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: 2015 volume:13 issue:3

Article
EDITORIAL: CANCER STEM CELLS

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Abstract

Keywords


Article
THE CHANGES IN PNA, WGA, AND UEA I LECTIN BINDING PATTERN IN THE UTERINE TUBE EPITHELIUM BY EFFECTS OF ESTRADIOL AND PROGESTERONE THERAPY IN RAT

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Background:The carbohydrate histochemistry in the epithelium of the uterine tube was found to be related to the uterine tube physiology and morphology. Objectives:This study investigated the changing binding pattern of peanut agglutinin, wheat germ agglutinin, and ulexeuropaeus agglutinin I lectin to the epithelial cells of the rat oviduct ampullary region in response to the effect of combined estrogen and progesterone hormonal administration. Methods:This experimental study was based on injecting the animals with doses of estradiol and Progesterone hormonesduring the successive estrous cycles. Then, the ampulla of uterine tubes were identified and prepared for paraffin sections. The peanut agglutinin, wheat germ agglutinin, and ulexeuropaeus agglutinin I lectins were used to label the tube section; the sections were examined by fluorescent microscope. Results:The three lectins used in this study showed analogous pattern of binding behavior. The uterine tube epithelium of the controlled group showed bimodality of binding, while that of the treated group showed a third pattern of lectin binding in some of the epithelial cells. Conclusion:The ciliated cells that are transformed to display a secretory function are called the transitional cells, the formation of these cells is influenced by hormonal factors and the pattern of the lectins binding to these cells could be considered as a histochemical marking. Key word: Lectin, uterine tube, carbohydrate histochemistry, hormone.


Article
RESISTANT HYPERTENSION IN CHRONIC RENAL FAILURE

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Background:Several factors involved in the pathogenesis of hypertension among chronic renal failure patients including sodium and water retention, increased activity of vasoconstrictive systems, decrease activity of vasodilatory systems, increased intracellular calcium, increased arterial stiffness, sleep apnea, hyperparathyroidism, erythropoietin and renovascular disease and dialysate composition and prescription. Objective:To assess the prevalence of resistant hypertension in chronic renal failure patients and to study the relation between primary causes of renal failure, smoking, non-steroidal anti-inflammatory drugs, body mass index and hepatitis C positive with resistant hypertension. Methods:A case-control study of five hundred patients with hypertension and on antihypertensive drugs was conducted during the period from August 2013 to December 2014. Three hundred of them are complaining chronic renal failure. All patients underwent a history and physical examination at baseline. Blood pressure measurement was done for them and blood urea, serum creatinine, serum electrolytes, hemoglobin level and random blood sugar were estimated. Results:Patients with office blood pressure 140/90 mmHg or those treated with antihypertensive drugs are considered as hypertensive, which made up 87.9% of patients with chronic renal failure. The prevalence of resistant hypertension is 31%; all of them are receiving more than three drugs. Resistance hypertension in chronic renal failure associated with high body mass index, left ventricular hypertrophy, and symptom complaint and non-steroid anti-inflammatory drugs but not related to urea level. Conclusion:Resistant hypertension in chronic renal failure is almost always multifactorial in etiology, may be more sensitive to sodium than the general hypertensive population. Resistance to diuretic in chronic renal failure contributes mainly to resistant hypertension. Keywords: Hemodialysis, resistant hypertension, chronic renal failure


Article
THE VALUE OF MIXED SOMATOSENSORY EVOKED POTENTIAL IN THE DIAGNOSIS OF LUMBOSACRAL SPINAL CANAL STENOSIS

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Background:Lumbosacral spinal canal stenosis is a common cause for chronic low back pain. The diagnosis is mostly radiological, yet, the extent of neural impairment cannot be expressed by radiological means. It is hypothesized that somatosensory evoked potential indicate a nerve root involvement complementary to the neurological examination. Objectives:To evaluate the usefulness of different parameters of mixed somatosensory evoked potential in the diagnosis of lumbosacral stenosis. Methods:Thirty five patients with Lumbosacral stenosis, clinically and radiologically confirmed by MRI examination and 20 normal individuals were enrolled in the study. Mixed-somatosensory evoked potentials of tibial nerve was done using subdermal monopolar needle electrodes at 4 channels; cortical, lower thoracic, lumbar and popliteal. From these channels negative waves (N45, N25, N20 and N10) were studied for both latency and amplitude, besides the central sensory conduction time which represents inter-peak latency between N25 and N45. Results:The cutoff values of N25, N45 and N20 wave latencies presented highly significant differences between affected sides and controls; with the highest difference given by N25 wave (P< 0.0001). There was no significant difference regarding N10 and N25-N45 latencies. The mixed somatosensory wave amplitude cutoff values showed equivocal results about the sensitivity and specificity percentages. Conclusions:Mixed somatosensory evoked potential study can be used as a supplementary test in the diagnosis of Lumbosacral stenosis. N25 wave has the highest diagnostic yield due to having the highest sensitivity and specificity. Equivocal results of the evoked potential amplitudes and their lower sensitivities and specificities compared to evoked potential latencies, lower their validity in the diagnosis of Lumbosacral spinal stenosis. Keyword:Cutoff, sensitivity, specificity, referred.

Keywords

Cutoff --- sensitivity --- specificity --- referred


Article
ANTIBACTERIAL ACTIVITY OF FENUGREEK ESSENTIAL OIL AGAINST PSEUDOMONAS AEROGINOSA: IN VITRO AND IN VIVO STUDIES

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Background:Multiple drugs resistance has increased due to the random use of available antimicrobial drugs in treatment of infectious diseases. Objective:To investigate probable antibacterial effects of fenugreek essential oil extract against Pseudomonas aeruginosa Methods:Twenty eight isolates of P. aeruginosa were collected from skin infected patients in Al- Yarmook teaching hospital in Baghdad. Antimicrobial susceptibility tests of 14 antibiotics were performed using Vitek2 compact system. The antibacterial activity of essential oil was evaluated using agar well diffusion method with minor modifications. The broth micro dilution method was used to determine minimum inhibitory concentration. Then animal experiment was performed in five groups of mice (n=7, for each) as following: control, induction, treated with fenugreek alone, treated with Gentamycin alone, treated with combination of fenugreek and Gentamycin. Then histopathological examination was done after seven days of the treatment. Results:P. aeruginosa isolates are highly resistance to trimethoprime/ sulfamethaxazole, while sensitive to amikacin. Minimum inhibitory concentration of fenugreek essential oil for highly resistance P. aeruginosa isolates (n=10) as followed: 6 isolates with minimum inhibitory concentration = 1.2gm/100µl, and 4 isolates with MIC= 0.6gm/100µl. Minimum inhibitory concentration of gentamycin was equal to>=16. Conclusion: Fenugreek essential oil has higher antibacterial effect alone and in combination with gentamycin than gentamycin alone. Keywords:Antibacterial activity, Fenugreek, Pseudomonas aeruginosa.


Article
ULTRASOUND GUIDED ASPIRATION VERSUS DRAINAGE UNDER GENERAL ANESTHESIA IN BREAST ABSCESSES

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Background:Despite the fact that breast abscess is becoming less common in developed countries, it has remained one of the leading causes of morbidity in women in developing countries. Ultrasound has been shown to be useful in diagnosis of breast abscesses, guiding needle placement during aspiration and also enables visualization of multiple abscess loculation and thus useful in needle aspiration of breast abscesses and is associated with less recurrence, excellent cosmetic result and has less cost. Objective:To establish whether ultrasound guided needle aspiration is a feasible alternative treatment option for breast abscesses. Methods:A prospective interventional study conducted on 144 female patients with and age range from 15 to 55 years. One hundred and twenty four are lactating and the other 20 are non-lactating. They were divided into two groups; the first group comprised 72 patients treated as outpatients by ultrasound assisted aspiration of pus while the second group serves as the control comprised 72 patients who are treated by drainage under general anesthesia. For both groups, data regarding early complications, hospital stay, return to daily activity and late complications were recorded. Follow up for up to 3 months was done for both groups. Results:Healing rate of the two groups had no statistically significant difference both overall and at each visit. There was only 1.4% recurrence rate observed in the ultrasound guided needle aspiration group while there was 6.9% recurrence rate observed in the incision and drainage group. Conclusion:Sonographically guided percutaneous aspiration of breast abscesses represents a less invasive and very promising alternative to surgical incision, showing the following advantages: no general anesthesia required a superior cosmetic result and shorter hospitalization. Key words:Breast abscess, Ultrasound guided aspiration, Incision and drainage


Article
IMMUNOHISTOCHEMICAL MDA CHANGES OF THE NEWBORN RAT FRONTAL CORTEX AFFECTED BY PRENATAL KETAMINE EXPOSURE

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Background: Ketamine has an excellent analgesic property and is widely used currently to provide “sedation” for minor procedures. Ketamine has been proved to potentiate deletion of large numbers of neurons from the developing brain. Objectives:To investigate the neurotoxic effect of prenatal ketamine exposure on newborn rat frontal cortex using malondialdehyde antibodies as immunohistochemical marker. Methods:Seventy two pregnant rats were divided into three groups I, II and III (24 rat for each group) and exposed to ketamine at different gestational periods (7th day, 11th day, and 18th day, respectively). Each group was subdivided into four subgroups including the control subgroup A injected intraperitoneally with normal saline, and the experimental subgroups B, C and D rats injected intraperitoneally with different doses of ketamine (5mg/kg, 10mg/kg, and 20mg/kg respectively). Paraffin sections of the frontal cortex of the newborn rats were immunohistochemically stained with Expose Mouse and Rabbit Specific HRP/DAB Detection Kit. The Aprio Image Scope v.9 software was used to evaluate the anti-MDA antibodies immunohistochemical reaction. Results:Non-significant variability between the subgroups B and C of group I, while significant variability was found between these two subgroups in groups II and III. The values obtained from subgroup B in all the groups I, II, and III had no significant variability compared to the control subgroup (A). The values obtained from subgroups (C) and (D) showed statistically significant changes compared to the control subgroup (A) in all the groups (I, II, and III). The results showed significant variability by comparing the results of subgroup (D) with both subgroup (B) and subgroup (C) in all the groups. Conclusion:The anti-MDA immunohistochemical reactivity shown in this study suggested that lipid peroxidation is an event occurring during ketamine induced neurotoxicity, this event leads to apoptosis. Keywords:Cortex, prenatal, ketamine, neurotoxicity, immnuohistochemistry.


Article
PREVALENCE OF CORONARY ARTERY DISEASE IN SYMPTOMATIC PATIENTS WITH ZERO CALCIUM SCORE UNDERGOING CORONARY CT ANGIOGRAPHY

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Background:Non-invasive coronary angiography is being increasingly performed by computed tomography angiography to assess obstructive coronary artery disease. There is increasing interest in the absence of coronary artery calcification, as a “negative” cardiovascular risk factor. The frequency and clinical relevance of coronary artery disease in patients without coronary artery calcification are unclear. Objective:To assess the presence and the severity of coronary artery disease in symptomatic patients without coronary artery calcification (Calcium score of zero). Methods:One hundred and ten cases (62 females and 48 males) with mean age of 50.4 years with no detection of calcified plaques in the coronary arteries (coronary artery calcification score=zero) were studied. Known or suspected cases of coronary artery disease underwent a coronary computed tomography angiography examination. Calcium score examination was conducted immediately before coronary computed tomography angiography. Degree of stenosis was found by comparing the luminal diameter of the narrowest segment of the artery with that of a more proximal or distal normal segment of the same artery. Results: Stenosis was found in 23/110 patients, giving a prevalence of (20.9%), among the 23 cases with stenosis: the right coronary artery stenosis was found in 19/23 (82.6%), left anterior descending in 11/23 (47.8%) and left circumflex artery in 5/23 (21.7%). Mean percentage of stenosis was highest in right coronary artery (59.9%). In 52.2%, only one vessel was involved, in (43.5%) two vessels were involved and in (4.3%) three vessels were involved. Conclusion:Coronary computed tomography angiography can clearly demonstrate noncalcified atherosclerotic coronary plaques in a large group of patients with suspected coronary artery disease. The absence of coronary artery calcification does not exclude the presence of significant stenosis in symptomatic patients with no coronary Calcium. Keywords:Coronary artery disease, Zero Calcium score, CT coronary angiography


Article
ANTIMICROBIAL RESISTANCE PATTERNS OF ESCHERICHIA COLI O157:H7 ISOLATED FROM STOOL SAMPLE OF CHILDREN

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Background: Enterohemorrhagic Escherichia coli is a subset of Shiga toxin-producing E. coli that can cause diarrhea or hemorrhagic colitis in humans. Hemorrhagic colitis occasionally progresses to hemolytic uremic syndrome, is a major cause ofacute renal failure in children and morbidity and mortality in adults. Objective:To determine the susceptibility and resistance of the most effective antibiotic to E.coli O157:H7 associated with bloody diarrhea. Methods:Two hundred patients with bloody diarrhea were enrolled in this study. Escherichia coli were isolated on Sorbitol MacConkey agar with Cefixime and Tellurite and tested by latex agglutination test. The susceptibility and resistance for all bacterial isolates were identified by standard procedures resistance patterns such as disk diffusion test and minimum inhibitory concentration. Results:E.coli O157:H7 found in 37 (18.5%) out of two hundred stool samples. The highest rate was found in 18 cases (48.64%) out of 37 infants aged 3-12 months, 12 cases (32.43%) in infants aged 13-24 months, and the lower rates was in children over two years old (18.9%). E.coli O157: H7 was completely resistant to gentamicin, ampicillin, nalidixic acid and co-trimoxazole; high rate of resistance to cefotaxime and ceftazidime, moderate-to-low rate of resistance to ciprofloxacin, amikacine, ceftriaxone and Imipenem and no resistances rate to levofloxacin. Out of 37 isolates 29 (78.3%) were β-lactamase producer and 8 (21.6 %) isolates resistant to β-lactamase antibiotic patterns but not produce β-lactamase enzyme. Conclusion:The high-incidence rate of E. coli O157:H7 infection in children associated with limited number of drugs effective against E. coli O157:H7 with high prevalence of resistance to more than three antibiotics. Keywords:E.coli O157:H7, Enterohemorrhagic Escherichia coli, disk diffusion test, minimum inhibitory concentration.


Article
EXPANDABLE METAL ESOPHAGEAL STENT DEPLOYMENT IN PATIENTS WITH MALIGNANT DYSPHAGIA

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Background:Palliative therapy is the only treatment for inoperable malignant dysphagia. Therapeutic option of self expandable metallic stent has been proven more effective and safest than other conventional palliative therapy like esophageal dilation, plastic stent and laser therapy in malignant dysphagia. Objectives:To study the outcome, efficacy and complications of self expandable metallic stent deployment in patient with malignant dysphagia. Methods:Fifty patients with malignant dysphagia comprised of 38 male and 12 female with malignant dysphagia treated palliativelly with self expandable metallic stent were studied. All the patients were submitted to upper endoscopy and forceps biopsy before self expandable metallic stent deployment. Analysis of stent expansion, mean dysphagia score, complications and mean survival period were carried for the study group. Results:Technical success rate of self expandable metallic stent placement was 86% in first trial and reached to 100% in the second trial. Early technical or patient's complications were negligible. Most important late complication was tumor overgrowth obstructing the stent. The mean dysphagia score point 1.9 and the mean survival period were 3.1 months. Conclusions:Self expandable metallic stent deployment is successful and rewarding procedure for immediate relief of disabling malignant dysphagia with negligible morbidity and zero mortality. Keyword:Self expandable metallic stent, Malignant dysphagia, Esophagus, Iraq


Article
EFFECT OF CYP19 GENE ON POLYCYSTIC OVARY SYNDROME PHENOTYPE IN IRAQI WOMEN

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Background:Ovarian androgen overproduction is the key physiopathologic feature of polycystic ovary syndrome and the bulk of evidence points to the ovary being the source of excess androgens, which appears to result from an abnormal regulation (dysregulation) of steroidogenesis. Aromatase is an enzyme complex responsible for a key step in the biosynthesis of estrogen. It is encoded by CYP19. Objective:To examine whether the rs2414096 of CYP19 gene contributes to genetic susceptibility to the polycystic ovary syndrome hyperandrogenism in Iraqi women. Methods:A Case control study was conducted in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University and Al-Nahrain Forensic DNA Unit, Baghdad, Iraq for the period from February 2012 to February 2013. Sixty-five healthy women serves as the control group and eighty-four infertile women with polycystic ovary syndrome, divided into two subgroups depending on the body mass index (< and ≥30 kg/m2) were studied. Restriction fragment length polymorphism analysis was performed to determine the genotypes of rs2414096 of CYP19. Clinical, anthropometric, hormonal and biochemical parameters were also estimated. Results: Genotypic distribution of rs2414096 of CYP19 was significantly different in polycystic ovary syndrome patients from that of control women. The frequency of GG genotype was higher in the patients, while AA genotype was higher in control women. Those with GG genotype have lower estradiol, estradiol/testosterone and higher testosterone, luteinizing hormone, follicular stimulating hormone than those with AA genotype. Conclusion:The present data suggests that single-nucleotide polymorphisms rs2414096 in the CYP19 gene is associated with susceptibility to polycystic ovary syndrome hyperandrogenism in Iraqi women. Keywords: Polycystic ovary syndrome, CYP19 gene, reproductive hormones, Iraqi women.


Article
DIAGNOSTIC VALUE OF SOMATOSENSORY EVOKED POTENTIALS IN CERVICAL MYELOPATHY

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Background:Cervical myelopathy is a condition caused by narrowing of the spinal canal leading to cord dysfunction. The most common causes are congenital stenosis and degenerative stenosis caused by spondylosis. Objectives:To confirm the diagnosis of cervical myelopathies using somatosensory evoked potentials and possibly to localize the level of the lesion. Methods:An electrophysiological study had been carried on 61 patients with cervical myelopathy (41 female and 20 male) aged 48.66±11.72 years and 41 healthy volunteers aged 44.8±10.53 years. Sensory and motor nerve conduction study and somatosensory evoked potential for all were done to evaluate the peripheral nerves and sensory central pathways. Results:No significant difference was demonstrated in the sensory and motor nerve conduction studies from the healthy subjects. Somatosensory evoked potentials showed statistically highly significant changes in the N13, N20 latencies, amplitudes and N13-N9 and N20-N13 central sensory conduction times of median nerve on both sides. N13 latency has the highest specificity and sensitivity among the somatosensory evoked potentials parameters. Those patients who had prolonged central sensory conduction time between N20-N13 suggests an upper cervical lesion while those having prolonged central sensory conduction time between N13-N9 suggest lower cervical cord and/or cervical root affection. Conclusion:Motor and sensory conduction studies are usually normal in CM. Among SSEPs parameters, N13 latency was prolonged bilaterally, CSCT abnormal bilaterally, N13-N9 and N20-N13 latencies unilaterally (Right side). Mononeuropathies, polyneuropathies, radiculopathies and plexopathies should be excluded before diagnosis of CM was made. Key words:Cervical myelopathy, electroneuromyograhpy, somatosensory evoked potentials.


Article
CARDIAC ELECTROPHYSIOLOGICAL EVALUATION IN STROKE PATIENTS WITHOUT CARDIAC ABNORMALITIES

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Background:Physicians have known for centuries that primary cardiac disorders can lead to stroke, but the realization that strokes may result in the cardiac abnormalities is much more recent. Cardiac disturbances are common following stroke such as cardiac arrhythmias or repolarization abnormalities. To provide optimal care, it is essential to distinguish whether cardiac abnormalities are caused by acute stroke or unrelated to it. Objectives:To evaluate the cardiac electrophysiological changes in patients with stroke and study the correlation of stroke type, electrocardiographic and echocardiographic findings with the holter findings. Methods:A case control study was conducted on 52 persons of either sex; involving 32 patients suffering from stroke for the first time without underlying cardiac disease, and 20 healthy persons. Electrocardiographic examination to record cardiac electrical changes, holter record for one hour to detect changes in heart rate variability parameters and echocardiogram to asses heart function have been done for each patient and subject control. Results:No significant difference was found between patient and control groups regarding sex and age, but there was a significant difference between the two groups regarding the SDNN, SDANN, rMSSD parameters, QT dispersion, ST segment shape and T wave shape. Conclusion:The Electrocardiographic changes can occur in stroke patients without cardiac problems. The non-invasive parameters (heart rate variability, QT dispersion) are useful tests in patient with stroke to assess cardiac abnormalities. Key words: Electrocardiographic changes, stroke, cardiac problem.


Article
EFFECTS OF METFORMIN ON HORMONAL PROFILE AND SEMINAL FLUID ANALYSIS IN OBESE INFERTILE MALE

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Background:Overweight and obese men have an up to 50% higher rate of sub-fertility when compared with normal weight men. Possible management options include weight reduction by dieting or surgery and medical treatment to correct specific endocrine abnormalities, but as yet none has been proven to be effective. Objective:To verify the impact of decreasing body mass index by giving metformin on hormonal profile and seminal fluid analysis in obese infertile male. Methods:Eighteen obese patients whose body mass index was 30-40 kg/m2 and with mean age of 29 years (range: 22-42 years) with idiopathic asthenozoospermia were enrolled in the study. Standard semen analysis according to WHO and hormones assay which include: follicular stimulating hormone, luteinizing hormone, prolactin, testosterone, and estradiole were performed at baseline and after 12 weeks of therapy. The enrolled patients were asked to take metformin 850 mg twice daily orally for 12 weeks. Results:A significant decrease (p<0.001) in sperm count and sperm activity after 12 weeks of treatment with metformin. While there is no significant differences with respect to other spermiological parameters. A statistically significant decrease in the level of serum prolactin after 12 weeks of treatment with metformin whereas no significant differences with respect to the level of other hormones. Conclusions:Although metformin has the capacity to decrease the level of prolactin, it decreases the number and activity of sperms. Further studies are recommended to investigate whether there is any association between infertility in human males and chronic metformin use Keywords: Metformin, infertility, male, prolactin, overweight, obese.

Keywords

Metformin --- infertility --- male --- prolactin --- overweight --- obese.

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