Table of content

Journal of the Faculty of Medicine

مجلة كلية الطب

ISSN: 00419419
Publisher: Baghdad University
Faculty: Medicine
Language: English

This journal is Open Access

About

Journal of the Faculty of Medicine – University of Baghdad

A peer- reviewed journal published Quarterly by the college of medicine –Baghdad University

ISSN: 0041-9419

E-ISSN 2410-8057

The Journal interested in publication of clinical and basic medical research.


The first issue of this Journal was published under the name of (Journal of the Royal Iraqi Medical College) in April /1936, approved by the council of the College as a general journal dealing with the news of the college and few scientific articles to encourage the teaching staff for research publication. The journal was published randomly and ceased during World War II due to financial difficulties.
In 1946 Prof. Dr. Hashim Al Witri, the college dean, assigned republication of the journal and urged the teaching staff to participate and publish their research in the journal. Despite his effort the journal remained irregular in publication. In 1959 Prof. Dr. Faisal Al-Sabih became the Editor in Chief of the journal when he returned from the United Kingdom and appointed on the teaching staff, restructured the journal and changed its name to (The Journal of the Faculty of Medicine) and used new scientific system for publication of articles.
The first issue of the new series started in June 1959. The journal continued to be published on a regular basis since then without interruption in (four issues during the year). The journal became registered the international number (ISSN) in 2000 and entered in many important international indexes.
After 2003 the journal continued despite the difficulties involved in every aspect of the country and by the beginning of 2004 the journal progressed through a series of changes to reach a level that can be recognized internationally.
After 2010 the journal became published electronically of the same edited issues.
Recently the journal became recognized by the (Index Copernicus) and publicised internationaly.

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Contact info

e-mail:iqjmc@comed.uobaghdad.edu.iq
mobile:+96407709826825

Table of content: 2011 volume:53 issue:2

Article
Montelukast As An Add On Therapy In Asthma As Compared To Its Use In Asthma Associated With Concomitant Rhinitis Symptoms

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Back ground: The use of Montelukast in mild and moderate asthma has been studied ,allergic rhinitis or rhinitis and asthma are strongly inter related, Montelukast has been used in both conditions, whether treating rhinitis will improve asthma control ,a point which has been stressed recently. Objectives: To evaluate the effect of Montelukast in mild and moderate asthma according to Global INitiative For Asthma guidelines ( GINA),and to compare its use in asthma alone and in asthma which is associated with persistant rhinitis symptoms. Patients and methods: Seventy patients who fulfill the criteria of mild and moderate asthma according to Global INitiative For Asthma guidelines had been recruited from the consultation clinic of the respiratory diseases in Baghdad Teaching Hospital from the 1st.July 2009 to 31st. December 2010,patients were divided in to 2 groups : Group – 1 patients with asthma only which was subdivided into 2 sub groups: 1-a on salbutamol inhaler on need and 1-b on beclomethasone inhaler 800Mgm/day in addition to salbutamol inhaler on need.Group- 2 patients with asthma and rhinitis which was sub divided in to subgroups: 2-a on salbutamol inhaler on need and 2-b on beclomethasone 800Mgmlday in addition to salbutamol inhaler on need. Evaluation of day and night time symptoms, records of rhinitis symptoms and measurement of FEV1(Forced Expiratory Volume in 1st. second) and FEF 25-75%(Forced Expiratory Flow)were done to all patients .Montelukast 10 mg/ day was given to all patients for 4 weeks,and reevaluation for day , night time symptoms , rhinitis symptoms and measurement of FEV1 and FEF 25-75% were done . Results: There was a significant statiscal improvement in day , night time symptoms , FEV1 , FEF 25-75% and rhinitis symptoms after Montelukast treatment than before treatment ( p value < 0.05), Montelukast use in asthma alone as compared to its use in asthma which was associated with rhinitis did not show a significant statiscal improvement in outcome response in day,night symptoms and in percentage of change in FEV1 and FEF25-75% (p value>0.05) . Conclusion: Montelukast improved day , night time symptoms , FEV1 , FEF 25-75% in mild and moderate asthma ,it also improved rhinitis symptoms but Montelukast use in asthma alone as compared to its use in asthma which was associated with rhinitis did not show a significant statiscal imrovement in asthma control regarding day,night time symptoms,FEV1 and FEF25-75% values.

Keywords

Montelukast --- asthma --- rhinitis


Article
Attenuation of the cardiovascular response during rigid bronchoscope a comparative study using intravenous lidocaine and sublingual glyceryl trinitrate

Authors: Muhanad A. Ahmed
Pages: 115-120
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Background: one of the complications of rigid bronchoscope is the cardiovascular responses that may carry a dangerous drawback during and after the procedure. Prevention and control of these events will be crucial, especially for the old and cardiovascular debilitated patients. Objective: The study aims to control and attenuate the unwanted hemodynamic responses to the rigid bronchoscpe using intravenous lidocaim and GTN. Method: a study was performed on three groups of patients undergone a diagnostic procedure of bronchoscope. Each group consists of 20 patients at the same age and relatively similar pathology. The three groups (group one, two and three) received lidocaine, glyceryltrinitrate and no drug respectively. The changes in mean arterial pressure, heart rate and rhythm were taken and monitored. Several readings were taken through a five to ten minutes interval and at recovery. The doses are calculated equally for all patients. Results: marked changes were noticed in mean arterial pressure which has been increased especially during the introduction of the instrument through the trachea. The same were happened for the heart rate, which increased tremendously at the same intervals. The same was applied for the rhythm. Lidocaine has attenuate the change in the rhythm, while the glyceryl trinitrate prevented the high elevation in mean arterial blood pressure more than the other drug did.
Conclusion: Hemodynamic responses to the rigid bronchoscope, can be attenuated and blunted by the usage of anti-arrhythmic drug (lidocaine) and the vasodilator glyceryl-trinitrate, intravenously and sublingual respectively. Lidocaine I.V given 3 – 5 minutes prior to the procedure will protect the heart from grand changes in its rhythm. And to a lesser extent control the high elevation in mean arterial pressure. Glyceryl-trinitrate (GTN). The two drugs successfully attenuate the hemodynamic responses to the tracheal instrumentation by the rigid bronchoscope.


Article
Prevalence of Anemia among Iraqi Patients after Renal Transplantation

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Background: Although the issue of anemia after renal transplantation (RT) has received increasing attention lately, the data on the exact prevalence of post-transplantation anemia (PTA) in the Iraqi patients are limited.Objective: In this study we sought to determine the prevalence of PTA among Iraqi patients and to correlate the renal allograft function measurements and the use of immunosuppressant with the prevalence of anemia.Patients and Methods: One hundred and twelve (74 male, 38 female) kidney transplant recipients (KTR) attending the kidney transplant center at surgical specialties hospital were studied. All patients were on maintenance, combined immunosuppressive therapy. The renal function tests [blood urea, serum creatinine, and creatinine clearance] and the hematological tests [Hb, HTC, and white blood cell count (WBC)] were determined in all patients. Anemia was defined according to the gender-specific K/DOQI classification. Results: In this study, we identified anemia (Hb < 12 g/dl in males and Hb < 11 g/dl in females) in 25% of the patients (28 out of 112).The anemic patients had a significantly higher mean blood urea and serum creatinine levels and lower mean creatinine clearance level than the non-anemic patients. Among the immunosuppressant drugs, patients on tacrolimus combined with mycophenolate mofetil (MMF) had significantly lower Hb and HTC compared with patients without such treatment. Conclusion: Anemia is common in Iraqi patients after RT. The PTA is associated with impaired renal allograft function when compared with non-anemic RTR. Immunosuppressant including tacrolimus combined with MMF was correlated with decreased Hb and HTC concentrations.


Article
Congenital adrenal hyperplasia: hospital based study

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Background: Congenital adrenal hyperplasia is a family of autosomal recessive disorders of cortisol biosynthesis. Depending on the enzymatic step that is deficient, there may be signs, symptoms, and laboratory findings of mineralocorticoid deficiency or excess; incomplete virilization or premature puberty in affected males; and virilization or sexual infantilism in affected females. The most frequent is 21-hydroxylase enzyme deficiency, accounting for more than 90% of cases. Objectives: to review cases of congenital adrenal hyperplasia registered in children welfare teaching hospital- medical city- Baghdad. Patients and method: This study included all patients who were presented and registered in the endocrine clinic of the children welfare teaching hospital- medical city complex as a case of congenital adrenal hyperplasia from the 1st of January 1990 till the 1st of Jun 2009. Demographic informations together with epidemiological, clinical, diagnostic and therapeutic data of the patients were collected. Results: The total number of patients was 60 patients with mean age (6.321) +/- (3.996) SD and male to female ratio of 2:3. Seventy percent of patients presented within the 1st 6 months of life, 61.9% of them were females. Thirty-one (51.7%) patients were delivered in the hospital including 72% of those who were presented within the 1st month. Forty six (76.7%) patients were presented with ambiguous genitalia with or without other presentations, 8 (13.3%) patients presented with salt losing only and 6(10%) patients presented with pseudo precocious puberty with or without other presentations. Consanguinity between the parents was present in 86.7% of patients, 33.3% of patients had positive family history of similar condition, 36.7% of patients had positive family history of neonatal death due to dehydration or abortion and only 3.3% of patients had history of hormonal therapy during pregnancy. Twenty two (36.7%) patients were reared with false sex, 95.5% of them were females reared as males, 33.3% of them accept to change their names & sex of rearing to definitive sex as females and one male (4.5%) patient reared as female had change his name and sex to male. Seventy percent of patients were diagnosed as 21 hydroxylase deficiency, both salt loser (71.4%) and non salt loser (28.6%), (10%) as 11 hydroxylase deficiency, (18.3%) as 3β hydroxysteroid dehydrogenase deficiency both salt loser (54.5%) and non salt loser (45.5%) and (1.7%) as17 hydroxylase deficiency. Conclusions: The commonest form of congenital adrenal hyperplasia in Iraq is 21 hydroxylase deficiencies. There was delay in the diagnosis in spite of hospital delivery, and this may lead to psycho-social problems for the patients and their families regarding changing the sex of rearing. Many patients having genital anomalies did not operate upon yet.


Article
Predictors of Perinatal Outcome in Full term Neonates with Hypoxic Ischemic Encephalopathy.

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Background:Hypoxic ischemic encephalopathy (HIE) means failure to establish effective spontaneous breathing after complete delivery & leads to many changes if not diagnosed or treated immediately as mental retardation, cerebral palsy and epilepsy. Objective:to study the demographic and clinical predictors of perinatal outcome in full term neonates with hypoxic ischemic encephalopathy. Methods: Forty two neonates were diagnosed as cases of hypoxic ischemic encephalopathy by specialist pediatricians& admitted in Children Welfare Teaching Hospital & Al Kut Hospital in the period from January 2008 to March 2009. Predictors studied were sex, birth weight, Apgar scores at 1,5,15 min., meconium aspiration, lethargy, muscle tone , convulsion. Outcome was also recorded. Statistical analysis was done by the use of fisher exact test. Results:The total number studied were forty two neonate. Half of them were born at home & others in hospital with a male / female ratio= 1/1. Thirty three newborns had normal birth weight & nine had low birth weight. the mean apgar score recorded for sixteen neonate born in hospital at 1 minute = 4.3 ± 1.922, at 5minute=6.06± 2.08 and at 15 minute = 6.62± 2.33. out of the 21 hospital born babies with HIE, 6 died and 15 improved and out of 21 home born babies with HIE4 died and 17 improved. The difference was not statistically significant. P. value.0.7. Conclusion: Full term newborn babies with HIE died more frequently if they were males, with low birth weight, with Apgar scores of`< 4 at 1 min., 4-7 at 5 and 15 min., meconium aspiration, convulsion, hypotonic. Hypertonia and lethargy were noticed to be associated significantly with perinatal mortality in newborns with HIE

Keywords

Predictors --- HIE --- Fullterm Neonates


Article
Infectious bloody diarrhea in children 2 month – 5years, Descriptive hospital Based Study

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Background: Dysentery is an important cause of morbidity and mortality associated with diarrhea. About 10% of all diarrheal episodes in children less than 5 years are dysenteric, but these cause about 15% of all deaths attributed to diarrhea. Objective : To demonstrate the most common pathogens causing bloody diarrhea in children between 2 months and 5 years old, to describe some of the associated factors accompanying bloody diarrhea and to highlight the most important clinical features. Patients and methods: A descriptive study of 82 children, between the age of 2 months to 5 years with bloody diarrhea, who were admitted to the Children Welfare Teaching Hospital/ Medical City/ Baghdad during the period between 1st of March 2009 to 28th of February 2010. Information regarding demographic data was taken from their parents. All the patients were examined carefully mainly for the signs and degree of dehydration. General stool examination and stool culture done for patients with bloody diarrhea.Other 100 patients with acute watery diarrhea were also taken as a comparison group. Results: Entamoebahistolyticatrophozoite was the most common isolated pathogen in the study group specimens. It was identified in 38 (46.3%) of patients followed by Shigella species in 10 (12.2%) cases and the least was non typhoidal salmonella in 5 (6.1%) cases. The most vulnerable age was 2-24 months 51(62.2%) cases. Fifty eight and half percent of patients were from urban areas. Half of the patients (50%) were bottle fed. The majority had chlorinated tap water supply (82.9%). This study showed a higher frequency of the following symptoms: Fever (73.2%), Tenesmus (46.3%), Rectal prolapse (1.2%) and convulsion (4.9%) in patients with bloody diarrhea; while in patients with watery diarrhea, the frequencies of these symptoms were: (62%, 28%, 0% and 1% respectively), Severe dehydration was observed in only (15.9%) of cases and the majority of them were seen in patients with bacterial bloody diarrhea. Conclusions:Entamoebahistolyticawas the most frequent offending pathogen in patients with bloody diarrhea in this study. Infants 2-24 months old were the main affected group. Bottle feeding preference,and non-boiling of drinking water made children more prone to have bloody diarrhea. High fever and tenesmus were the most frequent clinical symptoms associated with bloody diarrhea. More frequent bowel motions, high fever, and convulsion were all more commonly seen with bacterial bloody diarrhea than in amebic bloody diarrhea.


Article
An ‘early interval ' (Delayed Urgent) laparoscopic cholecystectomy for acute cholecystitis: evidence to support a safe surgical procedure.

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Background: Delayed interval cholecystectomy can be performed to overcome the logistical difficulties in performing ‘early urgent’ laparoscopic cholecystectomy (LC) within 72 hours of admission with acute cholecystitis (AC), and to avoid earlier re-admission with recurrent AC in patients waiting ‘delayed interval’ cholecystectomyObjectives: To evaluate the safety and feasibility of ‘delayed urgent’ LC performed beyond 72 hours.
Methods: Patients admitted with AC were scheduled for urgent LC. Patients who underwent ‘early urgent’ LC were compared with those who had ‘delayed urgent’ surgery.
Results: Fifty consecutive patients underwent urgent LC for AC within 2 weeks of admission. There were no conversions and no bile duct injuries. Delayed surgery (n=36) neither prolonged operating time (90 vs. 85 minutes) nor increased operative morbidity (9.7% vs. 7.7%) or mortality (2.4% vs. 7.7%) compared with early surgery (n=14). Although delayed surgery was associated with shorter postoperative hospital stay (1 vs. 2 days, p=0.029), it prolonged total hospital stay (9 vs. 5 days, p<0.0001).
Conclusions: Delay of LC beyond 72 hours neither increases operative difficulty nor prolongs recovery. It might be more cost effective to schedule patients who could not undergo ‘early urgent’ LC but are responding to conservative treatment for an ‘early interval’ LC within 2 weeks of presentation with


Article
A study of 82 patients of non-traumatic terminal ileal perforation in Al-Kindy teaching hospital

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Background typhoid fever is the commonest cause of non traumatic terminal ileal perforation in our study with a grave postoperative morbidity & mortality depending upon preoperative time delay &/or type of surgical intervention practiced.
Objective to evaluate the frequency of non traumatic causes of terminal ileal perforation, their presentations,perforation-operation interval effect on complications, as well as different modalities of treatment and their complications.
Methods the study is a prospective study of 82 patients with perforation of terminal ileum diagnosed by explorative laparatomy in Al Kindy teaching hospital ,Baghdad, Iraq from April 2008- December 2010, all of the patients were examined clinically & investigated by plain x-ray of abdomen, ultrasound, complete blood picture, laparatomy was done for them after resuscitation and intravenous antibiotic, tissue biopsy was taken for paraffin section histopathological examination, and patients were followed for complications.
Results: the study of 82 patients revealed that their mean age 42 years (±14) ranging from16-75 years, with male to female ratio is 2, 28:1. The main cause of perforation is enteric fever 59 (71.95%) of patient, non specific inflammation 17(20.74%), Chronic granulomatous lesion 5(6.1%). The main presenting symptom in all patients was severe abdominal pain associated with fever, and abdominal distention in variable degree.The operative finding was single perforation in 61patients(74%) , two perforations in 8 patients(10%) and multiple in 13 patients(16%). The simple closure was done in 50 patients(60%), and other treated by resection and end to end anastomosis , Loop ileostomy,Resection and ileotransverse anastomosis, and follow up of patients revealed that 7(8%) died postoperatively , 3 patients(3.6%) developed wound dehiscence,6 patients(7%) developed enterocutanous fistula ,10 patients (12.1%) developed wound infection and 6 patients (7.3%) developed residual collection.
Conclusion non-traumatic perforation of terminal ileum is not uncommon and the most common cause is typhoid fever, and carries high mortality and morbidity rates specially in delayed presentation & diagnosis group of patients.


Article
The Role of Resistin in Patients with Primary Fibromyalgia

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Background: Fibromyalgia syndrome (FMS) is a common rheumatologic syndrome with multiple manifestations and associated with many diseases, it characterized by chronic wide spread muscular pain and tenderness. Resistin is an adipokine discovered in 2001 and considered as a link between obesity and type 2 diabetes by antagonizing and resisting the action of insulin as it name encompass ;resistin (resist insulin) . It is secreted mainly from adipose tissue in mice and from white blood cells besides the adipose tissue in humans. Research reviled that resistin has a role in some inflammatory diseases like Rheumatoid Arthritis (RA).
Objective: The objective of this study is to measure Resistin concentration and to evaluate its role in the pathogenesis of primary FMS.
Patients and methods: Fifty patients with primary FMS were included in this study (37 females and 13 males) the age range of (17-65) years (Mean ± SD) (40.13 ± 12.0) years, and thirty healthy individuals volunteers (21 females and 9 males), whose age and sex matching with FMS patients, age ranging (18 - 63) years, (Mean ± SD) (36.1 ±10.0) years. Resistin concentration was measured in sera of patients and controls by ELISA kit. Anthropometric measurements like body mass index (BMI) and waist circumference (WCr) were taken, besides other features like sleep disturbance, emotional distress, and fatigue were reported.
Results: Resistin concentration was higher in FMS patients than controls (2.15±0.9) ng /ml vs. (1.57±0.6) ng /ml. This elevation was highly significant statistically (p=0.003).Other measurements in patients group like BMI, WCr were (28.39±5.0) Kg/m2 and (100.34±13.21) cm respectively .These values were highly significant when compared to their control group (p=0.002) and (p=0.008) respectively . Serum resistin level was positively correlated with both waist circumference (r=0.411,p=0.003) and age (r=0.405 ,p=0.004) . Waist circumference was positively correlated with age (r=0.604, p=0.000).Clinical features like sleep disturbance, emotional distress ,and fatigue showed highly significant difference between the two groups . No significant differences were reported with respect to age and sex.
Conclusion: The result of the current study suggest that Resistin might have a role in the pathogenesis of FMS.

Keywords

Resistin --- Fibromyalgia


Article
Performance of computed tomography indiagnosis and evaluation oftraumatic intracerebral hemorrhage

Authors: Haider Q. Hamood حيدر حمود
Pages: 156-159
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Background:The intracerebral hemorrhage (ICH) can be classified as traumatic and spontaneous. The frontal and temporal lobes are classic sites for traumatic ICH, which are less commonly affected by spontaneous episodes. Computed tomography (CT) scanning is the most accurate radiological method for demonstrating the acute lesion of intracerebral hemorrhage (ICH). Both types are of high density, but traumatic bleeding is more frequently multifocal, in this study we are dealing with traumatic type of intracerebralhematoma. Aim of the study is to identify the accuracy and performance of CT scan in diagnosis and evaluation of intracerebralhemorrhage.
Patients and methods: 60 patients were examined, their agesrange from 30-70 years with means age 48 years old, they were 36males (60%), and 24females (40%).
Results: Our study reveals, the male patients (36 patients) were more affected than femalepatients (24 patients). Most affected age group in our study was 60-70 years old, 18 patients (30%) with no gender difference. Acute ICH was more than other ICH types, patients with acute ICH were 24 patients (40%) 15 male patients and 9 female patients, patients with subacute ICH were 20 patients (33%) and patients with chronic ICH were 16 patients (27%). In our study, the RTA was the most causative mechanism of ICH, 27 patients with RTA were seen in our study (45%), followed by shell injury which were 24 patients (40%) and then the fall from hight (FFH)which were 9 patients (15%). The most common CT feature noted in our study is the brain edema and it is seen in 27 patients (45%). Basal ganglia were most affected brain region (45%) of cases.
Conclusion:CT is available,rapid imaging modality in the diagnosis of ICH, so it is suitable for diagnosis and evaluation of ICH as emergency cases in casualty department and it is valuable in evaluation of traumatic I.C.H. especially in acute stages.


Article
Psychological Impact of Religious and Spiritual Beliefs on Life Quality of Two groups of University Students

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Background; this study is designed to assess the effect of religious and spiritual beliefs on quality of life among two groups of university students in Iraq and Jordan.
Objective: to examine the psychological impact of religious and spiritual beliefs on quality of life and to implement the Quality of Life- Spiritual Religious and Personal Beliefs(QOL-SRPB) questionnaire for the first time in both countries .
Method :A convenient sample of advanced medical students from Baghdad college of Medicine in Iraq and College of Medicine in University of Science and Technology in Jordan recruited during April 2008 to complete 200 forms of the Arabic modified version of QOL-SRPB simultaneously.
Results: Analysis of the findings revealed higher measures of importance regarding spirituality in the Jordanian group in comparison to the Iraqi group; however, comparable mean scores of all facets were reported in both groups
Conclusion:. Both studied groups showed comparable results due to the presence of shared belief system and cultural norms .despite the circumstantial hardship of the Iraqi group they showed reasonable satisfaction to their quality of life.


Article
Toward more objectives teaching clinical skills:

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the clinical teaching courses so far did not take the required attention and unfortunately because on granted that all doctors are expert in it without attention on directions ,for that reason we think that all clinical teaching is the most neglected part of medical teaching and for this reason it is found that there are many deficit in it and it is worsening that ward round were haphazard and taking excitement in many aspects.for this reason more than attention is needed to construct more effective clinical courses and teachers have to be trained on it.As it has been noticed that this needs more research and we should check the following : 1. Monitoring the active participation by the student and how many of them stand as on observation only. 2. Any of problem been solved during the clinical session and dose the clinical exercise contribute to solving of clinical problem. 3. Where are most focused been given, is it to basic and clinical science or it has been spend on for other materials. 4. Do the student been supervised closely while they interview the patient at bedside.5. Did the student given enough time to practice their skills.6. Does the teaching in the session is patient oriented or disease oriented. if the answer to these above questions were yes then this is typical clinical tutor but many students in the study shows the contrary.we can try to plan the technique which can be introduced to improve our clinical teaching.

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Article
Thrombocytopenia in Iraqi Pregnant Women

Authors: Sana D Jalal --- Asmaa M Thanoon
Pages: 171-174
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Background: Thrombocytopenia is the second most common hematological abnormality in pregnancy following anemia. However, its incidence causes and outcomes received scarce attention, particularly in developing countries like Iraq.
Objective: This study was conducted to determine the incidence, causes and consequences of thrombocytopenia on both the mother and fetus.
Material and Methods: Platelet counts were performed on 600 pregnant women in their third trimester and on 200 age matched non pregnant healthy women, as well as 150 of the newborns of the former groups.
Results: The overall incidence of thrombocytopenia in pregnancy was 8.6%, with the gestational thrombocytopenia implicated in 76.9%,. Hypertensive disorders (pregnancy induced hypertension, preeclampsia) were the second most common causes of thrombocytopenia in the studied group. Other diagnoses such as HELLP syndrome and Disseminated Intravascular Coagulation (DIC) were infrequent. The 2.5th percentile significantly differed in pregnant women (117x109/L) than the control group (162 x109/L) with the histogram of platelets counts shifted to the left during pregnancy. Among pregnant women with mild thrombocytopenia (platelets count 100-149x109/L), 94% were gestational in origin with a decreasing proportion of the latter with increased severity of the thrombocytopenia. Except for one lady with DIC, all other pregnant ladies completed their pregnancy with no reported complications and none of the followed up neonates had thrombocytopenia.
Conclusion: Similar to worldwide studies gestational thrombocytopenia is the commonest cause for thrombocytopenia in pregnancy in Iraqi ladies and for healthy pregnant women, platelets count > 117 x 109 /L late in pregnancy does not require further investigations and could be considered as a safe threshold.
Keywords: Thrombocytopenia, Platelets, Pregnancy.

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Article
Overexpression of HER-2eu receptor protein in Urinary Bladder Carcinoma, An Immunohistochemical Study.

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Background: Bladder carcinoma is one of the most common cancer worldwide, it accounts for 6.5% of all cancers, with highest incidence in industrialized countries .It represents the fourth most common cancer in men and the eighth in women. Bladder carcinoma depends in its pathogenesis on a combination of genetic and environmental factors, these factors produce phenotypic changes that allow normal transitional cells to become cancerous and finally acquire the “malignant phenotype". Many attempts had been tried to explore the role of some genetic abnormalities encountered in bladder carcinoma. It has indicated that many genetic abnormalities may underline the pathogenesis of cancer evolution of urinary bladder like VEGF , P53, Bcl2 and RB, but nowadays a scientific efforts have raised the possible role of Her-2/neu in bladder carcinoma, and the rate of its overexpression in bladder carcinoma is ranging from 2% - 74%.
Objective: To estimate immunohistochemical expression of HER-2 eu receptor protein in Urinary Bladder Carcinoma in relation to other parameters; sex grade, pattern of tumor and stage of tumor .
Methods: The present work is performed in the Department of Pathology and Forensic medicine, College of Medicine, Kufa University. Formalin fixed, Paraffin-embedded blocks from 60 (43 males and 17 females) patients with urinary bladder carcinoma were included in this study. A group of 12 patients with chronic cystitis were included as a control group. Avidin-Biotin Complex method was employed for immunohistochemical detection of HER-2 eu.
Results: HER-2 eu overexpression was positive in 41.6% of urinary bladder carcinoma, while there was no expression in benign bladder tissue (P<0.05). HER-2 eu immunohistochemical staining was positively correlated with, grade and stage of urinary bladder carcinoma (P<0.05).
Conclusion: These findings support the role of HER-2 eu in the carcinogenesis of urinary bladder carcinoma regarding behavior, and aggressiveness, and thus HER-2 eu could be considered as a poor prognostic parameter in urinary bladder carcinoma.


Article
Assessment of bone marrow angiogenesis using F VIII-related antigen and its relationship to proliferating cell nuclear antigen (PCNA) in multiple myeloma.

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Background:Multiple myeloma (MM) is a malignant clonal expansion of plasma cells. Previous studies had demonstrated that both bone marrow angiogenesis as measured by microvessel density (MVD) and PCNA were increased in variety of malignant disorders, including multiple myeloma. Objective: Assessment of angiogenesis in bone marrow of MM patients by using immunohistochemical stain to measure microvessel density (MVD) using factor VIII –related antigen and to evaluate the expression of PCNA antigen in plasma cells of MM bone marrow sections . Also to find the correlation between these two parameters and between them and the percentage of plasma cells infiltration in bone marrow of MM.
Patients, materials andmethods:This retrospective study was conducted from May2007 toJaunary 2008 on 37 bone marrow biopsies diagnosed as multiple myeloma, along with 10 age matched control subjects who had reactive plasmacytosis of less than 10% in their bone marrow. The cases were retrieved from recording archive files of Department of Pathology in the Teaching Laboratory of Medical City Hospital, laboratory of Al- Yarmouk hospital and AL-Yarmouk National Center of Haematology.Three sections were taken from each formalin fixed paraffin embedded bone marrow trephine biopsy of MM and of control cases. One representative section was stained with Hematoxylin and Eosin (H&E), while the other two sections were stained immunohistochemically for factor VIII-related antigen as an endothelial cell marker, and for PCNA as an indicator of the proliferative state of myeloma cells All stained sections were examined by light microscopy and the mean vessel density (MVD) was estimated and was used for statistical analysis. For immunostained PCNA cells, thelabeling index scoring system of Alves et al was adopted for estimating the percentage of positive nuclear staining.
Results:This study revealed that there was a significant increase in bone marrow angiogenesis and in the expression of PCNA in plasma cells of patients with multiple myeloma compared to control cases. Moreover this study showed that PCNA correlated significantly with bone marrow microvessel density and both parameters correlated significantly with the percent of plasma cell in the bone marrow of patient with multiple myeloma.
Conclusion : Both PCNA and angiogenesis as expressed by MVD were increased in multiple myeloma and both of them correlated with the percentage of plasma cell infiltration which reflected the activity of the disease .Moreover the proliferative activity of plasma cell as represented by PCNA expression was closely related to angiogenic activity , thus it can be proposed that both markers reflect the disease activity and they may provide additional information when included in the initial evaluation of myeloma bone marrow biopsies .


Article
mRNA in situ hybridization analysis of VEGF in chronic lymphocytic leukemia

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Background: Several factors render chronic lymphocytic leukemia (CLL) an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic lymphocytes and recent advances in molecular genetics techniques. Among molecular markers, vascular endothelial growth factor (VEGF), have been widely studied.Objective: The aim of the study is to evaluate the role of VEGF in the pathogenesis of CLL and its role in disease progression.
Patients, materials and methods: A retrospective cross-sectional study was done on 60 patients with chronic lymphocytic leukemia (45 males & 15 females) compared with 20 controls (anemic patients), all recruited at the Medical City Hospital/ Teaching Laboratories/ Baghdad from January 2004 to December 2007. The bone marrow biopsy of each was re-examined histologically. In situ hybridization was performed utilizing biotin labeled VEGF cDNA probes.
Results: The frequency of VEGF positivity was 95% (57 of 60 cases). A statistically significant inverse correlation was found between increasing VEGF scores and lower packed cell volume level and lower platelet count. A statistically significant association was found between advanced modified Rai stage and patients with high score. In addition, there was a statistically significant positive correlation between increasing scores of VEGF and advancing clinical stage.
Conclusions: The score of VEGF is high among patients with advanced clinical stage of the disease.


Article
P53 Expression in Gastric Dysplasia and carcinoma in Erbil City

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Background: Alteration in the expression of p53 tumor-suppressor protein is an event that occurs frequently in human cancer, but the practical implications of this phenomenon are yet to be fully exploited.
Objectives: to determine the value of p53 expression as a marker of tumor aggressiveness and the relationship between p53 over expression and clinico-pathologic variables in gastric adenocarcinoma.
Material & Methods: The expression of p53 was studied immunohisto-chemically in 10 cases with gastric dysplasia and 85 cases with gastric adenocarcinomas using formalin fixed, paraffin-embedded tissue samples. D07 a monoclonal antibody to p53 protein was used for the immunehistochemical analysis. The correlation between p53 expression in gastric dysplasia, gastric adenocarcinoma and clinicopathologic variables were analyzed.
Results: P53 positivity was found in 48.2% of gastric carcinoma cases, and 40% of gastric dysplasia. There was a significant correlation between the rate of p53 over expression and tumor grade (p = 0.015), and also with carcinomas associated with lymph node involvement (p = 0034). There was no significant association between p53 protein expression and histological type (p = 0.171). The association between p53 protein expression and the depth of tumour invasion was found to be statistically insignificant.
Conclusion: The results obtained suggest that P53 protein expression is a useful biomarker for the assessment of gastric adenocarcinoma aggressiveness. The preoperative assessment of p53 expression in gastric carcinomas can be helpful in identifying patients with higher grades and more advanced tumors. P53 immunoreactivity can predict lymph node status in patients with gastric carcinoma.


Article
High Expression of P53 protein in Recurrent Pregnancy Loss Could Play a Role in the Pathology!!

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Background: Recent data provide evidence that p53 plays a critical role in mediating pregnancy by regulating steroid hormone activation
Objective: localization of semi quantitation tof por protein at the materno-fetal interface, in patients with recurrent pregnancy loss.
Methods: Immunohistochemistry analysis of p53 protein using paraffin embedded sections of curate samples obtained from 40 women, who where divided into three groups: 24 women with RPL, 10 women with abortion for the first time, and 6 women with induced abortion.
Results: The mean value of the expression of p53 protein in the RPL group was (65.8±2.16), which is significantly higher than that of the second group (48.0±2.81), and the third group (50.0±4.66), (p=0.000).
Conclusion: High expression of p53 protein in women with RPL may have a role in accelerating placental apoptosis leading to failure of pregnancy.


Article
Serum levels of cytokines (TNF-α, IFN-γ& IL-10) in Type-2 diabetic patients with HCV infection

Authors: Zena T. Mall-Allah --- Eman M. Saleh --- May Y. Saour
Pages: 198-200
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Back ground: Type 2 Diabetes mellitus (T2D) is a common complication of all liver diseases. However clinical and experimental data suggest a direct role of HCV in the perturbation of glucose metabolism. The aim of this study is to investigate the role of HCV infection as a risk factor to develop type 2 diabetes mellitus, and to study the immunopathogenicity of HCV in diabetes mellitus patients, through the assessment of IFN-γ, TNF- α and IL-10 serum levels.
Objectives: Is to investigate the role of HCV infection as a risk factor to develop type 2 diabetes mellitus, and to study the immunopathogenecity of HCV in diabetes mellitus patients, through the assessment of IFN-γ, TNF- α and IL-10 serum levels.
Patients and Methods: Thirty six known T2D patients attending the endocrine and diabetes center in Baghdad for check-up were enrolled in this study. Their age ranged from 15- 70 year. Twenty one patients have T2D only while the other Fifteen were have diabetes with HCV infection. Thirteen healthy individuals without any signs or symptoms of disease were also included in this study as healthy controls. Serum levels of cytokines including IFN- γ, TNF-α and IL-10 were analyzed by ELISA immunoassay.
Results: Higher serum levels of IFN-γ and TNF-α were observed in the investigated HCV patients with diabetes (43.87pg/ml, 68.1pg/ml respectively) compared to T2D patients (19.75 and 55.10 pg/ml respectively) and controls (8.08 and 31.4 pg/ml respectively). The statistical analysis revealed a significant difference between these three groups (P= 0.01). The mean serum levels of IL-10 were significantly elevated in T2D group as compared to HCV patients with T2D and control groups (28.7, 10.32, 15.78 pg/ml respectively, p=0.05).
Conclusion: The over production of proinflammatory cytokines (IFN-γ, TNF- α) and the low IL-10 level could play a crucial role in pathogenesis of HCV that leads to T2D via increasing the insulin resistance.

Keywords

T2D --- HCV --- IFN-γ --- TNF-α --- IL-10


Article
Molecular detection of Human Papillomavirus genotype-16&-18 in tissues from patients with prostate cancer and benign prostatic hyperplasia

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Background: Highoncogenic-risk genotypes of human Papillomavirus (HPV) infect a wide range of human cells, including prostate tissue that give rise to benign prostatic hyperplasia and prostatic adenocarcinomas. Objectives:This study aimed to detect DNA of HPV genotype-16 &18 using in situ hybridization technique in prostatic tissues from benign prostatic hyperplasia and prostatic adenocarcinomas, and elucidate the association between these HPV genotypes and prostatic carcinogenesis. Patients and methods: Forty-eight (48) formalin-fixed, paraffin embedded prostatic tissue blocks were obtained ,among them (28) tissue biopsies from prostatic carcinoma with different grades and (20) benign prostate hyperplastic tissue blocks as well as (10) apparently normal prostate tissue autopsies which were collected from the archives of Forensic Medicine Institute / Baghdad and used as prostate healthy control groups. Detection and genotyping of HPV was done by highly sensitive in situ hybridization technique. Results: The signals of in situ hybridization reactions of both HPV-16 and HPV-18 in prostate cancer cases in the present study was 25% (7 / 28) whereas in BPH, HPV-16 was detected in 45 %( 9 /20) and HPV-18 was presented in 35 %( 7/ 20). Neither HPV-16 nor HPV-18 was detected in the apparently healthy control group.The percentages of HPV 16 and HPV18 were increasing with advancing of grade of prostate cancer. Conclusion: Our results indicate that the oncogenic HPV-16 might contribute to the development of subset of prostate tumors. In addition, HPV16&18 might have a crucial role in progression of the prostate cancer and benign prostatic hyperplasia Key word: HPV-16; HPV-18; prostate cancer, benign prostatic hyperplasia,in situ hybridization.

Keywords


Article
Role of SalivaryTumor Necrosis Factor-alpha and Immunoglobulin-Ain Recurrent Aphthous Stomatitis

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Background:Until today, the etiology of recurrent aphthous stomatitis (RAS) remains unknown, although hints of its etiologic basis lay on genetic susceptibility, infectious agents and alterations in immune mechanics.Objectives:The aim of this study was to investigate the possible alterations in salivarytumor necrosis factor-alpha (TNF-α) and Immunoglobulin-A (IgA) level in patients with RAS and its relation with clinical types of disease.
Subjects and Methods:Salivary TNF-αlevels were investigated in50 RAS patients and 25 healthy controls by enzyme-linked immunosorbent assay (ELISA). Single radial immune diffusion method was used for estimation ofIgAlevel in two studied groups.
Results:Salivary level of TNF-α was significantly higher in RAS patients than in healthy controls (p<0.001), Moreover, the level of TNF-α was significantly increased in minor type of disease than in major and herptiform types (p<0.05).On the other hand, the levelof IgA showed no significant differences between patients and healthy controls and neither among clinical types of disease(p>0.05).
Conclusion: These findings suggestthat saliva provides an ideal medium for the detection of pro-inflammatory markers of the oral cavity, moreover; salivary TNF-α may play an important role in pathogenesis of this disease and it may also have an important role in the search of new treatments for this disease. As well as these results indicated to a possible role of mucosal immune system in pathogenesis of RAS.


Article
Enzyme linked immunosorbent assay (ELSA) investigation for Human Kisspeptin and progesterone Levels in female having regular menstrual cycle

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Background: Kisspeptin the product of the gene Kiss1 is a G-protein coupled receptor legend for GPR54. Kiss1 was originally identified as a human metastasis suppressor gene that has the ability to suppress melanoma and breast cancer metastasis. It is recently become clear that kisspeptin-GPR54 signaling has an important role in initiating GnRH secretion at puberty, the extent of which is an area of ongoing research.
Objective: The present study was designed to determine the change of plasma kisspeptin levels during the menstrual cycle
Materials & Methods: A total of 20 women from friends and relatives pool were involved in this study. Selected from frinds and relative .They were selected after measuring their progesterone level on day 21 of menstrual cycle (excluding women who have anovulate menstrual cycle; low level of progesterone) , and then on 1 -5 day of the next menstrual cycle. All measurements were done in Teaching laboratories in Baghdad Teaching Hospital in Baghdad/Iraq. Five mls of blood withdrawn from each selected women by veinpuncture of selected women. ELISA technique was used for the measurement of serum kisspeptin -1and progesterone level. Data were expressed as a mean ±SD. Results were evaluated using the student t-test for paired data. Conventional methods were used for the correlation and regression analyses.
Results: Results obtained showed that the levels of serum kisspeptin and progesterone were significantly higher on day 21of menstrual cycle than during menstruation period with p<0.01, also it was found a significant positive correlation of kisspeptin level with progesterone level (r= 0.77 ,p<0.01).
Conclusion: The results determine the role of kisspeptin on ovulation, and give a possibility for its beneficial manipulation of human fertility.


Article
The impact of inflammation on Resistin, IL-6 andCRP in Acute Myocardial Infarction Patients.

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Background: Inflammation contributes across the spectrum of cardiovascular disease, including the earliest steps in atherogenesis. Myocardial Infarction (MI) is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque. It has been suggested that the adipose tissue may play an important role in mediating this chronic inflammatory process, human resistin, is a 12.5-kDa protein, it found in the inflammatory zone. Interleukin-6 (IL-6) is a pro-inflammatory cytokine, it secreted by T cells and macrophages to stimulate immune response. C-reactive protein (CRP) is a protein found in the blood, the levels of CRP rise in response to inflammation.Objective: to determine the role of Resistin in Acute myocardial infarction patients and its effects on IL-6 and CRP.Patients and Methods: The study included 50 patients with Acute Myocardial Infarction and 40 healthy subject as control, levels of resistin, Interleukin-6 (IL-6) and CRP were measured.Results: The levels of resistin, IL-6 and CRP were significantly elevated with (p<0.001). There was positive correlation between resistin with IL-6 and CRP in acute myocardial infarction patients.Conclusions: There was significantly increasing in levels of resistin, in acute myocardial infarction patients and this increasing may be related to inflammation. Resistin positively correlated with pro- inflammatory factor (IL-6 and CRP) so it have inflammation properties may consider a cardiovascular risk factor.


Article
Developmental Changes of Axonal Excitability: Refractory Period Measurement in Normal Children

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Background: “The absolute refractory” period is the time interval during which the nerve fiber is in capable of conducting another impulse after a conditioning stimulus and the determination of the refractory period distribution in a nerve can give a good idea about the characteristics of the conducting fibers constituting that nerve as it reflects their excitability and could be used as a sensitive indicator for the ability of the nerve fiber to conduct pairs of closely spaced impulses.
Methods: The new collision test was used to measure precisely the absolute motor refractory period and the paired shock technique to measure the absolute sensory refractory period in the ulnar nerves of 167 normal infants and children to identify age related changes in the excitability of the nerve fiber membrane.
Results: These tests showed that changes in the membrane properties of the fastest and the slowest motor and sensory fibers differ with age. Fastest fibers have more prominent and rapid reduction in their absolute refractory periods (increased excitability) at the successive age groups during the period between 6 months to 6years of life, while the slowest ones have more gradual and prolonged membrane changes (as assessed by the dispersion of the refractory periods)
Conclusion: These electrophysological findings point to a period of rapid increment in the nerve fiber diameter, myelin thickness and the possibility of addition of new functioning nerve fibers during the process of growth and development, since each fiber has its characteristic absolute refractory period from birth.


Article
Ovarian antral follicle number and the amount of gonadotropin used in ovarian stimulation in polycystic ovarian patients.

Authors: Hanan L.Sudek
Pages: 228-232
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Background:Polycystic ovary syndrome is the most common cause of anovulation, and the number of antral follicles is of great importance in determining ovarian reserve, so identification of patients with diminished ovarian reserve help in choosing individualized and well managed ovulation induction protocol. The aim of the study is to find out if the number of ovarian antral follicles could affect the amount of gonadotropins used in ovarian stimulation in polycystic ovarian patients. Patients and methods:Ninty four infertile polycystic ovaries women, attending the infertility clinic at Baghdad teaching hospital, during the period of November 2005 to October 2006, were compared to 62 control group women who have unexplained infertility.After exact history and examination, ultrasound was done to both groups at cycle day 3 for antral follicle counting. Then ovarian stimulation was started with gonadotropins,and another ultrasound was done on cycle day 13 for mature follicles confirmation. Results:Antral follicle number was found to be significantly higher in patients than control groups (9.98 ± 2.09 vs 5.40±2.02). Age was found to be negatively correlated with antral follicle size and number in patient and control groups. After measuring the number of mature follicles at cycle day 13 it was observed that the antral follicle number was correlating positively and significantly with the number of follicles at cycle day 13,but negatively with the amount of gonadotropin used for ovarian stimulation in patients and control groups.Conclusion:Antral follicles number is significantly higher in polycystic ovary patients and they correlate negatively with age.Antral follicle number is a good predictor of the number of gonadotropinampouls used for ovarian stimulation.


Article
Induction of Microsomal Liver Enzymes by Silymarin in Experimental Animals

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Background: previous researches showed that the hepatoprotective effect of silymarin was through inhibition of cytochrome p450- system (e.g. protection against Amanita toxin), in addition to protection from free radicals generated by this enzymatic system. In contrast to that, many evidences clarified that silymarin may increase first pass metabolism of e.g. cyclosporine and benzodiazepenes. Objective: Our aim from this animal experiment was to relieve this confusion and detect that this herbal extract is absolutely hepatoprotective or induce hepatotoxicity in other conditions.
Materials and Methods: this study was performed on 15 healthy male rats randomized into two treatment groups; first group (5 rats) pretreated with phenobarbital (I.P) then given acetaminophen (I.P) and the second group (5 rats) pretreated with silymarin (orally) then given acetaminophen (I.P.); while the last five rats were considered as control group for comparison . Activities of SGOT, SGPT and histopathological sections were detected for both groups and compared with that of control.
Results: for both treatment groups, the activities of transaminase enzymes were significantly higher than control group. Meanwhile; activity of these enzymes and severity of hepatic damage were significantly higher for Phenobarbital group compared with silymarin.
Conclusion: we can conclude from this experimental study that, even though silymarin act as hepatoprotective by multifactorial mechanisms (antioxidant, increase glutathione level, antifibrotic, anti-inflammatory and enzyme inhibitor), it may act as enhancer for some hepatotoxic agents (like acetaminophen) by cytochrome P-450 induction mechanism.


Article
Captopril versus enalapril in the protection of the gastric mucosa against NSAID induced gastric mucosal injury in rats

Authors: Samir Y. N. Matloub سمير مطلوب
Pages: 236-240
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Background: Different mechanisms have been suggested for the development of nonsteroidal anti- inflammatory drugs (NSAIDs) induced gastropathy. Angiotensin converting enzyme inhibitors have been suggested to have gastroprotective effects. This study investigates the gastroprotective effects of Angiotensin converting enzyme inhibitors, captopril and enalapril on indomethacin induced gastric mucosal damage in rats . Materials and methods: The study was conducted on 50 adult male albino rats, divided into 5 groups, the first served as a control received the vehicle , the second received indomethacin orally of 60mg/kg. The third and fourth groups were pretreated orally 30 minute prior indomethacin with either captopril or enalapril. In order to study the possible role of nitric oxide (NO) in the gastroprotective effect of captopril; intraperitoneal NG-L-Arginine Methyl Ester (L-NAME) a nitric oxide synthase inhibitor was given 30 minutes prior to captopril administration followed by indomethacin and this served as fifth group. The rats were then sacrificed after 4 hours and their stomachs were isolated and submitted to macroscopical assessment and for the measurement of the gastric prostaglandinE2 (PGE2), and myeloperoxidase (MPO). Results: Captopril in a dose of 15 mg/kg produced a significant reduction (p <0.05) in the gastric damage score .These protective effects were associated with a significant increase (p <0.05) in gastric PGE2 levels and marked decrease (p <0.05) in MPO activity, L-NAME pretreatment didn't abrogate the effects of captopril. Enalapril pretreatment failed to show the gastroprotective effects of captopril. Conclusions: The prophylactic use of captopril in this study prevented indomethacin induced gastropathy .This protective effect was associated with PGE2 upregulation and decreased oxyradical generation reflected by a decrease in MPO activity .Enalapril failed to produce the gastroprotective effects of captopril.


Article
Type II- Pleuropulmonary Blastoma: A case report

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Summary:
Pleuropulmonary blastoma is a rare and aggressive neoplasm typically presents in young children, younger than 5 years, as a pulmonary and/or pleural-based tumor. We reported a case of type-II pleuropulmonary blastoma (PPB) in an 8 month old infant who presented to Al-Khansa'a Maternity Hospital in Western Mosul with a history of repeated attacks of shortness of breath and signs of pulmonary infection unresponsive to treatment. A bronchoscopic examination showed a mass involved and obstructed the orifice of the main bronchial tree of the right upper lung lobe. A thoracotomy was performed; tumor involved the right upper lung lobe, the covering pleural surface and invading the mediastinal structures. Right upper lobectomy was performed. Tumor had cystic and solid components. It characterized histologically by a mixture of primitive blastematous and sarcomatous elements.

Table of content: volume:53 issue:2