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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Contact info

iraqi_jms_alnahrain@yahoo.com

iraqijms@colmed-alnahrain.edu.iq

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

Table of content: 2012 volume:10 issue:3

Article
EDITORIAL: COMMUNICATION SKILL

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Abstract

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Article
SEMI-AUTOMATED COMPUTATIONAL METHOD FOR SKELETAL MUSCLE FIBER TYPING WITH LECTINS: CORRELATION WITH MORPHOMETRIC STUDIES

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Background :Muscle fiber typing has been an extensive field of study for many years. Though, limited researches applied lectin histochemistry in the clinical diagnosis of muscle disorders; attention was directed mainly towards enzyme histochemistry. Objective:The use of lectins as recognition systems based on specific protein-carbohydrate interactions in correlation with muscle fibers morphometric standards and optical density features to favor the diagnostic procedures of muscle disorders. Methods:Cross-sections of tibialis anterior muscle from 15 adult rats were stained with Con A, PNA, SBA, WGA, SWGA, LFA, UEA-I, and UEA-II lectins. Photographs of stained sections were analyzed with ImageJ 1.44 software for muscle fiber area, perimeter, optical density, and integrated density. Results:There were statistically significant differences between the parameters of muscle fiber types under study (P<0.05) concerning Con A, LFA and UEA-II lectins, but not for the remaining lectins, regarding the optical density and integrated density of muscle fibers. Conclusions:Lectins make accurate recognition of muscle fiber types on fixed paraffin sections when combined with computerized methods to quantify the features seen in muscle biopsies destined for pathological investigations. Key words:Lectins, Muscle fiber typing, Quantitative, Optical density, Morphometry


Article
EXOCRINE PANCREAS UNDER THE EFFECT OF GLUCOCORTICOIDS: HISTOLOGICAL AND MORPHOMETRY STUDY

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Background:The histological changes obtained from the effect of glucocorticoids on exocrine pancreas is well known but little is known about the morphometrical changes on the acinar cells and ducts which are associated with the histological findings. Objective:To reveal these morphometrical changes which are associated with the histological changes occurred on the exocrine pancreas by the use of different doses and durations of dexamethasone. Methods:Healthy female rabbits were used and divided to six groups. The first four groups regarded as the treated groups, they received different doses and different durations of dexamethasone sodium phosphate. The fifth and sixth group considered as the control group. The pancreas obtained from these animals were processed to make a paraffin blocks, the slides obtained were stained by H&E stain, and Masson′s acid Fuchin Aniline blue Trichrome stain (MT). Diameter of serous acini and intercalated ducts were measured, height of acinar cells and intercalated duct cells and counting of serous acini number in a unit area were estimated. Results:Histologically, by H&E, degenerative changes of serous acinar cells were evident which were dose and duration related. By MT stain there was decrease in collagen fibers in the interlobular spaces. Morphometrically, the diameter of serous acini, height of acinar cell and glandular density were decreased when the dose and duration of treatment were increased. Conclusion:There was increase in exhausted acinar cells as compared to metabolically active cells when the dose and duration of dexamethasone sodium phosphate treatment were increased. Key words:Exocrine pancreas, glucocorticoids and morphometery.


Article
ROLE OF VISFATIN IN THE PATHOGENESIS OF GESTATIONAL DIABETES MELLITUS

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Background:The recently discovered adipocytokine visfatin has insulin-like properties. It lowers blood glucose and improves insulin sensitivity; however, clinical data on visfatin are limited. Objective:To evaluate the role of visfatin in GDM (gestational diabetes mellitus), we determined visfatin levels in women with GDM and healthy pregnant women. Methods:A total of 60 women were evaluated: 30 women with gestational diabetes mellitus and 30 healthy pregnant women to serve as control subjects. Serum visfatin concentrations were analyzed using an enzyme-linked immunosorbent assay the study was done in Al-Yarmouk Teaching Hospital during the period from November 2010 to March 2011. Results:Serum visfatin concentrations were significantly lower in the gestational diabetes mellitus group (0.27±0.1 ng/ml) than in the healthy control group (1.37±0.25ng/ml) (P=0.0001). Conclusions:Our results show that there are decreased concentrations of serum visfatin in gestational diabetes mellitus subjects and this may indicate that visfatin plays a role in the pathogenesis of gestational diabetes mellitus .However; further experiments are needed to clarify this role. Key Words:Visfatin, Gestational Diabetes Mellitus


Article
MOLECULAR ASSESSMENT OF STAPHYLOCOCCAL BACTERIA IN HIGHLY EDUCATED COMMUNITIES

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Background: Emergence of resistant strains of staphylococcus aureus, namely methicillin-resistant S. Aureus (mrsa) in all levels of urban and rural societies has become a haunting problem for the recent world. Objectives: This study assesses and explores the transfer of resistant Staphylococcus aureus bacteria in certain high social class of community focusing on nail as reservoir for transmitting the infection. Methods: One hundred swabs taken from nails were collected from college students in Malaysia. Assays for identification and differentiating Staphylococcus aureus were conducted to identify target bacteria. Moreover, this study compared the efficacy of the different identification tests with gold standard, PCR assay. The tests used were tube coagulase, DNase agar test, antibiogram, several routine biochemical identification tests and PCR assays. PCR assay used specific primers for resistance or species-related genes: mecA, ermA, ermB, ermC, msrA, linA, femA, and nuc genes. Results: A total of 155 bacterial isolates were isolated from college students’ nails, non-PCR assays of identification and resistance detection revealed presence and spread of MRSA in nails of 3 college students. PCR-amplification of the nuc gene was used as a baseline test to detect Staphylococcus aureus. 20 isolates were detected as Staphylococcus aureus using traditional tests while PCR showed only 4 isolates are S. aureus, only 3 of them are MRSA. Sensitivity of antibiogram ranged from 88.9 to 100% but its specificity was very low (0-100%). For tube coagulase, sensitivity was 36.4-100%) while specificity was also not so high (66.7-100%). Conclusion: Collectively, nails proved to have potential for the transfer of MRSA in community of college students in South East Asia. Moreover, PCR assay for identification of S. aureus resistance proved to be superior on other methods. Keywords:Staphylococcus aureus, MRSA, PCR, antibiotic resistance


Article
IMMUNOHISTOCHEMICAL EXPRESSION OF EPSTEIN BARR VIRUS ANTIGEN LATENT MEMBRANE PROTEIN-1 AND BCL-2 IN CLASSICAL HODGKIN LYMPHOMA

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Background:Different genetic and environmental factors appear to be involved in the pathogenesis of classical Hodgkin’s lymphoma (HL) and among them is Epstein Barr virus. Objective:To evaluate the immunohistochemical expression of the Latent Membrane Protein-1 of Epstein-Barr virus and Bcl-2 in Classical Hodgkin Lymphoma and to correlates this expression with some clinicopathological parameters and finally to find if there is any relation between LMP-1 and Bcl-2 in classical Hodgkin’s lymphoma. Method: Retrospective study of fifty paraffin-embedded blocks of lymph nodes biopsies from patients diagnosed as Classical Hodgkin’s Lymphoma. Three representative sections were prepared for each case. The first stained with H&E and the other two sections stained immunohistochemically for LMP-1 and Bcl-2 . Results:Immunohistochemical expression of LMP-1 and Bcl-2 was detected in 90% and 66% of Hodgkin’s lymphoma cases and in 60% and 80% of control subjects, respectively. The patients (9/50) who were less than 16 years were positive for LMP-1 antigen. 21/45 (46.6%) of positive cases for LMP-1 & 14/33 (42%) of positive cases for Bcl-2 were of mixed cellularity subtype. Intensity of LMP-1 but not Bcl-2 expression was significantly high in mixed cellularity compared to other subtypes. No statistically significant relation between LMP-1 and Bcl-2 expression in HRS cells of Hodgkin’s lymphoma cases. Conclusion:The high prevalence and high expression of LMP-1 confirms the association of the virus with HL. Although Bcl-2 is highly expressed in HL, the two markers were not related to each other. Keywords:Classical Hodgkin’s Lymphoma, Epstein Barr virus, Immunohistochemistry, Epstein Barr virus latent membrane protein-1, Bcl-2.


Article
D2-40 AS A POTENTIAL MARKER THAT DIFFERENTIATE VERRUCOUS CARCINOMA FROM SQUAMOUS CELL PAPILLOMA

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Background:Verrucous carcinoma is a distinct variant of oral squamous cell carcinoma characterized by slow growth and rare metastases. It may present diagnostic difficulties as it may be inaccurately diagnosed as squamous cell papilloma. Objective:The study performed a comparative immunohistochemical staining for both entities to obtain a possible method of differentiation. Methods:The study involved 13 samples of oral verrucous carcinomas and 10 samples of oral squamous cell papillomas which were stained immunohistochemically with antibodies to the lymphatic endothelial marker D240. Results:In all samples, the entire epithelium of verrucous carcinomas was positively stained with D240 whereas only the basal cell layer of squamous cell papillomas was positive. Conclusion:D240 could be used as a differentiating marker between oral verrucous carcinomas and squamous cell papillomas. Keywords:Verrucous carcinoma, Squamous cell papillomas, D240.


Article
HISTOPATHOLOGICAL CHANGES IN ADULT MALE RAT’S LIVER INDUCED BY CONTINUOUS DARKNESS

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Background:It is well known that liver is an endocrine as well as exocrine gland; it also synthesizes, accumulates, detoxifies and transports certain substances. Melatonin is the principle hormone of the pineal gland, which is mainly secreted at night and it is definitely documented to regulate the physiology of all tissues and cells keeping their normality. Objective:This work is designed to study the effect of continuous darkness on hepatic tissues. Methods:Adult Wister albino rats were kept in complete 24 hours darkness for successive 4 periods. Rats were divided into 16 groups. Group II, III, IV and V were left in continuous darkness for 2, 4, 6 and 8 weeks, respectively. Group I†, Group I††, Group I†††, and Group I†††† were the control groups for group II, III, IV and V correspondingly. After the last day of the dark period for each group, the animals were dissected under effect of anesthesia. The liver was weighed and right lobe of liver was processed for study its histopathology. Results:The results showed no important histopathological effect on short and medium periods, while on long periods; there was histopathological changes represented by clear lobulation and inflammatory cell infiltrations. Conclusion:Continuous darkness affects the hepatic tissues of rats depending on the length of exposure. Key words:Melatonin, Darkness, Liver injury.

Keywords

Melatonin --- Darkness --- Liver injury.


Article
OBSERVING THE OUTCOME OF USING NEUROAID [MLC 601] ON A SAMPLE OF IRAQI STROKE PATIENTS

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Background:Stroke is one of the major causes of morbidity and mortality throughout the world, and carries greater economic costs. [MLC 601] originates from Traditional Chinese Medicine approved in 7 countries as drug that can aids post-stroke recovery. Objective:To assess [MLC 601] efficacy in improving outcomes of Iraqi patients’ stroke. Methods:Two hundreds ischemic stroke patients and 17 intracerebral hemorrhage patients were participated in this study; they took [MLC601] at the onset of their disease for 3 months and were assessed monthly for the motor power using modified Rankin scale mRs scale, speech, and visual field assessments. Results:mRs grade [4-5] were changed from (zero out of 159) at onset to (89 out of 55) at first month and to 98 out of 134 ischemic stroke patients after 3 months; also mRs grade [4-5] were changed from (1 out of 17) at onset to (12 out of 17) at first month and to 12 out of 17 intracerebral hemorrhage patients after 3 months. In 44% of the enrolled patients with aphasia were improved. Visual field assessments showed improvement in 43% of the patients with homonymous heminopia after 3 months [MLC 601] treatment. Conclusion:[MLC 601] is associated with improvement in all post stroke disabilities and placebo controlled trial is crucial to assess the benefit of it. Key worlds:Stroke, intracerebral hemorrhage, MLC 601, NeuroAid


Article
EFFECT OF BLOOD FLOW RATE ON DIALYSIS ADEQUACY IN AL-KADHIMIYA TEACHING HOSPITAL

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Background:Adequacy of dialysis is one of determinants of morbidity and mortality. The Blood flow rate is one of important factors of adequacy of dialysis in patients with Hemodialysis. Objectives:To assess the effect of blood flow rate on adequacy of dialysis. Methods:Seventy patients maintained on regular Hemodialysis in the dialysis unit, Al-Kadhimiya Teaching Hospital. Their body weight and blood urea level before and after hemodialysis sessions were recorded, volume of ultra-filtration, duration of dialysis and blood flow rate were documented in a checklist. Both (kt/v) and (URR) were determined at three different pump speed (150-200), (201-250) and (251-300) ml/min. During hemodialysis, the hemodynamic status and vital signs of patients were monitored and controlled. Results:Efficiency of dialysis was calculated using the standard formulas. Paired t-test showed no significant difference in dialysis efficiency between the three groups. Conclusion:Higher rate of inadequacy of hemodialysis, and no significant correlation was observed between BFR groups. Key words:Hemodialysis, Blood flow rate, Adequacy of dialysis


Article
STROKE IN IRAQI CHILDREN: EXPERIENCE OF CHILDREN WELFARE TEACHING HOSPITAL

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Background:Stroke in childhood is serious disorder about which little is published. Objective:To determine demographic and presenting features of children with stroke. Methods:A cross sectional study was conducted on cases of pediatric stroke admitted to Children Welfare Teaching Hospital during May 2008-August 2011. Cases classified radiologically into ischemic and hemorrhagic types. Basic data and clinical presentation were gathered. Results:Sixty nine children (49 boys, 20 girls), aged 1 month-14 years were enrolled. Annual hospital admission rate was 54.2 /100000; boys:girls ratio was 2.5:1, girls were younger than boys. Ischemic stroke was found in 58% of cases. Patients with hemorrhagic stroke were younger than those with ischemic type. Those aged <1year account for 55.1% (82.8% of patients with hemorrhagic stroke) while half of those with ischemic type aged 1-5 years. The commonest presentation in both types was seizure, mostly among infants. About 2/3 of patients were from Baghdad. Conclusion:Stroke in children is more common among boys. Ischemic type is commoner than hemorrhagic. Those with hemorrhagic stroke tend to be younger than ischemic. The majority of children with hemorrhagic type present at age younger than one year. Seizure was the most common presentation in both types. Key words:Stroke; Iraqi children; Ischemic; Hemorrhagic


Article
DIAGNOSTIC ACCURACY OF (FNAC) BIOPSY IN PALPABLE MAMMARY LESIONS

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Background:Fine Needle Aspiration Cytology (FNAC) has advantage of providing a diagnosis before the time of surgery; this situation enable the patient and surgeon to discuss and decide the type of surgery to be done and may obviate the need for a 2 stage procedure in surgical management of breast cancer. Objectives:To study the accuracy, sensitivity and specificity of FNAC of solid breast mass compared to histopathological examination. Methods:A retrospective study includes 126 female patients palpable solid breast mass aged 17 to 67 years with masses in the breast. FNAC and histopathological studies was done to all of them. Results:Fifty six patients had mass in the Rt. Breast and 70 (57.4%) had mass in the Lt. breast. 58 (47.5%) masses diagnosed as malignant (54 true-positive and 4 false negative) with diagnostic accuracy of 93% (54 of 58). Sixty four patients (52.5%) were diagnosed as benign (62 true-negative and 2 false positive) with diagnostic accuracy of 96.8% (62 of 64). Conclusions:FNAC is simple, quick and relatively low cost procedure, with minimal patient discomfort; it is helpful in reducing the number of breast biopsies done for benign breast disease. It can provide a diagnosis before the time that operation is performed and this may help to obviate the need for two stage procedure in surgical management of breast cancer. Keywords:Solid breast mass, FNAC, Histopathological examination.


Article
LOWER GASTROINTESTINAL BLEEDING: AN ETIOLOGICAL STUDY

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Background:Lower gastrointestinal bleeding (LGIB) is defined as bleeding from a source below the ligament of Treitz. Most series which studied the etiology of the acute LGIB showed that Colonic diverticulae and angiodysplasia were the commonest etiology identified, ranging from (17- 40%, 2-30% respectively). Colitis including the inflammatory bowel disease, account for 6-30% of cases. Uncommon causes of LGIB include colonic neoplasia in 11-14% and anorectal lesions in 4-10% (mostly due to hemorrhoids,). Other less common cause is small bowel source in 2-9%; rare causes include Dieulafoy lesion and colonic ulcerations. Objective:To verify the etiology of LGIB in Iraqi patients. Methods:The study group included 100 patients who were suffering from acute lower gastrointestinal bleeding and referred to the endoscopy unit in the Gastroenterology and Hepatology Teaching Hospital. After the initial history, physical examination and laboratory studies were obtained; all patients with hemodynamic instability were resuscitated with intravenous fluid and blood transfusion. Colonoscopy performed within 12 hours of hospitalization (with or without an upper endoscopy), with the aim of reaching up to the cecum in all cases. Results:Of 100 patients (55 female, 45 male) 78% presented with haematochesia, 11% with red maroon stool with malaena, and 11% with malaena only. Bleeding due to colitis was the most frequent diagnosis, which is reported in 38 patients. The diagnosis of anorectal lesions and colonic neoplasia were the second and third most common diagnosis (21%, 12% respectively). Colonic diverticulae in 12 patients, colonic angiodysplasia in 11 patients and small intestinal source is 5 patients and 1 patient with colonic Dieulafoy lesion. Conclusions:This study showed that inflammatory bowel disease; colorectal polyps including post polypectomy bleeding, diverticulosis, angiodysplasia, and hemorrhoids were the most common causes of lower gastrointestinal bleeding. Key words:Lower gastrointestinal bleeding


Article
THE VALUE OF ULTRASOUND AND COLOR-DOPPLER FEATURES IN THE ASSESSMENT OF SINGLE SOLID THYROID NODULE

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Background:The use of ultrasound (US) in the assessment of thyroid disease has greatly increased the detection of small thyroid nodules unrecognized at clinical examination. Objective:To determine the accuracy of the diagnosis of the nature of solitary thyroid nodule by ultrasound in comparison with histopathological findings and to correlate the different sonographic and color-Doppler (CFD) findings with the results of histopathology of resected nodules. Methods:The nodule size, echogenicity, presence/absence of calcification, lesion margins and vascular pattern of 63 patients with solitary thyroid nodule referred for US assessment). Results:Twenty four patients (38.1%) had malignant thyroid nodules and 39 patients (61.9%) had benign nodules as confirmed by histopathology. The large nodules show benign histopathological finding more than the small nodules (no significant difference; 56.5% vs. 25.4%, respectively). Histologically-confirmed malignant lesions show hypoechoic appearance and calcification more than benign nodules. The Malignant lesions presented more frequently than did benign nodules as solid hypoechoic appearance and irregular or blurred margins (52.2% vs. 47.8%;), and intranodular vascular pattern with calcification (63.3% vs. 36.4%) and the sensitivity and specificity by ultrasound in the evaluation of these nodules will be more and have highly diagnostic accuracy (58.3%, 79.49%, 71.5% respectively) in comparison to the former feature (50%, 71.79%, 63.5% respectively). Conclusion:We conclude that the typical appearance of nodules in thyroid carcinoma is irregular hypoechoic mass with internal vascularity and calcifications. Uncommon appearances of carcinoma include hyperechoic texture, intrinsic hypovascularity, and sharp regular contours. Uncommon sonographic features were found to occur more often than expected. Keywords:Thyroid nodule, ultrasound, color Doppler


Article
SURGICAL TREATMENT OF SUPPURATIVE CHONDRITIS, LIMITED VERSUS RADICAL CHONDRECTOMY

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Background: Suppurative chondritis of auricle due to burn injury is a devastating complication which usually results in deformed shrunken ugly ear in spite of many modalities for treatment. Objectives:To document clinical nature of the injury, the results of various methods of treatment, and to recommend the management protocol of chondritis of burned ear. Methods:From Nov. 1998 to Nov. 2010 a prospective study performed on 100 patients 110 ears in Hilla Teaching General Hospital, Al-Kindy Teaching General Hospital on surgical treatment of suppurative chondritis. All cases were due to flame burn, and all were given prophylactic systemic antibiotics. Results:Forty six of patients were males (46%), 54 females (54%), ages ranged from 1 year 35 years with mean 24years, partial thickness burn 80 patients (80%), full thickness burn 20 patients (20%) . Patients treated in three groups; the first group 20 ear (18%), treated by only stab wound drainage which resulted in 100% recurrence, the second group 20 ears (18%) treated by limited wound excision which resulted in 85% recurrence, the third group 70 ears (64%) treated by radical wound excision which resulted in 10% recurrence, total loss of auricle occurred in 10%, moderate deformity occurred in 80% of ears, mild deformity resulted in 10% of ears. Conclusion:Surgical treatment of Suppurative chondritis gives superior results by radical excision. Key words:Chondritis, Suppurative chondritis, Burned ears, Radical chondrectomy, Deformed ear.


Article
EARLY PRESENTATION OF BILATERAL MORGAGNI HERNIA IN AN INFANT. CASE REPORT

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In this report, a rare case of bilateral Morgagni hernia is enlightened in a 7-month old infant weighing 6.5 kg, presented with shortness of breath and fever for 5 days duration. There was a history of the same attack at 2 and 5 months of age and treated as a chest infection. He was admitted to pediatrics emergency unit for investigations and treatment. Plain chest radiography revealed retrosternal bowel herniation and Barrium-enema revealed bilateral big Morgagni hernia .Reduction of herniated contents (transverse colon and omentum) done with repairing of bilateral big Morgagni hernia through transabdominal approach. This case is a very rare and interesting one, because of an early bilateral presentation, and the fact that it occurred in a male infant.

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