Table of content

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: 2012 volume:10 issue:2

Article
EDITORIAL: AGEING AND SENESCENCE

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Abstract

Keywords


Article
EFFECT OF AQUEOUS EXTRACT OF TURMERIC ON PATHOGENIC BACTERIA ISOLATED FROM SEMEN IN A SAMPLE OF IRAQI INFERTILE MEN

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Background: Contamination of semen with sexually and none sexually transmitted bacteria plays an important role in male infertility, contaminating bacteria should be eradicated by antibiotics, but most of bacteria become resistant to available antibiotics. Therefore most researchers search to find other antibacterial agents. Objective: To evaluate the frequency of bacteria in semen of infertile men and investigate the antibacterial activity of aqueous extract of turmeric (AET) on certain isolated bacteria from semen of infertile men compared with that of doxycycline as a standard antibiotic. Methods: Forty two semen samples obtained from infertile men attending The Higher Institute of Infertility Treatment and Assisted Reproductive Technology were evaluated bacteriologically using standard bacterial culture. Then investigated the antibacterial activity of AET on certain isolated bacteria from semen of infertile men compared with doxycycline using disc diffusion method. Results: Out of 42 semen samples of infertile men, 35(83.03%) were infected with different bacterial species (spp.) accompained with highest incidence rate. The overall frequency of N.gonorrhea and S.epidermides was 8(19%) and for remaining bacterial isolated from semen (S.aureus, G.vaginalis and E.coli) were 6(14.28%). Comparable antibacterial activity of ATE and doxycycline was found to be evident against most isolated bacteria (P<0.001) in mean inhibition zones of AET between Gram’s positive and Gram’s negative bacteria (23.35±0.68 and 8.35±1.52, respectively). Conclusion: Most of isolated bacteria from semen of infertile males had high frequency, which were generally accepted as pathogenic bacteria. Antibacterial activity of AET was comparable with doxycycline against most isolated bacteria and it was found more effective on Gram’s positive than Gram’s negative bacteria. Keywords: Turmeric, pathogenic bacteria, semen, infertile men


Article
AGE-RELATED CHANGES IN HUMAN SKIN: HISTOLOGICAL, MORPHOMETRIC AND IMMUNCYTOCHEMICAL STUDY USING S100

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Background: Aging has many effects on a person’s skin, from wrinkles and sags to increased risk of certain skin conditions, such as skin cancer. As people age, their skin begins to change due to environmental, genetic, nutrition and other factors. Objectives: Understand some of the changes that occur in aging skin including changes in the general morphological, histological and architectural arrangement, epidermal thickness, basement membrane and histochemical changes in melanocytes. Methods: Skin specimens were taken from the anterior abdominal wall of 30 human males at different ages. General histological preparation for paraffin blocks was performed and the blocks were sectioned at (5-6µ) and stained with H&E. S100 protein was used to demonstrate immunohistochemistry labeled melanocytes changes with age. Histometric measurement of epidermal thickness and basement membrane thickness, using eyepiece graticule was performed on these groups. Results: The young age group showed a uniform arrangement of cells in all stratums of the epidermis while the old age group showed diminished thickness of the epidermis. A significant difference between young- adult age group (A and B groups) and the old age group (C group) was recorded. The epithelial basement membrane thickness was increased with age significantly (P value ≤ 0.001). Melanocytes demonstration using S100 showed that these cells tend to be situated at the tips of rete pages, there number are generally low and didn't varied a lot between young and adult age groups. There was yet marked decline in the number of melanocytes in old age group. Conclusion: Aging as a process have a marked influences on skin morphology, thickness, cellularity and basement membrane. Key Words: Aging, skin, S100, morphometry and basement membrane


Article
IMMUNOHISTOCHEMICAL EXPRESSION OF MMP-3 AND MMP-8 IN BREAST CARCINOMA. A CLINICOPATHOLOGICAL STUDY

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Background: Matrix metalloproteinases are enzymes that are involved in the digestion of the components of the extracellular matrix (ECM), cell surface receptors for soluble factors and junctional proteins and physiological processes such as tissue remodeling, but also in the stimulation of tumor growth, invasion, and metastasis. Objectives: To assess the immunohistochemical expression of MMP-3 and MMP-8 in breast carcinoma and to correlate this expression with clinicopathological parameters including patient’s age, tumor size, grade, subtype, lymph node status and lymphovascular invasion. Method: Sixty-two tissue blocks of breast carcinoma specimens were collected from Al-Kadhimiya Teaching hospital and Teaching Laboratories of the Medical City Center. Three sections of 5µm thickness were taken from each block and stained with H&E and Immunohistochemically for MMP-3 and MMP-8. Results: MMP-3 and MMP-8 expression were statistically correlated with patient's age, tumor grade, tumor size, histological subtype, lymph node involvement, and lymphovascular permeation with the exception of MMP-8 and age. Strong expression for MMP-3 was noticed in invasive carcinoma, high grade tumors, large size tumors, cases associated with positive lymph nodes and lymphovascular permeation (positive correlation). Negative expression for MMP-8 was noticed in most of the cases associated with lymphovascular permeation and positive lymph node(s) involvement by the metastatic cells (inverse relationship). Also a negative expression for MMP-8 was noticed in most cases associated with high grade, large size tumors. Conclusions: Assessment of MMP-3 in breast carcinoma reflects the grade of tumors and can predict progression of insitu to invasive cancer, lymph node involvement and lymphovascular permeation so that it may be useful additional prognostic factor. Expression of MMP-8 correlates with a lower incidence of lymph node metastasis and lymphovascular permeation and can be utilized as a marker indicating a good prognosis to these patients. Keywords: Breast carcinoma, MMP-3, MMP-8.

Keywords

Breast carcinoma --- MMP-3 --- MMP-8.


Article
THE PROLIFERATIVE PATTERN OF THE VENTRICULAR NEURO-EPITHELIUM OF EMBRYONIC RAT FOURTH VENTRICLE

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Background: Studies have shown that the ventricular neuroepithelium (VN) of the dorsal metencephalonrepresents the site of the cerebellar GABAergic neurons progenitors' production. These studies used different histological techniques but all have provided qualitative information regarding the biosynthesis and cell mitosis. Objective: Quantifying the proliferative activity of the cells at the (VN) during the embryonic period. Methods: Nine age groups from day 13 to day 21 albino rat embryos Rattusrattusnorvegicusalbinus were investigated with Ag-NOR staining technique. Results:There was a statistically significant difference (p<0.01) between cellular activity at different age groups with a maximum proliferative activity on the embryonic day 15. Conclusion: Ag-NOR staining technique provided a valuable quantitative index of cell proliferation at the (VN) of the developing cerebellum. Key words: Ventricular Neuroepithelium, Rhombencephalon, Ag-NOR, Quantitative


Article
THE EFFECT OF AGING ON HUMAN TESTIS: ANATOMICAL AND HISTOLOGICAL STUDY

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Background: Aging of testis is gradual dysfunction of body organs and tissues due to reduction of cell number and loss of cell capacity for reproduction and regeneration of its structural elements. Objective: To study the age related changes of the human testes anatomically and histologically. Methods: Forty testes of twenty adult Iraqi male cadavers, with age ranged from 20-69 years were taken from the Forensic Medicine Department of Tikrit and Azadi Teaching Hospital in Salahddin and Kirkuk province, respectively during the period from November 2006 to September 2007. The testicular specimens were divided into five groups according to cadaver age. Tunica albuginea was removed to investigate the lobular and tubular structures of the testis, by anatomical and histological procedures. Results: The gross metrical measurement and anatomical inspection revealed that a negative correlation was existed between the process of aging and the weight of the postmortem, testis. A strong directly proportional positive correlation was found between age and the thickness of basement membrane, interstitial spaces between seminiferous tubules. Tubular sclerosis was observed in some testis specimens of senescent cadavers associated with a decrease in the number of the lining epithelial cells of the seminiferous tubules and sclerotic changes in the walls of testicular blood vessels. Conclusion: The process of aging leads to testicular changes such as tubular diverticula and decrease in number of leydig cells. Key words: Aging, Leydig cells, senescent testis, seminiferous tubules.


Article
THE FREQUENCY OF FLT3 MUTATION IN FIFTY FIVE IRAQI ADULT PATIENTS WITH ACUTE MYELOID LEUKEMIA

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Background: Mutations within the FLT3 gene, which code for the class-III-receptor kinase FLT3, ranked within the most frequent recurrent known genetic markers in acute myelocytic leukemia (AML). Internal tandem duplication (ITD) mutations in the juxtamembrane domain of FLT3 gene occur in 20-25% of AML. Objectives: This study designed to detect the frequency of FLT3-ITD mutation in adult AML patients, and to correlate the prevalence of this mutation with the clinical presentation of the patients and their response to induction therapy. Methods: The study comprised 55 AML patients and 33 healthy controls. For each patient, complete blood picture, blood film, bone marrow aspiration and biopsy was done. FLT3-ITD mutation was detected by conventional Polymerase Chain Reaction technology. Complete hematological remission achievement after induction chemotherapy was assessed by clinical examination and full laboratory investigations. Results: Out of 55 AML patients 8 (14.54%) had FLT3-ITD mutation and all of them presented as de novo AML. Moreover, 6 (75%) out of 8 mutated patients were newly diagnosed whereas 2 out of 8 were in relapse and were not on any therapy. The mean age of patients who had the mutation was lower than those without the mutation; also the majority of patients with mutation were male. The mean WBC count in mutated patients was not significantly higher than non-mutated patients. Higher bone marrow blast cell percent was found in mutated patients. FLT3-ITD mutation was mostly detected in M3 (37.5%) followed by M2 (25%), and lastly in M1 and M4 subtypes (12.5% for both subtypes) of FAB classification. Four out of 8 mutated patients failed to response to induction therapy although they were with good compliance to drug and 1/8 died throughout the induction therapy. Conclusion: Since FLT3-ITD mutation was associated with higher WBC count, significantly higher bone marrow blast cell percent and low rate of response to induction therapy; therefore it had been considered one of poor prognostic factor. It is a factor in defining risk stratification of AML patients. Keywords: AML, FLT3-ITD mutation, conventional PCR, FAB sub-types


Article
IMMUNOHISTOCHEMICAL EXPRESSION OF CD34, SMOOTH MUSCLE ACTIN AND TYPE IV COLLAGEN IN BREAST CARCINOMA. A CLINICOPATHOLOGICAL STUDY

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Background: Tumoral angiogenesis is essential for the growth and spread of breast cancer cells. Objective: To evaluate angiogenesis by measuring microvessel density (MVD) with CD34 and its maturity with smooth muscle actin (SMA) immunohistochemistry and to study invasion of basement membrane by tumor cells using type IV collagen. Methods: In the present study microvascular quantification was undertaken on 52 cases of breast carcinoma and 5 cases of benign breast lesions after immunohistochemical staining of tumor vessel, using CD34 antibody and SMA antibody. Microvessel quantification was performed at x400 magnification in the three most vascular areas of the tumors (hot spots). Results: The difference in MVD between benign and malignant cases is significant (P= 0.001). MVD is significantly correlated with L.N. involvement (P=0.004) and lymphovascular permeation (P=0.001), no statistical significant correlation between MVD and age of patient (P=0.656), tumor size (P=0.052), tumor grade (P=0.324). Conclusion: Measurements of angiogenesis may have clinical utility in the evaluation of breast cancer, particularly for estimation of metastatic risk. A high MVD may be a poor prognostic marker of breast carcinoma and a target for antiangiogenic therapy. Key words: Angiogenesis, CD34, SMA, Collagen IV, breast carcinoma.

Keywords

Angiogenesis --- CD34 --- SMA --- Collagen IV --- breast carcinoma


Article
SUB THALAMIC NUCLEUS DEEP BRAIN STIMULATION: IRAQI CASE SERIES

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Background: Sub thalamic nucleus (STN) Deep brain stimulation (DBS) electrodes are implanted into STN and programmed by external pulse generator. DBS alleviates the cardinal Parkinson disease symptoms and reduce the need for levodopa and related drugs and eventually reduces levodopa-related motor complications in advanced Parkinson's disease. Objective: To evaluate the STN DBS implantation in Parkinson disease patients. Methods: A retrospective evaluation of data base of the patients operated on for STN DBS between Jan. 2010 and Jan. 2011. The study involved 11 patients (10 males and 1 female) with an age range between 39 and 65. Surgical implantation was done in the Neurosciences Hospital in Baghdad. Unified Parkinson's disease Rating Scale was reported before surgery and 3 monthly after implantation. Paired t test was used to test the significance of difference between 2 means. Results: Highly significant differences (P < 0.0001) in the activities of daily living, Tremor, Rigidity, Bradykinesia and Gait parameter. There was no difference in Postural stability before and after. There was 65% of the patients reduced their levodopa medication dosage after STN DBS. One patient out of 11 (9%) developed intracerebral hemorrhage. Conclusions: STN DBS is very successful in managing motor clinical manifestations in advanced Parkinson disease and reducing levodopa medication. Key worlds: Parkinson, Deep brain stimulation, subthalamic


Article
PCNA EXPRESSION IN CAGA STRAIN H. PYLORI GASTRITIS: IMMUNOHISTOCHEMICAL AND INSITU HYBRIDIZATION STUDY

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Background: Carriage of Helicobacter Pylori (H. Pylori) in the human stomach is associated with increased risk of peptic ulcer disease, distal gastric adenocarcinoma and gastric B-cell mucosa associated lymphoid tissue lymphoma. Several studies have shown increased evidence of increased cell proliferation in the gastric mucosa both in human carrying H. Pylori, and animal model of H. Pylori infection. Objective: To study the immunohistochemical expression of Proliferating cell nuclear antigen (PCNA), as a proliferative marker in the gastric mucosa of patients infected with CagA Helicobacter Pylori demonstrated by insitu hybridization method. Methods: Gastric antrum and corpus biopsies from 99 patients with dyspeptic symptoms (50 men, 49 women, and median age 40) were analyzed for H. pylori, presence of chronic inflammation, intestinal metaplasia, and atrophy according to updated Sydney system. Insitu hybridization technique was done to detect cagA H. pylori. Immunostaining for PCNA (Avidin- Biotin method) was performed on paraffin embedded tissue specimens. Results: Forty four patients (44.44%) had H. Pylori cagA positive strain. Atrophy of gastric mucosa was present in 14 (14.14 %) patients. Intestinal metaplasia was present in 8 (8.08%) patients. The frequency of atrophy was significantly higher in cagA H. Pylori gastritis than non-cagA H. Pylori gastritis (p=0.041). The frequency of intestinal metaplasia was significantly higher in cagA H. Pylori gastritis than non-cagA H. Pylori gastritis (p=0.023). PCNA labeling index (LI) of the gastric glands was significantly higher in presence of atrophic alterations (p <0.001), intestinal metaplasia (p <0.001) and in cagA strain H. Pylori positive gastritis (p<0.001). Conclusion: The rates of gastric glandular atrophy, intestinal metaplasia, and epithelial proliferation increase in the presence of H. Pylori infection, and are further increased when H. Pylori is of cag A strain. Key words: cag A H. pylori gastritis, PCNA immunohistochemical expression.


Article
MORPHOLOGICAL AND HORMONAL STUDIES RELATED TO AGEING CHANGES OF HYPOTHALAMO-PITUITARY GLAND IN RABBITS

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Background: The hypothalamic - pituitary axis is an auto-regulating system that realizes a tight integration among the endocrine, nervous and immune systems. Objective: To identify anatomical and microscopical age changes of hypothalamus-pituitary gland. Methods: Eighteen female rabbits are divided into 3 groups, group A (4-6 months), group B (12-24 months) and group C (36-60 months). The rabbits are sacrificed and dissection of hypothalamus, pituitary gland is done, anatomical position, their weight, measurements and histological study of their sections regarding the number of different cell types. Results: The weight and number of cells in different parts of hypothalamus and pituitary gland are negatively correlated with age.The serum thyroid stimulating hormone (TSH), growth hormone (GH), prolactin hormone (PRL), and adrenocorticotrophic hormone (ACTH) hormones almost remain unchanged while the level of leutinizing hormone (LH) and follicular stimulating hormone (FSH) were increasing with age, and the prolactin hormone level primarily increases with age then decreases with advancing age. Conclusion: The weight of the Hypothalamus and pituitary gland is primarily increased before age of 24 months, and then it started to decrease. The effects of aging inversely on the function and structure of hypothalamus and pituitary gland. Key words: Aging, hypothalamus, pituitary, HPA axis

Keywords

Aging --- hypothalamus --- pituitary --- HPA axis


Article
SURGICAL REVISION OF VENTRICULOPERITONEAL SHUNT IN HYDROCEPHALUS PATIENTS WITH INTRACRANIAL TUMORS

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Background: Patients with intracranial tumors are predis¬posed to persistent hydrocephalus, often requiring a per-manent CSF diversion procedure with shunts. Objective: This study reviews the long-term experience with ventriculoperitonealshunts for the management of hydrocephalus in patients with intracranial tumors. Methods: Patients with intracranial tumors who underwent ventriculoperitoneal shunt placement for hydrocephalus from January 1999 to January 2009 were included in this study from four neurosurgical centers in Baghdad/Iraq. During the 10-year period, medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retro¬spectively for all patients. A total of 187 intracranial tumor patients with hydrocephalus were included. The median follow up was 391 days. Malignant tumors were present in 40% of the patients. Results: Overall shunt failure was 27.8%. Single shunt revision occurred in 13% of the patients and 14% had multiple shunt revision. Tumor histology, age and a procedure prior to shunt placement (ventriculostomy/ Ommaya reservoirs) were significantly associated with the shunt revisions. Shunt system replacement and proximal shunt complication were significantly attributed to multiple shunt revisions. The overall shunt revision within 3 months, 6 months, 1 year and 2 years was 17.7%, 18.7%, 19.8% and 24.1%, respectively. Conclusions: The results of the studydemonstrate that VP shunting is an effective procedure for the man¬agement of hydrocephalus in patients with intracranial tumors. Age, tumor histology, and a procedure prior to shunt placement (ventriculostomy/Ommaya reservoirs) were significantly associated with the shunt revisions. Key words: Brain neoplasm, Cerebrospinal fluid, Surgery, Shunt


Article
RISK OF FACIAL PARALYSIS FOLLOWING PAROTIDECTOMY

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Background: The facial nerve should be sacrificed only if there is strong indication. Sometimes it is possible to sacrifice only part of the facial nerve and this termed "semiconservative parotidectomy". The commonest operation performed is superficial conservative parotidectomy, which is removal of the parotid superficial to the facial nerve with nerve preservation. A total conservative parotidectomy was performed only if clearly indicated by the pathological condition, since the complete freeing of the facial nerve in this operation increases the incidence of nerve paralysis. Objective: To demonstrate under what circumstances is the surgeon likely to be called upon to sacrifice the facial nerve deliberately, and mentioning what be done to reduce the risk of functional facial paralysis following conservative parotidectomy. Methods: The material comprises 30 cases of parotidectomy of all types. We analysed the incidence and degree of functional facial paralysis following conservative parotidectomy and also we reported some experimental work attempting to elucidate its etiology. We classify the degree of facial nerve paralysis to grade I, absent or slight, grade II moderate, grade III complete. Results: We did superficial parotidectomies for 22 cases, 19 had grade I, two had grade II and only one had grade III facial nerve paralysis. Conservative total parotidectomies done for 2 cases, one had grade I and one had grade III facial nerve paralysis. Semiconservative parotidectomies done for 4 cases all had grade I facial nerve paralysis and lastly radical parotidectomies done for 2 cases, the results had grade III for two cases facial nerve paralysis. Conclusion: To reduce the incidence of facial paralysis after conservative parotidectomy: carrying total parotidectomy only when clearly demanded by pathological condition by avoiding washing out the wound, and by measures designed to preserve the blood supply of the trunk of the facial nerve. The present study support that ischemia is the principal factor in post-parotidectomy functional facial paralysis. Key words: Parotidectomy, Facial nerve, Mixed tumor


Article
ANTIPHOSPHOLIPID ANTIBODY IN SERUM OF GUILLAIN-BARRE SYNDROME PATIENTS

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Background: Studies have provided convincing evidence that Guillain-Barre syndrome [GBS] is caused by an infection-induced aberrant immune response that damages peripheral nerves. Despite intensive research over the past two decades, the immune target is still unknown in patients with acute inflammatory demyelinating polyradiculoneuropathy [AIDP], the most frequent variant of GBS. Objective: Measuring of immunoglobulin G [IgG] and immunoglobulin M [IgM] antiphospholipid antibodies [aPL] of incidental untreated GBS patients and comparing them with that of normal population. Methods: This is an age and gender matched paired case-control study at Al-Kadhimiya Teaching Hospital between 1-Dec-2008 and 31-Jan-2010. Each patient was paired with the age and sex matched control which was useful in controlling the confounding effect of age and gender on possible case-control differences. The aPL were measured by Immunometric Enzyme Immunoassay. Results: Eleven patients with GBS (cases) and eleven age and gender matched controls included in current study. The GBS cases have higher IgM and IgGaPL titers than healthy controls [P=0.026, P=0.13 respectively]. The GBS cases IgMaPL titers have negative correlation with duration of illness [r=-0.494, P=0.12], while the cases IgGaPL titer have positive correlation with duration of illness [r=0.243, P=0.47]. The GBS cases that need mechanical ventilation have lower IgM and IgGaPL titers than cases that do not need mechanical ventilation [P=0.1, P=0.06 respectively]. Conclusion: GBS cases have statistically significant higher IgMaPL titers during the first week [p=0.028] and the first two weeks [p=0.026]of illness than healthy controls, and aPL may have a protective effect in GBS. Keywords: Guillain-Barre syndrome, Demyelination, Antiphospholipid antibodies and autoantibodies.

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