients with Pulmonary Tuberculosis in Baghdad

Authors: Hashim M.Al-Kadhimi --- Haider Noori Dawood
Pages: 125-129
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ABSTRACT: BACKGROUND: Mycobacterium tuberculosis causes the most common type of human tuberculosis worldwide .The most common mode of transmission is by inhalation of droplet nuclei from expectorated respiratory secretions.Active infection is diagnosed by documenting the presence of M tuberculosis in respiratory secretions or other body fluids or tissues.Age is an important determinant of the risk for the disease .The risk may increase in the elderly OBJECTIVE: To compare the effect of age between elderly and younger on clinical and radiological presentation in patients with pulmonary tuberculosis in Iraq. PATIENTS AND METHODS: A prospective study was done for 251 patients with smear positive pulmonary tuberculosis in outpatient's clinic in the Chest and Respiratory Disease Specialized Center in Baghdad.Collected from January to May 2009.The following parameters were assessed: Age, gender, symptoms, risk factors, radiological findings, and incidence of recurrent .The relation of these parameters between elderly and younger was evaluated RESULTS: There were 174 young adult patients and 77 elderly patients .The elderly group age was between 60- 80years ,and younger adult age was between 17-59 years. There was no significant difference in the symptoms between the two groups .Family history of pulmonary tuberculosis (p=0.009) was more common in young adult, while DM (p=0.001) was more common in elderly .Comparison of radiological findings in young adults vs. elderly patients shown a typical findings (p=0.036) which is more in elderly .There was no significant difference in the incidence of recurrence between the two groups. CONCLUSION: There was no significant difference in the symptoms between elderly and younger age groups . Family history of PTB was more common in young adults, while DM was more common in elderly. A typical radiological findings were more in elderly.There was no significant difference in the incidence of recurrence between the two groups

Keywords

tuberculosis --- age --- radiology


Article
Does Normal Chest X ray in Patients with Chronic Cough Exclude Pulmonary tuberculosis?

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ABSTRACT: BACKGROUND: Tuberculosis is the second infection in causing deaths from infectious agent in the world, currently in Iraq approximately 67% of new cases of Tuberculosis involve the lung only ,cough is the most common symptom of pulmonary Tuberculosis , pulmonary Tuberculosis nearly always causes detectable abnormalities on chest film, but still atypical or absent radiologic findings can occur. OBJECTIVE: This study was designed to determine whether in patients with chronic cough normal chest X ray exclude pulmonary tuberculosis. PATIENTS AND METHODS: One hundred seventy two patients attending the respiratory clinic, complaining from chronic cough and they are suspected cases of tuberculosis, were enrolled in this study. A full medical history and physical examination was done then a chest X ray was ordered, for those with normal chest X ray finding (seventy seven patients), sputum smear for acid fast bacilli (AFB) ordered . RESULTS: 47 females (61%), 30 males (39%) with chronic cough with females to male ratio = 1.56/1.The age ranged between 17-67, with mean age of 37.16 years. The age of males ranged between 18-67 and the mean was 39.32 years, the age of females ranged between 17-66 and the mean was 34.93 years. X ray finding were negative in all the patients. Positive AFB in sputum smear examination by microscopy was found in only one patient but with ENT examination it was proved to be a case of laryngeal tuberculosis not pulmonary tuberculosis. CONCLUSION: Normal chest x ray in patients with chronic cough excludes pulmonary tuberculosis


Article
IL-5 As Indicator of Acute Toxoplasmosis

Authors: Suha A.AL-Fakhar --- Sami Y. Guirges
Pages: 134-138
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ABSTRACT: BACKGROUND: Exposure to Toxoplasma gondii may result in either chronic infection or acute infection, the latter being asymptomatic or symptomatic. Toxoplasma infection stimulates humoral immune response ,in addition to cellular mediated immunity. Also cytokines have a role in resistance to T.gondii like IL-5 which has protective role during infection with the parasite. OBJECTIVE: This study aimed to assess the correlation between IgM and IgG Toxoplasma antibodies and IL-5 in the course of acute toxoplasmosis . PATIENTS AND METHODS : 45women suspected of having toxoplasmosis were tested by ELISA IgM and IgG toxoplasma antibodies , and the level of serum IL-5 was tested using ELISA technique only on 32 women . RESULTS: The results showed that there are higher titer of IgM and IgG-Toxoplasma antibodies and higher levels of serum IL-5 in women with Toxoplasma infection . CONCLUSION: Serum IL-5 can be used as indicator to predict the presence of acute toxoplasmosis in pregnant women at high risk to toxoplasmosis.

Keywords

toxoplasmosis --- IgG --- IgM --- IL-5.

Table of content: volume:10 issue:1